Ma CY2002

WELL CONSTRUCTION RECORD WELL CONTRACTOR•�
WELL CONTRACTOR CERTIFICATION $: L'- o. 2
STATE WELL CONSTRUCTION PERMITN:
268368
North Caro'Inn - Dopartmonl of Environment and Nelural Fleeources - Minton of Water Quality • Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699.1636-Phone (919) 733•3221 Bobh j.( Qotj5
•
WELL USE (Check Applicable Pox): Residential l vl Municipal ❑ Industrial Agrlcullural El Monitoring
Rocovery El Float Pump Water Infection ❑ Other II Olhor, List Use:
2. WELL •LOCATIO�,A Show skejcl o+' Ilina location below) ,. J
Nearest Town"lS�Y County' U�
(noed Name and Nu
3. OWNER
Address
CCre„.•••-vte
Convnunny, sub(dll1vIslon nd Lot No.)
City T'lown - Slate
4. DATE DRILLED 140-0 a-'
5. TOTAL DEPTH aC S
6. CUTTINGS COLLECTED YES NO vr
7. DOES WELL REPLACE EXISTING WELL? YES NO of
6. STATIC WATER LEVEL Below Top of Casing: q FT.
(Use'+' II Above Top ol Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of cm sing terminated iUor below lend surface require e e vetlence In accor-
dance with 15A NCAC 2C. Ij-E 1i +
10. YIELD (gpm)• METHOD OF TEST 1(O
11. WATER ZONES (depth)
17 "I-ILORINATION: Type --Amount-S
1:,ASING:
DEPTH
F omrnlion Dascrlplion
1
a8 75y it - 4atW �k.
zip Coda
II addillonal space Is needed use hack of lorni
Wall Thickness LOCATION SKETCH
Deilli/n� lamalo Jyr e o m . �1 .1.1 (dal (Show direction and distance from nl least two Stale
From Tom-Fl•,�'> "` 'I�� '--'-"�-"" Ronds, or ollier map reference points)
From To FI.
From To Fl.
14. GROUT:
Doplh Malollol Mol_ lied
From G To ao_FI &inREfE IruK�d.
From To FI
15. SCREEN:
Depth Dlainelor Siol Size Material
From To FI In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
I DO FIERED
GONSTRUC
'I OFFICE
ad No:
Serial No.
Nta
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD FIAS BEEN PROVIDED TO THE - -L OWNEn.
o
NATURE OF P SON CONSTRUCTING TIIE WELL DATE
Division(); Wnier Quality, oroundwaler Section within 30 days
GW1 REV. 12/99

268376
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1636-Phone [phone] �///,,''
WELL CONSTRUCTION RECORD WELL CONTRACTOR* Ord RmAiV %2/41(.
WELL CONTRACTOR CERTIFICATION if: .27D.
STATE WELL CONSTRUCTION PERMIT#:
1. W ELL USE (Check Applicable Box): Residential IO Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Llsl Use:
•
2. WELL LOCATI (Show tch�off the location below)
Nearest Town:
/,tA0 /j_/xX__) County.
Sc e_
(Road Name and bets, Co •munlly, or S dlly slon and Lot NNq.)
3. OWNER ,� / a _ff. f�GUt.G�o
Address
DRILLING LOG
From To
DEPTH
Formallon Descdpllon
i 59 1A6 BKIreQck
Ily or Town Sta Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES' I NOI4
7. DOES WELL REPLACE EXISTING WELL? YES l_ f, NOW(
8. STATIC WATER LEVEL Below Top of Casing: .£(`/) FT.
(Use'+' II Above Top o Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with ISA NCAC 2C tile
10. YIELD (gpm): METHOD OF TEST fli 3
11. WATER ZONES (depth):
CHLORINATION: Type ____H-7-H---.Amounat-ilaiS It additional space Is needed use back of form
. CASING:
From
From To Ft.
From To Ft,
14. GROUT:
Depth
From 0 To d
From To
15. SCREEN
LOCATION SKETCH
Wall Tf}hickness
Depth
/ Ft. 1 Diametero1 5 or Wai (olg13J� it Dg (Show direction and distance from at least two State
a r Roads, or other map reference points)
Material
Ft OIONC2-0
Ft
Moto r E
i
Depth Dlarneter Slot Siz© Material :-
v -1-'
From To Ft In In _ -
r.,
From To FI In in
From To F1 In In.
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To— Ft
From To Ft
17. REMARKS:
MP RE)
1
C71
vn=
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. / v
19
FOR L ®`<1SI�ilOtY I
Quad N�-.1t
•1
Serial
AFI'I-��L�
SIGNATURE OF OF PERSON CONSTRUCTING THE WELL
original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-I REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. RAl kE/LA Wr/✓E5
WELL CONTRACTOR CERTIFICATION It/90
268385
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box): Residential tYJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Infection ❑ Other If Other, List Use:
2. WELL LOCATION: (Shows etch F the location below)
Nearest Town: / r JQr— County'
1, J
S'k,,n t
(Road Name and.Numbers. lrrqumbers, C muunl�ly,,;or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ./I 2///r/)') From To Formation Descdpllon
Address � �j e r (Fr -ye -Ark,
JShea
�C
City or ownTSlate Zip ode
4. DATE DRILLED
5. TOTAL DEPTH 'Cie) 1/
6. CUTTINGS COLLECTED YES I NOItF
7. DOES WELL REPLACE EXISTING WELL? YESNOR:"
6. 6. STATIC WATER LEVEL Below Top of Casing: "/ FT.
(Use -i II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated aVor below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST 1:?i q
11. WATER ZONES (depth)'
6 --3 1);Fit
-8eAnne$
12. CHLORINATION: Type "Writ Amount 5
1 ASING:
Depth Diameter
From 0 To Ft. L• DS
From To Ft
From To Ft.
14. GROUT:
II additional space Is needed use back of form
Wall Thickness
LOCATION SKETCH
or WeighnlFCt. Maledal RR (Show direction and distance from at least Iwo Slate
QUA. 14c C'SD.I Roads, or other map reference points)
Depth Material
From In To aQ Ft C.(114C-PIP-tita
From To FI
15. SCREEN:
Metlod
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
CCC
P90C)-611 Ill,
SI :1111V I Z 33J SO
c
m.;
r"
0
0
17, REMARKS:
I DO HERESY 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.
n
FOR OF �� US �.ttLY;.
Quad No: r----
n
.al Nojij I
Su
LIrc
SIGNATURE OF PERSON CONSTRUCTING TFIE WELL DATE
nal to Division of Water Qualify, Groundwater Section Within 30 days
GW'I REV. 12/99

North Carolina . Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• (JMAN k&iLA w r iv es
WELL CONTRACTOR CERTIFICATION 0: /540
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Resldentlal0' Municipal O Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, LIsI Use:
2. WELL LOCATION: n (SwLsketch of the location below) .y121aai �/ )
Nearest Tow/Fyl� 1r y �I County /1�' �
SL.M C.
(Road Name and Nu n. C�p�9/)�(^�,rm��u�nlly, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER .,�e/�-Ft ! fib/'' �7/�1 From To Formation Description
Address , ,(r'I rat4,7 A*,), ;qt
3lreel or F le No Q /j
City or fe<edn `��ry7 Stale Zip Code
4. DATE DRILLED '% 2l�,
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ( I NO
7. DOES WELL REPLACE EXISTING WELL? YES n NOR."
8. STATIC WATER LEVEL Below Top of Casing: _2 J FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS ' FT Above Land Surface'
•Top or casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.011e
10. YIELD (gpm): h(t7 METHOD OF TEST RLq
11. WATER ZONES (depth)
12. CHLORINATION: Type 41T r! Amount _11.WB II additional space Is needed use back of form
1 #SING:
Wall Thickness
Depth // Diameter or Weight/Ft. Malerlal (Show direction and distance from at least two Slate
From Q To /% FI 1b. D5 Vt.. P5 PYC"SDR Roads, or other map reference points)
From To FI. 9 1/n� ,/d/
From To FI .c/ /'f ' t /d %
14. GROUT: C /
Depth Material 1. Method / } 2d3 4 / in.
From 0 To a0 FI CnkiC.IIE e, ___Tuadreldi
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft. In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To FI
From _ To Ft
17. REMARKS:
LOCATION SKETCH
I DO IIEREDY 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.
no, 4_FIIuEUIS-ECNLY
qua No: —
_1
ial No.
268384
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odglnal to Division of Water Quality, Groundwater Section within 30 days
OWI REV. 12/99

10. WATER ZONES (depth). ) CsOI L�
11. DISINFECTION: Type -tit bIrC4 Amount Z
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
variance In accordance with ISA NCAC 2C .0118. i�tl r/,s, JJ
9. YIELD (gpm): Z-O METHOD OFT 511� I,_�tt1SZ�'ll�
Depths
From Q To \� Ft.
From To Ft.
From To Ft.
13. GROUT: Depth A Matc^ria�l t
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
_Method
Slot Size MauY �L) end t VA
in.
in.
Size Material
Ft.
From To Ft.
16. REMARKS:
ONSTKUCt
WELL CONTRACTOR COMPANY NAME YY(r
STATE WELL CONSTRUCTION PERMITS
(if applicable)
266578
� ��,�,I,' 51i PHONE S fast L90.7'a`e„3
ASSOCIATED WQ PERMITZ.
(if applicable)
1. WELL USE (Check Applicable Box): Residential fa 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: N/_ ! ] .County
(Street Name, Numbers, Community, Su vision,
Lot No., Zip Code) 2.
3. OWNER °c VMYLL
Address 1140 ��i�.Q{4lu �3/4-•
infL ( 5 t i Rout . \ Z115�
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 1 _b Z
5. TOTAL DEPTH: 7—(St eZ
6. DOES WELL REPLACE EXISTING WELL? YES NO ^NO 0-
7. STATIC WATER LEVEL Below Top of Casing: ` .c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
Topographic/Land setting
❑Ridge ❑Slope Malley RFIat
(check appropriate box)
P7 3 Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH 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.
z.5- IW
yv _iNr6 Ltal1
CL) vJ 6-t,o\---
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ands Natural�Reso ces - Division RI/rat/ r Qua�It(y - Groundwater Sec(�p�3
WELL CONTRACTOR(INDIVIDUAL)NAME (prtaQ kb ■ C�� _ate
CERTIFICATION BQ_„t
i
0
0
o
ra rn
>0
a — 0
C c
rt
9.)
boL
0 ..0
VI
to G
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A •OPT OF THIS RECORD HAS BEEN PROVIDED TO THE ViEcli. OWNER
I �
ATURE OF PERSON CONSTRUCTING THE WELL DATE
I1 I
bmiq t the original to the Qwisio of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27 99-_16_36_P_ho tc No..4919)-73b322 , within 30 days. GW-I REV. 07/2001

F(p`N 407' -0 STjkND"_
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�7 7
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) I I%A/Ai/r= 8 jag(
L / �`/7 CERTIFICATION,,X# c.22 8 / /
WELL CONTRACTOR COMPANY NAME, cit'r� tAi-i -/ ja""`( ""-LL PHONE
E 8 yt-xe r_l.� y� vsa
STATE WELL CONSTRUCTION PERMIT,' /t//If/ ASSOCIATED Q PERMIT# /(//#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: �i%/Yri/%Z2 County
��lr,-del- red .., 4"7 5 3
(Street Name, Numbers/,Community, Subdivisioonnn, LLoot�No.,�Zip Code)
3. OWNER. /i /7 /,t Zt tc c
Address 97t' ? ✓Pry , (4�`-a/1/ 4.1
(Sec, Sor Route No.)
.,W i../--4-ctA/. Cr ,,-.17ff 7 S `3
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED /,p/sl /2 L
5. TOTAL DEPTH: . DSS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / n 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): / METHOD OF TEST 7 n <6
10. WATER ZONES (depth): /3 0 / -2 D.rl
11. DISINFECTION: Type y' Amount e*), CZ /
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. �ja� rial
From_ To-QD Ft. #'2/ 9 L-
From To Ft.
From To Ft.
13. GROUT: Depth /�k�Material ethod r
From._ To� Ft. I ' c
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
From GRTo Ft. in. is
15. SAND GRAVEL PACK:
Depth Size Material
From /To Ft.
From To Ft.
16. REMARKS: /C? /f 1i frig )
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
a THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
264827
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)
DEPTIj DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Inc1u
numbers and common road names.
a
NATURE OF PERSON CONSTRUCTING THE WELL ATE
bmit the original to the 1 ivisi, n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-32 •i , within 30 days. GW-1 REV. 07/2001
ASHEVILLE iiEGHCI`+AL OFFICE

13. GROUT: Depth
From C Tor�C) Ft.
From To Ft.
14. SCREEN: Depth Diameter
From
�To Ft. in.
From � To Ft. in.
15. SAND/GRAVEL PACK:
th
From Ft.
From To Ft.
264823
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ��N//atural Resource �-/Division of Water Quality - Groundwater Section �/[�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Ai .t efv J I)) d /!) S tT/' 12-1-6-PRONE
CERTIFICATION St Nllj47Y9'
WELL CONTRACTOR COMPANY NAMESZULP,G t.i1.`- .1 LLt2 1 ILV>E 7C�--PHONEE A 4 y ` 6 v )
STATE WELL CONSTRUCTION PERMIT#{L ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential jg Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: ON:/�0��9' County�7 `
Nearest Town: / l Gdau
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 772-7
Address //fl, Jt-cciit2i
(Streyt 9r Route No.)
City or Town State Zip Code
(_ _) N/11
Area code- Phone number
4. DATE DRILLED 1/49% /D `-_
5. TOTAL DEPTH: 5 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO j2(
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / - C FT. Above Land Surface"
• *Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): c-2 r) METHOD OF TEST 2-ntP
10. WATER ZONES (depth): -3 n' ./R I
11. DISINFECTION: Types`
12. CASING:
Depths Diareter
From 0ToJO Ft.
From To Ft.
From To Ft.
,,Materiaa}}�� ethod
�i s
Amount n . /f g
Wall Thickness
or Weight/Ft. N aterial
#.2 / 7 t/ C_
4�r 3
BY CERTI
CONSTRUCTION ST
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
[Ridge ❑Slope ❑Valley PiFlat
(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 om at least
two State Roads or County Roads. I ' elude the road
numbers and common road names
L
LL1,'.a1� T THIS WELL WAS CONSTRU(,1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'iris, • Ia TH T A COPY • • IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE E ON UCTING THE WELL
a
ATE
GRn HpWATER SECTION
ASH vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
RItitillh- •36 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

264822
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)tO ,%% /1''IyL' CERTIFICATION Si 72
WELL CONTRACTOR COMPANY NAME iJCiXt,. J-rf�/b� Li I etn"'^a�222.4 PHONE IS(s 4' y`7-1 YO--U
STATE WELL CONSTRUCTION PERMIT# /V/H ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
N/�7
1. WELL USE (Check Applicable Box): Residential % Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: y�
Nearest Town: ,dl / County ///l "eizCu
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r i 2"' f. //i rt1
7 s Ytv lj'LL yi24x,12
Address
wl' ( o/'A/ u�No.)
/CAL 9 �
City or Town State Zip Code
&AO- / yy da.'Yy
Area code- Phone number
4. DATE DRILLED /l / / / r0
5. TOTAL DEPTH: . 5's
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: & 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / C FT. Above Land Surface*
' *Top of casing terminated at/or below land surface requires a
variance In accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OFTEST7 cf
10. WATER ZONES (depth): L -S Fr
11. DISINFECTION: Type Amount O , 4 9'
12. CASING: Wall Thickness
Depth Diameter
From C To si C Ft.
From To Ft.
From To Ft.
13. GROUT: Depth AMaterial Method
Frorn_ L_ To 2 G Ft. ca n2e- J l tie( /2,"
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front_To Ft. in. in.
From/ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft.
From To Ft.
QQ � `j I
16. REMARKS: N/Ct&i t- j` " ['-cisl'-'7)67
Topographic/Land setting
❑Ridge ❑Slope ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C�i Dti)-I1'iE CIc
or Weight/Ft. Material
�
LOC TION SKET H
Show direction a ' d distance in miles from . t least
two State Roads or County Roads. Include ' e road
numbers and con road names.
0-40
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
itiG 2-
q,� { SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
G R G UwLrL� 1 +t�i�l 1 to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASE.ILL2E7
�p. (91f) 733-3221, within 30 days. GW-1 REV. 07/2001

2660 64
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource�s���77- Division of Water Quality - Groundwater Section
onry r�
WELL CONTRACTOR (INDIVIDUAL) NAMA (print) / i /? /l'Lt CERTIFICATION�OftJ 7/7
WELL CONTRACTOR COMPANY NAME • AA OVi��-L I lei/ W70�%u.e4 PHONE /q/q(trXn1 407/ - /5
STATE WELL CONSTRUCTION PERMITS/ .. / /t% ASSOCIATED p1WQQ PERMIT# A�/ /7
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /%�%
Nearest�wn: ilL���///���� County Z
.(3e (i1`Y_✓ —C .% p %C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -1
Address V %/.Z L2(/
Street(Sptpr Route No.)
C?zigf4-4, //ti C , ,_ �7 S
City or Town State Zip Code
Area code- Phone niunber^ �/
4. DATE DRILLED Y/
5. TOTAL DEPTH: . S D6—'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0,
7. STATIC WATER LEVEL Below Top of Casing: /2 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / _j FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
valiance in accordan with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TESTT�1-4-1-1J
10. WATER ZONES (epth): ./- n 1 T L ✓`
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From_ To 20 Ft. -�
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To .£% Ft.
From To Ft.
14. SCREEN: D th Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
th Size Material
From !ApFt.
From To Ft.
Amount /$ oz
Wall Thickness
or Weight/Ft. Material
722/ (1lc'
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)
DEPTII TRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in milg's from at least
two State Roads or County Roads Include the road
numbers and common road nam
Matey L Method r.
Ceir�/x r GaiCti P4ti'
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
674-pl-c e 6%T4" y/l' y�
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
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
REUBEN CALDWELL CERTIFICATIONS/ 2140
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONEY*S 5, 54-3581
STATE WELL CONSTRUCTION PERMITS/ 1537 ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
260070.
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. WELL LOCATION:
l/1
Near�est gown: /Ot�%i r'
� f,�ry'
(Stmet Name, Numbed, Community, Subdivision, Lot No„ Zip Code)
3. OWNER: V'ktA) »J l {a. i)4I I I _J�'
Address 14-
(Street a Route No.)
Li0u2.t.oat/l1le we. 1�g7g7
�try or Town Stale Zip Code
C� �9- G 1'/ 9 — .3 '- In _3
Arta code- Phone number g-.,
4. DATE DRILLED 9 I J0
5. TOTAL DEPTH: / y- La /
County / 4ere/
�
WELL REPLACE EXISTING WELL? YES El NO
6. DOES
7. STATIC WATER LEVEL Below Top of Casing: Gr FT. :-1 4y , t ,
(Use "+- if Above Top of teeing)
Topographic/Land setting
❑Ridge ['Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degren/m(wteJsocoods)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
:1 Ai, i <AD H 41-1.4 1 /
4.L/1 - /,, ( `2i'.e%.I to, /C._
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of casing terminated at/or below load surface requires a
variance In accordance wills ISA NCAC 2C .0111.
9. YIELD(gpm): Ir METHOD OF TEST P\°/ C;-
10. WATER ZONES (depth):
t, ;r .Amount 11
Wall ThicknessW
Diameter r et t/Ft. Material
11. DISINFECTION: Type
12. CASING:
Depth A.
From— To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 10 To i -e Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
Mater'ai
t.
Method
r at ill
From
From
Depth
To Ft.
To Ft.
E PEMw129
1 DO IERCDY CE ITV
CONSTRUCTION STA
SEP 2 3 2002
Z_ 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.
Y "rd$AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrIN 15A NCAC 2C, WELL
\D NEDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO,TII ,E WELL OWNER
7-et. IC nIA ,ail �) , / :--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mal( Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phony [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION #: e2 C 77
STATE WELL CONSTRUCTION PERMIT#:
0 ' 0 1 J
1. WELL USE (Check Applcsbls Cox): Realdslleiti ® Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If Other, list Use:
2. WELL LOCATION: Show
Nearest Town:
location below) Co7% county:
(Road ,r . Connally, j • to No.)
3. OWNER
Address
ay or Town cep Code
4. DATE DRILLED L�
5. TOTAL DEPTH _ /L
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: FT.
(tee •.• s Above Top of Casing)
9. TOP OF CASING I5 FT. Above Land Surface•
*Top of casing teren4mad Igor below had stases* requires a grimes In accor-
dance wM it 1SA KCAL 2C Vie
10. YIELD (gpm): 5 METHOD OF TEST TAN
11. WATER ZONES (depth)' bp
12. CHLORINATION: Type 7-71 R
13. CASING:
Amount —7.--
womanish
nish
Depth , / Diameter Of 1F1. _M dial (Show dire least and distance from It two State
From-0 7 To e' Ft. 4 e 7 s�� Roads, or other crap points)
Fray To FL
From To FL
DRIWNG LOG
From To
DEPTH
rr 2-/
c
nJ
•
i r_, CS
CS
I„
t N2
n
If additional we is nomad use back alarm z
14. GROUT:
a
From To Oft, FL [2sest —
J�
From To Ft
15. SCREEN:
Depth
Diameter Slot Stze Material
From —�'�7 To in in.
From J To FL / In. / In/
From Yo FL [/ lo. In
16. SAND/GRAVEL PACK:
Depth Size Material
From
K ///To FL i
:mTo ( FL
17.
I DO HEREBY 4*irFVIM_
CONSTRt1CTAFtDARDS, AND THAT A
FOR OFFICE OJ4LY
Oiled No
0_u .s..
...
2C, WEL
THE WELL OWNER
OF PERSON coNs iUClkIfTHE WELL DATE
of Wear Camay, Sanbn within 30 days
;/,17
nw.r RFV. 12Ne
7.90

