Ja 2 CY2002

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME �(print)Ri dhnrd
WELL CONTRACTOR COMPANY N.AMET)a Ker Wet
254100
Division of Water Quality - Groundwater Section
/�
CERTIFICjJAryryTpIION/#O�rJt J�IIO 2
PHONE # BA 6Q 1— ILI�J
SLATE WELL CONSTRUCTION PERMIT# 1811 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest TownTUr e ee.
Cedar Vo U od
(Street Name, Numbers,Community, Subdivision, Lot No., Zip Code)
3. OWNER: (.y,
le —nail P,Ths
(�y I Address PI Ueda r
(Street or 4 No.) g�783
TiJrKrr25egPp Jlte C.)City or T State Zip Code
02&)- 98-aa14-a
County�f LC:kSOYZ
Area code- Phone number
4. DATE DRILLED 5 - 3- Oa-
5. TOTAL DEPTH: 18 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (H
7. STATIC WATER LEVEL Below Top of Casing: FT.
�j
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS II%3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST Timed
10. WATER ZONES (depth):
Gy pump installer
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 46 Ft. (Ott€ $DRz.I pve)
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To j Ft. COVIC'eek'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.
Method
Poured
Nia-11 j f%oad . Tait ISt Itkt•
TaYQ_ rii itt Cit firsf drive on
ri jfrt 7sd sroi wigren
{rtm. Well is a ena 01 odrtve-
Topoggra;hic/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
From To Formation Description
L
IN) o
<
yc
c--
LOCATION SKETCH U7 "t
coShow direction and distance in miles from at leas
two State Roads or County Roads. Include the road
numbers and common road names
From. 5/Ivo- NC- take I4uLy.10`/ -Fo
Tuek'&ce,ee . I-04'P Ie E on tositog.zgL.
p(.OI
16. REMARKS:
Ls II DO (#ERf),BY CER IF R
CONSTRUCT-1 STA C
J
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PF9.THAT A COPY OF THIS RECORD HAS BEEN) ROVIDED TO THE WELL OWNER
-4144
NATURE OF'VERSON CONSTRUC
S"10 -©--
LIDfC THE WELL DATE
i
iSuj?jnit t!lc Hrigine*F1e4-hk Divi ion of Water Quattly, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV.07/2001
�](�a 14i( plume NO, ('�I'j�733- 21, within 30 clays.

254572
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Najral Resources/ - Dii/vvsion/9f Water Quality - Groundwater Section e /
WELL CONTRACTOR (INDIVIDUAL) NAME (print / 1,0/rl,�LG /!/ltlar/ICGis CERTIFICATION #)a4p,7
WELL CONTRACTOR COMPANY NAME (print
lr/rel a tkr M1t+L I PHONE # 92S) iv ;.1. 2-2 vs Li
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(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 ❑ If Other, List Use
2. WELL LOCATION: ff II
Nearest Town: - County e�r9GKSt1f1J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
H 3. OWNER: $LZ/24 djjaAt. A
rA♦ .nr Address 11c1 C C Lao-r ?hx- _Sr
a Pt aert 6/1-
City or Town State Zip Code
( ) trni - r e V.
Area code- Phone number
4. DATE DRILLED 3-/B - 6.2.
6. DOES WELL REPLACE EXISTING ING WELL? YES 0 NO 04.
7. STATIC WATER LEVEL Below Top of Casing: 'a D6 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.. METHOD OF TEST Ai R
10. WATER ZONES (depth): 4
11. DISINFECTION: Type (+hnrJ/atr et Amount /t4 Lp
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 72 Ft. 4 /BB Ole:re.Q
From To Ft.
From To Ft.
13. GROUT: Depth Material Methoil
From_ To 2/% Ft. ( (ica2
From To Ft. v
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5. TOTAL DEPTH:
(Street or Route No.)
lack.°`1
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
2L4NISTAMDA
JU 11 002
HIS WELL WAS CONST
AND THATA COPY OF
d//
IGNATURE OF PERSON
Submit the original to the Div sion of Water Qualify.
Qyyp)paAtArgf@tggl9) 733-5221, within 30 days.
ASHEVILLE REGIONAL OFFICE
CON
topographic/Land setting
Idge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cited( box)
DEPTH DRILLING LOG
From To Formation escription
/ 40
6 6 - S/Ski-
fV
L
LOCATION SKETCH
Show direction and distance in miles frot
two State Roads or County Roads. Includ
numbers and common road names. ••
avaI wcAnvz,sai r
plc+ 13 "r,` 1� -/ ^ N2-3
rD IN ACCORDADr "'E ur�'ti
RECORD HAS BEEN PROV 1
'TRUCTING THE WELL
9CAC 2C, WELL
O THE WELL OWNER
?- le? - p2
DATE
Grou4or ,, ���y
Gro n j4 9 1k,, Hk(r OFFIC Sery cc Ccntcr- Raleigh, NC
GW-1 REV. 07/2001

266591
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources��rc1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/� (print)_ I- C, -± �j r Lz_Fc.L- q CERTIFICATION SF�D /
WELL CONTRACTOR COMPANY NAME &YEF 11, c - yoS. 11/&-Q f FL�I'yiy - PHONE # (Say La Y - '�/ 9a
STATE WELL CONSTRUCTION PERMIT# / 7 z 2 ASSOCIATED WQ PERRMIT#
(if applicable)
(if applicable)
1. 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 Use
2. WELL LOCATION'
Nearest Town: ) U eta
(Street Name, Numbers, Community, Subdivision, Lot Na, Zip Codc)
3. OWNER: -J r
Address 1 c} L{- , S 4-ra rey+-w-i L)UcrT Ca• r cJ L
(Street or Route No.)
l.t) . n e_s I(I 1 I -4 A!/ C. Angie
City or tt own State Zip Code
Area code- Phone number
4. DATE DRILLED %/ - % - D .2
5. TOTAL DEPTH: sa' i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: aO!) 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 accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST .2 1, r S
10. WATER ZONES (depth):
County (1 tt.r)C (Tvi
11. DISINFECTION: Type
12. CASING:
Depth
From D To [r 7 Ft. e "
From To Ft.
From To Ft.
13. GROUT: Depth
From /7 To Ft.
From To Ft.
1--1 ) /-i Amount 64 q
Wall Thickness
Diameter or Weight/Ft. Material
P LAC
/1 Material
i G AQ1 e—L(
14. SCREEN: Depth Diameter
From . To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Slot Size
in.
in.
Material
Topographic/Land setting
❑Ridge ?Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
�) /n%
C 7 -65
Forman escription
tia�-c_Z 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.
Method 0
Ley N o'
t..., 52
Material �" ^"`
" n
w
From To Ft.
16. REMARKS: 2
"l�129 H ttEaY CERTWI
CcINSTRUCTIOS STAN
i 1,
!Y
J u.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORDS BEEN PROVIDED TO THE WELL OWNER
Submit the original toi,the D
--27699-1636 Pborn-PIRr(919) 73
I
,e4ct /
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/,? - 3/- o
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Sul ice Center - Raleigh, NC
.3221, within 30 days. GW-1 REV. 07/2001
Z
aJ

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionvof Water Quality - Groundwater Section
'/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) % /Jh/ A/ C�// /E//9/5 /� CERTIFICATION #,24 /Y
/L)N X.A 4 /jam/ i PHONE # fKM eQ WELL CONTRACTOR COMPANY NAME 7/P Pa't-2�.-[ /� / �' 7 A S /
STATE WELL CONSTRUCTION PERMIT# / Tt ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EN' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION'
Nearest To n / ,, a ¢ 2.2. J oun
(Street N amc, Numbers, Community, Subdivision,
Lot No., Zip Codc)
3. OWNER: c%V*/ f'/Lr1 1f /n
Address �( (�
(S���;No.) „viz .eO „zee;
City o own State Zip Code
Topographic/Land setting
❑Ridge 0Slope ❑Valley Igelat
(check appropriate box)
Latitude/longitude of well location
-
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: /l/s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EV
7. STATIC WATER LEVEL Below Top of Casing: /C) FT.
• (Use "+" if Above Top of Casing)
8, TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):.25 METHOD OF TEST a h rs
10. WATER ZONES (depth): f(5 ' - a_S �Pm
11. DISINFECTION: Type HTN Amount /%
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From /9 To .?.SFt. !r "
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From © To A 1 Ft. Cn—vvvp n. '-Farr
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.
264033
(decrees, minutes/seconds)
a .S/ - . Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
iz s i os '
G�1
_vJh.,, ,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. -REMARKS:
i
Sub it the original to the Di fsion
27699QM061PI1 f TNR.StMIMI1- 221,
ASHEVILLE REGIONAL OFFICE
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD H.EEN PROVIDED TO THE WELL OWNER
/6-3/-'
TURE OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ithin 30 days. GW-I REV. 07/2001

From To
From To
13. GROUT: Depth
From 0 To o2
From To
14. SCREEN: Depth •
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
264032
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and al Resources - �Divisio/n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEE (print) )L1Al /L-4e-/� �) the
CERTIFICATION # ../ /'!
WELL CONTRACTOR COMPANY NAME ! 7/'P.-Osr o s(�/I S . `L toll V iiith/C� the -PHONE # (Sv.%6l -5/ 7"
STATE WELL CONSTRUCTION PERMIT# /3/U 1— ASSOCIATED WO PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IE Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
NearestjTgwn: County
(S
%SO//
(r-L/ i./_/ ✓ /'l u'.
Subdivision, Lot No., Zip Codc)
.
me, Numbers, Community,
3. OWNER: /// 4-). 4_,,,„/�Gln 1L�1.eN_
Address aas) C %3c ?e l
' Ah ` r (Street or Route No.)
L%//lie���,%� Yid- .�87��
City o own State / Zip Code
Area code- Phone number
4. DATE DRILLED l --SU - G.2
5. TOTAL DEPTH: a 2 T ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !3
7. STATIC WATER LEVEL Below Top of Casing: ltD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9'. YIELD (gpm): 6,0 METHOD OFTEST 1 h YS/
10. WATER ZONES (depth): °Wp '— L00 J�
11. DISINFECTION: Type
12. CASING:
f477 Amount .5
Depth Diameter
From 4 To „i.S Ft. c ri
Ft.
Ft.
Wall Thickness
or Weight/Ft. Material
PdiG
Material Method
Ft. /'D emote
Ft.
Diameter
in.
in.
Slot Size Material
in.
in.
From To Ft.
Topoggradphic/Land setting
❑Ridge RSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
• Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
DEPTH
From
a�5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: -
-•a
:r
grIglE lSaF`M
U
1 St A
NOV1 )
2l ubmit the original to the
w4p(1gpF& jgjp 733-3221, within 30 days.
ASHEVILLE REGIONAL OFFICE
I`IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
It ND THAT A COPY OF THIS RECORQHAS BEEN PROVIDED TO THE WELL OWNER
/C! -0/—D2
.Atl-
£^.,NATURE OF PERSON CONSTRUCTING THE WELL DATE
Divis on of Water Quality, Groundwater Section, 163ui Mail Seri ice Center - Raleigh, NC
GW-I REV.07/2001

WELL CONSTRUCTION RECORD
261132
North Carolina - Department of Environment and Natural Resources-(�jytsion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) \Z%%!'G/ . -- DDV.,,I �' — CERTIFICATION A *BOW
WELL CONTRACTOR COMPANY NAME rt erle-PHONE./
/4i6 2 ASSOCIATED WQ P a
(if applicable)
STATE WELL CONSTRUCTION PERMIT./
(if applicable)
1. WELL USE (Check Applicable Box): Residential.. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring O Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
4LSgL4° 1/70
2. WELL LOCATION.
Near own:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: 9 YfS1inA., sS
Address .S .0a -T{1 nrvsn S
(Scree or Route No.)
/! e Pr) i . �sr v) Me -es sits
City or Tow J State / Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED - 3 - D .2-
5. TOTAL DEPTH: /4/S ' L
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO"i-
7. STATIC WATER LEVEL Below Top of Casing: 41d 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): AO METHOD OF TEST or A ✓S •
10. WATER ZONES (depth):
//o - /1S '
I I. DISINFECTION: Type /I % H
12. CASING:
Depth
From To L & Ft.
Diameter
w it
From To Ft.
From To Ft.
13. GROUT: Depth � Jr",Material Method
From 0 To iD /
Ft. l fi.vtt.C�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
From To
16. REMARKS:
Ft.
Ft.
To o raphic/Land setting
❑Ridge €lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Descriptio
DEPTEI
From To
D 6G
G G ' i4it'
LOCATION SKETCH
Amount / , Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the rotyRl73
or Weight/Ft. Material numbers and common road names. O
l , o
I
CO
0
I a • • EiEEIC�Q�TI^^� AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
r ' D., AND THAT A COPY OF THIS REC•' a AS BEEN PROVIDED TO THE WELL OWNER
,3p,OL
S SIGNATURE OF PERSON CONSTR ING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
cg919) 33-3221, within 30 days. GW-1 REV. 07/2001
f u f-
GRO
ASHE L
0

5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur I Resources - Division of Water Quality - Groundwater Section
CERTIFICATION0/ .4"
PHONE ,/ f$up4 iiB -`-57
WELL CONTRACTOR (INDIVIDUAL) NAME, (print)
WELL CONTRACTOR COMPANY NAME& t
STATE WELL CONSTRUCTION PERMIT,/ / 02
(if applicable)
9/
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL -USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water nje tion 0 Other 0 If Other, List Use
2. WELL LOCATIO,
Neares Town: VeL County T�r',k.cO
QolLY/ �i 40 — /.��C.r��.,. ,3ien4-C1-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CJ 0 h ✓YI A w-h P.u)5
Address / 0 I L7Y A.aO S
Iva (Street or Route No.)
A/ c
City Town r State
Zip Code
Area code- Phone number
4. DATE DRILLED - O a
5: TOTAL DEPTH. a to 5 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO`
7. STATIC WATER LEVEL Below Top of Casing: 140 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
valiance in accordance with ISA NCAC 2C .0118. 't
9. YIELD (gpm): 4 , 5 METHOD OF TEST cQ rl r S
10. WATER ZONES (depth): 3Oh — cl • 5 c pm
11. DISINFECTION: Type )4T4 Amount
12. CASING:
Depth
Frorn Q To__10_ Ft
From To Ft.
From , To Ft.
13. GROUT: Depth
From 07 To in O Ft.
From______ To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From " To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From, To_
Diameter
rI
16. REMARKS:
IiI�
I DO HEREBY CERTIFY THAT THIg 4NST�D IN
• D
CONSTRUCTION STANS, AND THAT OF THIS'RECO
Top`o�raphic/Land setting
❑Ridge ?Act
❑Valley DFlat
111i((check appropriate box)
Latitude/longitude of well location
(degrccsminutes/seconds)
Latitude/longitude source:OGPS0Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatiop Description
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. M. teriPl,, numbers and common road names.
Method
Slot Size Material
in.
in.
II, Mgij ria' -
-o
S
W
ACCORDANCE WITH ISA NCAC 2C, WELL
tD HAS-BE'Ehl PROVIDED TO THE WELL OWNER
_3ioz
SIGNATURE OF PERSON CONSTRUCTING TWELL 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
North Carolina - Department of Environment and Natural Resources - Division of Water Qualit
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 8r art.“ L
WELL CONTRACTOR COMPANY NAME greA-0.4._ , /,( Pary . Gz.%,.I I d Pid np p'`),..e
STATE WELL CONSTRUCTION PERMIT# /l/ J ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
247243
y - Groundwater Section
CERTIFICATION#/3/2�/i`r`/
PHONE # (O'np 4^ `f'O . 3/7z7
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IfOther, List Use
2. WELL LOCATION: t /
Nearest Town: Ili e S kr- County V 0.-aA
ko e JeA_ 1_ rat c
(Street Name, Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER:[t2��'I-'
Address P n L trl[•_ -Cc' a
t�(Street or Route No.) 9�... .). a c.
City or Town Ste Zip Code
( )-
Area code- Phone number
4. DATE DRILLED `- I L, 1.) a
5. TOTAL DEPTH: 1 OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IW
7. STATIC WATER LEVEL Below Top of Casing: 4DO 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. 1
9. YIELD (gpm): ) METHOD OF TEST 2 kr.s .
10. WATER ZONES (depth): 46 ' - I�D-
(PDC ' - 11 2 ct Fvv,
11. DISINFECTION: Type H-1-I-1 Amount J /.11
12. CASING: Wall Thickness
Depth Diameter
From D To33. Ft. to s'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 TO,lt7 Ft %'.�. ± -1-6--1.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
or Weight/Ft. ater al
1V
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topogr hic/Land setting
❑Ridge R.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
G 3
_9a '705
LOCATION 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 CONSTRL\
CONSTRUCTION STANDS, AND THAT A COPY OF T
4-9
SIGNATURE OF PERSON C
Submit the original to the Division of Water Quality, G ound
27699-1636 Phone No. [phone], within 30 days.
D Saal PI�Via
UCTI cTFbE'KEWLn2
C 2C, WELL
HE WELL OWNER
DATE
'ater Section, 1636 Mail Se nice Center - Raleigh, NC
GROUNDW`,,ER 1EOJON GW-I REV.07/2W1
ASHEVILLE R`r_;.. '''^..E_
J
r

250770
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) 'Ytf r .'i ?kJ CERTIFICATION # :QV/WELL CONTRACTOR COMPANY NAME Grre !s'/. a Yt S. 1)T t U-I1 at / ni`t �,P . PHONE o ftco La « -3 7d /
STATE WELL CONSTRUCTION PERMIT# /46 .2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residenti$ - Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
.2, WELL LOCATIO
t T Ws^^yttLL'' CooLnty
g
ryp
(Street Name, Numbers, Community, Subdivision, Lot Nd., Zip Code)
3. OWNER'Frr a v4 / 11e—ut `To—n
Address P D Ben_ !Lois
n (Street or Route No.)
l NC
City or Town • State Zip Code
Area code- Phone number
4. DATE DRILLED I q - D Q
.: 5.'3TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO-14-
7. STATIC WATER LEVEL Below Top of Casing: ,2.i0 FT.
(Use ••+•• if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated atior below land surface requires a
variance in accordansj with 15A NCAC 2C .0118.
9, YIELD (gpm): / +b METHOD OF TEST a r
10, WATER ZONES (depth): '+DO ' — Y4- q p r-n
11. DISINFECTION: Type )4T i-1
12. CASING:
Depth _ r
From () To 4.26 Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From. O To . D
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Diameter
yr
Amount /3-8
Wall Thickness
or Weight/Ft. Material
,DVe.
Material Method
Ft. Cb Arleta
Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Slot Size
in.
in.
Material
Material
Topo raphic/Land settiag
Midge lope ❑Valley 'OFlat
(((check appropriate box)
Latitude/longitude of well location
(degrcesminutcyscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ForZnytion Description
D
„as RUS'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
JUL - 1 2002
GROUNDWATER SECTION
ASHEVILLE HbUIUNAL Urrlt,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARD$, 4ND THAT A COPY OF THIS RE AS BEEN PROVIDED TO THE WELL OWNER
1 ,ate
SIGNATURE OF PERSON CONSTRUZTING THE WELL DATE
-13
eV
c
0
cim
o�
cm
c.c
32
^'c
cnm
rnz
talis
--t
0
z
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07/2001

266262
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section / _
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [T1)*e VII5 I Jj') I) lrA fvb CERTIFICATION # .1/7 Y'
WELL CONTRACTOR COMPANY NAME h11iC p1I Illeil�i V'r ll-R Q((�.ynCi PHONE #i'a ,7/e2 L!-3 �-64
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ4ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential L2---Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: SVA-2 /�/C�_ County -J a C/c-3 ❑Ridge ❑Slope ❑Valley ❑Flat
JJ t7c'L//C/C L) f1 eei / /1? -�;� 1, ec, `C�' (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 2 c 7% `j Latitude/longitude of well location
3. OWNER: Al 0- 4 --f- /�
Address f q k y L q
(Street or Route No.)
12 41 l e/0 4 /C _
City or Town State
Zip Code
0-9- 2/c2h
(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 /.--) -/ 9-D�7
5. TOTAL DEPTH: c e-as
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: - /> FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST_ /029
ID. WATER ZONES ( -S51 7S U
LOCATION SKETCH
11. DISINFECTION: Type ��J" Amount ,�TAE. S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weighl/Ft. Mateppl numbers and common road names.
0 Depth - Dia eter
From To -t) Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To r f) Ft. (p, "7'7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
P
Method ,
OCnAx
Slot Size Material
in.
in.
Size Material
From To Ft.
a
O
16. REMARKS:
r Dp H Eft C$RT({'Y T.
II U DN-STAND
Stibmit_iheer rFttut l,plvisio
27 j636 Plkogt Nro (919,11733-3221\
WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER
ae
0 / mil-b- /
Gtivcci ~ /? / - D
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

263502
WELL CONSTRUCTION RECORD
Nonh Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1TT.e Dh15 I'TY) � )i Ai CERTIFICATION of (r°
wELL CONTRACTOR COMPANY NAME pflI Jc-��In.�r-i 1/19,IIvi I ^/( j.nc') PHONE 44211S24-3 L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential id---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-/en V) 112. A/ county Tea Lie Snry
�r EJ/ vhre4�t+ 2Z. Q'rnnn•
(Street Name. N-uummbers, Community. Subdivision, Lot No., Zip Code) l 3. OWNER: r lyl 14 l
Address ,/ S'b ,z)Eb,-bJ 5pk
(Street or Route No.) r� w)it uji A/� ��/-1-3
City or Town State Zip Code
F43) S73 - ()Or7
Area code- Phone number
4. DATE DRILLED 1 j — 2{ — d ,. t
S. TOTAL DEPTH: 3tc45-'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SS 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.
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): 3 METHOD OF TEST /I(JIUi J--,
10. WATER ZONES (depth): S S " (e) S' (�
/�
LOCATION SKETCH
11. DISINFECTION: Type it fj/ Amount 4 %4 AS Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter orei hr/F Wt. MMatep1 numbers and common road names.
From 0 To n2 ( ELY
From To Ft,
From To Ft.
13. GROUT: Depth Material
From ( To Et. coo , Dr
From To Ft.
14. SCREEN: Depth Diameter Slot Size - Material
From To Ft. in. in.
From To Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
Method
Su
From To
From To
Ft
Ft.
CEBY CERTIFY THAT THI
UCTION STANDARDS, A
Or--F�U(,;GVIRTER SEoli tdATUR
LuIOIJAL OFNCE
rttit t�QH{tiis: - •,
WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
0
276•'- 636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

263501
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 5�-(2, n h 15 1-11) II den £ •
w ELL CONTRACTOR COMPANY NAM&
4,nrs (rtlIaa4 Wei Ij,r,Ii;-Lra.j-nej
ASSOCIATED W ERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
CERTIFICATION p el /7 40
PHONE #i/ri% 52Y-3 U
I. WELL USE (Check Applicable Box): Residential Lai-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: 5_ y /you /I/ L County
�OCICStot)
,r ee/C GQm rI ,
(Sireei Name, Nuu ers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: .IJL_tI, c, �Ox
Address c1%,o- Byx l7
(Street or Route No.)
DIL-flee �C� C 3
oC ty or Town State 6 Zip Code
Area code- Phone number
4. DATE DRILLED l I - S -
5. TOTAL DEPTH: �3o--S
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
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO OJT
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
/
8 TOP OF CASING IS FT. Above Land Surface'
•Top of casing fermi n ated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2-7L-7S METHOD OF TEST h/O7lw7L�(-�
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.
11 DISINFECTION: Type Hfi` Amount r-2 T41 S
12. CASING: Wall Thickness
0 Depth Dia eter or Wet ht/Ft, Male I
From To, fl Ft.__ I/k pV
From To Ft.
From To Ft.
13. GROUT: Depth
From O To r`
Material M
Ft. Co7yt bat riQyethoii(d
From To Ft.
14. SCREEN: Depth Diameter Slot Size - Material
From To Ft. in. - in.
From To i Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
O
y
16- REMARKS:
(0 -I R,OrY E IIF ' Hk.
V RI'rt'I 4Nrni D9
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT COPY F THIS RECOBEEN PROVIDED TO THE WELL OWNER
l+QC(nn 11-5—D 2,
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
0§ 18314 . 1 3j3.3-3221, within 30 days. GW-I REV. 07/2001

263500
14. SCREEN:
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Sectiony/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [�-envilS I'M/TJQ�s'v lv� CERTIFICATION #d- / 7 le
W ELL CONTRACTOR COMPANY NAMt nnig I IaM4 ti)et��-1 vrr l�`L( j,nP v PHONE # esi.Sa 4--3 o7-G 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentialld--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Town: .2.47 N r -22 N( l�C_-K County c 5 ark—,
(p & 9 &OC.f[.c] £ /aa4-c,e-- t c-(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 04r. cf)�((-�?Q/7QLyU
Address o- / ,4 3
(Street or Route No.)
&G/h;i ;-ex 4/c__ c? 52i-
city or Town State Zip Code
Area code- Phone number f V D
4. DATE DRILLED 4
5. TOTAL DEPTH: �"5'(05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
b TOP OF CASING IS / FT. Above Land Surface
•Top of casing terminated at/or below land surface requires a
variance in accordance wit 15A NCAC 2C .0118. - -
9. YIELD (gpm): METHOD OF TEST_ hi/li7L�}--�
10. WATER ZONES (depth): b.S (�
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
Il_ DISINFECTION: Type
12. CASING:
n Depth
From 0 To
From To
From To
13. GROUT: Depth
From n To r�
LOCATION SKETCH
Amount TA-g S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Wei ht/Ft. Mate- 1 numbers and common road names.
Ft. o' /f P✓C
Ft.
Ft.
Material
Camnt,t
From To Ft.
Depth
To
From To
15. SAND/GRAVEL PACK:
Depth
From
From
Ft.
CLI
Method •
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
To Ft.
To Ft.
Material
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
0
II-7-o 2
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

259889
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
;hen CONTRACTOR (INDIVIDUAL) NAME (print) Ln n75 I-)- !i(L. rlv ' CERTIFICATION M cZ/710
WELL CONTRACTOR COMPANY NAW:1)2.I r i jd&)n.,n -t WP,11 k)Yet 11-1( Q- 17P4. P J PHONE M Qd-5( ,.J e21-i-3 sV-G' 6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W44ERMITS
(if applicable) - (if applicable)
WELL USE (Check Applicable Box): Residential id-"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 6 le h✓ r l l C Ale —County 3 L! (_(CS pyLJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I1'C kjc 1C-124 'f Z
Address SOY-- / ; rn 10,e ✓ La-1. A
(St eet or Route No.)
Peuka_t ; r / 3a S1os—
City or Town to Zip Code
L-rm - 41302l
Area code- Phone number
4. DATE DRILLED 7' —o
Z
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
5. TOTAL DEPTH:
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)
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): X2 METHOD OF TEST /07/JL7L!{-�
10. WATER ZONES (depth): 7 0 (�
11. DISINFECTION: Type Hill Amount
12. CASING: Wall Thickness
Depth Dia eter or Wei ht/Ft. Matepl
From 0 To c� 7 Ft. pY N.
From
From
GROUT:
From n
To Ft.
To Ft.
Depth
To r Ft.
From To Ft.
Material
Com 47
LOCATION SKETCH
ram" T,4I S Show direction and distance in miles from at least
Method
po,A2)
SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
U L I V C
SEP 1 8 20021�'
Submit the originafter tte Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (9190 733-3221, within 30 days. GW-I RSV. 07/2001
GRGUNDW'TFR S OT rinl
AS-EVALi_E ICI
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
� P- •;..,�,:.r ,. _ .RDS, AND TH`/�TA COPY OF THN�COBEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTTResources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cl)e n ✓) I S I I7 i9M n� CERTIFICATION # d.17 (to
WELL CONTRACTOR COMPANY NAME Wei I41{t I j, rigv PHONE n?2- '_S.2 4-366
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ'4ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATN:
Nearest Town: Ctl l3lll het h�[Sounty (I�� ��5 j/yL,
n
(Street Name. N-ulifbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1Ct../1Vann Ace Vigo Y I
Address 8" (- "7-; /`Gi c-'Q tact
(Street or Routed )
0-1.4 PI,h/1h`LL
Zip
) 3_ Snrn_
4. DATE DRILLED-6 `o
5. TOTAL DEPTH: 3 SO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
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 ISA NCAC 2C .0118.
9. YIELD (gpm): -3 METHOD OF TEST h 27LC,,�+
10. WATER ZONES (depth): /b0 (�
City or Town State
Area code- Phone number
254446
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
3
ode
1 I. DISINFECTION: Type HI-1 Amount
12. CASING: Wall Thickness
Dia eter or Wei hUFt. Mate al
efed
Depth/!7
From 0 To S Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To c 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.
MaterialCO 4-p
Method
16. REMARKS:
LOCATION SKETCH
r2 71). S 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
fl
I bb [U5RH3Y CER�T1FYi3
r— CONSTETCTTON-SYANP
Submit the origina.l-io the
27699-1636 Phone Nof_(919)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
5. AND THAT A COPY OF TH)S RECORD BEEN PROVIDED TO THE WELL OWNER
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

254447
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2ty1. p� (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
S DEPTH DRILLING LOG
Zip Code
)- 7f. 3 - '/G st/
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl-- Divisionof
Ce
of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s2 f7 h 1 5 IjJam\ A. CERTIFICATION # 01.�7
WELL CONTRACTOR COMPANY NAM&1Xmni s IIf,ri l. ynPHONE#irg&i_6;,2 —3 2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 3:9 (v'Q /VC-- County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /r a-rel 26, cnAri
Address () r b)c
(Street or Route No.)
v; Nw i//C
City or Town State
Area code- Phone number
4. DATE DRILLED — 7 -a
5. TOTAL DEPTH: ,ate?
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VJ-
7. STATIC WATER LEVEL Below Top of Casing: 2Q 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. `/u, /,
9. YIELD (gpm): SD METHOD OF TEST h 2/r74
10. WATER ZONES (depth): 50 / 3 D (1
From To Formation Description
LOCATION SKETCH
11. DISINFECTION: Type HIP Amount 4-TA-AS Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From r / jj +�
p Dia eter or Wei 10./Ft. Mate 'al numbers and common road names.
From do
From
Depth
0 To_ «'�-Ft. ”
To Ft.
To Ft.
13. GROUT: Depth Material Method
From n To r--D Ft. �7714y� rJLSLVCJ
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
14. SCREEN:
From
CONSTRUCTION STANI1
2_
From
From
It , KElvl R�: .
I
i 1)0 tieRtHY CEIt. I HY iTif T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-Cs
W
W
CD
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
the p[igi0aditfF [he ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

251544
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources��- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) In n-1 S I"I27 tin q")a, CERTIFICATION # J/ 7
WELL CONTRACTOR COMPANY NAMTk fTIh$ Iibl!Oth uiei: ih 611 JPHONE # e,P1 24-- Saba
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDQWQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential rtnicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: (3 it ✓t .;,c-Iisr°/VC-' County TLkSa
,- Hie mPn* (Lea
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r OIn./k Fo
Address 'l f h int -(h Al4 r /
(Street or Route No.)
l llowhee- C-
Zip Code
Cj(y or.1 ovuisra
Area code- Phone number
4. DATE DRILLED �-/7-OZ
5. TOTAL DEPTH: ,500
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO yy
7. STATIC WATER LEVEL Below Top of Casing: /Sl) 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): 3 METHOD OFTEhJO2» t
10. WATER ZONES (depth): , 3gv '
N ta
,�rC7
11. DISINFECTION: Type HfN-
12. CASING:
Depth Diameter
From 0 To j/0 Ft.
From To Ft.
From To Ft
13. GROUT: ,( Depth
From ToFt.
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.
Amount 2T��S
Wall Thickness
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From - To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
Material/
16. REMARKS:
Method
� (Ik
Slot Size Material
in.
in.
Material
-o
CO
CFI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
[ (PONS,IRWCTIQNrTANS RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II� (J1� ides.,� l7_ a
UU SIGNATURE OF PER ON CONSTRUCTING THE WELL DATE
11
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone N [phone], within 30 days. GW-1 REV. 07/2001
GROUI:DOIA'. ER SECTION
ASFIEVILLE REGiC)LPL OFFICE

3
251215
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcess- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (-)-e_YIN t Weil
TT!Q�Y1d CERTIFICATION #r'i-1761
WELL CONTRACTOR COMPANY NAMES7)€k7rnM IQ17/(/f_.. rl Weil d)Yr II /Yt6�.%fL C. PHONE #2t 9 tf-39- & 0
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ntetpal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2. WELL LOCATION:
Nearest Town: 515 V0.- / t County IS a C-(CS 'j D
F)a-1- L 5tetIeS
(Street Name, Numbers, Com unity, Subdivision, Lot No., Zip Code)
ax 9 h-7
(Street or Route No.)
n I0.,(-,a s N C— f 19 /
3. OWNER:
Address
r
City or
Zip Code ^
Area code- Phone number
4. DATE DRILLED /1 -i t -O .--
5. TOTAL DEPTH: 30_5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I —
7. STATIC WATER LEVEL Below Top of Casing: I 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 ISA NCAC 2C .0118. 9. YIELD (gpm): 3 O METHOD OF TEST A/117///Yt-/ -
10. WATER ZONES (depth): /75, ,4(7D (�
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)
DRILLING LOG
Formation Description
DEPTH
From To
11 DISINFECTION: Type
12. CASING:
Depth
From 0 To 3 7
From To
From To
13. GROUT: Depth
From f) To 0-0 Ft.
From To Ft.
14
�fhi
Amount )- 17)- C
Wall Thickness
Diameter or Weight/Ft. Material
FL (p, ` . I Se5(
Ft.
Ft.
Material
r2�rr.-0.✓T
Method
�rslvv�
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
VT 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
JUL - 9 2002
J
Submit' the ortinQal o the
ASHEVRitGNAL OFFC919)
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-I REV. 07/2001

245804
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• th-Pt1 n g 1-n j) AM a (.* f) h t- 11 t..4 �h
WELL CONTRACTOR CERTIFICATION #: .5 - , /770
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential " Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION jJShow sketch of the location below)
Nearest Town. )si / /-' n^—, «- County. : 1 et(h C AN m
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER (7)/?n•--` .�aCa%G'Sro, From To Formation Description
Address 5`f- (; 2)t2r1 ?1 crl—1 1 (/1 .1) lZ
(Street or Houle No �; `� /C'ems- A% ��T 17 7 .7
mica( Town State Zip Code
4. DATE DRILLED / -/4 -O %--
5. TOTAL DEPTH * 6-
6. CUTTINGS COLLECTED YES Q NOO-
7. DOES WELL REPLACE EXISTING WELL? YES Q NOR—
B. STATIC WATER LEVEL Below Top of Casing: .q'"n FT.
(Use sr' it Above Top of Casing)
9. TOP OF CASING 15 / FT. Above Land Surfaces
Top of using terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0113
10. YIELD (gpm): �S METHOD OF TEST GJ//V/lf f (1f-
11. WATER ZONES (depth). S-`C- /
12. CHLORINATION: Type /t
13. CASING:
From
0
From
From
14. GROUT:
Depth
To Ft
To Ft
To Ft
Amount `/LI /6
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Diameter or Weight/Ft. Material (Show direction and distance from at least two State
(C ' ( /kV Pc to, Roads, or other map reference points)
Depth Material Method
From 0 To ,Zit` Ft 0 Grn tri i r) fr?A A
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in In
From To — Ft in In
From - To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMAR
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
cn o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

266278
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L'r401/4/ (dike -CERTIFICATION # o2-287
FfllfdfL &( �/rIC' ✓L PHONE # gal `Jtir'egSO
WELL CONTRACTOR COMPANY N:\ME 9""
S AIE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential l/ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: WJi -14-1
T6roMOS 11IMl&1 ,ed
(Street Name. Numbers, Community.Subdivision, Lot No.. Zip Code)
3. OWNER: TbI7 /Y7' bC6
Address wh,f-f. el' N-C- 0-Sr7 get
County 4C/CS or✓
(Street or Route No.)
W!t r <h'ar �y. L'. .Zd 7d'9
City or Town State
4d8-Got
Zip Code
Area code- Phone number JY
4. DATE DRILLED JJ_
5. TOTAL DEPTH: (4O'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ere
7. STATIC WATER LEVEL Below Top of Casing: /oC 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): 1 Pk METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
DRidge BSlope ❑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 ulpr'NL Amount .2R CtS
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To So Ft. 6 %y- 71).'C✓LIOW pi/C..
From To Ft.
From To Ft.
13. GROUT: Depth Material/
From / To 2�4 0 Ft. m1Mt
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
Method
`I,prjS d
✓✓ il�(iLy P-f
From To Ft.
From To Ft.
6 ull. N11/
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads.
numbers and common road natijes
V'fr
C�
.^l.A/F M,
Wh
Include t% road
rX wzite
O
'L
fS - II
L.0 ELL
Y—GCITIFY THA"
NSTRUCTION STANDARL
A
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIC,, ATURE OF P
Su�T1t� (i' a"t_'�.�°t` rt'isiot of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276)'1-f63_lip61 hmn . )i9) /3S-322I, within 30 days. GW-I REV. 07/2001
pRONSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalnResoeurces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME C('print) Cle Le 1.A/r✓�f_ c41(c4 CERTIFICATION
4pP-387
WELL CONTRACTOR COMPANY NAME F41tct� (.r.12t1 L.y111. PHONE # (3231 i6o-o 13P
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
263106
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: W js:.4?%t.t
County 5gcfC f
I/atm& Ru1$r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jlnt MArffA+
Address 3(re VAr/t,,,( (L,'
(Street or Route No.)
t..tk;44rz,t. W G-
aB/ 13
City or Town State . Zip Code
lap )- i#q '1 _ r7 Ca,
Area code- Phone number
4. DATE DRILLED 9-r2R-o-
5. TOTAL DEPTH: 'a$G
6. DOES WELL REPLACE EXISTING WELL? YES Er NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /C0 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): 10 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
'Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1!. DISINFECTION: Type C ferhv&
12. CASING:
Depth Diameter
From 1 To I Si FL G. tktp
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 1 To A0 Ft. &Awl- OUMPcs.(
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.
Amount /( CA.MS
Wall Thickness
or Weight/Ft. Material
71i,Y.E (.tiitl Pvc•
16. REMARKS'
(� I bb f-^RF�Y t FRTfF,YI T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I CONSTRUCTION STAIhD DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_II II
Size Material
ry
LOCATION SKETCH
Show direction and distance in miles from a4Tleast.._
two State Roads or County Roads. Include Ibe road
numbers and common road ..mesd _`? _ -
Ala X`�` iNr-_...
11G P
S4e
94
c L'
6 -'
9.
3 *lc0
SIGNATURE OF PERSON STRUCTING THE WELL DATE
Sliti113iMhT Fb6 �191io the ['vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
12\7 44.1 F I 3 3221, within 30 days. GW-1 REV. 07/2001

254766
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res ccs - Di ision of Water Quality - Groundwater Section
VA ELL CONTRACTOR (INDIVIDUAL) N.-AA�I/E\ (print)�rrt)�((clYY�y /�,(`, /�q LJ.L }S CERTIFICATIION'#�7—' 3
\YELL CONTRACTOR COMPANY N:ANIE f ppo I UCy\ I (1 k. t/`� I I - I ) 1 k1'Y�-Q PHONE # ��y 6 pS]ZZ3
11 // J 1' • N zCAS Z.
ST ATE VAELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential OY !Vlunicipal/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' yLfSC)I{ Cl.4/founty �C
(Street Nam e. Numbers. Coihu tunity. Subdivision,)Lot No., Zip Code)
3.OWNER:RANT-4kA fiQY
Address 3
(Street or RoutLAN,Q.1
City or Toren State Zip Code
Area code- Phone number
4. DATE DRILLED CO 7---
5. TOTAL DEPTH: 3 C�/r[ /
6. DOES WELL REPLACE EXISTING WELL? YES , O
7. STATIC WATER LEVEL Below Top of Casing C)
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
'Top of rasing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3C METHOD OF TEST _al • 168W-C)iJ
N51 3p
IA-
Topographic/Land setting
❑Ridge �yampe ❑Valley ❑Flat
(check appropriate box)
Latitudeiloneitude of well location
(degreesin i nutesrseeo n ds)
Latitude/longitude source:❑GPS❑Topog raphic map
(check box)
DEPTH DRILLING LOG
From To Formation Dcscrip_ti_ooz-'(44,
fV
11. DISINFECTION: Type \sPi`g\..- � Amount Z
12. CASING: Wall Thickness
Depths Diameter or Weight/Ft. Material
From 0 To 1 0 FL
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From To Ft.S'W\CYcl-C, JAY -
Front To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND'GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
R
L
11 2
1.{,E. IAI4tS:i
� c
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.
Ws 7z
I\NQvvN55 C0 VC,
I DO HEREBY CERT
CONSTRLCTIOIN�i
GROUND?,;: S
ASHEVILLE _DONj
�10N
L OFFICE
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
�DS.AND TH. A COPY 0 - HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the oli��!inal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 31) days. GW-I REV. 07/2001

249505
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural 'Q'�Ps'rTrurces - ivision of Water Quality - Groundwater ection O j
(print) ) �r)(cS x" E ` CERTIFICATH V M Z� z ��
WELL C05rRAClOR (INDIVIDUAL) NAME (P ) /�G C{
jQn(�„fleiCL+d PHONE II 0 D 1
1VEL1. CON] R AC FOR COMPANY NAME '�f'-^. 11 11 - act) Z_
SEATE NTa.I. CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERM!
(if applicable)
1 WELL USE (Check Applicable Box): Residential Q Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL L.00.AT10Ni ,• p
Nearest Town: k/ 1-f Y\ J) 1 1 CL County.3"M
(Street Nunc. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: hOZ(�
Address ef -( '<(
6'L
/� (S``r• teta R ire b)
nVI I
Zip Code
City or Town State
)-
Areaode.Phonenumber •z_ �'
4. DATE DRILLED —
5. TOTAL DEPTH: 'loft
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO iEY
7. STATIC WATER LEVEL Below Top of Casing: )OO FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS ) FT. Above Land Surface'
*Top of casing terminated Wor below hind sarface requires a
variance in accordancetw)ith ISA NCAC 2C .0118. -
9. YIELD (gpmi): /'S METHO,q OF TEST
10. WATER ZONES (depth): 'L) (/) S 5
11. DISINFECTION: Type Iggrer Amount---
12. CASING: Wall Thickness
r Depth Diameter or WeighUFt. Material
c TD (
Ft.
To Ft.__
4
From
From
From_ To_ Ft.
13. GROUT. Depth Material__My.
From To Ft. � `>(� oc
From _ To____ Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Et. 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 0Valley C Flat
(check appropriate box)
Latitude/longitude of well local :in
(degrcesdninutes/seconds}
Latitude/longitude source:❑GPS❑Tope raphic map
(check box)
DEPTH DRILLIi G LOG
From To Formationescription:
o -
N
J
N
-b
LOCATION SKETCH
Show direction and distance in miles frr, n at least
two State Roads or County Roads. Inch le the road
numbers and common road names.
ri ) DUI)
(c49btt1/4-6ee-t .
I DO HEREBY CERTIFY THA ' THIS WELL WAS CONSTRUCT D IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST.AN OS; AND HAT P F THIS CORD HAS BEEN PROVIDED TO THE WELL 0 'NER
Submit f e o
Li27699-1636 Phone No. (919
bECHOR
I SHEHUE REGiONAL fF10E
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
.on of Water Quality, Groundwater Section, 1636 Mail Service Center - Ralel h, NC
221, within 30 days. GW-I REV 07/2001

Notlh Carolina - Ver ,lineal al Envhnnntenl and rlahuul Ileenwcne - lllvlelon al Wain( Ounlily • (houndnnlnr Section 6 2 3 $1
1636 Mail Service Censer • Raleigh, N.C. 27699-1636-1'hona [phone] �/ �' �DH
--ALlen 39eo --
WELLCONSTRUCTIONRECORD WL LC(IIIIIAUIon1E11iirlcnllolln:
S IAl E WELT. CONS1IIt)C11011 PEnr4I I II:
1. WELL USE (cheek Applicable Bat)! Residential Municipal LJ
bldusl1101 0 Agllcultural Li 14onlloric9 U
flecovory ❑ I(eal Pump Walor In(ocllon LI Other 0 II Other, List Use:
2. WELL LOCA11Oft (Show skaich of Illo location bnloW) \�C J
C lnef 0 1c { —County:
Newest town: � r
i11o341131ne and nWnbeel. Convnnnlly, m -Sabin lflon and 1011101 flour l o
3. OWt1E11 r•- r
Address ���jQ N ..? FAT AA --'— ;a _-_--__f�� —
-"(SIie6I o floula• ird -
Cbef_0 4Gzit;c„iie
• env nr low+ Stale
A. DATE UnIu.ED
5. 101ALUEP111 —/_s20_%— l —
IIU
7.. DOES WELL 1EPU\T EI7 Y( 1110 I J t-iu j-�
7. ROES WELL REPLACE EXISIIIJG WELL? YLSI
O. SIAINCWA1EfLEVEL Dalowt(oeleof I singllover Sc))__. _
rr. Above Lnnd Surincn•
9 1oPorCASING IS )_L_— lop of ti+hip Itrndnded el r below land audaee require1 a varl.nc� •ccon —
10. VI llhlsa rn): ._i_ UICINIODOFTESr�------
1U. YIELD I9Pn') ,-�—l� /�� i
1 I. \VAIERZONES (depth): ____—
A AmeUnl -- - 11 additional tree" it noeclt9 Isos' Irate
12. CIILORINA1ION: 'Into �-r`--- �:_- -
UIIILLIIIGLUG ___UE�I11____,
- Gems r, Uesaipr^
13. CASING
LOCA11014.SKcJCII-
Wan lhl, row,'(Slurw Jlreellon and J:z'anr:e lean zf lna::!ro e q
Ulatn Tor or mil hail. i. 1.laledal I`�
peplll �qJ� / L Ilonda, or oUKi r12P lettut!C polio` o
Fool 1
from _ 10 FI. :•�
LA
r10n1 1 o FL ----
14. GROUT: hlalollal Llulhod
Roplll c n 7 �,
now 10 ri. _-_.---------------
15. SCDEEII: iA;dmial
Depth Diameter Slot Sirb
to—ri In. _in.
From In.
From—_lo-11. in. --
Flom __
10 _— FI. In in.
16. SArlo/UnnVEL PACK:
Fore
from 1'
17. REMARKS:
Oep1
to
IDOIIENEOYCEn IFY ITAT11115WELL WA4ill15111
c. ' or 1
collsinucuon AN ,,, SECTION
ASF viiLLE REGIONAL OFF'
' run OFFICE USE UIILY
Duad Ito:
11
CO
C7
1CLEU II ACCOnoN11cE 'Mtn/1 NCAC r. vtELL
lIS nECO110 I IAS UEEII Pr1OVILEo "10111E Watt_L 010EP.
SI011A1011E or rr114OIeIC aI 1111 Cstun�wh)dn 1,)C� y�
SubridI adpin1110 Uivldan of VYge( ouIIy.,W
a
Ea IFIE Y.l:71
Selhl lo.

266199
WELL CONSTRUCTION RLCQEB
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
le ec e- CERTIFICATION P
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7 PHONE / f82 37 �7F7
/e/ Well Dirt\\ its
WELL CONTRACTOR COMPANY NAMEASSOCIATEb WQ PERMITN
STATE WELL CONSTRUCTION PERMIT% if a lWQ
if a Heal* icable
I. WELL USE (Check Applicable Box): Residential 1i7/Municipal/Publie 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Ilea( Pump Water Injection D Other D If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
Cr (degrees/minutes/seconds)F tits ma
Latitude/longitude source:OGPSDTO ograp p
(check box)
DEPTH DRILLINOIOG
From To Formation Description
2. WELL LOCATION: //
-� � 0L
Nearest 'lown:__ —
Uk
en, Community, Subdivision, Lot No., Zip Code)
(Street Name, Nu
City or Town State
(—co e
Area code- Phone number
4 DATE DRILLED /.2 Of J 0
REPLACE EXISTING WELL7 YES O NO W—
L u„. a^ IS Above Top of Caving)
5. TOTAL DEPT111:
6. DOES WELL LEVEL
7. STATIC WATER LE _ Below Top of Curing:
8, TOP OF CASING IS 1 Z IT. Above Land Surface*
,Ton of cuing laminated al/or below AC narsurface requires a
variance In accordance n
(0. WATER ZONES (depth):
�.�j Amount Ge
Wall Thickness
Diameter or Weight/Ft. Material
II.1DISINFECTION: Type
12. CASING:
Depth
From O To�
From LD To m
From To
13. GROUT:, Depth
from D To�
From To
14. SCREEN: Depth
F r011r T^--
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
zJ SO.ez/ ,_d6
Ft. -77/7 e:2/
Ft. ,Method
ats�1
Ft. 0.- as, �
Diameter Slot Size Material
Ft. ilt. in.
I L ht. ill.
--_ �N—_— TCI_I
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and com non road names.
Size
Ft._
Ft.
County 0-kca rt
d wills ISA NC
�r
9. YIELD (gpm): METIIODOFTESTi
Material
v a-ne o u DATE
SIGN RE OF PERSON CONSTRUCTING THE WELL
�ROUhJDWAI C tiE -I GWrI REV.h,NC
ASHEIL' E^ . S. e Division of Water Quality, Groundwater Section, Mad Service Center -Raleigh,
N
I7699-1636 Phone No. [phone], wtlhln 30 days.
0
0
r*1
0
3
o
0
IATT111S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF TI115 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
12 5-02
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat rat Resources - Division of Water Quality - Grain Ater er Section
NtioIII/ii7
WELL CONTRACTOR (INDIVIDUAL) NAME Larkin raft Lt )3
\Jt 11(l �Y1 N P
WELL CONTRACTOR COMPANY NAME ��et PHONE SSOCIATED WQ PEItMITN
if applicable)
STATE WELL CONSTRUCTION PERMIT.
f applicable)
WELL USE (Check Applicable Box): ResidentialQZMunicipal/Public 0 Industrial E Agricultural 0
Monitoring ❑ Recovery ❑ cleat Pump Water Injection ❑ Other 0 If Otter, List Use
Topographic/Land setting
2. WELL LOCATION: Count J 4C�l0YI L aidgc fSlope Malley OFlat
Nearest 'fown:
/« �� y (check eppropriale box)
Lalitude/longitude of well location
(de greee/mi nutes/secon da )
3. OWNER: Latitude/longitude source:OGPSOTopographic map
Address (check box)TH DRILLING LOG
DEEM
From To Formation Description
ClY —
(Street Nam
r
'1Q NCU Y�
iumbera, Community, Subdivision, Lot No., Zip Code)
aR Aed
he COT)
(Street or Route No.)
City or Town Stale
Ares code- thane /!' aZ
ber
4. DATE DRILLEDED
5. TOTAL------
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Rla'
7. STATIC WATER LEVEL Belot(UTop se °If Casing:
bove opo(Cuing)
8, TOP OF CASING IS �'L Ff. Above Land Surface*
*Top of cuing terminated at/or below land surface requires
',fiance In accordance with 15A NCAC IC .01I8.
9. YIELD (gpm): . METIIOD OF TEST4L_ ---
10. WATER ZONES (depth): 3 tib
Zip Code
a �- Amount L✓
I I. DISINFECTION: TypeWall Thickness12. CASING: Depth Diarnetcr or Weight/Ft. Material
To & Ft. 6,2f SD 2 ec
From O 6.23- _
From,ZU Tn�'�--Fl.
From To Ft.
� hod
13. GROUT: Depth�,�tia"Petesfw�
From__ To .2 0 Ft. d _--
From To Ft.
Uimneler Slot Size Material
14. SCREEN: Depth Ft. in. in.
From T^ in.
From
To Ft. in.
15. SAND/GRAVEL PACK: Depth Size Material
To Fl.
To Ft. —
From.
From
16. REMARKS:
tE 166IGERENY wERIfnF T1
264769
3
I p T iA-(iA ON KETCII
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and corunon road names.
80 :ZI 111 01 330 ZO
TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LaWELLOWNER
ce-- DATE
SIGNATU t1F PERSON CONSTRUCTING THE WELL
rR 911N[iiHtt BRodI Jitddo the RIvIslon of Water days.Quality, Groundwater Secllon,1636 Mall Service Center
GW l Raleigh,
2001
^e irIY6b6"4€Sahla4,e°0.G4 3-3221,,vlHrin 30 days.

264768
�J
2. WELL LOCATION: 4-06e'�Counly
Nearest'I owu:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
H./%7'et fSm
3. OWNER:----_��
Address G/ =' A
City or Town Stele
Ares code- Phone number / L
4. DATE DRILLED L
5. TOTAL DEPTH: z2-&
6. DOES WELL REPLACE EXISTING WELL7 YES NO F�
7. STATIC WATER LEVEL Belotf.
`U'op of Above Bop of Casing)
8.,TOP OF CASING IS ET. Above Land Surface*
•Top or casing terminated •Uor below land surface requires a
variance In accordance with ISA NCAC 2C .01 I,.
9. YIELD (gpm): �—
METHOD OF TEST �i__ /�-
10. WATER ZONES (depth):
II.ADISINFECTION: Type ZfT�f — Amount
Wall Thickness
12. CASING: Diameter or Weight/Ft. Material
Depth t SO.eu /27e
rront 0 Tort• �'• Sf�a i
From_J—To 5rf� Ft. L-� ,/f"Y
Frotn To Ft. _
13. GROUT: Depth ate al
To %D Ft. ",,1
Prom__��
From, To rt.___.--- .
d Diameter Slot Size Material
14. SCREEN: Depth in.
From T^._. Ft. it:.
To I't. ip. in.
From
15. SAND/GRAVEL PACK: Size Material
Depth
To Ft.
To
From
From
FI.
Method
ne
WELL CONSTRUCTION RL'LG4.D
North Carolina - Department of Enviromncol and NataalRe Resource Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) YY
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT,
(ifapplicablcI. ) - --
Box). Residential Er-Municipal/Public O Industrial O Agricultural ❑
e .ZYU3
,.Ea P� CER7IEICATION,
SSOCIATED WQ PERMIT,
an pplicable)_
WELL USE (Check Applicable ox .
Monitoring O Recovery O Ileat Pump Water Injection O Other O If Other, List Use
Topographic/Du-id setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuteslseeends)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
PHONE ,
MTH
From To
I O( ATI
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
O
N
0
n
0
0
iV
0
0
T THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�`eterL DATE
S GNATURE OF PERSON CONSTRUCTING THE WELL
t,FOUNCWtfER Sc Di ON
GW-I RBVNC01
,;,,FgbbfinH!-OifFIFIRQitHT6lhe !vision of Water Quality, Groundwater Section,16J6 Mall Service Center- Raleigh,
17699-1636 Phone No. [phone], within 30 days.
0
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CONSTRUCTION ST
1

WELL CONSTRUCTION IiLl:ui.,^. ? G =n� '754
North Carolina - Department of Envirotmlent and Na,jgaIR/esou cee9 - Division of Water Quality - Groundwater
Section Pio yo3
WELL CONTRACTOR (INDIVIDUAL) NAME
E ((print) ✓e ' \ � �` p CERE a fATI llf?V 3
WELL CONTRACTOR COMPANY NAME \ r �t\\CT. V \' \ ' " \\V )\
ASSOCIATE!) WQ PERMITil
STATE WELL CONSTRUCTION PEM1ITa (if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential M vtunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION J o e ,
Nearest Town: lG
id
(Street (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:L Cik
Address __ '
City or Town Stale
(--)"
Area code- Phone number O / a L
4. DATE DRILLED //
5. TOTAL DEPTH. /D 0
6. .Z
7. STATIC WATER LEVEL BelowToplop of Casing:
(� if.
Top of
8. TOP OF CASING IS �y� ET. Above Land Surfaces
•Top or es ;In g terminated at/or below land surface requires a
variance In accordance Ith ISA METHOD ID OF TEST_
9. YIELD (gpnt):. .
10. WATER ZONES (depth): 9t)
County D-4C/Lc4I17--
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
-- 5S
5ES —/O 0
DOES WELL REPLACE EXISTING WELL7 YES ❑ NO ❑
il. DISINFECTION: Type
12. CASING:
Depth
Fro1n_2_ TOE F
Frotn_ r�- �- ToF
from To_ R.
13. GROUT: Depth
Frorn�-_ To
Frorn To
14. SCREEN: Depth
Front To
from To
15. SAND/GRAVEL PACK:
Depth
To
To
Wnll Thickness
Diameter or Weight/Ft. Mate ial
t. 6- .�r?.I
Atc
1..6.•1,5 �S`eoz/
Ft.
Diameter
Ft.
rt. ire.
Rom
From
t6. -REMARKS:
ED IN ACCORDANCE WITH ISA NCA
Ft.
Ft.
C [ u
Goa el
1 OCA71�.-_,_ ON SKTG EI(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common toed naives.
t DO HEREBY CERTIFY MAT TI IIS WELL WAS CONS f RUC(
C 2C WELL
CONSTRUCTION STANDARDS, ANTIIAT»COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1al-
Ihod
Slot Size Material
_ in.
in.
Size Material
�02-21, [ c¢uC—
SIG ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the JIvlslon of Water Quality, Groundwater Section, 1636 Mall Service Ceenier' Rale112Vigh,
NC
2769Q-1636 Phone No. (91,9j 733-3221, within 30 days.
O
N
O
n
0
0
SY
fV

266197
From
13. GROUT:
From P
From
14. SCREEN:
From
From_.
15. SAND/GRAVEL PACK:
Depth
To__
To
Frmn.
From
1 DO HEREBY CE
�1, �Ous R L tpN
l '
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater
rou dwater Section NZ�C�f
WELL CONTRACTOR (INDIVIDUAL) NAME (print) All///i eec WELL CONTRACTOR COMPANY NAME 0% ��� y)ellA
PHONE N 7
1�_JZfy
i
STATE WELL ON PEMITN SSOCIATED WQ PERMITN
ifa licablc) ifs licable
I. WELL USE (Check Applicable Boa): Residential o_ i tunicipal/Public O Industrial O Agricultural 0
Monitoring ❑ Recovery O Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION' /
LNCi'C'/�Yi-P
Nearest 'f own:
id
(Street (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
(Sired or Route No.)
City or Town State
Area code- Phone number
4. DATE DRILLED Lti
5. TOTAL DEPTII: -2-P0
6. DOES WELL REPLACE EXISTING W LLL7 YES, CINO
F-
7. STATIC WATER LEVEL Below Top of Casing:
T.
(Use "+" If Above Top of Casing)
r
8. TOP OF CASING IS FT. Above Land Surface
• •Tap of cuing terminated et/or below land surface require a
v'rl*nte In accordance etith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 41-
10. WATER ZONES (depth): / VC
d �i1L
I. DISINFECTION: Type Amount
_---WailThickncss
12. CASING: or Weight/H. Material
/,'S-
County
TicL/Zsan
Zip code
Depth _ Diameter
Frog To Lj FI. b,�,
From___22_—To FI. G-zs'
To Ft.
Depth Material
To ____ Ft. -14/,1(-6
To Ft.
Depth Diameter
Tr, _ FL ill.
To Ft. in.
Size Material
FL
Ft.
Slot Size
in.
in.
Method
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudellongilude source:OGPSOTopograpltic map
(check box)
pEPTU DRILLJE f O_
From To Formation Description
r OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers end common road names.
sCO
w
IIATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c c C: e.-__- DATE
CROP yNAIL SUMOR1
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Sri
AS L FFL'C !. CFRCE
Tali -CI the or glint! to the Division or Water Quality, Groundwater Section,1636 Mall Service Ceenter- Raleigh,
NC
N001
11699-1636 Rime No. [phone], within 30 days.
i
mr

2. WELL LOCATION: /
Nearest town: i k 2 County 74 aft_
gin
Fej'c\wston r1 d
(Street Name, Nimbus, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,tJe/t Li//
Address 9h 7 4(' (enif
(Street or Route No.)
artesO' n (cC
City or Town State Zip Code
21r u 0t
�rI I�)()(J� PHONE ASSOCIATEtf4Q PERMITS/
if anplicab
(—)
Area code. Phone numbe r6� O Z
4. DATE DRILLED
5. TOTAL DEPTH: i(b�
6. DOES WELL REPLACE EXISTING WELL? YES NO (•U
7. STATIC WATER LEVEL Below Top of asing've npntCasing)
S. TOP OF CASING 15 / 2 rr. Above Land Surface*
'Top or cuing terminated Wor below land surface require
variance In accordance ,20mIsMETIHODOFTEST i�7!"
9. YIELD (gpm): i)
10. WATER ZONES (depth):
yys`
II. DISINFECTION: Type //7W Amount iyees,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 3°
FL G- 25- 562.L1 f'D/6-
From To
From To
13. GROUT: Depth
From 0 To .2P
rt.
Ft.
��yjdta guilt]
Method
Ft.d "6 iesfv
From To Et.
14. SCREEN: Depth Dimneter Slot Size Material
Non To Ft. in. in.
From To rt. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
Ft.
Ft.
WELL CONSTRUCTION RECORD 263548
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'eft(/ leecei CERTIFICATION II
♦IVJC' I I 837-2Y9 ?
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
if aoplicab
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public O Industrial O Agricultural 0
Monitoring 0 Recovery El Ileat Pump Water Injection 0 Other C If Other, List Use
Topographic/Land setting
(Ridge OSlope ❑Valley ❑Flat
(check epnropelate boa)
Latitude/longitude of well location
(deplete/minutes/seconds)
Lalilude/longitude source:OGPSOTopographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
0 - tit) C1a)
f0 - Siff( 5,-em,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ATTiIISSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DTIIATAAS ON COOFTHIS RECORD HAS EENPROVIDED TO THE WELL OWNER
.D- 25-O2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
eigh, NC
GF VI � e Q� �o Ihe� Division sv lliln 3 days. Quality, Groundwater Section, 1636 Mall Service Center REV. 07/2001
ASNEVI errs . (919) 33-3221, within 30 days.

2. WELL LOCATION: y 7acluon-
Nearest'IOwn: ,�S�(�/wa Count
tnectt-xn
rko
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 074ft /i (larel 0vae`i.
Address � Z-tbtil Carst-
(Street or Route No.)
C xtexo't f lac 22 1 \
Zip Code
City or Town Slate
(-J-
Ales code- Phone number
4. DATE DRILLED /O -2Y-0
5. TOTAL DEPTII: 3 00
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U-
7. STATIC WATER LEVEL BelowtTop of assing:enp c01ne) FT.
8. TOP OF CASINO IS l FT. Above Land Surface`
•Top or casing terminated .Vor below land surface require', a
variance In accordance with ISA NCAC ZC AI IS. •
9. YIELD (gpm): /dd METHOD OF TEST /J�' /
10. WATER ZONES (depth): 02 5s-
11. DISINFECTION:'I ype /-f T/t
12. CASING:
Depth
From, D To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To_2,fili Ft.
From To FI.
14. SCREEN:
Ft011
From
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount 14
Wall Thiciuicss
Diameter or WeiglitfFl. Material
GvC-
nei
Depth Diameter
To Ft.
To Ft.
16. REMARKS:
oN5� CTIONSTAND
TAT'
UJS
Siv is
to91-1636 11o11C V. 33.3.
Size
Ft.
Ft.
263546
WELL CONSTRUCTION RLCORD
North Carolina - Department of Environment and Nat rat Resources//JJ- Division of Water Quality - Groundwater Section
y0 -
erir /Ge,Gec co CERTIFICATION N
WELL CONTRACTOR (INDIVIUUAL)NAME (print) / ( PHONE N r8.281 ��'z /c'f �
WELL CONTRACTOR COMPANY NAME `%l'4 "- (,Jell Df ltItf t3
ASSOCIATED WQ PERMITN
STATE WELL CONSTRUCTION PERMIT" (if applicable)
if opplicablc)_
1. WELL USE (Check Applicable Box): Residential O-Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Ileat Pump Water Injection ❑ Other ❑. If other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GP5❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
v - c/NY
/5-- ]oo Gra,'- frt
Method
.(14;^C^
Slot Size' Materiel
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from ateast
two Slate Roads or County Roads. Include d eyoad_
numbers and common road names.
(.J
CJ
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10 23- 02
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
21, w1111ln 30 days. OW-1 REV. 07/2001

263541
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�/ '
WELL CONTRACTOR (irwIvwvAL) NAME (print) /e/7 /eecfi CERTIFICATION N Jya3
WELL CONTRACTOR COMPANY NAME i We% / Ink II l�PHONE N ro zC tni " 17,
-Dr l n0
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WTI PERMIT.
(if applicable)
(if applicable)
darsegrallIS
WELL USE (Check Applicable Box): Residential IEVMunicipat/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:: //
Nearest Town: �6Grol ee
%Ior4Jvck/c ,Q4•
(Street Name, Numbers,]]Community, Subdivision,
,A M4 0LJ/e-
SIC TP,Yti/ Go1Jf.
(Street or Route No.)
Nnarok.e.e. NL 2B'ltCi
City or Town State Zip Code
AT code- Phone number
4. DATE DRILLED /0 `/?- -
5. TOTAL DEPTH: / %0 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B'
7. STATIC WATER LEVEL Below Top of Casing: 2 O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance
with I5A NCAC 2C .0118.
9. YIELD (gpm): C METHOD OF TEST /"llit
3. OWNER:
Address
From To
13. GROUT: Depth
From 0 To 2 0 FL
County ICC/L.10n
Lot No., Zip Code)
10. WATER ZONES (depth): PO
11. DISINFECTION: Type /1 T /l'
12. CASING:
Depth
From 0 To .2 Ft.
From_ To YL Ft.
Ft.
/�
, )vlatf�al ethod
/or77G.i7� Plfore-
Diameter
G•2r
G•2f
Amount //1/ c vP
Wall Thickness
or Weight/Ft. Material
SDRZI Due,
• in? ifs-/
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)
DE DRILLING LOG
From To Formation Description
n _ 3 2 C 14/
72—/465 6rdr,174-e
From To Ft.
14. SCREEN: Depth Diameter
Front To Ft. in.
From To - Ft. M.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
Slot Size Material
in.
in.
From
From
16. REMARKS:
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.
D CN i 1Y �i
alto
ASH
RVUNp pxx
f fOli',: Fjfpftto.(9
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
ID-1. -OZ
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center
I RREVgh, NC
733-3221, within 30 days.

263536
WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Environment and Naat}lral Resources - Division of Water Quality - Groundwater Section .
WELL CONTRACTOR (INDIVIDUAL) NAME (print) We e (--!°i CERTIFICATION 0, VO
WELL CONTRACTOR COMPANY NAME z'iL///c-l�`� ✓iei! Dfilii ii9 PIIONE / (int__>?—'1" -)
STATE WELL CONSTRUCTION PEMtITa ASSOCIATED WQ PERMITMfif applicable)
ilicab
WELL USE (Check Applicable Box): Residential 12---"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ileat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Iongitude of well location
2. WELL LOCATION:
Nearest 'I own: G1e/0Ze"e
LOJ7J /T44CA-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: eryl/L/ r 4i4/
Address 9 jritc'/ es''v�ff
tStreet or Route No.)
Onerous_ -
City or Town State
Arca code- Phone number
4. DATE DRILLED /0-0V-0
5. TOTAL DEPTI I: 0 -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
County J'^aeis-ah-
2B1
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
hip Code
/.26- /f5/
,Lvt 300
7. STATIC WATER LEVEL Below Top of Cnsing: "2 & Fr.
(Use "4" If Above Top of Casing)
8. TOP OF CASINO IS /Z Fr. Above Land Surface°
'Top or centric terminated aver below land surface requires a
variance In accordance vrllh ISA NCAC 2C .0118.
9. YIELD (gpm): /1- METIIOD OF TEST /9' r
10. WATER ZONES (depth):
van)
1I. DISINFECTION: Type /tft
12. CASING:
Depth Dierneter
From_ 0 To 1 FL L- -f
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To FI.
From To Ft.
14. SCREEN: Depth
Fronr To Ft.
From To - Ft._
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Et.
16. REMARKS:
Amount
Wall Thickness
orWWeight/Et. Material
Y ee/
At Ciii
Ic t l
,�Method
y/etJuVe-
Diameter Slot Size Material
in. in.
in. in.
Size
Material
LOCATION SKETCII
Show direction and distance in miles from at (east
two Stale Roads or County Roads. Include the road
numbers and common road names.
0
'.3
Iwo 1REBYV/Etti1FYT~
CONSTRUCTION Sint 3A
AT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
tDS, ANQ,TI IAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
ID- 04-02
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GR NI8NMhM hffRTtf)t1 to the Jlvlslon of Water Quality, Groundwater Section, 1636 Mill Service Center - Raleigh, NC
ASHE14 gl 1,1)K„()4J,Cce "33-3221,within 30days. ,GW-I REV. 07/2001

263537
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirolunent and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL)NAME (print) 47/y �Qeece— CERTIFICATION/ 2VO
PHONE II �.4 p37-� G9 7
WELL CONTRACTOR COrIPANY NAME ///.//e7. Wei( 1'Y IIV%ri
STATE WELL CONSTRUCTION PEMIIT/ ASSOCIATED WQ PERMITS/ _ (if opplicable)
if applicable)
WELL USE (Check Applicable Box): Residential B—Municipal/Public IJ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery O ❑eat Pump Water Injection O Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ['Slope ['Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION:
Nearest Town: CX /0 t‘'e'e—
/i aik y/-oar Ci- e-ek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_ 719GrfAA <14,-
Address LPf / cawrtt.
(Street or Route No.) 2$�
Cnuo*Lce nx.
ci
Zip Code
City or Town State
Area code- Phone number
4. DATE DRILLED /0 or 4-
5. TOTAL DEPTI1: rosy
6. DOES WELL REPLACE EXISTING WELL? YES E NO EV
7. STATIC WATER LEVEL Below Top of Casing:
FT
or
8. TOP OF CASING IS / iL Fr. Above Land Surface*
•Top of casing terminated aVor below land surface requires •
variance In accardencey.
Ith 15A NCAC 2C011a
9. YIELD (gpnt): METIIOD OF TEST
10. WATER ZONES (depth):
II. DISINFECTION:'lype
12. CASING:
Depth
From CL To / 0 2-
From /oz To i-2
From To
13. GROUT:Depth
From
Diameter
6-ter
6 -;Ls'
Amount l`/ `tom
Wall Thickness
or WeigliVFl. Material
JOPzt Pdo
/P.S' Stee/
1�
cr ,. ethod
__f9() /
._To ,2 v Ft.
Front To Ft.
14. SCREEN: Depth
Front To Et.
From To IT.
15. SAND/GRAVEL PACK: Size Material
Depth
To Ft.
To Ft.
(degrees/minutes/seconds)
La tilude/Ioneitude source:OGPSOTopographic map
(check box)
GERM DRILLING LOG
From To Formation Description
0 - /0 D
/00-rS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the toad
numbers and common road names.
County
Yci C
Slot Size' Material
In.
in.
From
From
CONSTRUCTION
Ft.
Ft.
Ft.
Diameter
0
—n
W
CO
TIIAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
7ARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l0- De- 0'2_
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
GRVILLyVATERR$�CTIgqN� OWr1REV.h,NC
ASREVILLE` ATERIJEn 1%?e�al to the Division of Water Quality, Groundwater Section, Mall Service Center - Raleigh,
17699-I6.16 Phone No. tv19) 733-3221, within 30 days.

263538
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nap ra1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) //„e eLe" CERTIFICATION N 2Y03-
WELL CONTRACTOR COMPANY NAME ' /W
%,l/e/- Nell brill] v q PHONE N B �37-Z997
ASSOCIATED Q PERMIT#
STATE WELL CONSTRUCTION PEINTIT# (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IZI--'Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 fleet Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / /G
Nearest Town: C f7 zi fL
ROPOPA CUP (2d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: hi" t £l//49-""cf/t.
Address 5'p Ti, -6 /
(Street or Route No.) �� \�
f )nerot NC
City or Town State Zip Code
County D-GC on
Ain code- Phone number _ / O
4. DATE DRILLED /O _ O
5. TOTAL DEPTFI: D
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO k3�
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secundc)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DE NLOG
From To Formation Description
r/Lvf
/
2ff Z&O �,��•'tz
-
7. STATIC WATER LEVEL Below Top of Casing: / 2 FT.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS
/ Y FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires
•
variance In accordance with 15A NCAC 2C .011S.
9. YIELD (gpm): METHOD OF TEST yl(r
10. WATER ZONES (depth): .25-0
11. DISINFECTION: Type
12. CASING:
is T/t
Depth
From 0 To
From To
From To
13. GROUT: Depth
From O To
To Ft.
Depth Diameter
To Ft. in.
To Et. in.
From
14. SCREEN:
Front__
From___
Amount /i-/C
Wall Thickness
or Weight/Ft. Material
r /y/ ee /
Diameter
FL 6-25-
Ft.
Ft.
Ft.
A,'`" teii O AH�
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
16. REMARKS:
D
LL
Eir6npkEE,Y 4aR'gY
CONSTRUCTION STAND
)v'Y
Method
.i_sr e.
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.
— THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
bS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
to -to- 02
'" 11Rtc� SNATURE OF PERSON CONSTRUCTING THE WELL DATE
�V� ' E43; 5lon of Water Quality, Groundwater Section, 1636 Mali Service Ceenlr, RBVgh, 2001
ASH i 01 1 �dR"`OF 1 9) 7J0-3t2t, within 30 days•

2635:35
WELL CONSTRUCTION RECORD
North Carolina - Department of Env itoluuent and Nat ral Resources - Division of Water Quality - Groundwater Section
eV/ /cece CERTIFICATION II 2VO
WELL CONTRACTOR (INDIVIDUAL) NM1E (print) norm to 28t 83—t-2Q97
WELL CONTRACTOR COM1IPANY NAME //lilies' ell Df l ll) n!�
SSOC TED WQ PERMITS A
STATE WELL CONSTRUCTION PEM11Tt1 (if applicable)
(if applicable) I. WELL USE (Check Applicable Box): Residential Ig- Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery O Ileat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest'fowpit: (hero t .e.
long 11,-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: cCk( Lace -
Address 77;6c./ Caajt
(Street or Route No.) 2�1 \�
c\()romp ilk ZipCode
City or Town State
( )-
County 7aCaSoi'l
Topographic/Land setting
[Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/smooch)
Latitude/longitude source:f7OPSOTopographic mnp
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-to
4.D Sb—,7o0
5. TOTAL DEP'fll: ra} ,260— 5a S
6. DOES WELL REPLACE EXISTING WELL? YES O NO l9
Arcs code- Phone number
ATE DRILLED /0 —b?, o Z
7. STATIC WATER LEVEL Below Top of Casing: re FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 1___ FT-. Above Land Surface'
' •Top of using terminated atfor below land aurraee requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): l METHOD OF TEST Mr
10. WATER ZONES (depth): f 95
ne//7/ Amount d cd�
11. DISINFECTION:7ype Wall thickness
12. CASING:
Depth Diameter or Weight/Ft. Material
�
FronLQ--To Ai/ FI. G..2S •//t S
From To Ft.
From
13. GROUT:
From n
To R.
Depth
To.2D Ft.
,lnter al Wind
1 „c( tress -or
From To Ft.
14. SCREEN: Depth Diameter
From Tel El. in.
From To - Ft. in.
15. SAND/GRAVEL PACK:
Depth
fo Ft.
To Ft.
From
From
16. REMARKS:
Size
I DO IIEREBY CERTIFY Ti IAT THIS
CONSTRUCTION STANDARDS, AND
SIGN
Slot Size Material
in.
in.
Material
y d
rASCONSTRUCTED IN A
rfjh�'l, A COPY OF THIS RECOR
11 11
L,
RE
FPERSONCONSTRU
LOCATION SKETCH ,
Show direction and distance in miles from a(Ttast -
two Stale Roads or County Roads. Include Uie road_
numbers and common road names. ,)
0T
ANCE WITH I SA NCAC 2C, WELL
EEN PROVIDED TOTEM WELL OWNER
10- 02- 02
E WELL • DATE
n,1636 Mall Servlce Center - Raleigh, NC
Submit the original to the Division o Na6'♦!4�( unjlEy`,`Gsourrd GW-I REV. 07/2001
27699-I636 Phone No. [phone], 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) Ge/, J {('ee C'e CERTIFICATION II ot7u-1
1VELL CONTRACTOR COMPANY NAME l/l/e r PHONE s inn toy- 2 yy 7
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/I
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential PMunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELLLOCATION:
Nearest Town: (hero
��e
O/ Selco 2d
County �e2J6n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: £-46 gills on
Address 0'6 Tn6c/ Consf-
(Street or Route No.)
e YlhvC>`100 (V-C ` Ten to,
City or Town Stale Zip Code
( _)-
Area code- Phone number
4. DATE DRILLED 7 `a-Oz
5. TOTAL DEPTH: 3 V6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E'
7. STATIC WATER LEVEL Below Top of Casing: 5'0 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / z- ET. Above Land Surfaces
'Top of using terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0IIB.
9. YIELD (gpm): /0 METHOD OF TEST /lilt
10. WATER ZONES (depth): 330
11. DISINFECTION: Type f>`T4`
12. CASING:
Depth Diameter
Front 0 To 4.2 Y Ft. 6. Ar
Amount kite
Wall Thickness
or Weight/Ft. Material
From To Ft.
From To Ft.
13. GROUT: Depth 13t al
From 0 To.?� Ft. >'a -Mid
Method Mett
Mehods.av C
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Fl. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
262328
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
O - //r C/47
//r-) 410 (rrervi
LOCATION 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
YV
CD
N
0
0
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
slop of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
221, within 30 days. OW-1 REV. 07/2001

2. WELL LOCATIONy �f/
Nearest Town: r C"erore-e
/Only/ tir:PC�
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code)
3. OWNER: Xe/,°2's
Address ', /his./ CP15/.
(Street or Route No.)
nex O't9_2- IUC- ` ()_11-7 1 q
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 2-7/"0e2
5. TOTAL DEPTH: .1'/0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9r.
7. STATIC WATER LEVEL Below Top of Casing: KO FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS / z FT. Above Land Surface•
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): r METHOD OF TEST
10. WATER ZONES (depth): 31-5-
1I. DISINFECTION: Type
12. CASING:
13. GROUT: Depth
From 0 To iz° Ft.
/TI/
//re/
Depth Diameter
From O To /9" Ft. 6- 25--
From /96 To,202 Ft. 6-2
From To Ft.
to ' ,
Ktiv-270.,/)d
Amount 417 ye
Wall Thickness
or Weight/Ft. Material
"VC-
,/YV 5fo-
From To FI.
14. SCREEN: Depth Diameter
Front______ To Ft. in.
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
fytethod
I t.ffil'e-
Slot Size Material
_ in.
in.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natyfal Reso rces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable) _L7/ ElEl1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial Agricultural
Monitoring El Recovery ❑ Ileat Pump Water Injection ❑ Other El If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
l DO HEREBY CERTIFY Tt
CONSTRUCTION STAN
16r RI MARKS:
�L
eeG� CERTIFICATION.
PHONE . j *?) p37-29y >
ASSOCIATED WQ PERMIT.
(if applicable)
County 7ac2I0/1
262380
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - //-1° C/4Y
/20
"eon- .9 0
LOCATION SKETCFI
Show direction and distance in miles from at (east
two Stale Roads or County Roads. Include the road
numbers and common road names.
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
9-31-OZ
See —
SIGNATURE OF PERSON CONSTRUCTING THE WELL
r{ O kiltR of iIQfy_
FlSHE�.'!L°�_�I�FI'efPC4g�P>�r�Ethe C 'vision of Water Quality, Groundwater Seellon,1636 Mall Service Center - Raleigh,
NC
3-3221, within 30 days. GW-1 REV. 07/2001

13. GROUT: Depth
From D To 20
262379
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A// Y Ate G C2- CERTIFICATION NZ.16L?
PHONE N fi�-/)
WELL CONTRACTOR COMPANY NAME /���
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Q'Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ONDlG��
Nearest Town: !�
INVi(\1r-t'S erCx2ek
(Street Name, u//mberr, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , tSYP %& tAh f/
Address yid 7/;GA/ 4'4i/`•
(Street or Route No.) i e�� 1G
('nerc�fpe «�- `
City or Town State Zip Code
County (7tiLgfOh
Area code- Phone number
4. DATE DRILLED % 'AO--CZ'
5. TOTAL DEPTH: gar
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IY
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 cuing terminated at/or below land sat face requires
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): .3 METIIOD OF TEST -"it 7
10. WATER ZONES (depth): )50
1I. DISINFECTION: Type 17/7774 Amount r s'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0To 7`2 Ft. b'ZS, s4f'2(
,/9Y
From 75 To [(3 Ft. 6-,,2,5
From To Ft.
Mat vial
F 4'ff ne
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.
Nlelhod
16 RFMARKS•
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sotlrce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
b / v C/4
lo-Ws"— �/�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.
Ca
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
As"e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ASF{ 7f 6t'h OW-1 REV. 07/2001
7t 4 -16 mac a. 9) 7J� 3221, within 30 days.

WELL CONSTRUCTION RECO-RD 262323
North Carolina - Department of Environment and Na al Resources�J- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((print)/ Ter/y/C`e//e c't CERTIFICATION # ZY0 3
WELL, CONTRACTOR COMPANY NAME %J�,/le/' /N e/t OO^il�/?y -�CZG' PHONE # J )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential iH—Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION `/
Nearest Town: / en.v(ie
/1-3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6-ecrt2
Address C'i�, Th4 -( dogsf-,
(Street or Route No.)
(\nerokee (VC., �� l Iq
CounC/c1Ott
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 6 .2Y-0 2-
5. TOTAL DEPTH: /90
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lY
7. STATIC WATER LEVEL Below Top of Casing: 75 FT.
/ (Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / 2- FT. Above Land Surface*
*Top of cuing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): e METHOD OF TEST
10. WATER ZONES (depth): /OS-
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 60
/7,rif
Diameter
Ft. L-15'
Amount go,�
Wall Thickness
or Weight/Ft. Material
./frr SYee.l
From To Ft.
From_____To Ft.
13. GROUT: Depth �Teleri1
From 0 To2e) F Or arr
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.
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
SU - /to �r. n, l•�
14ethod
CSIwc-
Size Material
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
O
0
16. REMARKS:
D@''FI64BBk' C T Y I
CONSTRUCTION STAN 3
G ftkvaktifirskrig n#40 the D
ASH 27699€1636Phone Nee I(99 9) 73
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
c- On- 2s-O2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
5-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Ngural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A17/ %ee6e- CERTIFICATION B ts.7 Vet?
WELL CONTRACT OR COMPANY NAME "1, Vier PHONE # fig% tif%-2YF 2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
262350
1. WELL USE (Check Applicable Box): Residential ❑ i 1unicipaUPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: // //
Nearest Town: Geitrci County ?QC ¢S0/l
yehty 007/ i:n
(Street Name,flumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: syje/ , e° - "
Address
Cs (Str et o Ro to No.
/o Ti%iti% ��'45�-
ChnrOV
? 211 1Ci
City or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED S "/z-OZ
5. TOTAL DEPTH: 5-5-5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO P
7. STATIC WATER LEVEL Below Top of Casing: / 7f FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / - 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): 3 METHOD OF TEST /%i
10. WATER ZONES (depth): 5-- VO
11. DISINFECTION: Type /7744 Amount Alcy�
12. CASING:
Depth
FronLe2_ To /68
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ,2Z'
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G-.25 bit?, /1L/G
Ft. Oi koC/
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
in.
From To Ft. i...
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
*ef1cis-C.
Slot Size Material
in.
in.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
e'r/'S`
Ci4y
6-ta - GG
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r7
0
c.�
16. REMARKS:
CON ION STANDA
Submit the original to the Divi
22402140,0410011g !lPRt i 9) 733=
/SHEVLLE REGiOFA,. ii"h9^E
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
221, within 30 days. - GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4//) free e -
WELL CONTRACTOR COMPANY NAME ///il ter
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
262349
CERTIFICATION # 2 cidf
PHONE # VIP) PI7-.7FF 7
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential tTh Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO_N:/ ,, /
Nearest Town: cif e/02� County J4CLS0/n
(Street Name, Nhmbers, Community,OSubdivision, Lot No., Zip Code)
3. OWNER: CA/yi/wl/e0f /% ` flee,
Address
T
(Street r Ropte t'47 f� ' �-715 "'km {, C rar(o� IVC =1
City or Town State Zip Code From To
Area code- Phone number
4. DATE DRILLED 5--75 -0Z
5. TOTAL DEPTH: yo
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 4:1'
7. STATIC WATER LEVEL Below Top of Casing: /7.5—
FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 71- FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC IC .01I8.
9. YIELD (gpm): / L METHOD OF TEST fit
D 10. WATER ZONES (depth): /f %/
I1. DISINFECTION: Type
12. CASING:
Depth
From 6-, To /0(
From To
From To
13. GROUT: Depth
From b To 2 D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
rt.
Al741 Amount c 7
Wall Thickness
Diameter or Weight/Ft. Material
Ft. /,-2S� 5Ct t QvG
Ft.
Ft.
a�tffJ� al
Ft. O/'T/G l e
Ft.
Diameter
in.
Method
etlurL
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
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.
VD 77
16. REMARKS:
lErb HLREII Ci/R4Y
ONSTRUCTION SJANDA
7j
- S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
J6, VD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ee��_ S - - _2 Z - D L
1 NATURE OF PERSON CONSTRUCTING THE WELL DATE
Sntirgi 1119 IIIRAn9E691Uww Divisl
INUOV116bb Mine iFS>tL (9I0)CE33-32
n of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
1, within 30 days. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na((tral Resourjes - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (#print)/ //U"ly nee ce-
WELL CONTRACTOR COMPANY NAME .9f1///t-r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
262345
CERTIFICATION 1 a rQ.j
PHONE 1 fW) 837-.2r97
1. WELL USE (Check Applicable Box): Residential fEl--"Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: s,
1V014 Vork
County 7'C410/7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C1t' /y le//
Address ,9 Th 6u / Cog ff-
\QYe�-ud.00 treet�xRoute No.)
tJ 7 8'l I
City or Town State Zip Code
LJ-
Area code- Phone number
4. DATE DRILLED 1-0?-0Z
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: eta FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / L FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5— METHOD OF TEST
10. WATER ZONES (depth): 330
11. DISINFECTION: Type_Y1 //
12. CASING:
De
From D 6 e Ft &,./S r
To
From To Ft.
From To Ft.
13. GROFrom
l Top O jyta 7/41 / od
Fro To Ft. �f l7/g/x 7e5(/r e_
From To Ft.
14. SCREEN: Depth Diameter Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑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
— S' C/Ky
tiff. ft'
._0-60 c/uy
60 - 3 ya
fl ` ?It0
Amount 'Veil
Wall Thickness
or Weight/Ft. Material
Sit?/ "VC
Slot Size
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.
16. REMARKS:
ubmit the original to th - Divis
ASHEVILLE REGIONAL OFFICE
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5 -r-07 — t
NATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

262342
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat,ijral Resour,cgs - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)/C// /(ee G --e,CERTIFICATION'S �ZYO.3
�
WELL CONTRACTOR COMPANY NAME �l/er 4/e// PHONE ti fWk S'.s7-2F5
STATE WELL CONSTRUCTION PERMIT'S T r/D? cf 2 W ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: �ylvt
'rat t Kv-k?,P ` kb
(Street Name, Numbers, Co unity, Subdivision. Lot No., Zip Code)
3. OWNER: Ai 12/ 717e /t
Address % 77^46,/ CON iT-
e/� �� (Street or Route No.)
i ULo\QY0tQC (L'C O ("1/�
County 3-QC Alan
PO f1/4cx
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED Y '' OZ
5. TOTAL DEPTH: /2
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO fib
7. STATIC WATER LEVEL Below Top of Casing: 2 d FT.
c (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / Z- FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / r METHOD OF TEST AA %'
10. WATER ZONES (depth): // O
11. DISINFECTION: Type //Tf/
12. CASING:
Depth Diameter
From O To T�, Ft.
From To Ft.
From To Ft.
13. GROUT: Depth 2,Mat9iai
From 0 To .2t Ft. %0/ 1/ei
Amount 4c
Wall Thickness
or Weight/Ft. Material
.,Dd..2/ ,4'&
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.
Avlethod
/es:are
Slot Size Material
in.
in.
Material
Topographic/Land setting
GRidge ❑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
n —�
y - /.2D
/AV
LOCATION 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-'
;v
16. REMARKS:
<UEf1lONlST
r,I
.ia
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
'2'c'Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to t e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3704iNIMA pgf (. ) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 262341
North Carolina - Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / C Try nee c c-
�79 /cam we//
WELL CONTRACTOR COMPANY NAME
CERTIFICATION # ' if0,3
PHONE # Ian A32-2 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION?
Nearest Town: C hLc° County lac /soh
1-*/ rnr ner 1�i neh
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fk-Ty /Of e-
Address C/a 7n Ah / Can't
(Street or Route No.)
Ciernli Pe n 2.sst1 1G
City or Town State
PC Ftu
Zip Code
Area code- Phone number
4. DATE DRILLED 51-23-0 2-
5. TOTAL DEPTH: ? 5 6 /
Z
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fl�
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 2- FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): 02- METHOD OF TEST "/"
10. WATER ZONES (depth): 7 S o
11. DISINFECTION: Type /7/7// Amount %ic
12. CASING:
Depth Diameter
From 0 To 6 cli FL 6-)2.)-
From To Ft.
From To Ft.
13. GROUT: Depth
From C To a P Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
SORB / oC6/C
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
t
Slot Size Material
in.
in.
Topographic/Land setting
SICrige ❑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
CJ —
rS -790 6/4"2--7
LOCATION 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-i
0
CO
sD
16. REMARKS.
U0dN
:IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ey-L Y-2 3- a Z
P
:1 LL
Submit the original to th Divi
47699-ib36-R#rene-#a733-3
• UNDWATER SE„i ON
vILLE REGIOO,TL 2l.FI"r
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t21, 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) ,ent toeea C e CERTIFICATION # a 90-C
WELL CONTRACTOR COMPANY NAME %%%;//er fie// g'/lI.ioy -thC • PHONE # (PA $&7 - -Z49?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
262336
1. WELL USE (Check Applicable Box): Residential CXMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: herat
D-c4A,nj Cy6L/c
County -3-GlcS0/2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Foy boot'
Address c/p Tr be / CM, /- PO 940_1C
(Street or Route No.) a�
\ \ CLOG R`C UO11CI
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED Y -if-O2-
5. TOTAL DEPTH: ,217)0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: S/O FT.
7 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 2- FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance , with ISA NCAC 2C .0118. Q
9. YIELD (gpm): 7tMETHOD OF TEST J"9 it
10. WATER ZONES (depth): /60
11. DISINFECTION: Type ( 7- Amount 46,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To yd7 FL (--25 /vt' 5/e2
From To Ft.
From To Ft.
,Ma �jria)
To -2 FL
13. GROUT: Depth
From (7
Method
/LSfu/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.
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 Fomtation Description
0 - ?5'
>4-- 2g,
rAy e
(r/ka 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. o --
CO
,D
16. REMARKS:
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
dL
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
final to he 1 vision of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
G §� 4TEHh8bi r1411)(919) 7 c-3221, within 30 days. GW-1 REV. 07/2001
ASH I LE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/ Resources IA).‘
Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) i//LAN , ),� C� CERTIFICATION # 23 98
WELL CONTRACTOR COMPANY NAME 7'i'J I //'Q✓// wVI(' I//-/ /ft Ir9 -PHONE #,( ) C137-- -2597
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l/ Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ykiGt County()A[tcon)
(;pale (rc{
(Street Name, mbers, Community, Subdivision, Lot No., Zip Code)
a.R 1\G
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED ti/W
5. TOTAL DEPTH: ZO /5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EI/
7. STATIC WATER LEVEL Below Top of Casing: Sc FT.
, \ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / Z 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): '22i METHOD OF TEST Th i
10. WATER ZONES (depth): a / SO t
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Y \1Cl1n.1 d 'RV' 'RP QAC \l \ - (degrees/minutes/seconds)
Address (` /n T Off \ (`,pNS\ . Pn ('}'i;`X F-W7 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
Cnefoyco 1•.t. DRILLING LOP
Formation Descriptign
C/G o'
K2 rrh ni;7t I''
11. DISINFECTION: Type f/tiL
12. CASING:
y�
Depth Diameter
From To . (6 Ft. C iy
From To Ft.
From To Ft.
13. GROUT• Depth
From To 2b.- Ft.
From To Ft.
Material
262934
DEPTH
From To
D H/?
y0 2 5'
C)
LOCATION SKETCH
Amount y 2t .N Show direction and distance in miles from at least
WWII Thickness two State Roads or County Roads. Include the road
or W ight/Ft. Material numbers and common road names.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION STAND
Method
Slot Size Material
in.
in.
.ti
(IN„p� �1ED N ACCORDANCE WITH 15A NCAC 2C, WELL
F z1.1_ REOORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT[JILE OF PERSON NCCO CONSTRUCTING THE WELL
w
dhe/31/4-2
DATE
Submit the original to the Division of Water Quality, Groundwater Sectlon,1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORI)
North (arolinn I)Lparlmem orl]IvironlnenI and //Ntural Resources- Division or Water Quality- Groundwater Section
U
Uri I (UA r RA( IURI IADIA'InC AI,) NAAIC (,,riu9)_/j(/ , "4/ t1 u/4P� CERTIFICATION N /�
CI)CINElk lf'Ce IA/di 9-ripp I'IIONE # ff.)6'4?-357yy,�
S"
NI k l I. \\ I.I. ('O\Sll(r("I ION I'EI(\II'IN :\SSUCI VI till \VQ I'ER\IIIIt
lirup,l lic::hle) (il applicab!c)
266487
1 AA'L.LL LSI' (Chuck Applicable I3ox): Resiticn;ial �Munielpali Public D Industrial ❑ Agricultural 0
VIouitoring O Recov-cry 0 Heal Pump Wirer Injection ❑ Oilier ❑ IrOther, List Use
LU
Nearest
I I Town:
i Ill.)N//e
-. �,uu ny, SIII/dRIN1011, In, No.. lip
C del
t f)\VNIi R:
\tltlle„
1CoN J%rCie+
/ct Wc-w r pe
I,C„oa .r Kon)e Nu.)
77y
C,p av lU'.,,: SLR: Lip Code
I -
V,u coil..- Pinola nneiHr
.1 DA„: IRll.l.EU_ / -%7-
ru.rAl. Didn't!:o�
(,. DOES VA'L'LI. RLPI_ACI[ LXIS,ING WELL? YTS ❑ N() Elm
SIA I -I( \A'A I:R I.IIVIIL Rctom Top olCasii 3 1 I.
(us,r rAl,t,,
�. to or CASINO IS PT. Above Land Surface*
"1'up or ca,ing lurwinaled at/or below land surface requires a
c.u'ian¢ in accordant ith ISA :N(..\( _'C .III Ili.
o. VI I[LD I,_hm1: MLTI IOD or TFSf /
lu. AVATI[l:'/ON11S (depth):
I . I)ISINPL(I,UN_ Tvpe Amount
11 C ASIN(i: AVint ihicknesµ
)eptl,L I)i 111CLCr
rl„m o? 1 o �lr> rt. 4, /�
HOW To Il.
I ro111 10 1.1.
I 1 lrl Ol Irrk� Ut nh �g'� ,1 ,, u�+�al \Ictl,otl
I )inn V..-___ I, 2U._ Il. t�'�`"' I- cr,0io
1 tom To Ft _
11 S(,<I'.1'N: ucplh Di:,u,cter Slol ',i,c AIalel'ial
1 win la, I'I.
I iota ro 1-,- m- iu.
ic, yiANl).'likAVI' I. I'A(K:
Dcplli Siic %kiwiial
Tom lka I t.
Hunt
L. li1:.AI:A1(1s S'.
Ir
100 N
Rt� N -•A
al.� II'Ft. & Material J/ e/
Topo I pliie/Land setting
ORidee ❑Slope Kelley ❑Plat
(check al pn,pnc.ic box)
I.atil udellong ilutle of vell location
ltlegleesln„nuics sccoods)
L:uiludeilun �i(utic souree:O(il'SOTopographic map
le1,cck box/
DLI'TI I DRILLIN(i I.OG
rom To Poe Mali ,n Description
/Le
0 -2v
es- °etc
I X)CATION SKET('I I
Show direction and disLmce in miles from al least
Iwo Slate Roads or County (toads. Include the road
numbers and common road names.
/free 79
IS:IIW4 9-NVfZ0
V t t I IIS WELL WAS CONS ERUCTED IN ACCORDANCE AVI rI I )5A NCAC 2C WELL
DS AND THAN A COP': OF TI IIS RECORD I IAS BEEN PROVIDED TO TI IL WELL O\VNEIt
R
JA ! �I slc,N� AruP.E or rN-uoN co�usraacrl�Nc II vvra.l. D,cNe
L.Submit the origin: tl the I)iyision of VValet- Quality, Grouudw:ller Section, 1616 Vlail Service ('enter - Italeigh, NC
CA ovft,!T9q F7c rJFi iZ ' 4J.. 1919) 33-322I, within 311 v. (iW-I RI?V. 07/2001
AS `)ILLG Rr -
IQ l'1—OD—

WELL CONSTRUCTION RECORD
264817
North Carolina - )ej, utnienl or Environment and Na tint! R/esources - Divisiml or 1A'atcr Quality - Groundwater Section J/
\\ ra t. (-I)\-1 lt.\CI Olt (INUIVInC:\L) N:UII. ,rinn-- C' t4 '1-9-1✓,2�e CERTIFICATION H �Y/?
\\1.1.1. CU\'I It \C'1 °II C(I\I I'.\NV NAME ✓,(• LI% ,/i'- (��.^if rlIONE w Wror 642,1'8$1r
SI.\-I t: \\1 1.I. (O\SlItr('I ION REUNITES/ ASSOC' El) \VQ I'E1k\Ir1H
I:1 applicable) (if ap )j licablc)
VV'LI I. LSI'. (Check ,Applicable Box): kesiden'.i:tl NVIlunicipaltublic 0 Industrial ❑ Aericullural ❑
Vlonilorim' 0 Recovery 0 Heat Pump AVa'ier Injection 0 Other 0 ([Other, List Use
VVIiLL. LOCATION
Nearest "own_/Zl/A
County JAB 5-P'✓
(leAft/ /Z -
Isiic 1 ',lime. Nnmhcl,. Common�. Subdn'sinu. Lul So _ Zip( odt.
)\\ NI I:: �i n/��/��jQ�_
. 1,11 ens �7rt-%_//241.herr
t Slr.d nr RoteNo.)
02'i;771
sy/ye.
Cie, el loan SLIT( Lip Code
V de- Phone ntviiHr
HAIL 1I:IIIII) //'tJ-�_
7/56
[(VIAL DII III ... ,/�s t
DUNS VCNLI. RLI'LACL' EXISI'IN(i WNLL? YIiS ❑ NO
S A!R \\A!Id: I.1:A/biI. Below Top of Casio': y,.2 f-r.
(the i1 Ahoce lop ol Cr:ingl
l OP OI' CASING IS ---- I I Abucc I. and Surniee*
• oy or ca.iu„ mrmiu:rlyd :0/or helm% land nurfarc requires a
s:rriluree in acco rdun c. P)I h lie\ MAC 2C .111 IN.
1/- AiNii) (gpin): NILTI-IOD OI' TES( 4/r
lu. AAATI:R /ONES (depth):
I I.
12
I3
����Topographic/Land setting
�lllldge ❑Slope ❑Valley ❑flat
{check appropriate boll
Latitude/longitude of well location
I degrcc.. rllinulcs:.eeundsl
Lntiwde; longitude souree:.OGPSOTo iagraphic mop
(cheek hind
Dlil'"II I DRILLING LOG
'fo Porno lioi Ucscripl ion
- ✓' / - a O ,Civ
DISINFLUIION. Type /f Amount
LASING: Wall Thickness
I )cplh 2 Uiaiyner or AAYiehtla Material,
Iton(4To Ft.
it.&/i/ ,/� 5lec)
Roll' To__-- Pt.
boom To Pt.
c iKO1, l : Depth A \ ateri:d
From 0 i, 020 Pt.'''fa At. /e
Dual "ro I't
SCI;I'I:N' Ucpth Di:une1er
I tom Ill 11- II
I tom -- I o 1
1 ANI): (;R/AA I I. PACK
Ucpih Size VLacrial
Nletliod
rrM1-7
Slo: Sac M:tirl'i:Il
ill.
II1.
I nunu
I9 nm o
0A
l
LOCATION SKE'ICII
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
l-6lw 7
ITS WILL WAS CONSTRUCTED IN .ACCORDANCE WITH ISA NC'AC 2C, WELL
\ND TER.]
ITAT A Mr: CW TI I1S RECORD IlAS UENN PRO" ONO TO THE WELL OWNER
Il-,3Cr_C
Submit the original to lit • Div
-d2f.4A-4f..1fiL'lwaly L1.1:! 733-
(=t1oL
,SLE u:-t
IN;VFURE Of PERSON CONSIRUCII;NC,.1 II AVL'LL DATE
ion of AVater Quality, C:roundwaler Section. 1636 Mail Service Center- Raleigh, NC
221, vv ittin 3(1 (I I s. GVA'-I RHV. 07/2001

\YELL CONSTRUCTION RLCORI)
North Carolina Department ol Environment and'. tural I sou ces - Division or Water Quality -
\\IT I ( I)\IIt\( lint (INI)I\l nt AL)SAM 11. 111 - 4/9 uj»e
\\ICI I C(IN'I R AC TOIL COAIrAAA N.AIII
S I . \T 1: \\ lu.l. CO\S'112t('I ION I'1.11011 IM ASSOCI:\ I El) \rQ rr:R)Irru
itnpplicahlet (iF applicable)
264816
Groundwater Section
(ER I IFI(A UION p 021//
I I O,N E # f A'(y (O�22L5-7
I. AVI11. USE (Check Applicable 13os): Residential Municipal/Public O Industrial ❑ Agricu0ural O
.Nloniloring O Recovery O Beal Pump A'Va cr Injection ❑ Other O It Chhcr. List Use
_. AVIEI.1, LOCAL N
N isa (%9 Count
cc: N,uuc. Kumba.. ('rnnmuuilc. Subd insion, I t1 No
tin ce r Rou:p < 77
-. OAANI.12:.
\tithes,
Topotraphic/Land setting
Kidge ❑Slope ❑Valley ❑Plat
(check aprmrrinlc nos)
I.:niitt(Ic/longitude of well location
Idetgces: tintictcHscccudst
Iafilucic/oncitude So urccl]G[SOTopo gIaphic map
I check boll
1)I . I'TII
to,it s:-uc Lap Code 1-ruin To
��-(
-I D:1TIi DRILI.IiU
v. DOES VCELI. REPLACE EXISTING WELL? YES O NO
7. SIAIIC- VV.A IT21.lVlll. I Blow iop itletisirtthl-
tlSe itAhoy. loll orCusi:te)
TOP OF CASING IS FT. Above Land SurI ce*
'Top or raping Ior:nto:mvl al/or heto'v hind surface ret,tuires a
variance in uccurd:mec 111111 IS A NGAC 2C .111111.
H. YIIILDIgpm).7 iNIIiIIlODOF"IIISh A'/
AA"AI I1R ZONES (depth):
II DIS11II-("IION Ivpc
1)1211.I.ING LO(i
it 1111101 Ucscripl ion
S- vo
iayv. J_�
LOCATION SKIITCH
Show direction :Ind distance in miles Irons at least
12. C:ASING: AV:III Thickness two State Roads or County Roads. Include the Fond
Uepth Di. meter or Ayc:_h6M N. : tcri:d numbers nail colvlmnll road names.
Domf •lop.80 IT. y ,,ij fe./
Front- - _-_-Io
-- 1-'--
1-turn To IT __ ----
pAlaMethod( ROL;I_ Icth
:uu:aro O FIe,�ifs Vmp I hunt
I I SCRI!IiN_ Depth I)iantoter Sip: Svc NI:Peri:11
fowl To 1:1
I'10111 To 1:1. in-
13. SAND(iIAVlil -I ut::_
Depth Size Vltacrial
f-�-� — An,t-nm
Innl In II.
Icon In I't.
It F:\I:\RK5:
Ri/wa3-72/
Submit the or sal u
'_7699-IL t(,1 No •
GROUNDWATER SECTION
ASHEVILLE RECH-H.1C OFFICE
Il I-VF TIPS WELL \VAS C(:NSTRUCITD IN ACCORDANCE AVI III ISA NGAC 2C, WELL
JAMS, AND TI I:AT A COP':" OF TI IIS RECORD I IAS PEEN PROVIDED 10.111E WELL OWNER
s i N:V r0RE OF Pr:I:SON CONSTRUCTING "I I-u1 \YEt.I- Dale
the Division of Water Quality, Groundwater Section, I(36 .Mail Service Center- Raleigh, NC
19) 7 3-3221, within 30 days. (iAV-I REV. 07/2001

WELL CONSTRUCTION RECORD 264424
North Cat Mina - I )epartmmiil or Environment and N'ttulal Resources Division or Water Quality -
\\FLL(OAll(\('i(11(pVDIAlbl 01NAAII (prom) gc1*Lk Lpt
\\ i1 L ('(I\ II( \('I i)U UMW .Vs. \ \ \\Ir fj ,Zt We) I:'-�U/�+Q _. _ I•
St.\11.\\ Ll.l. (l)\SI RI CIAO \I'I:I:\Ill_a ASSI)(I.\llU) \\Q I'r:I(\IFrtt
I i(;gsl•I ieuhlel
Iif;ij �lirthlt)
Groundwater Section
(:r:uI IFICATION k 07549
IIOVI'. Il ( 42
\\'IlI I. I'SIi ((heck Applicable ISO\): Residetllial O Municipal :'Public
Nluniwnng O Recoyely ❑ I Ie;il Pump Water Injection 0 Other
2. AVI:LI, LOCATI(AN: (r It//
Nearest Towm.;4)r0---- (ounlvj 41,14.n/
04Nr,3e Pr,'
(Sue. r NameSubdAnion. ten No /ip ('Lie(
\ddie s 57Y�✓� r e 4 tX '
ISueel w (tonic No t
MG 7877E
Industrial 0 /\' rieuhural O
If Other, List Use VA_V rC k
�` �."Iopograph ic!Laud selling
rr.1 ge ❑Slope ❑Valley Dint
(cheek appnq,rIlte hurl
Latitudellongilude of well location
i.atitude longitude source:OG PSO ropo_raphie map
(cheek bust
DI:I'l'I I DRILLING LOG
Inr(l PorpJdil,y Description
vti /or
7. STATIC AVATER I FVI'L Below Top of Casing. J
4U e "4" If.4hove l'up ol'Casn:ld
S. TOP 01; CASING IS .-_._ liT. Above Laud Surface'
'Tap at casing lei uivalcA al/ur helots land stn'I'acr nvptims a
rari.w a' ill c00i a cc w ill) Ii.\ ;NCAC 2(' .0118.
9. YIELD (cpin): _._1c2.__ IA'IE.Il1OD ()I: IFILST
10. WATER ZONES (depth): - —
DISINITC`IION. Type Arti Amount
12. CASING: \Vall Thickness
Depthp 1 i meler or Weieht/FI. Malerta
From te2 To (aI I:I. •i _.51 -/
From To
HornTo
GROUT: Depth Nteeridl _ _ _ Nhshoti
From 0 To a
Flom To
rlp or , „„„ Sulk' hip (ode
Area rd:- Phone numb
4. DATI- UI(ILLI[D_ y�^'y-O�
i TOTAI. DL:PI'II: iOos-fr
6. DOIiS V\IIL.L. RLiI'LACIi FXIS"I'ING AA'liLI:' V ES 0 NO
15
IG
SCI(YI'.'<:: Ucpih I)1aineter Slot Size NlaIari:tl
from TO I I. in. in.
from To I I. in. in.
SAND/(iR AA'NI. PACK.
Ucplh Size ,Asaloons
Mons To I t.
[room To I1.
RI[\I:\I(KS.
fi
LOCATION SKIiICII
Show direction and distance in miles Rom :o least
two Slate Roads or County Roads. Include the road
numbers and common road names.
4yfrt) 7'/
CJ
11)0 IWREN)" (TRIMI 1' "IlIAT 11IIS VVELI, WAS ('O N'STRUC'IIil) IN ACCOI(I)ANCE AVITA ISA NCAC 2C, WELL
CONS TIMU('"I ION S I)ANI) ARDS, ANI) I1IA"r A COPY of .1111S I(IA ORD I lAS HIEN I'ROVIDPD TO TI IL WELL (iWNIiil:rio
er.._i �� y-oa
✓IGN:A IUI(P: ()r PERSON CONSTRUCTING TICE VVGLI. DATA.
Submit the original to the Division u( \Valer Quality, Groundwater Seeliou. 1636 Nlail Service Censer- Raleigh, N('
27699-1636 I'llunc N'n. [phone], vvithin 3(1 days. (i3V-I RIV. (17:20I11

From
From
WELL CONSTRUCTION RECORD 255201
North Carolina - Department of Environment and Natural RR 'sources - Division of Water Quality - Groundwater Sectiotn, /
WELLCON'I )t:\(Toll (INDIVIDUAL) NA:IE (print) /`e;�„ 4Q7 v/�'f� CERTIFICATION 114'Y499
WELL CONTRACTOR COMPANY N,\\IE73-1-Ce kle,i/.(14—--__...__---_----------- PRONE # quo'
SI ATE WELL ('ONS'I RU('IION ri:It AI II #
il;q,pl iLIlle)
ASSOCIATED \\'Q I'ER\i IT#
(il applictblc)
I. WELL USE (Check Applicable Box): Residential 12"-- NIunicipal:/Public ❑ Industrial ❑ Agricultural ❑
Nluniloring ❑ Recovery 0 lleat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
N//e7a�iccst Town:alO/✓a
c-� DIO de.- i)
County CI 9-667 /
(Street Name Numbers, Coutntuti y. Subdivision, Lot No., Zip Code)
3. OWNER: /'/Yjd Warr( eV
Address 7/ 7 1cafrc 000"Aup
4,
6.
7.
S.
9.
10.
(Sheet or Itou e No.)
N4Y
Cite i I o,en State
( )-
Area code- ('hone number
DATE DRILLED -/7 -002
TOTAL DEPTH: ,�
DOES WELL REPLACE EXISTING WELL? YES ❑ NO G✓
Zip ('ode
STATIC WATER LEVEL Below Top orCasing: *.. I'T.
(Use "✓' if Above Top olCasiug)
TOP OF CASING IS Q. FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. \
YIELD ()win):/ 0Z METTIOD OF TEST �'
WATER ZONES (depth):
11. DISI NFEC'TION: Typc_r/_
12. CASING:
From 'Lj
Amount
WaII Thickness
Depth Diameter or AVeieht/Ft. jylaleri-d
ee )
I-o—LZ FL /o i/V
From To PI.
From fo PI.
Topographic/Land setting
❑Ridge EA''lopc ❑VaIIey ❑Plat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lmiluda/longitude sourer:❑GPS❑Topographic n,ap
(check box)
DEPTH DRILLING LOG
From to Forn)alio 1 Description
O .2v
r20 99
99
//a
//0
ass
13. (iILOUT: Depth Material Method
Front v Fo r70 l:t6%4 k9S,,ei✓7- 100A/
From To PI.
14. SCREEN: Depth Diameter Slot Size Material
From To ht. in. in.
Prom "fu PI. in. in.
15. SAND/GRAVEL PACK:
Depth Size
To 1:1.
To FI.
Material
16. REMARKS:
LOCATION SKE'l'C'II
Show direction and distance in miles from at lead
two Slate Roads or County Roads. Include the road 0
numbers and common road names. CO a
Jilyw a3-741 weS71-
I DO IIEREBY CERTIFY TIIATTIIIS \VELI. WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
("m cO�S"I'I�L-K 1 0N. B"f � U, R k AND "MAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5
flit
I �
4i Submit the original to I to Diisiun of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
L7699-1636 Phone Nu. 191�) 733 1221, within 30 days. "r GW-I REV. 07/2001
OPCUI:UV:/S'ec SECII0N
AS;;E`.,'LLE BEf''Ci'iA'_ CFFiCE
lSz—I�"lJ�
SIGNATURE.OF PERSON CONSTRUCTING TT-IE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and nNNatural Resources
/- p)ivi ion of Water Quality - Groundwater Section
��.��
\ EI.l. ('OYI RAC! OR (INDIVIDUAL) NAME winch[ erei (EY,..// CEttTINICAATION#A(Y��,..2p
w'ba.l. c(ST It:\('TOR COMPANY \,\\II'. / i ce We// r/vMP PHONE w )o•co) 6-z7- (Jl7 /S
253396
STATE \\test. CONSTRUCTION I'EIL.\Irfq ASSOCIATED \VQ I'ER:m'1#
lit applicable) (ifapplicable)
I. WELL IJSE (Cheek Applicable Roy): Residential nii Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ I teat Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL-
LOCATION:,
Qi LOCATION :
Nearest To\ -n: di///J/ Old County .:"��tyv
7/l4o o �E? a-'i S Jc IL #sir
(Sirect Nunn. NlnubeIs Community.. Subdivision. Lot No.. Zip Code)3. OWNER: err- 4u(,tci
Address toy 6z
jj iSiiea ur Itoum Nu-1
QL%/SGcfoju, C.
Coy or Town Stare Zip Code
Arca code- Phone number
4. DATIL DICILI_ED==/•$/' �
5. TOTAL. Dlil'TI I:__LO f-_ /
6. DOES WELL REPLACE INAISTINC WELL? YES 0 NO Lh
7. STATIC WATER LEVEL Below Top of Casing: o7.S 1'f.
(Use "+'• irAbu'e'itip of Casing)
8. TOI' OF CASING IS C2, FT. Above Land Surface*
"I'ap Or casing terminated at/or below land surface requires a
variance in accordant; st ills I5•\ \CAC 2C .0118.
9. YIELD(gpm): COO METHOD OFTEST /9-7r
Ill. WATER ZONES (depth):
LOCATION SKI3TCl-I
Show direction and distance in miles from at least
Iwo Stale Roads or County Roads. Include the road
numbers and common road names.
Topoggr jphie/Land setting
❑Ridge 0Slope ❑Valley ❑flat
(cheek appropriate box)
Latitude/longitude of well location
(degreesin1 ices/seconds)
L:dinide/longitude source:OGPSOTopogr phic map
(check box)
DEPTH DRILLING LOG
From To 1-' w merlon Description
0 _ o7O (- hit
_pinta y
( brim//e
7&s
11. DISINFECTION. Type /771// Amount
12. CASING: Wail 'Thickness
Depth Diameter or Wei }ht/Ft. bh serial
From "a To to? Ft. 6, QV .i8* Se
i:ruin To rt.
Prom TO I'I.
13 (ikOU I Depth
lion, 0 To 020 Ft.
from To Pt.
14. SCRELN: Depth Diameter Slot Sire Material
From To FI. in. in.
From To P1. in. in.
15. SAND/GRAVEL, PACK:
Depth Size Material
ii;,heAr method
�✓a iv,.„
From To Pt.
From To lit.
O
16. REMrARKS.
I I(D FILUIELEV C RTJ Y . I. IM``1 S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTR CIE(0 S I\ N :'iL1:aG D LILA' : A COPY OF THIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
f—
I,;
:
Sjlibmit the original to the I ivisit D of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
_7(0p,0(,ifl)11,6)6Rvy�EOIlON733-3221, within 31) days. GW-I REV. 07/2001
ASHEEVILLE REGIONAL OFFICE
NATURE Or PERSON CO

WELL CONSTRUCTION RECORD
NOOh Carolina - Department of Environment and Natural Resources-Divissiioon of Water Quality -
WL:I.L('O.TIiAct OR (INDIVIDUAL) NA\IE print DA.AT e_ead/feu
WELL. C0.N IR.\CTOU CONII•AN\'.\A\IL: f eCtilei/ Qi 4", / p
STATE WELL CO\S I ItLCITUs I4:Rat ITk ASSOCIATED ED \rQ IEU%I rr/
(if applicable) Of applicable)
I. AVEI-I. USE (Check Applicable 13ox): Residential lEr--Nlunicip:d/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery O I lent Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL LOCATION:
Nearest Town: JY/Vq-
County Od
(Strccl N:nnc. Numbers. Community. Subdivision. Lot No.. Zip Code)
3. O\VNL'R: �1O t�/-;
Address // o e S to✓y
57Coy or 'I V/V nun Sue Zip code
( )-
Area axle- Phone numb
45. TOTI[DTAL DDR
ILLED �^�O�
6. DOES WELL REPLACE EXISTING WEL.I.? YES❑� NO
WATERL9�
7. STATIC WATER LEVEL Below Top of Casing: _p.,
-\Z_F'f.
(Use `f' i r A hove Top of Casing)
S. TOP OF CASING IS a FT. Above Land Surface*
'Top of cuing terminated al/or below land surface requires a
variance in uccorduucc With 15A NCAC 2C .II118.
9. YIELD (gpm): f METHOD OF TEST+
10. WATER ZONES (depth):
I I. DISINFECTION: Type__ Amount
12. CASING: Wall Thickness
Depth ��Dii jji)eler or \ 4i hl/Fl. M' eriul
From /� To y9 Ft. [O 29 •,g� sTee/
From To Pt.
From To Pt.
I3, GROUT: Depth Njalcri.d Matra
From 0 To 070 Ft.
From To Ft.
Straw er I(outn No.)
—AIL-- _078779
/G teed.,./ _wv
Id. SCI(El'.N: I)eplll Diameter Slot Size Mweriul
From To I'I. inin.
From To
IS. SAND/(112AVEL PACK:
Depth Size ,Nlateriul
From To Pt.
111. III.
From TO
Ib. RENIARKS
Su port Jnptmigio;;13Rict io;;)i\isinl
274114 ft 41111. N4. IU 22
1
DEPTH
From
ao sL
Sys
Groundwater Section '7
CERTIFICATION H 09)4/
HONE # (VA 4w /pa
%-
7Topographic/Land setting
Midge ❑Slope ❑Valley ❑flat
I eheck appropriate box)
Latitude/longitude or well location
(degree: ninures/seconds)
'Etude/longitude. source:OGPSOTopographic imp
(check box)
DRILLING LOG
'11a(io 1 Description
sivTo
4s
LOCATION SKI:I'C11
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include Ole road
numbers and common road names.
gYfro /07
San
3
O
CO
WELL WAS CONSTRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL
THAT AOI'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING TII
-f1-c�
LL DAI'E
of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. " GW-1 REV. 07/2001
O

WELL CONSTRUCTION RECORD
North Carolina - Dcpartiucut of Euvi ronment and [N•
lurall I/�esourt[i cs - Division of Water Quality - Groundwater Section
,
WELL ((1\Flee\C'I'l OR (INDIVIDUAL) \:\)I,/h:(print) f\i� /'/"h •`4�/'t%//P e CERTIFICATION /4r+ 9 �/
\C t:I.1. ('O\I It A (I' OR (1)All'ANN N.\\I P: -fr ce. t tlell� OvA,p PHONE n I s) 602-O3),9
s I Al I \\'t:l.I. CONS I Itt;(iio I'tamu fe ASSOCRc1ED wC l Elt\II'rn
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Er Nlunicipal/Public ❑ Industrial ❑ Agricultural ❑
1Nlonitoring ❑ Recovery ❑ I lent I'ulnp Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO :
Nca csl To\ •n.- /�h11 (•ounty44 CJ Q'IV
V�
(Street Name. Numbers, Community. Subdl r 0trn. Lot No.. Zip Code)
3. OWNER:
Address
(sl YI ,rt ({rake/Noe
AIAy/Jesv/l% W'C. 02gni5
liy nr l ou IISI.u. Zap Cudu
Arta code- Phone nwnbcr
4. DATE DRILLEDy—
i. TOTAL TAL DEPTH: yy,
6. DOES WELL, REPLACE EXISTING WELL? YES ❑ NO Nf
7. STATIC WATER LEVEL Below Top creasing: 30 FT.
(Use "4" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of rinsing Ienninaled at/or bcluw land surface requires a
variance in accordance with I SA NCAC 2C .0118.
9. YIELD (gpnl): 1 1AMETI-I0D OP TEST f\-1
10. WATER ZONES (depth):
253392
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Plat
(check appropriate Fos)
Latitude/longitude or well location
(degrees/minus siseconds)
L tiludc/longitude sourcc:❑GPS❑Topographic nap
rcheck box)
DIiPI l-I DI<I LLI NG LOG
From To Powritio9 Description
.-20 Ye.?
pNt'
q-1.1�
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diayn'ctter or AVe e t/It. NI terial
From-1.4 To fr'LT Ft. 6 /'y •/ISt J/c°L
From To PI.
From To Ft.
13. GILOU'1: Depth Nlutcrial Nlctllod
From D To 19.
From To Ft.
14. SCPLLN: Depth Diameter Slot Size M:ncrial
From To I:1. in. in.
From To Ft. in. in.
15. SAND,/GRAVE(. PACK:
Depth Site Material
From
From
I6. RENT/ARKS:
To II.
To Pt.
S Ihnlil t e oil ina1 I„ 111n 1)ivisi
27(O fit5.NitIN)411 N F-14� )-t2
ASH.:`/IEEE RG:L,vAI r r ?'
LOCATION SKEMI I
Show direction and distance in miles From al leas)
two State (toads or County (toads. Include the road
numbers and common road names.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
NI)"fl IAT A COPY OF '1111S RECORD 1 IAS BEEN PROVIDED TO TI IE WELL OWNER
s1:oIHV s-Nnrzo
;NATURE OF PERSON CONSTRUCTING Tl Ili WELL DATE
n of \\later Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
I, within 30 day s. GW-I REV. 07/2001

an
one
tMail Cr Sea • Dap n ment of Environment
onm nt and
1 Ga Natural
Resources
• Division
0l Water (Duality Groundwater Section
onh
olina
er
N.C.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
LL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT'S:
A❑
Municipal 0 Industrial ❑ Agricultural 0 Monitoring 9
Other ❑ If Other, List Use:
Applicable Box): Residential
1. WELL USE knack Heat Pump Water Injection
❑
Recovery CI
2. WELL LOCATION: (S o sketch of the location belocounry". �"U'�n,1/
NearestTown•✓�io� n F
e Name and / DEPTH
DRILLING LOG _--�
Road Name and tubers. omnunit or SubrF an• Lot No.) From To F •Maoo Description
3. OWNER LI' N� 0 J•S� rq
s
Address b , i 0 7S' rat)
vector •ouo `o. 2g 723 7s 7r 14nQ sy a/ ��✓ we
C (Iy &own tee Stale Zip /Code
Ciry rTown �/�� �i%�vi �'�
4. DATE DRILLED d oZ
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOD
7. DOES WELL REPLACE EXISTING WELL? YES [] NOPf
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+• it Above Top of Casing)
9. TOP OF CASING IS FT. FT. Above Land Surface'
*Top of casing terminated .Vor below land surface requires • variance In secor-
dance with 15A NCAC 2C .91.tq
10. YIELD (gpm)' lot METHOD OF TEST 141
; C e G✓e//9
246594
11. WATER ZONES (depth).
12. CHLORINATION: Type 17 / , Amount
13. CASING:
It additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diam�eele or W/C5'��hrt. 1 erial (Show direction and distance from at least two State
From �s' To 73 Fl jo //V '` V" `'' �� / Roads, or other map reference points)
From To Ft.
From To Ft 156-z
14. GROUT:
Depth Material ethod
From G To 010 Ft ^/Dv'!e_ n
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
From To - Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION S i.:..."..:a ' ND TH • T11 COPY OF THIS RECORD HAS BEEN P • VIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No:
Serial No.
E OF PERSON CONSTRUCTING THE 1 DATE
n of Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99
GROUNDWATER SE-
ASHft9LLE RE FF(
GIGh1"._ prriCF

WELL CONSTRUCTION RECORD 264329
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) L Mit--- t-�/p-n/IC_ CERTIFICATIONS# (761//—�
WELL CONTRACTOR COMPANY NANIE rj/ (NA.Ss (//�/ r��j/4 �9 �yU. PHONE # P7j/.�/'YIY
STATE VVEI.L CONSTRUCTION I'ERiAIIT# .ASSOCIATED AVQ PERMIT#
tit -applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CRSA;a2,cs
�LIC -De fit Cipc-cS
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'lu,J .DGv5/4
Address
(Street or Route No.)
C45111-1-r /1 C ? 8"7/2
City or Town State
County SicKR1n1
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9—q 0 2-
5 TOTAL DEPTH: /27
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: e9 Q 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 I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST d'v'
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑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
a - 3o Limy
3J- JYA-wt+c-.
0
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or AVeight/Ft. Material
From b To ..)0 Ft. (, pi
L.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From0 To a0
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.
Ft. e- I4 bealidlk-
16. REMARKS:
E1C HEE>Y R�c
CONST
LOCATION SKETCH .��
Show direction and distance in miles from arleast
two State Roads or County Roads. Include b..g road-
numbers and common road names. 1--
rm
t-J
cn
re
ASHEtt�gCSSICRtttLtttS 0• 9 , l) 7
©Ff'IC�._7
IFTHIS NL V'r8C 'S U E
S, AND"-�4P-'nn cm- H1.R O
SIGNAT.
OF 0 'C11\*%%CT'
14NCE WITH I5A NCAC 2C, WELL
SEEN PROVIDED TO THE WELL OWNER
E WELL
-,S 0Z
DATE
ivision cf Wafpr QR�unlHy, GroundwaterDWATER pectic n, 1636 Mail Service Center- Raleigh, NC
3-3221, Hithina�GH tletE REGIONAL OFFICE
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\N ELL CONTRACTOR (INDIVIDUAL) NAME (print)��""Y' Qe '( 1f-A,�Y/✓NC �,r, CERTIFICATION ttMQYGY'
\AELI. CONT IRACTOlt CONII'AN1' NAME4�itk 'SY"•..S bill a«t✓ yr- L PHONE # tp/(0), "�j7‘
STATE: WELL CONSTRUCTION PERMIT/ ASSOCIATED \VQ PERNIIT#
(if applicable) (if applicable)
264334
I. WELL USE (Check Applicable Box): Residential BMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
NAaarest Town: Sy I1//4
Csvtetts Cvice.k
(Street Name. N' umbers, Community, Subdivision, Lot No
3. OWNER: RAI.'(J*Id CGe/le's
Address j, e/ef,x2/y
(Street or Route No.)
naVs6J)-a c
City or Town State
County L ckst
Zip Code)
c2 T7aS—
Zip Code
( )-
Area code- Phone number�y
4. DATE DRILLED A /fa.
5. TOTAL DEPTH:
5j0S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 30-1) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or pelow land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): f H MET_ OD OF TEST ,i/ f
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:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D— 93 C/41
73— F05 �r�rN'Fc
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diame/(ter or Weight/Ft. Material
From To 13 Ft. & /i�'
From To Ft.
From To Ft.
13. GROUT: Depth /� Material Method
From 0 To a1 Ft. &Y14,e4 4 be4Aasottr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
put_
Size
If
Slot Size Material
in.
in.
Material
From To Ft.
16. REMARKS:
'WY THAT THIS W
Rtry
fO1,' 14
S bmit the original it; -the
2 o1NON1ATER SE • No. (919) 73-32n
CTION
ASHEVILLE
REGIONAL OFFICE
of \ 'ater
, witl it
T
IROPY OF THIS RECORD H
t OCT 21 2002
EtVE
LOCATION SKETCH
Show direction and distance in miles from aUttast
two State Roads or County Roads. Include tic&road'.
numbers and common road names.
AT(j E 01 PERSON CONSTRUCTIN THE
Il pp Npp�yy��TER SECTION
V L� RSgoshi'toFN ion
0
0
J
i.J
CJ
CT)
'CE WITH 15A NCAC 2C, WELL
N PROVIDED TO THE WELL OWNER
0 2.
YELL DATE
636 Mail Service Center- Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
264332
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/E]� (print)rpQ itirC%e. e Q - CERTIFICATION�'/367/y
WELL CONTRACTOR CO\1PANV NA\IE I,✓f)I✓& V5 W�/ (i9Yi'/l Rl0*, �l/t_ PHONE # (yN L.C.V. yji4,
5'FATE \\'ELI. CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(i (applicable) (if applicable)
7
WELL USE (Check Applicable Box): Residentialt2' Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery D Heat Pump Water injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: v_Yyivy-
County \rff<11
(Street Name. Numbers, Community, Subdiv
3. OWNER:
Address
City or Town State
on, Lot No.. Zip Code)
( )-
Area code- Phone number p
4. DATE DRILLED p -01
5. TOTAL DEPTH: (oo-5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): yo ME HSD OF TEST iti V
10. WATER ZONES (depth): t "=
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 7s- Ft. 1011(
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Di) EtL'aa .... c44n& ip.i..n/
From To Ft. t"'
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
pvc
From To Ft.
From To Ft.
16. REMARKS:
S lbmit th
276 MOla lV`i tT
ASHEVILLE R-(
Agricultural ❑
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
0 — C/ifir
-73--_ &or f/'%YNdfe_
7
•
LOCATION SKETCH 4
Show direction and distance in miles from't�east,
two State Roads or County Roads. Include the road:
numbers and common road names. ut-
O
IS WE
ND TH
Yt7FRT 4tFC R
NATL,11-1 PERM' CONSTIWNINGth
Water ,ttais _Gxnun(l.\v-tt®s�ec
n of \ lion,
3 3221, witkin 30 t1 UNDWATER SECTION
AERhVILLE REGIONAL OFFICE
CE WITH 15A NCAC 2C, WELL
N PROVIDED TO THE WELL OWNER
ELL DATE
636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

258616
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print4nnI:RR e�nine
WELL CONTRACTOR COMPANY NANI / ( J. L,cie/� LJ((�Vi (/'A
7/✓
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
5
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential$' Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO :
Nearest Town: Count4 Lien -,
f a —' ('i
d (Sireame, Ng bcrs, Comi ity, Subdivision, Lot No-, Zip Code)
3. OWNERAfd'1L.N{ut,.r t/
Address L/
(Street or Route No.)
City or Town State Zip Code
( )'
Area code- Phone number
4. DATE DRILLED 0 'I ,
5. TOTAL DEPTH: ) 035
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
3. 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): to 0 METHOD OF TEST Qti
10. WATER ZONES (depth):
Topographic/Land setting
DRidge 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
3o— /0_9f
CIa
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 3`3 Ft. 104
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Material , Method
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
Ft.
Ft.
Slot Size
in
in.
Material
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.
IV
t0
EOI�EI B E(�,TIiAT THIS WELL WAS2 C Ntt�ALDS, AND THAT A CO
AUG 12b02
Submit the orittina
SIGNATURE OF P
o the Division of Water Qu
AS R0L LEREGIONSAL WOflNo [phone], within 30 da
CONSTRUCTING THE \VE
I5A NCAC 2C, WELL
QED TO THE WELL OWNER
DATE
lity, G „- , r r * v r 1 r 6 MailService Center - Raleigh, NC
S. ASNE`,9LLE FEGiC:i L OFFICE GW-1 REV. 07/2001
- Groundwater Section
CERTIFICATION tt 30/ 2/
(pryg)Jr-!/'Y� PHONE # •-n
cc)

258610
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) (7)13///)A/.' &A/✓c CERTIFICATION /. 76/7/
WELL CONTRACTOR COMPANY NAME C✓F) 4t15. ////9*J,vc PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential2' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2- WELL LOCATION: L
Nearest Town: "V-5
OAa/toofn et -Ely —
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: id Li/f/y,ra
Address
(Street or Route No.)
County SA(4, t /0
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 7'-2.3- O a-
5. TOTAL DEPTH: /agu
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): -3-3/y METHOD OF TEST 43*
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- Jo (a Qa
'. TV �B
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From b To 30 Ft. to-T, po (>
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 30 Ftftm, 1--s [AFlilwlh-
From To Ft.
IJMeettho-dd /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C
ffN!R TN . (DS, AND THAT A CO
tab 2 1 20Q2
originalnut the
27699-1636 Phone No
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PE
{tP I IN ACCROIUANQE
ROBICO EtAS\BEEN.P
-I
ONSTRUCTING THE WE Li
Ie Division of Water Quality, 4roundwater Section, 163� Mail
019) 733-3221, within 30 days. GROUNDWATER. SECTION
ASHEVILLE REGION/L OFFICE
15A NCAC 2C, WELL
)ED TO THE WELL OWNER
DATE
Service Center - Raleigh, NC
GW-I REV. 07/2001
0

258609
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CO\TRACTOR (INDIVIDUAL) NAME (print) fir/-0( i/7/24— CERTIFICATION #
WELL CONTRACTOR COMPANY NAMEe✓I5- /ALt J)Hj/%Iif,y./�G— PHONE # n LK/ 7f'4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 3h''CV S
r N)or-I-a / d,
County c_Pcr
(Street Name, Numbers, Community. Subdivision , Lot No., Zip Code)
3. OWNER: R ebCA-1 KDA-Itl'
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9-Q.4,2-J 1-
5. TOTAL DEPTH: 9OS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*lop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 0 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Ji 5
;Lc_
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From0 To 3's FL 6 r / U`
From To Ft.
From To Ft.
13. GROUT: Depth Material
Frorn D To a-V I ' Learitt 44j4/n,Yc
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.
Method
Slot Size
in.
in.
Material
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
GROUNDWATER SECTION
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCQ(1 p,EcCVEE YKILU015ALNSIteC, W ELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECOIW HAS BEEN PROVIDED T U WE WEL_ OWNER
Submit the original to the
27699-1636 Phone No. (919)
ANA 1 uPE Uh l'hRSUN GUI
in opy@teezqualjN2Gro
1, within 30 days.
T
CTING THE WELL
Z-is _ z
DATE
AD
ter Section, 1636 Nlail Service Center - Raleigh, NC
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

251n84
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ands jNa�tural .nResourcces- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) cc�Aie amn CERTIFICATION 1P--.3b
WELL CONTRACTOR COMPANY NAME C/r/'Ytie OVIXl tdek ;i/ NJ,-T c
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # 410 A7x6r7 e
1. WELL USE (Check Applicable Box): Residential 14 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: L
Nearest Town: -Cy )0 County k)> -At NO
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: R,Nhfwt A-IIc-/t)
Address
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED . , i —0 '4-
5. TOTAL DEPTH: RO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires •
variance hi accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeea/minutes/seconds)
La:itude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH TRILLING LOG
From To Formation Description
1QQ —
11. DISINFECTION: Type
12. CASING:
Depth Diamete
From d To___ZOL Ft. '/
From To Ft.
From To Ft.
13. GROUT: Depth
From /) To 320 Ft.
Amount
Wall Thickness
or Weight/Ft. Material
!JI/Cl
Material//�. p. Method
Cave,,,Jtcs 4
From To Ft.
14. SCREEN: Depth Diameter
From To ' Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
From To Ft.
16. REMARKS:
Submit the original �o the
GRatRb@iidli6tRPJfaim(No• (919)
ASHE'VILLE REGIONAL OFFICE
TTHI
SIG
ivIsio of W
33-3221, withi
Slot Size Material
in.
in.
Material
1 itT 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.
O
1V
9a
-o
23
ANCE WITH 15A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
HE WELL DATE
on, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELLCONTR:\CTOR COMPANY NAME Cl%o(
STATE WELL CONSTRUCTION PERMIT#
Of applicable)
246723
N turla! Resources/i- Division'of Water Quality - Groundwater Section
;ch d /`7Ane- CERTIFICATION��,�I,((# 3623
&as It I1 OY//rwl�Ta'c PHONE # (O�d l,527=- 9-7
ASSOCIATED WQ PER911T#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nea est Town: Su/VA-
Countyr3L1.56)))
(Street Name. Number. Cominunity, Subdivision, Lot No.. Zip Code)
3. OWNER: fl r\k.L I"fkC%S
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number r�
4. DATE DRILLED / / — 02
5. TOTAL DEPTH: .SbS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
6. 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 ii Y
10. WATER ZONES (depth):
75- cS
Topographic/Land setting
DRidge 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
Front To Formation Description
n - 75" Eeleci
9'! I
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From D To 75— Ft. (<'A'
From To Ft.
From To Ft.
13. GROUT: Depth
From /] To a 1)
Amount
Wall Thickness
or Weieht/Ft. Material
Material r Method
Ft.Ct I/4t91 &doN,'�c pithin, ry j
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size
in.
in. in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSx12UCTION STANDARDS, AND THAT A
UF'TH}S
SIGNATURE Of
Submit the original to the Division of Watei Qu
27699-1636 Phone No. [phone], within 3) da
LOCATION 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
ON CONSTRUCTING THE ,E�
j i�I_/
ty, Groundwater Section f636
•
—D
W
cn
2C, WELL
VIDED TO THE WELL OWNER
DATE
tail Service Center - Raleigh, NC
GW-1 REV. 07/2001
l_nTtl.[7
A \

1fA{alt—
ETATSWRLLCONSTRUCTION PERMITS � --".'' WQ
graniblble) f Mastic►
1. WELL USE (Cheek Applicable Box): Residential", MttldoipsWublie 0 Industrial Agricultural 0 err0
Mooitoting 0 Recovery L] Heat Pump Water *lotion CI Other 0 if Otter, List Use 2 J U r 7 0 8
2. WELLLOCATION
Nearest Town: Cas(j'ers
Counq Jacks -I/
(testa terea,Nuw tti,Cemmuoly,taM sieloa,lotHo., bp Co*
3. OWNER:_ - le n/ 7—
Adams aCl�ma YtsG £ate -, �Zy %
(eaeetar Rana N0.)
(rashlers ne n27717
or Teen Sur 24p Cote
AMI) cod« hang now
4. DATE DRILLBI (F g^ A-,, ,caUfa/i r/G e,
t��
S. TOTAL DEPTH. ""`
d
6. DOES WELL REPLACE EXISTING WELL YES O NO 0
7. STATIC WATER LEVEL Below Top creasing; RT
ruse wit l
IfAaoue TapotD. )
6, TOP OF CASINO IS
L FT. Above Land Eunice•
'Tep o1 sst•p terieleaed efier Wow lead aorta require. e
van to eeten see with ISA NCAC 1C cite. �J
9. YIELD (gprr); / MET HOD OF TEST Prarire ui
10, WATER ZONES (depth);
11. DISINFECTION: Type Amomu______
12, CASINO: Wall 7aiolt a
Depth Dimater or Weight/Ft. Material
PIC_ To FY,
From_ _ . Ft_
Flom To FL
3. GROUT: Depth Paterie1 Method
From. To Ft.
FrontTo Ft._
14, SCREEN: Depth Dimmer slot Sire Material
From To
From( , _ To Pt in. In.
15. SAND/GRAVEL PACK
From D pis Sire Malarial
Ft
From To_ Ft_
16. REMARKS:
Topoimphia4Lsnd sorting
OR(dp °Slops }1Lrilley OFlat
tibuth4ali oftlawelllocatioa
Ladtuddl (4WWreWedaa.deeooad,)
oagl4be immallOPSCITopodraphk map
has* kat
MEM
From To Formation
LOCATION SYRTCcr
Show ditaatioa and distance coin adl Prom at last
two State Roads or' County Roads. include the road
numbest and coxSon road names.
S
t0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STA 4DARitS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
S ONATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Ie DNB thl�9: _ 0.41634 Mall Servies Omuta -RANO, NC
OW.I REv. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
GROUNDW'APER SECTION
SHEVILLE REGIONAL OFFICE
SHIPPED JUL 1 3 2002
0
0_
•

•• C4 t, vuNS rRUCTION RECORD 256706
Rath Cuollns - Daprunont atEnvtronmem and Nwal Raeotlrav Division of Water l
nueoolmtACTOM ' r Q IY ERTIF CATIOroundwater NoNo /
tIr1D1Y1DVAL)NAMI IertaO AUI G� f /G� CERTIFICATION
WELL coNTEACtOR COMPANY NAME 7? t- Six 1 f itVa v &artu ;Zing PRONE /1t 29-4-age/Se_
STATE WILL CONSTRUCTION PEPAWN
preDAiiuble) JIMOCG DoWQ
EVI a)
1. WELL USE (Check ApptiableTh:4 ktedde tt' o1pillyublktl lndustriel El Agricultual D
tdta talogID Recovery ID Neat Pump Water aotloo0 Other 0ltOther, List lisp
2. WELL LOCATION:
Nearer' Town: tgsjiLea
�huLa<111;6,. f _
Tope d matting
ORldp °Slop' 'b ❑Flat
Mock bwo
Lattuda111patglgida of well location
(�1
Ladtudanongiltla �opogtaphia amp
DDarnFrom To Foj
ctiptior
Amount Show dhootlLICATICOr and ol Prom at lout
wan TLloimera two Stale Roads at'Co my Roads. Include the road
O
N
L
c
r—
Method Ncn
11. DISINFECTION: Type
12, CASINO:
Depth Dlumter or Wei¢ntlFt. Mortal man and comtdoa rMd names.
From TO FI,
From_ _ To,.____ Ft.
Frost To Ft.
13. GROUT: Depth Mstfl1
FromTo Ft
FrontTo Ft
14, SCREEN: Depth
From To P
FromTo Pt_ in• — . In.
I S, SAND GRAVEL PACK
Depth SIN Materiel
From To Ft
L_ FamtTer Ft.
_____
.
D1 nester Slot Slur
t _In
_ In.
County 30.cS0.1
OW* NEALLMaim Cammuehr, 6ubl.Irbo, La Ho., Zip Ctdd
3. OWNER: ie0
Addroae ve stnt h Len G - PD7N7
nohCltt onaxoaeNe) o2�'7o 3
- atyorlbnu SEE Tip
TipOA
-
4. DATE DIt/LLED (fh-cshtder-.(i o(g/sv/o2
S. TOTAL DEPTH:- /ado"
6. DOES WELL REPLACE EXISTING WELL? YES D Nyr
7. STATIC WATER LEVEL Below Top of Casing: _FT.
8. TOP OF CASING IS / (use Nair Above Top ertl,Wye
PT. Above Lend Suffice
'Tip a Haig IersdnS atterbelow lad aurw Midi* e
NSW 1* worhap Fe% ISA NCAC 2C Altt
9, yaw (gp$; O• 025 ),IETNOD OF TEST P d1ur4,-+J
10. WATER ZONES (depth);
Mate[&
r,;
t0
* Ted Minn -id(
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WALL WAS CONSTRUCTED IN ACCORDANCE WITH RSA NCAC 2C WELL
CONSTRUCTION Akns1
8TAD4)
Z. D T A COPY OF THIS RECORD HAS BBBN PROVID$D TO THE WELL OWNER
/ Ce -2 I-0,21
SIGNATURE OF PERSON CONSTRUCTINO THE WELL DATE
Submit the original to the Div
2709.1636 Phone Ne, (919) 73
ECEOVE
GROUNDWATERN
ASHEVILLE REGIONALCETIOFFICE
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
0. t636 Man memos caster - Ramey NC
OW-1 REV.07/2001
SHIPPED JUL 1 3 an

255883
Natth Carolina - Daparpront of EnvIroomem and N
waI CO �RIMD1VTDUAL NAM[ Reeotn'Cq-DlvidonofWtdaQwtllty•Grouodwarliaotloa
WILL CONTRACTOR COMPANY NASI2 ��t'1CAyro1Qa
tram rim CONSTRUCTION macrl �`—Y uv,Zro PROWLafB�Y
if a9pibabgl _ TID WQ
1. WELL USE (Clunk Applicable Ho:): Raidontiall�, Id11g-oWal/P
A$tiou W a3 0
a O IahMrld
Monitoring CI Recovery 17 Heat Pump Water Motion CI Other
G
her 0 If Other, Lid 1.1--
2. WELL LOCATION:
Meerut Town: ?es Ootaty 0.c._
Ohms Nem, Ntuahen Cmae»ty, Su6dltleire, La No.. Zip Cods)
3. OWNER
Address
(IMP a Roar Ne.t
t.....} or Tent Sae YIP Cede
Any
A
hone nate
4. DTEDRRELLED.( drnrre_1) O(a/4Yloz
TOpoircchketand totting
01t1dp 0S naa1Uy l7Flat
(shook660
IWdeAtu a ide of well location
Iatlnxlntl �P map
pleat lue0
From To pow
S. TOTAL DEPTHS loon•
6. DOES WELL REPLACE EXISTING WELL/ YES O N0
7. STATIC WATERLEVEL Below Top ofCadog: pT
8. TOP OF CASINO 18(Use "IA If Maus Top otteeSnp
'Isp erodes wads*. aNert`M. w teed lithe* IntlFT. Above rw ButAoee
nee * meetiene wW ISA� METHOD
2C Mtt9, AT13R7(gp0 &S' METHOD OF TEST Fu^7o�
(depth):
11. DISINFECTION: Type,12. CASINO: Atnohal Show dttootloa aud1 l Prom at lent
Wall TLlamen two Sale Roads cottony Depth Dianne or welyittlFt. Maedaa nomben and co Ronde. Include the toad
Front TO F4 mtlloA road namoM.
Ft
13. GROUT! Th___
O
Depth
To Ft N.)
From To Ft. L
14, SCREEN: Depth llie oven C
From To FL Slot Sim Material
Proat,____„ TO lk �1In. __ in.
1 S, SANLVORAVEL PACK: " ' in.
From �h Else Material
Ft.
FroatTo_____ Pt.
16, REMARKS:
*aerial Method
COPS
! DO HUBBY CERTIFY THAT THIS WELL WAS CONSTRUCT130 IN ACCORDANCE win( SA NCAC 2C, WELL
CONSTRUCTION bTA�W(tRD HrtD Ty,AT A COPY OP THIS RECORD HAS BEEN PROVWED TO THE WPLL OWNER
SIONATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mali $eMca hater-Rayinh, NC
1/094636 Fhone Ne, [phone], within 30 days.
V. 07/2001
op
is
GROL : A 'E R F;:TIOi1'
_rl_ rFrICE
IECIEEIVE
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
4 El4Gwa4

gran WRLL CONSTtUCTION PRaalrn
f Tone wQ
SUBLikjjalialliaMinCiam
VIGIL CONTRACTOR p101rY1muAL)NAMa
Ninth Caroline - Decennial* of Environment mid Natural
Resources - vldonofWaist Quality OmuadmfwEeWee
(rrrrl__ `Do. • �rCINGIFICATION �
WELL commas*ooevAHY NAM1t.SL-rS-Fu�. 1�,../.,,....cN_i.._ ;� rxo nN (i d�� r y4_ 7yr
255886
1. WELL USE (CJ (Check ):ItaldmUU�M nielpal/Pu61b0 lndurgh@ Agricultural
Mod very Pump Water 0 Other 0 If Odar, Uri Use
2, W84LLOCAT! I
Nearest Tom Ui'ers County 3ac./ks.''?
(meet Ne m. Numlen, Cemmwlr, r'Adtddoo, Lot No., ZIPCo,)
3. OWNER:
Addrou IaJ )ram. >' `mono Rows No.)
City wren
4. DATE RULED LFrackurred) C(a/I1/of,
5. TOTAL DEPTH:_ Scto
6. DOES WELL REPLACE EXISTING WELL? YES C NO 0
7. STATIC WATER LEVEL Below Top of Cuing: PT,
8, TOP OF CASING IS / Wu "s I(Abve Top on:WV
Fr. Above Land Slaw
'Tip dung oradedN *Hor blow Ind India 'ee dree e
9 YIELD
a ss III welt ISA NCACW MIL
(rpm); / METHOD OF TEST P✓
10, WATER ZONES (depth):
11. DISINFECTION: Type Amount____
12. CASING:
From h Dlmntar or Weldn$t, Metarial
PromTo__ Ft
Frorri__,_ To Ft
13. GROUT: Depth
Prom To
FromTo Ft.
14. SCREEN: Depth Diameter Slot Sim Mendel
From TO Ft.in. , in.
Fron_-,To Pt,__in, In.
15. SAND/GRAVEL PACK!
De
pth
Ft,
From To Pr
16. REMARKS:
2rp Code
Material Method
T hto/Land Jetting
QRJdgs )alley)1IValley OFlat
Monk $j$ide�of well location
Latitude/Meade
Datil
From To
lenroCOPSOTopogrsphic map
mask box)
DRnt,�
Formation Description
Sue
Ft.
Sim Motad
LOL`ATi„�, ragniCu
Stow dinodon and distance in miler Prom at lout
two Stan Roads MO** Reads. Include the road
nnmben and comuioa road names.
CO
0
N
L
C
W
r_fl
I DO MEET CERTIFY THAT THIS WBLL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS. HER
`ANOAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THB WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the I sloe of Water Quality, Oro
t, wdhla 30 days.
GROUNDWATER SECTION
ASHEVIL'LE REGIONAL OFFICE
DATE
ttOn,1636 WE Sonia Carta -Raleigh, NC
REV. 07/2001
ASHROiNE REGIONAR LOFFICE
EN0 v.

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 Dr-1 11 ing, Tnr PHONE # H2A 752-7779
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2 5'7715
1. WELL USE (Check Applicable Box): Residential Ix 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: Sylva County Jackson
Knob Hill Estates, Sylva 28779
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Randy R. Mack
Address 960 Symphnny Ts1 ec R1 vd
(Street or Route No.)
Apollo Beach Florida 33572
City or Town State
(—)-
Area code- Phone number
4. DATE DRILLED 7/09/02
5. TOTAL DEPTH: 200'
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118,
9. YIELD (gpm): 1 5 METHOD OF TEST rotary air
10. WATER ZONES (depth): 1 40'
LOCATION 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.h1 /8 Sr;h R!1 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:
IICERTI
Ir,'CfSTRUCTION-ST4.I
I
i
GRO
ASHEV
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
tDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/6l//z_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
)5(14t e&,�T�al-to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
t9'9{(:�(r, 01f4rortt4 U919) 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
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION II 2809
WELL CONTRACTOR COMPANY NAME D Rnwman We11 Dri 11 i ng Tnr PHONE a ji78 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tX Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhea County Jpc1r�, can„
304 Cabin Pidgin C„11nwhea Nr 7R723
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Jeff Kosik (degrees/minutes/seconds)
Address 3051 Saw Grass Court Latitude/longitude source:OGPSOTopographicmap
(check box)
34746 DEPTH DRILLING LOG
State Zip Code From To Formation Description
(Street or Route No.)
Kissimmee, Florida
City or Town
(—)-
Area code- Phone number
4. DATE DRILLED 5/14/02
5. TOTAL DEPTH: 80'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: + FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 40 METHOD OFTEST'- rotary air
ID. WATER ZONES (depth): 80'
LOCATION 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
Diameter or Weight/Ft. Material
Ft.F1 /8 Srh RO PVC
Depth
From 0 To 35
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
Depth
To Ft,
To
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
From
From
Size
Ft.
Material
25'4391
c
ctS
n
^
�rrt
3 �o
16. REMARKS: f ? CO '
a
;CO,&;STQ.0 IONS
Ca n
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL t0 c
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

254392
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 M 2809
WELL CONTRACTOR COMPANY NAME D
Bnwman Well Drilling, Tnr PHONE Mt'12A 252-7779
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I$ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cullowhwe County .Tar•kcon
Flighergrnnnr1 Lot #9 Cnllnwhee NC 78723
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: James Warneke
Address 2251 Spring T,ake ('irrle
(Street or Route No.)
St. Clpud Florida 34771
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 5/ 0 9/ 02
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
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
7. STATIC WATER LEVEL Below Top of Casing: 1 0 0 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): 2 METHOD OF TEST rotary air
10 WATER ZONES (depth): 3 4 0 '
LOCATION SKETCH
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
0 Depth 3 0 Diameter or Weight/Ft. Material
From To Ft.F1 /8 Srh 80 Pvr
From To Ft.
From Ft.
Material Method
Ft. concrete gravity flow
Ft.
14. Diameter Slot Size Material
To
13. GROUT: Depth
From 0 To 20
From
SCREEN:
To
Depth
From To
From To
15. SAND/GRAVEL PACK
From
From
Ft. in. in.
Ft. in. in.
Depth Size Material
To Ft.
To Ft.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
_r
IV
4-
LO
0
16. REMARKS:
I nn uEREBY CERTIFY.
CONS11RUC(I ON S'1 AN
Lr
Submit the original to
27.699-1-636 P henrNo-t
GRCUD!D' i' SEGI t h
ASHEVLLL REGIONAL I EICF
he D
9) 73
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9C1 / //_ S 1/2l `/ /d
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

255010
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cir ide K 50.t.teyt CS
WELL CONTRACTOR COMPANY NAME CliAde 6atr..
0ACnns ,SOr• We t.nr roc
STATE WELL CONSTRUCTION PERMIT# C ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
CERTIFICATION # alj It,
PHONE # (2i�/ a55 768g
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 5, Ion.
County 3 e.-'r Xo't
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sts 11:c.Ma„i%seti
Address
(Street or Route No.)
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1.0' %3
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 171
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): 30 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑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
1{(O Over Act -Ann
yfQ bran/te
11. DISINFECTION: Type p{%&S Amount Ts-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From -I-1 To 4b Ft. Ski ik 21
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Cenen# (cure d
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
PIci56e
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
a
O
C71
-1
16. REMARKS:
I n0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1rp CONSTRUCTION SiTAMD'Rit JS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i� ^ �/ I I 6.13 -02
^`! GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tp the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' Raleigh,
NC
07/2001
27694_ y36 Phone No. (9l9) 733-3221, within 30 days.
L1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural` Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Clad �e K 5v,a.a60S
WELL CONTRACTOR COMPANY NAME � � ' CCC
STATE WELL CONSTRUCTION PERMIT# i" ASSOCIATED WQ P/ERRMMIT##
(if applicable) (if applicable)
255009
- Groundwater Section
CERTIFICATION # 2.4Se
PHONE # (�'9 ASS 16Zt
1. WELL USE (Check Applicable Box): Residential Ca 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: 6% .t.a_ County 14e*K+6ev.
1Mtnea U4%t Saysnnds. RJ 6ratua 22719
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Co. nc l�uv�
Address 3iS /deter Pot ,
(Street or Route No.)
Oily or Town State Zip Code
( 5€(* ro55
Area code- Phone number
4. DATE DRILLED 40'111-0Z.
5. TOTAL DEPTH: d45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO j 1
7. STATIC WATER LEVEL Below Top of Casing: .1d FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2.0 METHOD OF TEST RI.
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1 Z OVel 6!4AD*.
Q? 46 Graatre,
11. DISINFECTION: Type pa.s Amount 1'
12. CASING: Wall Thickness
Depth Diateter or Weight/Ft. Material
From -1'1 To q Z. Ft. (e"tt * St f taxvC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ``
From Q Tom Ft. Cejaea If 1Oucea
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
CJ1
0 HEREBY - - WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NSTRUCTION STAND r iS^N4�D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Silbm[ the original to the pivisi n of Water Quality; Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. i5rprY33-32
N• ' RE
ON CONSTRUCTING THE WELL DATE
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�inCI la, e K. Sow.ir r5
WELL CONTRACrOR COMPANY NAME CVit'-e. Sa°eS ‘rSewr 14614. f
251587
- Groundwater Section
CERTIFICATION # 07456
PHONE # (8244 ass 7&n
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 121 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 5 Vuc_ County ZNcetCSo'�
t]n\f: Mt._ Roaa 28/83
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r„)0.v(S O t '.s
Address log polo re.rc 0e24
(Street or Route No.)
' [taCKaSese.c— NC
City or Town State Zip Code
($28 )- a73-b5(n1
Area code- Phone number
4. DATE DRILLED Oy-olk
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f]
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST
10. WATER ZONES (depth):
p28'2 83
RI}
Topographic/Land setting
DRidge ❑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
t\ `k`k Over Berdo.�
4t-1 145
11. DISINFECTION: Type pa (s
12. CASING:
Depth
From A-\ To 4v
From To
From To
13. GROUT: Depth
From 0 To ZO Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Amount
Wall Thickness
Diameter or Weight/Ft.
Ft. (o v eb2t
Ft.
Ft.
Material
Cement
Material
?JC'is tie
Method
?cured
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
of can.if-es,
O
'D
V./
-121
S
c
O
0'
oC-) •• M
0 '
a r
rrt om
m‘.-4
rn
ry m70
LOCATION SKETCH Ga —1
Show direction and distance in miles fromat lent
two State Roads or County Roads. Include the road
numbers and common road names.
16.REMARKS:
I DO HEREBY CERTIFY THAT TH S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIO STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2
N IRE
k
i II
bmit the original to the ISon of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
99-1636 Phone No. (919) 7 3-3221, within 30 days. GW-1 REV. 07/2001
ONSTRUCTING THE WELL
ov/o2 y/
DATE
of
ICW .L Cf:-

257448
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and /Natural Resources-�/Division of Water Quality - Groundwater Section r��j
WELL CONTRACTOR (INDIVIDUAL) NAME (print)V/0 N,(/ jr /R� �4/-L_ CERTIFICATION tiyg///
WELL CONTRACTOR COMPANY NAME L. Z.-Z-r kk--/,
P i\I
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
N �,`'J`�-�(/JQ PHONE Hj# �0 /I /4 y97- o 9gz
40 . ASSOCIATED WQ Eli IT# 9/ 7D ry5/ 1
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town: County /N�ilt'.
e , . O
(Street Name. Numbers, Con unity, Subdivision, Lot)No., Zip Code)
3. OWNER:L, zi-� „,,/
Address •R /LIEU .�-i-
(Street or Route Na.) —
Aft
ty Or Town State Zip Code
)- IP0- 7716
Area code- Phone number d 0 / ,
4. DATE DRILLED h L�
S.TOTALDEPTH: b 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j'
7. STATIC WATER LEVEL Below Top of Casing: .6- FT.
11Use "+" 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): 07 © METHOD OF TEST 7,Lr r cl
10. WATER ZONES (depth): SD) //a S I
11. DISINFECTION: Typ9
12. CASING:
Depth DJjameter
From 0 Tod -3 FL Co y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,
From d To t,2 3 Ft. jjc#ic4 A i> fey
From To Ft,
14. SCREEN: Depth Diameter Slot Size Material
From . / . To Ft. in. in.
From N/� To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
1} I Pde_
16. REMARKS:
ijcO ,ST41UC.. 40tif T
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
IV
p
c
G) c`-
m
t•i
n-
r-1
to
LOCATION SKETCH -
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4RDS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the on ina to th
r 2767/9•a644�tc. o. (919
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days.J GW-1 REV. 07/2001

253443
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of WaterTQuality - Groundwater Section
���
WELL CONTRACTOR (INDIVIDUAL) NAME (pantiL L C. g // / S _ 7. 11 CERTIFICATION t'P1b
WELL CONTRACTOR COMPANY NAME whet l e--✓,.d.(.ee- later PHONE M JS II G V 9- D7 p s
STATE WELL CONSTRUCTION PERMIT# Ai/e4 ASSOCIATED WQ PERMIT# Tye 9S! Gt)
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential X Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI /�
Nearest Town: C�¢J un 9.24,7f - 9 7
T 97a7e- yS7!
(Street Name, Numbers, Community, Subdivrsi t No., Zip Code)
3. OWNER: 1.249
Address 3 839 ✓3-6'L1.tfle -
(Street or Route No.)
If/ 97//7a-t1SW
Cfr Town State Zip Code
Arca code- Phone number
4. DATE DRILLED 3/..2.sl6 2_
5. TOTAL DEPTH: SoS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO XI
7. STATIC WATER LEVEL Below Top of Casing: / g D 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
valiance in accordance with 1SA NCAC 2C .0I18. •
9. YIELD (gpm): .Z METHOD OF TESTT-G.44J
10. WATER ZONES (depth): / 9 0'
11. DISINFECTION: Type ffZeilika
12. CASING:
Depth Diameter
From_ To 90
From To Ft
From To Ft.
13. GROUT: Depth
Frorn _ To .[
Ft.
Slot Size Material
in.
in.
Amount /4 °S'
Wall Thickness
or Wei�tt/Ft. serial
#47 Pdc
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft
To Ft.
ethod,
Material
Ft Cte'vW
From
From
16. REMARKS:
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS COb
CONSTRUCTION ST_.t! . a S, a ' T A COPY
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
IV c
C.1T
—v m�
LOCATION SKETCH
Show direction and distance in miles from at 1eaa
two State Roads or County Roads. Include the road
numbers and common road names.
SIGNATURE
PERJ
NS
2
,i;1
FE
Submit the original to the Division of Water QuaEty, nndwater Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 day:. ASNGROUNEVILLEDWATER
R SE OFFICE
O
'ANCAC 2C, WELL
D TO THE WELL OWNER
,/,J,s/a z_
DATE
ervice Center - Raleigh, NC
GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PE12\IIT# ASSOCIATED \\'Q PERMIT#
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. ' Municipal/Public ❑ Industrial 0 Agricultural ❑
Moniloring ❑ Recovery ❑ Heat Pump Water Injection 0 Other O If Other, List Use
2 WELL LOCATION
Nearest Town:
V County s ale tit
Street Name. Numbers. Community, uhdivision, Lot No.. Zip Code)
3. OWNER:1onf.As a. Att C/t&.Y
Address 1}o( C-i 6trrfftria Cekc ..y Peg
(Street or Route No.)
S /vwn N 6210 ?P
Cit or Iown State Zip Code
( )-
Aran code- Phone be
4. DATE DRILLED JO7'/-02
5. TOTAL DEPTH: yos
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing /1`S FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /j' METHOD OF TEST 41:10
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING:
Depth
From 15 To /66 Ft.
From 'To Ft.
From To Ft.
13. GROUT: Depth
From Foj�,(Z._ Et.
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tnral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) dc-/R/iCriste t CERTIFICATION #3 41,.3
\\ELL CON TRACTOR CO\I IANI' NAME _en tt QE-pS• Lieli .2f'1/Jl)tif,J-Att.. PHONE # &52pC_ .976
To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Sizc
From To Ft.
From To Ft.
Ft
Wall Thickness
Ditnccr or Weight/Et. Material
PVC
Material
Diameter Slot Size
lat.
Ft. in.
16. REMARKS:
Method
267771
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees,Mi notes/seconds)
Latitude/longitude source:❑GPSOTopoL_raphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a - mad CI•Sry ,
/v0 - re) %#c *ei lc
W
L
)34 rat
^1
J U`
+'U
LOCATION SKETCH ;=ice
Show direction and distance in miles from ajcasty,_ tt
two State Roads or County Roads. Include j&e ro4 ;c
numbers and common road names. 0
ct
r•sqvism:4ard
Material
in.
in.
Material
O
N
0
rn
0
c-�
N
-21
Cr?
cn
Y THIS WE
1 S3 rFN ;S, AND TH
DEC — 9 2002
Submit the original t(o I e D
GROUNDWATER SEC I 9) 73
ASHEVILLE REGIONAL OFFICE
SIGNAT
T
C1BPYLbF S RECt.DR H
E or I'1cpfN (10CVST,I4L1CTIN
vision of Wate
-3221, ai hin 3
CE WIT-CN PROVIDED l'O THE WELL OWNER
H ISA NCAC 2C, WELL
Aa
WELL
DATE
Quality, Groundwater Sction 1636 Mail Service Center- Raleigh, NC
NDWATER SECTION GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anural Resources - Division of Water Quality - Groundwater Section QQ
WELL CONTRACTOR (INDIVIDUAL) NAMEr�(pr_in•t)� 4.0: � -/-�� CERTIFICATION`-#3623
\\ELL CONTRACTOR CO\IPANY NAME CrinUe 3 �i Oh�i: U� 4NL- PI10.\E # (�I�+�L� /j/4
267767
STATE WELT CONSTRUCTION PERMIT'S ASSOCIATED \\'Q PER\IIT#
(it/applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential2Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring D Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELI. LOCATION: (N.
Nearest Town: ✓ County ''"��''��''����""""
(9/d Dr 5- ib-vo 406,41
(Street Name. Numbers. Community, Subdivision, Lot No.. zip Code)
3. OWN ER:/W.C/Olt3 etgOl-i
Address C'cl /)7/�,%✓o ✓erA-/
(Street or Route No.)
5'Jun- AfcD17 74
Zip Code
City or own Stale
Area code- Phone number
4. DATE DRILLED U--020-tl1.
5. TOTAL DEPTH: 115-5-
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 � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): aC+ METHOD OF TEST /iY
10. WATER ZONES (depth):
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.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees mlames/seconds)
Latitude/longitude source:❑GPS❑Topog raphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- UG cm-7
Yb - vS ,tAzer; cite _
11
12
DISINFECTION: Type
Amount
CASING: i Wall Thickness
Depth , I Dian to or Weight/Ft. Material
From f) To L Et. 10'T( pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material �1 Method
From v To_aa Et. Ce4161,t tOltsgy e i
From To Ft. /"
14. SCREEN: Depth Diameter Slut t 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.
cS
16. REMARKS:
ERO
fzJNN A IA 4
C
DEC
HI
bY_ ..DYIN
_ 9 LC0'? J SIC N A1A)RE OP-RERSDU CY,a )rRu
Submit the original to tl a Div
b 'lj' i3t)'p , fluS° 1 ) 733-
ASHEVILLE REGIONAL OFFICE
sic nof
221, vv'ift�
K. MANCE WITH 15A NCAC 2C, WELL
1{,f5 BEEN PROVIDED TO THE WELL OWNER
/2 - ' -> Z
.Grout th ester Se
111 VfiTGIONAL OFFICE
THE WELL DATE
Lion, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELLCONTRACTOR (INDIVIDUAL) NAME (print) Ckve I Y/f/le/L
VVELI, coNTBACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERi\IIT#
(if applicable)
Pa/le[ (• '/ .0ri /l% f
CERTIFICATION #a.)81
PHONE # 3)'f3B
ASSOCIATED \VQ PERMIT#
(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 LOCATION:
Nearest Town: W11144r<,u- County rneRkd
" fltoMIM G•Alu/ �%
(Street Name. Numbers. Community, Suhdivision, Lot No.. Zip Code)
3. OWNER: your Pl•
Address vT67d'7
(Street or Route No.)
Loki -Lief N,C•
City or Town State
o2flt
Zip Code
(` )-_c8- 41a(
Area code- Phone number
4. DATE DRILLED )I-1C-ct-
5. TOTAL DEPTH: 4: V
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
7. STATIC WATER LEVEL Below Top of Casing /'V' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope CBValley ❑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. Typo ['.loi-llvz- Amount a.P fo#nai
12. CASING:
Wall Thickness
Diameter or Weight/Ft. Material
1 V C-
Material
Comer.*
14. SCREEN: Depth iameter
From To in.
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
f1vn/21/
Slot Size Materiel
in.
in.
Depth
From_1 To_72.4Et.
From To Ft.
From To EL
13. GROUT: Depth
From) To .o Pt.
From To Ft.
D
Ft.
Ft.
16. REMARKS:
t1A' 1
268764
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. cm,/t
/Fn
L. submit the uursin NFtb the
to. r 276139,16161 hhi6111 .9I9) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Olazeti
SIGNATUI2E OF PERSON CONSTRUCTING THE WELL DATE
'vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

268789
WELL CONSTRUCTION RECORD
North Carolina — Department of Environmental and Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MARK GETTYS CERTIFICATION # 2345
WELL CONTRACTOR COMPANY NAME GEOLOGIC EXPLORATION, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0
2. WELL LOCATION:
Nearest Town: DILLSBORO County JACKSON
HAYWOOD & LANDFILL RD.
Municipal/Public 0 Industrial 0 Agricultural 0
Other® If Other, list Use SOIL VAPOR EXTRACTION
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACKSONCODNTY
Address 401 GRINDSTAFF COVE RD.
SYLVA
(Street or Route No.)
NC 28779
City or Town State Zin Code
( )
Area Code — Phone Number
4. DATE DRILLED 10-29-02
5. TOTAL DEPTH: zoo FEET
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tzi
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS o.o FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C 0118.
9. YIELD (gpm): N/A METHOD OF TEST N/A
10. WATER ZONES (depth): N/A
11. DISINFECTION: Type N/A Amount
12. CASING:
Depth
From 0.0 To
From To Ft.
From To Ft.
13. Grout: Depth
From 0.0 To
Wall Thickness
Diameter or Weight/Ft. Material
5.0 Ft I INCH SCH40 PVC
From
14. SCREEN:
From 5.0
To
Depth
To
From To
Material
1.0 Ft. Portland Bentonite
Ft.
Method
Slurry
Diameter Slot Size Material
20.0 Ft. 1.0 in. 010 in PVC
15. SAND/GRAVEL PACK:
Depth
From 3 0 To
From To
Ft. in. in
Size Material
20.0 Ft. 20-40 FINE SILICA SAND
16. REMARKS: GP-los
Ft.
DEPTH
From To
0.0 5.0
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ® Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DRILLING LOG
Formation Description W
RED SANDYcSB T
5.0 20.0 BROWN SANDY SSSY W7It
0
�—,
COBBLE&
oc
fTi
1_,
m�
it) rna
c3
C!
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, inculed the road
numbers and common road names. ca
BENTONITE SEAL FROM 1 0 TO 3.0 FEET
_� Sa
5 It"
Isuck
I DO HEARBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC G THE WELL DATE
i)! n t_ u t Illeao4na th
w f-29699•t636-Phen of
L
c
0
Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

268788
WELL CONSTRUCTION RECORD
North Carolina - Department of Environmental and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MARK GETTYS CERTIFICATION # 2345
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
GEOLOGIC EXPLORATION, INC.
ASSOCIATED WQ PERMIT#
(if applicable)
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest Town: DILLSBORO County JACKSON
HAYWOOD & LANDFILL RD.
Municipal/Public ❑ Industrial ❑ Agricultural ❑
Other® If Other, list Use SOIL VAPOR EXTRACTION
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACKSON COUNTY
Address 401 GRINDSTAFF COVE RD.
(Street or Route No.)
SYLVA NC 28779
City or Town State Zin Code
( )
Area Code - Phone Number
4. DATE DRILLED 10-29-02
5. TOTAL DEPTH: 25.0 FEET
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 o o FT. Above Land Surface'
*Top of casing terminated aVor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): N/A METHOD OF TEST N/A
10. WATER ZONES (depth): N/A
11. DISINFECTION: Type N/A Amount
12. CASING:
Depth
From 0.0 To
From To
From To
Wall Thickness
Diameter or Weight/Ft.
5.0 Ft 1 INCH SCH40
13. Grout: Depth
From 0.0 To
From To
14. SCREEN: Depth
To
From 5.0
From To
Ft
Ft
Material
PVC
Material
1.0 Ft. Portland Bentonite
Ft.
20 0
15. SAND/GRAVEL PACK:
Depth
From 3.0 To 20.0
From
16. REMARKS:
To
Method
Slurry
Diameter Slot Size Material
Ft.
Ft. in. in
10 in.
.010
in PVC
Size Material
FL 20-40 FINE SILICA SAND
Ft.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ® Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0.0 10.0 RED/BROWN SANDY SIa
10.0 25.0 BROWN SILT WITICCDOBB
- cE.cS.
o:
rn fir.
CC
O
c.l1
cn ]S
n
n
ti
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, inculed the road
numbers and common road names. CD
L
1
GP-131 BENTONITE SEAL FROM 1.0 TO 3.0 FEET
Drie
!;;I LiQ'HEjFtBN CiTIt'Y TI
f, CONSTRUCT ON STA9�P
k L'
Submit the original to the D vision
l-. -27699-1636 Phone No (9 733-
P ° '
US WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
w1CC1d& i1/44"
3NATURE OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environmental and Natural Resources — Division of Water Quality — Groundwater Section
CERTIFICATION # 2345
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MARK GETTYS
WELL CONTRACTOR COMPANY NAME GEOLOGIC EXPLORATION, INC.
268787
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other® If Other, list Use SOIL VAPOR EXTRACTION
2. WELL LOCATION:
Nearest Town: DILLSBORO County JACKSON
HAYWOOD & LANDFILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACKSON COUNTY
Address 401 GRINDSTAFF COVE RD.
SYLVA
(Street or Route No.)
NC 28779
City or Town State Zin Code
( )
Area Code - Phone Number
4. DATE DRILLED 10-29-02
5. TOTAL DEPTH: 35.0 FEET
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 on 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): N/A METHOD OF TEST N/A
10. WATER ZONES (depth): NIA
1 I. DISINFECTION: Type N/A Amount
12. CASING: WalI Thickness
Depth Diameter or Weight/Ft.
0.0 To 15.0 Ft ( INCH SCH 40
From
From
From
13. Grou
From
From
To Ft.
To Ft.
Depth Material
0.0 To 10.0 FL Portland Bentonite
To Ft.
Material
PVC
Method
Slurry
14. SCREEN: Depth
From 150 To
From To
Diameter Slot Size Material
35.0 Ft. 1.0 in. .010 in PVC
Ft. in. rn
15. SAND/GRAVEL PACK:
Depth Size Material
From 13.0 To 35.0 Ft. 20-40 FINE SILICA SAND
From To Ft.
16. REMARKS:
DEPTH
From
0.0
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ® Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DRILLING LOG
To Formation Description
15.0 ORANGE/RED SANDY SILT
15.0 35.0 BROWN SANDY SILT WITH
COBBLES
r P
JA
C— r,2
O
>c
3 = o
re;
?
LOCATION SKETCH ul
Show direction and distance in miles from at least
two State Roads or County Roads, inculed the road
numbers and common road names.
GP-I51 BENTONITE SEAL FROM 10.0 TO 13 0 FEET
Siic
O
W
r_ 2
Lard
-c
I DO HEARBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r LUNN 1 RUCTION STANDARD&AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
\DATE
S
Suirniit the original to the DivjEi 6f.
27699-1636 Phone No. (919) 7332
f.*
NATURE OF PERSON CONSTRUCT EN i THE WELL
Yrs
O
J
Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
I, within 30 days. GW-1 REV. 07/2001

268786
WELL CONSTRUCTION RECORD
North Carolina — Department of Environmental and Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MARK GETTYS CERTIFICATION # 2345
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME GEOLOGIC EXPLORATION, INC.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box):
Residential ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest Town: DILLSBORO County JACKSON
Municipal/Public ❑ Industrial ❑ Agricultural 0
HAY W OOD & LANDFILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACKSON COUNTY
Address 401 GRINDSTAFF COVE RD.
(Street or Route No.)
SYLVA NC 28779
City or Town State Zip Code
Area Code — Phone Number
4. DATE DRILLED 10-30-02
5. TOTAL DEPTH: 30.0 FEET
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS o 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): N/A METHOD OF TEST N/A
10. WATER ZONES (depth): N/A
I I. DISINFECTION: Type N/A Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0.0 To 10.0 Ft 1 INCH SCH 40 PVC
From To Ft.
From To Ft.
13. Grout: Depth Material Method
From 0.0 To 6.0 FL Portland Bentonite Slurry
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 10.0 To 30.0 Ft. 10 in. .010 in PVC
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth
From 8.0 To
From To
Size Material
30.0 Ft. 20-40 FINE SILICA SAND
16. REMARKS: GP-121
Ft.
Other® if Other, list Use SOIL VAPOR EXTRACTION
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
0.0 10.0 RED SANDY AT
10.0
30.0
BROWN CLAYEY WI' W%17-1
COBBLES-+ '_t
r;
en _- -
C rri
O
CST
coat
m
t7
-1
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, inculed the road
numbers and common road names.
BENTONITE SEAL FROM 6.0 TO 8.0 FEET
XTI7AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
T Il (1 tONSTROCTION STANDAODS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L. (.‘0
i 1 SIGNATURE OF PERSON CONSTRUC I TH - WELL
L. t o 1 i 1
Submit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919) 7 3-3221, within 30 days.
J
zc
0
J
ATE
D
GW-1 REV. 07/2001

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] —r—
WELL CONSTRUCTION RECORD irRep e it/
WELL CONTRACTOR CERTIFICATION oN #: s
STATE WELL CONSTRUCTION PERMITS:
269939
1. WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: how sketch of the location below)
Nest Town: County'
(Road Name
3. OWNER
Address
mmunity, or iSupdIvIsion and Lot No.)
(Sfeoor \Vlo..).. ^ n r(Q F-1
City orw StWalel_ (= Zip Code I
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOIV )
7. DOES WELL REPLACE EXISTING WELL? YES n NO, yr
8. STATIC WATER LEVEL Below Top of Casing: 99S. FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated al/or below land surface requires a variance In accor-
dance with ISA NCAC 2C .0]18
10. YIELD (gpm): (_�j METHOD OF TEST 1
11. WATER ZONES (depth)*
Ck.S ern)
DRILLING LOG DEPTH
From To Formation Descdptlon
H c
ca
CHLORINATION: Type H TH Amount$
CASING:
Wall Thickness
Depth rDla;el�r cor'�elpa Material
From 0 To L4L Ft (y • d4
From Hie To 5In Ft.1,,15 • IRS
From To Ft
14. GROUT:
Depth Material Method
From D To Ft Concrete' pntkc-ed
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
a as
If 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)
at.fir r u J Lk.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY a' THIS RECO' a HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE tvi/P-dad.
94Y'
Submit origina Ion
Quad No: ' ' , ' 1 -= URE OF PERSON CO'' TRUCTING THE WELL DATE
_ Water Quality, ..round.__, er Section ,.thin 30 days
GW-1 REV. 12/99
I Sedal No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)4��/p/ £ 9Wc- CERTIFICATION #, Li7�J
WELLCON'r RACFOR COMPANY NAME C,�' c' eln0. »/Ci✓yl�v_ PHONE # �2.11--5W-;;;L
271145
STATE \P ELL CONSTRUCTION PERMED/ ASSOCIATED \\'Q PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentiah2-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IfOther, List Use
?. WELL LOCATION:
Nearest Town: S '�c-I/4
eta b., �fa
County 7/icP$O.0
(Street Name, Numbers, Community. Subdivision, Lot No-, Zip Code)
3. OWNER: JY 614-4.t5 {.
Address Mac /L-L
°t lore (Street or Route No.)
CityorTown State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED //l-tYJ-
5. TOTAL DEPTH: .2C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: t FT.
(Use "1-'' 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): (so METHOD OF TEST /r-r
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth
From 0 To 70 Ft.
From To Ft.
From To Ft.
Diameter or Weight/Ft. Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Front To Formation Description
-a - man t
13. GROUT: : Depth Material Method
From C9 ToQ,2 (a Ft. c't,1/4, /b-,✓sir!f f t/tied
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.
From To Ft.
16.REMARKS-
CONSTRUCTION S
tin
r
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. c
cHl-WEL,L AiC011,IR JCTED IN' ADAN] THKILA Cril?Y bV 71-115,REL RD
r
IG
A,TIJRE OF PERSQN CONSTRUCT
Bfoilli[Itj CRvakm e Div sioz of VVkiater Quality, Groundwatijr Sec
ASff;«d9af63?FCSfGiih9N®HpiCy 733-A221k within 30 days.
LOCATION SKETCH
O
co
m
IV
4-.-
CD
al
.DANCE WITH I5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
HE WELL
DATE
ion, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
Natural Resources
s--/JDivision of Water Quality - Groundwater Section p /�
WELL CONTRACTOR (INDIVIDUAL) NAME (prriint)G--/CArf (M. ///CLT�/11 D / CERTIFICATION #�/ 5/ /
'ELL CONTRACTOR CONIPANyNAMEA AA rcfrjsi Fbres• Lf e) ( 6- �(,'�I50--PHONE # 915)5,S t 5550
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMIT#
(if applicable) (if applicable)
2707n9
1. WELL USE (Check Applicable Box): Residential P2" D'l unicipal/Public ❑ Industrial ❑ Auricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: \II U Iq
N Count CU Aj
�}rC r Scr -i-+S 0 reek CA l
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope DValley in.irfat
(check appropriate box)
Latitude/longitude of \Tell location
3- OWNER:iX )Cs vI Ai( 3Ill 1 '{— IN (degrees'minutes:'seconds)
Address 5" r/ (L)P s4- I-)c, i r.0 S-t-rtei- Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
' U U [L. /J Q ?7'7 G DEPTH DRILLING LOG
nos or Tr State Zip Gode From To Fortpinipn Description
1S/c 1- LIL14- 9)oLi 4 C+ - 7 lc:L
Area code- Phone number
4. DATE DRILLED/✓et;Cmber 7 e>LCC:.Z 9,17 - 1 35 cc rei AD i 7-e--
5. TOTAL DEPTH: a Ur)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / U Ff.
(Use "+" if Ahoce Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
`Top of casing terminated at/or bolosv land surface requires a
variance in accordance ssjth I5.- NCAC 2C .0118.
9. YIELD (gpm): lc U METHOD OF TEST C i r
o.WATER ZONES (depth): 90--/35. yn--/7L)
I L DISINFECTION: Type HT H Amount rj . t o e /_
12. CASING: Wall Thickness
Depth DianDiaoller or WeightFt. Nlaterial
.From__To 39, Ft. (2 7g sired
From To Ft.
From To Ft.
13. GROUT: Depth Material
From /7 To_,;"L) FtTe P(J1C #-
From To Ft.
14. SCREEN: Depth Diameter Slot S
From To F1. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Method
/ L I
Material
O
in.
Size Nlatena
I DO HEREBY CERTIFY TI-IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
5, AN ; "HAT A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNETZ
/I /_ ? , l2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit th1vordgin.I to '' l ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (99) 731-3221, within 30 days. GW-1 REV. 07/2001
l33'7 Cc.0
5ra Ati 17'
/70 - /';?. Le- c1`-f-L'
I '7 ‘.9 _ 9Oc cj irct
LOCATION 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, 39, xyltjIr.
5a7 S tec� /Ect
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J 1 _,:r*S
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v:
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