Ha CY2002

WELL CONSTRUCTION RECORD
Nor lhLai arina-I)cp:uIntent or I".ncirtnutcnt ❑ndN {oral Resources
VA 111 I (OA I It.ALI OIt (IAIIA IDI :AI.) N.AAII- (Priull�^ l ��
\C tat t COST .\molt r »II \N\ NAME niCc wed,-
266486
- Division of Water (duality - Groundwater Section
v%f'C CI'IdIIPIGv'PIO.VH V677
M� I'!IONE I! (bzl/ 27'0-5/0
SI-.err: \\l!LI. ('ONSI't(C("I ION I'I{It.II'I'# ASSOCIATED \\'Q REIN\II'r#
it :In tlicahlc) (ilia )licable)
I . AA LI.I. CNN (Check Applicable 13ov) Residential VN:lunicipal/Public 0 Industrial ❑ Anricultural ❑
Nlonitoring ❑ Recovery G Heat Rump Wit or Injection 0 Other ❑ II Other, List Use
2VAI:Li. LOC:AIIO
Nc rest ToAAn_� yD G f Count
/ aM /— b��
,}�
i;i A ate. N has. l'o;m mnhy. 1uhJl n.-i u. Loi No.. 71p (ode)
()WNI':R: () e t
.\tithe., 1c_95 CAA sMA/, 4%/"
`'kP
(5!Ieet „t I&„nte N„.)
,�, Topographic/Land setting
L�11<liIge ❑Slope ❑Vtlley DFl:tt
1 h k)ppmpiat box)
1 abrade longitude ul vvel l location
tdcurccS miuwLs,Nec mdsi
Lalilude/Ion hitudc sourcc:DGPSDTopo orapltic map
{check boat
1)I[PTI1
llp„r Iona Sam /,Ip code how oll{ To
72
I. I)A IT DLLI: I<IUJ02'7/- 02 /or /?p
r0Tw. Ulil'"I it: 370
r:" DOTS VVTLI RId'LACL (LISTING WELL? YES ❑ NO
SA TIC AVAIL!: (.RNLI. 13eIowTop of C: si;'g: 023 1[1.
tn,e ... " irnh„t.- loprcn.i1�l')
.0 TOI' U1- C'ASIN'(i IS LT. Above !. and Solace*
rap or caorn: trnuinated anor helots laud surface re::,, us a
niriaaa• iu acrurdaii with I?,\ NC\C S-C.I0I18.
'LLD Igpn)1: � ri N-)I'.IlIUD
OF
t). 1 f1!S C A / /
11). AA'ATLR /()NI_S (depth):
II_ I)ISINI: CFION. Type
I'_. C :ASINO' VVali"
Depth I�).i:iSSS ode' or V.
11nn C% To (7Pt. Li*/
To
17om to ICI.
12 C:ROL I . Dep)h Nl v riul
tarn n it,do rl.Ce(hc
Isom Tu I'I.
S(I<1 I:N: Uep1L I)i;mieler Sin:
runt I I'I.
I;. SAND GRA 11AC R
Dcpli Size
Zyo 37o
I'Ilalt 1.1)
/yTW— Antr
DRILLING 1.0G
cipm Description
a
httn.,7/
�y/O 7 � NoSJ/i ti e
lo�a ,e
LOCATION SKNTCI I
Lint Shovv direction and distance in miles from at least
hicknesv two Slate Roads or County Roads. Include the triad
numbers and common load names. O o
:ichlift_ MaterialN
L n
1 c.
Ol
rn
rn
m
f745/,( ti/5y/
Ntethotl
Sac Maieri:d
LICi Lit
a
O
IS WELL WAS C'()NS'I RUC'TP:D IN ACCORDANCE Will I I?A NCAC 2C. AVFLL
NU TI I AI- A COI'1' OF THIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
Ifs-U-OT
iNAT: LE ()I: I'L;.sON CONSIILUCTINCi TI II! VA'EI.I.
DATE
Vuhmil the original to the )icisi In of AAtater Quality, (:roundvca ei Section, 1636 A lair Service Center- Raleigh, NC
'- M'Y7rt'!)1'Sinnc A0719t 733- 2 1, vrilhin 30 days. CiW-1 Iti V. 07/2001
10

WELL tOVSTRUCTION RECORD
.North (:Irolina - Dq,utnicnt of I:ncironrncnl and Natural
Resources - Division of water
\\ I:I.I. CU\'I li.\('rO It IINIII \'II)t AI.) \:\NI b: (print) �A y-V i Oe_
\,EI.LCI)N'I R\( WI: CO\IP:\NV NAND: fr'ce 1-1011 I2\1Mp
266485
Quality - Groundwater Section C�
CERTIFICATION # 24 to /
I'IION I? # (69-SI6.27- S
s I. Al I, vi•:1.1. ( 'ONSI'RL('l It)\ ITIZ\II'rq \SSOCIAT E1 \\'Q 11ERNIITN
l it aptheabhy I iI :q,plicuble)
I_ AA'I L1. I SL (Check Applicublc Box): Rcsidcn'.ial VMunicipul'Public ❑ Industrial ❑ Agricultural ❑
Nlunilorinu 0 Recovery ❑ Heat Pump AValor Injection ❑ Other ❑ IFOther. I_ist Use
VV}:l I. LO('ATION.
Nearest 1- in. (ANj"O.J Count
en, VArJe
I Sle�i ynine. Nwnbai S. ('uinml We, Nu hdi ci+inn. ut yb.. /ip Cadet
\imic,, I^�� O/
\ddress SZ (��
L9i el u> i7 Na.l O Tg�
ves
Iry oil l„�,n $kilo
)-
V lee os I. Iln� .
J UV] 'nth ll I: id 9
lul AI. DI!I III Ja7<
DUI S \\TLL 121iPLACE I:NIST NG WELL:7 YES 0 NO V
-' S VATIC AA'A"l IiR !I.A'I[I. Below Top of Casino: /3 I'
(Use it Ahme lop n(Cazincl
5. TOPOf ('ASING IS __ PT. Above Land Santee*
el lip nl a:uina lermin:ncd alur heluw land surface rc)1,ires a
vn rieu cc in accordance with 15.\ NCAC 2C .(11 IR.
YIPI.D Igpltl): MITI-IOD OF TI'.Sl pit r
In- WATER ZONliS (depth)
1 I. I)ISINI'LCIION. Type Amount
12. C ASINt is AVall "thickness
,/— Ucplh Dia n,r/lcr or Al sltt I t_ .NI;uerial
'Tom_-- To I't.
Iron1 _ 'to fl.
l (KOl _ U�pth /I_ M.verluyl .AIeh'!
Hon, u
'it, ,2ily
k row ll1 Pt_
-I N(Itl LN. I)eplh Diainelcr Slot Siz Material
I torn To 1'I. In. in.
I tom •lu..... I't in. In.
I;. SAND GRAA L I'ACF
Ihplh Sizc l:itLlua
Zip Code
Tom To Ft.
In RIM ,AR ICS
I'opogtaphic/Lead setting
❑IRidee ❑Slope Mc/alley ❑Plat
(Check appniprl: to box)
L:uiludc'lonpilutic of vicell location
1 Jeu cos. nilnnia. ticcondsl
Lmiludc/Ion gitude source:❑GI'SOTopo graphic Inup
dmck bull
DUPTI I DRILLING LOG
From To PI rl iatitn Description
c.)_() J2 _c_c4r1 Y
S e-
LOC'A]ION SKGTCIi
Show direction and distance in miles From al least
Iwo Stale Roads or County Roads. Include the road
numbers alld common road names.
f}ytu 16'
I DU I IIfIf E:I3Y (TR l In "I IAT T I IIS WELL \VAS C(NSTRUCTI(D IN ACCORDANCE WTI I I SA NCAC 2C, WELL
I'D\ S.,AND THAT A CORI'OF"DIIS RECORD I IAS L3IiIiN PItOVI DIA) TO THE WELL OWNER
SIGNATURE UP I'El:SON' CONSIltt1CTIN(i'I I ACELL DATE
I
1 '� �I ,�jubmit the origin:IMYr�I e Division of AArater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1o36 Plume NI. (91' ) 733_3221, within 30 din s. GW-1 RI:V. 07/2001
AS Fri!!! I ,". E

WELL CONSTRUCTION RECORD
.North (:tioliiin - I)cparinlrnl of llnvironnlent and N lorall [ cso bees - D:vision of Water Quality - Groundwater Section `C%
\\ Fir, t'OVII(M._IOR(I\I)I\ll)U:\I.) NAME
(print) tee,;" �J4)tiE- CERTIFICATION# F
\\ I:1.1. CON I It.\('I Y)B CO\)h.\\1 NAM()f / I to _11/4>��! '/' rP PHONE li tuCS) E;t27-55
S I.k I : \\ 171.1. l ONN I RC( 'I ION I'ER\Irl'M ASSOCIATED w'Q PERMIT H
I if:Ipplicahlcl (inapplicable)
I. AVEI-I. LSI! (Check Applicable Box): Residemi:d V;K Nlunicipal/Pub11c 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ I Ica) Pump Injection ❑ Other ❑ II Other, List Use
Nc:lresl TUwll: /1 .� kn./Count .
//X) zt
(Slice' 111)e N/�wnhei(. ('000nua!I'. Sohdi ei Shia. 1 of No. Zip Cud,.I)\VNI:It:-/\2�vn/ 6 -'/!� i
\Janes; � ✓jC. e
]Sheol Routs Not
(1-1/v 1/ ;u (• s7/6
llryin I..„n Sl.tre
lip Code
l )
1e. '"le Ill„ne alInN7
I. ILVI
L. lO"FAL DIEP:I11: ,,SO�j
6 DIES VVIH.I, 12EI'I.ACI' NXISTINCG AVEIL? 1'IiS HrNO ❑
7 STAII(7 VA'A) El: LL'VE1. IielowTop of Casibu: _j1C) _FT
(Use it Ahosc' I op orCl_+ingl
S. -1(1' ()II CASING IS ( Il. Above Land Surface*
nip ai casing terminated al/or below land surface rer.uires a
raria nee in accordance with I5A \'C\C 2C.1111 S.
'). i11 1_1) (epnl): / MNTI IOD OF FES_f .gt�
II1. AA'Al 12 /ONliS Ideplh): --
266484
Topogril!)hic/Land setting
❑RCH:-Slope Slopc ❑Valley ❑Plat
Idieck appromile bus /
Latitude/longitude of well location
Ideuces minulc.v'ce ndq
Latitude longitude source❑GPS❑Topographic map
(check box)
DRILLING LOG
IAIr(natipn Description
1)1 PIL1
I ton1 To
�t)
5cS
II_ L)ISINIII(CTION. Type /7 Anuunt
I . CASING: ��// jj��lac\Vail,lBe lese
Hon147 lo7UPLel* 10SY/nl
IN lh Di/ or\'. ,eht II lbntcr
11oin To Ft.
L
Iron] 1L 11.
l 2. lilt( WI Depth NIucrial ,A IeC lod
I Inn In.-_ 1'I.ge•Me_—
IIwo To II.
!-1 7('RIlltN'. I):plh Ol:unel I Slot Slic Mato! iul
I tom -1 o PI. in_ in.
Hoot Eo
111. III.
1:ANI)'(i 12Av F.1. I'A(K:
Uep1h Sizc AI;Ilcri;d
1It'll) fo_____ Pt.
1Io111 l
In. 12 1!\I:\I21'S.
EiA N -
Subnul the original 'o the
GP, i1 E'C)FINkl• (919)
ASHEVIL'LE REGIONAL OFFICE
LOC'AI ION SI<10 (1I
Shovv direction and dill:nee in miles from at least
Iwo State Roads or County Roads. Include the road
numbers and CO111111011 road names.
0
C_
b
CT
3
3
7.7
CJ1
V'f T I IIS VVEI_I- WAS C'(INSTRUCTLD IN ACCORDANCE Will I ISA NCAC 2C, AVELt.
DS, AND THAT A COPY OE TI11S RECORD BIAS 13EIiN PROVIDED TO THI? WELL OWNER
SIG
ATURE OF PERSON CONSTRUCTING TI IG WLLI. DATE
)icision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
33.3221, within 311 dtn s. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 266483
.North ('.alma - Ucpnruncnl or I',nv ironment and /Nola : l Resources - Division of Water Quality - Groundwater Section
\\1:11 l'U\ll.\Gl01211NI)I\Il)l':\LI \.UII!(print) /1 �/4 h.7 V/{ CERTIFICATION ttoW7
\V Fit ((1\I It.\CT0It ('ON I'\\V.0 ME / i(e 6NP// 9- firm, I'lIO E n 0?..6?)47It-fit
SI .‘IL: AA r:I.I. CONS.] RI C'I ION I'ERVIITN ASSOCIATED AVQ PER)lift(
(if:gvplicablcl (it applicable(
I- AI:I-I. USE (Check Applicable Box): Rcsidcnuul 1117**-IunicipaVPublic ❑ Industrial D Agricultural ❑
VIuni;orim_ ❑ Recovery ❑ I teat Pump AV'a'zr Injection ❑ Other ❑ I f Other, List Use
VV111.1, LOCATION:
Neal est To\vr 'LAV J/�,�Ay1/ ounr:
G L'_ er4 .hee %L1.v_
t 'I N.IIiJ. Nnlnha sCmnnuluil) Stiluli clue, I Or Nu_ tip Cod❑
,. (I\\'NF11t'j qA. 2e_v c
Vddress Ty+Sc1g3 i-J )
lip Code
c,.
( Tovn SO lit. AIr.•.oII, Ihnl, nunda
II[ Nth .I I I)/ 'i 002
rOTAI. DI.I'T I I: CAS
I)01 5 VA l LL [tilt/ACE ILXISI'ING AABLL?
NO
STATIC AA'AT1112. LEVII. Below Top oiCasil':.g: C<
tke"I"il'AI,uOL lop noctinpl
10! OP (./ASING IS fl-, Above and Surface"
'Top ul .aria„ tennit:lctl :ahv helm, land surface requires a
car i:mcc ill arcord:mr, „ Rh I5.k NC.ke 21.' .II113.
`1. YII LD (upin): NIICI'l1OD Of INS j»•r
I1). AA'A'fl(IR /ONGS (tiepin):
�Topographic/Land setting
1612idgc ❑Slope ❑Walley ❑Plat
'cheek uppt'i,pt'imc box)
Latiliide oneilude or vvcll loeulion
(degrees..minutes/seconds)
I ;Ililuddlongiludc SuurCein iPSDTopogrlphic map
(check boll
Ulip, a DRILLING LOG
From To Py L'
1:0ntiot Description
�� d
S�v /0.5
I I. DISINFECTION. Type Amr-lmt
12 CASING:
Depth
Ilonl f) To .5
n To
I ronl To
I GIt011I`. Ucpth.'1
Penn 'Co;2c0 I
VVtll ". hiek aces
Diy)riliii or\\eight ( t. \�Igteri',il
It.
t.
N la(crial Alcthod
I. r' .-
rr„III .11 t, I t.
I-1. S(It1.I. N'. Ilcpl, IEmricIcr SIo1 ':tic NLodii:d
1-Ann l o I . in. in.
Plan) To Pt. inin
1 min
F rUI❑
lo. It I.A1: A IthS'.
Drlah Size \Lind l
I
to
LOCATION SKN(CII
Show direction and distance in miles from al least
Iwo State Roads or County Roads. Include the road
numbers and common road names.
0
L
q
3
c-n
r Lh}0t) I I� {i it tj II I AT Tins \VI I WAS C(INS-FRIA IYD IN ACC'ORDANCI AVIl 1115A NUAC 2C, AVPLL lW)�N IRI(IC"PLV)�N 1; : 'DS, AND EAT A C01'-,' Of THIS ILLCORDI LAS L3LLN PROVIDED TO IMF, WELL OWNER
Jf
L�\
ER0LI 7,1041i3r111 11O!@LE-NI. ()II))
ASHEV'ILLE SECSISILAIL OFFICE
SRC 7A'IL'ItI101' 11IS1SON CONS 11tLiCHING r11eAVIiLL
DATE
Submit the original to the Division of VWater Qualify, Groundsvater Section, 1636 Mail Service Center- Raleigh, NC
33-3221, within ill da\ s. GW-I RL\'. (17/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and fee/
esouurces- Division
WELL CONTRACTOR(I(INDIVIDUAL) NAM`En (print) fee/ T// LM/jL2//IO C
NVELL CONTRACTOR COMPANY NAME/ C'�-e GC/e//iZ f)v. nf
STATE WELL CONSTRUCTION PERMIT#
(ifapplicablc)
266482
of Water Quality - Groundwater Section)
CERTIFICATION I(9'26 7,
P IION E # 1S' ) icy i tt J /
ASSOCIATED WQ PERMIT/4
- (ifapplicable)
I. WELL USE (Check Applicable Box): Residential LJ Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION:/
Nearest Town:
✓'
{Street inu, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:_t>iNu�
Address
County N4yLC OCI
(Street or Ror e No.)
City or Town State
Zip Code
( Area code- Phone number
4. DATE DRILLED,? 2-'Q)0
5. TOTAL DEPTH: / 7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er--
7 STATIC WATER LEVEL Below Top of Casino: /. FT.
--) (Use"+" itAbove Top of Casing)
8. TOP OF CASING IS ,x FT. Above Land Surface`
'Tip of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): r-x% D METHOD OF TEST /4/ 7—
10. WATER ZONES (depth):
I I. DISINFECTION: Type /7 7. Amount
12. CASING: Wall Thickness
Depths Diameter or Vcight/Ft. Ma erial
From rti To. 7 6' Ft. �, %� SY�
From To Ft.
Front To Ft.
13. GROUT: Depth Material Method
Front C' To 70From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑SlopeIley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mirnmes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For nati n Description
(-x?
y
5f 7-; ,•e
75, /ys"
LOCATION SKETCH
Show direction and distance in miles froin at least
two State Roads or County Roads. Include theaad
numbers and common road names. O
N o
rn
a
CI
iq 6/5
=
rn0
cur
r-)
0
Ism
Is I t I-li1JtEbY YJnt c
LUNS nctrC I lON ST.V)I
TA
A
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG Pif'A'FURE OF PERSON CONSTRUCTING THE WELL
DATE
Go9hro'T Thyprigir lv"d the f ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
4SFL2.7099 f4.'t,.hppgfr,'uiQpl9) 7:3 3221, within 31) dacs, GW-1 REV. 07/2001

North Carolina -
\V E 1.1, CONTRACT
WEL.l. CO.NrltAC
'FOR COMPANY NAME
WELL CONSTRUCTION RECORD
Department of Environment and ,Na oral Resources - Division
rOlt (INDIVIDUAL) NAM En (print) (`t / 1-/ 1M /✓7f' 2
/' Ctt//Q-/unr,f'
266481
of Water Quality - Groundwater Section
CERTIFICATION k?/ /
PHONE IX (i'40)(125//' 3%.h'
STATE \VELL CONS'rItUCIION PERMIT!? ASSOCIATED \VQ PERAIIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential EY Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 IIOther, List Use
WELL LOCATION: /
Nearelt Town: v>g i� _t V., / County/ �/GLGCL/
i7 `
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: /M Ze `e'
Address ./er
Street or Route No.)
//
ity o"[own State
Zip Code
)-
A rea code- Phone number
4. DATE DRILLED, --2 *)- 0°l)
5. TOTAL DEPTH: r7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fl
7. STATIC WATER LEVEL Below Top of Casing: Ci ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS C)c FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /c2 METHOD OFTEST/ •/�
10, WATER ZONES (depth):
Topogrr hic/Land setting
❑Ridge HSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑G P S❑Topograph is map
(check box)
DEPTH DRILLING LOG
From To Forman Description
C 90
�V /'.3 __
/1? /5�
I/55Ws
11, DISINFECTION: Type �%//% Amcunt
12. CASING:
From .N
Depth
To /`1/
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 75 W// __ .Yee,
From 'fo F1.
From To Ft.
13. GROUT: Depth Material Method
From 0 To :
Front To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
O
tNJ
L
a
(71
3C
fit
O
16.REMARKS:
7 TFIIS 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
LJ,
Submit the original to�he 1)i
2769941636 Plume No:i(919) 73-
SI
,NATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001
J

WELL CONSTRUCTION RECORD 2 6 6 4 8 0
North Carolina - Department of Environment and Natural Reso rocs - Division of Water Quality - Groundwater Section
WELL
L CONTRACTOR (INDIVIDUAL) NAME i"�� E/(yri�t), /fl C%�4In16 e CERTIFICATION (AY WELL CON'I'RACfOR COMPANY NAME / / % CP zue//a �t1r/1" PHONE N ('5)7 7 .6-`.1
STAI'I'I \\l!LI. CONSTItUCIIO,N I'ER,\IITN
(if a)plicable)
ASSOCIATED \\'Q I'EIt\I ITN
(if applicable)
WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial D Agricultural 0
Monitoring ❑ Recovery 0 Heat Purnp AVater Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
� Nc�est"town: jiu:f��c'$1../ C
% 'n f
Count'
3. OWNER: /04
Address 532?
City or Town
( )-
Area code- Phone number
4. DATE DRILLED/9 J- "< <
5. TOTAL DEPTH: /S)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I F
�
7. S"STATICWATER LEVEL Below Top of Casing: —7 IT' ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ca FT. Above Land Surface'
*Top of easing terminated art/or helms land surface requires a
" variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /IR METHOD OF TEST
10. WATER ZONES (depth):
ununity, Suhdivision, Lot No_ Zip Code)
-�ANr' .CN.
(Street or3ripne No.)
State
11. DISINFECTION: Type
12. CASING:
Zip Code
Depth , / Diameter
From ..� To -57 Ft. /_
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To U Ft. Ce-- '-Vt
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. _
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
Et�2idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longiludc of well location
tdegrees/mint ies/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For lati. Description
( 1-0l
-XV .5t
.g• /g -s`
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.
C.l1
Q
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A)2DS, AN�}//IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II �
/,\X7r. Gam;
---�Hil#tlf4�'}1C urigimk 0 the
f,c.}({IiG'9r (-G36 lritoirgniit.1019)
i
I -----
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
iv ision of Water Quality, Groundwater Section, 1636 Nail Service Center- Raleigh, NC
33-3221, within 30 da\s. GW-I REV. 07/2001
(Street,4j(n ie. Numbers, Con

WELL CONSTRUCTION RECORD 9 6 i 479
North Carolina - Department of Environment and N/�aSural Re onree- - Division of Water Quality - Groundwater Section
VVELI.CO.NFltACIOR(INDIVII)UAL) NAME (print) /AC;/ A 14 k.)//i/L CERTIFICATION # 24/62
WELL CO..NT ItACI-OR COMPANY NAME 7/'(& � �'('/�X / L •h7/ PHONE # ( (-f7- 5tf<
ST.VrE WELL CONSTRUCTION PER:\IIT# ASSOCIATED WO PERMIT#
tit appl icablc) (if applicable)
I. AV'I'I.I. USE (Check Applicable Box): I:esidcn'ti:d DU"\dm)icipaF1'ublic ❑ Industrial ❑ Agricultural ❑
VloniIoring 0 Recovery ❑ Beal l'unlp Water Injection ❑ Other ❑ If Ditto, I-ist Use
2 VVNI.l. LOCAIIONi /
Nearest I own: ( /J. C Count: /"1 i4G'(GC
r tilrca Nat, 0 Nwnh::: ('o:umnnlry Subuicl e ion. Ian No lip Coder
OWNER 1/l6/ (/FP'
winos `{_� %_iaUSI /1
CISI::c1 or itaul, NO 2/
1,„‘„ s:. le zip o:dc
I 1-
I_ DATE 1)RILLI:D t Y
,- TOTAL DiiPT11: /93
DOES WILL RI!I'LAC'li NSISTING N'GLL? YES ❑ NO -
STA FIG Below lop of Casil. g. 7 3 l:l
(Us,: "+- it Ahoy: lbp of Casil:o)
TOW OL LASING IS '->` FT. Above and Surl ice*
'l up ill ruing lcrruinalra attur below I:unl eurince requires a
' carivu et) in aeror d:mac eilh I5.k NCAC 2(' .III IX.
v. YIEL.D(epnl): (.� METHOD OFIF.SC
lu. AAAThR ZONES (depth):
I_ DISKN'11!C'TIO^L'I-ypc-_h'Z --- Anu'unt
I'. CASI N(i: \Vall thickness
Urprh IThimeICF or \\ cighl Tt. NI:ucrial.
I1„ln - To ,y 1't. ('0/ /6-
Wool
rorll Ill rI. _
(IItOI 1 I) pth i\Elul ail Nlcl hod
Is'nl ( al 2.----7U' It/ — v/
I rum Ill I'I.
I.1 s(I :EN: Depth Ui:lnlcicr Slot Siac Nimen:LI
limnTo FL in. in.
I tool To I:I __. in. in.
IL. S:\:NI)"(il:A\'I(!.PACK;
I)cplll Sri:. `•laic -
nl
limn _ to _ FI
horn I
to I:I!,AI,A121:S:
Submit the imaginal 'o the
G,— a! cv.t-) fv.C1404 Il)I())
ASVFV'!l'_ PF&LGiiAL OFFICE
Topographic/Land setting
2Ridue ❑Slope ❑Valley ❑Flat
(check npprupria:e boll
Latilttdcllongitudc of well location
IclegicestiinutesisecoLos)
I.aliludciltI1LiludC source:DCil'SDTopouuphic map
(cheek b,x
I)lil'Il 1 1)1211_I_INC! LOG
Froul to Ft ri )a1 on Description
�(: (IN/
9/ S --.7N
/// )
/n, /
LOC'AII()N SEET('I1
Show direction and distance in miles from at lead
hv)) Slate Roods or County Roads. Include the road
numbers and common road names
/ Gr
0
1V
r_
V•
A
cf1
O
:ATII IIS \VI91_I. \VAS C'UNSTIUU('IEI) IN ACCORDANCE WI"ILI I IUA NCAC 2C, WELL
2DS. AND TIIAl A COPY Op -Ft us RECORD IIAS 13ILNN I'It()A'IIWI) to Ti WELL OWNB12
IQ-a3 O -
SIGN: IU12E of I'E'.2SON CONS f RUC'TING III1. AVIEI I
DATE
)ivision of Water Qu:'.li(v, Groundwater Section, I636 \lair Service Center- Raleigh, NC
33-3221, within 3(1 day s. MY -I REV. 07/2001

WELL CONSTRUCTION RECORI)
North Carolina - Derailment nl' Environment and Jalural Rcunlrees - Di -isiun of APaler Qualify - Groundwater Section
VA EH CON 1ItVrbo1((IAI)IA (INDIVIDUAL) NA,AI I( (�ri�p l�r �� INA4° �iL�� CERTIFICATION # colY"'
el
t)L11(ONA1(AClint C'O)u'vNv,cvyn:�_7noCC_ LtilY- �(11 L-1f rno.vlt
I.\„: \\,-.LI. CONS'1 RL(''I ION I'IR\Irl'N ,\SSOCI.\llo:D WC) I'EIk\l1'EH
(iI;q, lIClhle) OF. i,licablel
264820
497-n s -S
I. AAI:I_I. I 'SE (Check Applicable Dos): Residen'.ial © N.lunicipall ublic O Industrial D Aericullural 0
A Ionilorin_ ❑ Kceoccry ❑ I -Zeal Pump VVa er Injection ❑ Other 0 II Other, List Use
2 AAId1 LOCATE/NZ /
Newest Town C/,e
(Nucel Name. :N' umhe.s, t'omunluiO. .Suhaic l3w0. I.0I No Zip Coat)
OAVNIf12 : 9-'A/I &tibcC/S
\tldress D. el
ISl.ael or Ruth,: N0.1
Cuv nr lo,n. (dale lipCoo&
\w.. c.,ar Phone I:umkt
lli I)RII.II'I)].2 i'r.<�
�. IU -AI. DIPIII:
6- DOIfS VA'Ii1_I_ REPLACE, EXISTING WELL' YES ❑ NO
7. STAT[IC VA'A! II21. I:VIiL l3clow Top of Casing:
Rho"( 'dnnoec cop of C asligl
.ti. l (11 O!' CASING IS � LT. Above Land Surface*
'Tip it casing terminated nl/tr hollow I:nul surface rrnuires n
ciriaroce in at rinlnncc with 15.\ \'('A(' 2C .III IN.
�,- YIELD lcpm): —J NILTIIOD OF THST A.
l (1. AA'A"hI:R /ONES (depth):
I I
12
Count ,' /LL1.;'Cf2/
Topographic/Land setting
1946dge ❑Slope ❑Volley ❑flat
(check appropriiile bus
Latitude/longitude of Well 10Colion
I Degrees mini(e): (econt10
L; tiludC IL)Il �ituJe souree:OG PSOTopoeraphic ntup
(chock hot)
phi) HI DRILLING LOG
I -tom To ftlrly:I fl0? Description
1 � /? s iyc l/
E.
DISINII:CIION-Type /.2
CASINN:
.� Uelvh Diameter
Ilum_-�;% To 72 !y,--y7-
Ilum
1.,,ua, To !'1.
I turn
II. nil.,AI:AI?b.S
GE
ASHEVILI_E REGIOiNH.VCFFiCE
Ann.unt
VVali hickness
ur \\eight'ft. -NJalert//d
t
/Af1
Uynh Nlel tia -- N elllnJ
Ucplh I)I,IIIICIII SLIT NI/e Malitial
t.
Dclnh Size
fu Ft
I) Pt
Submit the original to the
)19)
d a er hl
LOCATION SKIiTCl1
Show direction end dislanee in miles IFoni at least
two Slate Roads or County (toads. Include the road
numbers and common road names.
T ll IIS WELL WAS C GNSTRUC'TLD IN ACCORDANCE WIII I I5 A NCAC 2C, WELL
)S. ANL) Il I:AT A COI'/ OE 'I111S RECORD I IAS BEEN PROVIDED TO T IiE WELL OWNER
I-33-0(7*
SIG, A"t' I URI::OP PERSON CONSTRUCTING THE IL W13L1_ DATE
)ivision of Water Quality, Groundwater Section. 1636 dlail Service Center - Raleigh, NC
33-322I, within 311 days. (1W-I REV. 07/2001

^ P0rt
01 :ter sL •
WELL CONSTRUCTION RECORD
.Vol Ih Carolina - I)cp:lrtnlcnl of I:nvironnienl and v I Ural I%sourees - Division of AWater Qualify Groundwater Section
I
VA11 I('(1,AllbV(-Iolt(IAnlAllfl?Al-).A.AAII (priut)_ tkr
VAIll coA'I It. A c'I Olt cool P AAP NAME cewell 4Pv/h ------ - ,---I'lloNE: n csAit6*6Y
S I .\1 F. \\ ta.l. ('o\s I It t'('1'IOS I'1(R\ill tt .\SS0(IA ni)P'Q Pr -Antrim
ill ap �lil c;thlcl (ifapplicable)
CE121'11'1 CA ioN k
i'
I. AA 61_I. USE (Check Applicable 13oz): Residential Gr.-Nlunicipal/Public ❑ Industrial O Agricultural ❑
VInnitoring ❑ Recovery 0 fecal Pump AVa'cr Injection O Other O II Oiher, I.ist Use
VV'61.1. LOCATION.
Nearest Tow n:kVa yyy&_h✓/& County /Vt170/
/
tv (
J0Aw.a>ih. 1/eeA n /
tSrmel N,mic. Numbers. Couunuuilc, Subdic[sh,n. lot No.. Zip Code)
(IWNERL.D_Mi r .4 /L!4/C
:\ (idle Ss 37? .72'1/er w-- /DT.
t Sa. I or Route No.1
14/12/Ylied✓:�� /9/ e Jai
( r, or logo Sue Zip code
1-
Are, code- Phone numbs
-I_ I).AT1:O-
i TO"GAI_ I)liPTII'.-
(,. DQIS VA'IiLI. RI';I'I_AC'ti EXISTING WELLY YES
Topographic/Lai-1,a setting
❑Ridge ❑Slope SiValley ❑Pl:u
ichcck appripri e box)
Latiuulc'longitude or well location
I degrecs'rninulaa'>ccunds)
Lal Itu(Ic'longiludc source:OGPSDTopographic map
lebeok hay]
D I'I'-Il I URII.LI NG LOG
Flour To FoiyIIi1it} Description
rt
611 /too_ 5� ^ 4rD ro rSiroie
leG _TOOe
NO L
S EAII('\1`r\"flirt l.IIVI':I. Below Top oFC:uil'-c:.
lu.e r' Pi Al.,carip„reusing)
S "f(11' OI' CASING IS _ I`h. Above HMI SUIT:ICC*
'Fop or rasing Iv' min:ntil at/or belort l:uul SW face rr,pIir es a
cari.mce ire accord:umr n eta IS_\ \(':\C 2('.111 IN.
`I_ YIELD (ppm): ag NIEIHOD 01h TIS C�}'• r
III. AALAI I:): LONNS (depth):
II
1'
DISINPIEC1'ION. I vpe
LOCATION SKI'TCII
Amount Show direction and disnutec in miles Iron) at Ic:ul
CASING. AVail Thickness tvvo State Roach; or County Roads. Include thcn)ad
Depth I)i./fl/nctter or ACeiuhitt A1a cri:ill numbers and common road names.
Ill +� I) 6� 1'I. 6 f7 ��J/ rC.
froI l't_
1-rnn1 fo
11 (iIt(It I - Depth Nl a rein A1elli.
I winC) _l1�(,) It COiuGA;
I coin To 19_
-I S1 lU I.A'' Ucp1h I)ituneler Slot Svc Ni aerial
roin
IonI
S VND. OILAA I I I'A(T::
Urplh Size VI:acriul
3
li, RI VI-ARIKS.
It
.71
O
IEDE(Eidh liFrErpr (l.Lt1 111 TI IIS \YELL WAS CONSTRUCTED IN ACCORDANCE AA'III 115A NCAC 2C, WELL
r•.7 1)N IvI�C vftIU S" N '.-kRUS, AND (I I Af A COP/ 01- EIIIS RECORD I IAS t3LkN PROVIDED "HIE WELL OWNER
1 f 1 t U�
SIGNA URE0I'1'1-,S0N CONS IRIICIING I'IIIi AVIII.I. DAIF
Submit Ilse uri''ina to II a Division of Water Quality, Groundvvaler Section, 1636 Atail Service Center -Raleigh, NC
GROUNQAQfoFl 71/aNN 1. [phone], within 30 days. (iAV-I R.F.V. 07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
264818
North Corolino - Department or Iim ironnient and Na oral R/csourees - Division or Water Quality - Groundwater Section[
VAICLL CON! lt.ACIYllt (IAUI VII)t. I.)RVAI F: tn(print)i�`� CERTIFICATION a C)C6Cf
tAi1.I. CON I U.A ("I OR COAIVA,NV N.UIE �^re e-dCi/ct-- /Mp PHONE N (S.�CL7T ?5"
S I \ I I. \S I I.I. (Y ' .1 ItU(' I ION I'l• ]t)I I'I ll
lit aprlicahlcl
\ SS(1('I:\T f:U WQ 14:12A111 tl
(if npplcnble}
I. AA'I.I I. I ISE (Check Applicable 13o.v): lesideri,inlIlvIITAlitnicipnlIPtilnie 0 Industrial ❑ A rictllul
VToni toting ❑ Recovery ❑ Heal Pump AValor Injection 0 Other ❑ If Other, List Use
VV11.1. LOCATION.
Nearest Town: J9r//O/1/
�JLC
r $I1 eel ,Name, Number:. ('nuullu u/ll/p. Suhdi si<wn. l of No. Gp ('odes
OWNER /1/E'E+/5
I ,till. CI or ttnul- So
.04 ✓feet -ZOL✓4- &
Count
c1n 11'1111PII Sole /.ip Code
\IC.1 aulC- rhlnle nn'rd.a p -
-I. I):\'II[ 1)1<1 1.111) COR
hOIAl. DI!1'TI I: _70,5- lc/
b_ DOLS \ABET. REPI.AC'E EXISTING MIL' :' YI<S 0 NO fa.
ST ATIC AVATFI< LEVEL Below Top o[Casir_ t>73 FT.
((ke"I" il' Above Top of C':aiu,_7
5. TOP UIF CASING IS FT. Above Land Surface*
'l'up ul casiu„ terminated at/ur ache land surface requires a
„„rhino: in :¢cunlnncc aith 15:\ N'(::\C 2C .11118.
1111.1) (epnll: 7 Mhll!OD OF 4,l
VA';A"II'.R ZON ES (depth):
o 020
a0,f)
Q/c o
_27O ?ors
Topographic/Land setting
❑Ridge OSlope ❑Valley Ial
I. heck :Ipprnpriatc box)
I.aliludcrlaleitude Orwell Iocalion
a, c.Illill Iconda
Laliludc�loncinuie souree:LC PSOTopoeruphic map
Bleed host
WTI II DRILLING LOG
from To Fortnritiop Description
1 d
7-,V
LOCATION SKF: rC 11
I I. DISINFECIION. Tape 7% Amt•unt Show direction and (lislance in miles from at leas!
1' CASING: Wall llliekness tvvo Slate Roads or County Roads. Include the rood
DC'lh Di;yneter err A,eiglit'I_ Nlltel'i:tl ❑tIIlIheIs ❑Ills COIllIn011 land names.
I will t� Tot/. : /y / %3/-1 (
1-Eons To Ft. /5/5
Horn To Pt.
1 (RUC I : Depth Nlal crier[ method
1loin 0 TI1 do fl. Ca-,d-1)A
!pup to It
I . St I:1•FN: Depth
I'rnlll I n I
ti ANT)(IRAA I PACK:
I)gnh
Dons
t1. RI-ALARKS:
Dinlncler Slot :Hie Niacriul
in.
III.
Sin• 'd:seri:d
IM) I I,I II \l!I 1:111111 I - -II IIS VVoI I WAS C(INNrltUCreo IN ACCORD ANNUL W1111 I j,A NCAC' 2C AVIiLI.
)AS lit Id lt4N S�=ANIt I S. AND TI I AT A ('OI'• OF II IIS ItliCORU I IAS BEEN PROVIDLLD TO ll IF WELL OWNER
':\TW LIRE )I�
SIG C PEISON CONSIRUCTIN(
I lit \1. 11_1.
-111-C<7-
DATE
Submit the original It the D vision of Water Qwilify, Groundwater Section, Ih36 Allis Service Center- Raleigh, NC
ORtlffa(CRh iii .N4)1919) 73-3221, within 30 dnt s. GW-I RI'.V. (17/2001
PS' ['/ISLE RELIOR.RL 01-FIGE

WELL CONSTRUCTION RECORD
orth Carolina - Department or Environment and atura Resources - Division of Water Quality - Groundwater Section
�
yo 'be p1() 1 tom'- CERTIFICATION #'-r"/
ELL CONTRACTOR (INDIVIDUAL) NAME (prinQPs=
ELL CONTRACTOR COMPANY NAME riCe Wel/ iF
r ATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
262920
V /nil° PHONE # (Qs) 7-giVo
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑. If Other, List Use
WELL LOCATION , / /
N/earc(:yl Town: �1)e- County r' 0cop'
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
. OWNER:iei 4.4 rJ
Address 0 7s;..N 6rin✓cL 47'
(Street or Route No.)
nyrle N-t. d 70)
City or Town State Zip Code
( )-
Area code- Phone number,
DATE DRILLED /0 -//-C2 °2
. TOTAL DEPTH: 904—
. DOES WELL REPLACE EXISTING WELL? YES Q NO
r: /��
. STATIC WATER LEVEL Below To of Casing: b FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS a-- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith I5A NCAC 2C .0118. _
YIELD (gpm): 0Z METHOD OF TEST
1. WATER ZONES (depth):
Topographic/Land setting
9fdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) s
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
F.r at' /nDescription
DEPTH
From To
0 (20
/cc
490 -Qo
o s'
. DISINFECTION: Type //ft Amount
'. CASING: Wall Thickness
Deptht)i�fne)er or Weight/Ft. Ix�aterial
From -1-0 G� To ! g Ft.
From To Ft.
From To Ft.
GROUT: Depth
From 0 To
Material 7
Ft. e�'µe�
From To Ft.
I. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
i. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
REMARKS:
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.
4/3,
UO HEREBY CERTIFY THAT THIS WEL 'NH4rONSTRUCTED IN ACCO
ONSTRUCTION STANDARDS, AND TH (WY OF THIS RECORD HASI
SIGNATUI2IE OF PERSON CONSTRUCTING " HE
C`- ' - ,r.�IIOiJ
ubmit the original to the Division of Witter QUality,Groundwater ;Welk
/699-1636 Phone No. [phone], withiiirreliiYs.
E WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
I'D-II-O :)--
LL DATE
36 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
1
9
`/e

WELL CONSTRUCTION RECORD
262919
North Carolina - Department of Environment and ('Nttturat Resources - Division or Water Quality - Groundwater Section (, WELL O.\I R.\CI OI( (INDIVIDUAL) NANO: (priuD /
_____ pIl f e CERTIFICATION 4 �eJ
\\ELL('ONI UAC'rOR ('(1M IS\SV N,\MP: �rite- Wei)A..^'9 ' PHONE N fog) 2J- any
s'r.\7r: \\I I,I. CONS'I ItI'CIION I'EU\IITM
111;4Thu:title]
ASSOCIATED WO I'f:12:\1IT#
IiYapplicable)
I. WELL USE (Check Applicable Box): Residential GltNlunicipal/public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Beat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION:
Neal st:Town:.9'V "o nJ ('minty W Usoi
v e ,E
(Street Name. Numbers, Community, Subdnuiun Lot No.. Zip Codc)
3. OWNER,_
Address
(Suva m' I(Kaac No l
CAN / L.
mof Tulin Slim Lip Code
.Area code- Thine nwnhcr
z
I),\ I I U R I I .I.111) / D 7/0 - o 1.
5. "f01 AL 1)lil I I I (2,0s
(i. DOI S WELL REPLACE L '\CE EX IS LING WELL' YES O, NO 19"
7. SVATIC AVATI It LEVEL 13elow Top olCasm' FT.
(Use'•4 ' it Ahoac fop to - casino
S. TOP OF CASING 15 F1'. Above Lain Surface*
.rap of e:uiug termina(eII at/or helms laud surface requires a
‘al i:uiar iu p ncrurd:mc�eyshit li;\ \C\C 2C .1(1 IN,
9. A'IIFLD (gpnll: N1E"I'1 I01) 01' TI'Sl'.•¢9r/
10. WATEI{ ZONES (depth):
_�Topographic/Land setting
Sludge ❑Slope ❑Valley ❑Flat
(check appropriate host
Latitude/Ionginule nlAvell localiot)
f degrcea'n: i macs/ottt.nds
.aliludc/longitmle sourer:❑G IS❑Topographic nap
Idieck box)
DRILLING LOG
I rynatipn Description
From to
354,
rivziet
1 I. DISINFECTION: Type_ Amount
12. CASING: Wall Thickness
�L Depth / Di:}meter or Weight/Et. Nliterial
From 71 c2 To ff/FL_ _ _ �iQs 'ice
F r 0I11
From To
13. CiltOUT: Depth iilmeriai i Nletliod
From 0 To z0__ Fr ee^' e^' f"
From To
14. SCREEN: Depth I)i:uneter Slot Size Material
From_ To I`I. in. in
From To FI. in. in.
IS. SANI)/CiItAVEL I'AC'K:
Depth Size Material
Front To I:t.
Horn Ts, PI.
16. RI.NlARKS:
r7
�(� I I II
I DO I ILIUiI3l ('ICItT IPl' ll IAT TI-IIS \VL 1 \ss£OF4STI(C3C FF
CONSTRUCTION STANDARDS, ANDI" COPY—OFF'l 1115 RECORD IIA
LOCATION SKETCH
Show direction and disl:utce in miles front at least
two State Roads or County Roads. Include the road
numbers and common road n:unCS.
peL
0
ul
CLl WITI I ISA NCAC 2C, WELL
'N PROVIDED TO THE WELL OWNER
SIUiA'rA I tNkP; OF I'I:R.SON CONS RUCII N(I ll 1! Vlil.l. In—io—o
Oa —DATE
Submit I lit original to the Division of N'alcr Qunlity, (rot)ndts;)tt) pittiou, 636 Mail Su %ice Center 12alcigh6 NC
27699-1636 Thane No. [phone], within 3U'days. ---- GV1'-I REV, 07/2001

\VEI.L CONSTRUCTION RECORD
North Glrolinu - Department of Environment and Natural) Resources - Division of Water Quality
\CEI.I. ( )NA R. U1 OR (INDIVIDUAL) \A\I I, print) 7 eI)t^ L/4/ /o4
WELL COCA II \(' OR COMPANY NAME (.,e A C_✓,+'!
NA\ IT. \\ LI.I. COCCI RUCTION I'P:I(.\I:i 4 ASSOCIATED \\'(j 1'BR\IITN
il'applieuI eI Of applicable)
262918
- Groundwater Section /p
CERTIFICATION pap /
PHONE d p - gS %S7
AVEI_I. USE (('heck Applicable lion): Residential LR- Nlurueipalil'ublir ❑ Industrial ❑ Agricultural ❑
Vlonitorinc ❑ Recovery ❑ I leat Pump Witter Injection ❑ Other ❑ II Other, List Use
'_. WELL LOCATION -
Nearest 'lown' C//de
Cl
ul
_ni Li vPO
M6ers' /)f \rili4
(StIccl N;unc. Aumbel., Community, Suhd'cisiuu, lot No.. lip
3. OWNIiR- 77A/f-p 4C
Code)
Address .��-F-"`- L cif IC
IStrect n- None No
C.
City et Io'1 slJte
Area Otte- I'hone number
d. DATE. DRII.I.F.1) /�
S. TUFAI.01il'T11:,390 �
6. DOES VVGI_ REI'I.ACE F.XISIING AVELL? YES ❑i. NO EH'
7. STATIC WATER LEVEL Below Top or Casino: * P"h.
(Use "+" it Abocc'lop of Casing)
S. TOI' OP CASING IS FT. Ahore Land Sllrraee*
'lop of casing terminated at/or below lain surface requires a
Variance in accurd:mce aill! 15A NCAC 2C.11118.
9. YIELD (upm): %Qp N!F. rl-I01) 0FI FST /Q(�
ID. WATER /ONES (depth):
ftp c'de
_02o 79
2 9 1Ets"
Topographic/Land setting
Itiidge ❑Slope ❑Valley ❑Plat
(check appropi tatc box)
Lati tudellongitude or wet 1 location
I ticgreesmitumc.,sccond<)
Laliludeilongitude sourer:❑(il'S❑ lopogr phis Inup
Icheck hot)
DEPTH DRILLING LOG
From TO For na it Description
lJ 920 t
.q rPJra
�Ct' �e
11. DISINFECTION: hype gr— Amount
12. CASING: Wall Thickness
UgHh /Di.�n'cl/c
To 77 Ft.0p7
1 or U eight 1 1 A ;tterial
From f /et C.
LOCATION SKETCH
Show direction and distance in miles Bon) al least
two Slate Roads or County Roads. Include tI 0ld
numbers and common road names. Iv _.
From to II �"/539
From To Ft.
13. (iROU 1` I) •pill II:nen d Nitlhod
From i0 To alp El _e-2&M v7P
From To 1:1
14. SCREEN Depth Diameter Slot Size IAImcriml
From To PI in. in.
Front __. To I1. In. in.
15. SANI) (iRAA'Lit_ PACK:
Depth Sqc Maui MI
I:rom To PI.
1'ronl to I:t.
I6. ICFNI Al2KS:
I DO HEREBY CERTIFY TITAT T111
CONSTRUCTION STANDARDS. A
sic
Submit the original to the Divisit
27699-1636 Phone Nu. (919) 733-322
L 4A
'Old'Sl I UCh'f EDYlu
T A COPY OF THIS RECO'.
2E OF PERSON CONSTRUCTING 'HIE WELL
— — J
u of A'it'd@IQ)l1NiAs'FC,:fsatl3dt1A.ialer Se
FFICE
DANCE WITII ISA NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
DATE
lion, 1636 Mail Serriee Cooler- Raleigh, NC
(1W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
262917
North Cal olina - Department of Environment :uul N: lural /Resources/- Division of Water Quality - Groundwater Section //
\\-Y:I,L ('(1\'l lr.\('lY It (INDIVIDUAL) NAME P: /,,riup�el,1L{� /�� Y-///Y/e CEIi'I'IYICATIO\'q �T��/7-�.p \\Et.t. cos"N\(I olt Co>IPA,.V ',Asti.; J ,Ce /Nc//�Cj4N���,rllonE aOW) 7-pJ -
51 UI E WECI.1. Coal ldtc„u.\ 1'k:1(11IT N i ASSOCIATED \\'Q minim/
(if a) tlicahle)
Ii fa „Iicthlc)
I. AA'LI.I. USE (('hack Applicable 110x): Residential L7 Nlunicip;d/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Ilea( Pump Water Injection ❑ 011ier 0 If Other, List Use
2. WELL. LOCATION:
Neal wt 'huu n: ��}�✓��
v/7
IStrcel N,unc uwheis Cmnmunily. Subdrvivan, Lot No.. Zip Cade)
e✓ ff �it/�r�
( tit reel r Ituu No.)
1dress
ge-'14) C. a8
CtK,i in,n Slate zip Code
Arco code- Plane member
d. DATE: I)RILLLD `12— a-opZ
5. TOTAI. DI:PTI1: a0s It-
o DOES WELL RLI'LACE EXISTING VVELL? YES ❑NO V
7_ STATIC WATER I.1!VI11. Below Top of Casing: 3pdPT.
��77 IUse''4 it yhoe top or Casing)
fi. TOP OF CASING IS OC FT, Above Laud Surface*
*tit of casing terminated nl/or bcIoti East .otrfacu requires a
v; riancc in accord:mc • rill 15A NG\C 2C .0118.
9. YIELD (gpm): NIL:114OD OF TIiST 41!/
10. \VATLR ZONES (depth):
I I. DISINF LC'T ION. Type nouns
12. CASING: Wall Thickness
Urplh )I)I; il et r or \Cc ht1F1. }\)nlcri:/`
('rem � To SIQ H.
%� C% _ r
From To
From To Ft.
13. (iRO1.11-: Depthaterial -�� Vleihod
From To iD I:I. CIAlefwe..vf'
Front____ To
14. SCI0lI?N_Depth Diameter
Froth To
From To PI. in
15. SAND;(iICAVEL I'AC'K:
Depth Sizc
From To I�t.
From To PI.
16. RFNI ARKS
Topographic/Lan setting
❑Ridge ❑Slope Valley ❑I:ial
(check uppropriatc hum)
I.alitude/longitude or well location
(dcgrce%iminuiesisecund,))
i.alilude/longitude sourer,❑GPS❑ ropographie i1 ip
i chock bum)
DRILLING Lac
Fopir>Uescr iptitill E1
"4 //--
*fl4-//D 2„0�777Ye-
r4-.f e
I)I'1''III
I)um To
0
Slot Size Nlacrial
in.
in.
Nlatei'ia1
LOCATION SFSFTCII
Show direction and distance in miles Rom at least
two State Roads or County Roads. Include the road
numbers and common road names.
j87)
IV
0
01
11)0 IIPRIiI3Y CIiR'I1I'1' FIR I"I'IIIS \1'ELI, \
CONSTRIi(' IION .SI'ANDAItDS, ANI) '1 1IAT
Yf(1NATpith (
Submit the original lu the Division of VaIe
27699-1636 Plume No. [phone]. vvileum 3
z ' TRVC I hU-TN AtThkiii-k NC
by OF II IIS RECORD I IAS 13l'!IlN
L r
VITI-I I5A NCAC 2C, WELL
OVIDEI) T0'I11P. AVGLL. OWNER
10-g- 0
I'EI SON CONSTRUCTING TI AVLLJ.
GR \t. 'iEL
QuaAgNEZI!PpiRECvICIdr ScaeH)r` 101
:n S.
DATIi
Mail Service Center - Raleigh, NC
GW-1 REA'.07/2001

WELL CONSTRUCTION RECORD
262916
North Carolina - Department or Environment and Na mat Rcsouuccs - Division of Water Quality- Groundwater Section
/-, Weil CEIRTIFICAT`IIOiNN #C 09 /
T:I.L('(IN'I RA("I v OR ('O\II',\\V NANO: ! (CC Well it 14i1e PHONE # a7 i�17'— 3$
ST,,TE WEI.l. C'ONSI RUCTION I'EI(BIIT# ASSOCIATED \VQ PERMIT,/
( irapplicablcl
(il applicable)
. WELL USE (Check Applicable 13ox): Residential Ccr Municipal/Public 0 Industrial 0 Agricultural 0
Moniloriug CI ILeatvep' IT Ilan Pump A\lute1 Injection 0 Other 0 IF011icr, List Use
VA EI.l. CON"! l(.ACTOR (INDIVIDUAL) A,V,AI whit)
7,9
2. WELT. LOCATION: /
Neatest Town: /�.9NY�.,✓ County
a CL7/
(tines.: Name. Nmnbcis. Community, Subdicisi; n Lot No.. Zip Code)
3. ()\\NI.R v . ,,�7? re1/
Add l ss 69 C/ (As
RouteNa.)
JJ0 /
l'nvorloon Stale /_qt Cudc
Area onle. Phone numb:
4. DATEDRII.LIID f0/-j,2
5. TOTAL De1'T11:
6. DOGS WELL REPLACE EXISTING WELL? YES 0 NO yr-
7, STATIC WATER LEVEL I3clow Top of Casing: 33 FT.
(Use "+" if Above'I op of Casing)
S. TOP OF CASING IS 22 FT. Above Land Surface*
'Toy of casing terminated atior belu v laud surface requires a
variance in accordance 15.V NCVC 2C .1)118.
9. YIELD(gpnt): 6 IMETIIODOFTEST /9-%
10. WATER ZONES (depth):
I I. DISINFECTION: Type 7 Amount
12. CASING: Wall Thickness
Dcplh .� Di_ )older o+\)yO lVhl. ,.ucria�
From OK To Q PI /� ,//7/ �QfIO
Prom To I:1.
From To PI.
13. GROUT: Depth• Material Nlethod
From �. To &O FL pi. e-c/—
From To Ft
14. S _ IL I'l N: Depth Diameter Slot Size Material
From Il) 1:1. in.
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To F1.
From To Ft.
16. ILLNI ARILS
viz, c
Topographic/Land setting,_,,��
❑Rides ❑Slope ❑Valley LYT'lilt
(check appropriate bast
I.al i lade/lonbnude of well location
(detrrce -nliames .ceands)
I atiludc/Iongilude sourer.❑GPS❑Topographic map
(el eek box )
I)VI'Tl1 DRILLING 1.0C
From fo F lyl:d it311 Description
0 _n�0
I.()C'AIION SK ETU!
Show direction and distance in miles from al least
two State Roacls or County Roads. Include the road
numbers and common road names.
/ w 0276
0
tV
J
Ui
(•Il P" 1I�,�
I DO HEREBY C'HRll I�1''l lI:AT IIEIS WLLI. AA 1. (t xJ'ai R(YCIISD IN!'E��jNC4" ITII ESA NCAC 2C, WELL
r. OFE I EIS RECORD I ;AS 131iLN 1',2OVIDCD TO II11; W L.I L OWNER
It •
SIGNATURE dk I'EFLSON CONSTRUCTING 'HIE WELL
to-I-09,
DATE
Submit the original to the Division of \Vateli Quulifr Groundwater Section, 1636 Nlail Service Ccntcr- Raleigh, NC
27699-1636 E'hn e No. [phone], ,villein 30 dins. GW-I REV. 07/2001

NVE1.1, CONSTRUCTION RECORD
262915
North Carolina - Department or Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ EI.L (7)Nll(Artnit (INDIVIDUAL) NANII: ( Irian e,JX 24ij f e 'CERTIFICATION 'I'IIONN # c1)49
w'ICLLC(IN'llt:\('I(Ilt ('(1.\I I':\N \'NAM 1: �-(�/[jj�/���,/'^" ruonL: # �JcpJ(9><2'ftS`%
sl'AIT: m.11I.1. COSS'I IttCI ION PEI(.\I IT# ASSOCIATED \VQ PEI(,IIT# ---
liliipplicahlol (irapplicablc)
I. WELL. IJSIi (Check Applicable Box): Residential kr- NIunicilial/Public 0 Industrial 0 Aericuhural 0
Nlouitorinu ❑ Recovery 0 I teat Pump Water Injection 0 Other 0 I1.0llier, List Use
2. WELL LOCATION: /
Ncares ;bole IA/ NtfU�ta County 1/G✓C eat
($beet Name. Numbers, n unity. Stibdni+um. Lot No.. Zip Curici
3. OWNI'.R:�(e4tJ rMO So wy /
Address gg��iV �C� IJeureesGninulc /..ceondsi
I/gde source:❑(iPS❑Tupoglapllic map
tt reel ur Rout,: No.) (check tiro)Li/ Nefth/e y !- Qg9Ie DI.PTII DRILLING LOG
r l„,rn sidle zip code Irma I Ptjjiyatiyn Description
_d r o
Area cone- Phone number o% �(Q iv0
4. DATE DRILLED /0 f `0a /f '� 'OS''+•✓QSf•Y�
S. "TOTAL DEPTH:��,3" f os -�7S i2
rRV
6. DOES WELT, REPLACE EXISTING WELT.? YES 0 NO trr
7. STATIC WATER LI'.l'LL Below Top olCasinc: /5/0 PT.
4-1 (Use `r- if Above Top of Casing)
8. TOP OF CASING IS c>e FT. Above Land Surface*
*Tit of casing terminated al/or below Elul surface requires a
variance in accordaotc'v''lh 15A NCAC 2('.III18.
9. YIELD (gpnt): y MLTI IO) OF'I ES T /9q/-
10. WATER ZONES (depth):
11. DISINITCTION. Type 1/217'/1 Amount
12. CASINO: Wall Thickness
y" Depth d / Diateter or AA'e _htFt. Al: Icrial
Froi iS To5Y FL.& /y tJ4.011 L
From To
I'r Ulll To H.
13. GROUT: Depth Mataiul Method
From (2_ To ,2Q_ Ft._._ M_eN-_ --
FromTo Pl.
I-l. SCI{III.N: Ucplh Diameter Slul Nile Matoi:d
From To I i. in. in, _
From To FI. in. in.
15. SAND/GRAVEL PACK:
Depth Sic N1:Peri:d
Topographic/Land setting
i(Ige ❑Slope ❑Valley ❑Flat
(check appropriate ho,
Lalitudeilongitudc or well location
From To
I'roiu To
16. RENIAI{KS:
I DO I -(KILT B ' CERTIFI' Tl I ATTHIS WELL
CONSTRUCTION STANDARDS. AND THA
LOCATION SKEICTI
Show direction and distance in miles from al lead
two Stale Roads or County (toads. Include the road
numbers and common road names.
DINncC�R�lry� ewrrulsAN
RECORD HAS I' PROVIDED �
_ 10-9-Oa,
SI(iNATUR :��F �iR SON CONSTRUCTING Td IE w LL DATE
S' 12UC FI (CAC 2C, WELL
'V OF THIS IIS I O THE WELL OWNER
II
l"J
Sulrmil the original to the Diri.Siuu of W: Id' Q I: )jQC1( 40,1g17F1R S6.614 (;lion, 1(3(1Mail Service Cater- Raleigh, NC
27699-1636 Phone Nu. [phone], width 31) (IASk.EVILLE REGIONAL (.;-Fitt
1 GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department ment of Environment and //N �aatu�rall/ Resources - Divisionisof Water Quality - Groundwater Section
�[�/(� \\'1:1,1. CONTRACTOR II\III\'1UU,\L1:\:\\Ii (priiil)_ t.A1-I',q r�^KTV/r /'e CERTIFICATION # ( i/e
WELL CON I ItACrou COMPANY \,\MEffl 'cc ✓✓`J/y lLl''rp PHONE # t 6*T4rSSr
Si ATE \\I:1.1. CONS RUCTION I'P;IR\TIT# ASSOCIATED WO I'FR\III#
lit :Iplvlicahlc) (iriipplicahlc)
I. WELL UST? (('heck Applicable Box): Residential Vt<MunicipatiPublic ❑ Industrial 0 Agricultural 0
tAloniwring ❑ Recovery 0 Heal Pump Water Injection ❑ Other 0 IIOthcr, List Use
2. WELL LOCATION
Neaarest'Town:II/7p En'
(Sire,, Name. Nmnbeis, Community. S
County 4/104/130"
uhdi%ision. Lot No.. hip Code)
3. OWNER: JAt sr,/
Address /Q_e.4,/6
I cl ,r Itul,l, 5
Mamie lift-/lQ 4t
O.l
c2 25/
l lhur ltinn Slane Lip Code
( )-
Ana cmlc- Phone numh
4. DATE: DRILLED 0.2
5. TOTAL 13EPTH: OS
6. DOES \YELL REPLACE EXISTING WELL? YES ❑ NO
7, STATIC WATER LEVEL ISclow Top of Casing: /g FT.
(Use `+" if Above Top or Casing)
S. TOP OF CASING IS OR FT. Above Land Surface*
'Top of casing terminated at/or below laud surface requires
variance in accordance svilll I5A NCAC 2C .0118.
9. VIELD(gpm): /0 MIfl'IIOI) OF TEST firi-
10. WATER ZONES (depth):
1 I. DISINIILCTION. Typca Amount
12. CASING: Wall Thickness
1)ial)tctcr or AA'cirhl/hi Alalcri u�
From l-
oom To I
T
From o
From To
Depth.
/� , _/82 Sc•-e
262914
Topogryhic/Land setting
❑It i(Igc lope ❑Valley ❑Fhn
(check upprupnaa boil
Latitude/longitude of well location
( .:grecsnniuWcsisecmul..)
Lwiludarlongilude source:❑GPS❑Topographic map
rdleek hos)
DRILLING 1.0E
l:orlyati.. t Description
DEPTl1
From
O
m
d
o 9 &3
3 tS
f
I L (iROIII: Depth Nnic ial NlctIn d
hrmn To Pt.
From To—.--
14. SCREEN: Depth Diaulctcr Slot Size Nlatcri:d
Isom To Ft.
Prom To
I5. SAND/GRAVEL PACK:
Depth Size
From
From To It.
N1 icrial
16. Rli\IARKS:
LOCATION SKETCH
Show direction and distance in miles from at leas)
ova) State Roads or County Roads. Include the road
numbers and common road names.
# /SUS
ry
u)
t I
I DO 11I1RL13Y CERTIFY IITAT TIIIS WELL .d11 CONsTRUCTLD IN Aceei I5A NCAC 2C, WELL
CONSTRUCTION SIANDAIRDS, AND ILIA I I'Y OFIIITS RECORD HA 3It itN PROVIDED TO DIE WELL OWNER
iC—q—Ca,
CCN\TUT 101 jI' ERSON CONSTRUCTING IIIE FELL DATE
R iv
Division of \ 'a lcr�fitf1����j�{\�tt��f��flina. ILlG Mail Scrricc Cculcr - Submit the original to Ile• DirIt:dcigli, NC
27699-I636 Phone No. (9191733-3221, 111 1i 30 (t,)s. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2629E
North Carolina - I )cpurllnent of iromncnt and Natural Resources -Division of Wafer Qualify - Groundwater Section (()Vi tt.t(I OR (I\I)I\Ill! \I.) NAME (print) 6y' YR[�{)f4e CERTIFICATION # a49
\\T:1.1 CON I It WI OR CO\IP:\\\ NAME prt ce Wi//c- fvnO PHONE # S? ) 6Q71J7S
SI,\IT: \cr:Ll. CONIC! In CI ro\ I'ER\I Era AsssoclAIF:U \\'Q PERMIT/4
1 if:q,plicahlc) (if applicable)
I. AVI:LL USE (('heck Applicable 13o.x): Residential CVMunicipal/Public 0 Industrial 0 Agricultural ❑
Nloniloring ❑ Recovcry ❑ I lcat Pump Water Injection 0 Other L7 If Other, List Use
'_. WELL LOCATION: /�
Near 'NI fawn ) NN r Coully_y Al&/
Ltilrccl .Namte. n'nnlbrl.. ('rltlolla ll s' tilIhJ11' SiuI t]i.ion. Tad No 71li�i�Code)
i\Jdress C qSR/ 2„/
/sly sue,ut haute Nn) s+{/-
Clh nt llncn Stale hip Code
( )-
Area code- Phone flambe;
-1. I)AT E DRILLED
5. TOTAL DEPTH: ../e%5-
6. DOES VA'ELT. RLI'LACE EXISTING \VLLI.7 YUS D NO LHr
7. STATIC WATER LEVEL. 13clow Top of Casing: r,73 F"f.
(Usu'-+" it Almve Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface`
"Ill or easing Iernliaalerl at/or helm) i:uvl surface requires a
valiance in accord aucr tsilh I5.\ NCAC 2C: MIDI. _
9. YIELD (gpm): ,5 METHOD OF TEST /q-)--
10. WATER ZONES (depth):
1'rot11 To
�U
SSC
S-- /
Topographic/Land setting
,,�_,,.(�
❑Ridge ❑Slope ❑Valley llShlal
I check appropriate box)
Latitude/longitude or \yen local ion
idegrces'ntinalcstseeondsl
Lalitudc/longitude source:❑(iPS❑Topographic map
!check has)
1)1':I'TII DI(II.I.IN(i LOG
FXn�atign Description
O97
ve
LOCATION SKI:ICI1
I1. DISINFECIION. type � Amount
Show direction and distance in miles from al (cast
12_ CASING: Wail Thickness two Stale Roads or County Roads. Include the road
UcplhDiantcl .r or AA'ci I i'ft. material nunlbcrs and common road names.
Front "/j- To 6 9 1-f �,/ atee / -
flvlit) 376
•
Ul ;
From to Ft.
From--- "10 Et.
13. GROUT: Depth Al:ncrial Method
I-ronl 0TodQ Ft.CtME+_.vf
Prole To
14_ S(I(LI.N: Ucpih blonder Slot Site Material
From Iu Fl. in. in
From To II. in. in.
15. SANIX'(iRA VI'.I. PACK:
Dcplh Size Mlnieri;d
From To Ft.
From To Et.
16. RI.',NI,AI<IKS'.
I DO I IERLI31' CERTIFY TI IATIIIIS WELL
CONSTRUCTION STANDARDS, AND "ILIA
k�fC`C� .�GLS
SI(i NA'l tiR
Submit the original to the Division of \\';
27699-1636 Phone No. (919) 733-322i, with;
S'v2U6Y=LDIIN AICCI-IU�It
(. � 1
nl Wffl I I5A NCAC 2C, WELT.
TIN PROVIDED TO Tl-IF WELL OWNER
)1 RSONNrCONS UCTING .aLi 11i.i LL
er Q1.1 .'t,i,Si't1t9,111 1V mn. 1
3(1441$HEVILLE REGIONAL OFFICE
ID— a—
DAIli
36 Mail Service Center - Raleigh, NC
GW-1 I{13V. 07/2001

262912
WELL CONSTRUCTION RECORD
Nonh Carolina - I)cprounenl of Environment and CON.'
12esoJurces - Division of Water Quality - Groundwater Sectio^n���//
\\ELL OA'I R .LI Olt (INDIVIDUAL/ NAME (Orion4174 hA4u), Qi CC
ERTIFICAIION1 T�9.
v( I'.I.I. cONI Il (CrfU coylrA.Nv' .N vME //'.CC e
SI \'I T: \c Et i. CONS't ltUC"!'IO.\' I'P:It.\I ITq
ASSOCIATED \VQ (Tilt\II'I'a
ilicable) (it a ) Hirable)
PHONE a ON 6,2)- fa
I. AAI I.I- USN (Check Applicable Box): Residen'. al V9unieipal/Public ❑ Industrial 0 Agricultural ❑
lonitoring 0 Recovery 0 Beat Pump AVat_r Injection ❑ Other ❑ If Other, List Use
_. AV'EL.l. LOCKER N•
Nero isl Town: LI/Pt Count. ,yf' O
rtai19uFE ,Z°
(Slier' Name. Nunihe's. C'omuomil c Subdid+iou. Lot No. /.ip Co lei
OAA-'N1:R: al/h/)V Vlb:y e1 Ice ces/wlnu'esisccontls)
Address O,Aye Lt/q-l/ Latitude/longitude source:❑GPS❑Topographic map
1S"ec1 or Itowe No.l
..dime Se Zip Code
I 1-
Topographic/Land setting
❑Ridge ❑Slupc ❑Valley 121117-11
(dick apprnpriale boll
Latitude/longitude of well location
(cheek boil
DhPTI1 DR lid ING IAG
Front To jL•I1yItio)I Description
b 020
.Arc. code- Thane nuinKu
-1. DATE UIJLLI:U1Q 30 00?
5. TOTAL I)HPTI-I: 021{-f-
6. I)OIIS Wlil 1. RITI.AC'I.. EXISTING WELL:' YES ❑ NO
7. STATIC WATER LEVEl. l3eIowTop otCasir 0 LI'.
(Use it Ahusc Fop nr Casing)
N. TOP OF CASING 27. FT. Above Land Surface*
'"lop of casing terminated al/or behnr IaiIII•Iirface rcouires n
Variance in accordance e Oh Ii,\ NCAC 2C.1)1I8.
`). VILLI) (epm): /f-. NINTIIOD OF TEST 1112 ) T—
M WATER /ONIiS (depth):
I I. DISINFECTION. Fype_ r, Am; ant
12. CASING: \Va11 - hiekness
Derth '/ Di.}n�"eeici- nrAs i:41ILTl- t ttcn;d
1 �1o'n 7� To3y Ft_ 2, [/)1! .
From To
From To H.
I (LOUT: Ucptli AI aerial Nlcdtod
From Q In 0/O H. ((-16.4,--
From To II.
I-1. SCREEN: Dcplh Diameter Slo;: ize Material
I -Pon' To 11. in. in.
Prom 11) Pt. in. in.
I;. SANDiGIAAA'EI. I'A Chl:
Ucplh Size `datcrial
Pnun -I FI.
)1n To FI_
16. 1Eli:AI:Al2KS:
I DO I II.RI'131' CI IL I Il l ll IA f 1111S \\'I(I.I. \
;MCI ION S IANDARUS, AND 11 IAT
Submit the original to the Division of \\'at
27699-1636 flume No. [phone], o'ilhiu
LOCATION SKETCCI I
Show direction and distance in miles from at least
Iwo State Roads or County Roads. Include the road
numbers and common road names.
4Fi3&
1) IN A CEO )
( OF I I IIS RLCOItD I IAS B
LSON CONSTRUCTING TI-
'r Qn tIEiRQUri4Wt l&A)8 cjtONon, 16-
NEVILLE REGIONAL OFFICE
VI'll1 I5A NCAC 2C, WELL
LOV11)10) TO TIIII WELL OWNER
Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

262911
WELL CONSTRUCTION RECORD
North ('arolina - Department of Environment and •J plural/Resourcces - Division of Water Quality - Groundwater Section(
\\LI.l. CU\'I R.\(TOIt (INDIVIDUAL) N:\TIE (print) /-NLA ii-i-jUJJpe CERTIFICATION�/q°l�Q�
\\ I:LL C N'I R\('I OR CO\I1'AM' NAME Pr, 1LLApy9 PHONE d (S2f)lf��"
NIA l 1. \\I':LI. COSs'IIt CCFI(.N I'E1011E4 ASSOCIATED NC() pi:It\IFI'4
(if;ipplic[blc) (ifapplicablc)
I. AA'ELI. LSE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
:Aloniloring 0 Recovery 0 I!eat Pump VVa'or Injection 0 Oilier O II'Other, List Use
'_. \VELL. LOCATIO
Nearest 1o7:
PIA/ 474
( Sired Name Number
Coi
Count
it}', Subdivision, Ltd No. Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate hose)
Laiialde/longitude of well location
�. OWNER: Ll / [ � r ��' IJegrces t1I lnwesi3ceonds)
:Address _S .� /0
Si. iy. Latoudeilonuitude source:OGl'SD Topogrupltic map
VVerb
' (street uh Itne No.) (cheek bos)
erb_ge4cb J#4 5 Z DEPTH DRILLING LOG
I rtnn To Egry))atiop Description
Cilia h r loan State Zip (ode
:Aie.t ode -phone nunihs
•I. I)ATN DRILLED I(%— V- 02 _saw 6•
5. TO1.A1- DLP [LI: 745245.--{-i-
h DONS 'WELL REPLACE EXISTING Wald' YES ❑ NO L
Z S VATIC WATER. LEVEL 13elow Top olCasil:g: _0200_FT.
(Use "r' 0 Abnv. Top of Casing)
X 101' Of CASING IS R PC Above I. ,and Surface*
'lop or casing terminated at/or below land surface renuires a
variance in acaonlanve with IS;\ NCAC 2C. III18.
o, YIELD (gpni): / METHOD OF TES I. /9!r
Ilk AWATER ZONES (depth):
6D,SavoSzt
LOCATION SKIiTCI I
I I . DISINFECTION. Type /' Ammint Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth I i:j) eter or V.-cighat N venal numbers and common road names,
iL
From To I'I. # /33 ! d
From To
Ii- (iRZOUT Depth i Material 1 Method
Prom To Ft.
lo. S(IZI IIN'. Depth I)i:nn tei Slo: Hie Malc(i,il
Irons To fl- M. in.
Ft om To hl. __.in. _ in.
15. SANI),'GIZAVEI. PACK:
Depth Size \hiterial
I
1?onl Tn 11I.
1It1[\I:\KISS.
I DO IIF:RI:131' CIIRI IF1' llleATTHIS \VELL A
( )NS I RUCTION STANDARDS, AND Il IAT
IS &
�NSTRu :TED IN ACCOtib.#'
OF TI-IIS RECORD I IAS 13EI
In I ISA NCAC 2C, WELL
OVIDF.D TO Ti IE WELL OWNER
1, NOV - E Io-D4-Oa-
SIG,' \TURF h I' _iSON CONSTRUCTING II1E R'E 1L DATE
rrF ^i 2.
Submit the original to the Division of \\'alp r QugHXit ;`l;!'gtitf[llh dl•r';rFMFon, 163 i\lail tiu-vicc C'cnlrr- Raleigh, NC
27699-1636 I'huue No. ON) 733-3221, vrithin
GW-I RIEV.07/2001

262885
WELL CONSTRUCTION RECORD
Noah Carotin;( - Dcpartntent of Environment and :Jai Iral Itesoti cess - Division of Water Quality - Groundwater Section
�//G
\\FI.I.l U\'lit.\C'l llli (INUI\'InUAt.)N:\\II{ Innis v//\ ^A/U��� CER'I'IrtcA'I'IOV#q'}rF�(
\\(:L1,co\ru\( r(ntcomp kNyNANIE TICE_ We// ¢/1?)mp most.: a (( 6a%Sv�Sg
s I .\ Fl: \\I:1.1. CONS' RUC'IIO.N I'rli\IIT# ASSUCI:\i Et) w'Q rEI(\119'#
(i T:vplieablei (if api licuble)
I- AAEli USI[ (Cheek Applicable nos): Rcsidenllal C13'Municipal/Public 0 Industrial 0 Agricultural ❑
Nloniloring ❑ Recovery G I lcat Pump Water Injection 0 Other ❑ II'Other, List Use
2. WELL LOCATRAEJ
Nearest Town:. /y/ Corn*
j/vk/ t/tJ Jer / (owe
dSvccl Name, Numbers, Community, Subdivision. I. of No_ Zip C'udel
3. OWNER:
\Feel, III N,,.l v\9o79
Cllcor Irmo Sl.11c Zip Code
Vie.I code- phone combs
-1. DATE. DRll.l.r:l)_ OT,a7/_Q-2 —.
5. I0(,AI.DEPTH: , 251."i
Topographic/Land setting
LRftidgc ❑Slope ❑Valley ❑hlal
(check appropriate hos)
Lminulc/loneiuule of well location
Incgrces: minmes secoudcl
Latitude/longitude sourcc:OGI'SOTopoeraphic map
check ho')
D I'.I'TII DRILLING LOG
From To Forq)atiyn Description
O
:37
/a5 SS-Z<
(,. DOES VA'I 1 1 RN PLACE EXISTING WELL? YES ❑ NO E
7. S I ASic \VAIN It I I:V I I. Below lop 01Glsirg; leo PT. „-_ -__
tuse•.l-irnlniPc I op of C:I)n l
'TOP OIL CASING IS 0,- FT. Above I and Smlucet
'tit of caning terminated nt/nr below laud surface rerain•s a
variance in accoN:uree with 15.\ NCAC 2C .0118.
9. YIELD I�'pn1): J METHOD OF TES i' iE
In- AV'ATFR ZONES (depth): �7f
11 DISINFECTION. Type_. //T _ Amount
12. CASING: Wall Thickness
Depth Diameter or Ak'eighl.'FI N eerie(
Prom ro�_7 Ft. 6 /5/
Prom To Ft
a. (iROIJ I-: Depth Material Medved
I roe To 620 I.1. e ,v)9NJL
Prole To I t.
S(ltl':LN: Depth Di:umcter Slot Fize Manoint
Freon To__
Prone To
in.
5. S:\ND:(ERA\'P.L
Depth Size
1'10111 To I:I.
Mont To FI.
I DO IIl:I IiI1A C'FRIIFA TI-I:A'I" T I IIS VVIELL \VAS
CONS] RUCTION STANDARDS, ANI) 'HINE A C
in
•Iatcrial
SI(iNA"CURL OF 1
Submit the urigi nil to the Division of Water Q 1
227699-1636 Phone No. [phone], within 30 d
lity GhiG vendV*
LOCATION SKF:I'CI I
Show direction and distance in miles From at least
two Stine Roads or County (toads. Include the road
numbers and common road names.
1111S REC0120I IAS I3ELN
I IUA NCAC 2C, WELL
1 DED TO "HIE WELL OWNER
CONSTRUCTING rl11d 3V iLL
l_Se4ifoli136 NI
DATE
R
'Service Center- Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
264425
Nor111 Carolina - Ucparunenl or Lii'ironnlenl and itural Resources - Division or Water Quality - Groundwater sectio�n
,/
\\r:1.Itu.]ut.\(rtot lnuntut\II\:\auvSIl;m) �1 A hp4�-V�P� ,a,cn slrrlrlcoNa�c'7bC/
\\tl U a.CON I.\(.101Z :O\II'A\\ \ \If: /
/j._i Ce e_/ 9-LL"M __- rlioNE A (iirn)eQ1-1.J :S
S'I,\T I. \\I:1.I. CONS I Ill1 ('I1O\ I'E10111k ASSOCIA.1EI)\\Q l'Elt.\lII#
t ifnppllcal.lel (ifapplicahlcl
I. WELL USE (Check Applicable 13oyp. Residential LN' IA 1unicipaLpublic 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Rehm cry ❑ hcal Pump Water Injection ❑ Other O II Other, List Use
2 AVI I f_ LOCATION:
Nee est 1 own �iC1 NeS✓d/e_ (ounly ititic
Lii }L_
Ut.
11 1Ntine. N l. tan No (edit
3. OAVNI.R.
Addles,'
041
A /feadRTT e—J/,—
titles LI I<, alto Nt
)Ilcur IAncn Sl.11e /ipCode
Ace.t code- Plaine maul,
d. 1)ATI1 DI(I1.LED /9'O�
5. TOTAI.1)EPTI): 090.E
6. DOES VYELL REPLACE: iiXISTING wEL.I_'? YES ❑ 0
7. STATIC WATER LEVI11. Below lop or Casing: 3
(UFc". ilAbuvu lop orCasing)
S. TO1' Of CASING ISFT. Aboec Lau(! Surface*
'Icy of easing terminated ;Wm. below Imul surface requires a
variance in acrorJance sv ilk li.\ \C,\(1 2C .111111.
9. YIELD(gpm): /0 N1E: 1101)01'II.Sr/9''r-
I(l. AVATER ZONES (depth':
TopographiciLand setting
Wilde° ❑Slope ❑valley 013st
IckccA : rp l Pl li bin'
Latilude IongiIude of well locution
l.uliluda'lungihnh soulu:O(PS❑ fopogrgvhic map
(check hut)
DRI LUNG Loa
DEPTH
prole to PI, nitioi Description
D r)D w-
ctb _sue—_ _3.4hy<„V
ai �evOAC
LOCATION SKE1C'11
I I DISINFECTION. Type , Amount Show direction and distance in miles from in least
12. CASING: Wail thickness two State Roa(Is or County Roads. Include the road
Depth Di a%IC er in r AA'eighlFl /)alcrial uumbcrs zinc! common road names.
[roam..� To �02 Ira. (a1/V /0f'4.6•1C_
Hornto PI_ - 11 &1
front To,',.
13. GILOUI,r: \ Depth iAlutaiial fvIcuna
L'rom0_... To _Drip Ft. e ^en/
i'nnn To I -I.
Id. SCREEN: Ueplh Dimicter Slot Size INIolcrinl
Hum To I.1. in. in.
From To I'1. in. in.
15 SAN D,aR,AVEI. l'A('K:
I Jere' Size \latecial
roe' l
From To PI.
16. RI'.,AIARISS:
cJl
I DO 1 !HMO' CERTIFY 11 LAT 'MIS. VVEL1. WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND l ILAT .A COPY Of II IIS RECORD HAS 131111N PROVIDED TO l LIE WELL OWNER.)
SI( \;AlL!RI OF I'LI:SON CONSTRECrING !III! VABLL DATE
Submit the original In the Division or AValer Quality, Groundwater Section, 1636 Mail Service Center- Ralvi; h, NC—.
27699-163 6 Munk. No. (9191 733-3221, within 311 (lays. CiW-I REV. 07C0U1

261271
WELL CONSTRUCTION RECORD
North Carolina( - Department of Environment and N• oral csources - Division of Water Quality - Groundwater Section
\'1!LL('U\"I12.\C"ruR L1N I)I\'l ill!,\I,1\.\,t4:/Ittrilrq e^,f'�' 1/F �///�e CEIt,'t PICdTtOfi/N6f�//��/p.�
\\'1.:1.I. CON'I R.\("IO12 ('O.\IPAN\' NAM C /Ce �G/1 /l/.t� PHONE I/ . 4(� TWi�
S I ,' 111 \\ I:1.I. (' DNS 'I'RI-(''IION 1'11011 Chi ASSOCIA'1-Eu \\'Q I'ER\Ifl'N
lit applicable) (ifapplicahlc)
I. WELL USE (('heck Applicable Box): Residential td' Municipal/Public ❑ Industrial 0 Agricultural 0
INlonitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 IlOther, List Use
2. \VEIT, LOCATION: ))
Net res ft vl 'Ci4^/id 4/
I1 Fee,N;„„,. Numbers. Community. Subdivision. Lot No.
3. OWNER: f/'&7j, Lef+T�%cc
: \ddress /�'� 3
&
ISheel nr ILnne No.,
Zip Code)
64_NLAN •C. a-it%/6p
co). I owu Slate Zip Code
( )-
Area code- Phone numbe
4. DATE DRILLED y'023- Oa
5. TOTAL DEPTH: /25f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ere
7. STATIC WATER LEVEI. Below Top of Casing: / a FT.
(Use 4 if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'"rug of cuing terminated at/or below land surface requires a
variance in accordance r ilh 15,\ NCAC 2C:.11118.
9. YIELD (Bpn,): N1E:F11013 OF TEsf_aeir
10. WATER ZONES (depth):
Topographic/Land selling
❑Ridge ❑Slope HCdlcy ❑Flat
(check appropriate box)
Latitude!longitode of well location
(degrees/minuets/seconds)
Latiluda/lonciludc source:❑GPS❑Topographic map
wheel; box)
DI',I'TI1 DRILLING Loci
From To Forintt tion1I)escription
o ao -
cr.>o ss/
S
I I. DISINFECTION: Type /— ---Amount
12. CASING: Wall Thickness
Depthr^ Dial,eler or Weight/ft. Material
From_ To J DR. Ft. 6 4/1 r / ee /ee /
From To It. —_- —
From To Pt.
13. GROUT: Depth Material Nlethod
From Q To 0.2o rt. C.�I 6).-)e)--7-
Prom .10 PI.
14. SCI&EI N: Depth Diameter Slot Size Material
Prom "fo F1 in. in.
From To Pt. in. in.
5. SAND GRAVEL. PACK:
Depth Size I\lalerial
From To P1.
From To L'I.
16. RENI:\RKS:
LOCATION SKETCI I
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/ do 74
I DO I ILRLBY CERTIFY TIIAT THIS \\'ELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANI) THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
q- r;3-na,
.IC;NA'fURIi OF PERSON CONSTRUCTING /TIE WELL DATE
Submit the original to the Division of \\'aler Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 31) days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
261270
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
�/
\\ELL ('O N'I It.\C I OR(INDIVIDUAL) C;\\IIC ring) �/ i J��'e CERTIFICATION p C)916
\\ I:LL C(LNIR.\C'IUH COMPANY NAME /re WC/PP �d/rry PHONE # Vj, 7- "9$
SATE WE1.1. CONSIRUCIION 1'ERCI1Tp ASSOCIATED WQ PER?I IT#
(iI';q plirablc) (if applicable)
I. AV'LI_L USII (Check Applicable Box): Residential Er- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Ilcul Pump Wider Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Neatest Town: /�4YUQS(%i/ e
(moor
Street Name. Numbers. Camnn ncy. Sandi)ismn. Lot No.. Zip Code)
3. OWNER:
County,/'j✓OOO
I Ta or (tome Nu.l
4 csv IL( 07875ft
Cny or Ilntn Slate Zip Code
( )-
Ayescode- Phonenomlr
I. DATE DRILLED and ayO�
5. TOTAL DEPTH: USS17/-
6. DOES \VELI. REPLACE EXISTING WELL? YES 0 NO Er---
7. STATIC WATER LEVEL Below Ifop of Casine: 60 PI'.
(Use "+" if Aho e Top of Casing)
S. TOP OF CASING IS o2 FT. Above Land Surface*
'Top of casing terminated at/or below Imul surface requires a
Variance in accordauc}9sith I5A NCAC 2C. .0118.
9. YIELD (gpm): (S METHOD of TEST_Ar %
10. WATER ZONES (depth): /�
11. DISINI'ECIION:Iypc-- --/-/ Amount
12. CASING: Wall Thickness
Depth Prone 9i:1py:ter or AAei_ht/Pt. N:term)
To� Ft. CO /V "I
From To f-1.
I'rolll To I'I.
13. GROUT: Dept, Material
lion) O To o4J Pt. re.++PN.
From To PI.
14. SCREEN: IJcpth Dcnncter Slot Size Material
FrontTo Pt. in. in.
From To I`t. in. in.
15. SAND/GRAVE(. PACIC:
Depth Size MaIerinl
Method
Front To II.
From To FI-
16. RLNLARKS:
Topographic/Lan setting
DRidge 0Slopc alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/Ion,_itude sourcc:OGPS❑Topographic nap
)cheek box)
DI'.PIII DRILLING LOG
From For Hari n Description
two
q Y �(j TICS rDdj
4N0 S4w.0
LOCATION SKNTC'1E
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND TIIAT A COPY OP II-IIS RECORD I IAS I3EEN PROVIDED TO THE WELL OWNER
-«ic21 ultzt,
ct-ay-0�
SIGNATURE OP PERSON CONSTRUCTING "II ik WELL DATE
Submit the original to the Division of VVatcr Quality, Groundwater Section, 1636 plait Service Center- Raleigh, NC
27699-I636 Phone Na. [phone], within 30 days. GW-I REV. 07/2001