263438
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesQ- Division of Water Quality - Groundwater Section
G
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , �L I (�/// tQ j'1'en c na S 22 • CERTIFICATION
/#/�./Lp/ n ,y/
WELL CONTRACTOR COMPANY NAME J8,4,1_ ,, a LL4&' Lael r�-dI 44 PHONE if 10) L!'y / - 6 K r?L
STATE WELL CONSTRUCTION PERMIT# Arnd ASSOCIATED WQ PERMIT# V/11
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ( Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest To County
6Lfd- a--144,t ri
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / t
Address /y'7 5'_
Cam+= $ac
uN jl
"ilur oute No.)
State Zip Code
City or Town/�/
4. DATE DRILLED 9/3 0 /D L
5. TOTAL DEPTH: 11/27)_5—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (X
7. STATIC WATER LEVEL Below Top of Casing: /�n 5- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .!S FT. Above Land Surface*
• *Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): C METHOD OF TEST t ,ci t.0
10. WATER ZONES (depth): /6_1-1
11. DISINFECTION: Type v 2PZ/94f-- Amount //J °'
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. MMaterial
From 0 To�© Ft. th.2-i 1/' V C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method t
From 0) To c2f] Ft. ifgi'na' LcD)' /Pry
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From, o Ft. in. --in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Fro To Ft.
From,To Ft.
>� e.
Area code- Phone number
g7St
16. REMARKS:
cL._._ .
2 �I
IL O k*S'� BY EItWIF F 1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND • a a TH COPY # IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PE' ' ON CON ' DATE
Topographic/Land setting
❑Ridge titSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbe d common road names
gia5c
'FIPORPOICAKIRIOBtftOthe Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
l 9Wb661fGdiiiiNe.Q$NE7E 31-i 21, within 30 days. GW-1 REV. 07/2001
UCTING THE WELL

263433
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section.77
CERTIFICATION Fe2 /r y
WELL CONTRACTOR (INDIVIDUAL) NAMF��/,(piint)�� �p� �J� QQ ,,/ /
WELL CONTRACTOR COMPANY NAME ',L .,'-P.P.U+.e DLit/ IA .!-r.GG rr"/'rtirs-e-'-f PHONE it ( 7 tP YJ D lie)
STATE WELL CONSTRUCTION PERMIT# %y//4... ASSOCIATED WQ PERMIT# N/h'
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential I 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: County 771
See-4 g— -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address <ft-.cs, ft
(Sint or Route No.)
City or Tmig State
ry se Zip Code
Area code- Phone numbeD
4. DATE DRILLED r// /
5. TOTAL DEPTH: / S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JH,
7. STATIC WATER LEVEL Below Top of Casing: If 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 .0I18.
9. YIELD (gpm): .c7 METHOD OF TEST-r--c- -rJ
10. WATER ZONES (depth): _3 t)
11. DISINFECTION: Type 2iC
12. CASING: U
Depth, ,., Diameter
From D To a�L_ Ft. (p 7
From To
From To
13. GROUT: Depth
From_ To 2
From To
14. SCREEN: Depth
Ft.
Ft.
Amount '7 crt-
Wall Thickness
or Weight/Ft. terial
Material Method
Ft.
Diameter Slot Size Material
Fro o Ft. in.
Fro To Ft. in.
15. SAND GRAVEL PACK:
Depth
From /To Ft.
From . To Ft.
. !EiS: ](��
HEREBY CERTIFY I HA
NSTRUCTION STANDAlUb
GROUNDWATER SECTIpON_�
. WIllhfe StliditagoOdivisidn of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-3t11, within 30 days. GW-1 REV. 07/2001
Size
in.
in.
Material
tocelA
Topographic/Land setting
❑Ridge INSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
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 on road names.
a&lLit lig4
list iv c
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
TA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
C11
SIGNATURE OF PER
� 9�� 7/0 `z—
CONS CnNG THE WELL DATE

263432
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiioon� / , /
WELL CONTRACTOR (INDIVIDUAL) NAME(Sprint)�Q671-eif ifeA( ///�Nt),,iir1r/�/-�y� CERTIFICATION # 4/f7/
WELL CONTRACTOR COMPANY NAME .C1r-.002t.s LO 1 I .1*- t• Izl2 U PHONE # (f77 b yy"DY a 6
STATE WELL CONSTRUCTION PERMIT# WA ASSOCIATED WQ PERMIT# )Y 4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tit Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT-IO7-N)�: /� �n
Nearest TT: / 7 /2i1q/�LrA.L'� County2darLea.c,
(Street Name, Numb: ommunity, Subdivision, o., Zip Code)
3.
OWNER:
Address e17
(S or Route No.)
� 44-er mac.
City or Town State
sc-M' tea/
a EC
Zip Code
(yam- 775-?5'%5
Area code- Phone numbern
4. DATE DRILLED 7// 7/O f -
5. TOTAL DEPTH: oI y.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f$
7. STATIC WATER LEVEL Below Top of Casing: >% S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5- FT. Above Land Surface*
• *Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): /O ME HOD OF TEST
10. WATER ZONES (depth): l A t /f) Q
Topographic/Land setting
(Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
....€4.1.40
11. DISINFECTION: Type
12. CASING:
Depth// Diameter
From0To 7i% Ft. /nL
From To Ft. 7
From To Ft.
13. GROUT: Depths ,,, aterial Method ,
From. To____0_, Ft.
Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
Fro To Ft.
Amount lD C L- Show direction and distance
Wall Thickness two State Roads or County R
or Weight/Ft.Material numbers and common road
From To
16. REMARKS:
I ir60 }{REAP CERTIFY-
ECGNSTRUCTLQN STAND
IIII L../Lguhmit the original to t4e Div]
A �.4 hboiiti..1(929) 733-:
1
LOC TIO TCH
miles from at (east
Include the road
es.
0
0
01
s
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 N r
ATURE OF PERSON CONSTRUCTING THE WELL i DATE
sion of Water Quality, Groundwater Section, 1636 Maii Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

263431
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION#2 7�7
/` p
WELL CONTRACTOR COMPANY NAME } o /[.Yt-I i ALLY !/Y .�/J:7 Z PHONE it (,Y h y f' f O e
STATE WELL CONSTRUCTION PERMIT# Aii ASSOCIATED WQ PE'Iih11T# N/'Y
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential , Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest To
Co ty /ieOer`e
(Street Name,
Numbers,
Community, subdivision, Lot No., Zip Code)
3. OWNER/� l*f.)�ilG tL�r.(��C
Address et)
hir
City or Town
(SPt or Route No.)
State Zip Code
R 7Si---
(.."
Area code- Phone number��b / b
4. DATE DRILLED /G/G//
5. TOTAL DEPTH: ,Z E - 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j'
7. STATIC WATER LEVEL Below Top of Casing: ,>2 !) FT.
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS A 5 FT. Above Land Surface*
• *Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): is, 5 METij,OD OF TEST
10. WATER ZONES (depth): ,/n er / Co
11. DISINFECTION: Typeea_ — Amount _ b Z Show direction and dis : ce in miles from at least
12. CASING: Wall Thickness two State Roads or Co ty Roads. Include the road
Depth �Jameter ojr Wei/lit/Ft. Material numbers and common �. ad names.
From 0 To JZ) Ft. ,4 P 0t -
From To Ft. From To Ft.
13. GROUT: Depth ,, n� Material -
From�_ To Ft. turn, sa-
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. REMARK
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
EP
From To
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tom_
OF PERS
UC'rING THE WELL DATE
t the original to the Divi ion o Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ptypi 3221, wthin 30 days. GW-1 REV. 07/2001
ASHEVILL E REGIONAL OFFICE

263430
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section o �-7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cif D IVA/QI C j /i i I —
CERTIFICATION ib /O, 7 / �j�
WELL CONTRACTOR COMPANY NAME �CJi.1 LPL s ee Ii) UY//i.C-Gc.u/ PHONE # c' 4y7-U4U`�
STATE WELL CONSTRUCTION PERMIT# Ai/ ASSOCIATED WQ PERRMIT# N, /
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Pi, 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:��� �Q
Nearest Town://-�R / /n/ County7/7
roVc, N/b.RCh 41.
(Street Name, Numbers, CCommuni/ty, Subdivision, Lot No., Zip Code)
3. OWNER:1Zt% ✓��%�%�«
Address PIA, 1�d.7 e c) 69-/ Si J
(Svyetor Route No.)
M72/ �a,7 /l, , '7 S.j
City or Town State Zip Code
C--C)"
Area code- Phone number
4. DATE DRILLED Y// /U
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (&
7. STATIC WATER LEVEL Below Top of Casing: 4/ " FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .5 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): ,. 5— METHOD OFTEST%ad-LP
10. WATER ZONES (depth): 6_5' I
11. DISINFECTION: Type
12. CASING:
Depth
From rj To Ft.
Ft.
From To Ft.
From To Ft.
13. GROUT: Depth a Material .Mfthod
iX hocli
Material
'-C2,.i' Amount //7 G Z-
Wall Thickness
or Wei t/Ft. Material
Pi) c.
From To Ft.
14. SCREEN: Depth
From To Ft. in.
Diameter
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge etgiSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH ARILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in mile om at least
two State Roads or County Ro. ' nclude the road
numbers and common road n. • s. ®u1 ��
HERE'BY CERITF
- 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
--„motto
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
9/ii1©'z
t;.18iahigtt'tirofbright/inn the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASNF�p'g�gE1B3�1fh�Aie R9) 713-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
263418
1' Department f Environment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina - o ��]]/J /�,/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /YL �- e A/ UJ A d e S �2' CERTIFICATION 8, 71 Y
WELL CONTRACTOR COMPANY NAME
ASSOCIATED WQ PERMIT#
(if applicable)
�i,rA2.'d�r l/l��/IjG�G %�r/ PHONE 8 (� g9 /�j rD
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
4/ /xi
dig
1. WELL USE (Check Applicable Box): Residential* Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
CountYl_'
o7if2C,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER' / --121—cd
Address sc.,/1 ri. 4,t14) 4! /
(Soot or Route No.)
7110Asiate/- ij Cr 0/3-7.5_
City or Town State Zip Code
( )- 4.15 Nc
Area code- Phone number
4. DATE DRILLED 9/* /O 7
5. TOTAL DEPTH: / C C .
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: a.2 / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.5— FT. Above Land Surface'
' *Top of cuing terminated at/or below land surface requires a
variance 1n accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST-%.i-c-,
10. WATER ZONES (depth): 5 rt
1(/. DISINFECTION: Type 7 Amount b-L
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
v)
From To 70 Ft. 4, -19 #.2/ ©l/G
From To Ft.
From To Ft.
13. GROUT: Depth eat_ — Method r
From 0 Toc�Q Ft. 6 /ley
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Froo Ft. in. in.
From r To Ft. in. in.
15. SAND/GRAVEL PACK:
From To Ft.
Front 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 SICETCH
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...-5-
Lb CONS
Submit the original tothe
Gi276l24631ERtih6EN01019) 73
ASHEVIL LE REGIONAL OFFICE
Size Material
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PE SOON CON:1ttUCTING THE WELL ilATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
z.)
IS L LP
0
U1

263417
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAM (print) I � .f ♦ �£n i A L CERTIFICATION #.23) 77
1e,t�-r 2 t .(_) LGY t 4 PHONE # 10 /D99 CVY
WELL CONTRACTOR COMPANY NAME 1 �+H
STATE WELL CONSTRUCTION PERMIT'S /�/fi ASSOCIATED WQ PERMIT# /I'/47
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential % Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. Nearest WELLLOCA77 esi County
own::�/inn m
(Street N ,NNuumbers, Co�mm/unn�iit)ty, Subdivision, Lot No., Zip Code)
3. OWNER/./S� c/ U�3 l� lid t 2
Address
(S or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 9.�/ it Z.
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Jt
7. STATIC WATER LEVEL Below Top of Casing: qO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5— FT. Above Land Surface*
' 'Top of cuing terminated at/or below land surface requires a
variance In accordanc with ISA NCAC 2C .0/1g.
9. YIELD (gpm): M HOD OF TEST7-G-r14J
10. WATER ZONES (depth):ri t
11. DISINFECTION: Type�y Amount � G
ta
vv Wall Thickness
or Weight/Ft. (P' Material
/ ✓G
12. CASING:
Depth,
/+
From To `/ 0
From To
From_ To
13. GROUT: Depth
From 0 To . LO
From To
14. SCREEN: Depth
Fro
From To
15. SAND GRAVEL PACK:
Depth
From�GTo
From r To Q�"
16. REMARKS: �r7 ic1-/'%i1�o-�-c D'� {-��u^-�
cG?
Ft..
Ft.
Ft.
lameter
Material
//
Ft. / .C4.-nne.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Size
Ft.
Ft.
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
((check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETC
Show direction and distance in mi s from at least
two State Roads or County Roads Include the road
numbers and common road nam
dmwe w 4
7x '*.R gltYlnE71141F —+ no WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND 5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C1l
y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SiiiiniItCfA'Ei(tOfihe Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASMIALlikiREili cPF§10i 733-1221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
263668
North Carolina - Department of Environment and atural Resource$/ - Di(y lion of W. ter Q : lity - Groundwater Section/ /� /�
WELL CONTRACTOR (INDIVIDUAL) NAMEn print) / c elIllsn r li l:I f ( CERTIFICATION `#- (�r kO03 cif-2'G61
WELL CONTTtACTOR COiMPANY NAME / '1 /~" La ton 1 ell ( 11 r 14 PHONE # &2f & h 3-922_3
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERM
(if applicable)
II rt 2(0.7%
I . WELL USE (Check Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ••� 1f �"����jj l�
Nearest Town: _e1. it ounty y &tst
�P 7 7 A4 (3 72 ,t-- ra€.t G 237`s3
(Street Name. Numbers, C6mmunity, Subdivision, Lot No.. Zip Code)
3. OWNER:
Topoggraahic/Land setting
❑Ridge &Stope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
�� A (degrees/minutes/seconds)
Address W Latitude/longitude source:❑GPS❑Topographic map
or (( NA
�� - _l s.\ ci 3 ci w
Le I et. (S
City or Town
z s-1(c1
State Zip Code
DEPTH
From To
( )-
Area code- Phone number,
4. DATE DRILLED -1 I - O Z..
5. TOTAL DEPTH: Z(.i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IF(
7. STATIC WATER LEVEL Below Top of Casing E1O 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 ith I5A NCAC 2C .0118. /1)j
9: YIELD(gpm): METHOD OFTEST(Tzt/OW1 tarn Er
10. WATER ZONES (depth):
I1. DISINFECTION: Typela6IP"L Amount �.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 4)o`^? Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft. e mere (. 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.
Slot Size Material
in.
in.
(check box)
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include thSad
numbers and common road names. _.1 _.
(73
UI
r�l
c)
77.
C>
16. REMARKS:
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
44i- 9• z.o — A Z=
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
276gMtjpAttr iN4011ni 33-3221, within 30 days. GW-I REV. 07/2001
ASHEVILLE REG.OPN`AL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) £ &VC+C't \\- •S .,secs
WELL CONTRACTOR COMPANY NAME CAv e SGwb ,
%eC d S'ACtV punt �^c PHONE # (%2tti (o(5 ZCZ'Z-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
2€1256
CERTIFICATION # r��?
WELL USE (Check Applicable Box): Residential IA Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearestTown: Mor%1rc.-\W County Mad:5o
` h
4}kAo pis ass 7��
(Street Name, Numbtrs, Community, Subdivision, Lot No., Zip Code)
3. OWNER:-S6MrSatlwv, the.sSe r
Address 4D eac>x 223
(Street or Route No.)
Aiexa.. ssc- AC. 2$ io\
City or Town State
(IV )- 1e66- 1627-
Zip Code
Area code- Phone number
4. DATE DRILLED 8-\b-Oz
5. TOTAL DEPTH: WC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: toe FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated odor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): :0 METHOD OF TEST 9:1
10. WATER ZONES (depth):
Topographic/Lang„setting
VIRidge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
•
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
\03 oueC C3ecr3on
to ties Gee+ ire
I1. DISINFECTION: Type ?At s
12. CASING:
Depth Diameter
From i'\ To \OS Ft. Calk
From To Ft.
From To Ft.
13. GROUT: Depth
From O To 7r Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount (e.
Wall Thickness
or Weight/Ft. Material
i1.2 N
:Tl
Material
Cc+r1eAF
Ft.
Slot Size Material
in.
in.
Method
tausea
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
tV
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TA URE 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

Topographic/Land setting
Lorien Lane 28753 DRidge 0Slope OValley ❑Flat
(cheak appropriate box)
(Sued Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
1. OWNER: Bob & Connie Olson (dagrcc✓minutcs/saconds)
Address P.O. Box 939 Latitude/longitude sourec;OGPSOTopographicmap
(Sinai or Route No.) (cheek box)
Madison NC 28753 DEPTH DRILLING LOO
City or Town State Zip Code From To Formation Description
( )-
Area code• Phone number
4. DATE DRILLED jt/16/02
S. TOTAL DEPTH: 'RDQ'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fa
7. STATIC WATER LEVEL Below Top of Cuing; 4 FT
(Vac "+" I(Abova Top of Cuing)
8. TOP OF CASINO IS 1 ' 4 FT Above Land Surface`
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 1C,0111.
9. YIELD(gpm): 17 KET pDORTEST:.rotarY air
10. WATER ZONES (depth): `4
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment end Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION Y 280,9
WELL CONTRACTOR COMPANY NAME n Rnwrn n wrx11 nri 11 trig, inn- pHONt 1 (178 7S2-7779
STATE WELL CONSTRUCTION PERMITS
(if applicable)
ASSOCIATED WQ FERMITS
(If agplioablc)
WELL USE (Check Applicable Box): Residential la Municipal/Public C] Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Marshall
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or WelghVPt. Material
From 0 To 45 Ft..61 /8 Sckt_SD PVC`
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft concrete gravity flow.
From To Ft.
14. SCREEN; Depth Diameter SlotSizc Materiel .0
From To FL in.. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
County Madison
LOCATIONSKET9H
Show direction and distance In miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
Cr)
ry
From To Ft in in. co
16. REMARKS
E ,la
IJC
C111 �
CONSTRUCTION
--1
R f FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C;'WELL
S�TA NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pf�7ib2
IGNATURE OP PERSON CONSTRUCTING THE WELL DATE
11(
ASI ROILLF'NET O' F,�� FFfCpal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raletgh, NC
27699-I 3 FL,l,,, u. (919) 733•3221, within 30 days, OW I REV, 07/2001

WELL CONSTRUCTION RECORD
260174
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater A�kSectigon7p/, WELL CONTRACTOR (INDIVIDUAL) NAM Efprint),57.1 r1/ eh A d er S NT2 CERTIFICATION tb27 7
WELL CONTRACTOR COMPANY NAME AA).ee5 e )�,St,Ljytip � PHONE # 4 /o.1/94yra
STATE WELL CONSTRUCTION PERMIT$
(if applicable)
(if applicable)
4/
ASSOCIATED WQ PERMIT#
y/,Y
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Twtr �,.j�ni�` County1r� YC.
(Street Name. Nmnbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER /4
Address AriroS
7177. .( _Street or � /i/ RouteNo.)
C. r 28'7 s �_
City or Town St to • Zip Code
(---- )- mot//.s�
Area code- Phone number2 /15 t_
4. DATE DRILLED /
5. TOTAL DEPTH: / g,r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO,�(
7. STATIC WATER LEVEL Below Top of Casing: /[j FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Z. C FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan e with I5A NCAC 2C .0118.
9. YIELD (gpm): c S METHOD OF TEST ��C4i[-1".....
10. WATER ZONES (depth): //o 5j 2 /9:6",
11 DISINFECTION: Type
12. CASING:
Depth DiameterFrom ( To7 D FL Co =
From To Ft.—
From To Ft.
13. GROUT: Depth
From 0 To (1C 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
Amount Jr, ,ry'°Z-
Wall Thickness
or Weight/Ft. Material
,4&&J ,1n c1G
El6lEIA13`k
I DO HEREBY CERTIFY
COI$,STRUCTIO.NrS7 ANl
r Jt
GROUNDWATER SECTION
AS iF (€t9�G49N�6,9fFlGFa e D
wision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
LA.
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge %Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
se
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A C THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
E SR ON GUN5I RUCTING THE WELL
7/2/%
DATE

WELL CONSTRUCTION RECORD 260169
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 21ii AL�C S CERTIFICATION *a 7,31
PHONE# R'i 4/7-4 5/(16
WELT. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
40%
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential it Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION
Nearest Town:
(St Name. Numbers, Community, Subdi
3. OWNER
Address
treet or ute No.)
Countyl)/,ZLC
F2g7sy
sion, Lot No., Zip Code)
City or Town State Zip Code
4/#
Area code- Phone number
it,
DATE DRILLED 7/// /D 2-
5 TOTAL DEPTH: .141,S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 7
7. STATIC WATER LEVEL Below Top of Casing: .4 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): _577 METHOD OF TES i—/
i1<J
10. WATER ZONES (depth): 35/ //oD /
Amount g' 07--
11. DISINFECTION: TypefS
12. CASING:
Depth
From (% To.�70
From
From
13. GROUT:
From 0
From
To Ft.
To Ft.
Diameter
Wall Thickness
or#1)2
Weight/Ft. MtyC
Depth Material N ethod
To Ft. d/724r.t7
To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
16. REMARKS:
Depth Size
To Ft.
To Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING L143G
From To Formation Desction,-r
rr-1
ca
r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road namesoo-1"
4,2D THISLL
WELLELL WASCCONSTRUCTEDACCORDANCE
OOS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1/
SIGNATURE OF PE
CONST
1'
TING THE WELL
eAre
P/o
0
y0
e on^inal to f re Dil ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASf}? 6100,odp 733 3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 260161
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
y/,
WELL CONTRACTOR (INDIVIDUAL)NAM�F�(-,(prin.t)fleh,J eN gAE, dcS ham/• CERTIFICATION) 2$"Vr�
WELL CONTRACTOR COMPANY NAM EXy(4s.f2,4)L' e L�.<1 ��.� P NONE # �2stf /y�/J z3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /�
NeareAt Town: County]'%'%(,t.pL'�p�-I,..
," 42-7 s7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a
+I
Address /.2 ho_4- .J
t et or Route No.)
City or Town State Zip Code
(fir)- 89_ 3o 37
Area code- Phone number
4. DATE DRILLED 7A2-V/D Z_-
5. TOTAL DEPTH: it ..5'-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fX
7. STATIC WATER LEVEL Below Top of Casing: 4 b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 5— FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ��Gra#c.
10. WATER ZONES (depth):
1I. Qv
DISINFECTION: Type 4
12. CASING: V
Depth
From O To ,,2p Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From n To t.% f) Ft.
Topographic/Land setting
❑Ridge tfirSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Amount 4 02—
Wall Thickness
D)ameter or Weight/Ft. Material
.2� ©t/c
Material `
w \I
From To Ft.
14. SCREEN: Depth Diameter
From o Ft. in.
From To Ft. in.
LOCATION SKETCH
Show direction and distance in miles frotr least
two State Roads or County Roads. Include the road
numbers and common road names.
Method ,
_I FlY
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth/ Size Material
FromFt.
From /// To Ft.
I D IILREB\ CERTIF}
CONSTRUCTION STAN
CCO tip...:!.
GROUNDWATER SECTION
ps”nnuttnerigiRatmotIte Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2769v-1-636 rhdrwrNCZ919J)'I3S3221, within 30 days. GW-I REV. 07/2001
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPS' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
< x
�T� 1
SIGNATUR OF PE ON CON RUCTING THE WELL
747/6 z
DATE

Il�
257684
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNatural REUBENs CALDDELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 214
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. FHONE448 I?54-3581
STATE WELL CONSTRUCTION PERMIT" 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 9Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /N4/24
fl'qifiee
.
(Street N e, Numbers, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER. �` ,t -24 -
Address /e'r1 % / Cie r,-0
sfrisaeet or Route o.)
County �,/Yf%/ss+�
City or
TownowState Zip Code
(g)-rrr,4 .. O2 //
Area code- Phone number /
4. DATE DRILLED 7/ r2_9/ 2—
5. TOTAL DEPTH: ` /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: i.e FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2-0 METHOD OF TEST
10. WATER ZONES (depth): /i/LS� - 7—C (y-7"i1
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
11. DISINFECTION: Type
12. CASING:
Depth
From To •70
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2/1
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARK
(
7//7 Amount 3 07
Wall Thickness
Di eter or Weight/Ft.
Ft. itz f
Material
Ft. .47--sivaLt
Ft.
Diameter
in.
in.
Slot Size
in.
in.
Material
Size Material
Material
O
LOCATION SKETCH c
Show direction and distance in miles from art least_
two State Roads or County Roads. Include 0 _:
numbers and common road names. M
ib
B'5•
a:
0
4 lr
10; rdu `t
f? 13
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THFr WELI1 OWNER
////
IGNATUI OF PEN CONtS`I'RUCTING THE WELL ' DATE
1/Lt/D v
RpQ}1Frshti -#! @opipe Div sion of Water Quality, Groundwater Section, 1636Mall Service Center - Raleigh, NC
Asjj IP-II(61t!M pgNap01m733- 221, within 30 days. GW-1 REV. 07/2001

257718
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman ' - CERTIFICATION If 2809
WELL CONTRACTOR COMPANY NAME ID Rnwman Wel 1 Dr i 11 ing Tnr PHONE */ fi7Pi 757-7779
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LX 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: Marshall County Madison
12.5 Pe^tnr le-rner Renal --Marshall 28753
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Srntt Luther
Address 17R5 Rertnr rnrnnr Rnari
(Street or Route No.)
Marshal], NC 28753
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 7/15/02
5. TOTAL DEPTH: 220 t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IS
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST rotary air
10. WATER ZONES (depth): 210
Zip Code
11. DISINFECTION: Type tablet
12. CASING:
Depth
From 0 To 27
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.51 /8 Sc.h-_8D pvr
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
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material Method
Ft.
Ft.
Diameter Slot Size Material
in in.
in. - in,
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
RLS d1(3 1S11RUnTltr'YN SICi1
D , -- _,
T THIS WELL WAS CONSTRUL1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N. 7 a.okat•,
n
IGNATURE OF PERSON CONSTRUCTING THE WELL
7/42--
DATE
i
Submit the original td the a ivision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
--2469-9.71-631 PhontNba(919) 7 3-3221, within 30 days. GW-I REV. 07/2001
M

257441
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ��//
WELL CONTRACTOR COMPANY NAME./�LCV
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
atural Resources - Division of Water Quality
ASSOCIATED WQ PERMIT#
(if applicable)
- Groundwater Section
CERTIFICATION tibiq/7
/ /[
PHONE #r) �ON 7.D�p/
iv/if
I. WELL USE (Check Applicable Box)' Residentiale Municipal/Public El Industrial ID Agricultural 0
n
2. WELL LOCATION:-j��rr��79,,,, //
844,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Monitoring ❑ Recovery El Heat Pump Water j ction ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge I�QSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Nearest
3. OWNER:
Address
(Street or Route No.)
Nr f, 8'lo,S,J
)/3.
own Stat Zip Code
I— 2 9/
County
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 02 p J-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /jam 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 accordane with 15A NCAC 2C .0118. EST .L.r1�f
10. WATER ZONES (depth):
9. YIELD (gpm): fr MyTHOD OF
EST
o
11 DISINFECTION: Type 9,� Amount 96z.
12. CASING: VV Wall Thickness
Depth Diameter or Weight/Ft. Materialal
From 0 To %.45 Ft. #`�
From To Ft.
From To Ft.
13. GROUT: Depth
From 0
From
14. SCREEN:
From o—
From To
15. SAND/GRAVEL P CK Mate
De h Stze
From o Ft.
From To / Ft.
Ft.
To Ft.
DcptiV Diameter Slot Size Material
Material
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCAT •N SKETCH
Show direction and di- ance in miles from a east
two State Roads or Co my Roads. Inclu. the road
numbers and commo oad names.
.� 1W4
F
Method
(A) /vL-LT
Ft. in. —� in. 7
16. REMARKS:
ITI-FRyCTi ION
Sulbmit the original to the
J61¢,ph,,„i rye' (91-9-).?A3-322
PnoN
AS EV iL',_E I f I 01 _Iy
3-4
C'kr
91
w
WELL WAS STRUCTED IN
LL
D THAT A COON OF THISACCORDANCE
RECORD HAS BEEN PROVIDEDTO THE WELL OWNER
D d
NATURE OF PERSON CONSTRUCTING THE WELL
n of Water Quality, Groundwater Section, 1636 Mail Service Center
I REVgh, NC
I, within 30 days.
0
n _

255015
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
��rr 11 e K. 50.ta
WELL CONTRACTOR(fNDI�'fDUAL)NAME (prl1int)L�ta CERTIFICATION #
WELL CONTRACTOR COMPANY NAME CIla2. 604C.C3d.SDn. we k- .nt C tPHONE # (SAOt ass 768g
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if. applicable)
1. WELL USE (Check Applicable Box): Residential zf Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: / SM41 County NAca Iao-
Mat ti PAP" "S
(Street Name. Numbers, Nmmunity, Subdivision, Lot No., Zip Code)
3. OWNER: ApAC
Address
(Street or Route No.)
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED (e• '-Ot
Zip Code
5. TOTAL DEPTH: 'TINS
6. DOES WELL REPLACE EXISTING WELL? YES NO Gi
7. STATIC WATER LEVEL Below Top of Casing: 5
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15e METHOD OF TEST Rt
10. WATER ZONES (depth):
11. DISINFECTION: Type ?i,IIS
12. CASING:
Depth Diameter From }I To 10 FL21 —ri-35L-C
From To Ft.
From To Ft. —
13. GROUT: DepthMaterialMaterial Method
From (2 To Ft. CenenJ fbr<re d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1n—
From To
From To
16. REMARKS:
IDO
CONSTRUC
Ft.
Ft.
Amount la
Wall Thickness
or Weieht/Ft. Material
o Grad,te
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
DO
a
c
a
IV
J
0
c.lt
J
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NA•• RE OF PERSON CONSTRUCTING THE WELL
Submit the ori
lginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
iVRaleigh,
07 2001
27649-1Gone No. [phone], within 30 days.
DATE

255014
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C`riLp K S0.'t-t+17 C5
CERTIFICATION # 2-4 1(o
ack cs Son. is) l'II Ye.,r.; iitG _PHONE # (k"ftl tZ'S57y
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential d Municipal/Public ❑ Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION: / , /
//
Nearest Town: AA,deSh /(
County
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 9oan toMinor-
Address PO x 1,00
(Street or Route No.)
biatSlr:a /11c e2$754
City or Town State Zip Code
(I-1-4)- Ces9 • 9300
Area code- Phone number
4. DATE DRILLED 6-10.6t-
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZI
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): E METHOD OF TEST
10. WATER ZONES (depth):
R15_
11. DISINFECTION: Type ?SS
12. CASING:
From
From
From
13.GROUT: ao Cenea
From 0To
From To
14. SCREEN: Depth
Slot Size Material
From To
in.
From To in.
15. SAND/GRAVEL PACK: Material
Depth Size
Amount 7
Wall Thickness
Depth Diameter or Wei eht/Ft. Material
i-I To Wk FL 21
To Ft.
To Ft.
Depth Material
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
From To Ft.
From To Ft.
16. REMARKS:
—_
ttE131-rEKTir 1'
CONS RUICTION STA
Submit the original o the
-276T/4636P h..gr (919)
OFFICE
Agricultural 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
Method
&tare d
yy 205 Grande
s
LOCATION H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
-�.-
SI t MATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service CGwrl REVgh, NC
i33-3221, within 30 days.
O
r_
C
N
a
O
C.11
J
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
DATE

2. WELL LOCATIO
Nearest Town: ��N: //
L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CI: e_ K the tCS CERTIFICATION#s 76
8 S
\YELL CONTRACTOR COMPANY NAME l.)tirl e `em8"rS�1
u s tS a SDY\ 14 tT ; fitG PHONE # (02
STATE WELL CONSTRUCTION PERMIT# 4
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
255012
1. WELL USE (Check Applicable Box): Residential of Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
County
,00,4itt
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (j?tow.e.,e `15^:tr..
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED (0" %A" 0 Z.
5. TOTAL DEPTH: \tS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type ; t %t t
12. CASING:
Depth
From .14 To Sri Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From (0 To 20 Ft.
Diameter
is
Amount (�
Wall Thickness
or Weight/Ft. Material
Lk 2 L _rate
Material
Cement
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:
PDO HEREBY !LE tf i-yr
�CONSTRUCTtbN,S� i
II '
Submit the original to th
276994636 pho (919)
Method
&ere el
Slot Size Material
in.
in.
Material
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-) 53 ()Vf r Aerdnn
5 S 1 Z S 6-n2 ;te
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
LS:014iV LafinrZD
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
/—D.
DATE
- ION ION * ■ - OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentter1 REVgh, C01
733-3221, within 30 days.

255032
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) Sst
NAME (print) CU4Cje K :�>-1+y CCS CERTIFICATION #
WELL CONTRACTOR COMPANY NAME el lae `60,0itt.csa,]oi. well r'�,.v. C• PHONE # (v 0255 76iSy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 7404- set : qa t County t%ad:3 e,—
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: O:aat Sprat
Address (ptoe, Hecasot. Fen ISa
(Street or Route No.)
Filet ser:nd NC Zs7t/3
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ✓�" -0 2
5. TOTAL DEPTH: %O5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 56 METHOD OF TEST R
10. WATER ZONES (depth):
t 1. DISINFECTION: Type 1 113
12. CASING:
Depth Diameter
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-i SS Otit r Atrann
61n5 irrnn:te
1 N o
C...n__
From To Ft. C V
13. GROUT: Depth Material Method Iv
From 0 To 20 Ft. Cenci¢ ifbc<re d —4
From To Ft. A
14. SCREEN: Depth Diameter Slot Size Material '—
From To Ft. in. in. o (/rn
ra
From To Ft. in. in. 1 .....t
15. SAND/GRAVEL PACK: CO a
Depth Size Material =
LOCATION SKETCH
Amount S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names. c:
From 14 To;S 3 Ft. 0 21
From To Ft.
From To Ft.
From To Ft.
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s-er- o a
1
Submit the original to the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276994636-PIWUt.NQS19) 7 3-3221, within 30 days. GW-1 REV. 07/2001
S ATURE OF PERSON CONSTRUCTING THE WELL DATE

255027
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)CIrydt2 K. Sat -Iles 5 CERTIFICATION # a4•
WELL CONTRACTOR COMPANY NAME `- lu2 `->Q'J �S a •S4 n WWII tf1a�-P &tL PHONE # (St M t255 Val
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential VI Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town: Mar N:t% County :Sow
(Street Name, Numbers, Community, Subdivision, Lot Na, Zip Code)
3. OWNER: MAC.
Address
(Street or Route No.)
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 5- l4-o t
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Z
7. STATIC WATER LEVEL Below Top of Casing: VD FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9, YIELD (gpm): /00 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type P,YI S Amount 9
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From f-I To 3'I FL A21 ri 45E1'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CORMfbure d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS,;
t
-1 I I DO IFEREfrreeltiY:Y
CONSTRUCTION STA
I
•
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
4-I 37 Dvrr Ate Ann
4f05 6ran;te
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
co
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a 2
ICi t 1URE O N CONSTRUCTING THE WELL DATE
G f1 1 i'Nfg},i4� kr' 71Q l
ASH � �tRLGir°,�i�aC�aF��the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
47699-1036 ?none lCo. (vtY) /.0-3221, within 30 days.
GW-I REV. 07/2001

255026
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Cyrtp K .&10.L1ty7 C5 CERTIFICATION # 0-4
WELL CONTRACTOR COMPANY NAME n UW,tC n�.so n. iWP1I 4-1a. el 9tG PHONE # f27S) 355 nag
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ FERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential if Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearast Town: (Aar61-0.\\
Mur Mth "Sob
(Street Name, Numb rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
County Masi: Se. -
(Street or Route No.)
City or Town State Zip Code
( Area code- Phone number
4, DATE DRILLED b' IL-0 =-
5. TOTAL DEPTH: 110o5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing: Qb FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 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): 100 METHOD OF TEST_'
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.I.t 37 0vrr Rer.lnn
11 DISINFECTION: Type
12
CASING:
Depth
From f1 To 37 FL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (7 To 20 Ft. Cenen¢ fbure d
31 4L5 Graa,te
LOCATION SKETCH
Amount iO Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
A21 _OASIS
644
From To Ft.
14. SCREEN: Depth Diameter
From To Et. in.
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
D6 HREgY CERf ,F.
CON rctl ON
L �attmitlhgsrigin{tl to t
r 21691163tthii(dkd No. (91
Ft.
Ft.
Slot Size Material
in.
in.
Material
0
cri
co
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL
DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center �Vgh, C
9) 733-3221, within 30 days.

255025
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cap K So."t : 5
WELL CONTRACTOR COMPANY NAME I 5a +
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
On.
W
CERTIFICATION # 3-4 AL•
PHONE # tA"Sil e255 7Gbg
1. WELL USE (Check Applicable Box): Residential e Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use_
2. WELL LOCATION:
Nearest Town: SACSki it County AAA: 6e►-
$4N''S Ala. `Sa6
(Street Name. Nun -Peers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Attie
Address
(Street or Route No.)
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED S•20-oz
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): $o METHOD OF TEST_ R;
10. WATER ZONES (depth):
11_ DISINFECTION: Type p:II it
12. CASING:
Depth Diameter
From fl To_ Ft. (DT
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (7 To 20 Ft. Cenenf
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Amount $
Wall Thickness
or Wei cht/Ft. Material
/k ZL _1135iit
Method
rc re cl
Slot Size Material
in.
in.
From
From
16. REMARKS:
f SO EkB13Ij C -
F---N Rt CTION
GELLW
ASur19..--
�i�
$nhmit the ori�inal t
*)49-1.4341(litinc 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
- 46 Over Act -Ann
45 SoS Gran.'fe
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3
0
(P1
co
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
aZd — G a
GNAT PERSON CONSTRUCTING THE WELL
the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl �Vgh, NC
919) 733-3221, within 30 days.
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER
(if applicable)
WELL USE (Check Applicable Box): Residential Pi Municipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
(if applicable)
255024
it - Groundwater Section
Resources - Division of Water Quality
CERTIFICATION # (o
PHONE # (vs) ass n$$
1IT#
2. WELL LOCATION:
Nearest Town: " stssa.%t
County pit cuse,j..
(Street Name Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: P3 vac ne,-
Address '707 'cosies *Awe Re
(Street or Route No.)
Matekat% N23163
City or Town State Zip Code
(4s8)- b89. 4 201
Area code- Phone number
4. DATE DRILLED S•2t•et
5. TOTAL DEPTH: ZLS
6. DOES WELL REPLACE EXISTING WELL? YES NO lZ
7. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (epm): (0 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From d I To N2
From To
From To
13. GROUT: Depth Material Method
From (7 To 10 Ft. Cement ,A, re ul
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
f ; 1\f Amount el
Wall Thickness
Diameter or Weight/Ft. Material
Ft.
Ft.
From To Ft.
From To Ft.
16. REMARKS:
a., I DO BEAgtiy
CONSTRUCTION
Agricultural 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
4-1 yy Over Arralen
42 225 Gran;te
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
_i
0
c-n
I0
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—.?/- e�
Submit the original to
Gc ".276W1636flGr?hc No. (
ATURE OF PERSON CONSTRUCTING THE WELL
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh,
C
19) 733-3221, within 30 days.
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
(+i a :0.LIsyE CS CERTIFICATION #�.a(>
WELL CONTRACTOR (INDIVIDUAL) NAME/�(print)rat ld i
WELL CONTRACTOR COMPANY NAME Ctt a,e ectoAt Sa.5or. Well Z'�a/rnfr �G PHONE # (27A e255 76,8$
STATE WELL CONSTRUCTION PERMIT# v ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
255022
WELL USE (Check Applicable Box): Residential e Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: i"1o...R:O County M4dc Sr
-
(Street Name Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ccrrs1 11:91:ss
Address b2o Fe a linteon lnr 0.d
(Street or Route No.)
Morstl:lt /uc754
City or Town State Zip Code
(flt- On asgs
Area code- Phone number
4. DATE DRILLED 5. L• O L
5. TOTAL DEPTH: saps
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing: 22) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Z METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From +4 To 50
From To
From To
13. GROUT: Depth Method
From (7 To 20 lbure_d_
f:tti
Amount to
Wall Thickness
Diameter or Weight/Ft. Material
Ft. (ate # 21
Ft.
Ft.
Material
Ft. Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
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
SO Over Aercinn
Sn Zo5 Granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. c
0
L
C
;,
N o
�l =H
z-
tn;It-
ma
cry -,
m G
O -
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F r CONSTRUCTION SiTA S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
! t_.� _.. -- DATE
/I SI . ATURE'OF PERSON CONSTRUCTING THE WELL
Submit the original t the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center' REVgh, NC
11, 27699 1636 Phone No. 9 9) 7�3-3221, within 30 days.
RCF

255021
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prrint)Chide+ K Saul ttZCS CERTIFICATION # ail vf.
WELL CONTRACTOR COMPANY NAME Ctc.ipe 64u e-e5d.5Or. we YiC
v elf ' PHONE # (b' M 855 7GSg
STATE WELL CONSTRUCTION PERMIT# 4 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential e Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town: tintSla% County "aim)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'Soh.. /^once
Address Po beat =ot'I
(Street or Route No.)
MtLeSHW► pt.
City or Town State Zip Code
(In)- pn $he♦
Area code- Phone number
4. DATE DRILLED $'2ne•S
5. TOTAL. DEPTH: aes5
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
4-i f7 Ver An -Jan
Al
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. q
9. YIELD (gpm): 8 METHOD OF TEST Rt h_
10. WATER ZONES (depth):
11. DISINFECTION: Type ligs
12. CASING:
Depth
From i't To 2% Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (. To 20 Ft. Cenent fbure d
Amount 1
Wall Thickness
Diameter or Weight/Ft. Material
(,L 121 pJ �i5ts
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.
205 bran; to
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
O
L
C
N
O
t:d7
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION LAN DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S-2 y a2
r DATE
IGNATURE OF PERSON CONSTRUCTING THE WELL
h, NC
Submit the origin the Division of Water Quality, Groundwater Section, 1636 Mail Service CeeJntrl REV eig07 2001
27699-1636 Phoni1 No. (a19) 733-3221, within 30 days.
_JJ

255778
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),4L L e A/ /174 if O G^S .TR CERTIFICATION *a 77.V. ry
PHONE # Imo'). to �'7 n �i$-a
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
4,
ASSOCIATED WQ PERMIT#
(if applicable)
edit
WELL USE (Check Applicable Box): Residential I ' Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name. NumJ/1
3. OWNER: if- LGL W Aan-2, .iCJ�•�f�GGK
Address A 8a//l/6
(Streef or Route No.)
717al -/-i ,r/. c . ,.28 7 - 3
County6.41:42„.c.
Community, Subdivision, Lot No., Zip Code)
ity or Town State Zip Code
(k /o3/9-n 99
Area code- Phone number /
4. DATE DRILLED) 6 //a O 2--
5. TOTAL DEPTH: .9r,5-'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO PQ
7. STATIC WATER LEVEL Below Top ofCasing: .2..5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,..1 METHOD OFTEST Tie- U
10. WATER ZONES (depth): epn ' /.2Sr
11. DISINFECTION: Type �4Ct�i
12. CASING: //
Depth Diameter
From D To 7 D Ft. io
To Ft.
From
From
13. GROUT:
From
Amount 7 OZ.-
Wall Thickness
or Weight/Ft. Material
.2/ /UC-
To Ft.
Depth s� ��rr Material
To�0 FLJ`rs'/.f.r?ri
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To F in. in
15. SAND/GRAVEL PAC
Dept
From
From
3
16. REMARKS:
the
919)
C710N
Topographic/Land setting
❑Ridge OSlope 1KValley ❑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 Descriptioth
O —
LOCATION SKETCH Waf
Show direction and distance in miles from at least 0
\\o State Roads or County Roads. Include the road �-
mtrYtbers and common road names.
\T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AI�D,T.j-IAT A COPY,QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
37/f/a r
DATE
3-3221, within 30 days.
SIGNATURE OF 'fr1 SON (r 4STRUCTING THE WELL
ivision of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
40.

WELL CONSTRUCTION RECORD
North Carolina - Dcparnncnt of Environment and NaturalSaurResoycei - Di isi2n oftWater QualityYit- Groundwater S ction
WELL CONII:AD OR (INDIVIDUAL) NAME (print) i((....1X L yyrtttMMLL�� ( t..0 ft..14 '1 CERTIFICATIOF+Wa' ,Q 5
WELL CON'I' RACfOtt COMPANY NAME �.. ily.�tl • PHONE M '�n5+ rt-3
STATE IIEI.L CONSTRUCTION PERMITW
l if applicable) ;. WELL USE (Check Applicable Box): Residential VV.-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 1•
Nearest Town:111' Y3 It\
County] LL
ISiroci Name. Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: Ty., 1 k.' \ \tN.
Address 'f3 C x N1/2"
l (Suan or R okro.1
City or 'ruwn State Zip Cale
( )-
Area code- Phone number C
4. DATE DRILLED —3- 3 - Z"
5. TOTAL DEPTH: t .O 1
h DOES WELL REPLACE EXISTING WELL? YES 0 NO [B'
ixt
7. STATIC WATER LEVEL Below Top of Casing. \CQJ FT
(Use "t" it Above Top of Casing)
S. TOP OF CASING is FT. Above Land Surface*
-Tap of casing terminated at/or below land surface requires a
9. YIELD(gpm): Z-C METHOD OF TEST gal • axle W.-4k)
Submit the original
27699-1636 Phone No. 919)
GEO'J:ND':VA LT:: SECTION
ASHEVILLE REGIONAL OFFICE
variance in accordance with 15A NCAC 2C .0I1S.
10. WATER ZONES (depth): �D C-'
ASSOCIATED WO PERMIT
I I DISINFECTION: Type_ Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To_5 Z- Ft.
From.
From
From
13. GROUT:
From
From
la. SCREEN:
From To Ft. in
From To Ft. in
15. SANDiGRAVEL PACK:
Depth Size
Frorn To Ft.
From To Et.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWP i=R
e (h)t-0 (_-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
rvision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, JC
3-3221, within 30 days. GW-I REV. 0' 12001
ToFt.
To Ft.
Depth Matenai Method
To FI.fl CY2t uY
To Et. — —
Depth Diameter Slot Size Material
in.
in.
Material
(if applicable)
254/767
Niessomo
Topo_grapp is/Land setting
ORidge SSiope CValley Cii�at
(check appropriate box)
Latitude/longitude of well locatiet
(dagreenminutcsrseconds1
Latitude/longitude source:❑GPS❑Topogtriphic map
(check box)
DEPTH DRILLINai LOG
From To Formation Description
LOCATION SKETCH c7
Show direction and distance in miles from'btA asl o
two State Roads or County Roads. Inciudt(the road=
numbers and common road names.
lg- L-3
k \
.PC)k %\c
(ate; 61, \C3A
VICC
W

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural I urces
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
((pprin�t)(JdYWV(( CI
WELL CONTRACTOR COMPANY NAME 14 ,Cl /CILIA v_.'R
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMI
(if applicable) (if applicable)
254750
Division of Water Quality - Groundwater Section
nk_F1�i Ih6\c CERTIFICATION
2�3
N# �
11 [WI nil( PHONE # frTIcs s- eft z 3
Zl5
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i(' (r 'et \\ ` Countyfa d I SP�1l
(Street Name.. Numbers, Community, Subdivision, Lot No.. Zip Code) TI 3. OWNER: O) (and)hYtttf v'
Address 7ZithH.1-0...1(�LCt' DC•
�Y ,l,tarR�Q . "Cr 52
City or Town 'State Zip Code
Area code- Phone number
4. DATE DRILLED 5- Z."C Z-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FY
7. STATIC WATER LEVEL Below Top of Casing: ''i O FT.
(Use"+•' if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C -MIS.
5. TOTAL DEPTH: .3O I
10. WATER ZONES (depth): I .5
11. DISINFECTION: Type -19C1 eL r Amount 'L
12. CASING: WallThickncss
Depth to., Diameter or Weight/Ft. Material
From CO To qU FL
From To Ft.
From To Ft.
13. GROUT: Depth ,q Maten`_aJ) '-rr,n,
From To Ft.CtU11C7-e4t
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 Et.
Topographic/Land setting
[Midge ❑Slope ❑Valley !Eclat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
9. YIELD (gpm): (A METHOD OF TEST gig. � • C& k 'v
W
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/9- z3
Met o 11 0 9 213
3
wu11J1 C°Y-Thk , d •
Lives-rci
LkMQY `-1-0Y1kird •
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND ' •S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
mit the original to the D 4'iii
9-1636 Phone No. (919) 7131.S2
G cUND n 5LC 1C(J
ASEE`tILLE r PICE
"15-Qt.
NATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
, within 30 days. GW-1 REV. 07/2001

254R63
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IADIA'IDL'Al,) NAME (print) S CERTIFICATION..tit.,.-5S-
WELL CON" It.ACTOR COMPANY .N,UIE e to a) Lim$ GY LULL) PHONE *0(p•t!i) (y 1-1- ith t
SPATE WELL CONSTRUCTION I'ER.MIT# ASSOCIATED \\Q PERMIT#
of applicable) (if applicable)
WELL USE (Check Applicable Box): Residential EV-Municipal.'Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: AAa YhkM 11
County /1/In,A' 6z•
IStrect Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,`tsar/ F6 k
Address 8i 5(! Mc_rrinn) / tk)Uc-
(Street or Route No.)
lyt iR$ 0 t-1
Cily or Town State Zip Code
( 1.61- 4r)S iii
Area code- Phone number
4. DATE DRILLED f- 1/ - Q
5. TOTAL DEPTH: 38r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use "+" itAbove Top of Casing)
8. TOP OE CASING IS I FT, Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance in accordance with 15 A NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD OF_ TEST fi e
10. WATER ZONES (depth): 3Lt 5
I I. DISINFECTION: Type Amount / 5/
12. CASING: Wall Thickness
Depth �7 Diameter or Weight/Ft. Material
6
From / To 2 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From / To 20 Ft. C.erx.,- 7(J,u ei
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
Front To Ft_ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
l'opographici Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(degrees. m i nu ICS Seconds I
Latitude/longitude source:❑GPS❑Topographic map
(check bo'l
DEPTH DRILLING LOG
From To Formation Description
I - 2D 64.e Lt
fV
-0
LOCATION SKETCH
Show direction and distance in miles from at lea
two State Roads or County Roads. Include the read
numbers and common road names.
"D LQn , 9 Cfl tv
A
Ed cn ii tI
.L Ccurvo..-Via
-itk it
i(c4.iui
If:DO HEREBY CER1IErTI
C-0NSTRU TION STAI
G-C
L
It
-HS WELL WAS CONS
\ND THAT A COPY 0
tat c-4-2
GNATURE OF PERSON CO;
Submit the original to th Divit ion of Water Quality
26(\'ChL,6 AAThicit9'SOTINW) 733-3221, within 30 days.
ASHEVILLE REGIONAL OFFICE
r
( ED IN ACCORDANCE \VIT( I l_ NCAC 2C, WELI.
RECORD HAS BEEN PRO' DE. 0 THE WELL (1W).EI(
TRUCTING THE WELL
GROUNDWATER SECTION
Gro41YtwAtetSiet31ilivit6.WWtih s
DATE
ce Center - Raleigh, NC
CiW-I RFV. 07 2061
c-i -`

251662
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
p
WELL CONTRACTOR (INDIVIDUAL) NA)IE (print) A:{'z;G> / /¢ ALA�� �- . CERTIFICATION N / a5
WELL COS'I'R.\CTOR CO\I P:\Nl'N:\VIE ix/ IU3 tt( to, i( PHONE it )
STATE WEI.I. COSST RI:CTION PEIt\IITX
tit -applicable)
\SSOCIATED WO PER\IITtt
(if applicable)
1. WELL USE (Check Applicable Box): Residential C13' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ✓L(wt6143) ( County /4\a.ci.." -
(Street Name. Numbers, Community. Subdicisian, Lot No., Zip Code)
3. OWNER: citanrt Jt, tJ t
Address . 3F? i / tii ft& IVe !�
(Sweat or Route No.)
411.4- r=shalt T ('-
City or Town State Zip Code
G y9 q4'
Area code- Phone number
4. DATE DRILLED ter- / - D i-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO @-
7. STATIC WATER LEVEL Below Top of Casing: 7 C. FT.
(Use ">' if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST f?r17
10. WATER ZONES (depth): / 6 5
1I. DISINFECTION: Type r,.-.,ua1 £ Amount
12. CASING:
Depth
Frorn / To_ Ft.
From To Ft.
From To _ Ft.
13. GROUT: Depth
From ) To ',LO Ft.
Wall Thickness
Diameter or Weight/Ft. Material
/ F'.; ; Aka IyC 1
Topographic/Land setting
❑Ridge 0Slope eV -alley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/ e t
2U k'3 c t
c-
O
IV
LOCATION SKETCH ca
Show direction and distance in miles from at le=
two State Roads or County Roads. Include the road
numbers and common road names.
SX
Material Method jL c,1 /1 L1 ) -"No td
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
In.
in. 2.,c
���u L.t U--1'
Material
16. REMARKS:
CPS ('T\1 15
F THIS WELL WAS t
S AND THATACO
a /,, :.,�
L <_o
!rr Fr
eCEd W TH I5A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
) S A cz
SIGNATURE OF P=LSOt' CONSTRUCTING THE WELL
Submit the to the D vision of N ater Q )alityAS#7,r+I.Ii r$910 CE6 Nla
GROURID WZRShgNp t 9) 73 t-3221, within 30 dar
ASHEVILLE REGIONAL 0 H
DATE
1 Service Center - Raleigh, N('
GW-I REV.07/2001

254648
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat ral esourrceess'- Division of Water Quality - Groundwater Section y�
WELL CONTRACTOR (INDIVIDUAL) NAME (/pp�rint)tJUyyv5(r/ Alt -add ((O� CERTIFICATION #
WELL CON'I'ItACFOR COMPANY NAME cleah%(b.?a tCf (AlCII PHONE # fp-13) L2 X-I QALI
STATE WEI.L CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O. If Other, List Use
2. WELL LOCATION:�A
Nearest Town: Mon,
County MacL i
(Street Naine. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: /nnAAA, b
Address dD Loin Cal,
amt.-
R.d-
(Street or Route No.)
/IlI a.rn lbc{l 753
City or Town State Zip Code
Ogg )- eta /1 /3
Area code- Phone number/
4. DATE DRILLED 7 44 'a
5. TOTAL DEPTH: 26
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: o0 FT.
(Use "+" if Above Top of Casing)
8. 'FOP 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): tS METHODS' TEST i-ti
10. WATER ZONES (depth): o293
I I. DISINFECTION: Type b pxu,J lt/il Amount
12. CASING: Wall Thickness
DepthDiameter or Weig t/Ft. Material
sn
From / To 17et- Ft. 6 p Aire-- avt. f
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From / To Zo Ft. % Ir4+-w1- 'lard
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.
Material
16. REMARKS:
LIB JUN 1 1 2002
Spbmit the original to the o ivi i
Nib' • SE TIO
ASHEVILLE REGIONAL OFFICE
ELL WAS CONSTRUC
D THAT A COPY OF THIS
ATURE OF PERSON CO
n of Water Quality, Grou
, within 30 days.
Topo�gr�a9phie/Land setting
@S
lope Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For rr),ation;Description
DEPTH
From To
/ - 6D
tsar-r.«�G
r"n —
N
C—ram-
0<
o
ITT
LOCATION SKETCH cn
c-a n--
Show direction and distance in miles from aticast
two Slate Roads or County Roads. Include tlSeroat
numbers and common road names. Z
jO )526 6. /,, "d
?z
/afNO3I,01/4
HAS BEEN PROVIDED
TRUQTING
THE WELL
-o
2C, WELL
E WELL OWNER
2I- ells
ATE
dwateG.l5Zijt�inn11 4 C11e Cet ter - Raleigh, NC
ASHEULL �� N/ - -1 REV. 07/2001

• 252438
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION# 2140
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC. PHONE4%8 )254-3581
STATE WELL CONSTRUCTION PERMITS/15�7 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI ���// �� �/
Nearest Town• A41 ,M l/ County APAI--e/it, rtJ
(Street Name, Numbers, Community, Subdivisiopr Lot No., Zip Code)
q / nett., BB/tu c
/—
3. OWNER: ''22 /�.Y%
Address 9 / L/f it/41-6>r A .4et/a_.
(S7or Route No.)
S // c
City or Town State � Zip Code
��
Imo- h r'7 -3�Fj
Area code- Phone #umber
4. DATE DRILLED DZ
5. TOTAL DEPTH: 111
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO"C]
7. STATIC WATER LEVEL Below Top of Casing: &I FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires ■
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST of 6"-/
10. WATER ZONES (depth): C.O
11. DISINFECTION: Type 4-1"R Amount I/z_C? 49-
12. CASING:
Depth
From_ To 1.4( Ft.
From To Ft.
From To Ft. _
13. GROUT: Depth Material 9.—
From © To ) Ft. C' HL& '
From To Ft.
Diameter
i
tE'
Wall Thickness
or Weight/Ft. Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To�. Ftl
From iI I��} rTo Fti
16. REMAkKS 1
Size
Slot Size
in.
in.
Material
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descri lion
)0a02L/
I Li!. LC) Elsv. j/ .r./e
/ ct , t 1 e n ne. 1(
(19T
<2
/25
W
LOCATION SKETCH
Show direction and distance in miles from at legs
two State Roads or County Roads. Include the r�$d
numbers and common road names.
I DO HEREBY CE FY THAT THIS WELL W.ItS CO VSTRUCTED M ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION AND a :.0 THA OPY OF THIS RECORD HAS BEEN PROVIDED TO P LL OWNER
t
0
0
04
0-
cm
s_
0ti
H0
rn
rri
t7
0
Lop 6,
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

255097
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME R� u t L. „ CERTIFICATION #
01377
iLIs6M—�.ii+ 6•rlrl/ PHONE #�i6y9-oy8'a
WELL. CONTRACTOR COMPANY NAME )9/,57
STATE WELL CONSTRUCTION PERMIT/0
N�fy —ASSOCIATED WQ PERMIT/9
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Pi Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nprest Town:
(Street�,(N��
3. OWNER:t:67i7
Address
County_
rs, Community, Subdivision, Lot No., Zip Code)
3cp,,.w pact/ 1,t4v
(Svet or Route No)
City or Town State Zip Code
( 6y9_ os93
Area code- Phone number n t
4. DATE DRILLED
5. TOTAL DEPTH:../ (e S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO p4.
7. STATIC WATER LEVEL Below Top of Casing: '1_Fr.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS %s FT. Above Land Surface"
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): JO METHOD OF TEST 7 ee 4-•
10. WATER ZONES (depth): ies 1
11. DISINFECTION: Type kid:10 c
12. CASING: (/
Depth Diameter
From 0 Toe.20 Ft. 4 4
From _ To Ft.
From To Ft.
13. GROUT: Depth Material
From_Toc,20 Ft. (artl--S1
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKSU
Amount «OL
Wall Thickness
or Weight/Ft. Material
.2/ Pdr ,
Method ,
ti),Xintcy
Material
Ft. in. in.
R[ „its...
ERT 1� El'�F
I,,
I
,,,,m,
n
�d re-si
L.J SIGNATURE OF PERSON CONSTRUCTING THE WELL
Topographic/Land setting
1111,Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRILLING LOG
From To Fomtation Description
LOCATION SKETCIt
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
0
numbers and common road names.
OW`'el No
0
N c
qfte
0
CO
rr.
rn
to
0�
tD o
.AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tilt° 7
ATE
Snhmit rho nri$ inai tb the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GR QFi�„�'nl��0919) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHE\%tL i{tEtUiI,i]Jt L U

255096
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - GroundwaterondOSec Section
%8�
CE
N
WELL CONTRACTOR (INDIVIDUAL) NAME (print) PHONE # fb99iIn y�9
WELL CONTRACTOR COMPANY NAME 2.,.a.. 1 1 f ASSOCIATED EU WQ PERMIT# #
STATE WELL CONSTRUCTION PERMIT# N IA EDlWQ )
(if applicable)
1.
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL QN;rL�
Town: County ttezieOn "
Near-
ofTown:Xi
(Street NOMtNumbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER..-y fl
Address �s Q�
� (5q�� t or Route0ldl
7nN c. bag 7,52-
City or Town State Zip Code
(T- bigV" m29D Z
Area coda Phone number
4. DATE DRILLED yl// /D t-
5. TOTAL DEPTH: 4' '
6. DOES WELL REPLACE EXISTING WELL? YUS`❑ NO Pi
7. STATIC WATER LEVEL Below Top of Casing:XX FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / ( FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .011S.
•
9. YIELD (gpm): -3 M�FVFTHODOFTEST�ifev.#
10. WATER ZONES (depth): /..2 D' ea $S'
11. DISINFECTION: Type epel4tite
12. CASING:
Depth a Di
From To 6 a Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From__ To r90 Ft.
Amount /9 OZ'
Wall Thickness
..2— ror
Weight/Ft. yteirial
ir—
Agricultural 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
Material Method
P I LIN Mt,
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 Qoad=
numbers and common road names.
fani-t-ti1
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P RSO1tYCONSTRUCTING THE WELL
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001
LOLA
0

254637
WELL CONSTRUCTION RECORD
rth Carolina - Department of Environment and Na ral Resources -Division of Water Quality - Groundwater Section
LL CONTRACTOR (INDIVIDUAL) NAME (ppr/r�ii/�nt) 4 1h deek lit, CERTIFICATION#f-�27-C
LL CONTRACTOR COMPANY NAME (,/vd/✓R/t LHY /.Ue_/r PHONE # P11) G27/U9
V
x'FE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifappl icable)
WELL USE (Check Applicable Box): Residential IV Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: / 6 J 4 /1
County Ntad:60/1
/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: 5(43 fr 'fed
Address /,C Will 5ttet r
(Street or Route No.)
//660:1i t 2016
City or Town State Zip Code
tM )- 9 y — 9L?.L2r
Area code- Phone number
DATE DRILLED 4/ jt- G 2-
TOTAL DEPTH: V
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Topographic/Larfi setting
❑Ridge El 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 D scription
o (v Lrc /
STATIC WATER LEVEL Below Top of Casing: •i/d FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
YIELD (gpm): 6 METHOD OF TEST
WATER ZONES (depth): %.7c
DISINFECTION: Type Amount IA
CASING: %re-Itdland Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 44 Ft. Z. .22 Ole ti r
From To Ft.
From To Ft.
GROUT: Depth Material Method
From / To R d Ft. CQ-rt'u.1-1- Pb
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
REMARKS:
IOU
N
tit
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common r aa-rtames. .te_
,au1"a5-lo to
ter, r
ihuvr
QtA per Aie,e)
N
L
_C
—J
-C—
ELL WAS CONSTItUC
THAT A COPY OFTH `.
P TURE OF PERSON CO
5
£CkRI9ANLE WITIVa5
RD HAS BEEN PROVIDE
TING THE WELL
❑ivsionofV'•ater Quality, Groundw, ggBgl%rp ,4 rMq(jicrviee
"yy�{�i - n to theQ Yr
� �9�1 322I, within 30 days. ASHE` I 4,_ai0 4 OFFICE
W
C 2C, WELL CD
HE WELL OWNER
DATE
enter - Raleigh, NC
GW-I REV. 07/2001
rq
r
hR-
5

254635
3. OWNER: O cis ri r -
Address /en— pEt11U
(Street or Rou
Melr.s /itw NC -
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources - Divisionof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 644 it/ S CERTIFICATION if
WELL CON'TRACI'OR COMPANY NAME than/w Ge•�- /,U&PHONE felt) Vanvg!Jq
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT'S
(if applicable)
(if applicable)
L WELL USE (Check Applicable Box): Residential Fd" Municipal/Public ❑ Industrial ❑ Agricultural ❑ .
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:: ,/
Nearest Town: s4 �ca6/ 4&/( County Mt 4277
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code)RotateLL
Rot
ate l5
5_ 11a1/5 /2e1
to No.) 26 75'
City or Town State Zip Code
(57A)- 4A7 - N822
Area code- Phone number
4. DATE DRILLED Y- //'el--
5. TOTAL DEPTH: /V/C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LW-
7. STATIC WATER LEVEL Below Top of Casing: 016 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ao METHOD OF TEST /Vie
10. WATER ZONES (depth):
I I. DISINFECTION: Type Cya..,, che =id Amount yi
12. CASING: Wall Thickness
Depth
From / To 43
From To
From To
13. GROUT: Depth
From / To 26 Ft.
From To Ft.
14. SCREEN: Depth
From To Ft
From To Ft
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Diameter
Ft. (a
Ft.
Ft.
Material
42174-N-/
Topographic/Land setting
DRidge ❑Slope MAC/alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptio
1 /3
or Weight/Ft. Material
is jilt
Method
�lyd
z-
Diameter Slot Size Material
in. in.
in. in.
Ft.
Ft.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
2,4 etc / 9 23 Irvu. I it/
w-jv 51ow
I DO HEREBY CERTIFY THAT THIS WELL WAS CO
ry .a..:itaNnAVA S Nr THAT ACOPY
G
SMrmitqUeNorieidalNe D
27699-1636 Phone No. (919) 73: 322 , within 30 da
TUBE OF PE
n
of Water Qu
12 =Cld
ITC O CiDAN
S FngaR
OON.8leRU4 TAG THEWEL„J
t Hys GROUNDWATER SECT ON
's' ASHEVILLE REGIONAL OFFICE
a-t-
V Liz-`2)4
15A NCAC 2C, WELL GO
DED TO THE WELL OWNED
,2
DATE
Mail Service Center - Raleigh, NC
GW-I REV.07/200I
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

254634
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat/u�/a1 Resourcesur//-,fBacaDiivisio/n of Water Quality - Groundwater Section
WELL
_
ELL CONTRACTOR (INDIVIDUAL) NAME (print) �ct'eZi'ALrft,-S CERTIFIC`AA,TION#
WELL CONTRACTOR COMPANY NAME (,/Lar7I LUR //`.�G` PHONE # (Fla) Ll2 7 'r
STATE \VELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
fvrp<r4 fit /!
Nearest Town:
County Sad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /Ci L(
Address 2n clv jjv am p
(Street or Rowe No.)
/-ljage-pane-
City or Town State Zip Code
822)- f39
Area code- Phone number
4. DATE DRILLED 1- /7- Q 22-
5. TOTAL DEPTH: C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: Con 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): 4 METHOD OF TEST .fibe
10. WATER ZONES (depth): /yf
I I. DISINFECTION: Type Ci ra.wJktter/ Amount -51(/
12. CASING: Wall Thickness
or Weight/Ft. Material
gift pia4r
Depth
From / To f92
From To
From To Ft.
Diameter
Ft. 4
Ft.
13. GROUT: Depth
From / To 2-6
Ft.
nMaterial
r.I�i/�LK1
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
16.REMARKS:
Method
Slot Size Material
in.
in.
Material
Ft.
CAIEI EI3Y Ctu l?TtBY TIIIAT TIlI
Tt�STI C N fl iDD
�l
JUN 11 2002
S
Submit the original to the Livisio
27 "Po tf ti, Plum • NI (919) 7-3-322
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
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
�- 8D -t
/?- 5elE.5feW4—
//2- r' a-45 G'rc Awi r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
23- ,6 6r`r24A-
0, Y6 to Pt- 5 O L ilL'''r'W1I Y v d -
�
3-4 fired cart fit��
--1 : - , rm -
WELL WAS CONSTRU T U ACCS�
O ANC 1WITH I5 CAC 2C, WELL
Ca
THAT>Dk A COPY OF T 41 ORD HAS BEEN PRUVt= THE WELL OWNER
ATURE OF PERSON CI -• DATE
of Water Quality, Groundvsgty geFT ! -7Servic Center- Raleigh, NC
within 30 days. FlSHE\ L E RI .I. E1 irr GW-I REV. 07/2001
NSTIRUCTING THE WELL

254627
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /LUi4.i st CERTIFICATION#I.I QJ
WELL CONTRACTOR COMPANY NAME e�.i.7A/a431 tad/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural 1
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: /,//
Nearest Town: /1/2/L5 4 // County /144-e rsn✓
(Shea Name. Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: ee4C 47 feNC-
Address /kp r.wUe
(- ireet or Route No.)
P/ac.eta
Watt, fail Are. R42/y
City or Town State Zip Code
(Alt- 4/9 .047/!
Area code- Phone number
4. DATE DRILLED 1/-/39- G Z
5. TOTAL DEPTH: 3/f-4--
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 6 D 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 15A NCAC 2C .0118.
9. YIELD (gpm): /L METHOD OF TEST iir%Z
10. WATER ZONES (depth): /Li ,!
I1. DISINFECTION: TypeZtjaAf/AziL Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 47 4
From To
From To
Ft.
Ft.
Ft.
13. GROUT: Depth Material
From ! To 20 Ft. Cr At.,ort
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
cord
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
Topographic/Lang setting
❑Ridge ❑Slope alley DFlat
(check appropriate box)
Latitude/longitude of well location
(degreeshninuies/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
.that
DEPTH
From To
/ yo
ye 3Lir
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
213 t d l q� c"<sr
Matk-L f'�'r 24, ,od f, Ut-u�(r�r.(.., lr
Erick Mau.4 a AA -a, Jr-4...Le Leif
r`RWw 8-s°
silo /i it
/or docks-k- FreId
c
o c
N)
L
I DO HEREBY CERTIFY THAT T
IS WELLDWADS CONST
� I
C�lc SN� S aATU CPOPY
ON
JUN 1 1 2002
Submit the original to the ilk is on of Water Quality, ;goon Y e tiectu4(„ I636•til-Servi
•
1, within 30 days.
7699-1616 Phone No. (919) 33-322
Ili DLINACCO[LpANc WITH I9AkJ
lH ECOItD HAS-BEEN PRGVWB D. ,(
C64JRUCTING THE WELL
AS EJi - .�,t,c
PHONE # n21) le22-24'99
W
AC 2C, WELL 0
THE WELL OWNER
DATE
Center - Raleigh, NC
GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

09SISZ
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Wit K• .Sawyers CERTIFICATION #'J 2N36
WELL CONTRACTORCOIIPANY NAME Cede _Rioters 4-.3oa 0vwe,/ tfumf PHONE # £h-2M ^•6tS 7688
STATE WELL CONSTRUCTION PERMIT# 0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential,] Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 110E opt-;.t S
County
An Alf at._
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ciltd )4trnn.oAdd
Address b tl;AdIA4 „SfaftS Read
(Street or Mute No.)
140+ Spr;.tn s Nc atria
City or town d State Zip Code
(828)- G2a— 7299
Area code- Phone number
4. DATE DRILLED 04-02-02
5. TOTAL DEPTH: 1{7S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ,0
7. STATIC WATER LEVEL Below Top of Casing: Sb FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �
9. YIELD (gpm): I METHOD OF TEST /(
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From A-\ To 21 Ft.
Topographic/Land setting
❑Ridge ❑Slape ❑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
•1-1 e27 Over i5erda#.
cp
77 925 Gratin IV
fa 13 Amount
Wall Thickness
or Weight/Ft. Material
t ZI laSiir
Diameter
(Oki
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ZD Ft. CCMegt 'oared
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:
'D
to
D
f�
.. m0
LOCATION SKETCH
to
Show direction and distance in miles from at lea
two State Roads or County Roads. Include th- .ad
numbers and common road names. fria+ SPr', Ps$
Fr1,ze&aW FP
RA.
th,,y 2Z3`\
Submit the original t the
13 7699=16301-11604 1S141 (919) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Og/aa /az
URE 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

251764
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBENNatural Resources
CALDDHLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION/ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE4�(8 1254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (W"MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other El If Other, List Use
2. WELL LOCATIOt
Nearest Town: 1 AILS I: A 1-L 9ounty fY AF- S a /•,-
4 n50 Nw/ ao
(Street None, Num A', Community, Subdivision, tot No., Zip Code)
3.OWNER: A VAr0 coo IL
Address `t 0 5 o NU U: j� 0 '
lVl R2St1ALt_ ,Jc
No)
(Sweet or Route
City or Town Stale Zip Code
(838)- b 5r— ?53
Area coda Phone number
4. DATE DRILLED 4-./a 4 /0 3.
5. TOTAL DEPTH: 6 O5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (�J
7. STATIC WATER LEVEL Below Top of Casing: b 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. I
9. YIELD (gpm): ) I/a METHOD O TEST i G - A tit
10. WATER ZONES (depth): 14, O 'tot 6 Prn
31S5 I GPM
11. DISINFECTION: Type 01f1{ QD'7u Amount ,9 CJQ5
12. CASING: Wall Thickness
Depthra 1 Ft. 68rpeter SepiLa( t/Ft.
From 1 To �
From______ To Ft.
From To Ft.
13. GROUT.-t Depth Material n Method
From 1 To R. b Ft. C.bn�l3 1 t o JaeA
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
e /c�
1 DO HEREBY CERTIFY 11A
lliCONSTRUCTION STANDA S
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appopriale box)
Latitude/longitude of well location
at
(degreedminutes/samds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frg1m Tor F6rmihon 9ev _ p_ _q
, ( (pjL kS (UJfJ
f ni re,
/,9. C- Pnm c
Q ri NCrL'g
-,
—�c
it
caz
LOCATION SKETCH can !-.)
Show direction and distance in miles front legit
two State Roads or County Roads. Include the Ned
numbers and common road names.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
on of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. OWNER:
• 251763
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN Resources
-DBLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION Si 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONE4%8 }254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential "Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Not $91-1 N ES County ('(.A 41 SOea
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
bA gPo.)a-
Address ?. O sty G 4"
(Street or RowwEb No )
Wt Af6Q�)LI fvc ag-tgy
City or Town State Zip Code
(ta%)- ((4- - 443I
Arca code- Phone number
4. DATE DRILLED 4-`2 .5/0 a
5. TOTAL DEPTH: ) o ei.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2--1" FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC SC .011S. h ,G --A
Af� ( �
9. YIELD (gpm): '310 METHOD OF TEST t--1
10. WATER ZONES (depth): TO 1 SO GPrv-o
11. DISINFECTION: Type OTH 4 0 'X Amount I G`P f
Wall Thickness
or Weight/Ft. Material numbers and common road names.
12. CASING:
Depth Di ter
From i To a 5 Ft. in k
From To Ft.
From_ To Ft.
13. GROUT: Depth C materialMet
hod
b
From._ dmaoT To aD Ft. do
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(depeu/minutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To / Fomuttion Description
t7 , cSuroe.r�
11'— '70' Cos Qf+c-r
c
to— en9-aims lr �
From To Ft.
From To Ft.
16. REMARKS:
OC
>O
eve enZ
LOCATION SKETCH c P y
Show direction and distance in miles from at least,' o
two State Roads or County Roads. Include the road
6iR & 1W-
[ 6LI-1 `IPY T'HA
ONSTRUCTION STANDARfthf "
1"i
—s?c
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLWNER
�6
NATURE OF PERSON CONSTRUCTING THE WELL Aq
ATE
Sullyt ertOnagtg ffivisio
27419E1/636EPh§6dOVM I(909H133-322
0
of Water Quality, Groundwater Section, 1636 Malt Service Center -Raleigh, NC
, within 30 days. GW-1 REV. 07/2001

251996
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION N 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC.PHONE
48 )254-3581
STATE WELL CONSTRUCTION PERMIT* 1537 ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential YJ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neajest Town: / County
die, 7- m r-A
Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:'1a 5 ,4° di / m
Address e/O Crud) [.n2
i(Streett mane e No.)
ert�107,S - 9073
City or Town State - Zip Code
EPVC-• 1 9/
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descrioti
DEPTH
From To
Area code- Phone number — 2-1
4. DATE DRILLED a9`1> ?� -,/ — / re "
5. TOTAL DEPTH: ifS" r
crtf-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W'/
7. STATIC WATER LEVEL Below Top of Casing: .1 8' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): ISB' r— /
11. DISINFECTION: Type /14`
12. CASING:
Depth Diameter
From To 2-/ Ft.
From To Ft.
From To Ft.
Amount70-'
Wall Thickness
or cight/Ft. Material
/�� vrp /
13. GROUT: Depth 1v�ateshod
From © To %1 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: �tp nt
Depth Size Material y'r[1
From To Ft. �(
From To Ft.
eir
a• oT
z "1
a �m
3 ao
r_a
YLI/
--sue
en =
LOCATION SKETCH F y
Show direction and distance in miles fronts) lea%
two State Roads or County Roads. Include the rootl
numbers and common road names.
16. REMARKS:
rTh [E'Da' BREB* CbjlTl .i' T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
f ran
Submit the original to tite DI
(3969941636 ??foie N14919) 731
ASI:,.JILLE AL OFFICE
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
sion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 252282
North Carolina - Department of Environment and Natural Rp_s)ourc(es - ivision of Water Quality - Groundwater Section Q
WELL CONTRACTOR (INDIVIDUAL) NAME�//�i ((�pri�nt,�)..//i(cli-rtY1t-.( , El 1.i ni.L /I M.6\C CERTIFICATIONTjO Z�[-‘3
WELT. CONTRACTOR COMPANY NAME 114p Mleickief%..,tx l 11 Nina( �'t(p��() PHONE# g' �V5_� �
STATE WELL CONSTRUCTION PERMIT# '1 // ASSOCIATED WQ FERMIT#
( i f applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: VM$Y5 54I5t County Se..
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: CI . LJQQ 11
Addrrejss�, ' (bi k1Ct-i4. 7d•
c3 d (Streetf'or{iC e No.)
< Z 81
1 S
rty or Town StatetZip Cade
( )-
Area code- Phone number �( �
4. DATE DRILLED �"Z-`Y'1�
5. TOTAL DEPTH: Zal - /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 4X
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. n
9. YIELD (gpm): 1 W METi F TEST �l. I • NM
OHOD
10. WATER ZONES (depth)
. ) • i Li
11. DISINFECTION: Type �iti n- Amount Z
12. CASING: Wall Thickness
Dcpth Diameter or Weight/Ft. Material
From CO To 1 Z. Ft.
From To R.
From To Ft.
13. GROUT: Depth
N Material /� Met
From To Ft C &flC74`tt ��
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in. C
15. SAND/GRAVEL PACK: N
Depth Size Material am
From To Ft. -<
From To Ft.
ko
Slot Sizc Material
in.
in.
ttdopographic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL O
CONSTRUCTIOSTANDA' s D THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER CO
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
oldk.3 p-CZ>J
6-1-Oti
tt6NATURE OF PERSON CONSTRUCTING THE WELL
DATE
3n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
!I, within 30 days. GW-1 REV. 07/2001
t the origina to
9-1636 Phone No. (919) 7
JUL 1 0:202
CTIGN
PcFICE

252101
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION., 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE448 ?54-3581
STATE WELL CONSTRUCTION PERMIT% 1537 ASSOCIATED WQ PERMIT.,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 212 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: ii2. 4'/ .
»7 fiAi
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: v W. 1 i Tb ry
Address /1 e5 ,8e'K !t D '% ry y t-
City or Town Stale Zip Code
Area coda Phone number
4. DATE DRILLED Y3o%-2—
5. TOTAL DEPTH: / 2S r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O
7. STATIC WATER LEVEL Below Top of Casing: (3.7 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface require ■
variance In accordance with ISA NCAC 2C .0118. p
9. YIELD (gpm): %p METHOD OF TEST /l / tS'
10. WATER ZONES (depth):
County .#b:H.) . O
17 3
11. DISINFECTION: Type l-7V Amountyl.G+/1-
12. CASING:
Depth
From Tom Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 21 Ft
Diameter
or
Wall Thickness
Weight/Ft.
Material 'T
raGsorsi
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:
y �2 �_� E�
NTR`UC1O1
//
Jiff
aterial
ifilethorki
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DRILLING LOG
Formation Descfiptio
DEPTH
From
i0
° *rn
r,J
�m
rnz
m-0
LOCATION SKETCH u7 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
atio
o
,gT""
BAC Ls-7a
/
FI
% I /
THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN �/ A 2C, - •�- �f'
)ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T .r WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
pAm
Submit the on
inal
GROUNDV 9.JQ neNo.
ASHEVILLE REGIONAL OFFICE
the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
919) 733-3221, within 30 days. GW-1 REV. 07/2001

254577
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
VVELL CONTRACTOR (INDIVIDUAL) NAME (print) 110,42, �f
fi
WELL CONTRACTOR COMPANY NAME C a:7A//.d/✓fin a
Division/ of Water Quality - Groundwater Section
/.ld elteii/. CERTIFICATION
if PHONE it (972h) 6 z2'%Wu/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential fd' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: lotto had/ County .C.-Le--
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: be/-r. Bccc ..442s1,4--
Address (j 6 Alert r ea.n nt e
(Street or Rou e No.)
/6/t-2l a/ NL 2 /74 3
City or Town State Zip Code
(fk )- SA9d. /93 y
Area code- Phone number
4. DATE DRILLED , %i - // D 2-
5. TOTAL DEPTH:
.z 9s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -
7. STATIC WATER LEVEL Below Top of Casing: Li 6 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 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST Attie
WATER ZONES (depth): 2. 2-6
11. DISINFECTION: TypeeckaI,nQ� Amount '-'I4 C
12. CASING: ` Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 86 Ft. 4 i2 7 Po@
From DO To_Qip_ Ft. G .`U / 'V U C
From To Ft.
13. GROUT: Depth nMaterial ' Method/
From / To A 0 Ft. (�,�r.. P.rir. d
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From To Ft.
From
O HEREBYCER'IIFY IHA/Ti
NSTRpCTION STANDAR °,A
Topographic/Land setting
®'fudge ❑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 Deycription
DEPTH
From To
�G •�9s oy
-
o -_
—o
MC —c
�m
on
0T
N --i
LOCATION SKETCH CD 3
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o 2 /3 Q LA
tuLc Z
r
a �) p-ct Gn a �1 B4 List
3 WELL WAS CONE
D THAT A COPY OF
SIGNATURE OF PERSC N CO
Lr '1
1i 1
11EU 1N AULURDANCE WI-F 154+NCAC 2C, WELL
RECORD HAS BEEN PRO‘ ID,' TO THE WELL OWNER
—13 //- 62
STRUCTING THE WELL
DATE
GROUNDWATER SECTION GROUND TER SECTION
S,OQtgalttlig wicim ptoDpgRivision of Water Quality,-GruicnntiyP4q' pj(,yRip1((( j,YiFM it Ser✓ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

254575
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of/Water Quality - Groundwater Section IOC
WELL CONTRACTOR (INDIVIDUAL) NAME ((ppJrint) +/(�*!yq� /i/ Q/"I4/Lvs CERTIFICATION #.2�lJup'
\%ELL CONTRACTOR COMPANY NAME r •/<Art) /A2 "^^�' G tc,I 1 PHONE # (81X & L2 ) ysq
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Ma-bka I L County M hei t✓
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: p -
Address pp i ,32 L/
�� ` (Street or Route No.)
is-/- Teer,n He .287413
City or Town State Zip Code
(fa)- 422- 9932-
Area code- Phone number
4. DATE DRILLED 3 -1 / - 6 1-
5. TOTAL DEPTH: 2 2-.4"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IY
7. STATIC WATER LEVEL Below Top of Casing: WD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /i METHOD OF TEST !}s%L
10. WATER ZONES (depth):
II. DISINFECTION: Typ
12. CASING:
Depth
From / To /6 2 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From / To 20 Ft.
,26.0
Amount t e
Wall Thickness
Diameter or Weight/Ft. Material
4 a17421 Q(1
Material
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.
To Ft.
16. REMARKS:
Topographic/Land setting
DRidge HS-lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Demos-ccription
l(
4a,"..c6 ��....a-
do
N
DEPTH
From To
86 96
9, /67
CD ••
r`
>c
me
O
rfl
LOCATION SKETCH .tt. rn c1�
Show direction and distance in miles from ata3tst
two State Roads or County Roads. Include the road
numbers and common road names.
C' g c S C- c�c c S cc.0
Method exe j L02 M y A- (Th♦ A e
LtitiCQA,
,CC yen\cOr-A
�'\Av��Q�
Slot Size Material
in.
in.
Material
THIS WELL WAS CONST
S, AND THAT A COPY OF
S`IN ACCOR
FeCORD HAS BEEN PROV
SIGNATURE OF PERSON CONSJFRUCTING THE WELL
vision of Water Quality,
-3221, within 30 days.
AC 2C, WELL
THE WELLOWNER
/ Jr 6 9--
DATE
GHOUM,VA-ER - 1
tettSetitlApa.S3 4 Servi eCenter- Raleigh,NC
GW-1 REV. 07/2001

254567
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural e
3
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �
WELL CONTRACTOR COMPANY NAME l./'f'C' LNvfr�r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
urces - Division of Water Quality - Groundwater Section
CERTIFICATION #/V Y 9/ (�[[
PHONE # f 54N (0,»�' >J /
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ,
Nearest Town: N County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
G6 3. OWNER: C49-11 2S �%f��-
Address ,�y9 '�' ^.L"''
H— eet orrR u e No.),^/
L 9—P4j
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3 -d7 `Op-
5. TOTAL DEPTH: Liif r
6. DOES WELL REPLACE EXISTING WELL? YES LWNO IJ
7. STATIC WATER LEVEL Below Top of Casing: J oU 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 accordanscvith 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
L?}itK>o ❑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
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth / Diameter or We_ i6ht/Ft. Materi
From O To c07 Ft. (� 1 OC/fi
From To Ft.
From To Ft.
13. GROUT: Deptth r Mat t I thud
From Q To 'it) Ft F
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
16. REN ARKS:
ASR@
Size Material
N
—
C]1
yC
LOCATION SKETCH
• —'gy▪ m
r trt—
2Show direction and distance in miles fromtaleast
two State Roads or County Roads. Include the roiFA
numbers and common road names.
237/70 437
idec
4 a
Y, I' —HIS WELL WAS CO'
D THAT A COPY
IGNAT OF PER
r. e Dit ision of Water Qual
Odt) 733 3221, within 30 days
NSTRUCTING THE WEL
iA NCAC 2C, WELL
D TO THE WELL OWNER
DATE
[y, Grooundwater Section, 1636fail Service Center -Raleigh, NC
GROUNDWATER SUCTION
L_ASUfOILL.E . _ t OFFICE
GW-I REV. 07/2001

253447
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater �,b N il I C Section
77
WELL CONTRACTOR (INDIVIDUAL) NAME (print) O ALL CERTIFICATION jr? f1 p. yA PHONE # rtr,fA • Uq Oy0D
WELL CONTRACTOR COMPANY NAME.'-fA`' alit/ t7''P'� � f
#
STATE WELL CONSTRUCTION PERMIT# /r
ASSOCIATED WQ PERMIT(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neaie3t To
^v—v
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Stye r Route No.)
wa a Rota e N
City or Town State Zip Code
(—) No Ph n Al c
��r Topographic/Land setting
County/// h t ikRidge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Area code- Phone number c-�
4. DATE DRILLED 3�1../�L) Z r �'
C c
5. TOTAL DEPTH: 3 to O = -,
rp
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j'1 1 ,gym
rri
7. STATIC WATER LEVEL Below Top of Casing: _3a_FT. g_rri
/ (Use "+" if Above Top of Casing) �+
8. TOP OF CASING IS FT. Above Land Surface`
MC Inc
*Top of casing terminated at/or below land surface requires ■ X�
9. YIELD (gpm):
variance in accordance with ISA NCAC 2C .0118. r
S__
METHOD OF TES11 # (Ji n
n.
10. WATER ZONES (depth): g0 t e2e20 l —
3.25 r • _I•N H
11. DISINFECTION: Type � ttZ.0 Amount /1 GA Show direction an distance in miles fro. at least
12. CASING:
V Wall Thickness two State Roads r County Roads. In de the road
Depth i Diameter or Weight/Ft. Material numbers and co on naPte'.
Front To 400 Ft. le -p #,i PPG. //jy/, W/�
From To Ft.
Fron _ To Ft.
13. GROUT: Depth Material tartly
Method ,
From_ To_ Ft. C
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro.,, To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
b2Y 7S t
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
PEPTH
From To
16. REMARKS:
L
9 I Ik) HER)iBY t`iR
UUNSLRUL11UN
TA
4�a1 to
GROW'
ASPFVIi_L37SP dt03411hsPIcCN0.(9
CHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DA
a4#
SIGNATURE OF PERSON CONSTRUCTING THE WELL
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prlot)qLL CN �y
*7h d� Tf. CERTIFICATION 1J �7
6 � +
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# A91 ASSOCIATED WQ PERMIT# 4I//�
(if applicable) (if applicable)
253445
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water n)ection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T,
_ County i[LJ 242. r.
o�P qSt-
(Street Name, Nymbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE
Address OiRoute No.
7,1e4
City or Town Stale Zip Code
( -)- 4/0r —PF/aNC.
Area code- Phone number
4. DATE DRILLED-2 fy Jb Z
5. TOTAL DEPTH: .I b
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pc
7. STATIC WATER LEVEL Below Top of Casing: 71, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS S FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordancj with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST—r.Use
10. WATER ZONES (depth): /7:5 r a Qs
11. DISINFECTION: Type V Amount ,.2 oL
12. CASING: Wall Thickness
Depth ameter or Weight/Ft. Material
m�_
Fro To 1t> Ft. L.2f ft/
FroTo Ft.
From_ To Ft.
13. GROUT: DepthMaterial Method
From_ To o%f) Ft. LLt'�fsry
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16
Size Material
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
�. ) E�," iA L[.102, ih.h it PHONE # c�R�{��n�9 a9go
c
Lrn
1 r
�rn
m
N
•
LOCATION SKETCH
Show direction and distance in miles from a
two State Roads or County Roads. Inclu
numbers and common road names.
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND • T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNA t ' O. ' RSON CONSTRUCTING THE WELL DATE
U1
ast=
road
�3�� i;.i;.;E,,n;HStaH&CiHAbrigina to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS HG` iLl [ Rffry }6JillrOae Aid. [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
251583
WELL CONTRACTOR(INDIVIDUAL)NAME (print) _y'uelt� K, 4aa tc6 CERTIFICATION# 24$4
WELL CONTRACTOR CONIPANY NAME Clyde Sa. tegs tf Aeq acu R 949 PHONE # (g2F1 •?65 7GSp
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential H Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: M4e.1 14;ll County Mod'•tan
_ t:+*Kle CtetK c??7•51
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Rorr ISobase.
Address Po Box 19o0
(Street or Route No.)
MACS N'4\ nit 28734
City or Town State Zip Code
(8L8 )- Islet - 6444
Area code- Phone number
4. DATE DRILLED 03-37-of
5. TOTAL DEPTH: \ 0 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ET
7. STATIC WATER LEVEL Below Top of Casing: 5) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS X FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0I18.
9. YIELD (gpm): Q S METHOD OF TEST R, 5
10. WATER ZONES (depth):
11. DISINFECTION: Type ?z Il f Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 41 To 40 FL (ls/st 4b21 Plant c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2-0 Ft. (Gwent route-4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lanp. etting
❑Ridge ❑Slope I+3Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
N0 Ovtc Bedw...
DEPTH
From
�\
"(o
I05
0
P0 0
(rranA
u n
ZI
lD
rr(\
'Az
w
LOCATION SKETCH tO o
Show direction and distance in miles from at IeaS�
two State Roads or County Roads. Include the road
numbers and common road names.
Cor. '
r•.—\r TWHEREBY CERTIFY THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r 1 tONSZRUC11hlo /STkN , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IU
SIGNATURE OF PERSON CONSTRUCTING THE WELL
na/77/07
DATE
Submit the original to the Di ision of Water Quality;'i;roundwater Section, 1636 Mail Service Center - Raleigh, NC
1635 !'boalp(tt4C y19) 733 3221, within 30 days. GW-I REV. 07/2001
Acr. t _L't Or:'.0

WELL CONSTRUCTION RECORD
251582
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CINI4.4t X. .S Q '4' Cr5 CERTIFICATION # e2436
WELL CONTRACTOR COMPANY NAME Cil` ak N
.50-3.er5 d 6en try 4-Dk.^P PHONE # �ZS) .255-7685
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Chcck Applicable Box): Residential m Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Rav4 FF;11 County Hac:Sen
`e,Qf'.kle CreeK
(Street Name, Lumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: lager Rob.ns' o
Address U Rox /gee
(Street or Route No.)
Mors/kV Nc
2d7sy
City or Town State Zip Code
C$25)- 6,6,7- 5oec)v
Area code- Phone number
4. DATE DRILLED 3-a6-02
5. TOTAL DEPTH: 105'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO .f7
7. STATIC WATER LEVEL Below Top of Casing: Qj FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST iQ.0
10. WATER ZONES (depth): d'
11. DISINFECTION: Type P 115 •
12. CASING:
Depth Diameter
From +( To 40 Ft. (ay
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CCMett pored
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount r
Wall Thickness
or Weight/Ft. Material
Ik 21 pla6{.0
From To Ft.
Topographic/Land...e.tting
❑Ridge ❑Slope Pralley ❑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
tt 40 over 8erdon
O g
N
1/0 /OS �r a2q; FG� cn
N m
O` m
"-tom
m
ni73
CO -
LOCATION SKETCH
z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
5Q7-.)*-N%-
,y2L'
buy 19
fi
Mars b /
16. REMARKS:
EREbY\O'ER F i i T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
trt - e•1•
AND HAT -----THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ct h .t tt rgtthe
G0+421)-0hiiatc((9) 73
its
0.3./ iaz
SIGN OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality; Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�`�ylQ 1E„ 300.� e55 CERTIFICATION # 1 rA) L)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J
WELL CONTRACTOR COMPANY NAME C(yde Sa`.).,fcJ 3 ' '- tit\t L1\.nQ :1 PHONE # (S ..'3) SS 7(cSY
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential)(Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town;
nf
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t OrltVi ftCLACLI\/
County ink c/if'o'1
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3-0-3-01
5. TOTAL DEPTH: 3 15
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: VO 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): I5 METHOD OF TEST K-y
10. WATER ZONES (depth):
Amount
11. DISINFECTION: Type ?'
12. CASING:
Depth
From E\ _Lib_ Ft.
From To Ft.
From Ft.
To
13. GROUT: Depth Material Method
From C% To ''O Ft. (se- v. ri iiui
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
2498'75
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(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
+ I 45 O v e C tie; de=,
'{5
335 (cor.::
Wall Thickness
Diameter or Weight/Ft. Material
(c _ 4--a\ Yle.s
Slot Size Material
in.
in.
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.
t=t
rV
—o
1
w
W
CO
I r LS tOIDNRUCT
n
EMI!
N A
Submit the original o the
GROPOSNMThi WON OW (919)
ASHEVILLE F"TIi-INAL OFFICE
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3—o?— 07
NAAT RE-f3k-PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

249873
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) C\.\Le I:. `Y3b.iJ 'tf5 CERTIFICATION# r'�3 tc
d PHONE # (it.:ii) a 557(o5)I
WELL CONTRACTOR COMPANY NAME Ct-Ace Yis.)-\ECS 5'ak
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q 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. WELL LOCATION: Nearest Town: (1/1i.-52.z/
County AG 456"t
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: So.w.
t\7 PO re
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3- It- o n-
5. TOTAL DEPTH: 1165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 3 re) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5.A NCAC 2C .0118.
9. YIELD (gpm): o METHOD OF TEST K: 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
I 141 OVc hetdoe)
I. DISINFECTION: Type P•\+S
12. CASING:
Depth
From 'r\ To in Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From C' To 30 Ft.
Amount 0
Wall Thickness
Diameter or Weight/Ft. Material
')IA
Material
C v; e n }
Method
eocod
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
Ft.
Ft.
16. REMARKS:
(cc I;e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND T T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original t
77699- dad Ptuer^ 19) 7
GROUNDWATER SECTION
ASHEV/R L r r.roiONAL C-'�--
OF PERSON C
TRUCTING THE WELL
7-/--ov
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 249872
North Carolina - Department of Environment and Natural-`nResources - Division
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CV -Ile 1:. a�;,-A e-SS
G1 Yd v_ Y CV-Ile
Via.. L3L\k
\VEI.1. CONTRACTOR COMPANY NAME
of Water Quality - Groundwater Section
CERTIFICATION # y ' (0
PHONE # (5.,$) :9.5S 76SY
STATE \YELL. CONSTRUCTION PERNIIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 II -Other, List Use
2. WELL LOCATION:
r A
Nearest Town:GP}"{tr /�� County N(l. rtiSM
(Street Name. Numbers. Subdivision, Lot No.. Zip Code)
3. OWNER: S°^+ hood
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3"b g -c a-
5. TOTAL. DEPTH: 48s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Z
7. STATIC WATER LEVEL Below Top of Casing: 926 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS : FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST W-rj
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)
DEPTH DRILLING LOG
From To Formation Description
^l-t $1 C'V<i h-t-dcn
Cctr e
11. DISINFECTION: Type P,\\5
12. CASING:
Depth Diameter
From Et To 8,2 Ft. (t t
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To Ft. t_e:-e r't- 13e..:i �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
Amount 0
Wall Thickness
or Weight/Ft.
+--a\
Material
C'lcs
From To FL
From To Ft.
16. REM.ARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE O DATE
u it the original to the Di
2769 -1636 Phone No. (919) 733
GPDUNL1VY/Jia:,; t;CT'N
Si 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
249881.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C:\ ae'. K Snt.;..1 CXS CERTIFICATION # jut -3 t"
0
WELL CONTRACTOR COMPANY NAME CL4e -50`'"5vECS k Eat,. 13t\\ �S.\tr. C1 PHONE # (S1b) a55S7GG5
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential i Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: -
County _ 1 d /r Oil
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: Se-CCy
Address
(Street or Route No.)
gttac
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3-a3,-o2.
5. TOTAL DEPTH: t % 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: VC.) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST K:`i
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-EI 39 Ovcc R ;dc.m-.
_39 ISS Gcnr.;ta
I . DISINFECTION: Type Q,Avy Amount 9'
12. CASING:
Depth Diameter
From 4\ To 39 Ft. (c,A
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O. To i;'= FL c-`-"-""\- t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Wall Thickness
or Weight/Ft. Material
From To Ft.
16. REMARKS:
e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
irp
Nr, t IiNfAIV;diA
MAY 1 /
bmit the original to thr Divis
butte SOTS ,_7 3-32
t
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 - ._ - a.7
�TUR e PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -Groundwater Seciupt 4 .1/3t
WELL CONTRACTOR (INDIVIDUAL) NAME E (print)_Sksu—_gl—CERTIFICATION M j
WELL CONTRACTOR COMPANY NAME ydt etl._1tti,PHONEtt Sj�_40
.,2stt
STATE WELL CONSTRUCTION FERMI-fitASSOCIATED WQ PERMIT#
(if ap hp cable)
(It a plieable) -
I. WELL USE (Check Applicable Box): Residenriai Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection C Other 0 If Other, List Use
2. WELL LOCATION:
(S;rcci Nnq
Mnc
y, Numbers. Community, Subdivision, Lot No_ Zip Code)
Nearest Town.
County (S 0 r-)
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): __Jo METHOD OF TEST
l0. WATER ZONES (depth):
3 OWNER: Rt'+ckec � --
Address PO 1 -•It J9Q--
(Street or Route No.) ��75y
Pt PC5-)f:1,1__ -
Cit) of Tos'n State Zip Code
Area code- Phone number
4. DATE DRILLED OL Or' ei 3.
5 TOTAL DEPTH' kV.
249551
4W111
Topographic/La: etting
ORidge DSlope alley OFI;L;
(check appropriate box)
Latitudellongitude of well location
(degreesl nim,ies: seconds)
LatitudeYlongitude source:OGPSOTopogral."v" rr1 p
(check box)
DEPTH DRILLING ;t.,t,:,1
From To Formation De4ri',-jot
4 t _g 3_ _ Over .t.¢'.,al: lit. ._,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface"
Top of casing terminated at/or below land surface requires a
Ra
11. DISINFECTION: Type P;u' Amount
12. CASING: Wall Thickness
Depth Diameter of Weight'Ft. Material
From t\ To g 3 Ft. (o"_ 'k- dt rlaat:5—
From To Ft. From '(o Ft.--- ---
Material Method
13. GROUT: Depth (cured
From—O To aoM
_Fr. Ce<nt --
FromTo Ft._
14. SCREEN: Depth Diameter Slot Size Material
From_._-- 1 o Ft. in.
n.
From
To Ft. in. ._ in.
__ --
15. SAND/GRAVEL PACK: Material
Depth Size
From__ —To. Ft.__ — From To Ft.
! F5 &AGA: Fe.
LOCATION SKETCH
Show direction and distance in miles from 1 .:st
two State Roads or County Roads. Include ire: road
numbers and common road names.
rs
01
16. REMARKS: —
I DO HEREBY CERTIFY THAT STAND THAT A C( Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWI'I, :i'
/9'—a 2.
Suhhtit the origin t tl
27699-1636 Phone Nr. (91
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON
ISTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center RaleiREV g0. '1
733-3221, within 30 days.
c>
0

249538
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groun w ter r S r i t9t
WELL 2�
CONTRACTOR (INDIVIDUAL) NAME (Print)_(tJts1.
,-� PHONE # gM �`=fi,,12.2\
WELL CONTRACTOR COMPANY NAME CIt.'d � San r-, �41. i ill@
ASSOCIATED WQ PERMIT#
STATE RF.LLCONSTRUCTION PERMIT# - (ifa .livable)
iliaca
mlicnblel
I. WELL. USE (Check Applicable Box): Residential JE Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 other O If Other, List Use
•
2. WELL LOCATIO : c// /latX S'_rti%
Nearest Town: A
fS County
(Street Nme. Nuir.bers, Community, Subdivision, Wt No., Zip Code)
3 OWNER: Rcltr .06-n5cn --
Address _2(1Li x ace
(Street or Route No.) Q s WiI .Cc. air
7 sH
City or Town State Zip Code
Area code- Phone number '19 - O�
4. DATE DRILLED ----
5. TOTAL DEPTH, ICS
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
gil
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
F. TOP OF CASING IS I _ _ FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ao METHOD OF TEST 1__. .----
I0. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope [}valley OFI..
(check appropriate box)
Latitude/longitude of well location
1
(degrees/minmes/seconds )
Latitude/longitude source:OGPSOTopourittrh rat p
,:heck box)
DEPTH DRILLING 1 --,?
From To Formation De-.ri( ',lot
623
(c3 I05_
I 1. DISINFECTION: Type P; u- Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From rt _ To
(.0 Ft. (n'It M- dt $16st'C.
From To' Ft. From To — Ft. ---
11. GROUT: Depth
Material Method
From O To ae Ft. Ceatnr - u --
From To Ft. ___________
14. SCREEN: Depth Diameter Slot Size Materiel
From _ To Fi. _ in. _. in.
in. in.
From__. . To __ Ft.
15. SAND/GRAVEL PACK: Size Material
Depth
From_ To Ft. _
From_ _,To_ Ft.
16. REMARKS: __
LOCATIT� Hci
Show direction and distance in mites frlast
two State Roads or County Roads. Inclii4l :ej Li
numbers and common road names. -
I DO HEREBY CERTIFY THAT 7HISWELL WAS D THAT A COP CONSTRUCTED
THIS RECORD HAS BEEN PROVIDED 10 THE WELL 090,<:'.
% L
-NATURE OF PERSON CO. S TRUC'TING THE WELL. DATE
Sulinrit the original to t ' sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NI
GW-1 REV. ('
27699-1636 Phone No. (91 733-221. within 30 days.
cn -
0
GROUPIDV^.CATER SECTION
ASNEV'IL'_i= I:trGIOiNAL OFFICE

2 WELL LOCATION:
Nearest Town: V,Y:5\A. 1 Countr1rMSQI0'
(Street Name. Numbers, Community. Subdivision. Lot No., Zip Code)
3. OWNER: Or
Address Y
tS: cet er Rom
Cox oe Town State
Zip Cock
•
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural urces - /pivision of Water Quality - Groundwater ection \\'O
I { P 11 bk.-5 CERTIFICATH Sri 2� 3Ell CO�'fK \Cl'OH(1NDIVIDUAL)NAME (Drint)i G�iVu 7Ly
1 PHONEY �A5��� 3 .
it it
WEI.I. CUNTHAC"TOR COMPANY NAME Hp,. rl110 iv. L Il OIL(
ASSOCIATED WQ PERM
S rA FE DELI. CONSTRUCTION PERMIT*
iif applicable)
(if applicable)
249503
I. WELL USE (Check Applicable Box): Residential hd" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope OValley C Flat
(cheek appropriate box)
Latitude/longitude of well local sn
(degreedm inutcs/seconds )
Latitude/longitude source:OGPSOTope raphic map
(check box)
DEPTH DRILL('...:G 1 Q t
From To Formation ! escription
( 1- r-I
Mir code, Phone number 2_ 1 O_ Q --L I
4. DATE DRILLED
5. TOTAL DEPTH: IC‘`rI f / ,<
6 DOES WELL REPLACE EXISTING WELL? YES ONO 8IV
7. STATIC WATER LEVEL Below Top of Casing: I
(Use "+" if Above Top of Casing) S. TOP OF CASING IS I Ff. Above Land Surface"
*Top of casing terminated srlor below land surface regains a
variance in accordance with ISA *CAC 2C .011a. ///�JJ
9. YIELD lgpm): METHOD OF TEST
1ik(t
10. WATER ZONES(depth): 'WI I LP ) Ur
I I. DISINFECTION: Type Tg
12. CASING:
Depth Diameter
From (C] To 54Ft.
From To Ft
From_ To Ft.
13. GROUT: Dept; Material p�j/p
CDf�/r i
From To FI.t i- .f♦
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
1-romTo Ft. in. in.
From To FT in. in.
15. SAND/CiRAVEL PACK:
Depth Size Material
LOCATION SKETCH
Amount Show direction and distance in mites in n at least
Wall Thickness two State Roads or County Roads. Inch le the road
or Weight/Ft. Material numbers and common road names.
1 M t yvv_4 �o635 uN'
i
From To Ft
From To Ft
16 REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION SJSI 'DARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 .'NER
2-—CZ
Su
itrl ht nri ihal to the Divistdn
276 1 Phone No.
[phone],
OF PERSON CONSTRUCTING THE WELL DATE
ter Quality, Groundwater Section, 1636 Mail Service Center - Ralel h, NC
30 days. GW-I REV l/7/2001
L
c_PCU"...EC A ER SECTION
A L t l'DkAl_ O lIC.:E

249736
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) B9141,0 3/% h L CERTIFICATION thil 7ere
WELL CONTRACTOR COMPANY NAME .IO.7u L.41-al UYt PHONENE# ( 4 y9- a WO
STATE WELL CONSTRUCTION PERMIT!!A/AV ASSOCIATED WQ PERMIT,/
(if applicable)
1. WELL USE (Check Applicable Box): Residential Pi Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
(if applicable)
2. WELL LOCATION: n•
Near99Town:72%%Ltd Countyu77/a Ica n.t
�j et
¢JX
(Streetity, Subdivision, Lot No., Zip Code)
3. OWNER:1114o)
Address t // diezr ta-v+0 fn-cd
Maltatreallor Route No.)
Ne ' 2'7.l Z
City or Town State Zip Code
Area coda Phone number
4. DATE DRILLED &,/// �o ?
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: y6 t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /. _C FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST? nt'
10. WATER ZONES (depth): Z S ' X2S '
11. DISINFECTION: Type efeat
12. CASING:
Depth Diameter
From_ To J. 0 Ft. k y
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 2 0 Ft.
Amount /.2
Wall Thickness
or Weight/Ft. Material
#.Z/ pL/G
Topographic/Land setting
❑Ridge ISS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pR1LLING LOG
From To Formation Description
Material Method ,
Cr,o2u� J].Or1ilt47
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
Fro To Ft.
Fro To Ft.
rJ
LOCATION S
Show direction and distance
two State Roads or County R
numbers and common road n
TCH ry 0'
miles from atdpast
ads. Include the road
s.
j 4 2 z — 7D ,r;/
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
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
o. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 4 7 2 7 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
w'ELL CONTRACTOR (INDIVIDUAL) NAME (print) C ye _X �tlNytf4- CERTIFICATION 243(.
WELL CONTRAC"I OR COMPANY NAME \ ttAAG tQb.)�.1a GCS d So r\ L\C .% Q('._�Uid PHONE # fit �oQ mS\
S'I ATE w ELL CONSTRUCTION PERMIT# ��� ASSOCIATED WQ PER.MIT#
(if applicable) (if applicable)
WELL. USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION: //
Nearest Town:_ %JriLItc3L // County AO tl �SUh
(Sneer Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: `j ter a Du. bole'
Address _ills 'Inert en_ c m rareeY ,ids
(Street or Route No.)
uof 5panev< NC antis
City nr Town Stale Zip Code
( )-
Area code- Phone number
4. DATE DRILLED t"15'02
5. TOTAL DEPTH: (005
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 07,
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "r" if Above Top of Castng
8. TOP OF CASING IS _) FT. Above Land Surface'
Top of casing terminated attor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpin): _� METHOD OF TEST R:._
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box{
Latitude/longitude of well location
(dcgreesminmrsiseconds)
Latitude longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
{► G11 Aver (3rcdo
(n t
005 &MIA:tt
11. DISINFECTION: Type Patti Amount -7
12. CASING: 1 — Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1'j To (et Ft. 441/4 Seal- 2\o-ta)r:C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q To ZQ Ft. CGMeti4 POWILL
Prom __ _-_ To Ft.
14. SC.REEN: 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. c=
c
16. REMARKS:
D(CHEI6-i C TIL'
Gw,19AAiviftf M tr
ASI27091-3oFsiro4ok E7FdPf9)73
IV
03
c
c :-
E
r
c,t
m
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/`-'/S- b
SIGNA
PERSON CONSTRUCTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Etwironment and Natural Resources • Division of Water Quality • Groundwater
roundw ter Secti V
El -q— .0 ii. -`att&_ --
47271
\YELL CONTRACT OR (INDIVIDUAL) NAME prsa Y mow_,,,-_- PHONE li apli acQ naN
\ ELL CO.T R.\C'tOR COMPANY NAME 1.a- JOS-�d04--
ASSOCIATED WQ PERMITS 5'1 Al F, w EA,I. fapr ka le) PERMITM (if applicable)
t •. C app'�, icable i
! WELL USE (Check Applicable Box): Residential8l ManicipallPublic 0 Industrial 0 Agricultural 0
Slomtoring 0 Recovery O Heat Pump Water Injection 0 Other ❑ If Other, List Use_
2. WELL LOCATION: 77
Nearest Town:Le ar
Count1,--h 50i1
(Street Name. Numbers, Community, Subdivision. Lot No. Zip Coda
3. OWNER.._"ug--Il-ss- -
Address _e1n5_-Z.nd;aH Camfp _wreak /Zrd
!Sueei o Route No.)
Uo# pr;�a -s�—N�c— ot7if
City or Tone) _taco a Zip Code
Area code Phone number
4. DATE DRILLED_V__Aqa.--
5. TOTAL DEPTH: (nDS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Casing:
(Use "*" if Above Top of Casmg
8. TOP OF CASING ISL.—_
FT. Above Land Surfaces
`Tup of casing terminated attar below hied matzo requires a
variance to accordance with ISA NCAC IC' .0118.
9. YIELD (gpm): 02 METHOD OF TEST
10. WATER ZONES (depth): --' —
1 i. DISINFECTION Type ____ Amount (,
12. CASING: Wall Thickness
Depth Diameter orerial
L3S.- ,-Fr. -TMint"
From To-- Ft.
Frorn To Ft.
Material Method
13. GRCJU I'' Depth outeJ
Erom---Q-_- To_ .30 Ft._ C rtnt .--r
From__ To __ Ft.—.—
I4 SCREEN, Depth Diameter Slot Size in Material
From To _ Et. __in
From _ -To _. Ft. _in
15 S.AND'CiRAVEL. PACK: Material
Size
Elmo _To__ Ft. — -----
Hum ._ _To_ ____ Ft.
iP _
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(;heck appropriate box)
Latitude/longitude of well location
(degrees minntes:seconds)
Lantude'longitude source:OGPSOTopographic map
!check sax)
DEPTH DRILLING LOG
From To Formation Description
} 69_Omsk ar.tdovt
Co9_—___Ce_os G/a4;tt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Ineludape ad
numbers and common road names. rV
rYa- b
r) f :;
CO o
:6 REMARKS:
I D) HEREBY CERTIFY THAT THiS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
C oNSTHUC tION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN ',RCVIDEO TO THE WELL OWNER
DATE
RECEW� Ind
uhmit the origina to t e
699-16.tfr Phone No. 1919) tLLtJJ1
APR 19 2C0?
N.ATIJR OF I'ERSON CONSTRUCTING THE WELL
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1,within 30days. GW-! REV.072001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

249499
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural •n/rP`ources-P(ivision of Water `Quality - Groundwater Section/
WELL CONT ItACTOR (INDIVIDUAL) NAM/Et (priinntt))/f�yY�1V`Ci w4'CJ L)i.�1/ &1JL I ?A \( CERTIFICATTIIOjN# 412°-..
WELT. CONTRACTOR COMPANY NAME f-T%��.: /�.�<Y.l.i�}‘ V &.I.�1^\ f Dvi �I (�� C( PHONE # ( C.p CP 03- �1 Z, ^z'_3
1 'I'�\ It (( - ZIN .J Z
"
STATE: WELL CONSTRUCTION PERMIT#
E .NSTR
ASSOCIATED WQ PERMI
(if applicable) (if applicable)
UCTIO
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public D Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 11(.4 y 5 ka I
(
(Street Name, Numbers, Community, Subdivision, Lot,No.,
Zip Code)
3. OWNER: -5fi'
Qtx)di� 1 di7YYf`n���
Address 7 5• 141 /V-M1^1-0•"1 X F.- (A_t'L (Streetor Route No.) ..� !
County y1 ci/
City or Town State Zip Code
( )-
Area code- Phone number / - G _ i
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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
Topogra is/Land setting
❑Ridge ope DValley j_ 1 ��--
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance in accordance with 15A NCAC 2C .0118. n ,f11n
9. YIELD (gpm): (Q D METHOD OF TEST hE.1 • CW• (�4`
10. WATER ZONES (depth): c; 0
I Z e
11. DISINFECTION: Type •T Amount
12. CASING: Wall Thickness
From © To �ZFt.Depth 91an to o WeighUFt. Material
( �`
From To Ft. JJJ / -Vij
From DepthTo Ft. 7Z. V I- r �'\ 3
13. GROUT: Material -Io _ Met od �1 /
From To Fl. �pr'il C !-Q'tl n- �t,N�^�r1 �� r
From To Ft.
IV
R
IV
C)
-0
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r-
LOCATION SKETCH tv u>
Show direction and distance in miles from afTeast
two State Roads or County Roads. Include tr{i roaiU
numbers and common road names.
r10
16. REMARKS:
R*0 •EYC RT1F ry' • THI
CnSlil_ZUdTI(S"&tN!
Submit th' original to he D
G •r hTerfltoit9(9) 73
ASHEVILLE REGINAL OFFICE
D THA
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF TIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

2.495253
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources y- �Division of Water Quality - Groundwater Section any
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f i L GA/ Lf ft h o d� r.T. �I CERTIFICATION # I
WELL CONTRACTOR COMPANY NAME A...e(te5
PHONE # f )/.S/9 0,1126
STATE WELL CONSTRUCTION PERMIT# N//q ASSOCIATED WQ PERMIT# N/4%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I$ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Q _ ,o /J
Nearest Towy: 7)13/ 4Jd / County 7%% tC.
(Street Name, Numers, Community,CoSubdivision, Lot No., Zip Code)
3. OWNER:
Address s7 j9 ��^'� V7d
aor Route No.)
71/
e ZipCode
( ) 94 LP? , 3S9z
Area code- Phone number
4. DATE DRILLED //e2 i 6 2-
5. TOTAL DEPTH: '3 F�_T '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO la
7. STATIC WATER LEVEL Below Top of Casing: .2.5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): S•S METHOD OFTEST T.ln4IA
10. WATER ZONES (depth): / 7, '
11. DISINFECTION: Type j42 Amount 1.Z
VV 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
0
iv
12. CASING: Wall Thickness
Depth Diameter or Wet t/Ft.
From_ To JD Ft. (o 47 par
From _ To Ft.
From To Ft.
13. GROUT: Depth ,, _Material Method .
From_ To n% 0 Ft. tame ► 1 AMY/14 y
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To / Ft. Z in. / in.
15. SAND GRAVEL PACK:
Depth Size Material
oL
From To Ft.
From 7 To / Ft.
16. REMARKS:
� i
,i
AThrVIILL',
SI
Divi:
�. \4}733-3
n
LOCATION SKETCH sr
Show direction and distance in miles from at lea
two State Roads or County Roads. Include the r ad
numbers and common road names.
sale/ L
0
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A CO13Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/.26.Z
GNATURE PERSON CONSTRUCTING THE WELL DATIr
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
:21, within 30 days. GW-1 REV. 07/2001

249523
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /- Division of Water Quality - Groundwater Section o j:77
M
WELL CONTRACTOR (INDIVIDUAL) NAM (print) 0 aA`3 i/ a ,47 CERTIFICATIONO# p
WELL CONTRACTOR COMPANY NAME `- "' PHONE # (i A L99 04" b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 51 Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Toy¢n
County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:-itH a -
Address
�/1lZrA+s�c tfd
Wfr Zeet oir t/e N. 2 O 7 L
City or Town State Zip Code
4. DATE DRILLED / /
Area code- Phone number /
/ D
5. TOTAL DEPTH: 4 .1 f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 121
7. STATIC WATER LEVEL Below Top of Casing: V/2 FT.
8. TOP OF CASING IS /`'" FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): go METHOD OFTEST7�r try
10. WATER ZONES (depth): / S S
flea Amount poi oz
11. DISINFECTION: Type Y _
12. CASING: Wall Thickness
Depth Diameter orWe ght/Ft. tti al
From f) To 7 D Ft to o # l
From To Ft.
From To Ft.
13. GROUT: Depth /n, Material���y
From 0 To 02 0 Ft. ( enteaf
From To Ft.
14. SCREEN: Depth Diameter Slot Size
Fro To Ft. in. / in.
From To / Ft. / in. / in.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft. jFt.
(Use "+" if Above Top o Casing)
“ Mathod
Material
From To /
From / To
16. REMARKS:
Topographic/Land setting
❑Ridge %Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
J
•
LOCATION SKETCH
Show direction and distance in mil
two State Roads or County Road
numbers and common road • s. ,AgS G A
uYa
et,
0
from at least
elude the road tI-
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT
COPY OF THIS RECORD HAS BEEN PROVIDED TO TI7 WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TFIE WELL
DATE
ivision of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
$ubm]t the,oitgilal ti the i
27699-1636 Phone No. '(919) 7 3-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 254607
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTORCAeo o 10 (.J(2-\\ n ( -LTV
•
WELL CONTRACTOR CERTIFICATION #: '3.b R
STATE WELL CONSTRUCTION PERMIT.):
1. WELL USE (Check Applicable Sox): Residential Er -municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCAT\Q\�:( s\i\\< the location below) ,v-
(
Nearest Town* -ACnty
(Road N and Numbers, Coovnunl or Subdivision and Lot No.)
3. OWNEKR-PaMt9---R NkZ\QL
Address );L r c\(\� TQ G
`�c__1 \ \\` treet or outallo.) 3/ 1.. 1/do
City or Town 1) Stare zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOLD----
7. DOES WELL REPLACE EXISTING WELL? YES NOQ�
8. STATIC WATER LEVEL Below Top of Casing: 4,.5 FT.
(Use -+' 11 Above Top of Cuing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a variance In actor -
dance with 15A NCAC 2Crr0^11a
10. YIELD (grimy _ -DP_' METHOD OF TEST a .
11. WATER ZONES (depth).
DRILLING LOG DEPTH
From To Fo lion Description
to 1-0
)
12. CHLORINATION: Type Nuiki-A- Amount )/C •
13. CASING:
Depth Diameter
From To Ft
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
Depth n Material
From 0 To R. C) Ft l Q-me-t\
From To Ft
15. SCREEN:
Depth Diameter
From To ___ Ft _ In
From To Ft in
From __ To Ft._ In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
I DO HEREBI
CONSTRUCT
FOR OFFICE
Quad No:
Sfral No
Depth Size
To
Ft
To Ft
ItY
II additional space is needed use back of form
LOCATION SKETCH
Material (Show direction and distance from at least two State
Roads, or other map reference points)
teat la3 @ Ceee\CCa_Ce. \S-` �e�f
SA Th \c�.. e r1�6�I To
.� "Roc -it �uf t n8 icy 2. l� G . O a f' i I n e %.)(i
T1v. D
Slot Size Material
in
In
In
Material
11 '-SSifmit o
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
FTHIS R ORD(/H/9$BEEN PR VIDED�TT%OTHE W
WA"TWR1E OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section within 30 days
0
t_
'v
0
‘C:T
0- <
rnrn
�- rn
CO 3:
m�
UvfI"ER SECTION
ASHEVILLE REGIONAL OEFICE

254608
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] �� D I ,n
WELL CONSTRUCTION RECORD WELL CONTRACTOR:` \ On (fit ^ D ` -"P 1
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential E Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ((S�Shskgttgqh of the location below) (� ����
Nearest Town.\\C *�`�' — County: \ e �IXS�i
DRILLING LOG DEPTH
(Road N"d Numbers. Cornmuniry or SubdiNsion and Lot No.) ormalion Description
3. OWNER' "Q l?' P ` \.\�0� From To
(Address \yg \ cbc. C(� S`(\(�1\ 2 C, CD 3� rCC
aa
City or Town t Stale zip Code
4. DATE DRILLED O a-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOQ--
7. DOES WELL REPLACE EXISTING WELL? YES NO[
8. STATIC WATER LEVEL Below Top of Casing: (c, FT.
(Use ••• d Above Top of Casing)
9. TOP OF CASING IS ___-_ FT. Above Land Surface'
-Top of caring terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C ems
�
10. YIELD (gpm)• _ METHOD OF TEST X. I
11. WATER ZONES (depth)•
12. CHLORINATION: Type Amount
13. CASING: 1
From
From To
From To
14. GROUT:
If additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
Depth 9i r or Weight/Ft. Material (Show direction and distance from at least two State
To Na Ft t SD2-Tt PVC• SS Roads, or other map referr�nce points)
Ft. d-,�/73 VV mwu'�-1"`.w�x-, - CNN
Ft. j �C0.cCC�2 — o� M \ '--aS S A
Depth
n Material�1 Methodo I �r I �'13acK dwn, _Sob s',re
To Ft. P Q V_ cd_
on 0 maA.. /i4/E.
To Ft
From
From
15. SCREEN:
From
From
From
Depth
To
_To-
To-
16. SAND/GRAVEL PACK:
Depth
To To
From
From
17. REMARKS:
I DO HEREB
CONSTRUC
FOR OFFICE
Quad No:
Diameter Slot Size
Ft _ In. _ in.
FL_ In
Ft. In.
Material
In.
In.
Material
Size
Ft
Ft.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
FTHIS R ORD _ BEEN PR•VIDEO TOTHE WE
E OF PERSON CONSTRUCTING THE WELL
vision of Water Quality, Groundwater Section within 30 d
0
N
L
D
0
G •
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Duality • Groundwater Section
1636 Mall Service Canter - Raleigh, N.C. 27699-1638-Phone [phone] _'
WELL CONSTRUCTION RECORD WELL CONTRACTOR• /IN RmAN Z. 2A-z(,
268920
WELL CONTRACTOR CERTIFICATION #: o?OC 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential ✓I - Municipal D Industrial ❑ Agricultural EJ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)•b 1/7
Nearest Town: f S r!%S Coun
olP 3 11— ��'s-7o Subdivision � 2 7 9 tFlaatl Name and umber, Co unity, or $ubdly sWn and L No) DRILLING LOG
3. OWNER �.Z�/1 ill/ 7S
Ado �e�y, a5 y3
1 Cif y or TYwn k/ Stale zip Code
DATE DRILLED __I
TOTAL DEPTH n
ripaL
CUTTINGS COLLECTED YES n NOF4
DOES WELL REPLACE EXISTING WELL? YES NO[(
STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use 'i' If Above Top of Casing)
TOP OF CASING IS ! FT. Above Land Surface'
rop of casing terminated eUor below land surface requires a variance In accor-
snce with 1SA NCAC 2C .011E
0. YIELD (gpm); / METHOD OF TEST
1. WATER ZONES (deplh):
DEPTH
From To Formation Descdpllon
v coi
-�7
J
J r:
2. ^LILORINATION: Type fi 7! 1 Amount %% If additional space Is needed use back of form
3 SING:
Wail Thickness
Depth Diameter or Weight/FL Maledal
From To FI ✓1,a5 4 )bri%`L
From To FL
From To FI
1. GROUT:
Depth Material Method
From To aC7 �_FL z1YC21.4-E /;_y61y-„ir,f
-�-LJI,_
From To Ft.
1, SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To _ Ft In. In
From To Ft In. In
;. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
'. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least two Slate
Roads, or other map reference points)
36403/)121
—r1
,{') fTt
Hd Six/fires,{' / -C. w
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION TANDARDS,_AND THAT A COPY OF THIS RECORD HAS BEEN PVIDED TO THE WELL OWNER,
F OFFICE US
Jo:
Serial No.
towity
5
Submit odglnal�L11y1
tie (9-
r
RE OF PERSON CONSTRUCTING TIIE WELL
on of Wrier Duality, Groundwater 5eclion within 30 days
DATE
OW REV. 12/99
n
C.
L_-

6, SAND/GRAVEL PACK
Oeplh
To
To
From
From
7. REMARKS:
OWNER
3, O
North Carolina - Department of Environment and Nalural Resources - Dlvlslon of Water Quallty - Groundwater Secllon
1636 Mall Service Censer • Raleigh, N.C. 27699-1636-Phone [phone](//,'
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Xe Rim AN L. 24L.
WELL CONTRACTOR CERTIFICATION 11: oSOi}
STATE WELL CONSTRUCTION PERMITH:
268921
1 . WELL USE (Check Applicable Box): Residential IZ Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of th I cation below) IN\CL,al , A
Barest Town: ��"� Count''
t l P fit 11�>`it�d _ l%S S� ✓ /7l' , 17� 3
Road NameQd Numbers, Communit r $u Ivhslonend
L) • oI No DRILLING LOG DEPTH
ram. 4._J�._ •-�z�Y?, / ���
Address i W 1
1' 24."A'
clty or own �T Stale
a
DATE DRILLED v s -0a.
TOTAL DEPTH 3,g5
CUTTINGS COLLECTED YES I I No4
DOES WELL REPLACE EXISTING WELL? YES I J NOIVI "O -.
STATIC WATER LEVEL Below Top of Casing: 76) FT.
(Use -+' II Above Top of Casing)
. TOP OF CASING IS / FT. Above Land Surface•
Top of casing Iermineted •Uor below land surface require, a variance In accor-
snce with ISA NCAC 2C 116
0. YIELD (gpm): J` 0 METHOD OF TEST
1. WATER ZONES (depth)•
or liou e o
_)From To Formation Description
ap fig :
Zip Code ode
CA) ._
IV
2. LORINATION: Type H TN Amount LL_LS If additional space Is needed use back of form
3. CASING:
Wall Thickness
From O
Depth Diameter or W IphVF_I. Materlal.
To FI L • a 5 a1G•i�s Pub 3OR
From To Ft.
From To FI.
4. GROUT:
Depth Material Mollrod
From Q To v%('� FI 17/Y cai'EiIl!)Ir'Q.><`•',i`
From — To FI
5. SCREEN:
Depth Diameter Slot Size Malaria?
From To FI In In
From To FI In In
From To Ft In In
Material
Size
FI
Ft.
LOCATION SKETCH
(Show direction and distance from at least Iwo Slate
Roads, or other map reference points)
),„„) 42 led,
mws/axo, 71,C.
I DO HEREBY
CONSTRUCTI
1 OFFICE
Quad No:
Serial No
R,TIFY THATTt#tS-W€LL WAS L z.n.
t�J I JANDARDS, AND THAT A'DO
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1141 TUnE OF PERSON CONSTf1UCTINO THE WELL DATE
Submit odMarro Mar [[vision of Water Ouallly, Groundwater Secllon Wlltiln 30 days
j
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Cenler • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /1 D RmAN Z . 14«
WELL CONTRACTOR CERTIFICATION #: o? eA 7'
STATE WELL CONSTRUCTION PERMIT#:
I. WELL USE (Check Applicable Boa): Residential I&4 Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water injection ❑ Other El If Other, List Use:
2, WELL LOCATION: (Show sketch 1 the locallon below)
Nearest Town: y T L�•�'4up County.
163 f%en,
Address
GA
City or own Stale
DATE DRILLED /' - 0 a`
TOTAL DEPTH 3 1.Q 9
CUTTINGS COLLECTED YES I NO4
DOES WELL REPLACE EXISTING WELL? YES I J NO iv(
STATIC WATER LEVEL Below Top of Casing: .2.0 FT.
/ (Use -e• if Abovo Top of Casing)
TOP OF CASING IS ! FT. Above Land Surface'
Top of ceeing termtnated auor below land surface requires a variance In accor-
ence with 15A NCAC 2C ,elte
0, YIELD (gpm): a... METHOD OF TEST
1. WATER ZONES (deplh)•
DRILLING LOG
From To
268934
DEPTH
Formellon Description
0 - 1 D a Nit i-
I o0- 31.5 B&c;12ork
Wilt J rI aArSy
(nos Name fin umbers, Co unity, or Subdivlslon and Lot No.)
OWNER !A2 3eJ JLs.a GtiJ �I •�//W�1�
of dr Flnu e o. (2M at
Zip Code
0
CO
N
2 _ORINATION: Type 7T 7- l Amount low If additional space Is needed use back of form
3. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. �M�arte�dall (Show direction and distance from at least Iwo State
From O To / D D Ft, �' o 5 0714 rhs P L ,ULV. Bonds, or other map reference points)
From To Ft ^�
From To Ft L �C
I. GROUT: ���n
/ 1.0
From
Depth _ _ Material Mothod
5. SCREEN: " ' 0-5
Doplh Dlameler Slol Size Materiel
From To FI In In.
From To Ft In In
From To Ft In. In
6, SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft
CO
•'1
7, REMARKS:
I DO HERE&6RTlFYTHATTNSTRUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOk4 STANDARDS, AND THAT -A r' OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
rt OFFIC�IU$EONLY C7-
Ouad No: ) J L , IGNATURE OF PERSON CONSTRUCTING TICE WELL DATE
Submit erlplrl I to Division of Weller Ouallty, Groundwater Section within 30 days
ISerial No.
1 oa
GW.I REV, 12/99

‘...vi0011/
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1036 Mall Service Center - Raleigh, N.C. 27699-1630-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /I e RmAN Z • 3A-((.
WELL CONTRACTOR CERTIFICATION #: a7Da 7
STATE WELL CONSTRUCTION PERMITNn
I . WELL USE (Check Applicable Sox): Residential Er Municipal I1 Industrial ❑ Agricultural ❑ Monlloring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show llrg Ipcallon below)
Nearest Town: ""JVe County
(Fl6ed Name An
3. OWNER
Address
DRILLING LOG
DEPTH
From To Formation Descdpllon
,^^ (Sla orlloule No}0 'J /
`-�' CIIy or Torn 1 Stale Zip Code 7
t. DATE DRILLED a_ a—ba-
1. TOTAL DEPTH .j A O
CUTTINGS COLLECTED YES NO[
DOES WELL REPLACE EXISTING WELL? YES in NOrvi
1. STATIC WATER LEVEL Below Top of Casing: l b 0 FT.
/ (Use's' II Above Top of Casing)
I. TOP OF CASING IS ! FT Above Lend Surface'
fop of casing terminated at./or below land surface requires a variance In accor-
lance wllh 15A NCAC 2C .011E
0. YIELD (ppm): METHOD OF TEST
1. WATER ZONES (depth):
-
B&4 -q(k
IN)
2. •I.ORINATION: Type )-1 7H Amount f If additional space Is needed use back of form
3.... %SING:
Wall Thickness
Depth Diameter or WpIghVFI. Mat S l
From Q To LoI FIL.a5-2714,I;S
From To FL
From To FI
4. GROUT:
Depth AO
i Method
From D To � F1 COIYCPt•}F i^ �,ticic
From To FI
5, SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In. In
From To FI In. In
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To
7. REMARKS:
Ft
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map referer a points)
S
a%
I DO HEREBY
CONSTRUCTIO�J $ ��,NDARwS, AND tHMK A OOP
F JFFICE USE ONLY
Ou-u No:
Serial No,
UGTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
'1--ce a - a g- Get
w1]]Ai,'' LIRE OF PERSON CONSTRUCTING THE WELL DATE
Submll origineLio D4ilsion of Water Oualtly, Groundwater Section wllhln 30 days
GW1 REV. I2/99
i

North Carolina - Department of Environment and Natural Resources - Division of Water quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' BD 86 L.6. P -14-S
WELL CONTRACTOR CERTIFICATION N: . O.c 2
STATE WELL CONSTRUCTION PERMITS:
268905
1. WELL USE (Check Applicable Box): Residential[ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ • Other [I 11 Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nprest Town: J%�af_�'i,r �� countyCoun anadisnn
js Pa.A �/iU rlcJ lam+' ij lit Q C A75(11
(Road Name and Numbers. Community, or ubdivlsion and Lol No.) DRILLING LOG
3. OWNER Host, , &�TIer�jr:Se5. Inc. ('& f} job)
'J'- /- � From To Formation Description
Address pD iatu treeor oulo No.)
( .cnvOrr,lle nG. 711 - 256
City or Town Slate
4. DATE DRILLED
5. TOTAL DEPTH 95T5
6. CUTTINGS COLLECTED YES n NOf v/r
7. DOES WELL REPLACE EXISTING WELL? YES NO 1.
8. STATIC WATER LEVEL Below Top of Casing: 4.0 FT.
(Use'i II Abovo Top of Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
'Top of casing terminated et/or below lend surface requires a variance in accor-
dance with 15A NCAC 2C.9118
10. YIELD (gpm): 12 METHOD OF TEST
11. WATER ZONES (depth):
0 -7>f
2978 7
Zip Code
DEPTH
0
r
N
:o
l I G I
12. CHLORINATION: Type _ L Amount -r�r t�%l�s If additional space Is needed use back of form On
CASING:
Wall Thickness LOCATION SKETCH
Depth 2/ terneie r e ghVF . Mat
erial i7 (Show direction and distance from al least Iwo Slate
From-YL—To 7-/ Ft. �'1 L-R Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
FFromd To AO Ft �hQE;E ��UKl
From To FI.
15. SCREEN:
Depth Dlarneler Slot Size Material
Frorn To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
eecr egInc-✓/
%Ybdion Go .
n-o.
w
0
I DO HEREBY CERTIFY THAT THIS WEI 1 -WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTRN$ ANDARDS, AND THAT A,GOf Y c THIS RECORD HAS PEEN PDOV�O THE WELL OWNER.
FOR OFFICE U EOM LY �_O(_o�
,lad No: 91 ! TUBE OF ERSON CONSTRUCTING THE WELL DATE
it
1 L Submit origllial vision of Water Duality, Groundwater Section Within 30 days
Serial No.
GW-1 REV. 12/99
co r:
n

North Carolina - Department of Environment and Natural Resources - Division of Water Dually • Groundwater Secllon
1636 Mall Service Center - Raleigh, N.G. 27699-1636-Phone [phone]
268893
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
& b hr4 (JJ . YOT�S
WELL CONTRACTOR CERTIFICATION S: AOa g
STATE WELL CONSTRUCTION PERMITS:
1 WELL USE (Check Applicable Box): Residential Municipal P1 Industrial I1 Agrlcullural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show skelcli of the location below) �y�,2d I
Nvaresl Tow rnirSha II County t 5' h
a-k Old 'fi%LLsf &t.P n
( d Nameand�„ Numbeers-. Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
Q'A1 3. OWNER 71-a-I/p From To Formation Descdpllon
Address a; Cove pay
(Slreol or Roue o.
t,/ /;er "CI- 33W9
by or Town Slate Zip Code
4. DATE DRILLED .73-14-6?
5. TOTAL DEPTH '*'5
6. CUTTINGS COLLECTED YES pi NOj vf
7. DOES WELL REPLACE EXISTING WELL? YES E] NOlMM
8. STATIC WATER LEVEL Below Top of Casing: /76 FT.
(Use •+ II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of casing terminated et/or below land surface requires a variance In accor-
dancewllh 15A NCAC 2C .9110
10. YIELD (gpm): ;30 METHOD OF TEST 4
11. WATER ZONES (depth):
•
r (Z
75 - 25 r-d.p-4Ck-
12. CHLORINATION: Type 7 H Amount -+ t lk
CASING:
O
—3
v
cn
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth d (P j 76 plait r elg0VJ. material serial (Show direction and distance from at least Iwo Slate
From _a_ To Ft ((gyp Roads, or other map reference points)
From To Ft.
From To FI 9b Ro��K
14. GROUT: �l
Depth Material Molhod I_,,
From 0 To AO Ft �D11RE. E �r5iliiI f' (-
From To FI
15. SCREEN:
Depth Diameter Slot Slze Material
From To Ft In in.
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Slze Material
From To Ft
From To FI
17. REMARKS:
C) "
r-T
CO 177
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIDp}STANDARDS;-AND-ZHAT-A CfPY,QF- HI� D HAS BEEN PR VIDEO TO THE WELL OWNER.
I I
SID
A
Submit origins' to
L_/
Gt/r /� 3 roa
URE OF RSON CONSTRUCTING THE WELL DATE
Ision al Wnler Quality, Groundwater Section Within 30 days
GW1 REV. 12/99

26888J_
North Carolina • Department of Environment and Natural Resources - Division of Water Duality • Groundwater Section
1638 Mall Service Center • Raleigh, N.C. 27699.1636-Phone [phone] y� ((��
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 1Jc bhr' us- YS
WELL CONTRACTOR CERTIFICATION #: se9c R
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Float Pump Water Injection ❑
Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
2. WELL LOCATION. Show s -Ich of he location below)
arest _•wn:
County'
(Road Name and Nu
3. OWNER
Address
era. Co n, or Subdivision and Lot No.)
eo or ou e ' o
DRILLING LOG DEPTH
From To Formation Description
Clly or Town _ , tale
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NOI +4
7. DOES WELL REPLACE EXISTING WELL? YES O NO 1M
8. STATIC WATER LEVEL Below Top ol Casing: b FT.
(Use •i I1 Above Top ol Casing)
9. TOP OF CASING IS 1 FT. Above Land Surlace•
•Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C . 11
10. YIELD (gpm)• METHOD OF TEST
11. WATER ZONES (depth):
Zlp Code
•
fl
0 -VA
<f� - 505 kd Eck
- HLORINATION: Type _111 Amount Ott pi II 5
13. CASING:
crs
-n
If additional space Is needed use back of form
Wall Thickness
Deoth��_�22 'AelOJ !lloe1015 Material
(9 f V�"SD12
FromTo _7__rL' Ft. (p
From To FL
From To Ft.
14. GROUT:
1c�
Depth � Material Method
From d To $SO L-_ FI a fl Q-fr-I t
From To Ft
15. SCREEN:
From
From
From
16. SAND/GRAVEL PACK:
Depth
To
Depth Diameter Slot Size Material
To Ft In. In
To Ft In In
To Ft In In
From
From To
17. REMARKS:
Size
Ft
Ft
Material
LOCATION SKETCH
(Show direction and distance from el least Iwo Stale
Roads, or other map reference points)
Do-e St47 t
Q
I DO HEREDYrCEfjT1FY THAT THIS-WEt*-
CONSTRUCTION SITANDARDS, AND THAT A CCPISI
Sedal No. 'OR OFFICE SSE ONLY
Ouad No:
Submit odp
S
RUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
THIS RECORD HAS BEEN PROVI ED TO THE WELL OWNER.
ATE OF P SON CONSTRUCTING THE WELL ATE
)!vision al Water Quality, Groundwater Section Within 30 days
GW-I REV. 12/99
a

268872
North Caroline - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. !►N RTAN Z • 2AL�.
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITN:
1 WELL USE (CheckAppllcebte Boa): Residential la Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection El Other ❑ If Other, List Use:
2- WELL LOCATIOr��'�y/(�how ske h of lh`Q location below)
earesl Town:�K County
f
i 5
(Road Name and Num
3. OWNER
Address
LQINo.) DRILLING LOG DEPTH
4 From To Formation Description
rae or •ou a 'o.
CtiSAu e;:a r) r 02
CIIy or Town Stale Zlp Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES In NOV
7. DOES WELL REPLACE EXISTING WELL? YES u _ NO(
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated eUor below land surface requires a variance in accor-
dance with 15A NCAC 2C 0 a
10. YIELD (gpm): METHOD OF TEST r 5
11. WATER ZONES (depth):
CHLORINATION: Type 11 TH Amount /D_ 9_riI_IS
CASING:
0
IV
1V
If additional space Is needed use back of form
Wall Thickness
Depth Dlameler oraWflghVvFI. Material
From Li c To Ft b .5 Ql S PV6SO4C
From To Ft
From To Ft
14. GROUT:
Depth Material Method ,
From _D— To DZ0 FI i1171`ICni-E +ppT,EaL(L
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
Frain To FI In. In
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17. REMARKS:
I DO HEREDY GEM'1
CONSTRUCTIONIST
FOR OFFICE US: QMLY
Quad No: I'
Y"THAT T IS
DARDS, ANO THAT if./COD
' Serial No.
SI
Submit original
A
Lis
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
(*Ai ia'
litdA6firLay
-a
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
E OF PERSON CONSTRUCTING THE WELL
on of Water Oualily, Groundwater Section within 30 days
4 7& 0
DATE
GW-I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1638 Mall Service Center - Ralelph, N.C. 27699-1636-Phone [phone] r(n� -c
WELL CONSTRUCTION RECORD WELL CONTRACTOR• WELL CONTRACTOR CERTIFICATION OQp: D MI11J J. � DQ?
STATE WELL CONSTRUCTION PERMITM:
268871
1. WELL USE (Check Applicable fox): Residential ice' Municipal ❑ Industrial ❑ Agricultural D Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ - Other n if Other, List Use:
2. WELL LOCATION: sk Ictl of 1�1e location below)
est TQ9 Th /U/ O S ll county —1�'� .�•dOA-)
_ r
r r__
Roe Name and Nyqbers. Co nay or Sub on and Lot No.)
3. OWNER (Y!/QI -
Address
o No.r
al743
City o-?own Shale Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES (i NOI vf
7. DOES WELL REPLACE EXISTING WELL? YES I I NOR''
8. STATIC WATER LEVEL Below Top of Casing: cS FT.
' (Use •.• II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
•Top of casing terminated sVor below land surface requires a variance In 1a
accor-
dance with l5ANCAC 2C.p
10. YIELD (gpm)• GMETHOD OF TEST
11. WATER ZONES (depth): CHLORINATION Type 7 N Amounl.t7
.2_01S
CASING:
Depth[
From Ali To '7 T
From To Ft.
From To FI.
14. GROUT:
DEPTH
Formation Description
v
y ,3
If additional space Is needed use back of form
Wall Thickness
Ft. D •A itila •lcPV� MaT_Y5._edal
.1.U1C
Depth Malorlal Method
RQEiCTl"y_�U_TC_Ed_
Fromco To �.FI a
From
15. SCREEN:
To FI.
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From
17. REMARKS:
Diameter Slot Size Material
Ft In In.
Ft In In
Ft. In In
Size
Ft
To FI
Malerlal
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
+ C.
(11
n
c
I DO HEREBY
CONSTRUCTI
FOR OFFICE U
Nod No:
Sedal No.
if TI AT -THIS WELL WAS rfNSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
tilS NpARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVI D TO THE WELL OWNER.
��1is GU. /71—/7-10a
-ONLY
I
�r
Submit odpiiLdO
TUDE OF PESON CONSTRUCTING THE WELL DATE
Aston al Water ouallly, Groundwater Section within 30 days
GW-I REV. 12/99

268 '75
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone]//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR- N' RinAN L • LL(.
WELL CONTRACTOR CERTIFICATION #: 4DA 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Resldentlal Qr Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:JSiow sket 1 of the location below) .r l
Ne rest Town: aft County' c/A^�
arts baa_ 17.0
(Road Name and Numbers, Community r §ubdivlsion end Lot No.) DRILLING LOG DEPTH
3. OWNER 444 Gsr 4 Ca . From To Formation Oescdpllon
Address
C y�own % Slate
4. DATE DRILLED'1—Io2'O a-
5. TOTAL DEPTH nil S
6. CUTTINGS COLLECTED YES n NO��/
7. DOES WELL REPLACE EXISTING WELL? YES O NOI
8. STATIC WATER LEVEL Below Top of Casing: p FT.
(Use N. II Above Top of Casing)
9. TOP OF CASING IS ' FT Above Land Surface'
'Top of casing terminated sUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0116
10. YIELD (gpm): a 2.. METHOD OF TEST R.
11. WATER ZONES (depth):
�8^l5 Na - as -is QCk
j�z4R
2Ip Code
1V
1- CHLORINATION: Type ii7'N Amount l_ If additional space Is needed use back of form
CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter oraWeIghVFt. Material p (Show direction and distance from at least two State
From To 1+ D- Ft i/ ' 01 5 ry./•1 PVt-SO4C, Roads, or other map reference points)
From To FI - 'w
From To Ft.
14. GROUT:
Depth Material Method
From b To aZ-0 FI CIONCEEiE �Q(�td,
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To FI In In
From To FI In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
ea ca
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A come THIS RECORD HAS BEEN PRQVIDEDT{O7 THE�/WJELLL WNER.
FOR OFFICE $ELY � , ' �� A��
���[ �1
'`sad No: I 1111 r — t a TORE OF PERSON CONSTRUCTING THE WELL DATE
Submit odoltpr I. o Islon of Water Quality, Groundwater Section within 30 days
Serial No l,b) GW-1 REV. 12199
o

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Reielgh, N.C. 27699-1636-Phone [phone] �''
WELL CONSTRUCTION RECORD WELL CONTRACTOR' ND RmA/✓ 1 7WELL CONTRACTOR CERTIFICATION 0: ;c
'68866
A-Ll,
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show eke)
arest Town:
))iy S
Rb Named q. Community, orubdIvlslon and Lot No.)
3. OW R i ! /7roize c2'Y/
Address
ree or
City or Town Stale
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOI✓
7. DOES WELL REPLACE EXISTING WELL? YES fl NO((
8. STATIC WATER LEVEL Below Top ol Casing: 1jC) FT.
/ (Use II Above Top ol 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 .A 1Ja
10. YIELD (gpm): cf ; 7 METHOD OF TEST fl
11. WATER ZONES (depth):
h of the location below)
cu(y
Jo
o 21p Code ‘. 7,6
psflii
' CHLORINATION: Type Ti TH Amount
. CASING:
From
Depth I, Diameter
From
From
14. GROUT:
From Q
From
15. SCREEN:
Wall Thickness
or Weight/Ft. Maledal
To Ft G •015 d)4•1a5 >avGsDR
To Ft.
To Ft
Depth Material
To AO FI (DPICQ.E-FE
To FI
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
Method
ro r &CL
Diameter Slot Size Material
Ft In In
FI In In
Ft In In
Size Material
From Ft
From To Ft
DEPTH
Formation Description
BHirLoc k
IV
If additional space Is needed use back of form tV
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
fb(99/fis gr.
Jtiatth l 'of
-
0
m
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT'''. T JIuA-f,'kDS; ANQ, THAT A --carry THIS RECORD HAS BEEN PRO ED TO THE WELL OWNER.
O R
�. a CAA —a -- a_I ,C %, O�
vad No: it ��'IATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odgln: golvlsion of Water Quality, Groundwater Section within 30 days
edal No �, i GW-1 REV, 12/99
_IN
r ,F+I.00E
OFFICE
F
D
S
h
ASH -`IL..

North Coro:Inn • Department of Environment and Natural Resources - Division of Water Quality • Groundwnler Section
1636 Mall Service Center - Reielph, N.C. 27699-16384P11one [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' 36 hr uf. 0 'f4-S
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITN:
268841
1. WELL USE (Check Applicable Box): Flesidentlal EV. Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
flocovory r1 Float Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATIO ' (Show kelch f the locallpn below)
Nagre�l Town: County
—KYa n,
(9oed Nam umbers.. CCo mun(ll or Sub !vision and Lol No.)
3. OWNER
Address
Cliy Of Town Slale
4. DATE DRILLED
S. TOTAL DEPTH �t
6. CUTTINGS COLLECTED YES I [ NO[ v )
7. DOES WELL REPLACE EXISTING WELL? YES ( 1 NOM
8. STATIC WATER LEVEL Delow Top of Casing: 7 5 FT.
(Use •s• II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Lend Surface'
-Top or tieing terminated •Vor below I.nd surface requires i variance In accor-
dance wllh 15A NCAC 2C .9118 s
10. YIELD (gpm): f-1(O METHOD OF TEST Q
11. WATER ZONES (doplh)• j
1. sFiLORINATION: Type _I3._Lh--Amount 4
13. CASING:
DRILLING LOG DEPTH
From To Formation Description
- 25 r�rd pis k.
av7) 1p
Zlp Code
-o
If additional space Is needed use hack of form
lV
Wall Thickness LOCATION SKETCH -g—
Deplll ,--2 lamelzol r e 0L1V • ��M/ahe<daml p (Show direction end distance Irom nl leas! Iwo Stale
From �To )rD. - Ft. •� v � •� P r—'-v--'cu.`.� Roods, or olher rnap reference points) _
n f From To FL /v/r C`��
From To Fl eSTI-
/
14. GROUT: CSC / '- _--
rn
Depth Malarial 1
—
From • To �_�FI �(1R-EiE _
Y j i
16. SCREEN:
From To It U'Ae n C cf.)�;_..
c
Depth Diameter Slot Size Material o
From To Ft In In Cr..) c
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
Frorn To Ft
17. REMARKS:
I DO HEREBY C
CONSTRUCTIO
OR OFFICE
Quad No:
Y THATTHIS WELL WAk £0 'F UCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
I;InARDS, AN0.T11AT A� s0�' HIS RECORD BEEN PROVIDE E WELL OWNER.
//<<//NNE, ii//�!//// a _
3lODYA URE OF PER N CONSTRUCTING TIIE WELL DATE
Submit original la DI !sloe of Weler Quality. