He CY2002

265495
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section W/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /3 l«y 4IQ / S 0/ !f CERTIFICATION r=•__
WELL CONTRACTOR COMPANY NAME C'Ire,Yr\ RN*r V4)1 5 PIA rnP (o PRONE
N 2Y)(s43"1200
STATE WELL CONSTRUCTION PERMITS( _ASSOCIATED WQ PERMITS(
(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 ❑ Other 0 If Other, List Use
2. WELL LOCAT{ON-:�1
Nearest Town4eY IeteiSo/IUI1le- County1 k.4 *4'Son
14 lit K IP bQX r, K002
(Street Name, Numbers, Community, Subdivision, Lot No, hip Code)
3. OWNER: 17i;C O..kd r`r_i-bory Merklikey-25
Address 301' If0• 1-1-ttiCieberry oo4d
(Street or Route No.) a
CIerso0V)lle/ N Sfig a.
City or Town State . Zip Code
($Z4i)- a(7; 03aI
Area coda Phone number
4. DATE DRILLED /0—,3/ -OZ.
5. TOTAL DEPTH: QO 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: ilb 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 4'R
10. WATER ZONES (depth): 30
l 1. DISINFECTION: Type /177/ Amount
12. CASING:
Depth Diameter
From 0 To 2 & Ft. c A.
From To Ft.
From To Ft.
!3. GROUT: Depth Material Method
From_0 To ZO Ft.Siii</26fc /Hirs--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.
Wall Thickness
or Weight/Ft. Material
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/ O ,
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
/77 - y .Rf"
- SO 7 .74.,v4:5
IV
c
O
Cr
c"
m
-Y4
-c r=
CJ
CD tr
LOCATION SKETCH `J
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
tna
ruse
J lln ILb ikE'°L9B1f E
h9N
L
S.ttbm)t the original to
�f ,116994536 FIWie No.(
THAT THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A PY OF 12-1I £CORD HAS BEEN PROVIDED TO THE WELL OWNER
-3/-vz__ --
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentteer' RRHVgh, NC
9) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
s - Divisionio of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /C,I Ay M/
il
WELL CONTRACTOR COMPANY NAMEC-tt-•PRn Q jpr\M'e1\ S PtArtp (o
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,*
(if applicable) (if applicable)
264267
- Groundwater Section /7
CERTIFICATION w L7ci
PHONE tr( 27) (R rf `1200
1. WELL USE (Check Applicable Box): Residential Er—Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: � d ey5o/
Nearest Town 4if-nd'�S0nUiJIt county
WIenCial. Trod
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER::rP(f 4i p;an a ((we)l
Address r2Or/ Tng6l Tr.
i-k.ndersonU id ,e IJ c a 8')9l
City oR4r ste . Zip Code
Area code- Phone number
4. DATE DRILLED /O —7,3 — 0Z
5. TOTAL DEPTH: / 2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: Z O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / ' FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): G METHOD OF TEST lit 2
10. WATER ZONES (depth): / i.7 — 3 ejPr+r
/ CO 'Spm
11. DISINFECTION: Type // r/i Amount
12. CASING: Wall Thickness
Depth Diameter
cter or Weight/Ft. Material
From / To 7 D Et. i 2, G I-, eda
From_/ t To q 0 FL z V. C PC.-
From To Ft.
13. GROUT: Depth Material Method
From 0 To 220 Ft. Sr¢ARcf4C /t'1;rfL%O/Z.
From Ft.
14. SCREEN: Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth SizeMaterial
Topographic/Land setting
❑Ridge EISI pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3 3 °/ 4 r 5 ;sit/ oil ° 30 / /7/ L 2
(degreeslminuteslseconds)
Latitude/longitude source: ETTICSOTopographic map
(check box)
PERTFI DRILLING LOG
From _ To FormationCeDescription
0 gel
From
From
(Stree or Route No.)
To
Depth
To Ft.
To Ft.
.2 0 S`0
5'C —G 2—
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t
U
"1
kv THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'DARDS, A; THAT PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER —
y SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNDVt81 10$4tbfl9 ' final to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' R leIgb, C
ASHEVILLE •P4 23ppyigyq)Rp�g No. 919) 733-3221, within 30 days.
•

2642E6
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources -Division of Water QualityGroundwater Section
(ATI
WELL CONTRACTOR (INDMDUAL)NAME (pr[n� nN PHONE p CERTIFICATION
AT1°N w— 7 I
r� Y
00
WELL CONTRACTOR COMPANY NAME C r•
STATE WELL CONSTRUCTION PEPERMIT'SASSOCIATED WQ PERMITS'
if a licable
d t 1 C�"/ Municipal/Public 0 Industrial ❑ Agricultural 0
1
if a licable
WELL USE (Check Applicable Box): Rest
en to
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT;gN
Nearest Town:
Code)
(Street Name, Numbers, Community, Subdivision, nNo., tip
3. OWNER: JQ,✓xe
Address
City or Town State . Zip Code
Area code- Phone number _�
4. DATE DRILLED /0 /_ _/
5. TOTAL DEPTH:_air------_
6. DOES WELL REPLACE EXISTING WELL? BYESES 0 NO L1
7. STATIC WATER LEVEL Below
use" of Casing:
b ve Top or Casing)
8. TOP OF CASING IS
FT. Above Land Surfaces
variance in accordance of casing
with ISA NCAC 2C .0118.
requires a
9. YIELD (gpm): —_-- METHOD2F TEST fl i
10. WATER ZONES (depth):
/.j W Amount
11.2. CASING: DISINFECTION: Type Wall Thickness
1th Di eter or Wei ght/Ft. Material
Froma____.To 3 L Ft. 1 Ls�- vG
�� Pv4
From To—— Ft.
From To Ft.
Material
13. GROUT. Depth
From_S2— To�10 L_ Ft s/ARi—t
From To Ft.
iameter Slot Size
Diameter 14. SCREEN: Depth Ft. in. in.
From To Ft. in.
From To
15. SAND/GRAVEL PPACK:
E
From To
To
Size
Ft._
Ft.
Material
Top°gryphiciLand setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lati deJlongitude of well location
61 ° 2td.>
(degrees/minutes/seconds)sousouPS❑Topographic map
Latitude longitude rce:ce:8(check box)
DRILLING
Formation Dyscription
DEPTH
From To
1 O ATION SKETCH
Show direction and distance in rolles from Include at
least
two State Roads or County
Roads.e road
numbers and common road names.
Method
nrA2,
Material
ACCORDANCE WITH I SA NCAC 2C, WELL
E
STANDARDS,
AN THAT THIS WELL WAS CONSTRUCTED IN ACCORD `T Z L DZ
STANDARDS, AND T A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GTHE WELL DATE
��,r(q SIGNATURE OF PERSONCONSTRUCTIN
ASHEN:�LE RE ICE
Service AI
G b;'G!PL CFI Raleigh, NC
GWr1 REV. h, NC
27699-1Submit the original to the 733-3221,wiWater thin 30�days�ty� Groundwater Section, 1636 Mai) a ce
27699-1636 Phone No. (919)

MicO Hop.; Rrl
//Wy17.
13. GROUT: Depth
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources
y---Division of,Water Quality
Li
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lS.lr�y�x�W L £ n / '-
WELLCONTRACTORCOMPANYNAMECtrt t\ Ctn,.r\Ni II S Pump (t7
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
264265
- Groundwater Section
CERTIFICATION
PHONE cl3' 110D
7o80
I. WELL USE (Check Applicable Box): Residential D Municipa1Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I I_ , v
—bufino—ecin ex Sorl
Nearest Town: ii�t'Y�.pYSorivl t iZ County -I`i2%t�L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER• D(AS-k.) Wal %1—
Address PO f&y'II3
(Street or Route No.)
Ens Fla-I-Kodc-. N G aSs 7 to
City or Town State . Zip Code
(afe)- eaCie2—S.SLI
Area code- Phone number
4. DATE DRILLED /0 --/O — 0 Z
5. TOTAL DEPTH: '7. 2.6. DOES WELL REPLACE EXISTING WELL? YES 0 NO III--
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): METHOD OF TEST Ar'.e_
10. WATER ZONES (epth):
11. DISINFECTION: Type ,#777/
12. CASING:
Amount
Wall Thickness
Depth Di p or Z Weight/Ft.0
Front__-�_ To�_ (L Ft.
From .3 9 To 9 9 Ft. 2// C
From To Ft.
Material Method
P��
Topographic/Land setting
[Ridge ❑Slope DValley PPtt
(check appropriate box)
Latitude/longitude of well location
3y °/S' 174/ OS.2°27 '41 71..2
(degrees/minutes/seconds)
Latitude/longitude source:Q(SrPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From ToFormation Description
O — 35_ Dial`
.35 - 5 Ci 4'wrl
4-0 — 33.5 6Rwin lb -
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers anilfmmon road names.
zi
From t% To .Z 0 Ft. S141F1i/z he' AI rI PC /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
16. REMARKS:
wit) HE*.EEW,
Submit the on lnal
GRn(IND'i.11609466•PlioneNo
'-' d'� OFFIG-
Y THAT THIS WELL AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THA COPY OFF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
st y /(7 /7-6Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
[phone], within 30 days. GW-1 REV. 07/2001

264263
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section l
.L
WELL CONTRACTOR QNDMDUAL)NAME (print) C .L CERTIFICATION PHONE # ��� Do
WELL CONTRACTOR COMPANY NAME C t- r\ a
��t pt Porno co STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITp 7a08
ifa livable
if livable
bl Box): Residential UV-Municipal/Public❑ Industrial ❑ Agricultural ❑
1.
c,
2. WELL LOCATI9gN:
Nearest Town: c
�.�
WELL USE (Check Applicable ox
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
Topographic/Land setting
[+}-Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
,..,......._.._. _
.� (degrces/minutea/scconda)
3 OWNER: �, _-, �� , rf Latitude/longitude source:l iPS❑Topographic map
(check box)
nRILLRJ LLOG
Formation Description
r
City or
Town
Skal
Area code- Phone number 0
5. DATE DR
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: ) f- O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires � a
varianceaccordance 15 METHOD OF TEST !r ,Z
CAC 2C .0118.
9. YIELDELD(gpm):
10. WATER ZONES (depth):
County
I -Ci
l/ H Amount
11. DISINFECTION: Type Wall Thickness
12. CASING:
Diameter or Weight/Ft. 1�L�C
From�—
°�o _ Ft. L µ 2 7 .
To Ft.
To Ft.
Dcpth Material �nnMethod.
To — Ft. S.lLti�tf= a ,M TO
To Ft, Material
Depth Diameter Slot Size
Ftin. in.
Ftin. in.
From___
From
13. GROUT:
From
From
14. SCREEN:
From To
From To
15. SAND/GRAVEL PACK:
Depth
To__
To_
From
From
16. REM H
1 DO HEREB
CONSTRUCT!
th
IAP
GROUNDWATER CTjg
ASrEVILLE REsN)Tp!gglna
2
•
Size
Ft._
Ft.
Material
OEM
From To
r nreT'ION SKr 1 t,n
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N.
ltn
0-
r-±
r,3
UL
ED IN
5A NCAC 2C,
LL
Y THAT THIS WELL
THAT WAS
Y OFRTH THIS RECORD HACCORDANCE
N PROVIDED TO THE WELL OWNER
,ARDS, / _ Q
►I #
g GDATE
NATVRE OF PERSON CONSTRUCTING THE WELL
to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center ,leigh, NC
[phone], within 30 days.

264261
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
13R T ��h l rtl CERTIFICATION o_
WELL CONTRACTOR (INDIVIDUAL) NAME (print) yi�� PHONE N 0121) (/ of 3 - Op
WELL CONTRACTOR COMPANY NAME&I t'9th OtVgr \/.Iq{{ \ PtitMP Cn
� /
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/ � /tP
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ld' Municipal/Public O Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Neare'sOTown: �/ UI /fit° County I QJ GwScrL
/AJ . f n?jar ( Lk/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER..g a ene� f�l 1 ( -
Address I t lJ • �n bri ue-
(Strat or Rohte No.)
Cityorpal3 —75/ 7 • Zip Code
Area code- Phone number
4. DATE DRILLED / E - 2- - c 2-
5. TOTAL DEPTH: 2 `f 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
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 easing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): C METHOD OF TEST /gh /Z
10. WATER ZONES (depth): 2 2 5
Topographic/Land setting
❑Ridge LRSlope DValley DFlat
(check appropriate box)
Latitude/longitue of well location
5 O/ Al O3 Z° Z3 5 2 4i
(degrees/minutes/seconds)
Latitude/longitude source: PSOTopographic map
(check box)
pEPTH DRILLING LOG •
From To Formation Description
- ac D.aT
4 5--2, `t 5 ( /Z/9+.o,`h=
11. DISINFECTION: Type N T H Amount
12. CASING: Wall Thickness
Depth Di5neter or Weight/Ft. M.sterial
4
From 1 To 5 2_ Ft.0 2?c pl'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method��p
From 0 To 2 0 Ft. S/MRi>,3r.- .M,y,?--1 coo/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.
16 REMARKS:
r-'ipfrxFitFAYCER
I CONSTRUCfIO
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th road
numbers and common road1rlames. fd
o
EMATTHIS WEL
ARDS, AND
to
;aS'tib, ton
'I' _':; 7699t163.E: lCOneINP. (919
AS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A COPY Q/F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/O -2 -C 2
" 1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service CenterREi Rieigh, NC
733-3221, within 30 days.

264276
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- - Division 1of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) li + £fl �.�"e't CERTIFICATION «0RS, //7
I
WELL CONTRACTOR COMPANY NAME GIr9.Qn IIIni.er \J�p 1 S PsAmP (O PHONE # (?21) G 93-1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# '7/a41.
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial ErY Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: „
Nearest Town: Etm qt/ I , 1 -e_ County Y-1 er l �n
-RUJ _O-IN1 ed JJ
(Street Name,e,�`Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ec1fl&(ul! I'e Itr re t?- eScue.
Address PeaK (r, 30
(Street or, Route No.)
4d o, (Hire tuC ow7a'f
rty or Town J State . Zip Code
'731I
Area code- Phone number
4. DATE DRILLED % —Z 4 - 0 Z
5. TOTAL DEPTH: 2. 9
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Cuing)
.8. TOP OF CASING IS / FT. Above Land Surface•
Top of caring terminated at/or below land surface requires
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST Me `'2
10. WATER ZONES (depth): 1 L 5
11. DISINFECTION: Type 1J 71V
12. CASING:
Depth Dia2eter
From / To 2.4. Ft. G
From 2 C To 5'4 Ft.
From To Ft
13. GROUT: Depth
From O To Z C Ft. 55f-k,Qtl"tE.-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To • Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
.2/ C
Topographic/Land setting
❑Ridge ❑Slope ❑Valley E?)at
(check appropriate box)
Latitude/longitude of well location
3 ti ° 23' y /A/ O $1 ° 7.3 38 Q}
(degrees/miou seconds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O — 3
30 C(9 Scfra:Ci
r/?hoifr
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. /
Method
-PocAR
Material
16 REMARKS• - Hwy (
I DO 1 tERBBY CEP''4 THIS WELfWAS CONSTRUL I bD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAMP S, AND TH4 A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2-za
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Gpiltuislidnlietpriu the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
„Sr.Fi7692-7-3(0!AM6+ternfa1(49) 733-3221, within 30 days. GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264275
WELL CONSTRUCTION RECORD
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - 4 )zt/f}t<Jt cn7/}�' % CERTIFICATION IV2 bJ -/L1
WELL CONTRACTOR COMPANY NAME C-1t-Q,Qt"\ Ri Vfr `NC PUITI(3 En PHONE # 012Y) (/ 43 -1200
17a
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nkarest Town: P CIQVP
CIA-vr�r� fjreS±Ir-
(Sueet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROInA¢lkd(or-
Address 432 (:!trf-I'(dgt. Pace
(Street or Route No.)
Jo r IL s C a9'144s-
Countyikf lcUYS of
City or Town State , Zip Code
(Sf03)-&w --/791-
Area code- Phone number,
4. DATE DRILLED 7 `- O - 0 Z
5. TOTAL DEPTH: /L S-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E'
7. STATIC WATER LEVEL Below Top of Casing: 'TO FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
crop of cuing terminated odor below land surface requires a
variance In accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): '2 0 METHOD OF TEST L'-; /?
10. WATER ZONES (depth): / LC
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To -3 A
From To
From To
13. GROUT: Depth
From 0 To 9.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
f %%} Amount
Wall Thickness
Di cter or Weight/Ft. Material
Ft. 2 r/. L P✓G
Ft.
Ft.
Material
Ft. c4kn..C11-e2
Ft.
Diameter Slot Size
Ft. in in.
Ft. in. in.
Metho`f,
%Y7f-7—o0/1., 43
Agricultural 0
Topographic/Land setting
❑Ridge glope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
33 27 57V ogz°ty'Lib Li
(degreWminutes/s nds)
Latitude/longitude source:CddPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — /5— fJfr2'1"
/3 — 2 s- x.) /
2 5 — 3 0
�n—/GS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
10. Ir;EMARKS:',,
1 DO HEREBY CERTIFY TKA
CONSTRUCTION S
Size Material
Material
t
�Rrtft7j Mtn /lei
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND A COPY 0 IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
�
h 1n7bi' �! Divi.lsIon of Water Quality, Groundwater Section, 1636 Mail Service Center - alei h, NC
Na. (0 P 733 3�R22I, within 30 days. GW-1 REV g07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /3 Rysit SArm tin
WELL CONTRACTOR COMPANY NAME Girt? t1 Rhlie \NC II S PIA rnp Co
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264274
CERTIFICATION w CR5 l
PHONE
d _12 ��
1. WELL USE (Check Applicable Box): Residential 2 MunicipaUPublic 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tow,ft: 6-6-1-'` -- County'
nk vni v 0729
(Stint Name, Numbers, Community, Subdivision, Lot No., Zip Code)
cQ.QJ'Scfl
3. OWNER:CA'1(irr/6S e le -
Address 3(000 OIC 5-facie kid
(Street or Route No.)
nicd')QQs, C. a9S2/
City or Town State . Zip Code
.39a- 0
Ares code- Phone number �q
4. DATE DRILLED 9-- J - O 2-
5 TOTAL DEPTH: 3 575
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: 2 co 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): / C METHOD OF TEST 4,'i2
10. WATER ZONES (depth): 3 £5
11. DISINFECTION: Type ff %N
12. CASING:
Depth Diameter
From D To 3 Ft. _
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 O Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Amount
Wall Thickness
or Weight/Ft, �[aterial
A26 f "t-
Method
16. REMARKS:
iil 11
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ROJ �l rhone Noj (919)(133-3221, within 30 days. GW-1 REV. 07/2001
G
ASFCt.IL LE RI:;,;;dH ;7 '�r.c: 11
Topographic/Land setting
❑Ridge @lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
5/A/enx°i9isaLi
(degrees/minutes/ nds)
Latitude/longitude source: PS❑Topographic map
(check box)
DEPTH
From To Fo tion Description
0 _ / S IP/74tui
- _
25 - 365
DRILLING LOG
/r)7`
7,i fFY
LOCATION 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
Material
n
iJ
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
sS, AND T A CSPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
20 -O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)I Zyalilt "GM 1I'-h CERTIFICATION w
;5 /
WELL CONTRACTOR COMPANY NAME GIr&,Pn gait Vlv t{ S Purnp Co {P.�HOONNE M (r2P) G.2 43'10D
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# V L b a
(if applicable) (if applicable)
264273
I. WELL USE (Check Applicable Box): Residential CErMunicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: /)-� / /S
Nearest Town: F'S 5 /I County`f-�.-lrl
an
Liviscm pY/flq TKO I
(Street Nsme, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IDUAkS
Address 70 L aCn R
fto vst ST1or 1 A 1 C� c .
City or Towq State .Zip Code
(S )- CO — 5OS*
Arca code- Phone number
4. DATE DRILLED 7 - O 2--
5. TOTAL DEPTH: 2 •Z S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0-
7. STATIC WATER LEVEL Below Top of Casing: L0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
, *Top of cuing terminated at/or below land surface requires a
variance hi accordant th 15A NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TEST 4; R
10. WATER ZONES (depth): 2.90
11. DISINFECTION: Type fi rh' Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C To `7 9 Ft C ' 27 C Pit
From 7T To 7 g Ft. i i 2/. L PVC_
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2 0 Ft. 5 n kor!c M.' y 9- Povi<
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Topographic/Land setting
❑Ridge ❑Slope ley 0Flat
(check appropriate box)
Latitude/longitude of well location
36`2z' IHN0R2°33'/Lc✓
(degrees/minutes/seconds)
Latitude/longitude source:BC PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
—
D — 9' Q
9o— 22
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers : e - a on road names. o -
�\ de fJ
y)
l-n
3 Zia)
16. REMARKS:
DIrk( RRB
CONSTRUCT'0 STAND
Y
E1 17F-IgThAT'{'`IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
..,IAND THAT OPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
gig—L�z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Divi. ion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
cht Ipp& 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
264272
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 IZ y /VIE ya/7f / Y'h /7 CERTIFICATION w oRG / /
R WELL CONTACTOR COMPANY NAME C-1r9.t rl gall r \/lc I( k Pump (_n PHONE�I/ fin (/ �f 3 - 12 OD
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/ / OJ/24
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: I ,�
N est Town: 0/ldu(e County ncutso4
t ut&- /*-ri ed
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:(J//1e 1ttae- /Y go!
Address (pla0 Hut � tW
(Street or Route No.)
P-le}uier; kJ C ar 1
City or Town State .Zip Code
(Srdfij- to K'P -
Area code- Phone number in
4. DATE DRILLED 7 — / 3 -0 2-
5. TOTAL DEPTH: 50 7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EV
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): j METHOD OF TEST 4, R ,
10. WATER ZONES (depth): /00
11. DISINFECTION: Type Ho/
12. CASING:
Depth Diameter
From 0 To 36 a G
From _ To Ft.
Frcm To Ft.
13. GROUT: Depth
From 0 To ?
From To
14. SCREEN: Depth
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Ft.
Amount
Wall Thickness
or Weigbt/Ft. Material
21, C PYC_
Ma3terial Method
Ft. 54-Me 72:
Ft.
Diameter
Size
Slot Size Material
in.
in.
Material
From To
I DO HEREBY CERTIFY
CONSTRUCTION ST
N 'TEFfSkCTInf --
ealftfa/pe Di
Topographic/Land setting
❑Ridge EISiope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 z`t'5fW' oR'2°z7'576-2
(degrea/mioutea/seconds)
Latitude/longitude source:Q(�iPS❑Topographic reap
(check box)
DRILLING LOG
Formation Description
DEPIli
From To
o— z8
2.9 — S'0 14au..r' 54i /l
90 — 5 OaC PAR., ITC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa
numbers and common road names.
M
C
4
,O
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT f OPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—0 Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PERMITN ASSOCIATED WO PERMIT#
(if applicable)
(if applicable)
WELL CONSTRUCTION RECORD
264269
North Carolina - Department of Environment and Natural Resources - Division of/Water Quality - Groundwater Section �7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _L/,ak.7" <�/%7/ f'-`1 CERTIFICATION Of RS / I
WELL CONTRACTOR COMPANY NAME elrp,pn V,i\be \M* I) \ Pun it) p (n PHONE # 1727) L 43-12 Oa
9o7
1. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
arest Town
(Street Nurse,Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: A,r1y Acts
Address Rr / /30e /79
County
(Street or Route No.)
z./Acim../,+ lI/G
257790
City or Town State . Zip Code
(9)- 693 — ?it,
Area code- Phone number
4. DATE DRILLED 9 - C - O Z
5. TOTAL DEPTH: / 7 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 7 0 FT.
(Use'4" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface•
•Top of casing terminated allor below land surface requires a
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): ' O METHOD OF TEST /Yi rZ
10. WATER ZONES (depth): ga
I I. DISINFECTION: Type /le 7/71
12. CASING:
Depth
From / To :;'(
From 'PT To ',"L
From To
13. GROUT: Depth
From / To 20
Ft.
Ft.
Ft.
Material
Ft. Ss/sx t,
Diameter
L,::
Amount
Wall Thickness
or Weight/Ft. Material
2 74 Pa-'L
/.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
/14,y4 Foul
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley UFlit
(check appropriate box)
Latitude/longitude of wellllocation
36/z,-Y4/ ss< 7'tjw
(degrccs/minutcs/ nds)
Latitude/longitude source:anPS❑Topographic map
(check box)
DEPTH DRILLING LOC
From To Formation Description
- 2 0 A 2 J`-
2 (7 S' S
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and comma road names.
.775
C
16. REMARKS: N�11 2)�
REBY CER 1 YTkTAT
1hSTR33C LON,STANDARD
Sjrbmlt the original to the
WELL WAS CONSTRULIED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A " IPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t•�
r
c�
�,; I S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
�r
ivisi n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-322 , within 30 days. GW-I REV. 07/2001
l
ati; IOni
i'.��r l -;. 'iFRCE

ASHEIll 1 E
2642F8
WELL CONSTRUCTION RECORD
North Carolina - C l Department of Environment and N, atural Resources - Division of Water Quality - Groundwater Section �7
hf 1) CERTIFICATION a `>l1r)
inn 4 � 2 Or,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) %ZyI}/C?! �M It/
WELL CONTRACTOR COMPANY NAME C rP,e rl 11.1V4 r \61 # 11 .S Pt^ m p (n PHONE #
ry ��(/
STATE WELL CONSTRUCTION PERMIT%_
ASSOCIATED WQ PERMIT I C
(if applicable) ��
WELL USE (Check Applicable Box): Residential LK Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:H ay'O e C2o&VL-County /16.:7 /l)t .Co4
GrtuUet_Lak
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNERS%ikAlil LC/L Wl t—Lt
Address 7?5> & Ket-7,1 at il tee,
(Street or Route No.)
224(ZCeli nl c, zs790
City or Town State . Zip Code
g- 69$-i/4yr
Area code- Phone number,�
4. DATE DRILLED / - `i - 6'
5. TOTAL DEPTH: /7LQ )
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO Qr
7 STATIC WATER LEVEL Below Top of Casing: PI J FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS / FL 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 f tt
10. WATER ZONES (depth): 3 1.5
1 I. DISINFECTION: Type 1/Tit Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
(if applicable)
Topographic/Land setting
DRidge QSTO-pe 0Valley DFlat
(check appropriate box)
Latitude longitude of well location
(degrees/Minutes/seconds)
Latitude/longitude source:E9GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
d - 2 o a', rz r
7 '0/f0•I— 1)/7Pk, /ha=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and ce on road names.
From / To i) Ft. 0C 13,,2. 7. C f k'E-
From /5 To AFL (J �sZitt. P✓C—
From To Ft.
13. GROUT: Depth M serial Method
From 0 To 10 Ft. 544. RIP/5%t1. v Se- tiiii,e,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK.
Depth
From To Ft.
From To Ft.
Size
Material
Y THAT THIS WELL WAS
ARDS.�'AND THAT A C
/ ren
'✓ SIGNATURE OF PERSON CONSTRUL t INC THE WELL DATE
3
NSTRUCIE
OF THIS
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
OFrciii Ith-ptangina to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
'S4gL1 �-h�tone N . [phone], within 30 days.

From To Ft.
13. GROUT: Depth Material
From_(L—To11LFt. S7k
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK: Size
Depth
To
To
From
From
16. REMARKS:
I Db SERE'PYIFE n ' dONSTRUCTION
111
i I li
LI G'I
Submit the origi al to
27690;l W,?xF ip No. (9
,r_
Ft.
Ft.
264260
WELL CONSTRUCTION RECORD
Quality -Groundwater Section
North Carolina - Department of Environment and Natural Resources - DivisionioCERTIFICATION._l �of Water Qu 'Y
)'\ _
WELL CONTRACTOR (INDIVIDUAL) r .5- // DUAL) NAME (print) PHONE p N79t 20�
WELL CONTRACTOR COMPANY NAME C C a ASSOCIATED W Q PERMITM
STATE WELL CONSTRUCTION PERMITA if a licable
ifa licable
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
Nearer T
2. WELL LOCATION: , b- " � ❑Ridge ❑Slope ❑Valley r at
a •►r 4 S-�County r (check appropriate box)
well location
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code) 3
Latitude/longs de of a '7 loci
/./
C }-� .0 g (deeestminute heconds)
3. OWNER: i �L�/� Latitude/longitude source:G3OrPS❑Topographic map
Address ��`�� l (check box)
nuri r TNC LOG
Formation Description
oiw
st,k .ztpCo& From To
City or Town pJ — 't0—
Area code- Phone number
4. DATE DRILLED C) - f Z O
5. TOTAL DEPTH: �/
6. DOES WELL REPLACE EXISTING WELL? YES a NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2 c) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
vs:lance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 45 METHOD OF TEST .Z
10 V/ATER ZONES (depth): //�
-...= ICETCIi
/f rY. Amount Show direction and distance in miles from at least
1
1 12.. DISINFECTION: Type CASING: Wall Thicknesstwo State Roads or County Roads. Include the road
DepDiameter or Weight/Ft.
t. Material numbers and common road names.
/ �' , Ft -1- 2 g ( 2Ls.� - f
From
From — To_ Ft. S(_
Method
/i1 ' v SL/�crJl Z
Diameter Slot Size Material
Ft. in. — in.
Ft. in. in.
Material
ru
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS ra THAT 4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C C.2
iv
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceen`tteREVeri Rgh, NC
19) 733-3221, within 30 days.

264259
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -`Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e/?,ilJ!` t/fr/tA CERTIFICATION OR
WELL CONTRACTOR COMPANY NAME el MC U &.r k%(i 11 It PIA Cr)
STATE WELL. CONSTRUCTION PERMITM ASSOCIATED WQ PERMITM l Intl
• (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ff.—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I
Nearest Town: C.f - �tJ� /nCounty+kalCU IS�
(ik1fl1 lln n-' , LLLta I L4 a 1
(Street Name, Numben, Community, Subdivision, Lot No.,
Zip Cade)
3. OWNER: L (7/1,1/]2l . paA c�
Address TtO f LX I 12
(Street or Route No.)
�(evlon, NG a%73S-
City or Town State .Zip Cade
has—R837
Area code- Phone number 4. DATE DRILLED 'A/2
��
5. TOTAL DEPTH: 9~ll
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13..-
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface'
, *Top of cuing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .01I8.
9. YIELD (gpm): 2. METHOD_OF TEST A.'i
10. WATER ZONES (depth): R 5
11. DISINFECTION: Type H TH
12. CASING:
Depth Dieter
From To 2) Ft. L if
From 73 To LS Ft. Zt
From To Ft.
13. GROUT: Depth Material •
From__d_ _ To 2 O Ft. 6./Jk/?h7-!'
From To Ft.
Slot Size
Amount
Wall Thickness
or Weight/Ft. Material
z7 c Pi/c-
2/, L _ /7v'C,
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
PHONE M On Le 9 I200
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C4Fiat
(check appropriate box)
Latitude/1pngitude of well location
35 28 27A/ a81el.i 4/31-ti
(degrees/minutes/seconds)
Latitude/longitude sotrce:C rPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
©- Co •Ri
to - j ht7 Rnni`ty`
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
.jn y9epnr/.
in.
in.
Material
P
sag tallow mi., Rd
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS LL WAS CONSTRU(.IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A Cad OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
u
Stremi&the original to the Di
27699-1636 Phone No. (919) 733-
it `
LCFFICE
TURE OF PERSON CONSTRUCTING THE WELL
DATE
(Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
, within 30 clays. GW-1 REV. 07/2001

264258
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/1 CERTIFICATION w of Water Quality - Groundwater Section
�/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �-7./Zy��cl� �/�✓
WELL CONTRACTOR COMPANY NAMECit"f.4h R1usr \/do 11 'S PtArnp (n HONON ah„� (e 4S 1200
ASSOCIATED STATE WELL CONSTRUCTION PERMttWQ PERMITNN (if applicable)
(if applicable) /
1. WELL USE (Check Applicable Box): Residential 0' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town:- nU 11(2. County n
Geourtreec
(Stint Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I-E.0no....
Address fa-bt2. (''nX •col
(Street or Route No.) G r19 0:
I4Qvrd* v srrno ! I 1.a, a `6
City or Town State . Zip Code
(C - COSSS-7c
Area code- Phone number --/‘
4. DATE DRILLED
5. TOTAL DEPTH: 2 -/
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: AO FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
• *Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): q METHOD OF TEST 4-i t
10. WATER ZONES (depth): ! GJ
11. DISINFECTION: Type
12. CASING:
Depth
From / To 5 O
From 5-0 To 9 o
From To
13. GROUT: Depth Material
From D To 7 0 Ft. 6/744'ete.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From._ To Ft. in. in.
«rtt
Amount
Wall Thickness
Cialeter or ght/Ft. MMatcG
Ft. p.vc.
Ft. e
Ft.
Topographic/Land setting
❑Ridge ❑Slope Vley ❑Flat
(check appropriate box)
Latiiwdeilopgitude 9f well location
3S z3 Y' OB2 i? Ua'
(degrees/minute/ ads)
Latitude/longitude source:QGPS❑Topographic map
(check box)
PEL ING LOG
Formation Description
O•IZt
From To
©-35
3o L'0
G O - 90
Method
; X7f ?core.
15. SAND/GRAVEL PACK:
Depth
To
From Ft.
From To Ft.
TirTrris-777 i±13,0_-
I r \t CONSTRUCTION STAND
Li ft
atiblid(tithe- i-c hinittahe Div!
Material
Size Material
Citt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name
Odd C)64R--
S WELL WAS CONSTRUC I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ix,
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Centteer' RRHVgh, NC
h 2001
21, within 30 days.

2. WELL LOCATION:
n
Nearest Tow.
Tr non (--1
,Street Name, Numbers, Community,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nac}tral Resources - Division f Water Quality - Groundwater Section q
/J� k CERTIFICATION .2�1 7/
WELL CONTRACTOR (INDIVIDUAL) NAME (prtnt) Ay &Kir !Y� 41 ( 4 _ I n
WELL CONTRACTOR COMPANY NAMECRn 1 �fRtVPr \M I(S Pump PHONE p
p (O
VD
STATE WELL CONSTRUCTION PERMITS
r0 qa r ASSOCIATED WQ PERMITft
(if applicable)
if applicable
I WELL USE (Check Applicable Box): Residential 21---Municipal/Public ❑ industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
264257
I-�P-III���wIGtG County t71
Subdivision, Lot No., Zip Code)
3 OWNER-mGhaGk LC. Pre fey
Address C9 ip VOCJ �I1�
!(Street or Route No.)
j uwa_nn ore, B /'7&
Ciry or Town State Zip Code
)- /29R Dana
Area code- Phone number
4 DATE DRILLED 21'"
5 TOTAL DEPTH: 3 Z i—
n. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7 STATIC WATER LEVEL Below UTop se o fAbove ingTop of Casing)
. 8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated auor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST /7. rZ
10. WATER ZONES (depth): / L 7
11. DISINFECTION: Type
/1 T7/
12. CASING:
Depth
From / Ft
From l 7 To GS— Ft
From To Ft.
13. GROUT Depth
From 2 To 20
From To
• 14. SCREEN' Depth
From To
From To
15 SAND/GRAVEL PACK
Depth
To Ft.
To Ft.
Material
Ft. ith.2<12.
Amount
Wall Thickness
or Weight/Ft. Material
29c ht—
)1 L
Topographic/Land setting
❑Ridge 13Srlope ❑Valley ❑Flat
(check appropriate box)
Latjtudellongitucje of well location
33: '42 ' O'7A/ Oij 23 zOUJ
(degrees/minutes/seconds)
Latitude/longitude soorce:L"JU/PS❑Topographic map
(check box)
DEPTH DRILL NC, LOG
From TFormation Description
6o 1—
�,'r
6-0 - 3 7
J,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers a common road names. /
' r
Method 02i 111 // Lrm
M;19-/'a-rt Q11'4/
Ft.
Diameter Slot Size Matenai
Ft n. in.
Ft. m in.
From
From_
p REMARKS.
D674FF➢t cgrsT
CONSTRUCTINN Si
fir . tl'5101/f(tti tFe PP+N)1I to t
,N
Size Matenal
0
1��
c )
C7
S AND AT A BYOFTHIS RECORD ACCORDANCE IN
CORD EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center R llyeigh, N oUl
) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD 264256
•
North Carolina - Department of Environment and Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ibr(fad- R5rn
WELL CONTACTOR COMPANY NAME Cl rq,fn SZIV*r VI*? S PV.rr1P
STATE WELL CONSTRUCTION PERMITN
(n
Quality - Groundwater Section �7 /
CERTIFICATION a 1;S /
PHONE N f727) [t 43- 1200
ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential B" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town1-k-OCie VSonu t I G - County 4e—si d 2rso/)
ace. ra t s
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:P.100j III -rs
Address j'741 1v&-th r4-Ve Nor /G)
(Street or Route No.)
St.�� east Ln„ cL 337oa,
City or Town State Zip Code
(7a7)- SAL-0Ssso
Area code- Phone number
4. DATE DRILLED S -' 12 - O �.
5. TOTAL DEPTH: a85
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EY
7. STATIC WATER LEVEL Below Top of Casing: + FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS i FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 0 METHOD OF TEST Pt; r
10. WATER ZONES (depth): a g 5
11. DISINFECTION: Type I-1 i H Amount
12. CASING: Wall Thickness
Depth Diameter or Weigh� Weight/Ft. Material
From 0 To #-0 Ft. to 'bit- cZ7•
From 40 To I Do Ft. lc) dig' 1,
From To Ft.
13. GROUT: Depth Material Method
From O To c2 O Ft. Sn-Crc4e
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.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35° .QL' aatJ og2Gao' as -,Ai
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — toD 1D.rt
60 - 8o CIa/
8G - 90 San S}one
90 BPS
ran i 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.
in; )c k, poor
From To
16. REMARKS: -
1 I 19'j1) 11E 13Y OER,IfF
Com
u L,I
Submit the original to the
�42-71.ORMAOR 3TIKdA'(919)7
A° F, L. E R ' .','L. OFFICE
SIGNATURE OF PERS•N C
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF • ' ' CORD HAS BEEN PROVIDED TO THE WELL OWNER
$-12 —o 2
THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
264255
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) alyng ICJ% S tyli>`tr CERTIFICATION a ds?I
WELL CONTRACTOR COMPANY NAME Girt 4r g'tVfr \N'a tl S PIAmP Cr, PHONEO# (/27) (. 43-i-zoo
W7
STATE WELL CONSTRUCTION PERMITM ASSOCIATED Q PERMIT# 0g3
(if applicable) (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 LOCATION:
Nearest Town:
I"LL +ro
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fI50y R. Taskoe.
Address AO) 160 11
(Street or Route No.)
Dindir
N �
City arTo n State .Zip Code
(Q2A)- ZSO - 3 9.C2.
zd7zy
Area code- Phone numberg
4. DATE DRILLED U _ 9 - a
5. TOTAL DEPTH: / L 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-
7 STATIC WATER LEVEL Below Top of Casing: 4412 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0119.
9. YIELD (gpm): 10 METHOD OF TEST /LIR
10. WATER ZONES (depth): / 9 D
1 I. DISINFECTION: Type /41 TH
12. CASING:
Depth_
From To 2- Ft
From 1Z To %_O Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 O
Diameter
Amount
Wall Thicior ness
2`21 uFt. Material
/C-
21.'L
Material
Ft. 5 rr4'Rtty
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
fitly Pc-fivoi2
Slot Size
in.
in.
Size Material
ounty HE14/37250k/
Topogra c/Land setting
❑Ridge Rglope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of welUocation
3CD /9' 51i oA2 944'
(degrees/minutes/seconds)
Latitude/longitude source:l3dPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
3`V 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.
Material
T THIS WELL WAS CONSTRU(.IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g-12-07
t' SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
FF('t'�t"j1,�S riTh A o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ASHEV9 rrt o J L 8 1 � GW-I REV. 07/2001
27 99=1636 Ph -owe -Nu. [phone], within 30 days.

WELL CONSTRUCTION RECORD
264254
North Carolina - Department of Environment and NaturalatResources - Division of Water
2/
Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,gn ye9 ka/-S/YliLi.t CERTIFICATION w 1
WELL CONTRACTOR COMPANY NAME C"trp,e n Q.v-c r\/ASC 115 PU rt-10 En PHONE a if2Y) (jets- /2 Do
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
7096
I. WELL USE (Check Applicable Box): Residential Q—Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.�
Nearest Town: ,-CtySe5h0Q County
(Street Name, Numbcn, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6; 11 . Q h l rn-aj J r.
Address SS
rSe,Shtr,ceto at G 74a
City or Tgwn State . Zip Code
(8L8)- fig I-3333
Area code- Phone number
4. DATE DRILLED «- 6— a 2-
5 TOTAL DEPTH: / Z r
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 C 0 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): 9 0 METHOD OF TEST Ai IZ
0. WATER ZONES (depth): /00
11. DISINFECTION: Type
12. CASING:
Depth
From / To 39 Ft. .2vG
Fro:n ,. S To 5-9 FL G 2/. L s/C
From To Ft.
13. GROUT. Depth Material Method
From 0 To 2 0 Ft. 6-4-kREte Alitri-1'ov,e.
Hrlt
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
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.
, , K M,kycRIsl
1 DO HEREBY CE
CONS • ION
f!F
Topogra c/Land setting
❑Ridge DiSclope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 `?Ao 38A/ ogt •3 /a e4.2
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomp.ation Description
— a a ,Vrz
0 - 5-0 c3it o-el S roc
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common r. ad names.
vrl /Zd
THAT THIS WELL WAS CONSTRUC ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS. - J» THAT A 3 OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GEOY SIiiiy {ttRreb 1 to tie Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHEItILL��P One O. (91)) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc�ess.- Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - /Z U»n tr S e f"M
WELL CONTRACTOR COMPANY NAME C-1 t"O.re n Q i.r \/.1N tt \ Pt,.rnP Cr)
264253
- Groundwater Section /�
CERTIFICATION w %i rJ "r�
PHONE U2T - 12 QO
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT# 7 D ,..
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential B MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
: - i _
N�e restTown: /J VZQ St?a'2- County -f5 rf-L,
(Street Name,Numbers, Community, Subdivision, Lot No., Zip Code)
,1
3. OWNER: (ta-VO I d a i d
Address /8!> fish (—re. K + /'a r-
($trect or Route No.)
rs� Shoe, A.lC a €'7V
LCity or Town State . Zip Code
) 5?9/—J14,osL
Ares code- Phone number
4. DATE DRILLED 9-9 - o 2
5. TOTAL DEPTH: G D 5�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L—
Z STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 90 FT. Above Land Surface'
*Top of cuing terminated at/or blow land surface requires s
variance In accordance with ISA NCAC SC .0118.
9. YIELD (gpm): / METHOD OF TEST /} r r2
I . WATER ZONES (depth): 2 00
11 DISINFECTION: Type hi TN Amount
12. CASING:
Depth
From_ To 9R Ft.
From 7( To //2- Ft.
From To Ft.
13. GROUT: Depth Majtcrial Method
From 0 To 20 Ft. 3/i{SRet/_ lI VC —
Fro m 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:
Wall Thickness
(hart eter Wright/Ft. I-gt Jt-
G if z/c
Topographic/Land setting
DRidge ❑Slope [Galley DFlat
(check appropriate box)
Lati de/longitudeggfwelllocation
3J—'25,1 z9A o82°3c,/ew
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH PRILLING LOG
From To Formation Description
O— Go Qi21-
(0 *0 5re S 'di),;
6 — CU5 OR62; r'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and co on road names.
rj5
AS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tr the 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
_ 19) 7/ 3-3221, within 30 days, GW-1 REV. 07/2001
GR
ASHEVILLE PEGIONAL DFFIGE 1

264252
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources •• Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /JR yita-'/cee.7 M 7 4 CERTIFICATION r
WELL CONTRACTOR COMPANY NAME C-a r9.4 n RiVf r \1J V (l \ Ptn rrl p C
PHONE M ri27) 1/ di �' 1-2OD
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT# / J 95
(if applicable (if applicable)
I_
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Fle r/,cr
Oren f ritce
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:30Y22 Jt C' /Y) I ha
Address /9' We b Pia re
(Strect or Route No.)
F1e�1cher, Ale, g732-
City or Town State . Zip Code
(%Z8)- 108 7—/o 0-a.
Area code- Phone number
4. DATE DRILLED S - r- o 2-
5. TOTAL DEPTH: S"7S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ir.-
7. STATIC WATER LEVEL Below Top of Casing: I D FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
valance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST 9. /2
10. WATER ZONES (depth): 2 f
11. DISINFECTION: Type H i/t Amount
Wall Thickness
Depth Diar1r eter or Weight/Ft. atenal
From / To 72 Ft. 2,~/, L VG
From '79 To /79 Ft._L 1 - 2/, ( Pc_
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2 a Ft. 5.nh4/ef'Mi .4 Os7
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 Sizc Material
From To Ft.
From To Ft.
12. CASING:
16.REMARKS:
County 4-e-/CGUn6Y1
Topographic/Land setting
BM-dge 0Slope DValley ❑Flat
(check appropriate box)
Latitude/longitudeqf well location
2S °/E 2' 2ht/OS2'33'2Ye2
(degrees/minutes/seconds)
Latitude/longitude source:S❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 — 8D
t7 — /s'y
/ 70
/Qo — 5d5-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and co .on road names.
00
rK
Q
I'''
a
1 I Q H .EBY *~E.R' Y'?'At THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CGNSTRUCTIOP) STANpAR)S
Submit the original to
he D
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e-s -oz
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
C94709946S1TRhbiif;NS.fh919) 73
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /3R y4Mr
WELL CONTRACTOR COMPANY NAME Cl rte n R\me r Vd'a 1\ S
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
264251
- Division of Water Quality - Groundwater Section gat/ Hi CERTIFICATION w 7 5 //�
1
PtArnp (n PHONE #r12Y)Cc -1200
ASSOCIATED WQ PERMIT,/ Ca
gel
(if applicable)
WELL USE (Check Applicable Box): Residential ®' Municipal/Public 0 Industrial 0 Agricultural 0
Mor.itoring 0 Recovery 0 Heat Putir Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
NtNeearest Town:,u14 CI`-F\J.Y/r"1Ot/I E. County 74-4/1 O-e-USQy-,
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:a.,17/OLD C d
Address 150 Al. nit nt:.eSt.
t (StreetorRotitlNlo�a�73?
S(rn v t
City or Town State . Zip Code
X�). ro9a-
Area code- Phone number
4. DATE DRILLED %'25 L
5. TOTAL DEPTH: 2 L 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO e"
7. STATIC WATER LEVEL Below Top of Casing: `' D 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 s
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST M/TL
10. WATER ZONES (depth): , F/ S
11. DISINFECTION: Type /f %»
12. CASING:
Depth Diameter
From / To 3 L Ft._L
From 3! To 57 Ft. L 1'
From To Ft.
13. GROUT: Depth Material Method
From /7 To 2 0 Ft.:54-/SR/zt7_ M,y A-/ oor&
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.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
2? L "74'C.
21. L PVC -
From
From To
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope a/alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrtes/minutes/sonda)
Latitude/longitude source:EGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo ation Description
0 — /0 /�F_ N C).rty
L0 a/5— �i iz
Sir - 37J S,t
50 2,C j-- 6R✓tstirr=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
j4
C leftg
JD HE.RtthY ' R'�moIt`( THAT TWS�WELL WAS CONSTRULIED M ACCORDANCE WITH 15A NCAC 2C, WELL
�nNSTRu(. I lury h IMDARDS/A(NO THAT A, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
„th-Thm-n•-I Idal to 'he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
i li,tA T, Hi No. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001
al li.ii �� E
GROUND,
ASHEViLLE

I. WELL USE (Check Applicable Box): Residential Q 'Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery, 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
P�al w ell 305�� To +a I d e 4l~- is
2. WELL LOCATIONI I^ �
Nearest Town: D 0.vlA
., County f Pn ct-er
e LLks VIP 1-ane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SiLSa-u- &nest l7• Ian tits
Address PO (NOc (DIPS 4�1i- 8at'IKs Vie'O 1.41c
(S t or Route No.
Fast PLee(-Sou-) A.JC- W7a(p
City or Town State . Zip Code
(CC2-00- (aqa-40Da
Area code- Phone number /� /O o2 4. DATE DRILLED
5. TOTAL DEPTH: 45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ Ne D
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Cuing)
.8. TOP OF CASING IS I FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): I 0 METHOD OF TEST n '
10. WATER ZONES (depth): '-}' 70
11. DISINFECTION: Type (4 TH Amount
12. CASING: Wall Thickness
Depth / Diaipeter or Weight/Ft. Material
From I To (a8 Ft. (o1i8 ai, b PING
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth , Material _ Method
To 420 Ft. sa.K-refe DIIS- 4 Pa(A-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.
CONSTRUCTION
T THIS WEL
S. AND.THA
264250
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CJ r 5 n-1 -Fit, CERTIFICATION NicRS 7 1
WELL CONTRACTOR COMPANY NAME GIrORrI gal/r \I•J* 11 S QUm P (n P�H2ONNEE'# fp2Q) G per g/`�12,/co
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS/ Re .0 v- (� ♦-1(5'
(if applicable) (if applicable)
Pwecirill 80 5 n p 4-ss'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L9f'1'at
(check appropriate box)
Latitude/longitude of well location
3S5 19' 4 N nsa°a3t Ro,�
(degrees/minutes/seconds)
.atitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n _ coo dir
(o o t-f-`6 3 ra_n e te-
J,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. IncX de the road
numbers and common road names.
O
z
4
4v
e74-tt OlePs. Lit
L)
CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
17/a�/x Z
GNATURE OF PERSON CONSTRUL t ING THE WELL DATE
ECU"
Ir6f1 Nlal to t a Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
- �
ASNEVILI i
ibraifo. (91 ) 733-3221, within 30 days. GW-1 REV. 07/2001

264249
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
J
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /31; t 14 s✓ f i * J CERTIFICATION w 'J,5 '//� /
WELL CONTRACTOR COMPANY NAME Clnoien RtJ4r\?4 tI S PU(s'1P CIl PPY) L HONE aCf?2et"i 00
STATE WELL CONSTRUCTION PERMIT,* ASSOCIATED WQ PERMIT('/ J0 Lc 0/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential LN' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: '{-k-r)d€XS.crn:t(i£ County Ae-ncl traiii
)error-p,n 1ittoco
(Stet Name, Numbcn, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EIIAa Riat xni4e.C=cr -'i CQIIPc(e
Address C011-Pc Dr•(Street J
CI a-- FAO c.K) RNe�- No.)
City or Town State . Zip Code
(S )- (094 - 1%34,
Area code- Phone number
4. DATE DRILLED '7 - Z 7. - O 2.
5 TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO S
7. STATIC WATER LEVEL Below Top of Casing: D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): )) METHOD OF TEST
10. WATER ZONES (depth): /'`'/
8731
11 DISINFECTION: Type If T /1
12. CASING:
Depth
From / To ,`) 67
From To
From To
13. GROUT: Depth
From 0 To ] 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
Diameter
Ft. c 4 z. e Pvr;
Ft.
Ft.
Material Method
Ft. Srtki7/c!r7 M:X Se1700,C
Ft. •
Amount
Wall Thickness
or Weight/Ft. Material
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
C+3Kidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latittde/longitude f well location
/'79-4 R�012a 2/'d7t✓
(degrees/minutes/seconds)
Latitude/longitude source.OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(% - d 2 /1 t-
5 2 - /z. RArorra
LOCATION 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:
D
4 ,Y
HAT THIS
ARDS.
LL WAS CONSTRUL 1 ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AT A COPY •F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the origin . I to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GRO(29t9Xli 361Tht'JNo. [phone], within 30 days. GW-I REV. 07/2001
ASHEVILLE REGI012A1_ OFFICE

264248
WELL CONSTRUCTION RECORD
North Carolina - Departanent of Environment and Natural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)__ W / S>~, t% CERTIFICATION w 2 (2/
WELL CONTRACTOR COMPANY NAME Gi aim/ r \N'P II S PLArn p PHONE # fy21) U cf - 1200
STATE WELL CONSTRUCTION PERMITX ASSOCIATED WQ PERMITS `/L° 7126h1J
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI�9N: Nearest Town: //Ezud : R60L.V: /le County �{rTK tC�N'iZ5 0�.-i
o p S Ci-ncCutri
(Street Name, Numbers, Cmhmunity, Subdivision, Lot No., Zip Code)
3. OWNER. iTH Strip?
Address kr R Pop L03
(Street or Route No.)
//eixi :404.7l5 f/' A/C 2 S' 79 2-
City or Town /S to . Zip Code
$Z9)- e86"_ YOS3
Area code- Phone number
4. DATE DRILLED 7 - /9 - O 2-
5 TOTAL DEPTH: 2.6)r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1 '
7. STATIC WATER LEVEL Below Top of Casing: /1 0 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 I5A NCAC 2C .0118.
9. YIELD (gpm): / 5 METHOD OF TEST 4r'r.
10. WATERZONES(depth): /5'5_
11. DISINFECTION: Type %� %t Amount
12. CASING:
Depth Diareter
From / To C2 Ft. e
From L Z To / Z Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
j'Yc-
13. GROUT: Depth Material
From it, To 2 0 Ft. St4RG11n
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
MARKS
L l ,
n
rii • "RE9Y CER
CONSTRUCT)
Ft.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Loot
(check appropriate box)
Latitude/longitude of well location
35-u 22 05'N 6Sfz2'49w
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
O ^ 1 i tJLf"
//} - 205 Rtin
i'r[�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
hilt pre,
Cie
O
Material
Material
GROLIN u' "
ASHE1/JLLE2y4C9g
T THIS WELL WAS CONSTRUL, 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, - y THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
• al to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
�'?8F o. (9 9) 733-3221, within 30 days. GW-1 REV_ 07/2001

264247
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) n CERTIFICATION a__ _
WELL CONTRACTOR COMPANY NAME GI r4,4 rI Rf / r \M, U PtA TI P (n PHONE
2tO 2Y) (t 4 3- /200
7
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS l D✓O
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential N3 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Tom: t i CJ 1 I e_ County 4-1e-ndirscrn
OQd C liar t1e e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t), J,t Ej2jIza/hf,V
Address 4it /.t ))aca. (o a , Imo_ •
(StreeSt o , ute No.)
Id G
City or Town State . Zip Code
7' 38
Area codo- Phone number n
4. DATE DRILLED / -/7 - a z
5. TOTAL DEPTH: 4'96^ �
6. DOES WELL REPLACE EXISTING WELL? YES El NO 0
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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (epth): 3 5I,5"
DEPTH
From To
See nc
11. DISINFECTION: Type /7 771
12. CASING:
Depth Diameter
tE see_ From To Ft.
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
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.
Topographic/Land setting
❑Ridge ❑Slope EKalley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
35 a5 /4 oga a0 a-9cc.)
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LO(i
Formation Description
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
THAT THIS
CONSTRUCTIO' E3 .ARDS
V6endtiei� ¢ G F
ASHEVII_LE
drilled e cq W�e'�l d e_e_p eu-.
v ' loprlrhle an / / er 13%/
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001
Crlr1al reel ( was

264246
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resourcesce- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (TNDTVTDUAL) NAME (print) /2R/Ah/1 �Mr t "1 CERTIFICATION I' Z �//J
WELL CONTRACTOR COMPANY NAME Car -Pit n RiVtr \/.{p I{ \ Prop Cn �-7
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT* / g
(if applicable) (if applicable)
PHONE % Iy2TI G of -12 DD
1. WELL USE (Check Applicable Box): Residential in--Iviunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
NearesLTown: //fr
y/ l/FCounty f iEr✓d&rRsof.,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. / OWNER: RI- Zt AD tie
Address 7f .311
(Saect 9r Route No.)
HgMd/�, traiiii NC- 2 fin
City or Town StstF . Zip Code
(e2g)- G86-324r/
Area code- Phone number
4. DATE DRILLED 7 - / g " 0 Z.
5. TOTAL DEPTH: / G J
6. DOES WELL REPLACE EXISTING WELL? YES EI NO 0
7. STATIC WATER LEVEL Below Top of Casing: 'f0 FT.
/ (Use "+" if Above Top of Caning)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of wine terminated at/or below land surface requires a
variance In accordance with ISA NCAC 1C ,OIIS.
9. YIELD (gpm): /SJ METHOD OF TEST
10. WATER ZONES (depth): /L c2
11. DISINFECTION: Type //1 TY/
m / To /i O Ft, z
From G. O To /2 0 Ft. 4
Fro /_
From To Ft.
12. CASING:
Depth Diameter
Amount
Wall Thickness
or Weight/Ft.
2/.Z
Topographicand setting
Ee ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3>""°-i5/ /hi/ OR22./9' yyt�
(degrees/minutes/seconds)
Latitude/longitude source:QC PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo tion Description
L- — //t9 f'
//O — /L 7 /?Awi/'e
/L
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
l%� o
- numbers and common road names.
//
13. GROUT: Depth Material Method
From 0 To 2 a Ft. Sifki frt.r M `,tPane,
From To FL
14. SCREEN' Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
6. 'tiEMAR
I DO HEREElY C
CONSTRUCifID 1
LJ
TIFY THAT THIS WELL WAS CONSTRULI ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TANDARDS, AND THAJ)A COPY»F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GR ASHEVILLE
;EP'E cECk Qi11 riglnai to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
EEG � ,-1636 Hnune Na. [phone], within 30 days. GW-1 REV. 07/2001

264240
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J3Ryf wr s„,.9-4, CERTIFICATION 2571
WELLCONTRACTOR COMPANY NAME C-tr4.-en R1ver Ulv ll \ PtAmp Cn PHONE a �„Y &`!SOD
STATE WELL CONSTRUCTION PERMITS/ 6 7 /0 _ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential InunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N est Town: f /+✓dQOSowv-j Ur County l7FiXri=Rsn.t!
fie vat./ bei
(Scree ame, Numben, Comm iry, Subdivision, Lot No., Zip Code)
3. OWNER: Welts fi st7c5
Address Rr 2 h o r 2Fo 7
(Street or Route No.)
ibilsi(inisMseli0 WC-- ag/9 2.
City or jo85' /3eO .Zip Coda
05•2Area coda Phone number 2
4. DATE DRILLED G O —
5. TOTAL DEPTH: / `/,S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q"
7. STATIC WATER LEVEL Below Top of Casing: ZD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .eila.
9. YIELD (gpm): 2 0 METHOD OF TEST AIR_
10. WATER ZONES (depth): /20
11. DISINFECTION: Type // 7/47/ Amount
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Man
From 0 To j—/ FL 4 .2 %, e y
From ,i -/ To 2/ Ft. 2 / - �`
From To Ft.
13. GROUT: Depth Matcriai Method
From 0 To 7 Ft. S nkR.E/'Y Ai:fa Poo/2,
From To Ft.
Slot Size Material
in.
in.
14. SCREEN: Depth Diameter
Frorr To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
n6 L `SI It���� a
;DO HEREBY Chit LIP t' TFTf
NSTRUCTION STANDAR
s
Topographic/Land setting
❑Ridge ❑Slope O'ralley ❑Flat
(check appropriate box)
Latitude/longitude of well location
36-0.29 /074/ one 21 35i4;
(degrees/minutes/seconds)
Latitude/longitude source:DG`PS❑Topographic map
(check box)
DEM From To
0— 65
C5 /93
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.
%Yl:l�s
0
/ipRa
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE11
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-zo-02—
TI JRE
ATIJRE OF PERSON CONSTRUE 11NG THE WELL DATE
�p i° n(j,)CJ-to_,'111 Dtvfstdn of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
f/ 9 � aoY} o`(gf6j as aL1, within 30 days. GW-1 REV. 07/2001

From__
Frnm
ij I ' P ARKS
264236
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural RCSO CC - Division of Water Quality - Groundwater Section (7 /
m �y
WELL CONTRACTOR (INDIVIDUAL) NAME (pr1n0 ^ I'1--�� CERTIFICATION 025 (1
P PHONE et f4741�
• WELL CONTRACTOR COMPANY NAME C t" �' ASSOCIATED STATE WELL CONSTRUCTION PERMIT% WQ PERMIT%
if a licablc
if licablc
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
Topogra c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latb'md ngrtUdp of well Ion,
36- A g �8Z°z8 }G tJ
(de grees/minu us/seconds)
Latitude/longitude source:aGPS❑Topographic map
(check box)
L
Form,ation Description
2. WELL LOCATN: tyo
yy,earest Town: 5w r oWvr is Coun
(lit�'I VtetAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
n p
Zi Code
or C 87 9Y/3
Arca Phone number J/ z z
4. DATE DRILLED__=---
5, TOTAL DEPTH:��?
6, DOES WELL REPLACE EXISTING WELL? YES ❑N O
7, STATIC WATER LEVEL Below Top of Casing: 9
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of cuing terminated atior below land surface requires *
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): _si(2— METHOD OF TEST 4,A
10. WATER ZONES (depth): 3 ?4
1 1. DISINFECTION: Type /7' %1' Amount
12. CASING: WallThiclmess
Depth Di eter or Weight/Ft. Material
From / To 31 Ft. 6 z7 Pic
�_To Ft. it' A, rL
From
From To Ft.
13 GROUT: Depth
Material, Method
From O Tom Fin k M a _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 Siu Material
To Ft.
To Ft.
DEPTH,
From To
0 - 1745—
i OCATI� ON�CH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. ice;
15
A v
CJ
Ofr>;d, ra/ 1)2
D
W
1 DO C 2C, WELL
HEREBY CE: THAT THIS WELL A COPYOFTHIS RECORD HAIN S BEEN PROVIDED TO ANCE WITH I5A ATHE WELL OWNER
CONSTR CTION aARD�
o —/z —OZ
65VILLE RESI, SECTIIL SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ASHE1/IEEE RECICNP.L OFI-iC GW-1 Raeigh,NC 07/2001
Subrnit the �sigttnat tr the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,
27699-1636 Phone No. [phone], within 30 days.

264235
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
_ . tot- 841,1t-1-
CERTIFICATION a 257
n
WELL CONTRACTOR COMPANY NAME G,t-4.T Cl 1�'sVfr ANT l\ S to n'1P (0 PHONE k
ASSOCIATED WQ PERMIT»
STATE WELL CONSTRUCTION PERMITS `S if applicable)
(ifapplicable) -
I. WELL USE (Check Applicable Box): Residential EtMunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1)01--(A- -
7)AdlPg -br%_-
(Strcet Nam umben, Community, Subdivision, Lot No., Zip Code)
County I- r'd e-Mo
3. OWNER: PrPMnY) �CCI P-Araelley
Address Pe) PY)X gtee,
(Street ort Route No.)
D0.vtCt lei l- /
City or Town Sta . Zip Code
2-(oQ?'(3t-
Area code- Phone number
4. DATE DRILLED L J / '` 0 2-
5. TOTAL DEPTH: % c05
6. DOES WELL REPLACE EXISTING WELL? YESG vNO L97
7. STATIC WATER LEVEL ,Below Top of Casing:
(use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated at/or below land surface require
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): __�_ METHOD OF TEST 4i/Z
10. WATER ZONES (depth): /'(9
I I. DISINFECTION: Type NTH Amount
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
/ _ To 70 Ft. 221L
N
To_all_ "3 0 Ft. /.v'C--
To Ft.
Depth Material
Tom Ft. 6HAZh{v
13.
14
15
From
From 70
From
GROUT:
From 0
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
To
To
From
From
16.REMARKS.
D
ft3 ( 1 i
iH `�I DSO FIthREf(
c
Ft.
Ft.
FY THAT TH
AND ••S
Method
/Topographic/Land setting
ERidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latit�d7ongi ude of RI' ? W
?;s !7 �vN
(dogma/minutes/seconds)
Latitude/longitude source:CdGPSOTopographic map
(check box)
pEPTH pRILLING LOG
From To Formation Description
(2- /20
/20 - 3D5
Slot Size Material
in.
in.
Material
>2r
/Z,7wi�rl
I OCATION SKF UM
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
0 OF THIS RECORD HAS BEEN PROVIDED TO TELE WELL OWNER
► i T1 �..
_ SIG ATURE OF PERSON CONSTRUCTING THE WELL
o gine to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,
C
GROUNUWA ZONAL OIFFICE a N4. [phone], within 30 days.
ASHEVILLE REGIONAL OFFICE
DATE

WELL CONSTRUCTION RECORD 264231
Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
North aro i
CERTIFICATION N 5 '2J
WELL PHONE N
WELL CONTRACTOR COMPANY NAME G1 CO.t rl i:i�tt r \N'I 41 S rArnp (
STATE WELL CONSTRUCTION PERMIT$
ASSOCIATED WQ PERMIT$
if applicable)
if appl' linable
1. WELL USE (Check Applicable Box): Residential 6 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
ree - 00 y— :Yh
CONTRACTOR (INDIVIDUAL) NAME (prin0 fj„ .,
2. WELL LOCATION:
Nearest Town:
(Stint Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: "pt Tod/or
�'"� �
Address Po 8d c 96
(Street or Rq tpN Rid it
{tLr r/✓1J� �J /
County t-tu-t&derson
City orTown State 6g5 3St3a •Zip Code
ear')
Arta code- Phone number Iz ` N O Z
4. DATE DRILLED
5. TOTAL DEPTH: 3 $5 -/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2"
7. STATIC WATER LEVEL Below Top of Casing: fO FT.
(We "+" If Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land striate requires a
variance In accordance with I5A NCAC 2C .0118. Are 2
9. YIELD (gpm): r5" METHOD OF TEST
O. WATER ZONES (depth):
11. DISINFECTION: Type K%H Amount
12. CASING: WallThiclotes$
or Weight/Ft. Material
27, C Pvc-
2/ c f ✓e-
f9T41 (� 00
Topographic/Land setting
@edge ❑Slope ❑Valley ❑Flat .
(check appropriate box)
Latitudeflongr de of well location
3s°. I?'v4/V 06'2° 7(' Zi2J
(degrees/minutes/seconds) hre trap
Latitude/longitude source:IDGPS❑Topograp
(check box)
DEPTH
From 7o 70 — 3$S
Depth
From To L 2 Ft.
From C2 To_?. Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 O
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
Front -To Ft.
From To Ft.
Diameter
Material
Ft. Soket s=
Method
Al; f. c-FovR
Slot Size Material
in.
in.
Material
Formation Description
R Arof`-F�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n
L I4 R1MM.K --c^�- WITH
I DOHEREBYCE TIFY THAT THIS WELL APCOPOYNOFTTHI RECORD HAS BE IN ACCORDANCE
PROVIDED TO/THE WELL OWNER
CONSTRUCTION TA`ID3ARDS, AND L (, -L 5-' "0 Z--
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
CRDLr tDV» TE E �i9pal to he Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenterl REV.RRaleigh,
N 07/2001
ASV CVILLESR_ SiP� fiii
2769r-1o36 rh,,.,.iVe. (9,9) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina . Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section -Y�1 S4 / 1- LI CERTIFICATION a2_ /
WELL CONTRACTOR (INDIVIDUAL) NAME, (print) /� �fj� /ZYA'»t N791 is �f�'IZOO
WELL CONTRACTOR COMPANY NAME Y-Imen R'�Vtr \M* 1{ k PL.rr1p (n PHONE N
STATE WELL CONSTRUCTION PERMITN 07a 7 ASSOCIATED lWQPeERM1TN
(if applicable) - ( applicable)
I. WELL USE (Check Applicable Box): Residential ErMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: CUSG9 Olik,
it L s /Q0U
County i-I- ho Q-VSUn
(Street Name, Numbers, Community, Subdivision, for No., Zip Code)
3. OWNER: O) U l I tl d� CU.I qO����l
Address Rt'aA? IdoywaN-7
(Sweet or Route No.)
On° I t (tit Ai)C.+ a glq(;.
City or Town State . Zip Code
&kb- (g5 -31-H
Area code- Phone number
4. DATE DRILLED L— Z I O 2
5. TOTAL DEPTH: h Z. &
6. DOES WELL REPLACE EXISTING WELL? YES EIZNO ❑
7. STATIC WATER LEVEL Below Top of Casing: CO 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 ■
•ndance In accordance with ISA NCAC 2C .0I11.
9. YIELD (gpm): g METHOD OF TEST 4//2.
10. WATER ZONES (depth): 4 QO
11. DISINFECTION: Type YIN
12. CASING:
Depth
From 0 Toy8
From To G 9
From
13. GROUT:
From 0
Ft
Ft
To Ft.
Depth
To)0
Diameter
Amount
Wall Thiclaes3
or Weight/Ft. Material
2 /7, G ,OdU
21. L PdL
Material Method
Ft. A.ERFf-� %'fA. ersel`oof?
264230
Topographic/Land setting
❑Ridge ❑Slope lley ❑Flat
(check appropriate box)
Latitude/longitude of well locatiop
35°z5-/294/ Of2e20 !!02
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILL ING LOG
From To Formation Description
0 - GO /? t
Gg - 627 nnw/f�
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
From
From
16. REMARKS:
To Ft.
Slot Size Material
in.
in,
Material
j330`HER�EBYICE TIF2TTHIS WFI I WAS CONS
CONSTRUCFIOW S. AND THAT A COPY
fit"
S ATI
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road t ernes.
fG r}t6i25 /?d
tcUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RFyVORD HAS BEEN PROVIDED TO THE WELL OWNER
L �5 —0
OF PERSON CO STROLLING THE WELL DATE
11 o the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' RRaelgh, C
o. [phone], within 30 days.

26549G
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naa 11 Resources - Division of Water Quality - Groundwater Section /7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ____ s-iin
iii `i/7-11 CERTIFICATION a 2 7 U
WELL CONTRACTOR COMPANY NAME C"7t-p,P nRig-erUI41IS PLAIT') p(n PHONE N(p2Yl(as ef.c (2 Op
STATE WELL CONSTRUCTION PERMITN _ ASSOCIATED WQ PERMIT/4 _ 3I0
674
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I
Nearest Town: Da-' County 1-4endeYSon'
Old ! aa-t&cc, Ad - Easi YSU IP 1.Z t a--R_.
(Street Name, Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: Crnes1 U. 1'SancS
Address � P,�anl stied) i-ane
(Street or Route No.)
i-le-rIcJ exsoni j u f e- N C/ Q s'19a
City or Town State I , Zip Code
(S.2S- `Nao-
Area code- Phone number
4. DATE DRILLED .% ' 2 I O L
5. TOTAL DEPTH: 3 0 C
6. DOES WELL REPLACE EXISTING WELL? YES 2 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: (D0 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 require• •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST //Z
10. WATER ZONES (depth):
11. DISINFECTION: Type /1 771
12. CASING:
Depth Diameter
From / To L �1 FL to r/g
From To Ft.
From To Ft.
13, GROUT: Depth Material Method
tt. 5 1i/<!2471,` /I(:j' cL/?prq?
Amount
Wall Thickness
or Weight/Ft. Ma✓ial
G
�27i /
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. REpyMAR�KS:
gs-1Wu iloi(Y-'S
Topographic/Land setting
DRidge ❑Slope ❑Valley flat
(check appropriate boz)
Latitude/longitude of well Location
3f O jY' yb'44 Of7. 23' �✓ '
(degrees/minute)nds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
N c
Q 0
n On
c
g =r_1
la V
_ DC
LOCATION SKETCH 3 c
r-i
Show direction and distance in miles from a4}2ast Kw,
two State Roads or County Roads. Include to roa
numbers and common road names.
0
el Drw'
T THIS WELL WAS CONSTRUL 1 ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
sS, n THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the origina to th
�.__21bg9-1.(x3��t3a,i . (919
°Ho` OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

2R4278
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /.3/�t/rf /G%/{genii lI CERTIFICATIO 5 2/
r WELL CONTRACTOR COMPANY NAME C'j4en �tVf/r NV 1\ S PUrYlp Co PHONE a (}'2.7) - 120/;
STATE WELL CONSTRUCTION PERMIT(' (o "I gASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential VMunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town: @)A'i M L G- County 174e-/'10\F_6"Sr n
m (.b(r .w
(Street Name, Numbers, Community, Subdivision, at No., Zip Code)
3. OWNER. kk Sc cx e‘t-
Address 4CiS 151 b:on
(Sweet or Route No.)
/3C tr'IF)Ll Cal Ctf
iT'1' �tVe (R A,i7 s c.34vc (degrees:minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
q
City or Town State Zip Code
(.51 3)- 7`71 - Sae?/
Area code- Phone number
4 DATE DRILLED 6 -C-)e-
5. TOTAL DEPTH: (05—"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7 STATIC WATER LEVEL Below Top of Casing: :O8•2 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 I5A NCAC 2C .0118.
9 YIELD (gpm): / METHOD OF TIEST f4;/ L
10. WATER ZONES (depth): 2. 5
II. DISINFECTION: Type HTH
Amount
12. CASING: Wall Thickness
Ott r, ght/Ft. Mat pn_al
6C,
From '74 To d Ft. 4 b' 2/. Z l i/C-
Depth Diameter
From / To 7Z, Ft. 72 , %
From To Ft.
13 GROUT.
From C'
From To
14. SCREEN: Depth
From,, To
From To
i5
Depth Material Method
To 2 Ft.
Ft.
Diameter
Ft in.
Ft in.
SAND/GRAVEL PACK.
Depth Size Material
Slot Size Material
in.
in.
From To Ft
From To Ft.
i6. REMARKS.
F
II5
L J DO3HEREBY CERTIFY
CONSTRUCTION STAN
���11�ttrit-ti7>'he Di
ASFt`atit TrY % RJii) 733
Topographic/Land setting
E3Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
°a0' 31A/ oEra /71I tJ
DEPTH
From To
r - `I Cr
` Z; _ ` (if
4-, 4,
i/Crf tr f -
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road natnes.
cia
LL WAS CONSTRULIED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THA.A C Y 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

WELL CONSTRUCTION RECORD
264277
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME Cit-pp tl , kt-9 r \M t\ S ✓U rr p ([�
CERTIFICATION w-71-7 /[
PHONE $ 1127) G 1 - 1200
STATE WELL CONSTRUCTION PERMITS? i0 / W 3 ASSOCIATED WQ PERMIT$
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ITT Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: rA,YI, 6a/r)4//F Countyl /r ,-7Z50/r'
MOO nShinc
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:l1/�-RLTh JC2I2 5
Address PC-,,, ,t2Y 761-452
(Street or owe No )
&??3
City or Town, State . Zip Code
e2 )- i3-3,_>
Area code- Phone number
4. DATE DRILLED ,i -
5. TOTAL DEPTH: /l- 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O LY'
7. STATIC WATER LEVEL Below Top of Casing: GCJ 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST A -/Z
10. WATER ZONES (depth): /
Topogra c/Land setting
❑Ridge • lope ❑Valley ❑Flat
(check appropriate box)
Latitudeljpngiitude of well lgcation
35 %S 5%N O5/, (6)
(degrcea/minutesj/ econds)
Latitude/longitude source: V. GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
t p/,/P 7/p rr. (."-i=
DEPTH
From To
cei) - /
LOCATION SKETCH
I 1 DISINFECTION: Type /f r// Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness tv(o State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. at vial nu e common road names.
From To rf ' Ft. Z. if?.% % it 3 cs
From 1/ To > O Ft. L Y 7/, / %7C—
From To Ft.
13. GROUT: Depth Material Method
From C' To 2 e' Ft. 5R,2(47//8-:' Mel /O/»2
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ftin. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS.
Material
�1 tKj HEREBY CERTIFY
( A N*
II-LAP-hayS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCACt2C, WELL
C - S 'RUCf 57A4R , `AYD T} T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
QUA
A 2-
OF PERSON CONSTRUL I ING THE WELL DATE
ubmit the original to thelDivisian of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001
FSHEV''ILE RE
EC710PI
tit t'FFFCE

264226
WELL CONSTRUCTION RECORD
North Carolina - Department of Environmentand Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �J yRW/ 5777/ /ik CERTIFICATION w 2. 6171
WELL CONTRACTOR COMPANY NAME Ciirttn Rim/r \NQ t15 PU. rn p Co
PHONE # fy2? L e(3-12oD
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
WELL USE (Check Applicable Box): Residential Er—Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: �I
Nearest Town: F-//d 25041. IIIt County Itc4FI2500Zi
of L 1 iC L-oY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: lj,; k HFriltt ly
Address 2.03 /?E5jq& 6t
Street or Rote No.)
City or Town State . Zip Code
(ff - Gi,i — /925
Area code- Phone number
4. DATE DRILLED 5-- /7
5
. TOTAL DEPTH: 4 D (5-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO E
7. STATIC WATER LEVEL Below Top of Casing: Ye) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated *Nor below land surface requires a
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): 2 METHOD OF TEST I47(Z
10. WATER ZONES (depth): .3 ..?5- - / 5 pa
0 3 5b - 2 S p,,, LOCATION SKETCH
1 1 . i1 T/-t Amount 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 comryprjoO names.
Topographic/Eand setting
DRidge f7Slope ❑Valley ❑Flat
(check appropriate box)
La Itude/longitude of well location
° 15 3cN, pg,?°�a1 ,3 ILO
(degrees/minutes/ nds)
Latitude/longitude source:5GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O — 45—
DISINFECTION: Type
CASING:
Depth Diameter
From 1 To 24 Ft.-6 -/
From 3 b To 2 G Ft Z -W
From To Ft.
13. GROUT: Depth Material Method
From D To 2 (-2Ft.Ft. 6//AR�,'x if-Poo/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.
16 REMARKS:
`AO HER B"`-CEkNFY 7HAT
CONSTRUCTION STAJD ARDS
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-17-Cz
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GRothiffitnyitisi,esttrimitl
o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ASHEViii�9�t1 14(Lo tE(919) 733-3221, within 30 days. GW-1 REV. 07/2001

264227
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na al Resources -- Division of Water Quality - Groundwater Section �j )
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r� Kit
` aPith CERTIFICATIONW S ./
WELL CONTRACTOR COMPANY NAME C-1r4,t n 1SiVf r \IIQ 11 S Purr\2 cm PHONE % (127) Lel 1c- 1200
STATE WELL CONSTRUCTION PERMITN 6 9,23 ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential H Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT ON:// (f
Nearest Town //�U87 •$Phu/vi�//% County///.5,4214.OK/
0 {' S, UI`ot0. Digit
(Street Name, Numben, Community, Subdivision, Lot No., Zip Cade)
3. OWNER: ..50 54V'�S'l
Address 13 $7 /7RJe/= -511.
(Street or Route No.) 0 D&
City or Town State . Zip Code
rl )-9 — S
Area code- Phone number
4. DATE DRILLED .5 ^ Z t7 ` d 7
5. TOTAL DEPTH: 3 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-
7. STATIC WATER LEVEL Below Top of Casing: / 2 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface
•Top of casing terminated at/or below lend surface requires a
' variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /: METHOD OF TEST 4%rZ
I . WATER ZONES (depth): / L .S
11 DISINFECTION: Type 7 /71
12. CASING:
Amount
Wall Thickness
Dep 3 Diameter or Weight/Ft. Material
From /� To FL
From To Ft.
From To
13. GROUT: Depth Material
From 0 To 2 0 Ft. .5%fk/zChi
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Ft.
Diameter
16. REMARKS:
omit the original to t ae Di
GfAlnialF1109ELk4C ` I) 73
ASHEV LLE REGICPIAL OFFICE
Size
in
in.
Slot Size Material
in.
in.
Material
Topographic/Land setting
Edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lat' de/longitude of we l location
3S /51i3%N 062�291SSW
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo tion Description
a - 6 /a
/' l,'/7fn.: F
/9-A/
2 /-305-
(7�r3N�lfG
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
S WELL WAS CONSTRUC I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUL IING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

252138
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ral Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) S Q "1
WELL CONTRACTOR COMPANY NAMEC-Ir$R rI Riv4C VIQ II S PUrr p (n
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Groundwater Section _
CERTIFICATION #_
PHONE N 0/27) (/ 4 g - 120o
to 738' ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential IE(MunicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: iii-de/Zti'UUi //e County No/r.dcR567ci
Eaksiomic
(Street Name, Num en, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (0/Z;
Address Z2-5 Sy7,s
(Street or Route N
l7/g, GA. t5On1U:l/F ,tt-
City or Town State
622)- (97—/R85
Area code- Phone number
4. DATE DRILLED 2/
5. TOTAL DEPTH: /2 5
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
Allot/
Ayy Rd,
n. 2 S 792.
.Zip Code
7. STATIC WATER LEVEL Below Top of Casing: 2,0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated atlor below land sorfaee requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / C METHOD OF TEST A, 'ti
10. WATER ZONES (depth): /00
11. DISINFECTION: Type H %/7`
12. CASING:
Depth
From_ To %9 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_7___ To 20 Ft. Se9kRaiL
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
cter
Topographic/Land setting
❑Ridge 0Slope 0Valley L7Flat
(check appropriate hoz)
L itude/longitude of well locttion
35 AV i,3t0 dgt2 47 08W
(degrees/minutes/ nds)
Latitude/longitude source:CfGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 4L , MO—
z / 2.5 Ggmui */
"
Cm
o<
0
Do
rim
.. rn
LOCATION SKETCH
Amount Show direction and distance in miles from at Ieasc
Wall Thickness two State Roads or County Roads. Include th road
or Weight/Ft. atenal numbers and common road names.
2Z.0 do
Method
i K PO,,R
From To Ft.
From To Ft.
16. REMARKS:
Riau
G
711 HEREitY 4&�R.l�tt•Y .
,i;CdbiST*PCYIOrfq STAND '
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Li -1 Z -0 Z
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
—2749¢4616-Phenc#e:[phone], within 30 days. GW-1 REV. 07/2001
GROLPO!^Jr1ER ;ECHO"
�t C'.:I'_i l ' 0k AL OFFIC'

252136
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division Water Quality - Grwndwater Section _ J S� )
-f CERTIFICATION is
WELL CONTRACTOR (INDIVIDUAL) NAME (print) $/Z 1�AL(% ` n PHONE N �7 �-12OD
WELL CONTRACTOR COMPANY NAME Gt-O�rl om'° /\qqA1 Ali S P�.r cn —
ID Ip -1 5 ASSOCIATED WQ PERMITS/
STATE WELL CONSTRUCTION PERMITS/ _ — if a licable
ifa licable /
1. WELL USE (Check Applicable Box): Residential (-� MunicipalRublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATWN: ��r��d c-K50ir�
Nearest Town: /}/`/t; r2 fC'r Of /'L County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 2
tie,
City orTo y/ _State ,Zip Code
Area code- Phone number 4. DATE DRILLED 11 -/ 5 _ 0 7
5. TOTAL DEPTH: ! 7 5
6. DOES WELL REPLACE EXISTING WELL? YES El NO a
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST /4/ /Z
10. WATER ZONES (depth): / 20
11. DISINFECTION: Type /{ TN
12. CASING:
Depth Diameter
From To Ft. C x
From l S To 3 e Ft. 4 _
From To Ft.
13. GROUT: Depth
From To 7 /9
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
15. SAND/GRAVEL PACK Material
Depth
Amount
Wall /Thhickness
e2terial
a
' 1 Ft. P✓C-
alPVC-
From To
From To
16. REMARKS:
Material Method
Ft.5,*k/z�"/c- PVG
Size
Ft.
Ft.
Topographic/LanP setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
L titudeon tulle of well locati9n
35 /z l h �S�o z/ °ea-
(degtees/minutes/sewnds)
Latitude/longitude source:BGPS❑Topographic map
(check box)
DRItaC LOG
Formation Description
2 1W/FG
DEPTH
From To
O —
20 - I
fV o
c>rn
t `o=
V �CD
NCD
LOCATION SKETCH c4 nz
Show direction and distance in miles from M lea,t�
two State Roads or County Roads. Include roo
numbers and common road names. z
• Y--1j-1AT IS WELL WAS CONSTRU(.1bD IN ACCORDANCE WITH 15ANCAC 2C, WELL
UGtT1014-STAND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the origins to th
27699-1636 Phone N (919)
GHuUf: n(GICE
ASHEVIL...
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' g leigh, C01
733-3221, within 30 days.

252135-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionivof Water Quality - Groundwater Section _ 7sn�
" �-- CERTIFICATION N _ - �7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /=�i Zsy /9'K// PHONE M fP2� (/ 4��12'�O
WELL CONTRACTOR COMPANY NAME CIrf.tn flsVtr \Mv I\ S PtAm2 (n
/r ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMITp /a {' (if applicable)
(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 LOCATION:
Nearest cwn:r rCypP'� Ln)d County /7)i ✓4;7-R5oh
(Street Name, 0 Numee
b,, Community, Subdivision, Lot No., Zip Code)
3.OWNER: lucy
Address )Xt 2 PDX 361
(Street or Route No.)
/7lrrvrir`l�Se)A,L, flv
City or Town State
Zip Code
(82 q)- l/a'S ^ 01..0 z
Area coda Phone number,
4. DATE DRILLED 4/ Z 3 - 0 Z
5. TOTAL DEPTH: 2 CY.)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: G ( FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires*
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / �7 METHOD OF TEST 4- i /Z
10. WATER ZONES (depth): /6 4
11. DISINFECTION: Type // r/f
12. CASING:
Depth _
From / To 5 5 Ft
From 5' To 7) Ft
From To Ft.
13. GROUT: Depth Material Methodop
From G.)To 20 Ft. Sa�'Rlh; /14,k If/,x,i2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frort>_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Diameter
Gy 7/.Pr/c--
TopographicfLand setting
❑Ridge BSrlope ❑Valley ❑Flat
(check approprit:e box)
Latjtude/longitude of well location
3> 2, 1264 03'd°AO' yfw'
(degrees/minuregseconds)
Latitude/longitude source:QGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
f/7 7—
'.7 - 205` tta., fi5
PEPTH
From To
L 76'
0
—,
u o
3
-e
1
rT
uz
JOCATION SKETCH
Amount Show direction and distance in miles from3S1least?g
Wall Thickness two State Roads or County Roads. Include the road
or
Weight/Ft ed al numbers and common rpad,rlames. e
1IER±BjCERTI;
CONSTRUCIIUN J I A
GRi)i
.4SHE`: Ott/
D
���'l zllto the
ich dned QFlii,pk(919)
SIGNGNSIGNATUREO OF PERSONCONSTRUCTING CONSTRUCTING 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
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
AND THAT A GQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
12L -z 1-t-az

,Zip Code
(9..2,f_ G94/ - //4`/
Area code- Phone number
4. DATE DRILLED A' O z-
5. TOTAL DEPTH: g
6. DOES WELL REPLACE EXISTING WELL? YES D NO E�
7. STATIC WATER LEVEL Below Top of Casing: i(O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .ot I&
9. YIELD (gpm): t METHOD OF TEST 4,./�
10. WATER ZONES (depth): / 3 b - /spin
3q_ /S/pm
11. DISINFECTION: Type //IP/ Amount
12. CASING: Wall Thickness
Depth D}� ter or Weight/Ft. Material
From / To 4{O e%5' 27-Z Nd G-
From 2/ O To L 0 C 4 )./, L /'</`
From______ To
13. GROUT: Depth Material Method
From (2 To 2, O Ft. S/954,Efi� 4LX$-Poa/2,
From To F.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
2. WELL LOCATI /
Nearest Town: /'Nd5/25qp]u.Url//b County ///zevt.i,eSOiV
�ot))it r� lentf1i
(Street Name, Nun en, Community, Subdivision, Lot No., Zip Cade)
3. OWNER:A [r C AIfO,V 1� /�
Ad/dress/ �O /)wt,'Cruv li 7 ry
blf. 5/ZSOrcit.47/((Strec4-7 t or Rollie No.) ). Fi / 9.�
City or Town State 1.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources PtiOtvi$oonnJo% , ater Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (ping ✓l
WELL CONTRACTOR COMPANY NAME C, r'4P n RiuPr SM II \ Pt -Am p (n PHONE N
ASSOCIATED STATE WELL CONSTRUCTION PERMITN LOCO to WQ PERMITN
(if applicable)
(if applicable)
252134
- Groundwater Section
CERTIFICATION N_
-25?1
1zn`3rn( 4.32 20D
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
__Topographic/Land setting
B1 idge ❑Slope ❑Valley DFlat
(check appropriate Ito-)
tudefongrtu e of well location
'-� z n� L� �z t9
(degrees/minutes/seconds)
Latitude/longitude source:LRtiPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 JO
40 —353 -/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL TA C WC Y OFF THIS1ED IN ACCORDANCE WITH 15A NCAC 2C, WE
RECORD HAS BEEN PROVIDED TO THE WELL
CONSTRUCTION STANDARDS, AN�I'HA
Ft.
Ft.
Ft.
(� 0
0
C)
T
-73
zn
o<
>0
m
LOCATION SKETCH --
Show direction and distance in miles from at —4
ast z
two State Roads or County Roads. Include the road
numbers and common road n. es.
O
N
upmlt the original
H699-i636 Phone No.
L
WNER
SIGNATURE OF PERSON CONSTRUL LING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. -- GW-1 REV. 07/2001
GROUNDWATEP, Si LTrON
ASHEVILLE REGH» `EfIGE

252133
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources 'Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /� y/i1✓ � bin l ��
WELL CONTRACTOR COMPANY NAMECITiP,fTh ¶l*er\N411S PNMP Cn
CERTIFICATION N, ,_
--Z37I
PHONE Nf/2F1Gef -//DO
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I'MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearestTown:J/QC)/'iZ.Spti'.'✓r1fi, County/4-k..4l=/ZO'✓
(Stint Name,NuImbers, Community, Subdivision, Lot No., Zip Code)
//
3. OWNER: W y,✓r l /iC.)l=
Address k x
J (Street or Route No.)
/-/g/VC:L Ono&./lU,r/ /VG- 792-
City or Towp State 7 ,� / . Zip Code
Area code- Phone number
4. DATE DRILLED /f ' c7 "G Z-
5. TOTAL DEPTH: 2. C7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Itd
7. STATIC WATER LEVEL Below Top of Casing: / j ' FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .011E.
9. YIELD (gpm): ' 0 METHOD OF TEST
10. WATER ZONES (depth): /
11. DISINFECTION: Type // %/9
12. CASING:
Depth Diameter
From_ To 3 0 Ft. v
From 3 2 To // D Ft. G `v
From To Ft.
13. GROUT: Depth
From G0 To 2. ri
Amount
Wall Thickness
or eight/Ft. Material
zrc Pvc
Material
Ft. 5,44./;/724/5
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From_____,To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
21 P✓c -
Method�
At 2
Slot Size
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
-Topographic/L.and setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3.7 . O 3[ s' o8z 2 z S`/ 4)
(degrees/minutes/worlds)
onds)
Latitude/longitude source:QGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
s ,/z t
nn.5/37--
O
IV
- 205
? o�
=
O`
>0
-tom
rrtO
rrl
ri Nz
m�
LOCATION SKETCH v
Show direction and distance in miles from at least =
two State Roads or County Roads. Include the road
numbers and common road names.
0
51v
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND ' S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L,
Submit the original to the��isfiS
_ _27699-1636 Phone No. :(919).73.Y-
G
17L -30 ._0�
-NATURE OF PERSON CONSTRULIING THE WELL DATE
on of Water Quality;Groundwater Section, 1636 Mall Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
SECTION
`AL OFFICE

252132
j�I
Li 'il.. StdMitt1?xu1gh_)c
27699-1636 Phon o.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) E4 / mil/ Sin/T / CERTIFICATION M_ 7, 5I/
WELL CONTRACTOR COMPANY NAME GI rP.Q rl RtV4 r \ Y II \ PU rr) o Cr) PHONE IS in)) (, 43- 12 DO
STATE WELL CONSTRUCTION PERMIT# LI 76 8 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0.---Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sc ia<LIz-
1 2ci hip r L ou-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County {i"-ncier..Ylrl
3. OWNER: (i/IItPr YYlXra LISP 6YCwn
Address ?>(--io Al. Lik. e 6bcokmf t
(Street or Route No.)
L,rcCniCL, AiC,?B'790
City or Town State . Zip Code
6n)-4'4a-0l1u
Area code- Phone number
4. DATE DRILLED 3 -'i � 2-
5 TOTAL DEPTH: '7`
Topographic/Land setting
DRidge IrlSlope ❑Valley ❑Flat
(check appropaate box)
LatitudenonVude of well location
35 /- 3 3 c
(degrees/minutes�/ econdt)
Latitude/longitude source:OGPSOTopographic reap
(check box)
DEPTti DRILLING LOG
From To Formation Description
�- 85C' 1tt y
.5- iiC i- Cvtzi.it../h-
C
v
N O
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er-
7. STATIC WATER LEVEL Below Top of Casing: -2,6c, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .01Ig.
9. YIELD (gpm): 3 METHOD OF TEST NJ'S'
10. WATER ZONES (depth): //7
11. DISINFECTION: Type /i
12. CASING:
Depth Diameter
From / To '/''_? Ft. G L'
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To i.
Amount
Wall Thickness
or Weight/Ft.
� 7L
Material
Ft.14lv7i_'fi:
Ma�terial
NGJ%�
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 Ft.
From To Ft.
Ql }rt
-ra H �
3 as
w �
JOCATION SKETCH .~-
Show direction and distance in miles froTiat lesdst
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTR CTION STANDARDS, T A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

252131
r"
TR,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section h /
NAME (print) BR y hn ,Styli f A CERTIFICATION II �S /1
WELLCONTRACTOR(INDIWDUAL) n PHONE If N741 L rf S'12 ��
WELL CONTRACPOR COMPANY NAME Ctr-O.4n'RNV/r \Mtli \ Pc, mp Cn
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMITM(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential B' MunicipalPublic 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: .5A lc(dw
County { cPI sot(
(Street Name, Numben, Community, Subdivision, Lot No., hip Code)
3. OWNER: , /!;_.
Address I 1 1 r,lerP/7(e S-f1-€ef
(Street or Route No.)
{-)-ild ersoo& r ' I -e G .2_8 '14 e2
City or Town State . Zip Code
Area code- Phone numberyy
4. DATE DRILLED J 02..
5. TOTAL DEPTH: _-2,cr r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ea
7. STATIC WATER LEVEL Below Top of Casing: ar'- FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated atror below land surfaee requires a
variance In accordance with I5A NCAC 2C .0I18. r
9. YIELD (gpm): it: METHOD OF TEST ki12-,.
10. WATER ZONES (depth): / /t
11. DISINFECTION: Type /'/ /7
12. CASING:
Depth Diameter
From__ To L l- Ft. i
From G L- To / f C : Ft. /
From To Ft.
13. GROUT: Depth
Fron _ To 2 (. Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft. Material
27G /4 L
Material Method
15
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35° /5' a4t3 0 Sa /760
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DRILLING LOG
Foiptation Description
-1 Jf
PEPTH
From To
/! �
O
sic--zos
-v J�
c
in
3 nD
is o„t
-< c—n
^,'I
LOCATION SKETCH "o m
Show direction and distance in miles froat let�•-s
to State Roads or County Roads. Induct& the a`"a
number and common road names. .4"-
-91
,//;;Ir
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU(., LED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rNC S U IC�"7C1SOARDS THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v .�
Submit tEe origin
27699-1636 Phonel
t
o. (91
SIGNATURE OF PERSON CONSTRUL i 1NG THE WELL
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
GROUNDWA OR SECTION
ASHEVILLE ALL-;6HJAL OFFICE

252130
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - Division`of
Water Quality -Groundwater Section _�%
,.( ,J'', it G4,, /-'1 CERTIFICATION N 2_5_ / /
WELL CONTRACTOR (INDIVIDUAL) NAME (pr7nt)_� tt"
WELLCONTRACTOR COMPANY NAMEC'/l _rttn RN4r/\jla t\S Pv.mP Cn PHONE aD'2PI Ly -IZ°d
STATE WELL CONSTRUCTION PERMIT,/ IAS( ASSOCIATEDWQPERMIT#
(if applicable) (
WELL USE (Check Applicable Box): Residential 0----MunicipaUPublic 0 Industrial 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONII
Ne est Town: ct Jk?'f9 '_ County *if /C1/'l25/7v
{ t / /3 i Y 3% R .S0vlvd.4 C-.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /L'iitylI 4- 41,cc L--i i f1 inn
,390
Address t / hloe 5r91UCi,9 W,C-
(Street qr Route No.)
Ci- 7qty or Town9— y77Stateg . Zip Code
Area code- Phone number
4. DATE DRILLED .3—?f -(-'
5. TOTAL DEPTH: _.5 C' `I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E'Y
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 Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .L METHOD OF TEST Ai/Z
10. WATER ZONES (depth): / %D
11. DISINFECTION: Type /4 T I'
12. CASING:
Depth Diameter
From / To ( C/ Ft. G -4
From GC To /cC' Ft. G-y
From To Ft.
13. GROUT: Depth Material Method
From 0 To ), ei Ft. S 1k/i,: fE n1; Y xt`Pc?c'Qo
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.
Amount
Wall Thickness
or Weight/Ft. Val
Nl
2L6 PVC -
Agricultural 0
Topoggra�hic/Land setting
❑Ridge BSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/;ongimdde of well location
'3 /z </ziv 052 z/'2zw
(degrees/minutes�/ econds)
Latitude/longitude source:0GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- . “) 5,rkit
��,
SC - yc /3,2a&,,. 5,4Fll
/0 — SC} Giyery C-Rrixdte
From To Ft.
16. REMARKS:
t"1
0
n
b ni
-< cn
z_
o-<
LOCATION SKETCH >0
Show direction and distance in miles from atlast 20
two State Roads or County Roads. Include tltbroadNZ
common road names. r
t
numbers an
-'R
ti-
0
"
r '�u - Subialt the orig n
27699-1636 Phon� No.
Y THAT THIS WELL WAS CONSTRUCIED rN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUE 1 ING 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
GROUNDWATER SECTION
ASHEVILLE REGIONA' OFFICE

252129
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section egge,
CERTIFICATION Cali/WELL
WELL CONTRACTOR COMPANY NAMEC-1 rO.ttm RIVYc \M II S Pt.mp PHONE a £f271 G 43-t200
STATE WELL CONSTRUCTION PERMIT# (oz(SS ASSOCIATED applicable)
DlW bP RMIT#
(if applicable)
CONTRACTOR(INDIVIDUAL) NAME (print)
,wt- Sin/1-4
1. WELL USE (Check Applicable Box): Residential L'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: />`F,i jdR50/00 //r=
lied iwn ROL
(Street Name, Numbers, Community, Subdivision,�Lot No., Zip Code)
rr, �
3. OWNER: 3 �Iv/✓t ` y
Address T 2 I RO Y 2 93
(Street or Route.)
i71/5/a feR50e'Li/lh
County hTi'/vdit7/2Sr7//
1/17
City or Town S tE . Zip Code
(f25)- G�5 �/8i3'
Area code- Phone number
4. DATE DRILLED 3 - / 2 - O L
5. TOTAL DEPTH: L 0 5—
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: L 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance in accordant, with ISA NCAC 1C .0118.
9. YIELD (gpm): h METHOD OF TEST ,4/R
10. WATER ZONES (depth): A 7 0
11. DISINFECTION: Type N 77/ Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To %.Z Ft C y 2 7‘ _
From '72 To //:L Ft. Z 1i+ 2 /- t Pv (--
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2D Ft. sakRr-l`r 4/I;X dPa.'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
To Ft.
To Ft.
From
From
16. REMARKS:
Topographic/Land setting
ettidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 ° 2,,8' 9/4 0SZ /8 5VEX'
(degrees/minutes/seconds)
Latitude/longitude source:HOPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O — /05
05 G05— I{HWifE
c
N
3C
-C
n
a,a
O .i
IJI *Hi
-D nib
LOCATION SKETCH
Show direction and distance in miles frbred at Ieeas`t
two State Roads or County Roads. Incl Je theeaoad
numbers and common road names.
Hwy 79
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
0;CONS'(RUj 0 i aARDS,6RJD THA, A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sutbmtt"the orikhral o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Pho oe No. 919) 733-3221, within 3 -days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

252127
WELL CONSTRUCTION RECORD
North Carolina - Departrnent of Environment and Natural/Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _73Ryn'ry/s-_ Sms f'Z CERTIFICATION # 2571
WELL CONTRACTOR COMPANY NAME G]VttC\ tL'utr MY (l \ Pt.rnp Cr, PHONE p fl'�� (d?'I2 OD
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
( 798
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT[I N: ////
Nearest Town: / itt/k/SDdi✓/ II/= County 1/F.VC!/'iZS44✓
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
t n
3. OWNER: AU/ S C oI "MO r'i2�S. rote,
Address 2593 C4, 9�J=C /IUy
(Street or Route No.)
spnntA/✓L qy SC 2 93D7
City or Town State . Zip Code
-67.107
Area code- Phone number
4. DATE DRILLED 3- 2 6= C2 2
5. TOTAL DEPTH: /G5
6. DOES WELL REPLACE EXISTING WELL? YES O NO Et--
7 STATIC WATER LEVEL Below Top of Casing: !iO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
'Top of casing terminated stfor below land surface requires a
variance In accordance with I5A NCAC 2C .0118. ,r
9. YIELD (gpm): so METHOD OF TEST /T//Z
10. WATER ZONES (depth): /90
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From_/ To 7 X Ft. L H
From `i8 To /Di Ft. C ti
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. 64hRa
/fr/i
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
2 7! PSG
2/.4 Pv4_
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15.SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft.
Topohic/I and setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 /2'2/ 052
L/29'4/W
(degreec/minu seconds)
Latitude/longitude source: GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — 90
�C - /OC 6* 4j Sow/_
/00 - /G 5 /Rr'`42Ih5:
c)
a
E—
�7 r'1
ON *o
_Tz
J•OCATION SKETCH .c— y
Show direction and distance in miles from dti%asto
two State Roads or County Roads. Include the roaf
numbers and common road names.
,,��//Methopdd
/Ni4 so- th*? At
Slot Size Material
in.
in.
From
From
16. REMARKS:
,zg/r/o ' /0;/2 R
. I DO, [L"liq TAIS WELL WAS LL
AND 1$ 4 A COPOYQF THIS RECORD HAS EN PROVIDED TO THE WEUCTED IN ACCORDANCE WITH I5A NCAC 2C, LL OWNER
SIGNATURE OF PERSON CONSTRUL TING THE WELL
DATE
he D rision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. '" GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

252126
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section YSa.
Ji)1,4- n CERTIFICATION a .:}'j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) in ( OO
WELL CONTRACTOR COMPANY NAME Gl r4.2r �tV4r \/.)N II \ ()LAMP CO
PHONE a
STATE WELL CONSTRUCTION PERMIT,/ 5P'7I ASSOCIATED WQ PERMIT#
(if applicable) —/ (if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Area code- Phone number 4. DATE DRILLED ; - 2 S' _ Cr 2-
5. TOTAL DEPTH: an,S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
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 cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST AI r
10. WATER ZONES (depth): 2CO
l 1. DISINFECTION: Type lfTl'f Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 5_ L' Ft L #- z'7, G PVC -
From To Ft.
From To Ft.
13. GROUT: Depth
From C To 2 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.
From To Ft.
2. WELL LOCATION: ) ji
Nearest Town: ihr,nnJJK 6S�'olJij/'bounty r,_ eRSC+(/
10 111ir 5 1-4 he --
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I,h0t3-OOC);it, ' - t, Ch05111. tet6.C(CP (degrees/minuvshewnd+)
Address L//5 /3e✓,2A/ Ave Latitude/ongitude source:❑GPS❑Topographic reap
yy (check box)
I(Svect or Route No.) DEPTH DRILLING LOG
H✓e city ors Voiln;!!,.- /✓L '�'S 79k
From To Formation Description
City or Town State . Zip Code C 90—
(SL4)_(,9/0 .?lneS" yC - `/5
't5-- `%0�
Material Method
Ft. S,t/CQCfr_ %1(%k2-%ooR,
Size Material
L___Submltthe orighi4t6 the
2.1i69-1636 Phone No,019) 7'
Topogra c/Land setting
❑Ridge f35lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location r co
.i5° /5' 29"' OXa° .1 36,
c
LOCATION SKETCH -2,
Show direction and distance in miles from atdeast o
two State Roads or County Roads. Include the road
numbers and cokrtlon road names.
HLUY 0`1L
T THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 - z, —C' Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service CeenterJ Raleigh,
leigh, NC
3-3221, within 30 days.

GROUR
ACRE \ILL
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) $ay¢A/t �yet,114-7 CERTIFICATION a 2.3 i/
WELL CONTRACTOR COMPANY NAME C,rttf1 Rivtr\MYIIS Ptnmp Cr PHONE # 1p27) C. 43-1200
STATE WELL CONSTRUCTION PERMIT# 7 / tee. ASSOCIATED WQ PERMIT#
ifa licable (if applicable)
264239
1. WELL USE (Check Applicable Box): Residential B' 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: N/t A/CI. W<yvxhl1County Relvd//25ort,rCia
(Street Name Nu n Community, Subdivision,
ty, 'sion, Lot No., Zip Code)
3. OWNER: '/-}rt/d8 � 3; ku bo f sk c
Address b 79..? ✓ CreR}oni H4'i.
(Street or Route No.)
an.31-0.v A/C.- 2 87as—
City or Town State . Zip Code
(829)- k 25 8/z2
Area code- Phone number
4. DATE DRILLED 2- ' 19 - 0
5. TOTAL DEPTH: 3 2 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fd'
7. STATIC WATER LEVEL Below Top of Casing: C 0 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 D METHOD OF TEST /t2
l0. WATER ZONES (depth): 304
11. DISINFECTION: Type #77/ Amount
12. CASING: Wall Thickness
Depth
From 0 To Sfj
From ,5`E To 9 57
From To
13. GROUT: Depth
From O To 2
Diameter
Ft. L
Ft.
Ft.
Material
Ft. £akncir
From To Ft.
or Weight/Ft. Material
i"—
z/,C vL
14. SCREEN: Depth Diameter
From To Ft. in
From
To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size
Method
A&Y 4-1,1wk
Material
in
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [Flit
(check appropriate box)
Lat' de/I ngitudeofwelllocation
35 28 9Y74/ 08.2'x0# d2Jw
(degreca/minures/ nds)
Latitude/longitude source:QGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From _ 90
D - 32S
Formation Description
?/Zr
RlJI/Y
LOCATION SKETCFj
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Hwi
iq.
0
CA) .72
11n0 F REiTY CgR
ARDS, AND
SIGNA
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ •_,' /9—oz
OF PERSON CONSTRUL 'NG THE WELL DATE
al to he Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC'
!��Ttf No. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001
1i.:,, - OFFICE

no r rm if needel, 6 ade. w I
252125
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalturResources - Division of Water Quality - Grouadwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /3/1 yen; / SY4,7/1 t) CERTIFICATIONN=2..57/
WELL CONTRACTOR COMPANY NAME C1 rue n Qius r W v I{ \ PU m p (n PHONE N fin &' g
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT/I
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ETV—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: iini4m2R 0rl)U,..;County WEmarra609
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ;„, Pewc'S RV Pink
Address %- 2 at)/ 2 9/1-
(bit „rite,
e.h tree,o t No.) 2 g9ti/
City o Town State . Zip Code
(8 - Oga-46mlF�
Area code-P one number
4. DATE DRILLED X - L ' O 2--
5. TOTAL DEPTH: 7e5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: 4e2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / r' FT. Above Land Surface"
*Top of cuing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST S/k
10. WATER ZONES (depth): /Z
11. DISINFECTION: Type hen/
12. CASING:
Depth Diameter
From To /05 Ft. L. y
From_ To Ft.
From To Ft.
GROUT:
From 0
Amount
Wall Thickness
or Wei t/Ft. Material
bhis l
13. Depth Material
To /4CR. /eafIAadel
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
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ElFlat
(check appropriate box)
Latitude/longitude of well location
3s°300>g N 8a 3%/ g
(degreea/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,Pint
GaAP Fi
DEPTH
From To
0 - /00
/Oo - 17L55-
O
PO
LOCATION SKETCH w
Show direction and distance in miles from at leist
two State Roads or County Roads. Include theutad
numbers and common road. ngmes,
16. REMARKS:
I
ctrok
i
bmlt the original to the
2^f699-1636 Phone No.
GROUNO`%-JATER SECTION
ASVICVILL[ BEGICNRL OFT
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- 0 2_
ERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
1, within 30 days. — GW-1 REV. 07/2001
c

252124
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
',vat CONTRACTOR (INDIVIDUAL) NAME (print) /3r2y /}Kit- S,I71.frt CERTIFICATIONN 25 V
WELL CONTRACTOR COMPANY NAME GIrO.P n rgaitr \NI'e l\ IIPtnmp (n PHONE N p'2Y) to ef S-120D
STATE WELL CONSTRUCTION PERMIT# 67 41 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fB' Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: linvd,7/ZSevo i J//'County (/= irRoc /
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ARShrail </3Ii1Jtpwl
Address .2, 1E0x 23z
(Street or Routeyyo.)
/-Ir - i;ic-sckJL,/Ir- 1V�
City or Town State . Zip Code
(s_L- 1 9 o e z
Area code- Phone number
4. DATE DRILLED 2 — S - OL
5. TOTAL DEPTH: 2 L S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: 2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l 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): 6-0 METHOD OF TEST /l, /Z
10. WATER ZONES (depth): 2, 7 0
11. DISINFECTION: Type /i T/t
12. CASING:
Depth
From % To / 5
From / 3 To /36
From To
13. GROUT: Depth
From C To 2 0
Amount
Wall Thickness
Diameter or Weight/Ft. Material
G
Ftif zr/,L /N✓
Ft. CItz L five.
Ft.
Material
Ft. fi/ikK/%-7
Topographic/Land setting
❑Ridge ❑Slope ❑ValleyEFT;
(check appropriate box)
Latitude/longitude of well location r
.5 al' JO ng�° al Ic? t4)
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
a— /.3D l '/Zi-
/.3 i - 2c) /7 firer
O
1i
-e
—c
r-.
a�
-sr)
rn o<
>o
= m�
LOCATION SKETCHCO 0
Show direction and distance in miles from 3I least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
/ty7td0Og
14. SCREEN: Depth Material
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
1456
From To Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Sdy4g/oAr Q4
16. REMARKS:
LjY lK
IdN S
Submit the original to
27699 1636 Rtuane_No. (9
GROUNDWATER SECIIDJ
ASHEVILLE REE"II _ _FHOE
HAT THIS WELL WAS CONSTRUL 1 ED IN ACCORDANCE WITH15A NCAC 2C, WELL
ARDS, yyn✓ THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2-�`OZ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-1 REV. 07/2001

252123
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater SectiongtOSO
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 32/6frat 6,1f/ r h CERTIFICATION #
WELLCONTRACTOR COMPANY NAME Cr4.fn R'tusr \/.{p l{ \ PUIr)p (n PHONE # (2.7) (, 9 -1200
STATE WELL CONSTRUCTION PERMIT# �73e9- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential le Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: f-irvJrFJS,m✓l //r County 110iildr.7Z$Ot/
Topographic/land setting
❑Ridge WSlope ❑Valley ❑Flat
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
350 /9' gi40 08a° aa'a.ou)
3. OWNER: N . 5fC/ /0 (degrees/minutes/seconds)
O
Address FT 1 9 day_ L 0 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
4 E N i) FYZS el) r/ 9 L)( Ll e Ai C ZY7 JJEPTH FRILLING LOG
City or Town State Zip Code From To Forrnatiopp Description
0 -- .3 D,, '21-
>'3 - y v S 0i?,3,pifez_
Area code- Phone number
4. DATE DRILLED 2 - /2- - c L
5. TOTAL DEPTH: /T 5r)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f3'
7. STATIC WATER LEVEL Below Top of Casing: G. 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C MIS.
9. YIELD (gpm): I METHOD OF TEST 4,./
10. WATER ZONES (depth):
11. DISINFECTION: Type ad'/:r/ Amount
12. CASING: Wall Thickness
Depth Di e e or Weight/F[. % !Amelia]1
From To 5 g Ft. a � ri/C—
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (J To 1. 0 Ft. 5/tk/t/=tr-
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 SKETCF(
Show direction and distance in miles fro
two State Roads or County Roads. Include
numbers and common road names. e
Method
M ;1 s: %�o ,Z
16. REMARKS:
D1.JE4BY cEitnl Y
CONSTRUCTION STANE
v� 414-ati Kct
TRUl.1 ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUL I1NG THE WELL
DATE
i ?Fdt thee-thelie Di sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
44-1636 Phone No,0t{) 733-
221, within 30 days. GW-I REV. 07/2001
>o

1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) AR y kit. Sm / f-L7 CERTIFICATION # 251/
WELLCONTRACTOR COMPANY NAME elr P Rir \/.11.11S7 PN(Y1O (In PHONE # 0,2n Le -I-200
(if applicable) IOl�Sy 7 (if applicable)
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT%
25211E
1. WELL USE (Check Applicable Box): Residential LN Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATIN:J j /�`/ I.II
Nearest Town: Cw7Llr.IZ6QUr/%l/ti County Wifflk7cRSOw
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,�.5 StciRm
Address 30L C CI,4du,iUi 5?.
(Street or Route No.)
//rkrir-RsoLt�lU� N�� 287a9
City or Town State . Zip Code
(Sfl)- b'S- 3 /SO
Area coda Phone number
4. DATE DRILLED 2 S- O Z
5. TOTAL DEPTH:_ G
6. DOES WELL REPLACE EXISTINii tLL7 YES 0 NO 137
7. STATIC WATER LEVEL Below Top of Casing: 110 FT.
(Use "+' if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3D METHOD OF TEST i4irL
10. WATER ZONES (depth): /2
11. DISINFECTION: Type // %/f
12. CASING:
Depth Diameter
From/ To '75 Ft. (-4
From To Ft.
From To Ft.
13. GROUT: Depth
Fromm_ To 2 0
Amount
Wall Thickness
or Weight/Ft. Material
/ilfl Sto-al
Material
Ft. 6-'AJ7/ hz
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 2Flat
(check appropriate box)
L.atitude/longitude of well location
3S az OS 92°U'6tw
(degrees/minutes/seconds)
Latitude/longitude source:BdPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o - /o elrt
/0 - OU
9D /63y
-t
an
c
o-ez
m y
LOCATION SKETCFt z
Show direction and distance in miles from at least
two State Roads o County Roads. Include the road
numbers and comm 'n road names.
Method
IH,'P 0-Pav/t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
II)O HEREB
�GR3PF Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I ARDSIk.ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ii
L_ Submitthe orl>flnal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
oFlGllP`2S2,709-i$yblf4Gine No. [phone], within 30 days. GW-1 REV. 07/2001
` r IPE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

w
Ir
1/40
WELL CONSTRUCTION RECORD 252111
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tuJ a y/9IV 1— 6 %4,7 t r N CERTIFICATION 0 257)
WELL CONTRACTOR COMPANY NAMEG1rttn Q;V4r Wt tl Ptnmp Cn PHONE a ef27) Lir rf4— I2O0
STATE WELL CONSTRUCTION PERMIT. (-9 (6 Z ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: I / I
Nearest Town:1f/Irt00/?/{SA/ dif lF_ County / .ve. C SOkl
(Street Name, Numbers, Community, SSunubdivision, Lot No., Zip Code)
3. OWNER: Pray y /0I dc.k wg/ I
Address AT. / eel k ac
(Street or Route No.)
Z/Rcd,tt / 1JG z.—A79D
City or Town State . Zip Code
Ares coda- Phone number
4. DATE DRILLED 2. - %, C - 0
5. TOTAL DEPTH:_a.00
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B"
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 easing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): /7. METHOD OF TEST /WZ
10. WATER ZONES (depth): / 45
11. DISINFECTION: Type
12. CASING:
%/ Amount
Depth Diameter
Fro rrt__ __To 5 e Ft. L y
From 6 i To /2 5l FL y!
From To Ft.
13. GROUT: Depth Material Method
From i% To 2 0 Ft. 5»karh= M;r iF—PDw�
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.
Wall Thickness
or Weight/Ft.
�7.L
21.L
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge Glpe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3ha /2 234/ 08'2° 27',jrfly
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From
To Formation Description
/0 - 9m
70 - /Zir
/20- ltr
\
—IL po
LOCATION SKETGif mw
Show direction and distance in mi)�es from�itat least
two State Roads or County Roads. ncluQ the road
numbers and common roa. • ames.
16. REMARKS:
1 DO HEREBY CERTIFY THAT
<;UNM.I'STAND
Art
_ iLY
!I� I
Submit Ilrert ginal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-16 6 Ph ne No. [phone], within 30 days. GW-1 REV. 07/2001-
THIS
S, AND
L WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
T A COP X OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
22 -a.-
GR^'G i'NLL'1';^1A1'LR S TTiON
AStiRr'-;
SIGNATURE OF PERSON CONSTRUL i iNG THE WELL DATE

252114
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Je'r't kni n
WELLCONTRACTOR COMPANY NAMEC'1 t'ftn Ri�ar Wo It S Pt^mp (n
STATE WEL UCTION PERMITS
4 'I /y ASSOCIATED WQ PERMITS*
L CONSTR if applicable
if applicable) — /
1. WELL USE (Check Applicable Box): Residential LG' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
CER1TFICATION &fa 0S2-
PHONE it
2. WELL LOCATION:
Nearest Town: er/10^ ,
County /44(ICK5C
(Street Name, Numbers, Community, Subdivision,
3. OWNER: 'farms Nvn i/U'/
Address 0 en Y 7 /
(Street or Route No.)
�cr/Or /✓.� )ri'735
Lot No., Zip Code)
City or Town 0 State .. Zip Code
(X)g)- (L2 0/
3
Area code- Phone number
4. DATE DRILLED / - /4 - DI
5. TOTAL DEPTH: -385"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Et'.
7. STATIC WATER LEVEL Below Top of Casing: ..di 0 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / Ff. Above Land Surfaces
-Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST f A/ IZ
10. WATER ZONES (depth): RS / Gimi' LOCATION SKETCH 9 mTo
3AC' ? (TPm,
Show direction and distance in miles froasCflat left
l 1. DISINFECTION: Type l� TI-� OLLnt
itwo State Roads or County Roads. Incluthe Bad
`Nall Thckness
or Weight/Ft. Material numbers and common road names.
Topographic/Land setting
❑Ridge Ds1 'pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
"")
(degrees/minutes/seconds)
Latitude/longitude source:D P ❑Topographic map
(check box)
nNlliINGLOG
Formation Description
..1 1 v, t-rt
pEPTH
From To
n' 6•
,q' 7es
c
O
t71
12. CASING: 70
Depth
From/Alcove To 7/'
From_a__ To Aci
Frorn_ To
13. GROUT: Depth
From ( To , C 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
Diameter
Ft.l147 del VC
Ft. E y 2/ Pv
Ft.
/Mayteriai yMetho&l,
/r7
/:Er Nn Or
From To Ft.
From To Ft.
16. REMARKS:
RE—Geh1/49wueriet4,
ASHEVIL_L EE F,[,, .�
Material
bE
7ti / Mil
-9
rfti
s7 <
D.=
yo
me
-/„ •
7t1dflovil
THAT THIS WELL WAS CONSTRUCI ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P ' ON CONSTRUCTING THE WELL DATE
ral to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ce`1nter1 RREVgh, C01
L No, (• 9) 733-3221, within 30 days.
T-•
wet

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `, e. 41
WELL CONTRACTOR COMPANY NAME Gir'p f 11 alms c
STATE WELL CONSTRUCTION PERMIT(' C^ 7...?!
(if applicable)
252113
Resources - Division of Water Quality - Groundwater Section
pWp h5 CERTIFICATIONH -3082
�/.�p,((S Pin fY1 (1 CO PHONE # fin t S'1200
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential L'T 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: i//f 2 VCr County �G:2�/C`rsYA-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mt Re._ / 7 //6-/'
Address // (ihr/t/ey Md.(Street or R ute No.)
7lvc/F.ci r' R7al
City or Town State . Zip Code
cp,r)- 'Z` - ,Q L/ /
Area code- Phone number
4. DATE DRILLED / _- / "7 ' 01-
5. TOTAL DEPTH: /.2 5'
6. DOES WELL REPLACE EXISTING WELL? YES,❑ NO III/
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 5- METHOD OF TEST A'
10. WATER ZONES (depth): -4/0 ' 5-61)4
//'O' /C 4fM >
11. DISINFECTION: Type fir/1 Amount
12. CASING: ri5-
Wall Thickness
Depth Di eta or Weight/Ft. Material
From�/Y�/ MIC To a4/ Ft. ,-7.6 PVC
From To Ft.
13
From To Ft.
GROUT:
From C
Depth
To i L
�Material
Ft. SG�ie/C-
Topographic/Land setting
❑Ridge ❑Slope ❑ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3S° �C 7A' oir) 36' va't
(degrees/minutdseconds)
Latitude/longitude source:❑GPS❑Topographic rnap
(check box)
DEPTH PRILLING LOG
From To , Formation Descriptjon
O' 7l7 S< e-obiks
aU'
Metho
XV 4 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.
16. REMARKS:
O
nt
xm
ON
cc
.gym
O<
• edi
Ao
'v m�
LOCATION SKETCH co —t
Show direction and distance in miles from aaeast
two State Roads or County Roads. Include the road
numbers and common road names.
(� 1 DQ I-gP FRY r'F • TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
c [ (101 �1RtT[{-t1y'T'ANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L� u u J /-/7'v�
JUL
Submit theirigln
27699-1636 hone'
GROUNDWATER SET
ASHEVILLE REGIONAL OFFICE
SIGNATURE OFIERSON CONSTRUCTING THE WELL DATE
1 to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
o. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2
r-� -
WELL CONTRACTOR(INDfVIDUAL)NAME (pilot) TC tit OU1P tiS CERTIFICATION � 303
WELL CONTRACTOR COMPANY NAME C-Ir4.4ry RiV-er VIV I\ \ Pt^t1'1p (n PHONE p faak4 —120d
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
6'7a5
252112
I. WELL USE (Check Applicable Box): Residential lunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: / /
Nearest Town: %-/q/ /512C/7 County /4/C)-04/fin-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 7CO
(Surat or Route No.)
Act( �L'z
City or Town State
c%2X)- �53 42S5
Area code- Phone number
4. DATE DRILLED / O-�/3-(71
5. TOTAL DEPTH: r 5-
6 DOES WELL REPLACE EXISTING WELL? YES 4NO ❑
r(J
/L'
,-98731
Zip Code
I)
Topographic/Land setting
❑Ridge ESlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location w
75° 77' [7/,^' Odd) cos
(degrees/minutes/seconds)
Latitude/longitude source:194S❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/a �X r
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
crop of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST A /
l0. WATER ZONES (depth): r9ys
11. DISINFECTION: Type //7/I Amount
12. CASING: c Wall Thickness
Depth Di eter or Wei t/Ft Material
From/AM✓CTo 5-7Ft. / '' a�• PVC_
From To Ft.
From To Ft.
13. GROUT: Depth ,Material
From 0 To 90 ,Ft. SaArc,{e_
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.
c
O i
(V o
43,
c7
"
a �m
LOCATION SKETCH 9 m;.t
Show direction and distance in miles iturn at5ast
two State Roads or County Roads. Inct�de t} oad
numbers and common road names.
e
Le
o c
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL AA3 CONSTRUCTED
Y O THISHRECORADC� BEEN PROVIDED TO THE WELL OWNER
ANCE WITH I NCAC 2C, WELL
ARDS, AND TIjA
/-/8-0/
Submit the o
27699-1636 Phpne N
c70Y2/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
to the Division of Water -Quality, Groundwater Section, 1636 Mall Service Ceenteri RRBVgh, NC
. [phone], within 30 days.
GR0LRDVVASEFT L
ASHEVILLE. R.. -FFLCE

WELL CONSTRUCTION RECORD
2521 n3
North Carolina - Department of Environment and Natural Resources - Division /of Water Quality - Groundwater Sectionio
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2izy t,t s/y(lfl7 CERTIFICATION *f$ &=a S 7/
WELL CONTRACTOR COMPANY NAME C,r-0Rh Rig* tit I{ S PLA11-12 Cr) PHONE # (12 �l Ldf3-IZO0
STATE WELL CONSTRUCTION PERMIT#_ tl/ta"rASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 13KMunicipal/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: 11/k-7 )/S County PLAIaIer/CSo.t�i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: (JAM Th f%O.V
Address PO 6e/Se / 8(
(Street or Route No.)
Naples tJc5 i7(co
City or Town State , Zip Code
(M)- l4Q s— alSaq
Area code- Phone number
4. DATE DRILLED 0/ - 2 8
5. TOTAL DEPTH: !O5
—O L
6. DOES WELL REPLACE EXISTING WELL? YES 12iNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST A; .e
10. WATER ZONES (depth): eo'
11. DISINFECTION: Type if TN
12. CASING:I.O'
Depth Diameter
From_ To yO Ft G tj
From To Ft.
From To Ft.
13. GROUT: Depth Matjerial
From 0 To 2 U Ft. S4e{/Z -f/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 an
Wall Thickness
or Weight/Ft. Material
27c Pyc
Method
fitly' Y boi
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 9f1at
(check appropriate box)
Latitude/longitude of well location a
35 LI an' t?i OSa o'Z9 4du;
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o as ;� t
Ito— /05 ?AV/ir=
0
tv
3C
ay
01
0
o r,
im
on
Yc
.3 :,;cD
LOCATION SKETCI-j w m�
Show direction and distance in miles from r1FTeasteii
two State Roads or County Roads. Include Siroa5T
numbers and common road names.
old A54.4✓///F NLA
1
16. REMARKS:
RIT DThHEJ B�' C' TIot 7'H, ri THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
t 01�4STl i 0 T AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—_ /C�¢" ab€ _I!) SIGNATURE 0 Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
rtg q.i049) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

1C01. 'IR(IctIbNIST
WELL CONSTRUCTION RECORD 252 / 0$
North Carolina - Department of Environment and Natural Resources R- Division of Water Quality - Groundwa�t r Section '
WELL CONTACTOR (INDIVIDUAL) NAME (print) y�WF 5/h r /41 CERTiE'TC 7 N # 6
WELL CONTRACTOR COMPANY NAME CIrQ/,e_ n 9,hiv f VJP II S ()LAMP Co PHONE # Inn G 9
STATE WELL CONSTRUCTION PERMIT# . V// 39 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 17 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: Math--; County gitrilk`.641
(Street Name, Numbers, Community, Subdivision,��l/Lot No., Zip Code)
3. OWNER: (lim6E�y IV1ckiwVi=y
Address PO MoY &3
(Street or Route No.)
Nplms N/G a 9-7 0
City or Town S . Zip Code
(a2C- (aq9-97a'
Area code- Phone number
4. DATE DRILLED 0/ - 2,5 - O 2-
5. TOTAL DEPTH: 3 05
6. DOES WELL REPLACE EXISTING WELL? YES lErNO 0
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST All Z
10. WATER ZONES (depth): / 2 7 -_
11. DISINFECTION: Type f/! f%
12. CASING: lid
Depth Diameter
From / To 110 Ft. G1y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q To 20 Ft. SfrAIEt, 4/1,yi-POv42
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
2 7, b p!/G
Topographic/Land setting
❑Ridge Otlope ❑Valley ❑Flat
(check appropriate box)
Latitrde/long;tude of well locating o
3S 3 13 u) C 89
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,e zt
DEPTH
From To
O - 35
- 3 05-
16. REMARKS.
iV o
2n
ern
r r
rn
pi.;o
LOCATION SKETCH
Show direction and distance in miles fro IeasC
two State Roads or County Roads. Include e roo
numbers and common road names.
e w0l
cal
HEREBKCERTI T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Cf-z -o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original o the n 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROUNO VRFI—r Lof`FIrr91
ASHEVILL E_ ._.--
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
J�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)-4f4ygw r�£m,'f'h CERTIFICATION
WELL CONTRACTOR COMPANY NAME C-tr'4.4n Bluer \M4 41 S YUrn(3 (O
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
-asq j
PHONE #
/ S 5 ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential d Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 40i/>ir5 County NFAxiu16evey
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code)
3. OWNER: RomiskrmP 6 47 i tit
Address Pa /3oy 5-83
(Street or Route No.)
t1lapGa 6 IIIG 2 %0
City or Town State . Zip Code
(qfl}- (or64'^4-(0(<(II
Area code- Phone number
4. DATE DRILLED / - 3/- 04--
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): G/ METHOD OF TEST / A
10. WATER ZONES (depth): /20 " l S fin
310 3Spm
11. DISINFECTION: Type JJ%h` Amount
12. CASING: I I L/ Wall Thickness
Depth Diameter or Weight/Ft. Material
From / • To /1 Ft i H 27 G PPG -
From /2 To //7 Ft. 44 1/ G PdL
From To Ft.
13. GROUT: Depth Material
From 0 To 2 0 Ft. 5,/A/7e6=
From To Ft.
14. SCREEN: Depth Diameter
Topohic/Land setting
❑Ridge L•SSlope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location 1
35° 023' 09 OQa° a9 37
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description c
o - / 45 �ii�t O
2/l.,v (chi-
no cp
/0
s' - 3%th
s
a
Ern
o<
.Ern
Htti
T` �O
e/1=
rn=
r ti
O 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.
Method
,�ii; y %/--Ga9/2
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:
MCI
Submit the ori: final
T THIS WELL WAS CONSTRUCTND IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S,
1-•.1.. I� '
o the
GRO:705Atfirg4 SbbikOab. (919)
ASHEVILLE REGIONAL OFFICE
— 3/-oz_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality; Groundwater Section, 1636 Mail Service Center - Raleigh, NC
'33-3221, within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town: U I
3.OWNER: �' Ullle. 4fr21-e-ff-
Address P' Bo 530
(Street or Route No.)
f 6 -RtL o cut ►3 C av7 a'7
City or Telvn State . Zip Code
cigze- (p5cs--731(
Area code- Phone number
4. DATE DRILLED // — 7- O Z
5. TOTAL DEPTH: .30.5
6. DOES WELL REPLACE EXISTING WELL? YES O NO O"--
7. STATIC WATER LEVEL Below Top of Casing: Q 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of wing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST flip
10. WATER ZONES (depth):
276079
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resot Ces - Division of Water Quality - Groundwater Section l
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I3%U0.k t CERTIFICATION•QS?
WELL CONTRACTOR COMPANYNAMEC-tt-9.t tl Riu�.Jr\Nv 111 PLump (n PHONE%D(2Yt Gq -/200
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipallPublic f,7 Industrial ❑ A cultural ❑� "
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Qj If Other, List Use E 69U; re_ y� c ( or
St(
Topographic/Land setting
❑Ridge ❑Slope ❑Valley LdFlat
(check appropriate box)
Lati de/longitud ofwe111 catipn
I County Re-ndiA.S 7z 2
1r�lPtSPlahr.�r!)f`Ai(:a'n nel-n Pet aSucacu�',/ICrad,f
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) / u` V-0
'7 I
3762
(degrees/minutes/seconds)
LatitudeAongitude source:EdGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — 'EC) 0//2 t
4/0 - L D S 4 c-l/ Rook
/, c9 — 305— URthiu,'-t=
11. DISINFECTION: Type /1 %/i Amount
12. CASING: Wall Thickness
Depth Djarneter or Weipbt/Ft. Material
From / To ( 0 Ft. C
From 5-O To %o Ft. L -fr
From To Ft.
13. GROUT: Depth }�Material Method,
m Fro/7 To_(s�r� Ft..5,4- Rt h% vl r yL-ror, it
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in.
Pvc_
Pvc
From To
14. SCREEN: Depth
From To
From To
in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16.REMARKS:
Il HkKy3
CIbNSTRUT, f I
FY THAT THIS
}ANDARDS,AND THA
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Rows, Include the road
numbers and common road names,
C1 =
0
Cr)
So'n17104-P tRd
CONSTRUU1ED IN ACCORDANC WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN ROVIDED TO THE WELL OWNER
SIGNATURE
1 i OF PERSON CONSTRUL ZING THE WELL
L Submit the Origin I to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
hone T�lo. [phone], within 30 days. GW-1 REV. 07/2001
HOE 1
6 /— 3 / — c7 2_
DATE

276077
Submit thq'
hone alto the Division of Water Quality, r
27699-1636 hone No. [phone], within 30 days. GW-1 REV. 07/2001
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division �of Water Quality - Groundwater
Tr Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) aAy PHONE % fPT 1 (� ______ D
WELL CONTRACTOR COMPANY NAME C-tt-OR n �iV'e r \/.lY Ii ASSOCIATED WQ PERMIT% ('
STATE WELL CONSTRUCTION PERMITN if liable
if licabie /
1. WELL USE (Check Applicable Box): Residential C3 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �������
Ncrest Town: �.t,TcH - County
earest
(AO v1 fc+ft iQS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNERT1?IA0 j)REss
Address PC) BOX' 11'13�
(Street or Route No.)
City FL /1ft,NG73
n State . Zip Code1 G-r)c) 9 (,-St e1(
Area code- Phone number
4. DATE DRILLED ! / — /.y 07-
5. TOTAL DEPTH: 3 '/C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Be
7. STATIC WATER LEVEL Below Top of Casing: / 00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires •
variance In accordance,19h ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST »i2
10. WATER ZONES (depth): 3 2 S
11. DISINFECTION: Type
12. CASING:
Depth
Front-._ To / 3
From j To 33
From_ To
13. GROUT: Depth
From /%' To 2 O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount
Wall Thickness
Di eter or Weight/Ft. Material
Ft. I 1% / p✓G
Ft. 2/. 4 r'✓C.
Ft.
Material
Ft. RA kWh"
Ft.
Topographic/Land setting
G idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
31lc2dw v8141143zw
(degrees/minutes/seconds)
Latitude/longitude source:QGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 - 5 i2
�RMW/f"f=
�-- 3.95
Method
/Vl,'y
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name -
a
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST 4Cf TANDARDS, AND jT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//—/i?''O2—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ill
�1 r—
Fri
Q lity Groundwater Section 1.636 Mail Service Center - Raleigh, NC

276075
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /3/Z yfr� 7" S/J!J/�`1 CERTIFICATIONN '^g7r
WELL CONTRACTOR COMPANY NAME C'l r4.f n RIVf r W t tI S Pt,.rn O C n
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
PHONE fA74t Ie d(zi2on
WELL USE (Check Applicable Box): Residential Q---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town :44--node 'sonlif(e- Countyf-tA-terSon
Overhiii I—ige,
(Street Name,e,Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1Nu1 I b • ohnSon
Address .Sf%s F)Ve-I' h1 I } DrIVe-
(Street or Route No.)
}-IncJevsonui lie, 1JCc2 Y?2
City or Town State . Zip Code
(Z)- log I
Area code- Phone number
4. DATE DRILLED /d — ' V 1-
5. TOTAL DEPTH: 2. 4/3-
6 DOES WELL REPLACE EXISTING WELL? YES Erg.0 0
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top or casing terminated at/or below land surface requires a
variance In accordance ith ISA NCAC 2C.0118.
9. YIELD (gpm): .0 METHOD OF TEST AtA.
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley fat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:l'JGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From _ 9To
FoRunati on p,escription
Clny
6�a - 10 /(3i?nr✓sN ;Sb"'�/
'70 -' 2 517 a .vd/.x
1 I. DISINFECTION: Type 11771
12. CASING:
Depth _ Diat�r eter
From To 3 5 Ft. C 'f
From a'"5 To IV FL
From To
13, GROUT: Depth
From O To 2 0
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
From To Ft.
From To Ft.
16. REMARKS:
Material
Amount
Wall Thickness
or Weight/Ft. M renal
27.L vc
2zc rc_
Ft.
Material Method
Ft. Srn€n5L- /4I,y2fl�vr�i2�
Material
JOCATION SKETCH ��
Show direction and distance in miles K9n' at least
two State Roads or County Roads. InchrAe the road
numbers and common road names.
-__-_}De- fEREBY-CER THAT THIS
CONSTRUCT,II N'"B;7T DARDSS,
----% � 1. I1111
_LL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-a?
-„ SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
Submit the origil}al to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Pho1No. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001
q I,li rL 2r_.=

276074.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources( -'Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -[�i R3a2/0r5m/t 1 CERTIFICATION If C. lI
WELL CONTRACTOR COMPANY NAME GIr4,en 9,AmeC TIC 11 S PinmP (f1 PHONE # 0121) G. et3- 12 o0
7�a3
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential IH" Municipal/Public ❑ Industrial 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: - /��_
NearestTown' "SOM) 6 IIt County UX-I",ctO
Lnci/ct 6rr1cc, 2d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) p
3. OWNER: t &YYCI 2 &*nfAJ A &JO -if
Address /400 Ma/nw mr• #4i
(Street or Route No.)
!alum n S'S Ft 946e
City or Town �tatte / .Zip Code
(7d?)- 9,38 S,
Area code- Phone number
4. DATE DRILLED /2-d3--0L-
5. TOTAL DEPTH: 2 0 J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 2. 0 METHOD OF TEST Ask
10. WATER ZONES (depth):
Agricultural 0
Topographic/Land setting
ETI 'dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
07r✓ c084°2‘ i74/
(degrees/minutes/seconds)
Latitude/longitude source:90�PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C — O,Rt
2,0 3'o L%+
co o Cg3 /=A Rock-
//a - 2e)- UAAkri ff
11. DISINFECTION: Type /7' %/f
12. CASING:
Depth Diameter
From / To / 2 0 Ft. e;
From To Ft.
From To Ft.
13. GROUT: Depth
From C2 To 2 0
Amount
Wall Thickness
or Weight/Ft. Material
te-r-
Material
Ft. L'a.o(47Ete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
l�nv/z
Slot Size Material
in.
in.
Material
LOCATION SKETCH o '
Show direction and distance in miles from of least
two State Roads or County Roads. Inc10e the road
numbers and common ro. a names. --
I DO-}iEI7 BT-GE` i THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STICNDARDS, AN�FFIAT A CDPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11
m
SIGNATURE OF PERSON CONSTRUL t ING THE WELL
I t_./
Submit the ori0nel tthe Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
L . -27499 1616on No.( 19) 733-3221, within 30 days. GW-1 REV. 07/2001
rRi Li L';.T'l
To- _ L r (:'i (, F
/2 - Z3- oz
DATE

i l}i
Li Li•
L_
GROUNDWATER SECTION
ASF'EVll l E HE i OFFICE
276073
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
F
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAMEC1rf,C.n Rsitr \/SIR II 5 PuArnp co
STATE WELL CONSTRUCTION PERMIT,'
(if applicable)
ASSOCIATED WQ PERMIT,'
(if applicable)
CERTIFICATION / r
PHONE ify 2Y)(tc"1200
1.7a.47-S
I. WELL USE (Check Applicable Box): Residential e' Municipal/Public 0 Industrial 0 Agricultural C
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i c U scvol)(e County Q tr /''C-t s d /\
( 122LLv14 llui ; ec�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: h&(kL4L 7). ¢—r,dr�l�
Address 3410 i/n)Setwl CA
(Street or Route No.) a �3
44 �c cx L) iik, /JL
City or Town State . Zip Code
to Ra -13 13
Arta code- Phone number
4. DATE DRILLED /1, —/L — O 2-
5. TOTAL DEPTH: / I/9
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO By
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .7 C METHOD OF TEST
10. WATER ZONES (depth): / 2>
Topographic/Land setting
❑Ridge ❑Slope @Valley ❑Flat
(check appropriate box)
Latitude/elon_gitude of well location
33-O,3' S 7n/ 0V° 2I'2.arcj
(degrees/minutes/jcconds)
Latitude/longitude source:L7uPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
5:h-Wc1
CJ) JTw/<
/“/Z/t8l,h-7.
11. DISINFECTION: Type % T// Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To (S Ft. L r ? J 6 PIAL
From_ To /G}f Ft. L 5 2/ c. /adz -
From
13. GROUT:
From (3
To Ft.
Depth Material Method
To 20 Ft. bri.('/Zel1r /✓I� vd—rJa�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.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roadsnclude the road
numbers and common read namSs?
c 5
1"-:i
0
/twy L'/
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-CON3FR�A' STANDARDS, LAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r-,,
Submit tIJ
27699-163
JZ -1'7-n
✓� SIGNATURE OF PERSON CONSTRUU I INC THE WELL DATE
nal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Divi ion of Water Quality - Groundwater Section to
CONTRACTOR (INDIVIDUAL) NAME (print)1/ l C,�r�YdrY CERTIFICATION #
WELL CONTRACTOR COb1PANY NAME I JIAa inKr
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
IS1l
ell and lournp
PHONE # INS b 7-7263
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ic Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT N.
trust To I Coun JS�
eel division t'ot#
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER
.�
i2.7c ICi
:'address
($[rr7l�.� or Roue Ng6 v
endersonvQ27902)
ity or Town State Zip Code
62S)-L -1657
Area code- Phone number
4. DATE DRILLED )O-31--02
5. TOTAL DEPTH: I Ohi
/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ger
7. STATIC WATER LEVEL Below Top of Casing: 1-Q FT.
(Use "+" if Above Top ott Casing)
8. TOP OF CASING IS I•� FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118. —1�VJI
9. YIELD (gpm): 5� METHOD OF TEST 1eUJ
10. WATER ZONES (depth):
BDISINFECTION: puninstcWe
11. Type Amount
12. CASING: Wall Thickness
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C4Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Depth," p i ter
From U To_LL1__Ft. /S
From To Ft.
13. GROUT: Dept �t n Mate Metho Imo( hk on. Banner Farm oa-S-•
From To nl/ FiLoacreteiIturra /1 c_a P1?+'ackL • TaKe a. 'eft
or Weight/Ft._Mateyo'
SDkz 1 y_
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
264664
LOCATION SKETCH
Show direction and distance in miles from at least -.
two State Roads or County Roads. Includer& road
numbers and common road names. --
Front )fendersonvi )le takes 1-4
(04-} West +0 1-orse 314Loe .
Material —nBrannon 'toads l/4
n
u e
lint sae
1
l
in. 0_1'C 1Wfn-r'/lilt Reap
in.
Material
Kcd.Gofinx 1V2 rules
Tum rigqh-t 1VIo L.rosE reek-
Sabd ,sion , pn Bcuilor Lci ne -
-4v end. Turn right QI @ Stasis Coon
-Ib lost Ict (on tb€f r-o -deSac-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARQ$,�AND THAT A C Y OF/HIS REE RD HAS BEEN PROVIDED TO THE YELL OWNER
HE WELL
IGNATURE OF PERSON CON
TRUC
DA
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. 07/2(101

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N rural Resources - Division of Water Quality - Groundwater Sectionio�R
�q ^, /�•I CERTIFICATIONN✓(l
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / ICnnefh JIt C`-/SyJ,,�� (fin%y/� �/ ?
WELL CONTRACTOR COMPANY NAME ' c2J-�eerWP " QI7'4i f ilThe PHONE Ir 631/10u7-7 et.J
STATE WELL CONSTRUCTION PERMIT# I U l / ASSOCIATED'WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential H Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Near st Town. DnVI Ur° County 0nderot?
onntoacu nad
(Street Name, Nu rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `l a .. 5prg, QDrive
A[jl
Address I it I1� l
y
,t Iphezt orR6 iNa.)
A 30605
City orToa State Zip
Code
MP -PM- 3R85
Ar a code- Phone number, �J
4. DATE DRILLED /r.-2r7--Oa,
5. TOTAL DEPTH: -)05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Fi
7
DEPTH
From To
Topoggraphic/Land setting
[Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
±thud?/lorgitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
STATIC WATER LEVEL Below Top of Casing: _3O FT.
22 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /• 3.) FT. Above Land Surface"
*Top of casing terminated atlor below land surface requires a
' variance in accordance with 15A NCAC 2C .0118. —r-
9. YIELD (gpm): _J METHOD OF TEST 11,11 ed
10. WATER ZONES (depth):
By pw-rp installer_
I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth��/ Diamy'ter
Tom L Ft. ( // 9
To FL
To Ft.
Depth �I. Material
To Ft. (Itonlrere
From V
From
From
13. GROUT:
From 0
or Weight/Ft. Material
ini22► PV
LOCATION 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 Tn FL 1 1'.) - .- I ow14. SCREEN: Depth Diameter Slot Size Material ((
From To t. in. in. // ..
From To FL in. in. I Q.1� yD Ol d/l.(7
267173
F
From Alendersanvi/de Lee a
--o 1361 da.ve . TQKe a. Left on -
Method 'Pi-.1 �cuard G °erEon. C0 -I-0
Per-- �r�or, -fife I ri yht on Koh
G-�6/1 road`T7s to�'o a-_rlghit
L�on�inti:° i
15. SAND/GRAVELe PDepth
aiit.h Woo.! saki � d
Depth Size Material i./l U- t,"��
Ft.
Ft.
6�fE
From '-
From To =rr
rip Ti -,
fV ,Th^)J
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 O\VL4R
st- 2n -r'9Z
To
ASr_Dir)apjif§h3. "n 0
SIGNATURE OF PERSON CONSTRUCTING THE ELL DATE
he ivision of Water Quality, Ground‘ titer Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV.07/2001
33-3221, within 30 days.

267171
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) f*IChard McCrary CERTIFICATIONN
.9610
WELL CONTRACTOR COMPANY NAYIETo.rKe.r Well Qmd PI Amp PHONE q 12R)1 Q 1-7263
STATE WELL CONSTRUCTION PERMr1
IT# la 1 1 ASSOCIATED WQ PERNIITtt
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ErMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:_, eldel &W) I.
e CountyNefderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: n �•
Address nr conourI
(Street a Route No.)
zirconia(8z8G
City6r4o ' 04- it3 Zip Code
4.
5. TOTAL DEPTH: 4 2ci /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IR-
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use '4' if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface"
'Top of casing termhuted at/ur below land surface requires a
variance in accordant with IS:\ NCAC 2C.0118. ,.1
9. YIELD (gpm): �T1
METHOD OF TES1/Y7ed
10. WATER ZONES (depth):
Try puntp installer
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth {gym: peter or Weight/Ft. Matteerial
From 0 To 35 Ft. l� 1/ SDP2 I r v'
From To Ft.
From
Area code- Phone number
DATE DRILLED IZ I
8- OL
To Ft.
13. GROUT: Depth �( Material
From O To 20 Fit inn(' Ee
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.
r. Method
epU 'ed
Topogra uc/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic rnap
(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.
Frorrr_ 1.1end ersony(ue tca'e 255 -to the
Green I2iverRoadThCH . @13). A bottom
o f ramp tate_ a righ--t On -o Green i�i v eC
�00d CO& CpVLf/ ere I Cabin
Dt� . Turn
Slot Size Material
in.
in.
16. REMARKS:
aIn ral
28790
CreekRon�t OVL+e (7
Coin -in Crre,X 72d.
LeR- /Itit. ya.-f t � y
n
4*n -Tra. i ( '{v :or K frL (0 4 • 3ae,
-first k,ouse c n II Z m
rno
ti
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL z
() QIBNSITR�I�TjQN `r DARDS, AND THAT A C PY 0 //THIS RECO O HAS BEEN PROVIDED TO THE WELL OWNER
to LL'' ��SS '' ��z ! -7 r' --2_._—
SIGNATURE OF DATE
SIGNATURE OF PERSO ONSTRUCTING THF. WELL
. AN .,�.., •JJJ
Submit the orig iTto
27699-16361'hon No.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
CJI
the Division of Water Quality, Groundwater Section, 16361(ail Service Center- Raleigh, NC
19) 733-3221, within 30 days.
GW-1 REV. 07/2001
ys of)

North Caro tna - o _ f, ,/ /� ^��O
L) NAME (print) chard 410C rari CERTIFICATION #,
WELL CONSTRUCTION RECORD
-- Department f Environment and atural Resources - Division of Water Quality - Groundwater Section
1
WELL CONTRACTOR(INDIVIDUA I/ g18)647-7263
\YELL CONTRACTOR COMPANYNAME flrTP/r Weil ( d Paimp PHONE q
STATE WELL CONSTRUCTION PEILMIT# 15 l
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f2 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: JJII
N arest Town:� nn p-50M Ile- County`/VPnderson
tida!t J�cxcd
(Street lie,—`Nuummber�s, C�oommunity, Subdivision, Lot No., Zip Code)
3. OWNER: U"') ±Iinteri0Q
Address cilQ.TLds ObriVG
(SStreet or Route No.)
S792
C)-ityCOTer l ne3 Zip Code
8zb� (.� Li
Area code- Phone number
4. DATE DRILLED )2—Ib-O
5. TOTAL DEPTH: �s©5'1
6. DOES WELL REPLACE EXISTING WELL? YES �Pa yN�O ❑
7. STATIC WATER LEVEL Below Top of Casing: -!w FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
•Top of casing terminated atlor below land surface requires a
' variance in accorda �ce with ISA NCAC 2C .0118.
9. YIELD (gpm): �Js�— METHOD OFTESTTftred
10. W TER ZONES (depth):
f in -se ler
l I. DISINFECTION: Type
12. CASING:
Amount
Wall Thickness
or \Veight/Ft. Material
From 0 To .duo FL to Ta �e2( _PV('
ASSOCIATED WQ PERJIIT#
Depth Diameter
From To Ft.
From To Ft.
13. GROUT: Depth A Matenal
From 0 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
To Ft.
267170
Topogr hiciand setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude souree.CGPS❑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. 1-t
2-174-
(onl dle_ndersonoille- ec as
-/o St -Pam ?cad. -Take 3z'r f h
Method QKLC(d l) (ear�G�. ktc'
P a_ left on Afo_ef i nsr-R?yers. ` o
I vane -fa ij -end. gI
ult iil ncuddie_ 62C d.-
m-
16.
From
From ��-yLQ�
REMARKS: Well tua s Or�tnally �yI deep -we c(rilled amexfr� 20)/�
J� d 61A-
c.rt
c
z
To Ft.
Sgkmit the nrtu the
GROkiiW . �{ ¢t6 p (9 I.))
ASHEVILLE RE T(iNAL U�
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OTHIS fi,9 RD HAS BEEN PROVIDED TO THE W'•LL O\ ER
SIGN eVI LRE OE [RSON CON:,TRUCTIN f jELL D • TE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV.07/2001
733-3221, within 30 days.

267168
WELL CONSTRUCTION RECORD
Nort
Department f Environment onment and Natural Resources - Division of Water Quality - Groundwater Section
h Carolina -epartmen o nvir
•/I/� /��//���//��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kichardJile('rar CERTIFICATION#L010
WELL CONTRACTOR COMPANYNAME BarKer Well and Pump
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT('
(if applicable) (if applicable)
PHONE
;0) 01-720
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Nearest Town: j�gnt I2. WELL LOCATION:,,1 ,1 �SDn
PrSi7nVI III County/vI�
-Terr s (ae woad
(Street Na Numbers, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER:ennnie /1 endionon
Address
(Street or Route No,,
�.lnnk(orcnnv Il,o U(� 2A74Z
Q� 2/City ogT'zvn rn State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL. DEPTH: 051
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 19--
7. STATIC WATER LEVEL Below Top of Casing: 1140 FT.
]013 . LOCATION SKETCH
ns i-G C(� Show direction and distance in miles from at least
Amount
CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Weight/Ft. Material numbers and common road names.
From_ To 47 Ft. �o %S 5Pa2I Pv6 rrom Nendersonvi Ile -take A
From To Ft.
From To Ft.
13. GROUT: Depth Material Methoul
From 0 TOAD_ Ft. itnnert e- i
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. . in.
From To Ft. in. in. "" ""yy r
15. SAND/GRAVEL PACK: FJrI�e is ' d(;(,Lt- i"0110w
Depth Size Nlaterial
Topo�o aphic/Land setting
Il DRidge 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
11.
12.
I lJ f
h (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
"Top or casing terminated atlor below land surface requires a
variance in accordance w))th ISA NCAC 2C .0118.
9. YIELD (gpm): H in, METHOD OF TEST —nine/ _
WATER ZONES (depth):
pump,
DI INFECT ON: Type
Material
From To
From
16. REMARKS:
To
Ft.
Ft.
it
-towards Ed 1eyvl Ile. %urn le on
rrui t 1 c/nd koad , Fo II o vl end
Turn lef on 7errys G . a 7/io
of cz nu ie -fb ;�luirtfleys Cif r' -on-
-i-L v1 ht. If will be drive -
A9-7ct 9araj1 uuhere ail
C w
roof] up hall -b i tE ^'
G
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• DS, AND THA A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE,WELL • WNER
14-
CTING TFIE WELL LATE
C1L
SIGNATURE OF PERSON CONS
L.._ 5yhrui<..t}rry{I Y-yd,Pistr to the Division of Water Quality, Grounds\ ater Section, 1636 Mail Service Center - Raleigh, NC
t r 919 733-3221, within 30 days. OW-1 REV. 07/2001
pSFpJ_ p_Lt

266306
WELL CONSTRUCTION RECORD
h Carolina - Department of Environment and tural Resources - Division of Water Quality - Groundwater Se ction _
nth av
CERTIFICATION
L CONTRACTOR (INDIVIDUAL) NAME (print)
pJQY!!av
L CONTRACTOR COMPANY NAME
'el I and Rd/np
rE WELLRUCTION PERMIT# i!2 / 1 ASSOCIATED WQ PERMIT('
CONSTRUCTION
(if applicable)
(if applicable)
NELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
.tonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
PHONE #
YELL LOCATIQN:
Nearest Town
/MIwie4 Roa4-
,Street me, Numbers, Community, Subdivision, Lot No., Zip Code)
DWNER:
Address
(Street or Route o. 74 /
)pndersohvl Ile , A r.�
City or Town S to Zip Code
Area code- Phone number _ ^ 02
DATE DRILLED
TOTAL DEPTH: 10
DOES WELL REPLACE EXISTING WELL? YES� �❑y� NO FI�
STATIC WATER LEVEL Below tTop of AboveTopor Casing)
TOP OF CASING IS .T.
3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in acco.rdalae with 15A NCAC 2C .0118. Tin^�
YIELD (gpm): _ METHOD OF TEST tf L_
WATER ZONES (depth):
Topogra c/Land setting
IfIRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latituddlongitude scurce:DGPSDTOPcgraphic map
(check box)
DEPTH DRILLING LOG
From To
$uminstaua- Hon
DISINFECTION:Type CASING: Dia�} Wall Thickness
Deptiao Ft. / (/Rer
From � To
From To Ft. --
From To_ Ft.
GROUT: Depth Material —�' Method
From _ To o_ Ft. �!Y eider I I attic i
From To— Ft. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. -- in.
. SAND/GRAVEL PACK:
Prom
From
Depth
To
To
t. REMARKS:
)OH-
ONSTII
Ft.
Ft.
Size Material
Material
(iE,REIFY TTt.(4 TEAS \YEL
( -STA NDAR-DS, AND
Formation Description
LOCATION SKETCH
Amount Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
6r`6I From Alenderslnui Ile -&Le 64 Cast.
i urn f ere on .Toward Gap Road.
mourn riht on zebCorn i cad •
lure r9 ht on ✓ -Eton left a.
z�3 rwl-es)
Oc rper ¢2.oc>,d• turn rifitotg
tia.es Loco- Fo ll ow o rb d
oat arrows +a pfapt )&
q
r7U
A
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL rV
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER z
Pte
PERSON CONSTRUCTINs DATE
i-•a - �NATI). uF THE WELL
I(-2- —o-t—
ubmit the or 171 he-134, 4enTalikater Quality, Groundwater Section, 1636 Dlail Service Center - REVgh, NC 1
7699-I6361'g6p�"f_hie 00) t-}?322E y(hin 3( days.
L

WELL CONSTRUCTION RECORD 266305
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
atural Resources - Division of Water Quality - Groundwater Sectioo�n//y��(��
CERTIFICA�TIIO�Nfp/gt/dfal ,
PHONE # 833,07-12a
ASSOCIATED WQ PER\IIT#
(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 LOCAT N: ,�,/
Nearest Town: ertenonvi Ile- County./l0nderson
jyeome7re /dQP 7)riVe.
(St eet Name, Numbers, Com nity, Subdivision, Lot No., Zip Code)
3. OWNER r rry .S4unders
9Ven e��rr777'''sooy�:171e b ) a879Z
62e) O 27Y - „State Zip Code
Area code- Phone number r
4. DATE DRILLED I —,5"—w2
5. TOTAL DEPTH: o� 5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Address 0 �y1& /L.0/e Z
Str (or Route o.
STATIC WATER LEVEL Below Top of Casing: 3o FT.
p (Use "+" it Above Top of Casing)
8. TOP OF CASING IS I. J3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
•
variance in accordan a tth 15A NCAC 2C .011S.
9. YIELD (gprn): __ METHOD OF TEST —Tirned
10.
WATER ZONES (depth): ):
Ey p insa Lie( er
Topographic/Land settin
DRidge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of weli location
at
(degrees/minutes/seconds)
Latitude/longitude source❑G?S❑T000graphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
l. DIS NFETION: Type
Amount
12. CASING: Wall Thickness
Depti) j9i eter or Weight/Ft. Material
From 0 To loft Ft. 10 /A 6o12.z-1 PVC'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To_c2212_ Ft.s'OI?(tete-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
Method
Mt IWO/
Slot Size Material
in.
in.
Size Material
Ft.
16. REMARKS:
tt�
IFDOli ERFB ',ICL: TiFY T
&1vISTPIJTIO4S
S- ....r.'h2ofi;,+RayH
!�576 �h� 1:36�'I1tw c M1J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r mot )Jendersonville. 'ate_
61+ Cask -o dhEstruxt Cap
'Road. -rant rift ojtcLgo
/z, mile . urn left on 5yCama,e
ki e Drive. first drive- on
eee7nd
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL O
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OPNEN
M` ..._ 11
DATE
IGNATURE OF PERSON CONSTR
1NG THE WELL
e Div lion of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
733- 221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 6 6 3 0 4
North Carolina - Department of Environment and atural Resou(rces/- Division of Water Quality - Groundwater Section
��,O
WELL CONTRACTOR (INDIVIDUAL) NAMEM�Q(prin'//t)__le`nnethn/.N�,e(r CERTIFICATION
N�'dr/OT.P)
WELL CONTRACTOR COMPANY NAMEUO(�.YrKC( YV ell and amp PHONE q (57R174 -74
3
STATE WELL CONSTRUCTION PERMIT# i V { I ASSOCIATED WQ PERMIT#
(if applicable) (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 LOCATION:
Nearest Town:
C.unty) endersvt7
munity, Subdivision, Lot No., Zip Code)
(Street Name, Numbers
3. OWNER:
Address
r. hwas Rodgt `TIT
aanUUrlve
(Street • Route o
DI.Phdersonvil e zd79z'
City or Town State Zip Code
di a)- (agz-q(n35
Area code- Phone number
4. DATE DRILLED ) I --ZO—o 2.
5. TOTAL DEPTH: of 80 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: " FT.
p 9 (Use "+" if Above Top of Casing)
3. TOP OF CASING IS 1 •3i 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): f0 METHOD OF TESTT med
10. WATER ZONES (depth):
-33y pump insLauer
1 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth a
Di ter or Weight/Ft. Material
From 0 To�SL_ Ft. Fl% .D, PVC
From To Ft.
From To Ft.
13. GROUT: Depth //�I�Material,, Method
From 0 To (QC) Ft. &mere& Vowed
Frorn_ To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Et. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
Topo�gr�aphic/Land setting
❑Ridge I75Iope ❑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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Pant ,lendersonvifle +ake z5 S
-fo South L-c e &ummit R.oad-
Yorke a, Lele at South ivai'e_
5urnmif load. 6rosc /CLkte a.gd-
Material On- Fi ✓s1 l ek (dirk rode )• 4.
tale Firs' ri ' h.t - Sum,�np,�
Road. 60 if/ -t fie i�enfii�'eo
iiict/ ii/rs�/_r5,,a1 drive anal° 4
-4744
or Kl lQr�--TU/2 UV /tr� 0 ,ram
i
C!1 --I
z
Size Material
Ft.
From To Ft.
16. REMARKS:
I I 4-0Ot-IEREBY'CERTIS' , A
!�ICONSTRUCTION STANDA.2f
:(1'j.
lI.J
L__ 1
batniiL(thel—ti g6Gdlltiffie Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
'44-Iki't4iHr1,hI F014j 713 221, within 30 days.
GW-1 REV. 07/2001
N
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
P
r�..Z"Y✓w./tGiti. I k. = 1,2 C-v Z Z 12 G en—
IGNATURE OF PERSON CONST. UCTING THE WELL DATE
e—

WELL CONSTRUCTION RECORD 2 6 6 3 0 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION tt 010/0
Q PHONE /I M M 42 -7
STATE WELL CONSTRUCTION PERMIT# / (J / iJ / ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAMETJd-rKe
(if applicable)
r
1. WELL USE (Check Applicable Box): Residential I- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI,C}N:
N rest Town:
en�r�
(Street Na e,Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:L it e, SOT/
Address
rlgZ
,
Fle / pr (Scree/ �a� No.)
IL B28 Chit)-tty oorTTo&swn4- 5 - ate 3 Zip Code
ee_ County eridea/z
Area code- Phone number
4. DATE DRILLED it — q-az
5. TOTAL DEPTH: 3L 5 r /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO NJ
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I. FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST l rnied
10. W}.TER ZONES (depth):
!nstailer
11. DIS(NFECFION: Type
12. CASING:
From_
From To
Depths
To 50 Ft
From To
13. GROUT: Depth
From To 7 0
From .e
Ft.
Ft.
piynlee er
Topographic/Land setting
❑Ridge DSlope ❑Valley atgat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
SrDa2t
�
or WeightTt. Mate al numbers and common road names.
- front ,,Iendersonyille fake ,Z5 areiz
-to a ri h& On dajze drea . 7 Xe
right- Allis (la f load, 7 Re a--
ht at ooPers (reek Road. Go
Material,
Ft.�VerP _
F,.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
CNS
ER/BYE
RIkTISL
Et.
Ft.
Methgd
rizared
Slot Size Material
in
in
A out 03 les o.nd -are a- leis -at
»uppers Cl rem 04.urch r,9c4. 6?o
on wile:There Will be a
picket [glee Gn Me left.
Feriae -Lake a Ceie ors
?pad. 1st house on left.
Material
O
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL cri
DS, AND TJ AT' A COP �OF THIS RECORD HAS BEEN PROVED TO THE WELL OW[ .
�
/CND
SIGNATURE OF PERSO,
Submit the origin al to he Division of Water Quart
3:6111T4m No. (9 V) 733-3221, within 30 days.
RUCTING THE WE
O
DATE
, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
aF
/K/