WILL CONSTRUCTION RECORD
Ninth Carolina - Department of Environment and Na ural R sources - Div/ lion of Water Quality - Groundwater Section
'/�' JJ�� //qq � JJfJ \
\\EI.LCO\'(((ACTOR (INDIVIDUAL) NAME /(print JJ 2417j /e CERTIFICATION#�'__
\Y ELI. CO\ I RAC! COMPANY NA\IE�/ELF We//"t AIM/ PHONE # $'S) ?-8:591
STATE \VEI,1. CONSTRUCT ION I'Elt\II'I# ASSOCIATED \VQ 0E101E1'11
(ifnpplicahlc) (ifapplicahlc)
261269
WELL USE (Check Applicable lion): Residential ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Ilea( Pump Water Injection 0 Other ❑ If Other, List Use
3. \VELL LOCATION:
Nearf-st Town:
tSircn N•unc. Nwnbcrs. cow mutiny, Srhdn-isiun. Lot No.. Zip Code)
Address 1/-7 eNSe2 Latitude/longitude source:❑GI'S❑lbwgra )hie m;i)
ISi ect ur wtuu�lc No.l p-7 (check box)
�AN�.Y /v �, aU /�� DI'.PTN DRILLING LOG
City tic boo n Sate Zip Code From "Fo Fr 1 itior) Description
0 07° bay
Area code- non, numb _ l� / 3
4. DATE DRILLED 7-.2o- 0„2 D/C3 SS .mod q..eS t,e
5. TOTAL OIiP'I I I: /C7� -f'f- pr /or ,- ,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L! O
7. STATIC WATER LIi.VEI" Below' lop of Casing: /a FT.
(Use "iv' if Above "fop of Casing)
S. TOP 0h CASING IS 01 FT. Above Land Surface*
'Top of casing terminated art/or helms- lanrl surface requires a
variance in aceordauce s ith I5A NCAC 2C .01IS.
9. YIELD (gp111): 70 I MEI IOD OF I GST_f}r (
I0. WATER ZONES (depth):
LOCATION SKETCHc:.
I I. DISINFECTION.' type HT/T/ Amount Show direction and distance in miles front d4cast -._
12. CASING: Wall Thickness two State Roads or County Roads. Include tlit) road: -
Depth„ L)ia��� r or Ajs`•irehti Irt. Material
i cumbers and common road names.
From a To 0Ft. 6�QYS i85�7 - . - -
From To Pt.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley @flat
(cluck appropriate box)
Latitude/longitude of well location
From To Pt.
13. GI(OUT: Depth Material Nlethod
Prom 0 To do FL_T+e.,/)/-
Fnan To Pt.
14. SCRELN: Depth Di:nncler Slot Size Material
Prom Ti.) Fl. in. in,
From To Fl. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Pt.
From l o Ft.
16. REMARKS:
INIaterril
11)0 HEI(EBY CERTIFY TI TAT :MIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IIIIS RECORD I IAS BEEN PROVIDED TO TIIE WELL OWNER
SIC �'ATURE OF PERSON CONSTRUCTINGIIIE WELL DATE
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 flume Na. [phone], Within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
261268
North Carolina - Deparlloent or Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON'I RACiolt(I\nl\IUC:Al,).NA:ME: (Print) K +V I ire, CERTIFICATION# a4/69
%X (((NT 12 AC WIZ COMPANY NA)ii; ' e We// .P/i,*r,0 PRONE a fS 4.42-ern-
S PATE \VEt,I. C'ONSIRUCIION PEIL\III # ASSOCIATED \VO PERM( r#
(ifnpplieihlcl (11 appl icthlc)
2.
WEI.I. USE (('heck Applicable 13os): Residential B' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ (teat Pump Water Injection ❑ Oilier ❑ IIOther, List Use
WEL1. LOC'Al'I( N)
Newest Town: C/y�'e-
_eine% <
(Street Name. Numhms. Community. Suhdrvision. Lot No.. Zip Code) -
3. OWNER: aiket:C_� �/
Address �j�a,(�iiry<v iir.
I SI NO ar Route No.l
City or -fowl' State Zip Code
( Area code- Phone mmmhet q
d. DATE DRILLED /„ - Oa
S. TOTAL DEPTH:_.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL 13clow lop ofC'asing: /.'C FT.
(Use "+" if Above Top oiCasing)
8. TOP OF CASING IS ET. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accarrt:mce with ISA NCAC 2C .M 1N.
9. YIELD (Linn): 3fl METHOD OF'FEST���
0. WATER ZONES (depth):
11 DISINFECTION: Type_
12. CASING:
Ucpth�/
From t� To(OO
From Fu
„.,Topographic/Land setting
L9'Ridge ❑Slope ❑Valley ❑Flat
(check (ippropriate box)
Latitude/longitude of well location
tdcgrecsllninu lcs'seconds)
Latintde/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Fon latign Description
DEPTH
Prom Fa
41 Amount
Wall Thickness
Dia actor or AVeichl!ft. N atcrial
Ft.6%s/ ,/it e/
fl.
From Tu Ft
13. GROUT: Depth Method
From 0 Tod
From to Et.
14. SCREEN: Depth Diameter Slot Size Material
Prom To I'I. in. in.
From To It. in. in. --
IS. SANIXCGRAVEL PACK:
Depth Size Material
From To Pt.
From 1 Ft.
M:ucri;l
Ft. re41-wNr✓.71—
LOCATION SKETCII
Shoal direction and distance in miles from mast
two Stale Roads or County Roads. Include thiproad'
numbers and common road names,
tsog
J
0
rll
22)
7J
7-7
16. REMARKS:
1 DO IIERII13Y CERTIFY THAT TI IIS W FI.I. WAS CONSTRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL
CONSTRUCTIONS ANDARDS.ANDT1TAT A COPY OF -MIS RECORD IIAS BEEN PROVIDED '1011 IL' WELL OWNER
d%cc r� 1-1e,/,L, G l a o
SI{NATURE OF PERSON CONSTRUCTING THL WELL DATE
Submit the original to the Division or \\':der Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone Nu. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N. lur/al/Reso irees�f- Division of Water Quality - Groundwater Section `(�
U'F,LI, coy! It:\("ffllt (INDIVIDUAL) NAME (print) /l'Q TJ>l� a CERTIFICATION (�_
%%EI.I. CON.' 14AC7Olt CO\u'ANV NAME ,/; Ce.1,r7P.// 9-wrm j ID ION # (gag)) 6 '7— 1598
S'f A'I li \\'f:l.l. ('.o.\s'l RUC!ION I'EIt\II'IH ASSOCI:\TEI \VQ I'ERNIIT#
( if applicable) • (if applicable)
I. \YELL. USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
tAdonitoring ❑ Rcciwcry ❑ Ilent Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nea est :fovvp:
County
41ss✓•
N •one. Number... Qnauunby. subdivision. Lot No-. Zip Code)
3. OWNER.
Address
ISrce¢t t Room F1,0
City or Tim n Slate Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ? 13 0-2
5. TOTAL DEPTH: o70 S"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO KY
7. STATIC WATER LEVEL Below Top of Casing: 63 FI'.
(Use "+" if .Above Top of Casing)
S. TOP OF CASING IS ET. Above Land Surface`
'Top of casing terminated at/ur below land surface requires a
variance in accord:mc • with 15:\ NCAC 2C .III I%.
9. YIELD (gpm): /- MIiiI1oD OF TI'.SF/r%V—
10. WATER ZONES (depth):
Midge
setting
L�fRldge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/Ihnnes/sce mdsl
Latitude/longitude source:❑GPS❑Topographic nap
tcbeck hus)
I)RILUNG LOG
Formation Description
DEPTI I
From To
0 ('/a/
.20 71)
_70 /c'S
/CLC >oS
261267
11. DISINFEC'TION: type AVM. Amount
12. CASING: Wall Thickness
Depth Diameternr N'eighVPt. b7 uerinl
From "fro? To 6g_ FL 6 of %/y5�-•(_
hem_ To
From -fo rt.
13. GROUT: Depth Material Method
From CITOzO Cam _ I I. '
From To Pt.
14. SCREEN: Depth Diameter Slot Size Material
From To It. in.
From To FI. in. in
15. SAND/CiRAVIi,L PACK:
Depth Size \hucri:d
From To
From To FI.
LOCATION SKPITH rs
Show direction and distance in miles from a
Iwo State Roads or County Roads. Include tl`xstroad
numbers and common road names. I _.
O
Ui
16. REMARKS:
I DO IIBREI3Y CERTIFY TI IAT Tills WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND TI IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
✓Le 1/�tz CI' -I3-O�
SI(ii'4A I I. Rl 01: PERSON CONSTRUCTING T1II1 WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center- ILalcigly NC
27699-1676 Phone Na. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
261266
North Carolina - Department of Environment and N' turalResources - Division of Water Quality - Groundwater Section
\\'ELL COST ItACI OI( (INDIVIDUAL) NAN_iiD.: Trim) 'IHh ` 4 U)( e CEIrnFICATIO/N a (7y
\\'EI.L COST ItA(-1l)R CONII':\;NV NAND.: I r f /_4 // _ ✓"99 PHONE H fod7-8
5-99
STATE \\'ELL CONS 'll( t:('ll(lN I'EKMIII# ASSOCIATED WQ PERMIT/4
l i f applicahlcl , (if applicable)
I. WELL USE (Cheek Applicable Box): Residential IN' 1nnicipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I[Other, List Use
2. WELL LOCATI N:
Nearest Town: Q�
.51/]4oN nl
IStrcel Name. Nwubcrs, Community. Suhdixisim]. Lul Nu.. Zip Code)
3. OWNI I(:Ou) e 4/0,
Address &Q a& eitie.f
ISI eet or Rome No.)
499- I/��f Lr'
I u,at stale zip code
C'ounRA44nod
a28Tsr6
)-
Area Code- I'bnnc mmobc ,
4. DATE DRILLED / O�
5. TOTAL DEPTH:
6. DOliS WIiLI. REPLACE EXISTING \VEL .? YES ❑ NO M
7. STATIC WAI'EI( LEVEL Below Top of Casing: /.3o PT.
(Use "*-' if Above Top of Casing)
S. '[01' OF CASING IS a FT. Above Land Surface*
* 1 op of casing terminated at/or below laud surface requires a
variance in accordance „ilh 15,\ NCAC 2C .11118.
9. YIELD (gpnn):._„1.2 METI IOD OF II!SL4Jr-_----
10. WATER ZONES (depth):
II. DISIN[LCIION: Type
12. CASING:
From f0.Z
From
Ucplh
Diat1tctcr
/37 fL 44y
ro
From 1'0
13. GROUT: Depth
From -() To
From To
Id. SCI(IiIfN: Depth
Prom To
From I'o
15. SAND/GRAVEL PACK:
Depth
Prom
From To It.
Amount
Wall Thickness
or lII/Fl. 4Ieri)l
DI:I'ITI
Flom To
01)
/ at,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑flat
(check upprnpnale boxl
Latitude/longitude of well location
( dagrccs/tniuul es/sccondsl
L.atilucle/longitude source:❑GPS❑Topographic map
(click box)
DI(ILI.ING LOG
For oath n Description
Material Method
I) meter Slot Sin NWlerial
in. u.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at (cast ii
two Slate Roads or County Roads. Include tl 'oad_ ;
numbers and common road names. Imo„
/391
16. ILEMARKS:
1 DO HIiR1:13Y CERTIFY TI IAT TI-IIS \VELI. \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED To TLIE WELL OWNER
/ SIGNATURE OF PERSON CONSTRUCTING "ITIE WELL
G-18-oa
DATE
Submit the original to Ilse Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Italcigh, NC
27699-1636 Phone No. [phone], vwithin 30 days. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
261265
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / G
\\ EI.I. CONI It.\C3'OR (INDIVIDUAL) NA\I1? )rind ;+L L Q- CERTIFICATION aC?767
\\'EI.1. CON'I U.t(I OR (O\IIANY N.\\Ir: ink-e- Wei/ Y'/•'mj7 ['DONE a (fain 6d7-fSf?
Sr AI'I' \VCI.I, cONSt I31 CrION I'ER\I ITa
(ifapplicablcl
ASSOCIATED \VQ PER\IITtl
• (ifapplicahlc)
I. AVlfl.l. IJSI( (('heck Applicable Box): Residential I � Municipal/Public ❑ Industrial ❑ Agricultural ❑
dNlonitoring ❑ Recovery ❑ I teal Pump Water Injection ❑ Other ❑ If 0(hcr, List Use
2. WELL. LOCATIO :
NcaestTown: #e county giwoo
c P. Js�LACs
(Street Name. Nuinhcra. Community, Suhdisision. Lod No.. Zip Code)
3. OWNER: See —
Address /SOQ
S 36/0
C' y or 'lawn State Zip Code
Area code- Phone number
4. DATE DRILLED q,/7- oa
5. TOTAL DEPTH: 'gas— r-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO le
7. STATIC \VA'I ER LEVEL I3clow fop ()leasing: /00 PT.
(use ";"il' Ahoy,: Top of Casing)
S. TOP OE CASING IS FT. Above Land Surface*
*Top of casing terminated ad/or below Imul surface requires a
variance in accordance with 15:\ NCAC 2C.0118.
9. YIELD (gpnl): o MEII I0D OE'FEST /)r
10. WATER ZONES (depth):
TopogrltTiciLand setting
❑Ridge R. Slope ❑Valley ❑Flat
(check npproprialc box)
Latitude/longitude of well location
(degrees/minuets/seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
prom To Fa 1 iati n Description
0 /C2
o. dY
II. DISINFECTION: 'rypc 1/r Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FL b a(crial
14om_a� To�a PI. �p /� /Jick.5$iC
From To rl (l
From To
13. GROUT: Depth Material Method
From 0 To C9D - FL ees.eN74-
Front To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
From To h1. in. in.
15. SAND/GR.AVEI. PACK:
Ucplh Size Material
Front To I'I.
From To Pt.
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.
if ►613
16. RENI KS:
I DO HEREBY C'EKHFV lT IAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND TI IAT A COPY OF THIS RECORD I IAS 131iEN PROVIDED TO Ti IE WELL OWNER .:rr 4T q oa
SIG AI IJRE OF PERSON CONSTRUCTING "TIE WELL DATE
Submit the original to the Division of \\'ater Quality, Groundwater Section. 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 311 day.s. Ci W-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELLCONI I&\CFOIt (INDIVIDUAL) N AAIt: (prior HA 'at
t
SS El .LON'I11.\('I'ORCOMPANY .N.\\IEffiCe.- II Q. RIOp
261264
- Groundwater Section449
/ (�
CERTIFICATION /4 a7 Y 9
PRONE # WX.g)6a/'fa
s I ATE: \\T:Et. CONNI RUCTION I'ER\IITR ASSOCI:\TEU \VQ I'ERJIIT#
(ifapplicable) (if applicable)
I. WI[I.I. USE (('heck Applicable Hos): Residential N Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ I feat Pump Water Injection ❑ Other 0 If Olhcr, List Use
2. WELL I"OCATI
NIfsl Iwn:ode' '1`wbci
3. OWNER:
Address
eND
Count
tuna 'h'. Subdivision. Lot No.. p Codel
e
SiIreel or Rowe No.)
—11/NZ 0?7.2 /
C'av or Torn Stale Zip Code
( )-
Area coals- Phone numbs}�
I. DATE DRILLED %*it O<2
5. TOTAL UI:P"I'I1: /�.$�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EW
7. STATIC WATER L-EVLI. Below 'lam of Casing: .33 FT.
I Use "+" i1Above Top ofCasing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below laud surface requires a
variance in accordance ss'IL I5,\ NCAC 2C du IS.
9. YIELD(gpm): W.) 1METIIODOFTEST �i+✓
10. WATER ZONES (depth): /L
11. DISINFECTION: Type 7 Amount
12. CASING: Wall "(Thickness
Depth DiaLncicr or Weight/Ft. N ntcrial
From'o!, ToJ, Ft. 6 //
From "To Ft.
From To FI.
13. GROUT: Depth qMaterial
From To �_ Pt. (."enee
From To 1't.
14. SCI(LEN: Depth Diameter
From "lo PI. in.
Prom To
Topogyyphicitand setting
DRidge Si -Slope OVallcy ❑Plat
(cheek appropriate bocl
Latitude/longitude of well location
(d eg rc c s/m i n w e s!s c c o re d s)
L.atiludc/longitude source:❑GPS❑Topographic map
(check box)
I)EPI'H DRILLING LOG
From To Eon Description
r Ite
Sled roil
Slot Sirc M;ucriul
in.
in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To R.
it Oltl To
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles Prom at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
i/50S
1 DO HEREI3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANI) ll Ir\'l A COPY OF'HMS RECORD 11AS BEEN PROVIDED TO THE WELL OWNER
SIG] ATLiRE OF PERSON CONSTRUCTING TI IP WEI.I. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 l'hnne No. [phone], within 30 days. GVV-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Cai°MG - Department of Environment and N tlurul //Resources - Division of Water Quality - Groundwater Section
WELL ('ON'I IL\CI OR (INDIVIDUAL) NAME (print)_�j /bhD'e CERTIFICATION a �6�-J
/
WEt.t. CON I I4.UIOI COMPANY NAME .3C'? tUe_dp. Lw's' ] PHONE # (Vff) 4:77`nW
L c EI.1. CONSTRUCTION t'ER\III N ASSOCIATED NV() I'EB\11Tk
(if applicable) (if applicable)
261263
VVELI. USE (Check Applicable Box): Residential (Municipal/Public ❑ Industrial 0 Agricultural ❑
Nloni Orin u ❑ Recovery ❑ I (cal Pump Water Injection ❑ Other ❑ II Other, List Use
2. WELL. LOCATION:
Nearest Town: �i1/A�Np$V///e Count.
(Street :Nance. Numbers. Community. Subdivision. Lot No.. Zip Code)
3. OVVNER:A/• e kite, rent—
Addiess 9 tAe'4-Lj�J'ja,//er flr.
Doi or Route No_)
iYC�)1/e Pg2?C
4
6
7
v nr Town Slue Zip Code
Area code- Phone numt _
DATE DRILLEU.7 -6-Do
TOTAL DEPTH: (2QS- f f
DOES WELL REPLACE EXISTING WELL? YES /NO ❑
STATIC WATER LEVEL Below Top of Casing: 60 PT,
(Use'v" II Above Top or Casing)
8. TOP OF CASING IS oZ ET. Above Land Surface*
*Top of casing terminated at/or below laud surface requires a
variance in accnrdauc a e Ulu I5A \CAC 2C .0118.
9. YIELD (gpm): �� N1E-HiOD OF TEST/9'/%
10. WATER ZONES (depth):
Topographic/Land setting
FIViidge ❑Slope ❑Valley- ❑Plat
(check appropriate host
Latitude/longitude of well Iocalion
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑ Topographic map
(check box)
DEPTH DRILLING LOG
FI0
1 To
ForIaliyn Description
a. 4
I I. DISINFL('I ION: Type ,74744 Amount
12. CASING: Wall Thickness
Depth Di, '/ter or�VAeieht/Pt. Nat a;
(�' 1
From "Fa To-//2- EL (0 7 , "$ IT vNi ��`�
From To FI. /
From To PI.
13. GROUT: Depth Nlatcrial Method
Prom 0 "le • ,. r PLfen. eta/
From To Ft.
14. SCREEN: Depth Dianster Siot Size Material
From To Ft. in. in.
Prom "ro FI. in. in.
15. SAND/GRAA'IaL PACK:
Depth Size Nlatcrial
From To 11.
From To
16
RENI,\RKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO FIEREI3V" CERTIFY TI TAT THIS VVI:LI. WAS CONSTRUCTED IN ACCORDANCE WITI-I I5A NCAC 2C, WELL
CONSTRUCTION ST AJNDARDSS,, AND TI IAT A/CvOP/Y/OF THIS RECORD I lAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING IIIE WELL DATE
Submit the original to the Division or Water Qualify, Groundwater Section, 163E Nail Service Center - Raleigh, NC
27699-1636 Phalle No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 261 262
North Carolina - Department of Environment and Natural Resources - Division or Water Quality - Groundwater Section
s'p
6
\vri,i, ('OS'I ItAC1'OIt (INDIVIDUAL) NAME (prinl)Rpei�Sn 1 �-V 1L.(,2 CERTIFICATION q V
%TELL CON'r RAC'TOIt CO\I 1'AY\'\, NANO: "kite_ 's/C//A p(Lm 17 PHONE #
STATE \\ EI.1. COSSI RUCTION I'Elt\IIT# ASSOCIATED WO I'ER\IIT#
(i rappl icahlc) (if applicable)
&2 1pe2 %'gt99g
I. \VELI. USE (('heck Applicable I3ox): Residential I YNIunicipal/Public ❑ Industrial ❑ Agricultural 0
Nlonitorinc ❑ Recovery 0 I Teal Pump AValor Injection 0 Other ❑ I1Othcr, List Use
2. WELL LOCATION
Nca csl 'f wu:
�✓oadl
County W0001
(Slice: Name. Numbers, Community. Suhdicisiun. Lot No.. Yip Corte)
3. 0\VNII{:
Address
L/AvD Ju4 i /./
w4XNlreel nt antnc N n.)
,�C.
llc or Ines Slane
(
Lip Code
Area code- Phone numbe
4. DATE DRILLED /Foo?
5. TOTAL DEPTH: Or-14
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B'
7. STA'I'JC WATER LEVEL Below Tup of Casing: YO PT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surCmr requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 3 M5fHOD OFTEST i41i
0. WATER ZONES (depth):
11. DISINFECTION: Type �7/'/ Amount
12. CASING: Wall Thickness
Depth Diapnctcr or Weight/Ft. N19tcrlpl
From 't,2, To 83 F:!,,
From To
From To
13. GROUT: Depth
From_ 0 To al)
From T„
Material
.Ke., f
Iron,
cob 15,5"
$S /(R°
/gt) ,SOS
Method
14. SCREEN: Depth Diameter Slot Size Material
From To ht. in. in.
From To Pt. in. in.
15. SAND/(il(AVEI. PACK:
Depth Size Maseru]
Front To Pt.
From To Ft.
16. I{INIARKS:
Topographic/Land setting
gR idge ❑Slope ❑Valley ❑Flat
(cheek appropriate has)
Latitude/longitude of well location
Wept cc hninulvs/s conch)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPI'li DRILLING LOG
l o Pu)ll}}tatiyn Description
LOCATION SK P: I CI-1
Shove direction and distance in miles from at (east
two State Roads or County Roads. Inclucle the road
numbers and common road names.
I DC) I IEREt3\' CERTIFY ll IAT TI IIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND ll TAT A COI"' OF THIS RECORD 11AS BEEN PROVIDED TO THE WELL OWNER
�� r
et
lk;NALURN OF PERSON CONSTRUCTING TI IE WELL DATE
Submit the original to the Division of Wader Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone NO. [phone], within 31) days. CrW-I RIiV. 07/2001

WELL CONSTRUCTION RECORD
North C'tirolina - Department of Environment and Natural Resources - Division of Water Quail
\\'ELL COS'I'It.\C FOR(INDIVIDUAL) NAME (print)J( 6rfte.4 kt.
NS El I. CONT It. NCI OR CYI\t I'ANV NAME Atek�/9J .ne
261261
ty - Groundwater Section
CERTIFICAAT IION N �,///
['HONE p seaccensie
S I .NTE I.l.I. CONSI ItLCIION I'F:RNII'r# ASSOCIATED \\'Q I'EIt\IIT#
lir: (lic:tblc) (ifapplicable)
1. \VELI. USE (Check Applicable 13us): ResidentialMunicipal/Public 0 Industrial ❑ Agricultural ❑
VIoniloring 0 Recovery 0 Heat Pump Wat'„r Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Neared,, Town: (4/426
S�k (I re rs. Community. Subdivision. Lot No., Zip Codc)
Coun11/2414dCY
OWESER: Lc weln egg
:\,,dies, 96— #-t.✓ o,t o
beet /lottr��Route No.lW/,,
WitesSi `JJ' {Jrl ( � 6
Ity or lone Slate Zip Cutkc
( )-
:Alec code- Phone number
5. TOrAl. DEPTH: &5 t-
6. DONS WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL I3clow Top orCasino: Yr FT.
(Use "+" if Above Top olCaing)
S. '1 01' OF CASING IS FT. Above Land Surfoc(2*
'Iup ul casing IerIlIinled at/or below baud surface rennires n
\':I rl'.Illve ill :It'ul,rdallvc N lnl IS:\ NCAC 2('.011N.
9. YIELD (gpttl): atO METIIOt) OF TEST /4r%
I II. AVA'IER ZONES (depth): _
Topo�gra�)hic/Land setting
❑Ridge Mope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of %yell location
Idcgreestninules/seconds}
Latitude/longitude source:❑GI'S❑Topographic nap
(check box)
DEPTH DRILLING LOG
From Fy�m)tlion Description
ioctl.L
7y
71/
/os Mrs -
I I. DISINFECTION. Type
12. CASING:
./.-p� UcpllL., )igmcicr
Front / To /� Ft. k /l/%
From To
Amcunt
\Nall Thickness
or Weight/Ft.
1'1011 to Ft.
I3. GROUT: Daplb Material
From d To Et. e2m Pr'71—
Prom To IT
I -I_ SCI:I:I N: Depth Diameter Slut Size Material
1' eon) To Ft. in. in.
From "ro 1'1. in. in.
15. S:ANIb'GRAVP.I.PACK:
Depth Size \Material
Mljucrial
Method
From To
}'rum To
16. It1:N1ARI:S:
LOCATION SKEtCII ;\i --
Show direction and distance in miles Irom= least'-,
two State Roads or County Roads. Includc roiid-.
numbers and common road names. I
164.0oho9
cr.;
I DO I II(RIiI1Y CERTIFY TILA'T IBIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND TI IAT A COI'1' OF TI IIS RECORD I IAS BEEN PROVIDE}) TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Thins No. [phone], within 30 days. GW-I REV. 07/2001

256E399
WELL CONSTRUCTION RECORD
North Carolina - Dcparunen( of Environment and(bE turul /Reso[4rees/- Division or Water Quality - Groundwater Section/�/G
\VELI.COS"I l(.\CLUR (INDIVIDUAL) NA\IE print)/14)�f( �{41U) e CERTIFICAFIONq 2/C7
\\T:1.L(ONuu(TOI COWAN N.\\IE_ri(e Lk' H 0.12LLrn/2 PHONE a fPei 6.?786-5 '
SLATE will, CO.\sl'Itl'.CIION I'I R\i frk _ ASSOCIATED \\'Q PERMED/
Iil applicable) (ifapplicable)
I. „Tu. liSI: (('heek Applicable 13os): Residcmiul MunieipaVPublie ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 I (cat Pump Water Injection ❑ Other 0 I10lhcr, List Use
2. WELL. LOCATI /
Neatest fovv'1County.
LMN.i ernU
(Street Name. Numbers. Cora train ity, Subdiciciu 1. Lot No.. Zip Code)
3. OWNER: JCP lid A*
Address OW it—
4
5
G. DOES WELL. REPLACE EXISTING WELL? YES 0 NO'
7. STATIC WATER LEVEL Below 'lop of Casing: �.3 PT.
if Above Top of Casing)
8. TOP OF CASING IS C2 PT. Above Land Surface'
kacl
Zip Code
SiOil nr Rook No.l
4tL
ly nr TmYn State
Area code- ('hone nwnher
DATE DRILLED 7 //'Do7
TOTAL DEPTH: 3or
*'fop of casing terminated atior below land surface requires a
variance in accordan • 'ina I5A NCAC 2C .0118.
9. YIELD (gpm): J METHOD OE TEST*f
10. WATER ZONES (depth):
II DISINFECTION: Type_a Amaral
12. CASING: Wall Thickness
Depth Diameter orAA'eight/Ft.
Froia_ To_.,.5—If 1 . (¢
1/9
From To Pt.
From To Pt.
13. GROUT: Depth Material
From _61) To00 FL
From To
Topographic/Land setting
❑Ridge Mlope ❑Valley plat
(check appropriate box)
Latitude/longitude of well location
(degrees/m iuules/second_s)
Latitude/longitude source:❑GPS❑Topographic map
(check hoxl
DRILLING LOG
Form ttioN Description
'v-
DEPTH
From To
D 20
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the" road
h teria4 numbers and common road names.
kc
Method
14. SCREEN: Depth Diameter Slot Size Material
From To _ :1. in. in.
From To FI. in. in.
15. SAND/GRAVEL PACK:
Dcplh Size (Material
From To FI.
From To Pt.
16. RENI,ARKS:
T TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS. AND "I11AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I 1,
Subwil the original I the 1
u )19)7
GROUNDWATER SECT 1
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON/CONSTRUCTING THE WELL. DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 3(1 days." (iW-I REV. 07/2.001
0
--
r
_

256896
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura esources - Division of Water Quality - Groundwater Section ///
WELL CON"IILAC'rOlt (INDIVIDUAL) NAME (print) VP- af0o�rre CERTIFICATION #��rO CV
WELL CONTRACTOR COMPANY NAME fir,• Ce Life II e Pvin f PHONE #
4t“a71s"
STATE w'ELI" CONSTRUCTION PERMIT# ASSOCIATED WQ PERa11T#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 133 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION': II
N rest Town: LAN hip
/S[ITr/e
County t %t/ood
{ et Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3.OWNER:/' / s4r7/t'Je
Address ?9 Lotv�Vae. V t 4N •
(Stree r Route No.)
('A4010A/ /U.C• 0?67/(0
City or Town State Zip Code
( )-
Area cote- Phone numhe
4. DATE DRILLED /—c2-0a
5. TOTAL DEPTH: o763�
6. DOES WELL REPLACE EXISTING WELL? YES trf NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Kr FT.
(Use "+" i f 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 accordanfecwith 15A NCAC 2C .0118.
9. YIELD (gpm): 'Y a METHOD OF TEST B0"��
10. WATER ZONES (depth):
Topogr�a hic/Land setting
❑Ridge MSlope ❑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 F. ati.n Description
a0
I I. DISINFECTION: Type %�%
12. CASING:
5/ ap pr
From ��. ToDepth //^Y/ FL (L�iO�/J/
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. terial,
/jtC
13. GROUT: DepthACmMatcritd » Method
From— Too_10� Ft. P^„
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N
fV
a
N
co
16. REMARKS:
tS ToMSTIUU OihftT
LC I 3
Submit the origin:I o th
GROUnet9Ett4!LhPEPT4°- (9"
ASHEVILLE REGIONAL OFFICE
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7-a-o-2
SIG I TUBE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-322I, within 30 da)s. GW-I REV. 07/2001

25689
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality - Groundwater Sectiono,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rc gi%0i 1nI r CERTIFICATION # t�
�
WELL CONTRACTOR COMPANY NAME free cud/ Y_-O✓Mf PHONE # ( a27 0""'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I f Other, List Use
2. WELL LOCATI N: �//
Near^stToown: RNYO/✓ County
M J ,o v e_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
/
3. OWNER: / ) s'r4•sP-S n I
Address &Ro Mai Crvt go'
(Street or Route No.)
CA+k'4 ft'i ( a,17fie
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 7- 0 o�
5. TOTAL DEPTH: 05-
6. DOES WELL REPLACE EXISTING WELL? YES Br -NO ❑
7. STATIC WATER LEVEL Below Top of Casing: cQ0 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 accordan with 15A NCAC 2C .0118.
9. YIELD (gpm): see° METHOD OF TEST /3e
10. WATER ZONES (depth): �L
1 I. DISINFECTION: Type 7- Amount
12. CASING: Wall Thickness
FromDepth Diameter or Weight/Ft. tteriaj
To aO Ft. Tv /y�%.S`fi('.
From To Ft.
From To Ft.
13. GROUT: Depth Material 'Method
From 0 To -42 Ft. ce nt eN
I'ronl To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size .Material
From To Ft.
14. SCREEN:
From
From
16. REMARKS:
A0
GROU
ASHEVILL
To Ft.
From
0 /0
/p o7a
(>2a 02o5
6<
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 06at
(check appropriate box)
Latitude/longitude of well location
(degrees/m i nu teslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Fr t do 1 Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ig 5g
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4, 7- / -o 0z_
SIGNA tE OF PERSON CONSTRUCTING THE WELL DATE
I to tke Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
611. (9I) 733-3221, within 30 days. GW-I REV. 07/2001

€9�
WELL CONSTRUCTION RECORD
North cat otina - Department of Environment and Natural Resources - Divi, ion of Water Quality - Groundwater Section // // //
\\EI.LCO.\Ill.\CT(llt(I\I)1\IIWAt.)NAME (prinDrTC Bra- . ,Ire CERTIFICATIOINp eVe
WFAA , CON I11:\(TOR CO)II'AN\':\A\II:
Nr.\IT. \vi:II. CO\S'1111'C-1lON I'EltAitl'u
I tl:gvplicahlc)
rice Pori p 1.11oNt; u gn)l a7 eng
ASSOCIATED APQ PERAIRR
(irapid icahlc)
I. WELL USE (Check Applicable Bosh Residential Municipakpublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 kcat Pump A\later Injection ❑ Oilier ❑ If(lhcr, List tlsc
2. WELL LOCATION:
Nearest Fooywn: WAIN Qb V; Ile County)4Y1 rnell
Joe idn,Uer /Vifn/.
(Street Name, Nuwhcts. Community. Subdivision, Lot No_ Zip Code)
3. OWNER: Atizs/D-V VQ'
AJdress &Ot¢ koo Kout LN'
(Seca or Route No.)
ny or Toni] State Zip Code
( )-
Area code- Phone number
T. DATE DRILLED 7- 3-007
5. TOTAL DEPTH: 3osfr
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: GO ET.
^� (use ''!"irAbove Top ol'Casing)
S. TOP OF CASING IS oC FT. Above Land Surface
'Tap or casing terminated al/or below land surface requires :r
variance in accordance with l5.k NCAC 2C .111111.
9. YIELD (gpm): (20 METHOD OP TESTA ih
ID. WATER ZONES (depth):
I I. DISINFECTION. Typc__iT Amount
12. CASING: Wall Thickness
Depth ,/ Djameter orAWeight/Ft.
From �'a 10 �7 Ili. ((�P y
From
From To FL
13. GROUT: Depot Material
From
From Tb It.
14. SCREEN: Depth Diameter Slot Size Material
From 'Itt I I. tit,
From To
15. SAND/GRAVEL PACK:
Depth Sizc ptucriul
z-�TopographiciLand setting
Ridge ❑Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of \veil location
I degrees! m i nw es/seconds )
Latinate/longitude source:❑GPSOTopographic map
(cheek box)
DRILLING LOG
I gnutiyn Description
DEPTH
From To
I-OCATION SKETC I
Show direction and distance in miles from al 14
two State Roads or County Roads. Include Ihe¢ppld
Ialcriid numbers and common road names. r-
41Arti 76
Method
Bain To
prom To
I('. REAiNtKS:
toplilt :.11wli II AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WILT I5A NCAC 2C, WELL
)NS'3R�C I`IUN '1'� <DS. AN THAT A COPY OF TLIIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
AUG 1�d�A'A®fAllla/
r
11 mi a the Division of \Valer Quality, Groundwater Section, 1636 flail Service Ccntcr- Raleigh, NC
ASHED3"41VILLE 14 ONA a/No.. 1919) 733-3221, within 30 days. GW-I REV. 07/2001
ATUiRI'.OF PERSON CONSTRUCTING THE WELL DATE

256692
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/'
WEI.I.CO\Ilt.\CI'Olt ((INDIVIDUAL) NA:\I Ef (rrin) �eirt j)\A,/PC' CERTIFICATION #/4?99
WELL CONTRACTORCOMPANY NAME J Ce WC.//i—AV I'l1UNE# ON )((pt79.5
S'rAll: \\'Fall. CONN.IRUCTION I'EN.\I ITl
l if applicable)
ASSOCIATED \\'Q I'FR)I rrN
(if applicable)
I. WELL USE (Cheek Applicable Box): Residential (Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ I leal Pump AValor Injection ❑ Other ❑ II Other, List Usc
2. WI;I. L. LOCATION:
Nearest Town: /41R�uei r/kk
S "ley. •
,.
Isllcrl P.•A me. Numbers. ('olmnunily. Subd,Vision. Lot No
Court tY14 /Gt/o&t
/
3. OWNER: �rv�iON
Address
rvev. , ',/
Zip Codcl
(si, torTtUnt' o.)
tC' /4J yC 4S7rs$
C' yor I,, ,, Sidle
Zip ('ode
( Area code- Phone number
4. DATE DIt11.1_ED 7-/27_Qa
5. TOTAL DEPTH: alb" i-
6. DOES WELL REPLACE EXISTING WELL? YES'//❑ NO V
7. STATIC WATER LEVEL 13elow Top oltasing: yo2 FT.
(use "+" ifAbove Top of Casing)
S. TOP OF CASING IS ET. Above Land Surface*
'Top of casing terminated at/or below laud surface requires a
variance En a ccordancc 11h 15A NCAC 2C .1)118. •
9. YIELD (gpin): b MLTI-I0D OF -TEST /14/c
10. AVATER ZONES (depth): __--
DISINFECTION: Type_/kr_ Amount
CASING: Wall Thickness
From ��
Depth,/ Diayi't•r or Weight/ht.
To rot PL&4
From To Pt.
From To I'I.
13. GROUT: Depth Malcrial
From T o 020 I:LCE e,V��
From To PI.
14 SCREEN: Depth Diameter Slot Sizc Material
From To I'I. in. in. _
Front To I. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Malcri;l
II
12
Icrial
N lethod
lioin To FL
prom Tt) ---'-- Et.
16. RI?NI;ARKS:
Topographic/Land setting
[Ridge CISlope ❑Valley ❑Flat
(check appropriate boxl
Latitude/longitude of well location
(degrees/minutes/seconds)
L:Mimic/longitude source:❑GPS❑Topouraph is map
(check host
DEPTH DRILLING 1.0E
From To Fort ali n Description
0 moo.
LOCATION 8KEIVII
Show (direction and distance in miles from al (cast
t\vo State Roads or County Roads. Include the cad
numbers and common road names. tv
4/21/
r
IN)
\D
11)0 IiEREI3'i' CERTIFY TI IAT TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTR(1CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TI IE WELL OWNER
fellI
I
stdvmthq lgl panto twr
1 27699-1636 Phone No. (911
.((;NATURE OF PERSON CONSTRUCTING TI Ili AVELI, DATE
Sion of Water Quality, Groun(I nato Section, 1636 Mail Service Center - Raleigh, NC
3-1221, within 30 days. GW-I REV. 07/2001
C-
n
n
mz
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

256891
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
LNatural Resources - Di
VE.1. (O\IR('Ott(INDIPIDL:A) NANOpriutlNarr`'X. liter -
\\Eli. ((N'1lC\CTOIt CO\ll'\NP NA\lI•: rice 4e//tr 0v.,-2 S I ATE WI.:l.l. CONStutCIION I'Eu\I rr# ASSOCIATED WQ I'EIt\I rr#
lit applic:d'le) (ifapplicable)
ision of Water Quality - Groundwater Section
s//�q
e- CERTIFICATION ftIW4 /qp
PHONE # (yf�77f7
I. WELL USE (Cheek Applicable Boa): Residential reMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ I lent Pump Water Injection ❑ Other ❑ 11'Olher, List Use
2. WEI.I. LOCATION:
Neatest Town:�A N71J.-r Count)
�sfAie „or
6Slrccl N:une. Kulnhcl. Cunnunnily. Suhdit{pion. t td No.. Zip ( de)
3. OWNER:- -£�� �ire✓ fa))/
Address Yin)cAl ,t, ev' e Q/
l tit rctll or Route No.)
/
Coy or l men yule Zip Cute
.A Fea aide- Plume noodle'
-1. DATE DRILLED ?
5. 'TOTAL DEI'TIi: 4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9'
7. STATIC WATER LEVEL Below Top oi'Casing, JIM FT.
(Use "+- if Ahove Top olCasing)
8. TOP OF CASING IS 2 PT. Above Land Surface*
•Top of casing terminated ardor below land surface requires a
variance in mordancy with ISA NCAC 2C All IN.
9. YIELD (gpm): __ X./ METIIOD OF TEST fT
to. WA'I'NR ZONES (depth):
LOCATION SKF:I'CIi
I I. DISINFECTION: Type _, Amount Show direction and distance in miles from at least C.
12. CASING: Wall Thickness two State Roads or County Roads. Include t_ -,
Depth Diaytcicr or Weight/Ft. Pl. (, aerial numbers and comnwn road names.
Fenn 'i n Q0 P1 1Q��,/ i ....C)41 G
From To FI.
From To Pt.
13. GROUT: Depth,77,�, iM:ueri:d ,Nielhed
From 0 To 020 Ft.ies, e, i)
Prone To PI.
�,�Topographic/Land setting,
tlTRldge ❑Slope ❑Valley OFIaI
(check appropriaie box)
Latitude/longitude of well location
(degrees/minutes/seeunds)
Latinide/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From 'I'o For yiatipn Description
/O
4 � fie
14. SCREEN: Depth Diameter Slot Size Material
From To
From To
15. SAND/GRAVE(, PACK:
Depth Size Ninlerial
From To
From To
16. RENLARKS:
*I iv/ 7
I DO IIERLI3Y CERTIFY TI IATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COI'Y OF THIS RECORD I IAS BEEN PROVIDED TO TI1E WELL OWNER
A 7 _
1 iZ'
Sub V hc'I e4.C(11h
?76t i
7G I m N. ql9
`l- la -OD---,
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of 3 ater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
21, within 30 days. -' CiAV-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

256897t
To Pt.
14 SCREEN: Depth Diameter Slot Size Material
From To 1.1. in. in.
From To FI. in, in.
Method
15. SAND/GRAVEL PACK: —rHit
N en
r C)
From co
Prom
Dcplb Size Material
To Pt.
To
WELL CONSTRUCTION RECORI)
North Carolina - Department or Environment and N tural esources - Division of Water Quality - Groundwater Section
(�
\\I:I.L('(INi itArr(1R iisitiVIDDAI.) NA\tl( (print)Jy�r 751,72e' CERTIFICATION # U'/�.q7
\\'E.I.I. COM It WI OR ('O\IP:\NV NAME _rice 16//St Amp I'IIONE N Sn�I G,27-53 k
styli: \\WEI.I. COST RICTION natal114 ASSOCIATED \VQ I'ER\IITN
Of applicable) (if applicable)
1. AVEI.I, LJSIi (Check Applicable 13ux): Residential f�Nlunieipal/Public ❑ Industrial ❑ Agricultural ❑
Nloniloring ❑ Recovery 0 Heal Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION.
Net 1'sl Tpw is elgO e County
9' AND 7erral Ci
rc N:une. Numbers. Commonly. Subdlei%ion. Lot No.. Lip tittle)
3. OWNER:
Address
city or Tmcn slam
Area code- Phone numbm
d. DATE DRILLED 1p-026-02
5. TOTAL min} : sf T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: 4/30 FT.
(Use "+"ifAbove Top ofCasing)
8. TOP OF CASING IS oC FT. Above Land Surface*
"Top 14 casing terminated at/or below land surface requires 11
variance in accordance/with I5A NCAC 2C .0118. �L
9. YIELD (epm): a METHOD OF TEST nil
10. WATER ZONES (depth):
Lip ('ode
opographic/Land setting
Ri(Ige ❑Slope ❑Valley ❑Plat
(check appropriate boll
Latitude/longitude of well location
( dcgrccs/minulcs/sccond.$)
Latinate/longitude source:❑GPS❑Topographic leap
(check boa)
Dlil''ffl DRILLING LOG
Plum 'I-o En -minim Description
b
-2o ,3
63 /a,
/p s MCC
[ LOCATION SKETCH
1 I. DISINFECTION: Type /7 T� Amount Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
1 Depth ial)lcier or Weight/Ft. M: trial numbers and common road names.
From /d To / FL U �%2 f' L
From To Ft. # /53S From To rt.
13. GRou I : Depth Malarial
fm ro(i 'fu 02a_ P/�
t. C ent eN7
Prom
Ft.
I6. RliNIARKS:
11)0 HEREI3Y CERTIFY TIIAT THIS \V13LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
STANDARDS, AND TEAT A COPY OF THIS RECORD I IAS 1312.EN PROVIDED "(0'I'llli WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I II
St/hmit (fieOriginal to tJhy e'7)ikision of Water Quality, Groundwater Section, 1636 Nlail Service Center- Raleigh, NC
27699-1636 Thane No. 19 9) 73"-3221, within 30 days. " G W-I REV. 07/2001
GROUNDWATER SECTION
ASHEV'ILLE REGIONAL OFFICE
2

256893
WELL CONSTRUCTION RECORD
North C urolina - Department or Environment and Nat Ira! Re 'outc s Division of Water Quality - Groundwater Section
[�/
\\t.I.l (f)Nlli.\C"I(/1i 11,\UI\'till \I)V:\pl h: viol) {'1 /� ,f 6O CEI(I'I PICA"fIONq�rUl�
'\ I':1.1 CON1 IL \f'I 'MU ('OM l':\N1 NAME / ce G1Le//t T _b /,•/ I'lIONE
S'I'A FE \\-EI.I. CONS( I(t: CIIU\ 1'ER\II-I4 ASSOCIATED \VQ I'ER\II'f#
(il:q,pliclhle) (ifapplicahle)
114
6,27-tnr
I. WELL. USE (Check Applicable 13ox): Residential Ik I\lunicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ileat Pmnp Water Injection ❑ Other ❑ If0thcr, List Use
2. WELL LOCA'l t(
Nearest Town:
_ 'eu
N:
O/ )'v e
(Street Name. Numbers, Community, Suhdiv
Addiess ! .Nei
3. OWNER:
I Snecl or itOnle Nn.
Cityoro,cn slime
( )-
Arca code- ('hone number
d. DATE DRILLED �-0 2—
5. TOTAL DEPTH:Sri.
6. DOES WELL ILEPLACE EXISTING WELL? YE 0
7. STATIC \VATEIL L.EVEI. Below 'fop of Casing:
(Use "(' if Above Top of Casing)
S. 'I'OI' OP CASING IS F"I'. Above Land Surface'
'Fop for casing Iernliusled at/or 6eluo' I:uld surface requires a
variance is casing
ter:mre with ISA NG\C 2C AI IN.
9. YIELD (gprn): �0 ME"I'I1OD OP TEST �4/�'"
10. WATER ZONES (depth):
Count)
nl Lot No.. Zip Code
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L9t at
(check appropriate hoc)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boil
DEPTH DRILLING LOG
liunl To I$i align Description
0 o20
00 /per
/05- ts-
11. DISINFECTION: Type// Amount
12. CASING: Wall Thickness
�Depth Diameter or Weight/Ft. ueria(
From ,LoC7 To % PI. 6,71 745i.[
Front To I :I.
Front To
13. GROUT:Depth Nlaterial Method
From 0 To .a Ft ('e....e.~1
From To Ft.
14. SCREEN: Depth Diameter
From 'Itt P1 in.
Prone To PI in.
15. SAND/GILAVELPACK:
Depth Size
From to Ft.
From To PL
Slot Size Material
in.
in.
Material
16. REMARKS:
LOCATION SICIi.TCII
Show direction and distance in miles from at (cast
two Slate Roads er County Roads. Include the road
numbers and common road n:m)es.
ow a1r5-
Si¢lillI11SIf N
rn
AUG 13 _
ubnlit the original to the Divis
it_ 1 , ' t r 111 3
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC' 2C, WELL
ND TI IAT A COPY OF TIES RECORD I IAS BEEN PROVIDED TO TI11i WIiLI. OWNER
iNAIURE OF PERSON CONSTRUCTING THL WELL
DATE
on of Water Quality, Groundwater Seel ion, 1636 Mail Service Center- Raleigh, NC
21, within 30 (lays. " GW-I REV. 07/2001

255200
WELL CONSTRUCTION RECORD
Not ('arolina - Deparunenl of bib imminent and Natural It 'sources - Division of Water Quality - Groundwater Section
\V LI.I. (ON'I It.\C'I Olt (INDIVIDI \L) NANO.. (pi int))/,le�i/ 1(f IP y CERI Il:ICAATION Itt,'P iP
\VL:I.L(I1N'IIt.\UIIn((ONIPAN\N.\NIE /�;(I<vY.//K "WV _._IV u ION fS\aIIt[O'2%-$D-9S
S I AIL \VL:1•I. CONSI;ITC 'I ION PEIC\)rru
if applieuElc)
ASSOCIATED AVQ t'ERVIII'#
(if applicable)
WELL USE (Check Applicable lion): Residential V Nlunicipal%Public 0 Industrial 0 Agricultural ❑
L\loniloring ❑ Itecovery 0 1 teat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N •''ursl'I'owl): .dZ2 SVr Count
� puEC'ra�
(Street N:IIIIe. Number., C(mnnmlt
3. OWNER:
Address
City Or lawn 5
Arcs code- Phone number
d. DATE DRILLED (D- 13- 0 t^Z
5. TOTAL DEPTH:-7-(0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casino: /00 FT.
(Use"f if Above lop or Casing)
(i T01' OE CASING IS FT. Above Land Surface*
`Top of cuing terminated al/or below laud surface requires a
variance in accordance with 15.\ NCAC 2C.t)1 lib
9. YIELD(gpnt): %c-2, MEIlIODOFTEST_ILL
10. WATER ZONES (depth):
Subdivision, Lot No.. tip Code)
[gN
1n1
?_25`3 7
hip Code
1I
2
Depth Ditunctcr
From -)-‘2l 0 �D II. 674/
From "10 Et.
From "To
13. GROUT: Depth
From ( J lb c,/fx P(.
From To FL
Material
DISINFECTION: Type ) I" ri� Amount
CASING: Wall Thickness
or Weight/Et. Material
9S4Y�1
14. SCREEN: Depth Diameter
Front To I1. in.
From To fl. in.
5. SAND/CII{AVEI. PACIC:
Depth Size iblaterial
From To
Prom To
Topographic/Land setting
f lge ❑Slope ❑Valley ❑Ilat
Idled: appropriate box)
Latitude/longitude of well location
t degrees/nlmui cs/seconds)
Latitude/longitude source:❑GI'S❑I opographic map
Ichcck box)
DI'.PTI I DRILLING LOG
Isom To Pon Description
/0 a s _54- 4
765
Method
Slot Size Material
in.
in.
16. REMARKS:
.J
LOCATION SKETCH
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
W /3q5
0
St broil the (original to the 1� icisi(n of Walcr Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27b�' t"{,}bQ11' 4b-Ri )• ,�7-3 3221, within 30 clays. GW-I REV. 07/2001
4SHL\'iL -PJT
\A ELI, WAS CONSTRUCTED IN ACCORDANCE WITI-I I5A NCAC 2C, WELL
D"TIIAl A COPY OF "IBIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING TILE WELL DATE
JJ

255199
WELL CONSTRUCTION RECORD
\\'EI.1. COSI k.\C I Olt (INUI\'IUL'::ST) N:UIIC (print)
North Carolina - Department or Environment and Nat ral R sources - Division of Water Quality Groundwater Section CERTIFICATION tl (9�rr//? PIIONE # ( %-Z 8
\\r:I.I. CON Iu,\("I'OR ( .\l I':\N\NAME
\T r: \c I!I.1. (().\sI RC(I'ION I'ERSI ITA
i l';tppl ieahlel
to
ji Ce_1N€//
ASSOCI:VEEI) \rQ 1'EI \rrl/
(if applicable)
I. AVLLI. USN (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Rceovery ❑ I Icnl I'unlp Wader Injection ❑ Other O I[011ler, List Use
2. \VELL LOC'AIION:
Nearest Town:/ &, )e_y//e/ County.
IStrec1 .Alone. Numheis, Conm unily. Subdtvidao, Lul No., Zip Code}
3. OWNER: Cf�IJ�
I
6
7
Address
(Urccl or Route No.) 'y�yp
/mac , r2Vi "
ity or Tuna Slate Zip Code
)-
Arca code- Phone nwnbcr
DATE DRILLED J2��`
'I"ORAL DEPTH:DOES WELL REPLACE EXIS"PING WELL?
STATIC WATER LEVEL Below Top of Casing: '9.3. FT.
(Use " . - if Above lop of Casing)
8. "TOP OF CASING IS FT. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance in accordance w ith 15:\ NCAC 2C MI I8.
9. YIELD (gpm): ��_ MKT' IOD OF TEST 61.+K
10. WATER ZONES (depth):
II. DISINFLCIION: Type Amount
12. CASING: Wall Thickness
From
erAVeighUPl A erial
L)e )th Diameter
`�- To Co1 Pt. /
From To 1'I.
Front To Ft.
13. GROUT: Depth Material `J
Front b To __(z__ Pt. Cem.e.JT"
From To
YES ❑ NO
Id. SCILLEN: Depth Diameter
From To FI. in
From To 1"I. in
15. SAND (112AVEL PACK:
Depth Size
ham To PI.
Topographic/Land setting
�idgc ❑Slope ❑Valley ❑Flat
(Check appngrtiatc bull
Latitude/longitude of well location
(dcgrecslniowesscconds
I ditudc/longitude sourcc:OG I'S❑Topographic map
IcI1eck hoc)
Dl:P1]1 DRILLING LOG
Iron) To F Irly)alio t Description
.2o 63 s tidY
(� 3 40S y�4.1) e
A05" 30� r< .. e
Method
Slot Size Material
in
II1.
Material
From To Pt.
16. RI:M:ARI:S:
LOCATION SKYTCI-I
Show direction and distance in miles from al least
twr Slate Roads or County Roads. Include Ole Ind
numbers and common road names. prdE
L
� mom;
W m
0
/9
c)_
I**-.E. %TitU C 14ON.STANDAR[$
1
Sirbntil the original to the i)ivisi
i'SPHILi PurIILL
S WELI. WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D IIIAT A COPY OF THIS RECORD IIAS 13EIiN PROVIDED TO Tim WELL OWNER
NATURE OF PERSON CONSTRUCTING TI IL WIiLL
DATE
n Or Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
I, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
('O\lR:\CI OR ('O\II':\\\'.N: S I:
NI AlI I: \\I:I.I. ('ONs I RC(' l loN I'EIOIII #
(iI a'plicablel
<^_5 �198
North Carolina - Department of Environment and N;u(9I I{_ - Dcsourriees v/Sion of Water Quality - Groundwater Section
COSII AC) OR(INDIVIDUAL):NAME (print) Me f/ka7t) P CERTIFICATIONif07969p
/�6 ite We_II /`VM PHONE t/ ]:[TI0'.c?.7-4� /O
ASSOCIATED WC) I'E1t\ITT#
(if applicable)
I. WELL. USE (Check Applicable Box): Residential L�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Ifeat Pump Water Injection 0 Other 0 Ir, Other, List Use
2. Wt.LL. LOCAII
Net I Tov))'ll:
:YtdO__tr��
(Street Name. Nmabels, R
unily, Sul di Ilion, Ltd No.. Zap Code)3. OAVNI R: Lori" /%'
Address Tlio 4 WeS � 1 M/e
(tilccl or Roots: No.l
Cored F.
l'nc or "Ino " Stale
( )-
Area code- Phone nanohei
d. DATE DRILLED_ -� -o ?
5. TOTAL DEPTH: rSos
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IW
7. STATIC WATER LEVEL Below Top orCasing: l(>,� FT.
(Use "+" if Ahnse Top orCisingl
8. TOP OF CASING IS (9 ET. Above Land Surface"
*Top or casing terminated al/Or btaow Knot surface requires a
v:u'iance in accordance with 15:\ \'CAC 2C.0118.
9. YIELD (gprD): / METHOD of TEST A.r
10. WATER ZONES (depth):
I I. DISINFECTION: Type /4/7-# Amount
12. CASING: Wall Thickness
Depth p Diameter or A1'cighi/PL Icrial
From 4� To Y/ _ Et.4
From To PI.
From To PI.
13. GROUT:• Depth Material / Method
From 0 To ao :ti *e,y
From "fo
County (4.4200/ Lld1tidge ❑Slope ❑Valley ❑Plat
lcheek appropriate host
Latitude/longitude of well location
.33o 6S
Zip ('ode
14. SCREEN: Depth D
Front To El
From To Pt
15. SAND/GRAVE(. PACK:
Depth
From To
From TO
16. REMARKS
Topographic/Land setting
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check taw)
DEPTH DRILLING LOG
from, To port iati m Description
/06-"
4
•o "speed
f t.✓r ��
egee
meter Slot Size Material
111. ill.
Size Material
LOCATION SKN'r('I1
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names. e
p O
# i t
S \b ELT. WAS CONSTRUCTED IN ACCORDANCE WITI3 I5A NCAC 2C, WELL
DTHAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TOT TIE WELL OWNER
LP
NATURE OF PERSON CONSTRUCTING TI IE WELL DATE
St Innil the original to the Ip ivisil it or\\'ater Quality, Groundwater Seelion, 1636 Mail tiers ice Center- Raleigh, NC
a- y:tT IIr-711 mute , 46,,7t3-3221, within 30 days. GW-I REV. 07/2001
`;hWl'u r,. JFriCE

255197
WELL CONSTRUCTION RECORD
North Carolina - I)cparmlent of Ens ironment and N• rural Resources - Division of Water Quality - Groundwater Section
\\1:1.L (oN'1 WI OR (INDIVIDUAL) NANO: (print) Lff4U fife rn r• ,/
CERTIFICATION topr�7ngona�Y�9
\\El.I. COS I It A(' 1 OIt COMPANY :NA\IP: fr/t..e____Wejj j/ tv pig(% I'no\E a1521if / ,2?-gss
S'I:\T k: w i:1.i. CONS '1It( C'lION I'hIJII'Ip ASSOCIATED \\'Q PE1011.11
1 it ,applicable) (ifapplicable)
1. WE'LL. USE (Check Applicable 130.(): Residential EH'—Municipal/Public ❑
Monitoring 0 Recovery 0 I teat Pump Water Injection 0 Other 0
_'- WELL. LOCATION:: �`
Nearest Town:lii_�.- 5l/4 71//e
('rest J�e.0 ,NJ-e
ISlmcl Name. Number:, Community, Subdi�Isi
GO LI 111110410CCi
Lot No.. Zip Code)
3. OWNIJt: / a4/ Al
Address ,S Ai?" ,ec/
reel or Route Pio.1
qW c`•4 A C.
IIy or Torn SCnc
Zip� CP
( )-
Area code- Phone number
4. DATE DRILL.IU) �J�•y (Ja
5. TOTAL DEPTH: 6/7S—ci-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top ofCasing: '1 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 n
variance in accordance with I5,\ NCAC 2C .0118.
9. YIELD (pin): / MLI!!O!) OF TEST /1'•�
10. WATER ZONES (depth):
I I. DISINFECTION. Type
12. CASING:
Depth
Front To �i
From To
From To
13. GROUT: Depth
From O To g'0
From To
14. SCRI iN: Depth
From Ill
From to
I5. SAND/(:RAVEL. PACK:
Depth
From To
From To
Industrial ❑ Agricultural 0
11 Other, List Use
� �"Topographic/Land setting
KRidge ❑Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
1cgrees!n tomes/seconds )
L:Ilittide/longitude source:❑GPS❑Topographic nap
(check box)
DRILLING LOG
Fort alio t Description
DEI'Ell
Front To
Amount
Wall Thickness
Diameter orWeight/It. void
F1.4/Y C'
Ft.
Material
Ft.)—
Ft.
Slot Sim
111.
in.
Size (Material
NIcthod
Material
16. I<FNlrAI<KS:
LOCATION SKETCII
Show direction and distance in miles from al leas)
two Slate Roads or County Roads. Include the mad
nun1bers and common road names.
113s
O
N)
•
"O
W
c
P
,
c,
0
r:
y'v
mcI
m
rn
m:
n
--t
0
rat
I1--f i-M.(D t i ltl<I.II.1 rHl
I 1 ONSQIWCIf(ON Sr:ANDE\R
I; II
1 S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD 11AS BEEN PROVIDED TO THE WELL OWNER
(9
:NATURE OF PERSON CONSTRUCTING THE WELL DATE
S ibnlil the original to the )icisit a of Water Quality, Grouudweter Section, 163E Mail Service Center - Ralrigh, NC
_�1MI')-i irPlitnit t.<90),1713-3_27I,vtithin31)(la)s. GW-1 REV. 07/2001

255196
II. DISINFECT'
122. CASING:
From %lc?
From
From
13. GROUT:
WELL CONSTRUCTION RECORD
North Carolina - Ucparimcnl of Environment and /N/y�
/Ltural sources - Division of Water Quality - Groundwater Section
'//p
\\'ELL('O.\Ilt.\C'I'OI( (INDIVIDUAL) ;�\:\116: (pri(print)/C. e/� R/(/�ye CERTIFICATION n 02,7�!/
N't:I.1. CO..\ I I(:\("'I ()It ('O\II'A,\S
5I . \al! \\T:I.I. (T/\S 1111(' 11O.N 1'ERIIMTN
il;pplirahlcl
•GLLIIE2/ Lam/✓^ PHONE # 426)
6.?J Ci9t
ASSOCIATE{ \NI) I'ERNII'I If
( if:yiplicablc)
I. AVILE USE (Cheek Applicable Box): Residential VMlunicipal/Public ❑ Industrial 0 Agricultural ❑
Nonihrrine ❑ Recovers ❑ Ilea' Pump Water Injection ❑ Other ❑ ILOlher, List Use
2. WELL LOCATION: Nettle: awN
yl: ArOenI ur Coiiv� �
Nettle::
Va
(Street Nam,. Numbers. Community. SuhdicUion, Lot No.. Zip Coder
3. OWN{:R:_OE /I i✓ foRker
Address Po (o( a sea
{Street or Route Nm.i
oc��ljlil _ �GI
Cnv rr llnco Slate Gp Code
)-
At ea code- Phone mm�h
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (og FT.
(use,- it Above Top of Casing)
8. -rot, Of CASING IS •2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance fu accordance with 15A \'CAC 2C.0118.
9. YIELD (gnu):miiTHOD OF TEST afQ('
ID. WA'TLR ZONES (depth):
ON. Type ,/7Amount
Wall Thickness
Depth Dial ueler or \\'ciehi/Ft NI; Icrinl
-,7,7- 002
Topographic/Land setting
[32idgc ❑Slope DVallcy plat
(check appropriate hos)
Latiludelongitudc or well location
Idegmctihninmles/seconds1
tudeilongitude source:❑GPS❑Topographic map
{check boll
U I',PTIi I)RI1.1_1NG LOG
From To form tio)l Description
.2o /
Sr
Sr yis--
96- das-
si ,/ S e
To Ft.
lb fl.
Depth --- ----(\lateral)
From 0 To !>2?1 It. Cef"retea
From
14. SCREEN: Depth Diameter
Prom "To I'I. in.
harm 'To
15. SAND/GRAVEL PACK.:
Depth Sizc
From To Ft.
From To Ft.
16- RI'.NIARKS:
St',Iud.T 10(,I St.?)1N0Alt
LOCATION SKETCH
Show direction and distance in miles from al least
two State RoadS or County Roads. Include the road
numbers and common road names.
4/S7/
Nlcthod
Slot Size
n.
in.
;Nlatcri:d
tvlaleri;d
0
L
r
--O
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND TI IAT A COPY OF THIS RECORD I IAS BEEN PROVIDED TO TI IE WELL OWNER
NATURE OF PERSON CONSTRUCTING 111E WELL DATE
ubnlit the original to the D on of N"ater Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9)II,t:H I(,sN},t4117i)�_3-}»I,willlin30day,s. " GW-I REV. 07/2001
A E Vd LE REROC\IAL OFFICE

255195
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat Iral Resourcesu- Division of Water Quality - Groundwater Section/ /(�
\\'ELI. COVII(A("101t (INDIVIDUAL) NAME ((rint) ,,''// '/ / �/2 CERTIFICATION #42fG'/
\\fl.I. CON(R.\("I OR ('O.\IPANV NAME /_i_ece,2&�it- / ""71 7 PHONE # IC t) 6R7n
S I A l t: \\'EI.I. ('ONS')RL-CTION I'h:R.\I IT#
( ifnppl icablc)
ASSOCIATED \YO I'ERAI I'r#
(ifapplicable)
I. WELL USE (Check Applicable I3ox): Residential P Municipal/Public O Industrial ❑ Agricultural ❑
Nluniloring ❑ Recovery ❑ l lout Pump Water Injection ❑ Other ❑ II Other, List Use
WELL LOCATION'
Nfc�' cjat' 'fogy:�
ctfrelrCr %
e
ISlreci Name. Nmubem, Cunmuinily. Subdi
('oust)
o, Lul No.. Zip Code)
3. OWN(:k:*�r/erY1//
Address L //!!AM(/�i'�
(Slater or Route No.l
) A/C- 02g7.?)
Coy or Town Slate Zip Code
Area code- Phone nwnbe
d. DATE DRILLED i'vf/�-D�
5. Tartu, DEPTH: it:9Cli—
o . DOES WELL REPLACE EXISTING WELL? YES 0 0 Er-
7. STATIC AVATER LEVEL. Below 'l op of Casing: _3 FT.
(Use "+" if Abuse top of Casing)
8. TOP OF CASING IS a_ ET. Above Land Surface*
*Fen of casing terminated at/or below land surface requires a
variance in accordauu' ilb ISA NCAC 2C.0118.
9. YIELD (gpm): __A7 METHOD OF TEST /71/--
10. WATER ZONES (depth):
,Topographic/Land setting
i (Ige OSlope ❑Valley DElat
(check appropriate box)
Latitude/longitude of well location
(degrees/1niuutes/seeondsl
I.:lliltide/Iongitude sourec:OGPSOTopographie mall
(check box)
UIiP I'l DRILLING LOG
Prom "fo I', )rma(in DeSeriplion
/0 (.93
0Z5 JC
II. DISINFECTION: 'fype j Amount
12. CASING: Wall Thickness
'1 Depth i2nieIer or Weieht/Ft. Material
In)Infe2 To o�/IrL ji*c '
wont To r1
Tit
From
13. GROUT: I)eptlt Nlalerial
From 0 To 070 Ft. (B41e/3/74-
Front__ To
14. SCREEN_Depth
From To
from To
15. SAND/GRAVE(. PACK:
Depth
Method
Diameter Slot Size Malcriul
III.
From To Et.
Ervin to Ft.
LOCATION SKETCII
Show direction and dislance in miles front ;tl lead
two Slam Roads or County Roads. Include the road
numbers and CDIt1I11D11 road names.
/5-3 /
c
0
Site Material 'D
�RI
▪ cfs
..
ti
16. REND\RKS:
11)O IIEREI3Y CERTIFY lIIATlIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ibutil the original to the
699-1636 l'Iutill No. (919) 7
3
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
I, within 31) days. " GW-1 REV. 07/2001
G R il'j?a rn
ASP,: L

WELL (UN7 RA("IUli (INDIVII IAI,) NAME (prinl) njf`) g1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�j
CERTIFICATION N a776/
WELL CON'IR:\Cr(llt (TONII'.\NN' N.UIEYrisP_ well u^+p PHONE a f $43t io?)- g59g
Sf At: \\ EI,I. CONS I RC C11u\ PEEL\( I'I-N
l if applicable)
253397
ASSOCIATED WTI PEI011rN
(if applicable)
I. WELL USE (Check Applicable 13os): Residential « Municipal/Public 0 Industrial 0 Agricultural ❑
Nlonitorin g 0 Recovery ❑ Kean Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearast Town:
I Slreel Name, Numbcn, C,
�fi�.lr.f
unity, Subdivision. LuI No.. Zip Cole
3. 0\VNER: ?_ LL)
Address 1`3i J� 1 jnfor5 ,_,L1\0 t..
ettl SuccflCI— )
C it ur Prose St,uc Zip Code
Area code- Phone number
4. DATE DILILLIED
-o02
5. TOTAL DEPTH:_�O�
G. DOGS WELL REPLACE EXISTING WELL? YES 0 NO 127-
7. STATIC WATER LEVEL Below Top of Casing: 6 G FT.
(Use "+" if Above Top oiCasingl
S. Top OF CASING IS FT. Above Land Surface*
'"fop of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METTIOD OF TEST GI,
10. WATER ZONES (depth):
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth
From'. To
Prole To
or AA'eighilFt. Nlaterial
From To
13. GROUT: Depth Material
From __f% Too2'0 Pt. /&_eN7
From To
14. SCREEN: Depth Diirneier Slot Sve Material
Prom To rt.
From To
15. SAND/GRAVE(. PACK:
Depth
From To Ft"
From To Pt.
z� Topographic/Land setting
L RRidge ❑Slope ❑Valley ❑Flat
(cheek appropriate host
Latitude/longitude of well location
(degrees/minutes/seconds)
I litude/longitude source:❑GPS❑Topographic map
(check bo.vt
D1211.I.ING LOG
DEI'TII
NIUIhod
ti RI'nl \ )L e
Ripril..i,ii
C ONSTRUC 1 ION STA
I
i
L
GR
AS:
yyq R ECTI
to u,
Size Material
I T I IIS WELL
AND TFI
Po -n; tiot Description
LOCATION SKETCH
Show direction and distance in miles from at (east
tvvo State (toads or County Roads. Include the road
numbers and common road names.
sG
4 fl7(
VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A COPY OF THIS RECORD I lAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS( RUC ING-`FII EUVFLL DATE
irision of Water Quality, Groundwater Section, 1636 N1ail Service Center - Raleigh, NC
733-3221, Within 30 days.--- GW-I REV. 07/2001

253395
\YELL CONSTRUCTION RECORD
Nord' Cal olina - Devon of Environment and N• (oral Resources - Division of Water Quality - Groundwater Section
lk 1' f 61
NI Ell CON.' It.(( TOR (INDIVIDUAL) NAME id t �- Ln�r�v If �e- CERTIFICATION oN/a-7�) Q�-�,�p
\PEI.I. ('OS I It.\CI OR COSI PAN} NAME [ rCe ie 44/ PHONE # 4pl/-'�/�
.Sl AlE w r:1.l. CONS.' RUCTION I'EIPl I Ta ASSOCIATED WQ rEitnlrra
(if npplicablc) (inapplicable)
I. WELL USE (Check Applicable 13os): Residential Die--Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 I Icat Pump Water Injection ❑ Other 0 - I I Olhcr, I.ist Use
WELL LOCATION:
Nearest Town: /21
crrcY
Y(SUVcL ::mc. Nunbcrs.(
Viler Count) AlAtAVO'CLl
SuhJicision, LW No_ Gp Colc)
_. OWNER: 1V 00
Address 'c vU_9
ISticc ur uaulc o.l
ytopographic;Land setting
tidgc ❑Slope ❑Valley ❑Flat
(check appropriate boll
Latitude/longitude of well location
Idegrccs/minaICS/seconds)
La(iItala/loneiIUde source:❑GPS❑Topographic mop
n check box,
DI-:I'TI-I DRILLING LOG
City or Town Svne Lip Code front "fu Fon lati m Description
( )- 0 /D
Ales Cole- ('hone number /n 33
4. DATI! DRILLED S / <0_?
5. TOTAL DEPTH: &Li- fi,
- fa- 6?5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O
7. STATIC WATER LEVEL Below Top olCnsing: y0 FT.
Rise "4 if Allow Top of Casing)
R. TOP OF CASING IS FT. Above Lan(( Surface*
'Top or casing terminated at/ur below loud surface splines a
variance in accordance with I5A NCAC 2C .111 IS.
9. YIELD (gpin): / METIIOD OF TEST i/,i�
IO. WATER ZONES (depth):
LOCATION SKETCH
1 I. DISINFECTION: TYpe /9.7%51 Amount Show direction and distance in miles from at least
12. CASING: W;ll'fhickncss two State Roads or County Roads. Include the road
Depth Dial�ietcr or Weight/Ft. �V1'1Icri;d numbers and common road names.
From d. To 7 / _ I'I. ( iy /'/S' it
From 'l o Ft.
From To
13. GROUT: Depth Material Method
From %9 110 n20 Ft. CAn,e.41/
From Tu Et.
14. SCRIiIiN: Depth Diameter Slut Size Material
From 'fo II. in. in.
From 111(1 Ftin. in.
15. SAND,/0RAVI11. PACK:
Depth Size ;Nlatcrial
Prom To Et.
From To II.
16. REMARKS:
44/4
a-4o
si :01wV C-Nnrzo
I DO I Ilil(EI31' CERTIFY TIIAT TI IIS WELL WAS CONS'FRUCFLD IN ACCORDANCE WITH ISA NCAC 2C, WELL
Su mil the original to the Din
276 9-1636 Phone Nu. (919) 73 3221.
GROUNDWATER SECTION
ASHEV/ILLE REGIONAL OFFICE
I I IA1 A (.()I 1 OF THIS RECORD I IAS BEEN PROVIDED TOI'HE WELL OWNER
5- I L-I- 03%.
TURF OF PERSON CONSTRUCTING "HIE WELL DATE
of \Valet- Quality, Groundwater Section, 1636 Mail Service Ccnlcr- Raleigh, NC
wit kin 30 (lays. GW-I REV. 07/2001

253393
1 I. DISINFECTION: Type j#771/ Amount
12. CASING: - Wall Thickness
Depth �Di:�l;� r or WtighdPt. M ttriai
From To 5/7 FL 64 !T c
From .lo Pt. /
From To Pt.
13. GROUT: Depth intMattrinl Method
From To (90 Ft. (, ca+ei✓P.
From To Pt.
14. SCREEN: Depth Diameter Slot SL'e Material
From To FI. in. in.
From To Ft. in. in.
15. SAND/GRAV El, PACK:
Depth Site Material
From I-o II.
From I o
16. REMARKS:
\VELL CONSTRUCTION RECORD
North Carolina - 1)cparlmeot of Environment and Natural II esourcces - Division of Water Quality - Groundwater Section
/,
\'ELT, CONTRACTOR (INDIVIDUAL) NA\I prin0 er.A- D(�A/(1/ e CERTIFICATION p(yr/�7 [f WELT. CON I n.,CrOR CO\I I'AN S NAME 2i't // 94 ✓4, I'IlONE a (pxo) �J)— f-90
sa:\I T: WEl.l. CONS] R CT ION I'F:uNIITp :\SSOCI:\"FEU\\'Q I'EIc\l I'ra
1iF tpplicaliel (ifupplitnbla)
I. WI'.LI. USE ('heck Applicable 13oxy Residential (W Municipal/Public 0 Industrial ❑ Agricultural 0
i\lonitnring ❑ Recovery ❑ I Icat Pump \Vater Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: /A/R� P�U,J/e County_/y y/,ypod
%q% /•
(Street N:Ime. Nlnnbcn_ Community, Suhdlvisio t Lot No., Zip Code)
3. 0\VNER: ) 6
Address 4 ,,
1 'el or Rome No.)
164)t ,r i t t/% t de
ar or Torre Slate tip Code
A¢u nrJe Phnnc numhar
4. DATE. DRILLED S a/- 0-2
5. TOTAL DEPTH: 72rtE+.
6. DOES \YELL. REPLACE EXISTING WELL? YES 0 NO IW
7. STATIC WATER I.FVIi1. Below lop of Casing: fp/ _FT.
(Use `+" il Above Top of Casing)
S. TOT' OF CASING IS FT. Above and Surface'
"rep or casing lerminateJ al/or below I:unl snr(ace requires a
variance in aernrJ:mee sh ilb ISA NCAC 2('.0118.
9. YIELD (epm): p2,� METI-IOD OF TEST /g°r—
."-Topographic/Land setting
retidge ❑Slope ❑Valley ❑Flat
(check appropriate has)
Latitude/longitude of well location
(degrees/to inn lcs/secon Js)
I_alitude/longitude source:❑GPS❑'Rhpographic reap
I check nos)
UIi I'TI-I DRILLING I.OG
From To I oriilatii in Description
O
10. WATER ZONES (depth):
LOCATION SK ETCI1
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include Ile Toad
numbers and common road names.
//57
O
N
L
CO
O
CJ
Asi
GRnj] TViuT {1 ga
IS \VELI. WAS CONSTRUCTED IN ACCORDANCE \WTI 115A NCAC 2C, WELL
ND TI TAT A COPY OF THIS RECORD HAS 13EEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 163E Mail Service Center- Raleigh, NC
21, within 30 days.," GW-I REV. 07/2001

NVELL CONSTRUCTION RECORD
253391
North Camino - Ueparimenl or Environment and Natural Resources - JJDiv`issiion of Water Quality - Groundwater Section / \\EI.I. CON"! RACTOR (INDIVIDUAL) N A\lE (prinn$P� ged4I�y CERTIFICATION (�I�7
\I:1.1.0 OATR.\(IUtt CO\lpANv .\II PCE �k`II a- Po -if PRONE a (g) C..27-8S7g.
S I.\7T: \\ra.l. ('O\.S1 RUC! ION PER.\III # ASSOCI:\'rED WQ PER\IIT#
(iFapplieahle) (itapplicahlc)
I. WELL USE (Check Applicable Buz): Residential kT 1A1unicipal/Public 0 Industrial 0 Agricultural ❑
Nlouitoring ❑ Recovery 0 I feat Pump Water Injection ❑ other ❑-ICOther, List Use
2. WELL LOCATION:
rest Town: (AA\/Y-a
To.pogr_wLticit_and setting
�1� County ❑Ridge Dope �dlley ❑Flat
4 _//���----Y��"����77�� (check npprupnule box)
I Na. hip Code) Lalilude/longiludc of well location
ISirccl Smile. Numbers. Cummunily. Subdician
3. OWNER
Address
f n' ✓,
0
.Alen code- Phone mull,
4. DATE DRILLED_
5. TOTAL DEPTI-I:
/tivND le-�r�—
�.COSa4/
Isneet„ umllcria)
n
Zip (
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO V
7. STATIC WATER LEVEL Below Top ofCasing: e) FT.
(Use"a" 1 Above Top of Casing)
S. TOP OF CASING IS PT. Above Land Surfaces
'Top of casing lerminaled attor below land surface requires a
variance iu accordance w ilh I5.\ :\C\C 2C .0118.
9. YIELD (gpm): a7O MIiTI IOD OF TEST A,Y
10. WATER ZONES (depth):
I I. DISINFECTION: Type y Amount
12. CASING: Wall'Ihickncss
Ucplh Diapctcr or Weight/Ft. ME Icrial
limn -Z ToZ.9 FI. 4J /N 0( C
From "Co I I.
From "To PI.
13. (iliOUT: Depth Material�1.
From .0 -co ,a-2_,F1. iev1
From To 11.
I. SCREEN: Depth Diameter Slut Sire ,Nlatcri:d
From _--- •To F1in. in.
Prom To 1:1. in. in
15. SAND/GRAVEL PACK:
Depth r' Site :AFateful
From To FI.
From To 11.
(dcgrecsiminutcsrsccondsl
Lltituddloneitucle source:❑GPS❑Topographic neap
(check box)
I)EI'"fll DRILLING Loci
From To FF/o n atio t Description
C v2J L�/4/
7/ Z.9440.k
ALC
/b Rose'
hlclhod
16. RIM,\RKS:
LOCATION SKETC'11
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names.
.11
IMO a:12 Y d.'E611.1 _1TI
CUNS I ICLC I TUN S I /\NO*.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT COI'Y OF THIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
-23-0 a—
IGNATURE OF PERSON CONSTRUCTING -II F \A ' L.I. DATE
Yi;lnet! Fiume Fsswt ftimhe Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
A917109LLORMItF)KriNo0(410E733_; 221, within 30 days. GW-I REV. 07/2001

252098
W1'LLL CONSTRUCTION RECORD
North cat olitta - Department of Environment and Natural Resource •• --/Division of Water Quality - Groundwater Section
�j
\\'1'.L I. ('U Slli.\('"1'llli (I(INDIVIDUAL) NAM(grill I) f 6e_44 �/ CERTIFICATION #�(�� Q/
\vl:I.I, CON'I RAC! OR ('OMIS\T\':N.UI E rICe Wk. tl POMP PHONE k((�)%c%-SS`B
S I.\TF: \\'IAA. CO\SI RI COON FERMI"! 4 ASSI)CI:\"I-El) \VQ I'ERNIITW
t ifnpplie;ihlrl (itappliclblcl
I. \YELI- USE (Check Applicable Box): Residential Ig /Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ I leat Pump Water Injection Cl Other ❑ If Other, List Use
2. WVELL. LOCATION:
CNche Town. `,
herr�l �! _ESZistTeS
(Strccl Nun) Numbers, Community. Sub(11v
County 44 141o0
n. Lot No.. Zip Code)
3. OWNI'R: p)CJ( jv_eS
Address /J1 rtss/orsts/e ,i Y 25
five, nr Route Nu.)
Ulv nr Inn Stale
( )-
Area code- Phone titiannbe
4. DATE DRILLED_ O
5. TOTAL DEPTH: SSO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL 13e1ow Top of Casing: 630 FT.
(Use'-+" it Abum Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Tay oIcasing terminated at/or below laud surface rettuires a
variance in accord:utcc ith l5,\ NCAC 2C .11118.
9. YIELD (pm): METHOD OF TEST »' r
10. WATER ZONES (depth):
11. DISINFECTION: Type f)7t/ rT Amount
12. CASING: Wall Thickness
I)eplh LL// l!Dial1lyyt��er or Weight/FLp}ucrial
Froln �a_ To 70 FI. HO �/ Q[5/ia-
Zip Cod
� �Topographic/Land setting
LNRldge ❑Slope ❑Valley ❑Plat
(check appropnWe host
Latitude/longitude of well location
idegrccs'mintIes!sccouds)
Latitude/longitude sourec:DCil'S❑Topographic map
tcbcek bore)
DRII.LIN6 LOCI
Irgr ati in Description
otzwi
41Z)454404,10 �et-
1-P
Dlil'l'I-1
Prot)) ho
0 do
fl\,mm'------- To FI.
From 'fo----._--- Pl.
13. GROUT: Depth NI:aerial
From C) To oiD Ft. Ce..` €-v 7-
How To FI.
14. SCREEN: Depth IJiametci Slot Size NI it. i II
From To Pt. in. in.
From To Ft. in. in.
15. SAND/GItAVE-L PACK:
I)eplb Size Material
I91nn To Ft.
From To Ft.
lb. REMARKS:
Nlettn
LOCATION SKETCII
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TI IAA COPY OF 11115 RECORD I IAS BEEN PROVII)ED1110 TILE WELL OWNER
ALUM:. OF PERSON CONSIRUCTING'IJJI
u—
G-O
DATE
Sul mil the original to the Di isinn ul NVater Quality', Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27691 Irta::)r,WI!t`t r.')811f13i-3n21.
vithin 30 days. GW- I REV. 07/2001

16. RI'TI:\RKS:
WELL CONSTRUCTION RECORD
North Carolina - I)cp,ir(mein of Lii -iroulnenl and N'uula Resources - Division
wri.I.(o\'flt.\('Toli(I\nI\'IDUAL)\A.\IN (print) el 4-in A Udife—
\\T:I.I. CON( RA( FOR ('OSII'.\NY NAME riCe ('tie// se-w:yP
STATE \\'l:I.l. CONS(I{(:CFR )% PI:IL.\I I'rN
(i 1' applicable)
252097
of Water Quality - Groundwater Section
CERTIFICATION
/#074 f
PRONE # 1P1 /cRz- 5S-Fe
ASSOCIATED AAQ PERMIT?,
(irapplicahlc)
I. AVELI. USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Ocat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION:
Nearest To)vn:
4410r, M NC
(Sweet Nance. Numhe s, Community. Suhdiciaiun Lot Nt
3. O\VNI 12:2 D�N/4dALA4d lL
Address jib V.-ce
(Sncel or Rtnite bi
�
CO)
imtt Simi.(.
9
10
Zip Code
Area code- Thane ntmlbe 5TOIp
5. DATE DRILLED /9n2
. :'\L UI_'PTH: /yrj`"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I'
7. STATIC WATER LEVEL Below Top olCasing: ten FT.
(Use "+'' iIAbove lisp of Casing)
S. TOP OF CASING IS FT. Above Land Surface'
'Top nl'casing terminated at/or below laud surface requires a
variance in accorda nee with ISA NCAC 2C .0118.
YIELD (gpin): /5 METHOD OF TEST 4-r f
\VATER ZONES (depth):
Topo�graa hic/Land setting
❑Ridge NJSlopc ❑Valley ❑Flat
(dteck appropriate. box)
Lalillldc/longitude of well loc;nion
(degrees/minutes/seconds)
Lnlirude/Innginldu sourcc:C1G PS❑Topographic map
Ichcck Goal
DRILLING LOG
DNPTII
From To
lr)rnaton Description
I I. DISINFECTION: Type /1177, Amount
12. CASINO: Wall Thickness
Depth Diur )der or AVcighl/Pt. N Ileria�
P� r£
From
From f� 'fo�% Pt.
TU Pt.
From To Pt.
13. GROUTA' Depth Material bdclhad
From L To Ft. _nen ev
14om To Pt.
Id. SCREEN: Depth 1)i:tineter Slot Size Material
From To.._ I'I. in. in.
Prom To F1. in. in.
15. SAND/CRAVE!, PACK:
I)ep1I1 Size rA7ulcriai
How To Irl.
From To Ft.
Count
LOCATION SKETCH(
Show direction and distance in miles from at leas!
two Slate Roads or County Roads. Include the road
numbers and common road names.
_C
N 0
MC 0
0
t tn)
Ql cn
D yo
rn
nl
ca
r `)
_--
I DO I IEREl3Y C'ERTIFI II IA I.T1 IS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELLcn
°t•"^-"""`�"^" ^•" NI) THAT A COPY OF THIS RECORD I1AS 13EEN PROVIDED TO TI IF WELL OWNER
-Submit the original to the
27699-1636 Thane Nu. (919)
GROU?JR ATEP SECTION
ASHEVILLE REGIO'7AL OFFICE
L-aG-oa-
iNATURE OF PERSONCONSTRUCTING THE WELL DATE
in of Water Qualify, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
I, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N.tural * esour es - Division of Water Quality - Groundwater Section
WELL COST RACTOR(INDIVIDUAL) NAME(print))4- CERTIFICATION# as/69
WELL CONTRACTOR COMPANY NAME/ IVCC. LJe
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
252095
PHONE # (s a 6A? 7.
UM /-
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION/
Nearest Town: (/YDe_
to SS ve /e0/
County,%44t/000
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address 27,5".e urej ice/
,/ tie jr.)(Street or> eer 72
0
City or4own State egg,
Code
( )-
Area code- Phone number`/
4. DATE DRILLED ' '7"002
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lEr
7. STATIC WATER LEVEL Below Top of Casing: 6 .3 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 accordantss--yy'ith 15A NCAC 2C .0118.
9. YIELD (pm): OC METHOD OF TEST_ r r
10. WATER ZONES (depth)-
] I. DISINFECTION: Type /7, .4/" Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From l02 To t-2 3 Ft (o 75/
From To Ft.
From To Ft.
13. GROUT: Depth Material
q
From 0 To r, i) Ft. C PM ev 74
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.
aterial
Method
-Topographic/Land setting
NSRidge ❑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
Frain To F. atio Description
(J /0 F.
/0
war)
Igthafillynty
r •
N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
j33l
TC_
O IV o
a�
1 ▪ n
1 O
no
Z- C �o
W yz
C. CD
N O
2
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
�{ybmjt the original
__7`399 J1636 Phnne Nf
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, -Groundwater Section, 1636 IIail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 252°g4
North Carolina - Department of Environment and Natural Re ourc rs - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME( nQ,ei �% /1a vile CERTIFICATION#
WELL CONTRACTOR COMPANY NAME
rttc Pte// ! Vnp PHONE # 6g1 Oen
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑. If Other, List Use
2. WELL LOCATION:
Nl/wn6 N County
4/
(Slrect Name, Num it's Community, Subdivision, Lot No., Zip Code)
3. �1
OWNER:
%124��7A-y/ A4 .S I /
Address t"7 I[.f'Pi �O
CAN led
(Street or Route No.)
N.C.
City or Town State
Zip Code
( )-
Area code- Phone number ,
4. DATE DRILLED Y /0OQ
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 4-7rrv0
0 ❑
7. STATIC WATER LEVEL Below Top of Casing: o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 011< FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm); a? METHOD OF TESTR-t r
10. WATER ZONES (depth):
Topographic/Landsetting
❑Ridge ❑Slope VIley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Foj'on escription
DEPTH
From To
11. DISINFECTION: Type '-# Amount
12. CASING: Wall Thickness
L� Dept J 2 Ft gtagpccr ory��et/Ft. „jltvliterial`
From ? To P)
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4/37
13. GROUT: Depth Material L Method
From /J To 42,0 Ft. eenie,v#
From To Ft.
14. SCREEN: Depth
Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
c_
0
a
0 "'
on
z_
orn
G
Do
• m�
�m
.1 r
• nn:ay
-4
Cf1 o
16. REMARKS:
z
H€REB��,, EffTIF Thi T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
t NS RUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tO the (vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
CF 'l? PI8 rt(44'(919) 7 3-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILI_C HICK _ _ YrHLE

WELL CONSTRUCTION RECORD 252093
North Carolina - Department of Environment and N tur�all Il}eso rces/- D/)vision of Water Quality - Groundwater Section
,//
WELL CONTRACTOR (INDIVIDUAL) NAME tint) / e,,i 2.07-vt7 e CERTIFICATION # <kW
WELL CONTRACTOR COMPANY NAME %r'ce the// aAvsip PHONE # Id28) 0.z%-Rr?g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑. If Other, List Use
2. WELL LOCAT
Nea fcsyT,
(Street Name, Numbc s, Community, Subdivisi n, Lot No., Zip Code)
3.OWNER:��A >LC/igMjlP
Address ex ict t/ei$ E**Q/se /�
/,J4N/� (StreetiRoute No.)G 99'/4
`/ • City or Town State Zip Code
(_)-
Area code- Phone number
4. DATE DRILLED 7^.j' 0
5. TOTAL DEPTH: a?y'i
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO r
7. STATIC WATER LEVEL Below Top of Casing: /5'2.2 FT.
ll (Use'+" if Above Top of Casing)
8. TOP OF CASING IS (x FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accorda with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST A r
10. WATER ZONES (depth):
1 I. DISINFECTION: Type //r
12. CASING:
÷ Depth Diameter
From OZ To �6 Ft.6 A'
From To FL
From To Ft.
13. GROUT: Depth Material
From © To �0 Ft. reMeN�
From To Ft.
14. SCREEN: Dcpth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑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 F•r at .n Description
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Wcht/Ft. f eria7 numbers and common road names.
�w cQ7
16. REMARKS:
Method
Slot Size Material
in.
in.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
17—ThRetri
I SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (91 733-3221, within 30 days.
GW-1 REV. 07/2001
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252092
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Di
WELL CONTRACTOR (INDIVIDUAL) NAMEEtprr1ins)
/
WELL CONTRACTOR COMPANY NAME / nap We�/ `Y
SLATE WELL CONSTRUCTION PERMIT#
(if applicable)
isio
of Water Quality - Groundwater Section
'7
CERTIFICATION #07/[/6
PHONE # S
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /,
eros
N4ijN �Q
trees N t Numbers, Communiity,Subdivision,
/Tot No., Zip Code)
3. OWNER: Chet (eider/e y
Nearest Town:91, 2✓
County /��t�C1
Address Fj urro n .CU"
(iiN)4 A/
City or Town State Zip Code
( )-
Area code- Phone number")
4. DATE DRILLED y y' 6�
5. TOTAL DEPTH: (90r$
6. DOES WELL REPLACE EXISTING WELL? YES CL NO I
7. STATIC WATER LEVEL Below Top of Casing: 3,5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS DC FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accord a w'th ISA NCAC 2C .0118.
9. YIELD (gpm): 0( METHOD OF TEST /9' 7
10. WATER ZONES (depth):
11. DISINFECTION: Type #%� Amount
12. CASING: Wall Thickness
Depth 7 From fa To /125 Ft. 4.
}0i 'e/ter or Wei hVFt. terial
4
From To Ft.
From To Ft.
(Street or oute No.)
13. GROUT: Depth
From 7) To (90
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
oV7a /
Material
Ft. elei 4 e.ni y�
Ft.
Diameter
Ft. in.
Ft. in.
Method
Slot Size Material
in.
in.
Size Material
From To Ft.
From To Ft.
16. REMARKS:
'S U' O StANDAR
qfpripi
- ��� � F
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(dcgreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For .ati.. Description
0 a20 p
Qo /05'
/05 /-+ 7
02Ocs .r-•v/ 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.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
t
CXI
ZE�F PERSON CONSTRUCTING THE WELL DATE
S bmit the original to the ivisit n of Water Quality;'Croundwater Section, 1636 Mail Service Center - Raleigh, NC
2 pfj�ry CTIOTO iEVOI �V733-3221, within 30 days. GW-I REV. 07/2001
ASHt`. LLE r Hi!1L OFrluE

WELL CONSTRUCTION RLCORI) 25
North Carolina - Depot of I nvironntcnl and N: of W
rural I sour'es - Division ater Quality - Groundwatcr Section �'
\'FILL'°\TIRA(''bOlt (INDIVIDUAL) NAND'.(prim)1CJq-L .G'- 1 (LO �
/, I CERTIFICATION q ��^
7
%\' EI.I. CON ' IRACTOIt CO\ll'.\NY NAND! rice e Jr-.
bvt Alone a (9122£4 1)-116-9tr
.iI All.: \\ L .1. CONS. RCCI ION I'h:li.\I rra
ASSOCIATED \vQ ree\u ra (U ippllcablc)
(il'applicahle)
I. WELL USE; (Chock Applicable Box): Residential V Municipal/puhhc 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Ileat I'unlp Water Injection 0 Other ❑ IfOlhcr, List Use
2. WELL LOCATION:
Nearest 'Eq`vn: County
(Street Name. N ;i' b<rsC on11111 N. Bumf vI ion. Lot No_ Zip Code)
3. 0 \VNI:I2: cJ �7/11'
/J SLrs
Address L �_/O�-GKla �.i e—
Mp} _ --
(Slreel r nneNJ.l
7 .
lap Code
City or 'leer Slam
•—
Arca c,xlc- Phone nambca
-I. DATE DRILLED -27 pa_
5. TOTAL. DEPTH: /3 Cl t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top ofCasing: /0 FT.
^2 ( Use "+" i )Above'I-op of Casing)
S. TOP 01'CASING IS o� FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord:u¢c a'Ih 15A iN'CAC 2C .0118.
9. YIELD (g m): r
P METHOD OF TEST/Qi/-
10. WATER ZONES (depth): --
11. DISINFECTION:'hypc--,i7 — Amount
12. CASING: Wall Thickness
IJcptl D a n'ter or \\'c eht/FI. Material
From --lo 9 Et. e�y ;/sc 5Llee/
From To Ft.
From :To PI.
13. GROUT: Depth Material Method
I -non 0 To ao Ft. ?e,v/-
From To P(.
14. SCREEN: Depth Diauteter
I:rou)— to Ft
in
From To
15. SAND/(TRAVEL PACK:
Depth Size
From To
Front---- To
16. RI NIAR KS:
7Z� MA )
I d-3pO �Iry(Illtlk�l 6IG77
'�II'6I rqq
{ t<C1CtItJN STnNDm
Slot Size Nlaicri::l
in.
\ laic riuI
TopographiciLand setting
❑Ridge ❑Slope DValley IIt
(check appropriate km)
Latilude/longitude of well location
( degrccslminoles/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For ali ) Ucscription
DEI'TI1
hem To
020
LOCATION SKF:ECH
Show direction and distance in miles from al least
hvo State Roads or County !toads. Include the road
nunnbers and common road names.
#/gtsV
11S WELL WAS CONSTRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL
ND 1IIAT.A COPY OF THIS RECORD FIAS BEEN PROVIDED TOME WELL OWNER
t.I_ fl oa
G iN'ATURE OF PERSON CONSTRUCTING 'TIE WELL. DATE
UtiTn�l 'n-ttriF.- Diviion of VA'ater Quality, Groundwater Section, 1636 Mail Scrvicc Center - Raleigh, NC
Ae�7109plgo(pl gpn(NOy .�)Tiq 7t3-3 22I, i vv't It 30 d.n s. Ci AV -I REV. 07/2001

