Ma 2 CY2002

3. OWNER: e' 1✓ f n /C UL
%1i
Address 2i V i •� /�-�l
(Strqet or Route No.)
VQ-n 11.1,7�� /v r
Ciyy or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / -0 6
5. TOTAL DEPTH: c30
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /CL) FT.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. 7A /u,/,
9. YIELD (gpm): /0 METHOD OF $ 0/ir
I0. WATER ZONES (depth): J/ l
265479
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c I -e h h 1 51 / II))QM AJ CERTIFICATIONI$ 4 /7 Y'
r rr�v A Iij I I sFI it l l . YI P I PHONE #iA 2Sl —J e21-/-3 ;24 6
WELL CONTRACTOR COMPANY NAMR�.pnt � I� �I'C9^ �'
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED W ERMIT$
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIIOnN: ,,/ n nn
Nearest Town:! K�Q 4.4L) /�' /1P(',£ounty ///e C07J
et,n. 5,- R _ - 4. 9/f ` J
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
cb ' 9-:3 7C
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 11'/-» Amount_c2f.A.E.5
12. CASING: Wall Thickness
Diameter or Wei hUFt. MatepAl
From 0 ` t Ft. (f" Pr Lc -
From
13. GROUT: p Material Method
From (i Co4T MQ)ti r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From Ft.
Ft.
Depth
To
To
To
Depth
To r%D Ft.
From To Ft. •
1 DO HEREBY CERTI
CONSTRUCTION. STA
LhCL'i Irh SLR l Oi
L tvision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includea(e roP
numbers and common road names. N c
O E'a
rrl ,
▪ z _-
I on
v.r�
yG
m�
�o
rn
0
c4
--t
O
Z
0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
�S, AND THAT A COPY OF TH S RECORD H,S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?11e rm i 51I '-}Y) /) r2 fvl CERTIFICATION q /7le
YELL CONTRACTOR COMPANY NAME .hnc i'tlA �I nMA �))PI 1 Y`r l l Di/(j . ] . rL 0 PHONE N iSI ..-�Sa 4-3 a 6
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential C- icipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neaf est Town: it & l /kL/ 4/� ounty 4M(.Gl7 )O
//ranilbL// / 4//s 56j./n><Z /7
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:, lam, YY d)e-%r'S> C
Address '-1>. (_l, [ /l/ (cc)$(
(Street or Route No.)
F)Ct,Iv�
City or Town State Zip Code
F % 7y sV
A code- Phone num er
4. DATE DRILLED fol.- --6 2 ,
5. TOTAL DEPTH: fir?S-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: /SD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
r *Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): S METHOD OF TEST /02,07 -.
10. WATER ZONES (depth): "9?) (�
LOCATION SKETCH
1 1. DISINFECTION: Type 1-If% Amount rZ r,41j S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia etertor Wei ht/Ft. Material numbers and common road names.
0 To .�/ Ft. l pYe-
From To Ft.
From To Ft.
13. GROUT: Depth
From O To � Ft.
From To Ft.
From
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From
From
Material
82471
Me hod
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft
Ft.
Material
TDZS HEREBY CERTIFY
CONSTRUCTION STAND
G rU
-,lSSttbhulitihe trr1gi13a1-ie��e ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC t
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200p
265478
6£ :£ kid 6- 330 ZO
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
%j -3 -- 6 ot
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) N�2nl015 I /3Qn\cL CERTIFICATION# oZ/7(p
WELL CONTRACTOR COMPANY NAM& I X-nnV � It'd I Iu,,4 Wei Ql tfr II ). n P l PHONE # j'2-%1 _53 4 —3 24 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential YQ•---Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: R““ > County Ad(Y Lem
HT) I IQ/b rL — ei Lo i e_h . -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
/O / kir /104,�
3. OWNER:
Address
L� r
r2sIn
ity or To n St Zip Code
b9-V-3
Area code- Phone number
4. DATE DRILLED /
5 TOTAL DEPTH: - mrY''-
(Street or Route
F kidaLi 4/ /v
265477
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 la NO m�
7. STATIC WATER LEVEL Below Top of Casing: -'G) FT.
(Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
, variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 S METHOD OF TEST:5/OZUr)ieF
10. WATER ZONES (depth): (Q) /0 S) —5�_7
LOCATION SKETCH
11 DISINFECTION: Type R-1-14 Amount ,-2 T,4 13 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth// 7 Diaeter or it hdFt. Mate al numbers and common road names.
From To C-` / Ft. (n " 1 l ki Q V2
From To Ft.
From To Ft.
13. GROUT: Depth Material,
From n To (-,D Ft. eo40d 67,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Method `
pwV
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
Ft.
Ft.
6£:£ Wd 6-330Z0
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the oflginartothy Div Sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Al2'b99.1636-PhoietN-e. 1919)7
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
267240
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -
WELL CONTRACTOR (INDIVIDUAL)NAME
(print) s?)I f)VI15I IJ-f)!)ant%rt. CERTIFICATION #`st/7(
WELL CONTRACTOR COMPANY NAN1K ,I)111 1VIUjliFMr4 eiIThY`r II;Hd .)_4PJ PHONE # lU ..J e2 Li-3 gb0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION/:
Ne�yf{est Town: "A' 44, 'Lin/ /11 County 4)4; //X 2.
L nrce/rH!/9rl I /' it / SfrZe, C/ F
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
c
3. OWNER: /C ei rl ✓ / `, c (degrees/minutes/seconds)
Address .-1 �/ /t • `i 7 �„a /r> j (S 7> _�_ j,, 6—Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
U I fla l /Ua I Pi' S/ t2 �3 7 L' �7 DRILLING LOG
City or Town State, , Zip Code
7( - .s9-5- 7y97
Area code- Phone number
4. DATE DRILLED /09- 9.7 —d �--
Fro
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
DEPTH
m To
5. TOTAL DEPTH: t' 5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑—
7. STATIC WATER LEVEL Below Top of Casing: .BSc 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): c2 n METHOD OF TEST /X-
10. WATER ZONES (depth): /nc //70, ?TS 0
Formation Description
LOCATION SKETCH
I I . DISINFECTION: Type H±» Amount ,-2 -n9- 13 5 Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth
From 0 To 23.
From To
From To
13. GROUT: Depth
From n To r
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Diaptetter
Ft. (__
Ft.
Ft.
Ft.
Ft.
Material
or Weight/Ft. MMateptl numbers and common road names.
Diameter
Ft. in.
Ft. in.
ONSTRUCTION STAND
Method
om
Slot Size
in
in.
Material
Material
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
D THAT A COPY OF THjS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
W
r_
w
0
Cil
w
.4/
SI :,NATURE OF PERSON CONSTRUCTING THE WELL DATE
c
c
7into fi YignaJtd,,''byrerDivisonofWaterQuality,GroundwaterSection,1636MailServiceCenter-Raleigh,NC
699 1636 Phonc No. (4 73-3-3i21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) el)-enVIiS �)On\ di • CERTIFICATION# et/740
WELL CONTRACTOR COMPANY NAMtt I)111 C (dt)jlQ,4r4 Wei I 11'6 l l'lt Qrj ), yt e v PHONE # ,r_Suz L/-3 L 6 a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPERMIT#
(if applicable) (if applicable)
266263
I. WELL USE (Check Applicable Box): Residential unicipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: N I I /41-A/L DS I/O -County AlQ cm(---,
1�()CIc ('12 e 4emm,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / 4 ('e� u S 1l i 1
Address c` 6' 7 (>/c/ /71-1r RP
gi Aft Znit-Al
4/ e�k !
Racai_ty or Towg� Stalec2� 9/ 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
Area code- Phone number
4. DATE DRILLED / —/3-D Z
5. TOTAL DEPTH: c>2OS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance w th I5A NCAC 2C .0118.
9. YIELD (gpm): /-D METHOD OF TEST IOJ/}i7t�l/—,
10. WATER ZONES (depth): -7 (�
11. DISINFECTION: Type H-t-P Amount .a S
12. CASING: Wall Thickness
Depth Dia eter or Wei ht/Ft. Mate ��jjI
From 0 To FL r lii p
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From <i To ciip Ft. er).yr
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:
Bv'CERTIFY THA
I'•VaN:sT,A D
�. II
S ibi r+gin? tu-tti \ivisioll or Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
7 1000.p,k Np, 0t9dFip-3221
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
D THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWICBR
0 d is—/3-LJ -
ATURE OF PERSON CONSTRUCTING THE WELL DATE
within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 6 6 2 61
North Carolina - Department of Environment and NaturalTTResources - DivisionofWater Quality - Groundwater Section / -
WELLCONTRACTOR(INDIVIDUAL)NAME (print) chefl 1 51 1-�J11QN1 rU CERTIFICAT,I�/ON# /eZ/7le
WELL CONTRACTOR COMPANY NAMR t i II:Lk/4J I/JP4I 11 V`r J < 4. .) - of P i PHONE # lU --J a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential!<YMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI;
Nearest Town: rive /).2 %�� I /Ili /%Canty 44a (/71Z
(i)a.ja 1 7 Cinj)7iY)>
(Street Nadie, umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C / -i b 1 (Li-9_ ( ,
Address £f-13pf7 (/)0A-1
(Street or Route No)
F{ 107 � lr9v /j 'C tc, ec 1.
City or Town State _Zip Code
Area code- Phone number
4. DATE DRILLED ,- I k—Ll 2
5. TOTAL DEPTH: eBoF;
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ j
7. STATIC WATER LEVEL Below Top of Casing: ..S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118,
9. YIELD (gpm): Zn METHOD OF TEST_ /OJUi7LC(
10. WATER ZONES (depth): (P<S ' / .2O ' (�
Topographic/Land setting
DRidge ❑Slope ❑Valley 0Flat
(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
11. DISINFECTION: Typef
12. CASING:
Depth
From 0 To fliff
From To
From To Ft.
13. GROUT: Depth
From n To cD Ft.
LOCATION SKETCH
Amount ,-2 779- g S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Wet ht/Ft. Mate al numbers and common road names.
' Ft. /?� r/i
Ft. � �'e
/
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Material Method
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
A
O
c
CD
0_-
0 •
c •
c
0
r
Y> o
Fr 10
t
�T
0
G
Tfi`E'/CI_FON STAND Di a THAT A COPY OF THJS RECORD HPAS BEEN PROVIDED TO THE WELL OWNER
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
EREBY CERTIFY THATlT ` WELLWASCONSTRUCTED IN ACCORDANCE WITH 15A NCAC2C, WELL
(
Su mit the oral to ihe_Di iision
27692B636�Rhe e#0, %1 ry, 3221,
0

WELL CONSTRUCTION RECORD
266243
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :hen Yl15 An J' i2 nv CERTIFICATION# of//-r
40
WELL CONTRACTOR COMPANY NAMRIX. to fr)In.,4J WeiI1lY'kii Q� ),nfr� PHONE # e6i_.�a4-3.-66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Yd- Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: f7/74J i L 14/47e County (! a tii7t_)
,O/ Yg_- /-><,//t-I — f /( pi, r)-Lih w��Camm
(Street Name, Numbers, Community, Subdivision, Lot It, Zip Code)
3. OWNER: i) ` r tr.)
x r`p
Address F: f �l k� �
--� (Street or Route No.)
�YeY a. ;>lc. 617/.
,. ity or Town State Zip Code
,5 D — 8-7/2
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 'jr 5
6. DOES WELL REPLACE EXISTING WELL? YES O NO VJ-
7. STATIC WATER LEVEL Below Top of Casing: � f ' 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 tth 15A NCAC 2C .0118. .
q. YIELD (gpm): , METHOD OF TEST_ /020/71---,
10. WATER ZONES (depth): -3F) rt (l
Topographic/Land setting
❑Ridge OSlope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(dcgrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
11. DISINFECTION: Type H-7411 Amount c"T4 A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
De th Dia eter or Wei hb'Ft. Mate fit numbers and common road names.
From 0 To .L. �-. Ft. i / QYv
From To Ft.
From To
13. GROUT: Depth
From n To
To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Ft.
Material c
Ft. Cant Mt r0
0
m
rn
cN 0<
r.
c
NZ
0
O -/
0
16. REMARKS:
From
Ft.
From
From
Diameter
Ftin.
in.
Size
Ft.
Ft.
Method
C,
Slot Size
in.
in.
Material
Material
ubmit the original to th Divis
T'fi' e 33-3;
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
GNATURE 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
AS': f.:-.(4:itiLL FACE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAMjES. �(print) c7).efl k11S /In j )wf1 f�i CERTIFICATION # O1/7 4
WELL CONTRACTOR COMPANY NAMt betnij C 140110.4w4 I)Th I aiY`r l l'at c{ -PIP PHONE Ni7-e6i_.5%2 4-3 16
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WCPPERMITtl
(if applicable) (if applicable)
265794
1. WELL USE (Check Applicable Box): Residential D- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: , ?f9*kLi//,t/(2ounty
r942. e,28__CIra,kS C-12 I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip ode)
3. OWNER: La r-P-3 �Q VI S
Address / g 9 �i ��G J i -P /7- 'acts.
kiStreet or Route C
y or Town State phi ^Zip Code
tin to
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
Arca code- Phone number
4. DATE DRILLED /
5. TOTAL DEPTH: //0<'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: $0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): /0 METHOD OF TEST /U)U,
• variance In accordance with ISA NCAC 2C .0118.
7L({
10. WATER ZONES (depth): / 7b (�
11. DISINFECTION: Type iff%<
12. CASING:
Depth Diameter
From 0 To g.3 Ft. !'2
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r` fD Ft. D.yyr 07 ptw x.)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Amount .-. %,i A S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or WeighUFt. Ma numbers and common road names.
Sce�
16. REMARKS:
or a a —OS -o a_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
S>t mitt al to t e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
�.�� tt �) GW-1 REV. 07/2001
A GPC't 4"¢ +iY No (91') 733-3221, within 30 days.
1 DO HEREBY CERTIF,Y'THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
-CONSTRUe HON i, ApII/ARDS, AND THAT A COPY OF TH S RECORD S BEEN PROVIDED TO THE WELL OWNER

265793
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality CIJ WELL CONTRACTOR (INDIVIDUAL) NAME (print) tuP 12,2lll1tJ / /Ion j_
WELL CONTRACTORCOMPANYNAME cQ13)-DS Q.Y. 2/i :t->Y%)I (7t oI ZNt
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
- Groundwater Section
/ -
CERTIFICATION # « / 7
PHONE # ? aki C- �— 3
I. WELL USE (Check Applicable Box): Residential — unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 ICOther, List Use
2. WELL LOCATION:
Near st Town: ��4k2 l /v7 County 14(2 P.I(yt
nt-al(Z inZ/1-J
Community, Subdivision, Lot No., Zip Code)
(Street Nan
3. OWNER:
Address
l; )91-e)-v L-erl 1�-1
(Street or Route No.)
itv or
— St
Town Stae
Zip Code
cz9
Area code- Phone number
4. DATE DRILLED /
5. TOTAL DEPTH: c f``,[7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 71--
7. STATIC WATER LEVEL Below Top of Casing: y n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*'fop of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): 40 METHOD OF TEST A/at/J/-2,-
10. WATER ZONES (depth): 0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road=
aA
Topographic/Land setting
OR idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type /-/d-Lf Amount a t4-R S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To // Ft. &
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From V To 6-2+ Ft. P 0,-k1/4--enar !, zei
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
pY�
From To Ft.
To
From
REMARKS:
Ft.
numbers and common road names. 0
0
nrrl
•
C
aL
T Ern
j0
m
rrnn
(elrrnn0
ca
O --I
1/40 0
I DO HEREBY CERTIF ' Milli THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA(4 91R )S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
13RCAY: 1W-:'1F.R. SECTION
ASHgyi '�:;1Ci�At. OFFICE
v
C'L/G42tL /r7 -i`c —.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2001

264659
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section \YELLCONTRACTOR (INDIVIDUAL)NAME
(print) 3)Zn hl 5 Al )jnM dai CERTIFICATION# 01 /7`// o
\YELL CONTRACTOR COMPANY NAM&IXhj�ti $'F1 JI(}M� lileii )Y`r It TN r4 �.Ylf , PHONE #105*i_S,2 Li-3 26 0
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED NY Q PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI• r
N1eajestTown: ray 1 /.i'C>County 1.
�f (rn (L ei.2.4--4/vi,:, a4-1—. (rrn,
("free; Na.ne, Numbers, Community, Subdivision, Lot No Zip Code)
3. OWNER: Ye t )��
Address _,O.ROX (in.j
(Street or Route No.)
f) Cmkl, J �NC_ t E7VF/
Cry or Town State Zip Code
-- 5 2 — /,;•2
Area code- Phone number
4. DATE DRILLED JI—J 9' d _--
5. TOTAL DEPTH: ✓7L7_5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ J�
7. STATIC WATER LEVEL Below Top of Casing: 3 h P') 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. AJ�//�
9. YIELD (gpm): /' METHOD OF TEST i7t4-�
O. WATER ZONES (depth): (.0 (a
O a (1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeiiongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
I I. DISINFECTION: Type /71- f"/-7
12. CASING:
DepthFrom 0 To
From To
From To
3, GROUT: Depth
From n To r
From To
14. SCREEN: Depth
From To
From To
15
Diameter
Ft. /�
Ft.
Ft.
nn Material
0.0-47
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Amount .-2 T, S
Wall Thickness
or Wei ht/Ft. Mate 1
/ P ��'-
Method
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY F TH)S RECORD HQS BEEN PROVIDED TO THE WELL OWNER
/I Q nnq�J(� �(—/ 7-69 7,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Nonh Carolina - Department of Environment and Natural ResourcesI- Division of Water Quality - Groundwater Section
weLL CONTRACTOR (INDIVIDUAL) NAME (print) c�Znnl 5 /-�-n ( ��
CERTIFICATION q of 1% 4v
WELL CONTRACTOR COMPANY NAM CC has � o por,4 WejI4)�II. .e1 PHONE N
a��_.5a4-3 ae
STATE WELL CONSTRUCTION PERM ITp
(if applicable) ASSOCIATED W ERMITit
(if applicable)
I. WELL USE (Check Applicable Box): Residential ids Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 01 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATL.O� :
Nearest Town: PPj2/h K L.; 4/ County () Gin
<R/21-1, 141E °eTm, - LET II;���
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
f K � ct b ceb
3 OWNER ,
Address !So r5`1e/ „to a. /I--&- L
Route o.
(Street or N )
Pr (r tn� A/c e 17/
City or Town State Zip Code
_)- r j 7,3 Y./
Area code- Phone number
a. DATE DRILLED 7/—/S— D '7
5. TOTAL DEPTH: c3 D. S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J�
7. STATIC WATER LEVEL Below Top of Casing: 9-0 FT.
8 TOP OF CASING IS / (Use"+'• if Above Top of Casing)
FT. Above Land Surface"
'Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .01I8.
9. YIELD (gpm): MET OD OF TEST h/Oiti71�/�
10. WATER ZONES (depth): /(0 SI (�
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
I I . DISINFECTION: Type %} -%"� Amount ,--.2%f} A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
nn Depth Diajneter, or Weiaht/Ft. Ma numbers and common road names.
From V To FL (r� "
From To Ft. S /
From To Ft
13 GROUT: Depth Material Method l
From n To r Ft. CP-yt 4'j+� 170yA-)
From To Ft. I
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. •
CJ
-
C)
16 REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYYOF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or L
264660
SIGNATURE OF PERSON CONSTRUCTING THE WELL // DATE JO �—
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

264661
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section Co WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-he h 15 / I / I�Ow\ ck, CERTIFICATr,IOON p`r117
WELL CONTRACTOR COMPANY NAM&Y.t)jjtS (r )jIQ,ytr4 Wei Ikl ye; (J 74 +/l(_j.4P v PHONE 1 iSl..Je2 L/--3 a-6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
WELL LOCATION: M
Nearest Town:K,�,%kL(.2/ County a L(74i
/7 L LU„Jt_ go- r27 1.)n .,,c73T
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: :11 rneC% inh'S
Address 117 I G/ , d e `pet r I C t•- h R
(Street or Route No.)
f Qhn C—
C73V
City or Town State Zip Code
?(,a) c_5i24— 92/0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED //- S` —4
5. TOTAL DEPTH: r .371 ('
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / 0 - FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated atlor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /020/7L�i
10. WATER ZONES (depth): 77 ' (�
LOCATION SKETCH
1 I . DISINFECTION: Type At f» Amount 4 %A 13 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia'etter or Wei hVFt. Matep numbers and common road names
From To %y Ft. /n-- l pYY
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To - Ft. CQyyr dj,� rOlA'I/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THjS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

264662
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionof Water Quality - Groundwater Section//�
�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e�-e n1115 '-!'/%'Tam A CERTIFICATION cline
WELL CONTRACTOR COMPANY NAMI K.hjl1S (701IQgnr4 Wei I.[) yet 1��.!�-1'l tr PHONE%go-2S)—.5a L1-'3 26
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED W ERMIT%
(if applicable) (if applicable)
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 To/yin: pp4til/Lr/7/% ounty/j g(A)c,
.j lrreenu (Lc p.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Z t°% SC
Address &.5 6 rPP/v Area h.
(Street or Route No.)
ranv!70 • Joe �7397
yoQcr wn9_ Statgc2�� Zip Code
Area code. Phone number
4. DATE DRILLED Il—)/ —o 0--
5. TOTAL DEPTH: 47z Q S
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(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
7. STATIC WATER LEVEL Below Top of Casing: SC) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Ya METHOD OF TEST IVW,7f
10. WATER ZONES (depth): to 7 (�
LOCATION SKETCH
II. DISINFECTION: Type g if A' Amount ,�7"A1 A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth// `` Dia eter or Wei htlFt. Mate '• numbers and common road names.
From Tom Ft. /
!sa
Pr
Ci
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To r Ft. CP/ni Om J i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material -�
From To Ft. in. in.
From To Ft. in. in. '°
I S. SAND/GRAVEL PACK: rii)
Depth Size Material
co
From To Ft.
From To Ft.
16. REMARKS:
Method
074
MTh
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H 5 BEEN PROVIDED TO THE WELL OWNER
ei 044 l d,ku � l ! / — 0 2-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centteer' Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

264658
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality —Groundwater Section �""
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cbenoi 5
"' / ii A, • CERTIFICATION II ol%yam
WELL CONTRACTOR COMPANY NAM& p)')iC'C�LI�.ytri Weil II �kt/(j 7TnP l PHONE #%C. e21/-3 off-ec
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ'4 ERM1Tp
(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: f:/)44/k/1/74/(-- County &{Cla9i i
t/lJ CP')inmi 6 yL -
(S:reei Name, Nunt5ers, Community, Subdivision, Log No., hip Code)
3.OWNER: -)`li+ ft)r i))a.' t-.c21{')'h2l
Address r-2 4L.2(1 L rPn%u JOd r7 1b /
(Street or Route No.) �o 9 6 z
f tir ori /'e7, ,
City Town State Zip Code
'7 73J-- 3 4
Area codc- Phone number
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
4. DATE DRILLED J/ —/ ,1 —4 2
5. TOTAL DEPTH:. �S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0-----4---
7. STATIC WATER LEVEL Below Top of Casing: °Pp 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 req ulres a
variance In accordance wit 15A NCAC 2C .011S.
9. YIELD (gpm): METHOD OF TEST Alip)gi7L�%--+
10. WATER ZONES (depth): ,itZ 5- (�
iI- DISINFECTION: Type {ff» Amount 4%J4t S
12. CASING: Wall Thickness
0 Depth Dia��eter or Wei ht/Ft. Matep
FromTo�� FL ( 1` p
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r Ft. 00.-Yr a7s r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
i cD
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
20
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1ltD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYOF THJS RECOBEEN PROVIDED TO � WELL OWNER
�I
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAMEj� �(print) cbe n VI i 5 J4l) ' I a•A rl�• CERTIFICATION M�ol /l `t
WELL CONTRACTOR COMPANYNAMICINIMc Idt01IQr.1 I)MiI1 vSj I"It Q�(, 7rt' PHONE u a<_.l at"/-3 �-6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ'PERMITS
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIpN:7
Nearest Town: .?)���L �ounty Main(
trig OYu tJLOl) / C'vvnrn •
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / i YYI iQhhQt t 5
Address -S D c5'Q /P15 /-fin // Pry )
(Streetor Route e— c2176.1
City or Town Stateo.)
Zip Code
Area code- Phone number
4. DATE DRILLED /J—/ 5 — Lt
5. TOTAL DEPTH: cSO' '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ,/.2 b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT.Above Land Surface"
'Top of casing terminated at/or below land surface requires ■
variance In accordant wit 15A NCAC 2C .0118. /
9. YIELD (gpm): METHOD OF TEST //WU/7f
10. WATER ZONES (depth): 1 ao
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrees/minuta/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type it% /
12. CASING:
Depth Stt.
eter
From 0 To in ft Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material -�
From n To rip Ft. can,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount 47-,49 S
Wall Thickness
or Wei t/Ft. Mateppl
Pr
I6. REMARKS:
Ft.
Ft.
Method
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH s
Show direction and distance in miles from east a
two State Roads or County Roads. Include telsroaC
numbers and common road names. n 0 m
o<
CM at:t-t
rri
CJ m z
`D • 0.
rI H_REEY C€R
CONSTRUCTION S
GR0lit :a.tititEtlieorti
ASHEVILI.2B7
Mal to t
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL --
S, AND THAT A.COPY OF THIS RECORD S BEEN PROVIDED TO THE WELL OWNER
Or 1 -= J
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7)-eh V S S I-)-O /M (L CERTIFICATION N c2/740
WELL CONTRACTOR COMPANY NAM&IX'j)fl1c WPiI ¢1Yr-1ll': lc .).KP PHONE N 11i_SZ o2 L/-3 b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMITN
(if applicable) (if applicable)
262298
1. WELL USE (Check Applicable Box): Residential la--Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: raA-2JLL / N County /1
a Pn fry)
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Cod.-)
3. OWNER: P,O-c./ (000ci
Address 9-4 A' el ;•rr L g✓a ara
(Street or Route No.)
/'/) niyt
City or Town State Zip Code
4/— %7
Area code- Phone number
4. DATE DRILLED /6 --
5. TOTAL DEPTH: 3n S^
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V—'
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
cii""7 3 V
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. / _
9. YIELD (gpm): Sr METHOD OF TEST A102/ i7Ll(
(� uI
10. WATER ZONES (depth): ,- CY" N.)
0
11
12. CASING:
Dept
From 0 To ITO
From To
From To
!3. GROUT: Depth
From n To r D
From To
14. SCREEN: Depth Diameter
From To Ft. in.
To
DISINFECTION: Type
Diayietter
Ft.
Ft.
Ft.
Material
Ft. do,ryr Gyi
Amount ,2 7 "AWS
Wall Thickness
or Wei ht/Ft. Mate
Ft.
15
From Ft. in.
SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Method
PCIA
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
leek !4 - —a
w _
uo
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to th - Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.'(9tt 733-3221, within 30 days. GW-1 REV. 07/2001

262297
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c )-eID 1151 /Jt) jTl C)an^L CERTIFICATION #/o1/%y-
\YELL CONTRACTOR COMPANY NAMSb'.htjI i Jt f)1104nd II)EII.b vi I1':](�j- ) YL PHONE #nth iH —J e2. 4-'3 ,2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. 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. WELL LOCATION:
Nearest Town: ;/14tikL; /1//V(rounty
G/fv CAyr n-t •
a CIm
(Street Na:ne.��Nuumbbers, Commmnity, Subdivision, Lot No., Zip Code)
3. OWNER: 0,_h t'h/LI L(in n 7
Address (0,--nr•1q i?) c *F--)
(Street &lout No.) a
/-1-4,11(L1rtJ A/c- o2 1-77lI
City or Town State ✓� Zip Code • [
Area code- Phone number r7
4. DATE DRILLED /6 - / — D ��
5. TOTAL DEPTH: !in Sr -
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 IZY 0
7. STATIC WATER LEVEL Below Top of Casing: //)0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a _74.
variance in accordance ith I5A NCAC 2C.0118. /
9. YIELD (gpm): METHOD OF TEST A/Mi/
10. WATER ZONES (depth): J U
—I
LOCATION SKETCH al
1 I . DISINFECTION: Type W-'/"if Amount r� TIFFS S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. lnclu3 the road
0Dia��eterWei ht/Ft. Mate 1 numbers and common road names. o '
From Ft. lr7a` or WpV
From Ft.
From Ft.
13. GROUT: Material Method l
From Ft. eyyt a-y, flrnA
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft. •
From
From
Depth
To
To
To
Depth
To e
E CIE R1 UMARpS
IS
1 HEREBY CL!{�FY
CONSTRUCTION $ N
OCT 3 0 AT1'9
u
c)
Ca)
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT COPY OF THjS RECOBEEN PROVIDED TO THE WELL OWNER
//I}Qgn J' 7 _ p
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ASHEOUNENE
P NE%
z/699-1636 Plum
al to i he Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
9u. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001

262296
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division )I of Water Quality - Groundwater Section
\\ELL CONTRACTOR (INDIVIDUAL) NAME (print) t'he Dh1S /'}'/} /)QIA Cap CERTIFICATION J17 (
\\'ELL CONTRACTOR COMPANY NAME .I)fl S If toys- 1.0ei q)ve, I I'Ngr{ T-4 P l PHONE Nitic _3a 4-3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQi'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: i A/ County Aia-G(nt
� OL ci61 %) CL tin) 8 p, COm ran
Street Name. Numbers, Community, Subdivision, Lot No., Zip Cede
3. OWNER: 2e I I A"Vt
Address 7---4< / fan. ,P e?
/ (SIreeAr Route/[/J,o.)
4-j'A l� l /� 4/ tr 02473
C/(
City or Town State Zip Code
)-
Area code- Phone number
3. DATE DRILLED t O � 3 —C� a—>
5. TOTAL DEPTH:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑FIa1
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: C.' FT.
(Use "+" if Above Top o Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01I8.
9. YIELD (gpm): / METHOD OF TEST '—,
LOCATION SKETCH
Show direction and distance in miles r9n atTSst
two State Roads or County Roads. Include Mi., road
numbers and common road names. IV --
C23
Lip
L�
w
(Du
II DISINFECTION: Type Ji t» Amount c;TR-AS
122. CASING: Wall Thickness
Depth Dia�p�eter or Wei ht1Ft. Mete I
From 0 To 7S Ft. !rJ" 1/ 's( %%��
From To Ft.
Frorn To Ft.
13 GROUT.: Depth
From n To Ft.
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Nlateriai
Cem411
Method
Th
From To Ft. •
ECEthn
I DO HEREBY C
CONSTRUCTIO
OCT 3 0 2002
n
1'J
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
JDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/6- 5 —U
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
GROUNDWATER SECTION
ASHEVILLE REIBIONAhhl3F6Itfinal r) 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
P� �

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-Ne C1 Y11 $ /In jll/Y1 (rJ CERTIFICATION # o2.17'f
WELL CONTRACTOR COMPANY NAMQ .nnlS frtDjl().�r� 111Pil yeti imir j.n,? , PHONE#�'J-%_Set L/ 3 24
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
262295
WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: r/24-I�ILLn»
5Gc�M.JrrIt LOfN1'u
Name umbers, Community,
Subdivision.
(Street Lot No.. Zip Code)
3. OWNER:-7S a-`fit%/s #Rai i7`
Address C%0% �Pa/Gs se/
(Street or Route No.)
F2&4,7wL7A/ cg73
ity or Town Stale Zip Code
)- — c2"3 5 %
Area code- Phone number /�
A
4. DATE DRILLED /— l —D aJ
5. TOTAL DEPTH: 30.5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lZ1------r-
7. STATIC WATER LEVEL Below Top of Casing: /A/9 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordant with ISA NCAC 2C .0118. N.,9. YIELD (gpm): MET OD OF TEST 11/2Wr7L1"�`
10. WATER ZONES ( epth): t2 L/ -5 r (/
�— LOCATION SKETCH
11. DISINFECTION: Type 7fle Amount , 2 %/t M S Show direction and distance in miles from at least
12 CASING: Wall Thickness two State Roads or County Roads. Include the road
Diabp�eter or Wet hUFt. Matep numbers and common road names.
Ft. /�" p
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 Formatioescoption
_j
Lrl
Depth iz
From 0 To
From To Ft.
From To Ft.
13 GROUT: Depth Mate:_2I
{7 From () To r Ft. a,47t arx
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:
IECEILV I_0_EPF t\TIFY THAT THIS WELL WAS CONSTRUC:IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CUN t tc,JVL N frrANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
rr a
OC! 3 0 23, SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
-
GROUNDWATER enth original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHEVILLE REGION712-00pItthone No. [phone], within 30 days.
GW-I REV. 07/2001

262583
WELL CONSTRUCTION RECORD
Noah Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) t 7)i i)Y)ISI IJ-1/l(a,A rlt✓ CERTIFICATION,�If oZ/740
WELL CONTRACTOR COMPANY NAM& I X,hjlt S (('Dll/2„nrT Wei ,Y1 vFt l -yt .es P v PHONE N IS) ..J eZ —3 ge,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED Wd3PERMITN
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential C---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 &A././4-L; ,J/vCounty//, rn
-(-7Y1--J
E L
Street Name, Numbers, Community, Subdivision, Lot No., Zip Cod:)
3 OWNER: (t�//i e— h LrJvrt� 7 /
Address /T/ a () (20.thl2J @ --- Q,r.✓
(Street or ou No.)
Cu or Tywn Sore -3/ S — Zip Code
9-
Arca code. Phone number
4 DATE DRILLED2-
5. TOTAL DEPTH:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V3-
7. STATIC WATER LEVEL Below Top of Casing: Rz) FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated actor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /kt)?!'1h
10 WATER ZONES (depth):
I I. DISINFECT
12. CASING:
From 0
To
,7 ,-,.[. / 9 p� LOCATION SKETCH
ION: Type ' 11/ Amount S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Wes ht/Ft. Matey' I numbers and common road names.
!/ (p Z . Y
Ft. , / P
From To Ft.
From To Ft.
13. GROUT: Depth Material `,
From O To rD Ft. CQdh 02,"
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
5 SAND/GRAVEL-PACK:
Depth
From To Ft.
Method
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
1=.. I DO HEREBY CER1WY
j lI l
I iv
L '
( r- Swbmi[ t--e-Wtgip the
"SHE ill-1d94.1636 Ptone;i ..(919)
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
fi
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 262954
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-h� nnl 5 kr) IQ. rid CERTIFICATION # tY-)%CP
WELL CONTRACTOR COMPANY NAME(C�lIQMri I11Pa�1i Y`, t'� ��'1(d .�-Pt PHONE #pL —3 ;2FJ
STATE WELL CONSTRUCTION PERMIT# Qrjp
ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential l:;1-"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Ne rest Town: I RAiVLL 1 (1� County _/1' 172 a77L_}
eks CYc-e6L OCn rr
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code)
3. OWNER: SIC GI earL
Address cj; 0. B P)x j C I
(Street` or Route No.)
9I ctl h I VrrvA /l7� 77
�(� City royn9_ Surer Zip Code
Area code Phone number
4 DATE DRILLED I U- a5 —D
5. TOTAL DEPTH: coos-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ole
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: 1 5-r) FT.
/ (Use "+" if Above Top of Casing)
8 TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated aUor below land surface requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 0 METHOD OF TEST /02/J/1-.
10. WATER ZONES (depth): I eta ` ;100 '
LOCATION SKETCH
I I. DISINFECTION. Type Amount ,.-2 TA- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include thcoad
Depth Dia eter or Wet t/Ft. Mateyi .1 numbers and common road names.
To�
� V C�
Ft.
From
From To Ft.
From To Ft.
13 GROUT: Depth
From n To rV Ft.
Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
p
Method -
�1
Slot Size • Material
in.
in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Ft.
From To Ft.
I DO HEREBY CERT
pp�� (C5ONSTRUCTION S
NV\
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY F THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1.7r 40-25-0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
.,t:bitu 't iiro rig'Intil`to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-t REV. 07/2001
U

WELL CONSTRUCTION RECORD
Nonh Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section // __
WELL CONTRACTOR (IN DIYIDUAL) NAME (print) 3-e�111 5 I k I inn\ 1j CERTIFICATION# o1/%`f'
�'2�_5aU-3 ab
w'ELL CONTRACTOR COMPANY NAMKI X.hpt C �cAl�2,�a (l)P.1I ��r I l->< . )_ n P � PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W(j'TERMIT#
(if applicable)
(if applicable)
262953
WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NeaLdst Town: R 1 L) t-County
I —RA / : J —et tarn 2 .
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER Ia7nn,)nt.�_ / di / I r it
Address ?fl (b - 9-y / ? ,� a
(Street or Route No.)
Qemh v 53 — 7/3
City or Town tate / � D Zip Code
9 )- `to - [/L
Area code- Phone number
4. DATE DRILLED /L� — S —D �---�
5 TOTAL DEPTH 305
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 /
7. STATIC WATER LEVEL Below Top of Casing: / ..S0 FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS / FT. Above Land Surface'
•Top of cosine terminated odor below land surface requires a
variance in accordan with ISA NCAC 2C .011 S.
9. YIELD (gpm): o2 5 METHOpD OF TEST /07Uy
O. WATER ZONES (depth): 609 -
I L DISINFECTION: Type { 114
12. CASING.
Depth
From 0 To
From
From
To
To
Amount J--¢_ru
Wall Thickness
Diayy��eter or Wes hVFt. MMatei
Ft. (� r 19
Y t
Ft.
Ft.
i3. GROUT: Depth
From_ To rV Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Material 7 Method
dzi.. \
pea
"55. itEklIAR-SiS
NOV
GROUNDWATER SECTION
ASHEVILLE EGIONAL GFFICE
�ub,,,,, to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGVJrI Raleigh,
Vg07/2001
27699-1636 Phone No. [phone], within 30 days.
Slot Size - Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles frfW at least
two State Roads or County Roads. Include the;road
numbers and common road names._
I DO HEREBY C' T F f THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION T NDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
qf i la /6 — r- 5 —o a--,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section "
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�-et1 V11 5 '�-n I) CERTIFICATION N 01 /7 (to
WELL CONTRACTOR COMPANY NAME hn[i irtil u4 Wei II \/c lftxt(( ),N1- 4 e 1 PHONE iS)—Sa L—3 6
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ'PERMITN
(if applicable)
(if applicable)
1 \VELL USE (Check Applicable Box): Residential Id---Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELLLOCATI9.N �9
Nearest Town: /1"-- Ll County //j 2 (,Yt
(Street Name, Numbbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: \l- 1) II1°f()
Address 5[1 /YCd /✓: // R(4
Atii�Ll or /L'
(Street Route No.)
F r
�_City or 79w(09 Suteq g; Zip Code )e be
Area cock- Phone number /,
4. DATE DRILLED /0— 6-U 2�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 17Y---
262952
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
7 STATIC WATER LEVEL Below Top of Casing: /0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with I5A NCAC 2C.0118.
9. YIELD (gpm): °X S METHOD OF TEST /0I1Uy71 --,
10 WATER ZONES (depth): °1st ' (�
11. DISINFECTION: Type b141-4
12. CASING'.
0 Depth 2 Dia eter or Wei hVFt. Mate m
p1 numbers and common road names.
From To ) Ft. (_- ll, pYCi
LOCATION SKETCH
From To Ft.
From To Ft.
13. GROUT: Depth
From (5 To Ft.
Amount TA-. S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. include the road
Material
a0-4rn titt
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
fi RFM AR KS
1``1II77
D9 CaPRFRWCARTI
CONSTRUCTION STA
1 WAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D 4,RDS, AND THAT A COPY OF TH{S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NOV • 1✓
lam(`
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/f —36 —d
DATE
GRO ASHEVP ti filtgteX iikA the pivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
j6
sco99-t 6�6 ?none rvo. t9i9) 33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Nonh Carolina - Department of Environment and Natural Resources - DivisionofWater Quality Groundwater
rou CERTIFICATION Section
Nti on
WELL CONTRACTOR (INDIVIDUAL) NAME (print)♦�� n✓) 15 ' A ryIIn,v SIii /P-3 a-�j 0
WELL CONTRACTOR COMPANY NAM& r �r,VII C ICAl1nra (I)PI I u Yet 11-:FYI P J PHONE w
ASSOCIATED W&ERMIT9
STATE WELL CONSTRUCTION PERMITS (if a licable)
(if a linable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
) WELL LOCATION:
Nearest Town: /..- A ��County &tli-Z
G,e ry-k yYl.
(Street Name` Numbers, Community, Subdivision, Lo(No., Zip Code)
3 OWNER:
Address
Cit r Tow State Zip Code
ram)- �l 2Ri7
Area code -
Phone number ,(
4. DATE DRILLED
5. TOTAL DEPTH: r�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC -WATER LEVEL Below Top of Casing:, l7 FT.
(Use "+" if Above Top of Casing)
8 TOP: OF ASING IS — FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires o
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2.— METHOD OF TEST
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING. pia eter
Depth
From To FL
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To-_ Ft.
From To Ft.
14. SCREEN: Depth
From To
From To_-
15. SAND/GRAVEL PACK Size
Depth
From To Ft.__
From To Ft.
25D
16 REMARKS
TDAHNEd5C R
CONSTRUCTIS4''IS"
GROUNUWPJdbrSiEQhlallriginal
ASHEVILLE Rr !,! • •, :I,,,,, a,
Diameter
Ft. in.
Ft. in.
Amount
Wall Thickness
or Wei hUFt. Matp e-i t
Material Method
Slot Size Material
in.
in.
Material
262951
H
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
t nCATI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
1.7
YTHAT THIS WELLWASCONSTRUCTED INACCORDANCE WITH ISANCAC 2C,WELL ----- NDARDS, AND THAT A COPY OF TH S RECORD.H,S BEEN -PROVIDED TO THE WELL OWNER
it) -3t -o
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri �Vgh, C01
[phone], within 30 days.

261290
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section // --
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) c� n E71 5 I jl) 1T) (ln\ AV, CERTIFICATION #t /7 `0
WELL CONTRACTOR COMPANY NAMSt.hf i C (J II2�a I1Jel 1 rtl Yer 11 Th 4, _) . rI P . PHONE # � J6_,5/e2 L%-3 c2 �J' 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQYERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Id�Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ialf./kL� yj/,?/(� County �Ql'irr j
h R Lc.e-. a ' ocn. 4<.. r LO n .P
'Street Name. Numbers, Cornmmuniy, Subdivision, Lot (16., Zip CodoV
3. OWNER: rlJerr-) i'ecLe f or--)
Address .33 Q'•fi
8.�'S' (J
(Street or9toRte No.) g %
Zip Code
'f in- load_ tr2-9 D
Vrly or Town State
Area code- Phone number
4. DATE DRILLED N.Y.-- '-C1
5. TOTAL DEPTH: �, i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ J.
7. STATIC WATER LEVEL Below Top of Casing: .5-0 FT.
(Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): V METHOD OF TEST h/07/JJr71 (/
10. WATER ZONES (depth): - / 7 S` (f
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
LOCATION SKETCH
11. DISINFECTION: Type H'tF Amount .-2 71)- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Wei ht/Ft. Mate 1 numbers and common road names.
P g Y C1 ry
To Ft. /� lit P
From 0
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r-"D Ft.
Material
Cern a
Method
CD/4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL - - -
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) C -)enI MI 5 /-'D II(2,-A III CERTIFICATION # a1/740
WELL CONTRACTOR COMPANY NAMQ'.I)ntC ICD Il%rysd11 Wei I1)Yew I1-14 .I.n e PHONE #ia%11S2.L/-3 60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
261857
WELL USE (Check Applicable Box): Residentialld.---Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:y/(j/[ q ps
Nearest Town: ,4✓(� County �QCI1>'ZJ
eCLti AOJ far �r�,
(Suez( Name, Num'bei s, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Fllr+AuJu
Address .71-5'b C/ P_LLd2i `1
(Street or Route No.)
N C� : %/
Zip Code
g3 ,- -y gg /S7
Area code- Phone number
4. DATE DRILLED -.2 7-0 2
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑�
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well locatipn _
(degrees/minutes/seconds) z
Latitude/longitude source:OGPSOTopoLrc%phic-map
(check box) _ ---
DEPTH DRILLING LOG:
From To Formation Description:.
7. STATIC WATER LEVEL Below Top of Casing: 02 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST
10. WATER ZONES depth): 7-,25
11. DISINFECTION: Type
12. CASING: Wall Thickness
0 Depth ri Dia eter or/Wei hUFt. Matep'
From To r-i-� Ft. ii P Y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To ri7 Ft. (94yyt COMA—)
From To Ft. _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
I ERttA!CS
0
tv
LOCATION SKETCH
Amount ,--3 / A -A S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
DO HEREBY CERTIFY TH 'I TF S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDAROC, f'VD T/•,H��A�T/�n
A' COPY
OFTH{1SS RECORD H S BEEN PROVIDED TO THE
/WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNDWATER SECTION
kW/1 kE4sti0MA-tOkhiEbivisi\n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division)I of Water Quality - Groundwater Section //'-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c)-nv115 /11/)/i fs� CERTIFICATION# o1./7 le
WELL CONTRACTOR COMPANY NAME t)ntS I Ilatri 11)el I1) Yetjl7u Jr e) PHONE # 7S)l_Sa 1,1-3 gG
STATE WELL CONSTRUCTION PERMIT/4ASSOCIATED WERMIT#
(if applicable) (if applicable)
2RO2fl
1. WELL USE (Check Applicable Box): Residential id---"Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI0'N:
Nearest Town: /—�-96- CJ
County tie 41
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (.VC?rit(�,b` gyyjC•l
Address 8. An,L,0id, Lr IG,-4 pr-!-
(Street or Route No.)
I� a), .in- /1/e 7 (7 V
City or Toveo State yip Code
)- -. h9 / 7 g,S
Area code- Phone number
4. DATE DRILLED c9
5. TOTAL DEPTH: aS. 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
✓� LOCATION SKETCH
11. DISINFECTION: Type /f--/-14 Amount 4 TA -A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depths. , Diapeter or Weight/Ft. MMate 1C�i numbers and common road names.
From 0 To /5 Ft. o r` Y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To r6}f7 Ft. COern aqui #20-1AA2
From To Ft.
14. SCREEN: Depth Diameter
Ft.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: — 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /p METHOD OF TEST iili/piXt,
10. WATER ZONES (depth): /.2 (�
From To in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size ' Material
in.
in.
16. REMARKS
r.�
RII �� � I� ill -_ �11,''l� Irr�
I.�0,,,,.EeY�EIFT„,
LCONTTRUCTION STAND
ILL
-11S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER -
S
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
)Q',th^grYfr•-iigigi3i;idY"he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
An60411116361Ptne No (§1P) 733.3221, within 30 days. GW-I REV. 07/2001
0

2A0212
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME� �(print) xh-enVl1 5 finTarA Cry CERTIFICATION # n/7 ee
WELL CONTRACTOR COMPANY NAM& Ain t S 140 tin„ c1 Wel I r v4 II .7, n P J PHONE #i62-5(_5;2 LI-3 g6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential id-"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /TPA-ZV /,2/ County /4C2vme /
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 417 L/ ALe2.l-Yi 5 rrt) L
(Street or Route No.)
C'Y2)1 lL l 1 /t/ C 2 S 7 3
Cit or Tow,ca LS,tate ? / Z' ode
Area code- Phone number
4. DATE DRILLED —0.2_-
5. TOTAL DEPTH: 02,2_5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: LVO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): b METHOD OF TEST ikl/a'i�r
10. WATER ZONES (depth): L-3 ® , /0 (�
I I. DISINFECTION: Type Hill Amount
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
4 T,4 A S Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Diapeter or Wei ht/Ft. Matep' 1 numbers and common road names.
From 0 ,To U Ft. to 1 /k, pY
From To Ft.
From To Ft.
13. GROUT: Depth Meth
From 0 To Ft. Q�
Material
�?'Y1
From To Ft.
14, SCREEN: Depth
From To
From To
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
two State Roads or County Roads. Include the road
16. REMARKS:
itpQ`�1,�N,�E.R,E 1pE1i
0014BI R(`ICTIbN.. 9NrIaf
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the nriglnal t� hhb Divi
21E01441M PIVA,(Sl eTI�.,&733-3
ASHEVILLE REGIOtt AL i) Ft
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001
Q

WELL CONSTRUCTION RECORD 260209
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section /
WELLCONTRACTOR (INDIVIDUAL) NAME (print) ['hi)11'1151 /16/16.,-A , CERTIFICC�A,TIIOONtla/ /74o
WELL CONTRACTOR COMPANY NAME1'hnjS (d jli nd Wei I.1i�r II', it�_j-. K P J PHONE%QA-X)—J`o2 Li —3 'G
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W ERMITS
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential D- unicipal/Public❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: rg ML i / 4/E,County /)"Let-LJ>`—
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:'r-e-ro 015 d I
Address 39-40() •e12.1 2a.,
(Street or Route No.)
IC; $5IIrr ns ee. IZ
3 zi (40
City or Town S)tat Zip Code
4Lb'5- k Se- - 94
Area code. Phone number
4. DATE DRILLED -1 /�
5. TOTAL DEPTH• 440 5—r
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)
DRILLING LOG
Formation Description
DEPTH
From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑��
7. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C.0118.
9. YIELD (gpm): - 70 METHOD OF TEST 1)29
10. WATER ZONES (depth): /br r
LOCATION SKETCH o
I I. DISINFECTION: Type H tF Amount Mk S Show direction and distance in miles fron!j] least."
12. CASING: Wall Thickness two State Roads or County Roads. Includi; e road_'
0 p Diameter or Wei ht/Ft. Mate 1 numbers and common road names. r`i -
From l(f/ Ft. (r7� rl ii p/L c„>
Depth
To
To
To
13. GROUT: Depth
From () To r(7
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
From Ft.
From Ft.
Ft.
Material
(%m0r
Ft.
Diameter Slot Size ' Material
Ft. in. in.
Ft. in. in.
Method
16.REMARKS
Size Material
Ft.
Ft.
r' . , i, , • I
n ��`iDaniEREB'YCFRTgF
V I CONSTRUCTION STA
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY FTH S RECOBEEN PROVIDED TO THE WELL OWNER
Q`^1n�&Ark 9—/6 —0
GROU(5dINriTrEhli[G1' I to thi
ASHEVII. yar eF 1(94.9,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

4.
5.
6.
7.
Depth
From 0/ /� Dia eter
To (4, Ft.,
From To Ft.
From To Ft.
13. GROUT: Depth Material
From O To r` Ft. (Oyyi tt?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
26020)3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section / WELL CONTRACTOR (INDIVIDUAL) NAME
(print)+benyll s J'te) ii rb-A f+� CERTIFICATIONS/ a/7 Ce
W ELL CONTRACTOR COMPANY NAME
fc},0l1Q,y<rl (/�P.II1)161 -144�,rlP J PHONE u 2 <i 2-/-3
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W IIPPERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town: (%%/}y1,4CL l 4/7 County / r l (,
FLtit-on- 12-d
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER's-p.je`, h / S C
Address W n
j(Street or Route No.) �s �l remeIat) I/� ag7 y-LI
q
p(%�Ci)ty orcToState.Zip Code
bSwn �2/3n%
Area code- Phone number
DATE DRILLED %
TOTAL DEPTH: i[525 •
Topographic/Land setting
17Ridge 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
DOES WELL REPLACE EXISTING WELL? YES 0 NO `
STATIC WATER LEVEL Below Top of Casing: /no FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): / METHOD OF TEST hJOUi7L({
10. WATER ZONES (depth): 02°25 ' (�
LOCATION SKETCH
I I. DISINFECTION: Type J{-/'f/ Amount 4 T -A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Wei ht/Ft. numbers and common road names. O
p tt
Method
From To Ft.
From To Ft.
O
c-n
16. REMARKS:
Itg)I-14E04, C RYItY RiiA" S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDIC, VD THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
12.23)
ln"�t 9-13—d
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
PL^ ,, ivisi )n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
R961ff46E6 h( terd92 (94 k;233-32II, within 30 days. GW-I REV. 07/2001
r

260207'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME, (print) s-hen 1tS /Jn/IQM rU CERTIFICATION It o1/740
WELL CONTRACTOR COMPANY NAMEjPtfl1 010IIQ,r4 Wei 1Z) ,6 lira Q_-174 eJ PHONES/ eii_5O. 4-3 L6 0
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WIOPPERMITN
(if applicable) - _� (if applicable)
1. WELL USE (Check Applicable Box): Residential ld-"Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: N�
Nearest Town: rft 0/7 n) it/C-^County Len
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (C% (4. 1 LeTh7_-e/2-•
Address (0 fie
(Street or Route No.)
Prom Ic! r- A/. /l/C-d c--89-
Ciry orown9— State D Zip Code
C-56Area code- Phone number
4. DATE DRILLED U/_/ —D
5. TOTAL DEPTH: 0,219'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO OT
7. STATIC WATER LEVEL Below Top of Casing: ED FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): $? METHOD OF TEST /702%i7L/�--,
10. WATER ZONES (depth): /9S' (�
�1
Depth Diameter
From Q To Gk Ft. (c7 '
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To t Ft. ee,yyt 07,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL 'PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH CD
I I. DISINFECTION: Type W'-%"/-f Amount WS Show direction and distance in miles from at/least r;
12. CASING: two State Roads or County Roads. Include tht oad'c'
numbers and common road names.
Wall Thickness
or Wei /Ft.
7/
Method
rnAJO
From To Ft.
. (tvjR1�S:ILI E � 1
I DO HEREBY CERTIFY T
CONSTRUCTION STANDi
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
Submit the ortginarto me Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Po
i..>
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
0 ,a —dam
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

D
aSEP
259891
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7)- f VI7 5 /101 J Q A rL CERTIFICATION if of /7 (to
WELL CONTRACTOR COMPANY NAM1�'I X.f)j')r 4 kip4 e1 I }) v'r l I I ' n P PHONE ',�a-Ss� .5 a. L/-3
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQPERMITY
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/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: Se4.- j bi11r County In(ri_INN -)
(Street Name, Numben, Com-muuniity, Subdivision, Lot No., Zip Code)
3. OWNER: ff) l" J Pre R
Address n bX j"a1t9
(Street or Route No.)
.)OC.kc td,ht , r- 37a 9-!
C'ty or Town State Zip Code
Area ode. Phone number
4. DATE DRILLED 9_ 2
5. TOTAL DEPTH: ,-,2
•
Topographic/Land setting
17Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:QGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT:
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / -- -FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): SO METHOD OF TEST //fej ,L-
10. WATER ZONES (depth): /O/9 s / .1.4.YJ1
LOCATION SKETCH
11. DISINFECTION: Type H-r/ Amount raa S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include tale road
Mate)); I
Depth Dia orWei ht/
p�eter Ft. pnumbers and common road names.
From 0 To �FL 1 Q Y N
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To ` _ Ft. CQiynb
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.
1 DO HEREBF/ C
CONSTRUCTIO
1 8 2002.. Li
(T7
0
TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
TANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNDWATER SECTION
ASHE'df_I_E R[G' nigiae1 to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No, [phone], within 30. days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i7)•enY)I S /-JtDj)1A rl'i CERTIFICATION #JO1/7?1
WELL CONTRACTOR COMPANY NAME I)nts 1�1I�r� I?Jell sfr Jl --14 .j,r1 e J PHONE #-lU.-e2 9-3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ�f�ERMITM
(if applicable)
(if applicable)
259890
I. WELL USE (Check Applicable Box): Residential Ld--Municipal/Public ❑- Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1.-/I,-lftints- ye —
County /Y2Cri U7L>
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .2r /I XOG(((.) e(v
Address
(Street or Route No.)
»Y (os s AvC- ,-ag 7 `f/
City o own State Zip Code
�)- A"a 6 _ ‘,2, .5 3
Topographic/Land setting
(Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone numbers
4. DATE DRILLED /—L� /!C—a %-
5. TOTAL DEPTH: T'" 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO &Y.—a-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"9" 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): e n METHOD OF TEST A /0z9,
10. WATER ZONES (depth): c 7(>
LOCATION SKETCH
I I. DISINFECTION: Type %T f"ff Amount 4 TA-13 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From 0 To
Depth 7 FL Dia eter or We(i hUFt. Mate numbers and common road names. , pYt' I N
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r9D Ft. p ()OA�
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
i, w, ;
R
1 1 DO HttttBY LER I114 TI-AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN :ASS, AND THAT A COPY OF THJS RECORD HQS BEEN PROVIDED TO THE WELL OWNER
SEP i S 2002 i_fi
to —
n-t
cn
IV
r—
CO
cn :
0
GROUNDWATER SECTION
ASHEWIthiR€EeGlith¢jiQflFt6Ehe D
l)—/6 —6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
•
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

261221
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)[ �-en V1) 5 I IdrA CERTIFICATION osn-%%4e
WELL CONTRACTOR COMPANY NAMI X,p)j(i Jd1IQw Wei I kT)Y J I R4 7YL e l PHONE u e6i_5a 4 —3 L b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W IIPPERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town: County MA /d!Y( t
C / ea- °A.ea . r74.7"'-j
(Street Name, Numbers, Communityy/,''Subdivision, Lot No., Zip Code)
3. OWNER: -R. /Iy iie ulein3
Address
e No.)
/7/(rF/LAI for RoutAre—) o2
Ci or Town State Zip Code
'' . 5-,- L — SR-9 q
Area code- Phone number
4. DATE DRILLED 9 - —a a--'
5. TOTAL DEPTH: rCQQ'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U-
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. / I U
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth): 5T '
II. DISINFECTION: Type H F Amount , 7"A A S
12. CASING: Wall Thickness
Depth_Th Diameter or Wei ht/Ft. MMatep l
From To FL Y C�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To FL COiyp Omh �: /ITN iv
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 Formation Description
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.
0
0
0
--a
0
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC.
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

261222
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural%�Resourcesj- DivisionofWater Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME� �(print) s l /l nos 5 P-71 P� aM di • CERTIFICATION #`oU7 (t,
WELL CONTRACTOR COMPANY NAMIC'I,)! t i 14101)(41.4 Wei 1 ej'1 6r I1 ;1(.t 1-YL P . PHONE # Bd-7S) —.5 o7. d —3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED 3V ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Id- Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / ^n
Neares Town: t,,f%/�' k/r) County /// GD�K-J
L-(n?1L-e- C'Prrrvni
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0471 1 QDP-ft.)
Address c• /37 /)1Ai-I °tit 0 a,
(Street or Route No.)
City or Town Stale,Zip Code
Fp9/) csaL_ 7372--
Area code- Phone number
4. DATE DRILLED 9 _l —D 7_ ,
5. TOTAL DEPTH: SicCc/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 12O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): , 5"METHOD OF TEST ltlUi7l� ,
10. WATER ZONES (depth): %O 3 Si (�
11 DISINFECTION: Type Amount 4 7- AS
12. CASING: Wall Thickness
0 Depth ` Diaye�ter or Wei ht/Ft.
From To lP. > Ft. (c'" f ! ,
From To Ft.
From To Ft.
13. GROUT: Depth
From (..) To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
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
Material
Pit 0--
Method poi
Material
can, b
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI�S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

259510
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME� �(print) c1.enYl l S I') II Om rU ' CERTIFICATION #oZ/7 (,o
WELL CONTRACTOR COMPANY NAMK I X',bnt i IJl) II2.ta (i)efl 1) Yerr.I f —Hip 1.4e l PHONE # r �,J`eZ L/ --3 �.6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential C---Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION; /
Nearest Town: 'QM-// ILL! 4t4/?County
I11 a aril__
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: g- °� /- Sen�
Address S /3 ,P:
(Street or Route No.)
/� 4''73V
Ciry or Town State Zip Code
-3 .449_ fin 7i
Area code- Phone number
DATE DRILLED 9-3 - ! ,2
TOTAL DEPTH. 71j0'
Topographic/Land setting
(Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
EPTH DRILLING LOG
From To Formation Description
DOES WELL REPLACE EXISTING WELL? YES 0 NO QII�
STATIC WATER LEVEL Below Top of Casing: e'C7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated aUor below land surface requires a
variance In accordance with I5A NCAC 2C .0118. /
9. YIELD (gpm): %2 -/ &METHOD OF TEST i029v
10. WATER ZONES (depth): / OL
4
5
6
7
LOCATION SKETCH
11. DISINFECTION: Type Amount 4 %¢A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth} Dia eter or WeighUm
Ft. Mate ' I numbers and common road names.
From 0 To / q/ Ft._ ��/
From To Ft. —eel
From To Ft.
13. GROUT: Depth Material Method
From ID To r2ZZ
Ft. coy71.4-m
From To Ft.
14. SCREEN: Depth Diameter Slot Size - Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
puL(L)
16 RFMARKC•
ILLLf,, f
H'FR RFv R-i y I F4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDA_ S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ASG \!q!qq 1 "T(,ti�1P,�'��he D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2 b7 I � �houc No, f -3221, within 30 days. OW -I REV. 07/2001

piYl-J
WELL CONSTRUCTION RECORD 2 5 9 5 0 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,i1) )117 S tin /)ln\ r(d CERTIFICATIONS or-n/7%
WELL CONTRACTOR COMPANY NAMSVII CInD/I�}in, I/1P�I�i,r ��'}<e me J PHONE g ,,�;%9-3 a,6 O
STATE WELL CONSTRUCTION PERMITS ASSOCIATED NVOP ERMITS
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential tMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1 O44-„t4c t / *' ,fftty in a
(Snee! Nam., Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: e ), I
Topographic/Land setting
t Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Address D Sl! U"L/At-S pu( (degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
e (Street or Route 73 V (check box)
��`-.) DEPTH DRILLINCLLOG
� rCXiry orT wn State Zip Code From . To
/" 36 9 51.9 c-/ Formation Description
g
Area code- Phone number
4. DATE DRILLED / _ !{_ Q a-
5. TOTAL DEPTH: t? 7 5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lli-
7. STATIC WATER LEVEL Below Top of Casing: 7d FT.
(Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance In accordance Ith ISA NCAC 2C .0118.
9. YIELD (gpm): 5D METHOD OF TEST_ 5//J/U.x�(�(a,
10. WATER ZONES (depth): c �Q
LOCATION SKETCH
1 I. DISINFECTION: Type f,4 Amount 02 7-A-A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth
From 0 To 477 Ft. M
Dia eter or Wei ht/Ft. atey' I numbers and common road names.
Map .
From To Ft.
From To Ft.
I3. GROUT: Depth Material Method
From () To r Ft.JO:rnbsl p
From To Ft.
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Ft.
From To Ft.
i6. izaENLIAIS:
2
I DO HEREBY CERT
CONSTRUCTION ST
L
GROU''JT"/A ER SECTION
O�FI E
Svbmrt thea� igtFial to she Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone Na. [phone], within 30 days. GW-I RSV. 07/2001
dAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
111 ADDS, AND THAT A COPYOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?)ZnY1, 5 -O iQn\ �� 7
/l ry / CERTIFICATION N o<- /% CP
WELL CONTRACTOR COMPANY NAM* 1 X.hj')t (J ilay,a �ijg I �r 11 % ('T5s e J PHONE N-,�a Li —3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQr'(1'ERMITN
(if applicable)
1
(if applicable)
WELL USE (Check Applicable Box): Residential l:1--"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO4N.
Nearest Town: rP 9- 2( /_) X/ County Al 2 C2r7�
(Street Name, Numbers,, Community, Subdivision, Lot No., Zip Code)
h
3. OWNER: �in f i - J o h yk s r-n n-
Ad/dress e;S// 0) CnDY1 QaneA.c 7? r 12
n (Stree1oRIute No.)
�� (3L,)- r> 7z - / 4` 9
Ciry rTown State Zip Code
Area code. Phone number p
4. DATE DRILLED / S b £-
5. TOTAL DEPTH: tO�"
259508
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
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (per
7. STATIC WATER LEVEL Below Top of Casing: /SD FT. -
(use "+"if Above Top of Casing) •:.._.. .,
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a - - --- - -- ---
variance In accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): 30 METHOD OF TEST h1/D/)/
10. WATER ZONES (depth): 5190 17'70
LOCATION SKETCH
1 I. DISINFECTION: Type gill Amount 4 TA, S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Weigh /Ft. MMateYI numbers and common road names.
0 To %e2 Ft. �, 6f
From
From To Ft.
From To Ft.
13. GROUT: Depth
From n To rV Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL'PACK:
Depth Size
From To Ft.
From To Ft.
Material,
slbf..� JI 5
I DO HEREBY
CONSTRUCT'
GROUNDWATER SECTION
ASHEVILLE R66I6 _tilaFiginal o 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
:R
N;
Mothod
m
Slot Size ' Material
in.
in.
Material
— FY THAT
ANDWELL
WAS CONSTRUCTED IN ACCORDANCE WITH -I SA NCAC-2C, WELL
FY THAT THIS WELL
THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER - -
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
—oz
DATE

WELL CONSTRUCTION RECORD
City or Town State Zip Code
Area code- Phone number r°�
4. DATE DRILLED /3c 2 , ti 7
5. TOTAL DEPTH: Sth 5—
25897i
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
nn
WELL CONTRACTOR (INDIVIDUAL)NAME
E���(print) c?I-en Y)7 SI /itjilQ-A�� CERTIFICATION M nz/%!P
WELL CONTRACTOR COMPANY NAMK/X,t)fIC (JtjJ204J IIWPl I.FI Y`s]i Th 77nr J PHONE Motif)-.-,f2 14-3Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W143PERMITIE
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential &Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
/�/�
Nearest Town: /F✓LL/ tf County / r r D Ce97-+
Anvc 1-e C
(Street Name. Numbers, Community, Subdivision, Lot No., Zip
Code)
3.OWNER: r/t •7);I1S/5���2 C4ti S�
Address en-„
(Street or Route No
15212, /ye, 73 V
Topographic/Land setting
DRidge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: //7 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): o� h METHOD OF TEST h /ke/t
10. WATER ZONES (depth): [,t r'') 0
LOCATION SKETCH
11 DISINFECTION: Type /f 11-/ Amount ,-2 T A A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From 0 To /%) n Ft.
Depth Dia eter or Wei hUFt. Matep' I numbers and common road names.
' r / pY
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From /3 To a'(7 Ft 0-9:yy1 47,1 polio
From To Ft.
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
Fro o 7r;I( I�� Lc' L in.
15. SA N V EL PACK. t
1 Depth Size; Material
Fr m Luuu ii .,Tp FL . 1
Fraht ''To 'Ft..
16. REMA
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
258974
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [%)fin lel'15 /'}'O j11 A rL CERTIFICATION # el/7 h
WELL CONTRACTOR COMPANY NAM/E'I .)?.F)'Y)[S �dA (�fZ,n� Ii ea Y`s llrk , 77.11P ) PHONE Y-3 ge,
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W ERMIT#
(if applicable) __ (if applicable)
WELL USE (Check Applicable Box): Residential t�Municipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: %2/ot (%L 1 R/ /),/eCounly in
AnCp7�
� C C14te P A
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: in (LE e Yu
1
Address / 9(pC1 /17agv)- /L, 2 d
Street or Route No.)
(��7gtN(, g73C�
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED - £-1 3 _a L
5. TOTAL DEPTH: , het)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 71-
7. STATIC WATER LEVEL Below Top of Casing: 37) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
crop of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD(gpm): !S METHOD _OFTEST hia?!Ji)f,
10. WATER ZONES (depth): / t5 (�
Agricultural 0
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
I I. DISINFECTION: Type
12. CASING:
Depth Dia eter
From 0 To / f Ft._,
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From_n To r9(7 Ft._ap yn Dot pcnuO
From To Ft. I
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in
LOCATION SKETCH
Amount e-2 r,4 �i $ Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or WeighVF'. Matt numbers and common road names.
15
16.
REM
RphblACyK)'il
ape UU
Ft.
F
Slot Size Material
in.
in.
Material
1 DO HEREBY TIO "FAQ n `�✓ LL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTR I t (c-iniid-r 111N 6utHAT k COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
OtA-k - -� 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-I R$V. 07/2001

258971
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionlof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c%)-PnY17 S rl�
I�I ifrA CERTIFICATION cT �7 (p
WELL CONTRACTOR COMPANY NAM rS fj) i ,4 Well:v`r_II De 4, 'Tn. e -I PHONE M 5.;24-3 g6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W ERMITM
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): ResidentialiXMurricipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: J PA/Lk L 7/l A/ _'County /,) cery(
Oa Hit 6Re
(Street Name,
IN'u 1mben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WO Yre to R 1 )
Address /0 Q30 5 L1J 2 lei }-f, g
(Street or Route No.)
(Yl t li,Yru P j
Depth,,,.,
From
From To Ft.
From To Ft,
13. GROUT: Depth
From n To � Ft.
From To Ft,
14. SCREEN: Depth Diameter
From To Ft in.
From Tor J't in
Bir,D-TEVELTP4K
: ,
D-pth
iom To Ft.
5 LOCATION SKETCH
11. DISINFECTION: Type hi'-f'%/ Amount .-2T,}. Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
apt Dia aer or Wei NFt. MMatepgl numbers and common road names.
U To 33 Ft. Y C�
Material
om
SEp '° 2002
16. RhMARKS:
Ft
Method
01AYU
Slot Size ' Material
in.
in,
e - Material
l
variance In accordancywith IS
9. YIELD (gpm): i0
10. WATER ZONES (depth):
x33/73
City or Town Suitt Zip Code
33F�S)- e�744_ 49f77
Arca code- Phone numbs,
4. DATE DRILLED a"'a 7 —D a—.-,
5. TOTAL DEPTH: dtOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: t a SET.
(Use "+" if Above Top of Lasing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
A NCAC 2C.0118.
METHOD OF TEST )I iUIUi7G(�
al)
Topographic/Land setting
❑Ridge OSlope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
O
Coo
n
CO
J
R(1LINPWA'.ER SECTION
DO ¢(E €'id"cakT ffts,T rgrrr us WE.,L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THS RECORD HS BEEN PROVIDED TO THE WELL OWNER
—a7—°
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
c_Cl
a
0
0

WELL CONSTRUCTION RECORD 258972
North Carolina - Department of Environment and Natural Resources - r1Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEE,,(pHnt) c�-17P)I 5 M-}D/IoA, . CERTIFICATION# 01/7el
WELL CONTRACTOR COMPANYNAMEt4fl tS kilo rri Iiieil,�iyfrji-}t yle J PHONE 01,11si-324-3 .:V-6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WiRERMIT#
(if applicable) (if applicable)
Ld�Muni
1. WELL USE (Check Applicable Box): Residential cipal/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: 112A,Vai 4/1/8--- County mas-Co7L,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: :beet be `-
Address c2(F_3`" er//J G( {/Qa
(Street or Route No.)
)`R.9N/41-, .y/ /VC. r /73ICt
City or Town State Zip Code'
g ) <5,- a 999
rA ea code- Phone number rA �+
4. DATE DRILLED tor %17 --D
5. TOTAL DEPTH:.-�,
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: , q (J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118,
9. YIELD (gpm): /, METHOD OF TEST I ketit -..
0. WATER ZONES (depth):.SQ �/ S—
(j
.2DD
I J
LOCATION SKETCH
11. DISINFECTION: Type Jf'-t%% Amount TA - A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter 4. or Wei VFt. MMatep� numbers and common road names
From 0To c% Ft._[2_ Y
From To
From To
13. GROUT: Depth
From t7 To rZ
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft, in
I a• HERE(EHL1f)BRY'J'G
STRWIl7N7N.
Ft.
Ft.
Material
Ft. CO471 aJ,
Method
rnA ;
Slot Size ' Material
in.
in.
ELL WAS CONSTRUE I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ACOPYOF TH)S RECORD 1-16S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
CO
J
y w 2 ,
DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 RSV. 07/2001

WELL CONSTRUCTION RECORD 258971
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater_Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pHat) c1):e n VI I s /4 IiQ,t ft/ .CERTIFICATION# a/7eta
WELL CONTRACTOR COMPANY NAME c (4-11 4 leienZ)6 6
3 /V-
Depth Oil Diap eter
From 0 /1 Ft. h
From To Ft.
From To Ft.
13. GROUT: Depth
From0 To r f7
bht Or Tf J I'3c v PHONE #7d-') S� 4
STATE WELL CONSTRUCTION PERMITS/- ASSOCIATED .W ERMITN
(if applicable) ... (if applicable)
1. WELL USE (Check Applicable Box): Residential C- t icipal/Public ❑- Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /-Q4ilc L) /)/ /VGCounty 41&cne •
Material
Ft.�
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
16
A!�DI�J SD hI'/ K.�
TOM to
rom To
SEP - 2002
MARKS:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: La_ r/2Q-6
Address / 1 1 Fri off. rl.�Re1
(Street eNo -
1 //11
c2 73 V
City or Town State Zip Code
g-(1)- Sr 2 ?/- Ski 9
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
Area code- Phone number �s
4. DATE DRILLED •.Y-2-9,
5. TOTAL DEPTH: oQr5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I�
7. STATIC WATER LEVEL Below Top of Casing: e l) FT.
(Use "+" if Above Top of Cuing)
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.
10
9. YIELD (gpm): METHOD OF TEST_//O)Z//
WATER ZONES (depth): /ift
r7f)
n LOCATION SKETCH
11. DISINFECTION: Type {I"-/'/-: Amount ,..7'/'YI; 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Wei VFt. p-numbers and common road names.
MMate ' I
nMethod �
1
Slot Size Material
in.
in.
lcire Material
1 DO fiRM1[41kTifR18f ACINrHIS W 3LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
_rnu@ NW4F14ti2WNAfritOjiND "CHAT A COPYY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
cis
r- -o
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

12. CASING: Wall Thickness
Depth To -7f D(apteter or WeihVFt. MMa7p
To Ft.
To Ft.
Depth Material Method
To riD Ft.__IfeAM �� Pa,)'0
Ft.
Depth Diameter Slot Size - Material
Ft. in. in.
Ft. in. in.
From 0
From
From
13. GROUT:
From n
From To
14. SCREEN:
From To
From To
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
CONSTRUCTION STA
GRO[vf ,fpIF"
ASHEVPLIEET GrieriV P�
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 5.7Vf)Y115f I-}y)/i(L.n rt..CERTIFICATIONN of/74O
WELL CONTRACTOR COMPANY NAM hits JJjfa,,J I))eald''Ift JI'1t.{ � e J PHONE N2S(i_3e24-3 , .6 6
STATE WELL CONSTRUCTION PERMIT ASSOCIATED W ERMITN
applicable)
ale
(if applicable)
259511
I. WELL USE (Check Applicable Box): Residential 0.---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: j ;e4/21,P.0 4/6 County �4 egd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: et
Address / H p P
(Street or Route No.)
m `j a (C IC6 Jai
�5
T
3 (F- J
or ow Sitate
Zip Code
a n- _3a- i7.-23
Area code- Phone number
4. DATE DRILLED �2-�L-
5. TOTAL DEPTH: e Q5
Topographic/Land setting
1lRidge ❑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
7. STATIC WATER LEVEL Below Top of Casing: , 3 (0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): dS METHOD OF TEST
5 (r
10. WATER ZONES (depth): //Q /,
LOCATION SKETCH
11. DISINFECTION: Type Hf/' Amount 4 7-,4, 5 Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
hC+, I
TMf�T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DADS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001
0

257Q?6.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Y.)Yfl S /-10 I IQrA rll CERTIFICATION # °I n co
WELL CONTRACTOR COMPANY NAM& J1nt i'S Ilteysri I J)Pl I e) Yes l I:leit . --n- 0 J PHONE N Ssi_So2L —3 )-6 3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITN
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential CYMunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: C�./Q A/IvL; /y ,j/tCounty ,M a (fix .
(Street Name, Numbers, Community,
Subdivision, Lot No., Zip Code)
3. OWNER: Oa rbk trY'tr r
Address 1 Si 9 hi l (e k O L�'� If�
d*.e it e rt
wQ 11 I (Street C to Ne. e2 1 7 3 y
City or Town State Zip Code
gag)-Sav— 53 5,
Area code- Phone number
4. DATE DRILLED U - =-
5. TOTAL DEPTH: 3SS'
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 pRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 020 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): 6' METHOD OF TEST !(JJUi7LC{�
10. WATER ZONES (depth): /DO ' (�
J.00ATION SKETCH
I I . DISINFECTION: Type H -/"f-/ Amount .-- TAPS Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
0 Depth Diameter or WeighUFL Mat`ef I numbers and common road names.
From To 6 O Ft. (� " f l k P I
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r Ayt Ft. C tr7 polAk/�
From To Ft.
14. SCREEN: Depth Diameter Slot Size - Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r'.
0
16. REMARKS:
:Q,HE kiEB11 4,R.TkY
ASH�t
-A THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARC , AND THAT A COPY OF THH�CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
he Di vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
E9) 733-3221, within 30 days. GW-1 REV. 07/2001

257835
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7)� n Y)1 5 fit,
" 1) CLA rU CERTIFICATION if 2 /7 Le
WELL CONTRACTOR COMPANY NAMK',hnj (�AII0.0,4 Wei Itiverjl-u4 . nPJ PHONE # i(i_.�a. t -3 �-66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ri---"icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI "��/e-Ca�/�
Nearest Town: '^"�,�r /i/k Li /v /� ounty All Q. Grn
& -ice
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address q a rS RccitR-cL
(Street or Route No.)
-2/ht-itI,A—) tiC a(i3 /
City or Town State Zip Code
( SaIF— r5,56 tre
Area code- Phone number r,
4. DATE DRILLED d -(� —0 2_-
5. TOTAL DEPTH: BO Cr
6. DOES WELL REPLACE EXISTING WELL? YES f3 NO 171--------
b
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
7. STATIC WATER LEVEL Below Top of Casing. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): di METHOD OF TEST 1 029 7u�
10.WATERZONES(depth): %D r21-/-0
I I. DISINFECTION: Type
12. CASING:
s Depth/
V
From 0 To
From To
From To
13. GROUT: Depth
From n To (-9(7
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
�(. LOCATION SKETCH
i1 - P Amount ,� %-%i-I 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. Matep l numbers and common road names.
Ft. DY C�
Ft.
Ft.
Material
Ft. CP471
Ft.
Diameter
Ft. in.
Ft. in.
Method
J�A/l/
Slot Size • Material
in.
in.
Size Material
Ft.
Ft.
0
16.REMARKS:
GE
ASHEVILLE HEG iR?.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001

257834
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME -(print) c� n hi 5 Al I)(1tAd CERTIFICATIONS 01.17 co
WELL CONTRACTOR COMPANY NAM& I i' 411 S'Un/liO'r^'i I1)PI I r IY'r l l -x q, ) n C PHONE S41161.52 Q-3 -b
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W
ERMITS
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential C - unicipal/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: 724 2 /C L ! y' !/' County
Yf ! R G+-d_ ei
(Street ame, Nlumbers, Community,Subdivision, Lot No., Zip Code)
3.OWNER: 1 /Q n/!�(J(2c)ate`
Address hi S A -
(Street or Route No.)
.//
Q /r
City or Town State Zip Code
� - .369... 7,V 5
rea code. Phone number O
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
DATE DRILLED 4. - 7.-O a-J
5. TOTAL DEPTH: o2.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m-
7. STATIC WATER LEVEL Below Top of Casing: a 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 _`5 METHOD OF TEST /07/Ji'7GC�-�
10. WATER ZONES (depth): 6o' ' 7S, g- 5 (�
I I. DISINFECTION: Type JFFP Amount _calluiL5
12. CASING: Wall Thickness
Depth / Diap�eter or Wei ht/Ft. Material
From 0 To IOC1 Ft. to ~ .
r l gi p Y Ci
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r9V Ft.
Material
32'Yr
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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o =;
16. REMARKS:
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
._A f0@_ to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
f(.16- FICe• (919 733-3221, within 30 days. GW-1 REV. 07/2001

257833
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1)� n Yl i 5 Mt) I12l\ Ai CERTIFICATION # of 17
WELL CONTRACTOR COMPANYNAMKt,,ijt ' I)n.ysr 11)PMIi1jl j. FL P J PHONE %< 32Y.3-66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITS
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Ld--Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
NearestryT�own:�%�/�lli/CL�n//J//County
72e» ill 1 / - ("1rzci c
(Street Name, Numbers, Community, Subdivision,vjLot No., Zip Code)
3. OWNER: eh ay les )/
(Street 5Address 9,gi /1'Pr✓ /` J/ ,erl
(Street or Route No.)
City or Twin State
Area code- Phone number c�
4. DATE DRILLED ?Sr-- e _-d
5. TOTAL DEPTH: ,, -5 S
c7J79 y
ip Code
Topographic/Land setting
[Midge ❑Slope ❑Valley OFIat
(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 ❑/----
7. STATIC WATER LEVEL Below Top of Casing: 9 n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,Cl) METHOD OF TEST II0201
10. WATER ZONES (depth): 6)1,25<
I I. DISINFECTION: Type
12. CASING:
Depth /
From 0 To '7-
From To
From To
13. GROUT: Depth Material
From n Tor Ft. epyr O
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
/L1 LOCATION SKETCH
P I F Amount . 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dies eter or Wei ht/Ft. Mate i 1 numbers and common road names. o
Ft.
Ft. (.7")
ry
Method
Crn
Slot Size Material
in.
in.
O
O
rI
0
16. REMARKS:
Oa,IEREBY,CERTI TPAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
L 01 9TRILJCTIGN ST 1taRDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SHOD
ASHEVILLE R
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
to tht Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ar lulu • [phone], within 30 days. GW-I REV. 07/2001
IONAL OFFICE

257832
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
�1(',,,x � CERTIFICATION # at /7 `Y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;TM h VI7 5 ' I � f n''A Ct_Sa 4-3 6 Q
WELL CONTRACTOR COMPANY NAM PHONEY XI
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: �P,4,/Ll/Li?/ County/72t t,r. )
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code)
3. OWNER: .h04.I�A
Address /46
m a6Gto ar *7�
(Street or No.
/k19-,4PLi w ii/C
City or Town State /
(fag-. 5a - 3 -7 s
Area code. Phone number f,_ r
4 DATE DRILLED d
5. TOTAL DEPTH: 0.1
. S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 73/ra-
7. STATIC WATER LEVEL Below Top of Casing:
90 FT.
(Use "+" if Above Top of Casing)
-cn�
)/ Lit;
a.173V
Zip Code
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
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
vaIn riance with 15A NCAC 2C METHOD OFTEST
9. YIELDELD (gpm): 3 o
10. WATER ZONES (depth): of/S/
11. DISINFECTION: Type
12. CASING:
Depth
From To D
From To
From To Ft.
13. GROUT: Depth Material
From__ To - Ft. no;t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Material
Depth Size
Wall Thickness
Dia netter or Wet ht/Ft. MMatep l numbers and common road names.
Ft._-12 r lC Y Ci
Ft.
LOCATION SKETCH
Amount .-.L !) T S Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
thod
Mel
Slot Size ' Material
_ in.
in.
From
From
16. REMARKS:
6R0UND'W.1Pp'S
ASHEVILLE REGIONAL OFFICE
To Ft
To Ft
2-4 44
--
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NDARDS, AND THAT A COPY OF TH S RECORD H/S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ina o the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentteer` R$Vg07 2001
c 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) c-h-enV17 s Ai/)QiA rlU CERTIFICATION# 0//7 c,
WELL CONTRACTOR COMPANY NAMB;.rync IlloMa IIiP,l 1l>ft l l ;14 .ri P J PHONE 1442-cdi_So2 4--3 a-6 0
STATE WELL CONSTRUCTION PERMITS/ASSOCIATED W ERMIT8
(if applicable) (if applicable)
257839
I. WELL USE (Check Applicable Box): Residential id- unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: M
Nearest Town: P/2,4-A//RL; W A/C County / I I Q tent,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(1r t1)bx, /1,5
(Street or Route No.)
3 2ysPi Or J rel/ e74c7/ 3
City or Town State 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
Area code- Phone number p
4. DATE DRILLED 6 -$ - 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Siff FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /S M yTHOD OF TEST Ades)%,.
10. WATER ZONES (depth): / h " / ' /
LOCATION SKETCH
I I. DISINFECTION: Type Hill Amount ,--•. MA S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diajneter or Wei hUFt. Mate' I numbers and common road names.
From 0 To I/d Ft. (O ! i{ Pr
From To Ft. a
Iv
From To Ft. i„
13. GROUT: Depth Material Method a
From () To r"D Ft. CO:yy, oi,� 10nl
From To Ft. i"0
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in. _i.
From To Ft. in. in. o
15. SAND/GRAVEL PACK: o cc
Depth Size Material c En -
From To Ft.
From To Ft.
16. REMARKS:
R,,
t
dORF NSt},RUCTIDN
3
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Z
1 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original t� the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
GROt3/419.41,d*l§tP?12 Ireti(V [phone], within 30 days. GW-I REV. 07/2001
ASHEVrILLE REGIOff,AL OFFICE

257840
❑
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division1of Water Quality - Groundwater Section �""
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1I.e no 151 /In Ij(2-A r:. CERTIFICATION., o1-/74a
\YELL CONTRACTOR COMPANY NAME t1f r C `CM) HO/At' Wei 11) Yt u :1t Q/j ]tt P PHONE M hXl 6 2 l-/ —3 16
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O- icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION,:
Nearest Town: fE,4-N(CLr/1/A/C-County Ma.Cn i ,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 0 {- ,Q 4/I-ec. J (degrees/minutes/seconds)
Address _.aL} / 96 A8,7?-7.e e e h- /2 c'_ Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No,) (check box)
Fran ([ In---/ve-- F 2 y DEPTH DRILLING LOG
Ciry or Town State Zip Code From To Formation Description
((e -, )- s -4' -.5-8a
Area code- Phone number n
4. DATE DRILLED tL 5—e)
5. TOTAL DEPTH: i©Q '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ3-
7. STATIC WATER LEVEL Below Top of Casing:S O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,— 0M HOD OF TEST 14 1OW/pit-%
10. WATER ZONES (depth): 5 / (�
LOCATION SKETCH
II. DISINFECTION: Type H t» Amount 4 TA-. S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia�eter or Wei hdFt. Mateppl numbers and common road names.
From0 To Ft. /O t t l i ' tie/it
From To Ft.
From To Ft. [_i
13. GROUT: Depth Material Method 3 ha
From () To ,-*0 Ft. Co,-yt Ov,7 pQLm'u) c
From To Ft. co r=`'
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in. iV From To Ft. in. in. m
15. SAND/GRAVEL PACK:
Depth Size Material r-_�
From To Ft.
From To Ft. CO
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQ JSTR(JCTION SIA.N.IDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
FH
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sdbthit the origi the Division of Water Qtrality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phon No. [phone], within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REOGNAI_ OFROE

257842
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section le
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cbef)1115 IjjY) f 1On1 Cs� CERTIFICATION It7 tall-7
WELL CONTRACTOR COMPANY NAMIR hn1 S (dtll0,J (Deaf, l l . j. K e J PHONE # e6i_3a Y-3 g6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L1--"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: Plefrkk L I AWN C- County Al & co-n
/1T a 6 h& R a — C- ru l c
(Street Name, Numbers, Community,,Subdivision, Lot No., Zip Code) ) 3. OWNER: - a Yvt C S . T i, OTn4.S
Address Gam S.Ch(i Li, 3T
(Street or Route No.)
1C1,.7,c� r l 33G,/(O
City or Town State Zip Code
)- S-37- 7S42
Area code- Phone number
4. DATE DRILLED - 0 id b
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
5. TOTAL DEPTH: --CSO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:.>ZSn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): '(5 METHOD OF TEST 1Dz0i7P�—+
10. WATER ZONES (depth): �-IS 5.2 S— (�
11. DISINFECTION: Type % -t 4 Amount .a 714-AS
12. CASING: Wall Thickness
Depth Dia eter or Wet hUFt. Matee 1
From To � (ir/ Ft. p I
From To Ft.
From To Ft.
13. GROUT: Depth
;�
From n To rs1V 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.
Method
I
Material
Caen,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-la
0
0
co
Ca
16. REMARKS:
I i H gtElY qER y
G-COASMUCTIO StIANI
I,
Submit the original tal the C ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROi6994636itignfSillft(919) 7:3-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL •OFF'CE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

STATE WELL CONSTRUCTION PERMITY
(if applicable)
(if applicable)
ASSOCIATED W ERMITA
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \%)I-tn V1 i 5 I J lTl ( Csi '
WELL CONTRACTOR COMPANY NAMIEhenn7 C'cn0(I�,rtri Wel I rf1Yet 1I rx 17n P
&
257841
- Groundwater Section CERTIFICATION Y of /7 `/,
PRONE Ye613e2 4-3 ;6 6
I. WELL USE (Check Applicable Box): Residential ItYMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: r.e.4�LkLi r1l,�County /i�QCn+v
Cr_bwe2
(Sleet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dn u_Ce,
Address S/7-lrwlt,// %o//S C;rGl,2
[ vat) k_ VA-) or RAi/ule&No.) a & 73 Li
City or Town State Zip Code
&( -W )- 3449- a fruti
Area code- Phone number in
4. DATE DRILLED er. -/-0 0-
5. TOTAL DEPTH: 3b,5'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: 09 n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): .S' METHOD OF TEST Alow i71�(-�
10. WATER ZONES (depth): %b ' (/
LOCATION SKETCH
I I. DISINFECTION: Type Jf -t f Amount c>2TA- ,Q S Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Diaj�Wei ht/Ft.
From 0 To ,22 / Ft. a eler "` or f /e
From To Ft.
From To Ft
13. GROUT: Depth Material Method
From To r'Tl/ Ft. po),U0
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.
Matef-iAl
two State Roads or County Roads. Include the road
numbers and common road names. 0
N
0
G7
rV
O
0
ca
16. REMARKS:
I DO HEREBY CERTIFY THAT r
WELL WAS CONSTRUCTED IN ACCORDANCE WITH
NCAC 2C, WELL tRIIicTION STAI�J9APL> TAN T,HfAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2—/ —o
1
Submit the original to
127699-1636 Phonci
GROUNDWATER SECTION)
ASHEVILLE RE(';','':,N -1r
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Divi: ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3?21, within 30 days. GW-I RSV. 07/2001
r;
0

ASHEVILLE REGIA1699I 3 P
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAMj��nvt E (print) 75 I 1.. 11nen CERTIFICATION If e>Z/74°
WELL CONTRACTOR COMPANY NAmmtl\ hrg 0010444 (1M(3l 1 vet J 1-u .( 74 n' t' i PHONE 1 %si_.5at/ —3 a-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITY
(if applicable) ��. (if applicable)
WELL USE (Check Applicable Box): Residential iYMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO ' ^
Nearest Town: U/!nTTO 470— County /Q /Yrrf j
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ql Q,X PGLY( i 9
Address a inr) /Y) ti ciA I e Ci t? e D
(Stree11 7' JNo.) 7h
City or Town '•) State ^ //'Zip Code
Area code- Phone number
4. DATEDRILLED-- (f--D
5. TOTAL DEPTH: 7572
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qll�
258628
Topographic/Land setting
Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/econds)
Latitudelongitude source:❑OPS❑Topographic map
(check box)
QEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: ?a FT.
(Use "+" If Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST
10. WATER ZONES (depth):
11 DISINFECTION: Type {ff"»
12. CASING:
Depth Dia eter
From 0 To in
Ft. '"
From To Ft.
From To Ft.
13. GROUT: Depth
From n To �-,0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL'PACK'
Depth Size Material
Material
CO;
-
LOCATION SKETCH
Amount -27"f} 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Wei /Ft. Mate I numbers and common road names.
Pr
pay
Method
From To Ft.
From To Ft.
r-
cn 7.
G
16. REMARKS:
RTIFY THAT THIS WELL WAS CONSTRUL FED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Orek,ck c--/q_d
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
GROUNDWATER4SIAhe orig nal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
No. [phone], within 30 days. GW-I REV. 07/2001

258627
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :,/.e fl YII S1 /-i-/)/)OM rl� CERTIFICATIONS/ o1./74
WELL CONTRACTOR COMPANY NAMircNinrl^ (dj)O�1JMII11y'.li;- 4e PHONE
SaSsf_.5a4-3 �6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WOPPERMITII
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential iYMunicipal/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: F/2A 1-;( L.) d/ / O-- County //I,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 00.A. _ (Cr KairrA r
Address Cf-hC' Pi v zYSi 0 ,2- 12 d,
(Street or Route No.)
Il2 oc • (s (4i4) /i/ C-
City or Twn Susie c Zip Code
�d )-3 4 qi — 6- 9L
Area code. Phone number //
4. DATE DRILLED if,/4 _ 0 IL"
5. TOTAL DEPTH:
• DEPTH
From To
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)
DRILLING LOG
Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !7i-
7. STATIC WATER LEVEL Below Top of Casing: -3o FT.
(Use "+" if Above Top of Cuing)
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): /5 METHOD OF TEST Al(17/i�7L1,L�
10. WATER ZONES (depth): /r/ 2' (�
LOCATION SKETCH
11. DISINFECTION: Type H-}'%/ Amount ,- TA- A S Show direction and distance in miles from at least
I2. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth From 0 To % 2 FLDia eter or WeighVFt. Mate common and compn road names.
Y
To Ft.
To Ft.
Depth Material Method
From
From
13. GROUT:
From () To rD Ft.J1Oyn dm.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL 'PACK:
Depth Size Material
From To Ft.
From To Ft.
6.,, ,EMARKS..-,
I W NbKbUY LtKII
CONSTRUCTION ST:
GROUNDWATER SECTION
ASHEVIL9tibilat@IeKirianato 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
I 'n
Slot Size Material
in.
in.
OS :Z lid 9Z 9fiv ZO
fHATTHISWELLWASCONSTRUCIEDINACCORDANCEWITHI5ANCAC2C,WELL
ARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Oral ;44.0 -16-6 te
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
c
rr;
D

258026
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1).en V175 /-l-AJTia-A rsv CERTIFICATION# d./74a
WELL CONTRACTOR COMPANY NAME''IX(�nt S (c ..LQre4 W el I li]f'r j 1-14 Tn a PHONE #4^a-Ssf ,3 a L,/.-3 l 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W E RMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Oi—Municipal/Public ❑- industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:,ti,L�.L
ounty /Y/(f Ko-yr
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER:4 �JohYL5(JyL..
Address e_ 7 /7 f m t /)1 r i1_c-1
n (Street or Route No.) G
Q i- I z /✓ ti �0 7,3
C' e ity or To769_ _Scatty
7-/ v�Zip Code
_
Area code- Phone number r
4. DATE DRILLED c -a c
5. TOTAL DEPTH:
Topographic/Land setting
❑Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/Iongitude 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 ❑I�
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 aUor below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OFTEST _hjw/ hit
10. WATER ZONES (depth):
11. DISINFECTION: Type 1-f'1/
12. CASING:
Depth Diagg��eter
From 0 To Ft. h"
From To Ft.
From To Ft,
13. GROUT: Depth
From () To Ft.
LOCATION SKETCH
Amount 4%,/} P 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. MMatepi numbers and common road names.
Pr
Material
COMI
yn'
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
16. REMARKS:
YCEK'fIFYTtl
ICONSTRUCTIONSTAND
-
J
M'NiNRK +bk 4TaJ .1?, Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
; 4ou(4days. 119) 33 3221, within 30
tGW-1 REV, 07/2001
Slot Size Material
in.
in.
fV
THIS WELL WAS CONSTRUL I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL a
KND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
cr

258625
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t7)-ef7Yly S l j jt,vt ,{v
jCERTIFICATION Y oZ /% le
WELL CONTRACTOR COMPANY NAM& I)°.hnl S Ir Jllant Y`rl l ^R n.P . PHONE M
asst S�z4-3 a6 t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WERMITM
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ld--Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: %1A,L)L L /517J1,4' County !r L p�,�t Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(Sueel Name, Numbers, Community, Subdivision, Lol No., Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: fa ClL ea f-1,e,
Address /3 G-CIOSS 4r42-
Cho, l v ( 'rRo4F-e , C,�r ,91vvy (check box)
C �! CiryorTown Sule /-7 Z; Joffe. DEPTH DRILLING LOG
F9.-3 )- S50 -. Gfds 3 P From To Formation Description
Area code. Phone number
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
4. DATE DRILLED C--;-/..p 2 _
5. TOTAL DEPTH: -4,e
6. DOES WELL REPLACE EXISTING WELL? YES O NO Ql�
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.,
(Use"+" if Above Top of Cuing) --
8 TOP. OF CASING IS /
FT: Above Land Surfacer
'Top of cuing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118. /
9. YIELD (gpm): ? METHOD OF /7/ //
0. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth c
From 0 To O _) Ft. p
From To Ft,
From To Ft.
13. GROUT: Depth Material Method.
From n To Ft. ( ..„ nrnA'0
From To Ft. /
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
/en TEST
a
o� LOCATION SKETCH
f� Amount rt T14. S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Wei t/Ft. MateoalL numbers and cornrnon road names.
� /
From To
16. REMARKS:
DO,'HEIRE6'(r CvE TI y
-0)k?-STRIUCT9ONST D
Submit the original to file Di
GMi..M:18061%71 4-019) 733
ASHEVILLE REGIONAL OFFICE
Ft.
Ft.
Slot Size ' Material
in.
in.
0
fV
C
cD
o'
IV
(J1
0
o1
CP
r ;
0
T IS WELL ANTHAT A WAS
CCOY OF RUu I ED IN ACCORDANCE WITH I5A NCAC 2C,-WELL
TH S, RECORD H S BEEN PROVIDED TO THE WELL OWNER
7 / WNW Tt�f 0 —ai - 0 2_....
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 258214
North Carolina - Department of Environment and Natural Resources _- Division of Water Quality - Groundwater Section --
WELL CONTRACTOR (INDIVIDUAL) NAME (print)['he fl1i5 ni)ilarAei ' CERTIFICATION */ of `f'
WELL CONTRACTOR COMPANY NAME —NV jthr)(I(402 Wei I Y'fl i-x4_ Yt- P J PHONE M 5";,2 4-3 1 b 6
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQr'(YERMITM
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential rd'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery C Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: &A-4/L L f /VN&. County M.Q fan.,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 6: t l J O k Ks D7V (degrees/minutes/seconds)
Address /9.11 Res, L I'L_ Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box)
rr. my-gS 1c j 3 3 9 / 'y DEPTH DRILLING LOG
}
City or own State Zip Code From To Formation Description
cfaj)- g13b 7_2.3 5
Area code- Phone number
4. DATE DRILLED rrf-9-0 2
5. TOTAL DEPTH: abS-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J�
7. STATIC WATER LEVEL Below Top of Casing: ,0 0 FT.
(Use "+" if Above Top or Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0I18. / /
9. YIELD (gpm): o25 METHOD OF TEST llW
10. WATER ZONES (depth): /PC U
LOCATION SKETCI-I
I I. DISINFECTION: Type }f f'ff Amount 4 I -A -A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth
i� To �y FL Diameter or WeiphdFt. Mate 1 numbers and common road names.
From r it&- ,.7
From To Ft. tV
From To Ft.
r-_
13. GROUT: Depth Material MethodTk";-)From n To r Ft. Co na,,
t.
From To Ft.
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft. in. in.
v
From To Ft. in. in.
15. SAND/GRAVEL PACK: .` no
r
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
\I DO HEREBY CERTIFY "iHr�"TFH S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
1 ICQ S.TRUCT1nU STAN.©MRQI liµ 4D THAT A COPY OF THIS RECORD HPAS BEEN PROVIDED TO THE WELL OWNER
Y-9-62
'�.. . L,-91 NATURE OF PERSON CONSTRUCTING THE WELL DATE
LSlubmit-Fheorigtrtafto_tlrgrlivisic�n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
249 1636 Phone No. (Q*),'733-322I1, within 30 days. GW-I REV. 07/2001
is 1', (6 I WU`

258212
4
5
6
7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ""
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) it) -en VI75 1inhi OzA CERTIFICATION# c,Z/74'
WELL CONTRACTOR COMPANY NAME /X,I)j')Li 14 ifr,,,tj WeiJ '1Ji-R ,).14e J PHONE ili0/—3aa9-3;6 O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WiIPPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ld--Municipal/Public ❑- Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neares Town: 74/4/p_county ,A4azen,
Res e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Pan r-qful,ei
Address 2l-� It-)h r �-e- () 0.-lc .J.S7— (79V 5
f{ (Street or Route No.)
i-tailuet A) oCin73
C ty or Town State Zip Code
,5:2c/_ inn/Z
Area code- Phone number
DATE DRILLED number,__,
DATE �.
TOTAL DEPTH: Ln,5
DOES WELL REPLACE EXISTING WELL? YES ❑ NO W—
STATIC WATER LEVEL Below Top of Casing: /02) FT.
(Use "+" if Above Top of Casing)
Topographic/Land setting
0Ridge ❑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
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): /� METHOD OOTEST //OVA
10. WATER ZONES (depth): //,5) < V 5 o a-o
y-/� r� LOCATION SKETCH
1 I. DISINFECTION: Type 1-75/y
4' Amount ,� / ' pJ 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
numbers and common road names.
From 0
From
From
Depth Dia eter or WeighUFt. Matt
To SJ Ft.,-f•d QYC�i
To Ft.
To Ft.
13. GROUT: Depth
From (') To r*D Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Material
15. SAND/GRAVEL'PACK
Depth Size Material
From To Ft.
From To Ft.
Method
p=)
Slot Size ' Material
in.
in.
16 REMARKS:
.a.
0
N
J^
rn
0
HEREB Y;CERTIFY l}F[A-pl S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
f&NsTRUt ituN, q dD THAT A COPY F THjS RECORD Hf3S BEEN PROVIDED TO THE WELL OWNER
////�I F —9 —D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
it t-krorigunal to feT;Divisio(r of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27599!-1636_Phanc No. (919)_733.322 , within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)N.1) -&h Y115 /�-f)IT'ON\rU ' CERTIFICATION# cZ/740
WELL CONTRACTOR COMPANYNAM6'tyf IC Jd0 thing WW)ellkl�r l I`( es,) Ple u PHONE Ii'Ai_S24-3 2-6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W IIIPPERMIT#
(if applicable) _� (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:,(P/l',t&Li 4/ Ate —County 4, Qtyq;
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7rt.10/} S{an4ie1,-1
Address _2 /.�- / /(i ✓-a rr Pet.
(Street or Route No.)
nr/a-2•1( l,�J ���. a 73 y
City or Town State Zip Code
'KW)- , 4 . g (.11-13
Area code- Phone number
4. DATE DRILLED / 3 —d Z
5. TOTAL DEPTH:
258212
Topographic/Land setting
L7Ridge ❑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
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated aUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): /0 METHOD OF TEST
10. WATER ZONES (depth): ') Z 4/ti
LOCATION SKETCH
I I. DISINFECTION: Type //f/1 Amount .-2 %A- S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Includg4e road
Depth Diapneter or Wei ht/Ft. Knells numbers and common road names. ry =
From 0 To7Ft. /�7 r (, Pr
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To r Ft. C.,9Yi Dig" poi /L9
From To /
14. SCREEN: Depth
From To
Ft
Diameter Slot Size ' Material
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELRPACK:
Depth Size Material
To Ft.
From
From
16. REMARKS'
To
it. ,:. 1 DOH ERE B('
--CONSTRUCTION STA 1111
�tI'4mat the o`rtigrp `ho th
47
Ft.
0
PO
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
tDS, AND THAT A COPY rirOFTT�HIS RECORD,nH S BEEN PROVIDED TO THE WELL OWNER
fk ! +�C4 ct-las —� 3 n 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
rn -
n-.
r.
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
258211
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7)-en Y1 I S Il / 1 (lM rU CERTIFICATION # �?% cf'
WELL CONTRACTOR COMPANYNAMK))9.I)n1C if)!1(},,a HMO If; II-ll�t �YLP J PHONE AibfrAsi_,524-3 g6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential t1.--"icipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: j—R J2 tie L/ n// County/ L coy -Li
(Street Name, Numbers, Community, Subdivision, Lot N��o.,- Zip
,Code)
3. OWNER: £°RJair)rrU / oCX/b
Address /D 35 Pn f/ s /32 Pa,
4
5
6
7
Tre -an le I eet or Route No.)
r s
City or Town tare Zip Code
81- (36q 3C`71
Area code- Phone number n
DATE DRILLED —6
TOTAL DEPTH: cL5 3
Topographic/Land setting
L]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
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: o?D r 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 accordancejr th ISA NCAC 2C .0118.
9. YIELD (gpm): >S METHOD OF TEST ,5IO7J hit
10. WATER ZONES (depth): (1 r
11. DISINFECTION: Type /f-t» Amount
12. CASING:
Depth Dia eter
From 0 To 7 Ft.l
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (3 To Ft. CO�r yr, polA� .ii
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size ' Material
From To Ft in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
,-' %-,4I S Show direction and distance in miles from at least
Wall Thickness
or WeighUFt. Moat pal
two State Roads or County Roads. Include the road
numbers and common road names. o =
v
-.o
O
N
.c—
r-i
16.REMARKS:
1 DO HEREfpy CERTIFY Pi
NSTRUCION STAND
fiSWELL WAS CONSTRUL IED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SI9NATURE OF PERSON CONSTRUCTING THE WELL DATE
SubmiLrht original to the Divisipn of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276;99-t636 Phone No. (919) 733-32j1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North (:,i. 1ina - Depalnnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
m71,(TIN I I(A("I Olt (INDIVIDUAL) NANIE (wins) e 'Ili) •�N"CS CERTIFICATION tl �.)((
6'5
1I 1I. I. (t)\ IIt WI Olt ('(I\II'ANV NAME (.ic 4).__LLJY_tI ' i• Lb-c' 7 I'IIONE a pi, 57-35oo
S I A I it 1vI:I.I. ('t )SS! Itl'(' l ION FERMI HO ASSOCIA'I'EI) WO I'ERNlfrd
Id1 applicable) (if applicable)
1 \\ I1. 1. UST? (Check Applicable )lox): Residential 6 Municipal/public O Industrial ❑ Agricultural 0
M Quito) ing ❑ Recovery ❑ heat I'unlp Water Injection 0 Other ❑ If filler, List Use
2 \VF 1 1 1 ()CA IIf )N.
Nrlresl I ttwtt: %U i'Counl •MP}(U r-
Nncct Taut)'. Nundm:c. Commmoily, Suhdi,ision• Lot No., Zip Code)
Addles, .225 L.� —SA.vA 13.y
i ISoccl or lion) No.)
/ Cl/ hilt' )) S 11
(0, or 1 a Scare Zip Code
plea t„dc I'himr nutilho U
I. 1/AIT. DR11 LEI/
C. TId/ I. I)YI'l11: / t/v
t)
11)
6. DOES VATILT. REPLACE EXISTING WELL'? YES 0 NO ❑�
7. S lAIIC WAI ER I,EVEI, 13clow Top of ('asing: A O FT.
(Use "I)" if Above Fop of Unclog)
8. TOP 01. CASING IS / FT. Above Land Sulnice*
• I ill llr tacitly. tl'rinh1:,lc1I mho/ Won Inllll S,Irtare requires 11
, nl iancr In artnrdincc 1• i16 I5,1 NCAC 2(' .(II l L
UL
1'IFI_D (grin):=-)_ NILIIIOD OF TEST . •"
WATER /ONES (depth): (70 /2(-7
I I. I)ISINI"P.("IION . "type �� J /.7 Amount (-2�
12. CASING: \all "thickness
Depth I)i.•npctcr or Weight/FI. NltticriL
;tl
pnan Tn )))....)1.)0
Fl.
I ttml To 1:1.
I rom -fo Ft
I3. (;R(IN 1,1 Depth_ ---" Nlalcri�
1 win �"/ fo.'y -_ I'I. (+i.c
1.1. St121[I rA I)cplh Diainctcr
1 IOI11 I11
in.
loan
15, SANUIO ItAVF.I. PAC "
Ucpth Sizc
I ion Il, Ft.
I Inn
16. It P.NIrAItkS.
Method
Slot Size NI;actial
.
in.
Material
258256
Topograyj)ie/Land selling
❑Itidge OSlope ❑Valley ❑Flat
(check npprt.priale box)
Latitude/longitude of well location
(degrees/minor cs/sccnnds)
laliludc/lougitudc source:❑GPSOTopographic map
(check hos)
DEl'fiI DRILLING LOG
From "fo Formation Description
0 5 Sc-7 095
/( L-'' 2% ' 7.
).00ATION SKETCH
Show direction and distance in miles from al leas)
Iwo State Roads or County Roads. Include the road
numbers and common road names.
DI) I lfr l lit Rlltl Clip I111' Ikl,\fl�.:�jIS WELL WAS CONS" IN ACCORDANCE Will I ISA NCAC 2C,WELT, Uwe
it4NIIM.Iii)L)tt)N SIAN' t111S. NI) II IAT A COPY OF III�tECORDIIAS BEEN PROVIDE1)10 IIE WELL OWNER.
Itii}I
�� � 1
>1 J
�u L..•J' ;NATURE OF PERSON S!RUC G 1l1E WELL DATE
1.rrlrnu4-.Urv-urr ;iu,rl to the )i1 isi In of \1':dcr Quality, (7ruundlvalcr Section, 1636 Mail Service Center • Raleigh, NC
2y, i 1'., 6161'Row No. (1)11i) 713 32 I, SI illiin 30 days. (i1V-1 REV. 1)7/2001

257158
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAN}I EE (print) c'be n:71 S /-jy) /1(,A rL CERTIFICATION,/# d-n/74'
' \e'ELL CONTRACTOR COMPANY NAME I.0,hn i � fr JI(2..,(4 IliPi 1 alt/f l l-}( � , rt a PHONE #05i_SO2 14-3 c2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED wiRERmIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential f--Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: l
1 7
Nearest Town: 0 /f(1 AT( County / i' a {(4( )
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 20 /Q vl7?a l f('j
Address +v5-3' `% S 7) Ore A et44 P
(Street or oute No.)
Ice SA. le Li A., /L'C-
.;Z l:'J3 f
City or Town State Zip Code
k)- e34-9— //O5
Area code- Phone number
4. DATE DRILLED / — / � —D 2__
5. TOTAL DEPTH: 3r.S
Topographic/Land setting
❑Ridge 0Slope ❑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 m-
7. STATIC WATER LEVEL Below Top of Casing: 5461 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 .0I18.
9. YIELD (gpm): / 0 METHOD OF TEST /102/Jr7f �—.
10. WATER ZONES (depth): � S D ,7 -7 5— (/
LOCATION SKETCH
11. DISINFECTION: Type if-{"/f Amount T,4 s S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ry ni Dia eter or Wei�hUFt. Mate},al numbers and common road names.
From 0 To b 6 Ft. n " . 2,.6f',na -I`"�—
From To Ft. re e /
From To Ft. _
13. GROUT: Depth Material Method O
From n To r`�(7 FL PCTytr(> no
From To Ft. r�
14. SCREEN: Depth Diameter Slot Size Material
I
From To Ft. in. in. no
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
t11 'r
1i10 ,R4BY`f'FIt-TIF
Y TI-
CONSTRUCTION STAID
JJ
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF TH kRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
AS ..276994f61�4iJtlilroQ
�CIRr, '( tyre dkleTit "1�to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33 3221, within 30 days. GW-I REV. 07/2001

Er
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 8.7).ehV)i 5 tin IJ(iM rt. CERTIFICATION# 2 7(P
WELL CONTRACTOR COMPANY NAMIi ,f)niC (ct(�fia4Ar4 Ille�l �l �, )i-u ,).tt('� PHONE # %_3i�4-3 ;Lb
• STATE WELL CONSTRUCTION PERMIT# ASSdC!ATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential (d--Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: f/�'.4,'L/C L / ,t'4'P County .41 e, ean-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L—C1 rQ (Z fr) e
Address f.22/.3 S'1•1 IZCr_»'1 SY',
(Street or Ro r e No.)
KisS'w„,.ze_ I
,3(i-7y-ct
City or Town State Zip Code
(1/07 S 9 7 _ (e5/ S
Area code- Phone number
4. DATE DRILLED '%-/ 0 -o 9.
5. TOTAL DEPTH: SmC 5"' '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 171--------
7. STATIC WATER LEVEL Below Top of Casing: /07, 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): yy_y METHOD OF TEST /Jk)//"i7L[.(.-,
10. WATER ZONES (depth): t' 07) 75 0
(7
LOCATION SKETCH
II DISINFECTION: Type H fill Amount 4 ng-A S Show direction and distance in miles.from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weil;h /Ft. Material numbers and common road names.
From Tor D Ft. (" " ,/( Q / 2
From To Ft.
From To Ft.
13. GROUT: Depth Material i Method
From n To (*fp Ft. et2.47L011 COWL)
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.
257157
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
D�
I CONSTRUCTION STA�tNb, DS, AND THAT A COPY OF TH S RECORD HQS BEEN PROVIDED TO THE WELL OWNER
°hiii,Lel
nl77:7, ,- TjGil
ASf t1SuthrfiLtlOg °ri,61 f.M the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 PhonENCI: (919) /33-3221, within 30 days. GW-I REV. 07/2001
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r')
-72

25'7156
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) the nhi 5/I ) IL),A^� CERTIFICATION', 02/7 40
' WELL CONTRACTOR COMPANY NAMEIX,t)Y)IS 'nli)110,04 Wei IYez II;1( ,j-.yt C.) PHONE M eii_,5.-;24-3 ;2-6 a
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED Wt5'ERMIT',
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q- icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1f Other, List Use
2. WELL LOCATION:
Nearest Town: R9 A. n .k1j71/4/c2 County
L' .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /L/2/ CTCA/?.SL9'C�
Address siem0y1C.cc-c-, cl/V at/
(Street or Route No.)
i—Ta91�1,4,6. %7C-
City or T wn State Zip Code
- ; w 9_ /
Area code- Phone number
4. DATE DRILLED 1— a ,P—L 2-,
5. TOTAL DEPTH: STn /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m%
7. STATIC WATER LEVEL Below Top of Casing:. C.1) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / 5 METHOD OF TEST i/OJ/J.f7L(,(--,
10. WATER ZONES (depth): 4'.SL, ' (�
LOCATION SKETCH
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
S73 y
4ritn
1 I. DISINFECTION: Type H t» Amount
%A- 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Dia eter or Wei hVFt. Material
From 0 To C7� Ft. n it1/ { Pr
C�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
�J
From () To ` Ft. (pyyt at ciy1/�
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. •
IS. REMj$KS:
S k I
DO I IEREBY CERTIFY TI
ONSTRUCTION STAND
two State Roads or County Roads. Include the road
numbers and common road names.
15 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL .
AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
fir 0 -# 7— a. 2--c z
Si
„NATURE OF PERSON CONSTRUCTING THE WELL DATE
0
1
7
0
DUI\ '�iVA ER SrC T I
�[� Yi�EigemRy to eeprvis'on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21b99-Ib30 I'nonc \u. (919) l.t5-3221, 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)ih-en Y1i 51 /1 TTim rU CERTIFICATION# r� /7(.
'WELL CONTRACTOR COMPANY NAME(
f IIny,ri �i�P(�r11Y`i 1�;1(d_ -yt f+J PHONE#Qr!-I5),-Sa t/ 3aZ e,Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 22-Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
7
WELL LOCATION:
Nearest Town: [ /11rLfCLi//L /r County 4 Q Ctn,
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: matyL{ Er-1
Address L51,20 LGL/r4GE' Z. c2->/ix
(Street or Route No.)
%—pianeJni A/c- ,5573y
City or Town State Zip Code
ski- . 3 h9 _ 3 99
257155
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED 2-_.�L9`- D 2
5. TOTAL DEPTH: 76.5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: ,�s FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / L.. METHOD OF TEST /1/2)22.77-C,f
10. WATER ZONES (depth): , SS -a (1
LOCATION SKETCH
I I. DISINFECTION: Type if #A' Amount TAA 5 Show direction and distance in miles from at, least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth /, Diameter or Ft. Material numbers and common road names.
From '0 To 7-� Ft. (r? ` p it
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,
From /3 To ,-,f7 Ft. apyyt al,, aPlfU
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CONSTRUCTION STAN
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF/T�H S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
,99 —v im
DATE
Ct
c;
2
yl
AS�ilr
SETION
'..i4QCa J Ike Div
c
o.
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-I REV. 07/2001

25654a
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionlof Water Quality - Groundwater Section
WELL
ELL CONTRACTOR (INDIVIDUAL) NAME T
(print) [1/-e n i71S J1-16I 1 t2'A rli CERTIFICATION# et-1 / y,
WELL CONTRACTOR COMPANY NAMIcI>.hni s (J jin.vtr3 wei I 1re-, J I :-7, y ne l PHONE */ —swa2 4-3 g6
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: e�
Nearest Town: %P ; 4,/LL; yv4/e -County Maeint_-,
Cav1.€13S (0�y _ i4ti' 5jnr.Cu,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: g 1�1IiCA,�Jh'av
Address /CF S/ �ftc-r'.t A✓`e-'
(Street or Route No.) Pr /( �` / <h4,1tdei-e r J c
City or Town State Zip Code
C7Q/ )- iu 3 - <1373
Area code- Phone number
4. DATE DRILLED �L,s- D
5. TOTAL DEPTH: 3 O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6'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 15A NCAC 2C .0118.
9. YIELD (gpm): 1Q 0 METHOD OF TEST /U)Ur7Ll,{-�
10. WATER ZONES (depth): FS 3 9S (�
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(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 H#» Amount ,_ %_} _ S
12. CASING: Wall Thickness
p `7't
Depth Diaeter or Wet ht/Ft.
From 0To 7 S FL [n.-
From To Ft.
From To Ft.
13. GROUT: Depth
From 1 To e Ft.
Material
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Nie'tbod
From To
Ft. in. in.
15. SAND/GRAVEL PACK:
Size
From
From
Depth
To Ft.
To Ft. •
16 RFMARKS•
Material
LOCATION SKETCH o
Show direction and distance in miles frorP�at least
two State Roads or County Roads. Inclup�the cEad
numbers and common road names. r no
tV __-
v.t-
m=:
—121
IV
G
CONSTRUCTION!e
i I
GROUND nfjt`}lheil4.11`0, lal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4Sk,EVILLE 9g_a6 _I Va.7019) 733-3221, within 30 days. GW-I REV. 07/2001
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'/—/S-D
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL

256541
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division
1 of Water Quality - Groundwater Section /
\VELLCONTRACTOR (INDIVIDUAL) NAME (print) J) nv)151 "It ,A di CERTIFICATION# of (ie
WELL CONTRACTOR COMPANY NAMKJio.ytri WPI alit L('.1��((j .J-rl('J PHONE 4056i_SO2 LI--3 a-6 a
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQYERMIT#
(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: °fir Ai C- County Al (7 Ctn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: WD"Yt.tici-t-a , Fy't-i-C', n�
Address (O g '1 ,j c-k e- c rn; d L 12d
(Street or Route No.) • 3
tr//�CCtry dll Town 7-Sintg„ 9 � Zip Code
'// yy
Area code- Phone number
4. DATE DRILLED / - a - D t-
5. TOTAL DEPTH: 1 S5 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I71--------
7. STATIC WATER LEVEL Below Top of Casing: o? 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
TEST
variance in accordance with 15A NCAC 2C .0118.
�DIUIrLl/-�
(� LOCATION SKETCH
Amount r-2 'IAA 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include rch
N"'
Depth Diaeter or Wei ht/Ft. Materialnumbers and common road names.
To /35 Ft. n - ✓
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
10. WATER ZONES (depth): 57)
11. DISINFECTION: Type
12. CASING:
From V
From To Ft.
From To Ft.
13. GROUT: Depth
From n To D
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Material Method
Ft cpnryt Oy� Po"
Ft.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft. •
11
--fQO-F{EAEBY (�' RT Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOINSt NDARDS, AND THAT A COPY OF TH}S RECORD HPAS BEEN PROVIDED TO THE WELL OWNER
Material
L n_
r
tV
rV
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
k EV (� A .T
ASHE ILL LS I$gbmlt theibriginalS the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
..27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
7 -o

25 1 4O
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section / -
\VELLCONTRACTOR (INDIVIDUAL) NAME
(print) c). f) h) $ I 1iC1M q1 CERTIFICATION # d-/7 Y'
\VELL CONTRACTOR COMPANY NAMK I X. [ S �(� �I il.ytr� II�P.� � e'r 11 -H'- T-YI (' PHONE # ni_So2 L/-3 .6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town: F2&4tk-InJ
nil 1 - M+'1 •
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County A/1 a (Ant )
3. OWNER: -t-1 D ' b 0(12_
Address e-b )�
(Street or Route No.) �t
1-12/4- ; ,0 • 4/ C c9_ 7 y y
City or Town State Zip Code
Area code- Phone number,.../
4. DATE DRILLED / —6 Z
5. TOTAL DEPTH: mil' S
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
9. YIELD (gpm): /0 METHOD OF TEST t lD2brif lvariance in accordance with 15A NCAC 2C .0118.
10. WATER ZONES (depth): 3 6,0 7! - 9 9'0
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 1-t» Amount ,� %%i.k S
12. CASING: Wall Thickness
,!t Dept Dia�eter or Wei ht/Ft. Material
From V To 3 Cif -Ft. (r) r ' —•
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To _ Ft ea yi 011
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.
1
r , REM ,J.R "3.
1 DU Ht tt5Y LH 2.Y1 THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ILDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
LOCATION SKETCH IN)�
Show direction and distance in miles frotirc�t lea -sr'
two State Roads or County Roads. Include tthe road-'.
numbers and common road names. N c_
tV
lD
cn
nljc
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROuNOV.'C r ft)N
ASFE 1 'i 1-ESiIt2tlslt the ar,.ig,iinal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

254912
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c).e it Vl, sI MY) jifarA CERTIFICATION # oZ17
WELL CONTRACTOR COMPANY NAME hits (c0ik J Wen y'ij I:lt.(,.}-M P J PHONE # 7%/_302 I/--3 a-6 V
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W
(if applicable)
ERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential C- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: N�
Nearest Town: iq} h ainAs? County ,/Y1 a-C.Crni
j: 1 1 p,"> W-c4
(Street Name, Numbers, Community, Subdivision,viLot No., Zip Code)
�J 3. OWNER: i m rrTh �C n A'1 Pi
Address / b 7 LC_IL2-v% Pia V Y-•
(Street or Route No.)
;IIrod �Q ?v;I' •
City or Towk/ State Zip Code
(547' 95-2_ Y/37
Area code- Phone number/
4. DATE DRILLED U
5. TOTAL DEPTH: 7.5'
Topographic/Land setting
DRidge ❑Slope ❑Vr.11ey DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J�
7. STATIC WATER LEVEL Below Top of Casing: .3 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): / 5 METHOD OF TEST /UZlli rt ,/—.
10. WATER ZONES (depth): 4f0 ,�0 D (�
11. DISINFECTION: Type
12. CASING:
Depth Diamj�eter
From 0 To 1 Ft. hi`
From To Ft.
From To Ft.
13. GROUT: Depth
From n To 9i7 Ft.
Material
32471
�t,,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Amount ,-Q %A-,Q S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or WeighUFt. Material numbers and common road names.
Method
FJJTwL/
Slot Size Material
in.
in.
16.REMARKS:
0
c_
C
a
Dow
0
Q1
od14 ER(EBY' CEATI Fy
r"�� CONSTRUCTION STAND
J
A
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Siufidtl6tYreT6iv6iiGTlfti4'the Division of Water Quality—, Section, 1636 Mail Service Center - Raleigh, NC
ASsif641E6ft,'' IrsQi444RF(Ei ) 733 221, within 30 days. GW-I REV. 07/2001

254911
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [7)•et3 YIi 5 Tit II (2n\rCERTIFICATION it 0Z/%40
WELL CONTRACTOR COMPANY NAM&t?gn(S (d>ollara Wei � �IYr j t ;l1.t rn a PHONE 8/0-54/_.ca 14-3 ,24 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
t. WELL USE (Check Applicable Box): Residential Yd--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(Street or Route o.)
City
(�j}� SCE t: __ r- 4 9 L
Area Phone number //
4. DATE DRILLED (, - / 3 —4 7
5. TOTAL DEPTH: .3 7.5- 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO --
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
2. WELL LOCATION: Nam.
Nearest Town: y/a-/) L 44 hS County ma Cn r 7
Tied/e Pa c £d.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6 PILL.(°
Address nX /7L/ L,L
i p In,2,Q. f� We «f 791
or( awn State Zip Code
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): S0 METHOD OF TEST
10. WATER ZONES (depth): (te O 0 C+
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To 7.P Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Methodl
From n To �t7 Ft. 02�r e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Dia eter
(..
LOCATION SKETCH o
Amount %�g $ Show direction and distance in miles from :astc,:
Wall Thickness two State Roads or County Roads. Include roa
or WeighUFt. MMateri� numbers and common road names. cV c`
y
:
^ c
eNr
w�
C2 nz
0
• t
From To Ft.
W
Ui
16. REMARKS:
RE YC�RT6F1)LL"I"
I. STRUCTIOIVV�$lyi)•'
=..` F.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS, AND THAT A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
—/3—a L.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the on Inat_[o.the D vision of Water Quality Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GAZIORIBI.63,64FluitEL &9) 73 -3221, within 30 days. GW-I REV. 07/2001
ASHEVILLE El-''ONAL

254910
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
n
WELL CONTRACTOR (INDIVIDUAL) NAME (print) the MIS I+n / 1 n,A d, CERTIFICATION # eel/7 (o
WELL CONTRACTOR COMPANYNAM& l)n(d651104.a n C'J PHONE # _Sa14-3 a6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIRERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentialid�Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /I) qh klit-13.7Ci County Ala G - 1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /kr"yrio-t/ SCliyyel{t S
Address 'P- (S,BTh< / LE .i
(Street or Route No.)
EI�S�:S 1= 1
y or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED G - /Is --a
5. TOTAL DEPTH: 0 .SS
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
7. STATIC WATER LEVEL Below Top of Casing: ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): n) C' METHOD OF TEST /uz/..,7g-Th
10. WATER ZONES (depth): -) S 4/0 er 0
LOCATION SKETCH
I I. DISINFECTION: Type %{" f'i/ Amount ,--2 TA -AS Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the 'lid
Depth O o
From 0 To .2/ FL
From To Ft.
From To Ft.
13. GROUT: Depth
FromFrom n To r-/t7 Ft.
Diapleter or Wei hUFt. Mate al numbers and common road names. N
p
Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
t CE npyl(T�
CONSTRUCTION STANUA
Submit, the original t43he_Dkvision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
Method
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
C
iV
A
O
U7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
eel'
la G,Ai�a.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Ertl
Ir 0
_rn
c<
rn0
=rn
rra
ma
—1
O

From
13. GROUT: Material Method
From n eo4-n� �QI,VC�
From To Ft.
L "%
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. f __rr.-'t
From To Ft. in. in. I �=
15. SAND/GRAVEL PACK: an
Depth Size Material a' nt--.
From To Ft. N,_
O msz
From To • Ft. - n
--I
G
16. REMARKS: _. -- - =
If. Ib Fi1fiR'F�Y CERTIF
CON
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C, WELL
aS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
an
255134
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -- Division
)I of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME
(print)Nh-e ll MisI'IlY7 I12A n� CERTIFICATION�# 417((e'
WELL CONTRACTOR COMPANY NAMK/ X�i S '(M11In,r1 I i�ei Ik1 V`i lim ).4 PJ PHONE # )S) S24--3 2'i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) __ (if applicable)
I . WELL USE (Check Applicable Box): Residential ld-----MunicipaI/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: nn
Nearest Town: /2,4 ,4kL;4/'-County (/rQCnyt>
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: / OWtQS / ak 1002
-". ,5
Address /70� 4/ree{a-</Zci
FE-G/F1k l(_J/1,/ StfeetCor uttJQNo.) �73
City or Town State Zip Code
ica_2(1- 369_ SC1/7
Area code- Phone numbep
4. DATE DRILLED h - 1 -D 1.
5. TOTAL DEPTH: Rn 5
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 fZJ-
7. STATIC WATER LEVEL Below Top of Casing: 4n 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 /kei7LC,�-�
10. WATER ZONES (depth): / R 0 1 (} n (%
LOCATION SKETCH
I . DISINFECTION: Type in -I/' Amount r2 T14,Q 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeichVFt. Mate numbers and common road names.
0
To / DI Ft. n r l S((( Y
To Ft.
To Ft.
Depth.-�y'�
To r7l/ Ft.
From
From
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHEi{499RG65a'9PAbriaNrtCIf919) 33-3221, within 30 days. GW-I REV. 07/2001
GRO$,M.12'+91M1q g SFI P,rtfl\ o the

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME
(print) v l /Q fl h l 5/in / ) Qn\ diCERTIFICATION#ol (/7 Y'
WELL CONTRACTOR COMPANY NAMQI.t'.Iln1s IIQMr1 � Wel}r)`fril'.lc Q(1,. YFP i PHONE #Z X) �-•5 24'3 �G'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQjPERMIT#
(if applicable) (if applicable)
254450
I . WELL USE (Check Applicable Box): Residential Yd—Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION. 117) q/G
Nearest Town: / County/r [ Q CC U
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER
Address
0.? 9- Ter Spnrc. SIQ.
(Street or Route No-)
ED /I / c2 c2
City or Town State Zip Code
3(c9- (0tQ3
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
Area code- Phone numbe{
4. DATE DRILLED (.0 -I) .- o 2-
5. TOTAL DEPTH: c. nD
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .3 n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /0Z0i71.-1,�
10. WATER ZONES (depth): /30 • (1
LOCATION SKETCH
11 DISINFECTION: Type H fH Amount ra%A- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or W,eirS�ht/Ft. Material numbers and common road names.
From 0 Tom a Ft. in " _-5-� p ve-
From To Ft.
From To Ft.
13..GROUT: Depth Material`'
From () To V Ft. eo,,-,t bY
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
Method
,
Slot Size Material
n. -o
in.
Material
16. REMARKS:
� c�.11
I tYT1ER�€'B 1LCEIF'lI TT
rISTRUCTION STANDARD
To
Ft.
W
W
0
6
Subr RQt41Ntbtigthdlg6ithl®division
n761• 6i16 hia6'titn, 14t7 177t
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
firms 0 � -eee G -7i �o
SIGNATURE 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

254449
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t-1)-envll SI /-1'/) IIQ„1 £ CERTIFICAAT�IIOO/N#`d-174C
\VELL CONTRACTOR COMPANY NAMIS Anti (RM!1Q.ytr4 Wet Ton it at .).K eJ PHONE #ilS)—Jo24-3 ble (]
STATE \VELL CONSTRUCTION PERMIT# ASSOCIATED WERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential - ' icipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ye—
Nearest Town: ER A -Ale i 2 County InQ.e« >
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
+
3. OWNER: /9 L. ej-(fs,Kd
Address lig Sep-Te/L,A)R r\ c-
r (Street or Route No.)
f QAtikl„J NC. ak7�
City or Town State 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
Area code- Phone number
4. DATE DRILLED G —/ —D 1-
5. TOTAL DEPTH: e .?OO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): /97) r-97j
1I. DISINFECTION: Type
l2. CASING:
F Depth
From V To /35 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To riiD
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
LOCATION SKETCH
Amount ,-,1 TA S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia afar or Wei ht/Ft. Material numbers and common road names.
r k »' -
16. REMARKS:
d`klEI2rrEBl{tEf ITIIk'V T iATf THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
DATE
Ft.
Ft.
Diameter
in.
in.
Material Method v
(mar as COLA.>
Slot Size Material
in.
in.
Size Material
CJ
0
SuIDR'ihJherorigipiatto-t terciivisio
-HMO-WE Phone Na. (9j9)I74,-3-322
ATURE OF PERSON CONSTRUCTING THE WELL
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

254448
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) ch-e f) h 15 /YTJ Larts.«i �U CERTIFICATION If0117 (to
WELL CONTRACTOR COMPANY NAMML.Y-l)nIS 'Sty/1(4J IIJeii))VFt lI ,Q/j . ✓tPJ PHONE gi'a°6 '_Sa L/-3 a-60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ`PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1:2 Lt✓/f/C County MQ ero-a
/'Iace r5o a- lL'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: In rat -C—lv
Address .5 9 fe.-i L. 14,1.
//.�/� (Street or Route No.) �7 f
/ / on+ iG lr.r.✓ ti/G ci-d 7 3 y
City or Town State Zip Code
k-�a
)- ,369_ c-s'2_
Area code- Phone number'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of welt location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4. DATE DRILLED —/b — 4 2--
5. TOTAL DEPTH: ;5-6'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7. STATIC WATER LEVEL Below Top of Casing: /e9 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): S METHOD OF TEST kZIJ/71-C,f--�
10. WATER ZONES (depth): y'5— (1
Amount ,2 TA-Q S
Wall Thickness
0 j� or Wei hVFt. MaterialLs( p Y
��
11. DISINFECTION: Type H- f"%y
12. CASING:
From
Depth
To Ft.
Dia eter
n
From To Ft.
From To Ft.
13. GROUT: Depth Material,
From () To rii7 Ft. e04-r 01,
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
}b. ii IL',
1 DO HEREBY CERTIFY If
CONSTRUCT6ONSTAND
Method
F)CD,JlJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
0 o
L nN
Diameter Slot Size Material e=
frn
in. in. o--
r;
in. in.
n-f�
o
CO co 7.-
.. fit.
0
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF TH{S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
iIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
AFL FL
Suhum the ut iginal to tl e Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

251913
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;he nI715 I'fr / ad% CERTIFICATION# el/7(W
w ELL CONTRACTOR COMPANY NAME Inc'I� 'fI1c^^gtdi tL)e I ��r l a(�_ .), rt Cr J PHONE # °K.. S 2 Y-3 Zb 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentialC--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: RA-A/hit j Alifrteunty 44/S ri-r,.,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: J0IlD LdLLIG�,..�
Address .'itin1 }A Ed
(Street or Route No.)
!`VQM(L/.i3 N O 07 e2- v
City or Town State- 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
Area code- Phone number /
4. DATE DRILLED G -L��! d -6
5. TOTAL DEPTH: "7�CO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4'fi, 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): IO METHOD OF TEST
10. WATER ZONES (depth): 9 ve/3 (�
LOCATION SKETCH
II. DISINFECTION: Type /14-7 k Amount c2 TA- /3 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth
0 / Dia�etter or WeighdFt. material numbers and common road names.
From To / , Ft. (n .` __�./ p Y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r,fp Ft. eDrr Gp� l!Tm''
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Material
fi RFMAPK&
D ��L_
0 HEREBY CCRTIf- -
CONSTRUCTION STAND
1
u¢rttit th€ul`igii4aY0 Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163fr?tmue No. (vl9) /33-3 21, within 30 days. GW-1 REV. 07/2001
O
W
Cn
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

254909
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) xh-Pn h l 5 /in I iQM A, CERTIFICATION IIof/7 `o
WE LL CONTRACTOR COMPANYNAM6'/X,fln%S /no AQ4,4 'DPI I '1•411 I. )-ncr I PHONE 401_ S24-3 gb
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable)
� �� (if applicable)
WELL USE (Check Applicable Box): Residential iYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: N�
Nearest Town: f'R /VId-, nJ County Al
(f)etIY6cLi r t., QeA
(Street Name, Numbers,umCommunity, Subdivision, Lot No., Zip Code)
3. OWNER: ,J o A n \ D Z; P/2
Address ,-2,3 7 7„fir-n -- /j d
(Street or Route No.)
TCf//24lgffee 2 1 / <-3 a6V
CO), of Tow Stat
e Zip Code
Area code- Phone number/
4. DATE DRILLED ID - 1 -O D--
5. TOTAL DEPTH: 7O '
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
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m-
7. STATIC WATER LEVEL Below Top of Casing: Co Sn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD(gpm): (o METHOD OF TEST_//UVU,
10. WATER ZONES (depth): 66,0'
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To e30
From To
From To
13. GROUT: Depth
From n To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
LOCATION SKETCH
/f PP Amount %n / S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Ft ( 1 Dia peter or WeiahUFt. Matej-it numbers and common road names.
Ft. �a
L ?-13�t
Ft. cc
c<
Z rn
mo
n
N�
rn
O
//11
Material
C-947t 43,
Method
Slot Size Material
in
in.
Depth Size Material
From To Ft.
From To Ft.
r 1'
h
11 DO IICREDY CERTIFY TIIAT'THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THHAT/�
A' COPY OF TH 5 RECORD H S BEEN PROVIDED TO THE WELL OWNER
AT04-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
,AuS,u,b,r)?it the original ,,to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-/6Y9-1b36-Phone No. (9T9)733-3221, within 30 days. GW-I REV. 07/2001
tT
Q

254098
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME
(print);he,n 01 5 fir ii(2,A r{, CERTIFICATION # 2/740
WELL CONTRACTOR COMPANY NAMS1X.I)fl1 010j10dnra Lije01611, 1,4P J PHONE #i'J-% _S24--3 ;2-6 )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /lrL
Nearest Town: rflitifrieL f /✓ County Ali
Q cen4
Co r/31
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
/` ' 3. OWNER: 0- C Lnf S+Y UG4-
Address 13O I- dope S Li ✓cl2�
(Street or/Route No.) 02 g 73 y
ity or Town State Zip Code
f'1'r%ft1C/,)J /i/C—
O )- 3 9- 9 V 8 O'
4. . I —D
Area code- Phone number
DATE DRILLED
5. TOTAL DEPTH: SO
a_
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l�-
7. STATIC WATER LEVEL Below Top of Casing: / 7 G2 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./U7�,
9. YIELD (gprn): METHOD OF TEST
10. WATER ZONES( epth): / 73
11. DISINFECTION: Type Hi- Amount ra S
12. CASING: Wall Thickness
Depth Diameter or Wei ht/Ft.
To Ft. b t/ i
To Ft.
To Ft.
Depth
From 0
From
From
Material
13. GROUT: /�Material nMethod ,
From fl To Ft. 1�Q�1yt brit I
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
RKS'•
r1-D@tjERLDY-CERTIFY1t THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL -_.
CONSTRUCTION STAND s, AND THAT A COPY OF TH{S RECORD H6S BEEN PROVIDED TO THE WELL OWNER..
LOCATION 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.Jl
W
lir
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sN'bti6lrlltythelRrigilta).fo the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9451 733 3221, within 30 days. GW-I REV. 07/2001
L/-

2r3563
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
lle
of Water Quality - Groundwater Section / "
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �Iin hl Sl fly" 11 QM A, CERTIFICATION # of/7
WELL CONTRACTOR COMPANYNAME nnii /IInMa II 2I d1Y`I 11 :l(ij �YLP J PHONE # SC_.5a 14-3 g6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential L l unicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /1/c NLA'i,D5/1C.--County
Punr1 I7_c\.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I-7 A P. LL C
Address Hos Ott y
i 02 E 7
$ � )1 (Street or Route
f . -� l
CiOoor 4.Yt r`Town )J State y Zip Code
roomy-�y�) ,512 r - L f / .5
Area code- Phone number
4. DATE DRILLED 5— oC 0 — r9---
6 eIran )
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/Iongitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
5. TOTAL DEPTH: /0, '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 173--''
7. STATIC WATER LEVEL Below Top of Casing: c2 1/) FT.
(Use' +" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
HOD OF TEST /�02Ui'YLI,(-
10. WATER ZONES (depth):
LOCATION SKETCH
11 DISINFECTION: Type H t» Amount ,-Q Tt4 A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From 0Depth Dia�'etter or Wei ht/Ft. Material numbers and common road names.
To r2J FL (n-- // , P4
From To Ft.
From To Ft.
13. GROUT: Depth Material nMethod
From n To c*f7 Ft. (nP
i CM
Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
16. REMARKS:
Slot Size Material
in.
in.
Material
E((r rrll (� \\\
l Lb Hi6El3Y CRT*FY
r---EON ION. STAN
A
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
dTrrTiF.ggrigRalfalthe Di
Onet611161ilkiii6INQF
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

253562
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section // --
WELLCONTRACTOR(INDIVIDUAL) NAME (print) c.h.e n kit 51 /41)Ji t2n'1 r1 CERTIFICATION��/It /of/7 cf'
WELL CONTRACTOR COMPANY NAMSi not c Jd>:) /IONI4 IDei yri 11-1< j . K P PHONE # 8o- xl _ 5 e2 U-.3 L
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /-i; C-Wti4 tDS,{t(Oounty /yl&.cn7O
t A-1- I E_ F or-L (L A
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 14 P ) L
Adddress Io"C' X II 1 4 (,/
I I h a (Street
csor Route No.)
1 e
.y, l V
tkjor Town State n Z Code
Area code- Phone number (5-'J y ? _0
4. DATE DRILLED
5. TOTAL DEPTH: /00,5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑y
7. STATIC WATER LEVEL Below Top of Casing: / 7 5' FT.
(Use "+" if Above Top of Casing)
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. ESTI/0Uy7t (/-.
I0. WATER ZONES (depth): / 7,cr (�
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance w th 15A NCAC 2C .0118,
YIELD (gprn): METHOD OF T
11. DISINFECTION: Type
12. CASING:
Depth I Diaf eter
From 0 To r2I Ft. /?
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To ;9-D Ft. Cant tY
From To Ft.
LOCATION SKETCH
Amount r- TA- g S Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
or Wei ht/Ft. Mate ial numbers and common road names.
Method
fjC' 20
1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
in.
in.
Size Material
O
tV
L
CJl
C.l1
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED T THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

253561
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)[ 7)I-e f) VIl 5fly) /ia-A rl, CERTIFICATION# cl. (.0
WELL CONTRACTOR COM PANY NAME hfti'UAJ1(1, 4 lileLIt\fi l H-)t q_ .�.YL P l PHONE # egi_5a L/-3 a6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential id- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
f:PA-LPLiA/4/ _County_4/4�n-
Nearest Town:
(Street Name, Numbers,
3. OWNER: c )/.7 i t to S L—G*aa7ut�
Address (/
h(Street or Route No.)
,-A{
13 % .
City or To Jn�So'State 3 3 gy—
Zip Code
( —
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /a_T) FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2l r METHOD OF TEST
10. WATER ZONES (depth): //£ " d D 70 `
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
1 I. DISINFECTION: Type Jf /-F Amount .-2 FAS S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Wei ht/FL
Y MMatepcommonnumbers and common road names.
To Ft. n `
From 0
From To Ft.
From To Ft.
13. GROUT: Depth Material Method l c
From n To �i7 Ft._ n p(J7AO 0
no
From To Ft. cr.
14. SCREEN: Depth Diameter Slot Size Material -- c,
From To Ft. in. in. I --I
in. rn
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
-73
Size Material 3 rr—i..'',
en:.
01 --ii
O
16. REMARKS:
Rg? IbEiYIN
0
ASH
FA AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A Z,DS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-5--/ 7- o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
IfF.ygJgAo the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
13h9(Le N €ic 9) 733-3221, within 30 days. GW-1 REV. 07/2001

AS GfLLE RCTGI NAL OFFICE) 733,3221, within 30 days.
WELL CONSTRUCTION RECORD 25356D
North Carolina - Department of Environment and Natural Resources - Division 11 of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7).e n v115 My) I F � G CERTIFICATION # .1/7 Y'
WELL CONTRACTOR COMPANY NAM&' I)rlt (- Iln..nr4 lileil4IY`rll:u .)-tte PHONE #VVe3o24-3 a-6d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential CI---Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONT:
Nearest Town: P1).• kL/Y County l72_444J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0..)• le.. S
Address .Sal t2) CP//S �/Uhw 2c-I
(Str et or Rout
l/ r1 1 7 3
Cry or Twp oState Zip Code
5"(a� - t<FS9
Area code- Phone number
4. DATE DRILLED 5-O
5. TOTAL DEPTH: "/ T)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO riLl----"`
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
7. STATIC WATER LEVEL Below Top of Casing: c3 CI FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. `/u��
9. YIELD (gpm): / METHOD OF TEST h /7L1
10. WATER ZONES (depth): 4L&O '
LOCATION SKETCH
I 1. DISINFECTION: Type }f-f"h' Amount ,-.2 TA- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
De th /� Diaetertor Wei hUFt. Mate al numbers and common road names.
From 0 To �O T Ft. (n ._ / % kg Pry
From To Ft.
From To Ft.
13. GROUT: Depth Material Method l
From () To ;7f7 Ft. ap.t2t Mr� �iL71.VV
From • To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
9S :h Wd S- Nnr zO
16. REMARKS:
PHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THjS RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to t re Division of Water Qualify, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / _
WELL CONTRACTOR (INDIVIDUAL) NAME (print) g7)•e n h l S /41) Il am U CERTIFICATION # of /7 (to
WELL CONTRACTORCOMIPANY NAM&.I)IjcS ��mllo�a II)P.Ii�I �[�ITI(�({..7nC'/ PHONE #ii,2c6i_.5-e2 �`-3 a66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ•PERMIT#
(if applicable)
(if applicable)
2535?9
I. WELL USE (Check Applicable Box): Residential trMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest own: l'2,4-MGL/4/,l/'ThuntyAfiQ ferit _)
4 -etcP_ 6' a, E
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FQ.rh (? A ill od, tie
Address o�-3
(St eel or Route No.)
1 n eergsr
City or Town State Zip Code
3 )- !Pb7 - b.33ti
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(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
Area code. Phone number
4. DATE DRILLED S .23 - 0 .0
5. TOTAL DEPTH: tSD S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: /.Q.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 I5A NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST h `/n�f,I--,
10. WATER ZONES (depth): (/
LOCATION SKETCH
11. DISINFECTION: Type 1f1-1-6 Amount 4 %A A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Wei hUFt. 0--
Material numbers and common road names.
Depth Diapeter
From 6 To_ _,_Ft. (O"
From To Ft.
From To
13. GROUT: Depth
From () To
Ft.
Material
0047,41
4,
Ft.
From To Ft.
Method
CD)/(..>
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
Depth
To Ft
To Ft.
Size Material
. ffEMrj1R S: L, \�'J �1L. I \I/I/ IBC
I D0 HEREBY CERTIFY T
CONSTRUCTION STAND
GROUNDWATER SECTION
ASHEAttitLhRbBlittifil ObPoli€ Divi ion of Water Qualify, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
LS:h Wd S-Nnrzo
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• ND THAT A COPY OF THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER
`IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater SectionWELL CONTRACTOR (INDIVIDUAL) NAME (print) x%).CD Vl i 5 fin 11 Qr/\ [li CERTIFICATION R et/ / y'
WELL CONTRACTOR COMPANY NAMM hf1S (�AjJOrr4 WW)PIa)Yet ll, .) nP J PHONE #ifg edi,___S 24-3 ,lb 6
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ4ERMIT8
(if a..licable) (if a..licable)
254097
1. WELL USE (Check Applicable Box): Residential r Municipal/Public Id" Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: r'R f') A/V LI ,t1 A//r f ounty .jY) n cn
W . n A� Gap P. A
(Street Name, N bers, Co munity, Subdivision, Lot No., Zip Code)
3. OWNER: W.nrk'I G k�c�ntt sr C •
Address W ; n14,/ (ro.) /2 a_ I fr /✓
(Street o oute
froM'i1-) NC—) 373�
Zip Code
City or Town 7 State
(—)"
Area code- Phone number /
4. DATE DRILLED c] - 30 -6 a-
5. TOTAL DEPTH: "91 n A `
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: o2 _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): ,.-2 n METHOD OF TEST 0.2bi7i
LOCATION SKETCH
11. DISINFECTION: Type "HP Amount ,-2 TD A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ,,... Diameter or Wei ht/Ft. Material numbers and common road names.
From 0 To 9.5 Ft. (�" P1 -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To €9D Ft. CQ-Yyt Ott COW
�
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
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
10. WATER ZONES (depth): `ha ) / 60 (l
16. REMARKS:
Slot Size Material
in.
in.
Size Material
N
W
14LDD HEREBYCERTIFY'TIf1
1 CONSTRUCTION STAND
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIfS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
orb �aaeP
IGNATURE OF PERSON CONSTRUCTING THE WELL
5-30-0 2
DATE
SBBttiiLthe'o�iginal to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
t t p sonoNO,19I4) 733- 221, within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
254096
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
- 11
WELL CONTRACTOR(INDIVIDUAL)NAME (print) c��hh15 1I!Qn'\di CERTIFICATION r-%%
I n P J PHONE the r6i_Sel 4-3 a6 a
WELL CONTRACTOR COMPANY NAMES C1ni� fro Unpnri Weil ix l��*Q )"
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
ISA NCAC 2C .0118.
9. YIELD (gpm): --3 METHOD OF TEST IO?h''i7f
3- ^-�
10. WATER ZONES (depth): a r //
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: C�
Nearest Town: rn,4.11.1CL(A� A/C --
A 4(0,
�nf/s /32• 2Ck
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3.11 14-/I Vt'1 nn et 1
Address .37 elle At 1 a_ f2-14_"
(Street or Route No.)
i'Qm l/ l vz. /1lr
State
City or Tow
�1- L
�'— Ot LI
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)
DRILLING LOG
Formation Description
DEPTH
From To
Area code- Phone number
4. DATE DRILLED S — 3 / -o a-
5. TOTAL DEPTH: /fb.5`
6. DOES WELL REPLACE EXISTING WELL? YES ElNO
7. STATIC WATER LEVEL Below Top of Casing: 'Cc0 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
LOCATION SKETCH
11. DISINFECTION: Type }it -f%4 Amount , TA- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth / Diam�'eter or Wei ht/Ft. Material numbers and common road names.
From 0 To -7( Ft. (� 1l k p
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From r—*D (r
To Ft. 77' 47, riQll
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
in.
From
14. SCREEN:
From
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. •
16. REMARKS:
DO )I HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SGAI DARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
$'ubmiCthe(Lr%'i!nal tot ie Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter` Raleigh,
NC
'� ��ggL1A1fi(PN'oki.�{bo 919) 733-3221, within 30 days.
i !
I—
CD
c> .;
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r-n
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�tt pp�o
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 8.1) -ei7 n i 5'r Ay / I el r4 d CERTIFICATION # r+a /7 (
WELT. CONTRACTOR COMPANY NAMES)-f° L4 lit Ilan, Ltl ell %-. //(2t VkL C PHONE k ) - 62 i/ - 3 a-�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
251990
1. WELL USE (Check Applicable Box): Residential U.--iolunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FYL2M 41 in, .) /j/tn inty /ViL2 /znt J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 3-6.91t e S it) i (1 yak ecn, (degrees/minutes/seconds)
Address -5 (^ 7 C h i n k G r r L- rt✓) Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
0.-i't 1Uh. &CI-0- • 3 o 5'7 —3 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
'J(a4-)- SleV- 4/3ka--
Area code- Phone number
4. DATE DRILLED .S - 4) -n Z
5. TOTAL DEPTH: /fO 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .-
7. STATIC WATER LEVEL Below Top of Casing: /L»J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): , 5 METHOD OF TEST 4/Li27,7c-e�--
10. WATER ZONES (depth):.3_ 6 x 1/
LOCATION SKETCH
11. DISINFECTION: Type li yr- / - Amount n2 1-4,es Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From Ln To 79 FL c/�k PrL_--
From To Ft.
From To Ft.
13. GROUT: Depth Material Methodc.
From 0 To „9--C Ft. "al/Lev PdltA---" N
From To Ft. MC
a
14. SCREEN: Depth Diameter Slot Size Material -<
From To Ft. in. in. 1
From To Ft. in. in. Cfs
15. SAND/GRAVEL PACK:
Depth Size Material S.
From To Ft.
From To Ft. r
CO
16. REMARKS:
‘n lWn nuntnm nnn
I v rthitE�f Y .41( f
ECQNstEgutri tQS'.
71)
1
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original td the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ekti '99-103t){e�}i pni hgry19) 7:3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;he n Vli S 1 Ilan rL CERTIFICATION eat /7 (P
YELL CONTRACTOR COMPANY NAMIi hn[i'IhD�I�M� II�Pi I�V[I�:k 4, �..nP PHONE #io-�...J oZ �-3 cz-/O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED We 'ERMIT#
(if applicable) (if applicable)
251993
WELL USE (Check Applicable Box): Residential rl----icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: my & &9rsf ,
y) & /in�ai.0-ry%, ,., r
(Street Nanfd Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ( pct is el- 2.e
Address J / am /V. /# -.0 P I a ZA-
(Street or Route No.)
i�.a &ce /ve, a g-73 y
City or Lawn State Zip Code
(O,eir-iS/-g— 0853
Area code- Phone number al
DATE DRILLED c.S o7—TJ,-,2
TOTAL DEPTH: an.S
DOES WELL REPLACE EXISTING WELL? YES 0 NO G3J--
4
5
6
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
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /.S METHOD OF TEST lwlir to
10. WATER ZONES (depth): SJ / 8 J r�4 /S
-/t y] LOCATION SKETCH
11. DISINFECTION: Type. gill' y
Amount r- / AL.Q S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
0 Depth
Diameter or Wei ht/Ft. Material numbers and common road names.
From To �'± t` Ft. [#J 1 k Q ��
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To r (7 Ft. 004l,,d/r, �J(DAY°
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.
Z1:£ Wd 9- AN ZO
c_
n
0 rri
0
o<
r m
>rri
r*t�
N=
mrl
c-a
ti
0
16. REMARKS:
1130 HEREBY .CERTlFV kr THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
= CONSTRUCTION STAND S, AND THAT A COPY OF THJS RECORD HP�S BEEN PROVIDED TO THE WELL OWNER
. lr / I t/bil�
S—� —t L.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original ti) the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GR( 69 W i &Phnudi6Va [phone], within 30 days. GW-I REV. 07/2001
ASH,EVILLE REG L CFFiC-

252831
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) s./T)-e h Ili s11 /-10!i Qifr�
s\ rL CERTIFICATION# /7 le
WELL CONTRACTORCOMPANY NAME hilt kilHiinveri Wei I.(TI yrr, II:k�(- J. e J PHONE #?)--5i aL`-3 g60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential Cl----Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: M
Nearest Town: tf7jYt) /Z"� County nth oxc
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
r� s /lro atm
Address
(Street or Route No.)
//c) c-V 117 /
tty or Town State Zip Code
g)- 3 &,9—
Area code- Phone number
4. DATE DRILLED eS—J(—,-0 2-
5. TOTAL DEPTH: e S
6. DOES WELL REPLACE EXISTING WELL? YES /❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Yf3 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 OF TEST lo7//z u
10. WATER ZONES (depth): QQ, ( (�
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type /411-1
12. CASING:
From V
From To
From To
13. GROUT: Depth
From n To e9iD Ft.
Depth Diafeter or Wet hVFt.
To -Ft. (n -
Ft.
Ft.
Material
0Onryt
From To Ft.
14. SCREEN: Depth Diameter
From To _ Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
D
LOCATION SKETCH
Amount ,L. t4 S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Material numbers and common road names.
Method
Slot Size Material
in.
in.
Material
c
0
0dcsc
c
of
zr;
YG
nrr
rr
rn o
c)
G
z
EilitayCEnIq MAT TH
(`OJRUCTION STANDARDS" -Al
L sid
..L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THES RECORD HAAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTRUCTING THE WELL DATE
SubmiQthe orioinal to the Divisi n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699 16gRhone Not (914) 7330221, wit
AS _ : r t. JFF: H
in 30 days. GW-1 REV. 07/2001

252609
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cbhQf YII S I/-}n_I ame\ A_, CERTIFICATION # Qi�% ,
WELL CONTRACTOR COMPANY NAMK/X,11ni S'thU IIa,r4 LL)ei Itltfr ll Tlt�t ]7 PJ PHONE #}if_SQ. t-i-3 oZ6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMIT8
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Q--Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: �Q/r,'v{'LL /14/?cCounty
fi// Ql9 r, e +,,,,lYk--
(Street Name. Numbers. Commt4ity, Subdivision, Lot No., Zip Code)
3. OWNER: (Tre in e. C21--144..
Address 7S Od Q. /,- n r4
(Street or Route No.)
i - ye} 'f M) , % 024-73y
City or Tow State Zip Code
._1� _ /_3
Area code- Phone number
4. DATE DRILLED 5 -
5. TOTAL DEPTH: 4// 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 m-
7. STATIC WATER LEVEL Below Top of Casing: /0 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance wit 15A NCAC 2C .0118. `
9. YIELD (gpm): METHOD OF TEST h/u, 2/, /7f
10. WATER ZONES (depth): / / „i 3 70
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To
From To Ft.
From To Ft.
13. GROUT: Depth
From (5 To r-"D
LOCATION SKETCH
Amount %A /� S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Wei ht/Ft. Material numbers and common road names.
7 / (S� p
Material
Ft. e0.71 dy
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 Material
in
in.
From To Ft.
16.REMARKS:
nEREBY CERTIFY THAT�THI
RUCTION STANDARDS-,
I
S bruit kkhe-origin-al ta-tretttvt on of y ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21699-1636`Phonc No. (919) 733-322T, with
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
0‘4-avh S L
E OF PERSON CONSTRUCTING THE WELL DATE
n 30 days. GW-I REV 07/2001

252608
WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION PERMIT,/
(if applicable)
North Carolina - Department of Environment and Natural Resources -.Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) sQ)7 ht �'n y
WELL CONTRACTOR COMPANY NAM
CERTIFICCAAT�,I7S1 f/74
/ONq o
PHONE #/o-�3o`Z L!-3 a6
I. WELL USE (Check Applicable Box): Residential ra--Municipal/Public ❑ Industrial 0 A
Monitoring 0 Recovery 0 Heat PAgricultural 0
ASSOCIATED W a'• ERMIT#
(if applicable)
ump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nearest
own:Arnty mom,
(Street Name, Numbers, C
3. OWNER:
Address
munity, Subdivision, Lot No., Zip Code)
(et or RouteNo.)
r�e2 E,�Stre73 ��
Cny or To State Zip Code
Area code- Phone number
4. DATE DRILLED 0 -Q „2
5. TOTAL DEPTH: __ 3?J��
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
7. STATIC WATER LEVEL Below Top of Casing:. _O _FT.
8. TOP OF CASING IS Use "+" if Above Top of Casing)
--1/ 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): /S METHOD OFTEST _A102P,
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:OGPSOTopographic map
(check box)
DRILLING LOG
To Formation Description
DEPTH
From
I I. DISINFECTION: Type
12. CASING:
LOCATION SKETCH
Amount ,_,2 %/,} A S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diajeter or Weieht/Ft. Material numbers and common road names.
From To %� Ft. /n " ---�. �, (�`�^/ Y
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To �D Ft.Method
From ��' P"�LTjtiJ
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.
,ttte ort ivak;
3'�049-L1,fr3(•P(�cmc0! 31
Divis
)E733-3
ITIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
,iAND THAT A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
i
L '' S 3 d
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
21, within 30 days. GW-I REV. 07/2001
CJ1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) 35-enVIi5 I-I-O !itM£ CERTIFICATION# of/7eta
WELL CONTRACTOR CONIPANY NAMIC pnt e (d� �InMJ 11)ea �r I ( , ), n C J PHONE # e6i_.52 !-3 a-6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Yd--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nearest Town: /%Q//1.%i/KJjf/f,:ounty MtQeml )
(Street Name, Nmnb-ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /ITU"Y4 r //
Address Li 7 3 /Lie2.7922 a /2—rg
/ n _ Street or Route Q12317
4
5
6
7
Ci or Town State Zip Code
�s �y-00o
Area code- Phone number
DATE DRILLED S-
TOTAL DEPTH: I L5 z
252784
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
DOES WELL REPLACE EXISTING WELL? YES ❑ NO —
STATIC WATER LEVEL Below Top of Casing: � r)_FT.
(Use"+'• if Above Top o Casing) t,.
8. TOP OF CASING IS / FT. Above Land Surface"
`Top of casing terminated at/or below land surface requires a _
variance In accorda9.ree with 15A NCAC 2C 011S
9. YIELD (gpm): /`5 METHOD OF TEST_ /).8.PPi7LC�
10. WATER ZONES (depth): I/( J //5 (�
1 I. DISINFECTION: Type
12. CASING:
0 Depth Diamf�eter
From To _3 7 Ft. 6 "
From To Ft.
From To Ft.
a
c
rrt
cP,
-m
03-
LOCATION SKETCH _ c�7,3
Amount ,=2 TA S Show direction and distance in miles from aCieast c
Wall Thickness two State Roads or County Roads. Include the roadr
or Weight/Ft. Material numbers and common road names.
13. GROUT: Depth Material
From n To Ft. e04r, pp,�
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From - To Ft.
16. REMARKS:
Method
nLlH/0
P
Slot Size Material
in.
in.
Size Material
I
0 HEREBY'CERTIFY TPFAT,'IIH
rSTRU TANDARD6$,
Sub . 0, trigitya# t t e0Division
276 6$'6„PhoiibIN67 4't•n�,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF TH S RECORD H • S BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUCTING THE WELL
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ithin 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) cT�- n✓lis /3-nll(„-\ Ai CERTIFICATION it 01,/74o
WELL CONTRACTOR COMPANY NAME pni i (br lo,I,tr4 I/Jel l QY' i l -u d -�. rt e J PHONE #j ffi_Se2 4-3 a-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WOPPERMITF
(if applicable) (if applicable)
252783
I. WELL USE (Check Applicable Box): Residential ti--- icipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use _
2. WELL LOCATION: Nearest Town: Q/{7) Al G County 4072 /ern,
rR 5 eerie e 12,-4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. AddressWNER: � CJ eel // Tp R ,
Y 7 d a /l rtu/t r /c Ln�
(Street or Route No.)
sb 0 -e P pe. I, 1 °t s o
City or Town State Zip Code
- h7(4 3(01
rA ea code- Phone number
4. DATE DRILLED r�i _-1,3 —A 7 2
5. TOTAL DEPTH: 5n. S `
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: / SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. / I�)�
9. YIELD (gpm): q. METHOD OF TEST h!
10. WATER ZONES (depth): STY,'
LOCATION SKETCH
11. DISINFECTION: Type jimi-if Amount 4'r4. S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and cormnon road names.
From 0
From To Ft.
To /67 Ftn"
From To Ft.
13. GROUT: Depth
From n To ,—*D Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Method
Slot Size Material
in.
in.
—117
0
16. REMARKS:
1 DO HERERY CERTIFY THAT THIS�'''� �\YELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STRUCTION STANDARDS, 1`1 THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
auk 0
I �1E
b
TURE OF PERSON CONSTRUCTING THE WELL DATE
Su it the original to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2769 -1636 Phone No 1,91 - 221, within 30 days. GW-1 REV. 07/2001

LOCATION SKETCH
11. DISINFECTION: Type Hf/ Amount c2. S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Wei ht/Ft. Material numbers and common road names.
To �75 Ft. el" PK al
To Ft.
To Ft.
13. Depth¢i;� Material Method l
To r7V Ft. CQyyi py .()CJA
From To Ft. YY
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
252782
O
IV
-c
—c
N
Material 01
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-D1111ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) x��f)Vl) s1 IMY) Qnn'rU CERTIFICATION # d./7 ee
WELL CONTRACTOR COMPANY NAME S 't� II2,�d I�Jei I 1 Y' l l c.4 .I. n P J PHONE #V e6i_.S a 4-3 2.6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential id- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town: %29-4,.6 L it/ County AO (ern )
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: m OY-e-.
Address a C(a Cia, (2,c1_
1 /vim (Street or Rou No.)
l � ag779
City or Town State Zip Code
8(t)- 5'4_ /4'Y
Area code- Phone number
4. DATE DRILLED 0 r
5. TOTAL DEPTH: d S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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)
DRILLING LOG
Formation Description
DEPTH
From To
7. STATIC WATER LEVEL Below Top of Casing: 9 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
tift
variance In accordance th ISA NCAC 2C.0118. h/oU 9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES ( pth): ri 7h'
From 0
From
From
GROUT:
From 1
c
0
c'0 _
rri
o
Y>c
m�
am
cnz
mz
0
16. REMARKS:
EREM' CE,RtIFYTHAT ITF
TMSW
Rife leNSTANDARDS,
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THRECORD HAS BEEN PROVIDED TO THE WELL OWNER
la
L
StIbLittAll4 sion
2769*636 Phone No. (9,10) /33.3221,
61
TURE OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
rithin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
252781
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section /-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [7)i n V) I S 14f)11(2,4 d. CERTIFICATION # d-%% ef'
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
nnts��
�L.t"eiId)sfrl�:lc.�4Pt(� PHONE #ia1{)�So24-3 c2G''
ASSOCIATED WQ4ERMIT#
(if applicable)
I . WELL. USE (Check Applicable Box): Residential Pd‹Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
/7'e
Nearest Town:
County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ' L'eal ry6 _C I � 1 rJ\� �.S
Address /r27 I.? r'r<AA er
(Street or Route Nti
City oliTown State Zip Code
rea y5
)- 796- R code- Phone number
4. DATE DRILLED c- /3 —0 a J
5. TOTAL DEPTH: . .?3n
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W�
7. STATIC WATER LEVEL Below Top of Casing: re/ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
LOCATION SKETCH
l 1. DISINFECTION: Type Ili'» Amount 4 rh- $ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
0 Depth �t Diameter or Wet ht/Ft. Material
From To /� Ft. (!t t / P ��
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r*D Ft. Syr 1) ()C)A20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
o36 RENT .RKS:
I DO HEREBY CERTIFY'1)-1
I if CONSTRUCTION STANDLi
numbers and common road names.
as O
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
am at/ 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
7
Gi t iEtr.
EtIiFiN A241h DFwsion of Water Quality, Groundwater Section, 1636 Mai( Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322I, 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)c7en iS itnjiO_rA rU CERTIFICATION#ror- /740
W.hjl ELL CONTRACTOR COMPANY NAMSIX'rS 14101Qgcir4 Wei Ih 1V`rll :lt�t 1rt. e PHONE #il�_Jo24-3 a6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential lXMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:Of� Cij rtV7 4/C ,,rr��t
Nearest Town: Yak�4County McLee n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: John lee ISo-,r_z
4
5
6
7
Address Let ('h 0ref_.5 ire'y 1\Yz„
(Street or Route No.)
b tiv dire, 02 l 763
City or Town State Zip Code
C2/' — .33 a-r
�rea elide- Phone number
DATE DRILLED S - '—!r 2
TOTAL DEPTH: IvQ'5'
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
DOES WELL REPLACE EXISTING WELL? YES ❑ NO VI,'"
252780
LOCATION SKETCH
11. DISINFECTION: Type HIP Amount c,2 S Show direction and distance in miles from aeeast
12. CASING: Wall Thickness two State Roads or County Roads. Inenyde t road
or Weight/Ft. Mart numbers and common road names.
rl� s
STATIC WATER LEVEL Below Top of Casing: if 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): / O METHOD OF TEST
10. WATER ZONES (depth): Q,&
Depth
From fl To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r*i7 Ft.
Dia eter
From To Ft.
Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
O
Method
p(DA iI/
Slot Size Material
in.
in.
Material
16. REMARKS:
LI.. DO FiERE,BY 4ERTIF
LI
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THjS RECORD HS BEEN PROVIDED TO THE WELL OWNER
Orr l} Q nnp�GzciC(1 5-9'_a
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
..,`' Spb}ptt-Eheer+ganalio the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
54E”141** k636i,PliU M. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 252779
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3-en YIIS I'�'O IIa,\ £ CERTIFICATION# ,1/7(P
WELL CONTRACTOR COMPANY NAMKh111101 4,14 Wei I 1) yet l l:k�J. )-1lf _1 PHONE #06i,Sal-/-3 ;,2-
STATE
WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tYMunicipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: r--PA-A,kLi 47/V0 c County /, of Gh1
(rat!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: M; KC- Z)CL
Address 70,2 S
(Street or Route NoW l�
tLJelQ.itd /_/ 3,. %o2y
City or Town State Zip Code
(3* 7;-3 -- «ng_
Area code- Phone number
4. DATE DRILLED Ste- I5
5. TOTAL DEPTH: a 0,5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST /OP/7f
10. WATER ZONES (depth): !q/2
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
1 I. DISINFECTION: Type H-tP Amount 4. %'} g S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeighVFall t. Material numbers and common road names.
From 0 70 Ft n h IlkP Y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method `
From n To r}t7 Ft. �.vyr D-r < f7CDA '1/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
A0rn
�m
N 0<
n
>c
-v -1
3 rn
am
Na:
• rn a
1 -)HERESY CERTIFY THAT'T
UC.TION.STANCIARDS,
J
4
Q� --y
?LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 2
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
69 TUBE OF PERSON CONSTRUCTING THE WELL
s-/5-0
DATE
Subnhit-thenriginaLto he Divi ion o- Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699 1634 Phor)eNo. [phone], within 30 days. GW-1 REV. 07/2001

596(
250940
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2P f)17) 5 14-7-0 1n,,,,'a CERTIFICATION # .d K 1 7 '
^
WELL CONTRACTORCOMPANY NANI F� 4�rIrJ i�D I/Q�nd 0 (ei 1 �%Y�t jl°7r aj ONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERS #
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential umcipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Flail kith t/ C--County t
Pr (v Gut �[
(Street Name. Numbers. Community, tSuubdivision, Lot No., Zip Code) Y
3. OWNER: (t cipY/�) ( prs
Address . / q ?Nit r. F7 (n, • )`p
-CG\
(Street or Route No..
Sf 9 na F M-hL 1-4,-- 3 7 3 77
C(i y or Town State Zip Code
p. go35 87
Area code- Phone number
4. DATE DRILLED i ` 1-/ -- n - --.
5. TOTAL DEPTH: it3 r 0 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5
7. STATIC WATER LEVEL Below Top of Casing: .� 0FT. .-�' "
(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): /5 METHOD OF TEST )l/',>/-Er)9 c
10. WATER ZONES (depth): Ipin' (�
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type
12. CASING:
Depth22 - D)'am e ter
From Cr) To -) C Ft. l(Y e
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To SO Ft.
LOCATION SKETCH
Amount 1 9 how direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
S'o /4' Z l•6 tl
f P tie
Material
C7 p yY) 21,j�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Method
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
r--3, , 16i�,REMr\RKS.;
J 1
.tt I DOHEI{LISY LEK( IF Ftr,
I. CONSTRUCTION STAt9A21E
i
-t
N
f.)
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \YELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
"C�ION S'ulfLntt thko.rletpµ te:the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 PT No. (919) /.,3-3221, within 30 days. GW-I REV- 07/2001

250939
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c)!i)hi 5 nil 1)fl AA, CERTIFICATION a /74o
WELL CONTRACTOR COMPANY NAMIS .hY)i C (C'6)`lasari Ii)PI I rFJY`r I I'7t 77.11. P J PHONE # esi_Sa2 4-3 3-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential L-YMunicipal/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: / r /: /J / grit IW 4ta t unty 41 a _cfm_%
l ems+ Ir\ in , n a
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /Nu / IOA--t2— 0i1--1—i ✓L>
Address 155 CTO nP n
(Street or Route No.) 7
�t(y
or Town State Zip Code
97r)-
�G1/— 07g�
Area code- Phone number
4. DATE DRILLED Lf — S— d
5. TOTAL DEPTH: car 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ql/
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. //
9. YIELD(gpm): / 5 METHOD OF TEST hloi/i7Lit,
10. WATERZONES(depth): ¶$ J (�OJ %� 5n
Amount .-. %4 A 5
Wall Thickness
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
l 1. DISINFECTION: Type
12. CASING:
From n
From
From
13. GROUT:
From n
Depth Diameter
To 4A Ft. /�? „
To Ft.
To Ft.
Depth Material
To e)V Ft. eQnp Oy
From To Ft.
or Wei ht/Ft. Material
/ p)
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
reyi
Slot Size Material
in.
in.
16. REMARKS•
p ��-�tlrr�t t4�lAlh
E6°°1� I(63a
AS>;EVILL_'
LOCATION 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
-c
c
na
an
=m
Or
-4o
^o
-*sr,
cn
ma
0
Z
uJ
gnat to
THAT THIS WELL WAS CONSTRUL I bD IN ACCORDANCE WITH I5A NCAC 2C, WELL
DARDS, AND THAT A COPY OF TH S RECORD H,S BEEN PROVIDED TO THE WELL OWNER
"S _ O
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

2. WELL LOCATIO
Nearest Town: 12143 kir ✓ /Vt-County fi) O-tent_)
�ler)�+
(Street Name, Numbers City, Subdivision, Lot No., Zip Code)
3. OWNER: f A, !I 0-etIOlt r L
Address /2f() Y'7: Are A/?
(Street or Route No.) y r
YDm(d I, Op /1/�
City or Town State Zip Code
SeOa) mac/_ 3j2Y
Area code- Phone number / i,
4. DATE DRILLED Li--0 9--
5. TOTAL DEPTH: ,5,3-21
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E7--
7. STATIC WATER LEVEL Below Top of Casing: /1)e) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): / METHOD OF TEST /J /C4 ,,,,,, -
10. WATER ZONES (depth): /CS (/
1 I. DISINFECTION: Type /71 tit Amount r,4-/35
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.I�Material
From n To Ft. (n `' -�-A- �-�- P F
From To Ft.
From To Ft. G
Material Method N
13. GROUT: Depth =
From C To 26 Ft. lf.-Prig rmT r 01w =
From To Ft. I
14. SCREEN: Depth Diameter Slot Size Material cn
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural,Resources - Division of Water Quality - Groundwater Section
en
WELL CONTRACTOR (INDIVIDUAL)NAME (print) I / 7
C]/-e;Iv), % S .)-C �fa.n d CERTIFICATION #
— 3 3- e 6WELL CONTRACTOR COMPANY NAME t ilhi 5 I //d->v1 trim O1z
r*//�/'/t-7-Lra1DNE #�,�-�� SaLj
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
251992
WELL USE (Check Applicable Box): Residential nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(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
16. REMARKS:
W
N
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
P
0 "
�
cm
o<
-4o
me
m
rn
rnZ
0
60 HEREBY Y CERTIFY tHP
QAjST1 R I ici-low STAN ET
yullr�ymn rt.thIf ariginal In.the�ivisi
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
VD THAT A /COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�igJ.�1��G�iSL �f 3 b - e
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh, NC
I, within 30 days.

251991
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
nr
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PE'aMIT#
(if applicable)
(if applicable)
1. WELL. USE (Check Applicable Box): Residential unlcipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIOO,1: . /
Neare i Town: irk/ e.) County
hme�QGII�;
f/+-�'wvi.-fi
r-
� /r c-A
(Street Name, Numbers,(dommunity, Subdivision, Lot No., Zip Code)
3. OWNER: -rQ Q c C S'- )
Address 14-L_ &/lkaCIniye 7 0 i ✓P-)
1 ( tree[ or Route No.) 62 g 1 Lj
Ylim U -I i1/l_/ •/
City or Town State Zip Code
y-_ 73 R�_
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
Area code- Phone number O
4. DATE DRILLED - -
5. TOTAL DEPTH: 4100
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO mT
7. STATIC WATER LEVEL Below Top of Casing: /he) 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): / 5 METHOD OF TEST h,OV,2"+—
10. WATER ZONES (depth): /fZ 3 £0 v
11. DISINFECTION: Type H.4- H Amount I 13c
12. CASING: Wall Thickness
Depth p Diameter or Weight/Ft. Material
From 0 To 1 / Ft. b " , 1 fl/ P ( Q
From To Ft.
From To Ft.
l3. GROUT: TT Depth^, Material
From V Tor Ft. 0-ed7L `P kir
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Method
p D(1r2
From
From
16. REMARKS
DI DO HEREBY CERTIFY'TH-1
CONSTRUCTION Smarm
JAL,
LOCATION 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 :C kid 9— AVW ZO
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
?ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
S?ll;khcRTkgP!u4tRLth:FDivis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4500Jt6 611114rie'NU. (9)9'433-3221, within 30 days. GW-1 REV. 07/2001
atural Resources - Division of Water Quality - Groundwater Section �
CERTIFICATION # c ) 7 Yo
HONE #%►o(. Y 5 2 tf " 3
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WELL CONSTRUCTION RECORD
251217
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �y
WELL CONTRACTOR (INDIVIDUAL) NAh\E '(print) PIh)I ,SII frIiQi,li"(�.� n CERTIFICATIONN# /'/
WELL CONTRACTOR COMPANY NAME PiiCi IIO/nj CUED Vt"i//ivv t,�+—/1 l_ ,. PHONE # g`A Y "3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ('PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tcipal/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: Of/z,/N�) 4/( County / I r3 Lent
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
(
Area code- Phone number
4. DATE DRILLED —6
5. TOTAL DEPTH: 4100'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m-
7. STATIC WATER LEVEL Below Top of Casing: 4'10 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
METHOD OF TEST d/ >11'1.
variance in accordance with I5A NCAC 2C .0118. / /
9. YIELD (gpm): /(J
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
3. OWNER: �A i? a I
Address ' .7 () /VD r (Gr s flAp
(Street or o/te � No.) �t ��
City or Town State Zip Code
3 9- 0fi
11. DISINFECTION: Type
12. CASING:
Depth
From To Ff
From To Ft
From To Ft.
13. GROUT:
From (j
Alfa, 3 9i) , 3 &' n
I4 4 Amount r-i- A-R S
Wall Thickness
Diameter or Weight/Ft. Material
69 .t
Depth Material
To 2-0 Ft. e i7r/nv%
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
Method
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L I :Z Nd ZZ ddv ZO
c
0
0
zrnm
O<n
crrl
O`<
ma
m
mill RI
—1
ti
0
16. REMARKS:
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GO�a '/ -�lh4 C
(a -6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
G
pr C'F1btp the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHY. @DE110NAbItilbF(fiE9)73-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 251216
North Carolina - Department of Environment and Natural ResourcesIDDiivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) xi-) V1Vr.VJ 419 )10/✓)A, CERTIFICATION
#etP
WELL CONTRACTOR COMPANY NAM&1)Pn VI) S f -oi) arA Until C/Y'r )1 h<Th r PHONE # ( t� SL C%`- 3 D-6:0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM2 IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ILI nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION%'"
Nearest Town: hQry)QJ✓k)N',Pounty m&2tr'l:J
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Saybi�iv,L)� fo,
Address 1/ n/ •�f :ti) t el l J i- f 1 r
11 (Street or Route No.)
I t t 3 e) 5`n
Q� is ,rv._, J�
Q Sri City or Tov�y State � Zip Code
y 3
) CI / /h
Area code- Phone number
4. DATE DRILLED .11-1 5" —6
5. TOTAL DEPTH: (pay—
JUL - 9 2002
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude.4ongit'de source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:3 R 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (I'.O METHOD OFTEF J/i1I/i "
10. WATER ZONES (depth): ,� �5
11. DISINFECTION: Type
12. CASING:
0
Depth Diameter
From To rQ 5_ Ft. �0
From To Ft.
From To Ft.
Amount t f- 5
Wall Thickness
or Weight/Ft. Material
f'
13. GROUT: Depth �l Material
From CI To o)-d Ft. A Porn pyl%
From To Ft.
Method
14. SCREEN: Depth Diameter Slot Size Nlateriai
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.
s IEk
v o
ER BYE�S I r THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
2
CONSTRUCTION tP NDARDS, AND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o1& 4j 2&?', r6L 174 / 5' —4' 2-/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNDO/d1ERt$f5614uisinal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHEVILLE2M&s:0f61b 066I119'`'o. [phone], within 30 clays. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 51543
North Carolina - Department of Environment and Naturalal'Re�s�our�ces - JDivision of Water Quality - Groundwater Section�t /-
WELLCONTRACTOR(INDIVIDUAL)NAME (print) C I e4WWO pp,,4'l✓f[O., CERTIFICATION# d//7 S�
WELL CONTRACTOR COMPANY NAM F1 /7n/ S /g-ni/avid WptJ c» Nisi,/ tK f PHONE #War SaY - 3 a--�D e)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PB/RMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fl_.1d.wticipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:��1,t/�
Nearest Town: CHID /l/� /// County 4 ene
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l %VIa4ito L
Address 177 0)011
(Street or Route No.)
10 /IL) "VC_ -26 3
Qt or Town State
g� �3b9-339
Area code- Phone number
4. DATE DRILLED 1—a
5. TOTAL DEPTH. 2 /ZC. 0 D r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I —
7. STATIC WATER LEVEL Below Top of Casing: o2 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): / &Pr) METHOD OF TEST
10. WATER ZONES (depth): /c20'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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
11. DISINFECTION: Type HI! F
12. CASING:
Depth Diameter
From 0To 7d Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From U T�-�.D Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Ft. in.
Amount a217943S
Wall Thickness
of ieig stt/Ft. Material
Material Method
Slot Size Material -fr
in. 3
From To in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
Ca3
COI
c
O
�
o�
cm
0<
>0
H�
rn
Pa
rn
Ufcn
2
rrl
0
y
O
2
r
IF
1D, ICOOS-- t(CTIhN A
i
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
Q f.1E 9S:6C Li/—O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I _SRbmittlte.original io the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2i1629 t636PhoneN,'i4..(919)'33-3221,within30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 251542
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t 7)-6I7 rl 1 5 I /1 CERTIFICATION # c / 7 5,
tVELL CONTRACTOR COMPANY NAM R flt7 7 / l fk vs PHONE # S c —3 P-6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential m nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: qq
Nearest To�wn: /n4AL, 1 L/4/ Alt —County Q-Cc&J
l74 115''++vOn irrU
(Street Name. Numbers, Comttunity, Subdivision, Lot No., Zip Code)
3. OWNER: (AT""f'fL W Ili C3-'71"S
Address 4 O- Incey4 Pa.(2 a_,
(Street or Route No.)
r'C6irl (/ I ro /tit- 9e
_ city or cwn State 7 7 yZip Code
4. DATE DRILLED 4 -.23 —0 2
5. TOTAL DEPTH: xi—b 3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZI-
7. STATIC WATER LEVEL Below Top of Casing:rQ() O FT.
(Use' +" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): ry%S METHOD OF TEST bl/il./l/iT_B,?-
10. WATER ZONES (depth): 4}S)' U
Area code- Phone number
Depth q
From_____ To 5 / Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material_ Method
From ° To g7J) Ft. e.e.,, 4/ y�1T _.
From To FL / _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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
11. DISINFECTION: Type Amount a 714-/�i5
12. CASING: Wall Thickness
or Wei ht/Ft. Material
/ Pity
Diameter
Gge
LOCATION 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:
RTFy,,T
7-;coN"fRUCTioN STANbA'
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
W
p.3-0
NATURE OF PERSON CONSTRUCTING THE WELL DATE
ubmit the original to the ivisi r n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
7-G:�GPf(1nq Mpc-MR) 733-32
�r H-Jr _ OFFICE
1, within 30 days. GW-1 REV. 07/2001

250897
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%YELL CONTRACTOR (INDIVIDUAL) NAM
''EE� (print) a P h Yl . S 1D 1 II ay, CI CERTIFICATION # ,�% ( 1
WELL CONTRACTOR CONIPANV NAME T)PA1115 I DIl ctn4 (L1?a1 tJ r. Ilfl .rnr VHONE# � 52ct-3 2_& 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER�IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: rYi)ri 4'l.-T.) County MO Crn,
(Street Name. Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (rre
Address /nJ q rat Le_ IcC(
(Street or Route Jb.)
ryanvi. � 4 C_ID273Y
City or Town State Zip Code
Area code- Phone number /
4. DATE DRILLED 7 41-D 2---
5. TOTAL DEPTH: (3 O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: r 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST /0nor7-I
10. WATER ZONES (depth): ,3 /0'
1 I. DISINFECTION: Type f1-f/4 Amount .-22 7-,4-R5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C To ( ') Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From CJ To -( Ft. C`can slim p7/24.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
To Ft.
To Ft.
(v' ,« P/C'
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
From
From
ti
STT
(CONSTRUCTION STANANDr'I L
Material
j
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
na
0 en
0c
Dv
m�
ao
m
y2
ma
tv 0
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND. THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
gad .Ideia
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
S}rinilit the oriyitat torfl eEDnis on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
--7.7631Tf6X6 Pbnne No. [phone], within 30 days. GW-I REV. 07/2001

250487
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ""
WELL CONTRACTOR (INDIVIDUAL) NAM•e (print) C�h}71 5 I �IN II\ A, CERTIFICATION #a./74a
WELL CONTRACTOR COMPANY NAM& I.r'nni S J�I)f Mrd Well 4)16 11 T . _ 1Th e J PHONE #t2-*/ .d5/2 L/-3
' STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WOPPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential le l' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ric 4 /1,kk L 1 ,V 4 /<' -County
/4,),-(2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER:jek!y l-IclI(611t✓
Address ,3e. R !Lr 'U) /lnt/
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
%i (Street or Route No.) (check box)
Lrin;pra-nr, f(__/L/ j— ) , DEPTH DRILLING LOG
City oTown State Zip Code From To Formation Description
)- ?9/—-3.?7'
Area code- Phone number
4. DATE DRILLED - •P — 0 0:---
5. TOTAL DEPTH: 55-'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V1-
7. STATIC WATER LEVEL Below Top of Casing: / ' FT. o
(Use"+" if Above Top of Casing) IV
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 .0I18. 9. YIELD (gpm): -?r METHOD OF TEST Ahnil',}t-4--. - -n
10. WATER ZONES (depth): ?b, 1 3 /i) / 47) (/
LOCATION SKETCH L
11. DISINFECTION: Type /1- f"/-/ Amount ,-2 TA- A S Show direction and distance in miles -from ardeast
12. CASING: Wall Thickness two State Roads or County Roads. Ir 1ude the road
Depth Diaffleter or W�IeiCg�htlFt. Material numbers and common road names. r ��
From 0 To ST Ft. (fir`--r-r-9-� QY�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (� To (-9-D Ft. fin ds7 f)olu
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
E Cbgiann
CONSTRUCTION ST }JD
2
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF TH S RECORDx3EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROt$dm1NGTBRe&Ef giiltil to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHEV1K91411,4E GENIQ) 733-3221, within 30 days. GW-1 REV. 07/2001

250486
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourceslI- Division//of Water Quality - Groundwater Section "_
WELL CONTRACTOR (INDIVIDUAL) NAME (print)• 2) en n is J'iit J(Qm Q„ CERTIFICATION # 4 ) 7 �/w
WELL COVER. -ACTOR COMPANY NAME2 y g iia-,(1 nilk T )L F PHONE #2,,- 1 5 i —3 ; � L
sT.YfE WELL CONSTRUCTION PERMIT# ASSOCIATED W PERNIIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential 0_—PAtmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Toojvn: FE4iz22i Al
/L C' _County 472a
f)eC S/CellJ /7),ne t.L(
(Street Name. Numbers:Community, Subdivision, Lot No., Zip Code)
3. OWNER: m 2t_11. //i)
Address -m (-, /2 d
(Street or Route No.) V
f—( 4i 1 eh) IV '---
�g7391
City or Town State Zip Code
.5 y-9_ 9 3zr 7
Area code- Phone number
4. DATE DRILLED 'T —.3 —6
5. TOTAL DEPTH: J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: <Al O 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): . 0 METHOD OF TEST .h /t2t9') -fg]
10.WATER ZONES (depth): �g r u
11. DISINFECTION: Type H f f+ Amount ,'V T4-/tS
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From /
5 To •7 Ft. (" r/ k' P VIC—'
From To Ft.
From To Ft.
13. GROUT: Depth^, Material
From 6 To 1YY% Ft. r4Orn d rt.-7—
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
Slot Size
in.
in.
Material
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.cttt
Topographic/Land setting
❑Ridge OSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
fV
—J
C-a
LOCATION SKETCH _w
Show direction and distance in miles frotn.at least -)
two State Roads or County Roads. Includtie r4oZ --
numbers and common road names. _ —
1 DO HEREBY-LER I Iry (1 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN[P RS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JUN 2 6 2002 �✓%%%,4 Wdd /`- 3 -t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNDWATER SECTION
AS t i inLt iRPillOjgin ty)¢fnhe Di rision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME `((pprint) 'IQ ViNll j'�I/�wri CERTIFICATION if S /71a
WELL CONTRACTORCOMPANY NAME s ()enniS IrfD ��(Iln L�IJP I� �'r. ��/y �Q^ ,�rtI�NE qg2�—.SaC{— 3 �.� 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
250485
1. WELL USE (Check Applicable Box): Residential L9� 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 wn:_ A-A/le 1:/i/ founty /fl?1 (inn )
a( np.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a), LraffireMC-Q
Address !Oh / SFgna 1 mq-n• Q�
(Street Route No.), C_ hadni.noo r r 3 7(AD5
iQ�fH�A )ry or 4 7 (State � J4L Code
rlCea code- Phone number �//
4. DATE DRILLED Ai- Lf- 0
5. TOTAL DEPTH: 1:R ns
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L`Y
7. STATIC WATER LEVEL Below Top of Casing: —6 - FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. '
9. YIELD (gpm): c 0 METHOD OF TEST
10. WATER ZONES (depth): -2 D -
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
IV
7-0
LOCATION SKETCH
II. DISINFECTION: Type 14 4 /-I' Amount ,-Q 7- -e S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di meter or Weight/Ft. Material numbers and common road names.
From t) To // % Ft. to ` / 0 Ili
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To . Ft. n 0 PH. ti'jY (7(f).l /1.._.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r
•,lMr.
I DO HEREBY CERTIY'TI AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lug
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
CFf LRIMA VER SEM!Oki
r.` 5'Utfrtlil,Wfg t1`iigin ahn1he-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 Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ,(print) J.en1115 fin ji aA rL CERTIFICATION # 4/7// `to
WELL CONTRACTOR COMPANY NAMK .
�yEhnl S (de lInAA,4 1119 V )_I :z..ft ) . n P _I PHONE #i'a$i_3a2 (-/-3 , 6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W4'ERMIT#
(if applicable)
applicable)
1. WELL USE (Check Applicable Box): Residential 1. Municipal/Public I, Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
1' Nearest Town: R/,LLPLim/L
/Ir'q/71r:,vi.lc pd
(Street Name, Ncimbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J Irr 13Peci5
County 44Ccfnx
Address 2f 4 / % m Beet! S 2d.
(Street or Route No.)
Fra/11iI;n) kT a 873y
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 - 7 — t` 2
5. TOTAL DEPTH: ?0 5—
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ii---
7. STATIC WATER LEVEL Below Top of Casing: /3t1 FT.
-, . (Use '+" if Above Top of Casing) .I... .
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a - --
variance in accordance with 15A NCAC 2C .011E.
9. YIELD (gpm): a 0 METHOD OF TEST_ h.lei � . c
10. WATER ZONES (depth): // S /%$ - U o c
LOCATION SKETCH t n-
11. DISINFECTION: Type Hfk Amount T,4 A S Show direction and distance in miles from leag
12. CASING: Wall Thickness two State Roads or County Roads. IncludpJJ e r
Depth Dia eter or Wet ht/Ft. MatgPgl „numbers and common road names. al
0 To '10 Ft. (n .` _ 7 eq.'
From
From To Ft.
From To Ft.
13. GROUT: Depth -.
From n Toj 7,1 Ft.
From To Ft.
Material Method
Cont
f,Zi :d
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
A
O
01
16. REM_ARKS: - - - - - - -
IEj I DOHEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL --
f CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
3— 7-0 2--
DATE
"Submit the orfginat to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
"S`I 2_Y 42143b-P one-N449a r33-3221, within 30 days. GW-I REV. 07/2001

L23G09-1636 Ph'onc No. (91,9)-33_32
250942
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J. (Q CERTIFICATION�# 0.^n /7 //P x
WELL CONTRACTOR COMPANY NAME\ennrs /Ja„d (/)Pil brd i K L✓ PHONE Ng2.y✓52 C74— ✓ ae 0%
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EJ.--Mffnicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:JirI.NL4A-D5ArC,County ,/r),) z )
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R OS _pyio S
pci
Address ,3 7 Lf Q S h 2 r r S
(Street or Route No.)
/hes)1Io As 1tfC
cUy or Town State Zip Code
sal_ ,QR3)
s?(it�
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshainutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED ,— i a —a
5. TOTAL DEPTH: 4L0C1 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [IL.'
7. STATIC WATER LEVEL Below Top of Casing: .S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): -T METHOD OF TEST�z___ O
10. WATER ZONES (depth): /6t D
1I. DISINFECTION: Type 49"14
12. CASING:
Depth q Diameter
From Q To -7/ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To ,5r) FL (?ems n% puS uZ-I
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount „ 2 Tk E5
Wall Thickness
oiWei t/Ft. Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
W
c
0
o0
c
Zm
rn
:Ern
Do
r rl
sIn
en=
0a
0
16. REMARKS:
aml' p0 P(ERBBY CERTIF'tylHryy`
J� f'hNSTRUCTION STANDA*
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS REC HAS BEEN PROVIDED TO THE WELL OWNER
Qc% 9,� 2�ad 3 a a o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
§u$tm+t-the etiginal to:-rthelDivisiOn of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
1, within 30 days. GW-I REV. 07/2001

249912
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME _(print) ($ 11 PI S Idn/lncild, CERTIFICATION # 02/ /Ge-
\ YELL CONTIRACrORCONIPANY NAMeJ)fpryis Ic//Q-n o)�(/�Yr III -YtC PHONE#r 5riL. 9-3 v-60 L)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
(if applicable)
L WELL USE (Check Applicable Box): Residential rd nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest T, wn: /P/ l/'riii/k h JS4 / �unty
�� r s ' (es r.-e—
(Street Name, Numbers, Community, Subdivision, Lot No.,
3. OWNER: (. (2r..7 C-)C-lr_.iC
Address - 5 th r$ e Crr) r t-
(Street or Route N .).
City Town State Zip Cod
easySbn QL
Area code- Phone number
4. DATE DRILLED 0 -(2 5 --L' . U.
5. TOTAL DEPTH: ?yob '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ©-
7. STATIC WATER LEVEL Below Top of Casing: 9/7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '' METHOD OF TEST L /,h7/f, r
l0. WATER ZONES (depth): Q
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Zip Code)
k �
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 147-1-1Amount ,42 / /4.Pi 5
12. CASING: Wall Thickness
Depth Diameter or Wei'hVFt. Material
From To Ft. lid" or
Pi/0
From To Ft.
From To Ft.
13. GROUT: Depth�l Material
From To ri1) Ft. ('!%m PHI%
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
1'
`l 07,(,2�
6£:£ 4!d Z-ddVZO
0
16. REMARKS: -
. -,
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
04 L 9,45/44
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Q. (}>#9 P33-3 I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
249701
North Carolina - Department of Environment and atural Resources - ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A ejl I)l S /Fo /Ia-,n cL, — ,-.i.P( CERTIFICATI�O^CERTIFICATION# d g/7 G
WELL CONTRACTOR COMPANY))
NAME droll bre- l/fiL/4t —{/ 62 Ci PHONE # -3—e. Cf—.3f-ie 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential Cl�nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
1 1 6-I 1 L R 4 l2 cx
Nearest Town:
Depth
From
From To
From To
13. GROUT: Depth
From 6To f2a
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
11. DISINFECTION: Type N •t H Amount a %i�iSS
12. CASING: Wall Thickness
Di eter or Weight/Ft. Material
0 To 7fl Ftikk P��
Ft.
Ft
ounty
�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J)+n
Address LF4I TT.,rn d)Crl? I'
(Street or Route No.)
- Ir2.,J k /nL) �:�� � g7.3 41
City or Town Stat
,S
Zip Code
C(1 )
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
Area code- Phone number
4. DATE DRILLED 3 —7-6 a--�
5. TOTAL DEPTH: �t)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El--
7 . STATIC WATER LEVEL Below Top of Casing: /3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): (-2 O METHOD OF TEST_,
10. WATER ZONES (depth): //
Material Method
Ft. ('&'r-e,
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
£S :C Wd se 2lvW ZO
16. REMARKS:
IS I D1;�(')� H REf�,Y t. RtWY)
yCUtNSPl1JctIf11V C EM
L Submit the nr'3ina�ll t�my tthe D
GBiF741 'S6 EIl]t I 101.9) 73:.
i SHElla LE REG I +_
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
#ate 3 - 7 - o
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

WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED
WELL CONSTRUCTION RECORD
249705
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
)endi s /lc I f ),n r , CERTIFICATION #) 17 10
(if applicable)
PHONE # ?3r 5';2td -3 get
PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public D Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: b/i' Qh ) .>, ,jf(.County /i Cmt )
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ‘...)r VYl \, (.c I (' YC),/vL. ,
Address c 3 Cn(t. m t
(Street or Route No.)
14 ; e h io.,�as �/c on 7 Y I
Sitkor Town State Zip Code
- Sa(n— 02.3 'f
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)
DRILLING LOG
Formation Description
DEPTH
From To
Area code- Phone number
4. DATE DRILLED 0 — a (1
5. TOTAL DEPTH: QS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L/
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 I5A NCAC 2C .0118.
9. YIELD (gpm): c 7 C' METHOD OF TEST AI/V
10. WATER ZONES (depth): Sri t-cZ) 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.
11. DISINFECTION: Type ,t(-f l-f Amount ta- TA AC
12. CASING: Wall Thickness
Depth Diameter or Weigh Et. Material
From � To ,S� Ft. (C�"
From To Ft.
From To Ft.
Depth
To,Z
13. GROUT:
From U
From To
14. SCREEN: Depth
From To
From
Material
Ft. O.Pgnu-r9/
Ft.
Diameter
Ft. in.
To Ft. in.
Method n
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LDO, IERLD'11_�Ckt,TI�'Y T
COTII,TRI�7CT'I3N,1$TAN DA
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THJSRECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to the Div
9;,.G1T;I636H1'N�rtlF'NY, t919) 733-
li
ASH[ GILLL F OFFCE
44. ' 3 -ao) -oJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
m_
cn rr
0

249700
North Carolina - Department of Environment and Natural Resources -j Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NA E (print) _ - 1 i7 i S 'fir i Q.yt (11 CERTIFICATION # o�. /7W
PHONE #i72 ir-;)rF-3g6o
WELL CONTRACTOR COMPANY NAM
STATE \\FELL CONSTRUCTION PERMIT# ASSOCIATED Wi ' ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential-Mimicipal/Public D Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
L
ounty /)'J a corn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /ly 14(LLti i»S
Address /!6) , '- .5,0p.,,,2+ 5 t,
(Street or Route No.) if
JIiahc Wy7 /
11Y y or Town State Zip Code
10,1/6- SaE n 2- 8�
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
Area code- Phone number
4. DATE DRILLED 3 - % -6 9---
5. TOTAL DEPTH: ?n5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ion 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): 2Gv METHOD OF TEST I-)�l,/k/ii-7- Y'
10. WATERZONES(depth): /RD ' O
1I. DISINFECTION: Type a+/4- Amount .r)-TAPc;
12. CASING: Wall Thickness
Depth c Diameter or Weight/Ft. Material
From ( To A � Ft. b A- ; 1 W P 10 ,
From To Ft.
To Ft.
Depth Material Method
To Qb Ft. (7Prna Fir io 31tAJ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From
13. GROUT:
From D
WELL CONSTRUCTION RECORD
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Size Material
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ES :£ lid SZ iVW ZO
O
e
r\ 0
m
0
16. REMARKS:
Submit the orioinnLto-t.Ue Div
£EV9l+LE RE i WI iM 733-
ASHEVILLE EGI Ji, AL 0
G��
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF'jHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
adz L ['&n , 3 i o z
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 249226
North Carolina - Department of Environment and Natural ResourceslI- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Co
/7/ S �/'tT�l j ( d 7 / CERTIFICATION # c2) tom/
WELL CONTRACTOR COMMPANYNAMPJ>'l)110 Homo LiL')1 d)l', )I,� aTVi� PHONE # &:QJ{ 5 C.y -'3 -6 C,)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: -F,049 (C )r )1) 4/County
//_ /
i r
(Street Name. umbers, Commu try, Subdivision, Lot No., Zip Code)
3. OWNER: /2: ri V-nIa(5n7-
Address
(Street or Route No.)
SAp2Sp .mil
City or Town State
C-21-
(��`� Zip Code
V[�L)7/- 07()) .;t .
Area code- Phone number
4. DATE DRILLED 3-L' -0
5. TOTAL DEPTH: t 2 5C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ©-
7. STATIC WATER LEVEL Below Top of Casing: R) FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
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
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 0 METHOD OF TEST G///).//iY�r/,)-�
10. WATER ZONES (depth): /ii%) U
II. DISINFECTION: Type ffd-i-a- Amount 47T /3_5
12. CASING: Wall Thickness
Depth c� C+� Diameter or Weight/Ft. Material
From () To D �3 Ft (� - / / a /-9 // e-'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To c Ft. (1.6.-yrt-(14v/ .>V24!u
From To Ft. I.
14. SCREEN: N: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
12 TIN Mika @[] HIS
N THA A COPY OF TH STRECORD HAAS BEEN PROVIDED TO THE WELL OWNER
I
MAY 1 7 2002
ubmit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
- $LCE4041) 733-3I, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
GNATURE OF PERSON CONSTRUCTING THE WELL
-L -0
DATE

WELL CONSTRUCTION RECORD
249914.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME _(print) N 'Pn VI f) J}f) 1 /arra d- CERTIFICATION # a /' Ca
WELLCONTRACTORCOMPANY NAMP>,l)YnotS !kkilome Wei IJ in eL PHONE q O CS/_3?4--3 .")6 V
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t'-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 644o
Nearest Town: 1) Tr& At i County 49 Cenl2>
14 t (: Gen v e, IGnp t /
(Street Name, Numbbeefs, Community, Subdivision, Lot No., Zip Code)
1 l.Lri f �Q�LC%ztz .L
(Street or Route No.)
/1-14rieget— C'-.
3. OWNER:
Address
4
5
6
7
.3oorn L
City or Town State Zip Code
(rah . <2 41 47' i 3�
Area code- Phone number
DATE DRILLED 3 .—o
TOTAL DEPTH: ?O S
DOES WELL REPLACE EXISTING WELL? YES ❑ NO IA -
STATIC WATER LEVEL Below Top of Casing: .2 b 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): 07 C) METHOD OF TEST J / n' /%--
10. WATER ZONES (depth): 2 ' ' ?D ' d
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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
1l. DISINFECTION: Type R a H
12. CASING:
Depth 7
From 0 To , J 7 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth -
From D To cD Ft.
From To Ft.
Diameter
,.
Amount (7-.) I J 6 5
Wall Thickness
or Weight/Ft. Materal
Material _4-,
Can't Th
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
B1 E kt
R F
t RUCTION STANDA
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�) 042- 'l I04d,"4 3 - g j
Sl
SubiwtitiPtIVAigRiSECii Divisi
7A6gga1'b1E IR
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

3. OWNER: %Z X . nnunen
Address e%iA C S to Yet-!_ 5
(Street or Route No.)
C-4--I x"s✓:r/� lZ /. 3 2 & air"
City or T wn State Zip Code
Area coo
4.
5.
6.
7.
9. /� u
0. WATER ZONES r� s )'
e Phone number �+t
DATE DRILLED �- cL%-a
TOTAL DEPTH: 70S'
DOES WELL REPLACE EXISTING WELL? YES ❑ NO m�
STATIC WATER LEVEL Below Top of Casing: a(t 0 FT.
(Use + if Above Top of Casing)
TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance {n accordance with 15A NCAC 2C .01Ig.
YIELD (gpm): � METHOD OF TESTA n rat
(depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 99 To 7D
From To Ft.
From To Ft.
13. GROUT:
From
From
14
/i Amount,%�ig-fS
Wall Thickness
Dia,Fneter or Weii hhtl t. Material
FL., r�7S ^ }O ✓(�.
Depthcrt Material
To r}(� Ft. (� ein v, 7/%
To Ft.
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
Slot Size Material
in.
in.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section CoWELL CONTRACTOR (INDIVIDUAL) NAME (print) J e n n i s /y /1 JiQM �i, CERTIFICATION # 4 / 7 r
WELL CONTRACTOR COMPANY NAME I )GYI Y) I S ITD II/J.wld 11)0.l l eP v't I -�, .� . Trn r' •PHONE # r 21 Li --a a4'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
249913
1. WELL USE (Check Applicable Box): Residential �fUnicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: / i€p4'eL i 40✓ _County �OcLm 2
Yend/e tvu.,.- Cc�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge f3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6£ :C hd Z— dd'd ZO
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-I REV. 07/2001
CO

9.
10. WATER ZONES (depth). /o<i / / 17)
11. DISINFECTION: Type if4-i+ Amount a 7-/3-13.5
12. CASING: Wall Thickness
Depth CC Diameter or Weight/Ft. Material
From i) To 5JJ Ftin" r t X p re-,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .) Ft. /77 cen7— 117,U1J
From To Ft. I
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
4-DO.H REL3Y CER'
CONSTRUCTION S'
iL
GF33
ASHEVIi
76 1 � . Nu. t(91'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Division of Water Quality - Groundwater Section J
WELL CONTRACTOR (INDIVIDUAL) NAM\ES (print) C D h i S `I� it /—'�/ 2. 7 CERTIFICATION # %7 t ,
\TELLCONTRAC1'oR COMPANY NAME t-neBYli S I 'In-jG /UP)) k)Yr 1l.-h-[��/.Trt CtHONE k eon'Say-3 '0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM4Tk
(if applicable) (if applicable)
249704
I. WELL USE (Check Applicable Box): Residential Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: M
Nearest Town: frf 4 I '1/Lj /I/�{,�7"/K2 -County' // I a Ce7?7
PO0lR,v GPDv-�._a Ike
(Street Nfaine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 47/ heeaeft.
Address 4' A'); YI T /- a /c - C ft Ccl
(Street or Rout/ No.)
FYQM IGI ,� �i/ L. Q a : y
City or Town State Zip Code
(8ak4- 3eicj q3//
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
Area code- Phone number
4. DATE DRILLED 3 -P7-D
5. TOTAL DEPTH: SO 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q/
7. STATIC WATER LEVEL Below Top of Casing:% FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. //
YIELD (gpm): /0 METHOD OF TEST h//121,/41^
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
fV
IV
C.21
-D
CJ
01
c,)
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ] 5A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUR
OF PERSON CONSTRUCTING THE WELL DATE
CD
L
C
ci_
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

249703
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division` of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print$J3ei) n, g fY1,0l Om rY CERTIFICATION # rQ l7 6
WELL CONTRACTOR COMPANY NAM F�yf) n, C )- /1442A MOO Il-�12L°/ PHONE # Bj 53 ti -3 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential KI--Nfunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1f Other, List Use
2. WELL LOCATION:
Nearest own: ✓Q47 l otj NC.. County
ti k Cern- -•
(Street Name, Ntljnbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J?A41
Address
R cm-0
( treat ortute No.)
ity or Town State
b
C2/
(/ Zip Code
S7 Sy 0 c9
Area code- Phone number
4. DATE DRILLED r 3-I R-O
5. TOTAL DEPTH: 3t7, S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: aS FT.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /_ METHOD OF TESTA/OP/FM
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:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type H744 Amount .-,2 7T4R S
12. CASING: Wall Thickness
Depth D'ameter or Weight/Ft. Material
From () To 8.„1._ Ft. (De - , / rW pve
From To Ft.
From To Ft.
13. GROUT: Depth Material/ Method
From 0 To aCi Ft. [l��zrt-">,./ j7 (}7,t/L�
From _ To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
L
From To
15. SAND/GRAVEL PACK
From
From
FL in. in.
Depth Size Material
To Ft.
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.
TRUCTION ST
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ea fileleigr,paC 3-i -0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ra�DJR'[1te �Xi�un'tlll tto the�Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
4bt-J-\27699s16.5'PfiorrE�iilli_Y4194733-3221, within 30 days. GW-1 REV. 07/2001

249702
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) hen n, 3 at 1I67a 8 CERTIFICATION # oL /
WELL CONTRACTOR COMPANY NAMR,NNeH S 11-12/1/o44 r{. /(JOH hr.11 flay)) :En G PHONE # J � C/ - 3 .;-%n Ci
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential --Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2. WELL LOCATIO4:
Nearest /.- Town: ) 42/1 /,vn)ti(�ounty .�%lI (
tTpK.
(Street Name, NLimbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 o e_. }fir
Address ,36-7/ Cal.h;il %)/Z
(Street or Route No.)
v;,i
City or Town State
(.321)- 2 le R- 3'R s
Area code- Phone number
4. DATE DRILLED 3 -//-
cP 7 ,f2)
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
5. TOTAL DEPTH: 3 055
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C9'
7. STATIC WATER LEVEL Below Top of Casing: .n FT.
j. (Use "+" if Above Top of Casing)
8. TOP OF CASING ES / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0119. /
9. YIELD (gpm): . 3n METHOD OF TEST h //!ul,yt�r�'
10. WATER ZONES (depth): / lc 2 j / 7 0 OO
LOCATION 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 llif- Al- Amount O7—A-RS
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From () To_ Ft. & / bK pve
From To Ft.
From To Ft.
I3. GROUT: ' Depth Material Method
From O To L 0 Ft. lt.r'-in.wt.7 r /124_,-C--•
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
r'
cn
rnz
0
l Dn MURPRV CURTIFV THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
.0)NiSThRI TIJN'StA 4$3 Fp , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 Mt} °} eaveLi 3 _,/ __0 -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
a
Submit the original to t
6fi99_Ifi7nnPNo (QII
l Iii +p1C h Fr `- CTIOI
SSHEV iL LF FLGIUHJ 'Lr L]FiCE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-:221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and.Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cJn v t S I Ia �, CERTIFICATION # 2) 7 e
WELL CONTRACTOR COMPANY NAMEIllz 11 Y\' S �-�)�I/M[� 11{�.�I d)Y 11 'l�-2 .i-k BONE # (,Y -� �, .y2 cf --3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMI
(if applicable) (if applicable)
249225
WELL USE (Check Applicable Box): Residential CT ilunieipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 0 /71-r) 4 (.1— County 114 E-(,nrt✓'
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
�UI'S�ff��-lu �ell '� �ramt''/
'r�rly� , to £y7H Cre
3. OWNER:
Address
(Street or Route No.)
City r Town State Zip Code
nth c y< t3k <<
3 39/y
Area code- Phone number
4. DATE DRILLED "9-
5. TOTAL DEPTH: l).S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: ?00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance h ISA NCAC 2C .0118.
9. YIELD (gpm):y t_ METHOD OF TEST
10. WATER ZONES (depth): 3 j(7'
I I. DISINFECTION: Type /// -fN
12. CASING:
_ Depth Diameter
From (1) To ? FL /o"
From To Ft.
From To Ft.
13. GROUT: Depth
From L.) To -t°J Ft.
Front To
Amount ,2 7-4 5
Wall Thickness
or Weight/Ft. Material
Material Method
C P.r,,.r-
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To FL
From To Ft.
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
LOCATION 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
N 72"
M
0
0
16. REMARKS:
I DO HEREBY CERTIFY THAT T-IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQN i RUFFIC
N 8TA1 A
L
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/
ubmit the original to th Divi.
7699-1636 Phone No. 919 733-3
',THE
SECTION
iC1i L ,FII .
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Z21, within 30 days. GW-I REV. 07/2001
iG> C�

249224
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
s.? -9n n //1 3 I**Atom 8 CERTIFICATION# c)/ 7A
WELL CONTRACTOR COMPANY NAM EcI„i�ni1) i (nl n. t J /f f�i1 d )Y r' PHONE # Bat- 5. Y - "3 6' 6
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
STATE WELL CONSTRUCTION PERMIT/0
(if applicable)
ASSOCIATED W'Q PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ nicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Putnp Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION: M
Neares Town: rY(2 i ;G /.�()��/// County &[7Dq )
(Street Name, Nmbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ',LA J. J c7Pt�n.�7-f—
Address <5 re 17. /72.-y7t /d_
(Street or Route No.)
I Yth. &- i) A% ,; [ 23 V
City or Town State Zip Code
(�1i? .3 4Lq - 8 Y
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPM:Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED ,) — 7 -D
5. TOTAL DEPTH: /<S(
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U/
7. STATIC WATER LEVEL Below Top of Casing: ,-QL) 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): o2� METHOD OF TEST /tl/)7/i,r_ey.
10. WATER ZONES (depth): /in ' (I
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 I. DISINFECTION: Type /i % /-1
12. CASING:
Depth
From r% To L�. 3 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 17 To D Ft.
Amount .;i.TA-RS
Wall Thickness
Diameter or Weight/Ft. Material
,IS5K D✓P
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Material Method
(2l.. o,., pOlt
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Slot Size Material
in.
in.
Size Material
From To Ft.
0
IV
a
16. REMARKS:
Submit the original tolthe Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GGh W1r_tNV(919) 73
ASHEVILLE REGIONAL OFFICE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-.;7 4)
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
249223
North Carolina - Department of Environment and Natural].J Resources - Divisionl of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) v-Ch fi t//S A'° //Ll,p aCERTIFICATION # / 7 40
WELL CONTRACTOR COMPANY NAME he 6 h 7 s /-17s/l4mJ Lor li br,1/,tC4ONE #fft f(-3:)6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: PRAti'kL 1 47,4/e _County p //� l )
T-nfl &_
(Street Name Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: :3 f'cie e ro/Lc 2 )
Address- c
(S reef or Route No,)
th [ e Cri_. 3 case
,rl
City (i or Tow 5 ate � Zip Code
lki��'1 SIC i / 3 q oC_.
Area code- Phone number
4. DATE DRILLED c,•2 — —o OL
5. TOTAL DEPTH: 757)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C4-
7. STATIC WATER LEVEL Below Top of Casing:. ?CIO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 FT. Above Land Surface*
'lop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /70 METHOD OF TEST 072/2/ ,h
10. WATER ZONES (depth): //12/'/ 2--S(`J
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type j-f.f f+ Amount .0- TA- BS
12. CASING: Wall Thickness
Depth /� Diameter or Weight/Ft. Material
From D To L, D FL (0". / i cc/ p ✓ Q
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From U To ,Q7) Ft. (tt,v,- j -1 jrl fl a .t'
From To Ft.
14. SCREEN: Depth Diameter. Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION 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:
DQ NFRFBV CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I TI4 CT1 O dt TAIJD 5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
``JJ a Gi Q-(L %4e7«.- — s -- D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LSt
ubmit the original tot a Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t ) 733 3221, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGi8NAL OFF.CE

249222
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .� P n h i S [ Q/Yt' ct CERTIFICATION # r2 / 7
WELL CON'r RAcToR COMPANY NAME T?n ni 9 0 0 •+& Wall d, r r. /( r), a/C Tti f PRONE 3 3 /' U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \YQ PERNIIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ilk-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearestiown: l%/4 ,t,kL, itiACounty //ro C0X
`j
tc f//e �' G�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C I at-lG 5 4-+1- l e
Address / L Ctnr e.R. (r rrcf t
(Street or Route No.)
.5hrdrshit��. G . 3 e, a 77
City r Town State Zip Code
y6.3- / 93b
Area code- Phone number
4. DATE DRILLED „ i_,ZQ -D 2
5. TOTAL DEPTH: c
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�-
7. STATIC WATER LEVEL Below Top of Casing: ,.3p' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / C METHOD OF TEST h //i7/l
10. WATER ZONES (depth): grtes0 7c) .r Vo
11. DISINFECTION: Type f-i'-f-/i
12. CASING:
Depth Diameter
From (] To s % FL (z'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To - 0 Ft. ge—os-z-vta ! " BILLAl_-,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount -7 TAR 4
Wall Thickness
or Weight/Ft. Material
‘ /' Mi t>
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
i(!uo R�B1�thEI jF
C NSTRUCTI N STAY
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
�A 2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�n St'`kW�!fA�ttR IMa1,ro the 1
AS` L*4L 1936131r09 ON,iq•'/W19) 7
a4 iiv//a40�,
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-ao
DATE
)ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

249221
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r P YI n r 5 /1- /1 Av CERTIFICATION # V / 7 tP
%TELL CONTRACTOR COMPANY NAME J'e n n', % 1710 I 1 (!m ?` Il )o I I bM, 1 I r, e({j PHONE # I;�.2 Sall - 3 a � 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential U—'1Cunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: n
Nearest Town: 12 thCL i�(/f�!' County/Y t(,ZC�ryt
aehbuwFc I-5 12 -
(Strect Name, Numbers, Community, Subdivision, Lot No., Zip Code)
L 3. OWNER: ci L an i
Address 73 / /91as ttba4.,„ a Rp 2d
i (Street or Route No.)
1—Y ‘2.41 i at.) I73 (7/
City or Town State Zip Code
(.? I2 .3 4- ' - / �' 4€
Area code- Phone number
4. DATE DRILLED a /—/� /—o L.
'1"�
5. TOTAL DEPTH: ) n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9—
7. STATIC WATER LEVEL Below Top of Casing: (F-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C.0118. /
9. YIELD (gpm): /63 METHOD OF TT (7 /U).(%
10. WATER ZONES (depth): nl .37 U
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type
%i- / 14 Amount ,.2 ! 4 8 c
12. CASING: Wall Thickness
Deptty , r Diameter or Weight/Ft. Material
From 0 Tok-ll— Ft. (o ..pv t-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To at) Ft. @ Qcs,--1 r rv_k12—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
om
rr.
0
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-�i
Submit the origi
27699-1636 Phone
SECLIOL.
COAL OH
o. 91
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
CP-0J"d)'
AS'ri,i+

247855
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -a)'e h n , S I0I I Om CERTIFICATION # / 7
\YELL CONTRACTOR COMPANY NAME ;NCVIhS Rit II On. a Well ,l, s4 T to P- PHONE #1y1 52-cit- 30-1p0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IfYunicipal/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: rOM7Iti I fZt )/J/ auntyA6 COY(
; cI(e 574 et— peg
(Street Maine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
ci0XV2r 691 �`
),
I- /' I (Street or Route No.)
1 c�` / / ljm 7 / rLS N � b 7
Ott or
Town State Zip Code
aag(/rQ�
Area code- Phone number ` 4. DATE DRILLED awl D
5. TOTAL DEPTH: 3 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0'-
7.
STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1.5A NCAC 2C .0118.
9. YIELD (gprn): / V METHOD OF TEST billanthe.A"
10. WATER ZONES (depth): /�. S' U
11. DISINFECTION: Type /1 P /+
12. CASING:
From 0
From To
From
13. GROUT:
From i) 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
Depth Diameter /
To 35 Ft.. (0 "1
Ft.
To Ft.
Depth
To.
Amount r/)-Es
Wall Thickness
or Weight/Ft. Material
/ /c7"✓---
Material Method
Cernrr1r pn0t2.
16. REMARKS:
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesiseconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
1J
-n
rn
0
'a
IV
CA)
L L
I COF'd RE111 V
^�S-pcualoil sir
i
u
Submit the origina
P699-I636Phonc N
IFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
248031
North Carolina - Department of Environment and Natural ResourcesI- Division of Water Quality - Groundwater Section
WELL
CONTRACTOR (INDIVIDUAL) NAME (print)s, 11 IIU 1 5 D l /Qirr (� CERTIFICATION # ,- / 7 k0
WELL CONTRACTOR COMPANY NAMFQ7/bay.; Lira) Z-r; 1/ell a�1. PHONE #(X/Y2
1-y1,3 0- 6, (_)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ I'RMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential lunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 1-=YQm (/ ),m ) County 7)7)Q. (,m
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ! r""" r Io ()—
Address 53 0-7-' 7 j /4 /L /mo d
(Street or Route No.)
l'ClA ,a I A,c_ c S 73
City or Town State,. Zip Code
Area code- Phone number
4. DATE DRILLED oZ
5. TOTAL DEPTH: on '
6. DOES WELL REPLACE EXISTING WELL? YES/ 0 NO Ca-�
7. STATIC WATER LEVEL Below Top of Casing: N (7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
""fop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S . METHOD OF TEST .b IOEW rh
10. WATER ZONES (depth): / / O 2 5 n
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
11. DISINFECTION: Type
12. CASING:
Depth
From () To ?i f)
From To
From To
F(FN Amount a.7/4-8S-
Wall Thickness
Diameter or Weight/Ft. Material
Ft. ''_ . /KC
Ft.
Ft.
13. GROUT: Depth Material
From D To 0 Ft. riT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
p ll Cl-. Q.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL
DATE
ubmit the original to the Divisf on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Jitm1 733-3
ASHEVILLE REGIONAL OFFICE
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (printh e_ Yl t i 'in J1
GROWWAYPIT
A9HDPLt_r FE
I ''r\\rd
f n1 ]1 ji On, r� W QH }1Y. �I �,t ,/. ,. r' PHONE # �'a�¢'- .S,�C{-,-,3 �G� C.
WELL CONTRACTOR COMPANY NAMECIP .
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
248040
CERTIFICATION # 17 co
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATIONL:
Nearest Town: k Y Q2- k Yil County /1\ 0 d-oh-_,
1�//C r�s l'-rnir
(Street Nat e. Nurs, Community, Su rvsion, Lot No., Zip Code)
3. OWNER: l f.h- JYGIN CnT
Address 3/2 m.J-n.,v ki P-r&
(Street or Route No't
r;VQivt ICICO e-
S73
City or Town State Zip Code
,thy _ 033
Area code- Phone number
4. DATE DRILLED -(5 —o
5. TOTAL DEPTH: a 7.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a-
7. STATIC WATER LEVEL Below Top of Casing: //) 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 15A NCAC 2C .0118.
9. YIELD(gpm): 7,5 METHOD OFTEST h lmd,i!
10.WATER ZONES (depth): c'3�7/) `
1 1. DISINFECTION: Type Nt/-f
12. CASING:
Depth Diameter
From Q To RR" Ft. /,,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To e�7) Ft. (J.P�rn 0i9/ 2(iU2J
From _ To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount .2- 773-B S
Wall Thickness
or Weight/Ft. Material
/& pre_
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
r3 �
'+i E E.
'co c (—'.
(J1
m
LOCATION SKETCH o
Show direction and distance in miles:Man at -least
two State Roads or County Roads. Ingtde t road
numbers and common road names.
16. REMARKS:
p 2
Sub u • •e� to th t Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-/5TD
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Ngtt)rx111R.egggteeS;:DiViiidn 6f7wiMfii)tialiay - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)`( Cr)/if S 1-10//0i a.
From
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
248041
pp CERTIFICATION#4,�/7
WELL CONTRACTOR COMPANY NAME,�e i), S fib a �)0I I r, II rue/ I. n is 17y PHONE c2c° , <) 2 U( - 3 a-G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PLRMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CzY Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ticiain (L l r — County /Y) a_eerrc j
(Street Name, NTrtbers, Community, Mbdivision, Lot No., Zip Code)
3. OWNER: J a-a-G • 5
Address 767 *r f'y.'5 ('r QcV
(Street or Route No.) g- 2 3 % Y /n J /Ci
•
City or Town State Zip Code
(gaky- e3 G;,c7 - iRs- 9
Area code- Phone number (,
4. DATE DRILLED 2 - / (
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C3'
7. STATIC WATER LEVEL Below Top of Casing: 1[7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / J METHOD OF TEST oti7/I in
10. WATER ZONES (depth): o2(9S • 2 if+
t 1. DISINFECTION: Type (fib/ Amount ,4. TA s
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (3 To 1) Ft. (c "" 1! PVC --
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ,i(% FL "4i /-1+2 pt}t4/L
To Ft.
15. SAND/GRAVEL PACK:
Depth Size
Frorn To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
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
r.
a
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.
16.REMARKS:
Submit the original to tlfe Div
696B19N11MAT9Rt8£ti91Ott 9) 733-
ASHEVILLE REGIONAL OFFICE
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT • COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
77 / -0
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
r
0
n
w
n
0

WELL CONSTRUCTION RECORD
24804'2
North Carolina - Department of Environment and Natural ResourcesI - Division of Water Quality - Groundwater Section
y /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) + d)pi a S /A17 ti a-,-}d. CERTIFICATION # c2 / 7 6,
WELL CONTRACTOR COMPANY NAME �U('r Vl)i lis fi ' ri 1P1Qll I)V. I (1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
PHONE # (gag) 52(t-;3 � U
(if applicable)
I. WELL, USE (Check Applicable Box): Residential (i(micipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:L,
Nearest Town: 1rJ1t7) /17
1ti77cn Q-cl
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SC" ire Cabe, -
Address .,?`ytgl2 Are / p
(Street or Route NCoo.)
L-a4i(GCice y JrC, „>7r&-1)
Zip Code
)- 5=/35 3
Area code- Phone number
4. DATE DRILLED cP—/ g----D1
5. TOTAL DEPTH: (pC'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .01(8.
9. YIELD (gpm): 3
10. WATER ZONES (depth):
)
County /Y) 0 6c7uJ
Topographic/Land setting
❑Ridge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi ruites/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
City or Town State )
METHOD OF TEST /7,ULyt-,
5 C> 0
e-
O -
ro
„t ,-)—
rn ,G^i
47.-n
11. DISINFECTION: Type 11
12. CASING:
Depth p
From /) To R.S Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From U To ozU Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Et. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Amount .2 7-425
Wall Thickness
Dia eter or Weight/Ft. Material
Material .� Method
n v ( uzLti
Slot Size Material
in.
in.
Material
From To Ft.
r_Fd
cn=
LOCATION SKETCH N )'''
Show direction and distance in miles from acteast o
two State Roads or County Roads. Include the roaF
numbers and common road names.
16. REMARKS:
• 6%HE E6
■ •'u•T C"
( 2T
I OMST
r,
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
/74- L0.2 -/e-o,9._
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
LSubmit the original tot a Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
'„j, l6pMf\QR0,L(ll9) 733
- "`ICE

248043
Diameter
Amount al-- r4 EC
Wall Thickness
or Weight/Ft. Material
P✓(),
13. Material Method
FLJte4?f °'/lam
From T o Ft. T7��
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print, \)C)117r S I tlIro Iism CERTIFICATION # /7
WELL CONTRACTORCOMPANY NAMER i i rEL PHONE # (�/pc S —3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P RMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residentia nicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1> YQ.t, /' l,vt
County
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /?II-Q61 Towjl()2
Address C -9 (� MIpn, I Ot.:j if R, R-c(
(Street or Route No.) �•J
Yarn IL1,.-) i�01473
Ci or Town State Zip Code
ar-F-J` U'to
Area code- Phone number
4. DATE DRILLED r—/ Q —D
5. TOTAL DEPTH:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�-
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): / 0 METJ-IOD OF TEST
10. WATER ZONES (depth): &
11. DISINFECTION: Type /-{ff-f
12. CASING:
From %)
From
From
GROUT:
From 0
Depth
To 9y. Ft.
To Ft.
To FL
Depth
To, b
Diameter Slot Size Material
in. in.
in. in.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
ASF,rVILLE R _f
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

247850
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s 2-' 11 h r 5 i-n //QM i4 CERTIFICATION # / 7 �'
WELL CONTRACTOR COMPANY NAMEcPn/11 S 4O/lli.r l Lt) CI) rill,?.NC -TK C PHONE # tS.L.Si . _'9 — Co 0
STATE )VELI, CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 4 %funicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL LOCATION:
Nearest Town: ,C✓d41 hi/ r 11_J County a- Cr)'l_.J
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: L.' d/ G OE h i a vac cc 1
Address 53 S /-t; r''?I'Ir{n�,—A
(Street or Rota No.)
('atrc1' /l/c rS 7 L/
City or Town State Zip Code
( S2 �— 7
Area code- Phone number
4. DATE DRILLED r�—/ <2 —+7 0--
5. TOTAL DEPTH: j ()[S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IA--
7 STATIC WATER LEVEL Below Top of Casing: ‘:' n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /S METHOD OF TEST b 1 In 1; ,h ry-
10. WATER ZONES (depth): , ,Q5 / 0
11. DISINFECTION: Type // t Al Amount r TA R S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From lJ To / / 1 FL ,"' :iS'V fO/'L—
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To (9 -0 FL a e P)l w i p/ ti L'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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
LOCATION 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
rn
0
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C WELL
DS, AND THAT A COPY (%ETHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the originaLio the
ra 276 L1tFi Pftntle'-Pl^h.4919)
ai/t %%L &Act /
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
133-3221, within 30 days. GW-I REV. 07/2001

247851
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / e h h t S l I ro (l a4') el CERTIFICATIONf�7��# 417 (‘5WELL CONTRACTOR COMPANY NAM ( en y7', 5 J" II n,r, A (.0 el I dJ r, II,'�w r,--CPHONE # (ms� t� ` 3 a-6 0
i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial D Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATIO
Nearest Town: -"ram ie./l
Latta LaJc 2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOIVI JI)(r-'-P
Q co-na
County
Address S/) ,
(Street or Route No.)
Fro v;nk-i /1/� r S73 L1
City or Totem State Zip Code
c- q (- 9-coin Area code- Phone number
4. DATE DRILLED r� -I 3 -0 .-
5. TOTAL DEPTH: iRa S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R7�
7. STATIC WATER LEVEL Below Top of Casing: .So FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. f�
9. YIELD (gpm): 50 METHOD OF TEST rJ )
10. WATER ZONES (depth): 30.-S
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
11 DISINFECTION: Type µd-N- Amount 0,_ TA- e s Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
��9n Depth , Diameter or Wei ht/Ft. Mat 'al numbers and common road names.
From CY To //5 Ft. lY e /re S r
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To n O Ft. e°r-+w-k,I DIN 'it?
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
O
fV
rn
-v
=L
fV
W
16. REMARKS:
a• •_•Gbr{Kftr
bNST$U 'TIO74 Si'(--3
A
LdI
t_
Submit the original to the 1
G Sri; )9; I66Phone 19 19)7
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 13A NCAC 2C, WELL
DS, AND THAT A COPY,,Q�F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 11
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 247852
North Carolina - Department of Environment and Natural Resources -.Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME1(print) 1 Po h I S I'tt0 I I a ,n a CERTIFICATION # D/ 7 40
WELL CONTRACTOR COMPANY NAMEc JJe Ai IA s /ln,,1 11)P1( t) vc, li n, ,v ,TH r PHONE # J )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IIQunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO :
Nearest Town: --"Yeir) <✓ 1 t vli A County /1 ` a. Lint"
D)JUAp1a 1A
(Street Name, Numbers, Commu ity, Subdivision, Lot No., Zip Code)
3. OWNER: lC.Yl�iANC4 tl)QY)ie-�J
Address r J 2 j Ledr) /.'Cy
(Street or Route No.)
O. r3/ 767
City or Tow State State Zip Code
25 9R-7-,39cat/
Area code- Phone number
4. DATE DRILLED a — /I —0
5. TOTAL DEPTH: 400
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: o2 o) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.q
9. YIELD (gpm): c O METHOD OF TEST V)/DUJ,-_,t8.-
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
L atir do longitude source:❑GPS❑Topographic neap
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 0`i-F+
12. CASING:
From
0
Depth Diameter
To t, Ft. (0 "
From To Ft.
From To Ft.
Amount � TA-8C
Wall Thickness
or Wet h Ft. Material
13. GROUT: Depth Material
From 0 To 71i Ft. n P./h T
From To _ Ft.
14. SCREEN: _ Depth Diameter
From To Ft.
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Method
Pour
Siot Size Iviaierial
in. in.
Ft. in. in.
Size Matertal
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads include the road
numbers and common road names;
0)
(n a:
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r,, ON$TI UE DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CL2�+tu1, // -0 2
Submit the origin
L _--
GEouNrt;;rr' (),Inn-
27699-1636 Phone
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-1 REV. 07/2001

247853
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources II- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CII I't� I)2 yl YIi 5 I11U IIetivs a CERTIFICATION # Cl/7 /D
WELLWELLCONTRACTOR COMPANY NAME O.nni s Han,,, rk_ Weil r�1ri,)1 ;Y-1.-6t ( PHONE #(ir SF 6-29— 3 g(o0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i-C,Q A//l/ raJ County Al (1 &r)L)
l , cko2 W>-Leif I Cam -tin •
(Street Name, Numbers, C6mmunity, Subdivision, Lot No., Zip Code)
3. OWNER: TO c -r,lv GOC> (/LoIg_
Address 772' /-/r(Ln,P-c> f��t,r�/l 4'»
(Street or Route No.)"'
hall Wyk) 4tC• (-2 g73 (/
City or Town State Zip Code
V.18J- 89.9_ 9/0g)
Area code- Phone number
4. DATE DRILLED ci - /) -O
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El--
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
Topographic/Land setting
DRidge DSlope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 fl METHOD OF TEST J/DLCi )"
10. WATER ZONES (depth): c r2,3 - O
I I. DISINFECTION: Type F/
12. CASING:
Depth
From [) To 75 Ft.
From To Ft.
From To Ft.
/-1 Amount .;L 7 8s•
Wall Thickness
Diameter Material
13. GROUT: Depth Material
From 5 To c b FL ee1,7-P n %
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.
Frorn To Ft.
Method
rI/)0
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cn
C.
C,
0
16. REMARKS:
ADO
L, 'I\ T CfJN
EREBY CE;
TRUCTIbN l
Submit the origial to
276,PRI63€1'1100e No. (!
diL OFFICE
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
av
922(L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001

247854
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C' 1-1 M j 5 /At //a, ,-
WELL CONT li:\CIOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # / 7 6
PHONE # (S S ' ac4- 3 26 0
I. WELL USE (Check Applicable Box): Residential VYMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: [f'Qa1/,tJ/utom-- County /f()/.Cenci
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \l,V 1 612r.i T c°-YY € I (
Address /,3 In ere_ j Y2' C. 2 /Z.-'
(Street or Route No.) �7
�"FL�mI<)1)1 A%(' A 7S L/
rCity or Town State Zip Code
, C ,a4 - Lf O
Area code- Phone number
4. DATE DRILLED c— 7- D
5. TOTAL DEPTH: (4),a„•=;'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G---
7. STATIC WATER LEVEL Below Top of Casing: /el (3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): V METHOD OF TEST / )blU,h-e�-
(0. WATER ZONES (depth): 4 S 0 5" ( j
11. DISINFECTION: Type ill/4
12. CASING:
Depth Diameter
From 0 To i) FL (/. °'
From To Ft.
From To Ft.
13. G12O UT: Depth Material Method
From 0 To ;) O Ft. 0 Pmm /1/ -a D LC 42
From To Ft. )
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount r,4 2 S '
Wall Thickness
or Weight/Ft. Material
i / S-( 7),./ P
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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
N
-rl
m
to
CO
W
16.REMARKS:
EBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
j(-3) ! CON/B.342r ,.c3N STA'N DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
I'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
— 276921636J'honc NA. (9191733-3221, within 30 days. GW-I REV. 07/2001

247856
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME{�(print) cbe t9 fr. i 5 1 Q II n CERTIFICATION#.-/7 o
Ns/ELL-
ELL coxRACLOR COMPANY NANIt.�/enrt7t /lblI OmJ&( el(Mrr 1f �1�-r�hc PHONE #has)' .524-3 ��00
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/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: /,( /rink L ;r' County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /)Y1)(s t. {-i. ems- ic( SI- i oI t J7t_e
Address - J 3 (_, L (.RJ LV_r1 L
(Street or Route No.-)
=tz�,lu,k) ,�'"- aS7 V
City or Town Sdate Zip Code
(Si Si- 3 A - 4.5 5
Area code- Phone number
4. DATE DRILLED ..S - 0 -Z�-
5. TOTAL DEPTH: r>I75" '
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO B--
7. STATIC WATER LEVEL Below Top of Casing: (5-0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9, YIELD (gpm): . D METHOD OF TEST h /Mb' n �.
I0. WATER ZONES (depth): %p' J kit) / .52 90
1 1. DISINFECTION: Type
12. CASING:
Depth Diameter
From 7) To Ft. (, n (a-/ P v
From To Ft.
From To Ft.
13, GROUT: Depth Material Method
From O To L.A7 Ft. f ern P n r r C (A (-Li
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
)ft-l+
From To Ft.
Amount . L 7-4 /35•
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
r
I Lai
-Submitthea'ioutal th the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2769-91 r1oncNo (919) 7133-322I, within 30 days. GW-1 REV. 07/2001
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ] 5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
c
cn
m
(75

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c e nf7i 5 /I/V//an„ �.
WELL CONTRACTOR COMPANY NAMIEchPYl n i S 1(011Onr1-(7)(9l),)J q-77177
248036
- Groundwater Section
CERTIFICATION # rX / 7 6
PHONE # J
S'I'A'I'f: WELL CONSTRUCTION PERMIT# ASSOCIATED \VO PERMIT#
(if applicable)
(if applicable)
L WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELLLOCATIOJJ:
Nearest Town: /'12.441.-)C L i/J// County
��, vt ✓ RertC1/4 lark
(Street Name, Numbers,/Community, /Subdivision, Lot No., Zip Code)
to 3. OWNER: —I Gl Y1 / a r ri,
C
Address ID ( Eve v' H /aca_
Q r'rri.
S2 f
Zip Code
i2 3y9
(Street or Route No.)
City or Town State
Area code- Phone number
4. DATE DRILLED ( - ,) —o
5. TOTAL DEPTH: ao S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6—
7. STATIC WATER LEVEL Below Top of Casing: c2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,m& METHOD OF TEST A /loci,/it,.g
10. WATER ZONES (depth): 0
11. DISINFECTION: Type 771-/t Amount
12. CASING: Wall Thickness
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
m
O
Ut
LOCATION SKETCH
€a 7-4_ R 5 Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To .S 5 Ft. (, re </ Y » a C
From
From To
13. GROUT: Depth
From 0 To
av
To Ft.
Ft.
Material Method
Ft. Pi,zn, e.1t. � 762{/l
From To Ft. /
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
16.REMARKS:
11100618.ERHIGTION S'FANDAF Lk
A I H 2 201-
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THATA COPY OF T�S RECORD�HAS BEEN PROVIDED THE WELL OWNER
THAT
o[ oLR
Submit the original to th Divi.
2M91A4fEICNKIRIMDS6.11910 733-3
ASHEVILI-E REGIONAL OFFICE
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-I REV. 07/2001
frs
G>

248037
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
� Division�tof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c' / e h n 1 S 1-1-0 10,41 ,41 6_ CERTIFICATION # / 7 1p
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
PHONE#a.
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential nicipal/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: Z74J k /,_.tJ//C- County /1 o n .>
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OAVNER: IrfyjI; .5- /5f/off-`—
Address ry ���: /-,•,. l�VJ
(Street or Routc34o.)
rc'?3V
C ty or Town State Zip Code
-ZA9- %7K'7
Arca code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:i-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E1.
7. STATIC WATER LEVEL Below Top of Casing: 76/ 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): frt METHOD OF TEST 2
10. WATER ZONES (depth): /% _S
i
11. DISINFECTION: Type /971- Ft Amount TJQ 4j
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From [n To U Ft. 66 " ,/ P / C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To ,62 Ft. (26'4 t 4/-_7 /OO>LA 3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Frorn To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frorn 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
n)
t �I
N
c_n
LOCATION SKETCH
- Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF IS -RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Diision f Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2765J64606ktjy{gTNP. $1p41:313-3221, Yithin 30 days. GW-1 REV.07/200I
ASETVIL-E REGIONAL OFFICE
G

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources( Division of Water Quality - Groundwater Section
VYELL CONTRACTOR (INDIVIDUAL) NAME (print) e ll v) f S J 110 8)
VYELL CONTRACTOR COMPANY NAME I fl Eli 5 Jd) f1Qrr LVC(� 3- j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMIT#
CERTIFICATION # 422 / 7
PHONE tt • S „V ce/ '-K'
(if applicable) applicable)
(if a
1. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIONe
Nearest Town: / I' /,i.47. // //IL)/ unty _ 0_r.p-»2�'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4''Pr ILI(?LL/o
Address 5-' -a- / ,vrt
(Street or Route No.)
V061(/ (, j
City r wn State
!� - % — r7/A i=
Area code- Phone number
4. DATE DRILLED / - 1 -
5. TOTAL DEPTH: , Q -S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 01O 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): G) METHOD OF TEST
10. WATER ZONES (depth): /C/ /,� / Q Z (-/ / 5
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/ /
1(I � a 11
t2, l�h
g73 �f
Zip Code
248038
O
N
i'I
cit
s w
LOCATION SKETCH O rim
I1. DISINFECTION: Type / f / Amount ,2 7-4- P nShow direction and distance in miles froira3least-+
12. CASING: Wall Thickness two State Roads or County Roads. Include e roStl
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 6 To / 3f' Ft. 1.> °"
From To Ft.
From
To Ft.
13. GROUT: Depth
From To ,91)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material Method
Ft. /'Oy T .
Ft.
Diameter Slot Size Material
Ft. in,
Ft. in.
Size
Ft.
Ft.
in.
in.
Material
16. REMARKS:
1 DO ugngAY C6oTIFY TIT A'TutS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
Of*T( JCEOP[S*DERt
v
I� SFN
APR 2 „ 2CW G ELL DATE
11J
S4bmit the original to the *ivisia
2 00 IK16Pbnue N� ono), 3-322
GROUNDWATER SECTION
AS" EVII-LE RECIDIIAL OFFICE
D THAT�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Yhikel (Y j o2 _ n
ATURE OF PERSON CO STRUCTIN THE W
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I, 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) ,The Y11'\'t S 'rIi�1 An'1O CERTIFICATION# a2 /7co
WELL CONTRACTOR COMPANY NAME DP47 lel] S / J/5 vtd Ltlell D V; II fN s/.Tri LPHONE 3O-(o0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P MIT#
(if applicable) (if applicable)
247857
I. WELL USE (Check Applicable Box): Residential I7--M—Unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest
rTown: [fGYN!'L/d 4/0--- County Al 2Lorr_J
mmu: ,
(Street Name,, Nf rs Commu::diy Subdivision, Lot No., Zip Code)
/
3. OWNER: ('4 OA L1 (1Pi .5 fa..-6
Address Ill. J+221-I\ I.tinr),L
F.17
(Street or Route No.)
l'F(Ln11ILu)
City or Town State Zip Code
>)- 34q_ 0639
Area code- Phone number/ 4. DATE DRILLED s—o2l' —D 0/---
5. TOTAL DEPTH: c. tom]
6. DOES WELL REPLACE EXISTING WELL? YES Cl NO 9—'—
7. STATIC WATER LEVEL Below Top of Casing: 6e) ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD (gpm): „? 5 METHOD OF TEST /1n//rY� ��J^
10. WATER ZONES (depth);
0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type N ff <
12. CASING:
Depth Diameter
From 6) To 6 3 Ft. 6,"
From To Ft.
From To Ft.
Amount c' T/t-us
Wall Thickness
or Weight/Ft. Material
I v PYC
13. GROUT: Depth Material
From 0 To D Ft. (f Pm Zi'
From - To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
__r_o_6
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 CONSTRUCTION RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
qi) G� t lc 701-0.10 1
l —,2 tt - .2_,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to t Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
77699-1636Yhone No. (919 733-3221, within 30 days. GW-I 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]
2,15.7507
WELL CONSTRUCTION RECORD WELL CONTRACTOR. IN-Pfl n, i /)C l) rm d (0o1) i v it
WELL CONTRACTOR CERTIFICATION Si: '. .Q /7G °
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential la- Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Recovery Heat Pump Water Injection [] Other El If Other, Ust Use:
2. WELL LOCATION: (Show sketch of the location below) 1
Nearest Town: h2/FNk L/ 4/ (' , County: .41 Q C/T7t
4. DATE DRILLED / — I /1—�
5. TOTAL DEPTH a tic.
6. CUTTINGS COLLECTED YES[]
7. DOES WELL REPLACE EXISTING WELL? YES NO1g--
8. STATIC WATER LEVEL Below Top of Casing: en FT.
9. TOP OF CASING IS (Ufe tf, a Above Tap of Casing)
FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118 10. YIELD (gpm): �5 METHOD OF TEST h/)1)//;71
11. WATER ZONES (depth): 1 D h
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER IDrta.p m0 O%nn01I DEPTH
Address h��{'�/.�J �?J 1 P'�(/ From To
i V (bt081 d�Pioae N . r
C^ ^ r
J rcum rl ;ii /(/ C , ;C o 77
City Of Town State yip
12. CHLORINATION: Type /t 1` N Amount it4 /A3
13. CASING:
Formation Description
If additional space Is needed use back of form
Depth Diameter
From 0 To Ft (('
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or WeIghVFi. Material
r10/ p P
Depth Material Method
From To Ft 0j�d.nY ii),,1
Fram T^ r" 1
15. SCREEN:
Depth
From To.
From _ To
From __ To
16. SAND Li —PA
From
From
17. REMAR
Diameter Slot Sfzs
Ft __ In
Ft __ In.
To Ft
To I I A: Ft
I DO HER BY CERi1F
ION'Y-
CONSTRUrT'STANO
FOR OFFICE USE ONLY
Quad No:
Serial No
.
THAT
y.t_ TioN
t$$ WELL: � � • STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AHDSTAND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,>7m.4 /.f-to)dn4*Q —lb—D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
Material
in
In
In
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
G W 1 REV. 12/99

245508
WELL CONSTRUCTION RECORD WELL CONTRACTOR- ��Pt� n, g I) A,„ a Wei)�
WELL CONTRACTOR CERTIFICATION #: ,93- cQ /7/n
STATE WELL CONSTRUCTION PERMIT#:
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]
1. WELL USE (Check Applicable Box): Residential t/X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: c 1llni iL I i-)✓ Ai C'-- County. - %') a 6,72_2
i/17 /r?c-) //1� /C. - , C / .3 477
City or Town State ZIP CWe
4. DATE DRILLED / -/h -G
5. TOTAL DEPTH .- 7. S
6. CUTTINGS COLLECTED YES ❑ NOD----
7. DOES WELL REPLACE EXISTING WELL? YES NO�
8. STATIC WATER LEVEL Below Top of Casing: / 5 FT.
(Use 1+ II Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• /0 , METHOD OF TEST h/N /1[ki / —
11. WATER ZONES (depth)• ��a 7 /0 ) Lin /
(Road Name andilumbers, Community, or Subdivision and Lot No.) - DRILLING LOG DEPTH
3. OWNER 7) /1cJ A.tt L C c4 rrOr� From To Formation Description
Address / LI P�2/`) r'it.
(Street or Haute N 6
12. CHLORINATION: Type /-/ N Amount V4 /r3 It additional space Is needed use back of form
13. CASING:
Depth Diameter
From 0 To `Sr Ft Cc ..
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
LOCATION SKETCH
Material (Show direction and distance from at least two State
`'r"r e :54-, 7 Roads, or other map reference points)
O o
y o
2 c:
o=
c
Depth Material Method
From _2_ To ZL(N Ft (I en,a 1 f I1 f n i 4
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To _ Ft in In
From
16. SAND/G
From
From
17. REMARKS
I DO HERE
CONSTRUC
FOR OFFICE USE ONLY
Quad No:
Serial No
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. BE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Qualiy, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 4 5 5 l f 9
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' �1.en r g /I nv I) a WO i i . r 11 r, el. .L1
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L/X Municipal 0 Industrial 0 Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ it Other, Ust Use:
2. WELL LOCATION: (Show sketch p1 the location below)
Nearest Town: Fe 4 A/lL L I ki li P County
Al Q-.Co-ni
(Road Name and Numbers, Co nity, or Subdivision and Lot No.) DRILLING LOG DEPTH
(
3. OWNER 1 �h.A L'bZ ss((yyff C r c7-1 From To Formation Dascdpuon
Address Rol S , Sk-'v" toA ce_a- 1
f (Street or Route No.) -( 7
City or Town State Zip Code
4. DATE DRILLED / !'b 0
5. TOTAL DEPTH .3 ati
6. CUTTINGS COLLECTED YES ❑ NOQ-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOn
8. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use': 11 Above Top of Cuing)
9. TOP OF CASING 15 / FT Above Land Surface*
'Top of casing tarminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): /Si METHOD OF TEST h/0/lrn M-
11. WATER ZONES (depth)' 3/5l
12. CHLORINATION: Type
13. CASING:
Depth Diameter
From 0 To /13 S Ft (.c.
From To Ft
From To Ft
14. GROUT:
Amount r�4/6
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
/kr/ 0 G P - Roads, or other reap reference points)
Depth Material Method
From 0 To ZLN Ft 0 B-», d.n / [ PTA ,1 ,
From To Ft --
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in _ In
From To _ Ft In In
16. SAND
om, _P ['t lltj )i3 MrI 1` In
From
apth Size I�i Material
Fr1TQ� Ft
From Ttl' IFt
17. REMA
I DO HE
CONST
KS:
ee
GROUNDWATER SECTION
EBY a:oE1JFV W1IRAttrkie .74, 1
e
e,
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
42,11MAn thafie2/1A..0
1_9_otz
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
GW-1 REV. 12/99
Serial No.

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]
245800
WELL CONSTRUCTION RECORD WELL CONTRACTOR• tb-en nil li j) n,., a C00 (1 ni C
WELL CONTRACTOR CERTIFICATION #: .y 640- _k / 7/',,
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Eal Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ��
Nearest Town: Obit) %,'<-- County:- , 22a
(Road Name //i andyy� Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
/s 3. OWNER ; /JA
1. --;. n SlOmd From To Formation Description
Address ..7), Cr Q On
(Street or Houle No.)
City or Town State Zip Code
4. DATE DRILLED I —/ /— 0 L
5. TOTAL DEPTH cQ` f;
6. CUTTINGS COLLECTED YES NO0-----
7. DOES WELL REPLACE EXISTING WELL? YES E NO©---
6. STATIC WATER LEVEL Below Top of Casing: in FT.
(Use': if Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated st/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• IS METHOD OF TEST hiP7/1 rn 4—
11. WATER ZONES (depth)• /tV /) r /
12. CHLORINATION: Type
13. CASING:
Amount Via
Wall Thickness
Depth Diameter or WeighVFt. Material
From 0 To Ft Cc' • r /f<L d7 t P -
From To Ft.
From To Ft
4
14. GROUT:
Depth Material Method
From C' . To t-i-(" Ft /t P.n, o.rlT O; '1t ,r ,
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. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
95 :1 add z? NV ZO
I DO HERE iv C
CONSTRU d
n11
I�
STANDARDS, AND THAT
FOR OFFIC
Quad No:
Serial No.
E ONLY
J�[
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y1 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
SY�Gf/G /L/IYQ0.1,1-�//
/--I/-0 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suhmt odglnJ to Division of Water Quality, Groundwater Section within 30 days
6Rl•tTER SECTION GW-1 REV. 12/99
l OFFICE

245801
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. 1I - n n r 9 /hull Elan A WQ, a r. t i 4
WELL CONTRACTOR CERTIFICATION #: S4,4
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Bax): Residential I! - Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: j rL l"t-Ge- l r./L7 Couny.
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER L .) l 4J Lc-^J /21 e .L) UW 1// From To Formation Description
Address S
S ou e N))
/'i lGniItIn� XCI- ' 'g73y
City or Town State Zlp Code
4. DATE DRILLED /—/S—CY/
5. TOTAL DEPTH .40 5
6. CUTTINGS COLLECTED YES D
7. DOES WELL REPLACE EXISTING WELL? YES Ej NOD_
6. STATIC WATER LEVEL Below Top of Casing: ,ft FT.
(Use •.' II Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface*
-Top of easing terminated atfor below land surface requires a variance In accor-
dance wtth 15A NCAC 2C .0118
10. YIELD (gpm)• METHOD OF TEST /0/M/l /I/ 6!—
11. WATER ZONES (depth). ) ' / % 0
•
12. CHLORINATION: Type f/ >` 14 Amount 't' / S If additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or WeighVFL Material
From D To SO Ft (e»' (if& Pi/P.
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To �1t" Ft n em >.r7T f) /n.c it
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in
From _ To _ Ft In
From To Ft. In
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
17. REMARKS:
In
In
In
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
SC:'t Wd ZZ NV Z0
I DO HER&BY OiFYINA`FTHIS WELLLW
CONSTR STANDARDS, AND THAT A
I
FOR OFFICE UkE ONLY -
Quad No:
Serial No
Submit
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
m,nr e Il10Q80AZ /--/-S -O 2
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
dgitul to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199
OFFICE
L

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] 245802
WELL CONSTRUCTION RECORD WELL CONTRACTOR• th-911 nr 4 )� J) nM a (*II i) r. 1.l Ph e4 Z1
WELL CONTRACTOR CERTIFICATION #: S4=10- cQ/`77,
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Il�� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: r X) 4 -I l: L r 4 -/ /1 'C' County.
4/6 ('rr.
(Road Name' `id Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 'i)C1)YK A fn rvtt`1t- 5 From To Formation Description
Address (i 1 Peu�A i r C.e I(,l
`Street or Houle}4o.)
1-PLULL1,k-) tiC_ .,�d73V
City or Town State Zip Code
4. DATE DRILLED /_14--ei
5. TOTAL DEPTH if -a5
6. CUTTINGS COLLECTED YES C NOEJi
7. DOES WELL REPLACE EXISTING WELL? YES E NOE-
8, STATIC WATER LEVEL Below Top of Casing: / FT.
(Use •+• If Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• METHOD OF TEST Hi/Win rfL
11. WATER ZONES (depth). 6,' /
n
12. CHLORINATION: Type h`
13. CASING:
Amount r!4 i,'
Wall TNckness
Depth Diameter or Weightpt. Material
From C To h Ft (c t r /jp /7 f P.
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
Frorn 0 To t" Ft n em r-rlY [ In.t rt ,
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. REMARKS*
If additional apace Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HE qp1 TIFY THATITIHIS,WEEL
CONST C �SThNDARDS, AND THA
FOR OFi-IIICE SE ONLY
Quad No: L '!,: Lod
Serial No.
Su
writ
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORDIHAS BEEN PROVIDED TO THE WELL OWNER. Qm m4 .4 /J1 f4//l l -1 Ci- -d 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
inal to Division or Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
GROURDWAT R SECTION
ASHEVILLE REG ONAL OFFICE

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR: 1 n n t 9 /)c 1) rm a (t)o l) by i i , , 7-)1
WELL CONTRACTOR CERTIFICATION #: 5441- , 77/n
STATE WELL CONSTRUCTION PERMIT#:
245803
1. WELL USE (Check Applicable Box): Residential En -- Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: rn4-ti/C L / -�/ /1l/' , County:
A/aCoat
(Road NameandNumbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 7-ni / /5 a-// {i2- From To Formation Description
Addresses / / e (/t geil�[oufeo.) AD , () h, /2c-i_
/' f/ 7 / L//,bS✓ tS4.- (' - _42/y3 V
City or Town State /Lip Code
4. DATE DRILLED /— t — d 9
5. TOTAL DEPTH , •'n�%
6. CUTTINGS COLLECTED YES E NO[2]i
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOn--
8. STATIC WATER LEVEL Below Top of Casing: -1- FT.
(Use'+' i1 Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface*
'Top of using terminated allor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm)' -el METHOD OF TEST /0//0/JIM rri-
11. WATER ZONES (depth): / �� / 971 //
12. CHLORINATION: Type l+t H Amount y4 /6i
13. CASING:
Wall Thickness
Depth Diameter or Weight/FI. Material
From 0 To "5ca Ft (r' r/f& Pt P.
From To Ft.
From To Ft
14. GROUT:
Depth
From C To 7--ft' Ft
From To Ft
15. SCREEN:
Material Method
(r /'iq,, 0,11 / n 1 r)t .\
Depth Diameter Slot Size Material
From _ To _ Ft in _ in
From To Ft._ in In
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
17. REMARKS:
Ft
Ft.
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREB R �FYiA -TH WeiLLFWAS i
CONSTRUC1+OFSAA
FOR OFFICE USSEONLY
Quad No: Li ;,
Serial No.
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORDIIHAS BEEN PROVIDED TO THE WELL OWNER.
M/rhm�� n6Qn/1.4e. `-15
'•i� -mod GNATURE OF PERSON CONSTRUCTING THE WELL
Submit cdglnal b Division of Water Duality, Groundwater Section within 30 days
GW-1 REV. 12/99
TION
OFFICE
GATE