WELL CONSTRUCTION RECORD 266301
North Carolina - Department of Environment and
Natural Resources - Division of Water Quality - Groundwater Section�t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Rl nid )(Leal CERTIFICpATIO/N�# 21 in
WELL CONTRACTOR COMPANY NAME AnprrlKer Well andPf 1 fop PHONE # Ft�1fd-Il%' .63J�
STATE WELL CONSTRUCTION PERMIT# 18 f 1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential G '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. Pr5Ol1Yl I le CountylV n
lnr1Prsnvi IC. ad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:: ode-Lie/6 e!py)s
Address KT . 1.5 0 A, I g5
)(Street or Route No.) 20 (70
,Zirrcnra _ArG
Zip Code
City or Town Statete
l/1LI7 )-�76 — 18 *1r-/
Area code- Phone number
4. DATE DRILLED I I' )J' OZ
5. TOTAL DEPTH. 12.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ef--
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 .33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
•
variance in accordan with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST TI YYled
10. WATER ZONES (depth):
By pump installer
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dia ter or Weight/Ft. Materi
From 0 To� Ft. 1' Q,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.it){1QretY_ Paired
Topographic/Land setting
DRidge 1LS-tope DValley ❑Flat
(check appropriate box)
Latitude/longitude of weil location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
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.
Ib
AEA- i
} CONSTRUCTIONSTAN,1
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. 1 r
ol�zi — FronL JIendersonv t
i Lle ake N
30(1th -Lo Green Rher oast yL
ToJCe an right on Green River
V n d. (�f /L�(vl U� f ;Ili come 4D
.
rE0k15 dreel<ROad tz° 0--- I e-Ft,
-rare_ a_ right on Ancle_fsor koad.
Will be -The First place oft -hi
r iiht past -I-he- Yellow er,
0 �
n
o rn
o
b rn
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL a=
, AND THAT A COPY OF T S RECO q HAS BEEN PROVIDED TO HE WE L OWNS£ m.
�01
�-
r �
URE OF PERSIN CONSTR
CTIN E WELL
DATE
'utih'rit the drigrriAP4Athe Di 'ision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
_ .VH-S4423G.`+J -3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
266300
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1 1 CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL)NAME
,(,print) O\,Pr�/ Buffer n�O,r r/
2/39
WELL CONTRACTOR COMPANY NAME 2 1nr�/Ker Y�1 el 1 a IZd Pump PHONE # t� (.Ca Ira �� `
STATE WELL CONSTRUCTION PERMIT# lei 1 I ASSOCIATED WQ PERMIT#
(if applicable) (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 LOCATI N: ,,I
r�erest Town: e2derSO County/Yencterson
KnjwjqaTorest- - 14-
(Street Na Numbers, Community, Subdivision, Lot No., Zip Code) m
3. OWNER: p O-ft.G,. 6 '
its
Address 1400 1-tanth111ng Oats
(Street or Route No
���
)49nriprsnnvi It , hie,
City or Town State Zip Code
(Ri%)_ Gib-4419 LI
Area code- Phone number
4. DATE DRILLED i I'l4-02,
5. TOTAL DEPTH: cy2 C'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fir"
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 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 "Ti tried
10. WATER ZONES (depth):
$y party ibttlli.er
1I. DISINFECTION: Type
12. CASING:
Depth Diarueeter
From 0 To I l5 Ft. /a'[ SO 6DQ21 WJW
Topogra ic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft.
From To Ft.
13. GROUT: Depth A Material
From 0 To a0 Ft.Cp k
Amount
Wall Thickness
or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. 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.
'Front- Nand arson Olt U kaaCte-
Kanu�aleoa.� onke 3D 5)fndles.
Tam right rob) Kaira a-Tbrat.
'� G' o -it *D -- is Oft
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Method
Pound
Material WIIl h.e YULYVE" b last lux/At !''o
22,
r
oresi
Lo&#ILE
16. REMARKS:
I DO-HEREB't CER
CO 4STRUCTIONSI
tea
n tt
cP
N
O
A
C!/
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL rV
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ll t Hw. iS, Z0c2
SIGN4&TURE OF PERSON CONSTRUCTING THE WELL DATE
_.,1
i`�--SuF>mf!•ttaeapi� ln'it to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
n, tiVN GW-1 REV.07/2001
(-"• �749V. Ib�,ti. I'.huwF FliiF(9 t9 733-J221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources, Division of Water Quality - Groundwater Section
�/�
• CERTIFICATION # 0 f
r,er p PHONE
I81
WELL CONTRACTOR (INDIVIDUAL) NANIE (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
266299
1. WELL USE (Check Applicable Box): Residential it Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT •N: ,I
Nearest Town: 1 �/1 ' I / ' Colintxenderson
\5urar ill nods t-#
(StruoName, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Str^for Route Na.) �`1 ���
1�ahrc G o/
City or Town Stat Zip Code
(8z8)-685-83-25
Area code- Phone number
4. DATE DRILLED IFL
5. TOTAL DEPTH: oQOS
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)
S. TOP OF CASING IS I' 33 FT. Above Land Surface'
•Top of casing terminated atlor below land surface requires a
• variance In accordance with I5A NCAC 2C .0118. -f-tV),.I
9. YIELD (gpm): aO METHOD OF TEST _/ 1 e(L
I0.1)ATER ZONES (depth):
Topo�gr�ayhic/Land setting
❑Ridge 2Sclope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
1_;rtitudellongthtde source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Y puny installer
t 1. DISINFECTION: Type
12. CASING:
From 0
From To
From To
13. GROUT: Depth
From 0 To c?O
From To
14. SCREEN: Depth
From To
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16.
I UI 7�t7�[E& _ __ EAR
/Yl - CONSTRUCTION S
Ij ,
Depth Diameter
To 126 Ft (0'%
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
.166 St -re
Material
Ft.Potere
Ft.
Diameter Slot Size
Method
Poured
Material
Ft. in. in.
in. in.
GF 'SFIb1nIt EC)Ct �i �j�i 3��o th
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.
From )le✓ldersonvilte. take ,W
t25 3:ou&h -to Gieerz 'River Ro
Cxit. Turf. r15ht SILvp sl n-
�hd
"Take first I&Ft (mil re.tus -Qa)
art( 90 ''/ miles . Take Q'� r,l.e�,aift
IYLta at /t ill Woods 24cvi5i0r7-
Foll ow drive -jv end - Ift gese
r7n ctrije Oa the riyni•o =, ,
C ic
i! L1loodds Sub "is .Sifnnv �<
n
ES n
ut
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
N
S, AND THA A COPY •F THIS RECORD HAS BEEN PROVIDED TO THE W LL OWNER
SIGNATURE OF PE
/
CONSTRUCTING THE WELL ATE
aZ._
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Division of Water Quality - Groundwater Section/7
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Kob�el)
1.1.44 e- n CERTIFICQATTIO/N /0iQ 7 9
WELL CONTR.kCTORCOMPANYNAMEBorker YY e)) and. f imp PHONE # AAA '7 /243
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
266298
(if applicable) 1
I. WELL USE (Check Applicable Box): Residential B—Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT /N
earestTown: .'Will . __/ County A.1/I f,L�
it V 1, I.} I .... / L zL)ifIt
(Street Na 1e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address es fl1(twin -!cult
(S[reetar Dote /s ` gqq
v2cf�,�Dol�Uu /�/ �Jl
(8
City)-C I4orT wn- R1�31 State Zip Code
Area code- Phone number o�
4. DATE DRILLED I �l
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑. NO Er--
7 STATIC WATER LEVEL Below Top of Casing: 40 FT.
2? (Use"+" if Above Top of Casing)
8. TOP OF CASING IS 1 ' d d FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accorda a with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 1 I { nec(
10. WATER ZONES (depth):
3y pumpinsi2uer
l 1. DIS(NFEC ION: Type Amount
12. CASING: Wall Thickness
Depth giameter or Weight/Ft. j1 tepal
From 0 To 740 Ft. t� 1/fl $DR2I �L(�
From
From To Ft.
To Ft.
13. GROUT: Depth //I Materially
From 0 To 40 Ft.L.n1ertt4e.
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
Topographic/Land setting
DRidge ❑Slope ❑Valley VElat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑To o aehic me
(check box)
DEPTH DRILLING LOG
From To Formation Description
nn Nleth d
rowed
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Front-.ifen_deriOnViLle -Lake
ehurek 3LreeL 4o kwwi a,
fkoad. Go 5.4 ?tiles o
KCa.n xga- . Take a r:qk i niLo
a, Fo✓yos L �u�a iso/7•
pro will be- ��-
time
From To Ft.
From To Ft.
16. REMARKS:
L
n
0
a
0
,„ 1 Cfl
.DQ'HEREB' CERTIF,f THAT HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL N
f—CON TRTICTToN sTA&AARtS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L. '--J SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Sktninit*- I-te,-o,rtgnrnTllEy(�t to Dyrision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASfl69 k[6336Pusiiireinik EV19) 73313221, within 30 days. GW-I REV. 07/2(101

WELL CONSTRUCTION RECORD 2 6 6 2 9 7
North Carolina - Department of Environment and
Natural Resourcesam/c-Division of Water Quality - Groundwater Section/�
WELL CONTRACTOR (INDIVIDUAL) NAME (printt)Z btl/d 1leL.rQr CERTIFICATION #oi0/10
WELL CONTRACTOR COMPANY NAME.�6r/ler YYe/! and PHONE #�z$ 649-�a63
STATE WELL CONSTRUCTION PERMIT# /B 7 / ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential I( Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot XJo., Zip Code)
3. OWNER: P ora h Adin
Address s. 5�'Uunraf Odd
(Street or Rof ) No.) 25731
`/O L ^`p...k
iry, —'7ACity r Tow 6? e Zip Code
Area code- Phone number
4. DATE DRILLED 11' 7-01
5. TOTAL DEPTH: 1 2.6 I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Cosine: 30 r FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS )•33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accurdn ce with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST /!m d
10. WATER ZONES (depth):
�y ITN punka
installer
11. DI FEC ION: Type
12. CASING:
t Depth Py�Jeter
From (1) To I1 Ft. fn /�1
From To Ft.
From To Ft.
13. GROUT: Depth Material
Front 0 To It; Ft. COrlekeie
From Ft.
14. SCREEN: Diameter Slot Size
Amount
Wall Thickness
Sore eight/Ft. Nl�J,�terial numbers and common road names.
1
Topographic/Land setting
DRidge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:f7GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
To
Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
VC) ironz iliendersonyi I le -kite Four
Seosoos Blvd. Toward bit East
Take o.. ri ht at Dana- Lott•
Turn n t orl-o Tac ,
Road . Past Fort�si ���
Method
toured
Material denteta-ry -i Q r/ h? 0447
�uneaYRoad . Wi l�fill-
Ft. in. in.
Ft. in. in.
Size
FL
Ft.
16 REMARKS
\ �
n, ' � r F
Jf puttFR FF#1 C'F RTtFY � D
r-),ILIIONSTR.UCTION STANDAR
J
SOOp tpe,oril itullioith:e Divisi
276/9-1436 it ioi.L e i3 73312
Material LITYI. ' ouse On Lie
Vivo thne while ag St
double Wide.
5 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT/AC Y F THIS j?,ECORD HAS BEEN PROVIDED TO THF/W�.LL OWNER
C�t�1/` ( /l/Y//
NATURE OF PERSON CONST U NG THE WELL / DATE
n of Water Quality, Gr ndwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
WELL CONTRACTOR (INDIVIDUAL) NAMEME/((prrii/ntt),_ ,_
WELL CONTRACTOR COMPANY NAME L/rI ile
�i,q
STATE WELL CONSTRUCTION PERMIT# 1 V ` 1 ASSOCIATED WQ PERUIT#
(if applicable)
266296
e;- Division of Water Quality - Groundwater Section
CERTIFICATION gg'jLW
PHONE #
(if applicable)
atural Resou
64T7?�,3
1. WELL USE (Check Applicable Box): Residential Dr Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT ON: N arest Town: -� CountyMendeson 4„
eI). dew L�stayte3
(Stet Name, Numbers, Community Subdivision, Lot No., Zip Code) c t-0 1 D
3. OWNER:
Address
cur Pkii tererrae
I)ovie (StFjmirida' 3332b
City or Town State Zip Code
)- 14TM—)661g
Area code- Phone number
4. DATE DRILLED t
b'CZ
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EY
7. STATIC WATER LEVEL Below Top of Casine: Inc FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS , I. 33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
. variance in accordj nc with ISA NCAC 2C .0118.
9. YIELD (gpm): _l &'.__ METHOD OF TEST Timed
10. WATER ZONES depth):
Topogra Ic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudc!aongitude source:CGPS"Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LEY I et
1 I. DISa(FECTION: TypeAmount
12. CASING: Wall Thickness
DepthDiameter or Weieht/Ft. Material
From �� To Ft. (0I�tg SD1721 ���1
From To Ft.
From To Ft.
13. GROUT' Depth Mai Method
1)001Pd
From O To zo Ft.0ni1
From To
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
From To
Size Material
Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH N �'
Show direction and distance in miles from at !Mist n
two State Roads or County Roads. Include tho;-ryad 5i
rvi
numbers and common road names. IV
Front )1enderson'i Ile Lare4
-to Edne/vi lie. Tarn rig{ o
Gilliam Akan -fain l2o(• o We
� fi Ins -1a Appleola- 2oc furn-
Igravel )road Gt
ushp
and bear Y
road h
rI G tT •
✓I(i�e(1e11 View-tswes Lot -ID
9OCHEREBYiCEt?,TIRVT
I CONSTRUCT • A
_�1
lr�,lrm AFyf,ocisuan(tiVpthe Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
„31-7691,163f63thoite Not k9! 9) 733)221, within 30 days. GW-1 REV. 07/2001
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f' ., N L-
SIGNATURE OF PERSON CONSTRUCTINI THE WELL DATE
ltL4l nn—

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment annd a. turaI Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /LI I2 4 AO
"
WELL CONTRACTOR COMPANY NAME,
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
266295
Division of Water Quality - Groundwater Section
VI CERTIFICATION
/#/n]LDID
VI PHONE # [n ICJ`f 7-/Z
ayY(�er VCe( and 8 &3
IV I
ASSOCIATED WQ PERV/IT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA�fiON„„::,� I
Nearest Town: lel(y1ersoflvi Ile County )frMdef n
Frui+laved
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
y���(S�ire-t or Ro(�te No.)
)J'ia'i M"' -t I\l�
,! �Ciry r own S z Zip Code
i,�•)-Ceti-.8z `9
Area code- Phone number —//
4. DATE DRILLED 4 b JQ2)
5. TOTAL DEPTH: f 6 r
28 74)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la"
7. STATIC WATER LEVEL Below Top of Casine:.SQ FT.
�j (Use "+" if Above Top of Casing)
I. 7
8. TOP OF CASING IS 3 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accorda ce with I5A NCAC 2C .0118.
9. YIELD (pm): + METHOD OF TEST J a_e_
I0. \ ATER ZONES (depth):
$u"93 inl<st2lle-
1 1. DI Lr FEC ION: Type Amount
12. CASING: Wall Thickness
Depth//yy�� ppia ter or Weight/Ft. ate9`',a!
From0 To l(j) Ft.lpl7P Svazi VC.�
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To (no Ft.Oonerei-e
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.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lit
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
o ,
r.)• t7 �
rr1 r:
N LJ—
O Zr'.=
>0
•s —�
LOCATION SKETCH O
Show direction and distance in miles from a�rleasti
two State Roads or County Roads. IncludertOe roe
numbers and common road names.
rom) endersorvi IIc fake 64 E.
+owand Ed ieyvi Ile. Take a
Method aa- FruiHand fZoad. GO fast
)larwd 10rt.h. I-.elderson ).iigh_ ��hool
Material +o curve (.L2- bO a"7vo-- hi I I-
3 houses on -Ehe_ rig hL,
on_ road. [ISO'.`j21 heWiock
hie.
From To
16. REMARKS:
1
4 DO-kEREB}'_C
CONSTRUCTION STAN
Ft.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A, OPY OF THIS ECORD HAS BEEN PROVIDED TO THE7ELL OWNER
SIGNATURE OF tfERSON CONS(UCTING THE WELL
I _J
L._
5PbYn1LpN/elgPitiFiiailEfJhe Division of Water Quality, Groundwater Section, 1636I11ail Service Center- Raleigh, NC
FS. ' '(,F -32L, within 30 days.
GW-I REV. 07/2(101

WELL CON I (LAC 1 OR COAIPA) NAAIE
STATE WELL CONSTRUCTION PER.\IIT#
(it -applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
jj�N�/{{��tural Resources - Division of Water Quality - Groundwater Section
%VELI, CONTRACTOR(INDIVIDUAL) NAME (print)11efinlaiaaerati CERTIFICATION ##ZOOg pp
PHONE # tli?) e`l'I-7%G3
12 1
ASSOCIATED WQ PERI\IIT#
(if applicable)
266318
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ 1 Other, List Use
2. WELL LOCATION:
Nearest Town: HendP/SohV/ lie' County)e/7de/SQ
tor(nlnir Road
(Street Nante, umbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
}�endersohvtlbe , AI el
City or Town State
(94Y)- 1085—'3J61
Area rode- Pltone nwnbe
4. DATE DRILLED Ci-Iq-02)
S. TOTAL DEPTH: •Q051
trier
.Q8'I(1,2)
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 35- ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1' 3 ET. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15:\ NCAC 2C.0118. -�-
9.. YIELD (gpm): _�25 METHOD OF TEST tired.
10. WATER ZONES (depth):
$y Qwnp inaEauer
II. DISINFECTION: TION: Type
12. CASING:
Depth Diameter
From 0 To st3 _ FLre t/€J
From To Ft.
From To Ft.
13. GROUT: Depth Material n Method
From 0 To go Ft.-e j oared
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Fa in. in.
From To Ft. in. in.
U. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From "ro Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley Utlirt
(check appropriate box)
Latitude/longitude of well location
(deg rees/minu tes/seconds)
Latitude/longitude source:❑G PSOTopographi c map
(check hoe)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH �
Amount Show direction and distance in miles from aFlcast
Wall Thickness two State Roads or County Roads. Include E roach
or Weight/Ft. Naterial numbers and common road names.
SD/Z21 tL Prondkndersenvi Ile %ate (o4Eas.t-
-f o Fru.i fi arcd Road . Tra, l
and qo -lo The erd roQ tart
+he- eft- l,annin 4
16. REMARKS:
be- ThvLl_carlVe_ h 44- r
A
CO
I DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND�,
THAT A COPY O1/F�'tTHII/SS RECORD HAS BEEN PROVIDED TO THE
THE WELL OWNER
NAT RF !((
1-1 L' Subrrili`the origit/414o Chet.
?7699-1636 ('hone No. (9191733-,
G U - OF PERSON CONSTR TING THE WELL DATE
ion of Water Quality, Ground%ter Section, 1636 Mail Service Center- Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
266316
North Carolina - Department of Environment and
�Natural
yResources
L-(Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /WC/CJ T Elva ern CERTIFICATION # 1 C)
WELL CONTRACTOR COMPANYNAME'ga-r}er Well and P(MY)1O PHONE # f511S9(2617-7263
STATE WELL CONSTRUCTION PERMIT/1 I O 1' ASSOCIATED WQ PERJIIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON: 11
Nearest Town: .erS County TI ender.S0/2
(ookside 1 htl'e ome Cs s Lof-ff- It
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑ValleyPflat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:r��l2, �et�'flr) (degrees/minutes/seconds)
Address n r�X Jr a�. Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
City or Town tate Zip Code From To Formation Description
(82$)- 6g3-(173n
Area code- Phone number
4. DATE DRILLED 4-13 -02
5. TOTAL DEPTH: 1 80
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casino if 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I •33 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): 10 METHOD OF TEST Tt med
10. WATER ZONES (depth):
3y pump insi-aiter
n
I\)
LOCATION SKETCH
11. DISINFECTION: Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include3he road
Depth Diameter or Weight/Ft. ' atonal numbers and
cornmon road names. �-{
FromO To 142 Ft. (V6 6Df221 yy( Yronl.✓Wendersenvilie 'I4'e.�54
From To Ft. -to BrODkSld6 Cairrip Ripaict.
From To FL y�t or�� I %z @Di Ies•,
l3. GROUT: Depth " blatetial n Method (Ef2mo_vK v
From 0 To_�O Ft. Ly�i'Ienit Poiu zi Croy-s 1-z6 -hen �I (z-
Frern To Ft �p ,, -
l4. SCREEN: Depth Diameter Slot Size Material Cprollna Clrele• , �u�ef
m
From To Ft, in. in. See (on O park • (' -_-
From To Ft. in. in. II--�� r
15. SAND;GRAVEL PACK: O✓� 1'v • -'
mo
Depth Size Material
From To Ft. rooksideAobi1Sie
From To Ft.
16. REMARKS:
Lot I7
t DO HgRE,ty cERT,1F `THA) IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
"ONS{RUC-TION-STA D.dl, AND�� OF THIS REC HAS BEEN PROVIDED TO THE WELL OWNER
J (oJ09/Ot
GN URE OF PERSON CONSTRUCTING THE WELL DA E
4111:
5uhptft Ihp e[)b+mil to th Division of Water QuaTit}', Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
GW-1 REV.07/2001
i it 0..i/I e Nb :1\9)a33-3 21, within 30 days.

w'ELI. CONTRACTOR COMPANY NAME Barker A r I I and u n
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
t•(�aturratl�Resources - Div sion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f\£./ult'Jt Ate £ Q,r CERTIFICATION #,_ ia
&a ro 45
259526
PHONE #
WELL USE (Check Applicable Box): Residential IRP-Munieipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI .f �
�1
'Arst_o l ownr'l Y) tdge fj County N�ndPrsorJ
(Street Name. Numbers, Com munily/ Subdivision, Lot No., Zip Code)
3. OWNER: II
Address
(Street or1PRoute aM �>°rson�(II� N � .7
City o awn State Zip Code
)- br35--4gq
Area code- Phone numbe
4. DATE DRILLED
5. TOTAL DEPTH: (AV
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
22 22 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1•d✓ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanc9 yid' 15.4 NCAC 2C .0118. -�.
9. YIELD (gpm): 7 y2 METHOD OF TEST l f n1Pd
10. WATER ZONES (depth):
Ly purrsinsia Uer
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth piirgeter or Weight/Ft. Material
From O To rb Ft. b /N 5tee
-Oz
From To Ft.
From To Ft.
13. GROUT: Depth /� Material1�, Meth9d
From To QO Ft.s "()1')IA,nLe Vot/ red
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.
La
DEPTH
From To
Topograc/Land setting
❑Ridge Ca Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) fV CJ
ode/longitude source:❑GPS❑Topogrppjtic reap.
(check box) n : _2
DRILLING—FOG-.-_'L2
Formation Desc,iptioh
n
tit F
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From. Alenderson vi Ile take.
(94- £vast. (o -b to cock R
anal turn right• (So cthcu t 1/2.mil e
and. turn I & on .)forth Ride Fe .
alacuk yz Milk. oixd proper
1 s oyL the right. }2aneh .k
brick
6t orne 12 6 ifor�fi
16.REMARKS:
Su
E 1' E
•11 • .• • ; ' isio
IIRP1RWit,t3221
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OFm THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
in C
0
ATURE OF PERSON CONSTRUC INC THE WELL
DATE
of Water Quality, Groundw. ter Section, 1636 Mail Service Center - Raleigh, NC
within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - D visggsiioyyyn���///of Water Quality - Groundwater Section /�/�(�
WELL CONTRACTOR (INDIVIDUAL) NAME�Qq(prriin't)/Ke\nA'npeth /j{ed (2 ) CERTIFICATION # 2DC3
WELL CONTRACTOR COMPANY NAME�IAQ. tKei± 14JeI I an (,f_ rrxLLfJ'7e
STATE WELL CONSTRUCTION PERMIT# b f' ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
259525
PHONE #Q )YJ"t - J(1?•'3
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIDN: �-t
Nearest Town: en dd Per Om lle County endeliOn
Trr s (treeK �oad
(Street Nan . Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: W/9 I2el�free.
Address G /7 err'[5 ('rem Roast
3. Oleic
zr reortia (Sheet eit No.) 10
B2S, `y 4& mSS�I5Gto ��/Ziiipp Code
Area code- Phone number r/
4. DATE DRILLED U — [ 0Z
5. TOTAL DEPTH: 0�0 S I
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 I. as 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 I', royal
10. WATER ZONES (depth):
1 -y pum�ON�Type�er
I
12. CASING:
Depth �1 o�3ter
From To 70l Ft. gi
From To Ft.
From To Ft.
Topoggrr phic/Land setting
DRidge E'fSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLINp.OG.;
From To Formation Dj§riptith-.-
rn
0
o 2
t
w E
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. Nerial numbers and common road names.
5DRZI G Flea Menders-orivi Ile -Late 25
soath -fo Bobs ereek. Exit: (Exit-
s i) Ta& a- ) elk off evil and. o
under c 5 South Turn.!elk
ori-Lo -the l.5f paved road.
CTY�y� areek- •Qd) Nouse. win be
- he I'sb- pease on rah . Brick -
{tease 0r<. -Ehe III•
13. GROUT: Depth AMateri 1
From l To .QC, Ft.(W lerek
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Youled Methgd
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
LDd''triEI.ef3Y CERTIFY T
CONSTRUCTION STAND
IS RIrRm.DWA t 0043 i tD(the Div
A�1�Y'i 46d6=7F1i�Y a p�5 711-
-HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THISS�RECO HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TI-IE WELL I DATE
sion of Water Quality, Groundwater Alien, 1636 Mail Service Center - Raleigh, NC
221 within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
]V, aturalRessources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL)NAME (print)J1,.1 ehardAlo.Orfr
WELL CONTn:ACTOR COMPANY NAME $aU. er Well 2nd Pomp
STATE. WELL CONSTRUCTION PERSIIT# I8 1 / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259524
Groundwater Section
�`tI/'�
CERTIFICATION # cQ0/Q
HONE # t3a3b47-7263
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 LOCATII'ON:
Nearest Town: tt ' / f ' P. II /1 I e countyliendation
Girard Pen K S
T �Fnngs d
(Street Name. Numbers, C nano i b-, Subdivision, Lot No., Zip Code)
3. OWNER:: r IUp (
Address Lf and PeoK„`3prings Pd.
(Street o Rowe No.)
lrcpnla G
Z J� aB7eo
62B)- w3-7475
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 8�-15-0
ci
5. TOTAL DEPTH: 05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e'
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use "" if Above Top of Casing)
8. TOP OF CASING IS 1. 4a FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.A NCAC 2C .0118. —�-
9. YIELD (gpm): I . METHOD OF TEST 1 I fined
10. WATER ZONES (depth):
- ynpDISINFECTION:
FEC 1. D SI ION: Type Amount
12. CASING: Wall Thickness
Depth l!� pia eter or Weight/Ft. Material
From 0 To_(pFt. OM o51WW21 pvcj
To Ft.
To Ft.
13. Depth Material
From
From
GROU I
From 0 Ft.l'onere.69
Topogr�aphic/Land setting
❑Ridge C3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box) -
DEPTH DRILLINGt DG o
From To Formation Dest ptiort'..,
rr 1
Meth I �u r�.ci
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:
0
5 Cr
LOCATION 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)kndersomlille taKe 025
South . Ta,Ce -the .Bolas Cr&k.
(EXif I). A4 bottom of exit -Fake.
a- r�ht an.ct o 'N.mi fie. R'rict
Rouse Oa -the le-R.
TRUCTION
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THtT 'OPPY Qf THIS RECQ&WHAS BEEN PROVIDED TO THE WELL OWNER
.IGNA"Fl.f2E OF PERSO
,Sj,11rittiLLkeerlgtniF4o1.-Die Division of Water Qualitj
27691J-1636 I smut Nir,( �iA1733-:221, within 30 days.
ONSTRUCTING THE WELL
DATE
'Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD ZSa S
1-3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grout cjr9
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(printt)ZahQ(ri,,rg�/e �rary CERTIFFICJAff I0
WELL CONTRACTOR COMPANY NAME e rker, Y' 1i laiui
STATE WELL CONSTRUCTION PERMIT# )S71 ASSOCIATED \VQ PER\IIT#
(if applicable)
(if applicable)
PHONE # tOL[J) 64%-1743
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
2. \VELL LOCATI N. ,,,,, ,,t
Nearest Town: C unty Nenderson
$oarulalloul UAdain ad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: O
Address .0, QX
cenderwhw ltle; to a 28743
City or Town State Zip Code `
828 )- 643-3W/7 (ten"
Area code- Phone numbe
4. DATE DRILLED �-01-02,
5. TOTAL DEPTH: Fj(iSr
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 1 •� FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord' nc rith I5A NCAC 2C.0118. --r
9. YIELD (gpm): L METHOD OF TEST 1 Imed.
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.
Topoggra ,hic/Land setting
❑Ridge LNSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location O
Iv
(degreeshninutes/seconds) r�1
Latitude/longitude source:❑GPS❑Topographra m
(check box) -_
DEPTH DRILLING I.RR
From To Formation Descron_-
137PuatP iltCPO (lier
11. DISINFECTION: Type Amount
12. CASING:
Wall Thickness
Depth Di�nieter or Weight/Ft. Material
From 0 To c I Ft.�Ot/fj 5DIt21 PVC,
From To Ft.
From To Ft.
13. GROUT: Depth nn -- Material
From 0 To AO FTWfeithe
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
PoMhod
ur,.�C4.e^ et
/
From
From
From
P -.
CO o
Firm n. iendersonuilie take Raw. 64East-
-to .-(ka Its Gap. Take a right a*-
earwallowRoad. Tare a Left on-
OI d afro r'dtee)C • Take- & mitt a±
./� Parcva,llow✓�i�oyur�taln %?oad.
e) 'flit ncUe. ` o ast Yk.t)bile
Lime_ on the WE -Fa sib an
-khe Iteit Slit) mile.
MARKS:
rN r°
ER IFY ''H
ONSTRUCTION STAN
rh_
>l'3tPdblIg TJq@,Ole Divi
k636 Phlonift400±119f 733
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND TH•T A COPY OF , HIS RECORD HAS BEE. "*VIDED TO THE WELL OWNER
GNATU - OF PERSON C
2� 9r'
UCTING 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 - Departtnent of Environment and Natural//Resources^]ur'- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print�QherL Eager- CERTIFICATION # (1( /.75,9/
UELLcoNTRAcToR CONIPANYNANMEBarKer tile 1l Qpd pump PHONE # 7-7.G3
STATE WELL CONSTRUCTION PERMIT# lei 1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259540
WELL USE (Cheek Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT N:
Nearest Town: Mond r.sonvi Ile County
leaderibn
(Street Nana. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 fllH, La Ll7 er
Address P.C.. is / 0 Li'
fiorie (Street or Route No.) iq�
city or Town State Zip Code
6345)- gq0—s 331
Area code- Phone mmmbe
4. DATE DRILLED 145 /2162
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES L7 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
q� (Use "+" if Above Top of Casing)
8. TOP OF CASING IS i • 3a' FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with L5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST —riffled
10. WATER ZONES (depth):
pump to ettlier
11. D S FECTION: Type
12. CASING:
Depth From To 73
Topogra is/Land setting
DRidge IfiRfope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ni nutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Ft.
From To Ft.
From To Ft.
IJiAT6-ter
Amount
Wall Thickness
or Weight/Ft. Material
SDkil in &
13. GROUT: Depth Material A Method
From_Q To 220 Ft. COnP1"2-It Vowed
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To
15. SAND/GRAVEL PACK
From
From
Ft. in. in.
Depth Size Material
To Ft.
To Ft.
-RUBY CERTIFY TI IAT TI
RUCTION STANDARDS, I
SlpNA—JR
-
iSubtnit iPOprigro ii, CO the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 1 boric No. [phone], within 30 da) s. GW-I REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include pi.9 road
numbers and common road names. co
From. Neltdtrsonviile -t*Ice44.
West -t-o Cummings Road • Take
a right tort *BigW'(IIow 1Z.ffad I
I s+ Ief+ C lv es Farm L 4
left when. if +urns -Fo event.
Cern{inue en gravel cto(Nft II.
Brar left oi+er second house.
'Drivt'en.ds of Property.
V =LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD H
AS BEEN PROVIDED TO THE WELL OWNER
27/ 70 JO
OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD 2 5 9 5 3 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%VELL CONTRACTOR (INDIVIDUAL) NAME (print) tRDberE Suficr CERTIFICATION # a /�/
.9
R'ELI.CONTRACTOR COMPANY NA91E�RrgC (l WeI rld j%llf' PHONE *0gZ6)bg7-7Z63
STATE WELL CONSTRUCTION PERMIT/0I e t 1 ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential fEr 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:f ender5DhW Ile. County gencberson
C OM Al ottrl-tai n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:tlf elirif Bathwell
Address 't. B Xn 40
(Street or Route No
NettdersGovi Ile , A 26192.
City or own State Zip Code
R28 )- b�is2(?1
Area code- Phone numbe
4. DATE DRILLED Mall"0
5. TOTAL DEPTH: I 2
O'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7 STATIC WATER LEVEL Below Top of Casing: FT.
qq 2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I- dor 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 TESTTimed
10. WATER ZONES (depth):
13y pithy) ?ASS-1/er
11. DISINFECTION: Type
12. CASING:
Topographic/Land setting
❑Ridge at1Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Depth Di eter
Front 0 To 27'
Ft(3t/i5
From To Ft.
From To Ft.
13. GROUT: Depth nA Material
From 0 To e20' Ft t'onreie
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.
Amount
Wall Thickness
or Weight/Ft. Material
Svg2.1 PSG
nn Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
FrontNevidersonvwe tabs 64 East.
Take a right on Xoward Gar/Road.
Tate o t FE on bld Sunset NW
11
Road. - Go Past Va;rka.ven B is'E
Chureh . F rs.e road on tJt
Cara-otutEain -fro "T Douse -
is lit- Corner on niht side;'
(.3
From To Ft.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S ' ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Sulrid Kf gtffi �f�)pivis)o 1 of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2716$hi�{r4}i'!' ..1, within 30 days. GW-I REV. 07/2001

ut*
(S
Pen dersonviile°, e c. z879z
City or Town State
L)- &,S5 -17907
Area code- Phone number
DATE DRILLED $-(9-O"L
Depth Di' gtgter SDP2I
From 0 To SRO Ft. 6/
From To Ft.
From To Ft.
13. GROUT: Depth A Material
From 0 To 2f) Ft. IOn(t}'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.
ober+930-l-er
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
VYELL. CONTRSCFOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# I D r 1 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
259538
CERTIFICATION # A 739
PHONE # RCS) (117-72123
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT11ON: I I
Nearest Town:71en7 ersonw I it -County Wender -SW
file i{-ouSP r'na.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
4
5. TOTAL DEPTH: 605r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q-
7, STATIC WATER LEVEL Below Top of Casing: FT.
et) (Use ""+"ifAbove Top of Casing)
8. TOP OF CASING IS 1. 3'� FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord' nce t ith 15A NCAC 2C .0118.
9. YIELD (gptn): 12 METHOD OF TEST 1 (YY ed
10. WATER ZONES (depth):
Zip Code
13y pump installer
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
PVC
Topographic/Land setting
[Ridge ❑Slope ❑Valley UPIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑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. r•'
Troviiiendersonvillt +oi4 b4
East -b Sugar Loaf R.o aid ero:
Method $FsaPoe ct Ivwhito Vinyl ek
Material Long drivewa
- hzuse Is -_
vis!ble fitote road. c;
16 REMARKS
DILIEHICEECILT A7 1 IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
pignut_ I ION S 1 ANDARp dND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I
2f ) ; J tru
a t^i `CNATURE OF PERSON CONSTRUCTING THE WELL DATE
St.411,uumffitypaktoAbelflivisio4n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2'411/EV(3,( lilt GdfM,1(9(19MF3-322 , within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 259537
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/y�(�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)'seen �n(�.�) t ikcCr CERTIFICATION # .(0KJ
\\'ELL CONTRACTOR COMPANY NAME ior�ker YV ell and )/Jilts PHONE #B�8)6g7-7Z63
STATE WELL CONSTRUCTION PERMIT# l8 / 1 ASSOCIATEEDD•WQ PERMIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential .Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Newest Town:J/endersonv(/le. countyXendersot,
Calloway Inane
(Street Name, Nu thers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Xeane& and cT&be 8u4rrClI
Address 333 d-&(0 ul a4 41Q/IP_
endersonvill
(treeet or Rowe(o.)
,
City or own State Zip Code
(p,ZB)-656 111Ql
Area code- Phone numbers
4. DATE DRILLED p—, OZl
5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14"
7. STATIC WATER LEVEL Below Top of Casing: FT.
/��� (Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) • O FT. Above Land Surface*
*'fop of casing terminated at/or below land surface requires a
accordance s ith 15
9. YIELD (gpm): a I METHOD OF TEST I I Med
variance in accordA NCAC 2C .0118.
10. WATER ZONES (depth):
'fay pwnp installer -
I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
From
Depth To 54 /t( FL 6 b Di eter or Weight/Ft. Material
SDkZi ill ri
281Q2
From To Ft.
From To _ Ft.
13. GROUT: Depth Material
From 0 To )Q Ft.COACY'CLt
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 sett ing��
DRidge ❑Slope DValley Wiclat
(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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Front )kendersonvilk_ L.tka lashEasi .
Turn rigirt Onto ..5 a -Loa Road:
to_mueruGo ko &low La & liefne Otte S.
Barn -it-me in - hedreu'eug.
Go Seati t -fo -(-he fop F 4're
hi(I. Brick aq cd brown .Paut3
Ony {louse o -bp o.Fhhlr
16.REMARKS:
F1R1EY bERVIF1EFH
ONSTRUCTION STAND
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
G ('
Tim.. Jet lfu�j (rd124b2
'NATURE OF PERSON CONS RUCTING THE WELL DATE
utipiuNtlym2a1Egttiolke Divis m1 of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
F 0MG56HEIGIf)ivN6.0Ff f733-321, within 30 days. GW-1 REV. 07/2001

From 0
From
From
13. GROUT:
From O
From
SCREEN:
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ri rlhard .Me racy
R'ELI. COSrRACTOit COMPANY NAMEB lla
Ker Wend mime
STATE WELL CONSTRUCTIONPERMIT# ! 7l ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259535
- Groundwater SectionlII
CERTIFICATION ##`✓/ 10
PHONE # gza) 07-720
I. WELL USE (Check Applicable Box): Residential Er—Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI Nww:II
Nearest Town:nendersom((llte
GP, ,4daereDri ve.
(Street Name,nbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .0CP
Address th Lo ► ewood L�lydr
St t
Hendersonville , fi(�', 28139
o.)
City or awn State Zip Code
B2B )J,47- Qq i 7
Area code- Phone number
p
4. DATE DRILLED Q 20—O2.-
5. TOTAL DEPTH: rjr
4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ir.-
7 STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use"+" if Above Top of Casing)
8. TOP OF CASING IS I.3J 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): _ld� METHOD OF TEST I 1 ni °t
10. WATER ZONES (depth):
6pump installer
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter
ty)�eter 5or tg Ft Material.21
To�3 Ft. �O
County b e-nderxn
To Ft.
To Ft.
Depth Material Method
l To ,'1(Ft.Entlerei0 red
To Ft.
14. Depth Diameter
To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Slot Size Material
in.
in.
Depth Size Material
To Ft.
To FL
16.REMARKS:
ONSTRUCTION STANDA
SI
SfIlAflil4Q�'6ibRtSGQbIQflk Divisi
A�k'I'�GN61� (8igF§-z4 v
Topographic/Land setting
DRidge ❑Slope ❑Valley LKhlat
(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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tleoad.
numbers and common road names.
From JJendersonville 90 out''X
a
�R
'Road. -rake a- retitle ah T !2
Tat a_ left aifcliflo(,i ooH=
�l' Tate a_ left 0...E 4dag�er T oo t
and- go -b 'Old. P�dp `"':
er (s-fln.
-the r�hi - l02 A dd jer rile .
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND THAT A CO
Y OJ THIS I'.CORD HAS BEEN PROVIDED TO THE WELL OWNER
c
3NATURE OF PERSON CONST
TING THE WELL
Z3—ez
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 da)s. GW-I REV. 07/2001

I I. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
To �.Jii7iiter
To 70 FL(o
Depth
To Ft.
To Ft.
WELL CONSTRUCTION RECORD 259534
North Carolina - Department of Environment and atural Resourceses- Division of Water Quality - Groundwater Section
\NELL CONTRACTOR (INDIVIDUAL) NAME (print) cjLeg ( I'er�,r�s CERTIFICATION #a 73c
WELL CONTRACTOIRCO\IPANYNAME�rt-ell anci w/1P PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1 / 1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential kr—Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATLION: II
Nearest Town:/-/ enderson n IIP� County 1- nd r on
ALiddle ForK Pond
(Street Name. Numbers, Corm-nullity,'I/Subdivision, Lot No., Zip Code)
-W
3. OWNER: nne�t U_ e(11ii
Address t 2 Box or`1/�
(S reet or Route No.) n
79z
City or Town State Zip Code
(B28)- (o2f- 4227
Area code- Phone number,
4. DATE DRILLED 8'z'oz
5. TOTAL DEPTH: 1551
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t9"
7. STATIC WATER LEVEL Below Top of Casing: FT.
q (Use"+" if Above Top of Casing)
8. TOP OF CASING IS 1•23 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accord• nce with ISA NCAC 2C .0118. tilled
9. YIELD (gpm): � METHOD OF TEST / IV)ICd
10. WATER ZONES (depth):
$r PAP installer
Amount
Wall Thickness
or Weight/Ft. Material
sogz; Pied__
Depth Material
To a0 Ft.P.nnerefe
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Size Material
FL
From To Ft.
16.REMARKS:
Topographic/Land setting
❑Ridge dope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic
(check box) ec�� --
DEPTH DRILLING WtyG ='
From To Formation DesGr ttiotr1/=_?
PMethod
oured
o
r
rV
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Front )Jendersonvillc rake 64
East -to Bat Cave.TaKc a idle on
,)dct.u.. 7y. Uo c2 miles -la At/oldie.
rorK k.oad on -the rin.t . G'o %z mile.
Material up txiddle rock 12octd- Crean(,
color house on the e.
S \VELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS Ry ORD HAS BEEN PROVIDED TO THE W OWNER
OF PE
ON CONSTRUCTING THE WELL iA E
d
S»bmit the orUnal to tQh, Ibbivisi n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2769t-0I WflGIONAL � E3-322
ASHIVILLE REGION L I.,
, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
ppNatural Resources' - Division of Water Quality - Groundwater Section ///���
ELL
E (printrRi
CERT
\WELL CON"1 R,\CTOtt (INDIVIDUAL)
NLAMEBar 1\e chard
hru Weil
Mflyap
PHONE I#ICATI)1,9
N # 7- 7Z63
STATE WELL CONSTRUCTION PERMIT# 1871 1 andASSOCIATED WQ PERMIT# ((ILL�997 7
(if applicable) (if applicable)
259533
1. WELL USE (Check Applicable Box): Residential Cir Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATr11ON:
Nearest Town: Hendersonv111e County Henderson
TurgeBea Trod/
(Street Name, NurnbersLrs, Coalmennity, Subdivision, Lot No., Zip Code)
3. OWNER: RIen t WOK.
Address Rt. t7 : ox 1 D IF
(Street or Rout o.)
i1endersonville KC 28792d
City.or vn tate
(628)-logy-38 z
Area code- Phone nuntbee, d
4. DATE DRILLED A-14—oz
5.TOTAL DEPTH: .Q05r
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ir -
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I. as FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15.4 NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST -rimed,
led,
10. WATER ZONES (depth):
By puny It1s niter
1 I. DISINFECTION: Type Amount
12. CASING:
Depth Dia�nJeter
From 0 To -a Ft. 6 it �j
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a0 Ft./nnl'rei"L
Wall Thickness
or Weight/Ft.
.sna ai
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valleyt
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic ni p _
(check box) `
DEPTH DRILLING12OG
From To Formation De iptioti-,
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 Front i1en.dersonville 4-ate 64-E.
Turn left on /toward Gap Road- •
6v Past Ze6 Corn Road and
Method
Poured
eXoss SnutLL bridge . Turn
rl
Material i1t pi Tar 'tee -"rail —
brick mouse fhe back
pat-fTailer.
Size Material
16. REMARKS.
AGRE( NA1t06dtothe
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, A 41 T AT A OPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
e_
SIGNATURE OF P
ON CONSTRUCTING THE WELL DA E �—
'vision of Water Qi:ality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectioniory
WELLn/ Q WELL CONTIEACI OR (INDIVIDUAL) NAME ((priinft)Robpr+ Bu -Jcr CERTIFICATION 4273 /
%VEI.L CONTRACTOR CO\IPANI' NAM Ega ) �jf Well and r tul0 nPHONE # 991647-7Z63
STATE WELL CONSTRUCTION PERMED/I S (I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential IVMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other Cl If Other, List Use
1
2. WELL LOCATION: J/
N rest Town: A " L e /,/ 1 1 County $ r"%'((;etsof
ereQ Ohareh '.ad
(Street Name. N!uu��tubbers, Community, Subdivision, Lot Nrs
o, Zip Code)
3. OWNER: g I�s. d S ,i M,i�(
Address O QAAU/i nod
(Stre a or Route
e2i.3 ^ity /„T'/4" r2445
Zip Code
Area code- Phone numbetb
4. DATE DRILLED p"I3-02J
5. TOTAL DEPTH: 130 f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS l •°a'3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (goal): 25 METHOD OF TEST J 1•{'J1
10. WATERZONES(depth):
P
I I. DISINFECTIONMa/ter
: Type� Amount
12. CASING:
0Depths
From To
From To
Wall Thickness
Dip Bier or Weight/Ft.
FL 5DIQ2/
Ft.
From To Ft.
Material
PVC.
13. GROUT: Depth Material Method
From i7 To_e21_ FL Pa tefert_ rbu1Md
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
259532
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 10Kr
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic in-ap
(check box) tV _
DEPTH DRILLINC.4.OG,
From To Formation D€ riptrori-f
p
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.
Front Need crsonv ilia Lake.
c Road . Tate a left &t
Lii+l River/1load , 7wrn Wight
On Berea. @KUrah bad. Lot
Material is on --I-he l•ek a p pro'tci �f
Pi) yards jus-L pasbrre, er /
16.REMARKS:
cWD IER£B'- C�iTI4NAl THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANL�A20, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SEP j 2 92-12 J -� idhZit-f� C'J ? � I
SI ' ATURE OF PERSON CONSTRUCTING THE WELL ATE
SHOUTIDVIATfili0.6GTIONtly Did sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
AS}if0141{ kcII0 (PF(([)1G)'Idb 221, within 30 days. GW-1 REV. 07/2001

STATE \YELL. CONSTRUCTION PER,\IIT#
WELL CONSTRUCTION RECORD
259531
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth -/u.c l'ro ry CERTIFICATION it 0.008
WEI.1. CONTRACTOR COMPANY NAME B orger We II and bump PHONE # 6 1 7263
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town
(Street Natte, Numbers, Co
3. OWNER:f,
Address
et or
LAWS/��(}i� �rr�{,(,[.[atoutc No.
We, 40 / ye1..,
CiryoSw Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: qz
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [5'
7. 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 easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ,/
9. YIELD (gpm): ,36 METHOD OF TEST S/201l,.J
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 60 Ft. 6 98
From To Ft.
Front To Ft.
13. GROUT: Depth l� �A/ Material
From 0 To 40 Ft(i17(CALte.
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 IB) fat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Front To Formation Description
0
ry
M
LOCATION SKETCH N c
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
5S'DR 21 PK-- Luca_ del ,ccjtzc -�A
2L5 6 4- L��a�a rl7a 0
goad . Jab— a_ t he_ S
.tairy ix, Lt2oad• J a "
yt2aat let,ct 9foad
7AtticiatiP
Wad 8-A-• lt
Method
"tun el
16 REMARKS
T4 TrtAr FE $ WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NSTRUCTION STANDAR S, 4v.D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SFP 12 2002
SIG '1ATURE OF PERSON CONST
— h., —en—
CT]NG THE WELL DATE
SulirsE dWt 4gEfteSE&TIOiJDivisio I of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
,riEYAIlkFi)Kalf)I/ ,94fl -zz7 within 30 days. GW-I REV. 07/200(

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and � Natural1Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)rI chard AUc Crary CERTIFICATION it .2010
WELL CONTRACTOR COMPANY NAMElin rKrr Well and Pump
STATE WELL CONSTRUCTION PERMIT# 1g'/yI ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
259530
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential [9"--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT ON:
Nearest Town: enderSooviIlt County Yenderson
alQ Far de 'Driye
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNERIIGO and LlsaFox
Address q Farside -Drive
(Street or Route No.)
�2ndersovlville , NG 2873q
City or Town State Zip Code
($2S)- 6A+4-1655
Area code- Phone numben
4. DATE DRILLED D-II'o%L
5. TOTAL DEPTH: IOSI
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ur"
Topogra hie/Land setting
❑Ridge tope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: FT. fv
(Use "+" if Above Top of Casing) Cr)
8. TOP OF CASING IS I. r� 23 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 Tl1Y1I°d
10. WATER ZONES (depth):
By purnpp iftsi-omor
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth s Diameter or Weight/Ft. Material
From D To ,1•5 Ft. W/13 SION21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a0 FLSA one rrk°-
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 Et.
From To Ft.
Method
Paneled
n
J
LOCATION SKETCH t--
Show direction and distance in miles fronrat leapt;"
two State Roads or County Roads. Includfhe road
numbers and common road names.
From 1lend.ersomi I Fe. +ate Ka.nuuqa.,
r2oad . T/ L On. Li ►tla River /2oacl
and so out- I n i Ic . lig ovz
Berea_ Gih
a Wku.rch Road. Go approx.
I Va. rrti Ies . Oft -E Iue dc
Estates wk.iclz is bib/ idaq t vtvc.
TfL on I-1-t)li Dr. g.7
ht., and_ a�b 7
l2 On Far*-idcrDr,
Gt yid -b lot or tj .
16.REMARKS:
liRIDBYVEP IF
LUIVJ I KUL 11UN S IA
1 2 2092
GRt1lJNUWHItM tt'$11)11'o the
ASHEVITIVFM 01dbpn©Pi•CF219)
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS A` D THAT_A C9PY OF THIS RECO S BEEN PROVIDED TO T� OWNER
SIGNATURE OF PERSON TRUCTING THE WELL ATE
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
North Carolina - Department of Environment anddqt/t�•�atural Resources - Division of Water Quality
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) I\I chard Atc ary
WELL CONTRACTOR COMPANY NA\IEEa�rKer Well and Po m/)
SLATE. WELL CONSTRUCTION PERMIT# I B f I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2595Z9
- Groundwater Section
CERTIFICATIONpp7#//��.�(/Q IIO /�
PHONE # szei eq /— /z6✓
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tow :Hen rsonvilla County �.
Thel-Es ` idre"Mond 1-nt ci �n
(Street Name. Numbere, Community, Subdivision, Lot No., Zip Code)
3. OWNER: oh �d
Address 4-20 oat
Ffll�2y
Venue
�JUIIIVQVL iIet�TRoetefNo J� 01N4Sz
Cityor Town State Zipe
AM- -f A-2 - RRo6 !load tinders)
Area code- Phone numb r
DATE DRILLED �13-02
4.
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I •�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): % METHOD OF TEST I I med
10. WATER ZONES (depth):
$y pump installer
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dia,n) eter or Weigh /Pt. Material
From O To_3 a_ Ft. (n VS 5D1421 PVC
Topographic/Land setting
r�n,s' ❑Ridge LNslope ❑Valley ❑Flat
I iler&ese Ve (check appropriate box)
Latitude/longitude of well location
From To Ft.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft.
13. GROUT: Depth n Material Method
From 0 To c 0 Ft.)'onerrete- Poured
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:
0
m
CD
LOCATION SKETCH o U -
Show direction and distance in miles fromiat IeaSn
two State Roads or County Roads. Include'thc r6ad
numbers and common road names.
from Aendersonvi Ile take H • 25
toward Greenville .Turn ri orl
Green River Road • G-o roty ma#e y
6 nu Itrs. road ends. tun Ief+
and.go -r) tvp of mountain. -bear
I4ft CWtd-ta-ke +tit first )e[t.
L.0& # 9 is on the r kt.
SEP 12 2092
GR
ASHE
I IliEiY,REF INS T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
P f )S, AND T AT COPY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
J SIGNATURfi OF PERSON O nAT
RUCTING THE WELL
the f ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
onifThe
pHtf19) 7;3-3221, within 30 days. GW-1 REV. 07/2001

257277
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalReesoururces/- Division of Water Quality - Groundwater Section
WELL WELL CONTRACTOR (INDIVIDUAL) NAME
(print) Koller+ 3u1-Ier CERTIFICATION/#1 �Af /y29
\VELA. CONTTRACTOR COMPANY NAME .L.LeC/�yKcr W'e%%� Jump PHONE # t$23b�i (-1 L/,7
STATE WELL CONSTRUCTION 1'ERNIIT# 1 / 1 ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential B-Municipal/Public 0 Industrial ❑ Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
crest Town: n County s '/ I 'AO/
lairStream diUtsioh -�ri+- /
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r dor) Garret.)
Address PO ol(- 1341
fOWQh (Sheet olLute Na.) 2 2'29
City o Town State Zip Code
9ql- 42Q?
Area code- Phone number
4. DATE DRILLED 7 / 3 /02-
5.TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS • 33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accorda c with 15A NCAC 2C .0118.
9. YIELD (gpm): 12. METHOD OF TEST`lmed
10. WATER ZONES (depth):
3Y pump installer
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth �1 Diajgter
From Q To 7a Ft. (01 QJ
From To Ft.
Topograp ic/Land setting
❑Ridge ope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation DescripYt_bn
o c
crl
t
0'r_
rn.
cr
c_n —'
9
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
or Weight/Ftl numbers and common road names.
1271 seriaFront )4endersonvi Ile., take
ldcuy • lAlese -It ri9A-t en
Eric/arta 2Jod . in a -
r,- g on Turnpike. Road .
e Ief.&on Chi Pole.
Erid9e. R.oa.d • Co Ciitolct
31if `vJ/ . Roper is oh `l e
♦7 q . eG_eelect/shwa)diucsioo
16.REMARKS: Leb 1ln
From To Ft.
13. GROGL Depth Material Q Method
From To cQO Ft.CpYere 'turfed
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.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I1?CO { UL I rains I Af DAit�i,
-1-1;iSubmit the original to th
L27699-I636 Phone No. (919 733-3
yr,,i.i^ cF Il'k
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-1 -
ton L
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sion 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 N tural Resources Divis'on of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)itonneth .l( ureic CERTIFICATION#n 8
WELL CONTRACTOR COMPANY NAME s�Ker Well and dram PHONE #R. 647-72 3
STATE \\'ELL CONSTRUCTION PERMIT# l / / ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
2r'7ZeR
1. WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 if Other, List Use
2. WELL LOCAT AN
Nearest Town: : / I ' I / Co4mt !1 ./ /
Vli'Lt[n a P� � eA ry ►,/
(Street Name. Numbers, Conn pity, Subdivision, Lot No., Zip Code) /
3. OWNER: J5b
Address
Zileconia_'sYti
No.)
as
42gity OD)
4aS ate 311 Zip Code
Area code- Phone number 0z
4. DATE DRILLED %
5. TOTAL DEPTH: _/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (Id'
Topoggr Ic/Land setting
❑Ridge IldSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG c
From To Formation DescRtiote
CJ
01
io
7. STATIC WATER LEVEL Below Top of Casing: FT. r
�(Use"+" if Above Top of Casing) — "r.
R TOP OF !`ACrAf(_TQ rr Above _.. Surface*
tz:
c-)
*Top of casing terminated at/or below land surface requires a CFI
variance in accords e with ISA NCAC 2C .0118. CI-1F-,
9. YIELD (gpm): 1 METHOD OF TEST ilmed
10. WATER ZONES (depth):
PUMP
(nstauer LOCATION SKETCH
11. DI INFEC ION: Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ^ Qta e,(er or Weight/Ft. Material numbers and common road names.
From 0 To a5 Ft. (0Ifi snaz) PV C,from �Ienders.thui -Iv
�f� ,°
From To Ft. M �5 �wth_ TU Greer
From To Ft. � �, J T^ v
13. GROUT: Depth Material n Method ?• e,/ r r0(.N � �a_ke. a.- r.il•� From 0 To�Q_. FL C!)j'j�l"�"� PQUY�II VC' � y`/l'}rL
From To Ft. Oh ea -bin erect toad.
14. SCREEN:Depth Diameter SlotSizc Material
FromromTed l.e_Oh - le- t To Ft. in. in. ci/lla-in
From To Ft. in. in. 15. SAND/GRAVEL PACK1^M 1 ky
t0U-U1 , a 1e- le F
From To Ft. Depth Size Material CM Comet" tea 4o net°
From To Ft. dx)Ve ,aj on -Lit le:FFL.
16. REMARKS
T DO EIEEB CE'RTIEY
COAT TP13C QDrST ATiI)
I J1
-Submit-Nle-or pt_na1-te.the Di'
Z7699-1
,634 Phuhe Nd00.19) 733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER /
SIGNATURE OF PERSON CONSTItUCTING THE WELL DATE
ision of Water Quality;trourfdwater Section, 1636 Mail Service Center- Raleigh, NC
322I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WEI.L CONTRACTOR (INDIVIDUAL) NAN (print)
WELL CONTRACTOR COMPANI' NAMED0Kei
STATE WELLCONSTRUCTION PERMIIT# J8 (yJ
(if applicable)
2572c87
atural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION ///
#J_
0013
PHONE # `1 /-7zh3
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural IA"'
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
N crest Town: County/let/2
III I o*jt1 oun¢ain old
(Street Name, Numbers, Con mnunity, Subdivision, Lot No., Zip Code)
3. OWNER: Of 5tofeO and (WiUion �nloe)
Address µ 2,
Aeryie�'SorNl I rP r R y ,o )
y°kTS-ln°5l
Area code- Phone number ��3t
4. DATE DRILLED t0 2b—OL
5. TOTAL DEPTH: 0 f ,,,,/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO yc
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I 'ZD FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord of vith 15A NCAC 2C.0118. —�'
9. YIELD (gpm): �Z METHOD OF TEST I (filed
10. WATER ZONES (depth):
13y pump irstLler
I I. DISIFECTION: Type Amount
12. CASING: Wall Thickness
From p��- Di eer �rfig ht/Ft.Cteel1
Topographic/Land setting
DRidge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
our) 21n Qad Latitude/longitude source:❑GPS❑Topographic map
as7gz
Zip Code
Depth
To Ft. co
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.dOnefete
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DEPTH
From To
PMethod
©(
(check box)
DRILLING LOG
Formation Description
5s,
L
cri
m
c.
LOCATION SKETCH (*a :is
Show direction and distance in miles froiCsat leas
two State Roads or County Roads. Inclu e�he rESd
numbers and common road names.
From IJendersonvi Ile. +ale
Of East-fouia.rd ELneyvirle.J
Turn right on Gi I I la.rn.Atounfrun
Road_ . Go etlactrE 1 O ywci-ds -
ricLht on rpi l a . Rout -than
Thad. `(ro -iv i y -Lerseetion w i-Fh
J[orLh` ,id jtZoa.d — property
j s on `jtt be .
16.REMARKS:
Submit the original to
A t EVH.LE REG /?L OFPI('.
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
IGNATURE OF PERSON CO
TRUCTING THE WELL
n Z(-0 2-
DATE
e Div sion of Water Quality, —Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and atural Resources - Division of Water Quality - Groundwater Section
l
r
WELL CON'I'RACTOR(INDIVIDDAL) NArMyrEL (print) y
WELL CONTRACTOR COMPANY NAMEEar Wel and h.L r`/ PHONE #
STATE. WELL CONSTRUCTION PERMIT# 11371 1
(if applicable)
257285
or ar
�%1Qrd�UleC�rar CERTIFICATION# 'D
ASSOCIATED \VQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Tr-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA IDN:
N arcs Town e}'i rsorNi Itt County HendersonHendersonHenderson
/IA�'tA 'Woo )--idd_r)*LIbio ►
(Street Name, Numbers, Community, Subdivision, Lit No., Zip Code)
3. OWNER:}terry ' ld Ifs
Address W(J W004 Y-4an1
(Street or Rout- No.)
aq
4.
5. TOTAL DEPTH: OS
6
Cityor4own 55 te Zip Code
Area code- Phone number�/
DATE DRILLED 4lI��OZ
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IfiZ
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 (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' cc with 15A NCAC 2C .0118. ,�-�
9. YIELD (gpm): METHOD OF TEST 1 I I71ed.
10. WATE ZONES depth):
Si amp nsf-rUPr
EC ION:
Type
11. DISINF yp
12. CASING:
Depth l �igryAer
From 0 To 35 Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft.
Material
PvC,
Front To Ft.
13. GROUT: � Depth q �M,ateeriial (t p�Metho
From 0 To 20 Ft. C[J/1L'I tlt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land etting
❑Ridge ❑Slope rt<alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
a c7
;:jF,i
c-)
Cr, t:
•
Cfl
LOCATION SKETCH c
Show direction and distance in miles from at least`
two State Roads or County Roads. Include the road
numbers and common road names.
Front idevidersovlNi Ile. t.0-
04-Jforfh. T(R at C'-f?ll ari
?oai. L on% &L4arLoaf
Go1/4{ mile. and earl ht
on Na.mrrier RoocL i /R
Low Gc� A+ amst of hi l l
take. if l" ofth /V VUUt l
Ii ddren p 1 • en5S On
Arches�e Nuroad • Peep '�
I 9 HERE Y CERT4F
FsrGtk'@&?g��i�
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, W LL
SAND THAT AC COP OJrT RECORD HAS BBEEN PROVIDED TO THE W L OWNER
Tr( Kla
•
IGNATURE\t9F PERSON CONS" TING THE WELL
naam the 0 ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
i J t 19) Y_3 3221, within 30 days. GW-1 REV. 07/2001
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N. tural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
(printt))/
WELL CONTRACTOR COMPAN'V NAME Sevier
STATE WELL CONSTRUCTION PER%IITN /87/
(if applicable)
?57281
Division of Water Quality - Groundwater Section 6
CERTIFICATION
/µ�7 /.(q/.Q/ p
PHONE H 62 697.72
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential !r Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town9S!end9r_ra Y/ /L County efdc%22/7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
•
3. OWNER
Address
1
(Street or Route
d%adefZinll_e
(fi i `} or Ti`S-3gt7B
Area code- Phone number �1 p
4. DATE DRILLED / " O C2-
5.TOTALDEPTH: OW
/9
Zip Code
Topogr is/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO R
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 accordancgw' h ISA NCAC 2C .0118.
9. YIELD (gpm): /.7 METHOD OF TEST-72O7 '
10. ATER ZONES (depth):
,Ael' Pump i22,Stet fer
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth i ter or Weight/Ft. Material
To Ft. Diet/
N
A
rl
LOCATION SKETCH c-
Show direction and distance in miles frol> !nerd':
twoState Roads or County Roads. Include the rtu d
numbers and common road names.
From 0 !OS P a5 pf� Fron ,4le4ders07u/!/e ea
From To Ft.
From To Ft.
13. GROUT: Depth
Method ,-
,r
/. 6 9 I. K oa
��rr
Material oad • 5 hci 761
From 0 To 0l0 Ft. OZ'1enee- 0/freci /_ j1 , n /
From To Ft. lr..5 nu crOCer /- (yp %/ram
14. SCREEN: Depth Diameter Slot Size Material - // _ ;t� .�T east ?,•�
From To Ft. in. in. l'f(�- and
r//,//
From To Ft. in. in. S f **h. a/ cu- a,oce4f 1 Vittben,
15. SAND/GRAVEL PACK: 7 fe_ /, - drive On lice-
Depth Size Material 9 il � ' /j C� -
From To Ft. (LOX �?I) /S TKJt-
From To Ft. - of „/ -C
16. REMARKS: UI
IiLER BY CERTIFY THAT i1Ft'
STR CTIGN STANDARDS, I4
Jul
Sub nit the original to the Divjsion
2769 )il AN PCQ21a No, (9I9) I' 13-3221,
i�Sur1 "£S
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPYOP�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1/NKF:PER f' l.i-/Z -Oz
TURF OF PERSON CONSTRUCT G THE WELL DATE
f Water Quality, Groundwer Section, 1636 Mail Service Center - Raleigh, NC
ithin 30 days.
GW-I REV. 07/2001

Front Mendersonui Ile. -Lake (#
64E. Prigs Ed.neVv i Ile- Gen
Method 31*vrt %•5 nri Ies to Gill 'tan.
"LIMA t.{tiv,. F2d. Go 4.4 miles +o s4vf
Slot Size Material
i nSJiLj ei . 11/, • Go LLh• A4-orne-
in. L .fist C�.kuxeh - TJL beside;
. I
Fr.
rr
0
Material
ASR169@tt6 rino,lierNfl.Fptv 7333221, within 30 days.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an atural Resources - Division of Water Qual
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�/ Ir�lcCro
WELL CONTRACTOR COMPANY NAME BariCer Weil £Ln-d Pi
STATE WELL CONSTRUCTION PERMIT# Ie 7/
(if applicable) (if applicable)
y
257280
Groundwater Section
CERTIFICATION # (QO10
PHONE # Ir 10) 6q 1 - [24')
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential L9---Municipal/Public ❑ industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: I {end rSDf 'v file County I- ende-rson
l i fle 0-rtoee rkoo d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:5k1r etiro
Address I 'Elrod rive_.
Ctonse /1reeIror RouteNo.)
9L/- 5
(04 )-
City or51rATown - LP; 17 Zip Code
Area code- Phone number
4. DATE DRILLED
5 TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12/
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I • 3•Pi FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. —�
9. YIELD (gpm): I METHOD OF TEST I I wed
10. WATER ZONES (depth):
eby pump jpgfnlfor
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From 0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To
15. SAND/GRAVEL PACK
From
From
Ft. in.
Depth Size
To
To
Topogra /Land setting
❑Ridge Nagope ❑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
Amount
Wall Thickness
Depth Diameter or Weigh/Ft. aat/erial
To Ft. (/)l/ .5DQ21 l'Y�a
To Ft.
To Ft.
Depth 7 Material
To an Ft. Conerefe.
Ft.
Ft.
PO
—Art
LOCATION SKETCH
Show direction and distance in miles from at least —
two State Roads or County Roads. Include the road••
numbers and common road names u'1
-The Leh. 5105 l ell- 4o l r1t• « road .Tf L o uer (.Older St✓wt2 m •
To 1✓e t.nd driueuxcy on he (�f.
Creek R.
16. REMARKS:
—HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
LAND THAT AOPY•OF THIS I CORD HAS BEEN PROVIDED TO THE WELL OWNER
c
SIGNATURE 0 PERSON CONSTRUCT G THE WELL DATE
u le e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

2572'79
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/�
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print)1` I chord AeCra 7 CERTIFICATION�.##2D lo�j
\VELLCONTRACTORCONIPANVNAME13arfkyer Well and Am*
PHONE # aii6R
STATE WELL CONSTRUCTION PERMIT# 187 I ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential M'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI..//11N,,,U:,,fPi'� Nearest Town: CIlor1)M n )/ � Couty)Jenderson
iacn'Roa d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: •
4EriC EII(O±
Address 111 Onteen Thrive
)knders�rnrrl�t Ranr') agygoZ
City or Town State Zip Code
(82E3)-(tar asps
Area code- Phone number
4. DATE DRILLED CO— ill —Oz
5. TOTAL DEPTH: 2261
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ire-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I ' �3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords cc with 15A NCAC 2C .0118.
9. YIELD (gpm): Q METHOD OF TESTTinted
f W1ed
10. WATER ZONES (depth):
15y Pump instater
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth �Dia'�ee er or Weight/Ft.
From To 5 Ft. la I 5DR2I
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To (W) Ft. CAnerek._
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
Material
)
Method
PourS
From To Ft.
From To FL
Topographic/Land setting
DRidge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
C71
LOCATION SKETCH
Show direction and distance in miles from at IcaS':
two State Roads or County Roads. Include the road
numbers and common road names.
0"
Front Nendersonuilk tale_
(0 4- West 4-05-oathi�
Take cc liNft on se)
Material ?oo-d- • lake_ t t- on
BroyierL Lane -fv aUJ-cQ $Or.
Lc* is Ott the side.
c
ti
16.REMARKS:
E IODIfiRltip ER IF
G�4ttH #te wilfl4b the
atiHlR4i7+Jk.nR,nr��jMc?? 19) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDEDry&'f HE WELL OWNER
C_
G ATURE OF P SON CONSTRUCTING 'ELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
/� /�-
\VELL CO.NTIL\CTOR (INDIVIDUAL) NAME (print) 1 oh/J/iy rrl ilil eCrary CERTIFICATION # s2M
WELL CONTRACTOR COMPANYNAME 'g arKrr �Y el/ earn /-Jl PHONE #eat LAF1-771,3
STATE WELL CONSTRUCTION PERMIT# 187 I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2565,53
L 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 LOCATI N: ,,(
Nearest Town: enders. nvt //ecounty Henderson
Foilin� rest oad
(Street Naine ambers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:, herm /uPY;
Address 45 Zabs ('reek Rd
(Street or Route No.)
2,rconin jfO. a87g0
City or Town State Zip Code
62)3 )Ana
Area code- Phone numbe
4. DATE DRILLED uo-2i — oz
5. TOTAL DEPTH: 2.0 I V
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 • 33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordappce with 15A NCAC 2C.0118. ram
9. YIELD (gpm): iJ METHOD OF TEST—1 I med
10. WATER ZONES (depth):
p I Vtst a1Ler
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diam •t r or Weight/Ft. Material
To 7$ Ft. /o'% 5DR21 (PVC,
From 0 •
From
To Ft.
From To Ft.
13. GROUT:
From 0
From
14. SCREEN:
From
From
15
Depth MaterialMethod
To±ZO Ft. LI,QYIPnfL e, Poittrrd
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
LJl IDO HE
�VCON tRQCTION sl-A
rt
Topogra c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
C - —
N
N
—
N c
t.:
rr3
o 6
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From )4 endersonv i Ile- toice 25
South -to Exit one. - Bobs Creek
'Road .Turn riq ht oLt enct_ of
es- t • Go 3 rr`fles -ta Fa Ii y
Creed. Cam 'tic, which i
010 -the_ rlq fit• I urn up Ganip
Road - p °pert/ is IX' 0n'1 -the
1 �Jl
L Submit the
loriginal 'fro the
GF 0P149,,h191lttt' SFCGi'e— o. (919)
ASHEVILL.E REGIONAL (VH' E
T THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
DS, Ab ) THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTR
—
ELL DATE
Division of Water Quality, Groundwater tion, 1636 Mail Service 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
r�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�Oberi 19uf ler CERTIFICATION #f(7,�9
WELL CONTRACTOR COMPANY NAME Enrryker We 11 * Pump
STATE U'ELL CONSTRUCTION PERNIIT# l Yi L I ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
256552
PHONE # 9.Gdl 447-776E7
I. WELL USE (Check Applicable Box): Residential NeKlunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Ne1arFst Town Count
PCIDZ�O/�Sf—
(StreettN.tamumbers, Conunun/tyy,, Subdivision, Lot No., Zip Code)
3. OWNER: 11Rre WIT!
Address �f ✓uorIQY) Lei Ve.
(Street or Route No.)
iknderspnvll(t- tie, 28741
City r Town State Zip Code
)- &Q5-(1Oo
Area code- Phone number �I
4. DATE DRILLED 10 -A4 -02.
5. TOTAL DEPTH: (055 f - /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L!Y
7. STATIC WATER LEVEL Below Top of Casing: FT.
v� (Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) • d- 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): v 2 METHOD OF TESTTi ed_
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.
Topogra is/Land setting
blentPson ❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLINGc6OG c
From To Formation Deyaoptioo
t_
pump iltsb lier
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth/ Q
From 0 To 10 (J
From To
From To
From 0 To l
13. GROUT: Dept Material P Method
Breit
From To
14. SCREEN: Depth Slot Size Material
From To in.
in.
pia(9eter or Weight/Ft. Material
Ft. to /P� SD eat PV&,
Ft.
Ft.
Ft. NW/AS—
Ft.
Diameter
Ft. in.
Ft. in.
From To
15. SAND/GRAVEL PACK:
Depth
From To
Size Material
Ft.
From To Ft.
r—
IV n
P0
1V
crt
ac.
From k&ndersom Il' -
£truth area -to KQ.n.c.tija-
'Roa.d - Go 5.1f mites -f o
K a )orest oft -the rigkt
LoE 2.2. On e.rbl-, -'
16. REMARKS:
I DO HER FRY CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
QbN9 tI STI W $ A DS, ANDT AT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c Z -0 L/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original o the i ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2,690 163E Phony No k919) 3 22I, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

256549
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - ivision of Water Quality - Groundwater Sectionh
WELL CONTRACTOR (INDIVIDUAL) NAME (print)TlICh7 Yd-..}4eCraiy CERTIFICATION it L oio
WELL CONTRACTOR COMPANY NAME ROYYPr Well 4- amp PHONE # 824647 —4263
STATE WELL CONSTRUCTION PERMIT# 187 l
(if applicable)
ASSOCIATED WQ PER\IIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Ft Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: A ' •
I 1 ers. / le_ County
Lit.* - 23rl • bal. Farm oarl
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4'/pf l
Address ey
irseS Sreetor RteNo
�Lll�
a g in)
(92s)- Sql-41 W City or Town State Zip Code
Area code- Phone number,
4. DATEDRILLED (—IB O2-+
5.TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO re
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I ' i i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordayre with 15A NCAC 2C .0118.
9. YIELD (gpm): aL. _ METHOD OF TEST Tided
10. WATER ZONES (depth):
I1. DUNIFECTIO' Type
12. CASING:
From 0
From
From
GROUT:
From C)
From
14. SCREEN:
From
From
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lyrlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) C
Latitude/longitude source:❑GPSOTopogr tic frOp
(check box) tv p
DEPTH DRILLIN(rEOG `
From To Formation DeIcriptio S7:
IVr.,_
Amount
Wall Thickness
Depth `t iseg r or Weight/Ft. Material
To a1Q Ft. (p ( O
To Ft.
To Ft.
13. Depth ateri �Ma
Sokal v4c
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
Method
Yu Ltrel
15. SAND/GRAVEL. PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
-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.
From , andersenui Ilt -take.
A IQ I -b tACDowell Pd.
Go I mile 4o Bradford
FormrnKOl4. bot 2, OTC.
r3k
DLt' (n\ I ,D�'?�lG��`'� H R�C1gpY OR
L' `n C(Ir3STp1 irrtr}pl.c§
I1�
ISubauttilQ-440�q:xhl to tte Division of Water Quality, Groundwater
G nji � i1t63 1 iallo. (91
-
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF T RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
) 733 3221, within 30 days.
'01
ATURE OF PERSON CONSTRUCTING WELL
—2 -az
DATE
ction, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and �yrNatural
_Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l Charcd '�/ry��/'MX/�/�� n CERTIFICATION # cloy)
WELL CONTRACTOR COMPANY NAME T2) rkQer l -QA 1l •y/(jafter Well ilitny, PHONE # )bQ1-7u,3
STATE WELL CONSTRUCTION PERMIT# 18 1 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
254102
1. 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 LOCATI N:
Nearest Town: Count __ h
ever, on k, a diutsinn-7i L D
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Orel and m ✓rLWC ! I
Address 1551 oil14 !I nad
(Street or oute No.)
ender-sonvlll� NG 98792_,
City or Town State Zip Code
(22B )4CIS— W73 7
Area code- Phone number
4. DATE DRILLED 5-10-01+
5. TOTAL DEPTH: asf
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fdr
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" i C Above Top of Casing)
8. TOP OF CASING IS I.33 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): 10 METHOD OF TEST Timad GJ
10. WNFER ZONES (depth):
�y puirp ii'ts aUvr
Topographic/Land setting
❑Ridge DSlope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds).
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C_
o
�
me
c
1,1
CJ1 —�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Frovrt Fefde.
ersonUi Ile +Qk
DI I FEC ION: Type
yPc
12. CASING:
/-� To Depth
l3o
From 0
From To
From To
13. GROUT: Depth
^O
From V To K
Amount
Wall Thickness
Di meter or Weight/Ft. Material
Ft. (of 14 .186 s}e.c►
Ft.
Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
From
From
16. REM
Material
Ft.s' onrnPle
FL
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Method
Poured
a5 .Turn r9k± onto Xorth,
alai n- Street . Turn I ef-i- on -
Queen Street. Lot is on,
Material
The riht - el-eate field.
OUeriooD
Size Material
Ft.
To Ft.
rPI t\
, il Li
CONSTRUCTION STA�
p
I
cr -r'
GR8Uhiiiit/ilia Otte. Urt.i the
SHEij
',r-1.'„t'
T THIS WELL WAS CONSTRUCTED IN ACCORD • NCE WITH I5A NCAC 2C, WELL
DS, A. 1 HAT A COPY OF THIS RECORD BEEN PROVIDED TyHIE WELL OWNER
SIGNATURE OF
ERSON CONS
�--0 —
UCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

Li
I
I
•
('rsuhntit the original to the vision of Water Quality, Groundwater Section, 1636 Mail Seniee Center - Raleigh, NC
"' 2\1699-1636 Pheiic Nd.049) 73 -3221, within 30 days. GW-1 REV. 07/2001
252461
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resour*Sr-
c�es - Division of Water Quality - Groundwater Section
p�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (chardJ/��( S �r�y�.•r CERTIFICATION # dl //l7/� J
WELL CONTRACTOR COMPANY NAME J cii /ter Well and Fa (p PHONE # ' �.�itQ.i
STATE WELL CONSTRUCTION PERNIIT# I a ' ( / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
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 LOCAT
N arest Town
Locust &rove oad
(Street Name, Numbers, Community, Subdivision, Lot
No.,
Zip Code)
3. OWNER gobed t Pak c:Q.
Address 't'• 6/ OX(St/
Een der-sanvi ller R Vc- a879z
County
City r own State Zip Code
��' )1pko2167
Area code- Phone number //
4. DATE DRILLED H"" 4-0 ^2
5. TOTAL DEPTH: as
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t-
7. STATIC WATER LEVEL Below Top of Casing: FT.
,'j (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /• -•frO FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord e with 15A NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TEST�IImed —cr1.v
Topogr hic/Land setting
❑Ridgepe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
10. WATER ZONES (depth):
Lunt installer
NFEC�flON: Type
12. CASING:
11. DIS� Amount
Wall Thickness
Depth �1 is eter or Weight/Ft. Material
Jdj From 0 To :J Ft. (0I� gSQ2.I PVC,
From To Ft.
From To Ft.
13. GROUT: Depth4 Materials,
From O To-&(L�/� Ft aerPle
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
rouitea�
Slot Size
in.
in.
Mated: I
From To Ft.
From To Ft.
O
N
A[
W
LOCATION SKETCH CO z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
from gclendersonui//a -Eat 64 bast-
7urn leaf on !toward Qap Road.%ake
a. ri yhi on Salis b ury Road . Turn
ortia Brooeside Canip and-
ntinue -to Locust Grovc koaci
pass &urnside7ai/ter
on the rSh-t 3/io
16.REMARKS:
,I�I I30 HERESY CERTI-F�T THIS WELL WAS CONSTRUCTED IN ACCORDAN WITH I5A NCAC 2C, WELL
\
CONSTRUCTION STAN(�AR S, AND THAT A COPY OF THIS RECORD HA EN PROVIDED TO THE WELL OWNER
G
ea
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
I1./T1
CC
WELL CONTRACTOR (INDIVIDUAL) NAME (prinotitl(C:ILL,i^,I,N.dJJ.
WELL CONTRACTOR COMPANY NAME'Off(�rY ell (l rtJ
_
STATE WELL CONSTRUCTION PERMITS( 16 q' ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1$/ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: JJ
Nearest Town:Od9t SOENI I County
('.ntmernnWood.s — oi- 4 L -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Chris qr� d J elle Albert ..
Address Isa Albeavrive,
Ffendersok1vi I!e or NC,No' a8'l9a
City or Town State Zip Code
($26—)- 6(0-3013
Area code- Phone number
4. DATE DRILLED 4-23-oz
5. TOTAL DEPTH: 44 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FE(
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118. 9. YIELD (gpm): .3 METHOD OF TESTT reed_
10. WATER ZONES depth):
ty pump ins 0LIer
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
13. GROUT:
From 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
252460
Division of Water Quality - Groundwater Section
Cary CERTIFICATION # aOr 0
PHONE # ria$) rcA n —1263
Topographic/Land setting
DRidge ❑Slope ❑Valley f3{lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) _
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
O -c
7n
—c orn
cm
z
W r`n
›i0
fV
rn
LOCATION SKETCH
Show direction and distance in miles froirall leaZ
two State Roads or County Roads. Include the roozi
or Weight/Ft. Material numbers and common road names.
ci" zl PVC' Porn Hendersonui llc take (o f as±
-to a left onh Howard_ Gap goad_
fL, Meth d a rigL —I-o E liana fork. which. is zeb
{ UW eta Corn 'Road. go l era of Zeb
Corn. Road and +lain lot. onto
Clear creek and then right pith)
Stepp 'React. Lob is or s IL•
Depth �l Diameter
From 0 To_o Ft. Co Vg
From To Ft.
From To Ft.
Depth Material
To o ir) Ft.ennofete
in.
in.
16.REMARKS:
/r:: I fj0 HFRE©Y GFRTIFN
�. :CONSTRUCTION STAN
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY F IS RE O�RD HAS B EN PROVIDED TO THE WELL OWNER
SIGNRE OF PERSON CONST C ING THE WELL DATE
Submi=t the ornrinal t the Division of Water Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ZP
L 76�ff1636._•�
7G';)lt RholtwY'IOi iJ(919) 733-3221, within 30 days. GW-1 REV. 07/2001
AS: iiii:.L t F-ICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 5 2 4 5 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. eartr Wel!O6d f
WELL CONTRACTOR CERTIFICATION.#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential 12( Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other Ejl If Other, List Use:
2. WELL LOCATION:I(Show sketch of the location below) i�EV�ERSnn%
Nearest Town' grAMFRSOKV JU r County'
gTt7WAR-MANOR -Ior+ 2i
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG H
3. OWNER �nA(4L.I) L. JOHNSON From To For DEPTH
Description
Address 1.103
"WEST I plait/ FAILLE
}YE wTzsoA/v/L4ovm Sa
g zocede
4. DATE DRILLED 11' ,—I ..
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOa--
7. DOES WELL REPLACE EXISTING WELL? YES NOE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' 11 Above Top of Cuing)
9. TOP OF CASING IS I' 33 FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 16A NCAC 2C .0118
10. YIELD (gpm): 5 METHOD OF TEST T mE D
11. WATER ZONES (depth)
BY PUMP (IJSrAU.eg.
12. CHLORINATION' Type Amount
13. CASING:
Wall Thickness
Depth Dr tor or Material
.5DR2,1 Weight/Ft. P'iC'
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 1) To r`O Ft (111A)CP.ETE ?CHIRED
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft In In
From _ To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
Material
Material
17. REMARKS:
''� sir i I
I DO HEREBYpr�!t{I UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI STANDARDS, AND THAT Y` THIS ECOROHA BEEN PROVIDED TO THE WELL OWNER.
Li
—Ui
TUBE OF PERSO CONSTR TING THE WE
FOR OFFICE U fLY' DATE
I SIG LL
i.__—,--5 amoral to vision o1 Water Quality. Grou star Section within 30 days
a✓
3 �m
11 additional space Is needed use back of 1ormO
LOCATION SKETCH fV
(Show direction and distance from at least two Slig
Roads, or other map reference points)
kRAA. UENDEfksoNU(LL.E TAKE &4 WEST:
TAKE fr R 1044r ouro lLI N G- R.D. TAKE
A R-tG- T O/JTO $.L4NTYRE eatleelf
RDPrD • TitKE A- LEFT ONTO `f (EW DietvE
FIRST PAVED DPjVE To FIRST LDT on(
-I KE LEFT EToWAtt AIANOC — L,or # z
Quad No:
GW1 REV. 12/99
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalResources - Division of Water Quality - Groundwater Section /�Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print)}\r�ukeI� et ary CERTIFIC[A.TIIO/N /#�y�tL00ty�lt/
WELL CONTRACTOR COMPANY NAME B rICe/r ke If it- (imp / PHONE # (m(p) UM"/-726:
STATE WELL CONSTRUCTION PERMIT# I h 1 1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
252457
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT ON:
Nearest Town: H P tom efsonUi l/P
CQ(1te
(Street Name, Numb , Community, Subdivision, Lot No., Zip Code)
County Raider -son
3. OWNER: Fria Gay error)
Address Po SOK a le E
F I(�oh S[reetojRou[eNo.) 287a9
($s) 6
City or Town—i171 State Zip Code
iq
Area code- Phone number
4. DATE DRILLED I-a-oz
5. TOTAL DEPTH: 30i l/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): 160 METHOD OF TEST I Imed
10. WATER ZONES (depth):
6y g'IU'1Lp installer
l I. D SI FE TION: Type Amount
12. CASING: Wall Thickness
Depth p Diav'eter or Weight/Ft. aterial
From To 68 Ft. 01lkl SIVal
From To Ft.
From To Ft.
13. GROUT: Depth
�Y �ll ate e MethPd
From 0 To ao Ft.Y�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.
16. REMARKS:
1 I DOHEREBY CERTIF
l t—CONSTITUCT oN STAN
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
No
o "t
X r_t
G% ~n
—O m-
- Am
LOCATION SKETCH • v,�
m:a
Show direction and distance in miles ironic?IeasHn
two State Roads or County Roads. Include:Iie r
numbers and common road names.
rn'c
From »en.iersonviQe -ae& )4iti.a5-N
-l-o.Xoples Road .TaEp a rah on_
jfe pies -fo rjgft fake
q r�igqht ortto 'eattteberrJr, t hneo
onlak Aeaciow Lan. . first. p .
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
I Viv\ina/ i- -
SIGNATURE OF PERSON CONS RUCTING THE WELL DATE
it71-jpf t i origiOalld the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
q f :27699 1636 Thrztte-
3221, within 30 days. GW-1 REV. 07/2001

250995
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�(Resources-/1Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME//��(�ppritnntt))glef1A'RD END ,R1 CERTIFICATION tLr/Ole)
wFl.I. CONTRACTOR COMPANY ♦ANIE8C(fRKER WELL END PLUM°
STAI'E WELL CONSTRUCTION PERMIT# D l ASSOCIATED WQ PERMIT/4
(i f applicable) (if applicable)
PHONE # e280/- Z63
I. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 11 Other, List Use
2. WELL LOCATION:
Nearest Town: NENDERSONVIUF County NEtJDE s1 J
UNION] I{ILLROAD
(Street Name. Numbers. Community, Subdivision, Lot Nu_, Zip Code)
3. OWNER:
Address 5aas
L
AP ROAD
(Street orRoute ' No
FLAT Rat2M31
City or Town State
828 698- 355f3
Area code- Phone number
4. DATE DRILLED 3-6
5. TOTAL DEPTH: SOri f
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Gd"
7. STATIC WATER LEVEL Below Top of Casing FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): eC _ METHOD OF TESTTMED
10. WATER ZONES (depth):
'$Y NAP INSiALLEl2
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dia eter or Weight/Ft. Material
From () To 40 Ft. SDRZI VC)
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.(ON1GeETE POuRFD
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
5. 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
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7a.
LOCATION SKETCH
GJ1
O.c
- —t.,
rn
3 am
IV raz
• ma)
w
Show direction and distance in miles from at Ie3Kt
two State Roads or County Roads. Include the road
numbers and common road names.
FROM HENPERSONJILE TAKE b4EAST
TAKE A RIGHT ON SUG/4RLoAF ROAD.
TA KE A LEFT ON RIDGE ROAD . R1 GHT-
ATuNION HILLCHURCH ROAD, amp Go
70 5TOPSIGN. TAKE A RIGHT ON
uNiON HILL (ROAD. GO 1/2_ MILE -(0
JkWSILE HOME ON KNOLL BEFORE
0 GRANaOhURI-TER 'DRIVE "•
f
H6.(� Et ,Ri�07 U=.
1
I DO HEREBY CERTIFY HIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH I5A NCAC 2C. WELL
CONSTRUCTION STANI 'J. AND THAT A COPY OFF THIS RECORD HAS BEEN PROVIDED TOTHEM LL OWNER
t. '/ �. L Kac- 2 •!• �)�7
( % ---
A
IGNATURE OF PERSCrN CSNSTRUCTI.{- THE WELL
GROUNDWATER CTIO'N DATE
VILL-E (REGIONAL OFFICE -
I Igunl o t le Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2091

10. WATER ZONES (depth):
Bi pump ip taxer
11. DISCNFECTION: Type
12. CASING:
Depth
From 0 To 61
Diameter
Ftblfel
252456
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)RI.'harrd Ake GQyy CERTIFICATION
/#.OtO
WELL CONTRACTOR COMPANY NAME J3arker `WeII (?ncLhitr19 / PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential G "Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,,,,ff� 1 ,,�
Nearest Town:+I enciersorN (Ile County l{enderson
(Street ame, Num ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Ste e andTln&SbllY.uf
Address 14 Kingston-14J Drive
(stuit, or Route No.)
FleildarsoniIto MP. 287Q2
Cit or Town State Zip Code
S )-(16-3515
9
Topographic/Land setting
DRidge L45lope ❑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 S-9,B"02..
5. TOTAL DEPTH: cia2€ f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accord nee with 15A NCAC 2C .0118. -�:
9. YIELD (gpm): METHOD OF TEST I f Y lea
LOCATION SKETCH CO o
Amount Show direction and distance in miles from at IeaSTr
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
$Daj I PVC from Nendersonui I le. foie I-26 -ID
Exit 22 WpwarctRd) Tixrr> left- on
Method *Jar& ROQ-d t,3o Cth-OUP'- 3 m(IeS
P0(111" Fo 7)ee6 Gat Roa�d. Turn lea ors t
<Deepap Road- • Tkp- rood wi LC
(v)split -sta+o +he.ngkt
o ± .Deep Oaf Loop • First coded
propertj ovi the tight.
O
N
r
0
oC)
cm
CO
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To P.0 Ft. %/1('Yr7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size
in.
in.
Material
Material
16. REMARKS:
T
I DO HEREBY_ CERTIFY
r—CONSTRUCTION STA"
(, ubmi[ the otiliillAlito the
A 'H27695-1636f PlitnalbiL9
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS EN PROVIDED TO THE WELL OWNER
3 ,2- -O2—
YNS
ATURE OF P SON CONSTRiTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 5 2 4 5 5
North Carolina - Department of Environment and �—^
Natural
'_rRelesourceess - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 L Baler CERTIFICpA�TIIO�N/#a b�/.�/
WELL CONTRACTOR COMPANY NAMES Prltlt�I� tract �Jf m:� PHONE # 6W/I I�"t 1r ILt73
STATE WELL CONSTRUCTION PERMIT# 181 1 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential le Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATtJIj�O,,N.�:(,�r�
GN,e,a,r'est Town:I lenc6ers nut (Ie County biend'2Y50Y1
5WVuc-Nr R4OGE Courrl 'ND
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mice GLOWaCKI
Address 7i4 44ARIpAI 'DRIVE
(Street or Route No.)
H EN D EI2s ola I u. E: 1J cJ ale) I
City or Town State Zip Code
)- 1,93-b700
Area code- Phone numbel. Q
4. DATE DRILLED 3'23"02
5. TOTAL DEPTH: 4301
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I"
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 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 TESTTIMED
10. WATER ZONES (depth):
€Y NAP I11SVAUtYZ
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft. bVe 50RZ1 Pv6
From To Ft.
From To Ft.
13. GROUT: Depth �] Material
From 0 To ap Ft. enme etE
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
From
To Ft.
To Ft.
Topographic/Land setting
I16.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 Formation Description
r
O cp
0
Stu co nlit
Ca
0<
Sc
1
�o
tn-7:
LOCATION SKETCH -c-r~
Show direction and distance in miles fronts leag
two State Roads or County Roads. Include the rdFdd
numbers and common road names.
FRlatil MENDE2SO VILLE TAKE HWY. 25/(2TH
To A R(GIfT 0,4 Bec)oesIDE eft Ro Ohre
Method A pieffr oN 1ufl JuwuN
OLL26D R c-H-Y ON ituwDEN /{!US Dour . G.EFT ON
FOOTH-Iu-s DAwE. LEFT ON Sw led-P
£tDCE . gicfr OPT szwuctfr 4tJ 3E Cou2T " 9W
Material
16. REMARKS
CONSTRUCTION Sftj
.J
1:, Sntt)if theptfiginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - igh, NC
- LL 71:150#10#18LPltiSh0 80. [phone], within 30 days. GW-1 REV. 07/2001
1 DO HEREBY CERi'IIII1Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—ii
SI NATURE OF PERSON CONSTRUCTING THE WELL A E

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
��p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth Ale Ln(Qr/ CERTIFICDATTIION#�yyp
WELL CO.NTRACTOI2 COMPANY NAME Ii0Yr�Cn Weil arta Pump PHONE # 82$ 6CITAZ-13
STATE \\'ELL CONSTRUCTION PERMIT# 'RI I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
252453
I. WELL USE (Check Applicable Box): Residential d Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT,1ON:
N arest Town:
` cif
CountykeaMOn
_ '1
(Street Naito umbbers, amunity, Subdivision, Lot No., Zip Code)
3. OWNER: IL. E• elIev
Address 127 Ander cn ("give.
(Street or oute No.)
Greenwood OC, a96%
City or Town State Zip Code
(2 - 03-0,25'
Area code- Phone number
4. DATE DRILLED 3-2-8-02
5. TOTAL DEPTH: 2-20 f
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 1•34- 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' METHOD OF TEST tmec�.
10. WATER ZONES (depth):
131 PAP installer
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
From D
From
From
Depth Dia cter
To (OLl Ft.
To Ft.
To Ft.
Depth
13. GROUT: Material
From 0 To____ZL Ft. tomee.i-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
or Weight/Ft. Material
5Daz( pre)
Method
pouted
From
From
To Ft.
To Ft.
Topographic/Land setting
❑Ridge DSlope ❑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
-O
9
c
wc
o• r1
cn
-.m
om
• nc
me
tnz
m r,
LOCATION SKETCH F• 2
Show direction and distance in miles from at gist i
two State Roads or County Roads. Include the road
numbers and common road names.
3C
From )4enciersonvi Ile fake_ East
foulard Ednejoilk. Uti t Past
Nominy Sranch good., tate the
2nd dirk road on -Elie- leP&.
Will be_ the +op l of ors the lea.
1Reedie Lot#1
16. REMARKS:
'the HEaEilY CERTIF
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
!LL/„v, (fie
�---Submit-thegrigfn t ,Tthe D
27699-114k Phone Na.i(9,79) 73
SIGNATURE OF PERSON CONSTR
vision of Water Quality, Groun
-3221, within 30 days.
CTING THE WELL DATE
water Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

250896
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�r�R•eso(urcess •- Division of Water Quality - Groundwater Section/
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print)RO6ER1 IJLL L.ER CERTIFICATION #27 39
WELL CONTRACTOR COMPANY NAME PARKER WELT. AND PUMP PHONE # B2S)(7Q1T-77&3
STATE WELL CONSTRUCTION PERMIT# IS f I ASSOCIATED WQ PERMIT#
( if -applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 2' Municipal/Public ❑ Industrial 0 Agricultural 0
Nlonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION:
Nearest Town:}1ENOFRSNANIU E County jlEADERSON
OLD eLEAR CREF_IC ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code(
3.OWNER: ADF E NFY
Address 27 CAC 229
( Street or Route No.(
HENpERSONVIUF NC 28792,
City or Town State Zip Code
8246 )- G'A5— 223 5
Area rode- Phone number
4. DATE DRILLED 2 -2S-0Z
5. TOTAL DEPTH: Co
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO e"
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
5. TOP OF CASING IS I • 33 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 TIMED
10. WATER ZONES (depth):
81 PUMP INstAU.Eg_
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft, Material
From 0 To 5 7 Ft. (01V0 SORT I r 71
From To Ft.
From To Ft.
13. GROUT. Depth Material
From i� To 20 FIPDNCRFTE
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Diameter
Ft. in.
Ft. in.
Method
tuRFD
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
O
N 0
b n�
-0 aaa
=3 cm
D<
Do
H.
IV rn>
mA7
LOCATION SKETCH t
Show direction and distance in miles from at leaCt
two State Roads or County Roads. Include the road
numbers and common road names.
PR-oA HENDER5c N' TLLE TAKE 64 EAST,
TAKE A LEFT ATFRLLITLAND ROAD
ANO GO To 5VoP S)GN , sTRRIGdfT
ACROSS TV OLD CtLEARL'REEt ROR'D
Slot Size Material AND 40 2. MILES . SITE 15 ON THE
in. LEFT.
in.
Size Material
Ft.
FL
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH IPA NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
bautiap 3'/_02-)
SR NATURE OF PERSON CONSTRUCTING THE WELL DATE
SuliPi{�t the oTagnral to thet4iicisof Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
tt—2-7b99-16361 hone No, [phone], within 30 days. GW-I REV 07/2001

2,1909.1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resources - Division'siof Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NANIE (p{riintt))t�r�OI)rfl-C��l /Btffug. CERTIFICATION
# an�379
WELL CONTRACTOR COMPANY NA.IEEA KER WGta- AND PAP PHONE # SAW7 7Lh3
STATE WELL CONSTRUCTION PERMIT# I B'1I ASSOCIATED \VQ PE12N11T#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:I—'1-�����.���
Nearest Town:}{ENDERSOAINPUE CountyI1 AVL�SdS-2O
1515FioP LANE
(Street N'tune. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
411, km N G Ron
(Street or Home No.)
TANA $C 287zy
Ciry l0 or 3— own Si to Zip Code
li?13) 4
Area code- Phone number ��pp
4. DATE DRILLED 2-.tq-at
5. TOTAL DEPTH: - 4115
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.33 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 TESTT 1/WD
10. WATER ZONES (depth):
�v PUMP iMsrt u.ER
I1. DISINFECTION: Type
12. CASING:
Depth �l Dia(eter
From 0 To ,Q5 Ft. 8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To an FL QoHe.PpT6
From To Ft.
14. SCREEN: Depth Diameter
From To Pt. in.
From ' To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topograa hic/Land setting
❑Ridge IDSlope ❑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
m o
LOCATION SKETCH
Amount Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. (1aterial numbers and common road names.
SD)32t vC FgOt HENDER50NVIui TAKE UPWARD
'ROAD •TU.RA OA TO KING 1Z0A-D AND
Go (1y NCI L.E . TURN RI a-Fi-r ONTO
13IstoP L.A'NE. CO To &rrroM OFTHC
01210E, TRAILER is trr END- C-e47
MD WNITE.
Nlethod
�CL1 CED
Slot Size Material
in.
in.
16. REMARKS:
TUCI O 4NSIANDAAI C
'U
Sutmi t,phe evginn to c,fllvlsia
24i9---1636 Phone No. (919917,33-322
WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
D T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tATURE OF PERSON CONSTRUCTING THE WELL
�oo�
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
, within 30 days. GW-I REV. 07/2001

249093
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
��.[)
\VELI. CONTRACTOR (INDIVIDUAL) NAME�,((pprriint))KEAN''FTrt ``Attr�vCCRAR CERTIFICATIONC#_____e
WELL co:yru,\CTot( COMPANY N:\\IEjJ/t/t�\I�\/GR Wr_LL' J`V MI7 PHONE # r02O) k1Q7-7263
STATE WEI.I. CONSTRUCTION PERMIT# 10 / r ASSOCIATED WQ PER)II I
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fit Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:H ERSUNW( t.E County
tiFF OF HWY. h4- EAsT
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER:iAANIT A PI-7] LLO
Address RT. Q, ox 2
(Street or Route No.) �����
HEN9FR•ni1V1u-E Sc.
-66E-3b42
Zip Code
NOF.R.ilN
Area code- Phone number
4. DATE DRILLED 2—Z6—oa
5. TOTAL DEPTH: 165 (
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 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMFD
10. WATER ZONES (depth):
$Y PIAAM INSTALLER
I. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 4 2 Ft. b
From- To Ft.
Front To Ft.
13. GROUT: Depth Material
From 0 To 2.0 _ FL Cosekre
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. N9atcrial
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
u
-no c
� c r
T
w r
c5
LOCATION SKETCH cn
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
smut NO FRcQ HENDERS4'JVILLE TAKE HWY.
,4- EAST. TAKE 1ST D121VEWAy PAST
Method TA'MARTRAIt.ER'PARK ON THE LEFC
Pa -12 Go To EAcK OF Raw AND TURN RIGHT -
IA FRONT OF OLD DAIRY BARN. (A
Diameter Slot Size Material
in. in
in. in.
Size Material
1-10USE WILL BE ON THE LEFT OF
"DANE — NOT THE 074E FOR WELL).
OM TH-E RIGHT You WILL SEE A DouSLE
WIPE Ato131cE tto4E• T'HE WELL WIU_EE
F1ERE •
16. REMARKS:
MINIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Fe k 2&_ __
SIGNATURE OF PERSON CONSTRUCTING TI-IF WELL DATE
tgpt-• t i. o_rn,LQa,ttolitie Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
A 99a1636 Phone Pdp(t%;LA) 733 7221, Within 30 days. GW-1 REV. 07/2001

VVELI. CONTRACTOR (INDIVIDUAL) NAM' (print
WEI.I. CONTRACTOR CO\II'.AM' N'A\IE
STAFF: WEL1. CONSTRUCTION PERI\IIT#
of applicable)
I8/1
249091
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resour es - Division of Water Quality - Groundwater Sectiion�/
• Butler CERTIFICATION # 9)7.9
PHONE # (025)/RI-74.
ASSOCIATED WQ I'ER\IIT#
(if applicable)
2,
WELL USE (Check Applicable Box): Residential EEK Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCA ON::
NeA rest Town: P11leriony1 II . Countyilenda 7
Green . Repo d
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Li II e_ Ed.v
Address IQv �Qnner✓�m Road
Norse����)trcc onieNo.) 87Ltz,
City own State ZipCode
(8 8)-) I- 361-
Arca code- Phone number I.1
4. DATE DRILLED 0 1-0Z
5. TOTAL DEPTH: 4051
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 52"
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS I. 53 FT. Above Land Surface*
up of casing terminated at/or below land surface requires a
variance in accord ce with 15A NCAC 2C .0118.
9. YIELD (gpm):'/2 METHOD OF TEST I I vnQc
10. WATER ZONES (depth):
II.SD1�Nmin
staller
12. CASING:
Depth
From Q To
From Q To
From To
13. GROUT:
From 0
From
Depth
To ao
Diameter
Topo�gr iic/Land setting
DRidge lfiSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Amount
Wall Thickness
or Weight/Ft. Maftef,elal
.IS51
S5
�j Material n Metht d
Ft.Soflare &t routed
To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
t✓
en
N
c r
ed
fir,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Frorw flertd Qrsvnv i (04 Eas+ -it
Fa/Aland .-Tian left IonOften Ain.
`Road. Land out_ road bginq craded-
onci @ ared. 44 -'o 1`Ib'Iberi-s
;9 odi e r ftt.
-IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RD
ND THAT A COPY OF THIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER
22 /tot-)
SIGNATURE OF PERSON CONSTRUCTING THE WELL ��ATE
{,Eirti43FgY4aq4{Fto the Division of Water Quality, Groundwater Section, I636 Mail Service Center- Raleigh, NC
}r1(r36 Phone Nii.1919) 733-3221, within 30 days. GW-1 REV. 07/2001

Depth
From Q To 2n Ft.
From To Ft.
From To Ft.
I3. GROUP: Depth Material
From_n
Depth,
249090
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) K� /}eerar CERTIFICATION #ill dl(i
w EIa. CONIR:\CTOR COMPANY .N,\MEBeirePrVlpll flintPu en PHONE # [phone]
SPATE \\ ELL CONSTRUCTION PEI2.\IIT/1 1(J/' ASSOCL\TED WQ PER)IIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential C•7" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ,1
Nearest Town. Hen rsomllle County Pendersprt
►.nee Falls Ro-j-* 38
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWVNER:Tar/W SWQ !leer
Address 11221 5Iadel-Rd
(Street or Route No.)
1 yers Ft- 3 3917
City or Town 1 State Zip Code
(q4f )-5µ3-W5ift,.
Area code- Phone number
4. DATE DRILLED 2 - 14-02,
5. TOTAL DEPTH: 10n5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Pe'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS La, FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in aecor once with ISA NCAC 2C .0118. ��
9. YIELD (gpm): METHOD OF TESTI.
Ii')')ed
10. WATER ZONES ( pth):
Et platy ins -latex
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Ll/8 %Rai PVC
To
Ft. Annette.
From To Ft.
14. SCREEN: Depth Diameter
From 'fo Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
Ft.
Topographic/Land setting
DRidge DSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
Poured
Slot Size Material
in.
in.
Material
From To Ft.
IV
a L._
Tom
t*
LOCATION SKETCH -�
Cn
Show direction and distance in miles from at (east z
two State Roads or County Roads. Include the road
numbers and common road names.
From l-{enclersonviIle-Fnee l4igqhwa.9
6 East- -to lee- On Fruitland Road.
Go 7.9 miles -It lei -Fort ort W -slt
Fretamanrioad .TaKe a Ie-R-
aFfe( subclivision eit vane anc90
-1-o -Fop of atsh�tll�l id9���ad.
V+ I redo olri dew c Lotdt 38
Lage rails
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTE
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
SIGNATURE OF PERSON CON
OIWANCE(WITtf ISA NCA 2C, WELL
1rHit<S BEEN PROVIDED TD it - WELL OWNER
)s/ate
E
TI
THE WELL
Submit the original to the Division of Water Quality, Grot1ndwatcF Scc(imr, t436 tMxR
27699-1636 Phone No. [phone], within 30 days. A
AT
cc Cet ter - Raleigh, NC
OFt.lr_ GW-I REV. 07/2001

SLATE \YELL. CONSTRUCTION 1'ER.\IITa
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
n�
WELL CONTRACTOR (I\DI\'IDL'AL)NAME (print)Rl chard AtcCra v CERTIFICATIOtN/J9D�IIO
\vE1.1. CON'I'R:\CTOR COMPANY NAME BarKer We.II o nd earn PHONE tt / jet - /2E3
I
249088
ASsocIA'rED WQ PERAHT#
(if applicable)
7
WELL USE (Check Applicable Box): Residential IR-- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Hendersonville County-Ienderson
T�+EtaJ� Rtearl - 5-ranIp i kay'efn l.nnoL
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: $ f.Lvid 5herr11I LI
Address t. 3, BOX I- C
(Street or Route No.)
nendPrsnrriillo, Nei 28'89
City or Town State Zip Code
(815)4)96-024LI3
Area code- Phone number
4. DATE DRILLED - II -02.
5. TOTAL DEPTH: a 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord ce with I5A NCAC 2C .0118.
9. YIELD (gum):METHOD OF TEST I I wed
10. WATER ZONES (depth):
$y pump installer
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
To 31 5nxz l Psi G
From 0
From
From
To
To
13. GROUT: Depth
From 0 To An
From To
Di meter
Ft. 1
Ft.
Ft.
Materiel
FL raonerefie.-
Nlethod
poured
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topoeraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
-73
W v
LOCATION SKETCH ^'^'
c-r
Show direction and distance in miles from 't� j'ast -'
two State Roads or County Roads. Include the roaL
numbers and common road names.
From Flande.rsonvi Ile- take Kanucq*aL-
Road_ +v e rob area . Turn rl3ht'o
Te}erft*n. Rd. 4o a.5 mi les and--
tatt a I e -f on .5tanlet Haven
Lane. ram drive_ pas+ barn
anal across creek -I-o +he lel+
and lL hill 6th blue_ nsobifek.ome.
Goo -ft Dui_ of drive.
—nTh It I.t) FIg12F Y\.Rf f+Ll
Il CaNstnRU Ti6N S'a DAli
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S AND TH T A COPY OF JAB RECORD HAS BEEN PROVIDED TO THE WELL OWNER
, � 4 "5/.—
SIGr)ATU RE OF P . SON CONSTRUCTINS WELL ATE
Submit the orioitDJthe Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
i'u27699-1636 PIRheeh` hiJ(919) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONTRACTOR (INDIVIDUAL) NAME (prfi�nq j t
WELL CON" RAC'TOR COMPANY NAN1E 1r1(er-Well4
STATE A\'ELL CONSTRUCTION PERMIT# I OXI
I if applicable) T�
WELL CONSTRUCTION RECORD
249089
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater � Section CERTIFICATION #.ij /.i/J7(J
urn p 8z8)6R7-'1zG3
ASSOCIATED WQ PERMIT#
(if applicable)
PHONE #
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Usc
2. WELL LOCATION:
Nearest Town: Hefd&rSOnu1 lie. County {gender
jtlnrk. Fre-emnn `R.oanl
(Street Naas. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER;/ IC net E. Daw.nipr
Address ,ie (i mitten -
(Street or Route No.)
Fairview f 2'2730
City or Town State Zip Code
($28)-112-3%6
Area code- Phone number
4. DATE DRILLED 1 3! %O2.
5. TOTAL DEPTH: 5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fit'
7. STATIC WATER LEVEL Below Top of Casing: FT.
- (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. —�—
f
9. YIELD (gpm): 5 METHOD OF TEST -Timed
10. WATER ZONES (depth):
By plump instance
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diiaaneter
From 0 To_Sr0 Ft /8
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Wein
(check appropriate box)
Latitude/longitude of well location
(degrees m i nu tes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
IV
,771
+ __r.
rCI) r7
LOCATION SKETCH •.cp
Show direction and distance in miles firomQDlear)
two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names. II
5DRal l vC) From Aendersonvi Ile. k14
n! e .64 E.
13. GROUT: Depth Material,a
From 0 To 0 Ft.ifn et
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
From To Ft. in. in.
Turn 144 on_ fit•-PQulRoad.Gc
Method
pOlirWCi -1-Wo iK I loe AC riC F(tef aft
koad. Tu.rrz ri ht. Property
tnil•e orr bete left.
15. SAND/GRAVEL, PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST
CONSTRUCTION STANDARDS, AND THAT A COPY OF
q1N AWCQRDANCE7WI,LH r CAC 2C, WELL
< E€Oith'HAS BI�EN'1VRC/Atd . • D THE WE OWNER
SIGNATURE OF PERSON; tONSTRUCTING THE WELL DATE
•
-off
Submit the original to the Division of Water Quality, croutldwater Section, 1636 Mai Semi'e Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-I REV. 07/2001

7. STATIC WATER LEVEL Below Top of Casing: CPO FT.
�j (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
' variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TES
10. W TER ZONES (dePth):
264672
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andd j/gtural Resources�-pDi�vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME,(print /UO4/ tier f—Ltt27) CERTIFICATION trA ?
!.f/ ufEwn� PHONE # yV41 dl-721
WELL CONTRACTOR COMPANY NAMES
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/a v
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nearest TownppVl'1!//�/fOi
Count (ll7tighJfl)
(Street Name, Numbers, Com 4 , Subdivision, Lot No., Zip Code)
3. OWNER:
Address
.X/ll
t/ t i (Streeet /oI Route No.) 2z735
City 1 5� 16)ttaie/lJ Zip Code
Topogr ic/Land setting
DRidge lope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopogaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number �
4. DATE DRILLED /0 �J 0
5. TOTAL DEPTH: / 6 0 l
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lEr- - -
�,t
—77
II.51 FEC t -a — Amount
12. CASING: p Wall Thickness
Depth
Ft. (7 t��8er/QZ/t/Ft. Materia�VCiI
From Tom_
From To Ft.
From To Ft.
13. GROUT: Dept�� Mat�O� tiL
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. inin.
in. in.
LOCATION SKETCH `D `--
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
thorn Lila££/ ,,cCtLic_ ¢—
n Eo tLvc / 5�J. 74A,oo.
t 8.ilat laitoua
Method
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
43/5 �rx- et 20ad
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A COPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/-.�64iL;1 (9-2*. y 1 26 C7
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

264673
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/
WELL CONTRACTOR(INDIVIDUAL)NAME (print)Xe)'nl,nlreLh /1(CCrary CERTIFICATION 8 er2Wg
WELL CONTRACTOR COMPANY NAME1Qk it I.c/-f It (laift 9914,he) PHONE # C5122/127"7L727
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fd-- Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
N t. rest Town:
(Street Name, Numbers, Com
3. OWNER:GLJ• d.
4.
5. TOTAL DEPTH: /C05'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO P'
7
Topoggraphic/Land setting
DRidge Zlope ❑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
Address
(Street or Rote No.) k�Q�e}7rn of a94
County
ity, Subdivision, Lot No., Zip Code)
City or Town
State
01
Zip Code
,5M-7ogg
Area code- Phone number
DATE DRILLED IO /J'o2)
. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS /•�o FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. ,,//
9. YIELD (gpm): —0 — METHOD OF TESTL%/i &t
10. WATER ZONES (depth):
1l
12
DISINFECTION: Type Amount
CASING: Wall Thickness
Depth Dia eter or Wneig�h1t/Ft. Material
From 0 To J�� Ft. to7�g SnP.2I PV&
From To Ft.
From To Ft.
13. GROUT: Depth �,/f �M"at,�e,,/ia�l
From 0 To rsQO FtLrn :/efe
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
��d
Slot Size Material Q✓t �Qs������
in. /- .9 r l/G�G(IC.L a
in. A�r�tt'' /I P�/, /�'..��j�1 %/n� y1�,,,rrny -.
Material pV�,f 4p�',�iJ�"""""" q ic7/wvu� ^� /`x.lL�
ll/ ll-�/�x+`w A/ �'M`/ i7j//� lKt.t�c/I�✓`- �' ,,el 1.
i444
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from tit least:
two State Roads or County Roads. Include jhe road.
numbers and common road names.
to get as a u g"Txt . (rim-ttom
VlL/n,P,,, J'z`C.D. n iu,YA� �. .110 daft
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
j0/ tr 0-i
SIGNATURE OF PERSON C9 1STRUCTING THE WELL DAT
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
I W rvjx- G

264674
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�(priin/ry�t�S1o, rber4nf„��Bn!-L{ier CERTIFICATION
n#Dj l'.7�/g
WELL CONTRACTOR CONIPANY NAME DCa•Qrke Well in d ump PHONE # f2OIb '72(223
STATE WELL CONSTRUCTION PERMIT# 187I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
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: ,,,,'" ',,
Barest wn: r, Co
el- Tt�r,I divisions I„ot# I
(Street Nartie, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Dal/ny t)4nq.,ela CiriFFr4-h
Address P.O. oK (2-ry'3
(Street or Route No.) 17 ail fiC> g:SIA
City &orfin- own State Zip Code
6,n)- gagq
Area code- Phone number
4. DATE DRILLED IC! —'1— OZ
5. TOTAL DEPTH: (,.SOS 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ur'
7. STATIC WATER LEVEL Below Top of Casing: p75 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 I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Tuned
10. WATER ZONES (depth):
5y p,tmp IFtstatt P .
11. DISINFECTION: Type
12. CASING:
Depth From To 1"Lr f"tr�
Ft
Topogr hic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Amount
Wall Thickness
Di_ a eter or Weight/Ft. Material
l85 tS eer
From To Ft.
From To Ft.
13. GROUT: Depth n Material
From 0 To oZ� Ft. �f)Ylere r;e
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.
LOCATION SKETCH N `_
Show direction and distance in miles frail -eat least —
two State Roads or County Roads. Include the road
numbers and common road names.
From )Jeytide(sonvi Ile -Wee
Trae� Grove Road 'Fa /-owa.rd_
pMethod
Slot Size Material
in.
in.
16. REMARKS:
GOO -oa c(- • ct kon ?oast•
ero �� nci 6e on_ l °efi
Qo-t��Trraee5ubdrvrsioa
Lot* i9'
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE)
(04: )2' 20rn7
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No, (9l9) 733-3221, within 30 days. GW-1 REV. 07/2001

264675
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an�dd Natural Resources I- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (prIn�t/)T(.C'P_rk 13L�tL,/!e,r ...���111 CERTIFICATION# 61759
WELL CONTRACTOR COMPANYNAMEI3arKer Well and / Mr PHONE # &.?9)b47-72&3
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 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCH N: ��,,
Nearest Town: �1de15ofNi //e Coun5r 1�enders
t5Jt ho RidgP L-Sta 1i°s tof a, Sce 2
(Street Name, bcrs, Community, Subdivision, Lot No., Zip Code)
3. OWNER:eabMMY l:, Y
Address 0 £-ax q)'7
Flotrk atreet or route No.) c2873/
City or Town Sta� Zip Code
(48) bn7-1/7
Area code- Phone number
4. DATE DRILLED I
5. TOTAL DEPTH: c? 3O'
6. DOES WELL REPLACE EXISTING WELL? YES n❑NO GY
7. STATIC WATER LEVEL Below Top of Casing: c-9 /�1FT.
(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 .011&
9. YIELD (gpm): '1 METHOD OF TEST I fined
10. W TER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Prfat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
G np ittstathor
11. DISINFECTION: Type
12. CASING:
From 0
From To
From To
13. GROUT: Depth
From 0 To 020
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Depth
To null Ft.
Ft.
Ft.
Material
Ft. C�one.fel-e.
am r
LOCATION SKETCH}
Amount Show direction and distance in miles from at Jest - Wall Thickness two State Roads or County Roads. Include the\toad
or Weight/Ft. Material numbers and common road names.
D1e2,J PVG From Jiendersonvl(fe fa,t 2
fa flaLI-Rock. Take a_ right al
Li-fifi River Read . Ta a.
i ea at e8 erreQ C)6Lu.rCIL Road-
-rake tit_ A.Lol i cie y Dri ✓e .
9pernx. f ht I-e -iv Welt S L.e.
Zlwerf2i die esia es
S-Pe. 2,
Method
ro(xred
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
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 CORD HAS BEEN PROVIDED TO THE WELL OWNER
�.2S ZooL
SIGN/(TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
fy�p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) refitaad-h Aleerary CERTIFICATION# n
WELL CONTRACTOR COMPANY NAMEaQYK�jl€( ei l ay )6( P )u/YYJ10 PHONE # f )
STATE WELL CONSTRUCTION PERMIT# I O 7 I ASSOCIATED WQ PERJIIT#
(if applicable) (if applicable)
264676
1. WELL USE (Check Applicable Box): Residential [ir Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
N-arest T.wn: I'IS'Et - County�elldetSYf
-/i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:.LJ)JC ' IS
Address I gg0 Ina isher bane.
gorse S'WP[reet o8,�dute No.)
ag7gt2.
City or Town State Zip Code
)- gqn- �.22q
Area code- Phone number _
4. DATE DRILLED I Q'2, —bZ-
5. TOTAL DEPTH: Di;
6. DOES WELL REPLACE EXISTING WELL? YES NO i:4-
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
2(Use "+" it -Above Top of Casing)
O 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. y
9. YIELD (gpm): ii- METHOD OF TEST —riffled
10. WATER ZONES (depth):
By umir)sta.Uber
t I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight Ft. N at riiy1
From 0 To LII Ft. Cl)78 SDIe2I JAIL
From To Ft.
From To Ft.
13. GROUT: Depth/J Material
^n
From 0 T0� Ft. eniefe,
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.
Topograp ic/Land setting
❑Ridge $lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude souree:0GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
rsh
an __
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. �^
roix AenderesonUi Ile kcke. )I -xi ourd Cap
a d. T urn right on /kdeh AWL�d-
Method G-o rax. I` ''le. Turn r) {tit. Cove
rnd O.r k Estates- Pf{fmav ad. Tara
left -On (chant Woad. -Turn ri -
ak Cove ym creek &fl .T a..
rI up eulde,sac. Go s.ereti rus-
Size Material 74) lot
ton. le/ pact ^ sJ
{t o ust due Creek &Lts Lf-63-
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 T E WELL DATE
Submit the original to the Division of Water Qua ity, Groundwater S lion, 1636 Mail Service Center - Raleigh, NC
27699-1636 ('hone No. [phone], within 30 days.
GW-I REV. 07/2001

264671
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAM ZIQ_
STATE WELL CONSTRUCTION PERMIT# /d 77
(if applicable)
CERTIFICATION M. DIO
PHONE WIPLATEZZe
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI!N:
Ne. - t Town
County/Yr%/A Ik J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Zip Code
Area code- Phone number /- /
4
5
6
7. STATIC WATER LEVELTop €
?? (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /•e4 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accord ee qith ISA NCAC 2C .0118.
9. YIELD (gprn): %, METHOD OF TEST/ a-
10. W TER ZONES (depth):
DATE
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley PCIat
(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
LrVLLLL' / -/ LJ
TOTAL DEPTH: q6S /
DOES WELL REPLACE EXISTING WELL? YES) NO Yl =
BelowofCasin ..�) FT.
1 FEC ION: T p Amount
Wall Thickness
Depth}` Dijiy ter or�rysiiiht/Ft pater -la'
From 0 To /./D Ft. lfl / O�' �
12. CASING:
From To Ft
From To Ft.
13. GROUT: Depth ,J Materialal
From 0 To (20 Ft.S�X__ � —
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH N
Show direction and distance in miles frorn'd?least-
two State Roads or County Roads. Include the road
numbers and common road names.
:Lori £✓-ua X" /ah--
r--- atO( tar/Q/Xd 40 .0
tv .. Cote_ t dt.. IQa. .
raw +
Material j U/-"- • /r�� •. i /-(/%.$
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN / AND THAT COP)! F T S RECORD HAS BEEN /yROVIDED TO THE WELL OWNER
Dice-( / Lt! I 0
SIGNATURE OF PERSON CONS RU ING THE ELL DATE
Submit the original to the Division of Water Quality, Gr dnater Section, 1636 Mail Service 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 Sectiio 739
WELL CONTRACTOR (INDIVIDUAL) NAME (prrtinnt) O/b�e f 'By+) r CERTIFICATION #
WELL CONTRACTOR COMPANY NAME.DQr cer W'el I and
STATE WELL CONSTRUCTION PERMIT# 18 1 / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264670
„p PHONE # ern IITt /2
1. WELL USE (Check Applicable Box): Residential IV Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection C Other 0 If Other, List Use
2. WELL LOCATI_N:
Nearest Town
Au/
(Street me, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
//ss•
41)
r2)- �
City or Town�� -3o79 State Zip Code
County
(S
oute No.)
cad
287o¢
Topogr9�PPhic/Land setting
DRidge Zlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:COPSCTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED /0- -OL
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 /- le- FT. Above Land Surface*
*Top of casing terminated at/or betow land surface requires a
• variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): —0— METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth giameter or Weight/Ft. Material
From 0 To %a Ft. to f(/8 SD�Zl/
From To Ft.
From To Ft.
13. GROUT: Depth yy Material 0Metthod
From _Q....._ To o2a Ft. COnit.a ) rn---xu
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.
Slot Size
in.
in.
From To Ft.
16. REMARKS:
tV
Show direction and distance in miles from #.east=.
two State Roads or County Roads. Include the road-
numbers and common road names.ditOnt 1� p
Wate-
-etc1 0 . �%a t a,
ak elect /9 . Ja a # FL
Material 46 se
2111
LOCATION SKETCH
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
at.
S?- c( 2.� e —
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-1 REV. 07/2001

264669
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Q
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(print)dly CERTIFICATION N#rA 8/?
WELL CONTRACTOR COMPANY NAMEB arker� Wei( and - PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# I b 1 I 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
2. WELL LOCA ON:
Nearest Town end el onuI Ile County f lende on
`Srad{ortL Earns
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �TTV Wcop.
Address 30! ,..5 ncr} Jrive
(Street or Route NRR.) �f Q.y
R/Jiz �Nfl7%l IY7 �C'� ad (II
City or Town State Zip Code
(2)- w04-1916
Area code- Phone number
4. DATE DRILLED I0-4 -02-
5. TOTAL DEPTH: QQ5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LW
7. STATIC WATER LEVEL Below Top of Casing: .20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I'-dr FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance�1with ISA NCAC 2C .0119.
9. YIELD (gpm): 12. METHOD OF TEST I (Y11ed
10. WATER ZONES (depth): `D
2y nl it Q((er LOCATION SKETCH
11. DISINFECTION: Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di eter or Weight/Ft. Material numbers and common road names.
From 0 To 40 Ft. tit%R S0a.2► PdG From �endersonnurlle 'fad I� ram' 'ID
From To Ft. a q (}{LA(a. d8o) Take Q le-F - it
From To Ft. (JJ n
13. GROUT: Depth Matz al 0 Me hod top 01 a t (coy. ODD it o�
From To an Rya/nettmires i gat j. Igi2 11 ILt. (go
From To Ft. ^Td`^, ((''��
14. SCR .E.N: Depth Diameter Slot Size *are a? 2 left, % Bradford aVrnS.
From To Ft. in. in. W1 - �nJ le of \ t kit
From To Ft. in. in. w)11 OX.. �yJ
Topographic/Land settingy
❑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
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THCOPY AT THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
20D
(Clot. ,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 6 4 6 6 e7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)RI chard it(eerary CERTIFICATION #DMO
WELL CONTRACTOR COMPANY NAMES aprk'er Well and Pcunp PHONE # [phone]-
STATE WELL CONSTRUCTION PERMIT# I 0 / / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential W Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI N: �'(r
Nearest Town: efidersonyilI County/tenderson
Laurel koun+air, Forest- Lot # a5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE Rra,02xn_ N Gd S cflil a
Address P. 0. $oK 1044
IJQ.a-t (Street 9r Route No.) aQ 72,4f
(1)2)- ty(gGn`14t}gto
Area code- Phone number
4. DATE DRILLED io -3-0Z
5. TOTAL DEPTH: 145 r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tEf'
7. STATIC WATER LEVEL Below Top of Casing: aQ FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS •3-3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (pm): g METHOD OF TEST-Valed
10. WATER ZONES (depth):
13y pump installer
Amount
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To a I Ft. to l%4 . 185 Ste.e.I
11. DISINFECTION: Type
12. CASING:
From To Ft.
Zip Code
From To Ft.
13. GROUT: Depth ,, Material Method
From 0 To 10 Ft. eonerete. Poured
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:
Agricultural ❑
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
r->
LOCATION SKETCH i:'
Show direction and distance in miles frotti at least
two State Roads or County Roads. Incldae theaoad
numbers and common road names.
rrom liendersonuitle UfwarGt
koad. -iurt right alio Deep GTy
toad -Tarn riht Onfb ! ctUyet
Drive. Go .7 `1r /es IT drive Cfl-
4Jie ri hi _ (Small Cofkaae hear
road 1_
La crei ✓��OILYLUt!%L ropiest
Lot - 025
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, TFJP�U /j/,�GOPYF THIS RECORD HAS BEEN PROVIL}ED TO THE WELL OWNER
-' st<l�T (f�// PERSON 4' SIGNA OF PERSON 0 UCTING THE WELL
DATE
Submit the original to the Division of Water QuaTtt, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200 1

264666
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalIu-R``esourc�es1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pri�n/t)l�Obe('C Bu±I-er CERTIFICATION
/#ei /39
WELL CONTRACTOR COMPANY NAME�arrrr Well anjt PLY90 PHONE # Ip2o)r/'7el -724
STATE WELL CONSTRUCTION PER.SIIT# I%1 I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Re...Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearestrand OTow n:Ne�aV5 t�2d rsonvczflit County Xenderson
b`It#
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Tame Irvuz
Address 1001 CQ St IhQQJO salee+
T(Street or Route NNo.),,,./3051 /
oeeoa G
(Z)1 re 12,47
Zip Code
Area code- Phone number
4. DATE DRILLED L�'.30-01�
5. TOTAL DEPTH: 90 f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I?d
7. STATIC WATER LEVEL Below Top of Casing: ,;6 FT.
22 (Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1.2 FT. Above Land Surface'
•'fop of casing terminated at/or below land surface requires a
variance in accordap e with ISA NCAC 2C .0118.
• 9. YIELD (gpm): I METHOD OF TEST
10. WATER ZONES (depth):
Sy pump it s30.1ler
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Pia ter or Weight/Ft. Material
From 0 To A l Ft. 1/J 18 ,Svka! eV (5
From To Ft.
From To Ft.
13. GROUT: Depth //,� Materia
From 0 To 40 Ft. l'OVlere1
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
Front To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Scope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/Iongitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH 7
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. IN) •
CO 7
Frew- )fen-dersonviile
Jd,u,t9. 6 -to Cdn of lie-. Take_
Meth° ale on_ St. Pe -1s 12oa.d.
-to a_ rr hh On G-raad ountain-
hlaterial et- left on liar it
Oaks Drive iv a- right arc.
L re-\1ieW
growl Oaks L014154
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
0 Q/1 t2
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 268633
North Carolina • Department of Environment and Natural Resources - Division of Water Quality
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H • Bowman
\YELL CONTRACTOR COMPANY NAME n BnwmAn Wel 1 1)ri 111ng Tnr
STATE \YELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(ifapplicable) (if applicable)
- Groundwater Section
CERTIFICATION If 2 8 0 9
PHONE v R2A 757-7779
1. WELL. USE (Check Applicable Box): Residential (X Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: Hendersonvildanty Henderson
8 Bradford Terrace, Hendersonville 28/39
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Edit Fellegi
Address 8 Bradford Terrace Lane
(Street or Route No.)
Hendersonville NC
4
S
6
7
City or Town State
( )-
Area code- Phone number
DATE DRILLED 10/17/02
TOTAL DEPTH: 270'
28739
Zip Code
DOES WELL REPLACE EXISTING WELL? YES 0 NO ]H
STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+" If Above Top of Cuing)
S. TOP OF CASING IS 1 • 4 FT Above Land Surface'
'Top of cuing terminated eUor below land sur(ece requires a
aria nee In accordance with ISA NCAC 2C .0111i.
9 YIELD(gpm): 6 METHOD OF TEST rotary air
10. WATER ZONES (depth): 1 00'
120'-180' LOCATIONSKETCH
I. DISINFECTION: Type tablet Amount 6 Show direction and distance in miles from at least
12 CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft.f 1 /8 Srh RO PVC'
From To Ft.
From To Ft,
I3. 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
To Fi.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(chock box)
DEPTFj DRILLING LOG
From To Formation Description
From
From
16. REMARKS:
4:DO HEREBY,CE,R°TI AT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
L 'CO NISTRUCTIDNSt�, 1S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/01/7/01.
DATE
Subrni then 4gane-1-tb the ''vision of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
u .iIA.R9 9§9.rON6he. �d�l9) 7 3-3221, within 30 days. GW-I REV. 07/2001
ASHEVtILLE t ;__''-_
•

268627
From
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION S 2809
W ELL CONTRACTOR COMPANY NAME fn it nwrn n Well llri 11 ing, Tnr PHONE I67R 752-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential EX Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town:Edneyville County Henderson
2 Bobcat Spur Road Edneyville 28727
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Joseph Drake
Address 2 Bobcat Spur Roaa
(Street or Route No.)
Edneyville NC 28727
City or Town State Zlp Code
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
)-
Arca code- Phone number
4 DATE DRILLED 10/02/02
5 TOTAL DEPTH: 700'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO (X
7 STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use'+" If Above Top of Casing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of easing terminated aUor below land surface require a
raria nee In accordance with 15A NCAC 2C .0111i.
9 YIELD (gpm), 1 METHOD OF TEST rotary air
10 WATER ZONES (depth): 4R0'
LOCATION 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 I DISINFECTION: Type tablet Amount 6
12 CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft..61 /8 Srh RD PVC'
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From 0 To 20
From To
Depth
To
From To
15 SAND/GRAVEL PACK:
14. SCREEN:
From
R. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
To Ft.
To Ft.
0
w
-71
rn
CD
CA)
_s
IV
J
16. REMARKS:
DO H
CO;NS1TRUCTION
Submit the origin
L___ 77.634-1636 Rhone
THAT THIS WELL WAS CONSTRUC,1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lDwZ/cL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001

Noah Carolina - Daperimont of Environment and Natural Flesourcea - Division of Water Quality • Oroundweior SoctIon
1630 Me ll Service Center • Raleigh, N.C. 27699-1636-Phone (919) 73-3•3221 , (( (�
WELL CONSTRUCTION RECORD WELLCONTRACTOn• BD mocklU. Polq
WELL CONTRACTOR CERTIFICATION N: (c)a g
STATE WELL CONSTRUCTION PEFlMITN:
1. WELL USE (check Appflcsble Boa): Residential Municipal n Industrial n Agricultural I I Monitoring
Rocovery ❑ Heal Pump Water Infection ❑ Other El If Olhor, List Use:
Nearest Town.
LH 0
Inoed Name and� Nu �Oil.b Community, or SuWon en
3, OWNER I l0 Ac cod
Address
2, WELL LOCATIO Show/sketch of the location below) /hitazixo
y County-- AA 11
MP 1XJC
01 OU 0
Clly or Town Slale
4. DATE DRILLED fp., /'0 a'
5. TOTAL DEPTH ,b5d6.
6. CUTTINGS COLLECTED YES 1 i NOI vi
7. COES WELL REPLACE EXISTING WELL? YES 1 1 NOM
8. STATIC WATER LEVEL Below Top of Casing: 9.r FT.
(Use'.' II Above Top ul Casing)
9, TOP OF CASING IS 1 FT. Abovo Land Surface'
•Top of oe.Ing terminated avor below lend surface requires n variance In accor-
dance wllh 15A NCAC 2CisQ 19 a
10. YIELD (gpm): . METHOD OF TEST tevi C
11. WATER ZONES (doplh):
&87a4.
DRILLING LOG
6: -Sod
Zlp Code
270111
DEPTH
FOmiellon De scrlpllon
0
23
/TJ
ON)
u I
1' 'LORINATION; Typo L____Amount acipa S II additional space Is needed use hack of form
1 .BASING:
Wail Thickness LOCATION SKETCH
Depth &S ?Homey yr,tejo yg. Mn�VC sk (Show direction and distance born nl least two State
FromTo 'Ft. (p �0 dU ja j Roads, or other map rolorenco points)
From To FL
From To FI
14. GROUT:
Depth Malarial
From Q To art �r Q-✓`7 E
From To F1
15. SCREEN:
poilitLMolhod
Depth Diameter Slot Size Malarial
From To FI In In
From To FI In In
From To FI. In In
16, SAND/GRAVEL PACK:
Depth Size Malaita'
From To Fl
From To FI
n n Lo
6 thll-. T'I
cn
17. REMARKS:
I DO HEREDY CiE[ I, Y':THAT THIS WELL WAS CCNIMII•UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S1i4.NOARD$, AND TI IAT A COP tali 'PHIS RECORD HAS BEEN PROVIDED TO TI-IE WELL OWNER.
tit / - 6-ai-e)
1 OFFICE U$EONLY
wad No• ;1 I .
,1
Serial No.
1
Submit odgIi1
Li,
• •'ATUnE OF PERSON CONSTRUCTING TI IE WELL DATE
• 0 vision of Water Ovellry, Oroundwaler Sectionwithin 30 days
GW.i T1EV. 12/99

North Corollnn • Dnpartmonl of Environment and Nolurnl Resource, - DIvlelon of Water Duality • Groundwater Socllon
1630 Mall Service Center - RaleIvh, N.C. 27699-1636-Phone [phone] (�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. �]P bh,A UJ P E> 44S
WELL CONTRACTOR CERTIFICATION p: eg 0 g
STATE WELL CONSTRUCTION PERMIT:
1. WELL USE (Check Applicable Box): Flesldenllal Municipal ❑ Industrial Agricultural I I Monlloring
Recovery r1 }-loaf Pump Water Injection ❑ Other If Othor, List Use:
11
2. WELL LOCATIO • Show s ceich of
the location below) Nearest Town' • YuSA) County' deitAge%3
(Fiord Name and 14mborn. Community, or ubdt'Islon and Lot No.)
3. OWNERpO �,wa. ^
Address 7
Sheol or polo No.
Gay or Town tale
4. DATE DRILLED Z. -•.7 0
5, TOTAL DEPTH LO S •
6. CUTTINGS COLLECTED YES I I NO14
7. 00ES WELL REPLACE EXISTING WELL? YES 1 I NOM
6. STATIC WATER LEVEL Below Top of Casing: tit FT.
1 (Use •e' II Above Top of Casing)
9, TOP OF CASING IS FT. Above Land Surface'
•Top of casing terminal ad .Uor below lend surface requires a variance In accor-
dance with 15A NCAC 2C .9p1) s
10. YIELD (gpm)• / iC11E
METHOD OF TEST G
11. WATER ZONES (doplh):
j
DRILLING LOG DEPTH
From To Fomiellon Description
II
D - 0,5
8'7-2 1oS -SO6
zip Co e
1? " FILORINATION: Type ._J--L7--Amount
ASING:
If additional space Is needed use back of form
Wall Thickness
From�Depth Ala�lL 1IloelvnU� MaT1.L:+u:x•
To `e9�R. (p
From To Ft
From To Ft
14. GROUT:
Depth Material
From Q To -Zia—FI CtIRQr`iE
Frorn To Ft
15, SCREEN:
Method
Depth Diameter Slot Size Malarial
From _.__ To Ft In. In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
From To Ft.
17. REMARKS
I DO FIEFlE
GONSTRU
R OFFIC
ad No'.
Serial No.
LOCATION SKETCH
(Show direction and distance Irorst Al least Iwo Stale
Bonds, or other map rolorenca points)
Ul
268377
1/24f5,4
7S ( 11111ii
I yl 4RE?=Li
Nbhf1QS,AtIOJIAT1,
'
USE. ONLY
n
Svbmll a
1
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Or TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
O NATURE OF PEf1SON CONSTRUCTING TIIE WELL DATE
to Division of Waler Quality, °mondwale( Section within 30 days
GW•I 3EV. 12/99

265474
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ME,an 14yura1lResource-sp Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NS(prlat /C' uct)e N/\ "A 1-I-�11 0 L�CERTIFICATION0
WELL CONTRACTOR COMPANY NAME(` LI be rl ea' )t✓ well 1 {17I\ N Cc --1-1‘t PHONE a 01,0 J5�-35a/
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable) /....Sn.4e 1 Oct -Ss 46 &O
1. WELL USE (Check Applicable Box): Residential 12"/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Street or Rader 2
r�
ea( City or Tow, State Tip Code
(� rm — i9 - 7D Z4
Area code- Phone number- /
4. DATE DRILLED /a/Z-m
5. TOTAL DEPTH: / `3 r9 l
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 7 Fr FT.
(Use "+- if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of culog terminated at/or below land surface requires a
verlaaco in accordance with ISA NCAC 3C .0118.
9. YIELD (gpm): -7 METHOD OF TEST /P
10. WATERZONES(depth): !iO - .3Se
Amount /4
Wall Thickness
FL Disinter or Weight/Ft. I %term
FL
2. WELL LOCATION::
SPA P ✓
Nearest Town: 5��- County i
�17 o�i�"'Bnr �ftii�rr %f
(Street Name, Numbers, Community, Subdivisions
Lot
tt,No., Zip Codc)
3. OWNER: ��/ . 1 fy--ne-a -/doe ' .
Address
l of P V-1 a
11. DISINFECTION: Typed
12. CASING:
Depth
tFrom_4O
From To
13.
FL
GROUT: Depth � i 6G , �/Y' //��t/. ;F-
Frorr�_ Tol1G— Fl. GiluY�r�' /y �J�Qv�
From To
Material
C
4114.
.1I?0-ipen es
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
( appropriate box)
Latitude/longitude of well location
(degrerymionsei/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check
DEPTH DRILLING LOCI
From To FQrmatipn Description
D - (� o
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.
From To
FLC�
to Slot S
14. SCREEN: Depth ize
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Material
From To Ft.
k 11916C4 11
CONSTRUCTION 1
2 iv
DEC 13 2.'__
GROW'
ASP[VIL
F
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER
O
N
c
rn
0.
Fri
led
4?
1 to t
/ Y/ hit I
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
) 733.3221, within 30 days. GW-1 REV. 07/2001

264521
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ancetbl (Resource - Division of Water Quality - G.rroundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�(prtettt,) P Uch o el \ " -Th w G L-L -7
CERTIFICATION a /53 /
WELL CONTRACTOR COMPANY NAME IM LI P IJ( /r lrl cod/ l"11lt(`i�t-l-N� PHONE a JgAyI c7,.S 51 -3.52
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERb117a
(if applicable) ka- tiLtent to-14+f /p'y ,
1. WELL USE (Check Applicable Box): Residential Municipal/Public El Industrial CI Agricultural El(
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(if applicable)
2. WELL LOCATIO
Nearest TTgwn:
/3/ CR.Gt.4
040
(Street Name, Number, Community, Subdivision, Lot No., Zip Code))
3. OWNER: 4i/Wt LYvmei?e./e — tQP !a
Address , /40. .- 7 /jsP s t «• t
Ltd or Rovi
City or Town State Zip Code
�dy(.r, <z P
Topographic/Land setting
sty % ral-t ra ❑Ridge ❑Slope ❑Valley ❑F1at
(cheek appropriate box)
Latitude/longitude of well location
0
tituddlongitude source:❑GPS❑Topographic map
(check box)
DRILLING wC2
Formation Des ripfion
12211111
From To
Or 240
Area code- Phone number ? O — 3 /
4. DATE DRILLED 101,flo Z- 15 / Jr ro
5. TOTAL DEPTH: , f$b 0,0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: to te FT.
(Use "+- if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface'
"Top of casing terminated aVor below Ind surface requires i
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3- METHOD OFT
10. WATER ZONES (depth): 3t5 4f 0
11. DISINFECTION: T
12. CASING:
Depth
From To /�
From To FL
From To Ft.
13. GROUT: Depth
FromFrom,_..t. To 40
From To
}rpr Ft._� 'tAmountDiameter or 4(
Wall Thicknessckness
hf t/Ft.M}te -
Ft.�` LayC
Ft. i
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sze 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. In de the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TQI THE WELL OWNER
'Xak-s.. t orksbs [ 3 J fl
SIGNATURE OF PERSON CONSTRUCTING THE WELL ` DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

256920
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)REUBEN
NAME (print) REUBEN CALDWELL
IVCERTIAFICATION, 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY4B )254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT,
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ler�
County /i 4tbL
(Stint Name, Numbers Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 7� /a .:n� /C4�
.efo
(Street or Route o.)
City or Town State
-q7�`/
Area code- Phone n (4"
4. DATE DRILLE X2 Z �u� T.
5. TOTAL DEPTH 2 Z,S`
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 9 £ FT.
(Use "+" if Above Top of Cuing)
S. TOP OF CASING IS / FT Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance la accordance with ISA NCAC 2C .0118. rj
9. YIELD (gpm): S METHOD OF TEST /C •
10. WATER ZONES (depth): / 70 3 6-lan&
Znp 4-9/-?76,6
11. DISINFECTION: Type%/Y7
12. CASING:
Depth
Fromm'( To /1
From To Ft.
From To Ft.
13. GROUT: Depth
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To - Ft.
4. "2n7 Amount :3 t '
Wall Thickness
or eight/Ft. Material
FL 2 /
Di
ameter
/O
Material Method
Slot Size Material
in.
in.
Size Material
ONSTRUCTION STAND
AUG 1 3 2002
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
/>0 - /oD
/AD- (> 6
%7 0� J7,
77o z9 y_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road : es.
S WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TTHE WfjLL OWNER
SIGNATURE
$ivisi
F PERSON CONSTRUCTING THE WELL
n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
1, within 30 days. GW-I RBV. 07/2001

255'060
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL CERTIFICATIONM 214Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
REUBEN CALDWELL DRILLING, INC •raoNEVI8 )254-3581
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITM 1537 ASSOCIATED WQ PERMIT# 3 gat 7---
(if applicable) / (if applicable) , 4.i,jl...o - C
(.err.. fa 7
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
Nearest Town:::
$/t7/s—(,titev"?
(Street Name, Numbers, Community, Subdivision, Lot No Zip Code)
3. OWNER:rU(r %rP h.w,
Address /304. 2f e 3 Ash.
(Street or Route No.)
T�ON:�
iV1 l�i�1 County eyLaad -r ,
-re-4.29 G.-A Reed a?eir,
,¢shed i// e ,#C- 2 e et0 -2---
City or Town State Zip Code
-42- l-g.8frt
Area code- Phone Dumber
4. DATE DRILLED (e f 14-- O pl- .
5. TOTAL DEPTH• c," o _5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: leo FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance Its accordance wltb ISA NCAC 2C .0118.
9. YIELD (gpm): e+----. METHOD OF TEST
10. WATER ZONES (depth): it 0 ' — t el> t "
ilfr t(swvt.
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From '� ' To e1"-�
From To
From To
13. GROUT: Teeth Material
From Q To 1-...0lJ^''"' «
� Ft. �'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Diameter
FL (P
Ft.
Ft.
Me
From To Ft.
From To Ft.
rip
(16.1,
L:
1 DOggygR�l T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL O
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cited( appropriate box)
Latitude/longitude of well location
(depea/minutea/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTI-( DRILLING LOCI
From To Formation Description
P' O - . tb
O - ?, Z7- grl.a-.nit`
Q.2.4-0-A-ae
3 n 5 - 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.
O
N
C—
N
CO
c
c
0
m
•
ms
CS, Ill Wartd
GP tr,
ASHEwU $0'
Tenn
VN-
SIGNATURE OF PERSON CONSTRULIING THE '.ATE
he Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
9) 733.3221, within 30 days. GW-1 REV. 07/2001
V

252440
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION, 2140
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC. PHONE448 ,?54 -3581
STATE WELL CONSTRUCTION PERMIT" 1537 ASSOCIATED WQ PERMIT,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
' Nearest Town: t'/1 11 1 S Q I V /Q County Am 0A)
rvl t <..L_ RIc3CL su(SOI IISIor>t 14. MILLS Vet �D
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
5/1 /0A
5. TOTAL DEPTH: S d
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E(
7. STATIC WATER LEVEL Below Top of Casing: 4- 0 FT.
(Use "+- if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordant with ISA NCAC 2C .0118. nn
9. YIELD (gpm): 3 METHOD OF TEST Q.IG - I} I R'
10. WATER ZONES (depth): I $ 0 — 1 G P f`'`
a'aGPM
I I. DISINFECTION: Type ,4TMI -SO% Amount a c e S
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Material
From To 5 5 Ft. G
From To Ft.
From - To Ft.
13. GROUT: Depth CMate�� h V shod.
From To a 1 Ft. m
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 lat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: `t c 4y I n� (degreea/minuteeheconds)
Address `p 39. ( A t)$T
CLAY NI L (L I L ° tQ n Latitude/longitude source:❑GPS❑Topographic map
(Street or Rout No.) (check box)
[110(ZSQS,{oc to DEPTH DRILLING LOG
(8 gCityorTownl' 31e ZipCodc Fro To ♦ FomldtionDescription
a) q 5 0 o Vt d7 aT-oe
Area code- Phone number 50 _ 140 ' (re-
4. DATE DRILLED f 4-0 '
146'- )2S r7RANIY6--
as -05'
o�
DerHEREBY'CERT1FY THA
ONSTRUCTION STAND
LOCATION SKETCH -o Rt.
Show direction and distance in miles frottTAt lea
two State Roads or County Roads. Inclu eQte ri'eC
numbers and common road names. r 2
r o
x
N
ti
.`1
VO
cd
c
-A4
M?LLS 12wfl—
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
T A COPY OF 1S RECORD HAS BEEN PROVIDED TO T WELL OWNER
.64- 5 Vo R
ATURE OF PERSO.r1 CONSTRUCTING THE WELL A
of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
o. 3221, within 30 days. GW-1 REV. 07/2001

253344
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNatural RELBENs CALDDELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIpFICATION N Z 14Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PIiONE4 8 �254-3581
STATE WELL. CONSTRUCTION PERMITN 1537 ASSOCIATED WQ PERMITN '1
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: Lt c-N e,f_ County NENOe2SP "3
NILLToP �fEG.) hSt:0-6S
(Street Name, Numben, Community, Subdivissiioon, Lot No., Zip Code)
3. OWNER: °"\ Lice` 64AArrtti%
Address 'Y1°l Cf/b& CfLo5S1Nv
Street oe koute No.)
tLecr A) L 9-SY q
Zip Code
(SAX)- GK-17a2 "t -6130
4. DATE DRILLED 5/ 3/b�
5. TOTAL DEPTH: 31 S
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of
8. TOP OF CASING IS FT. Above Land S
*Top of casing terminated at/or below land surface requires a
mience In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
a,o
Arca code- Phone number •
NO fZl
0 FT,
mg)
rface•
nn
fiopographic/Land setting
(Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeca//minutes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From - S
T tan'
ao
ao- Sao'
Sao'> 375�
10. WATER ZONES (depth): 1 G P
Sao o(-GP
11. DISINFECTION: Type k bi - QU %o Amount d C)P
12. CASING: Wall Thickness
I Dep Diameter or Weight/Ft. lAatpn
From 1 To Ft. PR Sofa l f Y G
From To Ft.
From To Ft.
M
13. GROUT: Depth
From To a 1
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
Ft. Ce:fneA f
Method
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
Formation D,gscdption
oJ61L(SN.)
t , re
l &P
G (2;atei
u<
Cm
L-1c
me
—
LOCATION SKETCU
CO
Show direction and distance in miles fro*jst legs
two State Roads or County Roads. Include the road
numbers and common road names.
o Y I E LJ
Q6Li vC
�J 4c(Se,-)
/7
THIS WELL WAS CONSTRUCTED )N ACCORDANCE WITH 15A NCAC 2C, WELL �/C
, AND N AT A COPY OF T}*S RECORD HAS BEEN PROVIDED TO THE WE OWNER
5/Ia-
DA
0
ision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
ity or Town
State

252100
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE448 )254 — 3581
STATE WELL CONSTRUCTION PERMITS 15 3 % ASSOCIATED WQ PERMITS/
(if applicable) j (if applicable)
1. WELL USE (Check Applicable Box): Residential 4J' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Get ro r• County
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
to02Yz-t5 1\P26;rJ
6-feta T(z-(e&Lg- f.
(t orouts No.)
L1 r4or3 ipStreeA 30058`
City or Town State Zip Code
(gain- coa8 — t 6i sak
Area code- Phone number S _ D
4. DATE DRILLED
5. TOTAL DEPTH: ID 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 6r
7. STATIC WATER LEVEL Below Top of Casing: •E ' D FT.
) (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of cuing terminated actor below land surface requires a
variance In accordqance wit 1¢A NCAC 2C .011S.
9. YIELD (gpm):104 �N METHOD OF TJEST at - A( �—�
10. WATER ZONES (depth):
l 1. DISINFECTION: Type
12. CASING:
Depth
From To 3
From To
From To
13. GROUT:/ Depth
From ,a To a o
IQ
Topographic/Land setting
❑Ridge ['Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre&minutes/sccoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEEM DRILLING LOG
Frog — To / ForptationDescription,
339 1— ge5' Q-A r)Yfl$
91e Amount o2 GcP.S
Wall Thickness
Dieter or Weight/Ft. Material
Ft.Sal P��
Ft.
Ft.
Material.
Ft. C. lThkrE NT
From To Ft.
tAtthaye
-
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.
O
3C
o.c
r'
LOCATION SKETCLaFj m%
c->
Show direction and distance in miles fro n{8t least
two State Roads or County Roads. Include a rgjd
numbers and common road names.
p.. u t_e 5
geAft uks.
16. REMARKS:
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S THAT A COPY S/ F THIS RECORD HAS BEEN PROVIDED TO THE WELL a WNER
SIGNATURE OF PERSQN CONSTRUCTING THE WELL DATE
o th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GR; t:1109=1- 3`6 Phone 00,4919) t 33-3221, within 30 days. GW-1 REV. 07/2001
Acl:\I.J;r

254679
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RELIBENNatural Res
ources - CALDDHLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION / 2140
REUBEN CALDWELL DRILLING, INC.
pxonE4i8 1254-358I
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f3 Municipal/Public 0 Industrial Cl Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: l
Nearest Town: 4 r20 etCounty Oe o N
(�<�,v tr. t LS (ltJC2 v`ILLS GII°ic
�rtte, Numbers, Congrubdivision, Lot No., Zip tole) let Ai I Del
(Street N
►-&P
3. OWNER: — ty a-07
Address '3'1ateSeet
or RE,16e No.)
City or Town Stale
(2} ti • 9
Area coda Phone nombu
4. DATE DRILLED 3
5. TOTAL DEPTH: et 4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0
7. STATIC WATER LEVEL Below Top of Casing: "2-
(use if Above Top of Casing)
8. TOP OF CASING IS _- FT. Above Land Surface*
flop or culag terminated atlor below Ind toffees requires a
(D raft, e
Zip Code
7/ S
variance la accord. 9 with ISA NCAC SC .0111. n I /I
9. YIELD (gpm): O- METHOD OF TEST 'Uv - 4 'L-
10. WATER ZONES (depth): 5 0 5 -nr-
NO 01/
D Fr,
11. DISINFECTION: Type
12. CASING:
Depth
From 1 To 4 3
From To
From To
CI OS- I Coen
1� N q o %/v Amount S c v 95
Wall Thickness
Diameter or Weigb1/FL Material
FL 6'tl S05Ial e/C-
Ft,
Ft.
13. GROIT::{ Depth Marmot Meth
From 1 To •Q`S Ft. Cerikeni 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.
TopographiclLand setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depees/m inutes(seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
/ Formation Description
0 ioatoo(LoerJ
GgAn) rE
S o y t/.)- GEr 9
5c5 - •)oS CDCD -E r
DEPTH
Frpm , To
es ' - so y
cIoc .S '
ADS - ei95' f,ail Nl'rt
GOrsn
CO
Q
LOCATION SKETCI( o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
V0 M
( iL-L� fi42
IDO IIERER GGR-TDvv THAT IS WFI L WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C• WELL
;ONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
:Z/
SI
-NATURE OF PERSON CONSTRUCTING THE WELL
3/>- j' /0
ATE
OMit,In l toi he Divis on of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
)1ff33;3221, within 30 days. GW-1 REV. 07/2001

252090
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN Resources
CALD- DELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS/ 214E
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING/ INC. PHONEY$ ,? 54 - 3581
STATE WELL CONSTRUCTION PERMITS/ 1537 ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 131 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: ts e a rJ County tj (W -SO"
3. OWNER:
Address b -(mot a i (z (Jb 4i L.0 Si
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
M o /Le —A 5 NA Ote> / 3
(Street or Route No.)
12- 46NIA GA
City or Town State 67Zip Code
A 2G O 1
Area code- Phone number
4. DATE DRILLED 3/a i o
5. TOTAL DEPTH: 3j r 5 ^'
6. DOES WELL REPLACE EXISTING WELL? YES NO l7-
7. STATIC WATER LEVEL Below Top of Casing: ri FT.
(Use "+" if Above Top Cuing)
8. TOP OF CASING IS a FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 0 METHOD OF TEST 2.t6 -1v-
10. WATER ZONES (depth):
/tOpographic/Land setting
101Mdge ['Slope ['Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degmes/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From a / Formation Description
50� �05 r g-atTe
3 05
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Material
From
From To Ft.
Depth Size
To Ft.
s �.1
c
N
z
z rn
LOCATION SKETCH .- 2,
Show direction and distance in miles fromcaleasE
two State Roads or County Roads. Include the road
numbers and common road names.
n-ii'. , S
+ 44eZwALLo c,J
d'-
r
Gn
A
p w 06e,et✓12 (gip, Jo J — cc° 5
BY CERTIFY i� ��. WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
NSTRUCI'ION STAND • n • is ( T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL,}0
+l � n, et —Lek
3 mot—
SIG ATURE OF PERSON CONSTRUCTING THE WELL
DATE
_�Gpt ND'e"LATER SECTION
S`1(514E _ RATERi1 E pfER[vislo of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
one o. [phone], within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION:
N rest T wn:`i r /" 4/
211(
254678
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources
CALDDELLn of Water Quality - Groundwater Section
RWELL CONTRACTOR (INDIVIDUAL) NAME (prlat) CERTIFICATION 0 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE I%8 )254-3581
STATE WELL. CONSTRUCTION PERMIT/ 1 537 ASSOCIATED WQ PERMIT,
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential a" --iv unicipa1/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Jot
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appoprirte box)
Latitude/longitude of well location
County-4441/aKirdeC
4lri/f � —
(Stnet Name, Numben, Community, Subdivision, Lot No. Z ! e)
4
3. OWNER/
Address �d lGL>
(suecta f 7/.5"
Si.?or Town Syys� Zip Code
(S 2)23/— 7g 9�
Arca code- Phone number
4. DATE DRILLED Z -to — D %
5. TOTAL DEPTH: 1? 2_5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top ofCasing: titre FT.
Li (Use "f" if Above Top of Casing)
8. TOP OF CASING IS / 2/17. Above Land Surfaces
'Top of cuing terminated et/or below lead surface requires a
variance In acenrdsnce rlth ISA NCAC 2C .0110. 1 t
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From / To_7`
Frorn To
From To
13. GROUT: Depth
From 0 To 7-0
From To FL
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 71>f
all Thickness
Diameter gs�eigilt/FL 71je num
FL /n Td(t j
Ft.
Ft.
Material ,, My
Ft. C
16. REMARKS:
°I
LJ1 DO HEREBY OEI
I —'-CONSTRUCTION ST
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From
TD Formation
Deofptjo n
r
io
LOCATION SKETCH --
w direction and distance in miles from iDleasp
tate Roads or County Roads. Include jjhe road
ommon road names. l7-r'0 o
l'iz�
THIS WELL WAS CONSTRUCTED IN ACC a • eAf' WTIH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD . BEEN PROVIDED TO THE LL OWNER
SIGNATURE OF PERSON ONSTRUd GTHHE WELL
islon of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3221,within 30 days. GW-1 REV. 07/2001
G d ; ,(k or(gtina to the D
ASN 494flSins 1Qi.F�c . _-

249128
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RE Natural
Resources
CALDD6Ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
PHONEY?($ I?54-358I
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC.
STATE WELL CONSTRUCTION PERMIT. 1537 ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 3/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQ� Nearest Town:
CountyA-Logna."
(Street Name, Numbers, Community, S bdtvision, Lot No., Zip Code)
3. OWNER: .�
Address
(Street or Route No.)
City or Town State Zip Code
Arta code- Phone number 2
4. DATE DRILLED 9--2 0 "�
5. TOTAL DEPTH: 72 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l2'
7. STATIC WATER LEVEL Below Top of Casing: 1/-O 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): e- METHOD OF TEST
10. WATER ZONES (depth): /14'f 4460 r tf(.'/.Y if 2t
11. DISINFECTION: Type #% f/
12. CASING:
Depth Diameter
From+ ( TO_TE__Ft. iY
From To Ft.
From To Ft.
Amount 2VDL
Wall Thickness
or Weight/Ft. Material
fa -sf Vc-
13. GROUT: Depth Material ethod
From 0 To 40 Ft. crer'rr7 /it.fze:i
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.
CONSTRUCT
TopographieZand 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 pescrjption
-73
LOCATION SKETCH — _=
Show direction and distance in miles from al lea
two State Roads or County Roads. Incldde the road
numbers and common road nam `ff
FY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
EROUNDWPSfihrfiftethiaki8ginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHEVILLE Rff . [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 259406
North Carolina - Department of Environment and Natural Resources -- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C �l \) . `) U J CERTIFICATION #,.c t\5� (0
WELL CONTRACTOR COMPANY NAME —SU 53\ Ce W e.\\ (' \ \\VINE\ PHONE # f 7-q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITLJ\
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential CS< Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:46,411
Nearest Town: 1\5\'e V\\,e County tt„ t Sci e.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Su c. rvt rsr
Address c • E3 *) p y.,
(Street or Route No.)
Vd\( 4t eLAD t`\C 2%11313
City or Town Stle Zip Code
(f4 )- (y a %- a\ t Area code- Phone number •
4. DATE DRILLED L\ -\co- o a-
5. TOTAL DEPTH: $O5
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO SiY
7. STATIC WATER LEVEL Below Top of Casing: to 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 ISA NCAC 2C .0118. J
9. YIELD (gpm): -5 METHOD OF TEST `)(12-eg VIM
I0. WATER ZONES (depth): ivivi e go S o
Topogra c/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuses/seconds)
Latitude/longitude source:DGPSfTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4/ y6 - g0-
11. DISINFECTION: TypeC ee \c C\. Amount 'Fa&i;'fo
12. CASING: Wall Thickness
pth Diameter or Weight/Ft. Material
13
14
15
From 0 To lite Ft. Ge) /G
From 1(0 To ei S Ft.
From To Ft.
GROUT: Depth Material
From To F
yt5 IT-`
fS 4AitJ
[.
From (0 To Z� Ft. i
SCREEN: Depth
From To
From To
SAND/GRAVEL PACK
From
From
Method
Diameter/ Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
To Ft.
To Ft.
RKS
LOCATION SKETCH N
Show direction and distance in miles from atekast `•��,
two State Roads or County Roads. Include ttToad;` r; `�Z
numbers and common road names. dr SaP'i'
D L ti7/ S
I DO I IEREDY CERTIFY TH
CONSTRUCTION STANDAF
fi n,.. i °- I i
.L�REP!m' Div
c7o99-1636 Phone Nu. t4 9) te3-
HIS WEL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND iHA COPY OF THIS RECO [l - - BEEN PROVIDED TO THE WELL OWNER
IGN * TURE OF
ERSO
NSTRUCTING THE WELL DATE
;ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

255662
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -'Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) R!b O 6, n LA 4 CERTIFICATION q g'Y/F i
WELL CONTRACTOR COMPANY NAME Ore a BYDS. Lc/te // '9 P4 Mph PHONE ('1816/ o Of -3/7�
STATE WELL CONSTRUCTION PERMIT# J4/4 2- ASSOCIATED WQ PERMIT('
(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:
Nealest)Town: z L4- Cava_ • County I -Liao Winh
(Street Name, Numbers, Commonly, Subdivision, Lot No., Zip Code)
L
3, OWNER. J /Ay
• Address /4IG 4 JNi r At /s Ave •
�j � (Strat or Route No.
Sou,�-lrprcrt, ,Ve &S4 L /
City or Town State Zip Code
•' Area code- Phone number
4,-''DATE DRILLED 5 - I - o Z
5. •TOTAL DEPTH. 7Q15 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gT
7. STATIC WATER LEVEL Below Top of Casing: . 300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S i FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TE$T rs •
10. WATER ZONES (depth): 310 5 ' - .3/4/ 4p en
72D' ' 7'/yrs prn
11. DISINFECTION: Type H Tl-1 Amount / 34F
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From_Q_To /tS Pi/O
From To
• From To
-13. ,GROUT: Depth . Material Method
From_L�._ To . D Ft. i e 1 7. e s 415 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:
Diameter
Ft. 4 "
Ft
Ft.
ial
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreesminutes/seeonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a5
1+'S' gra n lie 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.
DO HEREBY CERT1Fb' THAT TN S WEI L. WAjS�CPONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA '''ANTI Fh4.TTP�; ttPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
q ASH V L� R .kL Ori
y4 e/ 5-31-o s
SIGNATURE OF PERSON CONSTRUCTING TH ELL DATE
0
w
c
0
Submit the original to the Division of Water Quality, Groundwater Section, 163e Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

255071
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME `(print) WO PI/� �G AL CERTIFICATION # 27/8
WELL CONTRACTOR COMPANY NAME aPten,��//Bros . �E1/ 'I ti /t4/ p''NE # (8'JS VS 2't* "3/
STATE WELL CONSTRUCTION PERMIT# /'f.6 .2 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. 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 Tow4:� �F/Q 7G4Lt /7i
r County GtSon
LIndsaq !—coin Rd.
(Street Name, Numbers, Certfmunity, Subdivision, Lot No., ZipipCodc)
3. OWNER: .4 A_K nnn '5 ?�.1 F,—!n
Address 370 Lindsa.q Leer Ln .
(Street or Route No.)
F/AleAir, Svc On 732
City or Town State Zip Code
(-)-
Area codc- Phone number
4. DATE DRILLED a-a/-D1
5. TOTAL DEPTH: SOS •
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO QQ
7. STATIC WATER LEVEL Below Top of Casing: g0 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): /S METHOD OF TEST c2 hrs •
10. WATER ZONES (depth):
r _ tt
II. DISINFECTION: Type NT/Y Amounn� 9 L
12. CASING: Wall Thickness
Depth Diameter or We Material
From_i_To 41 Ft. G " PVC
From _ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To PO Et. /'Q .. lay
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
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 Forman ascription
4f9 ' SZ5'
r i e M
"DT , Li
To Ft
7 Si
16.. IS(ARKS:
1 DO HERE3.X-CERTILY THAT.TLLS]&ELL'
CONSTRUCTION STAMUAiRiRA6�AYdI') THAT
AJJ ,t UrHFCE
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
AS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
COPY OF THIS RECORD IjAS.(3EEN PROVIDED TO THE WELL OWNER
-3/-2-
SIGNATURE OF PERSON CONSTRUCTING SIZE 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

247145
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(i f applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
DAVIS MOUNTAINRD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN F. LAUGHTER
Address 909 DAVIS MOUNTAIN RD.
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
(828) — 674-5920
Area Code Phone number
4. DATE DRILLED 01/21/02
5. TOTAL DEPTH: ORG. 505' DRILLED TO 805'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO NI
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 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 ARD
10. WATER ZONES (depth):
County HEND
11. DISINFECTION: Type CHLORYTE Amount 23
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 28 Ft. 6-1/4" SDR27.6 PVC
From _ To _ Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
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 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH •
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. include the road
number and common names
HWY. #64W. FROM HENDERSONVILLE. LEFT
ON DANIEL DR. STRAIGHT AT STOP SIGN. RT. ON
DAVIS MTN. RD. 1-1/2 MILE PAVED DRIVE ON
LEFT. (TOP OF HILL)
0
N
m
to
rn
s
0
co
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS
Submit the original to the Division of Water Q
27699-1636 Phone No. [phone], within 3
GROUNDINAiJR SECTION
ASHEVILLE RLGIitC,1 OFFICE
ir2_ /— a/—/1
DATE
ail Service Center —Raleigh, NC
GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town: p\cae�-n
r\ County N\cler
Pb{-'
b rack L',cee »c E. SlGI�S �Ot e at104
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: so.\Q B.eeCe
Address \3\ S. (Yee¢e �*t.
(Street or Route No.)
Ocdec\ 27S7tQ`\
City or Town State
(%28)- R9t 19o'1
Area code- Phone number
4. DATE DRILLED \\' r't,-5. 0 Z
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ro
7. STATIC WATER LEVEL Below Top of Casing: \ S FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS 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): too METHOD OF TEST -
10. WATER ZONES (depth):
Zip Code
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TecV'CK 1t448.1.L. aollvletS CERTIFICATION# �'la�
WELL CONTRACTOR COMPANY NAME C.\.ar,2 -citGu%`aet W<11 d.4y* tic PHONE # (rYh71 &65- ZOZZ
STATE WELL CONSTRUCTION PERMIT#- • ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
266269
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
DRidge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
NMI
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic rnap
(check box)
DEPTH DRILLING LOG
From To Formation Descripti an
ke 98 OV&v S ode
qg 30S Gcw .«
LOCATION SKETCH
11. DISINFECTION: Type ' Amount \ S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
12. CASING: Depth Diameter or Weight/R. Material numbers and commonroad names.
From t� �ae 9\ck3t':e ' To r1$ Ft. t - a
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
rio Ft. l�m�4t `noured
From 0 To
From To Ft.
14. SCREEN: Depth Diameter Sint 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. REMAR
I tri
IT) I .DO HER
f CONSTRUCTION STA
LS
lc
4—
rncd:wet
O
U1
C..3
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
1-a5 oz
DATE
„ iLlSr 1t the grretn�l "Y the D
_*"27b99 16.t6 0lRate
SIGNATU
E OF PERSON CONSTRUCTING THE WELL
vision of Water Quality, Groundwater Section, 1636 Mail Service Center\ ; Raleigh,
NC
-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \�@CCiC\K 'G'w+yECS CERTIFICATION # 2-.4.4(4
WELL CONTRACTOR. COMPANY NAME CA SOL'arS3"SSA t�-"A'`a A'°rvl LACi PHONE # BZS) ees
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential lX Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: th%r Ho ewe County 'Men t. jr
t)e.ee ?.lase -
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: -3�4.1/4- d Qaz e ty Uw.�
Address \Zc Qe-x
(Street or Route No-)
MO4nkO . Vs lt*.•mle 'f\C
City or Town State
( 5523)- $St \52t-\
Area code- Phone number
4. DATE DRILLED \t) 1 -bL
5. TOTAL DEPTH: (DO5
a. -7 S
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 Descriptior.
Al2 Osles Cysc&G4'x
(cos
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO It
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): 1 METHOD OF TEST a1
10. WATER ZONES (depth):
1\Z
11. DISINFECTION: Type 0;US
12. CASING:
Amount t.
Wall Thickness
Depth Diameter or Weight/Ft.
From b1 To \\t- FL i.1/4-_— * Z.i
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a Ft. L'S'-'nx'r^t ?cut ea
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
From To Ft.
From To Ft.
16. REMARKS:
264405
202Z
Ccro• tp
LOCATION 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 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
\O- 1-OZ
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

261253
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
NI q• �j0..3NerS CERTIFICATION# 2/131p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) OO
WELL CONTRACTOR COMPANY NAME CIyp� S0.�r Z Soh Ne4 r} ?um) r•Aer PHONE # MR) 645 ten
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ewc� w
ia
Nearest Town: t\tt a County_ _
Pou&Pc eoeet €Sten Lot et to
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dt en Gevwee
Address toi tACEtltC Rt1
(Street or Route No.)
praer, nic 28-f04
City or Town State Zip Code
(Ste)- "Zat 6655
Arca code- Phone number
4. DATE DRILLED 7-t1-Ot
5. TOTAL DEPTH: 5os
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Sri FT.
(Use'•+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '� METHOD OF TEST R:ei
10. WATER ZONES (depth):
ppographic/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 Formation Description
4-I II O'tec section
11. DISINFECTION: Type Yt\\A
12. CASING:
From sr\
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To W Ft. Cement
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
llb
605 Grartte
LOCATION SKETCH
Amount 5 Show direction and distance in miles from at least
Walt Thickness two State Roads or County Roads. Include the toad
Depth Diameter or Weight/Ft. Material numbers and common road names.
To i\te FL lokv #ZI __pin.
Method
Qerareci
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 TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
8 22-dz
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh, C01
27699-1636 Phone No. [phone], within 30 days.
7-7

261252
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 1Natural Resources - Division of Water Quality - Groundwater Section
we LL CONTRACTOR (INDIVIDUAL) NAME (print) 1)9 RY:CK 'Snare CS CERTIFICATION # 1' '
WELL CONTRACTOR COMPANY NAME C\U. 54�eC is a tut*' ��s''�'� 'nC PHONE # (avA GG5" 'Lea -
STATE WELL CONSTRUCTION PERMIT# d ASSOCIATED WO 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 ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: t1Qhag CSOW \le�erp, County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Juan:k& Ent 'st,
Address FIT Z :jc n Z.bo
(Street or Route No.)
lken la eSonv; it v �c
City or Town State
(az$)- b?S- 3374
Area code- Phone number
4. DATE DRILLED S" 9 - a Z.
5. TOTAL DEPTH: '32 5
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 't FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): it METHOD OF TEST 111.
10. WATER ZONES (depth):
/YP+." fQ¢rco rJ
9..fi792
Zip Code
Tpegraphic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7-1' .rc raver ere cciiav•
rD re 3.21r
(tort 1-e
11. DISINFECTION: Type p115
12. CASING:
Depth Diameter
From 1/ To SC Ft. to -IQ
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .0 Ft. Ca "ent Poute-a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount
Wall Thickness
or Weight/Ft. Material
kt Zl elo St.t
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tt e�road.=
numbers and common road names.
CI)
rn
N
0
J
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
8-9 62
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center l REVgh, C01
27699-1636 Phone No. [phone], within 30 days.

2. WELL LOCATIO : 1
Nearest Town: e-/ -r tielc-
/f/r "yr k M T rs) c Lot No.. Zip
Name, Numbers, Community, Subdivision, Code)
3. OWNER:
Address
(Street or Route No.)
itSine i.4n . (dc
City or Town State
(�)- 3-50\
Area code- Phone number
ola 13'>
Zip Code
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural - Division ofWater Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C\ 'e Y. 5
t $4ti1
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT()STATE WELL CONSTRUCTION PERMIT# (if applicable)
(ifa 1icable)
I. USE (Check Applicable Box)' Residential la Municipal/Public 0 Industrial 0 Agricultural ❑
WELL U ec Monitoring 0 Recovery
0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topograp�h1c/Land setting
❑Ridge -BSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
County JYe ersr��
255245
- Groundwater Section
CERTIFICATION #�' 434
PHONE # 15g
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
re) YAn Diciea.r n
4. DATE DRILLED 7' `"°Z,
5. TOTAL DEPTH: I'a S
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO (el
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): 1 0 METHOD OF TEST R-'4
10. WATER ZONES (depth): d
11. DISINFECTION: Type_ ____— Amount 5
12. CASING: Wall Thickness
Depth Diateter or Weight/Ft. Material
To Si Ft.�"�— ai'2A ftc*tG
From_ j__
From To FL
From To Ft.
13. GROUT: Depth Material Method ``
From_Q_ To —.'a Ft. etawit.. cea re POu
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
DEPTH
From To
51
1 vet diner•:"'.
LOCATION 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
rra
C
G7
tD
0
IV
c.n
c:
0
�.a
Submit the original to theDivi
}aivo9-1636PhoneNo. (91xP733-`1' within 30 days. 1,
ASS
IS EL WAS STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY NOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERN STRUCTING THE WELL
•ion of Water Quality, Groundwater Section, 1636 Mail Service CenterGWREVI Rgh 2001
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - GrCEoundwater Section
ction 36
WELL CONTRACTOR (INDIVIDUAL) NAME (print) HONE # (4TI 355--.Y
e 50us
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (ifa licable)
(ifa icable)
1. WELL USE (Check Applicable Box): Residential t Municipal/Public O. Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
n
'e County /AA P.r-1O €AJ
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: tt C fjt.eaF e_ 7-1 ewt° CW' om. .0
Address
City or Town State
(t2s)- lent -,4\O
Area code- Phone number � ��
4. DATE DRILLED Kos
5. TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO j7
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance -with 15 NCAC 2C METHOD .0O118.
9. YIELD (gprn):
TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING: /
Depth%tom Diar eter
Fromt Toa FLU__ _
From To Ft.
From To Ft.
13. GROUT: Depth Material Method (routed
From___ To Z6 Ft. r
From To Ft.
14. SCREEN: Depth Diameter Slot SizeMaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
Zip Code
Q
258243
> 6pographic/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
Amount
Wall Thickness
or Weight/Ft. Material p
a:A J 5wr:e
From
From
16. REMARKS:
i F IS 1,,
U L'
Submit the original to the d'visi
27699-1436 Yha+aNu. (4L3)..Zi3-322
vor! ` L' E RE' (1 OHO
O
To Ft
To Ft
{Eric le. Ne' TT cJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and corrunon road names.
7ZY THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
TA D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
��� D•GAT�E
�'°'i RSON CONSTRUCTING THE WELL
I of Water Quality, Groundwater Section, 1636 Mail Service Ceentteerl Vgh, NC
, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater r Section
N 3(v
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERT IFICATit ( 2 e
e 6sus
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT('(ifa licable)
(ifa licable)
1. WELL USE (Check Applicable Box): Residential tit Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: . G O .o i✓I County '67e do rso n
ion, Lot No.. Zip Code)
(Street Name, Numbers, Community, Sub
3. OWNER:
Address
9""---TS—
City or Town State Zip Code
Area code- Phone number 7- 2 C
4. DATE DRILLED
5. TOTAL DEPTH: i-i0 S —
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
(Use "+" if Above Top of Casing)
7. STATIC WATER LEVEL Below Top of Casing: FT.
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variancein accordance with 1$A NCAC 2C METHOD OF TEST TEST FJ.%q
9. YIELDELD(gpm): A
10. WATER ZONES (depth):
11. DISINFECTION: Type -�y�---Amount i9 Wall Thickness
12. CASING:
Depth Diateter or WeighUFt. pM�at�eria�l �
From'__ To- Ifi _ Ft._iOtiI_ .__iO1*L .t.5._
From To Ft.
From To Ft.
13Depth
GROUT: Material Method
. From_,_.Q_ To,_�6_ Ft. rt s it �fouted
From To Ft.
Diameter Slot Size Material
14. SCREEN: Depth in.
From To Ft. in.
From
To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
To Ft.
To Ft.
258296
Topogr tc/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
UYz 30.-Lelor,
DEPTH
From To
y5
145 Yo5
From.
From
16. REMARKS:
S bmit the original to the D visi
276994636'Phone Na. (919) 733-32
IketZus_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
GNATURE OF'ERSON ON i TING THE WELL
n of Water Quality, Groundwater Section, 1636 Mali Service Ceenterl REV gh,N0001
C
1, within 30 days.
n
0
ELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'1.2-0Z
DATE

258233
K
5o.A.at05 CERTIFICATION# 2.4S6
e 5 aT lar in �*ele D +n� .ePHONE # f2249_. 55 7kil2t
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATION:
Nearest T wt;: Let County 111"oln.thnn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 14 vrt
Address `1`I °park_ La..?
(Street or Route No.)
gi�
leicl,•es l.1t
City or Town State . Zip Code
($2¢)- k, 5 NA • 03 $ef
Area code- Phone number
4. DATE DRILLED 7-25- el.
5. TOTAL DEPTH: St 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fez
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): I METHOD OF TEST f(Lsa
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From -VI To :Alit Ft.
From To Ft.
From To Ft.
Material
Cam.}
Amount
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 appticable)
I. WELL USE (Check Applicable Box)' Residential I4 Municipal/Public 0 Industrial 0 Agricultural El
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
% 38 _QN _..dtsn
Wall Thickness
Diarveter or Weight/Ft. Material
VC 3aV filarto
13. GROUT: Depth
From O Tot, 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.
16. REMARKS:
I DO HERE
CONSTIytflfON
Method
floueea
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.
� Uhmit the original to the ILta
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2Gs• In
DATE
e n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1699-1636 Phone No. (919) ' 33-32 1, within 30 days. GW-1 REV. 07/2001
iI'F EGTON
.1:... CFFjCE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prlint)l.itade K Sca-1Vte-C CERTIFICATION #
WELL CONTRACTOR COMPANY NAME C11.1e 5asdLiiess 50n well klu.�.r fnG PHONE # amr255 7(on
C ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
252840
1. WELL USE (Check Applicable Box): Residential f Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town:
Wa—
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
4erso.
County hieNpr;Sav
3. OWNER: Wo. cbk on acd
Address -;00 t-tnP Ozzt
(Street or Route No.)
Ilona Are
a879 2.
City or Town State Zip Code
41 R)- (085- 3oyy
Area code- Phone number
4. DATE DRILLED Lk- op.-0 2.
5. TOTAL DEPTH: 115
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: _ID 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
variancein accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): QO METHOD OF TEST ftl_
10. WATER ZONES (depth):
Topog_rap .c/Land setting
DRidge Iy1r8tope ❑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
.f.j (o(t Over Aerann
(00 I J 5
11. DISINFECTION: Type Phis Amount l
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4"1 To (DO FL 6-6 /k 21 P145i,:e
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0To 20 Ft. Cement ?cure d
From 1'o Ft.
14. SCREEN: Depth Diameter Slot Size Material iZasCk
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
Gran.'te
c,.
P
N �<
"o
r't
�G
mo
ern
N
LOCATION SKETCH r
rn
Show direction and distance in miles from 9FReast--,
two State Roads or County Roads. Include ti D roar
numbers and common road names.
`Garat.n I
aenTRE OF PERSON CONSTRUCTING THE WELL
Emit the original to the ivisi t n of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri REVgh, NC
r)�� (9733-32 �1, within 30 days.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2a-4.)
DATE

WELL CONSTRUCTION RECORD
249877
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
wELLCONTRACTOR(INDIVtDUAL)NAME (print) C' \e- 54 ctt=S
WELL CONTRACTOR COMPANY NAME Ct \3e yip �Ly bc„� Cxt\i
STATE Wt'EL1. CONSTRUCTION PERMIT/4
(if applicable)
UT
CERTIFICATION # 'ly'} lc
PHONE # 6423) -5J 7le S
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: AC,.4—s. s v
SVo]fW 10Q
(Street Name, Nurdhers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
Senn;;c< 3 tick3or,
t279 s3•ep? N.tk Rcac
(Street or Route No.)
\AcndeU•.nv:tte '3c
City or Town State Zip Code
Q8/92
( )-
Area code- Phone number
4. DATE DRILLED DI' ran 'OA
5. TOTAL DEPTH: 3oS
6. DOES WELL REPLACE EXISTING WELL? YES 90n NO El
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): k METHOD OF TEST
10. WATER ZONES (depth):
County --s• tj‘
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1 3`1 C v c c t; t', C101
VA 305
11. DISINFECTION: Type P` \75
12. CASING:
Depth
From t-\ To 34
From To
From To Ft.
13. GROUT: Depth
From G To '-` Ft.
Amount 5—
Wall Thickness
Diameter or Weight/Ft. Material
Ft. L,; L•-t 4-3\
Ft.
From To
14_ SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
Material
From To
From To
16. REMARKS:
Ft.
Ft.
Ft.
Slot Size Material
in.
in.
Method
oui
Material
4carT is
LOCATION 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 15A NCAC 2C, WELL:S jUC=10 S N le ' RIND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
R_� . :ai�ry r—a -tea
_,.S UR 4SF PERSON CONSTRUCTING THE WELL DATE
2 GRODUC
ASHEVILI F
bmit the original to thePivisil n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-32 1, within 30 days. GW-1 REV. 07/2001
OFFiLr _J

WELL CONSTRUCTION RECORD /�
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater2n eaioftQ(��j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ckc\ee- 1 • .fy3 SS CERTIFICATION# yz(*'
w'ELL CONTRACTOR COMPANY NAME C'(`:yde So.x I.at\\ S•t\'-nq PHONE # (5-"3) .a55 7 to sN
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 ❑ II -Other, List Use
2. WELL LOCATION:
Nearest Town: ,4 Vfdr X/
bill ld(nn
(Street Name. Numbers,'Com unSubdivision. Lot No., Zip Code)
3. OWNER: /1
bfou.%,.. e..
County /4Fir.>/•vee.l'dlf
Address
(Street or Route No.)
City or Town State Zip Code
(%21)- CP85- sacra
Area code- Phone number
4. DATE DRILLED 8' a't •oa
5. TOTAL DEPTH: I(SS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /X FT.
(Use "+" ifAbove 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): 426 METHOD OF TEST K: 3
10. WATER ZONES (depth):
878
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
+I 14 Ovcc i t;don
79 1laS
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 4 \ To 79 FL Le ,c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From G To 3 o Et. Ler-e r,tr ioeti.f vel
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
8—a\ ekes
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Gear: ; 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.
SC :C Wd Z -elaZC
cn
r+i
0
0
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
E OF P - sN CONSTRUCTING THE WELL DATE
�• ..he Di 3221w
ision of ater30 Qdauality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV.07/2001
, ithinWys.

WELL CONSTRUCTION RECORD
249548
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\VEI.L CONTRACTOR (INDIVIDUAL) NAME/.(print) C(t&,XQ K. 6a-i.. ctS CERTIFICATION# Ol-4?L
WELL CONTRACTORcoNIP.ANv NAME CA 1C '•St;.o1N rt, 1/4- Son- te3cl, llri 1t:1211oNE #6281" 622 732.E
STt'rE WELL CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMIT#
(it -applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial 0 Agricultural 0
Heat Pump Water Injection 0 Other 0 If Other, List Use
Monitoring 0 Recovery 0
2. WELL LOCATIO : hp
Nearest T`y"oywn/�/ enIC+terS-MItI t
6,1
(Street Name, N(i(imber Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'R - 6oAz-tr
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 2.-0S- OZ
5. TOTAL DEPTH: 2 4 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO je
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): k METHOD OF TEST R+>-
10. WATER ZONES (depth):
County hrerJers rllvJ
Topographic/Land setting
❑Ridge ❑Slope a'attcy ❑Flat
(check appropriate box)
Latitude longitude of well location
(decrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(D 5 Over flerdon
LS 245 (rr'an;+e
11. DISINFECTION: Type 9:1(5 Amount t
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From +t To (nS Ft. Tt 2i Flo -sift
From To Ft.
From To Ft.
13. GROUT: Depth Material Method,,
it,m(`-t From 0 To ZFt. Ce ent ! re ci
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
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.
c
N
Slot Size Material
in. _
in.
Size Material
•
(.rl
t+
rn
Cti
n �' 11
DI i FsREk't{ R\d1FY, FI
S WELL WAS CONSTRU TED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
THAT A COPY OF T S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2E OF PERSON CONST
HE WELL DATE
t-ttts<'4'#„'adtidl-tiiWIlDivisi t n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2Z6.99r1636 Phalle NO!, (91-9):733-32 1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRTJCTION 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 Rnmmw r) Wel 1 flr111 trig Tnr PHONEY A2A 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (If applicable)
260621
1. WELL USE (Check Applicable Box): Residential CR Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Q If Other, List Use
2. WELL LOCATION:
Nearest Town: Edneyviile County Henderson
Schiztands Place, Lot B-2 ;28727
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Eric Denton
Address 39 Gloria Orchard Lane
(Strew er Route No.)
Hendersonville NC 28792
City or Town State Zip Code
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area coda Phone number
4. DATE DRILLED 8/07/O2
5. TOTAL DEPTH: 9R S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DC
7. STATIC WATER LEVEL Below Top of Casing: 60 FT
(Use "+" If Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C ,OIIL.
9. YIELD (gpm): 1 5 METRO'? OF TEST rotary air
10. WATER ZONES (depth): 385
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft.,61 /$ Srh At) PVC'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20
From To
I4. SCREEN: Depth
From To
From To
15.SAND/GRAVEL PACK:
LOCATION 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. concrete gravity flow
Ft.
Diameter Sfot Size Material
Ft. in in
Ft. in. in,
Depth Size Material
From To Ft,
From To Ft.
n
rn
-u
-o
v
0
CD
16. REMARKS:
tiDdlHek . 7.l y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION TJ{$DARDSS,fAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j y• I N C - �a�wt r Nun VD Z It
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
i
GROUNDSIffliRitSklfelt% the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ASNPJILLEIIx�§016�31i'on tNU, [phone], within 30 days. OW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource; • Division Of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy A• Bowman CEATIPICATION.260.9
WELL CONTRACTOR COMPANY NAME 11
STATE WELL CONSTRUCTION PERMIT.
(if applicable)
ASSOCIATED WQ PERMIT.
(If;pplioable)
I. WELL USE (Check Applicable Box): Residential (X Municipal/Public Q Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonvi 11-untyHenderson
Hawkins -Springs Road Lot #6
(Street Name, Numbers, Community, Subdivision, Lai No., Zip Code)
3. OWNER: Wanda Marshall
Address 9 Victoria Drive
(Streit or Route No.)
East Flat,Roack, NC 28726
City or Town State hip Code
( )-
Area code- Phone number
4. DATE DRILLED R/19/n7
5. TOTAL DEPTH: 1 x1n'
Topographic/Land setting
❑Ridge °Slope °Valley °Flat
(chock appropriate box)
Latitude/longitude of well location
(dagrcclminu iaiseconds)
Latitude/longitude soureelCOPSOTopographic map
(check box)
DEPTH DRILLING LOG
From . To . Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES NO CI
7. STATIC WATER LEVEL Below Top of Casing. 20 FT,
(Use "+" If Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT Above Lind Surface" •
*Top of cuing terminated af/or blow land $ur(aco requires a
variance In accordance with 15A NCAC 1C ,eila.
9. YIELD(gprn): 7n METHOD OF TESTL'otary air
10. WATER ZONES (depth): 80
I I. DISINFECTION: Type tablet Amount 6
12. CASINO: Wall Thickness
Depth Diameter or WeighVFL Materiel
From 0 To 56 FLE1 /8 Sr•h RO PVC
From To Ft.
From To Ft.
13. GROUT: Depth Materiel Method
From 0 To 20 Ft concrete gravity flow
From' To Ft.
14. SCREEN: Depth Diameter Slot Size Materiel
From To Ft, in . in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
t-1 E C p
cLr
From
From
I D0 HER
CONSTRUCTIO
LLD
ii0CATION(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
CO
THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
DARDS, AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g i5
SI ATURE 0P PERSON CONSTRUCTING THE WELL DATE
WATER SECTION
.a' Wtl(IF�dEanal o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NO
27699-1636 Phone `o. [phone], within 30 days. OW -I REV, 07/2001
GROUND
ASHEVILLE
N

WELL CONSTRUCTION RECORD
r1�wr11 4., , t
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 Dr111 inge Tnr' PHONE,/ R78 757-7779
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential (2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Edneyviile County Henderson
Lamb Mniintain Rnarl Rrinayville 98727
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Brian & Angela Barnett
3. OWNER:
Address Rt 9, Box 683
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( )-
Area code. Phone number
4. DATE DRILLED 7/12/02
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l8
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 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): 1 + METHOD OF TEST', rotary air
10. WATER ZONES (depth): 300'
LOCATION 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 0Slope ❑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 Formation Description
11 DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft.51 /E SCh 80 PVC'
From To Ft.
From
13. GROUT: Depth
From 0 To 20
To Ft.
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
To Ft.
To Ft.
From
From
0
16. REMARKS:
I (D0 IRET1TQETAF
LCaWNNSI RUCTION STAl
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
704/ /v } ..t'fl. Y� —
raNATURE OF PERSON CONSTRUCTING THE WELL
/Z
DATE
O 2-
Submit the original tb the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
G, GW-I REV. 07/2001
t3116'49�MR3S�P9ibS31Nhl [phone], within 30 days.
AS IEVILLC i- f : P5 L 0 r1IEE

256145
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 Rotuma Wel 1 Tlri 11 i ng, Tnr PHONE # R28 252-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential IX Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Edneyville County Henderson
St. Paul Road, Ednevylle 28727
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Tnney Taws
1-42 Wi-llowhrook Read
Hendersonvislr` idrto` alo.) 28739
City or Town State Zip Code
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED 6/05/02
5.TOTAL DEPTH: 440r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (X
7. STATIC WATER LEVEL Below Top of Casing: B0 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 ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST'. rotary air
10. WATER ZONES (depth): 200'
I I. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 180 Ft.fi J8 SCh RO Pvr
From To Ft.
From To Ft.
Material Method
13. GROUT: Depth
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
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.
From
From
16. REMARKS:
GROUNDWATER
ASHEVILLE REGIONAL OFFICE
Submit the original o the
. 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
G/oS bi
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION#2809
WELL CONTRACTOR COMPANY NAME D RnWman We11 Dri 111nq, Tnr^ PHONE #g9A 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
256144
WELL USE (Check Applicable Box): Residential IX Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest TownGerton County Henderson
Ridge Vista Rd. Lot C, Gerton 28735
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Don Duffy
Address 1916 Belvedere
Ave
(Street or Route No.)
Charlotte NC 28205
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 6/03/02
5. TOTAL DEPTH: 800'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I%
7. STATIC WATER LEVEL Below Top of Casing: 2 00 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): 3 METHOD OF TEST rotary air
10. WATER ZONES (depth): 600'
Zip Code
11. DISINFECTION: Type tablet
12. CASING:
Depth Diameter
From 0 To 20 Ft..61 / 8
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
SrH MO PVC
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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
16. REMARKS:
EI3O' Qj T)iE;Y �` THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T,IC IO ST a .'d!' ., AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J ,�.'�.._...., L b3/az
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the ori:inal to t e Di ision of Water Quaky, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
j6,510d1R icE6b119h9) 733 s221, within 30 days. GW-I REV. 07/2001
unv
ASHEVILLE REGIONAL OFFICE
•

252106
L 1169946- SECTI(ifv
��=r t `15NAL OFFICE
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 ll Aoryiall Drilling, Inc PHONE # $2a252 7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Hnrsp Shoe County Henderson
Cozy Acres Lane, Horseshoe 28742
;Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Randall S. Day
Address 240 South Mills River Road
(Street or Route No.)
Horseshoe, NC 28742
City or Town State Zip Code
( )-
Area code- Phone number 4/ 0 2/ 0 2
4. DATE DRILLED
5. TOTAL DEPTH: 320'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12
7. STATIC WATER LEVEL Below Top of Casing: 80FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
`Tap of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST rotary ai r
10. WATER ZONES (depth): 280'
11 DISINFECTION: Type tahl et Amount F
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 1 08 FLF 1 /8 shr 80 Pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
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)
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.
Sh :£ Wd 9- AIW ZO
0
0
0
aT
cn
c
n
0<
Dcm
rn�
cnm
V12
mzi
cl
ti
0
16. REMARKS:
I DO HEREBY£ AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONIST I DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
YAK-ei Lilt .-2 lb Z...
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original ko thelDivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
33-3221, 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
\V ELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman
\\ ELL CONTRACTOR COMPANY NAME n_ Bowman Well Bril--.ng, Inc.
CERTIFICATION # 2 8 0 9
PHONE #
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersnnvill Bounty Henderson
16 Jade Walker Dr. Hendersonville 28792
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ronda J. Fountain
Address 16 Jade Walker Drive
(SveetRowe No NC 28792
Hendersonvillee
City or Town State
)-
Area code- Phone number
4. DATE DRILLED 3/11/02
Zip Code
5. TOTAL DEPTH: 240'
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 lI
7. STATIC WATER LEVEL Below Top of Casing: 20 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): 30 METHOD OF TEST rotary a i r
10. WATER ZONES (depth): 200
1 I. DISINFECTION: Type tahl et- Amount 6
12. CASING: Wall Thickness
Depth
From 0 To 180 Ft. 6 1/8 Sch 80 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To .1 SO
Diameter 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.
Material Method
FL concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
FrttIarb
r--_
16. REMARKS:,
Deprh Size
Ft.
to1 n Ft.
Slot Size Material
in.
in.
Material
I DO HEREBY CERTIFTH.A"' THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONZET- tc-
S
N
N
DARES, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
2

250898
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\Y ELL CO\TRACTOR (INDIVIDUAL) NAME (print) Jeremy H Bowman CERTIFICATION #2809
\\ ELL CONTRACTOR COMPANY NAME a Rnt(mpn well eri lling7 Tn6 PHONE # t2t2d-2--73_79
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E3 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land
Nearest Town: Hendersonvilunt Henderson
setting
Laurelwoods Rd Lot #45 Hendersonville 28Thid
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Dennis Garren
Address Rt_ 3, Box 297F
(Street or Route No.)
Hendersonville NC 28739
City or Town State Zip Code
(828)-891-1674
Area code- Phone number
4. DATE DRILLED 3/06/02
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: 140'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ER
7. STATIC WATER LEVEL Below Top of Casing: 20 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 ISA NCAC 2C .01(13.
9. YIELD (gpm): 12 METHOD OF TEST rotary a i r
10. WATER ZONES (depth): 100'
130'
11. DISINFECTION: Type tablet Amount 6
12. CASING: t� Wall Thickness �t
From 0 Doth57 Ft. Diar9etpb orWej ht/ b Mis;%J
From To Ft. b /
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 R. concrete gravity flow
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
l �f--�I?. SANU/G�RIVEU PA£ Depth, r
j / prom To lij F`1
I )\ From To i l tt
II I'. ,.. l vJj
11— 16. 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
0
b
N
N
N
wwi
DOr RLt.BV{'�t I'4141-THI WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
;__Sf2NSilt ']. S .f' DXthS, At D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6- J` 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

_watt .4.aniAlU fJ fON RE OMD
North Carolina • Dynamos* atEnvirormtent and Natural Reserve Division of Water Quality - Oroundwa(pr SectionwristCONTRACTOR(IIDIYIDUAL)NAMS Wet) .r—vi�
anntrlcnoN•
Wt&L CONTRACTOR COMPANY ?Wet
R UTI WILL CONSTRUCTION MINIM
WQ
1. WELL USE (Clock Appliable Box): Raldm.ist Music'public o
�00lodustrifil Agricultural 0
MseitorI g 0 Recovery 0 Heat Pump Water lion D Other C If Otter Lbt Use
2. WELL LOCATION:
Nearest Town: r s- ,e%I/er County IeJr1GUE.V'`3J}71
wee Wint Camiasky,aba.W.toa,Let Ne.,7.0Cots)
3.OWNER: 72g.YveII EA./lurk?
Addrone Trymoaf—
OhtMter ROWS Net
City or Tan Sue 7Tp Code
Arm ode. now attar,
4. DATE DRILLED (FY'aC urcf) 04034
3. TOTAL DEPTH: // 3o
6. DOES WELL REPLACE warm WELL? YES O NO/kf
7. STATIC WATER LEVEL Below Top otCadrtg _PT.
L. TOP OF CASINO IS / (Usr "*" If Abate Tcp elCatieg)
Fr. Above Land Scthoee
"hp elude. ereteewN otter New lad .ad*w metres a
ndew le wwdeaes Vet ILA NCAC IC ARIL.
9. YIELD (gpma: .5 METHOD OF TEST (t errA +u
10. WATER ZONES (depth):
11. DISINFECTION: Type,
12, CASINO:
F � Dlamter
Proms_ TO_____ Pt.
From , To Ft.
13. GROOT: Depth Materiel Method
PromTo Pt,
From To Pt
14. SCREEN: Depth Diameter Slot Sim Material
From__ To Ft in. __ In.
From-- To Pt. in. In.
15, SAND/GRAVELPACK:
From >� Sim M�
Ft
Froth To Fr.
255884
PROM a va VforS J�
Tarnd setting
QR lehsek Mat
ladiudeAtinglaide of well location
LatltudeMongpude So r0. opognpMo map
sat eau
/212111
Potation cdpd
Prom ToDescription
Amount
Well TLtdmsU
or WellAe/lt. Muerte!
wc,CrIr]N RYATr!H
Show dhedtloa tmd diatom in miles from at tout
two Stem Roads Edcounty gods. Include the mad
numbers and amnion road names.
c
Ncp
C_ cCO
C c
Cn n
c
Co
Plr,
ern
cn
16. REMARKS:
! DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS wxn T Al A COPY OF THIS RECORD HAS BEEN PROVIDED TO TITS WELL OWNER
Gr. Uri q R cEGIION
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Dlvldoe of Water Quality, Groundwater S•etlbn,1636 Mall **Mee Corder Ratak, NC
733-3211, within 30 days. 4114t REV. 07/2001
ECEEIVE
JUL - 9 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
.1
"cut*.4

4zaraksanusidamstres
North Carolina - Dopumtcnt of Environment and Natural bare -Division of Water
WU &coNnActot{arDmnuu tAMg tart .Lcl clI Quatiry-OSotwdcomom
WILL CONTRIOTOR COMPANY NANt r • -S'34'hc I' lli n " CENTittt,'Ain_ _
STATIC WELL CONRROCTION PZNMITY na PttONt d f�dBL %t�S VTR_
if Tat WQ eatTr
1. MWELLLUSE(Check �'Q Box): Rmidentlallji( hftttdo ablio Agricultural
Heat Fwvp War l<$eoyypp�n 0 Ober 0 If Other, List Usti
2. WEILLLOCATION:
Name!t 1owu:'elver Cowry P2ndP/ j/ 1 mu* lop* OVailiy °
T7phintand Flat
-......em.Muffin, Commwl4, Avhbe.LaHe.,LIpeta ft�areas �d
�ltodalignSihida of won location
3. OWNER- '�/. __
=--irk eVin Foley {
Address 6voL-Raw H 1l ' l rn le L to 2 teSit e 1
' ) GtlttaiaA oPm rani
e ,1 l7U? Solt boa)
IMES norrrn,Inrrv_I
From To Formation Dauiption
n r c w 2 l
d9'Or]r Ban Code
Mete mde. Me* Man
4. DATE DRILLED / 64ca a(o/'3.4
3. TOTAL DEPTH:. // 3o
6. DOES Walt REPLACE EXISTING WELL? vas O NO)1
7, STATIC WATER LEVEL BoIowTop ofCuinr PT.
S. TOP OF CASINO IS (Vet '4" if Alma Top et Cosine
FT. Above Land Sc,Aoea
"hp el Mocha brielaal 1 M r below land attar nyWrM ■
9, YIELD vials U� a ISA NCAC2C Aire.
10, WATER �2:ONES d IviliTH00 OF TEST 1- (,,,nd
( h
1 I. DISINFECTION: Type
12. CASINO:
Depth
From T From
Ft.
FromTo
13. GROUT: Depth
Prom to
PromTo_,
14, SCREEN: Depth
From To
Ptoto_ __-_..Tom_
15, SANLVORAVnEL .PACK:
Size
From To Ft
Ptotn_�To Ft.--
1 b. REMARKS:
100 HEREBY CERTIFY THAT THIS
CONSTRUCTION STATQU 4
Pt.
Ft.,
Dtatoalor Slot Size Mantel
PG lo, In.
FG in. ht
Amount
Watt Tabs
ter weight/Ft. edetedel
Method
Material
Show direotio, and from at lout c
two State Roads or County Roads. Include the®ad
numbers and comatt road names. [V
t_ n,
r-
m.)
U7
= m�
N
,mtprepeg
G
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WEI.L.
'NWT A COPY OF THIS RECORD HAS BEEN PR04ID o TO THE WELL OWNER
SIGNATURE OP PERSON CONSTRUCTING THEDATE WELL� -
Submit the orient to the Mahlon
27490-1636'boss Ns, ' 19 733-3233,
E C 0 U
JUL 1 8 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
J
#L 114 .5 " L]ter L;2
�
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
1636 Mali Swale* Canto - Rataln, NC
OW-1 REV. 07/2001
SHIPPED JUL 1 3 302

WELL CONSTRJJCrION REVS►RD
North Conlin - Deportment of Environment and Natural Rennet - Division of Water Quality - Groundwater Soatloe ro
WELL CONTRACTOR(MMVIRUAL)NAME (rrIa07/7-Skl.+c d-d Clra- -?rol ClttriIE ctt'nPnGTToMr o31Y OS
WELL CONTRACTOR COMPANY NAME 1 A ✓, i Pries ¢ PRONE a f a rN 3 -a`/5Q_
STATE WELL CONSTRUCTION PRIM171E _jt WQPIRMITTS
(Imitable) {it®IlaMMt)
256'705
1. WELL USE (Gook Applicable Box): Rasiden& MUololpaIPeb]b O Wha bI Q Agricultural 0
Mooltodna ❑ Recovery LI Heat Pump Water !q)eotbn 0 Other o, ItOdmr, List Uaa
2. WELL LOCATION;
Nearest Tow 11'1(115 2 j Veer Gunty e r
.011
(brat Nom,Nushes, dmaanity, 6ubdH1aka, Let No., Z4, Cede)
3. OWNBR:,_ P d-1"IejC ('bcv_h�,yn•
Address i7 Galen rye 2
+C
aorLdo2`a nC..Na.l Q 8 -aa
} « toi - t n. -9rQa ice'
4. DATE�ED I-rac-}ured 5-i toe a
3. TOTAL DEPTH• la bA'
6, DOHS WELL REPLACE EXISTING WELL? YBS U NO if
7. STATIC WATER LEVEL Bolow Top of Cuing: PT.
tun '4' If Above Top et Coat
S. TOP OF CASING IS FT. Above Land Sutftoee
"Pap of slag Sn (nMl MIN batot Wdaortae *Oro a
•raydrornw Is sssttdaaet Mbt ISO NCAC 2C AIM
9. Y{SLD (spin). 5 _ MBThOD OF TEST {Pwn0CLAf1
ID WATER ZONES (depth):
TOpopaphintand lotting
ORidp,Slops QVad(oy °Flat
¢MekaPpteprYbbad
Lotitudo/Iangft ide o&wel location
(da/raatfmlRt4sfseooade)
Lulwddlongituda IoaocOOPSOTopoarapbic map
Omsk MO
From To Foaaadloaiat�pdoR
11. DISINFECTION: Type Amon
12. CASINO: WalThlolmwa
Depth DLmdar or Wel¢tt/Pt. Amid
Prom To Ft
Prat_ To_,_,-__ Ft
FromTo Ft.
3. GROUT: Depth Mte ial Method
Pam_.To Pt.
Front__ To Ft.
14. SCRBBN: Depth Daman Slot Sim Manual
From TO Pl—Jo. In.
Prong -. �- To Pt _in in
15, SANWQRAVELPACK
Dspnt Size Wind
From______To___ Ft
Ptam To Pt.
1.1
Show climatic* and dinars: in mils doer at lout
two Stator Roads *tonrry Roads. inolude the mad
numbers end com ion mad tames.
C—
r-
-0
N
km
16. REMARKS:
1 D0 HEREBY CERTWY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION 67ARDS, AND THAT A COPY OP THIS RECORD EAR BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sobeilt the original to the bMsb
WATER SECTION
ASHEVILILEE REGIONAL OFFICE
Water Quality, Groundwater Section,1634 Mali Sara Cantor - RatdOb, NC
OW1 REV. 07/2001
GROUNDWATER R SE
ASCTION
HEVILLE REGIONAL OFFICE
1-.4END++t
SHIPPED JUL 1 3 2062

267079
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mr, s w Cazop, Jr CERTIFICATION if 21 48
WELL CONTRACTOR COMPANY NAME Camp' s Wp11 ,q, p,tmg (+rl Tnr- PHONE if 8 2111.1 d_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural IH
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: i kt)a Y C Countyijv N ° v �n vt
Rt. & /)/1 Ja rc R.
(Su-ecr Name, Numbers, C
triunity, Subdivision, Lot No Zip Code)
3. OWNER: 3 tYVtvin 1 IX
Address R-}. c (U vL! aYr- Rd
(street oc Rual V�C) Flat 1D o g 7J�
City or Town -/.State Zip Code
Area code- Phone number
4. DATE DRILLED a - 19 -
5. TOTAL DEPTH: j Sf S I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO S
7. STATIC WATER LEVEL Below Top of Casing: 4-5-
(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): 3 D METHOD OF TEST c i r
10. WATER ZONES (depth): 1 6 0
11. DISINFECTION: Type r h 1 n r i n
12. CASING:
Depth, Diameter
From___p___ To_� _3 Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
From_g_ To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Amount j c at
Wall Thickness /
or Weight/Ft. Material
gDR21 PVC
Material
Not Cement
Method
Hand
16. REMARKS:
TopoggSpphic/Land setting
❑Ridge 1511Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boxy
DEPTH DRII i.ING I.OQ
From To Formation Description
n 83 rn rt
?3 I87 rnY5DI1date a rnc-k
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
WELL WAS CONSTRUC1hD IN ACCORDANCE 1LITH 15ANCAC 2C, WF1 I
A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCT
X
G THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days, GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
262141
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James rr Camp, Jr
CERTIFICATION # 71 R 8
WELL CONTRACTOR COMPANY NAME Came s Win 11 R Pnm jr rn Tnr PHONE #837R) as3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ♦a Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: D411a Countyllevvte(SoYV
IrJ sce•eq Lath
(Suet Name, Numbhs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ma 2Kci tc.k5
Address �2v1 �iiv� SoRq In.
I (Street or oute No.) J
tic Ptd eabvt I e IJ C? g l l a
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE MULLED " a 11 RI ` D
5. TOTAL DEPTH: /LK
6. DOES WELL REPLACE EXISTING WELL? YES [Id NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4-5. FT.
(Use "1" 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 1SA NCAC 2C .0118.
9. YIELD (gpm): 16 METHOD OF TEST 41 r
10. WATER ZONES (depth): 11.0
11. DISINFECTION: Type f'h l nr i nR
12. CASING:
Depth Diameter
Fro t_q To .So Ft 6 1 / 4
From To Ft.
Froth To Ft.
13. GROUT: Depth
From__(_ To 2 p Ft.
Amount 1 G��
Wall Thickness
or Weight/Ft. Material
wwR21 PVC
Material
Pleat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To _ in.
15. SAND/GRAVEL P
Depth
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION ST
THA
Method
Hand
Material
Slot Size
in.
in.
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTR DRILLING LOG
From To Formation Description
n _S fi r ti 5 nd
S o j 4 5 NSol t dated ro c_IC
).00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
el f kt)Po d
CO
CO
AWRSSeCJ J RU to IN ACCORDANCE WITH 15A NCAC 2C, WELL
s�•'a - :5 ►..Qn'0P DOWEHIS '•1 CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS aN C'N ' UCTING 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

260031
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camp, Jr
CERTIFICATION e__2_13R
WELL CONTRACTOR COMPANY NAME Camp' c We.11 & Pnmr Cr>< T n r" PHONE IS2A) r1Y7-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT,/
(if applicable) (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 LOCATION-.r'
Nearest Town: County li-CYJeV50Y1-
�e11 nT-t
(Street Name, Numbers, Community, rSubdivision, Lot No., Zip Code)
3. OWNER: k7T kvt5o.
Address 1 e
0 B o K 44 5-
. i I u 1(Sveet or Route No.) o� g 7, 3
a Nl��-
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 14' a 9- b g
5. TOTAL DEPTH: 6i'i5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )55
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): J D METHOD OF TEST A i r
10. WATER ZONES (depth):
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
qra✓el ,r
un30/, dted rock
DEPTH
From To
15- c45
11. DISINFECTION: Type rh 1 nri nit Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_0_____ To '.5- Ft.6 t /4 gDg.21 PVC
From_ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_0_ To 20 Ft. Neat Cement Ha
From To Ft.
14. SCREEN: Depth
From To in
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
Diameter
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.
CO
rV
as,
a
I tieIiBRE9Y CEEJLlair HT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI t
CONSTRUCTION STANDARD& AND THAT A COP F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
a/n4e.d, %% • Ll/ q - I 0 - DA
NATURE OF PE ON CONSTRUCTING THE WE DATE
SlOnlitr beioilgltedabithe Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
0gk119= 63t6 olikine'riga .01-3771, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 256343
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL, CONTRACTOR (INDIVIDUAL) NAME (print) James kr_ Ca mI', Tr CERTIFICATION B 211 8
WELL CONTRACTOR COMPANY NAME Campr R ['Tall R Pump Co , Tnr PHONE 8$2R) d"1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lid' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injectionj❑q Other 0 If Other, List Use
2 Nearest Town:,
own: [5 A t (cuJ e County lie K � Stitt
Mdd IP ;K romm •
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
/ Topographic/Land setting
MRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 31tti a It I ( C it at Pit (degreeslminuteslseconds)
Address ((o ti R red�tdA K RA • Latitude/longitude source:❑GPS❑Topographic map
(Saee[ or Route No) (check box)
Air, ! u S (1 0 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
�a)- n ri[rll
Area code -Phone number / 11/1 �a e/0C Cr 410/iA4tea rock
4. DATE DRILLED iP— ,cY—°a
5. TOTAL DEPTH: fI D —
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: CIO 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): c3 METHOD OF TEST Air
10. WATER ZONES (depth): (.! Nkw: Wit
11. DISINFECTION: Type Ch 1 nr i n p Amount cl Cu i 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From__ To PSI Ft.6 1 /4 gDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_o To 20 Ft• Neat Cement IIand
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.
Material
16. REMARKS:
0
.. N
L
r
n^
O v.
c)
LOCATION SKETCH w 2
Show direction and distance in miles from at least'
two State Roads or County Roads. Include the road
numbers and co on road names. X
1 ;aYk
II Bat Ca J C
tiftd EY5ci1VIIIe
rifstr 'TI'ON'@TANDT
Li
Submit the original to tl�e Di slon of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
agl9t1gi3 TharatNif,0919) 733- 221, within 30 days. GW-1 REV. 07/2001
ASHENILLE REGIONAL OFFICE
HIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• (g4
IGNATUROF PERSON CONSTRUCTING T
DATE

247796
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James us Camp, Jr. CERTIFICATION # 71 3R
WELL CONTRACTOR COMPANY NAME ('amp' q WPM $ Pump Cn Inc PHONE #$7R) 453-7322
STATE 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 ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �n
Nearest Town: T111_c C�L-
Countyk0`,-•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: � �',j(o`'-`�"A.ta
Address (. o \--te \ ,1( r
et og
\'1-'L+,A1J (J`YwzY:URoute No.) �V! r28iq 2
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED I - \3 • 0 3-
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 1L1.--NO 0
7. STATIC WATER LEVEL Below Top of Casing: Q () FT.
(Usc '4" 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): , 0 METHOD�OF TEST -tAir
10. WATER ZONES (depth): ! 0
11. DISINFECTION: Type ('h l nri na
12. CASING:
Depth Diameter
From_# To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_g— To 2 O Ft.
Amount `). (AA!('N
Wall Thickness
or Weight/Ft. Material
gBltPl PVC
Material
Neat Ccmcnt
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
i'--�1I Lam. ics,:
D�, I DO HEREBY CERTIFY
Im . CONSTRUCTION STAND
-. i
L.
Method
Hu
Slot Size Material
in.
in.
Material
Topographic/Land setting
tTidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fart From To ion JIDesctption
O NOS Jd-i.(A/f
-n n
m
7.
O N:
LOCATION SKETCH N o
Show direction and distance in miles from at leasF
two State Roads or County Roads. Include the road
numbers and common road names.
IS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WFI I
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
IGNA OF PERSON`CONSTRUCTING THE WELL
�Cn NrI iiti PJiCl? rr
.Submit ttfestitinaljtoi _ f ' ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Cam1-, Jr CERTIFICATION #91 .B
WELL CONTRACTOR COMPANY NAME ('amp' S Win 11 & Pimp CrL TnC PHONE #ffi7R) 4cV 7 12 2
247790
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 2" Industrial 0 Agrict(lat 0 1
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use .. Z UVJ.XP l.�`
2. WELL LOCATION f1
Nearest Town: Q iv, ,V (k
County AQi' a ldb0-,
(Street Name`, n
Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \CIL°, n-p \ A UA At 1�
Address e9-1
(Street or Route No.)
City or Town State Zip Codc
(9.b3)- `Ill _ tkaa0
Area coda Phone numbr
4. DATE DRILLED 1- X • i7 `1-
5. TOTAL DEPTH: 3 Q s'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tp
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 cuing terminated at/or below land surface requires a
vulance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): \ METHOD OF TEST 8 i r
10. WATER ZONES (depth) r, 00 yln0
11. DISINFECTION: Type rh 1 nr i na Amount,` ')-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From__0 To 'AC Ft.6 1/4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_ To 2 0 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.
Neat Ccmcnt Hancam
16. REMARKS:
Topographic/Land setting
❑Ridge L)SIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH FRILLING LOG
From To FArmatiOna, cs tjon
S So. ' /Li .
rl
JOCATION SKETCI-[
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 TH
CONSTRUCTION STANDARDS,
iNfni
ct
Submit the original to the Division of
27699-1636 Phone No. [phone], wit
`u CimiSTRUC'Pn P4 ACrORDANCE WITH 15A NCAC 2C, WFI I
COPyi-0FiTH RECO AS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSTRI�i G THE WELL
ater Quality, Groundwater S
SEMOR
ASL:`,ILLE RL� U j,L C'F I :E
DATE
action, 1636 Mail Service Center - Raleigh, NC
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)gl) Al A/ / N (7 f%4 /- CERTIFICATION #. a g) 77
WELL CONTRACTOR COMPANY NAME/ S-Uaa,Vrl/in i'.i /.CJ.r'C/' 2 ;//tt. PHONE # 4,25() 4y%(SSG 6 /
STATE WELL CONSTRUCTION PERMIT# /V i% ASSOCIATED WQ PERMIT# fia LG,J.3-5
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential)' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest o lierJai,.�.[./,l/dCountya J/ yr
Q:i5'�Conna�Pa J,pCod/
(Street ame, N rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: elYJiA '
r
Addres,//), i, 1rroT�wiL/
1/(Street ordoute No.)
ii.,,�tiaNam& iv.c. .,2 `? 73 /
City or,Town State
Zip Code
0-(A?). /P9,3'9/7
Area code- Phone number
4. DATE DRILLED ///'i //J
5. TOTAL DEPTH: 57) S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IS
7. STATIC WATER LEVEL Below Top of Casing: /a O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / -5 FT. Above Land Surface'
'Top of wing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .011S.
9. YIELD (gpm): y METHOD OF TEST /-1-44
10. WATER ZONES (depth): qD
11. DISINFECTION: Type U i,, Amount .? 4 1
12. CASING: Wall Thickness
Depth Diateter or Weigbt/Ft. Material
From_12___ To k c Ft 6 ? p.2/ Yr/c
From To Ft.
From To Ft.
13. GROUT: Depth
Material Method,
From hTo Jc' Ft Ctt .c`2✓ tV..)./tn/
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 7 To Ft.
From / To Ft.
16. REMARKS:
^64787
Topo phic/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 pRILLING LOG
From To Formation Description
jOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roag
numbers and common road names.
O
N
O
rn
0
/77
N
O
J
O
isx`,+,(i i
CONSTRUCTION i'ON ST 4'D IS WELL WAS IN ACCORDANCE WITH 15A NCAC 2C, WELL
THATCOPYCONSTRUCTED OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER
—4 % (-vr-tom 1342 /1/ /G 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SiftilisititheimiduattaTIEle Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r thLibaiiiiiik`Nt (9t9) 733-2 221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
264788
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section©n
WELL CONTRACTOR (INDIVIDUAL) NAM (print) (prim) .2 1:7.4 QI- // CERTIFICATION St -2 /) 7 /
WELL CONTRACTOR COMPANY NAMEXLUW Ly� /n tIP GeGC �..yr 7.2". PHONES # fro') c O
STATE WELL CONSTRUCTION PERMIT# N�H ASSOCIATED WQ PERMIT# G'- / Z%
(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: / •
N Town:4 *-ti44 cLo-tc%/fi CountydA.tvndt
1tia o'.v I fi' 3 /
(Street Name, Nunch�ers, Community,, LotSub�di�visioon,No., Zip Code)
3. OWNER•2C)�eay&�I+��r
Address �s -�-� �. , �l P �-4-ri 12/
(Street arapoite No.)
l+-h iCii73J
City or Town State Zip Code
C.,t1)- 497-2,g57
Area code- Phone number
4. DATE DRILLED /// ' / C 2_
5. TOTAL DEPTH: /4/ C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO }Sl
7. STATIC WATER LEVEL Below Top of Casing: /5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD OF TEST — betit f
10. WATER ZONES (depth): ./ OJ t
11. DISINFECTION: Type /1'A
12. CASING:
th
From To yU Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From /7 To .2P Ft.
Material
Amount _5`- tf
Wall Thickness /
Diameter or Weight/Ft. Material
/jl7 C
From To R.
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.
M thod
It J4/y
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
[Midge ❑Slope ❑Valley IgFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pR1LLING 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.
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
40 .Oa& /i/y/c Z
GNATURE OF PERSON CONSTRUCITNG THE WELL DATE
ripginarrp(;(Ge Divi 'on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4 684 ib3Qi bOire:No.191 )E733-3 21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) p. r_, A�.,4/ / P. 13 I- I- / CERTIFICATION
WELL CONTRACTOR COMPANY NAME /(tx.)a-,V,44.(,21t+ /.cL J2/J22./ 7J= V- PHONE # ,(P.24 / 99-t) li82
STATE WELL CONSTRUCTION PERMIT# /V/141 _ASSOCIATES PERMIT# it 7429.4/
(if applicable) (if applicable)
264789
1. WELL USE (Check Applicable Box): Residential Qi1 MunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: �%o�,-r-eit ,-doCounty?r-ticee-zc
l ni» if e.G/ LA -Li 15' 7. 5 /
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:7 -ty 1/Aj
Address 7r/ 7 (,cat; ,k Pj LP
(Street or Route No.)
71/,,, zd.,t.udlo Ate. R7?/
City or Town State Zip Code
R95-,L%D 2—
Area code- Phone number
4. DATE DRILLED ///7/r Z-
5. TOTAL DEPTH: ./
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO )$I
7. STATIC WATER LEVEL Below Top of Casing: //D FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS / s FT. Above Land Surfaces
, 'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): /t METHOD OF TEST-r-iyufi
10. WATER ZONES (depth): �o. i ' /.?_5" '
Amount Z
11. DISINFECTION: Type F1v& t?
12. CASING:
ameter
From /) TDo�//D Ft i_I"
From To Ft
From To Ft.
13. GROUT: Depth Material M od ,
From n To „2Y] Ft �PTrna�i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Wall Thicknest
or Weight/Ft. Material
From / To Ft.
From To Ft.
16. REMARKS:
NSTRUCTION STAND
Topographic/Land setting
❑Ridge $4S1ope ❑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
Show directi
two State Roa
numbers and
0
LOCATION SKETCH
n and distance in miles from at 1
or County Roads. Include the ad
on road names.
/ 0112/(2,7
>c
r N2
av
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
SubpgtijMt� $ging[folthe Divisi n of Water Quality, Groundwater Section,1636 Mail Service Center -Raleigh, NC
24699+1636 amine ill (919rf33-32 1, within 30 days. GW-1 REV. 07/2001

2. C S40
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalQResources - Division of Water Quality - Groundwater Section
'/
\w ELL CO\T12,\CI'OR (INDIVIDUAL) NAME (print) Sze d �(J.) 4/ I �� CERTIFICATION
)#/2,�(�76.1,C7
.-l.C'Qh [...data 7 Z PHONE # (2 /0 Y1—a/172y25
ss ELL CONTRACTOR CO7IPAN\' NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
N/A1 ASSOCIATED WQ PERMIT#rl . /(1J
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 (!Other, List Use
2. WELL LOCATION'
Neatest Town: v_f��,jZzly�CountyL,.fac
fl
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1Ld1t11A-.
Address xt ry9 l�n C[:u1� �4/�n &c tjA .
(Street or Route No.)
kg z"in - N ('. „.2g%9/
dug or Town state
690 -j.ze9
Zip Code
Area code- Phone number
4. DATE DRILLED /,9 /�,e) z.-.
5. TOTAL DEPTH: /" /9 er
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO,
7. STATIC WATER LEVEL Below Top of Casing: S 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7.5 FT. Above Land Surface*
*'Top of casing terminated at/or below land surface requires a
variance in accordanf /a with ISA NCAC 2C.0118. •
9' YIELD (gpm): 7 METHOD OF TES17
10. WATER ZONES (depth): /&.5
1 I. DISINFECTION: Typefa Amount /a 4,0
12. CASING: Wall Thickness
Depth Diameter or Weight/Ei. Material
From 0 To.3S1 Ft. 1'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From /3 To-3S FL qy si
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From fo Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
16. REMARKS
Er
F$' ItflEl2f�1=,
S U ll t
Ft.
Ft.
Submit the original tc the
GROW! L .i€AIBiEZINI N(919) 7
ASHEVILLE REGIONAL OFFICE
Topographic/Land setting
DRidgc ,'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninu tes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKET
SI ow direction and distance in
tw. State Roads or County Roa
nut burs and common road nam
les from at least
s. Include the road
s.
T THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
E
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

264831
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / /�
—r— . /
WELL CONTRACTOR (INDIVIDUAL) NAME) (print) / P I/ e J�i1i .V%¢o:CERTIFICATION #.27t � ����
WELL CONTRACTOR COMPANY NAME_ .r4vi 2.-�_lLf/fe �L� IIlI/'/� A^ 7-��1��11 PHONE #
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 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
ounly_ j c.
a-a--nc-ire-p w „y U/ .14 i/ .2 Cl 7 3.2
(Street Name, Numbers, Community, Subdivision, rdt No., Zip Code)
3. OWNER:»U t/ N Lei
Address /' * C-44 °J 7
(Street or Route No.) O
esat.2 ti ha A/.e. k 73t
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED //9///,/ 0 2_-
5. TOTAL DEPTH: •2 Y 5
6. DOES WELL REPLACE EXISTING WELL? YES NO i
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Y. j 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 d METHOD OF TEST2 - -r-P
10. WATER ZONES (depth): „VG l D /
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type �j Amount /?. 4'!
12. CASING: Wall Thickness
Depth / Diameter or Weight/Ft. Material
From 9 To G-D Ft.__64_ it-.2" % / -
From _ To Ft.
From To Ft.
From 0 To
13. GROUT: Depth 4 Material �`/
.TJ Ft. re--rite+ti'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From To Ft. in. in.
15. SAN /GRAVEL PACK:
Depth Size Material
From // To Ft.
From / To Ft.
D' 67R1 v1
I DO HEREBY CE44
CONSTRUCTION d
LOCATION SKET r H
Show direction and distance in Iles from at least
two State Roads or County Ro ds. Include the road
numbers and common road n mes.
/
CHAT THIS WELL
A COPY OF THIS RECORD WAS HASID
N ACCORDANCE WITH I SA NCAC 2C, WELL
ARDS,
BEEN PROVIDED ED TO THE WELL OWNER
�
/m/in/n
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GROUNUV)ATER SECTION
ASREVILLs fjt`mi f(haic 1 to t to 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

L.0 TION T H
Show direction and distance miles from at least
two State Roads or County R. ads. Include the road
numbers and common road ames.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t
CERTIFICATION %J 71'Y
/ il�r- 7�Y-r-�
WELL CONTRACTOR COMPANY NAME •/�Pl�' LI 't'D� IA Pt.i PHONE #
STATE WELL CONSTRUCTION PERMIT%
(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
/v/n ASSOCIATED W Q PERMIT% / K %i /
(if applicable)
2. WELL LOCATION) l
Nearest Ton: - County /!q
297 2—
(Street Name, Numbers, Community,itjSubdivision, Lot No., Zip Code)
3. OWNER:�-2'/2e�/ cieue tzat- *-qa�
Address /- z /4i-" i1/4d
(Street or Route No.)
_ - > 4L01 A/,i', 9g7?Z
City or Town State Zip Code
(r,,29)- a 72 --3/v2 0
Area code- Phone number
4. DATE DRILLED /r/&/'o
5. TOTAL DEPTH: /S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J21
7. STATIC WATER LEVEL Below Top of Casing: Co FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /3 FT. Above Land Surface'
' *Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /r METHOD OF TEST
10. WATER ZONES (depth): 5gS
264830
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)
ED PTH pRILLING LOG
From To Formation Description
11. DISINFECTION: Type 9i'f
12. CASING:
Amount D. S
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 72 To G, 0 Ft by #-.2./ 11 L
From To Ft.
From To Ft.
13. GROUT: Depth Material
Fromm To_._s. Ft. Co-ii-tn.:�6
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. is
15. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft.
From To Ft.
ethod r
u /'7
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STRUCTION STANDARD D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
pit submit thG !whims) (A the Pi yision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 one o. (919)?3s-3‘21, within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
260175
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
/� WELL CONTRACTOR (INDIVIDUAL) NAM (print)�A11e // CERTIFICATION #4Z'77
WELL CONTRACTOR COMPANY NAME Jd LI i/.!i/ I/ �A ' PHONE # 4 99 OM
ASSOCIATED WQ PERMIT# 7© /3
(if applicable)
/LI
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:
Near(st Toyy
Street Name, Numbers, Comm
3. OWNER:
ounty/'V.Pm.rJfz ,ricer.
.9/,792—
ty, Subdivision, Lot No., Zip Code)
Address lrAt-
Area code- Phone number ,f
4. DATE DRILLED 7// je)
5. TOTAL DEPTH: /9
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 021) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.5— 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): MFTHOD OF TEST /-4-ntp
10. WATER ZONES (depth): , I
b2�79`z
Zip Code
(Street or Route No.)
(no i444/4 C
City or T,own St e
en lv 9l — 7,2 .2 8
1 1. DISINFECTION: Type r 2 Amount n3t'C bZ
12. CASING: V Wall Thickness
Depth.? Diameter or Weight/Ft. Material
From r�9 To bit) Ft. 4 4\21 Olio._
From To Ft.
From To Ft.
13. GROUT: Depth //�7 Material Method ,
From 0 To o%D Ft. l.2-4—Me.�r ' u ). Jflty
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.
-2
NSTRUCTION STANDAR
[yiIE WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
072224 nap
Topographic/Land setting
❑Ridge XSIope ❑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 Deseiirdion
ry co
)_
rn =-..
LOCATION SKET
Show direction and distance
two State Roads or Coun
numbers and common
miles from at least
oads. Include the road
ad names.
°We CL
W
#iy
7///
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sy� iQ,�'hg11 �4 T °ta ticeNpivisio a of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
— -2969Hi636 Phone o: (A'140{z-z» , within 30 days. GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PERMIT#
WELL CONSTRUCTION RECORD
260172
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
//
WELL CONTRACTOR (INDIVIDUAL) NAME (printL,,/ Ll e ,1 �q4 6d c 45 Va/' CERTIFICATION B, 2YS"
WELL CONTRACTOR COMPANY NAME ,JeeM.L.(�k7 L(JL'ey WO2 PHONE /# �� /09f oVsZ
40 ASSOCIATED WQ PERMIT# ye 49(p/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATHW:
Nearest Town: ,,jj�{/.j,I,i.L2._ County/Zest/
A d • e29979t
(street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: ///(Z22i!'L4!Gr )
Address 1-3 0
(Street or Route No.)
City or Town State Zip Code
( )- n/,n9— 9/o1?
Area code- Phone numbe7-5-
6 ,kIz IT--
5 4. DATE DRILLED J !J
. TOTAL DEPTH: . DOES WELL REPLACE EXISTING WELL? YES/`❑ NO�j% r
7. STATIC WATER LEVEL Below Top of Casing: 9FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S -/S FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordan e with I5A NCAC 2C .0118.
9. YIELD (gpm): [� METHOD OF TESTrLn-c.
10. WATER ZONES (depth): /,)o
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
0
Gq n
ti
c,a
O
LOCATION SKETCH to
11 DISINFECTION: Type feerr,/v/.i Amount y OZ. Show direction and distance in mile fromrailleas35 ;_n
12. CASING: Wall Thickness two State Roads or County Roads. nclude the rold 1
De thy�)) Diameter or Weight/Ft. Material mbers and common road �name..
From 0 To ?O Ft. (e) 17 ,#.2/ 9UC �Y" 'J
From To Ft. V F
From To Ft.
13. GROUT: Depth Material Method
From iJ To o%(J Ft. L..�I -fit p.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.
16.REMARKS
E& C R'pl'FY ihh1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDAfl;S,fAND THAT A COPY OOFT, JJ$ RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSflUCTING THE WELL
DATE
Sti&ort4OpeAtmigiingqithe Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
PfdtfriVll6L3f6 P fiGirk; Nk. (0491)CE33-32 ! I, within 30 days. G W - I REV. 07/2001

S ATE WELL CONSTRUCTION PERMIT#
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) {At L e_ /y bhp d/o3 in.
WELL CONTRACTOR COMPANY NAME d1�
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
260159
CERTIFICATION i.1.t / 07
PHONE # tYS b4/9-ae/243
I. 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 LOCATILO�N: �yq
Nearest To n:) eLehi,n..€ D ounty-k
2 ' a2:792--
(Street Name, Numb Community, Subdivision, Lot No., Zip Code)
3. OWNER. flat
--
Address 7X/ (�t S ✓ ft
(Street or Route No.)
, .& A/-!'. ,.7g 29L_
City or vn State Zip Code
Area code- Phone number
4. DATE DRILLED A/SD /D t
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �I
7. STATIC WATER LEVEL Below Top of Casing: / ID FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TES I' Jam/
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To Ft. le
T F
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)
DEPTH DRILLING LOG
From To Formation De cE'ptio
ry c;
no
From
From
0
To
13. GROUT: Depth
From O To 4n Ft.
From To Ft.
14. SCREEN:
From
Depth
0
Ft.
Material
Amount //2 OZ
Wall Thickness
or Weight/Ft. Material
®Uc`
ethodt
Diameter Slot Size Material
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
t .
1,Ettr
DO HEREBY CERTIFY
L'ONSTRUCTION STANDA' )S
SEP 2 4 2002
GROUNDWATER SECTION
A6H€rkUtf-fFhliEGItAiil166RO Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 7312I, within 30 days. GW-1 REV. 07/2001
•
CJ1
LOCATION SKETCH
Show irection and distance in miles from at least
two State : oads or County Roads. Include the road
numbers ancommon road names. c AT4 t
Ad
vOrr tjo5c ESTxTeS
T I111S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
N
COPY QETJ>4IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNATURE OF
EIf `yL N CONSTRUC%fING THE WELL
T,
%/34/D Z--
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources _Division of Water Quality - Groundwater Section v/
CERTIFICATION drag?7
W'ELI. CON-I-RACTOR COMPANY NAMES PHONE (gig kW0Qp23
WELL CONTRACTOR (INDIVIDUAL) NAM (print
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERiSTIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town:
�e C unty74
(Street Nanie, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4
Address 2 te.c%� aj »
��' �///nn/ (Street or Route No.) 25/77y
( )
City- or Town /en Stale Zip Code
G97- -
Area code- Phone number
4. DATE DRILLED /2� / /D t--
5. TOTAL DEPTH: /11 T
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 /i—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): ter MET OD OF TEST L.-in('
10. WATER ZONES (depth): 1 .3
11. DISINFECTION: Type M— Amount _
12. CASING: v Wall Thickness
Depth", Diameter or Weight/Ft. Material
From 0 To J 6 Ft. 1 $,J/ t/C.
From To Ft.
From To Ft.
13. GROUT: Depth _1ato�nal � Metl. od i
From To(� FL--I��'TW "`5
260158
Topographic/Land setting
❑Ridge 'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) _
Latitude/longitude source:❑GPS❑Topogra is niap
(check box) 6.)
DEPTH DRILLING430G".=1
From To Formation Des�iptiQn;-'
v
'co
From To Ft.
14. SCREEN:
From o
From To
Depth Diameter
15. SAND GRAVEL PACK
�D lath Size Material
From / To Ft.
Ft.
Slot Size Material
Ft. in. in.
Ft. in. in.
From To
16. REMARKS:
ID
•
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.
p, LA)
a
REIGRETtNV-A
SEEP2 4 2002
ubmit the original to the Divi
769'-1r r 733-3
GROUNDWATER SEC I
ASHEVILLE REGIONAL OFFICE
•
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AJ _ HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-griL
GNATURE OF PERSON CONSTRUCTING THE WELL
ATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

25575E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
Quality - Groundwater Sectiono
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ��,/91 �L� G /y ��Qp d' t� 5,—., � .. CERTIFICATION 1t,27 Ay
WELL CONTRACTOR COMPANY NAME.4P.ic4J jZ2S-G/ J� / PHONE # fLaiS�)Lregsf Usti
ASSOCIATED WQ/PERMIT# # /gGG
(if applicable)
STATE WELL CONSTRUCTION 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 LOCATIO
Nearest To QfiL/.t County .e-sm.0
�QAa 4974-y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !'tic �Rl'
Address us-v .(� y eu-t o
(Street or Route No.)
At,
.277,2
City or Town State Zip Code
(sa2)- l' 941- /9t,s
Area code- Phone number
4. DATE DRILLED Si `j/ /O `L_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 4 FT.
(Use •'+" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordancue" w1 th 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST72ar cD
10. WATER ZONES (depth): ,-2tm S "1
11. DISINFECTION: Type
12. CASING:
Depth 2i m ter
From 0 To FL c/
From To Ft.
From To Ft.
13. GROUT: DepthMaterial. Merthod
From 0 Too.�f7 Ft. I?.,+ltc✓o - %�''�l—yam%�
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in
From To
Amount Fr
Wall Thickness
or Weight/Ft. aterial
15. SAND/GRAVEL
pth
To
To
Material
Topographic/Land setting
DRidge ?Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic u1i
(check box) ▪ CD
DEPTH DRILLINGLOG n�
From To Formation Depptio^j
0
-v
fV Chd:
G
LOCATION SKETCH
Show direction and distance in miles om at least
two State Roads or County Roads. elude the road
numbers and common road name
16. REMARKS: � (9-C c.c .. 00.0 4-i)
100 ITERBBY CERTIFY
1 " dtkSTRUCTION STANp4
Submit the original t) the
(r I' 3MOLIol'i8 Phbrii Nti. 919)
PECHL CFFICL
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
eAK s/ii/' i
SIGNATURE OF PE SON C RUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section�717
WELL CONTRACTOR (INDIVIDUAL) NAME (print) aro NA// e /,3A L L CERTIFICATION tI� SR' ! /off
PHONE # (R.i�llj dypc.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
AV), ASSOCIATED WQ PERMIT# #
255755
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIoN�/y�/
Nearest Town:.GO County-�'/'/
s�✓07.t
efre
ct
(Street Name, Numbers, C munity, Subdi ion, Lot No., Zip Code)
3 OWNER: L!Zu.&_/¢J ��G ��coiff
Address ,0 �f�r zeta, rf
.a��(Street or Route affi.)
u 4C, 019732
City cc Town State Zip Code
8)-t7f9— 77
Area code- Phone number
4. DATE DRILLED -5—/D,/A `7
5. TOTAL DEPTH: t.Z SS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO %
7. STATIC WATER LEVEL Below Top of Casing: JO 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 accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): - METHOD OFTESTT�Gr-c.0
10. WATER ZONES (depth): /
I L DISINFECTION: Type
12. CASING:
Amount 5 y az.
Wall Thickness
Depth, Diameter or Weight/Ft. Material
From b To 7 n Ft.[.4 41- / ®// r
From To Ft.
From To Ft.
13. GROUT: Depth�l Material`'
From 0 To 4AA
0 Ft. / L/wwY
From To Ft.
14. SCREEN: Depth Itameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAV
From
Fro
Depth Size
To Ft.
To Ft.
/
Method
Jiibt
Slot Size Materi
in.
in.
16. REMARKSSt
I�'DO RERP;?BYXEItr1IFYlF
£uN51 RUCTION S t AN DA
Topographic/Land setting
KRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic maE.
(check box) 0
DEPTH DRILLING G
From To Formation Des• .0 ttot >~' ,
LOCATION SKETCH
Show rection and distance in miles fro
two S :te Roads or County Roads. In
mb t.and common road names
V
ar-
�.1.P.a. /7 v-t.e rt.s .
IT 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
•
at least
de the road
?7iCA
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
d
Ti+��, o the 3ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
iSHi-4T4-iffil*CSnetf0(019) 733-322I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
255 754
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/J NAME (print) /7L.� e/�� ode.S 4T? CERTIFICATION#4 ///VpV
�, r
WELL CONTRACTOR COMPANY NAME /1 /�� 'if /' PHONE #�yJ Oo
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER T## 424. .y�7
(if applicable) (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: ' Q
Nearest Town: CountyL¢/
A/O- -4 Ape n2 sr7y2
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: & -- L4J ,�',,a_/�&t '
Address S b %q .q22 i vI s
p (Street or Route NE.)
J�a? eate Ale .2 ?,yt_
City or Town State Zip Code
.153-SS63
Area code- Phone number
4. DATE DRILLED _57.,2 9/ 0 2-
5. TOTAL DEPTH: s2 2S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ' METHOD OF TEST12_#t-u
10. WATER ZONES (depth): 'S
1 I. DISINFECTION: Type/
12. CASING: v
Depth !Diameter
From D ToslaFt.
From To Ft.
From To
13. GROUT: Depth
From O Toni
From To
14. SCREEN: Depth
From To
From o
15. SANS'" RAVEL PACK
Depth
From To
From To
16. REMARKS:
mount 4:17"
Wall Thickness
or Weight/Ft. Material
cPdC
Method r
in.
Material
Topogr phic/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 c
From To Formation Degiptic
c
-
LOCATION SKET I H
Show direction and distance in ' files from at (east
two State Roads or County Ro s. Include the road
numbers and common road na
IDOEREBYCERTIF AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I CON TRUCTION STA wA DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF ERSON fdONSTRUCTING THE WELL DATE
i .Submit the originaljo the Division of Water Qualit, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
276t688 PliioltaNt. [phone], within 30 days. • GW-1 REV. 07/2001
N h, f
0

WELL CONSTRUCTION RECORD
255784
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
2,1Y
WELL CONTRACTOR (INDIVIDUAL) NAME Q (print) ��/� L ew e4 0 ./dn� . 5 �, CERTIFICATION tla r/
WELL CONTRACTOR COMPANY NAM E.,cJ.LL ej� ��O 1 , PHONE#p.zdl /0/9-c4' e
STATE WELL CONSTRUCTION PERMIT# /v/if ASSOCIATED WQ PERMIT# ¢L Leg?
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATIOB:
Nearest TownmID rLa
I�f a
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7724 \&2_t# r<qdio2oas.jv. —c- -.
Addr • s #- ? C y/.CiLd -p�.wt
(Street or Route No.)
WC*. rC• tO9792—
City or Town State
•
9. YIELD (gpm): S METHOD OF TEST? *tI O
10. WATER ZONES (depth): //o ' — /7S'
Zip Code
( ) 4/0 Ph0tic
Area code- Phone number
4. DATE DRILLED 5/.2, /D 2-
5 TOTAL DEPTH: .,2 L. T I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f%
7. STATIC WATER LEVEL Below Top of Casing: ft7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
I I. DISINFECTION: Type z,.Se = Amount 4'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To'g Fl/ft °I P d e
From Q9' To//Co' Ft. 4 * .Sri,,/ s Tie
From To Ft.
0Z
13. GROUT: Depth Material�_Method
�a�
From t7 To rZ C> Ft. �'u�.-b/ ._, , 1 S-nt. e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To F . in. in.
From To Ft. in. in
15. SAND/GRAVEL P
From
From
16. REMARKS:
County�s�y, ...
Topographic/Land settin
❑Ridge ❑Slope DValley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees(minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
r
O
O
LOCATION SKETCH
ow direction and distance in miles from at least
tw State Roads or County Roads. Include the road
nu bers and common road names.
S
C tF
6
0
\I
\I
(ipnIE EF� C T'frYT
nNi'fR IC O T JDI
submit to th
e�g� ry , '
2'} r�9'7wo-p(rtmvlio. (919
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
RDS, AN THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
w ©rf s�TE
SIGNATURE OF TRUCTING THE WELL ATE
RSON
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
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 SectionqJ��jj
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (Res AII//G 8/4.CL CERTIFICATION#02f.77
PHONE # Cgs40* WO
WELL CONTRACTOR COMPANY NAME.Cpee A ..Pt a teA// tt)L/.I q
SPATE WELL CONSTRUCTION PERMIT# 41/4 ASSOCIATED WQ PERMIT#. /09eJ %
(if applicable) (if applicable)
255783
aiaf
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest own:Si .Q.40?-deeto County i an.c
Jv �J 77T ge w e29792_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LiL�OFyG /4G2rrr�t
Address,Xt'y t✓XC�.yy� Atty. Lai-L.
(Street or Route No.)
A . 01sit 79t
City or Town State Zip Code
($''Y)— 4V6-- o74/5-
Area code- Phone number /
4. DATE DRILLED ./J/ 20 o t
5. TOTAL DEPTH: \yep s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J°t
7. STATIC WATER LEVEL Below Top of Casing: /3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 13 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): /Q METHOD OF TEST eo
10. WATER ZONES (depth): /4 S
11. DISINFECTION: Typezgara
I2. CASING:
Diameter
13
14
15
From
From
From
GROUT:
From O
From
SCREEN:
From
From
SAN
Frorn
From
Depth
D To O Ft &
To
To
Depth
To o2 n
To
Ft. y
Ft.
Material
Ft. (% taee4,4
Amount g 0
Wall Thickness
or Weight/Ft. Material
fgc
Ft.
Depth Diameter
Ft. in
To Ft. in
GRAVEL PACK
Depth Size Material
To Ft.
Ft.��
Method ,
!-4 1» /
Slot Size Material
16. REMARKS:
7 J DOliHET,E
,, }- ltjt-tt.f4,7g ua,., he D
27699'1636-y11one Noc(9t9) 73:
Topographic/Land setting
❑Ridge INSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG c
From To Formation DeRptiCiE
0
C 'i
_rn
3
fV Ny
n
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads
numbers and common road nam
n at least
lude the road
0
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
1 'L rd' t2a /n r
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
vision of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

255099
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water ✓ QualityJ- Groundwater Section�i
WELL CONTRACTOR (INDIVIDUAL) NAMED (print) 9FL eRA')L4 %/) dr' S ` T5 . CERTIFICATION NJ V/
WELL CONTRACTOR COMPANY NAME CJ.Pi�2.,2a- *^ Lt�-�'� C fr(/ PHONE N Jynto)_lo Sr9OVKY6
STATE WELL CONSTRUCTION PERMITS A/fl% ASSOCIATEDapplicable)
1 c bPERMITS i /� £ sty
(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: g
Nearest Town• o �✓� rA
(SineWaame, Numbers, Community, Subdivision, Lot No., Zip Code)
ty or Town State Zip Code
Area code- Phone number
4. DATE DRILLED y// /D t
5. TOTAL DEPTH: /8�
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 /`S FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
valance in accordan a with ISA NCAC 2C .0118.
9. YIELD (gpm): ME pOD OFTEST 7anr9
10. WATER ZONES (depth): /4'S'
ountyl1S
11. DISINFECTION: Type )E2e Amount g. Dz.
12. CASING:
Depth ameter
From1_To SD Ft. #-2/ PIJC
From To Ft.
From To Ft.
13. GROUT: Depth Material M.eethod ,
From 0 To 00 Ft. �'t.+za tJ "
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:
r
iri
DO'HEREBYICERTIFY TF
CONSTRUL iIUN STANDIA..
Wall Thickness
or Weight/Ft. Material
Size Material
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesfseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from a east c
two State Roads or County Roads. Inclu • 41713roace
numbers and common road names. c ?
»q
O o )
LP
"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 THE WELL IjAATTE/
fiF!h .hoorign7i&pitheDir
AS27699-166i1'hone_No-0)733
awn of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
rt

255093
,2169! 1636 Y honk Nh. (?Q 1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionc' 7�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION D p�
WELL CONTRACTOR COMPANY NAME 4..109, 7 PHONE # !Ina L yr n yO2
STATE WELL CONSTRUCTION PERMIT# ___ .4/14 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 If Other, List Use
2. WELL LOCATIO :
Nearest Town:
_ .19-nY /e2 J879'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERTt 07 Tenet t/
Address �7 4 a 1 0sagi.1.11170,9 P cI
(Streetoor Route NaY
ea-t C Abr. r2fl9t-
C
ta¢)ity- orflStatee 9u zip Code
7 �
tmty/
(if applicable)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley frlat
(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
Arca code- Phone number/ / 6 z_
4. DATE DRILLED
5. TOTAL DEPTH: 07 o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 58(
7. STATIC WATER LEVEL Below Top of Casing: -2 S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): METHOD OF TEST 7t -%t- il
10. WATER ZONES (depth): At _I"
11. DISINFECTION: Type pia 6# Amount S OZ
12. CASING: Wall Thickness
Depth g Diameter or Weight/Ft. Material
aJL
From_ To / d Ft. y teal
From To Ft. /
From To Ft.
13. GROUT: Depth, Material ' Method
From_ToQ Ft. G.✓110 IlLe�tl_L(w7i
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:
c
0
r
c
LOCATION SKETCH f V c {
Show direction and distance in miles fromgPleastt r
two State Roads or County Roads. Includetile rogi}
numbers and common road names.
N
IS WM.1 WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DA
GNATURE OF PE ON CONSTRUE ZING THE WELL
'ubiu1t the original to th Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733- 221, within 30 days. GW-1 REV. 07/2001
D.�
06o2

255100
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalaty��Resources -
/Division of Water Quality - Groundwater Section
y �f
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A ( .- C AI 9? 4 T/ d' e .5 ....77P CERTIFIC�AT,ICON flI D //�
WELL CONTRACTOR COMPANY NAME �)�,/ (.i )��'"�"".PHONEE p# (Mn140�.6-/ea
STATE WELL CONSTRUCTION PERMIT# �Jy�' OCIATED WQ PERMIT# fir— 6p 1� o 6
(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: oL
Nest Town Countyr1.
r ,.gin .7.--facrarC.- 2 R 772_
(Streit Name, Numbers, Commu-oitY, Subdivision, Lot No., Zip Code)
3. OWNER'La -L€t st' 7I22,1
Address,z`t < Ord
(Streefeor Route No.)
fi/ssieir , r,, Jar. Nr . 2 f 7 9 2-
City or To State Zip Code
(so- &9r— 9V6 4
Area code- Phone number,
4. DATE DRILLED 5///
5. TOTAL DEPTH: 4/O T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,i
7. STATIC WATER LEVEL Below Top of Casing: 2.7 C FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 2 5" FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance hi accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TESTI2.# -c>
10. WATER ZONES (depth): .cis
11. DISINFECTION: Type freWds-
12. CASING:
Depth Diameter
From_12_To_sO___Ft. 6 1-
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_/ To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 47.3- o Z
Wall Thickness 9
or Weight/Ft. Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land settin
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
J)EPTI-1. DRILLING LOG
From To Formation Description
/ /
Method ,
),t l Ptc y
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include road
numbers and common road names. N C— c
a,
DJ
CO
„.9
tfr
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0
c
NSTRUCTING THE WELL a ATE
,, �c al o th= Division of Water Quality Groundwater Section,1636 Mail Service Center - Raleigh, NC
J .Ph6lii tilo. (919)
AL Or HOE
33-3221, within 30 days. GW-1 REV. 07/2001

253443
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
p L,
WELL CONTRACTOR (INDIVIDUAL) NAM (print) 4 CERTIFICATION #K 9 D'J
WELL CONTRACTOR COMPANY NAME � PHONE # Se
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# IL 6 o
(if applicable) (if applicable)
1. 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 LOCATIOfI 076,04
county., D
Nearest Town:
eh f(2sTin1A s/tslr$a2 DR.
(Street Name, Numbers, Commwity, Subdivision, Lot No., Zip Code)
3. OWNER: I 114eff y� (defaces/minutes/seconds)
Address as& pietat - 'a is . Latitude/longitude source:❑GPS❑Topographic map
(Stnxt arO Route No.) (check box)
ize,� r DRILLING LOG
T�a0 �G4 From
To Formation Description
c
0
IV
r n
Z c.
Topographic/Land setting
❑Ridge ['Slope ❑'✓alley j3Flat
(check appropriate box)
Latitude/longitude of well location
City or Town State Zip Code
(Bag )-4n-o3s2t
Area code- Phone number
4. DATE DRILLED J/5J o Z
5. TOTAL DEPTH: ca Q T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FT.$
7. STATIC WATER LEVEL Below Top of Casing: iq
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 'C FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 72.701,4l
10. WATER ZONES (depth): /O
11. DISINFECTION: Type (12gerta Amount /Dr
12. CASING: Wall Thickness
Depth, ameter or Weight/Ft. Material
From_u___To "5 O Ft. #. / flue_
From _ To Ft.
From To Ft.
13. GROUT: Depth Material aM,�ethod,
From_ To -3 D Ft. C2ni r t I ' Ille.y
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fromfir To Ft. in. in.
From To Ft. in. in.
15. SAND/ RAVEL PACK:
Depth Size Material
From �f To Ft.
From A/ R To Ft.
Ld LL, 'd \'1 IS'
CONSTRUCTI
GIt g_
LOC ION SKETCH
Show direction and • istance in miles fro •• at (east
two State Roads or ounty Roads. Inc de the road
numbers and co • on road names.
en
c�
Ul
6
2
0
v
11 tuft Ed Bd
to E bt< `"' 2 Z.26 E
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/S/o Z
SIG TUt�. OF PERSON CONSTRUCTING THE WELL DATE
GROU" r''RFj final to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHEVILLE
2 t699-1036 Phone -No. [phone], within 30 days. GW-I REV. 07/2001

249731
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalResources - Division of Water Quality - Groundwater Sectiono
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) !7'n N1 M / E I31i1 L L. n p� CERTIFICATION tk S� 77
WELL CONTRACTOR COMPANY NAME,��Ga L[4) [2.10-4(tiP4.4I ) PHONE # (01)44(9 O/i S'D
STATE WELL CONSTRUCTION PERMIT# g/hr ASSOCIATED WQ PERMIT# G 799
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential h Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town'%
i s--
County-e...44.40.14.
T. �e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
,S
3. OWNER: lz rJ..,b t.. i.4
Address /Ci ! 4/ ri ? v
(Street or Route No.)
Gin 7J1 7
City or T nos State L ^ Zip Code
Area code- Phone number K L�
4. DATE DRILLED �// 8 / b a
5. TOTAL DEPTH: T. p,S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IY
7. STATIC WATER LEVEL Below Top of Casing: 95 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 15A NCAC 2C .0118. •
9. YIELD (gpm): OD OF TEST? nc "
10. WATER ZONES (depth): O
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth ameter or Weight/Ft. Material
From 17 To fL Ft. 7UC,
From To Ft.
From To Ft.
13. GROUT: Depth atenal
From 0 Toc1VO Ft. LAW
To Ft.
From
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 It - To Ft.
From �J�%f To Ft.
Me od•
Topographic/Land setting
❑Ridge f8ISlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DE DRILLING LOG
From To Formation Description
I
D
m
rt,
LOCATION SKETCH o
Sho direction and distance in miles from a
two S .: to Roads or County Roads. Include
numbe and common road names.
We
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND I92)33 AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s
c
east
road
d/t/o Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
B�iBNil 1'W!'bt3 iiidlri the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
A�d� {6� F}7333221, within 30 days. GW-1 REV. 07/2001

J
4. DATE DRILLED the, /D 2-
5. TOTAL DEPTH: 1 /S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: ts2.S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �' 6 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): _�Q_ METHOD OF TEST�fsyf�
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality - Groundwater Sectio�n/7�J/ /
WELL CONTRACTOR (INDIVIDUAL) NAME
11(p�rt�nttI)-Vo/,,��J�C,, ^^i(I (�.. /1 D Ci GS CrI: CERTIFI(CAATFON#gypg1
WELL CONTRACTOR COMPANY NAME 'a� //�/^^"(-ASSOCIATED
Lae' PHONE # f g) 4, y7' 07 tD
STATE WELL CONSTRUCTION PERMIT# Gt-1T -Or L n `r ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
4(/,
249518
1. WELL USE (Check Applicable Box): Residential I21 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: O n
]ty
es *fr
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Ke,rt#t.t r Y'j
Address >2 / /e.1-4 � y al-244-0
�,( rn trot or Route No.) tmi ?l n
,�. City or Teen /_a�9 Zip Code
- Area code- 'Sy/
nnnuum
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
11. DISINFECTION: Type
12. CASING:
Amount /J en -
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 9S Ft. 1p 1- 4t & / Pri Ce.
From To Ft. '
From To Ft.
13. GROUT: Depth Mena} ,
From 0 To Ft. Hf
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From , r ,n To Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From A/ To Ft.
From / / / To Ft.
ethod
16. REMARKS:
•
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th road
numbers and common road nam-s.
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
DATE th
ATttiF(E OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
(+®}y1(dOrnongtoo(tt19)733-3221,within 30 days. GW-1 REV. 07/2001
ASi t JILLE r IONRL OFFIC

25<4G55
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural es
WELL CONTRACTOR (INDIVIDUAL) NAME (print J
WEI.I. CONTRACTOR COMPANY NAME
ces - Division of Water Quality - Groundwater Section
—%- CERTIFICATIONp
y'a(q�T / 1 Q1.y(,f'I/LAD� U) PHONE # (1aH 64)--74, t
SLATE U'ELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
Wy 451
L WELL USE (Check Applicable Box): Residential LY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION ll
Nearest Town: ran ,�e_ County % _9(0( cst-.j
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �t
Address
1301
tfe4vzsir Dine No.h 2,../ >73
C ty or Town St to 960 Zip Code
Area code- Phone number I�
4. DATE DRILLED 3 —OA-
5. TOTAL DEPTH: ' 6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ei'
7. STATIC WATER LEVEL Below Top of Casing: 4fl 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 vith 15A NCAC 2C .0118. r
9. YIELD (gpm): , _ METHOD OF TEST pill
10. WATER ZONES (depth):
11. DISINFECTION
12. CASING:
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minotes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,^s-C
C
11C3J\\Q.
DEPTH
From To
0 Cl G
(-10 1(0Th
c
rV c
G _
TypeCI,Cif) v(C'. P C{ Amount IRS C
Wall Thickness
Depth Diar1ieter orn eight/Ft.
From �, To
From
From To Ft.
13. GROUP: Deptl Mazer�al,�
From___ To Ft./dirltx�_—.
From To Ft. l�
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:
T THIS WELL WAS CONST
)S, AND Tp AT A COPY OF
SI NATURE OF PERSON
ision of Water Quality,
3221, within 30 days.
LOCATION SKETCH
Show direction and distance in miles from aT'Teast
two State Roads or County Roads. Include the roaif
numbers and common road names.
TYM
ONS UCTING THE WELL
[ GER cG�110�
rounA ;TEC L Ed IPnC110. 04All(*rvice
W -,
AC 2C, WELL
THE WELL OWNER
ATE
Center - Raleigh, NC
GW-1 REV. 07/2001

254653
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (prin
‘YELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
e$ources - Division of Water Quality - Groundwater Section
CERTIFICATION 1* DYi/
PHONE # Q*OS d? -24Yi
Giz646
1. WELL USE (Check Applicable Box): Residential ISd/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION L
Nearest Town: 14M'•�Jr0
County
(Street Name, Nwnbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 91)rh
AddQ
4
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l�
7. STATIC WATER LEVEL Below Top of Casing: - FT.
Topo raphic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For ation Description
DEPTH
From To
0 i O (o
t&(.v Lo05
Tess
(Street or R6oute No.)
,mkt r4
City or Tou`State-0; 47" Zip Code
( )- COl—lJ
Area code- Phone number r.
DATE DRILLED �
(Use "4" 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): t2,„ METHOD OF TEST
siAp
10. WATER ZONES (depth):
l I. DISINFECTION: Typert�n Lxun Amount an
12. CASING: 11 Wall Thickness
Depth Dipdne1er or Wet VFt. M nal
From a To, Ft. SO 4'
From 4r� To/b:o Ft. 6 'it( tl From Top Ft.
GROUT: Depth rf Match I Nlolhod A
From To 2� Ft.� r/
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:
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.
Cis 2-s'5 giaa a-2-7•
(l 7
IFKT
A
N:.R �.TIpN A.
JUN
2
EM
HIS WELL WAS Ci
• D THAT A COP
ubmit the original to th Divis
G • - l s`1A . r • . 00It) 733-3
ASHEVILLE REGIONAL OFFICE
GNATURE OF P
on of Water Qua
I, within 30 days.
GCTED IN ACCORDANCE T
F THIS RECORD HAS BEEN PI IE
`
5A NCAC 2C, WELL
ED TO THE WELL OWNER
A
rvice Center - Raleigh, NC
GW-1 REV. 07/2001
iWd LI NITZO

254652
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section(�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) aY—� j ? / CERTIFICATION #,.94c /
Cfepf7jjjI9e/l (h'�t jM.I.Q)✓� PHONE #rZ281 6J-740
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# 6g' O
(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 ❑ Other 0 If Other, List Use
2. WELL LOCATION -
Nearest Town: rie.c1-4✓ly.. County „
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 9
Address p.a j 110
HencieSc torRoue )
4
5. TOTAL DEPTH: 1 9.51"--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14-
7. STATIC WATER LEVEL Below Top of Casing: 1,, ' FT.
(Use"+" if Above Top of asing)
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 METHOD OF TEST A,✓x-
10. WATER ZONES (depth):
sty or Town State Zip Code
)-
Topographi and setting
❑Ridge pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For{nation Description:
cc 1�5
Area code- Phone number qq
DATE DRILLED ,Tod -
II. DISINFECTION: Type
12. CASING:
Depth�*--
From To J
From To
From To
13. GROUT: Depth
From () To
From To
O
Ft. Deg
'/geter
Ft.
Ft.
Ft.
Ft.
Matcria
IN..)?di=
L
C
4 11
Atnount 111-5 C
Wall Thickness
or ght/Ft. M rial
7ett� C-
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16.REMARKS:
thod
Material
LOCATION SKETCH
0
.•
ca
Show direction and distance in miles from Stt$hast--,
two State Roads or County Roads. Include the roa
numbers and common road names.
1
pa
AAA -
Material 0y„_., /r. (P�/
M- ed-
_tom
EHE.EBY CT Y
C NST Cnn ST
U N 20UZ
T
THIS WELL WAS CONS
COPY 0
GNM'URE OF PERSON CO
Ii FE FEv
li7 ACCOR iANtF WIT41 I A NCAC 2C, WELL
RECORD HAS BEEN PROV m TO THE
6WELL OWNER
STRUCTING THE WELL I DATE
qSQUjb��init tile (kri final to�q he D vision of Water Qua[jy, Groutitbknie& Seetin'f TZ 16)Ntail Ser
ASH€V1L'LEf�i y�Fli`,� ASHI-`liL rsci'.: OFFICE
9) 73b-3221, within 30 days.
'ice Center - Raleigh, NC
GW-I REV. 07/2001

254651
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin i!' V e CERTIFICATION it)) a Y 9
)
�� '�I• PHONE #76 /��j
/F WELL CONTRACTOR COMPANY NAME .-. //�,,,T� /r r�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# tat 6�3LL
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential I tmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0, If Other, List Usc
WELL LOCATION: C J,
Nearest Town: Pat) �••^.^Y^I�I
County__P??j
(Street Name, Numbers, Community, Subdivision,
3.
�J(f
Lot k1o., Zip Cpr{e)
OWNER:
ere LV4
Address S (.. -i T etc
/t , // 2l
k�
City or Town
( )
(Street R ute No.)
State
Zip Code
Area code- Phone number
4. DATE DRILLED S
5. TOTAL DEPTH: Li
Topographic/Lands ' g
DRidge ❑Slope aniley ❑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
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO fil%
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top o Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords a with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST A.
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth tameter
From To 7.. Ft. 40 II L
From To Ft.
From To Ft.
13. GROUT) De ki/ Materi I
From 0 Tod-) Ft.
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
'L- Amount IQ e
Wall Thickness
or /.-),lo etghtlqEt. II..l�erial
Diameter
in.
16. REMARKS:
ethod
Slot Size
in.
in.
Material
Material
T
J
et.
r-'
ntl
rn
LOCATION SKETCH 'F,7 rn
cT
Show direction and distance in miles from 43east_
two State Roads or County Roads. Include the roa
numbers and co on road names.
i—) �RA;141
06%301--
I DO HEREBY CERTIFY THAT THIS WELL WAS C
REocrtur
JUN 1 2 2
Submit the original to the
27699-1636 Phone No. (91a) 733
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
AND THAT A COP
SIGNATFH2E OF PEI
ision of Water Qua
3221, within 30 day
-T£©-Hd-AeeornANCE-n r1 i I115A NCAC 2C, WELL
S RECORD HAS BEEN PR(O\IkED TO THE WELL OWNER
/>&)L
ONSTRUCTING THE WEL}. DATE
���r,T' R SEC11uiJ
�� r'�`pG�(uq�n{�F}OpVtail ervice Center - Raleigh, NC
GW-1 REV. 07/2001

254646
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural R ( urcccs��s - Division of Water Quality - Groundwater SectionWELL
/ n
%YELL CONIRACrOR COCTOR MPANY NAME ME (print) I R4 j e p I CERTIFICATION ## i--2 /
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (0>15---
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ft, Municipal/Public Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑, I['Other, List Use
WELL LOCATION14
Nearest Town: County
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address /to FGt rt, ;Pc-) CT
(Street or Route No.)
iPo, lie n c
City or Town
State Zip Code
(p5)- loSS7-S?/Co7
ArA code- Phone number !Y O�
4. DATE DRILLED t_ /}�}
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YI S ❑_NO B--
7. STATIC WATER LEVEL Below Top of Casing: ) FT.
(Use "+" if 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 I5A NCAC 2C .0118.
9. YIELD (gpm): f/9 A th&1 METHOD OF TEST Pit
ID. WATER ZONES (depth):
Topographic/Land setting
td is ❑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
O
r_
r—
LOCATION SKETCH 0
cShow direction and distance in miles from at &st -'
I I. DISINFECTION: TypcC;'1Ci 1Ft�.f� n Amount � I I C- �
12. CASING: ° Wall Thickness two State Roads or County Roads. Include the road
Dept�T Dia er or et UFt. �f�; n�al numbers and ommonn'road names. (�
From To d 5 Ft.- MSS SSA
�,y„�%L
From To 1S / Ft. I r f!IA� j f � Gj�kr.C7J 1y/(/
From To FL D r 9s ) V I
13. GROUT: Dept M tcri I ctho j�
From___ To i(J FL
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Material
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
JUN 1 1 20
Lb—
V 0-
6.,
/J_jyj�—//
U ✓12 err'/gpitt
Submit the original to the
GR2d6W61NA Ell1i3PEf S919) 7
ASHEVILLE REGIONAL OFFICE
THIS WELL WAS a
S, AND THAT A CO'
GNATURE OF P
rk_ Ire,, �' ° \ ij r� ,
RIUCTED IN-'ACCOIibAtdr
;THIS RECORD HAS BEEN rbl
CONSTRUCTING THE Wf:\LL
vision of Water Qt. ality, Q p¢L'dD roar€$01i3101,636 Ma
-3221, within 30 days. tSi-I VI LE RI:CUMI I. OFFICE
i I5A NCAC 2C, WELL
DED TO THE WELL OWNER
DATE
Service Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /-�DivMisioon of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tP «nJ l �) oaf
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable.)
254645
- Groundwater Section
CERTIFICATION # 127 7J
� 1 e» n �j(,t/ f kct7 U,(t/I PHONE # fY01]I (OCe
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Ir ttnicipal/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:
County / Etta
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (PC-A-c) 1
Address ySo S. Ms l/C hi UPC
(Street or Route No.)
Mi/Is hwer n c
City or Town State
( Area code- Phone number 6-_/r �tN
4. DATE DRILLED d oC
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111---
7. STATIC WATER LEVEL Below Top of Casing: .2O FT.
(Use "t•' 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 • Ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST AR
10. WATER ZONES (depth):
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ( ❑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
I I. DISINFECTION: Type
12. CASING:
From
From
From To Ft.
13. GROUT: Depth
O� s(% From 0 To Ft.
From To Ft
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Depth
To
To
16. REMARKS:
mount
Wall Thickness
Diameter or Ligh Ft. tertal
Diameter
Size
O
LOCATION SKETCH CO
Show direction and distance in miles from atieast o
two State Roads or County Roads. Include the road'`
numbers and common road names.
da
1 d, g/"""o 4A1
thod S / i `Jt D r ""'i. egge ��/
Slot Size Material
in. in.
in. in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS C
', ANDHAT A CO
i N1
rn
UCTED IN ACCORDANCE;'{✓vi i I5A NCAC 2C, WELL
HIS RECOKD. HAS BEEN tlli-c�IDED TO THE WELL OWNER
JUN 1 1 002 fr GF U .P11 r ,,NJ,
Submit the original to ae Di /ision of Water Qt ttity )-s46nhrd6•.kkrr SrcaiS mail Service Center - Raleigh, NC
27699-1636 Phone No. (9 9) 733-3221, within 30 clays. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
SI
NATURE 0
PEI2SOtJ CONST 12UCTING THE WELL
DATE

254641
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectio
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Se MOO?
%YELL CONTR
ACTOR COMPANY NAME
SLATE WELL CONSTRUCTION PERMIT#
tit -applicable)
CERTIFICATION# 7
CI e ff facie tad/ PHONE # forgs 6d0 -! f/C >
ASSOCIATED WQ PERMIT#
(if applicable)
(*.Lin /o
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O. If Other, List Use
2. WELL LOCATION: u
Nearest Town: /' County
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address . 9 (6X L-195
(Street or Route No.)
\VL> \\Q_ c 3Vlga
City or Town State Zip Code
(11.:1Fr)- CoSS-Gii -//>
4. DATE DRILLED ,S- 9 / " 6�
5. TOTAL DEPTH: ali,S�
6. DOES WELL REPLACE EXISTING WELL? YES.❑ NO ❑—
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" ilAbove 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): (Sr METHOD OF TEST
10. WATER ZONES (depth):
I . DISINFECTION: TypCr(At A%Amount 2 C'-
12. CASING: i Wall Thickness
!ifla!
thud
Area code- Phone number
Depth((�^^ D' peter
From To �tJ _ Ft.
From To,_ Ft. n icier
From To Ft.
13. GROUT: Dept. n�A
From 0 To .t_ _ F'
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
From To Ft.
From To Ft.
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
ND T A COPY OF T
Sudirti t the ortdgTHo t
27699-1636 Phone No. (91
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longilude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From
To Forn,ptio(o_Qescription
W1 0%) C\`G n. T
G
(O ---
iv
r
c
-v m
—J
S mac:
m
LOCATION SKETCH .r cf,='=
m-i
Show direction and distance in miles from al e;st
two State Roads or County Roads. Include the -road c
Z
numbers and common road names.
69
1P 9" km
URE rF PERSON C{JNST
QM ACCORDANCE WITH I
:ORD HAS BEEN PROVIDE;
UCTING THE WELL
(bv3RV
GROUL EcO� 9r10E
sion of Water Quality, G ounFF_ Service
T
733- 221, within 30 days.
AC 2C, WELL
THE WELL OWNER
DATE
Center - Raleigh, NC
GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

254616
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural'urResources - Division of Water Quality - Groundwater Section �7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `11O'Y7 do r CERTIFICATION# d'i
Cis 0210-k
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f )
I. WELL USE (Check Applicable Box): Residentialunicipal/Public ❑ Industrial ❑ Agricultural ❑ .
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town:
County
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
, I I (Buse "Route N3.)
( ���/�y�o�r�Town �����'C_ State _ -95—
Zip Cole
Area code- Phone number e�.
4. DATE DRILLED 00 iil -Oa)
5. TOTAL DEPTH: 4 a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: MCD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. yN
9. YIELD (gpm): ) VI METHOD OF TEST at1l_
10. WATER ZONES (depth):
T�opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form Lion Description
ti 4an AWAS..
I . DISINFECTION: TypeG1fl'(10 C.&Amount I' _
12. CASING: Wall Thickness
Dept or
To Ft._ Di m�ter �r p
From
From
From
To Ft.
To Ft.
Mue_
13. GROUT:: Depth^ ter'al N hod
From (J To Ft.--__
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.
16. REMARKS
c
O
tV
r
C Er
LOCATION SKETCH
Show direction and distance in miles from at4gast —rt9
two State Roads or County Roads. Include tlWroac>`,ir�,-.;
numbers and
cu'
'
y/ommon road names.
641 � Of�//�
te,
( -
boa c T4YEHAT:4-11S WELL WAS
v1LUNS 1 Rut_ rON ST-At DA D THAT A COPY ACCORDANCE
OF THIS RECORD HAS BEEN PROVIDED O TH
MN 11 200
ATURE OF PERSON CONSTRUCTING THE WELL
c nti(�}U('VMt hh ,fig d , Division of Water Quality,Groundwater Section, 1636 Mail Service CeSter-
R3 RE tUL2UL i
Hl� f falvrA� �33-3221, within 30 days. GW-I
SECTION
ASHEVI1_LE REGIONAL OFFICE

251661
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Ren`ssouurcess-- Division pof Water Quality - Groundwater Section
p
WELL CON'LIRACTOI2 (INDIVIDUAL) NAME ((pprint) Teq* into / 't CERTIFICATION/5r¢ynJt7/(��//�
P. ELL CON'TR. ACFOIt CO\IPAN\ NANTE l-./P 13A la gee Oce�I I,4r fltn� PHONE 1$ go) (n 1,1 -273 /
STATE WELT. CONSTRUCTION PERNIIT# ASSOCIATED WQ PERMIT# 'or 6,64 J
of applicable) ( if applicable)
1. WELL LSE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION: (�
Nearest Town: gAsaL _ County
(Sacet Name. Numbers Community. Subdivision, Lot No., Zip Code)
Typographic/Land setting
�idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: ,.. s £Lsj 1 (dcgrees. minutesiseconds)
Address lops- %L, � /1 Latitude longitude source:DGPS❑Topographic map
�� `"' (check box)
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( )- icy- 130s— 0 Os cl ,
Area code- Phone number r/ �cl LILI� Olen
4. DATE DRILLED \) `6-OpZ �'
5. TOTAL DEPTH: 4 l r N
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e� r :
7. STATIC WATER LEVEL Below Top of Casing: ''O 0 FT.
(Use `-s" 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 acco rda nee ith ISA NCAC 2C .0118. t
9. YIELD (gpm): METHOD OF TEST
ID. WATER ZONES (depth):
reel or ours No.
/a e irlf.1411C!'1 c gr23%
11 DISINFECTION: Typ
12. CASING:
t Depth
/� q Di' m ter or W'eig L Ft. M enal numbers and common road names.
From Toni f Ft. �/y f " ru L� /' ^z- I�
From To Ft. /lJ_ ✓(j' r4
From To
ep I t. iJI A /I
13. GKO UT/� Depth
t at -Ea ethod 'fl frl"_, lM/ .FJ{'ny/,/
From (/ To Ft.--� ,tM Gte From To FL
14. SCREEN: Depth Diameter Slot Size Material15 SAND/GRAVEL PACK:
-[L/�""O' -
ft+
LOCATION SKETCH
CJ
.ryyu I a."._ Amount A t/2 [' Show direction and distance in miles from atceast c
Wall Thickness two State Roads or County Roads, Include the road -
Fro
m To FL in. in.
d-ej
Depth Size Material
From To Ft.
From To Ft.
16. RENIARKS:
DcO.R_Y u'E
C NZTRLCTION
I FOT
D
IS WELL WAS CONS
ANWTUAT A COPY 0
ED IN ACCORDAN A I . NCAC 2C, WELL
RECORD HAS BEEN PRO\�E E TO THE WELL OWNER
I LT
TURF: OF PERSON CONSTRUCTING THE WELL
41 mil thc.).,gin't�oo�'tin Division of Water Quality
A 4,0 30,l $ 0,Att OFF N 733-: 221, within 30 days.
DATE
L TER ` l
Gro `E� t*PC,1.-�a !� IScniccCenlcr- Rulcigh,.NC
GW-1 REV_ 07.2001

254659
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res rces - DivisionMof Water Quality - Groundwater S# Section
VCELT CONTRACTOIt (INDIVIDUAL) NAME (print) V e �Qn ge- CERTIFICATION ? 7(�
Cil
Ctel9a) U +L %IiIU PHONE#( //) 6)/ ?1f4�
ATE WELL CONSTRUCTIONPERMIT# .\SSOCI:\TED WQ PERMIT/0
(it applicable) (ifapplicable)
n ELL CONTRACTOR COMPANY NAME
2
WELL USE (Check Applicable Box): Residential t lunicipal'Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
VVEI.L LOCATIONfl
Nearest Town: CA.009A
County hen/,�c..,
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
.Address
(Street or Route No.)
nL
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 9�
7. STATIC WATER LEVEL Below Top of Casing: `I0 FT.
(Use`* if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or hclow land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3Q METHOD OF TEST
10. WATER ZONES (depth):
Zip Code
T ographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees 'minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
(' 11 C_ n t T
DEPTH
From To.
City ctJrown State
)-
Area code- Phone number r�
T. DATE DRILLED S Fool
II. DISINFECTION: Type 46...t
12. CASING:
DeptL7p Dyarneter
From 0 To r / Ft. �ji VII
From To Ft.
From To Ft.
Amount -3 Oz
Wall Thickness
or Weig UFt. M rial
13. GROUT: Depth //�� renal
From To �l.' FL i4C
From To Ft.
Id. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
19. hod_ a
CJ o
-13
.1 . ,
eT
LOCATION SKETCH
Show direction and distance in miles from?leas22
two State Roads or County Roads. Include the road
numbers and common road names.
Cv —
Prae Pik
OF -
Slot Size Material 6� ��, jY ��
in. n / /i/n1N,i
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
r. Y., R4�TItY..a~
HIS WELL WAS
ITHATAC
THIS RECORD HAS BE
TH I5A NCAC 2C, WELL
VIDED TO THE WELL OWNER
Submit the origi al to fix Divl
E.'F3'Mrili)) Ati N"8. '"bill v) 733-_
A6"EVILLE REGIONAL OFFICE
IGNATUI2E OF PERSON CONSTRUCTING THE FELL DATE
;ion of Water Quali[ L µ<j n�frriT�r` cFnkil�, 1636 Alail Service Center- Raleigh, NC
221, within 30-4tesa5N L C RB It t '� 0FF'CE GW-I REV. 07 2(101

254636
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res u
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
es - Division of
Water Quality - Groundwater�Sectionri�/
CATION #
WELL CONTRACTOR COMPANY NAME ^f ^^'N—`. aid''-t_ 2 PHONE I #1 yli)L�,-)1-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential l unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 'We/5
County Head.
(Street Name, Numbers, Conununity, Subdivision, Lot No., Zip Code)
3. OWNER: gintA-
Address 0 Of L 4
(Street or Route No.)
n�P)c re_ -?XO
City or T%r'ig ii_State s/ Zip Code
Area code- Phone number
4. DATE DRILLED "i..)
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO &
7. STATIC WATER LEVEL Below Top of Casing: tf0 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 ISA NCAC 2C .0118. p
9. YIELD (gpm): ) METHOD OF TEST t /1
10. WATER ZONES (depth)
II. DISINFECTION: TypCifylt)\ l4.Amount '4--4
12. CASING: Wall Thickness
Depth Diameter or ght/Ft. M nal
From O To U Ft. _1Q. (r yL
From= To= Ft. & iy "r r
From To Ft.
13. GROUT Depth . Materia
From_ ToJa_ Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope sett y ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ini nutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo ation Description
cQ(o (AO
thod
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
Size Material
16.REMARKS
I DC
CON
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
695-i— 0,-1+ 13 %,
16 P -tje R;g-4-1-
919-L, 4* IprKc LSD
T i }� I) /F lSetm.yT
S?g;M05 Cue, % ski ai I g
t, Fp Ft r'P ITWY THAT THIS WFI tVAS Cl7
AlE1.2 ST A C0'4
SIGN n'i U 24
1 1 2002 J
Subm t tl e original to the Division of Wa
2761. 9-1636. Iron No _49191 733-3221, vithin
GROUNDWATER SECTION
ASPEVILLE REGIONAL OFFICE
rV c`
C c'-
s eter,
.J W E v CDC
RUCTED IN ACCORDANCt. rVf11H ISA NCAC 2C, WELL
THIS RECORD HAS BEEN `LCV DED TO TIIE WELL OWNEIt,3 rn.�
✓ •.r v, Y'
OF PERSON CONSTRUCTING THE WELL DATE OCn
—t
G
GROUNDWATER SECTION,�,� Z
er alit nfOiL1LtErV}Ltelt%FLt®QFIL4'6 Mail Service Center - Raleigh, NC
30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
254631
North Carolina - Deparunent of Environment and Naturra�l-R�esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEj1(print) \Pk<P.0 1�-( OCA- e CERTIFICATION #1- /(C• /
WELT. CONTRACTOR COMPANY NAME 1 &T Q-\Z-3Cw_ -e9 \ \'c.�, \1\\\\t tle)---OC. PHONE #ap�r�] ((.,Q? S LV&R
SATE 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 ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:A�1e'AC\ Q�OEut\P County Ne(\cp��CJ (\
(Street Name,, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1\mm' P �c, ;
Address 1 31
(Slree or Route No.)
City or Town State Zip Code
(D )- 6.25-et)5S
Area code- Phone number L
4. DATE DRILLED I I I G3-
5. TOTAL DEPTH: /o25
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Lie° 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): AS METHOD OF TEST CL-AC-
10. WATER ZONES (depth):
11. DISINFECTION: Type C
12. CASING:
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 Foration Description
0 \�� Ct�lr v
tag
LAmount .1 C' Wall Thickness
1 Depth Dia eter or Weight/F_ Material
From / To )'-) Ft.Cyt(LLL ,2l
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 conunon road names.
\�\CJ IJ Vt -\—e A L 0 �.
C 1LU �S cL C-C> C \ C57 0
From To Ft. _
13. GROUT: Depth Material Method V�� UQt��j `'\ �C�C�
From CI To ? CH Ft. CP1)1Q.1l 1 • rot fC From To Ft. l.A.TC 'LC SC_O A\-e>v_G_ C2 6
14. SCREEN: Depth Diameter Slot Size Material �� ��� cm\(J A�j���(}��
From To Ft. in. in. (� \ ` J � _ ��--
From To Ft. in. in. \ \U \C \11n �L) Y"t":
SAND/GRAVEL PACK: � \
No t�
N
c
16. REMARKS: ;a "'1 = `-r^
15.
Depth Size
From To Ft.
From To Ft.
Material
I H-(C Y IT -Y II
DC S�UC I( 1 S R
IS WELL WAS CONSTRUC
ND THAT A COPY OF THIS
sL
ALLOICUANCC WI I 11 ISA
HAS BEEN PROVIDED
JUN 1 I z
NATURE OF PERSON CONSTRUCTING THE WELL
GRCEUNOWAC
ubmit the original to the Division of Water Quality, Groundwgtor) fgcit[ogct
784uVolArnlA rc(ibP
ASHEVILLE REGIONAL OFFICE
33-3221, within 30 days.
2C, WELL
TELL NLzIb
III
11- C.
DATE
0
CTI( N
ad gr:Tice Center - Raleigh, NC
GW-I REV. 07/2001
0<
ar-
rn
c4
H
G

254626
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # # 1
PHONE # P'U a}
J )
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ I f Other, List Use
2. WELL LOCATION�^
Nearest Town:,'O,mr4 County
(Street Name, Numbers, Conununity, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
'tg l^ri$Wro
h et or Route g 73cf
State Zip Code
City or Town
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE XISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: to ica_FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface'
*Top of casing terminated at/ur below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): � METHO TEST
10. WATER ZONES (depth): %
ographic/Land setting
L9Tliidge ❑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
LOCATION SKETCH
1 I. DISINFECTION: Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth I Dpmytcr oreight�Ft Miirl numbers co ninon road names
From To Ft. (p
From
13. GROUT
From
From ( )
To Li I Ft. C
To Ft. v , l t n n / .-�f
Dept ater'al e[hod f' {�r_�.,.�--,v (KY�_t/ /(�_jCl//�6_".`,"r.
To 00 Ft,
From To Ft.
14. SCREEN: Depth Diameter
From
From
15. SAND/GRAVEL PACK:
Depth
Slot Size
in.
in.
Material
4 "L/
To Ft. in. O
To Ft. in. N c
Size
From To Ft.
From To Ft.
16. REMARKS:
4JD It EI H� C I{ '
�i.TRDCT O T I
,J�UN 1 1 200
Material
THIS WELL WAS CONSTR..
AND THAT A COPY OF TFI
S
IN ACCORDANCE WITII �.
CORD HAS BEEN PROVIDE
SI NATURE OF PERSON OONSIRUCTING THE WELL
GROUNDWATER. SECTION
ctthmit the original to e Division of Water Quality, Grou >Ftkk4Sef'IonA6104E IServic
G k{y?'67"6TfffitStECNIK 9 9) 733,3221, within 30 days.
ASHE't7(LL� REGIONAL OFFICE
14
L E?
c =;
c
Yc
� m �
� ^ m
rr
AC 2C, WELL W E
THE WELLOWNE� r
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001
on
l y

254625
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ral sourc s -Division of Water Quality - Groundwater Section
Nat
WELL CONTRACTOR (INDIVIDUAL) NAME (print) • •� CERTIFICATION
WELT. CONTRACTOR COMPANY NAME ,� _ �.,, - - _ G{Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/0tat C 3
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ElMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: II
Nearest Town: ,1�✓lsnA ounty fhpiratsi
(Street Name, Numbers,
Community, Subdivision, Lot No.,"Zip Code)
3. OWNER: m � CR41— la
Address 9. 1p�3 �-�0�
( r ofincitt or Route No.)
vim., //fir L
( City or Town 6,iState 58,05_,ZipCode
Area code- Phone number ��33 ff��
4. DATE DRILLED (-f -19 -O/
5. TOTAL DEPTH: gas-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: /s ' FT.
1
j (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 Ib I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Landiatting
DRidge ❑Slope 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 Description
rs &5 ot o5 ot1c AM
11 DISINFECTION: Type
12. CASING:
13.
From6 To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From
From
ftrv.a
De h D' ter
Pt ne/
o .}t J Ft. (p f
T
To 5—Ft 6, tale
Amount 1/2 C
Wall Thickness
or.Weirtht/Ft. Mirtyrial
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.
48�
FromTo Ft. �n Cart
GROUT: Del_ ter I h'I�ihod Vol Il r ) 1 /,r CZf[7'ff)
O ( d/.rw f� 1 LkC7ln_A_ C Y 1
Slot Size Material
in.
in.
16. REMARKS:
Material
I"o
I DO HEREBY CERTIFY THAT THIS WELL WAS COIN 1DU1EU IN ACCOILUANCElt\e t 111, 5A NCAC 2C, WELL
CONSTRUCTION STA ARDS, AND
(`THAT
TAA—COPY q Iff11S RECORD HAS BEEN Pad,VIDED TO THE WELL OWNER
/•' / GNATUIZE OE PERSON ONSTRUCTING THE WEL� �DAT���
�+��i9• 11
GRO NDVdA7FR SEG11•0'i��'
E
tbmit the on rtnal to the J v on of Water Qua ity, C, tCBIgEtS. 1�Ln0�P°EMail Service Center - Raleigh, NC
699JUNr I'io4e 112QQi.I9) -3 : 1, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

254622
•
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural rces - Divisionivisof Water Quality - Groundwater Secti9
WELL CONTRACTOR (INDIVIDUAL) NAME (print)n�ye /Mee CERTIFICATION#/�tOO(,,�/J�
WELL CONTRACTOR COMPANY NAME C /1° r) /I La* PHONE # f/b_ /y) `" '^ 7
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# I <o J
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Pd� Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: '�✓-r�AA.W County PailL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street orneRoute No.) )-10,-5171
City or Town (n State Zip Code
flea- 2 1-c $ a
Area code- Phone number _)),
4. DATE DRILLED ( "j
5. TOTAL DEPTH: 603-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1.00 FT.
lapographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fo ation Description
0 3tt
'14 Coc 5
(Use"+" if Above Top of Casing)
8. TOP OF CASING 1S ) FT. Above Land Surface*
`Top of casing terminated atfor below land surface requires a
variance in accurda ccrth 15A NCAC 2C .0118. r
9. YIELD (gpm): _._.. METHOD OF TEST
10. WATER ZONES (depth):
II DISINFECTION: TypeCflOX\u. _A_ Amount a. C'-
12. CASING: `` Wall Thickness
Depth Diameter or eigh Ft. NJ-Serial
From Tore' FL r L ( UL
From To Ft.
From To FL
13. GROUT:Depth, / Material $
From 0 To Aft Ft. DeAn QcN.S
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
O
tV
L
c-
r-,
-m
�:77
r-
4-
r:
LOCATION SKETCH rn
Show direction and distance in miles from at st
two State Roads or County Roads. Include the road=
numbers and commo road names
4 .eve- s)-/��/
. 99' l
��� �
o G 7tL
r / �{y,�Q
Material 1
al
• 164Vt (
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
I DO HEREBY CERTIF
(TENT2U! 1O1»1r4
JUN
Submit the olgino'7o th
THAT THIS WELL WA.
ND THAT A C
27699-1636 Phone No. (919 733-3
TRUCTED IN ACT -Ur —di -Pk C
THIS RECORD HAS BEEN P1
TH I5A NCAC 2C, WELL
VIDED TO THE WELL OWNER
GNATU
F PERSON CONSTRUCTING THE WELL
GROUNDWATER SECTION
ion of Water QualtAbleail4lt@fRQ6/PN&LPaR10636
21, within 30 days.
DATE
Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat ral R-s. rces - Division of Water Quality - Groundwater Secti9,n
WELL CONTRACTOR (INDIVIDUAL) NAME (pr nt) if I �•C.•1 - . CERTIFICATION # dj'1'1�j �ry
WELT. CONTRACT OR COMPANY NAM # f ) E • ' / ' PHONE 6 w _)JJ/, T
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifa )licable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(if a. licable)
254620
(.U•L (005
2. WELL LOCATION: yyff
Nearest Town: nakeliaa County
(Street Nano, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(S et or flout lo.)
City or Town Stale Y�G Zip Code
( )-
Area code- Phone number 1 l / D�
(p
5. TOTAL DEPTH: I a 5-
6. DOES WELL REPLACE EXISTING WELL? YErS, ❑ NO tI�
7. STATIC WATER LEVEL Below Top of Casing: - .9_FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING !S 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): 3 0 METHOD OF TEST
10. WATER ZONES (depth):
I
II. DISINFECTION: Typer1'.[: nt IIr f o,... Amount � C
12. CASING: \ Wall Thickness
Depth Di meteLr or hi/Ft. Mittrial
From d To 4r- Ft. Co \� 7 (a L
From To Ft.
From To Ft.
13. GROUT: Depthhs, Material
From To :/"L) Ft. n^
From To Ft.
14. SCREEN: . Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
4 DATE DRILLED
Typographic/Land setting
Le'Clge ❑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
-oc- Lk
From
From
16. REMARKS:
tV
L
c
c
z c--
0=<
ZE rr,
.- c
-1\
rrl
CO r
two State Roads or County Roads. Include the oad n z
o
numbers and common roa names. ,e^3
LOCATION SKETCH S"v
Show direction and distance in miles from at lea
1'p)otiti - (NOf\l
Slot Size Material
in.
in.
Size Material
I nn HFRFRV CERTIFY THAT THIS WELL WAS CO
SI+ 11
TUREOFPERSON
JUN 1 1 LOO
Su mit the original to the Di
276 9 trs36 Plw
GROUNDWATER SECT ION
ASHEVILLE REGIONAL OFFICE
�ST�21'f-,IE
1DiN£C(iiRlir�N� W IT'15A NCAC 2C, WELL
IS RECORD HAS BEEN Hit V Cf3D TO THE WELL OWNER
ONSTRUCTING THE WELII. DATE
ision of Water Qua ity, Grtti)6i4 ter Setti®n 1 F636 Mail c ervicc Center - Raleigh, NC
3221, within 30 day - ` GW-I REV. 07/2001
11

254618
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural k-CResources'(i- Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME/l(print) \e P.\ .-.f `' `C1GCa _
WELT. CONI'RACI'OR COMPANY NAMR UJCt-\�Lx SQ.-9 `tc.-\\`,\`s f1c )-10(•
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
- Groundwater Section
CERTIFICATION#1�'
PHONE #
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use
2. WELL LOCATION:
Nearest TownW o \\\ e County\\e fA Pi son
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:U„CS,t\x0. 0(\oN$VSO fN
Address' tS (,n QGk' r3G5
(Street or Route No.)
H' u,11 e 1� c r-QE`19
bCity or Town State Zip Code
)- l0%i7-WSL/
Area code- Phone number
4. DATE DRILLED Li/
0 a
TOTAL
DEPTH: 5. T A • : �
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
��,Topographic/Land setting
L7Rtdge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninues/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(5 14-19 r-C-)\Q —
\ 41 91111\ 1 E
7. STATIC WATER LEVEL Below Top of Casing: Co 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST (L\ (
10. WATER ZONES (depth):
11. DISINFECTION: TypeG(161.41.0 Amount \'ki CI
12. CASING: Wall Thickness
or Weight/Ft. Material
From 0
Depth
To
From iiO To_LL? _
From To
13. GROUT: Depth
From C. To ,DG Ft.
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Diameter Slot Size Material
in. in.
in. in.
Material
Diameter
Ft. a"1 -0 VC
Ft. a t PVC
Ft.
Material - Method
CPNAP(\t" (fl ]t -6_
IV
t_
r.
0
> in
• rn
C.:LOCATION SKETCH 3 cn=
Show direction and distance in miles from atTkmast rn'
two State Roads or County Roads. Include ttroacg
numbers and common road names. z
' C,) . Q."--CI Dane Scr\oo1 . - Yz m /
o IC5Coeer acC('oSS orw
t.Sc c e \vow \/o r\ ix;,) ��s
woo \-\C
O (N
16. REMARKS:
I DO HEREBY CERTIFY THAT TI-IIS WELL WAS
ND THAT AGQ
1777
200
SubmitJthe original fo th
27699-1636 Phone No. (919 733-3
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
IGNATURE OF PERS
GROUNDWATER SECTION
on of Water
.r:t1Srk,//� I:.4,.Ent IT FE CF-
-m^^-
21, within 30 days.
i
TRUCTED IN ACCORDA TTH I5A NCAC 2C, WELL
F THIS RECORD HAS BEE, SVIDED TO HE.IWELL OWNEII-
DATE
ELL
ail Service Center - Raleigh, NC
GW-I REV. 07/2001

254573
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur�Resources
t-pDivision of Water Quality - Groundwater Section/o
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'VP_ ' MAN? e CERTIFICyAAT�II�((ON/tI_{2(tT�f// �,��/
WELL CONTRACTOR COMPANY NAME C /c, n W frfccj W 4/ atill•�8 PHONE # (q95 ( G -'40
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 1nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: lel /)el Uf Ile- County
He.ndc,fx
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: II C Aid
Address �f'O. 8X y/-
(Street or Route No.)
P..) Pn dome PI__
City orT wn State
( )- &qd 79)9
Area code- Phone number
4. DATE DRILLED ,3 140 —
5 TOTAL DEPTH:
6. DOES WELL REPLACE XISTING WELL? YES ❑ NO El—t—
Zip Code
ographic/Land setting
tdge DSlope ❑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 o For ation Description
rtq
�D QC\
7. STATIC WATER LEVEL Below Top of Casing: r�c ) FT.
j (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 accordapce with ISA NCAC 2C .0I l8.
9. YIELD (gpm): j METHOD OF TEST ft2 5
10. WATER ZONES (depth):
11 DISINFECTION: TypkaJ`-Amount /c/ C' •
Wall Thickness
12. CASING: /�
Depth tar ter !iIFt.
M nal `e ,
From To Ft. �z((,��(,.�ljy�h(o.o,ed
From�To � /'
From To Ft. , /� A; `l Y_
(3. GROUT: Dept /� Material ethod hx�`"4 ���(((///���
From To s'�/ Ft. �(�P�i net -
From / r ToDe FL��-i ato
(4. SCREEN: DepthDiameter Slot Size Material
FromToFt.in.in.
From ToL Ft. in. in. �
I5. SAND/GRAVEL PACK: 3A 1Y1 A /5
Depth Size Material / I I I "I
From To Ft.
From To Ft. 1 �"�"`
O
c
16. REMARKS:
THIS WELL WAS CONS1
AND THAT A COPY O=
r cr
v o`
Dc
3C �C
mA
LOCATION SKETCH IV c->
Show direction and distance in miles from at Fist o
two State Roads or County Roads. Include the road Z
numbers and common road names.
11514NCAC 2C, WELL
DEC TO THE WELL OWNER
SIGNATURE OF PERSCN CONSTRUCTING THE WELL
DATE
ision of Water Quay, GrouliStOtitFr'.SAFiRoSED"1it ONlail Service Center - Raleigh, NC
3221, within 30 days. ASHEYILLE REGIONAL OFFICE GW-1 REV. 07/2001

25•1569
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and.Natural
Resources'(Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAMEl(print) \f \ ` P.C� `ACC -e
WELL CONTRACTOR COMPANY NAME/VC-C `-. ��1 x`1t lle t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERRMIT#
(if applicable) (i f appl icable)
- Groundwater Section
CERTIFICATION`` # r CL.1 `M S L�
PHONE # �Y'3 ( (`4- `
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ``\\ 11
Nearest Town. _G E;,Q t.) v1 County -Nen e.C5CC'
(Street Name, Numbers, Communittyy, Subdivision, Lot No., Zip Code)
3. OWNER: b C ni
V `= seXSG
Address \ Ok5G X Vc
(Street or Route No.)
GPC-CU<— nC
City or Town State Zip Code
Bag) (9a5 18tiu
Area code- Phone numb
4. DATE DRILLED 1 ' Oa
5. TOTAL DEPTH: L%(05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO--0-
7 STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ka FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan e with ISA NCAC 2C .0118.
9. YIELD (gpm): QL.— METHOD OF TEST Q\ r
10. WATER ZONES (depth):
11. DISINFECTION. Type 0\0-A— Amount 'tt 3 C
12. CASING: Wall Thickness
Depth Diameter or WeiahUFt. Material
From l To I-10 Ft. &I`I ' / 92I (Yte`c—t
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_O Tote; Ft. CQMQ(w tp uCe....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:
Material
Depth
From To Ft.
From To Ft.
Size
16. REMARKS:
EICZSHTELECE11110
JUN 11
Submit the original to he D
GR.OSIASI ffhEI t0?ct'1s9 9) 73
ASHEVILLE REGIONAL OFFICE
THIS WELL WAS CON
AND THAT A COPY 0
SIGNATURE OF PERS
vision of Water Qualit
I-3221, within 30 days.
'opograph ic/Lampc tting
L ..Idge ❑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 Forrtrtation Description
H. C 41.0_
O
wr
00
D r�
ti
D m_
LOCATION SKETCH n"
Show direction and distance in miles from Ileasd
two State Roads or County Roads. Include the roaa
numbers and common road names.
reass
I7-Cnx. WQ0.oQ— . U\GWU
--X% a Z S�Q iix O' r` � 3'-
RECORD HAS BEEN PRO
CON STRUCTING THE WELL
GrouuuraiSti'i�WHEVILLE,t a4�l Hyf61
� Ser
NCAC 2C, WELL
TO T.1-IE ELL OWNER
DATE
ice Center - Raleigh, NC
GW-I REV. 07/2001

254596
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section q
C. CERTIFICATION # -X�7,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ...Es -CC Coo'c� ���1 ! �a -n� p!
WELL CONTRACTOR COMPANY NAMIEc PO 51 L 107PQ ``�La\` JC\\\, f SZf\C -PHONE # 1,,, -- ' 1 o'-Y
t
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PE Rb71T# (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential fiY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION: /Topograp
hc/Land setting \ i
Nearest Town: if.s iL.)A\ Counta9d''P,nOC\ idge ❑Slope ❑Valley ❑Flat
(Street Name, Nmnbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
(Stror_Route No.) 0Q,A�
City or Town State Zip Code
W)-((-1-a�cr\
Area code- Phone number r'l, I \\ ,l
4. DATE DRILLED oC
TOTAL DEPTH \ l D S
5.
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): A Z METHOD OF TEST as. c
10. WATER ZONES (depth):
11. DISINFECTION: TypeQ\\f`r Iti�—ti-e-Amount 1,Q. 0 -
12. CASING: Wall Thickness
or Weight/Ft. Material
soQa1 4uC
From 4 (
To Depth S3
From To
From To
13. GROUT: Depth Material Method
From Ci To 'LC) Ft.C,.ePfle(NT oo:C�0-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(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
5-a, k(c S %vas>ci
16. REMARKS:
JU
Submit the original to th
Diameter
Ft. lP
Ft.
Ft.
2 itirlsvAlt te-r1bN
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.
\ \CiaCT` _ C� P c1 `- CC e Q_K- t/2 en
CND
I�jI,
IS WELL WAS CONSTk[.
ND THAT A COPY OF fl'T
s�
iD IN A -CC RDAN l F
GNATURE OF PERSOE °NO
Div sion of Water Quality,
733 3121, within 30 days.
ECORD HAS BEEN PROVI
TRUCTING THE WELL
Grogak4,* §001,5fp3Illa Sery
0
fV
L
Cr.
-J.
C
O
n
J _=
3
F u>_
.. m�u
va G
JCAC 2C, WELL
0 HE WELL OWNER
DATE
cc Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturr_allRResourcesCIA
(- Division ofWaterQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/�(print) i \ \ E CI� ,' `C�iCJ�I. CERTIFICATION #�(VX^ /(�• /
WELL CONTRACTOR COMPANY NAMt{ 1FCL\>\..�G. t'e—Q k \ \\. 1 j \\t flt;)JnL PHONE # ( (Cd-C \4 R
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if attlieable) (ifa licablc)
254589
1. 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:* e.r\cicSr nk.) v\\ '0 County \ Q� 'P.0 Y\ y:
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER:0\�--1.�Q. }�V\ 6Th
Address ' (-" JO
\` `\\ (Street orRoute Na.) p
1160L--)�
eltb-i CI"
City or Town State Zip Code
Bay)- JCL?' /55 r7
Area code- Phone number
4. DATE DRILLED �A2 l loa
5. TOTAL DEPTH: I(o5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q-
7. STATIC WATER LEVEL Below Top of Casing: (DO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118. -
9. YIELD (gpm): \ G METHOD OF TEST Cl_\C
10. WATER ZONES (depth):
II. DISINFECTION: Typec)Fxpv\QS Amount ' 0
12. CASING: Wall Thickness
Depth Diameter or WeighUFt.,aterel
From I To 50_ Ft. to `N2 77 l
From55O To 2 U Ft Co CDfaI
From To Ft.
13. GROUT: Depth Material _
From fl To 2 0 Ftf PCm n
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frain To Ft.
Topographic/Land setting
B'Aidge ❑Slope ❑Valley ❑Flat
(check appru firiate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For'tation Description
_
0 7.O
Zc� /(o5 �►c,. _ t
Method
d
16. RENIARKS:
D EOI{fSl'R .'T� ?j j
JUN 1 1 2Ii
Submit the original to t e Div sion of Water Quality, Grot ndwatd?FffSLi®HU 636 MeiltS.Utv'ce Ce \ter- Raleigh, NC
fKgo a lAls ,,. No. 91' ) 733-3221, within 30 days. ASF=..[NIECE RFBIO'.JAtCFFICE CW-1 REV. 07/2001
GROUNDWATER ECTION
ASHEVILLE REGIONAL O FICF E
THIS WELL WAS CONSTRUCTE u
AND THAT A COPY OF THIS ft C
LOCATION SKETCEI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. (- /.-,.
<\e .c_\,(,D
QC- we C\ a. E�
. GZ Q
\s`
eJ \ s- \ rz Q k e_
CD
irr
�_
XCCORDA?CFt WIYH 15A N2C, WELL N -'
ta
D HAS BEEN PROVIDED T4 ELL OW ER z
aaa
TING THE WELL DATE
SIGNATURE OF PERSON CONSTRU

254590
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat
WELL CONTRACTOR (INDIVIDUAL) NAME (�pnry ) J
(,.,t' A n
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use_--
Topographic/Land setting
SREdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
ral/R�e ources - Division o a er ua - 49/
L, i[- (hock CERTIFICATION# 7
Too I si f Water Quality Groundwa_terr,Sectio
UM/eh n.,..! I ,PHONE # 4141-
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATION: ))�
Nearest Town: Henol<q q, fie -County r7 C/Oskt,50/1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: SuJ lM5on
Address
ty or Tgwr� State Zip Code
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For
Area code- Phone number 42,
T _ v ..D�
4. DATE DRILLED O-`� 5. TOTAL DEPTH:_____
OES WELL REPLACE EXISTING WELL? YES ❑ NO S-�
6. D 7. STATIC WATER LEVEL Below Top of Cboie/66 FT.
(Use if"+" Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanegwith ISA NCAC 2C .0118. n�r
9. YIELD (gpm): d/� METHOD OF TEST !Y)h
10. WATER ZONES (depth):
tJ ^ Show direction and distance in miles from at least
Amount � Include the
DEPTH
From T a
4a ceS - =
ati
n Description
1 I. DISINFECTION: Type�v\a/�
12. CASING:
Depth,Diamet r
From 0 To Ft.n
From To Ft.
From To Ft.
Material ethod
13. GROUT Tot�o Ft. c fI L1 u
Fromsl—
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
To Ft. in. in.
From
15. SAND/GRAVEL PACK
LOCATION SKETCH
two State Roads or County Roads.road
Wall Thickness
or Weight/Ft. M erial numbers and common road names.
tL 4,id did loo vdS
From
From
16. REMARKS:
Depth
To
To
r
Si"ER -Ni U& ��.t CIA
N -i02
Submit the original t
Ft
Ft
Size
Material
Material
THIS WELL WAS CON R;"TED IN ACCORDANCE WIT 1
S, AND THAT A COPY 0 l'�FIIIRECORD HAS BEEN PRO ID
UU
NCAC 2C, WELL .r
TO THE WELL 0
I . � DATE
V SIGNATURE OF PERSON CONSTRUCTING THE WELL
GROIN 4Teh SEC ION
1 ivision of Water Qualit , Gro1Fitdivd[er_ � _4't60C'l4 it Ser ice Cee'ntr' Raleigh, NC
REV.07 2001
the
3221, within 30 days.
i
.E9) 7
ASHEVILL REGIONAL OFFICE

254586
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources�i-t Division of Water Quality - Groundwater Section Q /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ve7T /N/j//j�/'j�) � CERTIFICATION # P L WELL CONTRACTOR COMPANY NAME / L ��bA, 1 nL . P/H,AJO/N'jE�# �Ctll 6c) -AQ�(
I
STATE WELL CONSTRUCTION PERi\11T# ASSOCIATED WQ PERMIT# (�L4 29
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential IS nicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: blend cPsmrrlh°County-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
liende$560 War PC. 19,
(Street or Route No.) )9)
Zip Code
City or Town St to
O- G%.�-- )S)
Area code- Phone number//�� �� OO'
4. DATE DRILLED 'o
5. TOTAL DEPTH: 3 ys
6. DOES WELL REPLACE EXISTING WELL? YES 0 /N'O 11Y-
7. STATIC WATER LEVEL Below Topof "ifAboeT FT.
c
(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): S METHOD OF TEST Rt.e
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge gietbpe ❑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
0 L93 CA t r -c
L,e3 (. 1-1 S Cam\ o.tN N't e
\\ O —
IN,)
11 DISINFECTION: TypeC��(U>\of Amount if. it.2T
12. CASING: �Ja Wall Thickness
Depth Diameter
N or Veight/Ft. M
(� t
From 6 To FL �Z{
From 43 To Ft. 6 74
From To Ft.
13. GROUT: Depth et Material 1 - ethod 1
From 0 To 09O Ft. Cem• T �r�*/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
L
r
J
ni
rn;o
LOCATION SKETCH cla—,
Show direction and distance in miles from at lea=
two State Roads or County Roads. Include the road
rial numbers and common road name O �
feud
J(�-ILT'yc°
tE D�lrj-IF}Bjj' a(2TI
LU1NJ IItUI. 11 kJ IAI
-7)k. THIS WELL WAS CON " tim ArrnRDANCE`Wltgt I A NCAC 2C, WELL
'.LRf ha j
d, AND THAT A COPY 0 f RECORD HAS BEEN PROW DIED TO THE WELL OWNER
t_
LL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
G§t5liss4kfo,q.ittciRhe Division of Water Quality, Grotf'iidttater Section 1636,Mai1 Se
ASFP414Pft R41LRtIFAtt9) 733-3221, within 30 days
vice Center - Raleigh, NC
GW-1 REV. 07/2001

254609
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 ./1' \, n 1 Ln c
nc
WELL CONTRACTOR CERTIFICATION #: % I
STATE WELL CONSTRUCTION PERMIT#: _
1. WELL USE (Check Applicable Box): Residential 12-----Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI�N• rS ow sketch of tit location below) ry\ Q
Nearest Town., ` en Q -cr.fl > ��\ 2- County: ��` �
(Road Nam4nd Numbers, Community, or Subdivision and Lot No.) DRILLING LOG Fo`�Uon Description
3. OWNER LS' Q S C1X W e- \\ From To o io; De
Address \ \ 6 M \�2� l� LA — o, a-5 ecraPe\ It
\�` V;\\ � (Street Me No. -- lGa
City or Town ( '� Stale C Zip Code
4. DATE DRILLED 2310a
5. TOTAL DEPTH ._a? a5
6. CUTTINGS COLLECTED YES ❑ NOILI-----
7. DOES WELL REPLACE EXISTING WELL? YES NOe'
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use,' 8 Above Top of Casing)
9. TOP OF CASING 1S/ FT. Move Land Surface*
'Top of casing terminated at/or below land surface requires m variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD (gpm)• ra 0 METHOD OF TEST O -'C
11. WATER ZONES (depth):
•
12. CHLORINATION: Type C OM ' 0)- Amount 44 0-
13. CASING:
Wail Thickness
Depth Diameter or Weight/Ft. Material
From t-I---ToL11 Ft �' `/
From To Ft.
From To Ft.
14. GROUT:
Depth Material_ ethod
From 0 To 20 Ft Pe in e n f
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To ___ Ft __ in. _ (n
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 HEREB
CONSTRUC
FOR OFFICE
Quad No:
Soda! No.
TiffTAT HI V
T DARDM,TINAT
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)
now St.)b- 6\ u..oc\_ • boa-,-4.•
Cm_ O . Q -ca dsl& �Y' °-Q -
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, W
F THIS RECORD HAS BEEN PROVIDED TO THE W
4ATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 clays CI, REV
17199 R S r'
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

254602
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 rn �� `\\ ‘iJ1C
WELL CONTRACTOR CERTIFICATION M:
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential Er -Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Nearest Town: EnC\VC—ThrThwN\ \ Court 1-
WELL LOCATION: (Show sketch of the location below) ty. q \ \\ Q C- `
2.
(Road Name and Numbers, Commusity, or Subdivision TO Lot No.) DRILLING LOG
3. OWNER SJD c2 P t i Vt ,C \ \CV_ CC From To
Address \ X -� >:clv��cl�M 1C(I, �� L—
.\ (bUeetp(�a o.) e.05fl( i \ -1 C.) _-l�
City or Town ' , Stale 1 Zip Code
4. DATE DRILLED' ,�
5. TOTAL DEPTH .'S0M
6. CUTTINGS COLLECTED YES ❑ NO[�
7. DOES WELL REPLACE EXISTING WELL? YES U NO©--
8. STATIC WATER LEVEL Below Top of Casing: k FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS ‘ FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C,Q116
10. YIELD (gpm)• ' METHOD OF TEST c-t- k-
11. WATER ZONES (depth).
12. CHLORINATION: Type h t Amount
13. CASING:
Wall Thickness
Depth 9i',,"'f ter or We hUFt.
From ( To LA CD Ft / S0(c orl
From To Ft
From To Ft
14. GROUT:
Dept /, Material
From L) To �G Ft L P m e T i
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To _ Ft _ In
From To Ft In
From __ To _ Ft In
16. SAND/GRAVEL PACK:
Depth
From To
Size
Ft
__ in
In
In
From To Ft.
17. REMARKS:
Material
DEPTH
Fort Description
\
a�
It additional space is needed use back of form
LOCATION SKETCH
Material (Show direction and distance from at least two State
C.� Roads, or other map reference points)
C 1&cQ
_Method )
Joutaa- ji2�S�S. GO /nI ct
C /V3-72 97 S7Zi/71 ?d 7VSP SS
Malarial 2 n / G n r0 _ [J/ �12, 0
tV
C
-r
n •
I DO HEREBY Cr
CONSTRUCTION
FOR OFFICE USE
Quad No:
DARDS, AND THAT A CO
Y I N 1 1 2002 1
Submit oriai'
1RUCTED IN ACCORDANCE WITH 15A NCAC
0 THIS RECORD HAS BEEN PROVIDED TO TH
IGNATURE OF PERSON CONSTRUCTING THE WELL
a to Dwlslon of Water Quality. Groundwater Section within
Serial No. GROU DWATER SECTION
ACI IEV1 LE REGIONAL OFFICE
DATE;.
GW1 REV. t?J99
L PL l 1Ir EF SE CIHON
ASHEVIL. 4tEGiONAL 0,JE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mal Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTORC, easm--)0342-e139-Attx\\ A C
WELL CONTRACTOR CERTIFICATION #: ec
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (mock Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCAT_,(QN: (Show sketch of the location below)
Nearest Town: MCounty:
(Road Name and tArnbe,rs. Corm nI , or Subdivision and Lot No.)
3. OWNER M .• v\Q'JQ
1-\' l.3&-Q-P (be to
\r�s4.40
City or Town I \ State Zip Code
Address
From
14. GROUT:
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO2--
7. DOES WELL REPLACE EXISTING WELL? YES NOEr
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use'+ 8 Above Top of Casing)
9. TOP OF CASING IS . FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 0118—
10. YIELD (gum). 1 n METHOD OF TEST
11. WATER ZONES (depth). \Y\__`a(r�l'
12. CHLORINATION: Type ELL .Amount
Or a o.
254603
DRILLING LOG DEPTH
From To F• -lion Description
a \er _
13. CASING:
If additional space Is needed use back of form
LOCATION SKETCH
WWI Thickness
Dept Oi ter or WeighVFt. Material (Show direction and distance from at least two State
From } 1 To . 3 Ft.. 9 q ciV`' Roads, or other m reference points)
From To Ft. %\ E . \ G 2 L C9M
\L N 11v� �{\,noeu_txcCl \\f
To Ft
Material ethod
From TTopC) Ftl�1 .QMP.(\ cz,o
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
To Ft
From ._
From
17. REMARKS:
I DO HEREBY
CONSTRUCTI
FOR OFFICE
Quad No:
To
Ft.
\ti"7'� I 5 c Q\ \-\\Qsti
WPJht *\--Iv\ . \i\
1� TH/1TF#IISL I ODT TRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
ANDARDS, AND THAT A OO'1' r F THIS RECORD HAS BEEN PROVIDED TO THE W
1 2002 G JATURE OF PERSON CONSTRUCTING THE WELL
Submit or final to DivWdn of Water Quality, Groundwater Section within 30 d
Serial No. rpnIIN[jWATER SECTION
HJnt VILLE REGIONAL OFFICE
710
AS fl E R[C A,\AL.
LA-PIN
C:A

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°
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: _
•
254604
1. WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:Show sketch of the locatkon below)
Nearest Town•\\ 3\f•-0 e C SINU Q County: \\ Ce.
(Road N and Numbtrs. Commnunity�or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER \/3 X---A3 From To F m+ationDescription
Address QS --\ 1 0 OQvi \r-c
\� u.`` P ��p si lor e No. �S)sCQC lq % ar\ - 4(CS N.
OcCI-R X R E_
City or Town I ) \ StateZip Code
4. DATE DRILLED /
'iG D-
5. TOTAL DEPTH 4 l.c S
6. CUTTINGS COLLECTED YES❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[-
8. STATIC WATER LEVEL Below Top of Casing: , RO FT.
(Use'? II Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
Top of casing terminated atlor below lend surface requires a variance In accor-
dance with 15A NCAC 2C 116
10. YIELD (gpm) METHOD OF TEST P a C
11. WATER ZONES (depth)•
12. CHLORINATION: Typed .81.1. 5SL--Amount-S_=L-4_`
13. CASING:
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Di ter or weight/Ft. Material (Show direction and distance from at least two State
From -1, j To aaR Ft (D,I 4 ci(le'a \ MP- ` (lit.— Roads, or other map reference points)
From To Ft « t Qc�c.
From To Ft ' I a M , Cyr R-F
14. GROUT: //
S °e C) Ft �C( C\'\ QcMeCPtlk� --II acT E . Veil W hG�-P 01-1i(- - -
From To
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
From To Ft
From To Ft.
17. REMAR
IDOHER
CONSTRI
Y
Material
44T41S WEL�W�1S
N STANDARDS, AND THAT A C
FOR OFF
Quad No:
Serial No
2
E O8LW! T 1 2002
Subir t odoi
094.1451 IN
ER SECTION
c.
p ' \ G COST
Q �eQ� P_ W R^_� �& _O
)NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C
Y OF THIS RECORD HAS BEEN PROVIDED TO THE
z :l Nd L I Nnr zo
c
ro
p
/'
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section within 30 ays GROUNDWATER SECTION
1!VWM IONP.L OEHCE
AbHEVILLE REGIONAL OFFICE

254601
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 CONTRACTORn�ij) ` �e ry x �0 ii Clu-00 "�1c •
WELL CONTRACTOR CERTIFICATION #: n�( 11 V I
STATE WELL CONSTRUCTION PERMIT#: _
1. WELL USE (check Applicable sex): Residential LJ Municipal ❑ Industrial ❑ Agricultural D Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) `S \ �� c
Nearest Town' F'N6 PC--ze,N -P County: 1 2
(Road Name and Numbers. Conpuolty. or Subdivision and lot No.)
3. OWNER c N1),_ V--C(\/Z��oe
Address 0 ��3x `C L J
(Street or Route No.) p -1-3
��r>v�.c�� A�r�mQ NC Q J
City or Town i State Zip Code
4. DATE DRILLED c 0 /
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOQ/
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOf3
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use's' 11 Above Top of Casing)
9. TOP OF CASING IS ) FT. Above Land Surface'
'Top of casing terminated sVor below and surface requires a variance In accor-
dance with 15A NCAC 2C .0118 �
10. YIELD (gpm)•_ METHOD OF TEST
11. WATER ZONES (depth)•
DRILLING LOG
From C To
(3 I
;-i //off)
•
12. CHLORINATION: Type \ } \\) `Ct kO�- Amount
13. CASING: C\\Ct
Ia_ L
Wall Thickness
Depth Di ter or Weight/Ft. Material
Tom_ Ft CP' 1 \) e
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From S) To7C Ft.CPn\(-) ACm‘ ^LL
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft In
From _ To _ Ft _ in
From _ To — Ft. In
16. SAND/GRAVEL PACK:
From
From
17. REMA-
I DOH ... L R Al[THtS
CONS i • N STANDARDS, AND TH
FOR OF .[ SE *NO 1 2002
Quad No:
Su
Depth Size
To Ft
To Ft
Material
In
In
In
Material
Serial No.
CROUWDWAT1R SECTION
ASHEVILLE MEG ONAL OFFICE
A
DEPTH
Fcamation 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)
i\V • V`L 2 CM-C2CS � 1P_V_LACL'�.
cit
O
CONSTRUCTED IN ACCORDANCE WITHI5A NCAC 2C,
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE W
r P h/! A
*NATURE OF PERSON CONSTRUCTING THE WELL DATE
1 i
ori( final to Division of Water Quality, Groundwater Section within 30 days ___ _ ___
Gwrl 367.i tv: 9 j'_.
NER.

254600
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: CI`m
2n t , � o�-IW,Q Q �s ���,'floc)��
WELL CONTRACTOR CERTIFICATION #: a( J I
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential `Lim Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: (Stiow sketch of the location below)
Nearest Town• AP N c\C-01\L``") Q County: 119.},\C\
(Road Name and Numbers. pommunII`y °r Subdivisiogiand Lot No.) DRILLING LOG DEPTH
3. OWNER �('t VCL \ \(\\\\�\ -`\KO From To omuUon Description
Address \ ietraer\ O)< o.)a > Q%�� C \ rN
City or Town t \. G\ Zlp Code
4. DATE DRILLED `
5. TOTAL DEPTH • 4 C) -
6. CUTTINGS COLLECTED YES ❑ NOD
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOD--
8. STATIC WATER LEVEL Below Top of Casing: 'r) FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ` FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a varlanc In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)' r2 (1) METHOD OF TEST laA�,
11. WATER ZONES (depth)'
•
12. CHLORINATION: Type
13. CASING:
jYtINv & Q0---1/4--Amount it C •
Wall Thickness
y Depth Di ter or Weight/FR. Material
Fromm�—To 13— Ft 61N S7Z -217 RVL
From To Ft
From To Ft
14. GROUT:
Depth Material
From fl To 2x'i Et OPIIV2n1
From To Ft
15. SCREEN:
Depth
�vtethod
I n(
Diameter Slot Size Material
From To _ Ft
From _ To Ft
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
I DO HEREBY
CONSTRUCTIO
FOR OFFICE US
Quad No:
Serial No.
J
In _ In
in In
In In
Size
Ft
Ft
) N 1 1 2002
Material
Submit origin
1 JNDWATER SECTION
ASHEV LLE REGIONAL OFFICE
to Di
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)
\L- \( Lkii\.
Z :Ii Nd L I Nllf ZO
UCTED IN ACCORDANCE WITH 15A NCAC t , d EEL
S RECORD HAS BEEN PROVIDED TOT "'LL OWNER. II
RE OF PERSON CONSTRUCTING THE WELL
Off of Water Quality, Groundwater Section within
DATE
ASHF`.iILLE RE'_;ICNAL OEROE

266890
North Carolina - Department of Environment and
WELL CONTRACCOR (INDIVIDUAL) NAME C(prnii�nt) l �1 act
WELL CONTRACTOR COMPANY NAME S. (- Do (el?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
i - Groundwater Section
CERTIFICATION St Roll
PHONE "C4`1
Resort
- DivisionofWater Qual ty
1. WELL USE (Cpeck Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring la' Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: IN, OF I e 5 County I -ten aof'"-n
k as c t, f<9 -Inn piece
(Street Nam Numbers, Community, Subdivision, Lot No.,, Zip Code)
3.OWNER: cheyrCn phzilei �S (0b
Address NW c (tor P4fih V" Iota-
(SUect or Route No.)
NgpIPs NC --
City or Town State Zip Code
(—)
Area code- Phone number
4. DATE DRILLED la- Ice -ea
5. TOTAL DEPTH: . L
6. DOES WELL REPLACE EXISTING WELL? YES ONO (W
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 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/ /k METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
11
From
From
From
13. GROUT:
From %
From
Depth
To O
To
To
Depth
Tom_ Ft.
To Ft.
Ft.
Ft.
Ft.
Diameter
Topographic/Land setting
❑Ridge ❑Slope Malleylat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
'Yqn S'Ila-
ED PTH
From To
0 ,;to
Amount
Wall Thickness
or Weight/Ft. aterial
etp `
Material
pc;
14. SCREEN: Depth Diameter
From (96 Tom_ Ft-2__in.
From To Ft. in.
15. SAND/GRAVEL PACK
Dep Size
From ca 6To alFt. 1 L .5
To Ft.
Method
and
Slot Size
DIO in.
in.
Material
on
16. REMARKS:
Material
f(Y
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. W
nvk
5 4-ef
10 110
•
13
I�
3
v
F4wy a 5
ASHrV9�
GFil?tlgnVILLE LEc.Thirt't
THIS WM' I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COP OF s S RECORD HAS BEEN PROVIDED TO THE WELL OWNER�
I2_—
OF P
RSON CONSTRUCTING THE WELL DATE
'sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
CPL
rn
r'4

North Carolina - Department of Environment and Noturnl Resources - Division of Water Ovally • Groundwater Section
1636 Mall Service Cenlor • Ralolph, N.O. 27699-1636-Phone [phone] "? WELL CONSTRUCTION RECORD WELLCONTRACTOR: Be' bh[ Ur . PQ145
WELL CONTRACTOR CERTIFICATION 0: e2a S
STATE WELL CONSTRUCTION PERMIT":
268930
1. WELL USE (Check Applicable Sox): ResldenllalL2 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other DII Other, List Use:
2. WELL LOCATION: (Show�lsketch of the Ilion below)
N:west Town: {4 P.n[�e-CSfl-�iy1�JJ1P County: Hn P d1'crse'K
tJ ` U}1 ? r0i 0 /'1 s%q
(n,ed Name and Numbers. Cyyq��niiry.,, or Subdivision And Lot No.) DRILLING LOG
3. OWNER From To
r-
Address
Clly or Town Slalo
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES j I NO[7f
7. DOES WELL REPLACE EXISTING WELL? YES (1 NO(If
8. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use •.• II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of casing terminated •Uor below lend surface requires a verlence In accor-
dance wllh 15A NCAC 2C .911e
10. YIELD (gpm): 3O METHOD OF TEST i ok
]
11. WATER ZONES (dopth):
Zip Code
1 'HLORINATION: Typo .1±16L___Amount 351)i (1
13. L.ASING:
DEPTH
Fomnllon Dnscripllon
RA-
0
CO
a
N
Wall Thickness
From 0 OTolIlSln Fl Pla�l etritla Ma�[edDlZ
From To FI
From To Ft
14. GROUT:
From 0
Frorn
I5. SCREEN:
Doplh Material
TO l0 FI tv2_0
To FI
Motpbltn_
Doplh Diameter Slot Size Malorlol
Front To FI In In
From To FI In In
From To FI In In
6. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI.
7. REMARKS:
If additional space Is needed usa hack of form
J
LOCATION SKETCH
(Show direction end distance from nt least Iwo Slate
Bonds, or other reap reference polnls)
1ccus+ Gvove 1
He.ndorsal/ VIIls =_ KC_
-127
CO
0
I DO HEREBY:CERTIFY -THAT .TIIIc WEl_I WUL,gNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIVTTACOpV.,QTuns RECORD HAS BEEN P OVIDED TO TIIE WELL OWNER.
OFFICE USE ONLY II
s....d No: Ij!
Serial No.
11 7 /6 1-1g-oa
$I,gNATUnE Or ERSON CONSTKUCTINO TIIE WELL DATE
Submit oilolnetliJi, Divlslon el Water Ouelily. Groundwater Section within 30 days
Dw.1 nEv
12/99

North Corollnn • bopertmonl of Environment and Nolurnl Flesourcee - Division ol Water (Duality • Groundwntnr Section n n 1 p
1636 Mall Service Center • Relnlph, N.C. 27699.1636-Phone (919) 733•3221 rr (�a `�J C1
WELL CONSTRUCTION RECORD WELL CONTRACTOR• �D 6 hry L1 J . P --s
WELL CONTRACTOR CERTIFICATION N: .- (2 R
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Resldentlal I of Municipal n Industrial n Agrlcullural ❑ Monitoring ❑
Rocovory ❑ Heal Pump Water Injection ❑ Oilier n If Olhor, List Use:
.. WELL LOCATION: (Show sketch of the location below)
{J serest Town: a- County. Hende r-scSry
J4,t,en, 0l- ,C 1�-�,,. a ry( og87.2V
(nond Name nd Numb/�re, Cormwnlly, or$SibdIvIslon and Lol No.) DRILLING LOG DEPTH
. OWNER hC ICI s& Jern eS From To® ^ ���Fom�nllon Onscrlptlan
Address Iffy^ `�
- van G� ( -0
wt.)
UClly or Town ' Slate Zip Code
DATE DRILLED i-aq --Oa
TOTAL DEPTH CDC5 •
CUTTINGS COLLECTED YES Li NO[A-
DOES WELL REPLACE EXISTING WELL? YES I I NOI 4
0
r v -
�7ii - 0205
STATIC WATER LEVEL Below Top of Casing: I, tar, FT.
(Use •r•• It Above Top ol Casing)
TOP OF CASING IS 1 FT Above Land Surface'
op of cnsIng lerminnled el/or below land mites requires a' verlance In eccor-
InYIELD (gpm)cNCAC 2C.q Ile !) METHOD OF TEST 1 1/4.1 ) . WATER ZONES (doplh):
0
2 'LORINATION: Typo—4_-d--Amount 1_03p1111.5 If additional space Is needed use back of form
L_
. „nSING:
�a Wall TIllckness
From�DToll _all_ -FI. �las I Dlejoi;u Malnd_,»
From To FL a �1
From To PI.
GROUT:
Depth Malodor_ h_od , Mol
From 0 ToDe th FI �aB Eit f 6 ,(�aa
From To FI
.SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To FI In In
From To Ft In In
. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Fl,
REMARKS:
LOCATION SKETCH
(Show dlrecllon and dlsinnce from nt least two Stale
Roads, or other map reference points)
U n for Hill "'tl d-
Dana_ , I\UC
I D011EREDf,GCCyy TtFY THAT THIS WELL WAS'
CONSTRUCTION TANOAFIDS, AND TI IAT kg:
!iili
OFFICE (USE ONLY
]ur No:
Serial No.
Subndt odp nal I
-4TRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
IOF THIS RECORD HAS BEEN PROVJQED TO THE WELL OWNEn.
-aq-oa
MIME OF PERSON CONSTRUCTING TI IE WELL DATE
Division ol Writer Ouellly, oroundwaler Section within 30 days
GWI REV. 12199

•
26S91
North Cnrolln, - Department of Environment and Natural Resources - Division of Water Ouallty • Groundwater Section
1636 Melt Service Center • nal nigh, N.C. 27699.1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' & 6hrA U a Ppi+
WELL CONTRACTOR CERTIFICATION M: O.; 5J
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check App6eeble Bosh Resldenllal Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Beal Pump Waler Injection ❑ Olher D li Other, List Use:
2. WELL LOCATI : (Show sketch of the IocalloP below) �'
Nearest Town IM.A-1•L.i�' County. yrgd 3. OWNER mbere. CorrrrVnlly, or Subdivlsfon and Lot No.)
(need Name
Address
eel ar
Clly or Town ^ ^Sla1lo
4. DATE DRILLED fik- -•I - `'r"�
5. TOTAL DEPTH at C
6. CUTTINGS COLLECTED YES NOI71-
7. DOES WELL REPLACE EXISTING WELL? YES ( NO
6. STATIC WATER LEVEL Below Top of Casing: 0 FT.
Zip Code
vf
(Use ••• If Above Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surlace•
'Top of casing terminated attor below land surface requires a variance In accor-
dance wllh 15A NCAC 2 118 s
10. YIELD (gpm): ZU METHOD OF TEST
11. WATER ZONES (depth)•
GRILLING LOG
DEPTH
From To FormeAon Unser:peon
a os
0
c.0
fV
-
EJ
I ,FILORINATION: Typo T N Amounl35
13. CASING:
1\
='
C5
I( additional space Is needed use hack of form
Wall Thickness LOCATION SKETCH
Depth �I plum lal Drteityg. laledall ..� (Show direction and distance from et least Iwo Stale
From To c I Ft (p �(a dj T�S:.T.11ke Roads, or other map rolorenco points)
From To FI.
From To FI.
A. GROUT:
Ire Depth Malarial Mol_ hod
From d To AO FI af.jIZ_r;4�
FrOnl To FI
I5. SCREEN:
Depth Diameter Slot Slzo Merolla;
Frorn To FI In In.
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
9 „64,2,d,
,4 ihir.
CO
0
o
Lo
3
CO C't
0
0
r
I D0 HEREBY CER
CONSTRUCTION S
,R OFFICE USE
Ouad No:
Sedat No.
nos, AND ',TI IAT A COryo
NLT
SIOn)
Submit original l B4s4flo
TED IN ACCORDANCE WITH ISA NCAC 2C, WELL
i 11ECfO11D HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRA
O TIIE WELL OAIE
a of Water Quality, Groundwater Section within 30 days
Gw.I NEV. 12/99

North Cnrollnn - Department of Environmanl and Natural Flesources - Dlvlelon of Water (Duality • Groundwater Section
1630 Mall Service Censor - Raleigh, N.C. 27699.1636-Phone [phone]
268910
City or Town Stale
DATE DRILLED a -a CJ-L%a'
. TOTAL DEPTH mzeN• •
CUTTINGS COLLECTED YES NO 1,7
DOES WELL REPLACE EXISTING WELL? YES Li NOM
STATIC WATER LEVEL Below Top of Casing: ET.
(Use'.' II Above Top of Cesing)
TOP OF CASING IS FT. Above Land Surface'
op of casing terminated eVor below land surface requires R variance In eccor-
mce wllh 15A HCAC 2C.911e
). YIELD (gpm): %n_ METHOD OF TEST
1. WATER ZONES (deplh)
t2 ILORINATION: Type _-J_ H—AmounlG12i
1..,ASING:
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
BD fJhrA uL Qs�-�S
WELL CONTRACTOR CERTIFICATION 0: Oa R
STATE WELL CONSTRUCTION PERMIT":
WELL USE (Check Appheeble eon): Residential I Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, Llsl Use:
WELL LOCATION: (Show sketch of the location below)
N
arest Town: • ' I • sll• _ County
Henderson
!Road Name end Nu .ors. Cornrnunlly, or Subdivision and Lol No.)
. OWNER T(�s Y�ell ye 5rr1i
Address
��r ✓d our a879a
Zip Code
DEPTH
Fom,ellon Description
0
W
3
r..)
IV
rn `
If additional space Is needed use hack of form
LOCATION SKETCH
Depth I, pla'elo! d�be�odu Ma I (Show direclion and distance from at least Iwo Stale
From To Ft (p LIT (a Floods, or oilier map rolorenco points)
From To FI.
From To FI
I. GROUT:
Wall Thickness
Depth ia Malarl MolhoJ
From _ 0 To �r0 FI �nLteialpi sci
Frorn To FI
3. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI In In
3. SAND/GRAVEL PACK:
From
From
7. REMARKS:
Depth
To FI
To
Size Material
Ft
0
1-1-award C/a? twirl'
I4enders title , i C
w
0
I DO HEREBY
CONSTRUCTI
Ti OFFICE
Ou.o No:
Serial No.
TIFYSHAT_THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
Af4DAF?DS,IANq'TtIAT A coTHIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER.
r Adc
•T+1TUn SON CONSTRUCTING TIIE WELL
Submit (At3 bivlslon of Weser Dungy, groundwater Section within 30 days
DATE
GW.I nEV. 12/99
n-:
cl
n
0

268892
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL cons -macron.
Bc b ti IL P n-S
WELL CONTRACTOR CERTIFICATION 0: e;Oa g
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential( Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATION: (Sho sketch
of the location below) u a
�N/e�arestTown: C[ ndQM�'1VIlie County' Hencleisa-V�
J. 1 , JAul ll �-ed LL)lA.QP )
��( Dori Name and umbers, C tinily, or S bdlvislon d Lot No.) DRILLING LOG DEPTH
3. OWNER Eric. -"arki h From To Formation Description
Address Ir�l (;
�� (Slreol or�;o`u 'No. 0 — 01t/ r R
1-150i sviU F� ( Lioao7 ao - (corn RLacQck.
City or Town �1 Slate Zip Code
4. DATE DRILLEDT"a-a-'O'
5. TOTAL DEPTH (tnF a�
6. CUTTINGS COLLECTED YES [ NOI VI
7. DOES WELL REPLACE EXISTING WELL? YES I I NO[71
8. STATIC WATER LEVEL Below Top of Casing: FT. :::.r3
(Use •.• II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of casing terminated .Vor below land surface requires a variance in accor-
dance with 15A NCAC 2C .y118 s
10. YIELD (gpm): 1 METHOD OF TEST 1 C
11. WATER ZONES (depth):
12. CHLORINATION: Type _117 H Amount is 3 t (lS
CASING:
r.>
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth plat tar yl ,Ip�V1 Material (Show direction and distance from at least Iwo Stale
From _YL—_ To aO Ft (p JC •,l .7 Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material MoI
From 0 To �.�Ft Qon2E-i& MU IK
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To FI In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To Ft
From To Ft
17. REMARKS:
rYlinl'1ie RoJta
H endersanvi tie ;;'fir,
I DO FIEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTHUCTt9NSTANDAROS-ANBTNAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFI E USE ONLY I74)
�/f/r �'�a a—b ` L
rad No: 1ISIGNATURE 0 PERSON CONST UCTING THE WELL DATE
Subrett ri 1n al to Divlslon oI Water Duality. Groundwater Section Within 30 days
Sedal No. GW.I REV. 12/99

u , Stec/ Ioi Aou
City or Town Slate
4. DATE DRILLED
5. TOTAL DEPTH n O
G. CUTTINGS COLLECTED YESL NO VT
7. DOES WELL REPLACE EXISTING WELL? YES n N0[ tf
6. STATIC WATER LEVEL Below Top of Casing: FT.
(Use's' II Abovo Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated eUor below lend surface requires a voidance In accor-
dance with 15A NCAC 2C .911
10. YIELD (gpm): / METHOD OF TEST
11. WATER ZONES (depth):
r
1_ .,tlLORINATION: Type \-'ITN Amount at(IS Ifadditional space lsneeded use back olform
a273a 3Co - 905 r�',r-d ckc-,
Le
Zip code
W
N
North CnrolInn - Department of Environment and Holum' Resources - Division of Water Duality - Groundwater Suction 2 6 8 8 4 8
1638 Mall Service Center - neloleh, N.C. 27699.1639-Phone (919) 733•3221
•
WELL CONSTRUCTION RECORD WELL CONTRACTOR' BD bhrA Ll. PE:4+s
WELL CONTRACTOR CERTIFICATION If: y'ja Q
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): nosidenfal l vl Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Oilier n If Other, List Use:
Rocovery r1 I-loal Pump Water In)ecllon
2. WELL LOCATIOtr: (Show,p ketch of the location below) A
N rest town: - ^� �•� County-IL�n.0 p'�
,�arAiv 7 , r�(T3.z
(nand Name end rJq en C dl or Subdivision nn Lol No.) DRILLING LOG DEPTH
3. OWNER L [�J From To Fonnnllon Descdpllon
Address
13. CASING:
Wall Thickne�ss
Deplii() inlamel T r�7rinedVr�l. MT� alerial
FromTo FI
From To F-1
From To F1.
14. GROUT:
Depth Malarial Mothod ,
From 0 To .AO_�t1 FI R-kf _ E �1SLK�._
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
From To Ft In In
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth
Frorn To
From To
17. REMARKS:
Size
Ft
Ft
Malorlal
Iv
r
LOCATION SKETCH
(Show direction and distance from nt least Iwo Slate
Roads, or other map reference points)
A WO ad
lattat
I DO HEREBY Cr TfiY }IA¢THiS'WELLIWASE
CONSTRUCTIONA f 1 ARDS, AND TI IAT A CO
•
I, JR OFFICE LISELO�!LY
Quad No:
Sedal No.
ASNE'YIL'_t
ONA
Submit odein Ho DI
I
^F
UCTEO IN ACCORDANCE WITH I5A NCAC 2C. WELL
FIIS RECORD HAS BEEN PROVJ DEO TOSI1E WELL OWNEn.
J_ clot-o�
'Jf1E OF PF+f1SON CONSTRUCTING TIIE WEU. DATE
clonal WRIer Duality, Groundwater Section within 30 days
GW.1 nEV. 12/99

North Caro/Inn • bnperimont of Environment and Natural Resources Minion of Water Quality • Groundwater Section 2 6 8 8 4 2
1638 Mall Service Center • Raleigh, N.C. 27699-1638-Phone [phone] •
WELL CONSTRUCTION RECORD WELLcoNTRacroR• 0 6hr4 US. t'o'i%S
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Resldenllal I viz Municipal ❑ Industrial ❑ Agricultural LI Monitoring ❑
Recovery ❑ I foal Pump Water InJecllon ❑ Other Ei If Other, Llst Use:
( np+u y ' DEPTH
3. Q ,4/ATx 9� --S'"`-�r• \\ From To Fomulion Onscdpiian
Addres9 1P, o aor Xu o No.) 1
faneuviue Nt agia�ta - $a +
Clly or wn If:).
Zip Code
4. DATE DRILLED a— to-tj
5. TOTAL DEPTH eXSC\•
6. CUTTINGS COLLECTED YES n NO(vi
7. DOES WELL REPLACE EXISTING WELL? YES n NO 4
8. STATIC WATER LEVEL Below Top of Casing: 1S FT.
(Use •. II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dancewllh 15A NCAC 2C. 110
10. YIELD (gpm): Q METHOD OF TEST q
11. WATER ZONES (depth): )
OWNER
2. WELL LOCATION: (Show sketch of the location below) I�
Nearest Town: 1endQYj �f ISlQ• � j Co�unty TIQIICI�rJr inl
3O4Q dt4,y, 2.0 t. 462.t0 Lit/Id/County-
t "�9 A
Flow Name and Numbers, Co; nit , or Subdivision and Lot No. DRILLING LOG
TC'Y1 �1- r eta £brri
S O - e36O' vy
12 'LORINATION: Type T H AmountAS
13..,ASING:
v
-v
V -- 3
If additional space Is needed use hack of form , =:
Walt Thickness LOCATION SKETCH
nn Depth n PIT'? yr,)veloryg. 1a s 1 t2 (Show direction and distance from nl least two Slate
From _a_ To l) FI, (p ,�Io S Roads, or other map roiorence points)
From To FI
From To Ft.
14, GROUT:
Depth a Malorlol Method
From 0 To_10.___FI Cp1'Ij2-E1E
Frorn To FI
15. SCREEN:
Daplh Diameter Slol Sly') Malorlol
From To FI In In
From To FI In In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. FlEMARKS:
To
Size
FI
FI.
Material
7, ,;bar 7gai/S
HenderscrvR 11e Sic
b
(A
zc
(.J
O
W
100 FIEFIEDY GE
CONSTRUCTION
F OFFICE US
Guns No:
Serial No.
HAT,TRISWEI;L WAS F0
WIGS, AND, TI IAT'}i COPY
5
Submit odolnall .: vl
J
CTED IN ACCORDANCE WITN 15A NCAC 2C, WELL
IIS RECORD HAS BEEN P,ROVIDEO TO THE WELL OWNER.
RE OF ERSON CONSTRUCTING TI IE WELL DATE
Ion of Wale( Quality, Groundwater Secllon Wllhln 30 days
GW-1 nEv. 12/99
L
0

North Cnrollnn • bnparimant of Environment and Nolurnl Resources - Division of Water Duality • Oroundwnler Section 2 6 8 8 -i 0
1636 Mall Service Center - Relolph, N.C. 27699.1636-Phone [phone] {� (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 1Jo hint' US. PD4.1-S
WELL CONTRACTOR CERTIFICATION ": (7a g
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Boa): Flesidenllal l.l4 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring n
Recovery ❑ Heat Pump Water Injection ❑ Other D If Other, List Use:
2. WELL LOCATIO : (slioow sketch of the Ioca below)
earest Town: Rer r�-i.erS•+fe v�e County H P.i ersQ�
71g'g�wc .Cie �adtol/�
(Road Nam n_d1Numbers. Convnunlly, or Subdivision end Lot Nppo.) DRILLING LOG DEPTH
3. OWNER al ph 4- S0.c.nuv1,N l-arn. nom To Formation Dascrlpllon
Address 'a"-1 1. J
Clly or Town Slate Zip Code I OO 25 p.of k'
T. DATE DRILLED a_ I2—ba
1. TOTAL DEPTH �'J �
3. CUTTINGS COLLECTED YESLI NO 4
DOES WELL REPLACE EXISTING WELL? YES I I NOI 1f
3. STATIC WATER LEVEL Below Top of Casing: '$ C) FT.
(Use •.• II Abovo Top of Casing)
?. TOP OF CASING IS I FT. Above Land Surface'
Top of casing Ierminsied el/or below lend surface require. a variance In accor-
3ance wllh ISA "CAC 2C. 11e s
10. YIELD (gpm): -cJ METHOD OF TEST RI
11. WATER ZONES (depth):
2 'LORINATION: Typo AmounIn_plaS
3..,,ASING:
nn Watl Thickness
Noma-- To 'Ft. 'Namely .�Jlae�advS. M�tYSS .lZ
From To PI. 7�. I�+S
From To FI.
4. GROUT:
Depth a Malodor �Method r
From 0 To _IQ__ Cba2Ef6 j1nK�dU
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft In In
6. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
O
W
c
r:
iJ
If additional space Is needed use hack of loan _D
LOCATION SKETCH
(Show d!recilon and distance Iron nl least Iwo Slate
Bonds, or other map reference points)
61-q94.. W:113
CGer Fan; '[C
CDCO
'71 n _.
Fri
CO
CD
CO c
I DO HEREDY CERTI 9,41ATTHISWELLNYAS,DOrilirST If ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAIN4,1005, AND THAT A COPYIbr THI TECORD HAS BEEN PROVIDED TO THE WELL OWNER.
F OFFICE USE O L air cgir
a-1--%- e0�
EX...., Na: U �; SIGNAL OF p RSON CONSTRUCTING TIIE WELL DALE
Subml( original to Elk/Won )l Wnler Quality. Droundwaler Section Within 30 days
Serial No. GW.I REV. 12/99

North Carolina - Department of Environment and Natural Flesourcos - Division of Water Guellty • Groundwater Soctlon
1630 Mall Sorvlce Center - Galelph, N.C. 27699-1636-Phone (919) 733•3221 •
((��
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 36 hint aL t'ofk
WELL CONTRACTOR CERTIFICATIONf7
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Residential l vl Municipal III Industrial n
Recovery r1 Heal Pump Water Injection ❑ Other n II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
eat Town
'11 tar)
3 4. DATE DRILLED a,— n'
5. TOTAL DEPTH ,34'S'•
6. CUTTINGS COLLECTED YES( NO14
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: 17.5 FT.
(Use •••• II Above Tap of Casing)
FT. Above Land Surface'
County
7
(no • Name a d Numbers. Co'
3. OWNER(NnA..e
Address a
ay or Tom)
9. TOP OF CASING IS 1
•Top or casing terminated eVor below land surface requires a variance In actor•
dance wllh 15A NCAC 2C .9110
10. YIELD (gpm): r METHOD OF TEST f C\
11. WATER ZONES (doplh)
&c7q V!
Zip Code
268838
Agricultural ❑ Monitoring ❑
DEPTH
Formellon Descrlpllon
to 0 — 34.5 atiCk
i. .HLORINATION: Typo _ T H Amount.J...pd15
13. CASING:
J Wall Thickness
From �l.J DT(oth I. Qt / Fl {>la Ib .l I eledvg Matedal
iYS�21LK
From To FI
From To FI
14. GROUT:
Front
Frorn
15. SCREEN:
From
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Daplh Malarial Mol^ f
o TO ao rt hR_E�& Kid.
od
To It
Depth Diameter Slot Size Materiel
To P1 In In
FI In In
FI In In
Size
FI
FI
Material
O
Li
NJ
If additional space Is needed use hack of loan
Iv
LOCATION SKETCH
(Show direction and distance from nt least Iwo SInt4) o
Roads, or other map rolorence points)
0
c.>
rn
O
�.o
0
O
I DO HEREBY
CONSTRUCT'
ecaiFYilHAFTHIS WEL[;VJA C-11UCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
HISJANbARbS ANO 71 TAT A P THIS REC RD FIAS BEEN PROVIDED TO THE WELL OWNER.
. A�b �MLY 4 2' �OL
i FTURE OF PER ON CONSTRUCTING THE WELL DATE
u 'L
Submit Oatha o D vision of Water Quality, Groundwater Section Within 30 days
JR OFFICE U
Oared No:
Serial No.
0
CJ
A`; ICE
OW-1 nEV. 12/99

269225
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naat rat Resources -(Division of Water Quality - Groundwater Sectionor
WELL CONTRACTOR (INDIVIDUAL) NAM9 (prifnt)�,JI n , NN lc /.� I9 /-- L.. /J CERTIFICATION # J 77
WELL CONTRACTOR COMPANY NAME,U-r (J�,iJt ( .U-2// ✓&/l 7.Gte PHONE # «,/N 1 G /7- DY ez
STATE WELL CONSTRUCTION PERMIT# /V /%>7 ASSOCIATED A PERMIT#t/o sit,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (8l 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
County
2-
tat NamSumbcrs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tiflL . ! .y � �
Address a2 y,� �eu�1 } t e Fr/� YZ19
// (Street or Route No.)
J+ tQarr--tl A/C
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /,2/,2D/Pn Z
5. TOTAL DEPTH: //
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,raj
7. STATIC WATER LEVEL Below Top of Casing: / C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance hi acwrdaa a with 15A NCAC 2C .0118. .�
9. YIELD (gpm): METHOD OF TEST /-6e .v
10. WATER ZONES (depth): Ytn /9 i
11. DISINFECTION: Type Amount 7 oz
12. CASING: Wall Thiclmess
Depth ameter or Weight/Ft. serial
From_2_To .� Ft #02/ //L'
From To Ft.
From To Ft.
13. GROUT: Depth pf �Mate�rial od
From 0 To a9/) Ft. U�YYLe 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.
6LisEmARIcsr'
j1 DO HEREBY CERTIFY 1
LCONS,t)ADCT10N STAND
L_
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 811Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograpgc map
(check box)
DEPTH pRH,1titG Leo
From To Formation-Ftesc4 n
co
f1
rn
c)
es)
wn 0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the ro d
umbers and common road names.
C \/ a viz
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
ASH . I, HOE
ml e o ti glnat to the Dlvls on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
(.t 1 (UCi/ X2/r9 t/p 2
SI NATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/ - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) p V % // C A �/J N / CERTIFICATION #a/ g
WELL CONTRACTOR COMPANY NAME)CJi.4%P/iY+/1id.C��f /�(.1-P,I� 7�-cc PRONE # (K 'i to y9-Dy�Y'd
STATE WELL CONSTRUCTION PERMIT# /17/117 ASSOCIATED WQ PERMIT# # [D R iC
(if applicable) (if applicable)
269221
I. WELL USE (Check Applicable Box): Residential El 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:/b �-hc4 Countyy` 41-‘-t f
//S /%L415p,N Pied c ,2879i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tee-e-1TsX1�L t_
Address //..
(Street or Eoute No.)
N• C. 2 79 Z
r -4 )-y os Town n- 579� Zip Code
Area code- Phone number
4. DATE DRILLED it_///,./ D Z
5. TOTAL DEPTH: NIL, 'i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: AFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires ■
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): QP METHOD OF TEST-%rrt-P
10. WATER ZONES (depth): / e5 I �D 7-)'
Topographic/Land setting
❑Ridge ❑Slope riValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
c
(degrees/minutes/seconds) W o
Latitude/longitude source:❑GPS❑Topographic dap
(check box) ' ' c -:-'
DEPTH ARILLIN .OG` r"
From To Formation Doecnpttnti
n
I\t
w,_
w
LOCATION SKETCH
11. DISINFECTION: Type? _ Amount K v - Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ) To -3 & Ft. y #-a /
From To Ft.
cUC.
From To Ft.
13. GROUT: Depth Er ethod
From 0 To Ft. ferry Lk Y
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
o Ft.
To Ft.
From,
From
16. REMARKS.
A *4rbittBr alliaY
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
, AND THAT A C��OjFY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
cc e Di ' ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3*, 6 6YpoRONa (9[19 73 3221, within 30 days. GW-1 REV. 07/2001
pm-
5e

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -S%P I C ilkJ.8 / CERTIFICATION to 76 V�
WELL CONTRACTOR COMPANY NAmEiLiz on &agydi tdecir�l,/.V,: PHONE # (i zS)In �J�/-Dlip 11
STATE WELL CONSTRUCTION PERMIT# fy ASSOCIATED WQ PERMIT# * 7s44 S'
(if applicable) (if applicable)
269220
I. 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. WELLLOCAT19N: ,o
NearestT�oQwn:/y2 CG County,
e2 -1- 'd[ aJA f/onPel7SGa1cST.>15'792
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:WI7'l,' ij-
Address Ul) ,
(Street or Route No.)
City or Town Stale
-
„24799
Zip Code
Area code- Phone number 1
4. DATE DRILLED /2/70 / D ._
5. TOTAL DEPTH: 4 r S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑'
7. STATIC WATER LEVEL Below Top of Casing: 4 .4 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7-.6- FT. Above Land Surface*
'Top of casing terminated actor below land surface requires ■
variance in accordance Mth ISA NCAC 2C .0118.
9. YIELD (gpm): THOD OF TEST —re;
10. WATER ZONES (depth): /1' 0 I 1% D r
11. DISINFECTION: Type , r .ore
12. CASING: //
Depth, ter
From C.) To let) Ft.
From To Ft.
From To Ft.
13. GROUT: Depth /I Material� Method ,
From 0 To � b Ft l_ps�1..e.�.�r' ram,,-1,.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.
Amount
Wall Thiclmess
or Weight/Ft
#.2. /
Topographic/Land setting
❑Ridge tilSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou ce:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Descriptor
r� 0
1
1V
1V
CO
G
j.00ATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road
Material numbers and common road names.
16. REMARKS. T'' r
j r~j I 4-DQ HEREB's CERTIFY TBTh'' THIS WFT T WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT
CONSTRUttiON STAND,SRbS, AND THAT A COPY OF TFjI$ RECORD HAS BEEN PROVIDED TO THE WELL OWNER
u L!,
, u6unt the n igFazl tttlihe Di
AS 27699.I636 Phone No. (919) 733
i7 01--el
SIGNATURE OF PERSON CONSTRUCT WELL
/D.2/IO/D Z
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

269080
7. STATIC WATER LEVEL Below Top ofCasing: 3'G FT.
(Use "+" if Above Top of Casing)
S. "TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated aCor below land surface requires a
variance in xeco rd a nc with I5A NCAC 2C .0118.
9. YIELD (gpm): /J METHOD OF TEST (L r
ID. WATER ZONES (depth): ,2 - Q at) /
,r✓
�1 -^� Liam'
II. DISINFECTION: Type ff T Amount Hi 5 P<-
12. CASING: Wall Thickness
Depth Diameter or Weieht'Ft. Material.
From (i To/ri / Ft. & `i /5 ' Sfc'c
From To Ft.
From To Ft.
13. GROUT' Depth Material Method
From 0 To 20 Ft. Cerne,Jo- 1 rip
From To Ft.
14- SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
13. SAND.GRAV'EL PACK:
Depth Size Nlaterial
[Toni To Ft.
From To Ft.
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reys�ource(s�- Div
ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAV11^E �n(print)(T((N�C /r�� /!�,%e-T'(���j CERTIFICATION k -')97
WELLCONTItACTOR COMPANY NAME .4A4 t sett /N.(e S. U�ell C, t1\//; PHONE 0*{�.. gr1. 76550
S'rATE \CELL CONSTRUCTION I'ER\IIT# ASSOCIATED WQ PERMIT#
(if a..licable)
(ifa nl icable)
I. WELL. USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C ) V C`- County rGC SC r).`
fv3 �pre* v'-{)-
(Some Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
N
3. OWNER: --\\TN
Address ,
(c\ruet or Route No.)
\C JPl',�=_F'F
City or Town State Zip Code
- 3 b :i.
Area code- Phone nuns xr
4. DATE DRILLEDL
6. DOES WELT. REPLACE EXISTING WELL? YES ID NO Lj LLD .) _ ;�yG,
5. TOTAL DEPTH: - OC%
Topoa�fe/Land setting
DRidge L'S'lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deereesbo inutesisev en ds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek hex)
DEPTH DRILLING LOG
From To Formation Description
D — III (.\.ov\
Ezyo —
(4:-A—,?, C;
1loG ;-).1r, 1.2
-C ;41--e_
dn.r,t�-1
\\4.Iv 4 i-
i'ii /J e
( wet'
— S (x.) rt. rct c'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J � ILI 3 'q UILL_ iVL.Y r C
h) 4 5 P"- f -P
v^r40(
cing
r
O
W
re(
co
n
0
---Submit the original -tit) the
(' -. 276994636 Phone Ni)-4919)
D IN ACCORDANCE WITH I SA NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TQTFIE WELL OWNER
�L-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
)ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-322I, within 30 days. GW-I REV. 07/2001

North Cnrollnn • Dopertrnonl of Environment end Natural Resource, - Divlelon of Water Ovellry • Groundwater Section 2 ! 0 1 2 4
153e Mall Service Center - Relolph, N.C. 27699-1636-Phone [phone] ((��
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BO Lk, b.rr . PEfin
WELL CONTRACTOR CERTIFICATION: .�Q, 2
STATE WELL CONSTRUCTION PERMIT"!
1, WELL USE (Check Applicable Box): Flesldenilal l�0 Municipal ❑ Industrial 0 Agricultural Monitoring LJ
ROCCIYery Float Pump — t -- Li Other fl If Other, List Use:
2. WELL LOCATION: ($1rts sketch of he location below)
Neer oil Town'
P County
DEPTH
t Y DRILLING LOG
and Name and Nu Old . Common! r ' ubdlds on and Lot No.)
3. OWNER �'-v�/L ,/� From To Formation Description
Address /iratoffiLf 57 (�id Q/ /C.O'
C(IIyor Town Stale J e ZipJCoodee72- X•
4. DATE DRILLED 0
5. TOTAL DEPTH 6. CUTTINGS COLLECTED YES LI NO(V[
7, DOES WELL REPLACE EXISTING WELL? YES NOWT J
8. STATIC WATER LEVEL Below Top of Casing: �F/� FT.
(Use'.' II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface•
'Top of es s Ing terminated eUor below land surface requires avnlence In eceor-
dance wllh 15A NCAC 2C .9 IA
10. YIELD (gpm): / C METHOD OF TEST
11. WATER ZONES (depth).
0
17 ,HLORINATION: Type _. J-13`I
-----Amount If additional space Is needed use back olform Ni
cJ t
ASING:
From To FI.
From To It
14. GROUT:
Dept-h� n c (�,MalarialMethod
From Q To �Fi ilk-El
E �rl•�'"/L`(''�-r,�{.'
Frorn 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:
From
From
17. REMARKS:
Depth
To
To
Size
Ft
FI
Material
LOCATION SKETCH
Wall Thickness
Depth lamelo 1yr a QIIV �r1 �M�ale ,ill s (Show direction and distance Iron] nl least Iwo Slate
�To _rs v Fl. ••1 I'� ` Flonds, or other map reference points)
From
fiel2AA'W 0/
eitera/OLL
0
0
n
I DO HER(EQYGERTIF!Y THAT THIS WELL
GONSTnIUQTK N•STANDAROS, AND Ti [AT
F R OFF4E USE ONLY
I,,.,ad No:
Serial No.
,NSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
Y or TEIIS RECORD HAS BEEN PROVIDED TO TI E WELL OWNER.
.IONAIURE OF ERSON CONSTRUCTING TIIE WELL DATE
Sebn$$l oduln I to Division of Winer Dually, Groundwater Section within 30 days
GW.I REV. 12/99

North Cnrollne - bnperimonl of Environment and Natural Resource, • Dlvlelon of Wnler Quality • OroUndwnlnr Socllon
1638 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone]
270100
kwad No:
Serial No.
WELL CONSTRUCTION RECORD WELL CONTRACTOR* BD ✓AS bhp • 5
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT":
WELL USE (check Appec.ble Box): Residential I Municipal El Industrial ❑ Agricultural El Monitoring 1
nocovery ri Float Pump Water In)ecllon Pj Other 1111 If Other, Llsl Use:
2. WELL LOCATIO(Jy(Sho sketch of the Vocation below)
Neareet Town: /r K uJJ County.
Apid(tif �re, Co mynlly, q Suhdly end Lol a 10,4441,0,
(nand
3. OWNER
Address
aly or Town sale
d. DATE DRILLED ,..• - 6 •
"
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES( ( NO(Vf
7. DOES WELL REPLACE EXISTING WELL? YES O NOI 1,4
8. STATIC WATER LEVEL Below Top of Casing: ET,
(Use '.' 11 Above Top ol Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of cuing lermineted sUor below lend surface Tequilas a variance In accor-
dance wllh 15A NCAC 2C. I1e
10. YIELD Wpm): /0 METHOD OF TEST
11. WATER ZONES (depth)'
obAsau
DRILLING LOG DEPTH
From To
Formnllon en s CI pllon
U - /a 5,
/025 - 4/0,3
Zlp Code
cork.
.-D
O
3
IV
r
'HLORINATION; Type a.AmounI . i (IS
1J. CASING:
11 additional space Is needed use back ol form
Wall Thickness LOCATION SKETCH
Depth lame.. �v -
egr e o. �MaleLdaa�Jll I(Show direction and distance from nt least Iwo Slate
From To Tl "r •J Fronds, or other map rolorence points)
From 0 To Lai PI 0/e•;S ./ni
From To FI
14. GROUT:
0 Depthd
Malodor.(LK From To �Q FI Cbn�-EfF
Flom To FI
15. SCREEN:
Depth Diameter Slot SIzd Malorlol
From To Ft In. In
From To El In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
*t
ry
7.7
r
cm
rr a
I DO FIEREDY IGERTIFYTHAT TIitS WELL WAS 09 ROOTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
R OFFICE USE NLY 1 THIS R CORD HAS BEEN PROVIDED TO THE WELL OWNER.
}JI STANDARDS, AND TIIATAC� vV W. �J ( Q 1 CONSTRUCTII N ST d-+
?
; SION TUBE OF ERSONCONSTRUCTINO TIIE WELL DATE
Submit od&lnal to (vision ol Willer Quality. Groundwater Sedan wltliln 30 days
OW.t REV. 12/99

North Carolina • Doperimont of Environment and Natural Resources - Division of Water Quality • Oroundwalor Soction 270097
163B Mall Service Center - Ralolph, N.C. 27599-163E1-Phone [phone]
Frain
From
•7. REMARKS:
WELL CONSTRUCTION RECORD WELL CON macron, 30 b}1r� at PEA-4-s
STATE WELL CONSTRUCTION PERMITN: 0,7A
WELL CONTRACTOR CEB'rIFICATION 0:
WELL USE (Check Applicable Box): Residential 1-77
Recovery n Heat Pump Water Injection n
2. WELL LOCATIO
)PB,areal T0"n:
3.
Municipal Industrial 0
Other C] If Olhor, LIst Use:
iow ketch of lie location below)
ounly
OWNER /7/
j,%r/
(Road Name and Numbers, Cowlly, or Subdivision and Lot No.)
Address
//�1 'Streator oulo Frio.) /^C
CityTown /� Zip Code
4. DATE DRILLED
TOTAL DEPTH ,i•
D
;. CUTTINGS COLLECTED YES NO1 VI
DOES WELL REPLACE EXISTING WELL? YES Q NO 17
i. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' II Above Top of Casing)
). TOP OF CASING IS 1 FT. Above Land Surface'
Top of ca s lag terminated aUor below land surface require a a variance In Oscar•
lance with ISA NCAC 2C.Q 1a
!0. YIELD (gpm)' /9 METFIOD OF TEST
1. WATER ZONES (doplh):
la/wit/,no
Agricultural 0 Monlloring LJ
Qe Salu,d p 2�
DRILLING LOG
From To
DEPTH
Fours lion Descrlpllon
r
I
iLORINATION; Type 7�kAmounI a II additional space Is needed usa hack of form
9. LASING:
/7 Wall
Thickness
Depth `7 Wl�� U,ia�uJ MaLYS 1al
From To �FL.P al �
from To FI
From To FI.
4, GROUT:
Depth Mato] Mol_ eL ,
From De th - �4R te�E I U � •
From To FI
5. SCREEN:
From
From
Doplh
To
To
From To
6. SAND/GRAVEL PACK:
Depth
To
To
Diameter Slot Size Material
FI In In.
Ft In In
Ft In In
FI
Ft
Size Malellal
LOCATION SKETCH
(Show direction and distance from nl least two Stale
Bonds, or other map rolorence paints)
Cifilje_ /tali .IG.S ir.
I DO HEREBY CERTIFY
CONSTRUCTION STA
A OFFICE USE
Owed No:
THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DOS, AND TI IAT A'COPY.OfrTf IS RECORD FIAS BEEN PROVIDED TO TILE WELL OWNER.
SIONAilljt)E OF PEF1SON CONSTRUCTING TI IE WELL DATE
Submit original toil*Ys}6 al Wnler Quality, Groundwater Section within 30 days
GW.I REV. 12/99
I

From To El
From To F1.
14, GROUT:
Depth Malollol Mol Trod
From Q To aQ—FI �ttR E41 j"1'_U—�_�d-._
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In. In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From
From
17. REMARKS:
To FI
To Ft
Noah Cnrollnn • Department of Environment And Natural Resources • Division of Water Duality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone (919) 733•3221
•
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo Lin c J RAILS
WELL CONTRACTOR CERTIFICATION 0: (<)a Q
STATE WELL CONSTRUCTION PERMITN:
270096
I. WELL USE (Check nppllc.ble sox): Flesidenilal Ld Municipal I -I Industrial n Agricultural 1111 Monitoring ❑
Recovery ❑ Float Pump Water Injection ❑ Other El If Oihor, List Use:
2. WELL LOCATION .how s etch of the.loca on below)
est T-wn:-�:�i/,/_-i.L/. -�-- t County.
(Flood Name and No en. Cmrmunll y'.r ubdlvlslon and Lot No.)
3. OWNERd"C�.lt%r, RCLLC �(
Muieo or Roaa sa. e ays9
Lily of Town O�-0Slaie Zip Code
4. DATE DRILLED a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI I NOI4
DOES WELL REPLACE EXISTING WELL? YES NOM
6. STATIC WATER LEVEL Below Top of Casing: ��jp FT.
(Use 'd II Above Top of Casing) c_
FT. Above, Land Surface' Fla
9. TOP OF CASING IS 0
•Top of co sing le rminnted et/or below lend surface requires a vedmce In accor-
dance wllh 15A NCAC 2C//q�1616
-
II YIELD (gpm): 1.L� METFIOD OF TEST
11. WATER ZONES (depth): ��-- ll '2
I' `ILORINATION: Type _h T H Amoun� n T (IS If eddillonal space Is needed use hack of form
13..,ASING:
w
—T'1
IV
Walt Thickness LOCATION SKETCH
Depth Plamelo jinn. a iV . ��M�alle(daat p (Show direction and distance Iron) nl least Iwo Sinte
From To T. ' �1°'I eJ ��'-"'•� Bonds, or other map reference points)
�J�•C/(N.w i r 714i
S
CO
I DO SIEFIERY[cETT.pnrilW THIS W---- ELL WAS IIRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUCTIIQti1 ANDARDS, ANO'TI TAT A'CO Y sr, THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
' 3 OFFICE IJSEONLY I I ���'� �"' 1 / r�
Iwad No: 11URE OF P SON CONSTRUCTING TIIE WELL
Serial No.
�-Q a
DATE
Submll odt nat to o'vision al Weiler °veiny, Groundwater Section within 30 days
OW.I nEV. 12/99

North Cnrollna • Doperlmonl of Environment and Natural Resources - Division of Water Duality • Groundwater Saction 270090
WELL CONSTRUCTION RECORD WELL CONTRACTOR' 30 bhp ✓�. Po��s
WELL CONTRACTOR CERTIFICATION ft:
STATE WELL CONSTRUCTION PERMIT#:
1638 Mell Service Center - Raleigh, N,C, 27699-1638-Phone [phone]
Rocovery ❑ I-loat Pump Water Injection ❑
2. WELL LOCATION. (dhow sketch of the.location below)
Ne eat Town: 7WJ Oiy1 ( r1 n
� U I��LRJLx�
Ooucity'
Vloed Name And Number', Common lly, Subdivlslpn and Lot No.)
3. O N�YYCLO
Address d i P 04/4/zLo ijeI,
1 (Shea" -1 or fToulo o1J~ `"
Clly or Town Stale
ft. DATE DRILLED ./7-a2
5. TOTAL DEPTH 4OS
6. CUTTINGS COLLECTED YES NO{ Vf
7, DOES WELL REPLACE EXISTING WELL? YES NOM
8. STATIC WATER LEVEL Below Top of Casing:7Q FT.
(Use'Y' II Above Top of Casing)
9. TOP OF CASING IS I FT Abovo Land Surface'
'Top ol casing lerminel ed 'Co( below land surface re quire a ■ variance In accor-
dance with 15A NCAC 2C .9lte s
10. YIELD (gpm): ij METHOD OF TEST l C\
11. WATER ZONES (doplh):
•
i' '-ILORINATION: Type Amount
13.—ASING:
Zhu Code
1. WELL USE (Check Appllcebie Box): Residential EX Municipal ❑ Industrial I 1 Agricultural D Monitoring ri
Other Ei II Mort List Use:
Cite
DRILLING LOG
From To
/o a - s 3 s k.
DEPTH
Formation 0n s cdpllon
-a,
0
—s-s
Iv
If additional space Is needed use hack ol form
r —•
rr 5
Wall Thickness LOCATION SKETCH
(Th Depth/ plarn iir jitive1Q v[d. MTV aI 5012 (Show direction and distance Iron] nl least two State
From v To F. (p I`� (�j Ronds, or olher map rolorenco points)
From To PI
From To Ft
14. GROUT:
Depth Material Method
From in To _ID_FI a42EiF
Frorn To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To PI In. In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
Frain To FI
From To FI
millo 662,1fitajte
r
r
17. REMARKS:
I DO HEREDY C )FY THAT THISW€tt WAS afidi 41].1CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUCTIO STA BARDS, AND TIIAT A COP'r1 T g 1- .y 2
1 OFFICE US . Y I ��L/ r �!( - / /-6 "-
wad No: i Siotf%� RE OF ERSON CONSTRUCTING 111E WELL DATE
Submit odQlnalto'Olvi ton of Water Oualliy, Groundwater Section within 30 days
Serial No. l OW.1 REV. 12f99
I
IIS RECORD HAS BEEN PROVIDED TO TI-IE WELL OWNER.

North Cnroilnn - Doparimont of Environment and Natural Flesources - Dlvleion of Water Ouelly • Oroundwnlor Section
1630 Mall Service Confer - nalolph, N.C. 27699.1630-Phone [phone] , (( (�
WELL CONSTRUCTION RECORD WELL CONTRACTOR' 30 6h UJ. i�c2i5
WELL CONTRACTOR CERTIFICATION A: ,.q Oa Q
STATE WELL CONSTRUCTION PERMIT/I:
270087
WELL USE (Check Applicable Box): Residential Municipal n Industrial Agrlcullural Ell Monitoring ❑
Rocovory r1 Moat Pump Water InJecllon ❑ Other II Other, Llst Use:
2. WELL LOCATION
Nearest Town
(nand Na
3. OWNER
Address
how s etch of the Iota Ion below) U /. /- - )
o County' l��jy)61144-67t
ILUZ,
ans, Cormvnlly, or S dlvl ion and Lot No.)
ele(nRoullo No.) 4-7
/C `e 44 . C o�795Q5
City of Torn Slate Zip Code
4. DATE DRILLED 7-75-4 a
5. TOTAL DEPTH eO NO���
6. CUTTINGS COLLECTED YES j
7, DOES WELL REPLACE EXISTING WELL? YES O NO t"
3. STATIC WATER LEVEL Below Top of Casing: Q FT -
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS i FT Above Land Surface'
-Top of casino terminated sUor below land surface requires a voidance In scoor-
dancewith l5ANCAC 2C 11M1
10. YIELD (gpm): f d� 1ETNOD OF TEST
11. WATER ZONES (doplh):
12 HLORINATION: Type . .J-_HtAmounItilli t\S
,ASING:
DRILLING LOG
From To
0 -7a
70 - 7ot
DEPTH
Fomrnllon Dnscripllon
�rzn�k•
Lo
0
ry
If additional space Is needed use back of form
rT
Wall Thickness
�,1��� n �
Depth plarn 1 .pitiseicIUg MaLYS:,11iLC.
FromTo -Ft, r1 la d
Frorn To FI
From To FI
H. GROUT:
Depth t Malorlol
From Q To 0 FI enQ-L-4g
From To Ft
15. SCREEN:
!hod
LOCATION SKETCH
(Show direction and distance from nt least Iwo Slate
Bonds, or other map relorenco points)
hiaiduo-nsAg€
Doplh Diameter Slot Size Material
From To FI In, In
From To FL In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANO TIIAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
'4 OFFICE USE 0
ad No:
Serial No
a>, %t
SIOTJ4,iu a OF PE SON CONSTRUCTING TIIE WELL DATE
Submit od0lnal to dlylsto of Water Ouellly, Oroundwaler Section within 30 days
GW.t nEv, 12199
'Li;
i

•
North Carolina - Dnperimonl of Environment and Natural Resources - Division of Water Ouelly • Groundwater Section 27 0 082
1636 Mall Service Canter - Relolpii, N.C. 27699-1636-1'hone (919) 733•3221
WELL CONSTRUCTION RECORD WELLCONTRACTOR' 3o bhr� J. 1. 0 +s
WELL CONTRACTOR CERTIFICATION 0: lia 9
STATE WELL CONSTRUCTION PERMITN:
i. WELL USE (Check Applicable Box): Flesldenllell Yi Municipal ❑ Industrial I 1 Agrlcullural 0 Monitoring El
Rocovery [1 Flout Pump Water InJecllon ❑ Other If Other, List Use:
2. WELL LOCATIO (Show ketch or theloc lion below) L f ' �)
Nearest Town: I County' 1� -Q)I eindO
tho two(
�M Na me'1Ay Nurr�or e. Co�mur try, or sobdIdl7vlsloA nn91 Loh.N/o.).),� DRILLING LOG DEPTH
3. OWNERRam/eL�J /'i M.4--•p aS.Th[l[-e(' From To Fomrnllon Onscrlpllon
Address
rer l(oulo No. 7��n 0 — `Q 0 ��
— CI or Town StateZie Coo"de /0 V - 2 �"� r�7 ~-V C lc, Q
it, DATE DRILLED D" 6 —
n
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO 4
7. DOES WELL REPLACE EXISTING WELL? YES 1 1 MORI rm
1
6. STATIC WATER LEVEL Below Top of Casing: (4O FT.
(Use 'r' II Above Top ol Cnslnp)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of cesing ler min need AL/or below lend surfice requires n vedance In accor-
dance with 15A NCAC 2C_:51I1..q n
10. YIELD (gpm): V METHOD OF TEST e f\
11. WATER ZONES (doplh)'
W
1' LILORINATION Type \ T N Amount
ASING:
r')
If additional space Is needed use hack ol form
Wall Thickness LOCATION SKETCH
(vTh Depth Plamelfo,J r e p iv g . M�Vfl SD t•2 (Show dlrecllon and distance from nl least Iwo Slate
From To /ix) •FI .'•'''�" 1 SIP Bonds, or other map reference points)
from To Ft
From To VI
Id. GROUT:
Depth Malol Molrn
From Depth nhQEiF
hodL
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
Frain To Ft In. In
From To Ft In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Maleilal
From To Ft
From To Ft
Fri
07.41
0
17. REMARKS:
I DO HEREDY CERTIFY TI-F(TTLTHIS:WELL WAS CONSTIy�1 t}D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OFITFII ItIECORD HAS BEEN PROVIDED TO TH WELL OWNER.
.I OFFICE USE ONLY
IWed No: Sedal No.
7-/0-a.2
SIONAIUFF b I RSON CONSTOUCTING TIIE WELL DATE
Submll odpinal to Division 41 Wnler Quality, Orvundwaler Secllon within 30 days
GW.1 REV. 12199

270075
North Carolina Onparimonl of Environment and Natural Flesources - Dlvl,Ion el Water Quality • Groundwater Section
1636 Mall Service Center - flelolph, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
BO aft Pog---s
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PEFlMITN:
1. WELL USE (check Appucebie sox): Residential j N Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ II Other, List Use:
WELL LOCATIQr7: (Show sketch of )he location below) ^ ^ ��
Nearest 'T�own:�1rgV� rY��i1US'�Athe C'�`o�u�`n-Q�tyS1�.ilQV 1"V
(no Name end Nu ors. rrvnu:dly, of Subdlvislon and Lot No.)
OWNER L. Qhx't67n&ian7 From To
Address �aNCA 4h), `RIM)
� ree al Dula
ullJoJ
DRILLING LOG
cuithesuitienC as79 1. o - - Uv 7,o-
Cllyor Town Sl ale Zlp Code
DATE DRILLED a
. TOTAL DEPTH a:S
CUTTINGS COLLECTED YES I 1 NO(Vf
DOES WELL REPLACE EXISTING WELL? YES NO tf
STATIC WATER LEVEL Below Top oI Cnsing:/ j FT.
(Use 'e II Abovo Top ol Casing)
. TOP OF CASING IS I FT. Above Land Surface'
Top or oaf tng terminalad el/or below lend suriste requires a vsrlance In sccor
,rice wllh 15A NCAC 2C. I jA-
0. YIELD (gpm): METHOD OF TEST
1. WATER ZONES (doplh)•
DEPTH
Forroollon Das cdpilon
t
`ILORINATION: Type _Inn_ Amount/ ( t
1 ASING:
Wall Thickness
From�Depthtt.A O dl elo Vg aaT CS �1LK
To aa Ft.. I
From To PI / / / /� - �i
From To FI /•f"[� l�/—�_p_�1
A. GROUT:
Depth .y.Mnnalol11l0l Method , 7/
From � To �FI �rlu�ETELLS.�. 64Cl+
From To FI
5. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To FI In In
6. SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
From To Ft
17, REMARKS:
I DO EIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION SYANo�AROS, AND TFIAT A COPY Of''Th(I`iD HA EN PFy�VIOTHE WELL OWNER.
P OFFICE USE (1NLY I
YY// 7_ 2 4 - a a.
1. Quad No:
Serial No,
If additional space Is needed use back ol lorrn
SIOl4LLATI/R
Submit original tot ULYlslo
LOCATION SKETCH
(Show direction and distance from nl least Iwo State
Roads, or other map rolorence points)
OF ERSON CONSTRUCTING TIIE WELL OAIE
of Wirier Overfly, groundwater Section within 30 days
GW.I REV. 12l99

North Cnrollna - bnperlrnont of Environment and Natural Resources - Division of Water Duality • Groundwater Soction
1636 Mall Service Cooler - Relalph, N.C. 27699• 1636-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTFlACTOR• Bo bhts LA((. Peffs
WELL CONTRACTOR CERTIFICATION A: C7 u' 57
STATE WELL CONSTRUCTION PERMITA:
1. WELL USE (check Applicable Box): Flesidenllal I N Municipal ❑ Induslrlai Agricultural ❑ Monitoring ❑
Recovery ri float Pump Water In(ecllon ❑ Other If Other, List Use:
2. WELL LOCATIOF(} (Show sketch of the loca)ion below)
Nprnrost Town: Nerd Q='Sdn 11'/l4 Oounty. �Qn� Q(5Oi't
(Road Name and u on. COI nily, or Sug9dtvislon And Lot No.)
3. OWNER —nu r✓a5 al{e.V�
Address - l 66 i
t-2 ni-A-aseson V I/ f
City or Town ^^ 1 Stale
4. DATE DRILLED " d- I `� O�
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES! I NO VI
7, DOES WELL REPLACE EXISTING WELL? YES NO Vi
B. STATIC WATER LEVEL Below Top of Casing:FT.
(Use (Use 'rill Above Top ol Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
'Top or casing lermineled el/or below land surface requires it variance In accos-
t 0. YIELD (gpm)' f vv METHOD OF TEST r C
11. WATER ZONES (doplh)' )
DRILLING LOG DEPTH
From To Fomrnllon Description
3-17Q _ ate.
Zip Code ,��
ed-
k.
5 0
N
JJ
rn, II
[IN.)
7 L,
1 '-ILORINATION: TypoL-.-.6_____ Amount rq!/ i lI` S If additional space Is needed use back ol form r r-
c--,
r
13. CASING:
Wall Thickness
Deplll nn pla�I eleUJ Mnledal
LCS�..1LLtC
FromTo r-1-it- Ft. (1WD dj
From To FI.
From To Ft
1A. GROUT:
270066
LOCATION SKETCH
(Show direction and dislonce Irorn nt leasl two Stale
Floods, or other map roforence polnis)
t_ _ _ o
w
n
�u K�
Molhod / I
N
From To FI
15. SCREEN: �:Tr,
Depth Diameter Slot Size Malaita! - _ �O
� n
From To Ft In. In l'
From To FI In In `
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. FlEMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION 4TANDAROS, AND THAT A COPY CT'j'AIIS &1[CORD HAS BEEN PRQVIOEO TO THE WELL OWNER. r
R OF
Dyad No:
Depth //�� Malodol
From 0 To AO_FI E
Serial No,
sidNA1l(
Submit orloln& to
F PERSON CONSTRUCTING IIIE WELL DATE
of Writer Quality, Groundwater Secllon within 30 days
OW -I REV. 12/99

•
North Carolinn . bnparimonl of Environment and Natural Flesources - Division of Wnler Duality - Oroundwnlor Suction 270065
1636 Man Service Gaoler - Raleigh, N.G. 27699-1636-Phone [phone] • .
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo hint' US. PCI+S
WELL CONTRACTOR CERTIFICATION 0: .- (')a Q
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Boa): Residential1X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ I!oal Pump Water Injection ❑ Other ❑ 11 Other, List Use:
2. WELL LOCATIO Show ketch of the location below) ,/ _
Near II Town: �" �0 ;!'lls— County • /nitit,�1 ti
(no(rd /Jame ayy Numbs s. Coor;mvnlly. "or�Subdi)vl�sio(r �and Lol No.)
3. OWNER }SSA YC iln1 L1itl�Y-2 �ff
V 0.r Pd . hi.
iToulo
sax,, PS C 3 aao 7
Address
City orTown State
A. DA EGRILLED S-ag-o%-
5. TOTAL DEPTH SD.-S
6. CUTTINGS COLLECTED YES LI NO vr
7, DOES WELL REPLACE EXISTING WELL? YES NOM
B. STATIC WATER LEVEL Below Top ol Casing: FT.
(Use •.• II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated •Uor below lend surface requires a variance In 'coot -
dance wllh ISA NCAC 2C.9 1lt a
10. YIELD (gpm): METHOD OF TEST R1
11. WATER ZONES (depth):
zip Code
DRILLING LOG
From To
DEPTH
Fonnellon DescrIplIan
o - ' o es
go - 505 CZCJC.
c
-r.
N
J
'HLORINATION: Type �LL__� Amount
I . CASING:
0 r.
IN)
r
II additional space Is needed use hack ol form cs
rtr
Wall Thickness LOCATION SKETCH
(� Depllt�(� lamelo jr IejoL1UF1. MY� QkZ (Show direction and distance from nl least Iwo Slate
From _1 —To-I2--1FI I� Roads, or other map reference points)
Flom To FI.
From To Ft.
14. GROUT:
Depth Malorlol Method
From _IL To 2.0_Fl a4RE4E
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
filinotIALMLonon
c
0
w
sT
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION StANOAROS, AND-TI IAT-AGBP'F6F RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
«GU • Qom- .ag•6 2-.
R OFFICE USE NLY r
Wad No:
Il
Sedal No.
SION 1u91 OF PERSON CONSTRUCTING 711E WELL DATE
Subndl original to 0 v9Ip ol Water Duality, oroundwaler Section Whilin 30 days
,_.i OW.l nEV. 12/99

North Carotin/1 - Doperlmonl of Env[ronmanl and Natural Flesourcea - Division of Writer Ovally • Groundwater Soctlon
1638 Mall Service Center - Relolph, N.C. 27699-1636-Phone [phone]
270063
WELL CONSTRUCTION RECORD WELL CONTRACTOR;
Be, b hT U,j. Pe +-S
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMITN:
Oc R
I . WELL USE (Check Applicable Box): Residentially('
esidentialIy(' Municipal ❑ Industrial D Agricultural El Monitoring ❑
Rocovery ❑ Float Pump Water Infection ❑ Other if Olhor, List Use:
2. WELL LOCATION: ($how sk
Brost Town:
fN IzZWi OJnixlCQr
(nand Name n d Numbers,
Cort,nlly.y, �r Subdivision and of No/)
Oleic b
3. OWNER € S - (]lY €ra C'e,. AJeL•(-h4,h
Address b QSh €V. t Ile Rw1 `ice
Sheol it / No. /1 ag!
Zlp Code
Clly or Town Stale
4. DATE DRILLED ID S- 6 a-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NOI�/j
7. DOES WELL REPLACE EXISTING WELL? YES NO[ tf
8. STATIC WATER LEVEL Below Top of Casing: - FT.
(Use 'd II Above Top of Ceske)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of cesinp ler mineled sUor below lend surface requires a verisnce In accor-
dance with ISA NCAC 2C.41)18
10. YIELD (gpm):METHOD OF TEST
11. WATER ZONES (depth):
tvl an
RILLING LOG DEPTH
Rom To
Formation 0a s cripllon
0 - 3a R�
3 d - 305
0
1 'HLORINATION: Typo_ E_AmountQ-s t'11S II additional space is needed use back ollour)
I . BASING:
Wall Tldckness
Depth O FI. nla111 r fitteidu� Mt�VC'-SDIZ
From To
From To FI
From To FI.
14. GROUT:
From
From To FI
15. SCREEN:
0To .mn! FI COIiQ/IJ1(a1_MolhadTepthMalarial
Depth Diameter Slot Size Malorial
From To F1 In In.
From To FI In
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size
Frorn To FI
From To FI
17. REMARKS:
In
In
Material
LOCATION SKETCH
(Show direction end distance Irom et least Iwo Slate
Bonds, or other map roforence points)
vlrTh
/armed•
q� w
oigail; m
L.)
s=-
r✓
m:a
� n
C.
I DO HEREBY CERptFYiTFTATTPEttWAS TS-Wtplas
CONSTRUCTION 5TAMgARQS,ANQ'THAT A COI 0
I ;,'1—
R OFFICE USE INCY
wad No: Sld(t)•ur E • PERSON CONSTRUCTING TIIE WELL
Submit odpinat IQ-Bivl'ilpn al Writer Quality. oroundwater Secllon within 30 days
I
r
'KlI
TED IN ACCORDANCE WITH ISA NCAC 2C, WELL
RECORD HAS BEEN P NVIDEO TO THE WELL OWNER.
Serial No.
DATE
GW1 fEV. 12/99

North Cnrollne • Department of Envfwomanl nod Naturnl Fleeourcea - Division of Water Duality Groundwater Section
2'70062�:
1636 Mall ServIca Conies - Ralolph, N,Q. 27699-1636-Phone (919) 733•3221
FOR OFFICE U E Qit>tikY"-
I,
Ovid No:
Serial No
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 30 b6r� P '14s
WELL CONTRACTOR CERTIFICATION N: ( c; R
STATE WELL CONSTRUCTION PERMITN,
1. WELL USE (Check Applicable Pox): Fiesidenllal ray Munleipal 1 1 Industrial
Rocovery [1 Noel Pump Water Injection ❑ Other EiII Olhor, List Use:
I1
WELL LOCATION; (Shot' skkelcho te_Igcation below) S �jna
Ngarest T • 0WO Q e County. __.1j'� �.�J
o r.r^ ,�
a CJCC!/'t t , rethif th >
ed Name n Numban, Co nay, or Subdivision end Lot No.)
3. OWNER OQN•
Address
City ar To„n5 Slate
4. DATE DRILLED
5. TOTAL DEPTH R 5
6. CUTTINGS COLLECTED YES NO(Y{
7. DOES WELL REPLACE EXISTING WELL7 YES O NO t'
8. STATIC WATER LEVEL Below Top ol Casing: - FT.
(Use 'ell Abovo Top ol Cnsing)
9, TOP OF CASING IS FT Abovo Land Surface'
-Top of cestng terminated et/or below land surlece requires a verlence In sccor-
dance wilt' I5A NCAC 2q l0
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (doplh)•
ZIpCoda
Agrlcuitural 1111 Monitoring I
DRILLING LOG
DEPTH
From To Ft/frontlet, Description
D -at4
a4 -ass
c
—J
0
12. CHLORINATION: Type _nil__ Amoune9 11 S
13, CASING:
II additional space Is needed use hack ol loran
Cfl
Wall Thickness LOCATION SKETCH
Deplll_ " FIam�elof teJp u[I' Male adll (Show direction and distance from nl least Iwo Slate
i J
From To - •FI, eISO Roads, or other map rolorence points)
Fiona
To FL
From To FI.
14. GROUT:
Depth Materiel Molliod
From (c) To a FI ai1fiEiE IeUKfd
From To FI
15, SCREEN:
Capin Diameter Slot Size Material
Front To PI In In
From To FI In In
From To FI In In
15. SAND/GRAVEL PACK:
Deplll Size Malarial
From To FI
From To FI
17. REMARKS:
cn_
r'l
0
I DO HEREDY CERTIFY THAT THIS WE
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTIIUCTIQN ST:ANOAROS AND T,I IAT A COP ' s' HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.)j' /9-6
Of PERSON CONSTnUCTING TIIE WELL DATE
Submit ortain i ttI Islon of Wale( Ouallly. Groundwater Section within 30 days
GW.I nEV, 2/99

•
Nanh Cnrolinv • Dopadmont of Envlronmonl and Naturn! Resources • Division of Water Ounllly • Oroundwnlnr Soction 2 / 0 0 6 1
IG3d Mall Service Conner - ftaloiph, N.C. 27699-1638-Phone (919) 733•322I • .
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Bo bh,4 J. Po4�-s
WELL CONTRACTOR CERTIFICATION n: (')a R
STATE WELL CONSTRUCTION PERMITN!
1. WELL USE (cheek Applicable Soa): Residential Mx Municipal I I Industrial ❑ Agricultural ❑ Monitoring
Recovery ri Heat Pump Water Injection ❑ OIIIer ❑ II Other, List Use:
2. WELL LOCATION; (She skel h of the location below) (/ Q �,, �/J
Nearest Town. 2 County 14P-A d �rd�
3oa 4402 � /
(Roan frame ar.y�/arob . Community, or subdjvllo1and LoLNo.) DRILLING LOG DEPTH
3. OWNER - �T%C-(. ��i/TJ , f From To
AdJress 300 Y
(Sheol or ou o o.. ag na / (�
Clly al Tone Stale Zlp/Code '+ _�
4. DATE DRILLED 'ba'
5, TOTAL DEPTH
6. CUTTINGS COLLECTED YES NOI7f
7. DOES WELL REPLACE EXISTING WELL? YES NOM
0. STATIC WATER LEVEL Below Top of Casing: ,r fO FT.
(Use '4'11 Above Top of Caning)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of cestng let mineted el/or below lend surface require. a variance In aocor-
dnnce wllh ISA NCAC 2Cyy116 a
1 G. YIELD (gprn): :of) rMETHOD OF TEST P.t )
11. WATER ZONES (dopth):
12. CFILORINATION: Type --F--Amount4P L i`s
13. CASING:
Fo mnllon Dascdp(Inn
Wall Thickness
DepthLTI plamm,,el ram
V :Esoy
Prom To FI ly f� (a j
From To FI,
From To Ft.
14. GROUT:
Depth Material
From fl To __.Q_FI (SnREli
From To FI
Molod
0
f
rV
0
J
If additional space Is needed use back of term
0T
LOCATION SKETCH
(Show direcllon and dlslance horn al least Iwo Slate
Roads, or other map ralorence polnis)
rn
;DU
15, SCREEN:
Doper Diameter Slot Size Material
From To Ft In In IV
From To Ft in In cJ
From To FI In. In C.77
16. SAND/GRAVEL PACK:
Depth Size Malellal
From ' To FI
From To FL
17. REMARKS;
rn
0
I DO HEFIEDY CERTLFYTHAT-THIS WELL -WAS- TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S1TANd,AI10S, ANO TIIAT A COPY 01."TJ1I RECORD HAS BEES PROVIDED • TI-IE WELL OWNEII,
FOR OFFICE USE ONLY
Ouad No:
Serial No.
-62
SIONATFri
Submit odpinal to p,2
E 'F PERSON CONSTRUCTING TIIE WELL DATE
n of Miler °uellly, Groundwater Section w11111n 30 days
GW.1 REV, 12199

North Corollna • Department of Environment and Natural Resource, - Division of Water Quollty • Groundwater Suction
1 e36 Mall Service Canter - Raleigh, N.C. 27699. 1636-Phone (919) 739•3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Bo Lk" lA . Paq--iS
WELL CONTRACTOR CERTIFICATION 0: 8
STATE WELL CONSTRUCTION PERMITN
270059
I. WELL USE (Check Applic.bl. Boa): Residential 0" Municipal n Industrial n Agricultural ❑ Monlloring
Recovery El Heal Pump Water In)ecllon n Other n II Other, List Use:
2. WELL LOCATI
No areal Town' r _,
Ino' nd mama Numbon. Co r ty, en Subdivision end Lot No.) DRILLING LOG DEPTH3. OWNER i From To Fombn lion Description
Address 1 a3 . t � -..� �
SIre,Iorro ee. _�'R
9su a9�1 a os Eck.
Uly or Town 1 Slale Zlp Coda --
5. DATEDRILLED 1.1 ,b a TOTAL
5. TOTAA L DEPTH
6. CUTTINGS COLLECTED YES NO(V{
7, DOES WELL REPLACE EXISTING WELL? YES ( 1 NO[Vf
6. STATIC WATER LEVEL Below Top of Casing: /S FT.
(Use 'e' II Above Top of Casing)
9. TOP OF CASING IS I FT, Above Land Surface
'Top of easing la r minal.d a Uor below End surface requites a variance In accor-
dance nllh 15A NCAC 2C.y118
10. YIELD (gpm): 2)O METHOD OF TEST
11. WATER ZONES (dopih)
(Show sketch e ta, Ipc;311on o6ei°w)
Count), 4Q-d.A'\ci_A.o Ck J
0
Q
Ui
0
t
12. CHLORINATION: Type Amount o } 1 i if additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth parnelal Ol Welcyg. edaI (Show direction and distance from nl least Iwo Slate
From _(JLL1—To ..] --FI IW !Of ry1• IW Roads, or olher map reference points)
nom To FI
From To II.
14. GROUT:
AA--�� Depthn Malarial Molhod ,
From 11 To A1_ FI �Y�.�� — {�.a.vV`+r, pr_vsy,J -
Horn To FI
15. SCREEN'.
Depth Diameter Slot Size Material
From To It 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:
100 fIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCT IOtl. STANOARDS, AND TI IAT A COPY OF IIS RECORD HAS BEE ROVIDED TO TIIE WELL OW EI1
FOR OFFICE USt'ONILY
Quad No:
Serial No
SI. NA1
Submll odglna )4 t
is 1;uiti
�(1 FICE
ti &C' 11- 8-60-.
PE F PERSON CONSTRUCTING 111E WELL DAZE
Ion of Water Quality, Groundwater Section within 30 days
GW.1 REV. I2/99

•
•
North Der -cline - Department of Environment and Natural Resources - Division of Wnler Oualliy • Groundwater Socllon
1638 Mall Service Cenlar. Relolph, N.O. 27699-1638-Phone (919) 733•3221
270057
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
3 o b h r A J. PH/4-
WELL CONTRACTOR CERTIFICATION M: J [7a g
STATE WELL CONSTRUCTION PERMITM!
1. WELL USE (Check Appuc.ble Box) : Residential 12 Municipal I I Indusirlal ❑ Agrlcullurai I I Monitoring 1 I
Recovery r1 Baal Pump Water InJecllon I1 Outer n If Olhor, List Use:
2. WELL LOCATIO Show ketch of Ilre loc^a^llon below) (r •�;,-.1I ,s r,
Nearest Town' .1.)A_X_.'L i s County. k.S.A'c �Lllii -)
DRILLING LOG nand Name Nu au.Comm
unity, uholy on Iand L 1 a) UEPTH
3. OWNER II lil'1{ to _ fsom To Fomrallon Descripllon
AddreSs
Clly of Tmm Stale
4. DATE DRILLED 1"0 a
5. TOTAL DEPTH i7
6. CUTTINGS COLLECTED YES NOIV{
7, DOES WELL REPLACE EXISTING WELL? YES I I NO[tf
6. STATIC WATER LEVEL Below Top of Casing: .n.p FT.
(Use 'a' II Abovo Top ol Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of ce,Inp terminated et/or below Isnd surface require. a variance In accor-
dance wllh 15A NCAC 2S. 115
10. YIELD (gpm): '5 METHOD OF TEST q
11. WATER ZONES (doplh):
'J
t
12. CHLORINATION: TypeAmount aa.p111SIf additional space 15 needed use hack of loran
13. CASING:
1' 1
r
cn
Wall Thickness
SKETCH
�Depllt _ O plarneloJ ,pr'telp g. 6�Vf 5012 (Show direction and distance Iron' nl Ieasl Iwo Stale
From To — FL Jp FJ �tl (o ej j Floods, or other map rolwence polnis)
From To FL
From To Et.
14. GROUT:
Depth - Material
Flom n To FI. CoaQ E7 E
Fram To FI
15. SCREEN:
Method
Depth Diameter Slot Size Material
From To Ft In, In
From To Ft In In
From To Ft In In
I . SAND/GRAVEL PACK: Depth Size Size Material
From To Ft
From To FI
17. REMARKS:
0
G3
—n
rTl
N
iv
CO
01
I DO HEREOY CERTIFY THAT THIS WELL WASQONSTRUCTEO IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTI'UCTION STANDARDS, AND TI IAT &CI) Y OF THIS RECORD HAS BEEN PROVIDED. 1TIE WELL OWNER
FOR OFF It- SEONLY_ I _.. - 1. �Ili �.��
5ubn t> /C
Quad No: '
Serial No.
SIONAlUf1E OF PERSON CONSTr1UCTINO� TI IE WELL
al to Division ol Water Ouallly, Groundwater Section within 30 days
GWI REV. 12/99
- 7-o a
DATE
t.
GROUNE1:7ER SECTION
ASHEVILLE REGIONAL OFFICE

Nanh Carolina - Dnparimonl of Envlronmanl end Natural Resources - Dlvlelon of Water Quality • Groundwater Soctlon
1538 Mall SeMce Cantor - rlalolph, N.O. 27699.1636-Phone (919) 733•3221 J
2700
WELL CONSTRUCTION RECORD WELL CONTRACTOR,
o b � rj J. 9r2i-FS
WELL CONTRACTOR CERTIFICATION A: J (1")� Q
STATE WELL CONSTRUCTION PERMITAI
1. WELL USE (Check Appllceble Bo.): Flesldenitallvl Municipal 1 1 Induslrlal0 Agrlculturai 1 1 Monitoring
Flocovery ❑ Noel Pump Water Infection I1 Other If Other, List Use:
2. WELL LOCATIO Show $ etch of the locn below)
NeNe een - )1 IYM_J.)J County
my
Fiona Name a ndN.�urrrrboin.. Cwmnvnlly, or Subdivision, r, d Lot No.)
3. OWNER '+ (AA.�/-2.h� �Jr ��'"nnSl!(lY—^^�
ICt�
Address
eol-ol TEu10 No.)
.r
Clly or To„n Slate
4. DATE DRILLED �'
5. TOTAL DEPTH 3a7-
6. CUTTINGS COLLECTED YES 1 NOI �r
7, DOES WELL REPLACE EXISTING WELL? YES 1 NOCMf O B. STATIC WATER LEVEL Below Top of Casing: as FT.
(Use'.' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of using Is l minnlad silo; below lands url ace requires A vedance In eccor•
dunce with 15A NCAC 2C.91 6
10. YIELD (gpm): , METHOD OF TEST
t 1. WATER ZONES (dopih):
From To
II
DEPTH
Fommllon DescrlplIon
-tea
2,2%b3
Zlp Code
c.>
J
TO
12. CHLORINATION: Typo AmounI6Sp t ( 5
13. CASING:
Wall
Thickness
From v DTollt_ _ FI Plamelol dJloejollul. M,',1VC S�IZ
Flom To�� FI, Ip•i� I� i
From To Ft
IA. GROUT:
Depth Materiel
From To .aL2— FI aR R big
From _ To FI
15. SCREEN:
Doplh Diameter Slot Slzo
From To Ft In
From To Ft In
From To FI In.
16. SAND/GRAVEL PACK:
Depth Slze
From To FI
From To Ft
17. REMARKS:
MoI'u�.. LL.
Material
In
n
In
Malellal
1( additional space Is needed use back of Iorrn
1.)
c-
c1T
n
LOCATION SKETCH
(Show direction and distance from nt least Iwo Slate
O
Bonds, or other map tolerance polnls) W �'
rn . led
�.
w
(n
0
O
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS —AND ILIATACfPY Or TFIIS RECORD HAS BEEN PROVIDED T -THE WELL OWNER
yyj,�l• 1.--". % / Q
FOR OFFICE USEy11NLY Ir�� "v n ttU `1"(p a�
Goad No: �' Idl�l`T URE OF ERSON CONST CTINO TIIE WELL OAIE
5ubndl odolnEHJ, Ivlslon of Willer ouenry, Oroundwaler Section within 30 days
Serial No. '�_�_� ..• . GW-1 nEV. 12/99

North Carolina - 'Department( of EnvIranman! and Nolure! Flesources - Division of Water Quality - Groundwater Suction 270049
1030 Melt Service Canter - Relolgh, N.G. 27699-1636-Phone [phone] .
WELL CONSTRUCTION RECORD WELL CONTRACTOR 1Jo bhr._.‘ . t o4%S
WELL CONTRACTOR CERTIFICATION N: a 2
STATE WELL CONSTRUCTION PERMITN,
1. WELL USE (Check Applicable pox): Residential L2 MunlcIpal l I industrial 0 Agrlcuilurai 1 I Monitoring
flocovery ❑ Float Pump Water injection I I Other in II Olhor, List Use:
2. WELL LOCATIO
Nearest Town;
ho sn•
ny N 6 161
(noed Rame and Numberss Convnunlly,/ ubdlvIsslon end To
3, OWNER Lki tyvY
Address \-
Clly er Toren \\• St�ate� Zip Code
4, DATE DRILLED 1u" 6 3-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES J NO V(
7. DOES WELL REPLACE EXISTING WELL? YES J NOR'
8. STATIC WATER LEVEL Below Top ol Casing: 20 ET.
(Use'.' II Abovo Top ol Ceelne)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of ces Ing terminated stfor below land surface requires �a variance In accor-
dance with 15A NCAC 2C 115 ' V`
10. YIELD Wpm):5 0 METHOD OF TEST
t I. WATER ZONES (depth):
r o the location below) sf\` ii `liV"
eh
I ► _ County t
o.)
DRILLING LOG DEPTH
From To
Fomrellon Oa scrip lion
II
R .-1—
A
lJ
0
0
-'a
;v
s
12. CHLORINATION: Type Amount a f pi. I 5 If additional space Is needed use hack al form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth la , r /elo v[Tm. Material (Show dlrecllon and distance Iront least Iwo Slate
From To _ to -FI. fJ Flonds, or other map reference points)
From
To FI
From To
14. GROUT:
FI.
Depth Malarial
From f) To 1 .t2_FI aRQkir
Froln To FI
15. SCREEN:
Molliod
Depth Diameter Slot Size Material
Froln To It In In.
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK: Depth Size Size Material
Frorn To FI
From To FI
17. REMARKS:
atp 2d.
acA `fLC.
I DO HEREDY CER LEY TFLATJUIS WFI I WAS_CDLSTRII TED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION .TOA,RDS, AND TI IAT ACOPY §C'?- IS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER.
SIGN /sIJr1E OF P RSON CONST nUCTINO TIIE WELL DATE
Sub ii original's on of Willer Quality, Groundwater Secllon within 30 days
I GW-I GEV, 12/99
FOR OFFICE USE ONLY
Quad No: !,
Serial No.

Cllydr Town Stale Zip Code
DATE DRILLED 6•7).8•6 .
5. TOTAL DEPTH •
6. CUTTINGS COLLECTED YES { I NOIv[
7. DOES WELL REPLACE EXISTING WELL? YES I I NOM
6. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use'111 Above Top of Cnslnp)
9, TOP OF CASING IS i FT, Above Land Surface'
'Top of casln g ter minnled sear below lend surface re quires a vedence In accor-
dance with 15A NCAC 2C 79110
10. YIELD (pm): (F Ci.
P HOD OF TEST
ET
T\s
11. WATER ZONES (doplh)
North Cnrolina • Doparimonl of Envlrommanl and Nolurnl Resources - Dlvislon of Water Ovally- Oroundwalnr Section 270048
1636 Med Service Center - flelolph, N.O. 27699-1638-Phone [phone] •
r
WELL CONSTRUCTION RECORD WELL CONTFlACTOFl•BO bhr� U J. P19�i5
WELL CONTRACTOR CERTIFICATION If rocR R
STATE WELL CONSTRUCTION PEfMITN!
1. WELL USE (Check Appuc.hle Boa): Flesldenllal L.tJ Municipal fI InduslrIai l I Agrlcullural l I Monlloring
Recovery r1 Heal Pump Water Injection n Oilier 0 If Other, List Use:
2. WELL LOCATIO Show kelchCof the bacallon below) 777(�I/� . _,{/ ,r ,.�- \
Ne at Town: Q Q� Sni-JJ.t4�..0 County' M1S-VYC AXJW U /0
(Road Name Numbers, Commit or SSabdlvtslon end Lol No.) DRILLING LOG UEPTFI
OWNER From To Formellon Onscrlpllon
Address Lula It Li) ,r,z_
a879 I 9l0 - n1S �lR CJ
W
0
12. CHLORINATION; Type Amount
13. CASING:
//�� Wall Thickness
/'�
From VJ DTo1I `7 1P.-FI. �I• J {Ie ejo V, J M°LYSZ,211K
From To FI. W I�
Fiom To FI,
Li. GROUT:
Depth MalarialMolliod ,
Flom FI 'ahQEiE UK�d.
Frorn To FI
15. SCREEN:
Depth Dlameler Slot Slze Material
Front To FI In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Slze Material
From To FI
From To FI
17. REMARKS:
If eddlllonal space Is needed use hack of form
o
LOCATION SKETCH
(Show dlreclion and distance from ni least Iwo Stale
•noads, or other map (olorence polnls)
'aiih.waod
dot
O
W
I DO HEREBY CEPTiP1T HAT TRITWELt WAS l,Ut
CONSTRUCTION STA95A1IDS, AND 'TI IAT A COPY
r
FOR OFFICE USE
Quad No'.
Serial No.
NtY
sl0
Suborll original II
:TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PR! VIOED TO THE WELL OWNER.
E OF P RSON CONST UCTINO TIIE WELL DATE
n of Waier Ovallly, Oroundwaler Section wllhln 30 days
,,. GW•I nEV. 12/99

Nodh CnroMR • Dnperlmonl of Envlronmonl and Nalured Resources • Division of Wailer Quality • Groundwater Secllon
1678 Mall Service Canter • Relolph, N.C. 27699.1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELLCONTUACTOR• 130 bh€A US. Po'f+5
WELL CONTRACTOR CERTIFICATION 0: A
STATE WELL CONSTRUCTION PEPMITMr
1. WELL USE (Check Applicable Box): Residential Ld Municipal n Industrial I I Agricultural I I Monitoring U
Rocovery r-I Ifoal Pump Water Infection H Other rl If Other, Llsl Use:
2. WELL LOCATIO Show ketch off Li"."
below �(� r��•y.
Naorest Town: +1'L1!3r11i County' 11KJ1 �.J..LJ4U ICAO
DRILLING LOG DEPTH
( and Na ne Numbers. Carrtnunlly, o Subdivision and LinNa.)
3. OWNER (�OYYC3Y1lOJA
Address/
Ireat Of 31 2lioulo a
\113
FOR 0
Dusd No
Serial N4
C 3•8go4.Q,
Clly or Torm SIale Zip Coda
4. DATE DRILLED 'J_•� o�
5. TOTAL DEPTH � .
6. CUTTINGS COLLECTED YES I ) NOI vf'
7, DOES WELL REPLACE EXISTING WELL? YES Q NO t'
5. STATIC WATER LEVEL Below Top of Casing FT.
(Use •a• If Above Tap of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
top of casing terminated aUm below lend surface require. a variance In accor• dance wilts wllh 15A NCAC 2C.p1Jl1
10. YIELD Wpm):1 a. METHOD OF TEST
11, WATER ZONES (depth): 3 iV im='
e
12. CHLORINATION Type Amount If eddlllonal space Is needed use hack of loan
13. CASING: - -
270047
From To Fomnllon Description
D - R 5
85 - 5.5
iy
rV
ro
C c
Wall Thichnese LOCATION SKETCH
Depth Diartmlal giyvel:J�1uU. Mayc s� j (Show dlrecllon and distance from nt least Iwo Slate
From To -FL (WD (� it:
j Roads, or olher map reference points)
Flom
From
14. GROUT:
To
To
Fi.
Ft
Ire Tepllf Malorlol Mal_ h_od ,
From " To 11) t I anRlo{.F paunc _..
Frorn To II
15. SCREEN:
Dopin Diameter Slot Size Malorlol
From To Ft In In
From To Ft In In
From To FI In In
I6. SAND/GRAVEL PACK:
Depllf Size Material
From To Ft
From To Ft
17. REMARKS:
I DO EFIEF}Y G M-FRY—TliALllil4 WFl WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTEU TIQN $TANpAR0S, ANOjt4I4 COPY OF THIS RECORD HAS BEEN PROVIDED TO TI IE WELL OWNEIT.
fir ( l o a5-o a
ICEI•USE ONLY
—J
SIGNATURE OF/'ERSON CONSTRUCTING TIIE WELL DATE
pinal to Division al Wailer Oualily, Groundwater Section within 30 days
GW.I REV. 12l99
rr,

North Caroline - Dopedmonl of Envlrommnnl and Nalurnl Resources - Dlvlalon of Wnler Ounllly • Qroundwntnr Soctlon 270043
1933 Mall Sen4ca Center - Raleigh, N.C. 27699-1636-Phone (919) 733,3221 •
•
WELL CONSTRUCTION RECORD WELLcoUTnACron• 3P bITT� L. PO +
WELL CONTRACTOR CERTIFICATION b: ,-ROa 2
STATE WELL CONSTRUCTION PERMIT#!
1. WELL USE (Check Applicable Box): nesldenllalLX Municipal 1 I Industrial [] Agricultural 1 1 Monitoring
Fiocovery ri Float Pump Water infection
II
Other 1 1 II Other, List Use:
2. WELL LOCATIO (Show sketch of the location below)
N areal ToAnt County
(Road Name a-n-d�mn Nubo•rl Cnrounny or Sy�bdlol n and Lol No.)
3. OWNER ,y/. M CJ
Address
1
DRILLING LOG
nom To
_
Clly or Toren Stale Zip Code ���
4. DATE DRILLED
5. TOTAL DEPTH
6, CUTTINGS COLLECTED YESI 1 NO[V
7, DOES WELL REPLACE EXISTING WELL? YES NOM
8. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use '17 If Above Top of Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•Top of caring let min Bled allor below land surface requires a varlance In accor-
dance with 15A NCAC 2C .411E
10. YIELD (gpm): _/_'Q__ METFIOD OF TEST f(� q
11. WATER ZONES (depth):
r 7 9 �j 75r eof of, il00
lo.)
ne
12. CHLORINATION: Type \"1t N
13. CASING:
DEPTH
Earn/NOW' Daf crlpllon
Amount 7� 1 (IS If additional space Is needed use back of form
Wall Tldcknese LOCATION SKETCH
�Depllt , Ft.
Pla� t fij liai [T. Mo„ lerlal (Show direction and distance Irom nl leasttwo Stale
From To _•� Ip (o j PVC S K Ronds, or olher maptolerance points)
From To F I id P `' . •� Wei
From To Ft Jl(Y) (:( I�./6uJ- Ef1,L � �[�
14. GROUT:
Depth /_ ' Malor1161 Mol Ilod
From l`� To mS�PI (�h�ET6
Frorn To Fl
15.SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In.
From To Ft In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Slze Material
Frorn + To Fl
From To Fl
17. REMARKS:
I DO HEREBY CERTIFY THAT II US WEI 1 WAS
CO-TIIUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIOfiS NDARDS AND TI IAT A COPS' tHIS RECORD HAS BEEN PROVIDED TO TI IE WELL OWNER.
I
FOR OFFICE U'Erx,4N Y
Quad No: SI a UrIE OF PER •N CONSTRUCTING TIIE WELL DATE
rSubndl origin? •. al !stoner Miter Quality, Drvundwaler Section within 30 days
SeAal No. . „, CW.1 REV. 12f99

27 0 0 -1 0
•
North Carolina . Doperlmonl of Environment and Natural Resources - Divlaion of Water Ouality • Groundwater Socllon
1538 Mall Service Center - Ralolplt, N.Q. 27699-1639-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
3 b h) L>s. P&�� s
WELL CONTRACTOR CERTIFICATION A: 0,2 2
STATE WELL CONSTRUCTION PERMIT':
1. WELL USE (Check Applicable Box): Flesldenllal lad Municipal ❑ Industrial ❑ Agricultural I J Monllonng ❑
Recovery ri Float Pump Water Infection Oilier ❑ If Olhor,, .List Use:
2, WELL LOCATIO ( how sketch of the location below)
�I �C/YYl�
reetT/o���•,j'(f�f��(lL���jCounty !�
me and f n Cortmunl�5ubdlvi Ion and Lol No.
&ta9at
InNENa }{m¢ Y� j )
3. OWNER `7/IL.bYI s/eZ/l,(�„-/lac-14r
Viz
,Slreal or oulo No.)
-f _ hr a 7a9
Zlp Codo
Address
Clly or Town Stale
4. DATE DRILLED G •- "O
5. TOTAL DEPTH a. f
6. CUTTINGS COLLECTED YES I 1 NOE✓I
7, DOES WELL REPLACE EXISTING WELL? YES 1 ) NO T/
6. STATIC WATER LEVEL Below Top of Casing: ij Er.
(Use 'rill Above Top ol Casing)
I
9, TOP OF CASING IS FT. Abovo Land Surfaco'
'Top of ces Ing ler mineled sUor below land surface requires la vigilance In spoor -
dance 'filth 15A NCAC 2C .g116
10. YIELD (gpm): - 0 METHOD OF TEST Re C\
11. WATER ZONES (doplh):
DRILLING LOG DEPTH
From To
Fomin lion Description
b - S,
5 € - 3as 'RFcLc4 k.
w
12. CHLORINATION: Typo Amoun1e5SN( S
13. CASING:
II additional space Is needed usa hack ol form
Wall Tldcknese LOCATION SKETCH
Depth pla^elal jrr )'Jelpw[l. 2dal (Show dlrecllon and distance fromnl least Iwo Slate
From _CD --To S 8 -FL IL. Jt+�>- 11 ((�n yj Ronde, or other map relorence points)
Prom To II.
From — To Ft.
14, GROUT:
Depth Materiel Mo1rnU Ir��d�Ocl
From f
� To �Ft �42E�F
From To FI
15. SCREEN:
Doplh Diameter Slot SILO Material
From To PI In In
From To Ft In In
From To Ft In In
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
FI
Ft
thAndo-oon
ab. &icy& vtLicizi
17. REMARKS:
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEFI.
I DO HEREDYCERTIFY THAT THIS WELL WAS
CONSTRUCTION .tAN0ARDS; AND TIIAT A
FOR OFFICE USE ONLY
owed No:
Serial No,
ATURE OF PE SON CONSTRUCTING TI IE WELL DATE
Divlslon of W61er Ouallly, Groundwater section within 30 days
GW-I REV. 12/99
oa

North Carollnn - Onparlmonl of Enviranmonl and Nolurnl Flesources - Division of Water Quality - Oroundwnlor Section
1638 Mall Service Center - Relolph, N.C, 27699.1636-Phone (919) 733•3221 ��r (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BP bh14 LLl, PE)4 -
WELL CONTRACTOR CERTIFICATION p: �a 2
STATE WELL CONSTRUCTION PERMITS:
270005
1. \VELL USE (Check Applicable Box): Resldenllal L2 Municipal ❑ Industrial ❑ Agricultural I I Monitoring ❑
Rocovery L1 Float Pump Water Infection (J Other ET If Other, List Use:
2. WELL LOCATION. (`how s -lett of thee location below) JSithijsl
N a r e sl Town1 •��a-/I� rI 14N° County
I�l.lA-A lasho-�
3.
OWNER
(pond Ham p and Numbers. C rrvrunny, or $ubdlvls tzIrrin1LAbolo
Address c2,Q
IClly Of Town --TT Slate
.4, DATE DRILLED -dS b�-
5. TOTAL DEPTH 3 Q
6. CUTTINGS COLLECTED YES( 1 NOP{
7, DOES WELL REPLACE EXISTING WELL? YES NO 1M
8. STATIC WATER LEVEL Below Top of Casing:--,5c1---17.
(Use '+'II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
•Top of cssing lerminsted ,Vor below land surface requires a variance In spoor.
Mince wllh 15A NCAC 200118
10. YIELD (gpm): isMETHOD OF TEST
11. WATER ZONES (dopih):
t
12. CHLORINATION Type - 1 Amounts 1}11 -L1S
13. CASING:
heal ar Iloula t1o.)
and SOY10 -- C-U a.879 L_ 5 3 - , 65
Zip Code
DRILLING LOG DEPTH
a -53
Dl53FI Wall Thickness
CIaZI�J MaterIal
From�•
From To
From To Fl
Id. GROUT:
Depth M�n"��L Mol_ I>_od r
From � To �FI J- u ��
From To F1
15. SCREEN:
Depth Diameter Slot SIz6 Material
From To FT In. In
From To Ft In In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth Size Materlai
From To FI
From To FI
Fommnon 0a s cdp lion
U
IU
n
II additional space Is needed use hack of lone
LOCATION SKETCH
(Show direction and distance from nl least two Slate
Bonds, or other map reference points)
r •
!V
IV
6-3
W
o�
0
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
GONSTRUCTIOtTSTANDAROS, AND TI IAT A COPYof,'•T IIS ECORD HAS BEEN PROVIDED TO THE WELL OWNEIT.
FOR OFFICE USf",ONLY
pond No:
Serial NO.
SIgNAT
Submit odglnal to,
nE fdf PERSON CONSTnUCTINO 111E WELL
Ion of Writer ouellly, Oroundwaler secllon within 30 days
GW-I REV, 12/99
DATE

North Caroline - Dopertmont of EnvIrnnmoni and Natural Resources - Dlvleion of Water (Duality • Groundwater SockIon 2 6 9 9 9 8
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone (919) 733•3221 r
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 3P bhrs UJ. 9o'1-1-S
WELL CONTRACTOR CERTIFICATION 0: 2 (`)a g
STATE WELL CONSTRUCTION PERMITNt
I . WELL USE (check Appuc.ble aox): Residential )" Municipal I-1 Industrial n Agricultural ❑ Mongering n
Recovery (1 Boat Pump Water Injection (T 011ter l II Other, List Use:
2. WELL LOCATION: Show , ketch of Ilio location below)
Neaarreal Town ent-^-J`''Q`'X- County.
(Road Rayne and Numbers nr ,� or
Subdivision ant) lot No.)
3. OWNER av tbet �r w )
Address
_li�����/�/� �,� /� nC0/, �, n�Jn
4o 'nchAcL 21 11 1 •No,, 4 R 7 d�
Clly or Town Slate Zlp Code
4. DATE DRILLED - 7-0
5. TOTAL DEPTH . !IS
6. CUTTINGS COLLECTED YES NOIYf
7, DOES WELL REPLACE EXISTING WELL? YES NOM
B. STATIC WATER LEVEL Below Top of Casing: Lit FT.
(Use'.' II Abovo Top of Casing)
9. TOP OF CASING IS i FT. Abovo Land Surlace'
'Top of casing terminated eUor below lend surface requires a vedenca In accor-
dance wlih 15A NCAC 2C'.9II1A
10. YIELD (gpm): T METHOD OF TEST
11. WATER ZONES (dopth) l f
12. CHLORINATION: Typo !�_Amounle5a T
13. CASING:
DRILLING LOG DEPTH
From To Fominuon Descrrpllon
D -/5',
•445 - .365
Inc k. o
r
0}
v
.L
1V
If additional space Is needed use hack el larm
Wp'altThlckne sf
Depth)/ ! Plate UtTelaciVg Mai YS �lii�
FI .(y
From To FL
From To It
14. GROUT:
Depth Material Method r
From --0.— To � FI anail___ E� J('�"(T"�`�—
From To FI
15. SCREEN:
Dap 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 FI
From To FI.
17. REMARKS:
I DO HEREBY CEBTIPry THAT. THIS. WELL WAS,CONSTR,OL`pTE
CONSTRUCTION ST/1NDNriDS,_ AND THAT A COPY ore II'III1-
FOR OFFICE USE ONLY
Quad No:
LOCATION SKETCH
(Show direction and distance from nl least Iwo Slate
Bonds, or other map reference points)
vi
DIN ACCORDANCE WITH 15A NCAC 2C, WELL
IECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-i7 Ua
SIONAlEtd6-CF PERSON CONSTRUCTING TIIE WELL
5ubndt original to GIs; s on ri Weler Duality, Groundwater Section within 30 days
DATE
GW.I REV. 12l99
Serial No.

North Carolina bop/oh-Boni of Envlronmonl and Naturnl Fleaourcea - Dlvtelon of Willer Ovally • Oroundwolor Socllon
1638 Mall Service Cenlor - flelolph, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOn, Bo Lint UJ. P&4+s
WELL CONTRACTOR CERTIFICATION A: Qa Q
STATE WELL CONSTRUCTION PERMITN:
269953
1. WELL USE (Check Applicable Boa): nesidenllal l vl Municipal [ I Industrial ❑ Agrlcullural I I Monitoring ❑
Rocovoryr1 Heat Pump Water Injection n Oilier If Other, List Use:
2. WELL LOCATION; plow $ etchof Ilse •Iota Ion below)
N areal `own'. PLR'/`� I72tO J County
(hoed Name a d (Jumbo's. e7rmunlly, of Subdlvv>1 and Lot No.)
3. OWNER AryLCa �CI (/ 07
Address
Clly or Town Sl ale Zip Code
4. DATE DRILLED m "SD
5. TOTAL DEPTH O�
6. CUTTINGS COLLECTED YES I 1 NOIVi
7. DOES WELL REPLACE EXISTING WELL? YES I NOM
8. STATIC WATER LEVEL Below Top of Casing: /o! FT.
(Use's' II Abovo Top of Casino)
9. TOP OF CASING IS i FT Abovo Land Surface'
•Top of ceetno let min sled .Uor below land surface requires II variance In actor•
dance with 15A NCAC 2C.gl
10.YIELD (gpm) J11
METHOD OFTEST t`lq
11. WATER ZONES (doplh): \1
12. CHLORINATION: Type Amounlje%111-S
DRILLING LOG
From TO
- as
13. CASING:
Wall Tldckn[ese�
From�Depth a �11amelg ricllael° UJ Alaj�'S:_ isial
To FI.
From To FI.
From To Ft,
I . GROUT:
KK��
Dann' � - Material
From l To AIn LFI con 2El[
From To FI
15. SCREEN:
Method
/
Depth Diameter Slot SIN.) Material
From To FI In In
From To Ft In In
From To Fl. In In
16. SAND/GRAVEL PACK:
Depth Size Matellal
From To FI
From To FI
DEPTH
Fomratlon Da s crlpllon
r.a
IV
II additional space Is needed use hack of form
LOCATION SKETCH
(Show direction and distance from nt least Iwo Slate
Roads, or other map relorence points)
17. REMARKS:
I DO FIEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION -STANDARDS, AND TI IAT A COPY-OETIIS RECORD FIAS BEEN PR VIDEO TO THE WELL OWNER.
FOR OFFICE USE
Quad No:
Sedal No.
9NLY
J LL
sib
Submit original lo�
i
USE OF PERSON CONSTRUCTING TIIE WELL DATE
len al Wets( Quality, Groundwater Section wllltin 30 days
CW.i nEv. 12/99

FOR OFFICE USE ORLY.;
Quad No:
.,edal No.
North Caroline - Departmont of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] - ,'
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 77a' RmAN Z .c�fCL.
WELL CONTRACTOR CERTIFICATION It:: t)#. y 7
STATE WELL CONSTRUCTION PERMITS!:
269941
1. WELL USE (Check Applicable Box): Residential Qr Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show
�sketch of the location below) ,/ ,row
Nearest Town:,/&U v)/7��e County fier,�{'1��,yf%�
134 .lsck,Wa-e-- 'd
(Road Name
and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Chni. PpcJS From To Formation Description
Address `n / Se71C1*• - (SSree o ou e'No. 0 -
h`9•t ShoP talr 7W3 sa - 25.0 B> lleoc k
City or Town e Zip Code
• a
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESf NO0 -�
7. DOES WELL REPLACE EXISTING WELL? YES Q NOl
8. STATIC WATER LEVEL Below Top of Casing: G FT.
1 (Use'.' II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
h
W
-fop of casing terminated aVor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C�y01111,0 c ;
1 D. YIELD (gpm): METHOD OF TEST r J r
11. WATER ZONES (depth)•
rV
12. CHLORINATION: Type I•I / H Amount 43 If additional space Is needed use back of form
CASING:
DepthQ Diameter
From 0 To (J2 Ft G.a5
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
or W IghVFI. Malerlal
all •!;s Pve_sDK
Depth Material Method ,
From b To � Ft C'vNCe.E7 ou E
i 6 trL
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Materlal
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roads, or other map reference points)
�eloele Qa.S e l
Horse she, n. C,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
t' s g-9-02
SILNA
- - Submit odglneNe-G
F PERSON CONSTRUCTING THE WELL DATE
Water Duality, Groundwater Section within 30 days
GW-1 REV. 12/99
UA
'HCE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jerejny H. Bowman CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME n RnwmAn Dial i3T1111ng Tnn PHONE Y fi7f1 757-7779
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMIT',
(if applicable) (if applicable)
271399
I. WELL USE (Check Applicable Box): Residential R Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Flatrock
580 Dixrir-la .Tnnp 28731
(Street Name, Numbers, Community, Subdivision, lot No., Zip Cod
Ga ly Henderson
c)
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Robert & Michelle Doenig (degrees/minutes/seconds)
Address 580 Divide Loop Latitude/longitude source:OGPSOTopographic map
FLat Rock (Street Weir No') 28731 (cheek box)
City or Town State Zip Code
()-
Area code• Phone number
4. DATE DRILLED 11 /20/02
DEPTH
From To
5. TOTAL DEPTH: loot
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 . 4 FT. Above Land Surface*
'Top of easing terminated at/or below land surface require a
variance In accordance with ISA NCAC 2C .0111.
9. YIELD(gpm): SO METHOD OFTEST't.rotary air
10. WATER ZONES (depth):
60' 100'
1I. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter orWeiOgh�VFc. Material
From 0 To7Fi FLb1/8 SCh-8D PVC'
From To Ft.
From To Ft.
I3. GROUT: Depth Material Method
From 0 To 20 Ft. concrete
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
DRILLING LOG
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.
gravity flow
From To Ft.
From To Ft
16. REMARKS:
O
CO
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
// l Zo ld
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
O
(0
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
M
r
r:

WELL CONSTRUCTION RECORD 271402
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Jeremy H. Bowman - - CERTIFICATION Y28O9
WELL CONTRACTOR COMPANY NAME T) RnwmAn we11 i)r'I 11 ing• Tnr PHONEY 878 75?-7779
STATE WELL CONSTRUCTION PERMITY ASSOCIATED WQ PERMITY
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Q Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Arden i countyHenderson
21 Laurel Terrare Drive 28704
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: Tracy Messer
Address 21 Laurel Terrace Drive
Arden NC (Street or Rou2131.17 0 4
Ciky or Town Sute Zip Code
( )-
A«a code. Phone number
4. DATE DRILLED 11 /01 /02
5. TOTAL DEPTH: 160'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IH
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Usc'Y" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) a
DEPTH DRILLING LOG
From To Formation Description
•Top of casing terminated Wor below land surface require' a
variance In accordance with 15A NCAC 2C .0111.
9. YIELD(gpm): 15 METHOD OF TEST rotary air
10. WATER ZONES (depth): 1 00'
II. DISINFECTION: Type tablet Amount 6
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft.81 /8 Sch._SO mum
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 R. 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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1 ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pi 0; JDL_
ry . .-�-•-------
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-i REV. 07/2001
LOCATION 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
W
Ca)

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 a 2809
WELL CONTRACTOR COMPANY NAME P Anwmnn Wel 1 ❑rl 11 ing Tnr` PHONE a f98 252-7779
STATE WELL CONSTRUCTION PERMITY
(if applicable)
271403
ASSOCIATED WQ PERMIT/0
Of 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: Arrlan County Henderson
19 Sarn:l Drive 7A704
(S rcet Na,ne, Numbers, Community, Subdivision, bat No., Zip Code)
3. OWNER: Toni Metcalf
Address 19 Sams Drive
(Street or Route No.)
Arden NC
City or Town State
( )-
Topographic/Land setting
❑Ridge ❑Slope ➢Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) ••
28704 DEPTH DRILLING LOG
Zip Code From . To Formation Description
Arca code- Phone number
4. DATE DRILLED 11/04/02
5. TOTAL DEPTH' 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DI
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "a" if Above Top of Cuing)
S. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of cuing terminated at/or below land surface require. a
variance In accordance with ISA NCAC 2C .011s. 9. YIELD (gpm): 1 0 METHOD OF TEST rotary air
10. WATER ZONES (depth): 1 60 r
LOCATION SKETCH
I I. DISINFECTION: Type tablet Amount 6 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material • numbers and common road names.
From(_ To 11 0 Ft.g1 /8 Sch_8D PVC
From To Ft.
From To Ft
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.
16. REMARKS:
O
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER —
CD
///6 tt ern
74�
S NATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC.
27699-1636 Phone No. [phone], within 30 days. GW-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) Jereply H. Bowman ' CERTIFICATION g 2809
WELL CONTRACTOR COMPANY NAME D flnwmAn WP11 nri 11 ing, Tnr PHONE MR7A 2 2-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) - (if applicable)
272177
I. WELL USE (Check Applicable Box): Residential a 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: gendersonsri 1 1 (gounty Henrlprson
283 Pinny nak Hi11c Drive 28797
(Sireei Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Darren Cochran
Address P.0 Box 2018
Fletchsa-
(Street or Route No.)
NC
78732
City or Town State Zip Code
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED 12/10/02
5. TOTAL DEPTH: 775e
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tX
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface req ulres a
variance In accordance with ISA NCAC IC.0118.
9. YIELD (gpm): 1 0 0 + METHOD OFTEST rotary air
10. WATER ZONES (depth): 775'
II. DISINFECTION: Type tablet
12. CASING:
Depth
From 0 To 77
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14 SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
ELF 1/8 Sch_8A Pvr
16. REMARKS:
Material
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ftconcrete gravity flow
Ft.
Diameter Slot Size Material
Ft in. in.
Ft. in. in.
Size Material
Ft.
Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
- Cy3NS RUq{1'IWb S 4N S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J1 �;
J%!1ii3., /X/ie /et_
Submit the original to the D
27699-1636 Phone No. (239) 73
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
M

Address cOfl /Q-1 S/
(Simko: Route NO.)
htt242 \r:. ,;�Sr1c7')
City or Town State Zip Code
4. DATE DRILLED_Lip_
5. TOTAL DEPTH rr.n
6. CUTTINGS COLLECTED YES ❑ N„r
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO',
8. STATIC WATER LEVEL Below Top of Casing: FT.
``4 (Use '.'ll Above Top of Casing)
9. TOP OF CASING IS l ft FT. Above Land Surface'
'Top of cuing terminated ■Vor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0 8
10. YIELD (gpm)• METHOD OF TEST Ai t2 tit i rs4
11. WATER ZONES (depth)• 1\ W , cl-b
DRILLING LOG
WELL CONSTRUCTION RECORD WELL CONTRACTOR• l( ler0._ ttJ t t FiYft
WELL CONTRACTOR CERTIFICATION Si:
STATE WELL CONSTRUCTION PERMITS!: S J2
1. WELL USE (Check Applicable Box): Residential fC!`- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: p A.".1 r2S County: I\•\I O€Q-s , 0�
tL )tt CO.
(Road Name and Numbers, Community, oLSubdivision and Lot No.)
3. OWNER InJA lr 25 at 9Vbt Y. Pellet From �I To "� Fommion DescripUa+
6 - 1- 01:2i__.. Vr
710 99.
f) - (a0c (',r2.t.VI't
12. CHLORINATION: Type
13. CASING:
Amount
Wall Thickness
Depth Diater PP((WeigpVFL Meta!
From�To Ft. 6/ S 5t list
From To Ft.
From To Ft.
14. GROUT:
Depth Mayerial Method
From _(L To _Ft. Sat' it CATS &,JIVQ
.
From To Ft.
15. SCREEN:
f; c:, ,,) 0
DEPTH
II additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at leas! two State
Roads, or other map reference points)
Depth Diameter Slot Size Material
From To Ft In _ In
From _ To Ft. In _ In
From To Ft. in _ in Vivo:: W)f..L_
16. SAND/GRAVEL PACK:
,trti
Depth Size Material ta /, /
From To Ft.
From To Ft �+
17. REMARKS: PiO7c( Y 6o(/ ' ,C?ttAJM -7e5-7
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A C
FOR OFFICE USE ONLY
Quad No:
Serial No.
(NOIM4 c2 `eteir\-
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
y / , S RECORD HAS IjEEN PROVIDED TO THE WEU- OWNER..
SIGNATURE OF PERSONtitCOONNSTRUCTINGTNE WELL DATE
Submit original to Division of Water Quality, GroundwaterSection within 30 cloys
GWI REV. 1293
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and/ Naturalya�Reso cces1- Division /Q�Wat r .uaaj�(ty
WELL CONTRACTOR (INDIVIDUAL) NAME
� (prin9nt)U t yvel1`a- 1pK. �rM1
WELL CONTRACTOR COMPANY NAME Ap I e 1ZSI. VYj,I'.LJ1IS SIi
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(inapplicable)
(if applicable)
266572
- Groundwater Seciop o3
CERTIFICATION Y11 _ ,.�+
PHONE
n It 'VOL
I. WELL USE (Check Applicable Box): Residential Q"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI• :
Nearest T. n:
Topoggraphic/Land setting
❑Ridge USlope ❑Valley ❑Flat
(check appropriate box)
(Street Name. Numbers, Community, Subd)visign, Lot No.. Zip Code) all. Latitude/longitude of well location
3. OWNER:
Address Mike!
Y"
r(SocNOr7eNo.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED it-q -o L
5. TOTAL DEPTH: 2-'S r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
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 SC .0113.
9. YIELD (gpm): METHOD PEES
ID. WATER ZONES (depth): '40 `
11. DISINFECTION: Type bl�`r Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C To C* t5 Ft.
From To Ft.
From To Ft.
13. GROUT: DepthMaw;
From To Ft.}y ; •�
From To Ft. 11
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.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fotntation Description
T I. Gratis
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method ftL3 • Lee
pus( neA4 c 'c{
c.�
v
0
01
16. REMARKS:
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL
L.)r�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. (9I9) 733-322j1, within 30 days. GW-1 REV. 07/2001
Z-/O_0Z
DATE
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LC4
North Carolina - Department of Environment ands Natural�Reso es -`Division
WELL CONTRACTOR (INDIVIDUAL) NAME (print)LOT Y i la'
WELL CONTRACTOR COMPANY NAME uati fl!
/LWat`er Qua - Groundwater Sec(ie403
v' CERTIFICATION a:/ I*$'P i PHONE 0 �nfr WWIZL3
as at �vasz.
PERMIT
STATE WELL CONSTRUCTION PERMITq ASSOCIATED WQ
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: Topographic/Land setting
Ne rest Town: Couyy, [Midge 'Slope ❑Valley ❑Flat
JottedY f /.XfV5a' 14 In
(check appropriate box)
(Strcct Name. Numb , Community, Subdivision, Inc No.. zip Coda) Latitude/longitude of well location
3. OAdWdrNess ER (
*I(, 0 SJJ 35 YQ 3s 3
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED SPZ- t C _40 Z-
5. TOTAL DEPTH: U
WELL CONSTRUCTION RECORD 266571
tie 7�iV1t'
(degrees/minules/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPT1{ DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES pip 0'
7. STATIC WATER LEVEL Below Top of Casing: '44J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
`Top of casing terminated ator below land surface requires a
variance In accordant with ISA NCAC 2C .0118. ^
METHOD OF TESL j bIM11 1
10. WATER ZONES (depth):3 OOi .3 S
11. DISINFECTION: Typeerg
2 bI&$ Amount Z
12. CASING: Wall Thickness
//�� Deptho Diameter or Weight/Ft. Material
From_0 To �D Z' Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
az
9. YIELD (gpm):
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.
(-2
lad
Method
w
?:1USC eQJu4rq V'&
Ti
0
Ut
%D
16. REMARKS:
I DO HEREBY CERTIFY THAT TH
CONSTRUCTION ST*NbMDS, AN
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
MI" [Z-- 0 t,
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
1upmit.lite ttigf nal to the �v I¢n of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
f rov9-1636 rhuu. Nur(9+9)-7 3- tI, within 30 days. GW-1 REV. 07/2001
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L
-flexcleV ZI S� t) NC z--4'iSt--
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED IZ` ) \ ` C) Z
5. TOTAL DEPTH: Zfl S
6. DOES WELL REPLACE EXISTING WELL? YESI�0 NO i7'
7. STATIC WATER LEVEL Below Top of Casing: t1J `) 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 aceordan a gyLth ISA NCAC 2C.0118. ES ! ��
10. WATER ZONES (depth). /
11. DISINFECTION: Type�bli�`t Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To CPC Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material��(�
From To Ft.d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
North Carolina - Department of Environment and Natural Reso ccesl-`Division
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Frb Y VYel+J
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS -
(if applicable) (if a�licable)
Arced
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: l Count _yp.-�, �p
eQ to (C'F A YIC1 t4• Lf 1�f'OMt
(Street Name. Nuummbeen, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �[�CIZAY eS�
Address—ZF (%9 i� 3
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
9. YIELD (gpm): �'S T�HOp %T T G 4U
LOCATION 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_— Z0 Nf ^'
Method k.�`y-� uJc 1 r-C1 ' r —
1 I c t
Lift ri
to m
n_
CA
vD E
z
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
WELL CONSTRUCTION RECORD 266570
Ij[/Watgr Q.u1a� e - Groundwater Seo o�3
1 j( FR�1s wel\rn CERTIFICATION #7 ��/17
V.� `V� wK.�,' %U PHONE M $ WWI 74v
ss el
ASSOCIATED W PERM! L
C
1 DO HEREBY CERTIFY THrFT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCT! STANDARD", AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
EU.205
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Silj rr4itth r{gine%to the
Pi /
on of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WEL CarolinaNTR- Department of Environment and/ NaturalVotlfces - Division p(Watpr Qua
WELL CONTRACTOR (INDIVIDUAL) NAME
� (p__rin^^t)��1,.V.'0'7 Y \\A��rlel la -
WELL
WELL CONTRACTOR COMPANY NAME F-1 ,� �1P�•J1h1
STATE WELL CONSTRUCTION PERMITS
(if applicable)
WELL CONSTRUCTION RECORD 2 6 6 5 6 5
- Groundwater Sectio�3
,a CERTIFICATION 3e7
It PHONE litik &�.�A Via n +t
ASSOCIATED WQ FERMI
(if applicable)
1. WELL USE (Check Applicable Box): Residential 122 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: •
earest Town:ounty*4.. tX Steve
LtJesl ra
3U 94.41/4yttlt
(Street Name, Numbers, Community, Su ivision, Lot No., Zip Code)
•
3. OWNER: J44(6 Ltc j j
Address el 2.
(Street or C 1 1IS \LoCAk. Route t t t St
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED It* L3' 0 Z.
5. TOTAL DEPTH: ors
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cl."
7. STATIC WATER LEVEL Below Top of Casing: t 0 FT.
8. TOP OF CASING IS (Use"+" if Above Top ofCasing);
1 FT. Above Land Surface
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0I1S.
YIELD (gpm): i '�� METHOD OF TES r. cowa .
10. WATER ZONES (depth): I % fit -ltlp0
11. DISINFECTION: Type ab1tl_4
12. CASING:
TopogBz�phic/Land setting
°Ridge 0Slope °Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(desre&minules/seconds)
Latitude/longitude source:°GPS°Topographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
9. bjnh
Depth Diameter
From 0 To b`a Ft.
From To Ft,
From To Ft.
13. GROUT: Depth Materiel r - Method
From To Ft.�A1 LLY
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 Z
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.
'I i Wt.\ 4
tiS v. Gov',
L
Ca)
0
c.n
4.0
I6. REMARKS:
I D9 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CO 4. r. tp 1 a , STAND :, 4NU tt � A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG 1J'tJ OF PERSON CONSTRUCTING THE WELL.
DATE
IIII II
Sukhiitthe original to the Division ter Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-16316 Phone No. (9I9) 733-3221j withi 30 days. GW-) REV. 07/2001
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
\YELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CO.NTItACFOR COMIrANY NAME
(if applicable)
266611
atural Resource - Diyjsion of W ater Qua lity - Groundwater Section
/ /,.�f
S 1 CERTIFICATION
//#� pap 033 cc-2602.
STATE WELL CONSTRUCTION PERMIT# oa/OC t//✓l ( Q1/ i 1 I I/ i4 PHONE # &2tf W h 3
ASSOCIATED WQ PERM4Tft (t /t .2 (oS2_.
(i f applicable)
WELL USE (Check Applicable Box): Residential id" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCAT1pN: Topog�r �hic/Land setting
Nearest Town: ��, �C� Ridge l7Slope ❑Valley ❑Flat
j..7 L t(check appropriate box)
(Street Name. Numbers, Community, Su drvisioo, Lot No.. Zip Code) Latitude/longitude of well location
3. OWNER: b
Address {.
City or Town State f Zip Code
( )-
Area code- ('hone number
4. DATE DRILLED (0-- GZ,
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id
7. STATIC WATER LEVEL Below Top of Casing: Zp FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
• rop of casing terminated at/or below land surface requires a
(degreeshninutes/seconds)
Latitude/longitude source:OGPSfTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance in accordance with 15.A NCAC 2C.0118. //jj _4--
9. YIELD (gpm): 1-2—METHOD O TE TlYt7 /O 1q ton P {�
10. WATER ZONES (depth): 110Di CCU
I I. DISINFECTION: Type 41e4
12. CASING:
/�
Deptit
From n To V Ft.
From To Ft.
From To Ft.
13. GROUT:
From
From
14. SCREEN:
From
From
Depth
To
To
Depth
To
To
Amount -2-
Wall Thickness
Diameter or Weight/Ft. Material
Material Method
Ft. 0 (mere o(Lr
Ft
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From "ro Ft.
From To Ft.
16.REMARKS:
riE
riE
N
-C-. :-13
:-o
LOCATION SKETCH rm. r;
Show direction and distance in miles froma5leasu,
two State Roads or County Roads. Include the ro
numbers and common road names. ut
\D
Z<3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ZONETRUCTIJNiSTAND • a.•, ' ND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
©• it- vz
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to t e 1 ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
!27699-I636 Phone No. (91 733-:221, within 30 days. GW-1 REV. 07/2001
in He: E

City or Town State Zip Code
( )-
Area code- Phone number 7-7�Z
4. DATE DRILLED I O'
5. TOTAL DEPTH: Zen
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id
7. STATIC WATER LEVEL Below Top of Casing: LI'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
2C //ii —%�
9. YIELD (gpm): 4 0 MET,pH D OF TEST& Z1 eattin 1n PC
10. WATER ZONES (depth): av1 144.49
II. DISINFECTION:Type.-ra 6(4
12, CASING:
Depth Diameter
From (:) To \A-0 Ft.
From To Ft.
WELL CONSTRUCTION RECORD 263660
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i - * I p/ f�t
WELLCONTItACfOR / COMPANY NAME `i//1 la tQ f� 1 elt b 1 iltl
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERM
(if applicable)
(if applicable)
atural Resource? S Diyhio i off' W • ter Qu aity - Groundwater Section/ /� /-�}r�
CERTIFICATION # V1 V 3 cc-2` om.
PHONE # fg7hf W k 3 -'] Z2_3
t l 11 2(052_
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town'
f1t
County
(Street Na c. Numbers
`, ommunity, Subdivision, Lot o.Zip Code)
3. Address
�Y k1'v: ��,Lt.
Address t` Y C�
(Street 4 Roue No.)
HittdeY4puVilictAK' isi 1
sot
1�7
Topographic/Land setting
❑Ridge ❑Slope ❑Valley t 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
variance In accordance with ISA NCAC.0118.
From To Ft.
13, GROUT: Depth Material
/1
From To Ft. l Maitre
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 2-
Wall Thickness
or Weight/Ft. Material
0
LOCATION SKETCH '
Show direction and distance in miles from atxeast2_ -.
two State Roads or County Roads. Include lie roafl
numbers and common road names.
Odc
h;1S Lf ��kR
Method
Material
From To Ft.
From To Ft.
16. REMARKS:
141IP R T�CN+�y+
)(tag
32 K
ITHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. A THA A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�.Lr to-ot
tT
Submit the original to t e Div
a M9*at6db4'10WISEP1P16WI9) 733-
n'rinr
SIGNATURE 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\VELL CON'I'RACFOR COMPANY NAME
atural Resour eS- Diyjsion qw
ellS
ae iov ( ell. 1 I'll;vL
263657
ter Qu:Iity - Groundwater Section/- / /,
CERTIFICATION
//#� .�(.003 ci-260Z
PHONE # SD.aAf W h 3-92.23
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential lit/ Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town:
— KA
(Strc�uw.vNu Numbers, Community
3. OWNER: 7'
Address ZZI
Lel
U tJ C`oyn(y e< D —.
Vitt' j
, Subdivision, of No.. Zip Code) tip. 1 t.
r Route No.)
%As,
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED \C ' 3— CZ -a
5. TOTAL DEPTH: ZZrt
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO al
7. STATIC WATER LEVEL Below Top of Casing: 3 CA 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
d 'hISANCAC2C OI18 /i �-
9. YIELD (gpm). METHOD OF ESTl TZ1 /eth'1 ld! IKE/
Liz C�
10. WATER ZONES (depth): \ L1 7.-0 0
tI. DISINFECTION: Type ret /p�.
12. CASING:
Deptite Diameter Material
From To ILA Ft.
From To Ft.
Topographic/Land settingPrat❑Ridge ❑Slope ❑Valley Prat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sources❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance in actor ante rwt T
From To Ft.
13. GROUT: Depth
From To Ft.
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From
Amount �-
Wall Thickness
or Weight/Ft.
k
Material Method
ecneee Dint
Diameter Slot Size Material
in. in.
in. in.
16. REMARKS:
To Ft.
LO
Show direction and distance in miles from atfeast
two State Roads or County Roads. Include (he road_.
numbers and common road names. -
0
CATION SKETCH
C011.�V�`�YC.Q
Submit the original o the
GROtneWAb6B 6ftrattIC4h, 919)
ASHEVILLE REGIONAL OFFICE
JI
—J
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.,20) \C•lt -OZ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
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
WELL CONTRACTOR (INDIVIDUAL) NAMEAprint)
WELL CONTRACTOR COMPANY NAME a
STATE WELL CONSTRUCTION PERMIT# I -
(if applicable)
260191
atural R,espurrces - D'visio of �a)terCQ/�ality - Groundwater Section ^s
j5 ) fiS CERTIFICATION#/�-g00�j31.d0OZ
UnW2OO �r(��I� PHONE#(6ori1 CoAtJ-/2-z-3
ASSOCIATED WQ PERMIT# b Zz 241 5a '
(if applicable)
I. WELL USE (Check Applicable Box): Residential d Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: 1 e �eker
County 14-enciersc)Y__
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I 'Yt 4-
Address
�tit igt(Set orlVo) °L0 / 3�
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED i-dZ
5. TOTAL DEPTH: cP a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11
7. STATIC WATER LEVEL Below Top of Casing: !D 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
9
10. WATER ZONES (depth): e2'0 3
11. DISINFECTION: Type T-&( I. e_477 Amount 2..
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 'LA� Ft.
From To Ft.
From To _ Ft.
13. GROUT: Depth Material J Method
Ft. From To FL COM 1 V 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.
Topographic/Land setting
DRidge ❑Slope ❑Valley LSFIat
(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
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �I 1 ,/n^
YIELD (gpm): 0 METHOD OF TEST al V/ 1 Q I ner
LOCATION SKETCH
Show direction and distance in miles from east
o.,-
two State Roads or County Roads. Include the ro
numbers and common road names. vt
lJriil/ 13
by A fo ad ua Ytg
end 01' Is beige doub (ewid 2-
16. REMARKS --3
L
HE BY t'FRTI FV Ttid.i (Hjl WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
TRUCTION STANDARgB 4 THAT A COPY OF THIS RECOR HAS BEEN PROVIDED TO THE WELL OWNER
SubMMR011N t iQiiitIFt:et
L
ATURE OF ERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
, within 30 days. GW-1 REV. 07/2001
J'

WELL CONSTRUCTION RECORD
260185
North Carolina - Department of Environment and�,Na�ytuJral Reso/ut-'cees -/// D ision of Water Qualityli- Groundwater Section 2
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a 4J it Wa� / 1 CERTIFICATION as -.2kb .
WELL CONTRACTOR COMPANY NAME
STATE. WELL CONSTRUCTION PERMIT#
(if applicable)
. •
lbeki ^ IS taNeL(tat PHONE net.413.3'9LZ3
re rt
ASSOCIATED WQ PERMIT# Z,(w 6
(if applicable)
I. WELL USE (Check Applicable Box): Residential if Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump WfteSlnjection 0 Other 0 If Other, List Use
2. WELL LOCATIO �.
Nearest Town:1 //ts YV Ike( County
ens
(Street Name. Nmnbers, Community, Subdivision Lot Nd, �Z p Code)
3. OWNER: Or ks R• 8ur,.,ess
Address / f'3a n n l nU n e
//- —� (Strict or Route o,) JJ f% / /
use ,Sine /� �s /�
City or Town State Zip Code)
( )-
Area code- Phone numberA
4. DATE DRILLED O'02
5. TOTAL DEPTH: a 7
6. DOES WELL REPLACE EXISTING WELL?I TES 0 NO P
7. STATIC WATER LEVEL Below Top of Casing: / f a 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 wi ISA NCAC 2C .0118.
9. YIELD (gpm): __. METHOD OF TE T �'
10. WATER ZONES (depth): ) 90 vi�/C'
11. DISINFECTION: Type Amjunt 1-
12. CASING: WallTh ckness
Depth (� Diameter or Weight/Ft. Material
To /Q Ft.
From 0
From
From
13. GROUT:
From
From To Ft.
To Ft.
To Ft.
Topogr phic/Land setting
❑Ridge M hope ❑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
Iltl�.s
Depth Material Method
To Ft.c WQ
Slot pi7 Material
in.
tin.
Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
C/3 -.>--
IN)
o c--
LOCATION SKETCH "rb o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L- a l
#w,/a 42 KO
gannivig Lan c
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY QF THIS RECORD Hy4S BEEN PROVIDED TO THE WELL OWNER
NATURE OF PE SON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
I, within 30 days. GW-I REV. 07/2001

260180
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
Natur
al Resof/ut__t''C��s1ee�s -/ Di .ssaiaon-oof Water �Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /7fr La 44kpI i )\ CERTIFICATIONICjTI+(R��7% 03 c�6 p2
S WELL
WELL Cn\SOR TRUONIPANY CTION PERMIT'S r- )SOU ASSOCIATEDii\tYQ RNtcT tt PHONE et tt et a.qt
(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 LOCATIO a
Nearest Town:r tt%ly Vl S(`/ Coon
(Street Name. Numbers, Community, Subdivision, Lot N
Z p Code)
3. OWNER: kJ
cL I RJ'r.S
Address S 5
(Street or Rowe No.)�� Z J
-}f tv-dLei'a*mf )e Yt i
City or Town State Zip Code
5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El,"
7. STATIC WATER LEVEL Below To of Casing: &DC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above f Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance th ISA NCAC 2C .0118. / _ a �'
9. YIELD (gpm): � MET OD OF TE T dI r Cs.s r
10. WATER ZONES (depth): 114-01, r� a Zv
1 I. DISINFECTION: Type�f�1TJt 1 Amlount T
12. CASING: WalliThickncss
Depth.�F Diameter or Weight/Ft. Material
From 0 To 1 Z Ft. I
From To Ft.
From To Ft.
13. GROUT: Topth Material r1 Method
e[hO
From To FL�'pK�QtC 'es_
From To Ft.
14. SCREEN: Depth Diameter Slot izi: Material
From To Ft. in. in.
From To Ft. in. . in.
15. SAND/GRAVEL PACK:
Depth Size 1Material
To Ft.
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
( )-
Area code- Phone number .41
4. DATE DRILLED — 1 LPL..
TOTAL DEPTH: Z.14-7
From
From
16. REMARKS:
To Ft.
O
rn
u
ca
F m rC
01 LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ZC.R
usetayei Id •
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
CatSIGNATURE OF PERSON CONSTRUCTING THE WELL D AT
Submit the original to the D vision of Water Qu�lity, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2Z649.- _ C I 9) 73 -3221, within 30 days. GW-I REV. 07/2001
OFFICE

-2-
WELL CONIR,\CfOR COMPANY NAME Yr tt s'KsIC�,LIA-l* i CERTIFICATION #Z 034-�(002-
iuIntl. te&S1&L3
'� .��I t 1I PHONE
STATE WELL CONSTRUCTION PERMIT# � ASSOCIATED WQ PERMIT#
't n Z%6L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourfes - Di Sion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L_KL,
t e'
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ed Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump W(tte5 Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: `f -
Nearest Town: IYlto:I. Coun y SOIL
(Street Name, Numbers, Community, Subdivision, Lot Nit, Zip Code)
3. OWNER: icy. • unYpQS�
Topographic/Land setting 7�
❑Ridge ❑Slope ❑Valley Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address lt 0 .35 3 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) ry p (check box)
tYcSevaQ&Vf SSe AC. C,Ce 1 Z• DEPTH DRILLING LQ& =_
City or Town State f Zip Code From To Formation Descaplion=
( )- 1 r+l
Area code- Phone number 1
4. DATE DRILLED "6' o z-
5. TOTAL DEPTH: ?-0/
6. DOES WELL REPLACE EXISTING WELL? ' Es ❑ NO fY
7. STATIC WATER LEVEL Below To of Casingl FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above ILand Surface'
'Top of casing terminated at/or below land surface rei(uires a
variance in accordanecg�y ISA NCAC 2C.0118. . I ,.'y,
9. YIELD (gpm): Z..`� METHOD OF TESTC&.f r �{��'�1tv
From 0
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
From To
16. REMARKS:
260179
10. WATER ZONES (depth): °SS
-C tAN 11. DISINFECTION: Type iAmiunt t.
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Depth_,
To `J� Ft.
Ft.
Ft.
Material Q ft
Ft.CQ
Ft.
Method
sew'
Diameter Stet pize Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
-v
IV
w -_..
l
U� O
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.
upw c{ ma
1 DO HEREBY CERTI . iT THIS WELL WAS CQNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
N 1 tr! t al # • AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L,,
it the origi al t
1636 Phone No.
PA?ER SECTION
FEGIOsJAL OFFICE
SIGNATURE OF PE 2SQN CONSTRUCTING THE WELL DATE
he 1 ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
19) 7 3-3221, within 30 days. GW-1 REV. 07/2001

GROWWWIMIllt!p�RM' (919)
ASHEVILLE REGIONAL OFFICE
WELL CONSTRUCTION RECORD 260177
North Carolina - Department of Environment and Natturral Resou es - Di lion of Water Qualityli- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANAME (print)�) ;Asir/� 1 N1/ •
/ 1 CERTIFICATION (#�o�Q3�)402
STATE
WELL CO\SOTI CON1PANY NAMENSTRUCTION PERMIT# `ki ^ASfffG��'S������O,JJJ/C������•••,���,A'ip \b�Q RitT it PHONE #�if {l O�ZS*
(if applicable) (if applicable) G to
1. WELL USE (Check Applicable Box): Residential 6/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: 54+ C>,-�.-c. County AleJ���asa�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
•
3. OWNER: LyC C—, Pi I&
Address yid isp ?tl •
ic*tte(cet orljo No.) tS os
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED—rt..0
5. TOTAL DEPTH: I Uri
6 DOES WELL REPLACE EXISTING WELL? YES0 NO V
7. STATIC WATER LEVEL Below To of Casing: 0 FT.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley LolFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface* H
*Top of casing terminated at/or below land surface requires a
variance in accordance Alt 15A NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD? OF TESTG&L CCi's.t.j1V.)Lf
10. WATER ZONES (depth): 1 —LC)
LOCATION SKETCH p oT
Show direction and distance in miles from least-
two State Roads or County Roads. IncludtAile road
numbers and common road names.
11 DISINFECTION: Type''AbAA
12. CASING:
Depth Diameter
From O To De/ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material - Method
m FroTo FLCQV�n(Q�;..
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount L.
Wall Thickness
or Weight/Ft. Material
15. SAND/GRAVEL PACK
Depth
From To
From To
Size Material
Ft.
Ft.
T
oP dvae j �s-�
16. REMARKS:
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- v Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tlo the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

251-705
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res ces - Di 'i�sli/on'of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L A YYLI , . 1-1.A. K CERTIFICATION N Z14303
WELL CONTRACTOR COM PANY NAME
11p t't ek'Ietc I(- i\livers
Depth Diameter
From 0 To 3ty Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material .t�,�Method
From To Ftf ' CIC it 20Lei-
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
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
(Street Name. Numbers, I Community, Subdivision, Lot No., Zip Code)
3. OWNER: elA.Ct '&31Q.Y
Address 77�(i � L( `�' Y �: V-€
(Street or Route No.)
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 'l -) -O 7--
5. TOTAL DEPTH: 1cliO 1) I
6. DOES WELL REPLACE EXISTING WELL? YES
NO Cv3'
7. STATIC WATER LEVEL Below Top of Casing: —— FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface*
PHONE #�Zg C4pS1ZZ-3
I. \ N ZC,yS L
WELL USE (Check Applicable Box): Residential C3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: l Topoggrphic/Land setting
Nearest Town: ;d VI -It/ (`L/County Q)k('le(aS A (Midge iPSlope ❑Valley ❑Flat
I (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
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �t /�
9. YIELD (gpm): '1 R�_ C^I
METHOD OF TEST al • ak,`F(1V )
10. WATER ZONES (dh):
1 I. DISINFECTION: Type yfarB'L' ' Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
From To Ft.
To Ft.
a
*71
Z
N rn--
r, J
LOCATION SKETCH
Show direction and distance in miles from aRast
two State Roads or County Roads. Include the road --
numbers and common road names.
G)111�Y� Y���•
"'FLL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7, 5-CZ
lATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. - GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

257697
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res
tlflces - Di ii�sti�on'o/f Water Qualityit- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) h-�-sYYU I .11 4I r vti , L,j.C51 � CERTIFICATION #�7��-`tY/'ry 3
WELL CONFRACTOIt COMPANY NAME W f�a�I bit I( i‘��VL.Q PHONE #�Z1 & 3Att3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# V
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: `
Nearest Town: YfAL) 1 `� >.'Y C _County
wckeY.SoN.
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: O r ^ ‘X\ V�
+-� Address "t P I)YC '6.`'d 1��k.
City or Town
(Sired or Route No.) -71
Tl
e Zip Code
Topographic/Land�setting
tll ❑Ridge 8lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minmes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area code- Phone number �/
4. DATE DRILLED Pi— t)-0
5. TOTAL DEPTH: "left t /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fH'
7. STATIC WATER LEVEL Below Top of Casing: .11O 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 accordan e with I5A NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST A-) • `O CId1VAX—)
10. WATER ZONES (depth): ZZO( Z�
11. DISINFECTION: Type . ZCfl'BL--ci Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From e To___ Ft.
From To Ft.
From To Ft.
GROUT: Depth Material ,/�, Method
From To Ft.CO\CIC le OU"(
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
13
14
15
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
0
C
o) c-
n
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
-_I - Z (.Q
V c.T n
r
aLleastc
ro:4
16. REMARKS:
Cg0TlPV THAT —HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
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 Div'sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
t. 27609_1636Plume_No 3.9) 733-3221, within 30 days. GW-I REV. 07/2001
rn __...'�0'1

257694
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res 4, tlftccs(-�Di ii�sli1on,o/f Water Qualityit- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME � (print)((YY..j t/ZRi1)a) IA. {..O `1-1A ) , CERTIFICATION# Z3-sll/+3
WELL CONTRACTOR COMPANY NAME r'I 1 lA` t i IC lUJ (1 t ` ti�.Q PHONE # In IY�SIZ`Z_3
J 1\ \\ Zvf3Z
STATE WELL CONSTRUCTION PERNIIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:Iyy
Nearest Town: 1::)eY
County Vrekki"Y --S6
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:yYY '
Address 7_.5\
(Street or Route No.)
City or Town State
9
Zip Code
Z`ri)'15 Z
( )-
Area code- Phone number
4. DATE DRILLED e - ZL(" ©Z.
5. TOTAL DEPTH: &D ' /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q'
7. STATIC WATER LEVEL Below Top of Casing: CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
Agricultural ❑
Topographic/Land setting� l�
❑Ridge ❑Slope ❑Valley Le}Klat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C _OHS.
9. YIELD (gpm): Z. METHOD OF TE T gal • l(f 14_18 v eV
10. WATER ZONES (depth): CIO) 1©
11. DISINFECTION: Type Vflrgl.—� Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 113 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth aMaterial , _ r-��Method
From To FLc° VC° 1 C I C po LC'(
From To FL.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
G7
LOCATION SKETCH _;
Show direction and distance in miles from aiteast ".')
two State Roads or County Roads. Include t s roaciT
numbers and common road names. CD —
\O
16. REMARKS:
clEHEREBY CERTIFY' THA
NSTRUCTIO [STAND D
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Z9- OL
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the f ivisio \ of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27691M6$6fVNgtte N ,L jR)p733-322 , within 30 days. -' GW-I REV. 07/2001
ASrFir

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res ces'-SDi ision of Water Qualityit- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
1hf vt& F-LJ V--C11 CERTIFICATION# Z�`1T/��3
WELI.CO.\TRACI'oI( COMPANY NAME Apo f'rk(I� tc (,NI (( Yt1 k &q PHONE# In- Cn'J`tc -3
�-1 I`
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
257693
1. WELL USE (Check Applicable Box): Residential jX Municipal/Public D Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:�Nearest Town:,) u. Counly)QVx` 1
(Street Name. Numbers, Communit.Subdivision, Lot No.. Zip Code)
3. OWNER: 4)^ /A (g-e�
Address I? C_Q[� R�o7�O}S ?"
���j
1 1b q
/vim z D ( I C
City or Town State / Zip Code
( )-
Area code- Phone number,_, �(
4. DATE DRILLED ' Z`-t" OZ
5. TOTAL DEPTH: 3, Z. ?I 1 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CY
7. STATIC WATER LEVEL Below Top of Casing: A-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. //��
9. YIELD (gpm): Z. METHOD OF TEST gal • alciam-sot)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley BFIa
(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
n)
Z
10. WATER ZONES (depth): ) 00) 1 CS 0
1 I. DISINFECTION: Type . tcle)\ --� Amount
12. CASING: Wall Thickness
Depth - Diameter or Weight/Ft. Material
From O To '10 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.fidl elrit \-10 U`(
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.
Z
1V
O
t.0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO 1-TAND.' 1S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ubmit the original to the
7699;163,6 P4tone No. (919)
z9•o z
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001
CT] --,
GROUNDWATER SECTION
ASHEt9LLF REGIONAL OFFICE

Res
WELL
NAME
North Carolina - Department of Environment and Natural R
WELL CONTRACTOR (INDIVIDUAL) NA
WELL CONTRACTOR COMPANY NAME 1 /
STATE WELL CONSTRUCTION PERMIT# 1 f
(if applicable)
WELL CONSTRUCTION RECORD
25 7690
y
- Di ision (off Water Qualityit- Groundwater Section
(print) l(u•rYU yyLLk_I \!10 Lu Y. CERTIFICATION # -ZSC 3
Tl 1`f�is �'(1l] it lUJ I( Y1`1(�.Q PHONE # iZt (40Sict3
�j tx '� ZCRJZ.
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial 0 - Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:/�..,
Nearest Town:`lew L
County /7Gr1c4 L 1 WPC.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �N 101101 �Jate))
Address •tL 'SOX J ll}}ii
}Iexdeyt6or;" r°�lC .VQ, z?7Q3
City or Town State Zip Code
( )-
Area code- Phone number in
4. DATE DRILLED rife 30-0 Z.
5. TOTAL DEPTH: 40'1' —/
6. DOES WELL REPLACE EXISTING WELL? YES)Lot FT.
I
7. STATIC WATER LEVEL Below Top of Casing: LOt FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18. ^
9. YIELD (gpm): 10 METHOD OF TEST gal • ivu.48,v ,
Topographic/Land setting
DRidge ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
10. WATER ZONES (depth): 1Z'7) !the
11. DISINFECTION: Type . � fl`g‘- � Amount 1-
12. CASING: Wall Thickness
Depth tt� Diameter or Weight/Ft. Material
From � To 2..151 Ft.
From To Et.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.COvQ. 1 Q+ 20 U"f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
Ft.
Ft.
rJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r6
numbers and common road names. cr
IV ;r,:
C_s -CS'S-)
610 Q S Ho L(S/:.
I e sa 1>-4 6Y0 ?JL CL
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTIO STANDAI
$ubntitthe original
27699'd636 Phone Nd
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.o) -Oz_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
733-322I, within 30 days. -- GW-I REV. 07/2001
GROUNDV'47ER , N
ASHEVII I E —

Zip Code
( Area code- Phone number
4. DATE DRILLED Ire.) —D2 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lN'
7. STATIC WATER LEVEL Below Top of Casing: f D d FT.
8. TOP OF CASING IS (Use"+" if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
WELL CONSTRUCTION RECORD
WELL CON'FRACEOR COMPANY NAME rlp q sir 1 [ e
SATE WELL CONSTRUCTION PERMIT# r /
Of applicable)
257711
North Carolina - Department of Environment and Natural Res ces - Di ision of Water Quality - Groundwater Section
� rrr� ([�q ��1 � (/ / � �q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f. Y U (I?JrvCltCJ LJ,,.()S CERTIFICATION # 3
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential y) Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION_,
Nears t Town: If e r
ill aid Gip
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
/J a At
s�
3. OWNER: ( iA ����(" /"4O `i
Address 49 :boy (H gip
/fs / ISIieor Route No.) rely
rLlwn !/e �/l/ r.
City or Town Stale
5. TOTAL DEPTH: 2.
County}Ief1l�C($C11 L
PHONE # 1 Z 61$39Zz.3
1• " zCySL
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m inu tes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance in accordance with ISA NCAC 2C.0118.
9. YIELD (gpm): 3 METHOD OF TEST Gd-I . a1t�� m.yo
10. WATER ZONES (depth): go ZOO j 6 6
11. DISINFECTION: Type ' j e L' i� Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To LIU Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To FL.SlocYe%'
From To Ft.
Method
L<Y
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•
!Den 18sittAncr. (TIIY 7`tiF
ONSTRUCTION STANDAR
V
SIG VATURE OF PERSON CONSTRUCTING THE WELL
eM8 WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
x D THAT A COPY OF T IS ECORD AS BEEN PROVIDED TO THE WELL OWNER
60-02O-DZ
IV
}
G)
1
IV
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
14S Ro
le
uJa�d/
DATE
purigpn tF, CFO -1IONDivisio i of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699e16361Phluid(b4490) i-3221 within 30 days. GW-1 REV. 07/2001
C7
r..
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalyRe�s4_LLfjcces - Di/vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME,/� (print) 1.—WY" IZ .1 f ()S CERTIFICATION #�7Z�4 V3
WELT. CONTRACTOR COMPANY NAME l� I' rk�) fs 1:. (( 1` 1j&4 PHONE In" (4p.ttt3
STATE \YELI. CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT/1
J t ZCRrJ Z.
l 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 II'Other, List Use
2. WELL LOCATI N: 4 .cam
Nearest Town: 0( 1
County C\c\ {' Y; )7\A.
variance in accordance s ith ISA NCAC 2C.0118.
9. YIELD (gpm): fJ METHOD OF TEST Gal
10. WATER ZONES (depth): 'S I (p
(Street Name., Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: it)
(Stred�r Route o
Zof
City or Town Slate j Zip Code
( )-
Area code- Phone number//��
4. DATE DRILLED kr 1 C Z
5. TOTAL DEPTH: 7 - 1 / — /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O Cr'
7. STATIC WATER LEVEL Below Top of Casing: 5� FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING 1S ( FT. Above Land Surface*
`Top of casing terminated of/or below land surface requires a
I I. DISINFECTION: Type \'C'gt\i Amount
12. CASING: Wall Thickness
Depth Diameter or WcighUFt. Material
From Q To 7—Ft.
From To Ft.
From To Ft.
Z
13. GROUT: Depth Material Method
From To FLNI. C1(Q% it `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:
M.rti �
Ca S 1 1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley !Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
r3 cs'
L
lV
O
LOCATION SKETCH c a cn
Show direction and distance in miles from at test 0
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS -
CI STII(UCTrOh: STT AR
LL,
I Li)`
t bmit the originalto the DroNign of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2 699.1636 Phone No. (919)
I. FaSI =ril:
ASH:YU it iic 01 - ^I -
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D AT A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ja �
La-6Z
NATURE OF PERSON CONSTRUCTING THE WELL DATE
1, within 30 days. GW-I REV. 07/2001

1 I. DISINFECTION: Type - \ Fi€ L' ' Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To Z-A FL
From To Ft.
From To Ft.
13. GROUT: Depth Material ff����Method
From To Ft. 3 C 1/Q f aY
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:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res cos - Di �i�sti�on'o/f Waater-Quality - Groundwater Section
\\'ELL CO\TRACTOR (INDIVIDUAL) NAME (print) L '(Y(� IJ�/Yi r v�j {„� �},(J]\ CERTIFICATION # Z.'iAt/3
\\ELI. CO.\T RACTOR CO)II'ANl'NAME) f�Clti'[ k. 1(- Yt\llv\,Q PHONE #1Z1-GtV5LIZZ-3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERktIT# t \ \ N.
7..-L4J Z+
(if applicable)
(if applicable)
254769
WELL USE (Check Applicable Box): Residential I< Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Usc
2. WELL LOCATION:
Nearest TownTa'f CO 0�
County
tkdei
(Strca Name. Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: -.A 6 V\ A
c'
Address {.0+ [..Q t (StreetL\tXSCC1
V or Rowe tt'l, r _
City or Town State % Zip Code
( )-
Area code- Phone number
4. DATE DRILLED L -14-1-
5. TOTAL DEPTH: Z CPI
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: U 0 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanceey�th ISA NCAC 2C.0118.
•
CJ
Topographic/Land hic/Land setting
❑Ridge ESlope ❑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. (Lpm ): -2-
METHOD OF TEST gal• K1t4\�t�
10. WATER ZONES (depth): (p Js— ('€ Z) 7_ 1 5
LOCATION SKETCH
IV
O
1
0
.53
CO _._
Show direction and distance in miles from at East
two State Roads or County Roads. Include thSoad o
numbers and common road names.
ZAP
D(..d RECUY ¢1i12TWY
_CdN:ST LICTIT'S
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6A/ etc
+ 1 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
!iJ
bntit the original to t to Di
.°0 1dM19) 733
ASHEVILLEE REIsiOI L OFHCE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 254758
North Carolina - Department of Environment and Natural •I ess/eurces ;ivision of Water Quality - Groundwater Section
•\\'ELL CONTItACTOR(INDIVIDUAL)NAME (print))8YYIS CERTIFICATIOjN# `.j09C3WELL'ELL CONTRACTOR COMPANY NAME 14rl�ck;?�. iIfl i'�i�� C( PHONE # jrC.DTID 0 5 -IZ- Z3
tt " z(r5Z
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ FERMI
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 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;
Nearcst Town: inks S `�Z\\Y& County J4-i; { C(.60VC.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
•
3. OWNER: f7
Address 4P t{']js
zwch (StreetsRRoute No.) Z�1 z '
City or Town ) State Zip Cole
( )-
Area code- Phone number 4. DATE DRILLED 5-/5- C Z
5. TOTAL DEPTH: 7 '4 1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO )ai
7. STATIC WATER LEVEL Below Top of Casing: `Fp FT.
(use"+" if Above TopofCasing)
8. TOP OF CASING 1S 1 FT. Above Land Surfaces
*Top or cuing terminated atlor below land surface requires a
variance in accordnn c with ISA NCAC 2C .0118.
9. YIELD (gpm): r METHOD OF TEST (d. I • Carth
10. WATER ZONES (depth): / Q
LOCATION SKETCH
I I. DISINFECTION: Type --(11 gLer Amount Z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dcpct , Diameter or WeighUFt. Material numbers and common road names.
From 0 To `/ �J FL
From To Ft.
From To Ft.
13. GROUT: Depth N Material / Mel
From To Ft l &I C 7-i`tc
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 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 Formation Description
0
tv
1
16. REMARKS:
- Z(A
4 Q Z1 O
C SQ -4�01 � C�
DO HER EBY CERTIFY THAT THIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ll.c/ 5 20 Z
li
it the original to the DivisittO
7699,1636 Phone No. [phone], v
URE OF PERSON CONSTRUCTING THE WELL DATE
Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
thin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
25°I 86
North Carolina - Department of Environment and Natural
STATE WELL CONSTRUCTION PERMITS,
(if applicable)
yvtL�c urces - ivision�o�f Water Quality - Groundwater Section Z [�
WELL CONTRACTOR (INDIVIDUAL.)
t)
Zi
CATION
WELT. CONTRACTOR COMPANY NAME }(prrasneie L%th ..l ,'l DY ( I� L( b PHONE 0tirL11 c.fi5 -1ZZ3
✓
ASSOCIATED WQ PERM
(if applicable)
II tt - z.(25 Z
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION r�
Nearest Town: t.1. t:~eoe1e
County % o&rkQ.Y40 YL
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: liOn .3 &
S
Address ZO'WO
5-)ti1g(QSi or Rou o.)
City or Town State Zip Codc
( )-
Topographic/Land setting
[Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesfminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED - I L! `O L
5. TOTAL DEPTH: ran
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ae
7. STATIC WATER LEVEL Below Top of Casing: (p 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 ISA NCAC 2C .0118. y
9. YIELD (gpm): S METHOD OF TEST n �tl 1 • L4 d 'wv
10. WATER ZONES (depth): 13 5
1 I. DISINFECTION: Type-rill,3LgT Amount
12. CASING: WallThickncss
Deptfoo Diameter or Weight/Ft. Material
Q To I FL
To Ft.
To Ft.
13. GROUT: Depth ,y Material /,, Met
From To FtC"d/fC7-e`tc �e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From
From
From
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
I DO HEREBY CERTIFY THAT
CONSTRUCTION STIQ4DAR
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ri �aYea+-•
0
3C
—c
tD
Sal
O
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CO
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH WELL OWNER
f 0 t-40z.
ZJ,JATURE OF PERSON CONSTRUCTING THE WELL DATE
`G
1mn me a gmar av me o,jr
!h or Water Qunliy, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
99-1636 Phone No. (919) 7 , within 30 days. GW-) REV. 07/2001
JUL ' 0
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

From c0
From To Ft.
From To Ft.
13. GROUT: Depth Matena r,, Met
From To FLJ'&flCt-e 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.
WELL CONSTRUCTION RECORD
250829
North Carolina - Department of Environment and Natural Rerturces -Division of Water Quality - Groundwater Section/
WELL CONTRACTOR (INDIVIDUAL) NAME
� (print)/)811/ SWQ /(."J11��k( j�S)(//'' CERTIFICATION ## "2j*VOC3J
WELT. CONTRACTOR COMPANY NAME J41O'iC'l.ic Ck%,(X%lj :J([L( PHONE #(Z1 V.t'D 3 _'Z/�Z,3
STATE WELL CONSTRUCTION PERMIT# f �I ASSOCIATED WQ FERMI
) I t) Zlk -% Z-
(i fapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential m'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATJON:
Nearest Town:'.__)“ r&itp(.f / it 4,' SC.County
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 1 `=kt(cj -CON=�C&
Address i(' ICc- 7 i
No.)
1-Cc tie (Street or Route .
City or Town State Zip Code
Area code- Phone number ,,
4. DATE DRILLED `-k-
5. TOTAL DEPTH: -50 `7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 'EV
7. STATIC WATER LEVEL Below Top of Casing: (OO FT.
(Use "+" if Above Top of Casing)
S. 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 .01 I8.
9. YIELD (gpm): Z- METHOD OF TEST NJd.1 '• CQm-j-ti►"--)
10. WATER ZONES (depth):
s7 LOCATION SKETCH
I I. DISINFECTION: Type ii aLer Amount Z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth //////Di meter or Weight/Ft. Material numbers and common road names.
To m Fte: 1
Topographic/Land setting
❑Ridge ❑Slope OIley ❑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
N
Gl
16. REMARKS:
I DO HEREBY CERTIFY THAT r WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
"- - -' - — THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rZ - ULr ATURE OF PERSON CONSTRUCTING THE WELL DATE
S mit the original to the Di
276 9-1636 Phone No. (919) 73
a SIN iq SECTION
A ['CULL: KEGICHAI. OFFICE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

n
WELL CONSTRUCTION RECORD 2508
North Carolina - Department of Environment and Natural •pis/9urces -Division of Water Quality - Groundwater ection 4�
WELL CONTRACTOR (INDIVIDUAL) NAME (pdn°)81 A wet 10 nkL I ?XSV CERTIFICATII Va Z.4°-3
WELL CON'IRACFOR COMPANY NAME }
S'EA'1'E WEI. I CONSTRUCTION PERM ITa
t i r applicable)
r-i t-{ I Pi I.� PHONE M c D J eft Z. 3
1 � _ Z'U J
ASSOCIATED WQ PERMI
ideidd%k.a 11
11 " - c
if applicable)
1. WELL USE (Check Applicable Box): Residential it 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:
�CounryQY1 6
(Sven Nome. Numbers. Community. Subdivision, Lot No. Zip Cnde)
G
3. OWNER....
Address 2) /v i"1 �' 5 f
twat or Route No )
City or Town State Zip Code
Area code Phone number
T. DATE DRILLED � 4O Z
5. TOTAL DEPTH: c''.( 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fri"
7. STATIC WATER LEVEL Below Top of Casing' (S FT.
(Use "a" if Above Tup of Casing)
S. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated Wor below lend serrate requires a
variance in accordance with 15A NCAC zC .0118.
9. YIELD (gpm): METHOD OF TEST
0. WATER ZONES (depth): 27_ r-\
11. DISINFECTION: Type Ali 1.6LE-i Amount 1/
12. CASING: Wall Thickness
Depth Diameter or WeighUEt. Material
From To SON Ft.
From To Ft.
From To Ft.
13. GROUT. Depth Material /M t
From To Ft.Oef111CY-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.
Topographic/Land setting
°Ridge °Slope IVVailey C Flat
(check appropriate boa)
Latitude/longitude of well local :m
(degreeshninules(sec00ds)
Latitude/longitude source:OGPSOTopc taphic map
(check box)
DEPTH pRILLF Q LOG
From To Formation ; escription
LOCATION SKETCH
Show direction and distance in miles fri n at least
two State Roads or County Roads. Inch ie the road
numbers and common road names.
16 REMARKS.
IV rnz
I DO HEREBY CERTIFY' •AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL "•
r QNS7!(tticiviO7N' .' !�• RDS, AND TSAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 /JR
■ /6 0
rw ��CaJ �l - G Z
raj
Submit the o igina7T t
27699-1636 Phone fto. (91
GICNECIEVVAIER SECTION
ASHEVILLE REGIC)NAL. OFHCE
.ATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Ralel h, NC
733-3221, within 30 days. GW-I REV U7/2001

WELL CONSTRUCTION RECORD
250834
( ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME � (prin�t)/)8YY((( ...(((l z) l�
WELL CONTRACTOR COMPANY NAME Kip1 K-t ei& }L,
# ' I'A
STATE WELL CONSTRUCTION PERMIT
(if applicable)
North Carolina - Department of Environment and Natural Rfspurces -
ASS
(ntikR l /,s}C
II al lid(
OCIATED WQ PERMI
(if applicable)
CERTIFICATION z4Q
PHONE # (Z1' Ot3- oft z3
it IV -zsaz_
1. WELL USE (Check Applicable Box): Residential la/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N � II
Nearest Town: hiA,el i I)) )
)
��/ Topographic/Land setting
County )- P Yli- s-}" _� �L ❑Ridge OSrlope ❑Valley ❑Flat
(check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l yv.. j'I <i ?\ '✓11`D 16Y J �
Address Q) tip' &C` (���
, • (Street or Rgute No.)
-1\ (O©tZ J
City or Town State Zip Code
( )-
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 5 - i } -c Z
5. TOTAL DEPTH: '7 (9 '7 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑rNkO l7t `
7. STATIC WATER LEVEL Below Top of Casing: ) 4-C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0I18. '
9. YIELD (gpm): _� 1-1- METHOD OF TEST ad. I • (dm-thi
10. WATER ZONES (debth): 3 'C
1 I. DISINFECTION: Type TA tE T Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 2 Z Ft.
From To Ft.
From To Ft.
13. GROUT: Depth A Mater`iaJ/,, Met o
From To FL(&nC1-i'tt
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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
) Al
Yam) -c. )2.11 Li)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN9ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�r
mit the original to the Did
9-1636 Phone No. (919) 733
•
GROUNDWATER SECTION
ASHEVILLE RECION.L OFHCE
-zOL
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001

1 I. DISINFECTION: Type ill gin- Amount t-'
12. CASING: Wall Thickness
WELL CONSTRUCTION RECORD
250833
North Carolina - Department of Environment and Natural[-/RRerr/r��'urces-jPr1�/iiviission of Water Quality - Groundwater jSectionnj ['
WELL CONTRACTOR
NAME
\VELI. CONTRACTOR COMPANY NAME f4�al �.1cf` '�7 �' n(f I I'f �( ��b-s( PHONEI #IlC.D C 03 - z- z3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERRIITW t 1 1t - Zl} S Z
(if applicable) — (if applicable)
f3/
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: C(S.C(,r`/ ) 1\ Q -
County j—Qv\41\ISU LL--
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
)
3. OWNER: l't1,C'
Address
/� ( - (Street or RouteNo.)
4 (mil Y•S7 f � l .tier\1
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 5 - C
5. TOTAL DEPTH: 4-6 'j r
6. DOES WELL REPLACE EXISTING WELL? YES ❑,JVO
7. STATIC WATER LEVEL Below Top of Casing: 4—'C) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S ( FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
9. YIELD (gpm): ,72.2 METHOD OF TEST gd. I • CGml-4t
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
Pd
yv-k. (`} l/ 1- 3
From C
Depth Diameter or Weight/Ft. Material
To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Maleria /� - Met
From To Ft. C&)1 CY-PA
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.
—D
IV
fV
r
16. REMARKS:
I DO HEREBY CER�TY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIONSTA.�:s..,yj, HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S(
• blot the original to the lDivis'on.4 Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9 -1636 Phone No. (919) 733-3
// `f-9-0Z
URE OF PERSON CONSTRUCTING THE WELL DATE
hin 30 days. GW-I REV. 07/2001

LJ• Cut
rn..; —
L S'Ubmit the original to the D
27699-1636 Phone No. (919) 73
WELL CONSTRUCTION RECORD
250831
North Carolina - Department of Environment and Natural •pnpurces - ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEt//((��^ppri���nntt,,),,,/////)f�YYtI\ CLUE/ 10 nt,14 1 �S II CERTIFICATION#
WELL CONTRACTOR COMPANY NAME Pt letrkt.iDY �.,ix II I I111.I M1 PHONE #fd Ot3-4fzz3
STATE WELL CONSTRUCTION PERM ITN ASSOCIATED WQ PERMIIS IS - z(c5 t
• (if applicable) (if applicable)
1. WELL USE (Check Applicable Box)z Residential UV/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: lr
Nearest Town:)k dETY-1 lr1(1 CCounty fiek(119Y 5(-
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
L
3. OWNER: it 1 1tYc2C3
Address tct \4 � I\,.t rti NlC l F \fl C' 7� LC/
(Street or (Rome No.), in
City or Town Slate Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3- Z- j-G z-
5. TOTAL DEPTH: 7e-)7 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LR-
7. STATIC WATER LEVEL Below Top of Casing: Z2 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QPlal
(check appropriate box)
Latitude/longitude of well location
(dogma/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
`Top olcasing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C.o118.
9. YIELD (gpm): (e I METHOD OF TEST gef (r o I4c
10. WATER ZONES (depth): 1 Or' �) (S c
1 I. DISINFECTION: Type -rig 6..�T Amount Z
12. CASING: Wall Thickness
r�i ` Depth Diameter or Weight/Ft. Material
From To �� Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material /_ Met
From To FI.(�li�C-Q`{t T O
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.
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.
Z_;
LcD(Ar�) IZ A
N
N
ON
16. REMARKS:
I DO HEREBY CERTIF THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
NSTIiUCTION ' ;n ARD" 5 THAT,A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J
01
-3221
,n r:nI+'r7FI, 5ECT10N
3 I;VAL OFFICE
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001
0
0
0
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0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural wRurces - ivision of Water Quality - Groundwater Section
- • , R (INDIVIDUAL) NAME (print) )/ Q CERTIFICATION # 4g0,3
WELT. CONTRACTOR COMPANY NAME Wpw (eglk1ak.IAX II �l II(i.(U( PHONE #tra 0t3-C4Z-z3
it " - z-Lc'SZ
WELL CONTRACT )81 L jLotf/�r. l }�
I I. DISINFECTION: Type t i an- Amount Z
STATE WELL CONSTRUCTION PERM ITN ASSOCIATED WQ PERMI
(if applicable) (ifapplicable)
250830
1. WELL USE (Check Applicable Box): Residential f'3' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: )4fnc€V5bW I SS tounty :(u�c----
(Street Nmne. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: '1V1-{Ht-C C
Address "LC`J(i ("1 k y�
V\.( i (Tk71 orn/\No.) Z1/) \
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3 " . I - CT
5. TOTAL DEPTH: 40 J /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EV
7. STATIC WATER LEVEL Below Top of Casing: ‘1..c.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 accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST hd.' • Co Ih4 ^^'.
10. WATER ZONES (depth): 7 zC' 3 ZC `, 4-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.
/Topographic/Land setting
PReidge ❑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
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. From Cm To ( Material
(C Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Mate
na /� Met
From To Ft.Cdl)1Csi-e k
Prom To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
c)�YQ
6 -i c- 4v g_
c
s
0
n
17 0^
70 c�
3 z�
N v'=
mz
NI -I
01 5
z
16. REMARKS:
I DO HEREBY CERTIFY THA1
A
juLl'I it the original to the Div ion
2769 1636 Phone No. (919) 733- 221, v
E L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
249496
North Carolina - Department of Environment and Natural E urces-P(/ivrisiyon_ of Water Quality - Groundwater ection
WELL CONTRACTOR (INDIVIDUAL) NAME
t (print) 2( 1')/4 ei L.iyt r�M1r,���-Ns.//�' j,&. pC CERTIFICATH qp 2-420.
WELL CONTRACTOR COMPANY NAME I9 (L1C L d L 1i 'II eY t �� (�1 PHONE 0 Cvt3 e!z- La1 tt I -Z(s'Z
STATE WEIA. CONSTRUCTION PERM ITN ASSOCIATED WQ PERMI
(if applicable) (if applicable) rtt�
!. WELL USE (Check Applicable Box): Residential d Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: `` `�"a' /�
Nearest Town:3-ifbt-A(` PV4A\S(ounty 14Cf1)LT-v-S9 v.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Vlat
(check appropriate box)
(Street Nome. Numbers. Community. Subdivision, Lot No.. Zip Code) Latitude/longitude of well local an
3. OWNER S 13'i,'s�i SS��� �K�r (dcgreeNminutea/seconds)
Address -Z(- r% Gin. vvN• — Latitude/longitude source:OGPS❑Tope raphic map
(Street or Route No)(check box)
Z`C R Z DEPTH PRI! LI G LOG
City or Town State Zip Code From To FormationI escriplion
}Nevi d-fY vi 11 C
636 Phone No. (919) 733-3
1 )-
Area code- Phone number
4. DATE DRILLED )- ) 5-(0 Z
5, TOTAL DEPTH: 2.0 -7 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. 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 atior below land surface requires a
9. YIELD (gpm): 3 (J METHOD OF TEST Qvariance in accordance wlib ISA NCAC 2C .011a.adI c�n�� �
10. WATER ZONES (depth): t 0 O
I I DISINFECTION: Type WCAmount 1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From tel To �o It
From To Ft.
From To Ft.
13. GROUT: Depth Material /� M tr
From To Err& l c-i-e- C
From ToFt.
14. SCREEN: Depth Diameter Slot Size Material
From To_ Flin. in.
From To Ft. in. in.
15. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To — Ft.
16,REMARKS.
N
--O
s
N
LOCATION SKETCH r )
Show direction and distance in miles fri ncarheas$
two State Roads or County Roads. Inch ke the road
numbers and common road names.
Lb u3sid -Kd
(n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ANDADS, ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 (NER
RE OF PERSON CONSTRUCTING THE WELL DATE
e orlg na o - e s iv s 2 Water Quality, Groundwater Section, 1636 Mail Service Center - Ralel h, NC
hin 30 days. GW-I REV 97/2001
GROUNDWATER SECTION
ASHEVILLE REND:TET.L OFFICE

STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ FERMI
I if applicable) l if applicable)
WELL CONSTRUCTION RECORD 2 4 9 4 9
North Carolina - Department of Environment and Natural Respurces • (vision of Water Quality - Groundwater ection
WELL CONTRACTOR (INDIVIDUAL)TRANAME (priinnt)) ).iAkVq, LtJ� .� CERTIFICATI< V M Z(,�0'`�
WELL CON') COMPANY NAME HAr 'de k' iL l nit( PHONE M c O3" ; z- z-3
z,V
WELL USE (Check Applicable Box): Residential 0 / Municipal./Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town:',i<- j(.-�V •,1,tC)l lSC •County :�Cd(7 YJcLti�,
(Street Nome. Numbers, Community, Subdivision, Lot No.. Zip Code)
1 t
3 OWNER: . )e-t- ) Y I'I-. ye
Address
Street or Ijowk No.)
N 1�
City or Town State Zip Code
( )-
Area code• Phone number ' O —7
4. DATE DRILLED
5. TOTAL DEPTH: 3Cp1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0-""
7. STATIC WATER LEVEL Below Top of Casing: j D O FT.
use "+" if Above Top ofCasing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
9
I0. WATER ZONES (depth): `,?CJ
I I, DISINFECTION: Type-TAgrer Amount ?i
12. CASING: Wall Thickness
DeptrhDiameter or Wcight/Ft. Material
From To 1 (-6 FromTot.
From To Ft.
13. GROUT: Depth N Matena /� _ Mft oQ�
From To Ft.0 tMc - `t( V 1'
From To_ Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. in.
From _ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C Flat
(Check appropriate box)
Latitude/longitude of well local NI
(degrees/minutealseconds)
Latitude/longitude source:OGPSOTopc raphic map
(check box)
DEPTH DRILLII G LOG
From To Formation I escription
Cr(
I)
Iw
0
*Top of casing terminated at/or below and sedate regnlm a
—.,
variance in accordance with ISA NCAC 2C .011S. /�
YIELD (gum) : Z_ METHOD OF TEST (tSd ) • i
r ,1
LOCATION SKETCH CFI c�
Show direction and distance in miles fri n at least
two State Roads or County Roads. Inch le the road
numbers and common road names.
C Li_
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ANDARDS, AND • HAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 (NER
_.. 6 l.?
FLE ,,, EH
Submit the - al to thq' s i
27699-1636 Phone No..(919 A
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Ralel h, NC
21, within 30 days. GW-1 REV 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 249494
ivision of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (prin�t)(/(c5I'�V1CS I,Jef ()
WELT. CONTRACTOR COMPANY NAME Y4pt K1.5VIl�� s L. IA -el i f)Y(�4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERAII
( if applicable) (if applicable)
North Carolina - Department of Environment and Natural
ources -
CERTIFICATION ## (it
0,3
\,r PHONE # ((gyp O3 CrzzS
II 11 z(S'JZ.
I. 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 Usc
2. WELL LOCATION: � ( _(
Nearest Town: red Kitty V) I I1 � County y-t Clkd e C
(Street Name. Nwnbers, Community, ubdivision, Lot No.. Zip Code)
3. OWNER: /) Y}L (I I) qt.
Address 1 0 15n x Is 5 t P
\' ' Street\kg jr Rout),
City or own State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED i- IQ-O2
5. TOTAL DEPTH: I "Fri I
6. DOES WELL REPLACE EXISTING WELL? YES ❑,NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface`
FT.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lr7gfat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fotnation Description
`Top of casing terminated at/or below land surface requires a ,
PO
no
variance in accordance s�A{th ISA NCAC 2C.0118. all.
n� D
9. YIELD (gpm): Z C/ METHOD OFTEST bl c4 I1 4C -`
10. WATER ZONES (depth): / C0 / 5 Q
rn _-
1 .:
-1-0, LOCATION SKETCH 2'
11. DISINFECTION: Type L tT Amount Z Show direction and distance in miles from atlst S
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
0 Depth Diameter or Weight/Ft. Material numbers and common road names.
From To 7�J Ft. /fi
From To Ft. CVO 1 (/ Y n/ -ef 6
From To Ft. ( )
13. GROUT: Depth Materi�a/l '/n Met od Xci KS_v5 ) "C
From To FL(d/Yl C t-e4l
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THATTHIS\WELL WAS
I
dt<tdS, t (U r;. •. THAT A COP
< :t' r'
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I- Z3- 2
i
Submit the original to the
qt of
27 99-1636 Phone Nu. (919) 73II-322I
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001
,NICE