WELL CONSTRUCTION RECORD
25'2090
North Carolina - Deparnnen( of Environment and Natural Resources/ur- ivision of Water Quality - Groundwater Section
WEI.L COSrR:\CTOIt (INIIV IDEAL) NASlE trim, Doc)" -I g ryrd �I e) CEItTt1•.ICA�TION//#`��-�l�O7 �/
\\ El I. CON I RAC OR (O\II'ANV NAND.: Ike Well t -et. / PHONE # I rv) r0°r%-TPA 7p
S (All( \\ EI.I. CONS.' RUCTION PERMIT# ASSOCIATED WQ I'ER\IIT#
til npplieuble)
or applicable)
I. \VI'.I-L USE (Check Applicable Box): Residential EY-Munieipat/Public ❑ Industrial El Agricultural El
i\lonitoring ❑ Reeovery 0 I leaf Pump Water Injection 0 Other a If Other, List Use
2. WELL LOCATION:
Nearest Town: L\I? $/A/e-il/IJ P Courtly
AiedS/',vP t/
(Street Name. No.:thers, Community, SuhJicision, Lot No.. Zip Code)
3. OWNER:
Address
(
;/121
J%rSt . .S_L btu
(street rn R ie Nt.l
_ej frora-•
City or Town
State
_r3Vi1z
Zip Code
Area code- ('hone numbe/r/
4. DATE DRILLED y-'� O-2
5. TOTAL DEPTH: /yamTT-
6 . DOES WELL REPLACE EXISTING WELL? YES 0 NO IY
7. STATIC WATER LEVEL Below Top o[Casine:
,Use " 4" i f Above "Fop of Casing)
8. TOP OF CASING IS P'f. Above Land Surface*
`Top nrcasing terminated at/ur hetuw land surface requires a
variance in accordance ssith I5.k NCAC 2C .r1118.
9. YIELD (gpm): c?O METHOD OF'II ST ,V'
10. WATER ZONES (depth):
11. DISINFECTION: Type __/./24 Amount
12. CASING: Wall Thickness
Depth Dapper or Weight/ID MI aerial
From *O2 To Y' - H. 6 /i� •/fl 3/
From
From
13. GROUT: I gr3^'rMaterial L Method
(� Prom 0 e^/7
/Topographic/Land setting
Ridge ❑Slope ❑Valley ❑flat
(check appropriate hox)
Latitude/longitude or well locution
(degrees/minutes/seconds)
Lillilude/longitude source:❑CPS❑ lopographic map
(dock box)
MT]] I 1)R ((.LING IA)(
From "fo Port iati n Description
a ? C%4)
To
To
Depth
To 490 Ft.
From To
14. SCREEN: Depth Diameter
Prom To
From To Pt. in.
15. SAND/GRAVEL. PACK:
Depth
Prom To
rein To
Slut Size Nlatertal
in.
in.
LOCATION SKIITCI I
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
N
c
—o
Size Material
W
16. RENIAItKS:
1 DO IIERLIIY CERTIFY tITATIIITS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRVC110 ANDARD_ AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSIIZT}cNNG THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. — GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

252.1/89
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Re ourcesDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) OAS Q 4It/ CERTIFICATION #42,p6�7p
WELL CONTRACTOR COMPANY NAME / %t`i WP//a / U/",O PHONE # aty-a° / t
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential fKMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection d Other O If Other, List Use
2. WELL LOC
ATIO
N arcs[ Tow+�"Il� Countyy ore
(Street Name. Numbe , Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Aa`7c Nei
( tree or Route No.)
/h V-Ile At(c2C7S-/
COS, or Town State Zip Code
( )-
Area code- Phone number,
4. DATE DRILLED y/� O a
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DA
7. STATIC WATER LEVEL Below Top of Casing: *75— 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): o26.— METHOD OF TEST /4f%
10. WATER ZONES (depth):
11 DISINFECTION: Type / // Amount
12. CASING: Wall Thickness
�, Depth Diameter or Weight/Fr. Mpteria,
From OZ, To 7g Ft. (p /Ai
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth A Material
To 02O Ft..PMP✓
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
L�3'�2idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To F.Hpatign Description
.o
Method
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
N
—co
CFI
W
IR
IS too RLCBTI�ON ISTA
LL{{PJ}0the original to th
GriOASHEVILLE REGIONAL eaOFFI E()19)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
', AND THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER ON CON
14
ING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

7u9')-I (nROUdmm'ohI 9tvFF4 )771 w
ASHEVII_F REGIONAL `(Frldt
WELL CONSTRUCTION RECORD
North Carolina - Ucparlmall of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\EI.I. CONTRACTOR (INDIVIDUAL) NAME (print)_ _.__Be-✓//� 074
,/� P CERTIFICATION W (�
\\EI.1.COY' It.\f"I ORCONIPA.N\" NAND'./ )t` 1ile,/iwl7c ruO:NE s (f45 7-eS'7S
SATE WELL CONS.' RUCTION PERMIT/1 ASSOCIATED \VQ I'ER\IITN
Or applicable) (i _/ Fappl icahle)
I. WELL USE (Check Applicable Box): Residential IIG i\7unieipal/Public 0 Industrial ❑ Agricultural 0
Moniloing 0 Recovery 0 Heat Pump Water Injection 0 Other IfOlher, List Use
2, WeLL. LOCATIONJ: �/
N• 1est Town:�av v TD � ('ouuly/ 491.-VOcr C✓
per-C (1.ve /%%%
ISlrc.l Name. Numbers. Cnmmuoiuy. Subdivision. Lot No.. hip Code)
7 /
3. OWNIiI(: `,,44,-1
Address S ,
(Snecl or Rowe No.)
.4N N ,ALE• 026// L_
C itv or Torn Slide
lip Code
Area C'kle- nhunc mm�brr
5. DATE DRILLED .z
5. TOTAL DEPTH: ->•-
G. DOES WELL REPLACE EXISTING WELL? YES NO LY
7. STAVE WATER LEVEL I3elnw Top or Casing: PT,
Use "+'•1I Above Top ofCasing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top or casing terminated al/ur below land surface requires a
variance in accordance ssilb IA\ NCAC 2C .0118.
9. YIELD (gpin): 3 METI IOD OF TEST a'r
10. WATER ZONES (depth):
252g88
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Iu
(cheek appropriate box)
Latitude/longitude of well location
(degrees'm inn icr'seconds)
La lilude/longitude source:❑GPS❑Topouraphic map
fchcck box)
DEPTII DRII.1.ING LOG
From To F �/rr ialion Description
,b /W
/�/O "eve
?n vyr
I I. DISINFECTION. Type // / Amount
12. CASING: Wall Thickness
t Depth Di)�.er or eiebt/Ill.
Prmn �oC To jjQ 1=t. (O e 5/eel
From To FI.
From To PI.
13. GROUT: Depth Material ,[ ;Method
From 0Toe.r/
From To
14, SCREEN: Dcpth
From -co
From To
15. SAND/GRAVEI. PACK:
Deplll Size iALucrial
From To
rrom To
IJiamcler Slul Size Malcriul
in. in.
in. in.
16. RENIARKS:
LOCATION SKE"ICI-I
Show direction and distance in miles From :It lead
two State Roads or County Roads. Include the road
numbers and common road names.
1171
O
N
--c
t
ch
—O
ca
Ell
IIG 210 CI.4211111(') I.A''r!Ii
i Ualf`1014-STANISAI - l2I)
iLL WAS CONSTRUCTED IN ACCORDANCE WIT] 115A NCAC 2C, WELL
I TAT A COPY DE THIS RECORD HAS 13EEN PROVIDED TO THE WELL OWNER
THE WELL DATE
I built the to the Uici 'on o Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
thin 31)CiW-I REV. 07/2001
'URE OF PERSON CONSTR C
D
c)
CC'
rn
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or
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mCD
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252081
13
14
15
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - ivision of Water Quality - Groundwater Section
'//
CERTIFICATION N L2j4 /
FI IONE a /na?%' $,t`ig'
\\-ELI. CON'f lt.\CWOIt (I\ DI\'IDEAL) N:\:\IE (print) DAB✓ [�G'vi-/ey
t to Lf)elbtAi p
w ELI. CON' U.\("IOR CO\I I•.. N\ NAME
s r,crr: \1 E1.1. ('ONSTTtt. Cr ION FEIt\IIT# ASSOCIATED WQ FERN'ITN
(il'applie:1111c) (ifappiicablc)
1. AVEI.I. USE Wheel, Applicable Box): Residential E (Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 I leat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL I..00AlION.
Nearest Town: e/ i i2 County
;�✓e.�/'r e
(Street Name. Ntnnbels. Community. Suhdic isiun Lot No.. Zip Code)
3. OWNER: der
Address ,32Q ) (We r7e/ %?I/
Sucel nr Rome No
9€7o2
Cuy or Io,vn Slate /ip Code
( )-
Area code- Phone number.,
4. DATE DRILLED 7Q—O°2
5. TOTAL DEPTH: /SSP'
G. DOES WELL REPLACE EXISTING WELL? YES
loand
NO L5�
7. STATIC WATER LEVEL Below Top of Casing: r FT.
(use",- it Above Top or 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 (pm): /0 METHOD OETESTfie
10. WATER ZONES (depth):
I1. UISINFEC
12. CASING:
�d From
From
From
GROUT:
From 0
From
Topographic/Land setting
:Ridge ❑Slope Le/alley Dial
(check appropriate hos)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sourec:❑GPSDTopographie map
rcheck hox)
DRILLING LOG
Pon )ativ I Description
DEPTII
From To
0 o20
Rx)
/AS
"I ION: Type Amount
Wall Thickness
De th'/ tiiin t•r or Nei hdFl j.
To 76 Ft. �y -,` J
To FI.
To 1'I.
Dept, Material
To o?O rt..(-.E'^t�"�
fo
SCREEN: Depth
From To
From To
SAND/GRAVEL PACK:
Depth Size
From To Ft.
4rj
LOCATION SKI:AT I I
Show direction and distance in miles Irons at least
two State Roads or County Roads. Include the road
nlcri;t), numbers and common road names.
e L
/31.) 3
,\iethud
Diameter Slot Size Material
n. u.
.N lalcrial
From 'l tl Ft.
IG. RENIARKS:
0
N
a4
-44
01
"O
01
din rQ'lilt i hII 11 M'41. T(41SI _ WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
L€-1 IGt STANf)4 1bTT IrjT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
±v - 03,
SIGN/ T UIE OF PERSON CONSTRUCTING iY�6ELL DATE
St1 null 1 u 011"n1l1I to jilliviei d of VV i(er Quality, Groundwater Section, 1636 N7ail Service Center - Raleigh, NC
27(99-161h(VIhoneN11.('N\J) CiIiG41� vrilhiln30da)s. w GW-I REV.07/2001
.1`UvI OF1lA i

252086
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Rsources - Division or Water Quality - Groundwater Seelio'nn[�/ /y�"
' / CERTIFICATION/#"251�-/p
\\'EL.I. CONTRACTOR COMPANY NAME �f,ee tell/%g:qa PHONE # (olrp) 6.2T SS9t
STATE: \\l:l.l. CONS.' I(1 ('IION PERMIT)/
(ilappliedble)
\\'EI.I. CON'IRACHM (INII\IDI AI.I NAME print) A / F- a>v/`e
ASSOCIATED AA'Q I'ERVIIT#
(i(applicahlc)
I. WELL USE (Check Applicable Box): Residential Pr—Municipal/Public 0 Induslrlal 0 Agricultural 0
Monitoring ❑ Ream cry 0 Beat Pump Water Injection ❑ Other 0 IIOther, List Use
2. WELL LOCAII ON:
Nearest Town:_ County cF Wan"
yC�c� OiFL'
(Sheet Name. Nurnbcrs. Cummlimity, SubrInikion, Lot No., Zap Code)
70� N
Llyoe (Sheet „^ko1(,.,1 ag��
City or'fo,vn Siatc Zip Code
Area rode- ('hone numhc//
4. DATE DRILLED 7"r2r:7-0.-F
5. TOTAL DEPTH: ...Oy1/2-17—
6. DOGS WELL REPLACE EXISTING WELL? YES VNO 0
7. STATIC WATER LEVEL Below Top o!Casine: FT.
1 Usc -4 - if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
•'I iq1 or casing terminated al/or below land surface requires a
variance in accordance with 15.\ NCAC 2C .0118.
9. YIELD (gpm): 3o METHOD OF TEST Ate!
10. WATER ZONES (depth):
11. DISINFECTION. Typer/9' Amount
12. CASING: Wall Thickness
Depth Di/meter or Wci ghUPt. M'ttcrial
From t02 To_SO? FI.�J/V ,/fk. See/
From To PI.
From To 1`I.
13. GROUT: DepthMaterial y Nlethod
From 0 To . ee--Le,/7
From To FI.
Id. SCREEN: Depth I)i:uneter Slot Size NLucri:d
From To EI. in. in.
From To ht in. in.
I5. SANDICGRAVIi1. PACK:
Oepdt Size ;Nhacrial
Firm) To
Front fo
16. ILEIIARKS:
Topo�gr,ap�hic/Land setting -
❑Ridge L SSIope ❑Valley ❑Flat
(shuck appropriate box)
Latitude/longitude olAvcII Iocanon
l dcgrces'min mcs/seconds)
LotiRtde/lungi(ucic source:❑GI S❑Topograph is neap
(check box)
Ulil'"fll DRILLING LOG
1'1.0111 To
0 ao
y /os
/os 3V..5"
I; 0 tioy Description
LOCATION SKETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names.
/363
FY-TlyittlTill-�� I. WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
((�' I I(ilN S`t`ANthAI JS[AN7ll� T A COPY OF THIS RECORD HAS BEEN PROVIDED TO TRIG WELL OWNER
CII
SIGd.11.1. OF PERSON CONSTRUCTING TFIL WELL. DATE
Sun mil he original lu the Divisi4 of \\ aler Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27 99-16' C (4111W1NthMITPPST-t31413111, with n 30 (lays.
GW-I REV.07/2001
ASFEV'll_'." `L310NAL OFFICE
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WELL CONSTRUCTION RECORI)
North Carolina - Depvamenl orEnvironment and Natural Resources - Division of Water Quality
\\'EI.L ('(1NI It O. TOR (INDIVIDUAL) NA.\I! (print) �l •� � {�FL'(1J!1'p
\\-k.l. CON 'II( :\(I'OR ('o.\lI \\\ NAME: bite_ the )LV-P1,v\ /J
SIAIE \\ r.i.l, (. ONS:RUCTION i'ER.\IIT4 ASSOCI:\TED \rQ 1'ER.\IITN
(il' appl ieahlel lit applicable)
25.2085
- Groundwater Section CERTIFICATION H .9s/b/c
�/-
PIIONE # JP6) 77-Sv le
I. WE?L1. USE (Cheek Applicable 13ox): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
(Monitoring 0 Recovery 0 !Teat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
NSalcst Town:
1 /d
eul Nunn:. kwnhcrs Connnunity. Subdivision- 1-
3. OWNER: ji(l Baum,
Address .3' i0 ./'.quip 001e
(Shoot to Itur No 1
WAY/U&SVJWe 4.7C Ca)g78
( lyur limo 9fnc
)-
Area axle- Name numb,:.
4. DATE DRILLED c-Od2
hip Code
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EiK-
7. STATIC WATER LEVEL Below Top of Casing: V. ET.
(Use "+" if Above lop or Casing)
S. TOP OF CASING IS PT. Above Land Surface*
'Top of cuing terminated al/or below lain surface requires a
variance in accordancec illi 15:\ NCAC 2C .0118.
9. YIELD (gpm): %"/ METHOD OF TEST ftr 1/4/".--
10. WATER ZONES (depth):
_ 5-
.�,Topographic/Land setting
IVJ12RIge ❑Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
I,nlihidallongiludc sourcc:❑GpS❑Togo graphic map
(check box)
DLPTI-I DRILLING LOG
I ins To Fo n alim9 Description
O 420 Cif r'
(A2o s)
n2or5
LOCATION SKETCH
11. DISINFECTION: "1_ype irAmount Show direction and distance in miles from al least
12. CASING: Wall Thickness two State Roads or County Roacls. Include the road
iruer or Weight/IT. M'verial numbers and common road names.
Method
14 SCRIiEN: Depth Diameter Slot Size Material
From To I1 in. in.
From To Pt. in. in.
15. SANI),'C;RAVEL PACK:
Depth Size Material
From To
From To
16. REMARKS.
L 11I01.iLVC Rl�l'
CST
A 1 f i' WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�• DTIIAT.A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f
S6 limit Iho wig' li`Sit
27(<r1fidliWRWI`Ihifm'3N4V( Or�QQ'l7711-122
A HE\H'L AL0 IGE
4-aQ-oar
NATURIS OF PERSON CONSTRUCTING TIII'. WELL DATE
n of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I, within 31) days. `� GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J,rt ,�..x�, 6
WELL CON'fRAcTOR COMPANY NAME 1%‘e toe/At ji/y/� PHONE # t/1'(p27-t5V
STATE WELL CONSTRUCTION PER;\1ITd ASSOCIATED WQ PERd1IT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential L0' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
VWELL. LOCATI N:
Near5st Town:: a'✓ /
Pi 'Veal J )k
f Str&f Name. Numbers. Community. Subdivisioi
3. OWNER:
Address
re✓
CountyUit'(cc/
Lot No.. Zip Code)
J ,/ (St etor Route No.)
Ci4N/DN t-
City or Town State
Zip Code
)-
Area code- Phone number
4. DATE DRILLED Q c?5 0 a
5. TOTAL DEPTH: A?o(.5'
6
7
Topographic/Land setting
❑Ridge ❑Slope 1Iley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Flom To Fo ma 'on Description
a0
/0 7
DOES WELL REPLACE EXISTING WELL? YES 0 NO L9�
STATIC WATER LEVEL Below Top of Casing: .Z? FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordann with 15A NCAC 2C .0118.
9. YIELD (gpm): ! METHOD OF TEST A -[
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.
86 /o7
0)&5 �l,d il., i<e
11 DISINFECTION: Type 757 Amount
12. CASING: Wall Thickness
o' \4'giyht/Ft. Site
Depth,,,
To
From }OZ Ft. 4:2 t�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To (9D Ft. _ _ Me--✓_
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To F1. r in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
-F"
0
cc
ri
0
16. REMARKS:
I DO HEREBY CERTIFY TF
CONSTRUCTION STANDA
c?�2 ✓J IGNR't'JREtOF ItbN C
g
FS W^, .LA�{ Ca/pSI�U
AND '/'T n np ns�7
248318
d(;/NJ,pturalll,Reso rocs/- Divisionsiof Water Quality - Groundwater Section' / �}
/7 l'� "` kAT t)//7 e CERTIFICATION# 244
N ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
a as-- O,),
Submit the original to the Divl La-et-VVaU�tfe�Tr� $a^1;ty 'ound vater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-t�� 3 LIC 'ta E'GI If1A OFFICE GW-I REV. 07/2001
CUCTING THE WELL DATE

I I. DISINFECTION: Type j9 774t Amount
12. CASING: Wall Thickness
From %poi To c79 Ft. Depth Diameter or Weight/Ft. aterial
% 4/ � ,%rC
From To Ft.
From To Ft.
13. GROUT: Depth Material t Method
From 0 To di0 Ft. CL^'FP.—r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
FromTo Ft. ( in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY
CONSTRUCTION STAN
2
IS *YE Li.W
, AND THAT A COPY OF
IGNATURE OF PERSON CONS
248319
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tura� Resources - Division of Water Quality - Groundwater Section ('�
\\'ELL CONTRACTOR (INDIVIDUAL) \'AME jprint) �'f' /ct¢�I/� Fr �'" CERTIFICATIONp t7A
\\'ELI.CON'I'12:\C' OR CO\IPANI'N.UIE r'Ce �✓e//%� �,/`' PHONE # 06q7.8sye
STATE WELL co:swi UC'TION 1'ER?(ITN
ASSOCIATED WQ PERMIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential'Q"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
Sed#49M
•
N
•
County
(Street Name. Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: fl�l.i�� l (iQ
py
Address .359 .5CO Da e
(y N 4 (Street or Route No.) 7/�
1/ ,/4:J N
City or Town State
( )-
Zip Code
Area code- Phone number
4. DATE DRILLED 07'a60"Z
5. TOTAL DEPTH: /c?S—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LW.
7. STATIC WATER LEVEL Below Top of Casing: 33 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS OK FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST4'"
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
❑Ridge 2Sclope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To For atio Description
0 b
Nal
41g /as
rw4//C
m/to
lld
O
N
1
„{7
1
-o
O
IN ACCORDANCE WITH I5A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
RUCTING THE WELL DATE
Submit the original to t e DivilMigollAWthi-FITaalltlANGroun water Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (91') 733R0$6 Utz1t hic0 10E GW-I REV. 07/2001
L
c

248320
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources 1- Division of Water Quality - Groundwater Section / Q
WELL CONTRACTOR (INDIVIDUAL) NA I (print) Re.4.� �A`f'U'/�� CERTIFICATION`` #.,�C2 4
WELT. CONTRACTOR COMPANYNA\IE rxe We ll{'Pun'p PHONE # 6.is)l�2'
STATE \VELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PER\IIT#
Of applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
crest Town:
('ou ere
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: c_ce_O 4blii7A"
Address `i O$ CIreie Dr
direct ot9 to Na)
/ehik-CA=vJrl/e S. o?ysss
City or "I State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED "Q5 002
5. TOTAL DEPTH: 315'5 +t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO MI7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*'fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): aMETFIOD OF TEST/¢/ ?
10. WATER ZONES (depth):
11 DISINFECTION: Typilik---We
12. CASING:
Countylrq} ci d
Topographic/Land setting
Cr'fRidge ❑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
0
/v
07
7/
To
/0
3F5
Fo m do Description
vG
e
Amount
Wall Thickness
,.2, Depth Diameter or Weight/Ft. M terinl
From / a2 To 02 Ft. 6, /V 139fG
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 4/20 Ft. t ea4e,71
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. i 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 (east
two State Roads or County Roads. Include the road
numbers and common road names.
i3 3
O
O
16. REMARKS:
I DO HEREBY CFI
CONSTRUCTION
CTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ONSTRUCTING THE WELL
DATE
Submit the origit al to It a Division of �V'ater Qm ity, 1 roundwater Section, 1636 Mail Service Center - Raleigh, INC
27699-1636 Phone. 'o. (919¢9e3$lAll$NAPNa•Ili
ASHEVILLE REGIONAL OFFICE
GW-1 REV. 07/2001
0

Duality • Groundwater Section
248321
North Carolina • Depanment of Environment and Natural Resources • Division of Water
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
prze_ Well* R,/'
WELL CONTRACTOR CERTIFICATION #:9y6
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential Er —Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI N: (Shpw sketch of the location below)
Nea est Town: 041- St A/ County )/L14,c
ertsord
(Road Name aJdrd_ N ers. Co it orr$ubtlivision nd Lot No.)DRILLING LOG DEPTH
3. OWNER /QlO/ eFy' /OW-,,// / From o• Description
Address / 4— Co v.v-/lV 29 VC/t1 !•. N .
(Street or Route o.) n2t)
City or Town SI a ZipCode
4, DATE DRILLED O /�
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES El NO in
7. DOES WELL REPLACE EXISTING WELL? YES [l NO(cr
8. STATIC WATER LEVEL Below Top of Casing: / FT.
To
//5
(Use': it Above Top of Casing)
9. FT. Above Land Surface'
'Top of casing terminated ul/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 16
10. YIELD (gpm)• 3' METHOD OF TEST ar
11. WATER ZONES (depth)•
TOP OF CASING IS (12
12. CHLORINATION: Type f / %# Amount
13. CASING:
Fo ati
ra
•HAP
II additional space is needed use back of form
rp� Wall Thickness
From �� Depth
//-' FI D %�r or Wgigyt. Ada riai/
1CS5 c7
From To FI.
From To FI.
14. GROUT:
Dept ��,weiMaterial t Method
From To (4© Ft 7
From To FI
15. SCREEN:
Depth
From To
From To
From To
Ft
Ft
FI
16. SAND/GRAVEL PACK:
Depth
From To
From
17. REMARKS:
Diameter Slot Size Material
1 in
in in
in in
Size Material
Ft
To Ft.
LOCATION SKETCH
(Show direction and distance from at least two Stale
Roads, or other map reference points)
I DO HERE!
CONSTRUC
R CE WITH 15A NCAC 2C, WELL
110 StTN RC79,Hjr;DI��LL GO OF THIIS RDECORD HAS IN OBEEN N1'ROVIDED TO THE WELL OWNER.
FOR OFFICE
Quad No:
Serial No.
S ONLY
MAY
1 5 2002
Submit
CNATURE OF PERSON CONSTRUCTINGHE�WELL DATE
•ngininal to Division of Water Duality. Groundwater Section within 30 days
GW.t REV. 12/99
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina Department of Environment and Natural Resources Division of Water Quality • Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• / r e (4//�¢y/vmt
WELL CONTRACTOR CERTIFICATION it: C2#'
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er -Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
Recovery [fl Heat Pump Water Injection ❑ Other ❑ IT Other, List Use:
2. WELL LOCATIO : (Show sketch of the location below)
Nearest Town: 4--1 io n/ County. 4/Gtibae�"/
L a,Y� 109,4N ,e,/
(Road Name and NiAbus,pommunit or Subdivision and Lot No.) DRILLING LOG
3. OWNER , I /lpr q
6 .' From To Forma
n / Q //
From
From
17.
C
FO
Ou:
Ser
Not
at No
Address 3960 _eae 29,,,,
/ (Street or Route No.)
A,Y0.-✓ 7v C.
City or Town Stale
4. DATE DRILLED -/" D_Z.
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOn
7. DOES WELL REPLACE EXISTING WELL? YES� NO('
6. STATIC WATER LEVEL Below Top of Casing: -GL0 FT.
(Use'+' it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor.
dance with 15A NCAC 2C .01
10. YIELD (gpm) 'Y METHOD OF TEST /26
dirt
11. WATER ZONES (depth)-
.11
Zip Code n.4C
ncJ
12. CHLORINATION: Type
13. CASING:
//7771
Amount
248322
DEPTH
on
4 rd
jar
a
scnplton
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
,1 Depth D/ia r or Wei V I. enal (Show direction and distance from at least two Stale
From /� To gO Ft -(C'�y x�� i°P
Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
/� Dept /� Material Method
From I / To t-(i Ft ( tUO"e-"v�
From To Ft
15. SCREEN:
Depth Diameter 'Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth
To Ft
To Ft
ClTI
ilC&KCERTIFY TI IAT Tt 112
RUCTION STANDARDS, AN
Size Material
CEkta dNtY 2CC
2
GROUNDWATER.SE
ILLt
ASHVAL
TION
OFFICE
AhA soR'
0
TV C
3
0
VE t WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
T COPY OF THIS RECORD HAS BEEN ROVIDED TO THE WELL OWNER.
® \ awJ+3•L�a
SIGNATURE OF PERSON CONSTRUCTING H WELL DATE
Submit original to Division of Water (Duality. Groundwater Section within 30 days
GW1 REV. 12/99

248323
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTItAC1 OR (INDIVIDUAL) NANlE (print) Qfi^' 4Ge,v71 e/ CERTIFICATION #O?V 7
i t ee wed se-tov r PHONE # (i7`6) b.2 J' b i $
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER)IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lire—Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest" own: (1e9'Oo AC,
r. t/ ern
(Street Name. Numbers. Community,' Subdivision, Lot No-. Zip Code)
3. OWNER:Oe../ We//S. / /
Address C/ J JJ 24r �ral'.C�r /ec
(Street or Route No.)
Coun tyy4TIPOY/
t 2 7/'
(_city pg7n_ 5' 4i Zip Code
Area code- Phone number
4. DATE DRILLED ?`/2`/O2
5. TOTAL DEPTH: /02.-Y'
6. DOES WELL REPLACE EXISTING WELL? YES lH' NO 0
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): .0)O METHOD OF TEST Ai -C—
IO. WATER ZONES (depth):
I I. DISINFECTION: Type /41 T/q
12. CASING:
Depth Di��eter
nt Fro�Jy FL
Front To Ft.
From To Ft.
13. GROUT: Depth
From 0 To oQU Ft.
Amount
Wall Thickness
or ggr t5 e %
ti
aterial L
ente,v
Front 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.
Topo�gr�aa hic/Land setting
❑Ridge MSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshainutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For rgati9n Description
rr9C)
av 617
67
$/ /a
Method
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
Ow iio
rfl
r. =o
0
0
16.REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a-1a-Oa
SIGN
ATURE O SON CONSTRUCTING THE WELL DATE
Submit the original t the Qivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GR® r 'FF8ERMOi (9 9) 733-322I, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

(9573l
Zip Code
6t28)- 5W(O 3&77
Area code- Phone numbeL
4. DATE DRILLED -/Q'et)
o?
5. TOTAL DEPTH: ? :11'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS C2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): /5- METHOD OF TEST /ter—
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.
WELL CONSTRUCTION RECORD
248324
North Carolina - Department of Environment and Natural Resources - ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �4i'ard Sr'!✓//C CERTIFICATION
N#�0/(�b7
WELL CO.T R:\CTOR COMPANY NAME/04Th{ ✓ r/Ae' ✓.n PRONE # i32$) 627- ./7
STATE \\'EI.h CONSTRUCTION PEI2\IIT# ASSOCIATED WQ PER\IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION�:/ /
Nearest Town: eiyiUeSv/�/e County, fi�lttiocy
44>Lurc A.N.
(Sticet Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: i T pp
Address /,3 ta" 4'n' e •
(Sin) or Route No.)
J»A/vef ICY/'f' 4 e.
get,
or Town State
I I. DISINFECTION: Type
12. CASING:
Topogrvhic/Land setting
DRidge Iclope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For ra n Description
877/
Depth
From+a To la Ft.
From To Ft.
From To Ft.
I3. GROUT: Depth
From tel
From
Material
To pZO Ft. eQ.4we,..-,—
To FL
Amount
Wall Thickness
ora Weight/Ft. �Vfa at
14. SCREEN: Depth Diameter
From To Ft. " in.
From To Ft. in.
Method
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
/3S
0
IV
0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0
:SON CONSTRUCTING THE WELL
DATE
01_lo€w9mo the Division of Water Quality, Groundwater Section, 1636 Mail Service Ccntcr- Raleigh, NC
ASH V L AIOh)FVLe°KIC89) 733-3221, within 30 days. GW-I REV. 07/2001
0

North Carolina • Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mad Service Center - Raleigh. N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 6nce weII g ruche
WELL CONTRACTOR CERTIFICATION #: c?V(p 7/
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential 12 Municipal [l Industrial ❑ - Agricultural ❑ Monitoring ❑ Recovery [l Heat Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) /
Nest Town: (r ry County.�Z116(/pt)/y
/96I c "re e/('Yet/
(Road Name agd umbers. Community. or Subdivision and Lot No.) DRILLING LOG
3. OWNERe 11 -
Address V
// /1 �% /62
From -1To
,/ ( ueet or /Oehoa
r27
27 Co
€ 3f'S
City or Town
State
4. DATE DRILLED 07/47`0477
5. TOTAL DEPTH 36 f f
6. CUTTINGS COLLECTED YES n NOfl
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: 3 FT.
Zip Code
248325
DEPTH
Fo ation Descnption
9N
S „z
(Use'.' it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C 0118
10. YIELD (gem).L7 METHOD OF TEST 4 rrr
11. WATER ZONES (depth) /t�.}/T
12. CHLORINATION: Type / r / Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
401 Depth 1' Dia%�titer or Weight/Ft. a vial (Show direction and distance from at least two State
FromTo " Ft. 6 , ' Roads, or other map reference points)
From To Ft.
From To Ft 1# R I/ /
14. GROUT:
Depth /��1 Material 2_ Method
From 0 To �0 Ft (e"eiv7
From To Ft
15. SCREEN:
Depth Diameter 'Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
7.REMARKS:
i WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
rN)
O
ED- I
SIGNATURE OF PEN CONSTRUCTING THE WELL DATED
Submit original to Division of Water Quality. Groundwater Section within 30 days
GW-1 REV. 12r99

WELL CONSTRUCTION RECORD
248326
North Carolina - Department of Environment and N tural esources - Division of Water Quality - Groundwater Section/ �}
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2 isaluipe- CERTIFICAA'TION/I Qr69
WELL CONTRACTOR COMPANY NA ME�l'te live// v— t✓/M� PHONE # (pat46G/ r5 /o
STATk: WELL CO.NST RUCTION 0E12811E8
ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public ❑ industrial ❑ Agricultural ❑
tNlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Neal •st T wn:
5 ow
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: /� tC (t,,f D CANie C
�/ (Street or ioute No.)
FA. 33770
Address Y y- J e/eArweiler- sr6 r� Dr
I I. DISINFECTION: Type
12. CASING:
Depth
From •tcZ To oZ1
From To
From To Ft.
13. GROUT: Depth /� Material
From 0 To FL CP""PAiY-
From To Et.
14. SCREEN: Depth Diameter
From To Ft. ' in.
From To Ft. in.
/` ran
Countyilieeed/
Cit r Town State Zip Code
(7a7)- s$ii 'L13/7
Area code- Phone number
4. DATE DRILLED a'a0_ 0 o7
5. TOTAL DEPTH: S05-(f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ni
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS (R. FT. Above Land Surface*
*Tup of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /9 „
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
QRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
F. atio Description
DEPTH
From To
/0
//TM
Ft.
Ft.
Dian etcr
Amount
Wall Thickness
or Weight/Ft M terial
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Size Material
16. REMARKS:
4/gig
(ll`i�l (ONE `. A
tid
MAY 1 5 2002
Submit the original to th Did
-1
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-ao-OD
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Ccntcr- Raleigh, NC
26R41bh AVIIERIlSC4Oil8 0 733-32
ASHEVILLE REGIONAL OFFICE
21, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
257303
North Carolina - Department of Environment and Natural L�Vr± Resources - Division of Water Quality - Groundwater Section //
WELL CONTRACTOR (INDIVIDUAL) NAM (print) �/'G( $rzcr�
CERTIFICATION A 'f'
PHONE k O A 4 - 3/ �D
ASSOCIATED WQ PERM!TA
Of applicable)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
1
(if applicable)
/Et
/4402
WELL USE (Check Applicable Box): Residential Municipal' Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 I (Other, List Use
2. WELL LOCATION,
e est,Tof n:____
l// // CS 'O
(Street Name, m ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i .L'L - -- -
n /(t& Pm , - ei &n„Ai
Address is
(Street or R eNo.)
alga-)
C y or Too/4 State Zip Cale
(—)-
Area code- Phone number - .�s , D�
4 DATE DRILLED G
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
5. TOTAL DEPTH: —12S�
ubmit the original to the
919
GROUNDWATER SECTION
ASHEViLLE REGIONAL OFFICE
-d
7. STATIC WATER LEVEL Below Top of Casing: % 00 FT.
(Use ••+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 D METHOD OF TEST
10. WATER ZONES (depth): GIPS —
11. DISINFECTION: Type
12. CASING:
Depth
From D To 1 I 1 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth atonal
From To .2/7 Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Diameter
tt
16. REMARKS:
Top�o}raphic/Land setting
❑Ridce Slope ❑Valley ❑Flat
check ;tppropriatc box)
Lmitudc'longitude of well location
Lant dt;lun_aitude suuree:OGPSOTopographic map
(check box)
DRILLING LOG
Fot nption DescSiption
DEPTH
From To
0 I17
►►7r ass.
/ )rs
Amount .�
Wall Thickness
or Weight/Ft. Material
cy'� ze
Diameter
Ft. in.
Ft. in.
Method
/Do
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
:RFRV f r.RnFY THAT TH S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RUCTION Si NW4f, DTUAT A COPY OF TH!S RECORD 11.- EENPROVIDED TOTHE WELL OWNER
NATURE OF PERSON CONSTRUCTING TIIE WELL DATE
n of Water Quality, Groundwater Section, 163o Mail Ser' ice Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natal Resources -
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
257302
Division of Water Quality - Groundwater Section CERTIFICATION &OW
-PHONE it (StaV[o If -j
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential_ MunicipalPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town: — //� Couty
(Street c, Numbers, Community, Subdivision, Lot No., Zip Codc)
%G.Wy 3. OWNER: 2-
Address aoa 0 A ®,k, ije J
(Street or Route No.) 336
�/ Ds
-
City or own State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED to-J7-o?
5. TOTAL DEPTH: .245
6. DOES WELL REPLACE EXISTING WELL? YES*NO...,
7. STATIC WATER LEVEL Below Top of Casing: 5 O T.
` (Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): J O METHOD OF TEST c hrs •
10. WATER ZONES (depth): . '.i 4 S ' - „abs--
Topoi'raphic/Land setting
❑Ridge Alope ❑Valley ❑Flat
/(check appropriate box)
Latitude longitude of well location
I dcpreai, m11[ntCSSeconds)
Latituderlomgitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
11. DISINFECTION: Type 1-47-0 Amount
12. CASING:
From
From
From
13. GROUT:
From D
From
14. SCREEN:
From
From
1
Depth Diameter
To jO Ft. to "
To Ft.
To Ft.
Wall Thickness
L
or Weight/Ft. b atcrial
lz
Depth Material Method
To a Ft. Cn..r—s-
To Ft.
Depth Diameter
To
To
Slot Size Material
Ft. in.
Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
in. in.
Size Material
16. REMARKS:
DEPTH
From f^
doo
0
.20' pGS�
h 1 v
LOCATION SKETCH
Show direction and distance in miles from at le.6_=
two State Roads or County Roads. Include the rtx 1 cS
numbers and common road names. _-'-
t ->n
CI TT
01
rn
tRnu LI Y
QLfrON,STR C)ON(; T D
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECI LI AS I3EF.N PROVIDED TO THE WELL OWNER
g - i - o'.
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
ision of Water Quality, Groundwater Section, 1631) Mali Service Center- Raleigh, NC
221, within 30 days. GW-I REV. 07/2U01
0
ASHEViLLE F: pcIONAL OFFICE

257291
WELL CONSTRUCTION RECORD
North Carolina - Department of Environmenth/�and Natural Resources - Divis'on of Water -- Quality - Groundwater
�ISection
�
Q 9Y'PAntJaC.- ah—r-Yr"' PHONE g C1a9-Jv-s _S / f% 4
i 4'oz
WELL CONTRACTOR (INDIVIDUAL) NA
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT*/
(if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipaUPublic 0 Industrial 0 Agricultural 0
ASSOCIATED WQ PERMIT#
(if applicable)
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCAT ON
Ne es_t LTown: !. C°ttn
(Street Name, Num m, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IC / 2 45) /9a �I to
Addres /$/D C �t�/�i�r=� " ` -
O,Q/// � ✓ `/GG of [/
Cit r Town State Zip Code
Arca code- Phone number
4 DATE DRILLED �o ' / g ' 0 9-
/ADO
5. TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .1 DD FT.
I (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 acc rde4 f/wh ISA NCAC 2C .0118. yf
9. YIELD (gp ): / / METHOD OF TEST of
10. WATER ZONES (depth): 4 /).5 / ' 9a5
11. DISINFECTION: Type
12. CASING:
From
From
From
13. GROUT:
From .V
From
14. SCREEN:
From
From To
15. SAND/GRAVEL PACK
Depth
To
Depth /b
To
I J%z ,aft Y' '
/-(TN Amotvpg
Diameter
Ft. /P it
To Ft.
To Ft.
Depth
To 2%) Ft.
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
Ft. in. in.
From
From
To
Wall Thickness
or Weight/Ft. papfr
„Material
Idccmes. in inutes:seconds)
Latituderlongitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
F'r/on}, T 1) f Fo n Description
Ft.
Ft.
Size Material
N -thod
CERTIFICATION*/2Y/ d
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
rr o
CJ2
rn
tT
0
16. REMARKS:
pi'l��,E�YCnER(! Yr�'H
;>L�t�TO'{S SPANBfAi
_original to thii Divis
j 49-1ti31, �dite Nre'1(9NJ) 733-3
A� uIL: rirFICE
F
IS WELL WAS CONSTRUCTED IN ACCORDANCE
PROVIDED TO THE WELL OWNER
I I 5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECOBEEN fBTtA� �/' O ER
GNATURE OF PERSON CONSTRUCT
THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center l REVgh7''_OUI
121, within 30 days.
c
c

259240
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) r Litt '- 'tU&L CERTIFICATION # J1%T//
WELL CONTRACTOR COMPANY NAME ae. EF t4(�ds . 1r)FLL -- Pia rip, rip J/L t PHONE (S2r� la S ` / 90
//
STATE WELL CONSTRUCTION PERMIT# iTiO ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO.
Nencest__To)vn: County-/�CJ/Ji
LUOf reek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 9 v Cl//�/ , /�
Address (f / 1 C /cal)
ypt
`19(1:
( reet or Route No.)
t'S 2e
fl7/e
City or Town 'Mate Zip Code
Area code- Phone number
4. DATE DRILLED li - .25-'0 2
5. TOTAL DEPTH: �,(
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordanceqwith�15A NCAC 2C .0118.
9. YIELD (gpm): o(e /! METHOD OF TEST rs •
10. WATER ZONES (depth): /n4 y — /a S
11. DISINFECTION: Type I -it)-) Amount �.,,,
12. CASING: Wall Thickness
Depth Di meter or Weight/Ft. Matey}al
From To �G+/ Ft. a' r/ /It
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To a tN FL C 0 vn,,LLA, l ±----e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge Slope ON/alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation ascription
a0
,.20
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( ) 8 /,3/-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
S,ttplt�i tale'origin$i ti Ale Di'ision of Water Quality, Groundwater Section, WO Mail Service Center - Raleigh, NC
+c 27699-1436Phone NU- [phone], within 30 days. GW-i REV. 07/2001
(7:-
0
0

259239
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) N -nett. - b'ra LC CERTIFICATION it 3/'Y//
WELL CONTRACTOR COMPANY NAME C'sr e_e 1-1P1VroS. L-Ve i) ±Buren. JP.C. PHONE # (erie. -3/'71'
`I STATE WELL CONSTRUCTION PERMIT# 1 " D ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ��
Neare Town: County /4/ /7)/.,% ei
rCH7 i707d — YlaLnvm, Yca—tl� i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER:�KrA nnbn ir;r - Vr)LOnetc-CA
Address P O Q L*yL / g6 0
(Street or ROUIC No.)
Wage P IA/Ai .VC fl 7 57
Ci r own State u Zip Codc
Area code- Phone number
4. DATE DRILLED �n - ?O _L - -
5. TOTAL DEPTH: /n S'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO*
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. , nn
9. YIELD (gpm): 7 METHOD OF TEST c2 7&a
10. WATER ZONES (depth): / 80 r — / 9m 07.23— 6pin-)
11. DISINFECTION: Type A777/ AmoLth //S
12. CASING:
Wall Thickness
�nt Depth Di teter or Weight/Ft. Material
From !J To 'S� Ft 1_
FromFrom
13. GROUT:
From D
From
14. SCREEN:
From
From
To Ft.
To Ft.
Depth Material j Method
To al/1 Ft. CO-rue-tt-T jet
To Ft.
Depth Diameter
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Size Material
Top raphic/Land setting
❑Ridge1Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(decrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form ion Des ription
G7 ��%/ r✓G- re-t
J�ZI l Ai ' w✓G .vr i 711-"-
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:
RCi—n I Li/
I
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IDS, AND THAT A COPY OF THIS RECORp44 S BEEN PROVIDED TO TIIE WELL OWNER
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Secs ice Center - Raleigh, NC
(919)�33-3221, within 30 days. GW'-I REV. 07/200I
GROUNDW'PTEP. S 6 ti
ASHEVILLE REGIONAL OrFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

2. WELL LOCATION: -ff �
Nearest Town: Qom+" County
11
T e /i.r Ltiv . cc,1 et
(St cat Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: i �j u L�il�O�
Address I Dcci Il -AI-t- 1 A..
a(Street or Route r,7/6
City or Town State CZip Code/
(
Area code- Phone number
4. DATE DRILLED S - 2 q
-
5. TOTAL DEPTH: ' `f 5 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tiC
7. STATIC WATER LEVEL Below Top of Casing: to D FT.
[ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith ISA NCAC 2C .0118.
9. YIELD (gpm): IF METHOD OF TEST 07 n rs
10. WATER ZONES (depth): 20D ' - 4/DS'
I1. DISINFECTION: Type 47-7-7
12. CASING:
Depth Diameter
From Z9 To SU Ft. (' "
From To Ft
From To Ft.
13. GROUT: Depth /+Material i Method
From D To 2n Ft. (G4t'+-1-9,_ /D jo
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft.
Material
P vc
From To Ft
From To Ft
E lJ Ifs 414Rio'
I DO HEREBY CE
J'JLCO �tN
255604
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment/eand Natural
�/Resources - Division ofWaterQuality
WELL CONTRACTOR (INDIVIDUAL)
71-
WELL CONTRACTOR COMPANY NAME M(rreP)N ,�,///_�! 5� -4 J/ V ' '` N''�Lite
STATE WELL CONSTRUCTION PERMIT# / O 2 ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
- Groundwater Section //
CERTIFICATIONr//# Sl' Y`
PHONE # f0n lv W 3/9V
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use - '
Topo raphic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
n
Q() 446
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 p
I) o
C� prr''
G r^
t— ter,
co
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)ARDS, AND THAT A COPY OF THIS RECO$IZH.AS BEEN PROVIDED TO THE WELL OWNER
7,2-el 1
' An/la—L. DATE
SIGNATURE OF P1RSON CONSTRUCTING THE WELL
GROUNDWATER SECTION
ASHEVILLE RFhGIQNAL OFFIGE
Su unl Jrc otrgrnal lrrthe Division of Water Quality, Groundwater Section, 1636 Mail Service Center-1REV607/31101
27699-1636 Phone No. [phone], within 30 days.
m
7.3
F

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division qfWater Quality - Groundwater Section '//
(]��$ 1 JGA CERTIFICATION # S
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � i �' � f� � ��.3/ %D
r to )P.I I a- Y"tr.Yys�j� ✓ PHONE #
WELL CONTRACTOR COMPANY NAME 'YY /.P Nt,-/ ✓'>
17O ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): ResidentialA Municipal/Public ❑ Industrial O Agricultural ❑
Monitoring ❑ Recovery O Heat Pump Water Injection O Other O If Other, List Use
•
2. WELL LOCATION./
N•
..k.Ea-d' 1/t- County k G✓n o
•
Nearest Tpwn:_ M `
(Street Nammc N bers, Community, Subdivisionn,,rLot No., Zip Code)
3. OWNER:JaA-0- 7/o-1/4 en -di _ - at!, - di-id
Address /3`U D 74,e,l A^-j oY—.
Topo iraphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude Source:OGPSOTopographic map
J / heck box)R
Yr// teNo.) i �� 2e,� DRILLING LOG
255603
r �L description
City or own State Zip Corfu
(_)-
Area code- Phone number
4. DATE DRILLED 5- 3 D
5. TOTAL DEPTH: SD S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO S•
7. STATIC WATER LEVEL Below Top of Casing:
FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / % METHOD OF TEST r2 h r-S
10. WATER ZONES (depth): /
11. DISINFECTION: Type �� 71 Amount
12. CASING: Wall Thickness
Depth �� Diameter or Weight/Ft. Material/9VC
D To Ft.
/
From
From
From
To Ft.
To Ft.
13. GROUT: Depth
From___To v2O Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
l
Method
-72-070
DEPTH
From To.
p /7G
7/.2 505
rno HEREBY CER Y
CONSTRUCTION StAN
V u L ; vd,y27 '..,j ` c,LA, _,
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
f }NILfyLppU'A�lr,�,$�u- Ito t le Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
ASHNILL7ih I636 GW-I REV. 07/2001
733-3221, within 30 days.
Formation
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.
OS:OIWV 8-1nrZO
I}(AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD NAS BEEN PROVIDED TO THE WELL OWNER
Z

255607
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of \Vater Quality - Groundwater Section
CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME n(print) o L Ly
WELL CONTRACTOR COMPANY NAME 67-PP»e 23rv5- OP/ / °/ K-YYe,li`'PHONE # lififA ��g 3/�
STATE WELL CONSTRUCTION PERMIT# /4' 2' ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential �.j Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water n)ection 0 Other ❑ IFOther, List Use
2.
WELL LOCATIO'' rr /
Near To n: /U1�t//7E'S,/z/It County /�/���,Gv��14-
(Street Name, Numbers Commu ay, Subdivision of No., Zip Code)
3. OWNER:
Address P O /girt 1 0/
i tract or Rqute No. 4cit-sedeoet
021739
City or wn State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 5'/7 -d -
5. TOTAL DEPTH: / 85 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO T
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0115. h1
9. YIELD (gpm): /0() METHOD OF TEST c2 rS •
10. WATER ZONES (depth): /1n.5' -. 1 DO cj pm
Topographic/Land settt
DRidge 0Slope ❑Valley]Flat
(check appropriate box)
Latitude/longitude of well location
(degrees ntinutevseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forman escription
DEPTH
From To ,
D 45
hf' /RS'
11. DISINFECTION: Type ,I7'/-H
12. CASING:
Depth Diameter
From b To %.J Ft. In 'r
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From AO To a0 Ft. Can-. p ,.t l o f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount / $
Wall Thickness
or Weight/Ft. Material
From To Ft.
From To Ft.
1 , IiEN\11,RK
1 DO HEREBY CE
CONSTRUCTION
V
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.
GROUNDVYATEP: SECTION
ASHEVILLE NERONAL OFFICE
T
r l Su bm't the ongma
GW
27699-1636 Phone No. [phone], within 30 days.
Y THAT THIS WELL WAS CONSTRUCTED INACCORDANCEWITH I5A NCAC 2C, WELL
h T)ARDS, AND THAT A COPY OF TIIIS REC�RD4 AS BEEN PROVIDED TO THE WELL OWNER
/�ttML LC/� 7_� -D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Tto the Division of Water Quality, Groundwater Section, 1631) Mail Sem ice Center - Raleigh, NC I REV . 07/2_001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Divisii)on of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME4print) /) 6) /') b* £
WELL CONTRACTOR COMPANY NAME (5-r PPln''e//. 23rD6 . //h l) ci A/ nib.l�Kf
STATE WELL CONSTRUCTION PERMIT# / 'y'n a.- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: �`•� ncS yr /)t County 7''1l.C/'deed
(Street Name, Numbers, C mmuniry, division, Lot No.. Zip Codc)
3. OWNER: %m HP2./no�tiS
Address .2 r? (e rra nPre s ASAze43 - d -
/Diu/I7esv,lit/ NC. as726
City own State Zip Codc
(L48')- S n 7 - -t 5- '7
Area code- Phone number
4. DATE DRILLED 5- /-3 - o :z
5. TOTAL DEPTH: , 1 DS '
6. DOES WELL REPLACE EXISTING WELL? YES 0 N04.
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use "r" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm):et) METHOD OF TEST -
10. WATER ZONES (depth): (v 5 r ' g cm-3v� r
255074
- Groundwater Section
CERTIFICATION 0074/ /8
PHONE #(l'jddOi/nsir -zi
Topographic/Land setting
❑Ridge ❑Slope ❑Valley la
(check appropriate box)
Latitude/longitude of well location
(degrees. ntinuies/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
3 5 CuE,
DEPTH
From To
U
3. ' aoS'
(Street or Route No.)
1 B5' —) 2'c prv,
1 I. DISINFECTION: Type k-1 T 1-4 Amount . . 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 3 5 Ft. is " {y t/ ('
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To on Ft. Ci'wPk
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
S;a,. e Material
From To
15. SAND/GRAVEL PACK:
Fro
Fro
16. RE
1 DO HE
CONSTR
T4'
To- rt.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
w
W
ERTIFY THAT THIS WELL WAS 'ONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A COPY OF THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER
0 L ICE - .20 - 6 1-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Ser. ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(pint) S.P9t3....rur�21ra IS CERTIFICATION # SO4L/
WELL. CONTRACTOR COMPANY NAME &rten G2 as . GIJP / 1 qr Aim?, /w/CPHONE # f21'Q /0 448'I/ 9tO
STATE WELL CONSTRUCTION PERMIT# 1 Vo ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential EV 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: Ca_ ln -it .r County Mitya-.odd.
—Bp r.ni'a L:bVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
&asa r7c
3.OWNER:.Wriva.ni.r.a Cntl/ Qs�
(f rce` orrRouNc I! T71d/G
N.yd ��
City or Town Sate Zip Codc
Address / / D/ _Ay
Area code- Phone number
4.`DATE DRILLED S 8 - D Z
. 5.;iTOTAL DEPTH: / [e S '
6: DOES WELL REPLACE EXISTING WELL? YES 0 NO le
7: STATIC WATER LEVEL Below Top of Casing: /r4D 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 avarianc//�1
NCAC 2C
YIELD
gm):accordance.2 15METHODOFeTEST it ArS
9. YIELD (gpm):'
W. WATER ZONES (depth): tot ) ' - / 2 s+P.-.4
11. DISINFECTION: Type l-/Tw
12. CASING:
Depth Diameter
From a To___a.
From To Ft.
From To Ft.
Amount 29
Wall Thickness
or Weight/Ft. Material
S1Lee/
-13. GROUT: Depth Material Method
From D To ?Q Ft. CeroeKi 71-op
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
16. REMARK
7,, i- Siz¢r
FI•
Ft.
a enal
I DO HEREBY CERT THAT THIS WET L W AS CON.
CONSTRUCTION ST
J
- . irAttOPY C
uuuti LFEILE
255061
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 13f`t
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
FotRation Description
Grave.bseeS
DEPTH
From To
?8' /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.
TRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
F THIS RECORl-IAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
0
r_
co
3
0
CO
N
.r--9/ - O .Z
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
/a609-1e16 Phone No. I9191733.3221. within 30 days. GW-I REV. 07/20(11

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NA I .UY (A' i1 1 H I— I A h )I
WELL CONTRACTOR COMPANY NAME ,, //
STATE WELL CONSTRUCTION PERMIT*/ / 1/4) - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
255079
Quality - Groundwater Section
/M/B�E (print) ,LJ( n . CERTIFICATION -I # �d 1/
Li'r r, P.�e, fUS LJ�1) rw.-w`pa r C PHONE # ems% Zig - 3 /'71)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ IFOther, List Use
2. WELL LOCATION:
Nearest Town: bJ/J-L//c
4e5)/t �- County fay 1<X>0A_
DI el TI'en /Ln. — (1ove. (- e-eik
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: r.rY1e5} 40S )en
Address I (p 171, Ct' u v i a P-k Pei'
(Street or Route No.)
[J�a nPSVt II-i ML �87gCc
City or wn State Zip Code
(—)-
Area code- Phone number / _ n
4. DATE DRILLED
5. TOTAL DEPTH: 405 ' `�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO TEI.
7. STATIC WATER LEVEL Below Top of Casing: x/D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / n METHOD OF TEST c2
From
r9 U
Topogg.aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Form n Description
/3-41
DEPTH
To
S%DS'
10. WATER ZONES (depth):
Ar-S
t
11. DISINFECTION: Type /-J TN
12. CASING:
Amount 1 (
Wall Thickness
Depth +. ,n DiOmtter or Weight/Ft. N aiteriaI
;U.)From 0 To ) Ft. ((n / f
From To Ft.
From To Ft.
13. GROUT: Depth ,�'�wuaterial Method
From n) To ,..0 Ft. t n-e�+—iT it p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
-1\
16REMARK�
I DQ HEREBY C
CONSTRUCTIO
AS Et E ELEGIES IE l OH HEE
Submit the original o the Division of Water Quality, Groundwater Section, 163ti Mail Smite Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW- I REV.07/2001
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
O
2� E
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NDARS, D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
. J to - 4.0 —aZ
SIGNATURE OF FUSON CONSTRUCTING -THE WELL DATE

. WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalNatuResources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) llQ (R7t•
✓� c3eLL n
(;
WELL CONTRACTOR COMPANY NAME C-re_P At. -Rro, - I/)r.l 1 4 Pa p) /%AC.
STATE WELL CONSTRUCTION PERMIT# I i-I- D '... ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
255078
- Groundwater Section
CERTIFICATION # '/ 411 *
PHONE # (e'a /o 4' g - 3/ 7d
1. WELL USE (Check Applicable Box): Residential' Municipal./Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use •
2. WELL LOCATION• 1
Nearest Town: (i�'a 7/t /vt.�t-n- County . / 2- e
��C:o %I—�.cI /P POD — /--IW t( / l c
(Street Name, Numbers, Community, Subdivisiio/on, Lot No.,,)Zip.kodcl
3. OWNER: �U74./ 1 L1 /-t/Ys `�(
Address / 7 /n Pine. /77•- v 5 t tvi
(Street or Route C .27 / /
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .Jr - a -6 2
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO P1
7. STATIC WATER LEVEL Below Top of Casing: Cob 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. �1
9. YIELD (gpm): lr , 5 METHOD OF TEST h f5
10. WATER ZONES (depth): 'T',o 5 ' - 5 cS p nm
5Lr5' / 5 �pv
IL DISINFECTION: Type 1. 4T I-1 Amount .a.
Wall Thickness
or Weight/Ft. Material
Pve
12. CASING:
Depth Diameter
From D To 35 Ft. La
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To a Ft. CL,w.o ) P
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15 SAND/Gilt/1VEL PACK:
From To F .
'N From To
J :i � )k: REMARKS:
Size Material
•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fo tmatiQ n„Description
DEPTH
From To
/D 35
S ' 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 road names.
O
N
L
CO
N
O
Cm)
W
sy_TqA4 THE
Ccl3iiaTROCTIPX STAND Yi i)s, N
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD jd.\S f}EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Seri ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
`-1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME%/PPAP
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Azn
257310
Di ision of Water Quality - Groundwater Section
CERTIFICATION # 600ig
PHONE #
u/n13,
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(Street Name, Numbers, Community, Subdivision, L9t No., Zip Code)
City n State
( )-
Area code- Phone number
4, DATE DRILLED J5- -/D -d.Z
5. TOTAL DEPTH: fn DS 1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 410 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
10. WATER ZONES (depth): .09,5- -' yen S3=5 -f1 f rn
I1. DISINFECTION: Type At% Amount /D,3
Wall Thickness
Topo$ raphic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: •�y,`y �iJ7, gad(dcgrccs.mimncs/seconds)
Address (' /7 /.9h ait.eiv o�ol doeW Latitude/longitude source:DGPSOTopographic map
/ntrce[or�R�ute DEPTH (check box)
r U DRILLING LOG
From To Fortgation Description
r ADS'
9. YIELD (gpm): /6— METHOD OF TEST ed7 t
12. CASING:
Depth trio
Diameter or Weight/Ft. terial
From To IJ(n Ft. /o N
From To Ft.
From To Ft.
13. GROUT' Depth aterial
From To 20 Ft. COOtii2L
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
6
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.
_ ch
•. rrt
CJI
-= c
Submit the original t the
l_
l 919)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. AND THAT A COPY OF THIS RECORD IjAS-AF`EN PROVIDED TO THE WELL OWNER
g./-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, I636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

257309
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 4 D
WELL CONTRACTOR (INDIVIDUAL) NAM (print) �r OM /�LL,, r/G'f i � p❑ �`/�� l �� 3/
WELL CONTRACTOR COMPANY NAME /[/> OS /1)'J/ Si Puir)j` PHONE # In Z.
STATE WELL CONSTRUCTION PERMIT# / r 02 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nealg�To�
(Si(Streett. Num s, Community
WNER:
3. O
Address 4?'7 v- 2 -"
(Street to No.
y �, or
��// Top, graphic/Land setting
�CountyY �/v 01 ❑Ridge ) Slope ❑Valley ❑Flat
(check appropriate box)
Subdivision, Lot No., Zip Codc)
42141
1(
City Town State Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED --/G —0.4
5. TOTAL DEPTH: 3.25'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: £ o D FT.
((Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST
10. WATER ZONES (depth): W%' — .3
11. DISINFECTION: Type %i%11 Amount 44r7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 9 To Ft. 6 '' Mid
From To Ft.
From To Ft.
13. GROUT: Depth AMaterial
From /7 To�}FL (jinx tit,
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.
Latitude/longitude of well location
(degrees in inutes/seconds)
• Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Form qn Description
DEPTH
From To
o 98'
98' 3.251
M hod
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3
rr
v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CnNSTRIlCTION STANDAR iS, • ND THAT A COPY OF THIS RECORDS-EEN PROVIDED TO THE WELL OWNER
2
i(-
�II
bmit the original to the D
99-1636 Phone No. (919) 7
c
CO_
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1630 Mail Service Center - Raleigh, NC
, within 30 days. GW-I REV. 072001
• t.LL RLF... L OFFICE

3. OWNER:
Addre s
257308
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu , I Resources - Division of Water Quality - Groundwater Section ,/
WELL CONTRACTOR (INDIVIDUAL) NAM (print) NI'/L/f L CERTIFICATION #�g%) 4 /
�' .Cr3 5, Psi s' P(8.21�4'Y- 3r719
WELL CONTRACTOR COMPANY NAME 7inifI, // C .PHONE #
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential4 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest'Ggwn:
County Aifideoct
L i 04.V
(Street tdamc, Nuji,rs, Community, Subdivision of No.. Zip code)
, D /34,Z /D 94
(Street . oute No.) b 78
or Town Stat Zip Codc
Area code- Phone number
4. DATE DRILLED 5 - 2,
5. TOTAL DEPTH: ./X5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 449 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .3 D METHOD OF TEST
10. WATER ZONES (depth): ' 1 Z. S" -' /Ps '
11. DISINFECTION: Type / 177J
12. CASING:
Depth _
From ,l% To 'J%i Ft.
From To Ft.
From To Ft.
Diameter
ti
Amount o%,!C
Wall Thickness
or Weight/Ft. Material
Pt//'
13. GROUT: Depth Material MKthod
From .0 To 020 Ft. &LntDz* ./cpJ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcurccs minutes/seconds)
Latitude/lon_itude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formatipn Description
DEPTH
From To
,n SD
SDI /Rs'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N
b CD
C Es
` ri
ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD H'B"f3EF.N PROVIDED TO THE WELL OWNER
Submit the original to t
one Na. (91 733-
GROUf D rR SECr)N'
ASHEVILL_ ;!rr. AL
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 163o Mail Sen ice Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/20U1

257312
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME print)
WELL CONTRACTOR COMPANY NAME t nt-QeLP
STATE WELL CONSTRUCTION PERMIT#
/ 4/D42
(if applicable)
ASSOCIATED WQ PERMIT#
(if appl icab le)
C
CERTIFICATION # '/Y
PHONE # f�7�t,K to44 /7
1. WELL USE (Check Applicable Box): Residential Municipal/Public CI Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATIO
NearesoTown
(Street Name, Num
3. OWNER: -
Address(
City
Area code- Phone number
4. DATE DRILLED eSJ - % - D -2-
5. TOTAL DEPTH: ?OS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO1-
7. STATIC WATER LEVEL Below Top of Casing: h 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 nh I5A NCAC 2C .0118.
9. YIELD (gpm): METHODqOF TEST / ✓gyp
10. WATER ZONES (depth): r25 !�� v - kUS r
7
n State p Zip Codc
11. DISINFECTION: Type f i N Amount /.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. M tteriiaall
From D To ,�/7 Ft. /
From To Ft.
From To Ft.
13. GROUT: Depth aterial Me hod
From To 010 Ft. CQMt tli
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.
n, Lot Nod. Zip Codc)
Topo aphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
p (degrees. minutes/seconds)
Q /e Latitude/longitude source:❑GPS❑Topographic map
.(Street Royte,No.) /may (y (check box)
.( �Q�l /yC: o2d 76-7 DEPTH DRILLING LOG
From To Formation Description
D i/I
a!)'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. p
rV
a
G,
16. REMARKS:
IL-; (occes-gtuf 'ION S
I,
Submit the origin Ito tt
27699- o. (90
CI it l'vA r : FFCHOI)
' i-t .JriCE
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD �yA-SHEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ! I l CERTIFICATION #
WELL CONTRACTOR COMPANY NAME on PHONE # {gal!6'/t �'31"7�
STATE WELL CONSTRUCTION PERMIT# 7/7) Z '
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
264052
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATION
Neare Tosn:� Count
7L J��%%C�
(Street Name, Numbers, Community, 6dbdivision, Lot No., Zip Code)
( n
3. OWNER: s1 -
Address 7 E
n �j� (Strj�t or Route No.)
Z /
City or T wnState Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED -5- .20
5, TOTAL DEPTH: yX6-1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7, STATIC WATER LEVEL Below Top of Casing: 4119 FT.
•
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �I �D
'9. YIELD fora): /GCD -l- METHOD OF TEST �S 1-4,-
•
10. WATER ZONES (depth): .2 1/4) ' - �SS
Topo raphic/Land setting
❑Ridge 71Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T�// FormaDescription
royal
///' LAPS-1 a fe
11. DISINFECTION: Type /17A/
12, CASING:
From ,9
From
From
13. GROUT:
From
From To Ft.
14. SCREEN: Depth . Diameter
From • To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
Ft. -
Ft.
Depth
'To /// Ft.
To Ft.
To Ft.
Depth Material
Tp Z Ft. (P rnO
Diameter
ff
Amount 72
Wall Thickness
or Weight/Ft. Material
ethod
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
NST C
Submit the on final t
' GFOUNDlgtkVliellir e No.
ASHEVILLE REGWRAL OFFICE
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECOO DD HAS BEEN PROVIDED TO THE WELL OWNER
74) -3/,02
i-t_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
)19)733-3221,within 30days. GW- I REV. 07/2001

252037
WELL CONSTRUCTION RECORD
-: North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM�r(print) r CERTIFICATION h`
WELL CONTRACTOR COMPANY NAME L7rt eAu. /Bei5 . j.eJe.-�-C. "I Niue PHONE # fgaot / dr/ g - 3 / 7v
" STATE WELL CONSTRUCTION PERMIT# 17"1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL -USE (Check Applicable Box): Residential.. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neare town:
FYDi-se, t'2t
nty9 /./A40
(Street Name, Nwnbers, Community, Subdivision, Lit No., Zip Code)
3, OWNER. 5I' rt'ith i-X
{Address �,,G_15— nrSP. (Ll�� %�i�
(Strectar/Route No.
%. 4 ) n
7L Sst',//e? NC.
CityTown State Zip Code
Area codc- Phone number
4.' DATE DRILLED Art - / _ p 2
3loS
5 TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 'l b 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. 11
9..YIELD (gpm): oI O METHOD OF TEST /� r5
a
10. WATER ZONES (depth): an -
11. DISINFECTION: Type f-f 774 Amount 4/0
12. CASING: Wall Thickness
Dept Diameter or Weight/Ft. Material
From /� To Ft r) P✓�
Fromm To Ft.
From To Ft
`13. GRGUT: Depth Material s ethod
Front {1 To ! (9 Ft. ( pay y enj
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
in. in.
in_ in
From To Ft
From___ To_
15. SAND/GRAVEL P,
Depth
From, To . 1Ft.
From To P l i lFt.
Li L,
16. REMARKS:
Sig Material I j
Tophic/Land setting
❑Ridge ope ❑Valley ❑Flat
check appropriate box)
Lat itude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forgtgjion Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
hh :£ Wd 9- AVW ZO
I DO HEREBY CERTIFY THAT THIS 1j{1rL14N048 CQN,S" ; ) TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN S7A:ND-THATKLUPY Ub IHIS RECOR AS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRQCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07/2001

52033
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAME/� (print) )bt� qL1/ a 3 ISrUJ t. CERTIFICATION # SAY'
WELL CONTRACTOR COMPANY NAME (Ire eno.''//B^ )'di IdeiI Pum�l 4u-c-' PHONE #122 G'Ie--3"7.6
STATE WELL CONSTRUCTION PERMIT# P Yam' '2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentiaMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Wate Injection 0 Other 0 If Other, List Use
2, WELL LOCATIO t // A
Nearest Town: '"S I/ram County Par 01)0e4
ten,
C ra-14— e
(Street Name, hers, Community, Subdivision, Lot No., Zip Codc)
3.OWNER• NP.41rL( J3e151-
Address / 9 g Pa..< U i on) a..
(Street or Route No.)
City Of Town 1 State Zip Codc
Area code- Phone number
4. DATE DRILLED - P -D 2
', 5:1:TOTAL DEPTH. MIS i5 '
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ,? 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordan a with ISA NCAC 2C .0118,
9. YIELD (gpm): _ i n METHOD OF TEST kr5 .
10. WATER ZONES (depth). 1 BD I - O g pry,
11. DISINFECTION: Type
12. CASING:
Depth
From_0 To k �
Ft-r -1 Amount as
Wall Thickness
Diameter or Weight/Ft. Material
Ft /.a" P li G
From To Ft.
From To Ft
13. GROUT: Depth
From f) To . D Ft.
From_ To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Material
e "
Dep
From To
From._ ^To
16. REMARKS:
Method
'oP
Slot Size Material
in.
in.
Jtz- n Miteri
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesminutcslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatiop Description
DEPTH
From To
4' 4 '
r�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.
11 i
I DO HEREBY CERTIF THAT THIS WELL WAS CONSTUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
. CONSTRU/)CTION STA1=!-NDTHAner l6N THIS RECORD HAS EN PROVIDED TO THE WELL OWNER
3i>.D2
SIGNATURE OF PERSON CONSTRUCTING E WELL DATE
.♦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. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
--saes
0-
<J9
03,2
-
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL') NAME (print) kr, 1 t ylr ) b bn CERTIFICATION # _2 1/ /2
WELL CONTRACTOR COMPANY NAM E(Yn/PJiI. &- . It )P�,L eI runt, (� r PHONE # /n 1itY -"3/ 94
STATE WELL CONSTRUCTION PERMIT# / e9 Z ASSOCIATED WQ PERMIT#
(ifappticable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Tgwn=
i
(Street Name, Numbers, Community, Subdivision, Lpt No., Zip Code)
,3. OWNER: LD PY nn, le St)er
'Address a/e I - tc�rx \/21)r.1 P.:rcis
(Street orRoute C No.) a$ 71 f I
City or Town State Zip Code
Area code- Phone number
4:: DATE DRILLED 4/ /Lo - D
45 tTOTALDEPTH: /6.5'
6.-, DOES WELL REPLACE EXISTING WELL? YES DJ NO
7. STATIC WATER LEVEL Below Top of Casing: 'ID 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 .0118.
9. YIELD (gpm):' aD METHOD OF TEST O b fS
10. WATER ZONES (depth): / z/5 ' - 3Pfprr.
11. DISINFECTION: Type /-17-R
12. CASING:
Depth Diameter
Front__(ZTo SC Ft t rr
:From To Ft.
Froth To Ft
13. GROUT: Depth •
/t Material
From L To 'o)Q Ft. L-e
From To Ft
14, SCREEN: Depth Diameter
From To Ft, in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
Amount -s 9
Wall Thickness
or Weight/Ft. Material
PVe,
From To
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
Topographic/Land se ng
DRidge ❑Slope 0Valley
(check appropriate box)
Latitude/longitude of well location
(degrees minuics/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show Direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
o
N c
3 0.
z.m
—c cm
z
O m
nc
_ �o
CJ rnz
F
cm) a
r s
I DO HEREBY CERTIFY THAT HIS WELL WAS CONSTRUCTEE IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS GSAAIII '#AT-A-CQlW THIS D HAS BEEN PROVIDED TO THE WELL OWNER
Vie)f Q Z
/Lt lliaLLr R� �i CHI( -�
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, i 636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

.2, WELL LOCATIO
Nearest Town:_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3; OWNER* J-t'tD I % uK �eeLeA-
Address 15 iv 13 r o evr "Pa. ,
• (Street or Route No.)
( LA. le) Ey r 1 Ie N c C28430(4,
City or Town State Zip Code
Area code- Phone number -/� -n2
4tl"DATE DRILLED 60. A-a+--Pt'e=,
. 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lit
7. STATIC WATER LEVEL Below Top of Casing: 4DD FT.
`` (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top ()leasing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. I
9. YIELD (gpm): ` e2 METHOD OF TEST a h r-5 •
10. WATER ZONES (depth): to no ' - a P rti
County f'tr?i�l✓0
11. DISINFECTION: Type 07-14
12. CASING:
Depth
From I) To R) Ft
From To Ft.
From To Ft,
Diameter
lou
Amount / 5/
Wall Thickness
or Weight/Ft. Material
pia
13. GRQU'f Depth Material Method
From_a__ To_a0_ Ft. 0o.vv.,exk rp
From To Ft.
14. SCREEN: Depth Diameter
From______ To Ft. in.
From_- To Ft. in.
15, SAND/GRAVEL PACK:
Pep
Front To ia
From To
16. REMARKS:
I
I DO HEREBY CERTIFY T 'SAY/�',L ,S CTEDIIINN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION
STAND : a , fl ITF9efi3 0 OE THIS, RRF¢UKL�HAS BEEN PROVIDED TO THE WELL OWNER
i/ E, ( /) I --Si' _ D z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Slot Size Material
in.
in.
,1.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionisof Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAME(print)(print) r3 r�r.J( a r ae 1. CERTIFICATION N�4/H" ��
WELL CONTRACTOR COMPANY NAME Carl retina- L1 re S . �Pi) �i Pu.w1,I .Lc PHONE q Jp�A G «J
STATE WELL CONSTRUCTION t'ERMITe /41Oa ASSOCIATED WQ PERMIT,/
(if applicable) • (if applicable)
2520?1
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
To o raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tdcgreex ininutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
n s/
0) e2S
::5. TOTAL DEPTH: 8a5- dr,l)a Gsty,s6 wsit
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
a
rn
F
c
0
orn
m
DC
no
--1-
rrt a
art
cn z
rn
0
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. 07/201)1

255608
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r/ 11.4J , rU e ii CZl CERTIFICATION # '/
31)
WELL CONTRACTOR COMPANY NAME Ge— rI* 1'�e 1�rog . LOQ I k 4 ump,A,wPHONE p JG7�r'3/'7 n
STATE WELL CONSTRUCTION PERMIT,' 14 0 a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATIOjJ
Nearest T Wild ri- -U///c Countyog
Le.�'ab/i
(Street Name, Nus, Community, Subdivision
3. OWNER:
Address
City or To State
(—)-
Arc_ code- Phone number 4. DATE DRILLED 1-/9 -1)_'
5. TOTAL DEPTH: lo%L.S'
, Lot No.. Zip Code)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ili
7. STATIC WATER LEVEL Below Top of Casing: ant) 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. pith I5A NCAC 2C.0118.
9. YIELD (gpm): LE METHOD OF TEST „�nt C 4 r5 •
10. WATER ZONES (depth): 3 gS l - '4 rm
11. DISINFECTION: Type F 77-/
12. CASING:
Depth Diameter
From 4 To 2L) Ft. 6 '/
From To Ft.
From To Ft.
Amount , /
Wall Thickness
or Weight/Ft. Material
PVC.
13. GROUT: Depth Material Method
/�
From ,n To aD Ft. ! dieram
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:
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. ntinuroahcconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Qescription
ao' 4 VS'
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.
RUCTION ST
fl),
AsI F`27699C9f606'0
,9,
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITFI 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7_2
SIGNATURE OF PERSON CONSTRUCTING Ti IE WELL DATE
L--� gl�pnF,tdt 1C 9Elgitth't to the I ivision of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
r L( WELL CONTRACTOR (INDIVIDUAL) NAME (print) . E Ck_AAJ- �l-.Jr IA-f1e I CERTIFICATION # 32)+0
WELL CONTRACTOR COMPANY NAME a r e-e-n'IP d3roS. CVr-I1 4 Pu toop.11 pr PHONE #t4'' -3/7n
STATE WELL CONSTRUCTION PERMIT# / "f' D 2- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential. Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: 'II
Neare t Town: L-1.k 1 e- County 4-Ind
a i ctl e o AP_P l..
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: 1 1)!Ane— 4 /mot AAA, t 7St C strri
Address r,l 4 3 1 iv o J k S reA- r r 1—Zf� •.
Street or Route No) J
c.., �C
City or To State Zip Code
Area code- Phone number .2
4. DATE DRILLED 'i' - .6 - 0
5. TOTAL DEPTH: S h25'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 3 h r5 •
10. WATER ZONES (depth): I
Laic( c 4 ash 93
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To I41
From To
From To
13. GROUT: Depth
From f) To s^�.D
From To
14. SCREEN: Depth
From To
From To
fiTH
Ft.
Ft.
Ft.
Diameter
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
S-)-e e-
Material }T,
4JY�-¢-�P"
Ft.
Diameter
Ft. in.
Ft. in.
Method
Slot Size Material
in.
in.
Size Material
255076
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat %/Creaks,skc.
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form ton Descri Lion
I4G' .2KS/,Y,"l . ,a-t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
FFE j1jITIAT TH S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STANDARDS, A D THAT A COPY OF THIS REC[�2D HAS BEEN PROVIDED TO THE WELL OWNER
.ra _ e26 —D 1
0
c
c
N
CO
a
0
W
SIGNATURE OF PERSON CONSTRUCTING THE
ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

255073
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisioniof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
1 (print)�o A1.1 //e.2>A� nnmIt
k 21/6
WELL CONTRACTOR COMPANY NAME (y✓P. P nP. �f"� /(%O.// W i'ap rre PHONE (8.2Oot 4/-9 —31 It
STATE WELL CONSTRUCTION PERMIT# ,
/ T/D .z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential*. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 IFOther, List Use
•
2. WELL LOCATION:
Nearest Town: Co o-w- County
tFi IaYJ�
%
(Streetflame, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER
City or Town State
Area code- Phone number
4. DATE DRILLED 4 '///// -4 .2
5. TOTAL DEPTH: �C's
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 4°
7. STATIC WATER LEVEL Below Top of Casing: /. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3- METHOD OF TEST o2 h rS
10. WATER ZONES (depth): .2— Pm
3 85 ' - c(p Inn
11. DISINFECTION: Type I —IT I-} Amdunt
Wall Thickness
or Weight/Ft. Material
Pve.
Topographic/Land setting
❑Ridge 0Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
Idegrces ntinutcsiseconds)
Latitude/longitude suurce:OGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To
Format o Description
Kj/ C trlhrl�.ja
To4cL 6' Ida fi
Address //)/ Ql./%FvP.St Rd • -
1 orR Route /1(' 287/5-
L-0- - Zip Code
12. CASING:
Depth
From DTo R 11- Ft.
From To Ft.
From To Ft.
13. GROUT: Depth /� Material Method
From D To -DD Ft l o,✓vtD
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
,From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Diameter
�)I
From
From
16. REM
I DO HERE
CONSTRU
u
'I Y CERTIFY THAT THIS WELL AS C INSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
TION 'wf, g,'1, ' 'F
/-%HtsT A COP OF THIS RECORD HAS PROVIDED TO THE WELL OWNER
y�. ,y . LE HE:dui UFHCF
�-�Z' _/c _ O ;-
��
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Ralei
C
Submit the original to the Division of Water Quality, Groundwater Section, 1630 Mail tiers ice Ceenterl REVgh, N W I
27699-1636 Phone No. [phone], within 30 days.
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.
c
O
tV
L r?
cc
C0 o�
a rr
?
o CO 2:
rn:.:
Ce r7
CO --�

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
255072
/,F1 CERTIFICATION # e.7 i/g
WELL CONTRACTOR COMPANY NAME I' Y✓PPIIP �a roc• b•-)P 1/ 9f P11 ,`utiL•PHONE # (�la �y� -'�/� STATE WELL CONSTRUCTION PERMIT#
10Arr /.deAL
/'/€9 2
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 I[Other, List Use
2. WELL LOCATION: /
Nearest Town: J/u YIP S V t l /c" County � /f� [e)d�ne1�
�.o-� 7-141 F_'r5 0 -� �ro n ttx.i_X_y�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
Topoggraphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 0L i* t.-tOrvxp S - G 1ex , c, p tro,-,,Lint degrccs.tit intucsisccondsl
Address of 4,Qn,r k TP rra_u_ 71)r . - .atnude/longitude souree:OGPSOTopagraphic map
(Street or Route No.) (check box)
DEPTH DRILLING LOG
From To Formation Description
Description
b Ip�i XG
I, -
CQ, ( Al C. a-2 A ‘;
City or own State Zip Code
Area code- Phone number 4. DATE DRILLED 4/-/7" D �,
5. TOTAL DEPTH: 2 45'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (G d FT.
(Usc "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): e n METHOD OF TEST of h r6
10. WATER ZONES (depth): c2 25' - leP Q f> >•+-.
11. DISINFECTION: Type HT/-)
12. CASING:
Depth ''// Diameter
is
From t To T Ft. G "
From To Ft.
From To Ft.
13. GROUT: Depth
From /) To a D Ft.
Amount L-7t3
Wall Thickness
or Weight/Ft. Material
PVC.
Material
e,tt+
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
rDepth
From 1-'1.0`" I'_� It.
From l 1-Fe-- Ft
16. REMAR
Cve
I DO HERBY C 3RTIFY THAT THIS WELL
CONSTRL CTIO yif ,t1 11
Method
Slot Size Material
in.
in.
WAS C
ACO
Material
a/isr N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
N
c_
N
co
a
_s
0
CO
N
ONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
to /c -2-
SIGNATURE OF PERSON CONSTRUC
G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163h Mail Service Center
e ter) REV gh, NC
27699-1636 Phone No. [phone], within 30 days.

;t.
255066
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Rob I el 1Ide b bb� CERTIFICATION a .23"�9
s-.
WELL CONTRACTOR COMPANY NAME Lee rt a,/ Brans. //JO 1 / V Any) ULN!' PHONE a f8i8 Io 're .. -3J 113
STATE WELL CONSTRUCTION PERMIT# / 14.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 ICOther, List Use
AILVILACklei
.2.. WELL LOCATION:
Nearc�� 7To County
re nVE. - fOnelPr&c.. � /,//s
(Street Name, Numbers, Community, Subdivision, Loot No., Zip Code)
3.OWNER• 74rid G AlrystiS
Address 3a1/ Dcj/ea.aa ZI L�
(Street or to No.)
/Ja re<vf%/tr AJ( -2 71
City or Tooth State Zip Code
Area code- Phone number '/ -0
4.' DATE DRILLED �" '
5:'TOTAL DEPTH. 306'
6., DOES WELL REPLACE EXISTING WELL? YES 0 NO tilt
7, STATIC WATER LEVEL Below Top of Casing: zip FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS ' FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith ISA NCAC 2C .0118. .s
9, YIELD (gpm): oS
METHOD OF TEST %era .
1Q. WATER ZONES (depth): .28s- j&O gym
11. DISINFECTION: Type 1-1774
12. CASING:
Depth, Diameter
From To S 5` Ft 6
From- To Ft.
From To Ft
13. GROUT: ' Depth Material
From_ 1) To at, Ft. t
From To
14. SCREEN: Depth
From_ To
From To
15. SAND GRAVEL PACK:
Amount S6
Wall Thickness
or Weight/Ft. Material
PVC
From
From
tOkt'F
Method
/OP
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
16. REMAP.(
To Ft.
Material
I '
UJ
Topographic/Land setting
❑Ridge ❑Slope ❑ValleyFlat
(check appropriate box)
Latitude/longitude of well location
(degrecsminutcsiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatiop Description
DEPTFI
FromTo 0g�
2411 ,31,6' YJ Ael. a
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
N
co
b
0
w
N
I DO HERE3Y CE 2TIFY TEAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONF#/5`/Sht[1tFWATCOP Y OF THIS RECORD HAS N PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\V-1 REV. 07/2001

255084
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ciJ/�/(C.lat_-f1� ,.- r /3d
ictiC- " , CERTIFICATION# V
WELL CONTRACTOR COMPANY NAME /Ctn+.-''//QYDS. /[/F// CI vyip)x�,%t e . PHONE if —3/?D
LT
STATE WELL CONSTRUCTION PERMIT# / Ve a --ASSOCIATED WQ 7PERMIT#
(if applicable) Of applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other O If Other, List Use
2. WELL LOCATIO
Nearest T,�ppwn:- County
O-4.4.2 DQC) / / /
(Street Name, Numbers, Community, Subdivision, LotoNo., Zip Code)
3. OWNER: Sli3 S h J1/J
Address 9/ / „
n2r ) (StreetRoute No �� 7 /G
City( or, Town Stale Zip Code
Arca code- Phone number
4. DATE DRILLED 7 ' 1-
5. TOTAL DEPTH: 4/05-
6. DOES WELL REPLACE EXISTING WELL? YES E NO
7. STATIC WATER LEVEL Below Top of Casing: (p,i T.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): <{. 5 METHOD OF TEST ,c i, r 5 •
10. WATER ZONES (depth): 2 SO - 4/05
l 1. DISINFECTION: Type N T l-j Amount to 7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Maatteriall
From n To Z -I Ft. 4 it r ��C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From V To ,a» FL 6D h
From To Ft.
14. SCREEN: Depth
From To
Diameter Slot Size Material
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From TO �.Ft
F-ProM : � Td 'Ft F\
4 -REMARKS:
rib HEREBY CERTIFY THAT TH WE L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A D T AT A COPY OF THIS RE SOR-D.I AS BEEN PROVIDED TO THE WELL OWNER
li 1
Topogpaphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(((check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From 1'o Formation Description
D -3 e /-`-1 •
"c 5/OS iL.a .1^
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
N
C—
N
CO
O
0)
w
c
0
cn
c
t
zrre
rn
cn
m
t7
—4
c
SIGMA
RE OF PERS9N CONSTRUZTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163n Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No.[phone], within 30 days. GW-I REV. 07/2001

255083
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # -1441/
WELL CONTRACTOR COMPANY NAME C7"✓2 tale yQS rzPi ct PHONE #
STATE WELL CONSTRUCTION PERMIT# / `" d 2 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
ffigyz d'.3/711
I. WELL USE (Check Applicable Box): ResidentiaMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water n)ection ❑ Other 0 I f Other, List Use
2. WELL LOCATIO . j
Nearest,T9wn: (o �t'7t,
(Street Name, Numbers, Community, Subdiv
ion. Lot No.. Zip Code)
3. OWNER: Ga. >�
Address ,24) Jv-4
( treet or Route N
ilfizb We -
City or Town r State Zip Code
(—)-
Area code- Phone number '' //
4. DATE DRILLED `t - /6'
5. TOTAL DEPTH: /86_
6. DOES WELL REPLACE EXISTING WELL? YES q NO itci
7, STATIC WATER LEVEL Below Top of Casing: L FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /off METHOD OF TEST a2 J r'
•
10. WATER ZONES (depth): /n.5 - / S S
11. DISINFECTION: Type hi %l-/
12. CASING:
Depth
From /9 To 07,6 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a v Ft.
Diameter
it
From To Ft.
Amount ,2
Wall Thickness
or Weight/Ft. Material
PZ'�
(Material //
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
Frnm
From - TO
Depth
To
REMARKS:
I;
I DO HEREBY CERTIFY THA
CONSTRUCTION STANDA[tD
Ft.
1 '
Topo raphic/Land setting
❑Ridge9Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
aD / ' £CS' ni •fi
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
.,. WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-;Vo.2
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1630 Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
m
0
GO
CO

255081
WELL CONSTRUCTION RECORD -
North Carolina - Department of Environment and Natural Resources - Divisionof
WAWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/Es (print) �AX.L—S_.... ttt.L .Yv / CERTIFICATION# ..7''7///8
WELL CONTRACTOR COMPANY NAME(7VPP..0 T3/o5 DP If 'i YiL.+p, Jt-c PHONE#IF W/o'F£i'-31in
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
7D .Z ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential Id Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: p
// Nea stT� pwn: County/
1�Ct 149eL�
Gza/,j.-
'cth a L'7LC- email Attie-, Attie-, J,i/S
(Street Name, Numbers, Community, Subdivision, LotLNo., Zip Code)
3. OWNER: (TnnP *a✓/�uLti - �'It
Address _3-2 // 4J-P-.i� t.)nn.d kat-
(Sne7. Route 1•0
Ci or Town State' Zip Code
Area code- Phone number
4. DATE DRILLED 1-/6"—D.2
5. TOTAL DEPTH: 9,2 6'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: 2t'c) 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): 3f ri METHOD OF TEST a la ✓ i .
/v
10. WATER ZONES (depth): �i�� - 3/9 J�rn
11. DISINFECTION: Type /-/ 7-7-/
12. CASING:
rr1
Depth Diameter
From /2 To 35- Ft. 6"
From To Ft
From To Ft.
Amount 96
Wall Thickness
or Weight/Ft. Material
PI'/
13. GROUT: Depth Material Method
From e To ,O Ft. ei-rvi-e..44-± hp
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
p v rD..pth Size Material
Frottr 11 lir
16. REMARKS:
Ft.
Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
45
3s' 7.25' n�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
0
0
w
1 DO HEREBY CERTIFY HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
-CON STi A DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c .
SIGNATURE OF PERSON CORUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

250766
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality - Groundwater Section ''
WELL CONTRACTOR (INDIVIDUAL) NAMA (print) ‘�r c(P) a,�'- �rnLC GI CERTIFICATIONO3
# s4Y//
WELL CONTRACTOR COMPANY NAME U rPe4'4 �r ” - Lc/P L.i ^f Tir n)B'Jri -- PHONE # yt2 4, �iS /7°
T/
�D .. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use N.t
2. WELL LOCATI
Nearest Town: County
e
Ua41 7i000
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
.3.OWNER ac tt Y'e �l
r Address Li-V. lc f 't I
(Street or Rout No.)
C N C_ 3 fi 7) In
City orty Town Zip Codc
(—)-
Arca code- Phone number
4.. DATE DRILLED -3 -
:'TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO NI
7. STATIC WATER LEVEL Below Top of Casing: to 6 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): ' Le 0 METHOD OF TEST .Q k rs
10. WATER ZONES (depth): 5
11. DISINFECTION: Type
12. CASING:
Depth
From O To 3 D
Frorn_ To
From To
13. GROUT: Depth
Fromi_To an
From To
14. SCREEN: Depth
From_______ To
From To
15, SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
1 FThl Amount ID 11
Wall Thickness
Diameter or Weight/Ft. Material
Ft. " PVC
Ft
Ft.
Material n\
Ft. ).1` niv�.wT
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Method
)t P
Slot Size
in.
in,
Size Material
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT
. CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RE
,tt
SIGNATURE OF PERSON CONSTRUCTING THE WELL
AIM 7 7 zNT
Topographic/Land setting
❑Ridge 4STSPe ❑VaN¢ , ?Fiat
(check appropriate boy(, , . i
Latitude/longitude of wellieRatiblf
( degrees. mi nutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
n >3dr
-30 ?vLo 5'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ASHEVILLE REGIONAL OFFICE
DANCE WITH I5A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
_z_62-
DATE
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rut I or'f I1T111111

2. WELL LOCAT"
NeareSt-Iq
(Street Name, Numbers, Community, Subdivision, Lot1No., Zip Codc)
3. OWNER. F?&_LDh.T 11 / t a iL
Address 4 S(t.Q Th a i-r.2. C0 51 . 'Rd •
�/1• (Street or R,W}s o.)
City or Town 'State Zip Code
Area code- Phone number
4. DATE DRILLED
S, TOTAL DEPTH: .Si zS '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cr
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 easing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. �r
9. YIELD (gpm): I DE) METHOD OF TEST r A k rs
10. WATER ZONES (depth): 3 Dr) - ! �o cy �ry
11. DISINFECTION: Type 1-+TN Amount LoD
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Tot 4 Ft.
From To Ft.
From To Ft
13. GROUT: Depth Material
Frorn 0 To �D Ft. C b mtmf
�g'714
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:
GRn��11uIIN�,,CF�` _ire _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCiTED.1414DANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AANDTHAT A COPY OF THIS RfiC'OAH.(1AS BEEN PROVIDED TO THE WELL OWNER
Size
AUC
Method
Slot Size
in.
in.
Materia
Material
250765
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural//�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEME(print) a YL( (lJlx_.l- h-� rt t u CERTIFICATION # 30 41/
WELL CONTRACTOR COMPANY NAMEI 4 MANZ,,/1.3n.)) 5 . Ljtl) d 4 t44f0 s'C PHONE # $ 6 Z% g - 31 7v
STATE WELL CONSTRUCTION PERMIT# /T 0 a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6d' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
wn: County od
fa ua a.
Topographic/Land setting
❑Ridge 2Slope ❑Valley ❑Flat
(chock appropriate box)
Latitude/longitude of well location:
(degrees, minutcs/scconds)
Latitudeilongitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forme Description
DEPTH
Fro To
to St
/, 4t . 3 S'
r�Yr'i2Ya 1 i'P
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
fV
a
70
fV
CO
SIGNATURE OF PERSON CONSTRUCTING THE WELL
s� _e.—
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
-- - n,,, , n1'9, ,N PL1111

250760
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �DD bin We-) ) E-) D CERTIFICATION 8 a% 4///
WELL CONTRACTOR COMPANY NAMFITrP.P-Vie [ICES. I r.i,s LC- •1 PLL.mp UMc- PHONE q sag - 3/'lb
STATE WELL CONSTRUCTION PERMIT# 140 a ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I!d/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
''.2. • WELL LOCATION: I
Nearest To 1) County 4aijnbctiI t Ct6� d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
. 3. OWNER: .I he. nil()ti 1 fl\O U cL
Address / O thD Cnld 1-t,rla,-r Tbr- .
(Street or o.)
hnsL eij or NA SGo'2S
City or Town / State Zip Code
Area code. Phone number
4. DATE DRILLED .3
5: TOTAL DEPTH: S/)S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: nri-esrQnFT.
(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 to accordaa�S�'ith ISA NCAC 2C .0I18.
9. YIELD (gpm): __oS-- METHOD OF TEST cQ A rs .
10. WATER ZONES (depth): -305 '- a a rm
a
11. DISINFECTION: Type HT N
12. CASING:
Depth Diameter
From_O To 3 S p1,
From To Ft.
From To Ft
13. GROUT: Depth
From D To O Ft.
Amount q a
Wall Thickness
or Weight/Ft.
Material
o irvxa.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Mater
From To ' Ft.
From To Ft.
Material
pve_
Method
Slot Size
in
in
16. REMARKS:
Material
Topographic/Land setting„.
❑Ridge ❑Slope ❑Valley Grist
(check appropriate box)
Latitude/longitude of well location
(degrees. nunutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To t Formation Description
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.
JUL -
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
N
N
w
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
. CONSTRUCTION STANDS, AND THAT A COPY OF THIS RE D HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTR C I ING THE WELL DATE
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27699-1636 Phone No. [phone]. within 30 days. CW-I RFV f17/nuul

250761
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM1MA (print) ZDr t 1a r-ll Ill— CERTIFICATION p.3. 4//
°a
WELL CONTRACTOR COMPANY NAMEC f'Pa41,'.23S O. (e/e�.( 4 I-t.,.,�,�4 c PHONE # ($-CIS) 4 Sig ..3) 70
. STATE WELL CONSTRUCTION PERMIT# /7"€C ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Pump Monitoring 0 Recovery 0 Heat Water njection 0 Other 0 If Other, List Use
2. WELL LOCATIO ' :
Nearest Town:
- lgsia
I County r'in.t� °mEet
(Street Nam umbers, Community, Subdivision, Lot No.. Zip Code)
Topographic/Land setting `" "
0Ridge (#Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location .
3.OWNER. 'JP'A.r1Pfit, e;, a i'JV'Ies—RusseJ)
(dcgrces minutcslscconds)
Address 7 F F: R: QQ CIA a..v2 -ad Latitude/longitude source:❑GPS❑Topographic map
tO11 (Street of Roate 4o.) (check box)
11P Su; /itt- A/C 0,P7OLD DEPTH DRILLING LOG
City or TVwn State Zip Code From To Formation Description
'1 D 185' E\ n -&-uu
Area code Phone number
4. DATE DRILLED ..3 - 1a-
, 5;1 TOTAL DEPTH: 185 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NC) -
7. STATIC WATER LEVEL Below Top of Casing: 4-D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of easing terminated atlor below land surface requires a
variance is accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): / 5 METHOD OF TEST rs
10, WATER ZONES (depth): 1S - 15 spry.
11. DISINFECTION: Type 1-1-1-
12. CASING:
Depth Diameter
Frorn_T,
From To Ft.
From To Ft
13. GROUT: Depth
From t1 To cap Ft.
From To Ft
Material
..., -t
Amount 3
Wall Thickness
or Weight/Ft. Material
"9 ye -
Method
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:
Ma er al
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J� S
JUL -
GROUNDWATER SECTION
ASHEVtLLF REdiONNL Ot- u,t
0
N
tV
N
w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND S, AND THAT A COPY OF THIS RECO$D HAS BEEN PROVIDED TO THE WELL OWNER
XI) .1 SD
/-41.2._ 5,/ a z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
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Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1616 Phone. Ala mini li1t111 within in d.,,,. rur , nr,r

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250762
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
NjJtral,(Resources - Division
ofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�• (print) �r�1_'� / q t � n HONE #ICATION M a'lig
-
WELLCONTRACTORCOMPANYNAMEI`Tre.e.'/C'ros. �L W f-/I irp.YRI' PHONE fSri GS1'S �'3 /96
STATE WELL CONSTRUCTION PERMIT# /T 4 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential F1.1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I(Other, List Use
• .2. WELL LOCATIO
NearestzT1own. eta,
( Art e ±TN-.' i e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3, OWNER. -Ke 1/ I in e V) s
Address 4/.2 .77; y Creek
County 440 A' b)e 9el
(Street or Route No.) /
City or Town State Zip Codc
Area coda Phone number
4. DATE DRILLED —3- 15 - D a
5: "TOTAL DEPTH. / sic '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO it
7. STATIC WATER LEVEL Below Top of Casing: g D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)• I Di) METHOD OF TEST 2 krs
W. WATER ZONES (depth): / Q 5 ' - g r
�'
11. DISINFECTION: Type I—E'-I—i Amount a 5
12. CASING:
Depth or Weight/Ft. Material
Front_a To 3 g
From To
From To
13. GROUT: Depth
FromD To )D
Front__ To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From, To Ft.
Diameter
Ft.
Ft
Material
/�
Ft. t n
Ft.
Diameter Slot Size
Ft. in. in
Ft. in. in
Wall Thickness
Pia
Method
Material
Material
16. REMARKS:
Topographic/Land setting
❑Ridge lipe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees ininures/sceonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form t n Description
30
gg Ifs'
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.
JUL
GROUNDWATER SECTiON
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT A COPY OF THIS RECO �.B+iAS BEEN PROVIDED TO THE WELL OWNER R
0
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SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, I63o Mail Service Center - Raleigh, NC
��cnn .cac DL.. _.. x:.. to' fix 1771 ..4N.:.. 10 d,.,c (1W-I RFV. 07"001

252.038
WELL CONSTRUCTION RECORD
.North Carolina - Departtpent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/1 (print) D .r l.ti F� PCERTIFICATION 8 o'i 4l g
WELL CONTRACTORCOMPANY NAME (�'re.r',nt ZRr'DS • De-1) 4-PIA Y11D �Nt. . PHONE # fS'. L zeig - a 70
STATE WELL CONSTRUCTION PERMIT# 1 ¥0 ASSOCIATED WQ PPERMIT#
(if applicable) (if applicable)
1. WELL 'USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
County
(Sweet Name, N
3, OWNER:
Address
rs, Community, Subdivision, Lot No., Zip Code)
v,
TV ! fames t-Y1 P ao,.)
(Street or Route No.)
le�Z1 ne51)t) ,1 nia 08181p
City or wn ... State ' Zip Code
Area code- Phone ntunber 07 -
4.' DATE DRILLED -� " D 2
'TOTAL DEPTH. R 45'
6, ,DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: to D FT.
(Use "+" if Above Top of Casing)
8..TOP OF CASING IS I FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance wltb 15A NCAC 2C .0118.
9. YIELD (gpm):' L METHOD OF TEST eQ }1 r s •
10, WATER ZONES (depth): a 5 ' - 5( P,r
11. DISINFECTION: Type )-1T1-1
12. CASING:
Depths ameter
From P To 83 Ft. it
From. To Ft
From To Ft.
13. -GROUT: Depth , Material Method
From 0 To .OD Ft. CoAnra,,,' }�-,0
•Fron>_ To Ft.
14. -SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:*_-�
Depth 1 r, 1.Si
From To ! ErI
From To . rht:'
I
iU L[
Amount .113
Wall Thickness
or Weight/Ft. e/a),
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T�o� Forma'oADescription
Q n{
3 02 ��� or-nnrul
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WEL4 . GON(S I I4G,TED IN
CONSTRUCTION STANDOI;PJS, AND THAT .A CDPYiOETtfIS"RECO
Yed
Ail -a lei
SIGNATURE OF PERSON CONSTRUCTING THE WELL
CCORDANCE�'WITH I5A NCAC 2C, WELL
THRS.3EEN PROVIDED TO THE WELL OWNER
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699.1636 Phnne No. (9191 733-3221. within 30 days. GW-I REV. 07/2001

..fit:' e'•:y . _ _+=—�.w.r:e.
WELL CONTRACTOR (INDIVIDUAL) NAMMA (print) Br-a-CERTIFICATION#S4 f /
WELL CONTRACTOR COMPANYNAME4r eth� '� e5 ��P.i i S(- 14-/rit t \lA-C •PHONE # Jg�.fOG 4/ - 1-1d
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD 2 5 203 9
North Carolina - Department of Environment and Natu Resources - Division of Water Quality - Groundwater Section
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential— Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
` 2. WELL LOCATI
Neare Town: Count
Ltik,e- Iva - .., —Rd •
y
At, GJD ol—
(Street Name, Numbers, Community, Subdivision, Lei No., Zip Code)
3. OWNER. 6 r
'Address A no `l LIDrv
(Street or Route No)
(City or Town State Zip Code
ALL
na P ed.
Z.2 V7Dj711
Area code- Phone number
4. "DATE DRILLED 3 - / 3 —OS
5:`<TOTAL DEPTH: Sa S '
& DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 1140 FT.
(Use "+" if Above Top of Casing)
8, ,TOP OF CASING 1S f FT. Above Land Surface*
*Top of casing terminated al/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)• 7 METHOO OF TEST c k r s
1Q. WATER ZONES (depth)• /S — ? jprn
11. DISINFECTION: Type 1-1-TP Amount Lo D
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Frotn .Cj To IDS Ft. I. " P l/C
From To Ft.
From To Ft
13. GROUT: Depth • Material Method
From D To aO Ft. 0 tNw.-..
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ftin in.
15. SAND/GRAVEL PACK: f"�
Depth 11 Size • Material ii , 1
From To rPQ E i,
From To�_d rfi i
J I Ii I
16. REMARKS:
Topo raphic/Land setting
❑RidgeSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrccsi minutcs/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To r Form Description
0 /DS
/DS' 32S' S1ti,Q
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
IV
1
0
—13
r
1 DO HEREBY CERTIFY THA" THIS *ELL WArSrcdMSTRUCTED IN
CONSTRUCTION STAND L ANb T-HAT-A-COPY.OF TNtS RE
CCORDANCE WITH ISA NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
$- e> -D.2-
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SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone]. within 30 days. GW-I REV. 07/21101

252040
WELL CONSTRUCTION RECORD
.North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEn(print) £ r i AI . CERTIFICATION # 3v'1/
ELL WCONTRACTOR COMPANY NAME&rP8. J YDS . LJP II 4Pumy) CAC PHONE # feat ill -3/ 74
STATE WELL CONSTRUCTION PERMIT# /T O a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialYl. 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: U )nir(r 5 V t Ile- County Pia Lama
L n l 1011 rl n rvn' .t.. �t ,'c1 Ree,
1. (Street Name, Numbers, Community, Subdivision, Lot No., Zip c)
3. OWNER. /5D L ..2) /v i SCD
'Address a La D '] Cn n z.cc.rnt J a r.
_ (Str/ c wn�,• p get ocF Route No.) 33 / /
City or Torn 2 State Zip Code Co
(J-
...: >. Arca code- Phone number . /
4."DATE DRILLED�-
Si TOTAL DEPTH. R $s `
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO „
7. STATIC WATER LEVEL Below Top of Casing: 8-0 FT.
(Use "+'• if Above Top of Casing)
8, TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118. n l
9.:YIELD (gpm):' I. 6 METHOD OF TEST Ct n r3 •
10. WATER ZONES (depth): 80 — / . S 3 j-,
11. DISINFECTION: Type ,/ L77 /
12. CASING:
Depth
From To_ 2 Ft.
Froth To Ft.
From To Ft
13. GROUT: Depth •
From D To a0 Ft.
From To Ft.
14.'SCREEN:Depth
From To
From To Ft. in. in.
15. SAND/GRAVEL PACK.
Depth
Front To
Diameter
Amount /(. 2
Wall Thickness
or Weight/Ft. Material
nMaterial Method
( a mtD s4-2
.
Diameter Slot Size
Ft. in. in.
From To
16.' REMARKS:
Material
ize Material !'.-,
Topographic/Land setting
❑Ridge ?Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To3 Format oq Description
a3 fl5'
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.
w
I DO HEREBY CERTIFY THA
CONSTRUCTION STANDA¢D, , AND THAT_AEC6IfORSF'
SIGNATURE OF PERSON CONSTRUCT
THIS M� S.�.CONSTRUcTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
a J - 2
G THE WELL DATE
0
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on
rn
o`<
Yo
mo
rn
ma
e4
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail tinnier Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

2.55601
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '`
WELL CONTRACTOR (INDIVIDUAL) NAM (print) ,/JP[ / �+ J ryY/,''r� ` o CERTIFICATIONOk �/� 7 /
WELL CONTRACTOR COMPANY NAME een& B.
lri-// V / �' A" -PHONE # eior6 l `Z'g `3/ 74
STATE WELL CONSTRUCTION PERMIT# ,,,iiii////
0�
(if applicable)
ASSOCIATED WQ PER:MIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ) MunicipaliPublic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
•
Top g phic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION: / ). ii Nearest :Town: j a is ` County
7 aei[n - ZsiAliia-
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Codc) /,,/
3. OWNER:: Alf I74 ieA)e f se. l/��zfte-y /J/`" 4- •
Addres /et ei 7 % L i /in •
(Street or Route No.) .4 g 6
Cipwr Town State Zip Code
(—)-
Area code- Phone number _
4. DATE DRILLED 3— I g - O
5. TOTAL DEPTH: cc-5- I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01 It
9. YIELD (gpm): METHOD OF TEST 2-, }'1r-S
10. WATER ZONES (depth): I Ce 0 I - qi ri Pm
11. DISINFECTION: Type 1-4Y k Amount
12. CASING: Wall Thickness
/� Depth Diameter or Weight/Ft. Mr ey
From F To /iV Ft (v
From To Ft.
From To Ft.
13. GROUT: Depth /Material Method
From 0 To aO 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 De 11(hKEHY 419 it Y
ONStRU¢ILION ST''AN
tH
1-
ubmit the original to the Divis'
161?) 4 s:'!h P'Prj g? 733-32
ASHEviLE PriMONALOFFICE
(degrees minutes seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From % ` . Forman()Description
/ / aas' .114.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
N
C-
r-
co
a
0
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
JD THAT A COPY OF THIS RE SY QD HAS BEEN PROVIDED TO THE WELL OWNER
3NATURE OF PERSON CONSThRCJCTING TIIE WELL DATE
on of Water Quality, Groundwater Section, 163n Mail Sen ice Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

255069
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaljResources - Divviission of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) St-t .3L. BY,tt CII.. CERTIFICATIIsO�N # 344 /
WELL CONTRACTOR COMPANY NAME CYYLGnt £7DS , Gie / / Y / hemp) ING • PHONE # imp L vs - 3/ 7,3
STATE WELL CONSTRUCTION PERMIT# J V6. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential µl Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION.t
Nearest Town: l[J6J/npSY/74 County A/Ay wood
-Pi nnaele_ ' L07` .J
(Street Name, Numbers, Community,
+S 6divisiion, Lot No., Zip Code)
3. OWNER: tr Cr/ -A i Qay LL
Address 'bo / dLer Trai
2 (Street or Route 1441, a. f l ?/ Ze
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED .3 -G - 0 a-
5. TOTAL DEPTH: . RS ' .[
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): % METHOD OF TEST 07 hr5—
10. WATER ZONES (depth): 44— r1 gPrr�
11. DISINFECTION: Type /-ETif-/
12. CASING:
Depth Diameter
From 0 To 24 Ft. G "
From To Ft.
From To Ft.
Amount s/
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth lMater�l
From_,ZTo_it Ft.
five
Method
rbr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
oats Size Material
1�1
16. REMARKS: j
I DO HEREBY CE4TIFY
TANE
Ft.
Ft.
Topographic/Land setting
❑Ridge SS lope ❑Valley ❑Flat
(check appropriate box)
Latitude/lonuitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTI L
From To
endi
aG 225'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
A
0
Ca)
tV
CHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
BARDS, AND THAT A COPY OF THIS RECOR¢N.4S EEN PROVIDED TO THE WELL OWNER
SO ..44 Y� ,r 3 / — D 1
SIGNATURE OF PERSON CONSTRUC ING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, I63o Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

io
255067
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) aL/Lat4 .211YLP1 LCERTIFICATION # 3a44/
WELL CONTRACTORCOMPANY NAME Grt CMG Brem5• /✓``Gl/ a PizD v, /N! .PHONE # dad/7d
STATE WELL CONSTRUCTION PERMIT# ISt i- ASSOCIATED WQ PERMIT#
(if applicable) • (if applicable)
1, WELL USE (Check Applicable Box): ResidentiaMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Wate l) Injection 0 Other 0 If Other, List Use
.2. WELL LOCATION1/
Nearest Town: [ ;eta7110A County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
. 3. OWNER: inru i5 • Sr re
Address PD &fl 9S /
(Streetpr Route No.)
iJP, /tie at7g6,
Cityb Town State Zip Code
'Area code- Phone number
4. "DATE DRILLED 3 - .25 - O s
5;'L TOTAL DEPTH. DDS r
& DOES WELL REPLACE EXISTING WELL? YES 0 NO til
7: STATIC WATER LEVEL Below Top of Casing: 4LD FT.
(Use "+" if Above Top of Casing)
8..TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ` 't METHOD TEST 2 hr5
l0. WATER ZONES (depth): /of- gp.,.,
LOCATION SKETCH
Show direction and distance in miles from at letC
two State Roads or County Roads. Include the road
numbers and common road names.
N
CO
Topo aphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idcgrccs' ininuresiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
• G9"
49 2eAS" y atie
11. DISINFECTION: Type H TN Amount 310
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To he 4 Ft._tpit P✓C
From To Ft.
From To Ft.
13.'GROUT: Depth . Material Method
From I n
To it Ft. ! r ?vox-1- +op
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15, SAND/GRAVEL PACK:
-PcP I �¢c
t�r0__ Ft -,
From
From
16. A1:M
Material
I DO HEREBY Cl{RTIFY THAT THIS WELL WAS OONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, CONSTRUCTION VAND0MDIEhusncTiw A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SHEVILL'" r-GIUjAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
S-3/ -e t
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1631i Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. CiW-I R FV. 07?71111I

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME
�� (print)_. /
.WELL CONTRACTOR COMPANY NAME(-rrP Pb1P. J'S/YQ5 QJP II Pa h'1�'%1 x6 f'-r
STATE WELL CONSTRUCTION PERMIT# J ,'Z7 Z
(if applicable)
255082
- Groundwater Section
CERTIFICATION # 3/0r/
PHONE # f,C/44/f /76
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use •
2. WELL LOCATION:
Near sit T9wp:
Name, Nuitibers, Com
3. OWNER: .tf 12
Address
Count/
%7 /.'LLL/Si
nity, Subdivision, Lot No.. Zip Code)
T.LA e.L
(Street oute No.)
r
?-
City own State
Area code- Phone number
4. DATE DRILLED 3 - S - D a
5. TOTAL DEPTH: 1 9,5
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO‘14
7. STATIC WATER LEVEL Below Top of Casing: to /^ 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): L U METHOD OF TEST r5
10. WATER ZONES (depth): I OD' — 185 '
Gm+�
411. -
�17z/
Zip Code
I1. DISINFECTION: Type 1-FT(-1
12. CASING:
Depth Diameter
From D To /n - Ft. La
From To Ft.
From To Ft.
13. GROUT: Depth
From 11-) To a D Ft.
Material
Amount c
Wall Thickness
or Weight/Ft. Material
Method
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 1 Ft.
1 Fro 1 or,
�
iI t.
t t 16. REMARKS:
J
I DO HEREBY CERTIFY 'tf{i4�I/
AN
[CONSTRUCTION STD S,
Topo rapnic/Land setting
❑Ridge Slope ❑Valley DFlat
heck appropriate box)
Latitude/longitude of well location
(degrees: minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formajeppn Description
D LS
(,S' 186 ' .1Cixe.u-.-Lc
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.
cc:01tin 8zNBC z0
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECO AS BEEN PROVIDED TO THE WELL OWNER
1GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163o Nlail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

25731.3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) /f/li�p U/'7 ' /4/42 /J CERTIFICATION #.'�/Y'/2
WELL CONTRACTOR COMPANY NAME YrP est
.L n.; , /ii�,// St- PLLGnp act .PHONE. q 10�� �Y'�' .3I '%°
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cou�L}ty_
p e_ 4tt.,t
(Street Name, Numbers, Communitydivision, Lot No., Zip Codc)
3. OWNER:
Address '/4'
S cat or Routs o.
City or Town C
State
Zip Codc
(-)-
Area code- Phone number
4. DATE DRILLED 3 -n-D 2
5. TOTAL DEPTH: 4RS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO*
7. STATIC WATER LEVEL Below Top of Casing: gQ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING [S / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 7 E� -
10. WATER ZONES (depth): .26 s - �,2. ipm
/4/02
Topo raphic/Land setting
❑RidgeSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees min es/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To 7 Formati n Description
y8
92' 4'gsr
S'gc - / �/z jp ��
From C 9r� /a / PUe-
From
From
13. GROUT: Depth /M:aterial
From o To �d Ft. t 2.NK tic .�
From To Ft.
14. SCREEN: Depth Diameter Slot Size tvlaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
11. DISINFECTION: Type ,' / .. Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To Ft.
To Ft
To Ft.
Method
From To
From To
Ft.
Ft.
N
LOCATION SKETCH m
Show direction and distance in miles from at9ehst c ^-
two State Roads or County Roads. Include th&oado
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION ST$1 DS, AND THAT A COPY OF THIS RE HAS BEEN PROVIDED TO THE WELL OWNER
-02
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original tol&hjp
eDivision of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
I27699-1636 Phone No. 419) 7:3-3221, within 30 days. GW-I REV. 07/2001
,T�,
DATE

249243
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME
E (print) 3b-nQ � r u_c � CERTIFICATION # tiDiiI
WELL CONTRACTOR COMPANY NAME&r WS'Stt q(3tFJJps . LZJp)) �Y Pm-ny / .4p.g PHONE # ($ai' e 3 ) 20
STATE WELL CONSTRUCTION PERMIT# / VOcZ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialil Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ''i
Nearest Town: CIS .t County I�a.t.4 tiwe.
n,`i' V3C'r
(Street Name, Numbernity, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
ri -7 A_' ocicr‘. kr/ .
(Street or Route )No.)
LDO ii nesr, ► 1!i NC a3inG
City or To State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED - l F4 -b 2
5. TOTAL DEPTH: 3 8 5 ' .,../
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO os�
7. STATIC WATER LEVEL Below Top of Casing: ( 130 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. rs
9. YIELD (gpm): IW t METHOD OF TEST oc ln r s
10. WATER ZONES (depth): li.o% i - ion R pM
LOCATION SKETCH
11. DISINFECTION: Type I-{ 1 1--4 Amount '1 I Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From O To Sb_ Ft. Lb " P V C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To c O Ft. Co.rn+e_...t --}-n-.p
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size Nlateri it
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/loncitude of well location
I decreesminutes. seconds)
Latitudeiloneitude source❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.55 ,3SS
From
From To
Ft
Ft.
c
c-a
16. REMARKS:
i WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
D THAT A COPY OF THIS ! t D HAS BEEN PROVIDED TO THE WELL OWNER
3-5 -oz
ATURE OF PERSON CON - ' CTING THE WELL
DATE
8\,,4 ivisioo of Water Quality, Groundwater Section, 163o Mail Serx ice Center - Raleigh, NC
2$99E1/h3 llthid DM 733-3221, within 30 days. GW- I REV. 07/2001

249240
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAM1f' (print) L�11�lJ /i if gT I -tit,/ j,i CERTIFICATIONAOf031)'(
WELL CONTRACTOR COMPANY NAME j-sY P P.M 11��-,// ///}},'Zf-i� , �[✓p�{7 Y W >vjz AP . PRONE q jD,,rD 4 z}'g' .^�.+/ %O
STATE WELL CONSTRUCTION PERMIT# `f(/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residenti i't _ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I(Other, List Use
2. WELL LOCATIO
Neareflown' t, �, County
d
1 vt 0 A
(Street Name, Numbers, Community, Subdivision, Luit No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
City or Town Slate �� VV
.287 / Co
Zip Code
( )-
Area code- Phone number a
4. DATE DRILLED — 9 - O a.
5. TOTAL DEPTH: I QS '
6. DOES WELL REPLACE EXISTING WELL? YES ,❑`�NO
7. STATIC WATER LEVEL Below Top of Casing: 4,0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan e w tA NCAC 2C .0118.
9. YIELD (gpm): obh 15METHOD OF TEST cl 11 f5 •
10. WATER ZONES (depth): IOC) •• (DO grrr-v
•
II. DISINFECTION: Type hI Y 1-I Amount caoZ
12. CASING:
Depth From t To 4—I!;
Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To 11)
Diameter
6 et
Wall Thickness
or Weight!Ft. Material
Material
Ft. Cn y,.e1/4.3
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.
Method
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARDS
Submit the original to the Div
Size Material
-N
AV
�Jj
«ELL
f
I
WAS CONSTRUCTED(
THAT A COPY OF THIS REC
r
R
S'IGNATURE OF PERSON CONSTf
aROW:CWHTER SECTION
sion of Viiithi-LiiiiiiiWCrOfifild4.ater
Topoyaphic/Land setting
❑Ridge MSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes seconds)
utitude/longitude source:❑GPS❑Topographic map
[cheek box)
DEPTH DRILLING LOG
From To Formarign Description
41 r
90 /
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
J
N
O
r*
r;
c
ORDANCE WITH( I5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
3--5'-U z
G THE WELL DATE
ectioli, I636 I lail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W- I REV. 07/2001

249239
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME(print) /Jr� aAA t JI—is p , / CERTIFICATION # SI d
i' «i
WELL CONTRACTOR COMPANY NAME&r P.P.LLE- �Y2o;i l!�l�-( 4 Pu.nfz0Y�PHONE IX L�J��GT8 31 �
ASSOCIATED WQ PERMIT#
Of applicable)
STATE WELL CONSTRUCTION PERMIT#
(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
2. WELL LOCATIO : �r
Nearest Town: G.� County3.
k apt) oncU
(Street Name, Numbers, Community, Subdivision. Lot No.. Zip Code)
1 11
3. OWNER: gin 1 I(: SS Lc'
Address 22.A '(Yior'nr nqv i e-r..) !'P�
y V)(Street or. Route No.) J /7
ti l%eS V r (iEC r Na / 6p
60
City or 'Dawn State Zip Code
(
Arca code- Phone number U
4. DATE DRILLED a —
5. TOTAL DEPTH: Cn /7
6. DOES WELL REPLACE EXISTING WELL? YES I I NO THE
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 Ith ISA NCAC 2C .0118. 11
9. YIELD (gpm): METHOD OF TEST t it (S
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
hoc appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds(
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH (cheek
LOG
From To Formation Description
1
11 (0OS' i-
10. WATER ZONES (depth): 401 1 3 ct pm
11. DISINFECTION: Type
12. CASING:
Depth
From I To (e ) Ft.
From To Ft.
From To Ft.
Diameter
II
Amount 1 Dr-J
Wall Thickness
or Weight/Ft.
Material
PVC.
13. GROUT: Depth ^Material _ Method
From D To Ft. Lt)X��i (tT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cn:_-
0;Jc
c�
1 DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
et. v1.
r
pi/ELL WAS
L N
CONSTRUCTED
THAT A COPY OF THIS RL:"
Crtl'
�
l�f �1i1 it' L, a iS
Pig_
SIG TURE OF PERSON CONS1RUC
CORDANCE WITH I5A NCAC 2C, WELL
AS BEEN PROVIDED TO THE WELL OWNER
_oz
ING THE WELL DATE
Submit the original to the D visiolARtj }I jLG
0 t4c We¢wate- Section, 163o Mail Sonic
ai 1�
27699-1636 Phone No. (919) 73.,-a22 t, within 30 days.
Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
249238
North Carolina - Department of Environment and Natural Resources\- Division of Water Quality - Groundwater Section
-ci�`F✓J LPl �i E EI ft; N gaf'/
/s (Si.7$G�f8�317D
CERTIFICATION
WELL CONTRACTOR (INDIVIDUAL) NAM1ty(print) t-,Tr
-PHONE
p0 T
WELL CONTRACTOR COMPANY NAME te...4 i. OS . ✓: `� ctvr.p .
I-L
/Sn a
STATE WELL CONSTRUCTION PERMIT*/
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential U Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOf (:
Nearest Tawn: ( County r__,t12
a15S
(Street Name, Numbe( Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: U 2 k n
Address 30 `7 f e �-�-
^(Street or Route No.)
City or Townwn State
vc,.-,r•�
EA.
c2' 71
Zip Code
( )-
Area code- Phone number
4 DATE DRILLEDo� — 1 — D ,. a ejl t w"4 f"
Topographic/Land setting
❑Ridge ❑Slope ' alley ❑Flat
tchcck appropffiVatee box)
Latitudetloneitude of well location
(degrees in inutes/seconds)
Latitudeilongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: 361 5 r aa v t
,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q�
7. STATIC WATER LEVEL Below Top of Casing: 11'1) 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. �^1
9. YIELD (gpm): / a METHOD OF TEST c h rS
10. WATER ZONES (depth): .5 % ' — l a J ct pm
11. DISINFECTION: Type N TI-I. Amount to `7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. tv aterial
From 13 To rX / Ft. w t r C
From To Ft.
From To Ft.
Depth �+ Material�
To r21) Ft. IDXYIR
13. GROUT:
From b
From To Ft.
MethodI
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 FL
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
I DO HEREBY CERTIFY
CONSTRUCTION STAND
PIS (Fa
S Witt )37AS'CONSTR)C E
AND THAT A COPY OF TH R'
SIGNATURE OF PERSON C
N ACCORDANCE WITII I5A NCAC 2C, WELL
D HAS BEEN PROVIDED TO THE WELL OWNER
J _oa.,
UCTING THE WELL
DATE
Submit the original to tte FORtkelfQ%411ta0 rounds
27699-1636 Phone No (91c.) 711M.21-4-iiftiRN14164. OFF ICE
ater Section, 1631 Mail Scrs ice Center - Raleigh, NC
GW-I REV. 07/2001

250767
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur I Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMAlf
El (print)
WELL CONTRACTOR COMPANY NAME I fee,71'P/.1�r0
STATE WELL CONSTRUCTION PERMIT# J41 D.
(if applicable)
CERTIFICATION# T/O
el)? rT r .PHONE 1/t72 L 5jg -3/7L5
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 IFOther, List Use
2. WELL LOCATION:
NeasestTQwn:
u
,ubL ed
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
Count
3.OWNER. . Urnn q
Address .? 3/ —Ras j/ c 1—j- rAJ e Re)
/K� (treet or Rou ea) a?q 7/6,
City or Town State Zip Zip Codc
Area coda Phone number
4. DATE DRILLED a - ' 4 -D a
TOTAL DEPTH: && 5
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /OD 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): w� METHOD OF TEST 42 h r s
• 10, WATER ZONES (depth): SAD RPm
11. DISINFECTION: Type N Tl-1
12. CASING:
Depth Diameter
Front To3G,.1, Ft. LP'r
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Front 0 To c b Ft. 1^o A-„p..,,_}
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.
Amount CI
Wall Thickness
or Weight/Ft. Material
Pvc
16. REMARKS:
Topographic/Land setting,
❑Ridge ❑Slope ❑Valley IFlat a^?
(check appropriate box)
Latitude/longitude of well location 1Reut
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Fo at on Description
n 3!0 . �o
.36.(c aG •u'
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.
JUL. - 1 20n2
GROUNDWATER SECTION
OFFICE
N
N
CO
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND S AND THAT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
Lac( .2 0
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SIGNATURE OF PERSON COR'STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mail Sen ice Center - Raleigh, NC
27699.1616 Phone Nn 19101 711.11/ I w,trr.:., in .r.,.,. .... ,._....

WELL CONSTRUCTION RECORD
2507138
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) Y' L((1.49-t Cr- CERTIFICATION # •30 'f �
WELL CONTRACTOR COMPANY NAME ( rearle- '�YJtee /i)e.1 i --I) Puvapi Zy -PHONE # j/ho•I4� 4/0
, u '�/70
STATE WELL CONSTRUCTION PERMIT# I `Y/Z? ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EKMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
• 2. WELL LOCATION: 14
Nearest Town: f 'laA Cl VQ ) 4,3 County a ui tb PA
TYl a .Lit Li 1 cud-- s v v e-
(Street Name, Nnifibers,Conununity, Subdivision, Lot No., Zid Codc)
3. OWNER: r( fk ex -
Address SC rl `- &sser a •
(� w(Street qr Route . g 71cate
/ /e City Ll Town State Zip Codc
Area code- Phone number
4. DATE DRILLED
5.1TOTAL DEPTH: -4-5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO r
• 7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+•• if Above Top of Casing)
8. .TOP OF CASING IS 1 FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9, YIELD (gpm):' '/• S METHOD OF TEST ? h rS •
• 10. WATER ZONES (depth): c2 o S r - 7. S r.p, r.%
11. DISINFECTION: Type I.4 TN
12. CASING:
Depth
From D To LZ-CI Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From-0.____ To OG Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Diameter
b rr
Amount Q 2
Wall Thickness
or Weight/Ft. Material
P U c:
Material Method
Co Ar64.:N f�
16. REMARKS.
Slot Size
in.
in.
Ma
ial
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
cheek appropriate box)'
Latitude/longitude of well location
(degrees minutes/seconds)
Latitudeilongitude source:❑GPS❑Topographicmap
(check box)
DEPTH DRILLING LOG
From To Formation Description
S19
49 SDS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material
C
0 11 I
JUL - 1 2002
GROUNDWATEf, SECTION
Ar"re"_lE r
O
N
Tro
-u
0
-a
N
N
ca
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN�pi�ARDS, AND THAT A COPY OF THIS CORD 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, 163b Mail Sen ice Center - Raleigh, NC
27699.1616 Phone No I9191711.1221_ within 10 dove Mkt -I RFV. 1)7/201)1

252041
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section ,/
WELL CONTRACTOR (INDIVIDUAL) NAM (print) c��/tuY,/�J/A.N,11 ...Wr � CERTIFICATION p '7-/
WELL CONTRACTOR COMPANY NAME &/GCn,��_[[ , OS . LUP// 9t' tLh9,, �DhS.iRe . PHONE 8 (d�it-3/%6
STATE WELL CONSTRUCTION PERMIT# 14.0 —11- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential DiC Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: _ County /�Q,L// 14od
YYIn�.,!na1 eb�. P4. rff
(Street Name, Numbers, Cdmmunity, Subdivision, Lot No., Zip Codc)
3. OWNER: -l1�
Address /'C tS6 or YY/may •
�l v//liRouetA-6 / ofl. %geo
Ci or Town State Zip Codc
Area code- Phone number
4, DATE DRILLED a - l 4 -D C1
5 "!TOTAL DEPTH. *OS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tit
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 wing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):' 4/7 METHOD OF TEST c h rs •
• 1Q, WATER ZONES (depth). 'fS' - 50 7/ry
11. DISINFECTION: Type 1-fYN
12. CASING:
Depth
Front,/ To 55 FL
From To Ft.
From_______ To Ft
Diameter
n
Amount
Topo aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Lat itude/longitude of well location
(degrees minures/scconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From 33 FormatiggDescription
.33 4105�
2e�
LOCATION SKETCH
74/ Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Materia numbers and common road names.
13. GROUT: Depth n Material Method
From_ To a0 Ft. r2Yn&&. t /nit
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth
Slot Size Material
in.
in.
From To ' Ff
From To Eli l� f
— Il 1
16. REMARKS; I IU
Stse
Material ii
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
LJ
HIS WELL WAS CQN-SIRSICTEtIN AC
ND THAT. A COPY OF THIS RECORD
CORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
PO
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rn
—0C
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SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
25.5070
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tu(SO bin n L%IDa6 b CERTIFICATION # /WI
WELL CONTRACTOR COMPANY NAME &reek,' Bros !.11 al Ph Vi,rt la! *PHONE #(8SLy8-3/70
STATE WELL CONSTRUCTION PERMIT# /4!o ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection ❑ Other 0 If Other, List Use
2. WELL LOCATION
Nearesstt own: ! -Qickn. County 2rA
ktist
_U.'r C fay-k
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: {%t41
Address ROIL.
lP4ehre. /4 Ln •
(ANet or Route No.) ,rp 73
City or Town Mate Zip Code
Area code- Phone number
4. DATE DRILLED a•aa-O
5. TOTAL DEPTH: /NS'
6. DOES WELL REPLACE EXISTING WELL? YES O NO I.
7. STATIC WATER LEVEL Below Top of Casing: hp 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): L 0 METHOD OF TEST Art s
10. WATER ZONES (depth): /45' - LO p rn
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude suurce:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D 77
77 /4'S'
11. DISINFECTION: Type
12. CASING:
H TN
Depth
From t To 77 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From._ To .2D Ft. CQ.Yw4a f
Amount c S
Wall Thickness
Diameter or Weight/Ft.
�„
e.
Material
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
r F ro VD Ft
�l
LiLI 16. REMARKS:
'
From To i Ft,
UJ
Size Material
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
0
tV
t_
PO
CO
0
0
IV
DO CHAT rHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITFI I5A NCAC 2C, WELL
NS I �*i 9'f'�(h� ARDS, AND THAT A COPY OF THIS RECORD H EN PROVIDED TO TIIE WELL OWNER
�/ 9141
NATURE OF PERSON CONSTRUCTIN HE IN DATE
0
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m
G
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mali Senice Center
I REeigh, NC I
27699.1636 Phone No. [phone], within 30 days.

247246
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaltuResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/'� (print) {J//�jY CL,d.I >ra CERTIFICATION # -44 /
WELL CONTRACTOR COMPANY NAME CrP fht' //Srtb • /E)PJ / c/ Pu 112p Vice PHONE # (ga6 c 'n - 3 / '7b
STATE WELL CONSTRUCTION PERMIT# / h` > - ASSOCIATED WQ PERM IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 9' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION•
Nearesr own: [ /) t ; V t / it County ,Lln // t.% Lc/
3to,
(Street Name, Numbeis Community, Subdivision, Lot No., 74ip Code)
3. OWNER: (:Lr v/ 1 �n1 rt) ^vte�
Address .3 r-1 en; IA env.
F
(Street or Route No.)
re Vanr�) NC
City or Town State
Area code- Phone number
4. DATE DRILLED / -/ I - D a
5. TOTAL DEPTH: -3DS -/
6. DOES WELL REPLACE EXISTING WELL? YES ID NO I�"
7. STATIC WATER LEVEL Below Top of Casing: aD 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 accordaa with ISA NCAC 2C .0118.
9. YIELD (gpm): 'iO METHOD OF TEST c }-t r3 -
10. WATER ZONES (depth): b G ' - 3t) q y, n.
9 I a
Zip Code
Topographic/Land setting
❑Ridge BSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitudeilon_itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D /S3
/53 .32'5
11. DISINFECTION: Type 1-1 T N
12. CASING:
Depth
From ail To /53 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From D To D Ft.
From To Ft.
Diameter
fit!
Amount �I n
Wall Thickness
or Weight/Ft. Material
s5 j-e e_ L
Material Method
Co Ann 4 +try
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road o
numbers and common road names. p
N
m
CO
-3
fV
J
•
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT
CONSTRUCTION STANDlDS, AND THAT A COPY OF THIS
il
SIGNATURE OF PERSON CON
A E NI'(�Ijt 14-6. N` le C, WELL
En PlOtUDE triT ' WELL OWNER
I
INi t EEL 2002
-4 _t5 2
ATE
Submit the original to the Division of Water Quality, Grouhdwat r Section, 1636 Mail Sen iJe Censer - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. , SECTION
GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVL I F 9EGUVFL OFFICE

247244
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N al Resources - Div/iisi��//jjr of�Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) +'-�(J111k_ W-.-Q ,[lD{�t 1 CERTIFICATIONO8024`/8
WELL CONTRACTOR COMPANY NAME &r'P�N)'' //C �/S4 tS . l a �C rl) d r Utq)JL4*PHONE # (di f 6,18 -3 f 9
STATE WELL CONSTRUCTION PERMIT# / 4Da ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Cd" Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other ❑ It'Other, List Use
2. WELL LOCATION;
Neares Town: County
(.L/S p/e . CA P o1 ore c:
(Street N m , Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address /54 Sq--z-//
(Streator Rou}eNo.) o2gnp /
4vn P51a /P, /✓C / DD �O
City or Tn State Zip Code
Area code- Phone number
4. DATE DRILLED I -/5 -n a
5. TOTAL DEPTH: Ss S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS
Nor man, mlz 55p.l e A
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3D METHOD OF TEST e } rS .
10. WATER ZONES (depth): NL)5— l/2- ,prv‘
11. I N Amount I Show direction and distance in miles from at least
12. Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutcsiseconds)
Latitude/lom_itude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To
g , Formti n Description
lo
G, R S.Q5 ' Az-n
DISINFECTION: Type
CASING:
Depth Diameter
From 0To SP T Ft. to'' Pve
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To D Ft. CO 4-err
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
N
rrl
ca
-v
a
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONST
CONSTRUCTION STANDARDS, AND THAT A COPY OF
SIGNATURE OF PERSON
(n
� `2•
�����, RugTING 11H 4)12
Submit the original to the Division of Water Quality, Groundwater Section I63ti bled $en is
27699-1636 Phone No. [phone], within 30 days. GROUN'iThA S. c l ION
y ASHEa, nrriCE
C
E N
'AC 2C, WELL
THE WELL OWNER
_4 —6
DATE
Center - Raleigh, NC
GW-I REV. 07/2001

247242
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionJof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
� (print) l�/? Al n /CJL' J,,4 CERTIFICATION # 2 Z%/ 8
WELLCONTRACTOR COMPANY NAME (Yr teak- £//�ro'5. lr�L)1 4Ya,fly, in-t PHONE # (S-bj L f�B' 3�`7�'
STATE WELL CONSTRUCTION PERMIT# / 4123 -•2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION,. // //
Nearest Town: // /L,,/nI3 v/lI!. County Na.ya>ennd-
P,nnif t- 11 IAie.
(Street Name, Numbers, Community, Subdivi on, Lot No., Zip Code)
0 //
3. OWNER: Tt,'ritevh� •.7.><[.( cjj ()JCS
Address 4I/%D6 CyzrDJei)r)j�Ur/Lett .J7r •
(Street or Route No.)
et-1
City or Town / State Zip Code
Area code- Phone number
4. DATE DRILLED / l ? " c> Z
Topographic/Land setting
❑Ridge ❑Slope ❑Valley l��lat
(check appropriate box)
Latitude/longitude of well location
(dcures minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To 4 / r Formation Description
r%g5 '
5. TOTAL DEPTH: '7gs /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
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 accordance ith ISA NCAC 2C .0118.
9. YIELD (gpm): __ METHO OF TEST o2 J- r_
10. WATER ZONES (depth):3R5'-I/4iprn 6 2a '-'/�yr»n
11. DISINFECTION: Type
12. CASING:
7 57 ee - 9 p ni
/-/ 7 F-/ Amount /
Depth
From C) To 1 Ft.
From To Ft.
From To Ft.
Diameter
re
Wall Thickness
or Weight/Ft. Material
py'C
13. GROUT: Depth Material Method
From T-o atf Ft. rd . i 9 iJ-" ID
From To Ft. 0
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 the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDryRQS, AND THAT A COPY OF THIS
SIGNATURE OF PERSON CONST r P G THE WELL
ELL
LL OWNER
— _/) z.
Submit the original to the Division of Water Quality, Ground%' a er Section, 1636 Mail Service Center Raleigh, NC
-z,W-I REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
247247
North Carolina - Department of Environment and NaturalResources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 5 t/�--CL-fM' \ LtJ CERTIFICATION #aii/&
WELL CONTRACTOR COMPANY NAME Gr ten't., 1t,7rDS. Ltle-lI v Pa.rnp, dot . PHONE # (Bail 4' 4/9' -31745
STATE WELL CONSTRUCTION PERMIT# /`/ O ..2 ASSOCIATED WQ PERi11IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 1 ,
NearerJ. ,Town: CG1.aa� County fif a.r,� y>oo
( "n.c+lt Te erwe�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: .-c{,}tI .—
Address 1L? Reaye+-dtn.rw u e..4- t4CAAan
(Sneer orRo tee No.)
City or Town / State
oZ O n ' Co
Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: a% 85
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO VI
7. STATIC WATER LEVEL Below Top of Casing: / S FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): £o a METHOD OF TEST e2 )' r s .
10. WATER ZONES (depth): Q'7be— Ieb t9 rr
11. DISINFECTION: Type I-1TH Amount SI
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
6,r
Depth
From D To 7 9 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From t' To no Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
Ft in.
Material
From To
P l/ r
Method
Slot Size Material
in. in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley Q}`lat
(check appropriate box)
Latitude/longitude of well location
(degreesm inutcs/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formaatrin Description
DEPTH
From To
0 '79
79 42f5 _n-raacfo
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the rot
numbers and common road names. -
rel
co
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI'.
.
SIGNATURE OF PERSON CO
Submit the original to the Division of Water Quality, Gro al dw
27699-1636 Phone No. [phone], within 30 days.
CTINQ TI IEiW'(ELL,sL
ter Section, 1630 Mail Ser
GRI1UP:'01IAtEP il_;i!C.N
2C, WELL
E WELL OWNER
a-6 -62
ATE
ice Ce ater - Raleigh, NC
CW-1 REV. 07/2001

249237
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
islpf
t '/ , :Ltn`p1 - 3/'7n
STATE WELL CONSTRUCTION PERMIT# � Y'� Qa ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NA/bJE (print) v t1—L(� \ �1"� r-(_l. P� _ CERTIFICATION #
WELL CONTRACTOR COMPANY NAMEI-7rP £rnc LLt.%k `F � $t PHONE #
1. WELL USE (Check Applicable Box): Residential Municipal'Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ ((Other, List Use
2. WELL LOCATION:�\\
Ne Town: Wr1� tie 5 Qs / /e. County �rL/ u>rek
I nn tar
(Street Name, Numbers, Community, Subdivision. of No., Zip Code)
3. OWNER:
�1 r1
Addressrm.
j \\ (Street) or Route N
IR�n/� ne SVr l/� k Ca
City({�'Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1 - a -0 a
5. TOTAL DEPTH: I S5'.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO*
7. STATIC WATER LEVEL Below Top of Casing: to n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .:W.) METHOD OF TEST a h rs
10. WATER ZONES (depth): 1 µP 1- a C J p rYv
11. DISINFECTION: Type I-4T
12. CASING:
Depth
From 1) To Q '�- Ft.
From To Ft.
From To Ft.
Diameter
6)1
Amount 33
Wall Thickness
or Weight/Ft. Material
PVC
13. GROUT: Depth Maas -rial Method
From 0 To ab Ft L�,n'�i.t.•-C •- 1-,--p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
1 DO HEREBY CERTIFY
CONSTRUCTION STAN
�L
Th
Topo(>raphic/Land setting
❑Ridge NfalSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees minutessecands)
L:oitudei lone itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T Formatio Description
SS' a
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
AT THIS WELL WAS CONS U 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ED , ND THAT A COPY OA- J RE S BEEN PROVIDED TO THE WELL OWNER
G. rJilr "I COD STRUCTING THE WELL DATE
ASHEVILLE REGIONAL OFFICE
Submit the original o the Division of water Qualit), G, °ands.. att.r Section, i63o Nlail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
c.
0
0

25-2042
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
r r rl
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME((7``YPI'-ry P
I .
STATE WELL CONSTRUCTION PERMIT'S Pia 02 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION'S JO t /
At PHONE 'S IV
G
p4 Sig "2/ 76
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2,': WELL LOCAT!%N
Nearest Town /.1 f)7P,S Vi // County PYI.J/alele
!' e_,
ame, hers
(Street N , Community, Sub
ion, Lqt No., Zip Code)
3, .OWNER. Lf npYGLC 6:NYet{ ovs /%i n
' Address b 44 S Usa) i
City Town , State
At
(Strcct or to NAleo.)
n e s v, r Zip Code
as)gc�
Area code- Phone number
4.''DATE DRILLED / —
5 :TOTAL DEPTH- t 465'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING 1S I FT. Above Land Surface
- *Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. 11
9, YIELD (gpm):' /GY? t METHOD OF TEST o2 rl r5 •
IQ. WATER ZONES (depth): a 5`0 ' - /DO f fPm
11. DISINFECTION: Type HT H
12, CASING:
Depth
From__ To / %'Y Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From D To c;D
From To
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Diameter
Gev
Amount 4 '7
Wall Thickness
or Weight/Ft. MaMaterialSint
Matel�Q�
Ft.
�Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in
Si Material ir
,-
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrecsi minutcs/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/a 41
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3
S
F
—J
I DO HEREBY CERTIFY THAT —HIS WFiLtWW7%S',CONSTRUCTED IN AC
CONSTRUCTION STANpgRDS, AND THAT IAICOPYOFILIlS R
7�c/%Cl�fft_
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ORDANCE WITH I5A NCAC 2C, WELL
AS BEEN PROVIDED TO THE WELL OWNER
-345
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\V-I REV. 07/2001

WELL CONSTRUCTION RECORD
252043
.Forth Carolina - Department of Environment and NaturalatResouurrces - Division of Water Quality - Groundwater Section '/
WELL. CONTRACTOR (INDIVIDUAL) NAM (print) 3�YLI/a-rl , f CTJ/"C/ A-aaJ- / CERTIFICATION# 3z54/
WELL CONTRACTOR COMPANY NAME&YCPLN,. [V3TD5 . //Jo / / '� ELT/
ant PHONE #) � 7g r Si ��
STATE WELL CONSTRUCTION PERMIT# / 4424 ASSOCIATED WQ PERMIT#
(if applicable) . (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If'Other, List Use
2. WELL LOCATIO
Neare ww.
/G
County_
(Street Name, N to rs, Community, Subdivision, Lot No., Zip Code)
�G
3. OWNER: C. �/ 4.7Y t cm)
Address 3 `l.5rdqe° 1/I L/7 .
/n (Street or R/oo/fo
'City or Town State
Area code- Phone number
4.:DATE DRILLED /- �
'. 5: TOTAL DEPTH. .7,25'
6. DOES WELL REPLACE EXISTING WELL? YES /❑/ NO
T
7, STATIC WATER LEVEL Below Top of Casing: D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /S METHOD OF TEST 2 h r s
• 10. WATER ZONES (depth): / RD- /. " A�nm
11. DISINFECTION: Type 1-4 T 1-1 Amount d
12. CASING: Wall Thickness
or Weight/Ft. erya
fl /Z
Zip Code
Depth
From_ To ,a 3 Ft.
From To Ft.
From To Ft.
Diameter
13. GROUT: Depth . Material
From CI To no Ft. C Ilwr�a...
From To Ft.
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in.
15. SAND/GRAVEL P
' Depth
From To
Frotrt__To
16. REMARKS:
in.
BIke JNtatekial
IISi
Ft.
n
`FSCTE a
ARDS,:ANDTHATFA COPY OF IRIS R�
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
Idcgrccs ninutcsiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Format Description
S,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.
0
ry
b
I DO HEREBY CERTIFY' IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA D "OD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
aw
o�
c
c<
Do
rn
me
zrn
m=
ti
0
z
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

270624
WELL CONSTRUCTION RECORD
• Depattment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CQN'k1 CTOit (INDIVIDUAL) NAME(print) r-RLh !3 I /t/- L f- 13ff��3 CERTIFICATION #
F4gT$ACTORCOMPANY NAME crrenr Bro=,. L,)r1I 4-r-tcrvpoldALs'-c PHONE#i7� �o/is 3/ 1n
iij;.CON&TRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if a.. licable)(ifa. licable)
WEi,Ir.U$E{Cheek Applicable Box): Residential 1VMunicipal/Public ❑
Monitoring 0 .Recovery ❑ Heat Pump Water Injection ❑ Other 0 I
WELL LOCATIOt>j
Nyargst-Town: C'.2.4. err_
(SaFet N
lti t / `r_l,..l
County a lIdt
Num s, Community, Subdivision, Lot No., Zip Code)
:OWNER' c. P/pt.- t r, C'"1'_,
'Ac4dress J f 9 /' (ry
(Street or Route No.) r _
ittOo1?- / AI G. er / .IJ
Town State Zip Code
ea,Fgde...Phone number 3 1-1-2P4Tt DL2ILLED / 3 S
?T,QT4L PI;PTH: •
9 S: y.1ELL REPLACE EXISTING WELL? YES 0 NO EY/
Talc WATER LEVEL Below Top of Casing: / r 13 FT.
v'+'1;�, (Use"+" if Above Top of Casing)
'Q .ovCASING IS I FT. Above Land Surface*
'yQR R(fosIp )frminated at/or below land surface requires
.yitrI ltlfe In, accordance with 15A NCAC 2C .0118.
EP (gpm): an METHOD OF TEST r'% h t' 5
?WA;TERZONES (depth): . r S - (a • —
ISINFECTION: Type 14 TI--1 Amount a.clr
Wall Thickness
',, Depth Diameter or Weight/Ft.Material
y roto 7) To g)gi Ft: Lb t l
tr ,...... To Ft.
?.From To Ft.
aI?UT Depth Material t, Method
Ff9lr?L' '%_'...'iiTo .._3,0 Ft. r...,rn_u-v *ire
To Ft.
N;"'i' Depth Piameter Slot Size Material
-To Ft. in. in.
qln
`',:To Ft. in. in.
/GRAVEL PACK•
' 'i'Depth Size Material
.. U To Ft.
[olt___5:.._,_To Ft.
Industrial 0
f Other, List Use
Agricultural ❑
Topographic/Land setting
❑Ridge 0Slope ❑Valley Ulf<
(check appropriate box)
Latitude/longitude of well location
(dcgreesnninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fotmatio Description
g2 / f-
9, d ' 2 a .5"' v.
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.
fig=
�GE Y jtTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IS.A NCAC 2C, WELL
N$TIJ 1 IONS ANDARDS, �D THAT A COPY OF THIS RECORD H PROVIDED TO THE WELL OWNER
i, <7iLett, 8 D 3
SIGNATURE OF PERSON CONSTRUCT NF \4 -L , f,%) DAT
0
CO
r
rn -
.D
0
IpriglQal tQ the Division of Water Quality, Groundwate f leetion. 1636Niiii erHawc�yt - R
huae�Vo. (919)733-2h within 30 days. — 2
W1
GC trc\I
gh, NC
07/200I

;WELL CONSTRUCTION RECORD
pit (bNHIVIDUAL) NAME (print)
270629
entof Environment and Natural Resources Division of Water Quality - Groundwater Section
katlyvt LL�•e.b b
CERTIFICATION #
€TOR COMPANY NAME Ore %Lein,//Jry , te)el t ¢ fct4, J1(GPBONE#§?i2CG 6919-5//76
VC9N TRUCTION PERMIT / 'tl) ASSOCIATED WQ PERMIT#
HPal. licable) "`' (ifa.. licable)
W L1..1USE'(Check Applicable Box): Residential Se Municipal/Public 0 Industrial 0 Agricultural 0
oRl,{Qggp Q, ',Recovery 0 Heat Pump Water Injection 0 Other 0 It Other, List Use
,4Y&I111` I,QCATIOf1
ptariAt)r,r9 Ytt �))t t.nCounty 1-tr7 t I L4 )C t
LA 4 `f /e , Ytil,rt�en�t-,'L l -i? t 44 i
0 Nam Community, SUbGivision Lot No. Zi
(SIMyi.Nantq, Numbers, P Codc)
3 OWNR•
Adciresk,i_ 91 b ii -,PA nL ; w
t �'n : (Street or Route No.) �-r /
Ve . —2r� ! ! LO
pny'or Town State Zip Code
s, ktione number 7 -
4,Tg,rp ILLED I < - - - D2
OET P ETH:' .,41.2St
REPLACE EXISTING WELL? YES 0 NO t-
teTT�; 'ATER,LEVELBe.lowTopofCasing: /CC) FT.
r,)'" (Use "" if Above Top of Casing)
.,P AASIi j(i IS I + FT. Above Land Surface*
pgp(Fq!ing terminated aUor below land surface requires a
I.c,O t1ycor44nce Ivith'. ISA NCAC 2C .0118.
pp}) I METHOD OF TEST Q li t t
ONES (depth): 4os - / S J p m ;
§INFCTION:Type,L1YR Amount LOP,
SIt4G: i Wall Thickness
Depth Diameter or Weight, Ft. Material
, ) '' To I DLc Ft. La“ P V C_
to Yt
SQ To Ft
4'QI,J Depth Material
n!,'Tit? To :AD Ft; i1 D a,1P,u-�
pr5)_4_, , To Ft.
Nr Depth Diameter Slot Size Material
To Ft. in. in.
in. in.
NQi t@MVEL PACK:
` ., L.' Depth Size Material
Ft.
Ft.
Method
-Ft P
to3t peNo. (919) 733.3Z21, within 30 days.
Topo�gr�ayhic/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrecsininutcs/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D 1 ND CD.c
!Oh' 4,95' ,t tttc-.. tT-
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.
61 :111 9—Wei CO
FM ?.CERTIFY THAT THIS. WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
IZIyJGTipN STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON `� ` +- �.' --.' DATE
11M,...043j,t, the Division of Water Quality, Groinfdwater Section, i636 Marl;
c
c
Center - Raleigh, NC
GW-I REV. 07/2001

4 WELL CONSTRUCTION RECORD
270630
"pArtme(1t of Environment and Natural Resources Division of Water Quality - Groundwater Section
Qf9R LINP1VIDLIAL) NAME (print) /C3h:C-1 GiTC>f /3r 12 C—Q— CERTIFICATION ft 3/) 9 /
g9N.,TRACTQRCOMPANY NAME l 9Ye Nat t L>o r; t )e—il 4 Re inp J t'-c- PHONE k f 1
�P`
1 LAi CQN%TRUCTION PERMIT# / 4C 2 ASSOCIATED WQ PERMIT#
+`",=� (if a.. licable)
(ifawlicable)
Tk:GS>w'(Chcck f4pplicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Bring £ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
1ygLL LOCATIO'sj
gar St Town: --t 1'Ln" County kiat/i Y net
�N � e N tubers Communi Subdivision,
Lot
(4.Iteit am , I ry, �'� No., Zip1Code)
OWNER t l } 1 1l # Dimn2I Cu nA/
' c '7ER Lb_
S S
(S[reet or Rome No.)
C
Citypr Town .. State Zip Cale
„ddp7 Phone number'=
p470;1R1LLE❑ 9-2L —GZ...
TACPEPTH: 205
3,1�LL REPLACE EXISTING WELL? YES 0 NO 0.7
I , Y'aTER JEWEL Below Top of Casing: in FT.
' (Use "+" if Above Top of Casing)
,cVfeC45l110 1S FT. Above Land Surface*
elf f S.04 ;Erlalgat;d at/Or belay land surface requires a
nstE9r# I¢ lFcgr#!(nf➢ WW115A NCAC 2C .0118.
{ELP (gpni): 'It D METHOD OF TEST
T ItZONES (depth): l `TD'— 1Yt' LetDapM
1n rS
SINFECTION: Type_
SNG: :.
Depth Diameter.
To 4—`1-- Ft (o [ 1
p = To Ft.
Amount 5) 1
Wall Thickness
or Weight/Ft. Material
P lJ C
. T Depth /� Material Method
E' iN'.4:2_To'Tf7 Ft l til✓1'�9lt &)
'F{Rp _____ To Ft
h§,(y EN . Depth .. Diameter Slot Size Material
inin.
in. in.
RAy PACK,:
Depti
nj'ts. ',r__Tp Ft.
t _
Size Material
Topographic/Land setting
❑Ridge EtSicipe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees: minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Q �' Li- I tYl4
Y ' 3 DC' /l t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
it By;.FERTIFY TpAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
cup N STANPARP$, D THAT A COPY OF THIS RECORD AS B EN PROVIDED TO THE WELL OWNER
417
SIGNATURE OF PERSON CONSTRHTI'Nq=THE WELL
1}egl,'iraPi tq thq Division of Water Quality, Ground4aler'Stection, 1636 Nlail Service C¢ r'et j. Raleigh, NC
$ psiv Ng (919) 733-32;1, within 30 days. GW I1 REV. 07/2001

WELL CONSTRUCTION RECORD
uta_-�Depart?ttept pf Environment and Natural Resources - Division of Water Quality - Groundwater Section
OVA (1NPIVIIPUAL) NAME/1 (print) - LL CERTIFICATION# 3U�/
1 P%IRACTQR COMPANY NAME /'re?LM0 `'tS� It eJ� f/ttZp r% C • PHONE # flaCp 4/ / `lC
'*`, Ir(et CQNSTRUCTION PERMIT*,/ Zt I 2 7
(if applicable)
270631
ASSOCIATED WQ PERMIT#
(if applicable)
' J J.. USF (Checl4,Applicable Box): Residential B Municipal/Public 0 Industrial 0 Agricultural ❑
gpi(oring CI Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
W>wI,L LQCATIO .r
NG s wn: / County 7e,e7Z,.jlr)-
AI?) IFLuA
'Nw nbcrs, Cortnrinni Subdivision, Lot No.,
(str(gt N
Zip
n Code)
OWNER.' l9 P. 1 /f4.4,10/x)
'Address'Address 2 n /-3(5 d/5� 2 8
(Street or Route.N .)
/71 ii(c, //e /7 �X766
City er Tow State Zip Code
,Phone number
ATFr QRJLLED E/ - ho - 4 u2
�Ie �2ECT l tic
k ? LL REPLACE EXISTING WELL? YES 0 NO EV.
p:4TER LEVEL Below Top of Casing: 7) FT.
(Use "+" if Above Top of Casing)
Dj?.,QFrCASING }S ; I FT. Above Land Surface*
apgf gaging terminated afar below land surface requires a
ificti;aq Ig fccaraagcc with 75A NCAC 2C .0118.
yip) P (gpi): "1 S METHOD OF TEST .2 !1 f 5 •
iATER ZONES (depth): • a 45 ' - I 5. 3p M
t1 WEQTLON: Type % T/-/ Amount.
,§}NG Wall Thickness
' Depth Diameter or Weight/Ft. Material
91p, To rJ / Ft %e " P U�
rgln_ To Ft.
onct_j , ' To Ft.
qI�>T r r'r Depth aterial M hod
(_ To .?.//. Ft. (�'P4rd is
`F_LRm.._ r "'_To Ft.
EN Depth Diameter Slot Size Material
To Ft in. in.
To—r Ft. in. in.
�AYEL" PACK:
Depth Size Material
To Ft.
f19 4. - _To Ft.
9Le
Topograpghic/Land setting
❑Ridge l lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
,/) 7 /
7/CpGS' iur, jd�
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.
BxwGFxT1FVTH4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5.A NCAC 2C, WELL
N'STAND AND THAT A COPY OF THIS RECORD HA N PROVIDED TO THE WELL OWNER
jL-r_.e LLL � - 2 � • e
SIGNATURE OF PERSON CONSTR
z #* x
tq the Division of Water Quality, Groundw
1¢ t,I'hptte Nth I919) 733-3221, within 30 days.
aleigh, NC
EV. 07/2001

WELL CONSTRUCTION RECORD
•
.urth`Qarolina -:Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
LLI,,CONTRACTOR (INDIVIDUAL) NAME (print) . rtrek 4- BrU t1 CERTIFICATION #-3D4'/
i-LP.CT CONTRAOR C.,COMPANY NAME re t tie, BTS1s. Wt 1I a- Pith. iti) ttit PHONE # tat;l '7D
.1 q E WEj4L CONSTRUCTION PERMIT# /4D -I ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Cr Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
271830
WELL LOCATION:
Nearest Town: biaaj nesv, 1 1a
ve
(Street Name, Number& Community, Subdivision, Lot No., Zip Code)
County !-ya ywOeei
OWNER:11 lien Prat /cs cb, Gary
Address %$ tt- NI 5t"lp h �r
(Street or Route No.)
�� t� NG S'l) LO
City or Town gtate Zip Code
Area code- Phone number
DATE DRILLED II' IS -02.
TOTAL DEPTH: £ DS /
DOES WELL REPLACE EXISTING WELL? YES 0 NO f3
STATIC WATER LEVEL Below Top of Casing: I DO FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
vorlance in accordance with ISA NCAC 2C .0118.
YIELD (gpm): 1 5 METHOD OF TEST Lv+ s •
WATER ZONES (depth): .?25'Ali pm 335 - Sgpm
1-4-7-
DISINFECTION: TypeShow direction and distance in miles from at least
Topogrhic/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 Descripti9n
h SSL / e7,-4 I/A Sos .
541 t Gta,.
H Amoun
4Ls - 3 in' LOCATION SKETCH
f" 7
CASING:. Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
V
From, 0 To SFt. to " .54e e / 00
i'rgm ` To " Ft.
From To Ft.
GROUT: Depth Material Method
From 0 To ; D Ft. (x a.w�e 4- 1 Ya f
From To Ft.
SCREEN:''' •.Depth - Diameter Slot Size Material
Frgm, To Ft. in. in.
From `'' To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frofp ` -To Ft.
i;:. REMARKS:
0
0
BY CERTIFY/THAT ,r,. WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
l�'f[©N SUA I()S, AP� THAT A COPY OF THIS RECORD HAS EEN PROVIDED TO T WELL OWNER
IF) ,Atx'41 4-<- )RC/l
S. ATURE OF PERSON CONSTRUCTIN THE WELL DATE
the Original to the Dl jision )f Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
a-1b36 Phone No, (919) 73i3-3221, within 30 days. GW-1 REV. 07/2001

2. WELL LOCATIQN: ,
Sun in., rr 4-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
WELL CONSTRUCTION RECORD 271825
North Carolina - Department of Environment and Natural,,//]Resources - Division((vi�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) eSYr/.( & a.* all 1 CERTIFICATION# 3t`f /
WELL CONTRACTOR COMPANY NAME L7rtP "L r�ros L.3tn W-Pump,JSC?HONE # - 3 / 7 0
STATE WELL CONSTRUCTION PERMIT# / 40 .3- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El---iv4unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
Nearest Town: Count
y ka-y LJood
3. OWNER: l j14k. L'e l a .wn l AAA - 2 - }L-ZT,3
Address 4 µ L0.,n n r,,.r1 a e .
(Street or Route No.)
baaA4VIESVl )It KJC. -`ar 8L
City of Town State Zip Code
( Area code- Phone number
4. DATE DRILLED I D 3--Da
5. TOTAL DEPTH: 30,5 '
6."DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-
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 with 15A NCAC 2C .0118. 1
9. YIELD (gpm):. f 5 METHOD OF TEST oZ k rs
10. WATER ZONES (depth): VS ' — f 5 QJ fs m
11. DISINFECTION: Type H Y H Amount 4 9
12. CASING:
Depth
From D To 9.5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To .D Ft.
From To
14. SCREEN: Depth
Ft.
Diameter Slot Size Material
Diameter
� tI
Wall Thickness
or Weight/Ft. Material
PVC
Material Method
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth- S,JP
Fromr
r��� ct i ".; 1r-,3/4)
Material
Topo�gr�aphic/Land setting
❑Ridge E*7Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeatitude/I neitude of well location
( degrees.minutcsiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forntlign Description
e,A
93 ' 9 D.c ' �+
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tEroad-)
numbers and common road names. :ra
O
0
16. REMARKS: ji
1 DO HEREBY CERTIFY THAT THIS WELL %VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRLICTION STAND D , AND-THA'PA CO OF THIS RECORD H BEE ROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THFWELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1630 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

2681`19
s>WELL CONSTRUCTION RECORD
pFpep of Environment and Natural Resources - Divt ion of Water Quality - Groundwater Section
'/
CT'OR{IN{11VIpUAL) NAME (print) �D /"1U `U CERTIFICATION N a, , / It
mod, =3." tt,!�
r gF yeMPANY NAME Cj-V CELtt, / ,Oros • We -II -F PLLisp • PHONE # jSf G L. «� -`3 / 7 �
�4 CONSTRUCTION PERMIT# I4 e -I ASSOCIATED WQ PERMIT#
r(if applicable) 4 (if applicable)
gar 47-11:4.,r ,,.-,a .,
WI,sI-'Iv (Chick Applicable Box): Residential ICK-MunicipaliPublic 0 Industrial 0 Agricultural 0
pt�onpgg q, Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
WEI.I. LOCATION• f
car st Tpwq: County NW/ j1 i0l.
ln.P.
(§U CJ NOmq Numbers, Community, Subdivision, Lot No., Zip Codc)
;Q4VNER' l I Q Ylle� C fC�1LfZ (degrees m inutes/seconds)
L Address 4 3 1 I'NeiG.. 1 4 "° Latitude/longitude source:OGPSOTopographic map
i c... (Street or Route No.) (check box)
Topog��r�aphic/Land setting
❑Ridge HSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
,Ciryypt T
A/c c28'72-1
, State Zip Codc
DRILLING LOG
Formation Description
,ikon number
' '19AJITLED . z.
•TpAPTH• F,' £P S
twgLl- REPLACE EXISTING WELL? YES 0 NO ore
' Tg19AMA.1.VELBeIowTopofCasing: I OD FT.
- (Use "+" if Above Top of Casing)
QPQF CASING IS 1 FT. Above Land Surface*
j pg(tuine terminated at/or below land surface requires a
sp�gge Ip 4ctordance with 1 A NCAC 2C .0118.
1 "a
RD�JT s Depth ; Material rr
�,T9 Ft.
' a ti*IkPib. Piammeter
Ft in.
�TP Ft. in.
I YEA, PACK
-_' ;Depth ; Size
_To Ft.
Ott Ft.
61tTIFx:T
NAND/
METHOD OF TEST 'oi h v$ •
O NS(depth) 1405' - 19p.••
f (o05' - 1q prrt
r:-
patwE 3TION Type 1-4 T 1-1 Amouin 9 2
( DdF�i�.� ,• Wall Thickness
Depth
To R 7 Ft
To Ft.'
Diameter
10tt
or Weight/Ft. aterial
Method
Slot Size Material
in.
in.
Material
DEPTH
From To
D 87 '
87 ' LDS'
sail.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.
0
0
rm
0
w
0
O
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D$, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l� ,03
',CSiONATURE OF PERSON CONSTRUC E WELL DATE! 7'
ttoo prpsion of -.throde Groundwater GW-1 fEE'y 07/2001
1636 Mail Service Center -,Fkaleigh, NC
Pip) 733t3221t within 30 days.

268130
WELL CONSTRUCTION RECORD .
� trungut of Environment and Natural Resources - Division of Water Quality - Groundwater Section
QRQNPIYIDUA+) NAME (print) rl�D-� f-RUL�L�I- JL8S CERTIFICATION #.�Hg
aft,RFQMPANYNAMECrte ,t5vo5• L11 YU hip) tb & •PHONE # $ /u - 31
dYS r
C$TRUC(,TO{Y PERMIT# 1710 � Z ASSOCIATED WQ PERMIT#
a.phcable)' = (if applicable)
ClieeIcApplicable Box): Residential W" Municipal/Public ❑ Industrial O Agricultural 0
I :I,eeovery. ❑• Heat Pump Water Injection 0 Other 0 If Other, List Use
c yn: ION 1 a�
ToWm: � �'1-�- County upped.
+ ` 15 (Pm -.de v asp /—), 113
FS.)'1apAGt Numberrs, Community', Subdivision, Lot No., Zip Code)
t-'n-14 a arose., nv-c A
& f•0a e_ I I ; oneha .v24
(Streetw' R.ute No.) p I
4- L a87G8
Zip Code
n Douy number
'ARII;'LED' I:� ' a - D a
rAtPEVTH•
9r�, EII:`REPLACE EXISTING WELL? YES O NO
ER J•EVEL Below Top of Casing: 1 DO FT.
(use -I- if Above Top of Casing)
C{j$jICIS , 1 FT. Above Land Surface'
•Fyt(ige tertnlaated attar heloW land surface requires a
C I 994t444c4 With 15A NCAC 2C .0118.
(gplp) 1.45 D METHOD OF TEST a J, ra •
ZONES (deptti3: Jr �5 ' - (o D as p'rvt
FECTIQN• Type I-krI-1
Depth Diameter
t To S4 Ft. C..
Ft
'DepthnMaterial
i#To it Ft. rD,tutw
tcp : ,
.Ft°
Depth Diameter Slot Size Material
To Ft. in: in.
I T-Ft. in. in.
L PACK:
eplp Size Material
Amount �S
Wall Thickness
or Weight/Ft. Material
pvr..
Method
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 8'rlat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
544
5✓05'
/lL
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
w
-n
r*t
tp
CO
a
0
0
4RTY THAT TFJjS,WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Trr�NDARi3S +ND THAT A COPY OF THIS RECORD,M4S.3EEN PROVIDED TO THE WELL OWNER
DATE
-j SIGNATURE OF PERSON CONSTRUCTING THE WELL
q
42 I)tyi ,o,n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t( 19 733.32;1iwithin30days. GW.I'Tilt .07/2001
0

WELL CONSTRUCTION RECORD
268151
D.yta}tment pf Environment and Natural Resources - Division of Water Quality - Groundwater Section
OR ONAIYIDHAL) NAME (print) R r Li 731, tl ca.- CERTIFICATION # 31, III
JCOMMPANYNAME C7reant B- axs ULt 11 4 Pit nrp,rr..t PHONE # fgf$L rf8-317a
IiTIRPGT[ON PERMIT# 14 b at ASSOCIATED WQ PERMIT#
licable) t (if applicable)
LIIS (Cheek Applicable Box): Residential NV Municipal,/Public 0 Industrial 0 Agricultural 0
op4or4 q Recovery. 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
„OQATION: A
"Tp}Yp County it y tob 0cL
Nenie; Numbers, Community, Subdivision, Lot No., Zip Code)
'i r> t
f.� e r r r s l- Fa r.ti. rZ-Ot-
(Street or Route No.)
NC
Zip Code
=.Pipme number.
JLLED °II-`I$-0a
„ 40s-
4134PLACE EXISTING WELL? YES 0 NO EV-
iciATER,.,VE1. Below Top of Casing: 4-0 FT.
7.z (Use "+" if Above Top of Casing)
t,�CASINq IS "' 1 FT. Above Land Surface*
,F,'IIPr IffullnAted at/or below land surface requires a
IR�cfgrie8ga with J$A NCAC 2C .0118.
'Wff1) Co METHOD OF TEST a hrs
4QIS (dept}i): 3 SD ' - Lo p rvt
INFCTION: Type /4774
Pepth' Diameter
S Tod Ft,
To =Ft:`
F To Ft.
DePtit
E�y#r Depth Diameter
Tp t,r . Ft.;' in.
DTP . ` Ft. ' in.
y�o yyEG, PACK:
+ Depth .,. `. Size
Amount go 9
Wall Thickness
or Weight/Ft. Material
PV c.
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge G31ope ❑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
lib L� lam
41) 41654 tYr0.PS, 4-1
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
TIF,.17 IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Np AND THAT A COPY OF THIS RECORD HAS r N PROVIDED TO THE WELL OWNER
N
TH
II
$u tf, DLvi won of Water FQuality, Groundwater Section,WELL enter aI s ' NC
1636 Mail Service Center - a
(9#R) pt3,a2I1, within 30 days.
RiEyCOI2001
1

WELL CONSTRUCTION RECORD . 268152
lent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
_
(( AYI(WAI4NAME (print) ig
(]Y/j 6n.�.�ii C % Lr 11C.L CERTIFICATION# 3G41 /
,9,514t7RMiYNAMEA e_e_sit 81,0I13 • WGI I PU ntp/ 7.1P PHONE # (
L'CQA,Sf13F14"i�YQN PERMIT# / 41 D 2 ASSOCIATED WQ PERMIT#
(ifa.. licable)'' (ifapplicable)
'(Qileak Appheable Box): Residential "Municipal/Public 0 Industrial ❑ Agricultural 0
ol4fMtopttS.C7 Recovery 0: Heat Pump Water Injection 0 Other 0 It Other, List Use
r�v� L.QCATIRN•
o 99stTown: Ci�...�, County
yen tki i-tA
Natge, Numbers, Communicf, Subdivision, Lot No., Zip Code)
wNER•° BP h O.Y
dress to I 4r1 nol t � 33r
(Street or Rout.)
_a 1 tZ ; ll C. .� 2 '7 / Ce
citypr.Town . State - Zip Code
`phone number
rI WRiLJ,ED j I — I I —D
are DE,PTH''• �i Lo 5 ' /
E$WELL'1tEPLACEEXISTING WELL? YES 0 NO �T
* WAT$R LEVEL Below Top of Casing: LieD FT.
•1';i i t (Use"+" if Above Top of Casing)
e0ING IS / FT. Above Land Surface*
WIN Igrtalo#ted M/or pelar• tend surface requires a
i rye'ordapff with 15A NCAC 2C .0118.
(gpni)" 13: 5 METHOD OF TEST j 1 v'S •
ONES (depth). '(Log1 — 3. ScJ P r+ti
Amount 't% g
Wall Thickness
,',Depth Diameter or Weight/Ft. Material
tq To Ft' /e le Pia>
Method
1U ?
Depth < Diameter Slot Size Material
in.
YELTACK:
'Depth Size Material
To Ft.
TP , Ft,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley LYFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Forma joDescription
DEPTH
From To947
g4/f y6s'
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
w
O
YIP kRTJFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
IQN SJ,6NDARWS, AND THAT A COPY OF THIS RECORq-HASREENI.ROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTf1`IQ THE WELL -RiE
pFil$i) Wl tQ jh@ Aivisien of Water Quality, Groundwater,.,$ettion, 1636 Mail Service Center Raleigh, NC
11op9 Nga(9192 733•32211 within 30 days. GWT'REV. 07/200I
r5

;WELL CONSTRUCTION RECORD .
? peSkl119t?lEnvironment and Natural Resources - Division oflWater Quality - Groundwater Section
.JQR(INpl}'IQUAL) NAME (print) �jJ 3j5/1 /Adf.p CERTIFICATION q+? y/2
or pa COMPANY NAME I:1VP es' Ti YDS - ii/P it 4 Pu WIti Ti.t PHONE # (gsf 6,4s-3/70
$TIWCI'IQ4 PEIIMIT# / 41D , - ASSOCIATED WQ PERNIITN
licable) - (if a..licable)
7 Sls'(Qheek`Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
1pgljoring E .Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
"fg,1- h, i,QLATIO,N
4•< •,,,J�
f t,r&+-s Cove.
Jggrq, Numbers, Community, Subdivision, Lot Na., Zip Codc)
4 t Y•
QV/NU: ✓SrD ti-}} L b°Ct
drys . :. 7� �/a/,-s )41 / 1 Rcl
rtiv Town: ( lJirL,�trx County ( ,
:a
f'E,C4TI9N: Type
Repth ..
,_Ta 30
f ,$ate-TTo
F-,To_.
Aepth'
Amount ale
Wall Thickness
Diameter or Weight/Ft. Material
Ft. P v r..
1-/ TH
n Method
Ft.
a o Ft. l 2ivu-i s�A /
•
Ft.'
Material
9pt0 ; [a Diameter
To Ft. in.
Ft' in.
VEL?ACK:
'.'pepth Size Material
_Tp Ft.
Slot Size Material
in.
in.
T.p';> Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley f9flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1) 30 '
atat
30' eiGS'
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.
,TIFYTHAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-121
W
0
SIGNATURE OF PERSON CONSTRUC
(Street or Route N/Vlo/)
. 'C�/l�st Y67n
city RrTown ?:'State - Zip Codc
eQ(fe= Phone number'
R.,
'A:MRIL.I ED / l - 11 o
� I ,TH: ` a/.'_<
?&,;WELT; REPLACE EXISTING WELL? YES 0 NO C/
('ERGEVELBelowTop ofCasing: LoO FT.
^..q ,`t' (Use"+" if Above Top of Casing)
QPQF.CASING IS FT. Above Land Surface*
q(Saein.R tar}nlnated ator pelow land surface requires a
it4:1$A NCAC 2C .6118.
(gpj�). 'METHOD OF TEST 0/ h r5 •
Z,.QNg$ (depth) 245 ' - 1.D 9 p ,.
268153
!
He WELL_ __ BAr II l I :i
t0,09#, t9 tltp D;ylstol; of Water Quality, Groundwatel' SeCtuon, 1636 NI ail Service Centet--jiaijigh, NC
e (9ig)733-3221, within 30 days. L' GW4HRE''. 07/2001
J.

SIGNATURE OF PERSON CONSTRUCTING THE I' 'ELL
WELL CONSTRUCTION RECORD
268154
.1,Dij rtment of Environment and Natural 112
Resources - Division of Water Quality - Groundwater Section
m I OA(INDIv1DUAL) NAME(print) �OD1* Le,.bb CERTIFICATION#cal'//o
TlitniCWItCOMPANYNAMEArePme }�v05" We 4 &mapTat.P • PHONE # L B.317D
91I:,CQN4TRUCTION PERMIT# j tilD 2. ASSOCIATED WQ PERMIT/3
-(ifa..licable) - (if a. livable)
US. (Check. Applicable Box): Residential L Municipal/Public ❑ Industrial 0 Agricultural 0
oring0_,;Recovery❑ Heat Pump Water Injection 0 Other ID If Other, List Use
WEL[. {.QCATIQN: , / __ , Topographic/Land setting
Ne4rg% p/Town: unty Hl_l/LZYVYS& ❑Ridge f951ope ❑Valley ❑Flat
! 1%yx i1 P_, (check appropriate box)
(Sfry iN9me, Numbers, Community, Subdivision, Lotibo., Zip Code) Latitude/longitude of well location
VAJ> R: i.x Cr / - etrp USbDrn� JDi
1(� (degrees/minutes/seconds)
134 /'q^,,,n • ���.�y„ Lo op Latitude/longitude source:❑GPS❑Topographic map
-- (Stre@t or Route i) J(check box)
G
�j a $7 aDEPTH DRILLING LOG
}CttyprToy/ Stafe Zip Code From To Forma3p Description
' 3SD t7.
trpQ,e;Phgnq number AA1Ll.ED 7 - 41D1
h D)PTH.' 3SD' /
.F.SWELLREPLACE EXISTING WELL? YES O LN
W . T (t LEVEL )3elow Top of Casing: tai't.} FT.
, (Use "t" if Above Top of Casing)
AS(1G IS FT. Above Land Surface*
"Q(cping tertnlgated at/or below land surface requires a
LOA 94Q110114 fyitI, (SA ISCAC 2C .0118.
(gpm), j S Q METHOD OF TEST .. L1 r 5 •
RZONES(depth): 'icon 1 ISOi- Jp
wFECT1ON: Type I -I TN Amount , $ t7
NQ: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 41% Ft. Lv I f P V C
pat� „, To Ft;
nn"r• t' Material
�,y' 1.19Pth� y
To b Ft. MLawl
''To Ft.
, is v,'"f•Aepth Diameter Slot Size Material
in. in.
n. in.
Method
**(TT
GRAVEL PACK:
sk . �..;: Depth - Size
To Ft.
*telt
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.
4r, c'
LY,:CERTIFXTUATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IS.A NCAC 2C, WELL
N STAND ' IS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
W
O
b3
DATt �1)i
2 g1 o the )Igision of Water Quality, Groundwater Seetton, 1636 Mail Service Center RdIt♦ig jtv�C
ha.9il • , Vp �1A�(?l9) 733-32;I, within 30 days. GW-I RE2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/print) _s�FJY4' �27/'/l rP CERTIFICATION M36il/
WELL CONTRACTOR COMPANY NAME inn -Ai-
/) L!/e/) -i PHONE p (A,i'SzG 7B -.3/74
STATE WELL CONSTRUCTION PERMIT# /7D-2 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
2. WELL LOCATIOA
Near ,st Town: l !fir t Countyrc
T kt
I o\e.e->-.. —R'—
(Street Nai Numbers, Community, � iSubdivision, Lot No., Zip Codc)
3. OWNER: g/,1.Lij X—L--('a 2 A&)
(Street or R/utc )
�
City o Town State Zip Code
Address 1/ 6 3 rpt 'rt a_e-v.. -Re� .
/z retieSvf / A/ C .78 726
( )-
Area code- Phone number
4. DATE DRILLED q - 18 - D a
5. TOTAL DEPTH: )
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ip
7. STATIC WATER LEVEL Below Top of Casing: 1 DS 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 accordan a with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST a 1-1 rS•
10. WATER ZONES (depth): ) Li- O' .2 0 q
11. DISINFECTION: Type /--17/ /
12. CASING:
Depth
From 0� To / DS Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From f) To c?6 FL CDAnn_LAJ -*err
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
Diameter
1, rr
Amount ,s/Gi
Wall Thickness
or Weight/Ft. Material
� C
From To Ft.
From To Ft.
261140
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box) Cree-
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomation Description
n /05'
//XS/ /
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 HERE
S�binit the original to
27699-1636
GROUNDWATER SECTIF
ASHEVILLE REGIONAL OFFICE
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
el,3p 6
OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
221, within 30 days. G W-I REV. 07/2001
e+4-r

13. GROUT:
From n
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAM?)(print)
WELL CONTRACTOR COMPANY NAME rKQGrt-C 75105//O // Y /44-7
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
261129
Groundwater Section //
CERTIFICATION # .3a5/�
PHONE # (g..O171' 3/ 71)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residentil9._, Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIObh /
Nearest Town: �Ae 471,
rnexy,ra,- )_a_,,.e_
(Street Name, Numbers:Community, Subdivision, Lot No., Zip Code)
County di///sA0/91
3. OWNER: flnxn Ir_ 0P *AAtfl
Address / YY)_e nto r� �-[n
eCLA. (Street or Route No.)C cg /
City or Town tate Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED Q ' 3 -6 Z.
5. TOTAL DEPTH: /N'S ' ,�,(
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO K*
7. STATIC WATER LEVEL Below Top of Casing: aD 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): / a METHOD OF TEST 7 ,A /S .
10. WATER ZONES (depth): �S - /
11. DISINFECTION: Type /1-1 nil Amount JDa
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From b To It, I Ft. to 't
Top raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/in inures/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatj�on Description
1 I
j/S
From To Ft.
From To Ft.
Depth /) Material Method
To ,i/I FLS .Pa '%
To Ft.
PVC
14. SCREEN: Depth
From To
From To Ft.
in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
Diameter Slot Size Material
Ft. in. in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS R AS BEEN PROVIDED TO THE WELL OWNER
9 -3O -6 z_
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 163ii Mail Sen ice Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-�DivJision of)Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D L\r/e-I)C CERTIFICATION#ay�2
WELLCONTRACTOR COMPANY NAME PYVPPAUL_ EKDri. LC)f_I? / L(i'�� PHONE # JXas L+48 -3/7 D
STATE WELL CONSTRUCTION PERMIT# I �` G "I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential„ Municipal'Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: Waynes v t 11e. County /-I tc LOCI (Street Name, NuIribbcrs(,, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 1 t r i . . TR6 +ts
Address 3 4 q l.. Atrei t'c t R.
No.)
ill
Cityo n State
Zip c
Area code- Phone number
4. DATE DRILLED LI —10 --I 2_
5. TOTAL DEPTH: E S '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO bl
7. STATIC WATER LEVEL Below Top of Casing: SOO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ` FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3, 5 METHOD OF TEST. a br4
10. WATER ZONES (depth): ' ' - 1 / 2, C e \
7 'tlS' — 3 �p,�.
11. DISINFECTION: Type i +Thl Amount C'i �-1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 13 To 4 Lf Ft. to i' PVC'
(Street or Route
1 Ytn clot` e Uc�.� �h t NC c` l'7 ‘
R1o' Cod
From To Ft.
From To Ft,
13. GROUT: Depth Material
/
From 1) To LLO Ft. f Q. 0......
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
261138
Topographic/Land setting
❑Ridge 0Slope DVilley la
(check appropriate box)
Latitude/longitude of well location
(decrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
O 4Io '
i(I.' S -S'
N ethod
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.
GRO(1NOWAIbP ac�lIUI•
ASHEVILLE REGIONAL OFFICE
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HnS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCT
>1r
THE WELL
y 30 -62
DATE
on of Water Quality, Groundwater Section, 1636 Mail Sere ice Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

261137
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # a 4 ) 7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rin 6) rs
WELL CONTRACTOR COMPANY NAME& YLP-N-E. Ja ✓07 • Le)e c4- / U.h�/� PHONE # (87� (o II" K' '3 ( �
STATE WELL CONSTRUCTION PERMIT# /70 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
e_p
1. WELL USE (Check Applicable Box): Residential MunicipaliPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /taco my u )O o
d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
) ile (Street or1Lg6tcNo./ (1/ 2 0 7 0
CO
E Ci( /or Town State Zip Codc
(—)-
Area code- Phone number
4. DATE DRILLED 4 ,c-e a.
5. TOTAL DEPTH: /5/5- I
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS , FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): -3D METHOD OF TEST
10. WATER ZONES (depth): / 65 / - c, 3 p rx--
11. DISINFECTION: Type H%%7 Amount I ID
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To a- 17 Ft. Id I PV C
From To Ft.
From To Ft.
13. GROUT: � Depth aterial Method_—
From Toopip Ft.
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley I
(check appropriate box)
Latitude/longitude of well location
J ��
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Size
Material
• j11 771 fit,
Fb0 HEREBY CERTIFY
CONSTRUCTION STAN
p/
(degrees:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forma Description
/) S% '
6-2)
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
rV
O
C-)
0
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTEN THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
A�h

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) Y ' B CERTIFICATION # 3b /
WELL CONTRACTOR COMPANY NAME(7YP 1421.E [`7�YDS . ledPJX LLh't fD PHONE # ani. yg - 31.74
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WO PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest own:
r
County
(Street Name, N- bers, Community, Subdivision, - ▪ Lot No., Zip Code)
3. OWNER: r-Rir e M' rnt ihh,It (14
8. TOP OF CASING IS
*Top of casing terminated at/or below land surface requires a
variance in accordance ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 2 k rs
10. WATER ZONES (depth): 3RD' - Jrcc DTr,
412...5 ' - 'H p m
11. DISINFECTION: Type H 7N Amount __9_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1.) To G 3 Ft. to /1 P1//'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From b To ,2 0 Ft. it Dt 4011
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
Address / D We Moto %k c -
(Sltree o Route No.) 8, ry
el esv i' Ne z '7 <0
C. or Town State Zip Code
(-)-
Area code- Phone number �? ,/
4. DATE DRILLED 7 - '% - o x
5. TOTAL DEPTH: .3 ''is r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lit
7. STATIC WATER LEVEL Below Top of Casing: . 30 FT.
(Use "+" if Above Top of Casing)
1 FT. Above Land Surface*
Topo raphic/Land setting
❑Ridge fSsjope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrccs,minutcs/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
q3S
' s'
From
From
16. REMARKS:
Ft.
Ft.
261136
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o
N
CD f,--
1
CO :.
0
N
NSTRUCTED IN ACCORDANCE WITH 5A NCAC 2C, WELL
Ct, 'eONtCRY ICTIOI T 1 v AT S,, AND HAT\A COPAS OY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9 30 . a z.
TDCOESIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
USuuhmmiitftyh6e$nnrriiginaa to th
ASHE�ILLE'f�EGiDNAC OtFICet (919)
Division of Water Quality, Groundwater Section, 1636 Mail Sery ice Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) s f qqqq
WELL CONTRACTOR COMPANY NAME "- /
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
yCERTIFICATION # a 4/
PJltc�i *s iJe/l -/ Puy ('KCbRONeASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residentiali-Munieipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: I OA nesu t I l e County i v vU
7)/ 1 &A.1yeA
(Street NaineJtaimbers, Community, Subdivision, Lot No.. Zip Code)
(Street or oute No.
City or wn State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED I -Q - b a
5. TOTAL DEPTH: /p DS /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. _ J
9. YIELD (gpm): .' METHOD OF TEST 7e,4ry •
10. WATER ZONES (depth): 4OS preN
11. DISINFECTION: Type H 771
12. CASING:
261533
Topographic/Land setting
❑Ridge 0Slope ❑Valley
(cheek appropriate box) r rip
Latitude/longitude of well location°
(degrees. ininutes/sceonds)
Latitude/longitude source:OGPSOTopoeraphW map',-
(check box) '—
DEPTH DRILLING LOG
From
TU % /
3. OWNER:
Address 3 rl 5 S l�i Ltiw
Li-OG�L u-D-.�7 ) C a$rl$to
Depth Diameter
From b To in % Ft. La is
From To Ft.
From To Ft.
13. GROUT: Depth ��tf Material Me hod
From D To�f�_ Ft. C(1.t-,/10-4+
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount /09
Wall Thickness
or Weight/Ft. Material
Pvr
From To Ft.
From To Ft.
16. REMARKS:
Fomiauop Descrt`pGon
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
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND $, AND THAT A COPY OF THIS RECORD EN PROVIDED TO THE WELL OWNER
62-
"DLI-
SIGNATURE OF PERSON CONSTRUCTING TI IE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 NI ail Ser, is
27699-1636 Phone No. [phone], within 30 days.
Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -)Division of Water Quality - Groundwater Section
'/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) O t .-v /l�- `I7�/1—,t6�/� CERTIFICATION # n77/
WELL CONTRACTOR COMPANY NAME VYGe4.d_ r3YVi - Lt.W`- T r D-' i PHONE # (ff.?8 to rF8 - 3y 16
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT# / Lk O a
(if applicable)
26158-'
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IfOther, List Use
2. WELL LOCATION:
Nearest Town: L1)f4-Aiae44v r I (e County rn.t'Wb
I-F- Sin }�.11s o-f- Liti-cJo0
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: �t 1 {1k
Address ) t1 O a 6.>-ait1.Jt )
(Street or Route No.)
) 4t.-A-a._ J G
I a.(.tne511 1 le) NC ']`6(e
City oown State Zip Code
( )-
Area codc- Phone number
4. DATE DRILLED 1 - - D '1
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B4.
7. STATIC WATER LEVEL Below Top of Casing: 415e 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): 1 METHOD OF TEST 0 %t rs
10. WATER ZONES (depth): `f'0 S" ( C�Q
11. DISINFECTION: Type H`TH Amount ) l 1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 5/ Ft. 't P.JC.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To OD Ft. (1�.vs.._F ..` " -'+irr
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.
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑FIp
check appropriate box) rJ
Latitude/longitude of well location-D -
477
(decrees: minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map --
DEPTH
From
S 1
To
5/'
/n tNc
(check box) -.
DRILLING COG Cl c
Fomlatin�escr
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STAND ;;AND THAT A COPY OF TIIIS RfaeOii HAS BEEN PROVIDED TO THE WELL OWNER
9_ 36 — r 2.
.9 Yr//�2Zi t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
OCT 1 5 2002
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Sers ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAMRprint)
WELL CONTRACTOR COMPANY NAME (9' r tote l
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
261585
Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #
ro5.lie) / 91 t IWPRONE#109i18 .7 la
.2 ASSOCIATED WQ PERMIT/0
(if applicable)
1. WELL USE (Check Applicable Box): Residential., Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: f , Topographic/Land setting
Nearest Town: ninii/ArAI�P Va.]Iea.founty 'H�? ❑Ridge Slope ❑Valley ❑Flat
Pi P, Tb fR 4' . (check appropriate box)
Latitude/longitude of well location
N
(degrees minutes/seconds) C-J -
Latitude/longitude source:❑GPS❑Topographic map -.-
(check box) -
DRILLING'LOG
Formn Description
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER:
Address
11J n(Street (*Route
e',1Ih. An" �g'i$�
City or wn State Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED q - to -- D a
5. TOTAL DEPTH: 1 LI S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 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 ISA NCAC 2C.0118. �l
9. YIELD (gpm): J G METHOD OF TEST d }i r 5
10. WATER ZONES (depth): 1 4 ® - 1 '4-5 '
v
Amount LJ
1l. DISINFECTION: Type 14TH
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From b To 5 r7 Ft. (.e j 1 P 1l c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To a D Ft. ("' D `" -13
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:
DEPTH
From To
& .SS
. 5' 245'
o —
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
NO
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANIy1Jj, DS, AND THAT A COPY OF THIS RECORD 11 EN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
O CT 1 5 Submit9
e�thoriginal to the Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME � (print)
WELL CONTRACTOR COMPANY NAME (rrret F, �,/iv h .0 l�%a>� /lly/2/ SG/IC-PHONE # fJa$ L `ig - 3/ 7.0
• STATE WELL CONSTRUCTION PERMIT# /42/3 ASSOCIATED WQ PERMIT#
(if arlicabie) <<// (if applicable)
1. WELL USE ((Check Applicable Box): Residentialg, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
264049
2. WELL LOCATIONNearest Tn: �� County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip /Codc)
3. OWNER:
944
Address nZ/2„
(// T«-
Ofir7
(Street or -Route No.)
a171.ty la)/Ytc 267 is'
Cityr Town State Zip Codc
( )
Area code- Phone number
4. DATE DRILLED `1— 2 .-- D 2
5. TOTAL DEPTH: • a eb r /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO76,
7. STATIC WATER LEVEL Below Top of Casing: _ 4'4 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 accordancewith 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST /7r5
10, WATER ZONES (depth): 2.2d /- 02 2S
11. DISINFECTION: Type {rig/
12. CASING:
Depth
From D To / 33 Ft.
From To Ft.
From To Ft.
• 13. GROUT: Depth Material Mejhod
From � To v2� Ft. CDnr+2�
From To Ft.
14. SCREEN: Depth - Diameter Slot Size Material
From • To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter
/nit
Amount
Wall Thickness
or Weight/Ft. Material
CERTIFICATION II JO 0/
Topographic/Land setting
❑Ridge V.Slope ❑Valley ❑FIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation escription
/2 /33
/3.3' al`s' ,sue fr
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,A-�_�WITH 15A NCAC 2C, WELL
S AND THAT A COPY OF THIS RECORDeX EN PROVIDED TO THE WELL OWNER
- 3/- 22
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

264055
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaltuResources - Division of Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) AI7%J/IL I A D ? [ CERTIFICATION # 3/G 4 /
•
WELL CONTRACTOR COMPANY NAME)�JaJJW‘z , dOi IULV % / r-4*av l-h"t-- PHONE k es? C r7 "3/ 713
STATE WELL CONSTRUCTION PERMIT*/ /4 —2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential
*L Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water nl jection 0 Other 0 IC Other, List Use
2. WELL%LOCATION:
NY7%
(Street Name,
.41. 'c2)!�-.
tiers, Community, Subdivision, Lot No., Zip Codf)
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
3. OWNER' f ! w -1) J<37">u""`� (degrees/minutes/seconds)
Address ) C) 71 7( Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
P� �8 7 2 l DRILLING LOG
Forma j,opt Description
L/T/' !
City rTown / State
Zip Code
• Area code- Phone number
4, DATE DRILLED % - /5
5. TOTAL DEPTH: 3.25
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: -1t9 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): 6/1)f METHOD OF TEST 02 Arc .
10. WATER ZONES (depth): — �5 '
11. DISINFECTION: Type /—f77-/ Amount ..l Za
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 3 8 FL G " PVC
From To Ft
From To Ft.
13. GROUT: Depth aterial
From li) To C2/7 Ft. / a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From • To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth - Size Material
From To Ft.
From To Ft.
Method
DEPTH
From To
n 38�
35� ' 325 '
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:
_ Submit the orig nal to
GROI)NOl No.(1
ASHEVILLE REGIONAL OFFICE
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)ARDS ;AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,1Ltat
/D- 3/-z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733.3221, within 30 days. GW- I REV. 07/2001

if.
12. CASING:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
Nattt oral/Resources -"vision of Water Quality - Groundwater Section'
-WELL CONTRACTOR (INDIVIDUAL) NA�MH rint) /S O/Jh//✓ J11,/ CERTIFICATION # v?/4//49
WELL CONTRACTOR COMPANY NAME-7/i1�2ZcCHONE 14 ( S �n 52� ' 3/ 26
STATE WELL CONSTRUCTION PERMIT# //-Si 2 ASSOCIATED WQ PERMIT#
(if applicable)
264056
(if avlicable)
1, WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Z. WELL LOCATION:
�( / County -
Nearest Town
F /2-44 -0-7AL- /riol.
(Street Name, Numbersbcommunity, Subdivision,, Lot No., Zip Code)
/I 3. OWNER: LJ:)6yC SI 2 -9�C,
Address 9,73 fi... ra- . �io-,i /t.
,���//�}}/J� (Stree/tp r oy et57No.)
Ct aYWwng. State
G !/Iii1'/
Area code- Phone number 4. DATE DRILLED 9- ail) -e Z
5. TOTAL DEPTH: /4 5 v
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i
7. STATIC WATER LEVEL Below Top of Casing: .S FT.
(Use "1-" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance ith ISA NCAC 2C .0118. I �
' 9, YIELD (gpm): / METHOD OF TEST 7t�a
10. WATER ZONES (depth):
Zip Code
-?8'7s/
/51.5-' - /P -,.t..)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley AFIat
(check appropriate box)
Latitude/longitude of well location
(degrees'minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Form ti n Description
DEPTH
From To
/4)6
/cc
LOCATION SKETCH
11. DISINFECTION: Type H7/J Amount „2 '7 Show direction and distance in miles from at least
- Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From `. To Hit, Ft. 4 " 5•I1-2o
From To Ft.
From To Ft.
13. GROUT: Depth Material
From / To Me hod
o�,) Ft. l Pn-xaaa,
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
16. REMARKS:
Size Material
C�
COO HEREBY r-,- TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL , - '_
i T1V9CT O WAR THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the on na t(
27699.163A P. No, (
GROUNDWATER 'SECTION
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
)19) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
• North Carolina - Department of Environment and ral Resources - Dii isJon of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) /0 A / A/ Life_ / A CERTIFICATION # .2 4//op
WELL CONTRACTOR COMPANY NAME CrPN n.'..�-os Zile)/ '1V /9�/np t fte PHONE # tr.�JSR /o 5%S/ 3 j %G
STATE WELL CONSTRUCTION PERMIT/0/ T/D.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264034
I. WELL USE (Check Applicable Box): Residential IQ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 ItOther, List Use
2. WELL LOCATION: /
Nearest Town: iYr�z /,?7J4,County
/o71 al3 k, sir)) p_,
(Street Name, Numbers, Community, Subdivision, Lot No., Z4p Code)
3. OWNER:
Address
Y-Lc�2�
p A Rt.)
/r i4/7,p
` , _��/ G(S[ree h,C eO ° . e 20 7SY
City wn State Z Zip Code
Area code- Phone number
4. DATE DRILLED 9-_q.v-6i
5. TOTAL DEPTH: /1)/0S '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 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): '7 METHOD OF TEST e2 A r s
10:WATER ZONES (depth): .5) 5' - m
705 • — 3Orm
11. DISINFECTION: Type f-/Y/-/ Amount /76
12, CASING: Wall Thickness
Depth , / Diameter
From I) To 9 if Ft. t7
From To Ft.
From To Ft.
13. GROUT: Depth saterial Method
From_ - To ld Ft. l Dn-nAtL 1/47
From To Ft.
14. SCREEN: Depth - Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth - Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C7P1•at
(check appropriate box)
Latitude/longitude of well location
/ ( degrees: minutes'scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forman n Descriptjon
DEPTH
From To
9.4//
94/7 /De95 •
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
s5)-7L
From
From
To Ft,
To Ft.
AS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
COPY OF THIS RECORD HAS PROVIDED TO THE WELL OWNER
/O -3/-oz
OF PERSON CONSTRUCTING THE WELL DATE
SD er Quality, Groundwater Section, 16.36 Mail Service Center - Raleigh, NC
276 - 9fflG5tithi 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
264042
ural Resources - Djvision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) _oh CERTIFICATION # 2-5./2
Y1 ) NAM"? (print) / */�j
WELL CONTRACTOR COMPANY NAME braP/? f., /%i// hp, -AN e PHONE a (X'.IY L S/S 3/ 7�
STATE WELL CONSTRUCTION PERMIT# /7/4 - ASSOCIATED WO PERMIT#
(ifa licable) - (if applicable)
1. WELL USE (Check, Applicable Box): Residential % Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: r
Nearest own:///D-/ph,;V)7,4 County iz2uuJDod
n/s reP.A 7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. /..P P _ c/ - X /)/✓
Address 5? :-JJlidarL/ /'1 o
(Street or Route N6.)
_/2-42Tf7/
7r'7/6
City or Town State Zip Code
( )-
Area code- Phone number
DATE DRILLED 9/—/e'6)
TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL? YES 0 NO *I
,7. STATIC WATER LEVEL Below Top of Casing: (o t) FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordange with 15A NCAC 2C .0118. /
.9. YIELD (pm): a METHOD OF TEST d h r4
10. WATER ZONES (depth): G 2S ' -
11. DISINFECTION: Type %I T7--/
12. CASING: -
Depth Diameter
From 0 'To ,Q rl Ft. Co " P U C.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method/
From 77 i/i To Ft. Le-rrya
From To Ft.
I }. 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 3 3
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
o ail rc2a—L.
45' �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.
) 16.- REMARKS:
Nu,/
WI' THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cVc
,J SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 7Z3-3221, within 30 days. GW-I REV. 07/2001

c,
WELL CONSTRUCTION RECORD 2 F 4 0 4 3
North Carolina ? Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sfr3L/J.r2-I Sraa t24 CERTIFICATION It 36"1"/
/ n
WELL CONTRACTOR COMPANY NAME V/'P ePi-e .Y11-7>5 ICJP11 a T//,IY JO.-PHONE # Xi-7V ‘ Y R 3/
STATE WELL CONSTRUCTION PERMIT# //17' -
(if
applicable)
1, WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
• 2. WELL LOCATION: ;
Nearest Town
/r$.,,
(Street Name, Numbers, C6mmunity, Subdivision, Lot No., Zip Code)
ASSOCIATED WQ PERMIT/4
County A42..yl,iD 4'61
3. OWNER: 9[r.lt,6�r.-- ` i AA-)
Address 3. S .gal t t ,eL.
/ Z ! ,(Street grRp {e No.)
y �/ �f Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED 9- 3 D- d z
5. TOTAL DEPTH: 57)) S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO %.
7. STATIC WATER LEVEL Below Top of Casing: L O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): - / .2. METHOD OF TEST g A YS
10. WATER ZONES (depth): /D S' - 7�/, r>, c'r e4J
`/F2),'/ Sgpm
1l. DISINFECTION: Type f-f%r9" Amount 90
':-- 12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From D 'To -/S Ft. /o '/ & et e.
From To Ft.
From To Ft.
13. GROUT' Depth Avlaterial Method
From 0 To 2n Ft. (D.,4t 47
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From___ To Ft. in. in.
From ' To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. -
Ft
(if applicable)
Topographic/Land raphic/Land setting
❑Ridge -Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesnn i n uses/seconds)
Latitude/longitude source:OGPSOTopographic map
(check bon)
DEPTH DRILLING LOG
From To Forman Description
/) «/8 XJn2 ,t4
57)6'
.2875/
From
16._ REMARKS:
Gt1/e / C(p.
City r own State
To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o0
0)
D �,
D ifBitt CTI15Y Tf-1A�„dry
a -
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
, AND THAT A COPY OF THIS RECO AS BEEN PROVIDED TO THE WELL OWNER
2i+L it /O-3/-aZ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Gii9h1ld(t3%lffRefiPe 9 he D ision of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
1181 0110€1 PQtAiAONKF01119) 73 -3221, within 30 days. GW-I REV. 07/2001

• WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu I Resources - Division of Water Quality - Groundwater Section
'/
A CERTIFICATION# 44"/9'
ja)/ 9 /Lnri AY6NE # (S',.?864/7-.3/72)
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
reur'.'L//'tare,
/ `J' 49.2
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
264031
1. WELL USE (Check Applicable Box): Residential 27-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nearest Town: 1[//LL/r1 e31//
(Street Name, Numbers, Co
Count )/—%//1Dded
nn l' vv,
unity, Subdivision, Lot No., Zip Codc)
✓ y
3. OWNER: sA..4-7
Address .5.3D /i)„z41.Lier.. 'Tr/.
(Street or Route No.) J
CE
City o own ' State Zip Codc
( Area code- Phone number
4. DATE DRILLED - /'7 _p
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q"
7. STATIC WATER LEVEL Below Top of Casing: .27)6' FT.
i (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
Topographic/Land setting
❑Ridge ❑Slope ❑Valley FdF'lat
(check appropriate box)
Latitude/longitude of well location
(decrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form ro Description
ize
4 7 5/25
variance In accordance } ith I5A NCAC 2C .0118. /�
4. YIELD (gpm): v METHOD OF TEST ? 7&4J •
10. WATER ZONES (depth): 4/45- pr.
11. DISINFECTION: Type /-/ 7-7/
12. CASING:
Depth Diameter
From 7) To 4/7 Ft. 6 "
From To Ft.
From To Ft.
13. GROUT: Depth
From I,To ofq
D Ft.
Material
Amount 4/.0
Wall Thickness
or Weight/Ft. Material
A lee -
From To Ft.
14. SCREEN: Depth • Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth - Size Material
From To Ft.
From To Ft.
Method
-/nr
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n
16. REMARKS:
Sub
27699Ri
R� 'on of
R{'AtY X"ICF1' w
LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
iAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7'zC/
RE OF PERSON CONSTRUCTING THE WELL DATE
Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
thin 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
YELL CONTRACTOR (INDIVIDUAL) NAMF{,.)print)
WELL CONTRACTOR COMPANY NAM42IA PJ-4,
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
3. OWNER;
Address
Obi, /L%.ct,
CERTIFICATION tI2 T22
• `/%// LGN Ilk PHONE # (322tee t'.�/ %A
ASSOCIATED WO PEERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION��: r / /
Nearest Town. lJ ' nesvr /A County ii,,,C.�lvOe'�C
C3lJ,�OLI �YP P ,� /
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
APrf rn tre 11
CJ Ane 90 7
�� (Street or Route No.) a �j 721
City Town /, State
Zip Code
(—)
Area code- Phone number -
4. DATE DRILLED %n- - D .
5. TOTAL DEPTH: 3XS/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
• (Use "+" if Above Top of Casing)
8, TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
'9. YIELD (gpm): 5 METHOD OF TEST of ✓c-d
10. WATER ZONES (depth): aln S — S"f/1m
I1. DISINFECTION: Type J/%fl Amount ��o
12. CASING:
Depth
From 7) To 47 Ft.
From To Ft
From To Ft
Wall Thickness
Diameter or Weight/Ft.
4 (/
13. GROUT: Depth mt
aterial
From To 2Z-- Ft. (rivOn-eri
From To Ft
14. SCREEN: Depth Diameter
Material
Ve
ethod
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.
264006
Topog aphic/Land setting
❑Ridge S1Qpe OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fonnat'on Description
r7 / O ' e'
�o e :gas' ��
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16.- REMARKS:
DO HFRRRY CFRTL ^ a.T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL '_)
ICtIS71 S'1�(;�� I,=N Nh/ D�� A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH.44 WELL 03WNERo
LS ll��iJ L`� J td-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1616 Phone-Nn (°I9) 73. -3221, within 30 days. G W- I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

264985
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division^of Water Quality - Groundwater Section ,/
WELL CONTRACTOR (INDIVIDUAL) NAME n (print) !>7YCi/�d /�- nt P1 CERTIFICATIONp# 3/�`�
WELL CONTRACTOR COMPANY NAME (tR ht Z/ f�JdQQ'S . /72 / '�4/h,/' Jet PHONE # (S4' G'Y'X-->/76
STATE WELL CONSTRUCTION PERMIT# ///A- ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential 3 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL
/ LOCATION i
NearesTown: 4na ounty9<4
y /4")
AL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i/c / a lir/D/954
Address 'Sly ./S/'O�-)I0 .��✓e, rel -
(Y(S,'% tre for Route E)
/„77z/
City or To Sftate Zip Code
( )-
Area code- Phone number
4. DATE DRILLED % - % -A-2
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Forma io Description
i
DEPTHFrom To
Lei) 33/
5. TOTAL DEPTH: 67).5
/
6. DOES WELL REPLACE EXISTING WELL? YES El NO L
7, STATIC WATER LEVEL Below Top of Casing: so FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
' 9. YIELD (gpm): //..'SJ METHOD OF TEST <22
10. WATER ZONES (depth): 3 gi) ` — �• �? m
Amount
11. DISINFECTION: Type Ai 7-2-/
12. CASING:
� Depth Diameter
From C/ To 3 3 Ft. In /z
From To Ft.
From To Ft.
13. GROUT: Depth
Material Me hod
_
From /% Too.�(� Ft. yh>itG�
From To Ft.
14. SCREEN: Depth - Diameter Slot Size Material
From • To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16.- REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
(✓ /- CL1NS IR[3 t KIN Sr"t A
t9S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//- 3,/j‘z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origina 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

264953
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section //
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) /JP//null /&rt 6.0._ CERTIFICATION# ✓67/
WELL CONTRACTOR COMPANY NAME tredoJu, g/ S /%/e-// PHONE # (t3 - /i 4'W - Si 72)
STATE WELL CONSTRUCTION PERMIT# I /) ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
T. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection ❑ Other ❑ I f Other, List Use
2. WELL LOCATION y p
Nearest,T wn: ((7iY[ jl77 County//X2/taviri�
(Street Name, Nu
3. OWNER:
Address
rs, Community, Subdivision, Lot No., Zip Code)
r fN l�CC.(C' - C&,YcJ ///LdL
(Street or Rout o. (/
L- 141 Ifni- /e_ M2 7/G
City or Town /State Zip Code
Area code- Phone number
4. DATE DRILLED 9-/.2 42-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: rlL) FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING 1S f FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /a METHOD OF TEST A /'S
10, WATER ZONES (depth): 7)e / - -� 0p en
'-/PoI,pi-
11. DISINFECTION: Type T/-/ AmotYnt
�.A
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From ,l) To // , Ft. 4 // S'/0.P /
From To Ft.
From To Ft.
13. GROUT: Depth Material! shod
From 4 To .2Z) Ft. cE/tit-Lo
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.
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo�rrpJ1"a ''on Description
^-Q.uee'
DEPTH
From To
L% /gG'
/26 //%5-/
irt-r TO
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQI$STAU TION STAN, S, AND THAT A COPY OF THIS RECORD HAS BEE ROV IDED TO THE WELL OWNER
--4
Submit the original ttbe'1
27699-1636 Phone No. ( 19) 7
-,'LI^IC11t
AShE IL Lr r
P,IcF
SIGNATURE OF PERSON CONSTRUCTING TIfE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001
•J

259247
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) _O�-u a f) , Hew re CERTIFICATION a 30 /
WELL CONTRACTOR COMPANY NAME (YrP P ne /J'OJS . /f/L' I / q Rilne, rAie PHONE # S/' - '3/ 7z)
STATE WELL CONSTRUCTION PERMIT# / 'y' D JZ ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /
Neare Town: l �(C, i ie
//!'C t/( OCX a.—
e Name,
Numbers,
(Strc Community, Subdivision, Lot No., Zip Codc)
3. OWNER:
Address
City Town State Z
(—)-
Area code- Phone number
4. DATE DRILLED S - ! q O
5. TOTAL DEPTH: 4105'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d.
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 accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): _ METHOD OF TEST c.2 9-t)ca-
10. WATER ZONES (depth): / 40 / — 6..P re,
11. DISINFECTION: Type /7177-i Amount '/`3
12. CASING: Wall Thickness
Depth" //// Diameter or Weight/Ft. Material
From To � f Ft. 4 I/ 67-e-e-(
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To 0'1/v Ft. ('a rn,n,3L /hv_.‘
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
From To
From To
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To,Foml/adonDescription
414/ (-era Vt.,/
e-frL '/OS' GrR VI , 1-e-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
is
SEP — 9 2002
Sub it the original to the Div s on
2769 221,
GROUNDWATER E 'Of
ASHEJILLE REGIONAL OFFICE
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEE Iy-.P[tOV IDED TO THE WELL OWNER
3/ - d 2
TURE OF PERSON CONSTRUCTING TI IE WELL DATE
f Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
+ithin 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 25 9 2 4 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #
l D
- PHONE a yr,s�J 444P'3/%�
ASSOCIATED WQ PERMIT#/
R C
WELL CONTRACTOR (INDIVIDUAL) NAMEE��(p�rint)
WELL CONTRACTOR COMPANY NAME C / eat 2 QJ • 1/ c �>n
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest owp:Coum'nty
itn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
City or Town State
( )-
Area code- Phone number ,/
4. DATE DRILLED g'/T - & z
5. TOTAL DEPTH: / '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NON,
7. STATIC WATER LEVEL Below Top of Casing: ✓?n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6,6 # METHOD OF TEST 2 /A YS
10. WATER ZONES (depth): SOS'/6p.5'
Topo raphic/Land setting
❑RidgeLSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: as isn '9 t2op (dcgrccs minutes/seconds)
Address .1539 / I-Gtu-ru1/lrs c aI*i-tl. LT f�LLatitude/lonuitude source:❑GPS❑Topographic map
,,JJ a (Street orRoute Non) (check box)
,11A- J (Street
l,C / (-) 9a637) DEPTH DRILLING LOG
Zip Code From To Formation Description
41 /2P` 4—
LOCATION SKETCH _
11. DISINFECTION: Type /-1 / H Amount 0 7 Show direction and distance in miles from atSl asr-
12. CASING: Wall Thickness two State Roads or County Roads. Include fri roatl4
Depth ,e/i Diameter or Weight/Ft. Material numbers and common road names. [1 _-
From j9 To ‘ V-- Ft. oo 'y lin)
From To Ft.
From To Ft.
13. GROUT: Depth Materia! Method
From To alb Ft, -yt
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r-f1
0
c.)
Co
16. REMARKS:
I DO
SEP - 9 2002
Submit the original to t
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD
HAS BEEN PROVIDED TO THE WELL OWNER
ul g-3L02
SIGNATURE OF PERSON CONSTR I ING THE WELL DATE
e Di sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
) 733- 221, within 30 days. GW-I REV. 07/200I
GROUNDWATER
ASHEVILE REGIONAL. OFFICE
--i

3. OWNER: / P M L
Address /9/ %/b n —
Strcct or RqujC o.)
il
City or Town (State
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
CERTIFICATION # .228s
WELL CONTRACTOR (INDIVIDUAL) NAM (print) 1 /�.y,��
WELL CONTRACTOR COMPANY NAME rLt'lit /S L/D-)� 4 / -PHONE p {bhp GY��'3/��
ASSOCIATED WQ PERMIT#
(if applicable)
259245
STATE WELL CONSTRUCTION PERMIT# 444'.f
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION;
Nea
County
Y�/7/ L XQ ltl Re' ,
(Street Name, Numbei, Community, Subdivision, Lot No.. Zip Code)
di 71'
2 / /t
Zip Codc
Area code- Phone number 2
4. DATE DRILLED S - I ? -
5. TOTAL DEPTH: 02 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO `yt
7. STATIC WATER LEVEL Below Top of Casing: ,6-12) 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. D
9. YIELD (gpm): /A. METHOD OF TEST 4.44
10. WATER ZONES (depth): /851 - /a Dr-,
11. DISINFECTION: Type %tTi-/
12. CASING:
Depth Diameter
From 0 To 'if Ft. 6 1'
From To Ft.
From To Ft.
13. GROUT: Depth Material y Method
From 0 To /, ni-L
Ft. Dn,c(.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount ,a '7
Wall Thickness two State Roads or County Roads. Include
or Weight/Ft. Material numbers and common road names.
/
7)
From
From
To Ft.
To Ft.
To 00 graphic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/lonuitude of well location
Ideerces. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
[check box)
DEPTH DRILLING LOG
Froni To Formation Description
(.:7-Y/I' VP!
Q� .2/�S / Ll✓✓/) Al 1 -I
LOCATION SKETCH
Show direction and distance in miles from at least_.
road.
rn
'.1 - -
16. REMARKS:
1 O 1 ERTIFY47IALTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
C. NS &U TIC�J AN�AI fl AND THAT A COPY OF THIS RECORD HAS 9LE�' PROVIDED TO THEW WELL OWNER
Y z
'' 11 DATE
SEP - 9 2002 J
ubmit the original to tht Divi
733-3
GROUNDIXT`R SECTION
ASHEVILLE REGIONi,L OFFICE
GNATURE OF PERSON CONSTRUCTING TI IE WELL
on of Water Quality, Groundwater Section, I636 Mali Ser ice Center - Raleigh, NC
.21, within 30 days. GW-I REV. 07/20U1

3. OWNER:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisi n of Water Quality - Groundwater Section
r�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I / CERTIFICATION�j#,�f `1'/o
WELL CONTRACTOR COMPANY NAME(9r# Pdfr, t Y/� �,GA N •PHONE # £7f 1 `3/r1)
STATE WELL CONSTRUCTION PERMIT# ASO-2
(if applicable)
I. WELL USE (Check Applicable Box): Residential
/l
259243
ASSOCIATED WQ PERMIT#
(if applicable)
Municipal/Public 0
Monitoring 0 Recovery 0 Heat Pump Water1lnjection ❑ Other 0 I
2. WELL LOCATION:
Near gTown a
s�
iiCounty
�t /+^
(Street Name, Numbers, Commu rty, Subdivision, Lot No., Zip Codc)
f.22l
Address AO ne7 /. / 5" q `,
MTe( tr ct r re No.) /C d 1J J�/
`'�v
r Town Stat Zip Codc
Arca code- Phone number ri
4. DATE DRILLED 6 — 2/— ) -
5. TOTAL DEPTH: 4/4 ��{
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO /";
7. STATIC WATER LEVEL Below Top of Casing: /fin FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): c 2 METHOD OF TEST et.f.
10. WATER ZONES (depth): L31s1 VVo)p/rr
I I. DISINFECTION: Type //77 Amount 6-4
12. CASING: Wall Thickness
Depth Diameter or Weight/Fr. Ma trial
From /2 To /_G Ft. 4 n _
From To Ft.
From To Ft.
13. GROUT: Depth atenial --� - Method
From 0 To nit() 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:
Industrial 0 Agricultural ❑
Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley t
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Forma on Description I
(9-!1/194 1 iC .
DEPTH
From To 6 /aZ/ /
/.MM r 4'5'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and and common road names.
D& CR f TI1 N AtHid.
t SEP - g 2002
Submit the original to th
L4it
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Divi ion of Water Quality, Groundwater Section, 1636 Mail Serice Center - Raleigh, NC
E.-i(i ) 733-3 2l, within 30 days. GW-1 REV. 07/2001
ASF'EvT LE REGIONAL OFFICE
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD a, SHEEN PROVIDED TO THE WELL OWNER
µll �. j/,C Z

3. OWNER:
Address
4.
5.
6.
7.
City or Town
Arca code- Phone number
DATE DRILLED 47— S-D.2
TOTAL DEPTH: YC+ 6 '
DOES WELL REPLACE EXISTING WELL? YES 0 NO
WELL CONSTRUCTION RECORD
259238
North Carolina - Department of Environment and.Nntt ral Resources Di ision of Water Quality - Groundwater Section ,/ �j
WELL CONTRACTOR (INDIVIDUAL) NAMMf�"(print) �_• /✓ - CERTIFICATIOrJNM�7`/d
WELL CONTRACTOR COMPANYNAMEL-,tPFFNF pCOS. /delt - 4 ny,j.ZVVrt PHONE /0 Gy l z52 - �'/
STATE WELL CONSTRUCTION PERMITS /
(if applicable)
ASSOCIATED WQ PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 IrOther, List Use
2. WELL LOCATIO
Nearest
L
County tW 4'6°4
4011../V) .
(Street Name, Numbers, Community, Subdivision, Lot o., Zip Code)
�n is �[t it,t La
To. • graphic/Land setting
❑Ridge aSlope Val ley ❑Flat
(chct. appropriate box)
Latitude/longitude of well location
/ de socurci:OGPconds')
Latitude/longitude source:OGPSOTopographic map
fStrcet or Route of / (check box)
c` () 0p 9/t) DEPTH DRILLING LOG
date Zip Code From To Formation Description
0 aa'
aa' uv5'
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 accordanceh 15A NCAC 2C .0118.
9. YIELD (gpm): _[ / METHOD OF TEST c2 h rS
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.
I1. DISINFECTION: Type /T L- Amount /�'%
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From /9 To 2 Ft. 6" " PYr
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From D To o2 Ft. ( 0-1-,,._ r Syr,--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
From
From
0
ry
Size Material i�r1
'9
U-1
16. REMARKS:
To Ft.
To Ft.
Innis a
n :• TI'
., r; 5)NS R11C N
r-A `ram
, Submit the original tio the
_ 1769n.IM16-Phene-Ner(919)
rN SEC11uhJ
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Jivision of Water Quality, Groundwater Section, 163ti Mail Service Center - Raleigh, NC
33-3221,within 30days. 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)xO
WELL CONTRACTOR COMPANY NAME Cy9.7 � - �! �P LC i/' /LY-t+�� 'f`�- 'PHONE kQ✓+u)
STATE WELL CONSTRUCTION PERMIT',�/[ o'er ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
'T
259237
/ CERTIFICATION N / !
g
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION _ //
Nearest�Town: CF/}e ent_
Ii LL�%ti'�iL f •
(Street Name, Numbers, Community,.Subdivision, Lot
No.Zip
Code)
3. OWNER: � 1-Lt-l.� f'��pp�
Address (((/////4 /o x < .��rr-n.r. /Jfi-s-)'
(44.114voucetxo olat/7/G
City or Town State Zip Code
Area codc- Phone numbcr
4. DATE DRILLED W' a el -2
5. TOTAL DEPTH: .57.).,6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO %,
7. STATIC WATER LEVEL Below Top of Casing: 919 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST c4+ •
10. WATER ZONES (depth): 06 / — / pill
1 I. DISINFECTION: Type // % f / Amount V S
12. CASING: Wall Thickness
n Depth n Dyameter or Weight/Ft. M eripl
From r7/ To .JY� Ft, l� /I /
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To 2z 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:
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
chcc appropriate box)
Latitude/longitude of well location
Idcgrees.minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Front To / Formafiop Description
3S' had' (iZr�/ y'}z
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL CO
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNED
SIGNATURE OF PERSON CONSTRUCTING
E WELL
/-D1
DATE
L.... Submit the original tit the l ivision of Water Quality, Groundwater Section, 1636 Mail Sery ice Center - Raleigh, NC
i r ;2g699-4&.4=P4top Np"919) 713-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
259234
North Carolina - Department of Environment and Natural Resources/-jjD�i��vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME//�' (print) is h/ n ' I/ e_ b 2) rt CERTIFICATIONO# ..74Y /2
WELL CONTRACTOR COMPANY NAME ( -rr ein _. I3�Ds. ir/�Il Pw-y r�y}�, PHONE # (lYo�4 G.3/7U
STATE WELL CONSTRUCTION PERMIT# J^f L) Z ASSOCIATED WQ PERRM(T#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential , Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other ❑ If Other, List Use
2. WELL LOCATION.e) y
Nearest Tpwn, ( /.i) County /"/�lddld.
U�`B L —
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �rJL2-t1e� TILt.4cL)
Address .v,
/3/. --Ta—te
(Street or Route No.)
["v.41 �r,. '71 C
City or Town ' State
(—)-
2'7/%
Zip Code
Area code- Phone number
4. DATE DRILLED g- /5' O -Z
5. TOTAL DEPTH: 3.zS
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO ,
7. STATIC WATER LEVEL Below Top of Casing: )AO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST
10. WATER ZONES (depth):
ads' - J inn LOCATION SKETCH
11. DISINFECTION: Type _1-4 T I -I Amount 40
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. to erial numbers and common road names.
G rr
Topographic/Land settin
❑Ridge ❑Slope ON/alley $1Flat
(check appropriate box)
Latitude/longitude of well location
(decrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo tion Description
From
From
Depth
e9 To 9 % Ft.
To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Ci To a Ft. C4 P '}Y--p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Show direction and distance in miles from at least
0
rn
iri
cl
0
CO
VD
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECQ1ZWnA BEEN PROVIDED TO THE WELL OWNER
sr -1-2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sty iptitl;Attri_ 4r' ttrynbpp the D vision of Water Quality, Groundwater Section. 1636 Mail Sen ice Center - Raleigh, NC
276991636 Phone N6: ' ' -3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /- Division of Water Quality - Groundwater Section
�/
WELL CONTRACTOR (INDIVIDUAL) NAMF,,1(print) �/s /j )it /J,P /, CERTIFICATION al 4/r+
WELL CONTRACTOR COMPANY NAME (Yv- /2-414 ,{/3 os • GJP / I Y AWN,/ +GPNONE # (liiQ / YD '3/'74
STATE WELL CONSTRUCTION PERMIT# /-TC/ 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259232
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest To n:
/-/�G7/72F 7J�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
7/4/ /v,o€t /z P .
c/ (Street or Routle No.) /
C�/1PSG�i/// / Z .2&flS
City frown State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED g'— / 2 - z
5. TOTAL DEPTH: �,(Wl
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Ad FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith ISA NCAC 2C .0118. ll
9. YIELD (gpm): � METHOD OF TEST A rS
10. WATER ZONES (depth): a?'i/S -Si qp ry)
11. DISINFECTION: Type f-t%H Amount SL/
12. CASING: Wall Thickness
n' Weight/Ft. pate
Depth Diameter
From 0 To 35 Ft. s 6
From
From
13. GROUT:
From
To Ft.
To Ft.
Depth _ /� Material
To .471Z5- _ Ft.0 e-1
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setti
[Midge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees. utinutcs/scconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To / Form4tjop Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
z
Me*hrd
le?
0
rn
n
-v
CIl
0
t9
16. REMARKS:
final b the
919)
Cr, ICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS. AND THAT A COPY OF THIS RECORD HAS - N PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

Address 3
Street or R
R
City or Town State
WELL CONTRACTOR (INDIVIDUAL) NAM) (print)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section,/
CERTIFICATION # A V/Si
J?0 L n ///P,6 h
259231
WELL CONTRACTOR COMPANY NAME l`7PFs,
/ry''//� vc . LDe)1 -1 Mini/ Jac.. PHONE #JB �((S/S'�3/7°)
STATE WELL CONSTRUCTION PERMIT# / .4 .2, 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 ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Near Town.
� r
(StrceL$amc, Nu
rs, C
ounty
mmunity, Subdivisio , Lot ip Codc)
I /) /-f (j l 1�9.f.P ,e
d
Zip Code
( )-
Area code- Phone number
.4. DATE DRILLED ri'D.4
5. TOTAL DEPTH• 028 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A,
7. STATIC WATER LEVEL Below Top of Casing: Zap 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): 3n METHOD OF TEST 7vL r
10. WATER ZONES (depth): aS-
J�.
3. OWNER: )—LP,
OOP-
11. DISINFECTION: Type J/T/y
12. CASING: Wall Thickness
1]iamPtP• pr Weight/Ft. Material
Depth
From t To Ft. _' /./ P it_
From To Ft.
From To Ft.
13. GROUT: Depth /r Material
From n To �U rt. CQd-r,+.e,k_"
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Size
Amount 5/✓
Depth
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
Topographic/Land set
/) ❑Ridge ❑Slope ❑Valley [lat
I v (check appropriate box)
Latitude./longitude of well location
(decrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fotmap Description'
DEPTH
From
To
aRs •
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:
SEF -
SIGNATURE OF PERSON CONSTRUCTING THE WELL
LIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF TFIIS RECORD Ijp313EFN PROVIDED TO THE WELL OWNER
DATE
Submit the original MAIM Divi 'on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
20599J iniPhbbe4C6:T(4O)F733-3 21, within 30 days. GW-I REV. 07/2001
ASHEVILLE REGIONAL. -r'

WELL CONSTRUCTION RECORD 25 92 30
North Carolina - Department of Environment and Natural /Resources -jDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM�(print) 1AQ//9 /LIP Q/) Q CERTIFICATION #,,a 4i/g
WELL CONTRACTOR COMPANY NAME IVfl /t , / ro5 , /i-JP / / °E LLmpJ L//t e . PHONE #fad) 4 Y � --Y %�
STATE WELL CONSTRUCTION PERMIT# / Y Zr -2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential
Monitoring 0 Recovery ❑ Heat Pump Waterllnjection 0 Other 0 If Other, List Use
2. WELL LOCATIO/�NJ::� �� p
Nearest Town: L2 42*'flP5 //i %/e- County f/(l. l//r/oo c�
(Street Name, Number epmmunity, Subdivision, Lot No., Zip Code)
3. OWNER.
Txl .c
Address .7Q^J �y> ciA_„ ,e'er
(Street or Route No.)
ta.ty /7.0 iz'c .2878 -
City or Town State Zip Code
. 4. DATE DRILLED S2— 9 —D a
5. TOTAL DEPTH: cR Y S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
] (Use "h" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): //5 METHOD OF TEST r,S
10. WATER ZONES (depth): aG 5' — sitp
285' - 5 qOm
11. DISINFECTION: Type I-4 T I-1 Amonftt
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From in y5fe .
Yr/Ce
Area codc- Phone number
To /DV Ft. _6 z'
From To Ft.
From To Ft.
13. GROUT: t
Depth Material t Method
From LC To 20 Ft. CPi4n_r�_1r,L fc),
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.
Topo raphic/Land setting
❑RidgeISlope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form i n Decri tion
/ 4 s o t
/1)
LOCATION SKETCH
Show Direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C.)
2
Lo F,
16. REMARKS:
— O?
Submit the original to he Di
,°8L( %)CP19)732
ru'r'J1LLE PLCRHION.,AL OFFICE
( TICttc `tfSTD E t
Y)J !I•
Municipal/Public 0 Industrial ❑ Agricultural 0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TI-IE WELL OWNER
c,
0-3/- 6 Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Son ice Center -Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME (rreen.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
259229
North Carolina - Department of Environment and Natural Resources - Di ision of Water Quality - Groundwater Section / (/
CERTIFICATION # d S` /d
//J
/4'D.,2
tJ // ' / Any, TN/ . PHONE # oCg !C i`8 3/ Z)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIICCCON::/// / /�
Near�,st/Town: /t ///,/ ounty 7-y k Lr,,k'G ogfi
,iL /I (
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERS; /IAJLy #9n/� - ZA -Le/
Address A / ! /g,Q J
(Sv t r bite No.)
CIO Town State 1 Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED al‘ - 7- ' -
5. TOTAL DEPTH: //)&5- '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ._3(,) METHOD OF TEST .
10. WATER ZONES (depth): Wh S ' - a2 etprn
91s i P.r
11. DISINFECTION: Type /-f / / / Amount /&
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From o To 0ZO Ft. G " /-P7/('
From To Ft
From To Ft
13. GROUT: Depth /Material
From o To (-V) Ft. [ thyLe�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land settin
❑Ridge 0Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
Fla
(degrees:minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Format] n Description
o ao
.a0/OGS-/
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
0
rV
CO
r1
cc]
1rrn9 PHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 0 2
? SjCR T O ��TAIb�BD s AND THAT A COPY OF THIS RE RD HAS BEEN PROVIDED TO THE WELL OWNED
WkLat
FP _ j) SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit
�the original to tale Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
��i�iiiid, iteingEtrP1dk19) 733-3221, within 30 days. GW-I REV. 07/2001
ASHEVILLE REGl01JAL QE9CE

259228
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/El(print) L / CERTIFICATION: Jz /
t// S/ PERM::
- PHONE # (g�f G `�8 3/ -7� el
WELL CONTRACTOR COMPANY NAME ✓ PPI // //.7t /J
STATE WELL CONSTRUCTION PERMIT: /i-)- ASSOCIATED WQ PERMIT:
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I [Other, List Use
2. WELL LOCATION:
Near t Tow t
ti4 ;t c
(Street Name, Numbcys Community, Subdivisi.
3. OWNER:
Address
A
tfu� �-
/96 3 c•'t
City or own
!Count Way/r)00d-
2. /
., Lot No.. Zip Code)
tL�C�C�
Grp - IV) ) SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original
GRocutiryA
ASHEVILI F REGIno+int
ON
treet or Route No.)
xi -et
State Zip Code
Area code- Phone number
4. DATE DRILLED 9 - 7 -Z
Topographic/Land setting
❑Ridge ❑Slope 14/a1ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
!! (degrees.minutes/seconds)
UU
CU . G ./ut,t.,Y ,eat - Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frog To Fomratll~Description
AD
a0 � ere Atet .r�
5. TOTAL DEPTH: St S �
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO `4_
7. STATIC WATER LEVEL Below Top of Casing: /DD 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): L C METHOD OF TEST
10. WATER ZONES (depth): 4zen z - /SgPm
11. DISINFECTION: Type Ain/ Amount
JJ 4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Majerial
From 40 To ;C:i Ft.
From To Ft.
From To Ft.
13. GROUT: Depth ,Material 99 Method ,
From / To (20 Ft. (P.7'YrfncT /vr
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 (east
two State Roads or County Roads. Include the road
numbers and common road names.
Cr) -_7
16. REMARKS:
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0-3/- a [-
DATE
o the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
[phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
259227
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /.LJ.VGC��[�L / CERTIFICATION# .�d V/
WELL CONTRACTOR COMPANY NAME (-;-1,C e-y,P r�oJs. /vie-// vI /[en.r, ‘L>-c PHONE # (Pay re? 3/7D
STATE WELL CONSTRUCTION PERMIT#
/x//,
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL
LOCATION:
Nearest Town: Lact Mat?,
�County NaykYve!
e/2
(Street Name, Numbers, Comt(inniiry, Subdivision, Lot No., Zip Codc)
3. OWNER. % �7- it
Addressfe) 4,///(j,
„te y.;oorRoute o.
City or Town State Zip
(—)-
Area code- Phone number
4. DATE DRILLED 2 - 6 -4 -1-
5.
TOTAL DEPTH: 95/S-'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A.-
7. STATIC WATER LEVEL Below Top of Casing:.3✓) FT.
(Use "h" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. q
9. YIELD (gpm): oi, 5 METHOD OF TEST aC ✓w-, .
10. WATER ZONES (depth): a8U ' - 5 hi
gas' - . jrJ1,0,
11. DISINFECTION: Type /-/Tim/ Amount /6 7
12. CASING: Wall Thickness
Depth _ Diameter or Weight/Ft. Material
From To .l� Ft. e "
From To Ft.
From To Ft.
13. GROUT: Depth ,Material
From 0 To , 2D Ft. Cr iM.e c,�
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.
To o, raphic/Land setting
❑Ridge I pe ❑Va'lley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitudelongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
lJ 67)' (? ,
5¥5
Method
Codc
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road`:
numbers and common road names. $
N
CD
c.a
tD
16. REMARKS:
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
8.3/- D -1--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sere ice Center - Raleigh, NC
27699-4636 Ph3rnFAmt 19) 7
-3221, within 30 days. GW-1 REV. 07/2001

259226
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources - Division of Water Quality - Groundwater Section ,/ p WELL CONTRACTOR (INDIVIDUAL) NAM//F�,,1(print) � p�/� E'i / rd CERTIFICATION q'a?ry' /d
WELL CONTRACTOR COMPANY NAME L're'tENC / ,?.f1'S. 1 c q f rHONE I/ ?y4,7- e7e'
STATE WELL CONSTRUCTION PERMIT# / 44 d- ASSOCIATED WQ PERMIT/i
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1, Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /ilttr-g!(nP 5 L/ //t Count
/ /24)0Oei_ - 7 i ez h
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: /VA . /� J e141 -%7%
Address ,339/ Lid)/ i/ Cie9Gi/
(Street or.Ro a No.) - re n to
City r Town State �/ Zip Code
4, DATE DRILLED ,) -/
5. TOTAL DEPTH. /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO P�
7. STATIC WATER LEVEL Below Top of Casing: �(i 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): 4,G) METHOD OF TEST A ln re, _
10. WATER ZONES (depth): /�5 ' - lc D ��m
L iA/7/2m- V� / e
Area codc- Phone number
11. DISINFECTION: Type }--T F�
Amount
12. CASING: Wall Thickness
/� Depth / Dia�reter or Weight/Ft. M eri.
From [.� To 6 LO Ft. A zz
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From % To a D Ft. r o .vu En si- -1-c .p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valleyt
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Format nnDescription
/O' /9s'
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:
YDr4T ClIQJIC l7Ot,ea t
OT
t -IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
UARDS, AND THAT A COPY OF TI IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—pf-3/- 02
SIGNATURE OF PERSON CONSTRUCTING TREW'ELL DATE
Submit the origina to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
—?7499-}4Li6-� [phone], within 30 days. GW-I REV. 07/2001
r,-I,r:��, r L�,

L
259222
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - D/ix'ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMa
,F' (print) (r e— .r CERTIFICATION # 2 S75'
WELL CONTRACTOR COMPANY NAMEI'7'/P P6C.L S. G�-e—/ -F 6tn-n>D frL PHONE # (S 4 SIB — 3L 749
/ D-
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED W'Q PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 I (Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3eU /.ice ��4.4.1-
(Street r o A��7lo.)
Li��'P�L
C Zip
City State V Code
3. OWNER:
Address
�// ,nC
Area codc- Phone number
4. DATE DRILLED 2 %- D t-
5. TOTAL DEPTH: 4'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: W FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm):METHOD OF TEST c2 I7 YJ
10. WATER ZONES (depth): %.?/)' — 2C) 4
County
Topo aphic/Land setting
O ❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
7 Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatio Description
i
DEPTH
From To
g gn
80 ' 4 5/52
11. DISINFECTION: Type f%77/-( Amount /e
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 77 To eF4 Ft. 4 " % (/('
From
To Ft.
From To Ft.
13. GROUT: Depth
From 00
From
Material Method
To aC Ft. 6D-4-nL,tt
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 the road
numbers and common road names.
16. REMARKS:
EC IS3 . S N
GC
_I S E P — 9 2002
Submit the original
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TI-IE WELL OWNER
1 L— i-e
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
the 1 ivision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
19) 7 3-3221, within 30 days. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAMJ,,(pdnt) +J7 J s I
WELL CONTRACTOR COMPANY NAME CTYG[1i e- 3�/'r'S. LC}P-EL `� �am
P
ASSOCIATED WQ PERMIT#
(if applicable)
261134
STATE WELL CONSTRUCTION PERMIT#
(if aplicable)
1. WELL USE(CheckApplicable Box): Residential]„ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
of Water Quality - Groundwater Section //
CERTIFICATION #.iij/)f
PHONE #
2. WELL LOCATIO
Nearest Town:
(Street Name, Numbe
3. OWNER: JbA/
Address 9941
County w .4'd
Community, Subdivision, Lot No.. Zip Codc)
(St et or Route NoA
CityTown State �/ Zip Codc
Area code- Phone number
4. DATE DRILLED 3-13-2 d eyIS�,
5. TOTAL DEPTH: 3 rtl)tcoz\t
6. DOES WELL REPLACE EXISTI G WELL? YES ❑ NO 1.
7. STATIC WATER LEVEL Below Top of Casing: i CO 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): 7 METHOD OF TEST 0 h rs •
10. WATER ZONES (depth): .205 ' — '7 4 .j> P✓l
11. DISINFECTION: Type >H T H Amount a➢
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees: minuies/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation escription
DEPTH
From
T3
D
I) 3v °
Depth Diameter
From D To 30 Ft. 6 ff
From To Ft.
From To Ft.
j3. GROUT: Depth }�aterial y M the od
From n To ,fin Ft. L��✓�-�+-/
From To Ft.
14. SCREEN: Depth • Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. te,_al numbers and common road names.
16. REMARKS:
0
N
0
0
r)
0
N
cr
c
D�Il HLIY gRIElY
CONSTRUCTION STAIN
LYZJI -12
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECC HAS BEEN PROVIDED. TO THE WELL OWNER
e 9 30 -6 Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GH9441wsvAINtA6igI♦{i($o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASH TAO- MSflAhe0W6)((t19) 7.23-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL)NAMEE (print) WELL CONTRACTOR COMPANY NAME eft -en
261133
Division of Water Quality Groundwater Section •• ,,//
CERTIFICATION # .'1/64 /
^� / PHONE # (d.C/ 470 3/TD
STATE WELL CONSTRUCTION PERMIT# /`Y .2 ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(if applicable)
2. WELL LOCATIO
Nearest T wn:. / / - t° County,///a)�.
(Street Name, Numbers, Community Subdivision, Lot No., Zip Codc)
3. OWNER: C$Pe9C-4 e_ ll%/
Address nLX1I,n
(Street ijo/fie No,ivc
City Town State - Zip Code
(-)-
Area code- Phone number a 3 ' d
4. DATE DRILLED 8-
5. TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
/ es -217 26
7. STATIC WATER LEVEL Below Top of Casing: /D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /. Jr METHOD OF TEST
10. WATER ZONES (depth):
To o raphic/Land setting
❑Ridge Sthpe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forma[}p9, Description
DEPTH
From To
.O 29
.? 4 1 ' p 2 '
-2Ars .
11, DISINFECTION: Type
12. CASING:
/ t 7 N Amount /.J .
Depth
From © To .1 7 Ft.
From To Ft.
From To Ft.
13, GROUT: Depth Material
Frorg/_ To 20 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
Wall Thickness
Diameter or Weight/Ft. Material
6 "
Mthod
aP
From To
From To
16. -REMARKS:
Ft.
Ft.
ncT — 4 ti_.22li
Submit the original o the
. (919)
GROU
ASHEVILLE REGIONAL OFFICE
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.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL N
S, ND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
t trc 9 310 C
SIGNATURE OF PERSON CONSTRUC TILE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

261131
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES print) Y/�/' '�"�AY�-�Z CERTIFICATIONAna 3/D.4/ e
WELL CONTRACTOR COMPANY NAME V izea!- S . 6�P✓r Q� Lf 1 PHONE # (dtfl7 4 44 ' `3i
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION,;
Nearpt Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fA /�1"�
Address 5' .t,! pn
/ (Street or Route No.)
neSUI fit, de-. o?tQ%Peo
City Town State Zip Code
Area code- Phone number O.Z.
4. DATE DRILLED (' /G ,
5, TOTAL DEPTH: /.15
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: JQ 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. 2 , B
9. YIELD (gpm): SQ METHOD OF TEST T&r
10. WATER ZONES (depth): /G S' - /.26"
11. DISINFECTION: Type .147/-/
12. CASING:
Depth Diameter
From Q To -a -2 Ft. 4 "
From To Ft.
From To Ft.
13. GROUT: Depth q /1 Material {-
From .D To .�D Ft. (9.rvr-[max-t
Amount /L
Wall Thickness
or Weight/Ft. Material
PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
Topographic/L d setting
❑Ridge DSlope Iley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formati n,pescription
S1 ' /25'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECO a - BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, I636 Mali Service Center - Raleigh, NC
-3221, within 30 days. GW- I REV. 07/2001
c5
c

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section,/
CERTIFICATION�yk la
PHONE # fld h 419 3/ 74/
9'4..2 ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
261130
1. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other, List Use
2. WELL LOCATION:
Nearer wp: k7nZt-i, r -44tw .County
Ot
(Street Name, (Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: j"✓L SS/.t/
Addretts 73or i09
(Street or Route _ g.)� .2871
City or Town State Zip Codc
(—)-
Area code- Phone number
4. DATE DRILLED 2-/s-0'2
5. TOTAL DEPTH: a2g5'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a S METHOD OF TEST oZ 74n
10. WATER ZONES (depth): /yS / - //4 ji N,
a6s l - .2 5 i;24. .
11. DISINFECTION: Type HYH Amount T`/
Wall Thickness
Depth Diameter or Weight/Ft. Materialat
From o To r2/ Ft. 4 N /' w
From To Ft.
From To Ft.
13. GROUT: Depth aterial Method
From Q To oL)�Ft. (<-74-20
From To Ft.
14. SCREEN: Depth . Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
12. CASING:
From To Ft.
From To Ft.
16. -REMARKS:
•
Topographic/Land settin
❑Ridge ❑Slope ❑Valley IF la
(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 escription
4 ao
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
0
Cy
CJ
0
4:—
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD ND ND THAT A COPY OF THIS RECORD LTA BEEN PROVIDED TO THE WELL OWNER 6 L
(� DATE
SulJtlrtheg4igy 1toth
27699-1636 Phone o. (91S
IGNATURE OF PERSON CONSTRUCTING THE WELL
e !!') sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
`TSS-421, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

261586
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural��jResources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME �(print)_� ?K G)/ �}i1t) \g{r!I eft CERTIFICATION�j# 3b %�
WELL CONTRACTOR COMPANY NAME fY✓ee V/e '' //f3 Yn5 „Oe-ii ''V eft
• PHONE k (2 /�' 9e 3/'7�
STATE WELL CONSTRUCTION PERMIT# /z%n a- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I ( Other, List Use
2. WELL LOCATION. 2� C Nearest Town: C, a _gip nCounty
kal
Min r�ta2�/C�" ,27✓ .
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: C'. � Address /Y7t , /1 4"- ✓
.221/6
Zip Code
C'_ fY/-et or Route o f
CityUo or Town date
Area code- Phone number
4. DATE DRILLED S "3LD -U
5. TOTAL DEPTH: q aS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 300 T.
(Use "4" if Above Top of Casing)
8. TOP OF CASINGIIS / FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / .2. METHOD OF TEST .2 ti rS
10. WATER ZONES (depth): 65 ' - I j P.,,
(in'",�Ampm
I I. DISINFECTION: Type 'T Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
Pyr
Depth n aplace/er
From To y7S Ft. Di
From To Ft,
From To Ft.
13. GROUT: A Depth /AtMaterial Method
From /2 To .2/9 FL [ 0 /16— p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topo aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tv
(degrees minutes/seconds) e)-
Latitude/longitude source:❑GhPS❑Topograp_ ma-..,_'
(check box)
DEPTH DRILLING LOG ..
From .121
Formatiop Description: `, -
Sig ' 9. 5'
LOCATION SKETCH
Show Direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITEI ISA NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUE
9_ 30 -6-2
TI1E WELL DATE
Su®Plrt th@ t ig&'94 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. 072UU I

North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J5.et/,QN 7--
WELL /I /—
CONTRACTOR CONIPANV NAME '' // J
STATE WELL CONSTRUCTION PERMIT# /4/7).2
(if applicable)
WELL CONSTRUCTION RECORD
264984
- Divisionviof Water Quality - Groundwater Section
/�* JJ /e1 — CERTIFICATION # ,sz' 4// /
/ rre.CJa.t -/ �lfM� �qv-G -PHONE # f J�V 4n 4 9 - •3/ 17/
ASSOCIATED WQ PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential yy, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other O If Other, List Use
�,n r rvtt J
wn: �'. r(s 4A/ County ki7t7/ii-i5Cd
)The '
(Street Name, Numbers, Community, Subdivision, Lot No.,Zip Code)
3. OWNER:
Address P /� j/*/A 998
YOM(S to or to No.) /A % l. ,> 207s /
r Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 8 -' 3 "D
Topographic/Land setting
❑Ridge 'Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees, ntinutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Format 9 Description
y
Ail / '7/).PC" / of
5, TOTAL DEPTH: - 7//.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -tiSt
7. STATIC WATER LEVEL Below Top of Casing: //V/) 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 accordanceith ISA NCAC 2C .0118. , QQ
'9. YIELD (gpm): �C METHOD OF TEST v7 7t
10. WATER ZONES (depth): `, 7) ' — 7DS
1I, DISINFECTION: Type .ITN
12. CASING:
Depth 1
From To A / • Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From i To 2D 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.
Diameter
/ /
4Material
Amount L!)9
Wall Thickness
or Weight/Ft. Material
ethod
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1
co
0)
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD S BEEN PROVIDED TO THE WELL OWNER
//- 3K DL
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the origina to -the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

264983
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM,,(print) �� /� /
�(p ) fI//JJOQ/N �1/E/3.6 CERTIFICATIOONq 2T/.�
WELL CONTRACTOR COMPANY NAME lee of L '&03 . 1/Ur. II Y Pm , c/Jn PHONE a (:I�%V G
STATE WELL CONSTRUCTION PERMIT# /Y44. ASSOCIATED WQ PERMIT#
(if aeplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential2:1. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: (r
Nearjt ( -Pl Y4-r- i/�/ `SY!C/iaty (lr.J Ld,ci-
(Street Name, Numbers, Community, Subdivision, Lot No.,o�.,/Zip Code)
3. OWNER: Ck'P� i eir/ - /`1P/I7
CI
Address Ss'%+ 71 f -34-14. (A),-)
(Street Ro to No)
Y 2 ,�e SP,Pe / C .. e7,6:
Ci4 or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 2'-/l -1
5. TOTAL DEPTH: 2 S'
6. DOES WELL REPLACE EXISTING WELL? YES NO 1/4111.1
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 actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. r�
9. YIELD (gpm): 5/9 METHOD OF TEST 0.
• 10. WATER ZONES (depth): .265 - 57) y) ,-,
11. DISINFECTION: Type / - 77/ Amount
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From To l&-) Ft. Z' " Pit
From To Ft.
From To Ft.
13. GROUT: Depth ,4laterial Met d
From 7) To de) Ft. / Pm.��uj
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From • To Ft. in. in.
Topog aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreesiminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formati n Description
41G ' ....25'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. c-..)
From To Ft. co
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
- CON TRO T(ON r D DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IS J/pR
i J/LA_Lfw 7dte-) //- 3C)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LJ
Submit the ongl al to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phon No. (S 19) 733-3221, within 30 days. G W-1 REV. 07/2001
GRONVOVEATER SECTION
ASHEVILLE 'REGIONAL OFFICE
2

Area code- Phone number
4. DATE DRILLED g' - - D 1-
5. TOTAL DEPTH: ,90.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: c 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 accord��s ce ith ISA NCAC 2C .0118.
METHOD OF T
10. WATER ZONES (depth): / �'-5 ' — t2O p m
YIELD
11. DISINFECTION: Type
12. CASING: -
Depth
From G To C C Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From D To 0 Ft. Crtv�r p_v,c
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.
Diameter
4, II
Amount �5
Wall Thickness
or Weight/Ft. Material
PVC.
Method
From To Ft.
Size Material
264982
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
1 (print) /af." j,/ � CZ-e2c2 .Q CERTIFICATION #e7�/
WELL CONTRACTOR COMPANY NAME f ` erer/V F -.e!5. Pt4z - / i/J r'ZPHONE # (MA G -V9 " 3 / %/)
STATE WELL CONSTRUCTION PERMIT# I J` ,0.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: i (
Nearest Town: j�RC�t P. 1/4 her( County 2L L
Lip1P ( Yr'P)C I ,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FlV / 4 / L
Address 1/7J
(Street or Route No.)
1'Ylnn ie IIn)l,,, A/C 87S/
Ci Town Sta e ' Zip Code
Topographic/Land setting
❑Ridge %lSlope ❑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
94 1 Z'.
9. (gpm ): EST n h r5
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:
Submit dthe floriginaa to th
GAO UiVUWHItH b2l:l It5I 0. (919
ASHEVILLE REGIONAL OFFICE
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�t z� Yd-c // — 3 e) — cO
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

s
e 7-
257301
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/�(print) �q�YL.� il..n + `t'r t LL'J CERTIFICATION # 3054
WELL CONTRACTOR COMPANY NAME(Y/PPA. f, .CXIS. LIJ F-�� 9L - 1 fraf. -PHONE # b cite - 31
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT', / 7.0.2
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipalPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IF Other, List Use
•
2. WELL LOCATION:
Nearest To
n:
(Street Name, N
3. OWNER:
Co �t2)a.yL Zd
crs, Community, Subdivisionn,, Lot No.. Zip Code)
ic
Address i Z) , -4-&,.r
6
(Street or Route No.)
id Ali //L1,
,<72 af7t4
City ofrown State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED '7'1"Q 2
5. TOTAL DEPTH: 'Jeri
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOij-
7. STATIC WATER LEVEL Below Top of Casing: all- 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): / METHOD OF TEST
10. WATER ZONES (depth): /4'D— %gpn
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tdeere<> minutes:seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Form,tipn Description
DEPTH
From To /
D 92
92 ` /ems'
11. DISINFECTION: Type
12. CASING:
NTN
Amount of d
Wall Thickness
or Weight/Ft.
Diameter Material
From 6 Ft. 6'' yoVe_
From Ft.
From Ft.
13. FromGROUT:
From
From
14. SCREEN:
From
From
Depth
To 9
To
To
Depth Material Method�"
To 62D Ft. Qirr.o /
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.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N c
a
C
D
U7
3 r'
From To Ft.
16. REMARKS:
t DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ICINSTRUCTIehfl STAND t P1D THAT A COPY OF THIS RECORD HA nE[N PROVIDED TO TIIE WELL OWNER
NATURE OF PERSQN CONSTRUCTING THE WELL DATE
bmit the original to the
699-1636 Phone No. (919) 7
Dta1'si
33-32
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NC
1, within 30 days. GW-I REV. 07/2001
GROUNDi".ATER SECTION
ASHEVILLE REGIONAL OFFICE

"'yk:gao Jl
_
257300
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources} - Division of Water Quality - Groundwater Section
n///
WELL CONTRACTOR (INDIVIDUAL) NAN E (print) 3r a..4,3 .7 rit rp- CERTIFICATION Zh 041 3`7D
WELL CONTRACTOR COMPANY NAM ! g �67rn 4 s�t4 �uls� A LC -=HONE Neye2A 6 i6
/41Oi ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
nje
Monitoring 0 Recovery ❑ Heat Pump Water ction 0 Other 0 I (Other, List Use
2. WELL LOCATION: /
Nearesj.,Town• ounty_� day
l�e9QP.r XUA� feet
'7
(Strcct Name, umbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: I r�Cf trrr 4 /r ipne4
Address (03 F[.Li,J,iR Kll
(Street or Route No.)
WayneI G G�0 n /
City own State Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED '7 — a - D
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /l/) FT.
(Usc "+" 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. O) (A
t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Tope rraphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(degrees minutesrseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From 4141 Z //�I ii--
4//a� �41 ' -s/4 3) nc-CC,
10. WATER ZONES (depth): a D 5 ' -' 4 S '
Amount -.0
Wall Thickness
or Weight/Ft. Material
Pve
11. DISINFECTION: Type
12. CASING:
Depth '/' /
From Q To Y' 7" Ft
From To Ft.
From To Ft.
13. GROUT: Depth wlater L j ,,,,�MMM�Le�,���',tth````'—od
From 40 To old 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.
Diameter
16. REMARKS:
cn
01
Cuhmit___ the original to t
pcu 4' $ 3bEhoM@NNf('.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5,A NCAC 2C, WELL
ND THAT A COPY OF TIIIS RECORD IH.A54tE- . PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING T
WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Nerctee Center - Raleigh, NC
3221, within 30 days. GW-I REV. 0712001

North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAMES (print
f_ WELL CONTRACTOR COMPANY NAME re PA+L roS �I r-f
STATE WELL CONSTRUCTION PERMIT#
WELL CONSTRUCTION RECORD
lit Groundwater Section
e CERTIFICATION
It '/2-4
/UV � PHONE # f92 43/7 's/D
ASSOCIATED WQ PE/RMIT#
257299
Resources - Division of Water Qua y
(if applicable)
1+4° 2
(if applicable)
1. WELL USE (Check Applicable Box): ResidentialMunicipal:Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: County
^7 t
zt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /.3. )
Address /..2 '1 Ali rn5
/J , (Street or Routei No.)
City or Town ^" State
v., Mel ..
0t 7/6
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED % -3 - D
5. TOTAL DEPTH: / 85 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l
7. STATIC WATER LEVEL Below Top of Casing: 41P FT.
/ (Use "+" if Abovc 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. n
9. YIELD (gpm): X METHOD OF TEST oV h ✓5
10. WATER ZONES (depth):
8S' 8� pm
11. DISINFECTION: Type 1477/ Amount 07S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1) To li 3 Ft to' iLt
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To_a Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
nMarerial
[ L
16. REMARKS
in
in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
I check appropriate box)
Latitude/longitude of well location
(degrees iuinuics: seconds)
Latitudc/loIIgitudc source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Foam i Descript'on
D 63
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.
(ftdi4EREB4' Mir
CONSTRI.ICTION 5
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH LTA NCAC 2C, WELL
S, AND TI{AT A COPY OF TIIIS RECO)R :1S BEEN PROVIDED TO THE WELL OWNER
p-/ADS
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
IT;
0
GR01$tFJIWI*L hte9CIE Wf to th
AS HE VI itiO§Ef1Sii R ldiVia (919
Division of Water Quality, Groundwater Section, 1630 Mail Set.ice Center - Raleigh, NC
733-3221, within 30 days.
GW-I REV.07'2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # SOW
WELL CONTRACTOR (INDIVIDUAL) NAM (print) ��f .J�/ ,/ 0
WELL CONTRACTOR COMPANY NAME(rfPitt- OS �//1. Wm/ at • PHONE 0IDOSzS ‘�ig•-3/
ASSOCIATED WQ PERMIT#
I if applicable)
STATE WELL CONSTRUCTION PERMIT# 11002
(if applicable)
2. WELL LOCATIOi
Nearest Town: it's Coun
(Street Name, Numbers, Comlquni , Subdi ison, Lot N . Zip Code)
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
Topographic/Land setting
❑RidgeASlope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
3. OWNER: '' y���vtt`o'_` p�
Address % �O /Ld On O(
Street or Rout ;Q /G
City or Town ?tatc Lip Code
(_)-
Area code- Phone number '/
4. DATE DRILLED 7--7' - E9-2
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ligt.
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
i (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
2variance in accordan 1th 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST c: YS
10. WATER ZONES (depth): /ZaD Z — 020
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From t2 To 20 Ft. 6 1 r
From To Ft.
From To Ft.
13. GROUT:/1 Depth„Material Method
From // To a Ft. (4'Yrt4t-+ p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 25
Wall Thickness
or Weight/Ft. h aterial
f .1RhMA k4
II I
I DO HEREBY {)112
CONSTR CTI 1'
Y
25'7298
(decrees in inutesyseconds)
Latitude/longitude source:❑GPS❑Topographic map
I check box)
DEPTH DRILLING LOG
From To Formation escnption
ao 42,051 i*-. te.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD H.ASJ3EFAL! ROVIDED TO THE WELL OWNER
\S -U DATE
J - SIGNATURE OF PERSON CONSTRUCTING TI III 'S L
GROLN[M VA)EH
ASHEVII Lr REG!h. NC
uR OFFICE
- i I ire -fin °�r pro the Division of Water Quality, Groundwater Section. 163o hlail sees ice CrCtr\\rrf REV�07?001
27699-1636 Phone No. [phone], within 30 days.

25729s
WELL CONSTRUCTION RECORD
f Environment d Natural Resources Division of Water Quality - Groundwater Section
ERTI
WELL CONTRACTOR (INDIVIDUAL) NAME Ipnnq ] P. � A 3/ 71j
i/J R' �I/PiI -. Yltnwf#. 'r'e.C' PHONE k Sidi In �g
ASSOCIATED WQ PERMIT*
(if applicable)
North Carolina - Depart
ment o nvironmen an y
�r it.A4 .I7ra CERTIFICATION # 3D�)
WELLCONTRACTORCOMPANYNAME Y/Ltw.r- Rice
STATE WELL CONSTRUCTION PERMIT* 440
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal: Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATIO:
Nearest T wanL} 2 76- B County
(Street Name, Nuu ,ers, Community, Subdivision,—tt\o.,,Zip Code)
3. OWNER: /�' ! /2 ^
Addrerl // 0
(Street ol- R to No.) na ��6
/_
�O,u4PSur/%t NC O
Ci or Town State Zip Code
( )-
Area code- Phone number D
4. DATE DRILLED 7- la
5. TOTAL DEPTH: 3Ln5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1.
7. STATIC WATER LEVEL Below Top of Casing: 6D FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS r 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): 3d METHOD OF TEST o2 ✓5
10. WATER ZONES (depth): -40 / - l30 9 Pam"
11. DISINFECTION: Type HT)"
12. CASING:
Depth
From 6 To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From ti To ,-9/1 Ft.
Diameter
6"
aerial
Amount 6
Wall Thickness
or Weight!Ft. Material
Pke
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
L6. REMARKS:
: I DO HEREBY CERTIFY
1: CONSTRUCTION STAN
Method
A>p
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge %Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitudellongitude source:❑GPS❑Topographic map
(check box)
DEPTI-I DRILLING LOG
From To Fotmati n escription
94/ 36. '
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
N)
0
01
rr
o
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEE " •VIDED TO THE WELL OWNER
r SIGNATURE
OF PERSON CONSTRUCTING TIIE WELL DATE
r
GRCIJr A FFC
AS I' ' yR a�pananklQbe Di ision of Water Quality, Groundwater Section, 163o Mail Sun ice Center
I REeigh. N 0111
27699-1636 Phone No. [phone], within 30 days.

r
257295
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur l Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (p
rint) /Jt' I D 1i
WELL CONTRACTOR COMPANY NAME a.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
G C—i.�
j,10 z
i TYP 'Utl CERTIFICATION It.2.2 8e
/Os . b)01) V AMID. JAE PHONE # (
ASSOCIATED WQ PERMIT
(if applicable)
1. WELL USE (Check Applicable Box): Residential tit Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: AA+_ County /A/k.('20L
) k
JY m
(Street Name, t umbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 4141 /f
Address S/.J ? 7,
(Street or Rout
%7
City or Town 'Mate
( )-
Area code- Phonc number J /D b
4. DATE DRILLED
5. TOTAL DEPTH: $s- �/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO -
7. STATIC WATER LEVEL Below Top of Casing: GD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): gS -r METHOD OF TEST o2 Arc
10. WATER ZONES (depth): a s ' - ISi p rn
11. DISINFECTION: Type H TH Amount / LO
12. CASING: Wall Thickness
Depth,/ A Diameter or Weight/Ft. Material
vC
From 6 To `i-e Ft. L
From To Ft.
From To Ft.
13. GROUT: Depth enMaterial 1, Method
From ,0 To a2D Ft. l�vra.l. 40-75
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
From To
16. REMARKS:
.y
it i 02g7/6
Zip Code
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley )iElat
(check appropriate box)
Latitude/longitude of well location
(decrees. minutes/seconds)
Latitudeiloneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To t Formatio Description
£ P 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.
I IX) HEREI't' '( R'(�FY THA
}},` p� / Divis
ab?b�? ILnP4? @R'? C F733-3:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD I-IAS BEEN PROVIDED TO TI-IE WELL OWNER
8 /-O•2
7NATURE OF PERSON CONSTRUCTING T' ttirELL DATE
on of Water Quality, Groundwater Section, I63n Mail Service Center
I REeigh, NC
UUI
21, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /1 { Q
WELL CONTRACTOR COMPANY NAME S Tiee nk..IJYILi /U4.�/ w �u mr�N'"'''r.
STATE WELL CONSTRUCTION PERMIT* J'S,/A ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
tural Resources - Division of Water Quality
25'7293
Groundwater Section /;
CERTIFICATIONnIO* .1 /7e ��
PHONE *L 26 LV
1. WELL USE (Check Applicable Box): Residential Municipal Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION/• )
Near t Town: l Le417t. County
i�l�, r k .
-�raa,+PI -PA.
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
(4;1) ea -1'UP f'
al SSA C. -5r0,ar-1, loll
(Street or Route No.)
(52 /.!c 23'7/to
City or Town State Zip Code
( )-
Area code- Phone number Jd�
4. DATE DRILLED %' /w
5. TOTAL DEPTH: / fZS ' o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ti0
7. STATIC WATER LEVEL Below Top of Casing: /dD FT. b
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance wlth 1SA NCAC 2C .0118. n
9. YIELD (gpm): to METHOD OF TEST oe 2 P5 .
10. WATER ZONES (depth): /t $ - G r"'
•
Topographic/Land setting
DRidge ❑Slope 0Valley .Flat
(check appropriate box)
Lai nude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
17/
DEPTH
From To
1f7' /46'
11. DISINFECTION: Type ET�
12. CASING:
From
From
From
13. GROUT:
From
From
14. SCREEN:
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Depth
To 417 Ft.
To Ft.
To Ft.
Depth
To �0
Diameter
G n
Amount /1
Wall Thickness
or Weight/Ft. Material
P)'C_
klaterial
Ft. C_4-9'ri-C
Method
Trip
To Ft.
Depth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From Ft.
From Ft.
C l ,-t S 7fi'^
h, NC
!SLG��,�H� OFFICE
ug mnwrre m4gtuaJ-to the Division of Water Quality, Groundwater Section, 163o Mail Sertice Center l REV607 2(1111
27699-1636 Phone No, [phone], within 30 days.
cri
LOCATION SKETCH e"'=
Show direction and distance in miles from aJlrast y
two State Roads or County Roads. Include D . roai£
numbers and common road names.
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECORD HAS BE PROVIDED TO THE WELL OWNER
viz
Z.
TDATE
SIGNATURE
YELL OF PERSON CONSTRUCTING Th ELL

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2K4'Ca A1�(I �.Ll rL�t1[�� CERTIFICATION�i# J�/D
WELL CONTRACTOR COMPANY NAME ( -r Le�,N/i $r'5 . (//PJ l 91 /�/GM� HONE # 120.19 �i+ Y�� `1 / 7�
STATE WELL CONSTRUCTION PERMIT# / D 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: y / / /{cl
Nearest Town: � r-w Count �/�,/ /f
/9a,3
(Street Name, Num rs, Community, Subdivision, Lot No., Zip Codc)
3. OWNER:
Addres
J.
259236
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
alo / (decrees ininures/seconds)
-24 /w) ��(--6t.�.-«,et/,.a l-uu�t Latitude/Ion etude source:❑GPS❑Topographic map
j(Striet or Rout �rh-yv-) (check box)
-nyfel ) Z SL Z0/ 5 DEPTH DRILLING LOG
City or Town State
Area code- Phone number
4. DATE DRILLED % / 7
5. TOTAL DEPTH: / 82S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: l ari 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): 1p METHOD OF TEST %sea.
10. WATER ZONES (depth): /fiZ1 / 4 qt rn
Zip Code From To Formation Description
4id /2 II
11. DISINFECTION: Type Fir/-' Amount
12. CASING:
From
From
From
13. GROUT:
From i%
From
Wall Thickness
Depth // // Diameter or Weight/Ft. Niaterial
To 1/Z Ft. , " i /
To Ft.
To Ft.
Depth m Material Method
To 0/0 FL [ QMtp u -I- -/zti79
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 HFRFRY CFRTIFV THAT
r1 EDN-STRII TIfONI; ilfA
pri
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.
ITZ
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL O
AND THAT A COPY OF THIS RECOR HAS BEEN PROVIDED TO THE WELL OWNUS
Submit the original to the Div
t 2769971.636.Phone No. (914) 733-1
IGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
259235
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section , / J
WELL CONTRACTOR (INDIVIDUAL) NAM (print) .4 - G „ ,// )) S i CERTIFICATION # egU y-/
WELL CONTRACTOR COMPANY NAME Ye ?Me-15. !!/2 /7 S/ tO'y)ntthl PHONE # lfr�' 3/7/9
STATE WELL CONSTRUCTION PERMIT# / a ASSOCIATED WC) PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION'
Nearer",Tpwn:Countyc//..(/1�iY�l.Cp
77�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. WNER: , , l
Address , 3.-2// o O/ 7Y.L,t-Cy/ ,
(1 n�I ($treat or Route No.) 07g 2 / 6
LI111 �-!Teel-, (,i6
City or Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED %- //r - )�
Topo raphic/Land setting
❑Ridge $lope ❑Valley 0Flat
(cheek appropriate box)
Latitude/longitude of well location
Idegreerminureslseeends)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tp , / Format Description
oj7 •
5. TOTAL DEPTH: .529,5-'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /) T
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordancg,with ISA NCAC 2C .0118.
9. YIELD (gpm): oC, METHOD OF,TEST c 7vze�•
10. WATER ZONES (depth): /80 - �Z3 S, - ,2Q fm
ll LOCATION SKETCH
11. DISINFECTION: Type /ITN Amount 94 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
nA Depth ,/ Diameter or Weight/Ft. Material numbers and common road names.
From Ql To 3L Ft. /n 'z /(fie
From To Ft.
From To Ft.
13. GROUT: Depth% AVtant4tMethod
From � TooFt. / P�Jtit@.i
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
16. REMARKS:
To Ft.
To Ft
0
r.)
tip
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD -HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
v
C>
?- 37- d,z
DATE
--SeHtn(tAbe, m'igti o the Division of Water Quality, Groundwater Section, 163u Mail Service Center- Raleigh, NC
27699=163G.hboneN4t3919) 33-3221, within 30 days. G\V-I REV. 07/2001

259225
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) ( K i n /Ld2/� ./y CERTIFICATION k 0.7447 P
WELL CONTRACTOR COMPANY NAME rice. l�/)S ! Fi� 6t-Mn._ ONE # de2 4«2-3/7
STATE WELL CONSTRUCTION PERMIT# /�
(if applicable)
ASSOCIATED W'Q PERNIIT#
(if applicable)
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 LOCATION /
1O 71-YI �lnt-' County)/LLu4ierZ
Nearest T
wn:
PVP._jj ,P7--r-
(Street Name, NumbZrf, C muni , Subdivision Lot /No., Zip Code)
ci f /' r
3. WNER: /l 7) %t
Address �/
dia4St ct or Rout o.)
t
City or Towna[c
an/6
Zip Code
Area code- Phone number
4. DATE DRILLED %- 3/- D 4
5. TOTAL DEPTH: /o 5.S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO A.
7. STATIC WATER LEVEL Below Top of Casing: 4%J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .5 METHOD OF TEST r2 t
10. WATER ZONES (depth): - pr
Topo. raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. m inutcs/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From Too3 Formati n Description
-33/ a$'
11. DISINFECTION: Type H 777 Amount //2 '7
12. CASING: Wall Thickness
A Depth Diameter or Weight/Ft. Mate ial
From 6: To 3=3 Ft. li+ " At/fil
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From A To .21 Ft. (C41c-t,tt± 479
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 the road
numbers and common road names.
16. REMARKS:
Submit the original o thf
27699" ' (919)
GROUNDWATER SECTION
ASHEVIL_E REGICTA'. osr'r,E
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORp-HAS BEEN PROVIDED TO THE WELL OWNER
yRG
3/- �y
SIGNATURE OF PERSON CONSTRUCTING TI1E WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divipion/of Water Quality - Groundwater Section
/�'s / G/t�-/ d CERTIFICATION N.2W/U
WELL CONTRACTOR COMPANY NAMES`eta/re, ( /05. �L L.1-( y� Gf v/ CAE k (.ZZK G�i� - "9/70
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
259224
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare
(Street Name, Nu
3. OWNER:
'`/J6tract or RoptLNo�
City or Town '�Ststc
( )-
r�/ To ppe Land setting
County /�YLt�J%/�/1 ❑Ridge Slope ❑Valley ❑Flat
(chcc- appropriate box)
n, Lot No., Zip Code) Latitude/longitude of well location
Zip Code
Arca code- Phone number
4. DATE DRILLED 7'/-3/- c2
5. TOTAL DEPTH: )"'.2,5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N
7. STATIC WATER LEVEL Below Top of Casing: T.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordanc5e with ISA NCAC 2C .0118.
9. YIELD (gpm): /'-j- METHOD OF TEST 02
10. WATER ZONES (depth):
1l. DISINFECTION: Type ALTN
12. CASING:
Depth
From D To 4 3 Ft.
From To Ft.
From To Ft.
Diameter
LD It
13. GROUT: Depth
From To .ap Ft
cMaterial
Amount
Wall Thickness
or Weight/Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Ft. in.
From To
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
Material
PVC
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Format' Description
pp 4/3
Method
From
From
Slot Size Material
in.
in.
Material
DEPTH
LOCATION SKETCH
Show direction and distance in miles from east:`
two State Roads or County Roads. Include the road'
numbers and common road names. Vd
U7
0
w
sp
16. REMARKS:
I DO HE' •..� HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELLtells
SFF LV..`L
Submit the original to th Division of Water Quality, Groundwater Section, 1636 ail Service Center -Raleigh, NC
27699-1_636 [phone], within 30 days. MailGW-I REV. oh7/2001
GROUNDWATER SECTION
ASHEVILLE REGIMA.- LF`Irc
DS, AND THAT A COPY OF . 5 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3/ a7
DATE

259223
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division)of Water Quality - Groundwater Section// �J
WELL CONTRACTOR (INDIVIDUAL) NAME%� (print) �D/�rt9 ILA CERTIFICATION q �,/'l`�d
WELL CONTRACTOR COMPANY NAMEL`''.ereWE PPS. JN�LL -I`ice/gym,, .2 ' .PHONE q 9_? In 449 - -3 / 7e)
ASSOCIATED WQ PERNI1T#
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentia, Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION%%
Nearest To)en: l (�L-(L>
� 5 vP/4
(Street Name, Numb Community, Subdivision, Lot No Zip Code)
3. OWNER:y 'L&L
Address 9,2 Llix-
/(iStreet or Rputp No.)
City or Town State ('
County i .ei
( )-
Area code- Phone number
4. DATE DRILLED
022 7/6
Zip Code
24 -O-2
5. TOTAL DEPTH: a4�'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
�/('�
7. STATIC WATER LEVEL Below Top of Casing: 6D FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING 1S [ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordant9 with I5A NCAC 2C .0118.
9. YIELD (gpm): (P() METHOD OF TEST h
Air //(1 6l /1`'/ —' (degrees minutes/seconds)
�j Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To>aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
DEPTH
From To, Form t n Description
C.)-5-
'
10. WATER ZONES (depth): //$$ ' - /i n ?TA,
11. DISINFECTION: Type /i71 Amount oP5
12. CASING:
From 4
From To
From To
Depth
To �"a< Ft.
Ft
Ft.
Di eter
Wall Thickness
or Weight/Ft. Material
pte
13. GROUT: Depth Material ,} ethod
From 7) To 0/i9 Ft. Ci7�LP-it-,
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 (east
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA D DS, AND THAT A COPY OF TIiIS RECORD 4A& EEN PROVIDED TO THE WELL OWNER
}t649tt-163tpribn `tvao t
L4U
SIGNATURE OF PERSON CONSTRUCTING THE WELL
37- ,5/— O z
DATE
_ Division of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
733-3221, within 30 days. - GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL Ol' ICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural JResources Division of Water Quality - Groundwater Section iv
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lI%YL/ �rct-e'.L A CERTIFICATION # SOW
WELL CONTRACTOR COMPANY NAME yPPa a. rp< . I,�PLC of r PHONE # 811' e Sid'' 3/ 'Aa
STATE WELL CONSTRUCTION PERMIT# /AM
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
261127
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
2. WELL LOCATION.
Nearest Town:_
079S
County 9.
(Street Name, Numbers, Community, Subdivision, Lot/No., Zip Code)
3. OWNER: / v evt -WC 11 Address s S".34' 10 lee. Cf
(SnGet or Route /Iv/ 77e
}� .7/>T. -n-
Lillf D/ e e2 9AL
City or Town State Zip Code
( • )-
Area code- Phone number
4. DATE DRILLED / .6 2
5. TOTAL DEPTH: 4/.2S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 3/) FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated auor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ig METHOD OF TEST a kr5
10. WATER ZONES (depth): / 20 - /S�q pm
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
( heck appropriate box)
Latitude/longitude of well location
(degrees, in inutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formati.n Description
t9 1/2 z
//.2 ' 4/J5 '
11. DISINFECTION: Type
12, CASING:
Depth
From 0 To //a Ft.
From To R.
From To Ft.
13. GROUT: - Depth Material )M'eth d
From i) To €n Ft io f
From To Ft,
14. SCREEN: Depth' Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
'/I!>'- $J
{--i-T {-i Amount a
Wall Thickness
or Weight/Ft. Material„
Diameter
6 f
Size
Material
E c L5 UEV tS
I DO HEREBY C
CONSTRUCTIO
OCT 4;
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
D�THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D 'l>• . AND THAT A COPY OF THIS RE a AS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
GROUNDWATER SECTION
ASHEVILLES ithial't: r - . 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
3

WELL CONSTRUCTION RECORD
261125
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section // Qp
_ 13 CERTIFICATION 1417/1" H
/L� PHONE #LU Z,ti —3/"/2)
WELL CONTRACTOR (INDIVIDUAL) NAMh (print)
}YELL CONTRACTOR COMPANY NAME jTeEEx'E .Jen
STATE WELL CONSTRUCTION PERMIT# /4/4
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N Town
t7 n�..
(Street Name, Numbers, Community, Sub
3. OWNER:
Address
County d , Gd
sion, Lot No., Zip Code)
»1O4 (snllnig r Mute n.) A✓C o(d 7S/
J �.
Ci Town State / Zip Code
Area code- Phone number U Z
4. • DATE DRILLED 7 - /
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degreesnn inutcstscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatioq,Description /
DEPTH
From To
92/ 11451
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l3
7. STATIC WATER LEVEL Below Top of Casing: Go 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): 2 METHOD OF TEST . h r s •
10. WATER ZONES (depth): gas / — 2J2 q pw
Amount /r/ 7
Wall Thickness
11. DISINFECTION: Type
12. CASING:
Depth
From to To 7.1 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a 0 Ft. C o .....-t.wA
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
Diameter
or Weight/Ft. Material
15-iJ1
Method
p
From
From
16. REMARKS:
GAB9fdb
ASH178990linfeitpp@
To Ft.
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
(V,
ruts WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 73: -3221, within 30 days. GW-I REV. 07/2001

264054
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
//Resources - Division Aof Water Quality - Groundwater Section
/...WELL CONTRACTOR (INDIVIDUAL) NAME (print) _F� /t / )x-/'a CERTIFICATION it /I/5'
/J /J I
WELL CONTRACTOR COMPANY NAM EA-PPI wo '!/'1�17.'vc. �,J,�Si" L# PHONE # {Mi.
Ole -2/e
STATE WELL CONSTRUCTION PERMIT# /44)02 ASSOCIATED WQ PERMIT#
if .. ... rvapplicable)
Industrial ❑ Agricultural 0
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION: Topographic/Land setting
Nearest Town: VZCounty�/J,{/(dDOd ❑Ridge ❑Slope ❑Valleylat
,f � ,v �,i /, 7 -/- Zia q LSJr 77� / /e'// "-"_ . (check appropriate box)
(Str/Nyy(e, Numbers, Community, Subdivision, LovNo., Zip Code) Latitude/longitude of well location
3. OWNER. '�IC e222.414
Address . / 9S"
2/
(Street orRoute No.) Co
City own State Zip Code ( )-
Area code- Phone number 3 �Q Z
4. DATE DRILLED 7
5. TOTAL DEPTH: a4115-'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO VL,
7. STATIC WATER LEVEL Below Top of Casing: /z' FT.
(Use "+" if Above Top of Casing)
. 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. e
9. YIELD (gpm): 4 5 METHOD OF TEST a
10. WATER ZONES (depth): /n .S' - 1( rP vn
11. DISINFECTION: Type
12. CASING:
Depth - Diameter
From 4 To 50 Ft. /o "
From To Ft.
From To Ft.
3. GROUT: Depth Material _1From /9 To zO Ft. ( a('
T Amount 3Lu
Wall Thickness
or Weight/Ft. Material
>SJ-L4
From To
14. SCREEN: Depth
From • To
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
D@11E BY CkTI t' �H
CONSTRUCTIOJJ STAN
AR
thod
Ft.
Diameter Slot Size Material
Ft. in. in.
in. in.
Size Material
Ft.
Ft.
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG
Formatip.n„Desc ript i on
DEPTH
From To
50
e57)' 24'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BE OV IDED TO THE WELL OWNER
/0 -3/_el-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
,(,.Tgggtlgggg(6,hfiPleigptplolthe Ditision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS'g@69 L[666 /IU1ir� F('9`I0) 733-3221, within 30 days. GW- I REV. 07/2001

264046
- WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)✓_77 .h_/s-C/L-LP. CERTIFICATION# *'(
� � n . � ' / 0
WELL CONTRACTOR COMPANY NAME ('sYP PL/ 5 - /JO Di 9f ieit, , LXa`CPHONE # N, S /o 'Y��`3/
STATE WELL CONSTRUCTION PERMIT# i�D� ASSOCIATED WQ P/ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County 7///z.Y`D!�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ‘-'/TYn 46-224/
Address «'70 77/ / /I /7 ro/5"
/d1 (Street or oute No.)
e /7fsYiVtu eve_ 0g7g
Ci or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 7-36--A�
5, TOTAL DEPTH: 9 IFS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IA
7. STATIC WATER LEVEL Below Top of Casing: .h 2 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): METHOD OF TEST r2 A '3
10. WATER ZONES (depth): /�l� ' — / OD '
11. DISINFECTION: Type /i T/—/ Amount AZ; 3
Wall Thickness
or Weight/Ft. Material
12. CASING:
Depth_ Diameter
From To Lt Ft. /A 'r
From To Ft.
From To Ft.
13. GROUT: Depth �ate ill �/T
From 40 To ali) Ft. r
From To Ft.
7�
1
14. SCREEN: Depth - Diameter
From • To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft. --
From To Ft.
16. REMARKS:
O th1l&CTiO=
.
NOV £1 ,
Snbmit the angina, to th
f FnrION- ief tkik (919
Slot Size Material
in.
in,
Material
Topographic/Land setting
DRidge Bslope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( dcgrcesiminutcs/scconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DRILLING LOG
Formatjon Description
DEPTH
From To
' 9
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.
FAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS,,/k1ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/A-3l- 1--
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. G W-1 REV. 07/2001

12. CASING:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and flat tr 1 Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAMF1(print) ` i> /7 / /i4A A /
\YELL CONTRACTOR COMPANY NAME tree /://JS- /,%i/ 4/nE122/) (lint
264047
- Groundwater Section
CERTIFICATION # , '
7//e
PHONE # (4. ,�6 sze "3/ 7'
STATE WELL CONSTRUCTION PERMIT# /'l ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential,a 1 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: i ^ /
Neares(Town:/ArylSNI //e- / County NCLG/UDD6GC
),,//et eli es- a/Pij 4I-YK- f�fc-nntnr/ J7eer
(Street Name41umbers, Community, Subdivision, Lot No.,Zip Code(pp
3. OWNER' % ��� Sirr//
nn v — LrO�L([1Yc(
Address c-2 zi J'
,
,treat or Route No.)
C' 71-e—
City or Town State
Area code- Phone number z
4. DATE DRILLED 7- 2
5. TOTAL DEPTH: .213s'
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO t
Of
Zip Code
7, STATIC WATER LEVEL Below Top of Casing: A%U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /c METHOD OF TEST
10, WATER ZONES (depth): / gS / - /5i Pm
11. DISINFECTION: Type ff %/-/ Amount 29
Wall Thickness
Depth Diameter or Weight/Ft. Material
From G To -5-5 S Ft. / " P L'e•
From To Ft.
From To Ft.
13. GROUT: Depth /Material 1
From To ,V) Ft. co AiAiA, A
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.
Met d
Tr 1.
16.- REMARKS:
Topographic/Land settin
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
Latitude/longi
a
(degrecsiminutes/seconds)
ude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D 5 5�z r_t AA./ _
55 '/s i DS'
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.
rt0
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN Ji V IDED TO THE WELL OWNER
/C)--3/-a2
SIGNATURE OF PERSON CONSTRUCTING TI-IE WELL DATE
Sub lluLtlte�cigwa to t Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROUpla9aftB(0,4 IEi. (91 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalurResources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME-1 to'
(print) 'at" /2/Yt
WELL CONTRACTOR COMPANY NAMEarPThoS /J.ttl c=rol 4/ r(.4e
STATE WELL CONSTRUCTION PERMIT#
(if arable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
• 2. WELL LOCATION: _// �/
Nearest Town: L�-� County / ' a izkei €
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) n
Address • C 7n /-u2a Ja-•—•-4• .on ,
3. OWNER: N r./ SI 0
264045
- Groundwater Section
CERTIFICATION 'ad/
# .3 0/
PHONE #toad lc �g �-9/74)
/10?- ASSOCIATED WQ PERMIT#
(Street or Route No.) �v,//r, vlt $7s r✓
City or own State Zip Code
• Area code- Phone number
. 4, DATE DRILLED fI `F ' D�
5. TOTAL DEPTH: - 9,2 ,r/
6. DOES WELL REPLACE EXISTING WELL? YES /❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (c /9 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance %ith ISA NCAC 2C .0118. D
9. YIELD (gpm): • / METHOD OF TEST 7�-° _•
/
10. WATER ZONES (depth): CD -/M', f /f-tu
M
Amdon/t _Lag_
Wall Thickness
or Weight/Ft. Material
Topogrjtphic/Land setting
❑Ridge laSlope ❑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
Forman Description
,Z'D , S / /.LnLip
11. DISINFECTION: Type » 7'21
12. CASING: -
Depth - Diameter
From 7 'To ail) Ft. j/(i
From To Ft.
From To Ft.
13. GROUT: Depth /M�aterial
From 4 To ,2 L Ft. D.t' ttj
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
Me hod
From To Ft.
From To Ft.
16.. REMARKS:`
L,{jDC iEi.Eny C4,T
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.
0)
V
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL DS, AND THAT A COPY OF THIS RECORD HAS p£EN-PRQV IDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
n,§tthq ,4 041.:ra to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phane-No:[phone], within 30 days. GW-I REV. 07/2001

`+l 5 6 0Gam.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_
"WELL CONTRACTOR COMPANY NAME l `t'✓ P.P -, S ' 1/
STATE WELL CONSTRUCTION PERMIT# RIO of ASSOCIATED WQ PER\ IT#
Of applicable)
(it -applicable)
PHONE #
- Groundwater Section
CERTIFICATION # .3n.//
fA?! S48 ,3/ 7/)
1. WELL USE (Check Applicable Box): Residentiall. Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water injection 0 Other 0 IlOther, List Use
2. WELL LOCATION
Nert Town:
A County
A - f .h.e7-e�i'i
(Street N>(me, Numbers, Community,
Subdivision, Lot t'♦� Zip Codc)
3. OWNER:_//
QL-tel C/'6. cY n1 `dry .
Address /3r zz-C-I)-�at^'uJ Oi�'m' '
(Street or Route Nor) g
City own State � Zip Code
(—)
Area code- Phone number 3 _
4. DATE DRILLED
5. TOTAL DEPTH: ,,? �S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO'.
7. STATIC WATER LEVEL Below Top of Casing: /GD 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): / D METHOD OF TEST 2 h r 5
10. WATER ZONES (depth): ZOO --no r
11. DISINFECTION: Type H TN Amount �3 2
Topo aphic/Land setting
❑Ridge Slope ['Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
escription
DEPTH
From To// Formation
6 U J
12. CASING:
Depth Diameter
From n To /n_�i Ft.&tt
From To Ft.
From To Ft.
13. GROUT: Depth aterial Method
From D To de) Ft. hin
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
. From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
LOCATION SKETCH
Show direction and distance in miles from at least o
two State Roads or County Roads. Include til5roa o
numbers and common road names. N ��
C r
r fico
r_.
1 0�
rig
yG
—a--
m
m
O m�
CJ7
O
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
-1 CONSTRUCTION STMWAt144)5, AND THAT A COPY OF THIS RECOI;B-kiQS BEEN PROVIDED TO THE WELL OWNS R
DATE
rL
Submit the original to flT EM
L—.27699-1636 Phone No. (419) 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL
vision of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh, NC
Al-3221, within 30 days.
5

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAMF},�rint)
.WELL CONTRACTOR COMPANY NAME) (e,os.. .12.4 Itie. I / a Pmp- +Q e'-e-'
STATE WELL CONSTRUCTION PERMIT# 142) -n-
(if applicable)
ASSOCIATED WQ PERMIT#
lif applicable)
255601
- Groundwater Section CERTIFICATION # - %`'/
/
PHONE #
'p�s,p ��-/%0
Ip o�fla
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water n)ection ❑ Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town: ' i / L County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
Topo€faphic/Land setting
❑Ridge'$Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
�X,,[ - — ��z/Z/[.1t-AV (degrees. in 3. OWNER: k—LF�ffti �/n��� -S G)
Address
/36 Wide. - r ..r.-•. Latitude/longitude source:❑GPS❑Topographicmap
(cheek box)
(Street Route
ri, .1/ Zip Code DRILLING LOG
From To
784
Ci r Town State
( )-
Area code- Phone number , /
4. DATE DRILLED iv - 7 " / �'
5, TOTAL DEPTH: 3 c5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO A.
7. STATIC WATER LEVEL Below Top of Casing: SRO 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 .0I18.
9. YIELD (gpm)• /5 METHOD OF TEST c h r5
•
10. WATER ZONES (depth): / gn - $D
11. DISINFECTION: Type l-4Tl-)
12. CASING:
Depth Diameter
From /i To /�9 Ft. 40'I
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To a0 Ft. ep w.L-w} 1 a p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount ,3
Wall Thickness
or Weight/Ft. Material
From To Ft.
From To Ft.
16. REMARKS:
DEPTH
2OS
Form tion Desc iption
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
en
0
0
0
0
^gym
c
R,
-4--
rn c,
Ntn
wan
RI "A;
0
Fr-1
L__ __Suhmit the orial to
.27$9911636Phote i No. (9
1 DO HERESY CERTI THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION S A In,' ' DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL `WNFR
Y�rl �UCT
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, I636 Mail Senice Ceenterl REVRaleigh, NC
9) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD 255600
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAM
5 (print) P 6 t p•
WELL CONTRACTOR COMPANY NAME ?✓PP nr (.Krn s . /1-4
WELL CONSTRUCTION PERMIT(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial O Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
•
/, Division of Water Quality - Groundwater Section
G,Ve,6 L (,J CERTIFICATION k .1.5//ry
I/ ci P/try i41e PHONE # 00 YA -3i'%16
2. WELL LOCATIO
Nearest
/1/45.2
(Street Name, Nu ers, Community Subdiv. ion, Lot No., Zip Codc)
3. OWNER:
Address
Street or Route No.
City or Town State I Zip Code
(—)-
• Area code- Phone number
4. DATE DRILLED 6 - 5-
5. TOTAL DEPTH: 41 Y6
6. DOES WELL REPLACE EXISTING WELL? YES O NO tit,
7. STATIC WATER LEVEL Below Top of Casing: /6 D FT.
f (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): '`/ METHOD OF TEST 0 bi r 5
10. WATER ZONES (depth): 2/2 5' - % q p m
ASSOCIATED WQ PERMIT#
11. DISINFECTION: Type H
12. CASING:
Depth Diameter ��/�
From i2 To to 2 Ft. L e
From To Ft.
From To Ft.
13. GROUT: Depth Material Method,�
From Q To on,* Ft. (' &nl L` /
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16. REMARKS:
-11 I DO HEREBY CERTIFY Tilyft
J i. JSTRIICTION STAND tb
Ft.
Ft.
Amount ,5/
Wall Thickness
or Weight/Ft. Material
•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley �Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
FromTo FormatiopJJescription
C/^^ h 4 /
ia' 4 /.5"
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECOR[JJ.GA\S BEEN PROVIDED TO THE WELL OWNER
,y_,z-61
SIGNATURE OF PERSON CONSTRUVCiiNG THE WELL DATE
L,Submitthe Qriginal to �he D' ision of Water Quality, Groundwater Section, I636 Mail Sen ice Ceen`teerl REV Raleigh,hNC
27O9 1636 Phdme �I1Q9FICE19) 73 -3221, within 30 days.

North Carolina - Department of Environment and N,tural Resources
WELL CONTRACTOR (INDIVIDUAL) NAM�EFJ�((Jgrint)
WELL CONTRACTOR COMPANY NAME)E-�J/ atil..-.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
Groundwater Section
CERTIFICATION a .�
255599
Di ision of Water Quality - y//k r i
yr �wp v/ PHOEp(Xol (oYs'-3/9°
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential S. Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Ne e (T wn:
3.
County
tl, P
(Street Name, Numbers Community,unSubdivision,n,Lot No., Zip
Code)/ p�
OWNER: ,,/2 / �ki.4 120JPK Cb-W--r`�'e (decrees. minutes/seconds)
Address ,?'7 9/i /%%Qi...000 aai, Latitude/longitude suurce:❑GPS❑Topographicmap
(Set or Route No.) (check box)
�a`%� �87/G DRILLING LLING LOG
nD
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
( heck appropriate box)
Latitude/longitude of well location
City or Town Sia(e
(—)-
Area code- Phone number
4. DATE DRILLED 4 -5- b 2
5. TOTAL DEPTH: 4'65
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: go T.
(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): /all METHOD OF TEST c2 1-,r.6 •
10. WATER ZONES (depth): /85 ' - /an 5P""
11. DISINFECTION: Type I--F t 14 Amount c .2
12. CASING: Wall Thickness
��11 5
Depth // Diameter or Weight/Ft. M erigl
From b To ~%t Ft. /n '
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To .2 D Ft. ro,,,,..LAa N
From
14. SCREEN:
From
To Ft
Depth Diameter Slot Size Material
To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
O HEREBYEE
La r-- I D-C6NSTRUCTI396I
�:,. SIGNATURE OF P&RSON CONSTRi1CTING THE WELL DATE
SlIbrilifTfie;ii & al to he Division of Water Quality, Groundwater Section, 163o Mali Service Centerl REVgh, NC 1
L]p {276199-163k.RhdiielNo._(9 9) 733.3221, within 30 days.
DEPTH
Zip Code From To
/ Format]
2os
escription
LOCATION SKETCH
Show direction and distance in miles from at least c
two State Roads or County Roads. Include th pad a --
numbers and common road names. L. n—
r a �
t 1.....„. T
to O<
rrzi-b
%> c
A• --+-,
Zr IT
m.7,2
c!t n
y
O o
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7--D 2

255598
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -1 vision of Water Quality - Groundwater Section ,/
WELL CONTRACTOR (INDIVIDUAL) NAME
t (print) RP t n J2L//2�b /� CERTIFICATIONpa /-/I5`/g
( Q tt)e,11 `-Y'uny)r dm. PHONE a (82D-4T '-3/%0
.WELL CONTRACTOR COMPANY NAME +/P P.rw,/ ros.
STATE WELL CONSTRUCTION PERMIT0 )Y2)2 ASSOCIATEDGcable)WQ RMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential. Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
•
2. WELL LOCATION:
Neare t Town: e 5 v. //c_/� County
VCL l r — t e
(Street Name, Numbbe�/�., Community, Subdivision, Lot No., Zip Code)
3. OWNER: _J�-L AL.,_ /)y`�/"Gq
Address )CO S &ha--- ��
2
(Street or Route No.)
Y} .h.t iY4c 0277g6
City o own State Zip Code
Area code- Phone number
4. DATE DRILLED 4 - /0 —D 2
5. TOTAL DEPTH: 6 05
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
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO /L
7. STATIC WATER LEVEL Below Top of Casing: .JD 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): .J METHOD OF TEST r
10. WATER ZONES (depth): 2 as ' - ��jje �m
1 I. DISINFECTION: Type Amount / O / Show direction and distance m miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
b d road names c
Depth W ht/Ft Material
To
From
From
From
13. GROUT:
From D
From
14. SCREEN:
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
�rvr 1)05— l� p m LOCATION SKETCH
1-4 7-0
From To Ft.
Diameter or gig numbers common t
Ft. to aPI/C? N
To Ft. C �^
To FL I— c.
Depth Material Method I o-�
To .7Q Ft. Cs2.v.,.t-w�- 1 e � coz m
-ice
To Ft �o
Depth Diameter Slot Size Material N.
71
t . rn �
CIj -�-I
0 G
Z
Material
, { flO.HEREUX CERTIFY TH TiiTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANIj�4R $ AND THAT A COPY OF THIS RECORD F1AS-BEEN PROVIDED TO THE WELL OWNER
V»N % 1-1--t-44.1-
SIGNATURE OF PF- RSON CONSTRUCTING THE WELL DATE
Submit the onginaldo the D vision of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
2769 ) GW-I REV.07/2001
oneN'o:' �919 73 -3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisioniv_��of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,QX/ f/'�'"'-a
WELL CONTRACTOR COMPANY NAME Ma-£ifl Ye2P v- /-u'»'/' -o She'
/S1D2
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: C County 2)000l
- S'm/, . SO Aar
(Street Name, Numgrs, Community, Subdivision, Lot No., Zip Code)
3 OWNER: r•m La.,,,,; t%
n(nl, f)-tr5 - Si-ni LZ.
Address / 4- 4 .-S -r P c.e.,,e..�nOa Ctiti-'
(Street or Route No.)
Cr/n.ry fl LS VI 11 E., /k/C ca87tc1s
City ortown State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED Io - S -0 2
5, TOTAL DEPTH: (a DS '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI.
7. STATIC WATER LEVEL Below Top of Casing: V-4) 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): aC METHOD OF TEST c) k r5 -
10. WATER ZONES (depth): 5 4 — (o b S '
11. DISINFECTION: Type H TH
12. CASING:
Depth
From U To 53 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To D Ft.
Amount / D 3
Wall Thickness
Diameter or Weight/Ft. Material
vC
L "
Material
CP,in-e-- ut-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
25559'7
- Groundwater Section
CERTIFICATION # 304"
PHONE # (�. G Y7 - 3/ 70
ASSOCIATED WQ PERMIT#
Tope raphic/Land setting
['Ridge lope ❑Valley ❑Flat
(((check appropriate box)
Latitude/longitude of well location
J b (degrcesminutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Slot Size Material
in.
in.
Size Material
DEPTH
From To
• 53 '
5i to OS
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
o
IV o
r- cT
CO zrer"
� c
A
rnr
3 m
O CO)
CD
CD G
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CofsI kUCTID1 RDS, AND THAT A COPY OF THIS RESQRD HAS BEEN PROVIDED TO THE WELL OWNER
v ---- DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
,
Submit the originiiF4n't ae Division of Water Quality, Groundwater Section, 1636 Mail San ice Center - Raleigh, NC
27699-1636 Phone to. [phone], within 30 days. GW-I REV. 07/2001
J

257307
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divi' on of Water Quality - Groundwater Section
CERTIFICATION #
9 Ca-ttr�/tC PHONE # NAG
WELL CONTRACTOR (INDIVIDUAL) N.ADib (print) /JYL'LA..x-(.
WELL CONTRACTOR COMPANY NAMELY/Wit A/, .
STATE WELL CONSTRUCTION PERMIT# /�J*'I 2 ASSOCIATED WQ PERMIT#
(if applicable)
/ -1
(if applicable)
1. WELL USE (Check Applicable Box): Residential) Municipal/Public O Industrial O Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 It Other, List Use
2. WELL LOCAT
Neares
(Street Name, Numbc
3. OWNER:
Address Vo'124
( reet or Romc
City or Town Stare
( )-
Area codc- Phone number
4. DATE DRILLE
5. TOTAL DEPTH: /Q_S%J I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOl
7. STATIC WATER LEVEL Below Top of Casing: .J %D FT.
/ (Use "+•• if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance nth ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST r s
10. WATER ZONES (depth): 80I -/DOr /f .9pin
GDD' - //,-�pm
11. DISINFECTION: Type N%y Amount 9.7
12. CASING: Wall Thickness
A Depth ` Diameter or Weight/Ft. Materi-d
From CG.)a To o Ft. G "
From To Ft.
From To Ft.
13. GROUT), Depth ,�•I aterial ethod
From Q To av Ft. `o Yr-}
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
Count
Community, Subdivision Lot No., Zip Code)
•
a9aD(-
Zip Code
D
-6�-
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topo rraphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(decrees. minutes:seconds)
Latitudeilon,gitude sourcc:OGPSOTopographic map
(check box)
DEPTI-I DRILLING LOG
From To Forma'o Description
D .15/•
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 [gyp t3 h;3f LtK1tli'Y, to --V IS WELL WAS CONSTRUCTED IN ACCORDANCE WITFI 15A NCAC 22C, WELL
C(3k4STRU{Ji,IO(;1 SUN .Ij61S AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ubmit the original to the Divis
33-32
ASHEV1iREGIONAL OEi10E
:NATURE OF PERSON CONSTRUCTING T' TEVVELL DATE
on of Water Quality, Groundwater Section, I63o Mail Seto ice Center - Raleigh, NC
21, within 30 days. GW-I REV. 0712001

L
WELL CONSTRUCTION RECORD
257305
North Carolina - Department of Environment and Natural Resources - Di isio cif Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVlDUAL)NAME
7 (print) Q�'/�A1- n/� D/ n CERTIFICATION��p'/7
WELL CONTRACTOR COMPANY NAME Y/'P pA�- °'-
Mel/ 4L t�acnp,%J)t 1. PHONE # y7lib 4Yg'3/r/.0
STATE WELL CONSTRUCTION PERMIT#
/ 4140 ASSOCIATED WQ PERM1IIT#
(if applicable) I if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 .Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Wate Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIIOOE:
Near�es"t Town: /J31J4-t/ dt. C/ountyr_
(Street Name, Numbers, Community, Subdiv,' Lot No., ..$)
3. Y,a•/�CLL�.
OWNER: -L /� nr —,`" n I
Address JS1D.� d i L) eel, KGr •
Y(Strcet.oJpoute No.) x (s7g /
Ci or4// at) �S O(O
Ci or Town State Zip Code
( )-
Area code- Phone number
4 DATE DRILLED 41 --.24'4'2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO*
7. STATIC WATER LEVEL Below Top of Casing: FT.
I (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'v�e with ISA NCAC 2C .0118.
9. YIELD (gpm): %5/ METHOD OF TEST D. V\ rS -
10.WATER ZONES (depth): Lc OD' - //V `l QpYY1
1 I. DISINFECTION: Type N-YH Amount /(a Y/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. MaterialVC
From 1) To /off Ft. to it
From To Ft.
From To Ft.
13. GROUT,. Depth Material ,
From L) To Ft. Ct-n znJX
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
5. TOTAL DEPTH: 906
etl od
Topographic/Land setting
❑Ridge DSlope DValley Flat
(cheek appropriate box)
Latitude/longitude of well location
(degree. minutes/seconds)
Latitude/loneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To 1 Formtion
lot' 901'
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.
1 n0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
-, DONSTRQCTIpN'ST / _a •:1tE , AND THAT A COPY OF THIS RECORD H4 EEN PROVIDED TO THE WELL OWNER
✓1 f' / -D 2
Submit the original to t
1636 Phone No. (91
GE:air:n // IER SECTION
ASHEVI(I E REGIONAL F:IFICE
I
iv
733,
IGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
sion of Water Quality, Groundwater Section, 163n Mail Service Center - Raleigh, NC
I221, within 30 days. GW-I REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionsiCERTIFICATION k d Y�o f Water Quality - Groundwater Section
'/
,7 Zz)64
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A � / n � PHONE # ��3� %�
�7 l�eil .} Qy_yp(-
� 1CC.
WELL CONTRACTOR COMPANY NAME rLenr— 17Yoti
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/444.5
ASSOCIATED WQ PERMIT#
Of applicable)
257304
1. WELL USE (Check Applicable Box): Residential) Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest
(Sirecy
3. OWNER:
Addres
Coun
Numbers, Com nity, Subdivision, Lot No., Zip Code.)
1
(Styepplppr Route O ,72r6
Cor Town Stoic Zip Code
(—)-
Area code- Phone number
4 4. DATE DRILLED
OTAL DEPTH .410 S
•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley `Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrces minutcsiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formtn i n Description
A
DEPTH
From To
D S� /
5. T : 6 I
DOES WELL REPLACE EXISTING WELL? YES D NO I/
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan e with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 2 hrS
10. WATER ZONES (depth): 3%51 - (PO cspM
Amount ,3 LD
Wall Thickness
11. DISINFECTION: Type ht 7N
12. CASING:
Depth Diameter or Weight/Ft. Mtateriaal
From D To ..5 (a Ft. is It
Y�
From To Ft.
From To Ft.
13. GROUT: Depth nMaterial Method
From 0 To at FLU -ern/ /oin
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 the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5.A NCAC 2C. WELL
CONSTRUCTION CTAFI,D/ARDS AND THAT A COPY OF THJSJtQCORD HAS BEEN PROVIDED TO THE WELL OWNS
-
SIGNATURE OF PERSON CONSTRUCTING TIIE \i ELL DATE
Pt
Stlb4iittthe original to t ision of Water Quality, Groundwater Section. 1636 Mail Sen ice Center
l REV - �07?U01
27699-1636 Phone No. (91 733 3221, within 30 days.
c
ErEj
CD
r
rn
m
GROL!Nrr':`/ATER SECTION

STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ` (print) �1- n 3 3rLA-CAnn CERTIFICATION# 3V`1/
WELL CONTRACTOR COMPANY NAME ( -r Rvc S L3cL\ rl ltssD •,�„i .PHONE k fr�Z4( L cl b' - 3 I O
I D a ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: r
Nearest Town: TY]R (G i e_ V4))cy.)County ) �,1_sticapLa.
1 hnThut )aX-t's a �c
(Street Namc, Numbers,/Community,, Su;•diivision, Lot No., Zip Codc)
be
3. OWNER: I��t 1) W l r/vv CLt j
Address /4D,. J)e 1t,L.eoct )2d .
(Street or Route No.)
I OEC-LS n E S VI I l e/ i-/ C. 3,5226
City o Town State Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED I a- 1 a- r) 2
5. TOTAL DEPTH: '1 b5
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO lay
7. STATIC WATER LEVEL Below Top of Casing: 3 S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): v3 METHOD OF TEST of 1-, r 5
10. WATER ZONES (depth): 2 Ott I — Q 5{ S
11. DISINFECTION: Type j--1 I k
12. CASING:
Depth Diameter
From % To I an) Ft. I n 11
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From l To .Q in FL C coo �t,r t -1 uTh
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 1 a 1
Wall Thickness
or Weight/Ft. Material
pv
16. REMARKS:
Topogrghic/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
Forma ion Description
DEPTH
From To
G ;to'
i av '7v_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.
to
LnQ HEREBY QERTJF THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
(`STIN412 S,/`ND THAT A COPY OF THIS RECORD HAS Ff PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/z-s/--
DATE
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919 733-3221, within 30 days. GW-I REV. 07/2001
0

WELL CONSTRUCTION RECORD
266595
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMNa
E (print) /'S r�I-) I Al /.J ) Et? ap CERTIFICATION k J 4// 2
WELL CONTRACTOR COMPANY NAME GUZI END+ E /Uiaan� - WELL 91 7 c�•�p TlLc . PHONE k (g, Ln T� "3/ 7e)
STATE WELL CONSTRUCTION PERMIT# /'iL>•-C ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential I2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: '"
Nearest Town://J77%)r5 V r /it County //y i✓ood
'<nt LnntL --A_-Q Ln
(Street Name, Numbers, mmunity, Subdivision, Lot No., Zip Code)
3. OWNER: � I I ‘ r��
Address I LI D a e_I Ikit)o net, r1 ,
(Street/ Route No.)
City r Town State ' Zip Code
( )-
4. DATE DRILLED /2 - /P' U 2
5. TOTAL DEPTH: / OD,S
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2
7. STATIC WATER LEVEL Below Top of Casing: ,5Ot FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5/,S METHOD OF TEST 2 k r S
10. WATER ZONES (depth): .i )'5 ' - '/ L , p,,.,
7,D� - � �r I OOS' - Zcs?
11. DISINFECTION: Type 1-1T—I-4 Amount / 1 17
12. CASING:
Depth
From n To /, Fi.
From To Ft.
From To Ft.
13. GROUT: Depth Material ., N ethod
From G To L5 Ft. CD.f t. Intt-(
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
� leres - f l7C
Diameter
10 rt
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IlPfat
(check appropriate box)
Latitude/longitude of well location
(dcerces. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
//4 Y' ' / nL � E ' 1/1i1�%ct—CL
LOCATION SKETCH
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.
Pv0-
Area codc- Phone number
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft
6S:01WV C-NVV?0
c
0
n�
am
c0
---m
orn
m
frl
rn
rr
rn�
m�
r7
ti
G
It:DU-HERfB; 7CE(tTl
•I NSFRUCF,(ON�LST4
Submit the originaljo the
99-1636Thone}Sio. (919)
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
2L}S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC�THE WELL DATE
/2 -3/ -a 2
Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
133-3221, within 30 days. GW-I REV. 07/2001
.J

266594
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r-Rf .A�r.' \ / /� Uo-('- ( CERTIFICATION #-.?5Z/2
WELL CONTRACTOR COMPANY NAME CSV e. Pam. o/ ..f5v-e� c. . Lt e J L c4- -7 f t w.p W..e .PHONE # 0.4 /,. 4ig - `3 / 7C
STATE WELL CONSTRUCTION PERMIT# `Y ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential li Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other ❑ IFOther, List Use
2. WELL LOCATION:
Nearest Town:
t County )-12.1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: ) 11 )�uc Il4-k-bn
Address I LI-(.',L nc"- 'Pact .
(Street or !tome No.)
j t.L nesvl Ile Ale 0287fib
City oPTown State Zip Codc
Area code- Phone number
4. DATE DRILLED 1 a- I I-
5. TOTAL DEPTH: Lo 0 S ' /
6, DOES WELL REPLACE EXISTING WELL? YES 13 NO C9'
7. STATIC WATER LEVEL Below Top of Casing: a DO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan5(e with ISA NCAC 2C .0118.
9. YIELD (gpm): I/ L� METHOD OF TEST c 4i es
10. WATER ZONES (depth): a 00 --
11. DISINFECTION: Type F-1 T♦-I Amount 7 4L
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft.
From To 20 Ft. J,
Topographic/Land setting
❑Ridge I71Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude suurce:OGPSOTopographic map
(cheek box)
DRILLING LOG
Formatiop Description
DEPTH
From To
,20
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To an Ft. C e- -E-,...._T -}Y -P'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
i I1 11--
III.
I4
Submit the original to theDivision of Water Quality, Groundwater Section, i 636 Mail Service Center - Raleigh, NC
1 L - -29699-1636 Phone Ni .(919) 33-3221, within 30 days. G W- I REV. 07/2001
2.
r !CHRTif 1 AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
At) ALL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
-G a

266583
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1 ^
l�1tf�� CERTIFICATION #„�
,
WELL CONTRACTOR COMPANY NAME Gre P�I.v2 , roS . I,1Je )I -I t' -fru PHONE # fg..�,('t/ 1/8 "3/ 7Z
STATE WELL CONSTRUCTION PERMIT# / 4 0 2 ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) d()Lin
(if applicable)
1. WELL USE (Check Applicable Box): Residential)l Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 1�
Nearest Town: ir�rt,tne;Ville County 3 a
C v 1jLrkY
Yvl eS u E Rct - Tiz�re-.LJoo!-C
(Street Nad e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: aa-f{) vs
S C_c< 11t-
Address P O in a S )
(Street or Route No.)
Ctmi !)C ,2(8 la
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED I a -a -b 1
5. TOTAL DEPTH: .-2,f15 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: La ('3 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): / S METHOD OF TEST ,.-2 kris
10, WATER ZONES (depth): ,a)/a c6 cs P nr,
a ' - 1 4 Prh
I1. DISINFECTION: Type H 1--4-1 Amount 4 /
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To iS Ft. b 11 PO C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a G Ft. Ccw . .,..) -}-tr-p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
NS' RUC(111 t1C
Topographic/Land setting(
❑Ridge ❑Slope ❑Valley IH.tlat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To t Form ti n Description
%J .
q ' -3OS ' J,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
0
ut
LSubmit the original t0`'the
7699-1636-Rhexe-NQ4I9) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
42,1-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
y/te
- / -o-
DATE
ivision of Water Quality, Groundwater Section, 16.311 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001
..

D
266583
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME n((print) ��Aj , CERTIFICATION p
,N # 24/� p
WELL CONTRACTOR COMPANY NAME C9rQEElsi Bros L) `/ st ( PHONE f Pa Sl /, 418-37 %0
STATE WELL CONSTRUCTION PERMIT#
/4/D2
(if applicable)
ASSOCIATED WO PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential O, Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
.d
2. WELL LOCATION: '- /
Nearest Town: I LLt° 5 V t) i d- County giro )doff
TA.vi Lr/D" 5u L.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: �f GhLLrcL etc
Address LI- 745lerAl ue
(Sir et or Route No.)
;ir%f nq*DA MA Oa5<74a
City or Town) State) Zip Codc
( )-
Area code- Phone number -
4. DATE DRILLED 1 2- 3- D 1
5. TOTAL DEPTH: 315
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14,
7. STATIC WATER LEVEL Below Top of Casing: (o D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with t5A NCAC 2C .0118.
9. YIELD (gpm): / r) METHOD OF TEST Ars
10. WATER ZONES (depth): 305' 153p
11. DISINFECTION: Type )--f YH Amount '/ Y
12. CASING: - Wall Thickness
or Weight/Ft. Material
Depth Diameter
From 0 To so Ft. to " pv c
From To Ft.
From To Ft.
13. GROUT: Depth - Material
From D To QP Ft. tvi. tj�-1
From To Ft.
14. SCREEN: Depth Diameter
From . To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(dcurecsr m in un>/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTFI DRILLING LOG
From To Formation Description
sI ' 3 RS-'
LOCATION SKETCH
d5Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
Slot Size Material
in.
in.
0
ut
OD
16. REMARKS:
I'pOHRRR3Y
GIO}JSThUCTIOJ
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q(�LL C' /z - 3/-4z
I _ 1 SIGNATURE OF PERSON CONSTRUCTING THE W ELL DATE
l Submit the original to the ivision of Water Quality, Groundwater Section, 1636 Mail Sere ice Center - Raleigh, NC
27699-1636 Phone No. (919) 7 3-3221, within 30 days. GW-I REV. 07/2001

City or Town State Zip Code
4. DATE DRILLED 11-11 -Da
Area code- Phone number
WELL CONSTRUCTION -RECORD
North Carolina - Department of Environment and Natural`` Resources - Division of Water Quality - Groundwater Section
k�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D In ut)e i\U b CERTIFICATION # a rF / h'
WELL CONTRACTOR COMPANY NAME Grr P.I...t .1'4 r os , 0ir, t 1 4 2.1a(4) PHONE # (2,29 to y8'3I .7b
STATE WELL CONSTRUCTION PERMIT# 1 4 0 ..L ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
266 593
1. WELL USE (Check Applicable Box): Residential C"Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It'Other, List Use
2. WELL LOCATION:
Nearest Town: £ o_-v±t*n. Coon ty d n 4 t key{
1�P-t^1 (x rL %v-rk p (ea
(Street Namc, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ('.r. Srv'a A-s
Address 3ci(n YY) Prt'cl Ca_. �,p
(Street or Route No.)
C e3-% 7 l lr
12cd .
5. TOTAL DEPTH: 061
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W
7. STATIC WATER LEVEL Below Top of Casing: S D FT.
(Use "+" it -Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I n METHOD OF TEST 2 it vs
10. WATER ZONES (depth): S Z 51 - 1 0 c3 p m
11. DISINFECTION: Type /4 77 l
12. CASING:
Depth Diameter
From C. To 10 i Ft. l o"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From /,` To 0D �o Ft. (0 .r-rr_p ,i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
Amount 5 5
Wall Thickness
or Weight/Ft. Material
PVl_
M thod
15. SAND/GRAVEL PACK:
Depth
From To
From To
16.. REMARKS:
r Dn HER TIFY
Frr C(7N-�S11KUCTIIO S'&N
L
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [DPI
(check appropriate box)
Laiitude/longitude of well location
(degrees; minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
d I 17 C 4 �y
16'7 ' ¢ /95 ' XfS
LOCATION SKETCH
Show Direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
agai
O
CJI
r,p
Submit the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
-27699.1636 Phone No. (19) 738-3221, within 30 days. G W- I REV. 07/2001
or -a

iLCO STkvc
L'
;OUJ92'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural)) Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) ?f)h1 zl /6) p._11)c> CERTIFICATIOpON#,,ay/�
WELL CONTRACTOR COMPANY NAME Gve...., y05. VQ /� iI J t'ttf}r) Tre - PHONE #3/7L
STATE WELL CONSTRUCTION PERMIT#
/4G
(ifapplicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential O�unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: -
Nearest Town: C[ .r..____lCounty�I-Joi
Cf)i) )C ___. p Lf 'TC/� ( L V e)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc) Latitude/longitude of well location
3. OWNER: A Y\0.. }�
'✓�C a� 1. ?, rl Si!✓\ (decree.. minutes/seconds)
Address 'i �� (e � U l.r4-C.1 ' e. R[& . Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box)
City or Town State Zip Codc
(—)-
Area code- Phone number
4. DATE DRILLED I 1 - C - (J 2
5. TOTAL DEPTH: '4- 05 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LY
7. STATIC WATER LEVEL Below Top of Casing: a 0 FT.
8. TOP OF CASING IS i (Use ^+" if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
4. YIELD (gpm): 4- METHOD OF TEST O. k r5
10. WATER ZONES (depth): 3 D S ' - a `J t'
t4D!-;i -3r is,v.
11. DISINFECTION: Type 1-4 1 1-i Amount, in
12. CASING: - Wail Thickness
Depth Diameter or Weight/Ft. Material
From Lf To v.3 `7 Ft. b 'I {I U r
From To Ft.
From To Ft.
13, GROUT: Depth Material Method
From r To 2t7 Ft. Co.-.v-oAi
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Topographic/Land setting
❑Ridge ❑Slope ❑Valley '$Flat
(check appropriate box)
DEPTH DRILLING LOG
From To Formatio Description
F) 37' 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.
O
o_
nC �o
16.. REMARKS:
to --
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL CO ES
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER Z
f CERTIFY irtwr
icksTA ! �
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
tV
ask
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sery ice Center - Raleigh, NC
:Z7699-T636P.Ttone No. [phone], within 30 days. GW-I REV. 07/2001
..e

26 )8
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
4,04
r�
CERTIFICATION # 3DY' I
ZY°S.lie11 c4 Cum/a%Jac PHONE# -311°
ASSOCIATED WQ PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ IrOther, List Use
2. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cod
3. OWNER. TaD Cs r'rEII epsn
Address 39 r-4.t.0 v t P t.L) •
/AA(Street
'l D-v^ IN Rout)C O) 8 7 1 Co
City or Town • State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1 j - of 2 -D Z
5. TOTAL DEPTH: tips'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 0.D 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): a METHOD OF TEST a rs
10. WATER ZONES (depth): a '+0 I — (4, e p
11. DISINFECTION: Type HT 14
12. CASING:
Depth
From 0 To Lot Ft
From_ To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To .a D Ft. 0 oanwn AAA
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount s `i
Wall Thickness
or Weight/Ft. Material
P VC
Method
Diameter
'A 1t
Topographic/Land setting
❑Ridge XSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
I degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTEI DRILLING LOG
From To Formatiog Description
0 4°3
4 3 ' yos'
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.
6S:01WV £—NW3c
16._ REMARKS:
1/(P00 Id-E�.RIOB'r gEI$TIF
�S Ci9NS1 RUbTrON STA
Submit the original t
°!U_; ".t64_(gPho0RiN0.%(919)
I ' JF( OFFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-g/ - o -2-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001
*.1

3. OWNER:
Address
2G6586
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR. (INDIVIDUAL) NAME (print) rt rt-t_P CERTIFICATION# 3b41/
WELL CONTRACTOR COMPANY NAME COP1'.PIE &vs . LPJ eJL. �► py •PHONE # (S.ZS nn317b
STATE WELL CONSTRUCTION PERMIT# / M D. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To
County PayWooal
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
b-ll�Szr11-13k� rlct
e >n
r Route No.)
FL
City or Town State
Zip Code
Area code- Phone number
DATE DRILLED ) I — aS —O 1
TOTAL DEPTH: 4 4/ 5
4-65.GOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: T.
(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): .Q 0 METHOD OF TEST of ),r.S .
10. WATER ZONES (depth): . 41) ' - 44S '
11. DISINFECTION: Type I—ITH
12. CASING:
Depth
From 0 To iD ri Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From D To 0.0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From . To Ft. in. .. in.
From To Ft in. in.
Diameter
�tI
Amount 77
Wall Thickness
or Weight/Ft. Material
PVC
Topoaphic/Land setting
❑Ridge `pJSlope ❑Valley ❑Flat
((check appropriate box)
Latitude/longitude of well location
(degrecs.minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
1011 Cl4S'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method c
LLMJ[ 41,1P o
IN)
Material ap. rC
CD
�,...,
-m
W o�
t: m
-o
m_
15. SAND/GRAVEL PACK:
p.
Depth Size Material 3
From To Ft. _ p
From To Ft. CA
tD
16.. REMARKS:
LC NOW' ST/
L
T
ire
L Submit the origina� o the
27693.1636 Phone. N . (919)
P(•
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
2D D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/iJ� sit Ne /.2 -3/ - 0 z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Sers ice Center - Raleigh, NC
733.3221, within 30 days. G W-I REV. 07/2001
tn2
m u
0
G
•.4

266585
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)'jo As N Wvi\fLi Lis CERTIFICATION #. 41/S
WELL CONTRACTOR COMPANY NAME PCFJIP.J F-Br ns . I3t l l --4-Rat. '3 tut • PHONE # j82A stria - 3 /9°
STATE WELL CONSTRUCTION PERMIT# /TLO Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' . Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest To n: I ne SU1il2.County
l-L"` e" L)efe9 r—AcL •
(Street Namc, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: 131 1 )1 Qwr�+ ?trot
Address •3d cvvk42_.t•- "
(Street or Route Nq.)
M •
City or Tow State Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED J1� a4 —D.--
5. TOTAL DEPTH: acts,
6. DOES WELL REPLACE EXISTING WELL? YES lJ NO nl
7. STATIC WATER LEVEL Below Top of Casing: 4'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 accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): accordance/with
METHOD OF TEST .2 )-Ni-S,
10. WATER ZONES (depth): 2 4s z- 40 3 p fw
11. DISINFECTION: Type
12. CASING:
►-+-r- N
Depth /
From D To 9Y' Ft.
From To Ft.
From To Ft.
Amount 41D
Wall Thickness
Diameter or Weight/Ft.
Material
PV•
13. GROUT: Depth 1
Material ''Mttethodd
From D To .DD Ft. ira.rnA1—w�. ^r
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley flat
(check appropriate box)
Latitude/longitude of well location
( degreesnninuws/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formati_op Description
DEPTH
From
94"
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
fV
L
W
JC
JC
0
ut
ry
0
cam'
;rn
a
IC rr
rn
0
r"on al
rt
rn
r JD
C
G
16.. REMARKS:
1(1 D©HEREBYC _ 1
IcONSTRUCyf."IO T
YNI
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original o t
uk U2769941630Phone o.(91
A I E
J
SIGNATURE OF PERSON CONSTR THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

264981
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and_t'a ral('�esources - Division of Water Quality - Groundwater Section
K-fd .lila d j --g,,.� CERTIFICATION /�
J� .{ (,�, aL . PHONE Si)„GS 4/R -3/ 9 /)
WELL CONTRACTOR (INDIVIDUAL) NAME/l (print)
WELL CONTRACTOR COMPANY NAME(�'A O ta, F.//I/C,(S . �C 1 v
STATE WELL CONSTRUCTION PERMIT# /4/ a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IFOther, List Use
2. WELL LOCATION:
Nears o
County.2
(Street Name, Numbers, Commu
Subdivision, Lot No., Zip Code)
3. OWNER: (fit-�t�Xl �!
Address 77 OL
(Street or Route No.)
-2r_j'n
City or Town J State
fl'%/ L
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED / / " PI" /' z'
5. TOTAL DEPTH: 3/ '
6.• DOES WELL REPLACE EXISTING WELL? YES 0 NO ltt
7. STATIC WATER LEVEL Below Top of Casing: /n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance jsIth ISA NCAC 2C .0118.
' 9. YIELD (gpm): METHOD OF TEST 7 hA
10, WATER ZONES (depth): .2 Q ' - R z
11. DISINFECTION: Type /7 7 /-/ Amount C-2
12. CASING: - Wall Thickness
Depth Di4meter or Weight/Ft. Material
From n To , 2/) Ft. (n a %)i/(?•
From To Ft.
From To Ft.
13. GROUT: Depth
From rf) To ,2() Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
Material
//.4i'n 0
ethod
Material
From Ft.
From Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 'Fla
(cheek appropriate box)
Latitude/longitude of well location
(degrees: ntinutesiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Forma on Description
.2n '
505'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
co
03
16.. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTInN STANDAR S, ND THAT A COPY OF THIS RECORD HAS B N PROVIDED TO THE WELL OWNER
�, �_ At ct-uL // sn —0 2.
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919y 733-3221, within 30 days.
GW-I REV. 07/200I

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Div
WELL CONTRACTOR (INDIVIDUAL) NA E print)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT*/ �'i�.� ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
n of Water Quality
264969
Groundwater Section
CERTIFICATION It.22 5'
PHONE/JAZVg-3/7/9
1. WELL USE (Check Applicable Box): Residential Municipal/Public CI 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water nlection ❑ Other 0 If Other, List Use
2. WELL LOCATIONn:: a+/
Nearest n: ! .13,-- Countyn� - {-nll
fr �.2-2A1 �!'
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER:
Address ,38_2 .zA-1.
(Street or Route No.)
2n41 �i fit- -A o. k /�
City or Town / State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED //-/i
5. TOTAL DEPTH: /Z
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ,` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordant}} w th ISA NCAC 2C .0118. /�
9. YIELD (gpm): /p/) METHOD OF TEST ,�
10. WATER ZONES (depth): / G $
Amount e9
Wall Thickness
11. DISINFECTION: Type /1
12. CASING:
Depth Diameter or Weight/Ft. aterial
From r) To 6 / Ft. 7. it
From To Ft.
From To Ft.
13. GROUT: Depth /Material 1� Method
From To :� �Ft. [ Pw>'--,-!p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
i5 i� I�O HEREBYII
O6NSttRUCTION $
Topographic/Land setting
❑Ridge OSlope ❑Valley y4Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Format on Description
a/ ha
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
it
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A)2 tit."
SIGNATURE OF PERSON CONSTRUCTING THE�"ELL DATE
vteJ
ISubmit the orig al to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl REV Raleigh,
NC
y1
_ - n37b' '1666 }'il*one No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
264968
North Carolina - Department of Environment and Natural Resources - Div's'.n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � . .L L ♦_ / CERTIFICATION # .'-7 85
PHONE # 1,UCi/ 4/-3/'7Z)
AZZ).1 ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:7 y
Nearest Town: L4-L--Zin^J County Q,>%Lc--)DOLL
/7) /T-' / C-L
(Street Name, Numbers, Community, Subdivision,rrLot No., Zip Code)
ub�
3. OWNER: /er^ C11-AL1✓
Address �L./2 2d.
(Street or Route No.)
c
City or Town 'State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED //-/
5. TOTAL DEPTH: a 5Z5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lk
7. STATIC WATER LEVEL Below Top of Casing: %/2 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): if METHOD OF TEST "RAJ
10. WATER ZONES (depth): /4; 5'
11. DISINFECTION: Type /-/TH
12. CASING: -
Depth Diameter
From t To 6 7 Ft. Z. 1/
From To Ft.
From To Ft.
13.
14.
15
Amount 3 3
Wall Thickness
or Weight/Ft. Material
P6'a
GROUT: Depth Material
From (*) To ...-/// Ft. ('DYa-i.N
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
M hod
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge "Slope ❑Valley ❑Flat
icheck appropriate box)
Latitude/longitude of well location
I degrecs minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fo �22i• Description
7) / %
A 7' 5'S' MA 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.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//35 —el 2
DATE
rl
SIGNATURE OF PERSON CONSTRUCTING THE WELL
74 tql tt arig to th> Division of Water Quality, Groundwater Section, 1636 Mail Sery ice Center - Raleigh, NC
/1276919Jit34{114141N(4 [phone], within 30 days.
GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME print)
WELL CONTRACTOR COMPANY NAME2 M P MU '' //Aft. f
/?
STATE WELL CONSTRUCTION PERMITN
(if applicable)
4.1) nor/
264967
CERTIFICATION N 31)1/
PHONE N fig-M L '7'2-3/ 71'
ASSOCIATED WO PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): ResidentialJ�{ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Waterinjection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town:
/) LC/
County /'�i),///rJni'<C
(Street Name, Numbers, Community, Sur division, Lot No., Zip Code)
/7
3. OWNER X.4-2L1
Topographic/Land setting
❑Ridge 11151ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
C
_ L(3�,� - -'(e / % (dagrcestminules/seconds)
Address P (7' /-3eYy / %�,' i Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
(24 (St �Jh '2 7/c DRILLING LOG
To Formation Description
d
AM
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 3 -?S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ¥ T.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
, variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST .; A r
10. WATER ZONES (depth): 3L=V)'
DEPTH
From
17/9 ' 325'
II. DISINFECTION: Type %/-D/- Amount S7
12. CASING: - Wall Thickness
Depth Diameter
7�
From To 'Y/ Ft. 6 '/
From To Ft.
From To Ft.
13. GROUT: Depth (II;
M hod
From /) To ,14 Ft. l G�2.2-42
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.
or Weight/Ft. Material
P
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.
TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GOhNSTRUCUON'S F r iS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/- 52) 6
(
L—i7: 7Submit the original to Hie Division of Water Quality, Groundwater Section, 1636 Mail Service Center
l REV- Raleigh,
NC 1
f 699-1,036 Phone_No. [phone], within 30 days.
WSIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

r J
1• /
Submit the original totfi
—2709 1636Phone N(919
264966
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s-Li ��-rt Y!/ CPn CERTIFICATION N -3V `e/
cJ t1 C PHONE W f.Y..'IS' 4'/8 - 3/
WELL CONTRACTOR COMPANY NAME �, /__--- L y
STATE WELL CONSTRUCTION PERMIT# /'Y!/ 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential G-7Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION /
Neare�/�,((Town: � r" i''J County ��•�4kitift
N1LC//.11h "I �.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
� .
3. OWNER: &L-.a hJ �'m2 /3 (dcgreesnninutes/seconds)
Address /' 7) �.7!'X P7 � _ Latitude/longitude source:OGPSOTopographic map —_/_ (Street or Route No.) (check box)
C GC--i'A<'v" nt -1,y7/G, DEPTH DRILLING LOG
City or Town S(ate Zip Code From To Format.t°� Description
( )- /7 6 f J 4 a-t�
Area code- Phone number ,� D 3 1/5' ' > — A A ""�t_,
4. DATE DRILLED //-- 7- 4-
5. TOTAL DEPTH: 3 a¥, 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
•9. YIELD (gpm): 9. 5- METHOD OF TEST .? Arj •
10. WATER ZONES (depth): 300 / -- 3V.5-'
11. DISINFECTION: Type /-, T/-/
12. CASING:
Depth Diameter n�/�
From (1 To a/' FL / /-
From To Ft.
From To Ft.
13. GROUT: Depth/�M�yiaterial Method
From /)To a/) Ft. ! ,e_ert_e Ili,
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:
Amount 445
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
❑Ridge 05`lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
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
WITH
5A NCAC 2C, WELL
EREBY CERTIFY THAT THIS WELL S,, AND THAT AWAS ONSTRUCTED IN ACCORDANCE I
COPY OF THIS RECORD HAS BEEN PVDED TO THE WELL OWNER
t-t /7 - 31' - 6 2-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center
I REVgh, NC
733-3221, within 30 days.
FJ

264965
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) /,�ll-GJ� ✓J CERTIFICATION # ,3Lt't//
urO 3/�
WELL CONTRACTOR COMPANY NAME 24-�+<- /�t.jc/ //J' 1V �-D! -t"'""}', `e' - PHONE # e29 G, Liz g- -
STATE WELL CONSTRUCTION PERMIT# (
(if applicable) if applicable)
//z/P-2
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential [3" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest, Town: L Coy my
(Street N e, Numbers, Community, Subdivision, Lot No., Zip Code)
topographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 2.24 Jy /4 421m/FC5h./ tdcgresiminutes/seconds)
Address `/ %36 /C.r]-a JtLQ P4L-A -/h-�- t--Latitude/longitude source:❑GPS❑Topographic map
Str�I�C-reet rRou[e No.)
DEPTH (check box)
e( 9 33 %1/� DRILLING LOG
{--I
From To Formation Description
44' ions
City or Town Stale Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED //- /-/ -44 Z
5. TOTAL DEPTH: /e945'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO 12"--
7. STATIC WATER LEVEL Below Top of Casing: 9a0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith ISA NCAC 2C.0118. pp
9. YIELD (gpm): —X-�— METHOD OF TEST o� 7�-+
10. WATER ZONES (depth): /1/4) - /S7 '
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 7) To n Ft. /o q
From To Ft.
From To Ft.
13. GROUT: Depth 4vtaterial
From Q / To 2/� Ft. P
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount /2'
Wall Thickness
or Weight/Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
16..REMARKS:
7 cc,o o-HEREBY GEAR
1U)CdWSTRUCTIONJS
Submit the origin I to t
UP, I) c , 699-d6 „ et! o. (91
ASHEVII FL' Hz1
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//- 3_a
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
e Division of Water Quality, Groundwater Section, 163o Mail Service Ceenterl REVgh, NC
733-3221, within 30 days.
N4

WELL CONSTRUCTION RECORD
264943
North Carolina - Department of Environment and Natural Resources - D v.s� Water Quality - Groundwater Section,/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2�JJr�—Y7 t'_- C 1-',T CERTIFICATION a.r% 417g
f r(�� / /7 r (`
WELL CONTRACTOR COMPANY NAME A C f.� f I'OS �/ : i i�{ /I/ PHONE # JsC15 �(J L �-3 / 7 v
STATE WELL CONSTRUCTION PERMIT# / rYU ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / 1
Nearest Tpwn:�P.�.-tJ2 SU) /e- county %h24/tDoou(
!-/z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: {JCS-i.-6- /L ,!d,el'�
Address /,r�/0 r —e J
(Street Route�No.)
CI or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED // /g'�
5, TOTAL DEPTH: .3L?S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
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 accordance/with ISA NCAC 2C .0118.
9. YIELD (gpm): / ,2 METHOD OF TEST c
10. WATER ZONES (depth): & .215 / — /1 r),
Topographic/Land settin
❑Ridge ❑Slope OValley tat
(check appropriate box)
Latitude/longitude of well location
(degrees m mutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Form ti n Description
z tu-LC)
DEPTH
From To
() 9 y
9 / ins '
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From /2 To ' S Ft. / i/
From To Ft.
From To Ft.
jnn� Lc
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. atenal numbers and common road names.
LL.1
13. GROUT: Depth ,4 aterial
From /9 To l.) Ft. l PM+2-4
From To Ft.
14. SCREEN: Depth Diameter
From . To Ft.
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
in.
Ft. in.
Mood
Slot Size
in.
in.
Material
Size Material
Ft.
Ft,
1I 'rOONStRI CTIPN
..K II L/)
i
l!
!JUi
L Submit the original to the
:736 @ � (919)
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L2/n1_ // 3O _ n
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 16311 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

From To
From To Ft.
13. GROUT: Depth
From fr) To �1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
print) (' '/(l
WELL CONTRACTOR COMPANY NAME K /4 B1.ae .CJrf-xo �C iJ/ /`;L/�' - PHONE # rV `7J --3� �a
ASSOCIATED WQ PERMIT#
(if applicable)
264942
CERTIFICATION # r�
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential pt, Municipal/Public ID Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Ne4rest Town:
(Street Niame, Numbers, Community, Subdivision, Lot Np., Zip Code)
3. OWNER: �LGL (-i-. /Q71// 2
Address 7,5-(2
✓ County Net-t/ GJo�Ca,
(12-it -2
treet or Route No.) U
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED //'/ "-1) -2
5. TOTAL DEPTH: a(3-4
6. DOES WELL REPLACE EXISTING WELL? YESpNO tIL
7. STATIC WATER LEVEL Below Top of Casing: ¥/)' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. �pp
19. YIELD (gpm): /,2 METHOD OF TEST 24,•'
10. WATER ZONES (depth): hiC / - / , 2. elf; rn
11. DISINFECTION: Type Al till Amount 54
12. CASING:
- Wall Thickness
Depth Diameter or Weight/Ft. Material
From to To 5/ Ft. L- " P t/c
Ft.
Material Method
Ft. cP -enJ 4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(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
73 -5// GI
7/ ?LrS' XU-7An.
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.
coca
16.. REMARKS:
�¢ubmiit theoriginalo the
ASHE %0?0 f� i,.,,41 01P,,l-(919)
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
eft
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
i33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAmg-- .IAL/-us
STATE WELL CONSTRUCTION PERMIT#
M
/4"/J /f
(if applicable) •
/rJ:-I/ a iN V, \L-e-
ASSOCIATED WQ PERMIT#
(if applicable)
264941
Groundwater Section., // //
CERTIFICATION #�ZL8
PHONE {sti L3/47--3/71)
1, WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest Tp vn:
County Y 4 ,...1 d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /� ./ t +,y� f✓ �t�
Address & 4' x /4—e- //n //e L4
<i �.CStreet or Route No.) /
-li /(/C_ %
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED // - /1-44,2
5. TOTAL DEPTH: 1796
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO -
7. STATIC WATER LEVEL Below Top of Casing: 1/4:..) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
' 9. YIELD (gpm): 3 % METHOD OF TEST a �✓
10. WATER ZONES (depth): of S/S
11. DISINFECTION: Type /-' 77-/ Amount g/
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From ./) To h c Ft. / '/ G/r
From To Ft.
From To Ft.
• 13. GROUT: Depth Material Mkt
From ^ Too-�ls Ft. �A.t�/E'�1�
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From - To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16.. REMARKS:
Ft.
Ft.
z/ss/-//2�/�J
Topographic/Land setting
❑Ridge ❑Slope ❑ValleyJat
(check appropriate box)
Latitude/longitude of well location
Idegrees;minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check boxl
DEPTH DRILLING LOG
From To Formation Description
)7)n�a.. t_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HERE$Y dER1I
— C-6NSTRUCITDN SI
tnya to th
CRUUE-�lGPbddie!AI&
ASiiF" L
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS pEEN PROVIDED TO THE WELL OWNER
e_f // 3 - 6 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW- I REV. 07/2001

D /31V .2I/
or Route y/ / -2 7 - S— R
.y�Q.LlCd /�,� xiZG < DEPTH DRILLING LOG
Topo aphic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
et(cheekb )
(. )-
Area code- Phone number
4. DATE DRILLED /13 — --6 -Z
5. TOTAL DEPTH: SA5
. 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO`$..
7. STATIC WATER LEVEL Below Top of Casing: e D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance t/Ith ISA NCAC 2C .0118.
YIELD9. HOD OF TEST
/25' - .3 r m,}
10. WATER ZONES (depth):
ti
11. DISINFECTION: Type /7' 7 N Amount 2
12. CASING:
Depth Diameter
From 6 .To %/v Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 60 To 016 Ft. LIPitrto ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From • To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
• From To Ft. -
From To Ft.
A /I
Wall Thickness
or Weight/Ft. Material
Pt'l'r,
ethod
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�rc�tt- Division of Water Quality - Groundwater Section '
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / a-417 , CERTIFICATION # 3GV/
£Y ,r4 i Amy)illicit18.i$ 418 — 3/ 2 6
WELL CONTRACTOR COMPANY NAME /P1' h.C//// vS �! {.�� Y Lt�h9 - PHONE #
STATE WELL CONSTRUCTION PERMIT# / T2,.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264050
•
1. WELL USE (Check Applicable Box): Residential,,.,Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO l
Nearest Tonr //1 CV/ //� Counttd Old
(1.0fsion,
2
(Street Name, Numbers, Com nity, Subdi Lot No., Zip Code)
3. OWNER:
Address
City or Town State Zip Code From To
D -7G '
72,' 30s'
FormationtiDescriptionc
on,GI Ce /z.
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: -
TIFY THATk THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
`BC, AND THAT A COPY OF THIS RECOR� -ki.\S BEEN PROVIDED TO THE WELL OWNER
T
Submit the original t
ne No. 19) 7
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
/ G — .3/ — 0 .Z-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW- I REV. 07/200I

264051
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEE!(print) 2 CERTIFICATION #„74%/4
WELL CONTRACTOR COMPANY NAME i?/CP-ILt Y45 //'.2�, CGS- i/ / ' PHONE # f Kg to/g -3/ 7 e
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# /7 ,612
(ifap?licable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION: ,. j
Nearest fwn: C;/t4 Cz'' County 2y6-)1>z-z-1
D4
(Street Nau c, N •'rss, Community, Subdivision, Lot No., Zip Cpdc)
fn 3. OWNER: V/'/[1 p
Address —1/ ,i7 4. 7'' )4z n �7` -
(Streqt or Route No.)
City or Town State' Zip Code
Area code- Phone number
4. DATE DRILLED /0 -/t' - n 2
5. TOTAL DEPTH: 3 4'S
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7, STATIC WATER LEVEL Below Top of Casing: /.S
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118. II oo
9. YIELD (gpm): /✓Z /1' METHOD OF TEST e.
10. WATER ZONES (depth): 3/ SO ,'- rep
FT.
11. DISINFECTION: Type /-1N Amount 6 /
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From D •To 73 Ft. G " Pi/c
From To Ft.
From To Ft.
13. GROUT: Depth aterial Method
From 0 To 020 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:
Size Material
Depth
From To Ft. --
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degreesAn inutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fo rmattiiinneesscript i on
DEPTH
From To
C� 73
73' s+'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.
CD
i-J
16.- REMARKS:
11 1-1E .B CE�YY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
. •at II NDARDS, AND THAT A COPY OF THIS RECORD HA EN PROVIDED TO THE WELL OWNER
/_ 3/ - D 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SO 4inal t the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROU
NVILLE�� ks4 %e No. 919) 733-3221, within 30 days. G W-I REV. 07/2001
ASHEVILLE D

SBU TI!t� ST L
Submit the original t
WELL CONSTRUCTION RECORD
North Carolina -. Department of Environment and Natural//Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((print) I-21.).h//V //1 J CERTIFICATION # Z7n?
WELL CONTRACTOR COMPANY NAME Are �
F.}co' ,QYUS . /Z4H M1/ DLLLht �H./.. PHONE #(� X L>' ��-3�7
'E WELL CONSTRUCTION PERMIT:,/.14 .Z ASSOCIATED WQ PERMIT#
(if a plicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential A, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: Cou ty_�`✓Q/zze
/)j)id,2 e, o (-01z
(Street Name, NuMbers, Com unity, Subdivision, Lot No., Zip Code)
3. OWNER. (75/Ch.)2.2/ U- is
Address /.3 / n-/ta 2.A1 ��
(Street or Route No)
Citior Town State Zip Code
(_)-
Area code- Phone number .
4. DATE DRILLED ie -/-2 - -
5. TOTAL DEPTH: 36 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j<1,
7, STATIC WATER LEVEL Below Top of Casing: gD FT.
(Use "+" if Above Top of Casing)
. 8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
'9. YIELD (gpm): /3— METHOD OF TEST i hrc
10. WATER ZONES (depth): 3,25v - r/if--ram
-3 Ns ` - fir,
. 11. DISINFECTION: Type // % // Amount 5/
o- 12. CASING: - Wall Thickness
Depth - Diameter or Weight/Ft. M t rj l
From / 'To A/i Ft. 6 `r
From To Ft.
From To Ft.
13. GROUT: Depth - Material , Me od
From L% Tp .JD Ft. [ O .c, 2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From • To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From To Ft.
16. REMARKS:
264053
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chcck box)
DEPTH DRILLING LOG
From To Formatio Description
g41/ b5-' /r4 AnaL
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.
CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e
eNo. 919)"
GR IfdDWATER SECTIO
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
)ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
th Carolina - Department of Environment and Natural'Resources - Division of Water Quality - Groundwater Section
.L CONTRACTOR (INDIVIDUAL) NAM (print) - ' /,I/(,1-M2t N�I�U P E , CERTIFICATIONOa.�� ��
.L CONTRACTOR COMPANY NAME rt. P.n2'/�/{ Ss. lie, /I -Y ?Itmp,i/w• PHONE # fin L Se -3/ 9U
rE WELL CONSTRUCTION PERMIT# /`f (/.+C ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264035
VELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
4onitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IFOther, List Use
VELL LOCATION
leacesijTown:_
OUa Ji ! "re
PO 4,9-73
/2-L -1
Street Namembers, Community, Subdivision, Lot No., Zip Code)
W NER:
'.ddress /43 / / Ao.a-e,i J2� r� G
(Street or Route No.)
�C D—✓.� ('. e %/6
City or Town StateZip Code
)-
.rca code- Phone number
)ATE DRILLED //9 / -a 2
-OTAL DEPTH: G2435
)OES WELL REPLACE EXISTING WELL? YES 0 NO
TATIC WATER LEVEL Below Top of Casing: nib FT.
(Use "+" if Above Top of Casing)
'OP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
earlance In accordance with I5A NCAC 2C .0118.
'IELD (gpm): ! DO + METHOD OF TEST ca%rS
'ATER ZONES (depth): / 95 t
)ISINFECTION: Type
;ASING:
f�TH Amount St3
Depth Diameter
tom /) To %/o Ft. /n i/
rom To Ft.
rom To Ft.
;ROUT: Depth Material C Method
'rom 6 To .211) Ft. (24»a2 ---a73-)
'rom To Ft.
;CREEN: Depth • Diameter Slot Size Material
'rom To Ft. in. in.
'rom To Ft. in. in.
;AND/GRAVEL PACK:
Depth Size Material
Wall Thickness
or Weight/Ft. Material
f
'rom To Ft.
rom To Ft.
LEMARKS:
Topographic/Land setting z
❑Ridge ❑Slope ❑Valley LffIat
(check appropriate box)
Latitude/longitude of well location
degrecsnninutcs/seconds)
Latitude/longitude sourcc:OGPSOTopographic map
(check box)
DRILLING LOG
Form ati9n Description
h-daee
DEPTH
From To
A 76'
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.
.3J
HEREBY CERTIFY THAT THIc
iTRUCTION STANDAIWSJ AN
AS%ON R41C
Dt A'C F DANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD H�3 BEEOVMDED TO THE WELL OWNER
2 I cm'(7ie� /L ' a/ -e5 z
r
SIGNATURE OF PERSON CONSTRUCIING—HE WELL DATE
nit the original to the Division of Wa P16Nt JHPr666iiIl iter Sec ion, 1636 Mail Service Center - Raleigh, NC
)-1636 Phone No. [phone], wirtBvr,� hRtGIONAL OFFICE GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(ifappltcable)
264041
al Resources - Divisjon of Water Quality - Groundwater Section
rint) /Ja
D.Ht .C2f)C /
CERTIFICATION # aZ'>//E'
- PHONE # f/I„Sri In 5'9 `-3/ ''
41
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest T
County 0 /.dDOd.
r t%1 ,.P
(Street Name, Numbers, C mmunity, Subdiv fon, Lot No., Zip Code)
3. OWNER Q h.A�� / /J -i
Address //o /X ,O �_lNt�.. Al?
t /%(Street / tP--, No.)
City Town State Zip Code
(—)-
Area codc- Phone number
4 DATE DRILLED // -/5 -( 2
5: TOTAL DEPTH: , ' S2S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er"
7. STATIC WATER LEVEL Below Top of Casing: //)LD 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): / O METHOD OF TEST 62 Ars
10. WATER ZONES (depth): 3a Sr - in a p
11. DISINFECTION: Type // 77/ Amount 54-3
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
To /// Ft. ''
From
From To Ft.
From To Ft.
GROUT:
From n
From
14. SCREEN:
From • To Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Depth /,M+v_aterial
Tp (-2/0 Ft. reAlitrit
To Ft.
Depth Diameter Slot Size Material
Method
in. in.
in. in.
Ft. -
Ft
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Forma i Description
// 6,
//% r . «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.
16. REMARKS:
WI le
lt. G TPSICTIOIViST JDFUTD
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD IjA� BEEN PROVIDED TO THE WELL OWNER
NOV 2 1 Lk_
Submit the original to he Di
GROOR W4Tr110312 /OitY 9) 73?
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesA- Divi 'ion of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAMfJ//print) cR9-(1.[�2-f /2 -ALA/ /
WELL CONTRACTOR COMPANY NAMWZi OD.4+/ �i+-1 /[/-CG4 c/ Any), JAL..
STATE WELL CONSTRUCTION PERMIT# /5°D.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Ed'/Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Neares Town:/
L. County
(Street Name, Numbers, ommunity, Subdiivvii ..n, Lot No., Zip Code
3. OWNER: Y/te-dM/h49
Address 44/2 /1(247,0.7Z �, 42-d •
(Street r oute+byA�'
` iZ4V/9/SF/%7, We fl7g
city., Town State Zip Code
( )-
Area code- Phone number
4, DATE DRILLED // -3/ - 1).2
5. TOTAL DEPTH: 6/4Z
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f3
7, STATIC WATER LEVEL Below Top of Casing: 06 FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST & Arc
10. WATER ZONES (depth): 5/4 5 - 2O r
11. DISINFECTION: Type /-/ TN
12. CASING: -
Depth Diameter
From 7% To c. cf Ft. 4 l/
From To Ft.
From To Ft.
From
13. Depth Material
From f/ To /2i Ft. (tine M thod
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.
16. -REMARKS:
CERT AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
t~OITI(UC!OI+ISTY
iI'
Amount % 9
Wall Thickness
or Weight/Ft. Mgtej�
Size Material
264980
- Groundwater Section, /7
CERTIFICATION # ..DIY/ /D
PHONE # (Sit L i/g''3 1 tl0
Agricultural ❑
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Cdf1t
(check appropriate box)
Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
9 FormatioDessccyription
' 4'4'}/ S ' I nn.. 11
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.
Submit the original o the
,Z7699-1636Phone 1$1b. (919)
FkICE
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3D -OL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Set. ice Center - Raleigh, NC
33-3221, within 30 days. GW-t REV. 07/2001
../

( )-
Area code- Phone number
4. DATE DRILLED //1> - .2 62 -h Z
5. TOTAL DEPTH: 7.,/ -6- '
6. DOES WELL REPLACE EXISTING WELL? YES El NO ES/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. �j
9. YIELD (gpm): %` METHOD OF TEST I7tF4
10. WATER ZONES (depth): /p S 1 - 1 '/7 j f fr^
7 S- I - /' 'it lf>.,- LOCATION SKETCH
11. DISINFECTION: Type /-/77/ Amount j Show direction and distance in miles from at least
12. CASING: - Wall Thickness two State Roads or County Roads. Include the road
From /�
Depth //// Diameter or Weight/Ft. Mg terial
To 'inumbers and common road names.
� Ft. /� " Y)/�-
From To Ft.
From To Ft.
13. GROUT: Depth Material Met od
From /1) To �/) Ft. (O4-n. ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From . To Ft. in. in. r.i
From To Ft. in. in. ,J
15. SAND/GRAVEL PACK: q7
Topographic/Land setting
❑Ridge LSSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
264979
• WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ural nResources - Division.iaof /Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)-_ALn,: ! /C )JJ 2r-� n CERTIFICATION # 4 '//'
WELL CONTRACTOR COMPANY NAM F h41-k-e� //7 . /t/_1-CJ. CY i�//r y r,*-r-e- .PHONE # ( 717 . - 0/ rZr
STATE WELL CONSTRUCTION PERMIT# // Lam,- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
Cqunty 1/ dOe'r4
'tt-II '2_41 %29�-h. uric //-/s A
(Streei Namc, Numbe /&Communniity, Subdivision,(�Lot No., Zip Code) / ,,
3. OWNER: /CA./7--i { ,p71 l✓Nd>.�+/ - /�lO Lt/�-e/L J�`' (degrecsminutes/seconds)
Address /) /% /'S/''7-! .6-3/$ Latitudeilon_itude source:❑GPS❑Topographic nmp
(Street oRoute No.) (check box)
l( 24-f,Y-J4v,//4 7ja-6 ,287I6 DEPTH DRILLING LOG
City0Ir Town State Zip Code From To Forman n Description
41n ' 7zS' ,.,,.:F,
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
• Submit the origin Ito t
GROUNDWATER SECTI'
ASHEVILLE REGIONAL OFFICE
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECOR\L'` BEEN PROVIDED TO THE WELL OWNER
ILI/A s 3 i) —( Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001
4

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionio�of Water Quality - Groundwater Section
ha!Q�+-t /�1
WELL CONTRACTOR (INDIVIDUAL) NAME ( rint) 1a-1.G/2 # CERTIFICATION✓w4l/
/.DAdt /rJn4/ 'Pe PUW L ePHQ?,(rier/Y
/Y/ �
ONE#r- 3/7C'
WELL CONTRACTOR COMPANY NAME N-Pl+L
STATE WELL CONSTRUCTION PERMIT# /O 2 ASSOCIATED WQ PERMIT#
(if applicable) of applicable)
264964
1, WELL USE (Check Applicable Box): Residential fd - Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: . % 1/ County -,c.c • , > P
6/Z4rig // fS
(Street Name, Numbers, Co unity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address qLIY/7J
(Street or Route Not 2
(t61/, 8,
Ci or Town" State Zip Codc
Area code- Phone number ,� . z
4. DATE DRILLED /
5. TOTAL DEPTH: l0 7) S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12/
7, STATIC WATER LEVEL Below Top of Casing: /IS 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): v11% METHOD OF TEST
10. WATER ZONES (depth): �n ` - .2
Topographic/Land setting
❑Ridge 1215(ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeilongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description�/
n 37' (/LlN
.37' /L%$/ /1..A e%t.
11. DISINFECTION: Type
12. CASING:
From 7)
From To Ft.
From To Ft.
LOCATION SKETCH
/7" 77/ Amount / O % Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Ma erial numbers and common road names.
To 3% Ft. 7 i!
13. GROUT: Depth Material y
From O To 'V 0Ft. (5.. 1Jezl
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
Me hod
From
From
To Ft.
To Ft.
16..REMARKS:
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4 y-ccJ //- 3G -az
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sub ' 1 to t ' e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROUIiii611)i0d �t{� �• (9l�) 733-3221, within 30 days.
GW-I REV. 07/2001
ASHEVILi_RECw.D.
aJP

264963
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources DivisionJJr of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM print) /-2C.Le---t-/f/J-J/-0 CERTIFICATION #.25//g
,CD
WELL CONTRACTOR COMPANY NAME h.kkL 44.4)4 . /tit& J-a`^"`,„, a_...,'" PHONE # (USL- z,S -3/ 71
/ I-1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION./
Nearest Town: Yl/1.f r�PSI// E. County�g ,joa<L_
��d V M /c-r ,)) , & ef-i
(Street Name, Numbers, Community, Subdijision, Lot No., Zip Code)
3. OWNER: /i— ..�--f >`27/44_40
Address �� /Z20. P ern 2/1
yve(Street or(tiara N.) .e r/7e/
rJ��%%tc ,SL/i f '/ / d �P
City Town State Zip Code
Area code- Phone number
4. DATE DRILLED /O - ,22
5. TOTAL DEPTH: .5o5
6. DOES WELL REPLACE EXISTING WELL? YES 1D NO IB'
7. STATIC WATER LEVEL Below Top of Casing: 4 n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. n
9. YIELD (gpm): / 2 METHOD OF TEST
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Clat
(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
/) 7/ n�`/[
77 s .. lJ zJ" ' A r✓n PAC U
10. WATER ZONES (depth): . 3 85 ' - / 2 g,Dr'r'n
11. DISINFECTION: Type /-FT/') Amount Y /
- Wall Thickness
Depth , / Diameter or Weight/Ft. Material
To %'Y' Ft. /o y' gM..
12. CASING:
From /%
From To Ft.
From To Ft.
13. GROUT: Depth
From To ,i Ft.
Material Method
('A-n2� t /7t7
From To Ft.
14. SCREEN: Depth Diameter
From . To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Et.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
_,s t[DO j{ER>Y CER
Ic NSTRUETION STAN1�
L, r Y-2)
I.
Submit the original to th
27499H116}6J'¢RpeoFl
AC«( E rt 6'G,3 HI
_/
.{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
Divi
733-3
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
lion of Water Quality, Groundwater Section, 1634 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001
w4

264962
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .0 %r I�J/7-/>-�'e--� CERTIFICATION#3G/!/
Xt1 Q /,zip"3/-7e)
�J et v:. PHONE # (8
WELL CONTRACTOR COhIPANY NAME h 1 P �., c. Y'1h-+'a // J/O/. 'Z`"'�'r
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# / 5/7) aZ
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use.
2. WELL LOCATION:
Nearest T wn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County 4?y
3. OWNER:
Address
(Street
r Route No.)
City oState
//37
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 24 5 /
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Et
Topograyhic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Laiitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
//9 X5 . (1l2r« t
7. STATIC WATER LEVEL Below Top of Casing: 47) 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): 6/D METHOD OF TEST c2 11.4
10. WATER ZONES (depth): & I/5' - -14 5
11. DISINFECTION: Type H. H Amount 19
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Materiaal
From 7) To 8S Ft. 6 // /
From To Ft.
From To Ft.
13. GROUT: Depth /,MP4'aterial Method
From O To .A () Ft. ! x-2-, i/'-p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
16..REMARKS:
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 Pn FmRFRY CFRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
�� r`-CONSTk1G'ION STr , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t1 i //_ 3n ,L- z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L Submit the original to a vision of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
w�on_t F36 Phone No. ( 19) 7 -3221, within 30 days. GW-I REV. 07/2001
or -Al
rRUUNi rpsF:CIGiAI

264961
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Div/isio/�%q of Water Quality - Groundwater Section
�
WELL CONTRACTOR (INDIVIDUAL) NAM print) f� re-int (�/4.!'*�✓ CERTIFICATION #,±i zi/9
/
WELL CONTRACTOR COMPANY NAME A PLA1-/ /� /Li)fol 7 l'-«4-.', \,lit-!" PHONE # fiti'-�A'( / yS��3/�U
STATE WELL CONSTRUCTION PERMIT# /4 - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential sr' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name, Nu
3. OWNER:
Address
/1
4
C or Town State Zip Cale
/ 1No.,
s, Community, Subdivisidn, Lot t Zip Code)
(Strec3 ot. Route No.)
6 2 g 7 (s p/
O2.e),//a/ U
(—)-
Area code- Phone number
4. DATE DRILLED /E) - 23 -p 2-
5. TOTAL DEPTH: //RS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E-1"
7. STATIC WATER LEVEL Below Top of Casing: /o/0 FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /2 METHOD OF TEST ) iif 5
¥z)t
10. WATER ZONES (depth): ' - 7' ' i7 ' i/A y m
c(
l
Topographic/Land setting
❑Ridge ❑Slope ❑Valley LHf let
(check appropriate box)
Latitude/longitude of well location
( degrees, m inutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For/m�ation Description
24-4-1
�.M tit,.'-•
11—,
DEPTI-I
From To
J .2
2' //Ss'
11. DISINFECTION: Type f-/ 7-2/
12. CASING: -
Depth Diameter
From 7) To - _ Q Ft. /A u
From To Ft.
From To Ft.
13. GROUT: Depth Material te(hod
From A To '21) Ft. (4DmO4x t z
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 /C) 7
Wall Thickness
or Weight/Ft. Material
PVC,
16. REMARKS:
LOCATION SKETCH
Show direction and distance in mites from at least
two State Roads or County Roads. Include the road
numbers and common road names.
LPO,-titRb Y;ChKtlt
11
{CONSTRI. Tt(DN
'�1 iL1;1
I iIt_ - HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
IM) AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
`Submit the original to t e Div
t0.9P11(63krilPlIfIP.olk'-t,,I ) 733-
_ 1 r ''0' 1A"ICE
//- 3tt - U1.
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
lion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001
.-a

264960
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME rint) A_Ail A-4L - 4e -t--- / CERTIFICATION #'3b`!/
WELL CONTRACTOR COMPANY NAME A-P-6.4,L'/78A.t=-n. /L/iJL Q' /'t+-..yn 6.1/u PHONE # fg2H 7 3/7�
STATE WELL CONSTRUCTION PERMIT# /4/D a ASSOCIATED WO PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential CMunicipaliPublic ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(if applicable)
2. WELL LOCATION: `�
Nearest Town: »z I / County /7a2J/Jl0ed
- /UCLA
(Street Name, Numbers, Community, Subdivision,, Lot No., Zip Code)
3. OWNER:
Address
44111;
4//Y .i.4a.
(Street ory.oute No.)
x/!u// // y2G
Ciry'✓or Town State Zip
Code
( )-
Area code- Phone number
4. DATE DRILLED /0 - /-)
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I'
7. STATIC WATER LEVEL Below Top of Casing: 1-4) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118. p
'9. YIELD (gpm): ,2/9 METHOD OF TEST
10. WATER ZONES (depth): //> / -
11. DISINFECTION: Type /-/ rH'
12. CASING: -
Depth
From f) To .S/ Ft.
From To Ft.
From To Ft.
Diameter
� //
Amount
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material ycthod
From D To V Ft. (Pi✓ra-ti Ct 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.
CONSTRUCTION ST
�Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutcsiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
?i)S'
!'e �7
JGGC1-
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 I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
// - 3 n - v C
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r 1,0 tti 440jgto the Division of Water Quality, Groundwater Section, 163ti Mail Service Center - Raleigh, NC
Ab 4uix did k xkEreto, 733 3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 264957
North Carolina - Department of Environment and Natural Resources - Division/ofAWater Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAM��1tE//(print) J/Q_f.l.vl. // D .l' -u A CERTIFICATION #.%�/r�
WELL CONTRACTOR COMPANY NAMPNA De+. , //L)-ts4-. ,/.Oft a /-rro 4.-e.- PHONE # IS.�g L 4Ifi -'3/ 7o
STATE WELL CONSTRUCTION PERMIT# /'T/}Z ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1'. WELL USE (Check Applicable Box): Residential [9"---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION; y�
Nearest T w < �L<-} County sWa pi.YYs
�Jn
(Street Name, Number( Community, Subdivision, Lot No., Zip Code)
3. OWNER: W/i// ,1-1y1--
Address 47 9
___.(Street or Route No.) `
City or Town 2State Zip
Area code- Phone number 9G1 fP
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Itlat
(check appropriate box)
Latitude/longitude of well location
C�cLA.IK[.f
Ih J.Ed, -. .
787/�0
Codc
4. DATE DRILLED /D ' 8' - 4 2
5. TOTAL DEPTH: / 8S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L37
7. STATIC WATER LEVEL Below Top of Casing: Q2C> 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): .2r METHOD OF TEST
10. WATERZONES(depth): //0 5' - .21) rpm
11. DISINFECTION: Type
12. CASING:
Depth
From L) To 4/5
From To
From To
13. GROUT: Depth
From /) To �C)
ff7-H Amount 1
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G '/ PVC
Ft.
Ft.
Ft.
Material Me hod
C�Dilvtl..rs-(
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:
(degrees; minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTI! DRILLING LOG
From To Formation Description
V ' /kJ '
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.
q)
DO HEREIlctly GER idre THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
COSSTRU_ eFlOMS, r i ' DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y,� ? II. %ems C)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
// - 3 L% - .z.
Submit the origins to th• Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GEO 10(4411/1 lio. (919
ASHE iILLE REC.giNAL OFFICE
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural7Resources - Division of/ Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /�finr nJt�t,. /4/J-- I� CERTIFICATION # �Zi)S
> 4 l.tw /64,a 2l'io �� V 1i �.,y •t.P HONE # (LeL y�_ 5 / 71%
/4221) -2—_____ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
264956
1. WELL USE (Check Applicable Box): Residential I"Municipal/Public 0 Industrial 0 Agricultural 0
• Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : s�/
Nearest Town: County f-YQCJonc
ea2 Ham!
(Street Name, Numbers, Community, Subdivision,b/Lot No.. Zip Code)
3. OWNER: t/ZLG / z' Y �9�9-ti
Address G, / �+�.iyr $Mt . ( -
Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /n - 7 -/>.2
Topographic/Land setting
❑Ridge ESIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutasiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To FormationpDescription
' /C)/)S .2 1A1?--nvd tJ
5. TOTAL DEPTH: //)/-0"'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Oil
7. STATIC WATER LEVEL Below Top of Casing: /G/) 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 accordaneeith ISA NCAC 2C .0118.
9'. YIELD (gpm): METHOD OF TEST g A rS
10. WATER ZONES (depth): 4 Rs / - �/.2 pm
J
11. DISINFECTION: Type Al 'TH Amount /541
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
• From /2 To .59 Ft. r/n 1a P6JL.'
From To Ft.
From To Ft,
13. GROUT: Depth Material ethod
From D To &[ Ft. LP.-vn elt ``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.
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:
IDO EREB' ICFj,RTI AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITFI 15A NCAC 2C, WELL
DL _CON !-SF,h DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II' '.t— SIGNATURE OF PERSON CONSTRUCTING TN WELL
u it
b_SArnitLtha.unMnal-10 the ivision of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
$700 636Plich 'p( 919) 33-3221, within 30 days. GW-I REV.07/2001
// - 3b -(-)
DATE
-J

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural//Resources - Division
/of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) /-�/) h / / �-1 �Fi%J L9 CERTIFICATION # d ///g
WELL CONTRACTOR COMPANY NAME 71 /3/1/o', LL'V,// '/- PithySnC.PHONE # LV�1S/ �z/4 `3I 70
�4/ - ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
1, WELL USE(Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
264955
2. WELL LOCATION:
Nea Town: `17 County
j/72 tSrw L 77E7
(Street Name, Num rs, Community, Subdivision, Lot No., Zip Code)
`t(},_-/t( /,/ rt5 /ej
(S reet or Route No.)
City or Town Stfe Zip Code
Area code- Phone number
4. DATE DRILLED /eO -3-4
3. OWNER:
Address
5. TOTAL DEPTH: /515
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ng-
7. STATIC WATER LEVEL Below Top of Casing: �n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance in accordangce with 15A NCAC 2C .0118. p
9. YIELD (gpm): 7/9/5 METHOD OF TEST 'k
10. WATER ZONES (depth): %a5'- /.S`(pprn
/ N 5 ' -
11. DISINFECTION: Type //r// Amount /g
12. CASING: - Wall Thickness
Depth - Diameter or Weight/Ft. Material numbers and common road names.
From /0 To �� Ft. /n // c e e L
From To Ft.
From To Ft.
13. GROUT: Depth .Material Method
From C) To ,V) Ft. 7 2.-11-J
From To Ft.
14. SCREEN: Depth !Diameter Slot Size Material
From .To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
Midge ❑Slope ❑Valley Elat
(check appropriate box)
Latitude/longitude of well location
)degrees.minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH (cheek
LOG
From To , Fontion Description
j/`rn
cid ' /'/_s ' V
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
)
w
16. REMARKS:
CONSTRUCTION STAND
{I
1
t
ubmit the original to th Division of Water Quality, Groundwater Section, 1630 Mail Sersice Center- Raleigh, NC
6-11ane-N 733-3121, within 30 days. GW-I REV. 07/2001
F 1 ,-i L ; RSE
i1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEENJ2RQVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL
// - _! Z.
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
-- Diviisss''on of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_//,��JYII-I 4-/71 C �.J,,r�Ja L'.� CERTIFICATION # 36111
WELL CONTRACTOR COMPANY NAME Prep -!LP S 0 . /VE. I 11 RI rnfi, 'nt, PHONE. # t gag ( 4'? -3/7n
STATE WELL CONSTRUCTION PERMIT# / 5//) 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264954
1. WELL USE (Check Applicable Box): Residential TY Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCAT�II//O��Nj:� /
Nearest Town: .. i e. County1/7/1)nap
(Street Name, Numbers, Community, Subdivision,d/Lot No., Zip Code)
be
3. OWNER: ( ./f/S ///f //fie -
Address 35.3 »/!-/e; P I/ u % / n ,
(Street or Route
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /D
5. TOTAL DEPTH: 3b5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
7. STATIC WATER LEVEL Below Top of Casing: /n /) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT, Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): on METHOD OF TEST a ACTS .
10. WATER ZONES (depth): ' - /Ls 5-
11. DISINFECTION: Type %-/ 7/Y
12, CASING:
Depth Diameter
From /) To h 9 Ft. ao //
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From 1) To .�» Ft. (&-r .i- /Cin
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
Amount `/2
Wall Thickness
or Weight/Ft. Material
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
Ft.
Ft.
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrcex minutes/seconds)
Latitude/longitude sauce:OGPSOTopographic map
(cheek box)
DRILLING LOG
Formasin Description
DEPTH
From To
59
Se) ' ql)61
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:
cd(`isTRUC1?Iowi ST{ANC}
I
I Submit the original to he Di
Z r9.9-16,161'htSnc Y)ro,f9 9) 732
L` , , i?L ;,EFIGE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS ROVIDED TO THE WELL OWNER
-3n -6z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 163ti Mail Service Center- Raleigh, NC
3221, within 30 days. GW-I REV.072001
wJ

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) G r CERTIFICATIONr# 2.23J�
L9' . Le)e t--.lm5 PHONE # (S 2-W L 'd-g
WELL CONTRACTOR COMPANY NAME ✓ e -P /I'/L/L .JY o 5 �1
STATE WELL CONSTRUCTION PERMIT# / D ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
261141
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: k
Nearest/Town: Cam-.t.p,-., County
/tl Dr mLO-ai
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
1 `t-tA orju4. ��D
�C\J
.5 revs
D/net CLAN.,
rfAA
(Street or Route
l—�•-a
Cityor Town
State
(—)-
Area code- Phone number
4. DATE DRILLED 9 - .q t - D
5. TOTAL DEPTH: .3-0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11.
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 with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST
10. WATER ZONES (depth): `i S
3. OWNER:
Address
GROUNDWATER SECTIS11
ASHEVILLE REGIONAL OFFICE
g1/(6
Zip Code
11. DISINFECTION: Type H TL-I
12. CASING:
Depth I Diameter
From D To a Li- Ft. b" PVC,
From To Ft.
From To Ft.
13. GROUT: Depth Material I Method
From b To 0li Ft. CS2s, i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Amount 90
Wall Thickness
or Weight/Ft. Material
Top aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrccs ininureshcconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 �
a t .C(
ahrs.
c w 1
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
O
17)
--11
w
0
+V
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECOfjA-I4 AS UEEN PROVIDED TO THE WELL OWNER
-5e -62
Submit the on na ti
No. (
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail tier%lee Center - Raleigh, NC
19) 733-3221, within 30 days. GW-I REV. 07/200I

256898
WELL CONSTRUCTION RECORD
North Carolina - I)eparuncul of Environment and 'Natatural /Resources - Division of Water Quality - Groundwater Section
\YELL CON,RACTDIt (INDIVIDUAL) NJ%ME print) /jr,)^ f%4 l7i1 ,e CERTIFICATION ,�t# 02441
�p�)
WELT. CONI I4.\CIOR C(,.\l i'ANY NAME /Y[e kvego-I Vy t'RONE # We/ &27g6-9
STATE WELL CONS.' RUCTION I'ERdl IT# ASSOCIATED NET) I'EIt\t IT#
l ifahplicablc) ( ifapplicablc)
I. \\'IiLI. IJSE (Check Applicable Box): Residential MunicipaUfublic ❑ Industrial ❑ Agricultural ❑
Nlonilorine ❑ Recovery 0 I lcat Pump Wafer Injection ❑ Other ❑ If Other, I.ist Use
2. WELL LOCATION:
Neal est
County*free Y
111rcc1 Nan+c. Nuwbcr> (Mn1). Subdivision, Lot Nu_ Zip Code)
3. OWNER: /-"li7nfLeri dabyle%
Address ' 2 .</e�j,1oNe / l
l SIIC'I or Itnulc Nn.)
i/e5u, e—I11� cSnee
C ty or I own State Zip (tle
( )-
Area curie- ('hone number
4. DATE DRILLED 7 a73'6-Z
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO 19'
7. STATIC WATER LEVEL I3clow Top oltasing: S� FT.
( Use "+" if Above lop or Casing)
8. TOP OF CASING IS a FT. Above Land Surface*
'Tun or casing terminated at/or below land surface requires a
variance in accordant •• s 1h U:\ NCAC 2C .0118.
9. YIELD (pm):7r MliTI l0D OF TEST A,C--
10. WATER ZONES (depth):
I I. DISINFECTION: Type // / , Amount
12. CASING: AV;dI Thickness
Depth DI}lcr tic Wei
From �� o ryFI.%J,rI_cen,ll
From To Ft.'
Front To P1.
13, GROUT: Depth eel"
Nlethud
Proph, Q To ao Ft. el"
Ftom To Pt.
14. SCREI.N: Dcptll Diaiuc er
From To
From To
15. SAN D/(1R,AVIII. PACK:
Ucplh
From To
From To PI.
Topographic/Land setting
Nt1i(idge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/Iongitude of well location
l dagreesfminules/seconds)
Latitude/longitude source:❑G PS❑Topoeraphic neap
(cheek box)
DRILLING LOG
-n:diet Description
DEPTH
Prom To
ACV
Slot Size
in
), in
Sizc Material
tvlalcrial
LOCATION SY:Iiftli
Show direction and distance in miles from al least
two Slalc Roads or Counly Rends. Iueludc the road
numbers and common road manes.
i1yo
16. REMARKS:
1 1)O 11
I:Izv Ca) rll,Y T..11��f TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)1-11.11)1I-AI )AiKl3i ANI) THAT A COPY OF THIS ., RECORD IIAS I3EILN PROVIDED TO TT IE WELL OWNER
-23-L7�
NJo v'
i IGNrATUItE OF —n7()7RUCTING THE WELL DATE
Submit the original to tl • Div sion of \\'tiler Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
)7600 16.14'''- oc No. (91' 733 221, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

249232
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s$Y t� Oat
Y'fap—t i_. ,t CERTIFICCAATTIIOON# -3D`�"i �D
WELL CONTRACTOR COMPANY NAME Grts�.R t -1 i / u...Af) 4 PHONEN(Y.fm L��8-
STATE WELL CONSTRUCTION PERMIT# /41°a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential"Municipak'Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest_,Town.
(Street Nam d umbers, Cotnmunity, hSubdivision, Lot No
o0 is (tin nc�
Address to q 0 Qc a C u a-1 N'+s
(Street or Ro No.)
II11 Malt/ iIt No_ a8'12G
City Town State Zip Cade
( )-
Area code- Phonc number I�
4. DATE DRILLED I ' '
<2 ` - -C)
5. TOTAL DEPTH: `(/,_`J '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fir-
7. STATIC WATER LEVEL Below Top of Casing: c2 00 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): 5. 5 METHOD OF TEST a I, rs
10. WATER ZONES (depth): to Do' 5-.5 ptr
11. DISINFECTION: Type ki -r t \ Amount 15 R
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From or) To 43 Ft. L.0 'I P� �
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To a O Ft. C Lvxt... �- it P
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Material
Fro
Fro
16. RE
I DO HE
CONSTR
ERTIFY THAT THIS WELL VAS
AC
I.- I Nh._ OFFICE
Topographic/Land setting
❑Ridge XISlope ❑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
p 43'
4-/3 R45'
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.
=off
N n..
.. m,N
PA)
1 o
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF ECORD HAS BEEN PROVIDED TO THE WELL OWNER
-02
SIGNATURE OF PERSO'1t ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail San ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

North Cnroflnn - bopartmonl of Environment and Natural Flesources - Division of Water Oueth y • Oroundwnlnr Suction 2 6 8 3 7 5
163e Mall Service Center - Raleigh, N.O. 27699-1638-Phone [phone] }��} , (
WELL CONSTRUCTION RECORD WELLCONTRACTOR' • Bo hint, IAJ. P& +s
WELL CONTRACTOR CERTIFICATION A: y'j,� Q L /
STATE WELL CONSTRUCTION PEFtmiTR: 7r (%fQN
WELL USE (check Applic§ble Box): Residential Llo Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery r1 Heal Pump Water Infection ❑ Other l If Other, List Use:
2, WELL LOCATION: (ioyv skel Ir~ 1 0l the location below)
Nearest Town: - ( �� �� County
Ste'^�
(nand Name and mbar', Coinriunlly,�Subdivision and Lot NO
3. OWNER
Address
e a et I el' -.Mid'
or Town / 1 Stale Zip Code
4. DATE DRILLED &.- a aQa,
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI 1 NO{V
7, DOES WELL REPLACE EXISTING WELL? YES Q NO tf
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use'+' it Abovo Top of Casino)
9. TOP OF CASING IS 1 FT. Abovo Land Surface
'Top of casing lei mineled eVor below bad surface require§ R voidance In accor-
dance with 15A NCAC 2C .911
10. YIELD (gpm): (np. METFIOD OF TEST Q
11. WATER ZONES (doplh): j
t
1' 'HLORINATION: Type _.T H Amount } f (t, If additional space Is needed use hack of form
1 :....;ASING:
DRILLING LOG
From To
D - ry
DEPTH
FomisOon Dnscdpllan
RA -
Wall TI Ickness
Depth
glametof fag. M� mortal
Front 10 To a 7 FL 6aff5 '�--�g�-S'j
From To Ft
14. GROUT:
Front I o 11.
'2
ea./
Depth Material Method ,
From D To �FI �h�friE r�U �f�.
Frorn To Ft
15. SCREEN:
Depth Diameter Slot Slzo Material
From To - Ft In In
From To Ft In In.
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
To FI
From
17. REMARKS:
I DO FIEREI3
CONSTRUC
F 1 OFFICE
Iuuad No:
Sedal No.
LOCATION SKETCH
(Show direction and distance from nl least Iwo Stale
Roods, or other map reference points)
J46244,AdvAJ
eyte306-
IT;
0
ci
Iir ToATTI,II3W WAS.
T'(tDA.RDS._)AN�IQ T'':IyAT. C
LONLY
Submit o
TRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
['THIS RECORD HAS BEEN PROVIDED TO TI WELL OWNER.
2
NATURE OF PE SON CONSTRUCTING TIIE WELL DATE
Division of Water Duality, Groundwater section within 30 days
GW.i REV. 12/99

WELL CONSTRUCTION RECORD 252630
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDI\'IDUAL)NAME (print) 3 •O• f) QC ,re i CERTIFICATION #aIgip
wrl�
\\ ELL CONTancroRCONIPANVN'.a�tef�AAfCSreene�'jro5. p e€l�� PHONE # (in &Sty 5556
STATE. WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
• (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ``
Nearest Town: V+.�t....Y tJ csv fl C County tY4ytt7et
S' osne �rr'n1S br
(Street Name. Number, Community. Subdivision, Lot No., Zip Code)
3. OWNER: %V
Adorers act it Legs ectoota Rc9
(Street or Route No.)
(`c\t.g8:e \la\\Ot a Tr7 5I
Cm' or own State Zip Code
(8.nri Lk`at-ti(P59
Area code- Phone number \\
4. DATE DRILLEDmC\.Cc�r\ � 02
5. TOTAL DEPTH: 2a ri —/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO UK
7. STATIC WATER LEVEL Below Top of Casing: HD FT.
(Use `+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 b METHOD OF TEST G. i r'
O. WATER ZONES (depth): I to 0
11. DISINFECTION: Type t T k* Amount 3 9 e I ttg
12. CASING: Wall Thickness
Depth Diar1etcr or(�Weinht.Ft. Nlaterial
From 0 To a7 Ft. G. tk PVL
From To Ft.
Front To Ft.
13. GROUT.... Depth Material
From 0/ To AC) Ft. Cee'(rNPA%jr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
014 REP 1'FYT
...)!CONSTRUCTION STAND.,
Nlethod
Top
Slot Size Nlaterial (� r
in. 5-1/4araa root% SJ C
n. 0
0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Bflat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For ation Description
^ 02 7 141/41
a — /L o c2 Cats) ,+e
Ibo - L. a co,.LN i
il,a aa5
r2�rcr3t'4C-
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.
Mood -CQ.e
/•cr Reif
cf cT IV r.\ C`\L D R 6
l>_)O took RC9
Size Nlaterial 7.
cm
:cm
zSm
So
m�
cs nt
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL" cm'ax1
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OgNER�
x -
�.9 • -- c Cur -. VA- cY
GN'ATURE OF PERSON CON?FRCCTING THE WELL DATE
-u ilttll rlre Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
A.0499t;6 0);0ttlleu�°C�(_A0733-3221,within30dars. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 232629
North Carolina - Deparunent of Environment and Natural
Resources
WELL
s
WELL CONTRACTOR (INDIVIDUAL) NAME (print)T D. f__I .
WELL CONTRACTOR COMPANY NAME
Ale
- Division o
f Water Quality - Groundwater Section
rrCERTIFICATION#di0
6,
el
9ul PHONE # (T1S SBto 555t)
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential C7 blunicipal'Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley nffaT
(check appropriate box)
Latitude/longitude of well location
3 (degrees/minutes seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MG. ie_ \-.) ct\ \ em NC_ Qc--)61 DEPTH DRILLING LOG
City or ijown State I Zip Code From To Formation Description
(fry) Sate -43aD O - 5� C\o.`
Area code- Phone number \
4. DATE DRILLED Mo\t•czN %-) aooa
5. TOTAL DEPTH: 5 5-n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lir-
7. STATIC WATER LEVEL Below Top of Casing: 5-6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*'fop of casing terminated at/or below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (epm): 3 METHOD OF TEST QCv r
10. \VATER ZONES (depth): I-9.Se) G\ - SoO
11.
12.
WELL LOCATION: ,1`
Nearest Town: \4 c' V4Uexi County j'tttyp.n4
Srr`c" ( Fn\\ V'tive
(Street Name, Nu fibers, Community, Subdivision, Lot No., Zip Code)
OWNER: m,c \ S'r S3oc&
Address O. cX 11-3I
DISINFECTION: Type V4-T H Amount /5?:il.
CASING: Wall Thickness
Depth Diar eter orAAVeieht'Ft. Material
To_5 1 Ft. (e pth
To Ft.
From
From
From To Ft
13. GROUT: Depth 0 tMaterial
From h To �0 Ft. E,cneto t'
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND'GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
C Obi`: $ T RU C"l I O N ;S T 1SN
Method
Slot Size Material
in.
in.
Material
&a- ago yak); se
afro -asa LtLoc-1 •-\
a8a-5co aJrQKD
5co- sow e _0;�
5oa-55o frcu..);it
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
HlV \ -1
Sit, o1<1 rDI-;0t„
tk.c.Acve etc r1
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I
it —3 O- Ic
t C„ni
1 i l SIGNATURE OF PERSON CONST#CUCTING THE WELL
Submit the original t`o`'�� the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, INC
ici �,699 }4k636Phoncilmad 19) 73
ASH, );Li
'E rI.- � c3:,
r, i:G
— lLl-ta
DATE
-3221, within 30 days. G\\'-1 REV. 07/2001
0
0
n
%n
Cn
z crrl
*
Tm
Dcp
-
rn
mo
cn
ry1
n
y
G

Amount 16oz
Wall Thickness
or Weight/Ft. Material
.188 steal
Method
2509G8
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre es'mi nutes'seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 40' clay & sand
40' 375' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ft.j-enoni to & rement ramped
Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
2043
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION N
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE #[phone]C91
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PER\IIT4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$? MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Haywood
Nearest Town: Clyde County
1293 Upper Crabtree Rrl
(Stint Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Buddy Melton
Address 1293 TIppar rraht-rea Rd
(Street or Route No.)
Clyde, NC 28721
City or Town State Zip Code
( 82 - 627-3988
Area code- Phone number
March 29, 2002
4. DATE DRILLED
5. TOTAL DEPTH. 375'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated atlor below land surface requires s
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 70' & 340'
11. DISINFECTION: Type HTH
12. CASING:
Depth Diameter
From 0 To 42
From To Ft.
From_ To Ft.
13. GROUT: Depth Material
From 0 To 42
From To
14. SCREEN: Depth
eter
in.
��..w,f'EP cFGlION
VILL`e REtIGE
.... _ - FYGIONAL THAT OFTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFTHISRECORD HAS BEEN PROVIDED TO TEE WELL OWNER
yll sT`���0 .1fl. aCA 3/a2 9/o-2-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days, GW-1 REV. 07/2001
Slot Size Material.
in.
in.
Material
•n]

26136 7
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR- a,-d
WELL CONTRACTOR CERTIFICATION #: 317
ar
Mw-is
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) 11 1
Nearest Town: Lt./R-� r-�S V'r I it/ Count IV A-u woad
(Road Name ar Numbers, Community, or Subdivision nd Lot Na.)
3. OWNER T �d�TJ�LJL)ODdCl .0-r-. 'J t,
Address cs% ei'eC LM�s•
(Street o/ Route No.)
-,Lt/A01-° ti z? 12-t
City or Town 1 State Zip Code
4. DATE DRILLED 911 °/en
5. TOTAL DEPTH a I ' I b r'
6. CUTTINGS COLLECTED YES ® NO(]
7. DOES WELL REPLACE EXISTING WELL? YES I NO
DRILLING LOG
From To
S-,
Jo-/5
tS-'1-o
8. STATIC WATER LEVEL Below Top of Casing: I-- % 4 ., FT.
(Use •i it Above Top of Casing)
9. TOP OF CASING IS 3 FT Above Land Surface'
Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011e
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth) 6•14' - IZ 6 5
25- - -i
12. CHLORINATION: Type Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From`t' 3 To 6•I5 Ft -n" Sc.k Lk> pvc
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From O To If -SS Ft 7*'*L Pr.-L rAnti T i7.
From To Ft
15. SCREEN:
Depth
From •O)• 10 To 6•I b
From To
From To
16. SAND/GRA1k�EL PACS Ea
-7b•121 Depth
Ft
Ft
Ft
Diameter Sot Size Material
in AIb in Pvc-
in in
in in
From OH ° To 6 FI
From To Ft
17. REMARKS:c33c 4 - % b. fc of- y-• �S
$ize Material
f# �- 5
Monitoring
DEPTH
Formation Description
lSa ai•
we 8
brow ,-) l,.�a. w�i Rath
?I•t'oc..1c Peal e s
CA-
131°0 Cdc•
1-. I...cew.
fLui 'nit -
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at (east two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIR RD HAS BEEN PROVIDED TO THE WELL OWNS
SIGNATURE OF PERSON CONSTRUCTING THE WELL OATS
Submit (anginal to Division of Water Oualily, Groundwater Section within 30 days
GMI REV. 12/99
FOR OFFICE USE ONLY
Ouad No.
Serial No.
o
GA

North
Carolina
na•Dpare ol nlonmen dDaiwa!
fieurco-vsion of Water Duality • Ground noon Secton
l laI lerPalev69e1a9 i
WELL CONSTRUCTION RECORD wELLCOIT111AClon' iV/c/� -
WELL CONTIIACTon CERTIrICATION B: o2`fD3
STATE WELL CONSTRUCTION PEn1AIIP:
262385
1. WELL USE (Check Applicable Box): Residential f 1UnIclpal ❑ Industrial ❑ Agrlculwral ❑ Monitoring ❑
hecovery ❑ Heal Pump Water bilecllon ❑ Oilier [I II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) / y` JQD d/
Nearest Town: h2yMJu2/ CountY • lY
CsMv Cp_aL /I
',load Dime and numbers. ConvounIty. or Subdivision nod Lot llo.)
3. OWNER 4 },ne AC e_
Address C/ff^,l / Coat) PO P,ak 5�4TL
Sli"eOToT T1oula 1to.
Cr r012& Pam_ arll�
City or Town Slate 2Ip Code
4. DATE DRILLED /-/S'dL•
5. TOTAL DEPIII 2Qr0
6. CUTTINGS COLLECTED YFS fl NOLJ— _
7. DOES WELL REPLACE EXISTING WELL? YES I 110g -
B. STAIIC WATER LEVEL Below Top of Casing: 5 p '- rT.
L (Use •s• 11 Above Top of Casing)
9. TOP OF CASING IS / v FT. Above Land SWlaco'
-Top of casing ierndnaled .Vor below land audace requites a variance In accor-
dance with 15A IICAC 2C .011E
10. YIELD (gpm)• /L METHOD OF TEST A/-
11. WATER ZONES (depth): het
D11ILLING LUG
From lo
/7_ 6r
l' r g4D'
12. CHLORINATION: Typo J/7
Anounl
DEP111
ronrjlr oescripiin
cA
, At
II additional space 1s nceerl r_-s^ back of Ivrn
13. CASING: nlWall en LOCAL ION SFCcI CH
eight
Depth Dlaolur or WelghVrt. Malarial (Show direction end ds:anca ban al In as! !pro Stele
b To $4 FI. ' '�r .(0/0/ Bonds. or other rr�r
7 Ieler ce points)
From ra
Flom lo F1
From 10 FI
73
_1
14. GROW: —I
I
Depth a °�/°�lal/
t
From to pj tc(774/ ,0
p
From 10 FI.
15. SCREEN: 0
Depth Dlanielor Slot Size Malodal ea
Flom To r1 In.
hi o)
From _ To FI. In. In
Fron, To FI In. In
16. SAND/GRAVEL PACK:
From
From
17. REMAR
rt.
Matoilal
I DO IIEPEbY cIEUIIFY MAT 11119 WELL�N7A9 '011s1 FIUCIED I l Accono LICE withi5A flcnc r. ytEu
Cousin JC1I d STANDAUDS AHD 111A A COPY OF IIS f1ECOUr I1AS BEEII PnOVICED 1O111E Y1_t1 on\EF..
_ �S�iQ,L uE r
FOrt OFFI?E USEitVILhI FEa' hi I r
Ouadllo: SIGNAL E ar PEn9011 C0tStt11Y:1IN0 r>t WELL
Subndl original to ()hellion opener ouellly Oroand«alai Seen wade !0 r2 YE
-0 -
0a T E
CFI.] EIE
L11
Seflal Ilo.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION #2809
WELL CONTRACTOR COMPANY NAME D Rnwman WP11 Dri 111ngr Tnr PHONE # 82A 9' 7-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
256154
1. WELL USE (Check Applicable Box): Residential I$ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATION:
Nearest Town: HendersonviltMunty Henderson
17 Bittersweet Knoll Lot #2 28792
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Ronnie Ruff
Address 17 Bittersweet Drive
(Street or Route No.)
Hendersonville, NC 28792
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 6/27/02
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IF
7. STATIC WATER LEVEL Below Top of Casing: 6 0 Fr.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 3 ,M ETq QDOFTEST-rotary air
10. WATER ZONES (depth): 240
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11 DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 25 Ft.f1 /8 SchRA PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
Material Method
Ft concrete gravity flow
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.
Jr111
O
tD
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r•--\ r_
rRlnlca. �P ! Z7 /o
I SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LLLL'. Submit the original to theh4iv slon of Water Qualit?, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
... 27699-1636 Phone No. (919) - 221, within 30 days. GW-1 REV. 07/2001
•
i
GROUNDVIATE
AShEd .E Rrr
SECTION
hid_ OFFICE

256153
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION 2809
WELL CONTRACTOR COMPANY NAME D _Bnwmarl WP1 1 Dr i 1 1 i ng Tnr• PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Dt Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonvill@ounty Henderson
Bear Rock Road, Lot #2-Section 2 28792
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER Jason & Stacie Souther
Address Rt. 19, Box 98 #2
(Street or Route No.)
Hendersonville NC 28792
City or Town State
( )-
Area code- Phone number
Zip Code
4. DATE DRILLED 6/ 2 5/ 0 2
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: 240'
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 4 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST'- rotary air
10. WATER ZONES (depth): 200'
I1. DISINFECTION: Type tablet Amount 6
12. CASING:
Wall Thickness
Depth Diameter or��Weight/Ft. Material
From 0 To 67 Ft.f1 /8 Sch_$D Pvr•
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
G
13. GROUT: Depth Material Method
From 0 To 20 Ft concrete gravity flow
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.
1D G
16. REMARKS:
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

256152
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION'S 2809
\YELL CONTRACTOR COMPANY NAME D Rnwman WP11 I)ri 11 i ngg, Tnr` PHONE ji28 252-7779
STATE \VELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I$ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Canton County Haywood
Scruggs Road, 28716
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Joe Lombardi
0 Scruggs Road
(Street or Route No.)
Canton. NC 28716
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 6/24/02
5. TOTAL DEPTH: 180'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1 5 METHOD OF TEST'- rotary air
10. WATER ZONES (depth): 1 20
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Zip Code
I I. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Ft.61 /8 Srh 80 PVC'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Ft. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
Size Material
0
lD
16.REMARKS:
I DO HEREBY CERTIFY I
CONSTRUCTION STAN
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Li
Submit the original to the D vision of Water Quality., Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001
27699-1636 Pho 9) 73
GFOUNDVJf.TER SECTION
ASHEVILLE REGIONAL OFFICE
•

WELL CONSTRUCTION RECORD
250851
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Jeremy H. Bowman
\V ELL CONTRACTOR COMPANY NAME f�
Binwman
Well Drilling, Inc.
CERTIFICATION # 2 8 0 9
PHONE # $2$252 7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER:MIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Canton
Pressley Mine Road
County
Canton
Haywood
2B/1b
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Marcus Amos
Address Prpaal cry Mi Road
(Street or Route No.)
Canton NC 28716
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 3/15/02
5. TOTAL DEPTH: 260'
Zip Code
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
6. DOES WELL REPLACE EXISTING WELL? YE8p NO ea
7. STATIC WATER LEVEL Below Top of Casing: _ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. 9. YIELD (gpm): 15 METHOD OF TEST rotary air
10. WATER ZONES (depth): 200'
240'
I I. DISINFECTION: Type tablet
12. CASING:
Amount 6
Wall Thickness
From 0 ToDept1 30 Ft. Di6 a le/ 8 srohWeight/Ft. M c
From To Ft. 80
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.concrete
From To Ft.
14. SCREEN: Depth Diameter Slot S
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth
Method
gravity flow
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. -�
0
0t,
crrt
0<
N ors
rn
>0
7ac
m
rn
O
N
XI
ze Material "O
in. ...
in.
Size Material
N
J
—i, µut .TO '�Ft.
1 7 L�, F0-in LJ a t! t o 1, F..
III
1 (-'�r, I6. REMARKS: JI1
j " '1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4ONSTRUCTION STANDAF DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL/ OWNER
v DATE
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
0
0

To
To
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION #2809
WELL CONTRACTOR COMPANY NAME TL Bowman Wall Drilling, Inc.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # 127fi72_7779
1. WELL USE (Check Applicable Box): Residential L Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Wayris sizi 1 lin County Uaywnnd
1 Wispy Wi11nw Road Waynesxri11e 28736
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Stephen Moore
Address 15 Wispy Willow Road
(Street or Route No.)
Waynesville NC 28736
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 1 / 31 / 02
Zip Code
5. TOTAL DEPTH: 340
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
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use'-" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): tt METHOD OF TEST rotary ai r
10. WATER ZONES (depth): 260
300'
11. DISINFECTION: Type tahl Pt Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 . To R7 Ft. 6 1 /R Sr•h RO PVf
From Ft.
From Ft.
Material Method
concrete gravity flow
Slot Size Material
in.
in.
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
QIOST tucTio, S hA
IISS 1 . �n
v� emu,
Submit the originaTTo
27699-1636 Phone r$o. (9
GRflUND'21ATrp SE-T.
ASHEViLLE REU1HR?
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//3t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-322I, within 30 days. GW-1 REV. 07/2001

9 5,e.COI if
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTWICATION/ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEpY7J8 )254-3581
1537
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentiatc(Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LOCATION:
Nearest Town: Cow 4 d
/D wee i� e C- LS 7i
(Street Name, Number, Community, Subdivision, Lot No., Zip Code) •
3. OWNER: T rC/-y �. /VAS% �„7
Address /e) /IfeC_/4-04Pnl /L(�
C^ -r (Stress or Rao 2-9' 7/
r/��Ciry orITown State Zip Code
( 'Ile- 7r
Area code- Phone number
4. DATE DRILLED /6°/,/
5. TOTAL DEPTH: 2- es 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: Zee FT.
-es " if Above Top o Casing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
*Top of cuing terminated at/or below Ind surface requlrr a
variance In accordance with ISA NCAC 2C .0111.
9. YIELD (gpm): 527 METH D OF TEST Al I'
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeeshuimaes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOCI
Formatign Description
DEPTH
From To
o -- 0
bd- »o
er
6 �3�
'7 et. tr. -7 ta
11. DISINFECTION: TypeJ Amount. —
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From -t ( To Co Ft. ..7Y`z/ 'Do C .
From To Ft.
From To Ft.
13. GROUT: Depth Material From D To �ethod
7—o FL rasem o�
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 the road
numbers and common road names. o? �CV
e Q elt/l'
16. REMARKS:
rHP EgJY ( iRT 'Y -- THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
..r
S, AND THAT A COPYAS THIS CORD HAS BEEN PROVIDED TO T WELL WNER
t/
SIGNATURE OF ' • • CONSTRUCTING THE WELL
a
ppSubmlt th ,,ri$ ,,yalll-Uto the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ASHE1;'iif�,111�A �OF"19) 733-3221, within 30 days. GW-1 REV. 07/2001

2479SC
3. OWNER:$ n.
Address /B4 S/Xf uti.
(Street or Route No.)
frit C •
City or Town State Zip Code From
0
Area code- Phone number
4. DATE DRILLED 2 — S _e 2--
IFIP
6. DOES WELL REPLACE EXSTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: gib 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 accordanc5e „,with 1SA NCAC 2C .01111
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): 1 CA' /n0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBENNatural soCALDDHLLDivision
of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIpFICATION# 2140
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC •PBONE11%8 1254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town:.a«Y
County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
leassail
5. TOTAL DEPTH:
11. DISINFECTION: Type /747W-
12. CASING:
Depth Diameter
From -f-I To 2..2. Ft. 44,"1
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To .24 Ft.
Material
Amount A( D
Wall Thickness
or Weight/Ft, idfterial
10?..2f ((/ C.
tieMea: ho
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
6. it1 S: p
U HEREBY ChR'I'I1h Y I '
pNSTRUCT1ON STAND ,
L� 1, ., e'm�
Topographi setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre Wmioutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation/e es'ption
2
22. 4 0 OW/
LQ
CDs
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road/en
numbers and common road names. ef, 646v
O
N
-n
m
G7
IN)
- rS
m
co —,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L1
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
GROUNDWATER_SECTION__
Sukautti(Lfoghi itro tyalpivisioa of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
s /699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
247987
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC PHONEF31%8 ?54-'3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural E3"
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA
Nearest To
County 59
(Street Name, Numbers, Commpnity, Subdivisj ,, Lot No., Zip Code)
3. OWNER: %\f.4.4 y-/
Address /®9 2- 912fwt •
W t«otes 1ftreet or Route No.)
City or Town State
Area code- Phone number$..
4. DATE DRILLED.- Q
5. TOTAL DEPTH: i69r.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type ne-
Amount _,/e
12. CASING: Wall Thickness
Depth Dtter or Weight/Ft.
From,_ To 2 / Ft. ,4 42 54€-L C
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To_ LFt. egw.l,--
From
To Ft.
Material
PVc-
Method
/1*eJ
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:
Topographi d 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
Format!n Description
DEPTH
From To
O etc
14' r.40'I4
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa
umbers and common road names.
CO
CO
fV
rV
W
t--ri
`71T-'HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
21i5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ii) 733-3221, within 30 days. GW-1 REV. 07/2001

3. OWNER:
Address
254 60
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (
WELL CON TRACTOR (INDIVIDUAL) NA31E (print) /(sco: e it Mcc c :z -, CERTIFICATION # ;2 6,3-
WELL CONTRACTOR CONIPANVNANIE -0 ti PHONE#2(CFY.
STAVE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIT#
Of applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ($Municipal/Public ❑ Industrial ❑ Agricultural ❑
`lonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ ([Other, List Use
WELL LOCATION:
Nearest Town: Cit.VI. FL.. v'
County Nt:..s Ccr:r c�
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
32.- N/ e iJ,if5 e /v
S
(Street or Route No.)
Oil /Lfd/'L1 /Ye 2 /E 7l G
City or Ton n State Zip Code
(RIF )- 13
Area code- Phone number
4. DATE DRILLED i - / 6 Z
5. TOTAL DEPTH: / 22
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: _;/6 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terntinated at/or below land surface requires a
variance in accordance with 15A NCAC ZC .0118.
9. YIELD (gpm): /6 METHOD OF TEST Jil.-
10.WATER ZONES (depth):
II
12
DISINFECTION: Type Otte,'
CASING:
Depth Diameter
From / To 7 Ft. (.,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From - To /0 Ft. ib Mc-.i J'a td
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 �Y
Wall Thickness
or Weight/Ft. Material
C /Idite 1
16. REMARKS:
Mil "rota) '
'EJ<f�2kw.T� Arm A
�I-fL�i 1 2002
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
3/
-p
—rn
LOCATION SKETCH 0
Show direction and distance in miles from Seast9.
two State Roads or County Roads. Include the road
numbers and common road names.
_ e `
'
A,taL. L /r c k, afen,
7tat«,.'
4 VG'-IALt
A0
"3 ix h
0
HIS WELL WAS CONS-R„j
AND THAT A COPY 0
IGNATURE OF PERSO
Submit the original to [ ' Div lion of Water Quality
17699-16tn pis 733-.721, Within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
'1 CO:
ED IN ACC RDANGE 1
RECORD HAS BEEN PROVIDE
TRUCTING THE WELL
NCAC 2C, WELL
i0 THE WELL OWNER
- /3 6; 2
DATE
Grotr;F1E)pl t 'F4( u� � Sery ee Center Raleigh, NC
GW 1 REV. o 7� 2001

254Go8
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu aJ Resources - Division of Water Quality - Groundwater Section
VAELL CONTRACTOR (INDIA IDUAL) NAME (print)-t-,rC'j/i/i J� "i CERTIFICATION #.LS,')5
VA'ELI, CON'lRACfOIk COMPANY NAME Cie 114 c c
GOZI PHONE # ff'2t) /.I 2. -7 rq'v(
STATE \\ELI, CONSTRUCTION PERMIT# ASSOCIATED \)/Q PERMIT#
(if applicable)
(i f appl icable)
I. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: //(3i 4 "s iii/Ie County Heti "fetid
(Street Nang. Numbers, Community. Subdivision, Lot No.. Zip Code)
3.OWNER
Address
LC
(Street or Route No.)
6Ci0S,,,.<6A_0k rt.
City or Town Sane
%sE_? %64)
Zip Code
us.* 4L1 3366
Area code- Phone number
4. DATE DRILLED ,65---/G- Ci 9-
5 TOTAL DEPTH: I2S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11/
7. STATIC WATER LEVEL Below Top of Casing: 13D FT.
(Use "+" if Above Top or Casing)
8. TOP OF CASING IS / ET. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): d%) METHOD OF TEST /9/%'
I . WATER ZONES (depth): LOP 5
1 I. DISINFECTION: Type..
12. CASING:
Depth Diameter
From To y_ Ft. 6
From To FL
From To Ft.
13. GROUT: Depth
From / To % 0 _ Ft.
From To Et.
Amount /i
Wall Thickness
or Wcight;Ft. Material
/ el /ile 1
Material
(101 : /Li
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND:GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
7t cJ
Slot Size Material
in.
in.
Material
16. REMARKS:
2002
THIS WELL WA
ND THAT A 1
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees: ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation DD'scription
/ 6 /1y<
/7 3 5' G'>
3 5- :.0 5 Citst.c,i,.�rrj
rJ
—
r—
r*,
r-+ a
LOCATION SKETCH o 0
Show direction and distance in miles from al leasiz
two State Roads or County Roads. Include the road
numbers and common road names.
rK < rl/(c /et i G<t< V-es (t-
j� ti' 5i i to s e -
)ft;ll/��(
/a !lets
IGNATURE OF Rs
S fLRU liyr- ,-
t1 ISA NCAC 2C, WELL
F THIS RECORD HAS BEE ,I�0 IDED TO THE WELL OWNER
•
N CONSTRUCTING TFIE \1ELL
Submit the orii'inal to thL Divsion of Water ualits,(6Ft(drJiu'Tl'i-h SEi
GG�9I� irYK'VFhaillsmiotY9) 733-_ 221, within 30 t ays. ASHEi.�L Rc'=i
A'HEVILLE REGIONAL OFFICE
0H- , 036 tit
f- /`- /-%
DATE
it Ser\ice Center - Raleigh, .NC
GW-I REV. 07 2001

6. DOES WELL REPLACE EXISTING WELL? YES ❑ 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 I5A NCAC 2C .0118.
9. YIELD (gpm): j(O METHOD OF TEST I fe-
10. WATER ZONES (depth): / 2 6-
1 I. DISINFECTION. Type Cr:\,..ale tcc Amount .r+-
12. CASING: Wall Thickness
Depth9 Diameter or WeightFt. )Material
From/ f To 7 Ft. Z. it L L_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From / To .26
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RENIARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CO,ATR:ACTOR(I]'DIAIDEAL)IS.-A)IE (print)/'/fz.:�,/4�L� �in4pcc.-S CERTIFICATION #t).�J eSo
\\ ELL CO\T R.\CIOR COMPANY NAME ( [2 ctn/ IL /C-/- tiiz-il PHONE # flFs) /. 22.7 y[,t4
STATE \\ ELL CONSTRICTION PERNIITp ASSOCIATED \\Q PERMIT[(
(if applicable) (if applicable)
25 656
I. WELL USE (Check Applicable Box): Residential LAY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: - 7
Nearest Town: L/i„_.-.tea County N/t,)rr�
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: iao)it4Ayk_ act IA<.Yh
Address 47l HU. tM.old iRi 0,rl La1A,t
I Street or Routo.)
kst nt. .Zh'17- I
City or l own State Zip Code
ctat)- 422 - 9g6 -.
Area code- Phone number
4. DATE DRILLED f- 9- L L.-
5. TOTAL DEPTH: iVS
Topographic/Land setting
❑Ridge IH51ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesrminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
20 /ti
2.rc.r4 f
C',zK: t
C-5
n) ''
0 m
•
c,� E
Show direction and distance in miles from :WcastE
two State Roads or County Roads. Include the coat
numbers and common road names.
J6. da,/, d fit 2 (6-„L_Aiil
LOCATION SKETCH
�� �d>..c r
it (74j
Slot Size Material `� G %-}vim-'`� �� � �.��W ��� �C
in. II� /
in. 4 kK J'-'L
0 Lys
Atalt �) ;� l- J� cam.
a-, , /L _-e-t A to k. iteS
6"Lt-A
oI O (ER Y (}'F141F7' TF t-♦IS WELL WAS CON
NS`P;12L ION S�TAKttARD$ NND THAT A COPY 0
,p l
ISubnlit the oritjnnl to tht Div imion of NV ater Qu alit_
2 0:.T0iSh'TihiRc A Oj 0 33-1 21, within 30 clays.
AFI!EVILLE REGIONAL OFFICE
t
II
T NA 'hariavrF[kvl
RECORD HAS BEEN PRO
J
GNATURE OF PERSC N CONSTRUCTING THE WELL
GroufiaUidiriit'S2bifi4EfoniiilEit Ser
ASHEVILLE REGIONAL OFFICE
NCAC 2C, WELL
TO THE WELL OWNER
9- 02-
DATE
ice Center - Raleigh, NC
GW-I REV. 07/2001

254574
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
!vision of Water Quality - Groundwater Section
WELL CONTRACT OR (INDIVIDUAL) NAME (print) At..q .t )' c.a eta 606 CERTIFICATION # 2 795
WELL CONTRACTOR COMPANY NAME G.e A) m ICJ^ W tI I PHONE # (8 L 7. a -7 VO I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential a"---Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CUdbfee.-•c4.l10 County_, ems+
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tin
Address 3 3 v-
(Street or Route No.)
fir 2R9A/
Cit or Town State Zip Code
(t)- 627 33.5—/
Area code- Phone number
4. DATE DRILLED ,3 - / 9 - fb
5. TOTAL DEPTH: R
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12"-
7. STATIC WATER LEVEL Below Top of Casing: 3b 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): /'2. METHOD OF TEST RJ R
10. WATER ZONES (depth): / G,{
1 I. DISINFECTION: Typ
12. CASING:
Depth Diameter
From / To GJ> Ft. le
From To Ft.
From To Ft.
13. GROUT: Depth Material
From / To 20 Ft.
AND\Amount 3\1-1 CLU\)
Wall Thickness
or Weight/Ft. Material
27
From To Ft.
14, SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
13.4 e " °rE°l`
Topographic/Land setting
DRidge ❑Slope B'Calley ❑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 Dcription
/ _ 4 [D,,....I
G 2fts aPs
J •c.H
T c
D ;4(
:
rn :.*J
LOCATION SKETCH N
Show direction and distance in miles from Plleasc
two State Roads or County Roads. Include the road
numbers and common road names.
Slot Size Material
in.
in.
Material
-e o� 4� (. y., 0L14c- £�tr
p b��-/�` 0 2,.�, v-v- s0 ,tom
/t'toy •
AP:
16.REMARKS:
I nil wry ppCEPTIFY TI [HIS WELL WAS CONSTR
TI?N$'ANDA AND THAT AA COPY OF T
IGNATURE OF PERSON
JUN 1 2002
Submit the original to th
176QQ-1l16 Phn^,. Np uly-
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
D iJ 4 Oft 3 • JC I
Rip rts.rie 'n: GAI Drullr)
197e N CAC 2C, WELL
TO THE WELL OWNER
N9i RUG INLG T1-1R WELL
Divi lion of Water Quality, Ground"nen- Sartion, 1636 M^° Cervic
733 3221, within 30 days. GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
DATE
Center -Raleigh, NC
GW-I REV. 07/2001

254571
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat
/y/ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L/Af.. —y/ , irar/nwz CERTIFICATION #'_571C
WELL CONTRACTOR COMPANY NAME Cl/to FT NuJ a f e r LfJe If
PHONE # (S2E) L12-7cZY
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0-I.-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
11 7
Nearest Town: Cad /o /✓ County f'la5 r✓<ne1
(Street Name, Numbers, Community, Su/bdivision, Lot No., Zip Code)
3. OWNER: flak le rf,/p..J
Address 512.. /-ii4a4,,) (I R.
(Street or Route No.)
�RNfOal/ /VC— 287I t
City or Town State Zip Code
(8).6 )- b kb? 9///
Area code- Phone number
4. DATE DRILLED 3 - .Z / - /i 2-
5. TOTAL DEPTH: La 5-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO gr.
7. STATIC WATER LEVEL Below Top of Casing: 11646 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 with 15A NCAC 2C .0118.
,
9. YIELD (gpm): METHOD OF TEST Pi-R
10. WATERZONES(depth): 4/SD
11. DISINFECTION: Typej2rapdu\_o:C_ Amount 2..% Lay
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 44 Ft. 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From / To 20 Ft. ea. nai-wiI
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.
27 PuC
Method
ppi.t
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope Iiley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For ation Description
CoCa Le \C
G aP (ob2<
0
c
-c
L
i=
H
�
>c
LOCATION SKETCH 3 aT
Show direction and distance in miles from atteast�
two State Roads or County Roads. Include 1,14..9 rod!)
numbers and common road names. ' 6
i, 1
d7O A-44t /i la /'A&II& Oa(lC,t.
/zoo it- Be o-Y /-�F .‘ ;1,6 f 404,-4 L
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
A
JUN 112002
Submit the original to th
27699-1636 Phone No. (919
AND THAT A COPY OF
2 t,ll
'^�INAC AN P
RECORD HAS BEEN PROV
SIGNATURE OF PERSON CONSTRUCTING THE WELL
L
Division of Water Quality, GroundBiltlit{SVefidit,Sl6 Mfail Ser.
AS 733-2221, within 30 days. _—_�'-` t �"' O ICE
15A
Eb
CAC 2C, WELL
0 THE WELL OWNER
-2,1-02-
DATE
ce Center - Raleigh, NC
GW-I REV.07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

254570
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resour/cess-- DivisionAof/Water Quality - Groundwater Section �`
WELL CONTRACTOR (INDIVIDUAL) NAME (priri0ntt)) �LtI/'�[4G /VICadoco+4 CERTIFICATION #L-J Q1 I'
WELL CONTRACTOR COMPANY NAME (,/.e en) !N-\c,/t/^ WC./( PHONE # Oa 1 �% 344 -i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:g�//
Nearest Town: e.44n. toe.) County /YL.x., „i ,•d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address ,C2o 'IL de Al val(j. e.{tir_e_
e..4w7chJ
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3 - 2 3-0 2-
(Street ar Route No.)
5. TOTAL DEPTH: /G 3T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fd�
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 D METHOD OF TEST g. iZ
10. WATER ZONES (depth):
l I. DISINFECTION: Type 61 rd w`I la K2mount w
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From / To 9 Ft. / 6 tee-1
From To Ft.
From To Ft.
13. GROUT: Depth Material
From / To 1.. 0 Ft. /'o_"-ra..rr '
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
Method
J1P2.t
Depth
From To Ft.
16. REMARKS:
h,D IEEB'1 Ci TIE/
viito, ., "P I�t
AS ' t2t r (EgIONAMOP1`ICEI733-t221, within 30 days.
Size
Material
HIS WELL WAS CO
AND THAT A COPY
IGNATURE OF PE
e Div sion of Water Qua
vm CO
Topographic/Land setting
❑Ridge LNSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To. Formation Description
/ 2 i [4.. ±.1- 6cir i
/GAr /vwi/'
c
Cr)
N
C
z
c->
LOCATION SKETCH N 2
Show direction and distance in miles fronbQ lea
two State Roads or County Roads. Include the road
numbers and common road names.� ��
sits/,
/7G re 1-/tat,zJ ' d-
5A NCAC 2C, WELL
D TO THE WELL OWNER
DATE
GROUNDWATER SECTION
fj rIcl F, ffrgtGiE AJoitnOtikintail4
rvice Center - Raleigh, NC
GW-I REV. 07/2001

254568
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources --I IIDivisttion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A//q G/ NL.as2Ou.S CERTIFICATION#�QJ/
WELL CONTRACTOR COMPANY NAME med.*? ";,Ka, /.(v
PHONE # ie71B) LA1-7Y8c1
STATE. WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
County
(Street Naine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Hc/v.riiA Mgr fit)
Address \etZ-Tt_3c-Nt t= C cePIL 172tu4
(Street or Route No.)
TsoszioES 7Ci F< 334L.09
City or Town State Zip Code
(5Lo1)- `194 -3-79 4
Area code- Phone number
4. DATE DRILLED '� - 2 7- 6 Z
5. TOTAL DEPTH: /Pl c-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a%
7. STATIC WATER LEVEL Below Top of Casing: BO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): .- METHOD OF TEST fr+t'
10. WATER ZONES (depth): 23 0
I1. DISINFECTION
12. CASING:
Topographic/Land setting
lEtifidge ❑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
/sue 9. terc dip 6" CAA,
c
c
0,
C R0
TYPe Ctrs- d
Depth r
From / To .?h Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From / To 2O Pt. iiT+.r..rp�
Diameter
Amount /14,
Wall Thickness
or Weight/Ft. Material
17 �vC �o�' /t 1 r4ad� %,."" red m R
aw 4 R� -y 5-6!tt n,d-/a
err Q 19-P /the 02
Aettocactcl
eg1�y /p° "
evag Loh & a
f�'A C21.t ciii-G
VCc ae ,, S,.tNP
nr
•i
�C
From To Ft.
14. SCREEN: Depth
From To
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Diameter Slot Size Material
Ft. in. in.
in.
Material
LOCATION SKETCH c
Show direction and distance in miles from at least z
two State Roads or County Roads. Include the road
numbers and common road names.
_ t Y THAT THIS WELL WAS CON..
glrr ir:• '•e • AT A COPY O
—ii WPM. Kea
V f f
JUN 11 2002U
Sub it the original to the Divi
2769 ; - phone No. 9f( 9) 733-1221, v ithin 30 days.
GRUNDWATR SECTION
ASHEVILLE REGIONAL OFFICE
UREOF PERSC
C
T l
o WaterQualt , Gro
g..
/ 4AS E P V
STRAgfIN`4r"i tHE . LL
ndwater Section, 1636 Milil Ser
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
NCAC 2C, WELL
TO THE WELL OWNER
DATE
ice Center - Raleigh, NC
GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR C \ ` ec L j\ \\ 3 C.\\.ttt1\C
WELL CONTRACTOR CERTIFICATION #: 0, b R-C
STATE WELL CONSTRUCTION PERMIT#:
254610
1. WELL USE (Check Applicable Boa): Residential L.1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOC\\rchnw ak Ic3 h of the location below) \� f A �
Nearest Town:n: County �`
(Road Napa
3. OWNER LA
Address
Numbers, Conmu ily, r ivision and lot No.)
ree • e 'o• , l I LU
City or Town '1 a Zip Code
4. DATE DRILLED 1I ,)G
5. TOTAL DEPTH 5G
6. CUTTINGS COLLECTED YES 0 NOD"-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ---
8. STATIC WATER LEVEL Below Top of Casing: / 2u.. FT.
(use': u Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• SC METHOD OF TEST
11. WATER ZONES (depth)
12. CHLORINATION. TypeAmount \ I40 _
13. CASING:
DRILLING LOG DEPTH
From TiF • lion Description
Wall Thickness
t
DepthgL \ Diameter or Weight/Ft. Male,(ial
From To �— Ft ‘9 ',Lk Sal`: 1 e L-
\Ipl
From To Ft Tv \C� Ldv� — \�G �L \�l
From To Ft.
14. GROUT: �C9 a)
!� Depth� /� beaten I �. �� (,,(ethodl \/ Q CND ( t
From SL To "'G Ft l "QmP H. X �` t ',u"v' -A.— l.(Sx\�S^L From To Ft �-� . C ,
15. SCREEN: \
Depth Diameter Slot Size Material
Q c'i Uj O1SZ
From To Ft In in N i]
L 92
From To_Ft._ in _In c =
From To Ft. In In c �;
r.�
16. SAND/GRAVEL PACK:
Depth Size Material ---
From To Ft S n"
From To Ft r (VI ;or-
",
c�
17. REMARKS: co
L
O \
If additional space Is needed use back of form
I DO HERE
CONSTRU
FOR OFFIC
Quad No:
uw
ONLY
J U N 11 2002
Submit
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reap ref ere ce oints)
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE
OFTHIS R ORD = BEEN PR•VIDEDTOTHE WELL
riglna
9NA OF PERSON CONSTRUCTING THE WELL
o Division of Water Quality, Groundwater Section within 30 days
I J 'IL'
II \.ii P
RIJ_--
TE,I''
EV. 12/99
Sena) No.
GROUNI ATER SECTION
An"EvI! I F nEGIONAL OFFICE
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina • Department of Environment and Natural
Resources • Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
254611
WELL CONTRACTOIC\S\\ `-"p)_0 """0'`tG •
WELL CONTRACTOR CERTIFICATION #: b $-
STATE WELL CONSTRUCTION PERMIT#: ,
1. WELL USE (Check Applicable Sox): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Q CO County � '`
(Road Name and umbers, �^ nity, o \Su\b and Lot No.) DRILLING LOG
3. OWNER •(� l •U CD
From - yTI
Address S0..t`"1
0
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO©�
7. DOES WELL REPLACE EXISTING WELL? YES EI
8. STATIC WATER LEVEL Below Top of Casing: /2 i'-
(use '+' II Above Top of Cuing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm). 1 METHOD OF TEST Q--'C
11. WATER ZONES (depth).
•
1C.o
Zip Code
4,1-5a5
NO®
FT.
12. CHLORINATION' Type RCS V\tI C Amount Big C
13. CASING:
Depth
From To Hi
From To
From
14. GROUT:
To
mu wall Thicknessy
tFt. / S t:r0w a7
Ft
Ft.
Depth
From To Ft
From To Ft
15. SCREEN:
Depth
From To __ Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From
17. REMARKS:
To
I DO HEREBY CE
CONSTRUCTION
FOR OFFICE USE
Quad No:
Serial No.
Material ?oove�
me,\- T
Diameter Slot Size Material
In _ in
rR
Ft
Ft
in In
In In
Size Material
U N 1 1 2tS0'!'
_Al
DEPTH
Formation Description
If additional space Ls needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
C-\f\ G, 0 -To 3 e n Vet o c L e P
TED IN ACCORDANCE WITH 15A NCAC 2C, WE
S R ORD(/H/!,$��BEEN PR VIDED(TTO THE WE
1' / �/ ,c 4cei
S13R111`1,�E OF PERSON CONSTRUCTING THE WELL
Submit original to DWI, on of Water Quality, Groundwater Section within 30 day
UNDWATER SECTION
7 :1 148 L I unr zo
;OU1dCWATER SECTION
ASHEVILLE REGIONAL OFFICE
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 254612
1636 Mal Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTORr-A e0.t`WC^ e, VZ'\\. &14\C
WELL CONTRACTOR CERTIFICATION #: rC 7 / I
STATE WELL CONSTRUCTION PERMIT#: 1____
1. WELL USE (Check Applicable Box): Residential LJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIIRN\ (Show sketch of the location below) \ raQ, �
Nearest Town' \ `\ � \
� County' er
(Road Namc and Nur(thers. Convne ty, o`S}tbQivision kid Lot No.) DRILLING LOG
3. OWNERQ(\(1P` �� J C'c��C iC From To
$
o5
Address 0-)\ t O D Q3t D_ Rc,W». z \
0 (btreet,9r fire No.) Qci� p
�� ` O Zip Code
Gryot Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[Er
8. STATIC WATER LEVEL Below Top of Casing: %O FT.
(Use'-' If Above Top of Cuing)
9. TOP OF CASING IS FT. Move Land Surface'
'Top of casing terminated atlor Glow land surface requires a variance In accor-
dance with 15A NCAC 2C .1a
10. YIELD (gpm)• �— METHOD OF TEST Q-`
11. WATER ZONES (depth)'
12. CHLORINATION: Type e"CQ°"\a r Amount C
13. CASING:
State
Depth
From To a�'
Wall Thickness
Di ter or Weight/Ft. Material
Ft
lD y soRa7 V uc
From To Ft.
From To Ft
14. GROUT:
Depth
From 0 To
Material Method
Ft. Ceme-V V \once.°
From To Ft
15. SCREEN:
Depth
From To
From __ To
From __ To
16. SAND/GRAVEL PACK:
Depth
From To
From To_
17. REMARKS:
Diameter Slot Size Material
Ft _ In. _ in
Ft in In
FL_ In. _ In
Ft
Ft.
Size Material
I DO HERE
CONSTRU
FOR OFFI
Quad No:
Serial No.
HF1F1 H1ET&S iLISfArC
C
1 2002
sub.'
TER SECTION
DEPTH
rEopration Description
\C
II additional space Ls needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
\NO\x�c. \ch�� -a c"\ `s
b&c\e.e26_ Luck\S \C) 0
STRUCTED IN ACCORDANCE WITH 15A NCAC
OF THIS RECORD HAS BEEN PROVIDED TO Th
.GNATURE OF PERSON CONSTRUCTING THE WELL
ortg nal to Division of Water Quality. Groundwater Section Withi
cocoll LF REGIONAL OFFICE
0
IV
L
J
-o
• rt
-'OWNER: �.,Y -
DATE
GW-1 REV. 12/99
GROUNDWATER SECTION
ASHE\IILLE REGIONAL OFFICE
y

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD
254605
WELL CONTRACTOR \PIN AO \ 0AA ^� 1 ' M? 1� `
�,'t C
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential D Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATI¢(J: (Show sketch of the location below)
Nearest Town' . fl N 01, County'
(Road Name and Numbers—Cgmmunity Subdivision and lot No.)
3. OWNER VV,P
Address
City or Town
4. DATE DRILLED
5. TOTAL DEPTH ----
6. CUTTINGS COLLECTED YES ❑ NO��
7. DOES WELL REPLACE EXISTING WELL? YES f B. STATIC WATER LEVEL Below Top of Casing: 4D_ FT.
(Use 'elf Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated .Vor below land sudacs requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• _ METHOD OF TEST
CW-
11. WATER ZONES (depth).
uv\o
DRILLING LOG
From To
State
a -
Zip Code
12. CHLORINATION: Type40.. Amountz
13. CASING:
Wall Thickness
Depth , Diameter or Weight/Ft. Material
_
From —To an-0 Ft (-2 Z SvR'?9 PUG
From To Ft
From To Ft
14. GROUT:
Depth Material Method Jt
From .C) To 7r') Ft. �mQn \OJCe_L%
From To Ft
15. SCREEN:
Depth Diameter
From To _ Ft in
From _ To _ Ft _ in
From _ To .__ Ft _ In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
Slot Size Material
in
__ In
In
1 DO HEREBY 9 FYTHAT THIS WE
CONSTRUCT ON AINDASDSICANDTI
FOR OFFICE U
Quad No:
Sedal No.
NLY
JJ
DEPTH
F mutton ! escdption
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) I %� ry/ -f� / /
la3 �Z7WO �Q�2� //T /"cVG/1Cc/ctCs
jtA tim CCU-v cj SAW__ 710 fik n / 0--
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
� THIS R /OD H BEEN
NNJPRR VIDED�T%O THE WE
401
7�o• TWRE OF PERSON CONSTRUCTING THE WELL
• Division of Water Duet Groundwater Section within 30 da
DATE
s _
GW-EREWI4ns4tER SECTION
ASHEVILLE REGIONAL OFFIC
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:` �l II l cn r"t KID ^ Lep' %�C •
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMITS!:
254606
1. WELL USE (Check Applicable eox): ResidentialO Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, IJst Use:
2. WELL LOCATION: (Show sketch (OA location below)
Nearest Town* '0ACounlY
(Road N and Numberse„CorivnIty, or Subdivision and Lot No.)
3. OWNER )) \ \ ©\_
Address \Cf*s \- pQ (\ \ O
DA l V S,,C?r att.
t t) (%`lo
or wn 1 State\ l Zip Code
City4. DATE DRILLED Ir—l1GZ S.,5. TOTAL DEPTH 1 S
6. CUTTINGS COLLECTED YES ❑ NOE-
7. DOES WELL REPLACE EXISTING WELL? YES fl
8. STATIC WATER LEVEL Below Top of Casing: Fr.
(Use'✓ U Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated Wor below land surface requires a variance In accor-
dance with 15A NCAC 2C,.9.1.38
10. YIELD (gpm)• / M METHOD OF TEST a it--
11. WATER ZONES (depth).
12. CHLORINATION: Type Amount
13. CASING:
DRILLING LOG
From To
CD 2—IP
9 ) CDS
Wall Thickness
Depth`
From D' r or Weight/Ft.Weight/Ft.beaten
To `C Et. ( '4 3 2r\ �V
From To Ft
From To Ft
14. GROUT:
Depp Material
From 0 10 0& C) Ft 0 p m Q-CC
From
15. SCREEN:
To Ft
�vlethod
Depth Diameter Slot Size Material
From To _— Ft _ In. _ _ In
From To _ Ft _ in — In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth
To —
From
From
17. REMARKS:
IDOHE
CONSTR
FOR OFF
Quad No:
Serial No.
To
Size
Ft.
Ft.
Material
DEPTH
Formation Description
1 apiNitm
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)
COV P R-C)
T 7HIS,WELLTh.lONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, W
OPT OF THIS RECORD HAS BEEN PROVIDED TO THE WE
1 2002
R SECTION
ASHEVILLE REGIONAL OFFICE
/t //!SA_
^IGNATURE OF PERSON CONSTRUCTING THE WELL
origami to Division of Water Quality, Groundwater Section within 30 day
ATE
0
a
C
J
-v
a
fV
tn
Q_
<t N
,; FICE

263744
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tyatural Resources - Divisioq of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COAIPAiNY NAME �ceb[(1 ti,�,(.�(� �fy`�[r�(
STATE VCELL CONSTRUCTION PE Rb1IT# ASSOCIATED WQ PER. T#
(if applicable)
(if applicable)
CERTIFICATION #
PHONE # 6241 <o R S- % 2-2-3
t 1
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town
$5
Count
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
3. OWNER:
Address 13l! �( 1Jf 11 W 08 Q1
rW
Topographic/Land setting
DRidge tdSlope ❑Valley ❑Flat
A,^ (check appropriate box)
Z t- l i n+ Latitude/longitude of well location
`' I (Stµet r Route No.)
vsfc'SL 151/4SYlWe_ 'it z.rtei<6
City tor Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 10' ZZ -sot
5. TOTAL DEPTH: 2.6 S t
6. DOES WELL REPLACE EXISTING WELL? YES O NO Cd
7. STATIC WATER LEVEL Below Top of Casing 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
- (degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
9. YIELD (pm): t MET OD OF TEST G4-I eat* P r
10. WATER ZONES (depth): ( , 2.00
11. DISINFECTION: Type i Q 6 Amount
2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To SL Ft.
From To Ft.
From To Ft.
13. GROUT: Depth ,Material 1e Method
From To Ft. �(f (C Oft
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
From To
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�•
y--ywY zo9
eoleyA c Y
O'(Q't <d O 1C 1 •
16. REMARKS:
S I. U FI• ',S N4,iAR
Submit the original to the Div
2769(
ASHY\.'LLe F GiCFJ:,L OMIT:"
i_J
s on
221
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IC-L3-07
TURE OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ithin 30 days. GW-1 REV. 07/2001
Oa

From
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
WELL CONSTRUCTION RECORD
263-741
North Carolina - Department of Environment and NyMattu'ral Reso rces - Divi ion of Water Quality - Groundwater Section 2
WELL CONTRACTOR (INDIVIDUAL) NAME (print) avA ll•• ..yL -'' L. •1 ERTIFICATION Z& O3, Z(,ac.
WELL CONTRACTOR COMPANY NAME Zi1�. YV•e{�"' , ('If 1` PHONE #g�'�7J�Z
II 0STATEWELL CO.\S'IR L'CTION PE RDIIT# ASSOCIATED WQ PERMIT r �SZ,
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCAT qN
Nearest Tow
tC
qOK
Cotli y
(Stye l Name, Numbers, Community, Sr d ision, Lot No., Zip Code)
3. OWNER: DOLSAA, 5 Y
Address 1'1 V (- ;CT Vail %t tt
(St cc Rout
tS1,�Wtsi ire z4s n
City or own State Zip Code
( )-
Topographic/Land setting
'1Ridge gglope ❑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
Area code- Phone number/�
4. DATE DRILLED IA- Z'OZ
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO H
7. STATIC WATER LEVEL Below Top of Casing: i 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. /p , ,r
9. YIELD (gpm): 1z METHOD OF TEST Ulkywv
10. WATER ZONES (depth): 1 t01 rrI "8 5
11. DISINFECTION: Type TiteCA;.T Amount Z
12. CASING: Wall Thickness
Depth Diameter Diameter or Weight/Ft. Material
f1 From el To O Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft. ei {t
To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
HAY (p3
Li.) Ale, wkd
-gut.aoc1 G. L
CL' flws4i t Co,r
Method
Size Material
From To Ft.
cn
-J
16. REMARKS:
TIErB
E4TI T' TFFA s WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
1 R;T N STAID ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-4)
at h 6J - r 1 yffi NATUR(O —E OF PERSON CONSTRUCTING THE WELL DATE O'L.
LS
jjj
Sulbmit the original to the D
visio 1
276'MR L& BN(AirE ENSE(9I9)Y33-322
ASHEVILLE REGIONAL OFFICE
of NVater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
263742
North Carolina - Department of Environment and Natural Re�so�prces - D' ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4MYYLt�.1NC�\k�S)�) � } ls*SL CERTIFICATION ## bpQ.tt+
\VELA. CONTRACTOR COMPANY NAME d\N Vlh u -Dali 13 PHONE#fa$l1'T3-9u3
It " "I 21,5E
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT
Nearest T
(Stre t Names, NNuumbers, C.,m.{mmnittyy,/�Subdivision, Lot No., Zip Code)
3. OWNER:B(CAL &od.
t11�0I/u
• f+
Address 1001'tZt5 Or, 5W'l-t L
AshoStreet or Route trd.) zssiO3
r N
City or Town State Zip Code
-
Topographic/Land setting
❑Ridge 1 81ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudc of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Area code- Phone number
4. DATE DRILLED IV- VI -a Z
5. TOTAL DEPTH: COO S —/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12t
7. STATIC WATER LEVEL Below Top of Casing: ICS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): 1. S METHOD OF TEST (a variance in accordance with 15A NCAC 2C .0118. ��t ��
l�
10. WATER ZONES (depth): 4--Z.01 '5Z01 ((O
C.o
I I. DISINFECTION: Type Tit Net Amount Z
12. CASING:
G�
Depth
From a To 110
From To
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
CONSTRUCTIO
GROOM SPiBifh . +R`al to
ASHEVILL
Wall Thickness
Diameter or Weight/Ft. Material a
Ft. P f4 r�C-.4 •
Ft. Ft. -fro 4j14ICJ COV '
Material Method
FLSo*e(tk —TO US CO Lt`�' ?•Z
t. J
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cfl
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
to- Z$-07
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso�utrsees - Di ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) gr Lau i.I 1 / \ CERTIFICATION# �O 31_��'2�O Z'
W
STATE WELLL CONSOR TRUOCTION PERMIT'# I ` ^ ASSOCIATED D t.�YQ R( \T PHONE it St Z�1 v L
(if applicable) (if applicable)
260187
1. WELL USE (Check Applicable Box): Resider dal Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION�� ) I ��a�
Nearest Town:Yi Coun y j�}a,
(Street Name. Numbe , Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cif Nosnn�
Address t 0 eWt Ctnc S U�
Co i(Street or Route No.
JJ /�1:+2 ? I vY
City or Town State Zip�Coode
( )-
Area code- Phone number
4. DATE DRILLED ? -3 U —6 "L
5. TOTAL DEPTH: a a rj
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q1"
7. STATIC WATER LEVEL Below Top of Casing: (00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above i.and Surface*
•Top of casing terminated at/or below land surface re
variance in accordance will I5A NCAC 2C .0118.
9. YIELD (gpm): --/ 5 METHOD OF TES
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth/
From 0 To lY
From To
From To
13. GROUT: Depth
From
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
„A
wires a
Topogrp�phic/Land setting
❑Ridge 10Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
TN7d/r i va 1
I`l3e)lt 1 Amaunt Z
Su
From
From
Depth
To Ft.
To Ft.
Wall (ITit ckness
Diameter or Weiiht/Ft. Material
Ft.
Ft.
Ft.
To
FL �uMaterial Q Ks
�AL1Jf
Ft.
M1
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
O
IV
r-r t
CO
CFI
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.
/Ifao'�ewv/,ci
,itanit
s“, Cj e
'--i rs
Hhi'
STRUCTION STANDARDS
nn
ELL WAS CONSTRUCTED NSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HATA COPYfIF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER
TUR
OF PERSON CONSTRUCTING THE WELL DATE
t ors.
t Ed WIN) 1 (vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
•u�'4i9 AIL 322i within 30days. , GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
1
North Carolina - Department of Environment and Natural Resoru-rsees -
Di ision of Water Qualityli- Groundwater Section 2�y�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) k4.YV YKit t �r..I�l l \ CERTIFICATION�jIS LLB 039-22-kO1
WELL CONTRACTOR COMPANY NAMES I be$L;` . &iki 1..j,Y1l two PHONE # t6 ilOa-q zZ
ASSOCIATED WQ PERMITIt
!!T..�
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial O Agricultural ❑
Monitoring ❑ Recovery O Heat Pump W Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI�7
Nearest Town:�(.c Coun
y
(Street Naas. Numbers, Community, Subdivision,ILot N .., Z p Code)
3. OWNER: ( cc vtc CJ}1(ST.ry,! nI
Address Q / a J4 •
City(r Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ElNO V
0 (Street,or Route
r/xV�Lr//l/e h'
X
7. STATIC WATER LEVEL Below Top of Casing. /COO 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 re wires a
n
variance in accordance 'th ISA NCAC 2C.0118. •
m
9. YIELD (gpm): r METHOD OF T - TG&/ kr%3�I
10. WATER ZONES (depth):
260184
Topoggra�phic/Land setting
❑Ridge fSSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O =
!V
r/, 0
r-+T
CO
1 I. DISINFECTION: Type / 9,Ltr Amount Z.
12. CASING: Wall ITh ckncss
Depth Diameter or WeiAht/Ft. Material
From e7 To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material ((,,,, Method
From To Ft.towel e k •�..t
From To Ft. LL 1
14. SCREEN: Depth Diameter Slot ize Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
HbliEBV LElc l lb Ir1A1
TRUCTION STANDARDS,
200?
O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/2/5/iiey Cove
IS ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
N THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J
IGNP TURF OF PE tSON CONSTRUCTING THE WELL
DATE
L9FOUNDln1ATER G IIQpJ�yy
Subppst nRPEIAL'[s1Jf hJF'flnston of Water Quh lity, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 none No. tuts) vs-4c21, vithin 30 dajs. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
nrly-.
C_.j 03
North Carolina - Dcparunent of Environment and Natural Re�snrlfces - Di 1i�sli�on'o/f Water Qualityit- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME rrr((pprrrri��int��t)) LcN�YTHsytJJCi YI(VV {kJ`�]1 CERTIFICATIONIt 7Z�NT/�3
\VELI. CONTRACTOR COMPANY NAME 'Ap r811113'�•I` U it I( t\ki �� PHONE #e aSl zZ3
I " " -LCsJ Z.
snit WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT/4
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Cl Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: Nearest Town: C(11r�� j
Countyl�u \-:)%
(Street Name, Numbers, Community, Subdivision, Lot No.,, Zip Code)
3. OWNER: CkT l 3 LAO11/t SI—
Address 13 Y< 1 Ye-i cS
(Street or IT.o No.) 2 t
City or Town State 1�.- Zip Code
( )-
Area code- Phone number n
4. DATE DRILLED 1 - O L
5. TOTAL DEPTH: Z
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [3'
7. STATIC WATER LEVEL Below Top of Casing: -43C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
Topographic/Land setting
DRidge 0Slope ❑Valley Hi-1M
(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
9. varianin ce
)•a1C,�F4,0,
lF�
10. WATER ZONES (depth): ' � 0 /
1
I I. DISINFECTION: Type ' r` t sLI :� Amount 'L
12. CASING: Wall Thickness
Depth .�1-( Diameter or Weight/Ft. Material
v2 From 0 To `- Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft. e_i)VCYQi. pc0 LC(
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.
r7
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the roSdd
numbers and common road names. n
ho
16. REMARKS:
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
JD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- IZ.-Dz
NATURE OF PERSON CONSTRUCTING THE WELL DATE
bmit tlte.original to the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
TR- 33-3211, within 30 days. G W-1 REV. 07/2001
ASH[V91 .1^9L. OFFICE

254765
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Retirees - ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDI VIDUAL)NAM�/E� (prin�t)(i(�yiV�(�} two. Q) 1.� t (h�1(� CERTIFICATTIIOjN#/-2j�0-3;
\vELI. CON'rR:\C'fOR COMP.\NY NAME f--f�u: /t-t. )cYC{t j v �.',R 11 l `1) 1,� PHONE # fl1 (Ft 3- -I t z-3
STATE WELL CONSTRUCTION PERMIT# ' / ASSOCIATED WQ FERMI
It It Z\� J�
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 19'—/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: f
Nearest Town: ka.Y.--Jr0 County FTCiLc0Dd
(Street Name. Numbers, Commonly, Subdivision, Lot No.. Zip Code)
3. OWNER: C kd�+ YQY��`l VN
Address "L ir(, � \ I 0 1
)11) S (Street or Route No.) z.,e�n�
City or Town Stale Zip Code
Area code- Phone number
4. DATE DRILLED � L9 -c Z
5. TOTAL DEPTH: 3 4 rI
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O @�
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S C FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordancerb ISA NCAC 2C.0118.
�
Z-Ql
Topographic/Land setting
❑Ridge 8STope ❑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
YIELD 9. (gpm).
METHOD RFTEST g4 I • C-}4t
10. WATER ZONES (depth): 3
11. DISINFECTION: Type IA -3 .? r Amount Z
12. CASING:
From
From
From
13. GROUT:
From
From
14. SCREEN:
From
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Wall Thickness
O
TIN
c
0
r,
c
--_
— r
LOCATION SKETCH W n
Show direction and distance in miles from atgcast o
two State Roads or County Roads. Include the road=
Dept„,p Diameter or Weight/Ft. Material numbers and common road names.
To 1 Ft.
To Ft.
To Ft.
Depth Material --//,,,, M t
To Ft.(��yy V csi-&k
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
i-/cOL( (17
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
it the original to the Div
2769'-1636 Phone No. (919) 733- 221
9-"!
,';.',L 'FFLE
4-2
URE OF PERSON CONSTRUCTING THE WELL DATE
IV Z
Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ithin 30 days. GW-I REV. 07/2001

10. WATER ZONES ( epth): (O5
11. DISINFECTION: Type Tlq eLer Amount
12. CASING: Wall Thickness
Depth Diameter or WeightiFt. Material
From To V Ft.
Frorn_ To Ft.
From To Ft.
13. GROUT. Depth Material
/e Met
FromTo Ft.�q Q'n C i i:Yl t&
From..__ To Ft. 11
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From fo
8. TOP OF CASING IS ( Fr. Above Land Surfaced'
*Top of casing termlosted sUor below lend sarfsce requires a
vartaoce In accords cc with I5A NCAC 2C .01)8. //
9. YIELD (gpm): d Z METHOD OF TEST Q� 1 • C�!}x� �
4
16. REMARKS:
Diameter Slot Size Material
inin.
in. in.
Size Material
F't.
Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) / (4tY
LS
WEL.l. CONTRACTOR COMPANY NAME }\okelt.
r,\ fE WE LI. CONSTRUCTION PERMIT,/
1 if applicable)
249504
ivision of Water Quality - Groundwater action
Iv a CERTIFICATI4 11 `_40-5
I_II
t� �� IL( t%t PHONE # 0 3 -tt7-3
ASSOCIATED WQ PERMI
•f1l I 11 — a:5 z_
(if applicable)
I. WELL. USE (Check Applicable Box): Residential Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: l rave
County 17C'LI it -La
(S!rcet Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Ci!) or Town
( )-
Area code. Phone number
4. DATE DRILLED Z—/z- Z
5. TOTAL DEPTH. /
6. DOES WELL REPLACE EXISTING WELL? YES ❑//NO 0
7. STATIC WATER LEVEL Below Top of Casing: CS V FT.
(Use "+" if Above Top of Casing)
Topographic/Land setting
ORidge @Slope ❑Valley C Flat
(check appropriate box)
Latitude/longitude of well local an
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopc taphic map
(check box)
DEPTH DRILL I', O LOG
From To Formationescription
N
r
LOCATION SKETCH
Show direction and distance in miles in n at least
two State Roads or County Roads. Inch le the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT T }S.. ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION S • rARD , AND HAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL 0 'NER
ZZL4 0Z
1636 Phone No. (919) 7331 22)1
TURF OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Ratei h, NC
vithin 30 days. GW-I REV 17/2001
GIELEiLII.GtIP.AtE SEEIIr
AIIIIEIP.IILLE REGIONAL L t'ir:F

J
WELL CONSTRUCTION RECORD
255775
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
l7�^//
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _4.CL eg ehode,5 if. CERTIFICATION #.2 nii
WELLCONTRACfORCOMPANVNAME f PHONE # (ton497-typo
STATE WELL CONSTRUCTION PERMIT# N/.LJ ASSOCIATED WQ PERMIT# /VA/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential X Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: f
Nearest Town: � Cotmty/y/
GCI.0 _ 77/#
(Street Name, AUG"uumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Atcb&p-z c-
Ad//drress,�/u, y Xt. //U
esa* ott-f Street It Route INo.) ts2
City or Town State Zip Code
(lfl- /r Q— nr4's
Area code- Phone number
4. DATE DRILLED .377/D 2-
5. TOTAL DEPTH: e2 p 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1$
7. STATIC WATER LEVEL Below Top of Casing: yb FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / ,j FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): %O IWTIOD OF TEST
10. WATER ZONES (depth): 5r -O'
11. DISINFECTION: Type iaeteMet Amount w OL
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t TOS0 Ft. %o y �wC-
2/
From To Ft.
From To Ft.
13. GROUT: Depth
From 1) To s�
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Ft. fA
Method .
f3 ,1
Slot Size Material
in.
in.
16. REMARKS:
�Y.I�DC1�-IE[�E[3„'jt CEI T
1101
Topographic/Land setting
❑Ridge Mlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
et
et
O
ry
C 2
r*1
o .=
Q
LOCATION SKETCH
n a
Show direction and distance in miles from atSst
two State Roads or County Roads. Include thooad o
numbers and common road names.
TAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j
SIGNATURE OF PE N CONSTRUCTING THE WELL ATE
GROLAith,MtElichistaka to the Division of Water Qualify, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASH EV'it2LL6,F64dfi1RLtt01eprim (919 733-3221, within 30 days. GW-1 REV. 07/2001

255101
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and rN� Natural Resources - Division of Water Qualityj- Groundwater Section^tang
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 9j.j AJ /J hei d e9S� - . oCI d • CERTIFICATION,_,,tang
WELL. CONTRACTOR COMPANY NAME J-P—i�% �� 41iP- 9• PHONE 4//'D yA2
STATE WELL CONSTRUCTION PERMIT# / r f * ASSOCIATED WQ PERMIT'S it/A9
applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: _�f)
Nest Town: ./2 CountyfwCLt L1 e nn'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r�
Address _ daa-r--t P Ski •
(Street or Route No.)
/ -44. n/. C. ----
City or Tawg State Zip Code
( )- No # - t rry-y442_
Area code- Phone number L/
4. DATE DRILLED 7/9/o z_
5. TOTAL DEPTH: /RS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tit
7. STATIC WATER LEVEL Below Top of Casing: /L FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 .0 FT. Above Land Surfaces
"'Top of casing terminated at/or below land surface requires ■
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): /_Li METtHOD OF TEST? -r co
10. WATER ZONES (depth): ,/ 0 5
11. DISINFECTION: TypeAmount O L.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
_— From_QTo3bFt. (o- A.Z/ P1/a
From To Ft.
From To Ft.
13. GROUT: Depth Material .Method
From 0 To a2o Ft. t •W'' rn'`y
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.
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees/mimrtes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Material
16. REMARKS.
c
JOCATION SKETCH c_
Show direction and distance in miles from afeast
two State Roads or County Roads. Include tyoac'
numbers and common road names. c:•
`
rn
rn,.
-D
N
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY a F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE 4
SIGNATURE OF PE ' •N C'' TRUCTING THE WELL
0
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
S919)133-3221, within 30 days. GW-1 REV. 07/2001

From
From
From To
13. GROUT: Depth
FromtO To tnI0
From To
14. SCREEN: Depth
From To
From 4Vfl To
15. SAND/GRAVEL PACK:
Depth
From /y/li To
From
To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�j
WELL CONTRACTOR (INDIVIDUAL) NAMEQQ(prin�t)t�%�LL e.d fh o d ep 6 ����T1�/. CERTIFICATION #& ,5 4d
WELL CONTRACTOR COMPANY NAME ,& Lttt. [40.1Zah h9? PHONE # @ 499-Dyer)
STATE WELL. CONSTRUCTION PERMIT# I,�% ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
249729
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest To : - County
(Street Name, Numbers, Community, Subdivision, o., Zip Code)
3. OWNER:Oaf'
Address . a %.2 .� . rn�e-'iH
(Streetor '/RouteC No.) •
City or Town State Zip Code
�l )- &ye- 77115—
Area code- Phone number
4. DATE DRILLED eat./ 5 / D 2L_
5. TOTAL DEPTH: 3t.2s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
7. STATIC WATER LEVEL Below Top of Casing: 4/Z. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % tC FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST t .,C/
10. WATER ZONES (depth): .//4,
11. DISINFECTION: Type 0ze -, Amount Ai 7
12. CASING: vv Wall Thickness
Depth A Diameter or Weight/Ft.Material
o To 9 Ft. b fl[_ cPlva.
To Ft.
16. REM
s I HO TiEREYCL&
CONSTRUCTION STAND
Ft.
,Material
Ft. GGlfli:
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IS:FIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map.
(check box)
DEP DRILLING LOG
From To Formation Description
Method ,
Minty
Ft.
Ft.
Size Material
,SRbnmit<the bt6
276991- 7.,,
r-�
IV
IV
LOCATION SKETCH
Show direction and distance in miles from at ast
two State Roads or County Roads. Include the road=
numbers and common road names.
rJ
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
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
he D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
D
oda

WELL CONSTRUCTION RECORD 2 4 9 9 01
North Carolina - Department of Environment and Natural/nIResources - /D)v'isiioon of Water Quality - Groundwater Section
7
WELL CO\TRACTOR (INDIVIDUAL) NAME print) Oned etee,' CERTIFICATION #�) p6/(, (,
\VELI. CONTRACTOR COMPANY NAME / / I Ge tveJ/'t *mp PHONE # (0"�/ - o'�/fJ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential It Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2.
WELL LOCATION: /' ,/
Nc,�t est Town: ?Pt iA� County
f � e-
(Street Name, Numbers, ommunnity, Subdivision, Lot No., Zip Code)
3. OWNER: `c..1:9n/s'e��
Address . 179N'/��u'rye
k ii*g kr o7.No)
(
Town State Zip Code
Area code- Phone numbe
4. DATE DRILLED.3—a'0'OO
5. TOTAL DEPTH: 9o,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I '
7. STATIC WATER LEVEL Below Top of Casing: 6,0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordanc with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST/Orr
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
f2idge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of welt location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fryer io Description
0
11. DISINFECTION: Type f/Eli Amount
12. CASING: Thickness
Depth' / Dia�� r or Wall Thick Ft.
From �� To 2 91 FL l6' 1 tom-_
From To Ft. 4/3C11
From To Ft.
13. GROUT: Depth Material /._ Method
From Q To do Ft. (en?et, 7
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 "fo Ft.
From To Ft.
L:
m H.
cn-
0
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3—Q0- oa
SIGNATURE C RSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Nail Service Center- Raleigh, NC
GR.
1AlFicirh6GiNyl`It,.,(�19) 713-3221, within 30 days. GW-1 REV. 07/2001
ASPE;ILLE REGIONAL OF

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ural' esou
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WELL CON! RA CI OR COMPANY NAME / C;TYe Ave./ E ✓eftn
249904
ces - Division of Water Quality - Groundwater Section
,//p
CERTIFICATION# `2y(P/
PHONE # W6) 2-n
STATE WEI,1. CONSTRUCTION PERIDIIT# ASSOCIATED WQ PER311T#
(if applicable)
(if applicable)
VVELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. \VELL LOCATI
Nell•Cst Town: Se
e
County. I'fluod
(Street tG tie. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / A rp / v
Address 70 7� 'ff e /1,dd e-
(Street or Route No.)
/U.C•
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED D—g-oa
5. TOTAL DEPTH: 707-F -
6. DOES WELL REPLACE EXISTING WELL? YES III NO Q'
7. STATIC WATER LEVEL Below Top of Casing: 411 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 67 METHOD OF TEST Ai sir
10. WATER ZONES (depth):
s7a
I I. DISINFECTION: Type /f T/1
12. CASING:
From f..2
Zip Code
Depth DiatyeJfe
To 73 FL to /V
From To Ft.
From To Ft.
13. GROUT:
From (5
From
14. SCREEN:
From
From
15
Depth
To do
To
Amount
Wall Thickness
or Weight/Et. M terial
_�Topographic/Land setting
MRtdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deereeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To F.r ati. Description
DEPTH
From
0 0
7S
/05
/dS
LOCATION SKETCH
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers andcommon road names.
0
Too
Depth
SAND/GRAVEL. PACK:
Depth
To Ft.
To Ft.
From
From
Material Method
Ft. C eM emit
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Material
0:
16. REMARKS: W
r o
C
H E C TI 'Y1- t1- ' :IL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Ot T ND R NrC `-IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'I URE OF PERSON CONSTRUCTING THE WELL DATE
Submkthe original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-16.1 JIRJUC+iNli$$§0X1 S221, within 30 days. GW-I REV. 07/2001
AS iL",1LLE REGLNAL OFFICE

WELL CONSTRUCTION RECORD
249903
North Carolina - Department of Environment and Natural Resources -/ty� ivision of Water Quality - Groundwater Section,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3QN �� A 7L isCERTIFICATION#�/%(!17
WELL CONTRACTOR COMr.ANv NAME fate Live// SFX/r•+Q/ r11oNE # (SJS)_____ _
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
( if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION/
NeAest' ywn) (*fy0 e.
�ufe "o✓e
(Street Nan Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: �e
Address 0 Z vs
(Sire a or Route No.)
/ttft eSV; //e A/•6.
C y or Town State
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From+r) To 76 Ft. 6 J/
From To Ft.
From To Ft.
13. GROUT: Depth '7 Material Method
From a To 020 Ft. Ce/1,etit
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
70S
Zip Code
)-
Area code- Phone number
4. DATE DRILLED �' �d ` O a
5. TOTAL DEPTH: y5"15 fr-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ME--
7 STATIC WATER LEVEL Below Top of Casing: y% FT.
(Use "+" i f 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 accordancgt ''th 15A NCAC 2C .0118.
9. YIELD (gpm): Y METHOD OF TEST4
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.
County 1
9 64JOC
Topographic/Land setting
(idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
D 10
/o 7r>7
7,7 / /
Amount
Wall Thickness
or \Veight/Ft,t `teJrial
rl (re
From
From
Depth
To
To
74/
Size
Ft.
Ft.
Material
Fsr atir Description
n40
/D # .r e.
/5Se 3
c
DO
b-122
CO ▪ 2.
✓ c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH I5A NCAC 2C, WELL
NSTRI IrTIDAt ST • TDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3- ID- -a
' Submit fhe.otiiinal lu.the
27699-1636 Phone No
(919)
SIGNATURE OF
RSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
133-3221, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
AS'IR-RILE REGIONAL OFFICE

2. WELL LOCATION: %/
Nearest Town: e. UQIQ
'1 f✓L?�J 1�Jns'
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dfirry/ d 4 r/
Address /g C,,rnU Se 4 ^t•
tvvtik trees or Rou e No.)
Zit), or Town State Zip Code From
0
Topographic/Land setting
L9<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
r • at' • n Description
`Pt j
7. STATIC WATER LEVEL Below Top of Casing: 9V FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /O METHOD OF TEST �%•�
10. WATER ZONES (depth):
To
11. DISINFECTION: Type /%T,t
12. CASING:
De t Diajn`e'ter
From taZ To 73 Ft. (C,
From To Ft.
From To Ft.
13. Depth Material
To a0 Ft. Ce..enz1—
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.
North Carolina - Department
JJ ty
WELL CONTRACTOR (INDIVIDUAL) NAME print)�r4•1 genii V
WELL CONTRACTOR COMPANY NAME
c [Veil 9 - 4-Ito
249906
- Groundwater Section,/ 7
CERTIFICATION # �77 /
PHONE # 1"`� 6.R '-5✓ p4
STATE: WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential II/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
( )-
WELL CONSTRUCTION RECORD
of Environment and Natural Resources - Division of Water Qual
County di/Pit:
Area code- Phone 4. DATE DRILLEDbJ— /-
5. TOTAL DEPTH: 3a s f-r-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Amount
Wall Thickness
or Weight/Ft. nterial
GROUT:
From 0
Method
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.
nn HFRFRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the origi to
'r7699-1616 Phone ' ,. (9
GROUNDWATER SECTION
J.' iLLE RLP'11;'.AL OFFICE
SIGNATUR
ERSON CONSTRUCTING THE WELL DATE
0
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Dcparnnent of Environment and N tur/a Re/$ources -)Division of Water Quality - Groundwater Section.
c
WELL CONTRACTOR (INDIVIDUAL) NAME print)/�el)I- 241U2/ CERTIFICATION# a7/tA?,�/-�
WELL CONTRACTOR COMPANY NAME /r ce ivp./l V PVAt/' PHONE # Ij ) 6.27— ` W
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential NJ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑. If Other, List Use
2. WELL LOCATION
Neare, ( Tow - " Ne are County etldooe>/
7 Ye ,/r .�s e
(Street Name, tNumber:, Comtnuunity, Subdivision, Lot No., Zip
Code)
3. OWNER /reA'%�^?uXw/421% No 4
eAerb fee (Sireetor_Royte No.
City or Town State Zip Code
Address - 0 EAf n1e —F/c✓D 4'» M.? Wi
( )-
Area code- Phone number
4. DATE DRILLED 3—a5"—oa
5. TOTAL DEPTH: 5' 's-0"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er'
7. STATIC WATER LEVEL Below Top of Casing: ,3/ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`'fop of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST f%'/
10. WATER ZONES (depth):
II. DISINFECTION: Type dr, Amount
12. CASING: Wall Thickness
Depth2; Dia eter or WeieiF,ht/Ft. Material
From tov?- To ' / Ft. 6' -4' ./p FS iSiee
From To Ft.
From To Ft.
13. GROUT: Depthj�7 Materia{L. , Method
From 0 To 7/ Ft.�jr1,J1' /OmP
From To _ Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
lflRidge ❑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
i3*-- KAY
/
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/3/s
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
h n 1� 11 s N
Submit the original to t
L27699 MAY 7 Pltotc» )u� Np.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
—
N7 S•
249905
3- ;S-O2—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
•3221, within 30 days. GW-I REV. 07/2001

249907-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat tral •RRR/777��P-souu ces - Di 'sion of Water Quality - Groundwater Section /�[Cy
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) eAl 7 a+� lrP� CERTIFICATION # �/ r'"/
WELI.CONTRACFORCOMPANY NAME 7/,C6) Ue/AARci-tf PHONE #tag) (,ou-Ss%e
STATE \VEI,I, CONSTRUCTION PERMIT# ASSOCIATED WC) PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
W EI.L LOCATION. ,�
Nc 'est Town' �� / - VA - County
/fa(i �.*,) . ��!� 'ep
(Street ame, Numbe////rs, Community, SubvIeKion, Lot No
3. OWNER:NiKe WP'b 4eC
Address ;ale Cta11C
p Code)
(Street or Ro ¢ 2� No.) �6
l�li4'JnlesOf lie Al C
C ty or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3-&-o2
5
6
7
TOTAL DEPTH: 3Ctyf fR-
DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0'
STATIC WATER LEVEL Below Top of Casing: (3 FT.
(x
9/�. (Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
"Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /5 METHOD OF TEST /9-
10. WATER ZONES (depth):
I I. DISINFECTION: Type
I2. CASING:
frit
Depth
From lc- To /03 Ft
From To Ft
From To Ft
��// Topographic/Land setting
LhRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshn inutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
F lion ascription
From To
0 °ea
(90 /0S '
/n,S" / 1/
/psi 3ES
giver
7
Amount
Wall Thickness
or Weight/Ft. Material
/
13. GROUT: Depth Material
From n To Ft. a? 'e /T"
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Method
Slot Size Material
in.
in.
Material
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.
/30 3
LC :e Wd Z- 2idV ZO
MAY
J
A
1 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3--D�
DATE
Submit the original tt the H ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GR t v , cr " Sit b"N 19) 7_3-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

249908
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRAC1OR (INDIVIDUAL) NAME (print) i9.1 (/e/[A5 lQ CERTIFICATION #95/67�/
WELL CONTRACTOR COMPANY NAME to Ce eJf PHONE # ('(>AT$1 G�a7-F45/S"
SLATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential M"Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:,/
Neatesj Town: (1/1�1 t.
Cfp QM A Mid".
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / /J (/�I'// /4NC e
Address y0 �iJ44,<-12 �e t'C.
(Street or Route No.)
Mae ,A c. a4707 /
City or Town State Zip Code
( )-
Area code- Phone numbeS
4. DATE DRILLED
5. TOTAL DEPTH: yG 5�
6. DOES WELL REPLACE EXISTING WELL? YES,4 NO Lti
7. STATIC WATER LEVEL Below Top of Casing O 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 15A NCAC 2C .0118.
9. YIELD (gpm): /° METHOD OF TEST d9'%
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
tfTit
Depth Dia eter
From td To 77 Ft. (8/9
From To Ft.
From To Ft.
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forn,.Lion Description
.I
DEPTH
From To
0 as
Amount
Wall Thickness
or Weight/Ft. M erial
%453t C
13. GROUT: Depth MaterialMethod
From 0 To r)o Ft. ter•te^'T4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
A
—o
N
CA)
rr -- rim
ubmit the original to
i�6i9J�1 liA $bC(TJN 733-32
ASHEVILLE REGIONAL OFFICE
J
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3- Iq-o�
F PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
1, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources
C• •. e 9-
WELL CONTRACTOR (INDIVIDUAL) NAME rint)
\\'ELI. CON'I RAC'rOR COMPANY NAME
249902
- Division of Water Quality - Groundwater Section, //pp
CERTIFICATION # C276/
PHONE # SS) &2-G5 /O
vM
STATE \\ ELL CONSTRUCTION PER\IIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1.
7
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Nlonitoring 0 Recovery ❑ Heat Putnp Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Near-t "town: �/-I'V r—f County
(S reef Name Numbers. Community, Subdivision, Lot No-. Zip Code)
3. OWNER: 11A)e
Address —S./
(Street or Route No.)
((Le /v; c -
CityorTown State
( )-
o2g7/C
Zip Code
Area code- Phone number
4. DATE DRILLED o7' - Da
5. TOTAL DEPTH: ayC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ic2 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance s 'ith ISA NCAC 2C .0118.
9. YIELD (gpm): _per METHOD OF TEST /7l
10. WATER ZONES (depth):
I I. DISINFECTION: Type f-/T
12. CASING:
From +a,. Depth Diameter
To� Ft. I�, /l,�
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 FL r
From To Ft.
14. SCREEN: Depth Diameter
From _ To Ft.
Front To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amotmt
Wall Thickness
or Weieht/F't. Material
Topographic/Land setting
1idge ❑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 F r ali n Description
CAO
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.
,15i$ 57ee I //
�YW I/o
Method
Slot Size Material
in.
in.
Material
•
rel
c+
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTI •-_aRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit jhe,'oi+ipinal
i.1 27699-1636 Phone No. (9I9)
GROUND
- ._H CITION
6HEVILLE REuC';'-TFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
a
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

733.3221 /
North Carolina • Department of Enviro C 27fi99 163&Phone (ur Resources - Division al Water Quality • Groundwater Section
1636 Mail Service Center • Raleigh.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION $:
STATE WELL CONSTRUCTION PERMIT#:
Municipal ❑ Industrial ❑ Agricultural ❑
Other ❑ If Other, List Use: �---
1. WELL co USEry(cheek Heat Purrap Water Injection 0
esidential
Recovery ❑
2. WELL LOCATION sketch al the location below)
Counry:
Near st Town:- 4 e
(Road Name and d Numb
3. OWNER
Address
-- - o. 3476
0l/Jjna,
r sole Zip Code
Ci y or Town ��rr
4. DATE DRILLED/ '� V
5. TOTAL DEPTH ?CS T+
6. CUTTINGS COLLECTED YES n NOD
7. DOES WELL REPLACE EXISTING WELL? YES j NOI
8. STATIC WATER LEVEL Below Top of Casing: dot" FT.
ll (Use'+' il Above Top of Casing)
9. TOP OF CASING IS oC FT. Above Land Surface-
-Top of casing terminated atror below land surface requires a variance In accor-
dance with 15A NCAC 2C .01111 Ar
10. YIELD (gem). / METHOD OF TEST 1—
11. WATER ZONES (depth)*
12. CHLORINATION: Type
13. CASING:
Amount
Wall Thickness
Depth DJ'ary91e or Weight/Ft. M erial
From 14-a? To C»J Ft la
'// '
From To Ft
From To Ft
14. GROUT:
!� Depth Material Method
From v To r Ft cc%se-7-
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To- Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To
Ft
24b'yb
-Monitoring ❑
DEPTH
Fo ilon aescription
11 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)
17. REMARKS:
100 HEREBY C 1✓?W/Etl WAS.CDNSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION 5 tnRgS. AD T�/4� C` tits RECORD HAS BEEN Pp VIDED� �T�O THE WELL OWNER
.
iFOR OFFICE USE rya}1.Y • A' 'J I S110
ouad No: I I j URE OF PERSON CONSTRUCTING THE • DATE
. SubrMMArigi •slon oI Water Ouaitty, Groundwater Section Within 30 days
Serial No. I GWt REV. 12199
GROUNDWATER SECTION.
ASHEVP LE REGIONAL OFFICE

2. WELL LOCATION: (Shim sketch of the location below)
Neare t Town: L 4t v tag el," County.
�o.v r 0✓ e DRILLING LOG
un
(Road Name umbers. Conu . or Subdivision and Lot No.)
r
7
_ors
3. OWNERe gev-_C"t/
Jo N c e=
(Street or, ouo o. c7k7/
City or TownState Zip Coda
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESf NOQ
7. DOES WELL REPLACE EXISTING WELL? YESyn NO[21--
B. STATIC WATER LEVEL Below Top ol Casing: FT.
(Use': d Above Top or Casing)
9. TOP OF CASING IS 02 FT. Above Land Surface'
-Top or casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C jig /
10. YIELD (gpm)• METHOD OF TEST Ar d
11. WATER ZONES (depth).
Address
North Carolina • Department ol Environment and Nalural Resources , Division of Water Oualiry • Groundwater Section
636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] f/n
WELL CONSTRUCTION RECORD WELL CONTRACTOR: / ire hie!/ li)MP
WELL CONTRACTOR CERTIFICATION #: a 9" 9
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ErMunicipal ❑ Industrial 0 Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
From To
0 070
12. CHLORINATION: Type
13. CASING:
Amount
Wall Thickness
Depth Diameter or WeigIWFL #dal
From 7 To _ i-<<--- Ft 2-4
-
From To Ft.
From — To Ft
14. GROUT:
r� Depth
From To dP Ft (1,0
From To
15. SCREEN:
Ft
Depth Diameter Slot Size
From To
From To
From _— _ To
16. SAND/GRAVEL PACK:
Material / Method
Material
Ft . in in
Ft in in
Ft in in
From From
17. REMARKS:
Depth Size
To Ft
To Ft.
I DO HEREBY Cl
CONSTRUCTION
FOR OFFICE USE
Dead No:
$anal No
Material
245595
DEPTH
Fomplion Description
a
11 additional space is needed use back ol form
LOCATION SKETCH
(Show direction and distance born at least two State
Roads. or other map reference points)
//O
0
N
*1
r*1
0
1
a
0
cn
Q7
St
Submit original
GRQUNDWAJER SECTION
ae r ILLE REGIONAL OFFICE
,TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OF PERSON CONSTRUCTING THE WELL DATE
or Water Ouaitly. Groundwaler Section within 30 days GW t REV. 12199

Depth
To
To
To
- North Carolina - Depanment ol Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636.Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: / CC wQ (( Cif
WELL CONTRACTOR CERTIFICATION #: 019'
STATE WELL CONSTRUCTION PERMIT#:
246598
1. WELL USE (Check Applicable soak Residential ID" Municipal ❑
Recovery ❑ Heat Pump Water Injection ❑ Other DII
2. WELL LOCATI
Nearest Town:
I: (Sow sketch of the location below)
\j/9 2 County.
7/ (Road Name ,anJ Numbers. Community, or ubdivision and Lot No.)
3. OWNER 047 U / /�/rrp or
CSAC Ti n A 0
Address 36 (Q } a,( (�
(� eet or ou o No.
(Of.U,t_os i 6 16
Zip Code
City or Town Stale
4. DATE DRILLED
5. TOTAL DEPTH S Et
6. CUTTINGS COLLECTED YES 0 NOE
7. DOES WELL REPLACE EXISTING WELL? YES [] NOf
6. STATIC WATER LEVEL Below Top ol Casing: FT.
(Use': it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
-Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011e
10. YIELD (gpm)- _s_ METHOD OF TEST 4-i r
11. WATER ZONES (depth):
•
Industrial ❑ Agricultural ❑ Monitoring ❑
Other, List Use:
/ttio0e/
DRILLING LOG DEPTH
From To Fonprali. sescription
4
.+DI
12. CHLORINATION: Type
13. CASING:
Amount
v
If additional space is needed use back of form
Wall TNckness LOCATION SKETCH
-i a Depth -)ma, Di/amfter or Weight/Ft. erial (Show direction and distance from at least two State
From To as / Ft 4J �y "5Y, C Roads, or other map reference points)
From To Ft.
From — To - Ft
14. GROUT:
Depth J Material / Method
/
From 0 To _a Ft CPA N/fT
From To Ft
15. SCREEN:
From
From
From -
16. SAND/GRAVEL PACK:
Depth
To
To
Diameter
Ft . in.
Ft in
Ft in.
From From
17. REMARK`'[
I DO HEREB
CONSTRUC
Size
Slot Size Material
in
in
in
Ft
Ft
Material
n =
SS
S l CC
STANDARSA 0
NSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
Cl
eCie,T - - DATE
S GNATURE0FOF PERSt'1N CONSTRUCTING THE WELL
sutatut original to Divisbn of Water Duality. Groundwater Section within 30 days GW 1 REV. 12199
ATER SECTION
EGIONAL OFFICE

24659'7
North
Mar Service • DCemment olf N.C. Environment and Natural
Re (919)1
Resources
Division ol Water Duality • Groundwater Section
1636
er
WELL CONSTRUCTION RECORD WELL CONTRACTOR: the We//oA-/
WELL CONTRACTOR CERTIFICATION N: 093/4
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable pox): Residential Municipal ❑
Industrial El Agricultural ❑ Monitoring ❑
Recovery (—] Heat Pump Water Injection ❑ Other 0 11 Other, List Use:
2. WELL LOCATIO ,(1Sho ketch of the location below)*kin c�
4/o4rv/v.
sii wn: �% County'
DRILLING LOG
ad Name an misers. ommunit . or Subdivision and Lot No.) Fo ii„r, Description
3. OWNER c14 Der ,yam' From To Y
Address d2S it `�� ^' Q
S ee or Houip (, 7-4
State
oa
DEPTH
(�%yo e
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES CI NOD
7. DOES WELL REPLACE EXISTING WELL? YES Q NOEr
8. STATIC WATER LEVEL Below Top of Casing: _��_ FT.
(Use'+' it Above Top ol Casing)
9. TOP OF CASING ISFT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 118
10. YIELD (gpm): METHOD OF TEST A•Nt*--
11. WATER ZONES (depth)•
Zip Code
3
•
12. CHLORINATION: Type Amount
13. CASING:
�.vs.me_
It additional space is needed use back of Corm
LOCATION SKETCH
Wall Thickness
Depth DI ter or orw ' t. anal (Show direction and distance from at (east two State
From+OR To 10.7Ft en, • n / Roads. or other map reference points)
From To Ft From To Ft - tl hr /3
14. GROUT:
Depth Material Method
From 0 To _)Ft. C�� eN t
From Tb FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft _.-- in. in
From _ _To R. in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From —
From _
17. REMARKS:
To Ft
Ft
To
0
c
I DO HEREB`
CONSTRUCT
FOR OFFICE
Ouad No:
SedalNo.
GROGNJW,%f>R S
AS'r!E`91 I_E R' .1
Sutinit o
SE
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I-I0•-
- , URE OF PER N CONSTRUCTING THE WELL GATE
Division of Water quality. Groundwater Section within 30 days
GW1 REV. 12199

7
Nonh Carolina • Depanment of Environment- Dand Natural Resources - Divisiosio
n of Water Duality •Groundwater Section
.v
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone (919) rit f_' Li./e//Pe
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:.
STATE WELL CONSTRUCTION PERMIT#:
ricultural ❑ Monitoring 0
Box): Residential
1, WELL USE (Check Heat1Pump Water Injection 0 Municipal
II Other, List Use:
Industrial CDA9
Recovery ❑ taped/
DEPTH
DRILLING G LOG __----
From To Fonn Lion Description
O qYo 41I
2. WELL LOCATION: (Show sketch r} the location below)
Neargst Town: /./A-VNe 1-/r//L` County:
icy. or SuJbdiv ion and Lot No.)
(Road Name and /N
3. OWNER
Address
5 trees orHoulo No.) �i 7p/
i1/96y weown Staie 0X ,
ty or Town�//��'� ,,���,,��1-0 Stale
4
5. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO fl
7. DOES WELL REPLACE EXISTING WELL? YES O NOpr
8. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use'+' 11 Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated .Vor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .01.48
10. YIELD (gpm): il METHOD OF TEST Ri
11. WATER ZONES (depth)• 12. CHLORINATION: Type /1T
070 77
/08
ce s'i/�"
13. CASING:
Amount
II additional space is needed use back of form
Wag Thickness LOCATION SKETCH
Depth D' r/n ter or Wei{an�ypt. Ma edal% (Show direction and distance from at least two State
From To 7aC
' Ft r %"" Jyee` Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
From 0
Zip Code
Depth,Material Method
To .2° Ft 4iNn/t
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To- Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Via, ale
0
—r1
rrl
CO
W
7,0
N
245599
0
17. REMARKS:
I DO HE
CONST
FOR OFF
Ouad No:
Serial No.
*STANDARD AND
E ONLY
ONSTRUCTED IN ACCORDANCE WITH 'ISA NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN P a VIDEO TO THE WELL OWNER.
—a3—cam.
SIGNATURE OF PERSON CONSTRUCTING THE Rf DATE
to Division of Water Duality. Groundwater Section within 30 days
GW-I REV. 12/99
OFRCE

1636 Mail Service Center •Raleigh. N.C. 27699-1636-Phone [phone]
Nonh Carolina • Depanment of Environment and Natural Resources • Division of Water DuLL CONTRACTOR: alityGroundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION #: ______12
--------
STATE WELL CONSTRUCTION PERMIT#:
Industrial ❑ AgrlCUltural0
1, WELL USE (Check Applicable Box): Residential U M Otherat If Other, tst Use: �---
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION: (Show sketch of the location below) WOO/
< A/ County:
Nearest Town: � n
(Road Name and Num•ers. Co
3. OWNER ?-
Address
nity, or Subc9vision and Lot No.)
Keel or • ou 0 ' 0.
eta 1p State
City or Town
4. DATE DRILLED —ov/-O
5. TOTAL DEPTH T
6. CUTTINGS COLLECTED YES n NOD _/
7. DOES WELL REPLACE EXISTING WELL? YES Q, NO j ✓i
8. STATIC WATER LEVEL Below Top of Casing: !�/
FT.
(use •+' it Above Top o1 Cuing)
9. TOP OF CASING IS oC FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In smear.
dance with 15A NCAC 2C .0j �16
10. YIELD (gpm)' -- /0 METHOD OF TEST A
DRILLING LOG
From To
p_ 4O
n / idy�D /7 0
Zip Code•
70
•//t?
11. WATER ZONES (depth)
12. CHLORINATION: Type
13. CASING:
Amount
246600
Monitoring 0
DEPTH
II additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth%�.-, va a or Wirt. a vial (Show direction and distance from at (east two State
From 4 � To `� e Ft. ( n;, "V / / Roads, or other map reference points)
From To Ft. � !
From To Ft -+-1 / �-/ 3
14. GROUT: c�
Depth �,` p Muria y Method
From b To L. Ft re
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
Depth
To
To
Ft
Ft
Size Material
100 HEREBY
CONSTRUCT
L
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN P • a VIDED TO THE WELL OWNER.
I -al-off
TURE OF PERSON CONSTRUCTING THE DATE
Non of Water Quality. Groundwater Section within 30 days
GW 1 REV. 12/99

North Carolina - Department ol Environment and Natural Resources • Division of Water Duality- Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] �%r,C e (rU
WELL CONSTRUCTION RECORD WELL CONTRACTOR. ELL CONTRACTOR CERTIFICATION H: set
STATE WELL CONSTRUCTION PERMITit:
Industrial Agricultural
1. WELL USE (Check Applicable Dos): Residential�Municipal ❑
Pump Water Injection ❑ Other If Other, List Use:
Recovery ❑ Heat , ,
2. WELL LOCATION: (Show sketch of the location below) ilk
Nearest T
ss ;
(Road Name a
3. OWNER
Address
wn
torw
umbers. Comment l or S'vision and Lot No.)
bores
we( er 'oum •by
uty w T Town State
4. DATE DRILLED 0. 2
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? Y S
8, STATIC WATER LEVEL Below Top of Casi . -
^� (use •Ii Above Top of CasiAQ
9. TOP OF CASING IS =G FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires • variance In accor-
dance wllh 15A NCAC 2C .911ft
10. YIELD (gpm): J 0 METHOD OF TEST
11. WATER ZONES (depth).
12. CHLORINATION: Type fir/7
13. CASING:
DRILLING LOG
From To
0 4
-1- 1 Depth/ O-arpeter
Frome/aN To 42 J Ft (/' /A/
From To Ft.
From To Ft.
14. GROUT:
From
0
Amount
246602
Monitoring ❑
DEPTH
Form tion • scdption
11 additional space is needed use back ol form
Wall Thickness LOCATION SKETCH
or wee tp / (Show direction and distance from at least two State
SS ij )/ Roads, or other map reference points)
Depth Material
To (OfJ Ft e^ICA't
From To FI
15. SCREEN:
W/925
ethod
n
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
Depth
To
To
Ft
Ft
Size Material
93:OI WV h- 833 ZO
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTR TH
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN P(tQVIDED TO THE WELL OWNER.
GNATURE OF PERSON CONSTRUCTING THE VtWEp GATE
to Division of Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99

1636 Mail Service Center • Raleigh. N.C. 27699-1636-Phone [phone] nit toe/
North Carolina • Department ol Environment and Natural Resources • Division of Water Quality • Groundwater Section
f�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. LL CONTRACTOR CERTIFICATION 1r: •• 9
STATE WELL CONSTRUCTION PER RMIT #: —
Agricultural ❑ Monitoring ❑
1. WELL. USE (check Applicable Box): ResidentialIndustrial ❑
Heat Pump Water Injection El Other If Other, List Use:
Municipal IDRecovery ❑
2. WELL LOCATION' (,st19w sketch of the location below)
/� County.
Town: �
(Road Name
3. OWNER
Address
De_
umbers -Community. or Subdvion and Lot No.)
trecl or -Ap
City or City or Town
4. DATE DRILLED —/ as0-7
5. TOTAL DEPTH .
6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
-Top of cuing terminated .Uor below land surface requires a variance In accor-
dance with 15A NCAC 2C .QyLip
10. YIELD (gem). / METHOD OF TEST
11. WATER ZONES (depth).
12. CHLORINATION: Type //Tq Amount
13. CASING:
From / e2
Depth 10 D' fl elor
To a % Ft 0/9
From To Ft
From To Ft
14. GROUT:
From 0
From
15. SCREEN:
Zip Code
DRILLING LOG
Wall Thickness
w Wpj ft.
Depth , Material y Method
To 00 Ft re's?6'4'7
To Ft
Depth
From To Ft
From To Ft
From To FL
16. SAND/GRAVEL PACK:
Depth
To Ft
To Ft
Diameter Slot Size Material
in in
in in
in in
From
From
17. REMARKS:
Size Material
7
DEPTH
Fonnatio Description
4 -1O
II additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least Iwo Stale
Roads. or other map reference points)
0
IT1
m
0
N
I DO HEREBY CERTIFY THAT THIS WELL W ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN P VIDEO TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE ar£� DATE
to Division ol Water Ouality. Groundwater Section within 30 days
GW-I REV. 12/99

246603
Ft
Diameter Slot Size Material
in.
in
in.
Ft.
Ft.
p I o1 Environment and Natural Resources . Division of Water Quality- Groundwater Section
Nonh Caroli
na- epanmen
1636 Mail Service Center - Raleigh, N.C. 27699-1636•Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION tt: 07
STATE WELL CONSTRUCTION PERMITS,:
iCe 1%
1. WELL USE (Check Applicable BeakResidential lir Municipal ElIndustrial El
Recovery ❑ Heat Pump Water Injection ❑ Other El II Other, List Use:
2. WELL LOCATIr (Sh,0w sketch of the location below) County-
/4/LVD oc/
Neare t Town: r R Al
e Ter /61 DRILLING LOG
(Road Name and rroers Co unity. orSubdivision and Lot No.) c L 70
3. OWNER �/ 'r( pS1 e
Address
C or Town tale
4. DATE DRILLED 7 o�
5. TOTAL DEPTH ---- 6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
(Use •: a Above Top or Casing)
9. TOP OF CASING 15 r."( FT. Above Land Surface'
'Top of casing terminated avor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0} 18
10. YIELD (gpm): (' METHOD OF TEST /%r
11. WATER ZONES (depth).
12. CHLORINATION: Type
13. CASING:
From
Amount
•
Agricultural ❑
Monitoring 0
DEPTH--
Forr7+ation,Description
f/
11 additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
Depth Di jar or v/ggryuFL jed?,t/ (Show direction and distance from at least two State
To /c7s Ft �7 /rjj rC?" Roads, or other map reference points)
From To Ft
From — To - Ft
14. GROUT:
l/ Depth ,,,Material Method
From To
070 Ft. `- en- e'-•7
From To
15. SCREEN: -
Depth
From To _ Ft
From To — Ft
From To — Ft.
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
I DO HERE
CONSTRU
in.
in.
in.
Size Material
11 yw a21(5-
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0
tT
�-0
ii o p DATE
NATURE OF PER N CONSTRUCTING THE WELL
Division of Water Quality. Groundwater Section within 30 days GW t REV. 12/99

North Carolina • Depanmertt of Environment and Natural ResourcesDivision of Water oualiry • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]��
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION 8: <—
STATE WELL CONSTRUCTION PERMITtt:
246604
1. WELL USE (Check Applicable Residential Municipal ❑
Industrial ElAgricultural 0 Monitoring ❑
Recovery ❑ Heat Pumpp x): Water Injection El Other
r p III Other, List Use:
2. WELL LOCATIO : (Sh9w sketch of the location below) 4 t�aC�
"'iv county:. /
NeareSl Town:
(Road Name an
3. OWNER
Address
—
tree'or auto
i+/� £•
`r �pState
4. DATE DRILLED L4012-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOLJ
7. DOES WELL REPLACE EXISTING WELL? YES [] NOler
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use •; it Above Top of Casing)
9. TOP OF CASING IS r>C FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C . 1
10. YIELD (gpm): / d METHOD OF TEST /9'r
11. WATER ZONES (depth).
DRILLING LOG
From To
0267/4
Zip Code /�i—
City or Town
12. CHLORINATION: Type
13. CASING:
From to
From
From —
14. GROUT:
Amount
Depth��j Dianrier erial
Kisar
To �1L= Ft. i0 /I/
From _
From _
15. SCREEN:
From
From -
'From
To Ft
To Ft
Depth
To _
To _
Depth
To
To.
To _— Ft.
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
I DO HEREB
CONSTRUC
FOR OFFICE
Quad No:
Ft
Ft.
Wall Thickness
or Weight/Ft.
Material
Diameter Slot Size
Ft __ in.
FL— in. --
in. --
Size
Ft.
Ft.
• TfiIS'WEa WAS
ANDARDS, AND THAT A
Method
Material
in.
in.
in.
Material
DEPTH
Fon align Description
/P
11 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)
tytiti /I
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�F THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
B� �—
IATURE OF PERSON .CONSTRUCTING THE WELL
Division of Water Quality Groundwater Section within 30 days
O
IV
rn
CO
t�
0
N
WNER.
11-0
DATE
c
CT' C7
C<.
GWt REV. 12/99

3. OWNER nit
Ne shown: (j4 e •
(Road Name an umooVf s. Co m nity, or SSuubdivision and Lot No.)
C cf �/n'L� 7
Address tla-)
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
^ Stale
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] Ol
WELL CONSTRUCTION RECORD WELL CONTRACTOR' /' rCe wed Yu»
WELL CONTRACTOR CERTIFICATION #: rig&
STATE WELL CONSTRUCTION PERMIT#:
246605
1. WELL USE (Check Applicable Box): Residential B Municipal ❑ Industrial D.
Agricultural ❑
Recovery ❑ Heat Pump WaterInjection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sh w sketch of the location below) County 'Z/��✓0 /
Lp±`1!.
28'1 l(n
6. CUTTINGS COLLECTED YES n NOT'
7. DOES WELL REPLACE EXISTING WELL? YES © NOn
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '.' it Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C. 11e
10. YIELD (gpm): METHOD OF TEST %}rr
11. WATER ZONES (depth)
Zip Code
12. CHLORINATION: Type }%i77/ Amount
13. CASING:
DRILLING LOG
From To
0 /b
7/
0
Monitoring ❑
DEPTH
lion Description
If additional space is needed use back of lorm
Wall Thickness LOCATION SKETCH
Depth Dia ew/r or Weight/Ft. /aaa��terial (Show direction and distance from at least two State
From+) ToL Ft l �7 �`f�� Roads, or other map reference points)
From To Ft
From — To Ft.
14. GROUT:
Depth Material Method
From 0 To �D Ft Ce ew l—
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth Size
To Ft
To Ft
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
From
From
17. REMARKS'
Material
92:011IV h-03.JZo
c
O
I DO HEREBY
CONSTRUC'I�
{La
IFY n1A I I HIJ W t LL W AJ
ANDARDS, AND THAT AC
FOR OFFICE
Quad No:
Senal'No.
NLY
f
P
(1TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(-a 3-0
DATE
SIGNATURE OF PERS a N CONSTRUCTING THE WELL
gmal tc Division of Water Quality. Groundwater Section within 30 days
C hE` 6Fi16
GW1 REV. 12(99

1 - North
Mail Service - DD paertmenl a a nv N.C. nt and Natural
Resou
(urces'7D vi sion of Water (Duality - Groundwater Section
eter
WELL CONSTRUCTION RECORD WELL CONTRACTOR: nice we/A-Pit
WELL CONTRACTOR CERTIFICATION II: 0796
STATE WELL CONSTRUCTION PERMIT#:
246592
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use:
2. Near st Town: 0/
WELL LOCATI (Sh w sketch of the location below) ry-iq/4/v n
/ "4— n/% Coun
(R d Name an ummmmmmbbbccb444444(Si Community. or,Subdivision and Lot No.) DRILLING LOG
3. OWNER /P/l -6 Ar /// 3 / frro1m To
ZO
Address Sop Q,'SyvAJ 1)A- I y 2 /J' v ..7
Str or Rou-l9 No/) / �j V �7 _
City or Town S� Zip Coda 7 & /r96
4. DATE DRILLED / Gt7I &
5. TOTAL DEPTH 4.9,5` >`
6. CUTTINGS COLLECTED YES NO❑
7. DOES WELL REPLACE EXISTING WELL? YES D NO((
8. STATIC WATER LEVEL Below Top of Casing: S FT.
(the' if Above Top of Casing)
9. TOP OF CASING IS ° FT Above Land Surface'
-Top of casing terminated at/or below land surlace requires a variance In accor-
dance with 1 SA NCAC 2C 414 18 �7�
10. YIELD (gpm): rs O METHOD OF TEST /w•
11. WATER ZONES (depth)•
52. CHLORINATION: Type /7 7 Amount
13. CASING:
From 7112
Monitoring ❑
DEPTH
Fo • atio Descnpllon
4
q.4d
419 q,/D
If additional space is needed use back of form
Wall Thickness
Depth To
nle)o wNfe�t�Il t.
o�Ft '/� '/06
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From To Ft v
From To Fi /1/ 641 7%0
14, GROUT:
Deptth MaterialMethod
From 0 To Ft (IP"e^r7
From Tb FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in. in
From __ _ To Ft _ in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
I DO HEREBY C
CONSTRUCTIO
FOR OFFICE US :O
Ouad No:
�UCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1- -oaa
1 URE OF PER r N CONSTRUCTING THE WELL
DATE
Submil original to DiAslon of Water Quality, Groundwater Section within 30 days GW t REV. 12199
Serial'No.
0 NDWATER SECTION
ASHEVILLE REGIONAL OFFICE

From
17. REMARKS:
I DO HERE=
CONSTRU
FOR OFFIC
Quad No:
Serial No.
North Carolina - Department of Environment and Natural Resources - Division of Water Ouahry - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
246593
WELL CONTRACTOR- /rte ke//C//te
WELL CONTRACTOR CERTIFICATION #: 079 /
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential i Municipal ❑ Industrial ❑
Agricultural ❑
Recovery n Heat Pump Water Injection ❑ Other ❑ 11 Other, List Use:
2. WELL LOCATIOQN�.: (Sh w sketch 'the location below)
Neeaaree,,st Tow9: LA-44�Ut s vi?e, County.
�
(. i).q .. hens (ow e K/r/
(Road Name ann umbe . Coin nity, or Subdivision/and Lot No.)
3. OWNER 5(io /, /9..✓N+^'9
Address L'Yo ((h. ,../ei al/e El./
n� I beet or outo(. RV74
City or Town State Zip Code
4. DATE DRILLED/l- O' a
5. TOTAL DEPTH .3as
6. CUTTINGS COLLECTED YES fl NOf]
7. DOES WELL REPLACE EXISTING WELL? YES r] NOV(
8. STATIC WATER LEVEL Below Top of Casing: e2 FT.
(Use'' it Above Top of Casing)
9. TOP OF CASING IS .FT Above Land Surface'
'Top of casing terminated aVor below land surace requires a variance In accor-
dance with 16A NCAC 2C .011a
10. YIELD (gpm): iO METHOD OF TEST A It-
11. WATER ZONES (depth)'
DRILLING LOG
Fsom To
/0
/c 33
i3 7 7
7 326
12. CHLORINATION: Type
13. CASING:
Amount
Monitoring ❑
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
From f� Depth7._Dia%/71flr or WeighVF1. �,1a(enall `
C'" (Show direction and distance from at least two Slate _
To 0FI. GC2-�— Roads, or other map reference points) `-=
From To FI. N.)
14GROUT: ;J,f r'1 c▪ -,
From To Ft I'\lvo a15 -
.
0
Depth �} Material y 1 Method .c _ r
From d To z CFI Je'ie�'j — a
From To Ft 3 r.
16. SCREEN: O m
c,
fV -i
O 0
Depth
From To Ft
From To Ft
From To Ft.
16. SAND/GRAVEL PACK:
Depth
Diameter
in
in
Slot Size
Material
in
in
in in
Size Material
From To Ft
To Ft
(GTIAY IIR ?I.N HH `.
ONLY
STRUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN P. • VIDED TO THE WELL OWNER.
GNATURE OF PERSON CONSTRUCTING THE
to Division of Water Quality. Groundwater Section within 30 days
DATE
GW-1 REV. 12/99
GROUNDVRTER SECTION
ASHEVILLE R=GISITA. OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) bete:044 A. ay. eiS CERTIFICATION # Z�t3b
WELL CONTRACTOR COMPANY NAME V
=nC. PHONE # tag 66s- ant
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C( n County 'Na.awooa.
1, anq C'jbo.`.ch fia
(Street Name. Ntitithers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R•Aca1.-Seeteg
Address Lehq %co.c1.
(treet or Route No.)
City or Town State Zip Code
( )- (oz't- 388(
Area code- Phone number
4. DATE DRILLED C1' 3 - oz
5. TOTAL DEPTH: 1 Z 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI
7. STATIC WATER LEVEL Below Top of Casing: .YLD 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): 15 METHOD OF TEST
10. WATER ZONES (depth):
•
TopogrOieLand setting
El Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( Li 3 over c%ecctio.+
Li I bra,`1e
11. DISINFECTION: Type Fr it S Amount $
12. CASING:
Depth Diameter
From 4 To 43 Ft._�-4_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Zo Ft. Cement Pnsrred
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
!t zt elos5t:c
l6. REMARKS:
EVTR
0
rn
I no HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-6
OCT - 1 2002
Submit the origina
77699-1636 Phone N
GROUNDWATER SECTION
SHEVILLE REGIONAL OFFICE
SIGNAT
Rt�
260601
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.
PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
. (919 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) textcK 1A So.'JyePS CERTIFICATION#2•t'136
WELL CONTRACTOR COMPANY NAME C\lde Sat -fly( * 5a:. ud 'en st (7 v.sp PHONE #(S2 1o65-T.ezz
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
260609
1. WELL USE (Check Applicable Box): ResidentialL,El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: c. de Countye e�
S1toe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 9vo.A
Address lug 5 ees Ccve
(Street or Route No.)
C.ivr1e
dy or Town State Zip Code
3872\
( )-
Area code- Phone number
4. DATE DRILLED ?- VS -tit
5. TOTAL DEPTH: ♦ AC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VJ
7. STATIC WATER LEVEL Below Top of Casing: .D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): METHOD OF TEST Ric?.
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge litSTOIC [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1 to% nve( fbecdc,
1a5 vcoin:te
11. DISINFECTION: Type (NU 5
12. CASING:
Depth Diameter
From NA To_in_ Ft. (0k1
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thicknes
or Weight/Ft. Material
'cam pQS!•c.
Material
con. enr
Method
cuce
Diameter Slot Size Material
Ft. in. in.
Ft. 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.
16. REMARKS:
C'S"UC�IO''"C�1'Nl�l'I CRY T141-T-TLIIS WELL WAS CONSTRUCTED IN WITH 15A NCAC 2C, WELL
NDTHAT ACOPY OFTHIS RECORD HOA BEENP ROVIDED TO THE WELL OWNER
1T
.nubmit the original to the Divi:
733-3
OUNDWi'TER SEC'CON
ASHEVILLE REGIONAL OFFfCE
ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ala-c-CtCK VI.• SG -NJ -et S CERTIFICATION # of," :i o
WELL CONTRACTOR COMPANY NAME C',tdtM ' Oc a -&`,+ WeU ti-pumQ T^C' PHONE # (&5) Cdo5 CC2t.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town: ,,, peW. tte
ko9`t Ctc.3 e.cd (kcd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: {it,A /,lo\anc1
Address 1Ocri Cta.34eed Raid
. (Street or Route No.)
ears\'Pe svme INC znt%
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED g " 1 X " e 2
5. TOTAL DEPTH: b05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: AD 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 accordan a with ISA NCAC 2C .OI I8.
9. YIELD (gpm): METHOD OF TEST R-c).
10. WATER ZONES ( epth):
11. DISINFECTION: Type ?Ate, Amount / 0
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t^\ To 9 S Ft. (o `I 21 Plek5t:C
From To Ft.
From To Ft.
13. Depth Material
To 70 Ft. Ce>~rew+
From To Ft.
14. SCREEN: Depth Slot Size Material
From To in.
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
County HQv..)tc.
Method
JotaCe�
GROUT:
From ID
Diameter
Ft. in.
Ft. in.
From Ft.
From Ft.
tvt"
I !iI ' -':
260608
Topograp��h'c/Land setting
❑Ridge 2Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
*/ rc 2le Wet deGAan
21; % o ho-S— (rran;+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
CONSTRUCTION STAN',,
611;:.,;. - 2 AI
0
GAMMA
ASF&titupg y T
27
II
IPA
RL the D
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days.
GW-1 REV. 07/2001

258246
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO M
7. STATIC WATER LEVEL Below Top ofCasing: 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 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
l2
CASING:
Topographic/Land ing
❑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
! \ SY ann. ae Airn
Depth Diameter
From 41 To B Li Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Zo
Amount Zo
Wall Thickness
or Weight/Ft. aterial
Material
Ft. csa-
Me
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 H
r1
ii,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and �Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CA ...lack. K. So.-*1tCS CERTIFICATION# c--1 3/o
WELL CONTRACTOR COMPANY NAME C?I.�.4e sa`^)V e5 t 6,5 u¢\\ddt evrli rkl.-PHONE # CV* 25 S 7 F $g
STATE WELL CONSTRUCTION PERMIT# G_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: County i,�..�. re•eat
orvie er
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ilta,A.11 bMis• .
Address
(Street or Route No.)
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED '7• tl - 02
5. TOTAL DEPTH: o2' 5
Zip Code
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
C
0
v
O
N
tT
ERTIFY THAT H
it
1'Stmit the original to the Dlisith
276�9-1636 Phone No. (919) 733�3221,
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- 1-
ELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001
r1S H _„i„-

258212
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),_,C4`e. X 'Sa .•N► CS CERTIFICATION # 2.4 V.
WELL CONTRACTOR COMPANY NAME C LOS Sa•a%rsr ir Sew .3ICU tpuemp rtPHONE #LIZ2 1255 Abaft
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: t,ie. a.�n ++ L County NO /,.-..c...t
arc ro.trae �� U Q
(Street Name• Numbers, Community, Subdivision, Lot No.• Zip Code)
3. OWNER Rc t•. Ma aia&
Address Z 1 C . .i.
tio.:yts4v11._ A1c aistaL
CitYor Town State Zip Code
(s2 e)- M2(e- «1a
Area code- Phone number
4. DATE DRILLED !- d-01-
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO WI
7. STATIC WATER LEVEL Below Top of Casing: /Oo FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS . FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST RI/
10. WATER ZONES (depth):
/T-,-,=��-,graphic/Land setting
i37Rdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
+I (00 o y.ts 3ansL<rw
(e0 ivS gj
11 DISINFECTION: Type .-
12. CASING:
Depth Diar eter
From 41 To (pO Ft. Wtf
From To Ft.
From To Ft.
13. GROUT: Depth Material Method`
From_a__To__Z6 Ft. teas at it } fouled
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount 5
Wall Thickness
or Weight/Ft. Material
*tt ftax:c
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HERE
C
LOCATION SKETCH _
s.
Show direction and distance in miles from �ji least;
two State Roads or County Roads. Include1thY road
numbers and common road names. c
v7
LD
a
0
<n _'
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-SIGN TRE NG THE WELL
/ I
Su¢mit [he original to the Divisiontt(%ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-32211, with
tt
DATE
n 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality-CEouIFICATION cSection
altsb
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERT # (ATI itS !i34
�, nu WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1.- WELL USE (Check Applicable Box): Residential Iil Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: p Topogra /Land setting
County._i aSd ❑Ridge lope ❑Valley ❑Flat
Nearest Town: (check appropriate box)
Latitude/longitude of well location
(Street Namee,. NNuumbers, Community, Subdivision, Lot No., Zip Code)
�� Q (degrees/minutes/seconds)
3. OWNER: � M• Qr'- ^a-`-' Address Latitude/longitude source:OGPSDTopographic map
nft n__ 0..l - (check box)
DEPTH DRILLING LOG
From To Formation Description
41 3 & t'l vta a tAAIIffini
25823'2
Ci r Town State Zip Code
(1 S_ n 1, • IioL
Area code- Phone number
4. DATE DRILLED 't•2-�•a-7-- 3$ %05 _ �`tt+
5. TOTAL DEPTH: OS
(�
ae
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gil
7. STATIC WATER LEVEL Below Top of Casing:if of Casing)
(Use" Top
8. TOP OF CASING IS % FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with t5-METHOD OF TEST `jti:/\
CAC 2C .0118.
9. YIELD (gpm): O
10 WATER ZONES (depth);
LOCATION SKETCH
Amount 5 Show direction and distance in miles from at least
1
1 12.. DISINFECTION: Typed Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft.
CASING: Material numbers and common road names.
From k]._- To__aL FLU —. JO IA _f_i__—Lt
From To Ft.
From To Ft.
13. GROUT: Depth
Material Metho
From_a__
To SO Ft. rC s i• routed
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
Ft.
From
From
16. REMARKS:
To
To Ft.
l�
Submit the original to th Div
27°9-16D4^$6ope-.,.�i 733-3
1c•,�:`:,_E FEGIid..,'1,L OFFICE
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ZS-aZ
GNATU
CONSTRUCT WELL DATE
c
ion of Water Quality, roundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

258231
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground ater Secction a6
_sl
WELL CONTRACTOR (INDIVIDUAL) NAME (prior)
t. 5*AA ��� Se ,,3e t VHONE # f4a9 ril6d%
ASSOCIATED WQ PERMIT#
"------ PP
if applicable)
(
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I WELL USE (Check Applicable Box)' Residential CifMunicipall
Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
�fp
Nearest Town: 1�Sa%-�t.L'/gY 4! County "Ho.;.
In (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i�.OtiA2v (aip...--wee.+
Address '1(e Yr Q n
(Street or Iwute No.)
tile
le tt ,kk: Code
Cuv lTown state Zip Code
(S )- 9z(,- 13zs
Area code- Phone number `� Z
4. DATE DRILLED 1. 2
5. TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES O NO jt7
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 actor below land surface requires a
variance to accordance with ISA NC C 2C OF TEST �..t
9. YIELD (gpm): R %
10. WATER ZONES (depth):
11. DISINFECTION: Type ?La Amount ,
12. CASING:
Depth
From 41 To =i it
From To
From To
13. GROUT: Depth
From 0 To ZO Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To
Wall Thickness
Diateter or Weight/Ft. Material
FLJt' __ Stt Plaa-:C
Ft.
Ft.
Topographic/Land setting
DRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/Minutes/seconds)
Latitude/longitude source:OGPSOTopooraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
41 tie
Material
C-ei,a..
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Ft.
Method
rota
Slot Size Material
in.
in.
Size Material
DYAn <3.444,1n,
Litt i.. o 5 g( g
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.
CD
N
CZ
GD
,fl
DC
0
N.)
U7
I DO . " CERTIF
T. T lit S 1 COP
WELLAA AS OYOF TSRECORD HAS NUC. IED IN ARDANCE WITH I 5A NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER
'1-8• oZ
I; I
ub it the original to the Div
2769 -1636 Phone No. (919) 733- 221,
GROUNDYVAIER. SECTION
ASHEVIL.I.E REGIONAL OFFICE
TUR'RSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
vithin 30 days.
GW-1 REV. 07/2001

FT.
w Top
Use "
STATIC WATER LEVEL Belo ( of Casing:
e 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 _c3 _ liMETHOD OF TEST
9. YIELD (gprn): U
10. WATER ZONES (depth): __----
DISINFECTION: Type_p_. AWamTtuct g Thickness
CASING: Depth ,� or Weight/Ft. Material
_ _ From To (o'.. 'GI 4) tt i_ c,
From To
From To — Material Method
13. GROUT: Depth Pouted
From_..QTo aFt. !'__�.artw i'
From To Ft.
14. SCREEN: Depth Diameter Slot SizeMaterial
From To Ft. is in.
From
To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - CERTIFICATON Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) HONE & 122I�5�-7 �
s 5a�►
WELL CONTRACTOR COMPANY NAME ASSOCIATED IVQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(ifa licable)
1. WELL USE (Check Applicable Box): Residential fit Municipal/Public 0 Industrial O Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
DRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
2. WELL LOCATION: County_11.
Nearest Town: 4`•c
5041-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or Town State Zip Code
(S )-_ _3� —
Area code- Phone number 12 Bl
4. DATE DRILLED
5. TOTAL DEPTH: 3't 5
DO
ES OES WELL REPLACE EXISTING WELL? YES 0 NO WI
7
11
12
258228
Dia eter
Ft. (o
Ft.
Ft.
From To Ft
From To Ft
16. REMARKS:
. AT THI
TA4$D
SIGNA
DEPTH
From To
--,1 �ortnn
LOCATION SKETCH
Show direction and distance in miles from at least,
two State Roads or County Roads. Include road
numbers and common road names. y. r--
C
0
tV
L51
L WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
"1-12-02-
2-
MG-THE WELL DATE
L LJ
Submit the original to the fl"4sion of Water Quality, Groundwater Section, 1636 Mail Service Ceenµteert Raleigh, Rgh,NC
07/2001
27699 t 41A Phone No [phone], within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

255011
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)arkt1. K NLts-lseSC CERTIFICATION # a-f('(f,
\YELL CONTRACTOR COMPANY NAME p octtJ-aCcS -� 5o,. Well Y� .,. _� _� PHONE # (Z2E) t&55 %GSH
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
l
(if applicable)
WELL USE (Check Applicable Box): Residential if Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION: G.1/Go° d
Nearest Town: tiltAtS O ge. County
Aini)1a. Che.ic CS4aa+1
(Street Namc, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Awe nett: fit- 74nnos
S
Address US M..fg( 5Y\e1
(Str t or Route No.)
aaclt NevAtt NC 4111 Si
City or Town State Zip Code
(4st)- q2(o 3411
Arca code- Phone number
4. DATE DRILLED (Detre- DT-
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 2v FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS V FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST RI
10. WATER ZONES (depth): t
11. DISINFECTION: Type pits Amount '1
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 3-1 To__„5j_ Ft. 6:14 A 21 _r5bS.
From To Ft.
Ft.
From To
13. GROUT: Depth Material
From (2 To 20 Ft. Cenenf
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
fbure.1
Slot Size Material
in.
in.
From
From
16. REMARKS:
To Ft.
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)
DEPTH DRILLING LOG
From To Formation Description
-4-4 S9 aver Acr.A
S°I 3fn5 Gran,te
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
p
0
c-1
J
I DOS HEREBY CUR t 1F-
_ CONSTRUCTION ST
AT THIS WELL WAS TH 15A NCAC 2C, WELL
ND THAT A COPY NOF THIS RECORD HAS EEN PROSTRUCTED IN ACCORDANCE VIDED TO THE WELL OWNER
(4-/2- a
NATURE OF PERSON CONSTRUCTING THE WELL
DATE
I I t�J _
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert Raleigh,
C
2
27645' -f63a Pfitinc-rNo. (9l9 733-3221, within 30 days.

255008
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural` Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C % a e X 5 en.)%CCS CERTIFICATION # 24$(s
WELL CONTRACTOR COMPANY NAME tt 6 5Ca4 4ew Jatt d"p M L.(PHONE # area 2SS 7619
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 51 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: / I,
Nearest Town: W 4ynef v; fl C County ff4}/Lased
caUned6 Cove to
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Oa Homtj (degrees/minutes/seconds)
Address iqo 10t ar tat SMe ly t%+r+ Cx c.cs�atitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) a
ttvSyntSY;1W PC
City or Town State
($PR)- 1i5(o 22L2
Area code- Phone number,
4. DATE DRILLED Ur 1N• tit,
5. TOTAL DEPTH: a-25
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 141
7. STATIC WATER LEVEL Below Top of Casing: VO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST 11‘:04,
10. WATER ZONES (depth):
atilt 6
Zip Code
DEPTH
From To
___ 4_t 101
(check box)
DRILLING LOG
Formation Description
over aeedon
(e� 2zs 6rek .:te..
1 I . DISINFECTION: Type p: ►t4
12. CASING:
Depth Dianiteter
From -VI To (Dl Ft. Vet
From To Ft.
From To Ft.
13. GROUT: Depth
From D ToZ Ft.
Amount g
Wall Thickness
or Weight/Ft. Material
* tt f %o ar:c
Material
next t et be
Method
f+ou(lea
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
LS:014 LZNWZ
�T \ IDOHEREBY CERTIFY TI
�"-\ I CONSTRUCTION STAND?
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
( AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to thje Div
27699-1636:Phone. Ka.01''9) 733-
GNATURE OF PERSON CONSTRUCTING THE WELL
-/S'- oa
DATE
ion of Water Qualit};'Groundwater Section, 1636 Mail Service Center- Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

255033
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C%.dHe K 6awlvlrl el CERTIFICATION # 9.4E4
WELL CONTRACTOR COMPANY NAME Claud! 3CMS ;CC3 at aat t..tl( 4- PIArnP INN PHONE # Its a 65 74E1
S'rATF. WELL CONSTRUCTION PERMIT# 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 ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t,a., 3 vyJ a County 11431Jegd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Charles d Arn, Morez,t
Address Po gor l9tj
(Street or Route No.)
Cyaa Ale
City or Town State Zip Code
ai87i
( )-
Area code- Phone number
4. DATE DRILLED 5• of - • e
5. TOTAL DEPTH: 1 o S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
Topographic/Land setting
(-Midge OSlope ❑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
Wok OW('& rdMra
49 tog 6torute-
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): fo METHOD OF TEST_at
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.
0
I I. DISINFECTION: Type P?ij4 Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From an To 49 FL 414 $}seal
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To LC Ft. CR. InCAt Pe ate el.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
G
16. REMARKS:
I DO HEREBY CERTIFY THAT T
CONSTRUCTION S?ANITAF
,1 �i I LIVATItRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divisbn of Water Quality', Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2769211636Jhone No (OM 13-"Pt1, within 30 days. GW-I REV. 07/2001
)''''; ',LIMO`
�L OFFICE
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER

255030
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C{4de._ K .S11asydd a�(ctS CERTIFICATION # 3("
PHONE # (S2fi) o?S5 Won
WELL CONTRACTOR COMPANY NAME Ctt t 6'0.0ite-VS d .50n- Weil traant &tC
STATE WELL CONSTRUCTION PERMIT# CC 6 ASSOCIATED WQ PERhIIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential PI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Town: Am fen)
County /i.)/f.0tTher
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VeiV;n )f+.q
Address Y---
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 5-1' ei
5. TOTAL DEPTH: 1Ms
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I71
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): SO METHOD OF TEST A
10. WATER ZONES (depth): d-'
11. DISINFECTION: Type P: as Amount 4
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Ft. (� #2I (ictSr.e
Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Et. Cement &ore d
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Depth
From *I To L 5
From To
Slot Size Material
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-( b s nvrr g,'rdnn
(05 ' 1 5 Grnn:te
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
N
L
c
N
r
in.
From To Ft.
From To Ft.
16. REMARKS:
0
cn
0
I DO H . ' T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
!I
L' 1 CONSTRU *TION 5TAt41J "'�� , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5- 9-eR
L �� Li i; .IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
_Submit the original to t! e Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
277699- b35711hopc,,_ ) 733 3221, within 30 days. GW-I REV. 07/2001

251586
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C.luel !- K. 5e��S CERTIFICATION # ati G
WELL CONTRACTOR COMPANY NAME CIyv6 dl .50 letl a S� Ne// e1- Put+.-p PHONE #(,Ql't 25_fl B6
SEATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential? Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: wave 5Y; n e County Kati oocl
fagi-ltee are,' K ,2872
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Rotator bp�ve
Address 15$ mere„ kVA ea) Road
(Street or Route No.)
ci%ae NC.
City or Town State
(428)- .23 44,93
Area code- Phone number
4. DATE DRILLED Otto\- 02
5. TOTAL DEPTH: 305'
9872k
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ia
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 accordance with ISA NCAC 2C .0118. n
9. YIELD (gpm): /2 METHOD OF TEST /s,'Q
10. WATER ZONES (depth): a
11. DISINFECTION: Type /, //S
12. CASING:
Depth
From +/ To /20 Ft.
From To Ft.
From To Ft.
Opographic/Land setting
51.1gidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
+/ /20 Ore/ t4eea'n1
/?0
30s
IV o
N
rm—
LOCATION SKETCH aD CD
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
Gy Zl p1a(1,r
13. GROUT: Depth ��77 Material Method
From 0 To iri Ft. elate/et *ter re/
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.
Frorn To Ft.
a CJe- \\
16.REMARKS:
I no HEREBY CEaT1FY THAT TH. S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTIO$1 S fyNQARD,S4 VDTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Si NATU OF F PERSON CONSTRUCTING THE WELL
Submit the original to the frvisi
27699-1636 Phone No. 4919).133-32
09/a/ /OL
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secaitp
S ',,
WELL CONTRACTOR (INUI VIDUAL)NAMF, (print) C\a�cif K. 50� �ec CERTIFICATION agp i
WELL CON"! RACTOR COMPANA' NAME Ctyd6 S>r-1.41.c42s, Set) (Jell. 1- 1-3) t^4 PHONE # 8( M)_-t1.Y.1_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERAMIT#
of applicable) Of applicable)
1 WELL USE (Check Applicable Box): Residential JD MunicipaliPublic ❑ industrial O Ag
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O IIOther, List Use
2. WELL LOCATION: 1
Nearest Town: (.74�4j� ✓LCounty .7t v7Lo
h 2_7
(Street Name, umbers. Community. Subdivision. Lot No.. hp Code)
3. OWNER: k',c Me2 kentc- R-
Address 16 t19 Gce„t am o 141'.__LXeres.sway
(Street m Route No.) e}
aagncsv:aG Nc d878(0
City or Town State hp Code
(in )- 1-151 o i77
Area code- Phone number
4. DATE DRILLED 2- Ix' o4
5. TOTAL DEPTH: o2tis
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: __FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST_ R3
10. WATER ZONES (depth):
I I. DISINFECTION: Type P:tt<
12. CASING:
Depth
From t\ _To (c11
From To
From To
13. GROUT: Depth
From 0 To a0
Amount
249549
,d' A, ONO
cultural ❑
Topographic/Land setting
❑Ridge Qistolt)e ❑Valley OFI;i
(chec( appropriate box)
Latitude'longitude of well location.
((Segrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograi+h6 cup
(check box)
DEPTH DRILLING It t ;i
From To Formation De:.i•;i} Lou
4i toY °Vet' Of d'sit C....�
((Ll _ Lis_
Wall Thickness
Diameter or Weight/Ft. Material
FL ki—_ 'k- IadY•c
Ft.
Ft.
Material Method
FT._Cen.ar burl
From _ To Ft.
I4. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK.
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
6-raA 1 tc
LOCATION SKETCH
Show direction and distance in miles from i .lest
two State Roads or County Roads. Include it rand
numbers and common road names.
0
rV
t.
cn
O
crl
16. REMARKS.
DO HEREBY CERTIFY THAT THIS WELL WAS CONS TRC TED IN ACCORDANCE WITH I5A NCAC 2C, WELL
'i DAR• AND TI��OPy)OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0....>.
U �� n 1- /j(l / d2
Submit the on
27699-1636 Pho
SIGNATURE OF PERSON CONRUC-TING THE WELL DATE
ulcr the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. Nt
r. No. 919) 733-3221, within 30 days. GW-1 REV. C Id

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CL.kyd,P u- `1a..5.1cet
WELL CONTRACTOR COMPANY NAME Clyde Sa•WyESS BLrt (..3 N-IAC11 PHONE # S.T>< .22 t' 1
STATE W ELL CONSTRUCTION PERb17# ASSOCIATED WQ PERMIT#
of a wliblel (f a cabe)
I. WELL USE (Check Applicable Box): Residential XI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: / /j
Nearest Town. Nlft /✓r4.50 //� Count:: /7i9//�oaai
(Stet None, Numbers. om Subdivision, Lot No.. Zip Code)
3. OWNER: :SarheS FCrquSnn _
Address
(Sueet nt Route No.)
City et Town State Zip Code
Area code- Phone number
4. DATE DRILLED_ _-ca_ _
5. TOTAL DEPTH: ot-05 —
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ail
7. STATIC WATER LEVEL Below Top of Casing: FT.
l Use "+" if Above Top of Casing)
R. TOP OF CASING IS ( FT. Above Land Surface*
"fop of casing terminated at/or below land surface requires a
sariance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): o2-0 _— METHOD OF TEST rza .-
10 WATER ZONES (depth).
249539
Groundwater Sedum
CERTIFICATION a'`Slrt:'.-'� �1.7r�
ltitlla 4111111
Topograph efLand setting
❑Ridge aSTope 0Valley ❑FI;.:
(check appropriate box)
Latirudelongitude of well location
(degreesiminctesi seconds)
Latitude/longitude souree:OGPSOTopogrrritd comp
(check Fox)
DEPTH DRILLING.LS.. a
From Toga Formation De.. -i; :tot
4I E{fti.'As11_-
I I. DISINFECTION: Type P' it Amount
12. CF.SING: Wall Thickness
Depth Diameter or W'eightTt. Material
From tl To 1° Ft. (p`4 4t-d1 4.I44b:CFrom To _ _ Ft.
From__ _ To Ft. _ - --
13. GROUT:Depth Material Method
From O To at Ft. Ceostat- gburs _
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:
9p an5_ Gran: tc
LOCATION SKETCH
Show direction and distance in miles from 1St
two State Roads or County Roads. Include't/ road
numbers and common road names.
cn 2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA'. t, ANDTHT AC Y OF THIS RECORD HAS BEEN PROVIDED TO THE OW
��SJt3'mi't`1heuori in
27699-1636 Phone No.(
GROUND' EP SECTION
ASHEVILLE'[9IONAL OFFICE
SIGNATURE URE:. OF PERSr3N CONSTRUCTING THE WELL DATE
lvision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh. tit
1-3221, within 30 days. GW-1 REV. 0 '; 'I4I

WELL CONSTRUCTION RECORD "19531
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sec' att
r- K. f\q\.NcfSmt S _— CERTIFICATION Y AF"IF1'
WELL CONTRACTOR (INDIVIDUAL) NAME (print)__y-.��dp
WELL CONTRACTOR COMPANY NAME CIyAe 5>A-I,4-8.8S h Son (Jett I,t-.,%0.1 —PHONE n 8( >b l_LI' ii T1dt
ASSOCIATED WQ PERMIT#
STATE \YELL, CONSTRUCTION PERMITq_--.-.----- (if applicable) _ •�yy�i.
(if applicable)
I. WELL USE (Check Applicable Box): Residentialxi Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:�// /%
Ne st'[own:jci,Vri1�»Siga _County /LOC
ybea
be?* fI ,9
(Street Name, Number s, Community, Subdivision, Lut No.. Zip Code)
�o kMy R.USSc 11 — (degrees/minutes/seconds)
3. OWNER: d Latitudeilongitude source:❑GPS❑Topograp!tn mi�p
Address (check box)
(Street of Route No.)DEPTH DRILLINQL„j„i
From To Formation De-c}'1;:+or
i) 121 Over__�[.i'ills r._.
TopograiCJLand setting
DRidge ope ❑Valley ❑Flrc
(check appropriate box)
Latitude/longitude of well location
City or Town State Zip Code
)-
Area code. Phone number
4. DATE DRILLED Q-aa -D1-
5. TOTAL DEPTH: 30E
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t£
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "4-" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface
4'fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm)' C3C5 . METHOD OF TEST k
10. WATER ZONES (depth).
ial 305
1 I. DISINFECTION: Type_l•ifi Amount
12. CASING: Wall Thickness
Depth Diameter or \Vdght'Fl. Material
From {-1 To I2I Ft. (n'4 dk- al losh,'s._
From To Ft. - -- From To Ft.
13. GROUT: Depth Material Method
From 0 To ae Ft. Ccaear _ _ bored_.
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:
Submit the original to the D
glyYko 9) 73
GROUNDWATER SECTI )k
ASHEVILLE REGIONAL 01 FiCE
(rraA': Cs.
LOCATION SKETCH
Show direction and distance in miles from 1 ast
two State Roads or County Roads. Include • toad
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A C'VPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OW1H•1.I.
2-22-D2
DATE
SIGNATURE OF PE[.SOi � .UNSTRUCTING THE WELL
vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh 'It
-3221,within 30 days. GW-I REV. t'i'�. ':rl

2. WELL LOCA.) Bpi
y � ?
l
Near:stiow5) O.. Ylky)Count t� w
(Street Name. Numh s. Community, Subdivision, Lot No . Zip Codes
3. OWNER ___ `n_e• rEc.
Address
(Sigel or Route No.
City ar Towr Stan Zip Code
/-
Arco code Phone nuinhe:
4. DATE DRILLED Ia \_Co
5 TOTAL DEPTH: 5`A5
6 DOES WELL REPLACE EXISTING WELL? YES O NO a
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "t- if Above Top of Casing)
8 TOP OF CASING IS _-_-I _ FT. Above Land Surface"
•lop of casing terminated al/or below land serrate requires a
variante In accordance with 5A NCAC SC .OIfa.
9. YIELD (gpm):. 147 METHOD OF TEST R: ,-
IC. WATER ZONES (depth).
I I DISINFECTION: Type Q:ll is . — Amount
12. CASING:1k Wall Thickness
Depth Diameter or W eighvFt. Material
FromA__ To r� I Ft. V__-7.1- -Q3L._
From _ To Ft. --
Flom To Ft.
13. GROUT: Depth Material Method
Frum ._.Q.._- TosaO—. Ft. cemtw4 _ PQutti
From _ To _ Ft.__
14. SCREEN Depth Diameter Slot Size Material
-irolr, To Ft. m. __ ir.
Ft on) To Ft. in. �-- In
15. SAND/GRAVEL PACK:
Depth Size
From To _ Ft.
From To FL _
I6. REMARKS:
1 DO HEREBY CER1IFY THAI THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
c ONST RUC TION STAN - RDS AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5
Material
WELL CONSTRUCTION RECORD ? 4 9 i n 4
North Carolina - Department of Environment and Natural Resources - Division of Water Quality GrCEoundwater
Section
Ntion
\S ELL CONTRACTOR (INDIVIDUAL) NAME (prinQ l�t_.X.,, Ss�ye�s�--
Sn W S Vjort LICSA tleal.sG9)-PHONE N (Q'r L 7 %
WELL C'ON'IR4C'fOR COMPANY NAME � ice— P
VVV ASSOCIATED WQ PERMITS --
5'1 AT F. \\ ELLCONSTRCCT WN PERMITS (if applicable)
of appllcabicl
!. WELL USE (Check Applicable Box): ResidentialE Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge QSTOpe ❑Valley ❑Flat
(check appropriate box/
Latitudeilongitudc of well location
tdegret% minutei seoondsl
Latitude 'longitude source:OGPSOTopographic map
(check Baal
DEPTH GRILLING LOG
From To Formation Description
__ ,21 poet 13e(dorl
r2l 545 & MA:te.
I 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. O
0
C r1
tr
tor
0
699- 1636 Phone No. 1919)
Gnr li 1 !,TE R. r5E' TON
NATURE OF PERS(%N CONSTRUCTING THE WELL
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 dacs. GW-I REV. 07/2001

26.6898
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Rich Lemire CERTIFICATION 2593
PHONE N f704) 504-9195
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
SAEDACCO, Inc.
1. WELL USE (Ch pplicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitorin Recovery ® Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATTJN N:
a
Nearest Town an Coun
/8t'/7 ,Snontew Hetj+.7
(Street Name, Numbers, Commuinty, Subdivision, Iot No., Zip Code)
3. OWNERS° Pvv.i p U-1
Address /t 2'O %
/j & (Street or Rout . ,
l/_C(%I
OLak
Huts
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /R .—,?I"0 2
5. TOTAL DEPTH: 36 '3--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: ) a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 FT. Above Land Surface"
*Top of easing terminated at/or below land surface requires a
variance in aceordan•qe� with 15A NCAC 2C .0118.
9. YIELD (gpm): 'A METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(chcck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Tan SANon
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. terial'�r
From 0 To a S I SFt. 9 r Sci. kid LV _
From To Ft.
From To Ft.
13. GROUT: Depth Mat q�}al
From 6 To PI,S Ft. Pat/And
From To Ft.
14. SCREEN: _Depth Diameter Slot Size
From c To rwi Q,SFt. at in.. fl It) in. 'VC
From To Ft. in. in.
Method
15. SAND/GRAVEL PACK:
ep h Size
From oi3'To 30,5-Ft. #' a.
FromTo Ft.
16. REMARKS:
- " CON HEREBY CERTIFY T 'F: T}''IS WELTWAS OCONSTRUCTED THIS
ACCORDANCEHA N PROVIDED TO THE WELL OWNER
WITH ISA NCAC 2C, WELL
,, CONSTRUCTION ST�,NIt>b, X+N0.T.�A fy �E 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.
1y
NATURE O
NS
sZmn LA x I
�a.3)rfZ
RUCTINGTHE WELL DATE
ubmtt the original to tl_ielDivisi n of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
6-Phone ZOTAdf79) 733-32 1, within 30 days. GW-I REV. 07/2001

268874
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1638 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BD bhr1 C�,I. P f)S
WELL CONTRACTOR CERTIFICATION N: of Do, 2
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Appuceble Pox): Residential Lb Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Olher If Other, List Use:
2. WELL LOCATION: )ow sketch of the location below)
aresl Town: ` � County'
3. OWNER
Address
(Road Name and Nu era. Co//mm//unity, or S
Y l� t�
44reel or Route024/711/1 F%p.,r a g7/1
City or Town Stale
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOI4
7. DOES WELL REPLACE EXISTING WELL? YES I NOM
8. STATIC WATER LEVEL Below Top of Casing: .co FT.
(Use': it Above Top of Casino)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated auor below lend surface require, a variance In accor-
dance with ISA NCAC 2C1348 j� s
10. YIELD (gpm): ¥ METHOD OF TEST
11. WATER ZONES (depth):
division and Lot No
A ce__.
Zip Code
C
DRILLING LOG DEPTH
Formation Description
From To
`/L -
/ Q
7'T �i� L I etoc .
;HLORINATION: Type _TT H Amount llU3
1,,. CASING:
If additional space Is needed use back of form
LOCATION SKETCH
Depth '/�[ pla;et yir:1g 1:k Mil SD (Show direction and distance from at least Iwo State
From To + 7 Ft (I, � nl (p aO Roads, or other map reference points)
From To FI.
From To Ft
14. GROUT:
Wall Thickness
Depth MaterialMethod
From 0 To AO_Ft Alit-E{ I aUitt
From To FI.
15. SCREEN:
Depth Diameter Slot Slze Material
From To FI In In.
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Slze Material
To FI
From
From To FI
17. REMARKS:
O
ct)
Ca41144" 77C f' c.
I DO FIER Cmiry THAT THIS WELL WARS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDE Q TO THE WELL OWNER.
coms-rnrci
N §frAfii}ARDS„hNoTH0
? 1 II
Sub rr i�n
"OR OFF$t -0E ONLY
Quad Na:
Serial No
`1&V .."ram� l/V r /.C/�7 isa'—d
SIONATURE OF P SON CONSTRUCTING THE WELL DATE
al to Division at Wale( (Duality, Groundwater Section Within 30 days
GW-1 REV. 12199

North Cerollna • Onparimonl of Environmonl and Naiurnl Resource, - Division of Writer Quality • Oroundwnlor Suction
1636 Mall Service Corner • Balolph, N,C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 3c hhr LEI.
WELL. CONTRACTOR CERTIFICATION A: ✓
268873 •
STATE WELL CONSTRUCTION PERMITA:
1. WELL USE (Check Applicable Boa): Residential lvl Municipal n Industrial I�I Agricullural I]
Recovery ❑ Ifoal Pump Water Infection ❑ Other El II Other, List Use:
2, WELL LOCATION: (: low sketch of the location below)
areal Town:
County
(nondd- me annd Numbers, Cormwnllnr Subdivision and Lot No.)
3. OWN Gaul 1 nth 11TAU"(I..)
Address
W t l ( rea� b rG
�+i1 l.I,I1.c �71 6
City or T Slate
4. DATE DRILLED
5. TOTAL DEPTH _,__
6. CUTTINGS COLLECTED YES I I NOI�/{
7. DOES WELL REPLACE EXISTING WELL? YES_Q NOM
6. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' If Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of ea, Ing terminated eUor below lend surface requires a varlence In sccor-
dence Mils 15A NCAC 2C .911E
10. YIELD (gpm): 5 METHOD OF TEST
11. WATER ZONES (doplh):
HLORINATION: Type _1±7 H Amount
13. CASING:
Monitoring
DRILLING LOG DEPTH
From To
l/��� Depth ey
From_J.�_ To 5
From To
From To
Id, GROUT:
ZII, Code
Wall
Thickness
PP
plealef ,IVeign. Mt�VC dal
FI j
FI
Ft
Depth MalElal Molliod ,
From d ToDe FI a vh�lo'�E p2.LL�>`d_
From To FI
15. SCREEN:
Depth Diameter Slot SIzo Materiel
From To Ft In In
From To FI In In
From To Ft. In In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
Fornsaeon Descripllcn
e.oc k,
0
W
T7
If additional space Is needed use hack of form
LOCATION SKETCH
(Slow direction end distance from nl least Iwo Slate
Bonds, or other map reference points)
hlati wo-edi `kJ C.
0
w
co
to
0
O
I Do FIERED Iry THAT THISIWk'LL WA's
CONSTRUCT MFANDARDS, AND TIIAT ACi
)R OFFICE
Quad No:
Sedai No.
$e ONLY
LJ
TRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
r THIS B,Egono HAS BEEN PROVIDED TO THE WALL OWNER.
'7—Iio 0�
IATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Division of Water Ouallly, Groundwater Section within 30 days
GW.i REV. 12l99
Cr
c_

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-�7Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM F (print) V) D N/U / e g ,qj. L CERTIFICATION #.-2 g27
PHONE # f( 9-/; Ego
/4//p
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
_ASSOCIATED WQ PERMIT#
(if applicable)
269217
I. WELL USE (Check Applicable Box): Residential Oil Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIONd•
Nearest To : IA n % Corm -tad%»
(Street Name, Numbers, Community, Subdivisioo, Lot No., Zip Code)
3. OWNER: tNu/f a-1.P Lye";
.
Address // ,� tl t outetf ..n,r�__/
(t)C7,vt , (1�iStoret a<R/✓tvCb ,217SZ0
or Town State Zip Code
(M) q-
Am coda Phone number
4. DATE DRILLED A2 /� / o 2
5. TOTAL DEPTH: /1 S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Z
7. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / j FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface require a
variance In accordon a wnh ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST -in/
10. WATER ZONES (depth): % i 2
11. DISINFECTION: Type9
12. CASING: Dj
FroTo Ft /.
ameyter
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
/ tP/'
13. GROUT: Depth9 0 Ft. a
From 0 •� TJ Ft ! 24moa-c's/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Fro To Ft. in in
15. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft.
From To Ft.
16. REMARKS:
DO i1ER4BYUE
NSTRUCTIO
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
-n
co c
N "tc;
m__
,,,
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Inciu
numbers and common road names.
6wit&
"ic
r
M
/1/2 ft L)/ST
t� R
V)
MAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Submit the originallo the
27699-1636 Phone [phone])
r,
0
lent
CD emad
S,4ND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,&11-ii' t, l/✓
SIGNATURE OF PERSON CONSTRUCTING THE WFT L
/2-/2/ 0 z—
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
133-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcess - Division of Water Quality - Groundwater Section
y �7
WELL CONTRACTOR (INDIVIDUAL) NAM�F(� (prlut)in f ,VN I c- / '.pi- 1 �9�1 CERTIFICATION # �,ry /
WELL CONTRACTOR COMPANY NAME) c�-PX-,,i_etU�I UJ2U ,date./S/,t, ' 7�-ul. PHONE # (P.,71S1V9-A Y�
SLATE WELL CONSTRUCTION PERMIT# /�/%9 _ASSOCIATED WQ PERMIT# /V1/4%
(if applicable)
(if applicable)
269103
I. WELL USE (Check Applicable Box): Residential," Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Near own: v(. CountyyfP
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
Code)
3. OWNER: 4 )%lau D /7/-4 Lc
Address ,4t ? _m C . ent'' _L 44}
�� (Street or Route No.)
N. P . ./v
tarry or Town Stare Zip Code
/,57-
Area code- Phone number
4. DATE DRILLED /V ../G ` -
5. TOTAL DEPTH: ,2 r ,5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. _C FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I/O C *- THOD OF TEST I n /t v
10. WATER ZONES (depth): ' S - /%D
11. DISINFECTION: Type �ij --te. /544-
12. CASING: U
Depth
From To jG Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From 0 To -2r) Ft
From To Ft.
Amount /el C .z
Wall Thickness /
Diameter or Weight/Ft. Material
69
Material
14. SCREEN: Depth Diameter
From ,-To Ft in.
From _ To Ft. in.
15. SAND/GRAVEL PACIC
Depth Size Material
From Ft.
From To Ft.
Method
Slot Size Material
in.
in.
tiL
L CONSTRUCTION ST
Topographic/Land setting.
❑Ridge 0Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descripti�t n
w
to
N
-c
—O ri
N I • I
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 WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
G —unblgitthe original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center -Raleigh, NC
ASP E'1 76994636Phone N&t{919)'33-3221, within 30 days. GW-1 REV. 07/2001
SC -

Nonh Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 1 0 1 0 9
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] /.
WELL CONSTRUCTION RECORD WELLCONTRACTOR• {JRiRW kE// -A (J; /ES
WELL CONTRACTOR CERTIFICATION N: /690
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Resldentlal IE.'. Municipal ❑ Industrial ❑ Agricultural CI Monitoring ❑
Recovery ❑ Heat Pump Water Infection n Other (] II Other, List Use:
2. WELL LOCATION: (.•ho sketch of the local on below)
N-- =sl Town: �- �. I _ _ County.
ad Name and.Numbets. C- mangy, or .+d Islon an• Lot No.)
3. OWNER
Address
DRILLING LOG
From To
DEPTH
Formation Descdpllon
tee or •oue'o
i..., / ..; XG 34 -1,/5 -$ re F c$
City or T. n Stale Zip Code
5. DATE DRIP ED_'
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NOj
8. STATIC WATER LEVEL Below Top of Casing: 74/ FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface•
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with ISA NCAC 2C.0 a
10. YIELD (gpm): METHOD OF TEST �4 q
11. WATER ZONES (depth):
r.)
r.y
'.7
rn )
1)
t--
12. CHLORINATION: Type '41T�"f' ' Amount '' s If additional space Is needed use back of form c.
1 'ASING:
Wall Thickness LOCATION SKETCH
0 Depth ‘( Diameter or WelphVFI. Material (Show direction and distance from al least two State
From To -� T FI lb. Qv. �')5 Rq'•SD9 Roads, or other map reference points)
From To Ft.
14. GROUT:
Depth Material Method
Frorn 0 To QO Ft Gn 1JCJ%P..e -pest_ eJ
From To _ Ft. 1
15. SCREEN:
Depth Diameter Slot Size Material
From To PI In. In
From To FI In In
From To Ft. In In
ID. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
n C•
r_.
O
G)
-T1
rTT
La7
fV
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION-SIANDAPDS, AND THAT A • Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
I •
•
Submll orldin I:
1./9-6a
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Duality, Groundwater Section within 30 days
GW1 REV. 12/99

North Carolina - Department of Environment and Natural FTesources - Division of Water Quality - Groundwator Section
1636 Mall Service Confer - Raleigh, N.C. 27699-1636-Phone (919) 733•3221
270058
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• { A2.'ec/`
WELL CONTRACTOR CERTIFICATI 0:
STATE WELL CONSTRUCTION PERMITH:
f-,P�l7 40it/
Boa
1. WELL USE (Check Applicable Box): Resldentialha- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other , I Other, List Use:
2. WELL LOCATIO ' (S.low sketch of the location below) L
Nearest Town: / 5 U 1-Q-� County' /11
amoa [ nprly ucl.��
oad Name and ben, Com ly, or Sy�dlN51 yYrd Lol No.)
3. OWNER VCat_ l &YMS-Thc'L
Address J 76 d
Sole pule No.)
a Y1r
a17a8
City or Town C' Stale Zip Coda
4. DATE DRILLED 2 a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES( 1 NOr✓1
7. DOES WELL REPLACE EXISTING WELL? YES n N0[ 3 -.
S. STATIC WATER LEVEL Below Top of Casing: -) n FT.
co on rt.
DRILLING LOG DEPTH
From To Formation Description
-3R
32 - aG5
B col e_vck
0
(use '+' II Abovo Top of Casing)
9. TOP OF CASING IS ' FT Above Land Surface'
•Top of casing terminated sUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0118 �s
10. YIELD (gpm): Q METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type H TH Amount L5Ir/l5
13. CASING:
Wall Thickness
Depll C, amcior or Weight/FL Medal
From C To 3 a Ft ' �%G.p5 From To FI.
From — To FI.
14. GROUT:
Depth - Material Method
From 17 To dap_ PI
From To Ft
15. SCREEN:
Doplh
From To
From To
From To
16. SAND/GRAVEL PACK
Depth
From To
From To
17. REMARKS:
hCre.fe
Diameter Slot Size Material
Ft In In
FI In in
Ft In In
FI
Ft
Size Material
0
-v r
IV
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other rnap reference points)
0
CO
T
r*1
co
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRU9
CONSTRUCTION STANDARDS,AND THAT reOta••Y,Dr
FOR OFFICE ,ISE ONLY
Ouad No: SIG;
Submit odgirigl i9
L
.L:IPF
Serial No.
g•oa
IATURF PERSON CONSTRUCTING THE WELL - DATE
Division el Water Quality. Groundwater Section within 30 days
GW-1 REV. 12199
ED W ACCORDANCE WITH 15A NCAC 2C, WELL
ORDZ/EEN PrIDED TO THE WELL OWNER.

North Carolina - Dnperlmont of Environment end Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] j7
WELL CONSTRUCTION RECORD WELLCONTRACTOR• / % A2/e.(// /C-R50/J
WELL CONTRACTOR CERTIFICATION if
270009
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box): Resldenila1121 • Municipal 1-1 industrial n Agricultural 1 1 Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (S ew ske ch of the location below) �I
Nearest Town: _ . •s e -- County' k`�
((load Name e d Numb:n. Corn/flood , or Subdlvlslo and Lot No.)
3. OWNER _ 111 t f �. ' u �.�' •
Address
t�Jt 11
Sheo or Hou a ao.
28
Cily or Town Slate
4. DATE DRILLED '6+-5-e a
5. TOTAL DEPTH 2 'S
6. CUTTINGS COLLECTED YES NO(i1
7. DOES WELL REPLACE EXISTING WELL? YES a rizr
3. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -< II Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated aUor below land surtece requirea a variance In accor-
dance with 15A NCAC 2C /"' .0116�
C.�.�
10. YIELD (gpm): METHOD OF TEST r
11. WATER ZONES (dopih)•
Zip Code
iUistra
DRILLING LOG DEPTH
From To Formation Oescrlpllon
-�y
`7H - /as
,LJe
8E Eck
O
c
O
—131
12. CI ILORINATION: Type El T H Arnounla' 1 T 1 /)S If additional space Is needed use hack of lorrn
13. CASING:
Wall Thickness LOCATION SKETCH
Depth L` plamelor or WelphUFi. . Aalleriah, s (Show direction and distance (torn at least Iwo Slate
From Q tied
/ 7 Ft. [• -1 SIG Di �Y _ Roads, or other -nap
prreffeerre�ncee points)
From To - Ft. SPILL
From To Ft (AI G71
14. GROUT:
D6plh - Material Method " � � J/ �, ,74
From D To �a_Ft hcre_fe _,lcus ea
From To Ft
15. SCREEN:
Depth Diameter Slol Size Material
From To Ft In in
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
Frorn To
From To Ft.
17. REMARKS:
Ft
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTE ItJ/ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI IAT A COLY.,OF THI ECORD HAS BEEN PRri a
OVI D TO THE WELL OWNER.
i.I � g5da
St NAlUnE O ERSON CONSTRUCTING T E WEH LL - DATE
svbrnil oil ?jilt ¢ Division al Water Ouallly. Groundwater Secllon WIthln 30 days
i OW -I REV. 12199
i,
i

North Carolina • Department of Envlronmonl and Nalurnl Flescurces - Division of Wnler Quality • Oroundwntor Section ry
1638 Mall Service Cooler - rlelolph, N.D. 27699.1636-Phone (919) 733•3221 270008
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo Linr i f 9o{+S
WELL CONTRACTOR CERTIFICATION N: ' Fja R
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential My Municipal ❑ Industrial I I Agricultural I Monlloring ❑
Recovery [-I Heal Pump Water Injection ❑ Olher II Oihor, Llst Use:
2. WELL LOCATION ww s1kelch of the location below)
Nearest Town: County r�VWQ add
W
4-
(flood Naa d Numbers. Convnur or Su division and Lol No.)
3. OWNER dc�.
Address
-----jJs.-
reo or lioue o
Clly dr Town Stale
4. DATE DRILLED 4'�l0..0�
5. TOTAL DEPTH ) S `71 •
6. CUTTINGS COLLECTED YES ) 1 NO Vr
7. DOES WELL REPLACE EXISTING WELL7 YES NO if
0. STATIC WATER LEVEL Below Top of Casing: FT.
(Use b' II Above Top ol Casing)
9, TOP OF CASING IS I FT. Above Land Surface'
'Top of ceslnq ter mInnted sUor below land surface require. a verlence In accor-
dance wiih ISA NCAC 2C. 1111
10. YIELD (gpm): 15 METHOD OF TEST
11. WATER ZONES (depth):
Zip Code
12. CHLORINATION: Type—Amounl} l 1S
13. CASING:
DRILLING LOG DEPTH
From To
Fomiellon Da s cdpllon
R T
Ce - 5l gS �d.CLck.
n
CO
n.)
0
w
If additional spacn Is needed use hack ol form
Wall Tldckness LOCATION SKETCH
(� Depth e / plain tot ➢r tin Vyl. Ma2V� S I (Show direction and distance from nl least Iwo Stale
From �.L--To -FL (p • L`e j Floods, or other map ralorence points)
Flom To FI �
From To FI / V
14, GROUT: l
Dept-hl n Ob Malor/lal Mol_ Ilod ,
From ToDe th - IYa�ETE J("h`fT"�`�'{_
From To Ft
15. SCREEN:
Depth Diameter Slot Slza Malorlol
From To FI In In
From To FI In In
From To FI In In.
16, SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
nC c
CJ
fTT
to
on
-o
C.)
w
c,
c)
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SIFANOARQS, AND -THAT ACOPY Of; I111S RECORD HAS
, BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY' r a � / �� c t -b 2
I?und No' SIONA1)911' F PERSON CONSTRUCTING111E WELL DATE
Submit odpinal la Dlvi/Ibp al Wafer Quality, orpundwater Secllon within 30 days
Serial No. _.' CW. I nE v. 12r99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �}�1
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BRIAN kE1
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
269927
A Li(.INES
/A/0
WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
WELL LOCATION: (Sho tch of the location below)
[-��,r wL
Nearest Town: L �O County' '�y.LLoL�
wOM/ ket
��
(Road Name nd.NuT(+bpn. Commo/nIJ� oslon and Lot No.) DRILLING LOG DEPTH
ER ! 'V From To Formation Description
3. OWN
%Crt /708
(Street or Houle N .)
Address
&ha•
Clly or Town Slate
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI J NOR/
7. DOES WELL REPLACE EXISTING WELL? YES n No["
8. STATIC WATER LEVEL Below Top of Casing: V 55•". FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
•Top of casing terminated eUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .a�,y[ 16
10. YIELD (gpm)' r�,r METHOD OF TEST �I 41
11. WATER ZONES (depth) -
//mil r -38..-7 heel lla c
427A 8
Zip Code
12 CHLORINATION: Type '411-
I{
ASING:
w
fV
0
IV
r r'
C)
Amount (S_145 II additional space Is needed use back of form
Wall Thickness
SKETCH
Depth Diameter or WelohVFt. Material (Show direction and distance from at least Iwo Slate
From 0 To //d Ft lb. 35 a1L. } 5 we-sDR Roads, or other map reference points)
From To Ft
From To FI
14. GROUT: Citadf.
-�nDepth Malorlal MethodFrom CITo r�ii Ft Cbl1Gf1P�P jeer. (i� P.C.
From To Ft 1
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In. In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17, REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OF
Quad No:
Jai No
'10 St dNLY';
u
L
ASNEcilL' E
\
'I
Sub fl cd
J
TUN
O HCE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
nal to Division of Water Quality, Groundwater Section within 30 days
2-7•aa
DATE
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD 2 713 9 7
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' - CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME it .BnwMAn We1 1 11r1111 ng Tnr• PHONE Y B7A 757-7779
STATE WELL CONSTRUCTION PERMITY ASSOCIATED WQ PERMITY
(if applicable) (If applicable)
I. WELL USE (Check Applicable Box): Residential DI 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: Canton
42 Floyd Drivp 28716
County Haywood
(Street Name, Numbers, Community, Subdivision, LotNo.. Zip Code)
3. OWNER: Bryan Whitner
Address 42 Floyd Drive
(Street or Route Na.)
Canton NC
City or Town State Zip Code
Arca code. Phone number
4. DATE DRILLED 1 1/ 1 4/ 0 2
5. TOTAL DEPTH' 1 70 I
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO IN
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use'W' if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Tap of wing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01IY.
9. YIELD(gpm): 50 METHODOFTEST.:rotary air
10. WATER ZONES (depth): 1201
28716
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degree a/m i noraMsconds)
Latitude/longitude source:OGPSOTopographic map
(check box) 1*
QEPTH DRILLING LOG
From To Formation Description
1I. DISINFECTION: Type
12. CASING:
Depth
From .0 To 75
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
tablet Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.61 /g Br), RQ PVC'
Ft
Ft
Material Method
A. concrete gravity flow
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.
Diameter Slot Size Material
Ft. in. in,
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
Co
Y
co
O
W
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
2ai 0
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 271400.
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin.() Jeremy H. Bowman' CERTIPICATION0809
‘YELL CONTRACTOR COMPANY NAME 1) Anwman WP11 Dr 11 i ntj Tnr PHONEY B2A 257-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(ir applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (x MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:ma,,gounty Haywood
W9oGds Road
(5trca ame, um bare, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: Dehhte Scroggins
Address W ods Road
(Street or Route No.)
ru's+.'.g,yics \lal ley Nu' R7S1
Gry or Town State Zip Code
(—)
Area code Phone number
4. DATE DRILLED 11 /255/02
5, TOTAL DEPTH' 1 4
6. DOES WELL REPLACE EXISTING WELL? YES O NO IX
7. STATIC WATER LEVEL Below Top of Casing: U+ FT
(Usa 'Y" if Above Top ofCuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
'Top of cuing terminated Wor below land surface requires a
variance In accordance with ISA NCAC 2C .0111.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) vr
DEPTH DRILLING LOG
From To Formation Description
9. YIELD(gpm): np METHOD OF TEST rotary air
10. WATER ZONES (depth):
I . DISINFECTION: Type
12. CASING:
Depth
From 0 To 52
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
tablet Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.F1 /8 Sch_$0 PVC
Ft
Ft.
Material Method
R. concrete
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
LOCATION SKETCH
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
gravity flow
Depth Size Material
From To Ft
From To Ft
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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. OW -I REV. 07/2001

259244
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Diviision/of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �/7 A/�j�C/'P. AA CERTIFICATION #�'/y79
WELL CONTRACTOR COMPANY NAME ern F»C- r/c /de i� d An fA t PHONE # f NG7lk"`j/7v
STATE WELL CONSTRUCTION PERMIT# T(d.t.ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential J� Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water nlection❑ Other If Other, List Use
2. WELL LOCATION/:,q9•
Nearer Town: (Llirat. Count
(4,t.i,j21v Farm •
(Street Name, Numbers, Community, Subdivision,siLot No., Zip Code)
3. OWNER: GC'C/(/r C / limit f,tfX{
Address l8.5" hi-t+-t AP rs A.t-n-r Zn ,
(Street or Route o )
City or Zip Code
( )-
Area code- Phone number
4. DATE DRILLED k -an -n2
5. TOTAL DEPTH: /4/S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .SD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): %1) METHOD OF TEST•
10. WATER ZONES (depth): /.2b r' /L3 'pni
dRivG
1 I. DISINFECTION: Type Al %7/ Amount / L
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ATo ifl,.5" Ft. 6," pi/C.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From L9 To di, Ft. (2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 15LFIat
(check appropriate box)
Latitude/longitude of well location
(decrees minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To / Formation Description
evg.5' /i%J ' / A_,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�OT7fUCN-S/pTHAT A COPY OF THIS RECORD H. EN PROVIDED TO THE WELL OWNER ) 2
1 SEP - 9 2002
- bmit the original to the D 73sio
2*99-1636 Phone No. (919) 7:3-322
GROUNDWATER SECTION
ASHEN'iLLE FEGiONAL OFFICE
SG
J,
NATURE OF PERSON CONSTRUCTING
HE WELL DATE
n of Water Quality, Groundwater Section, I63ti Mail Sers ice Center - Raleigh, NC
, within 30 days. GW- I REV. 07/2001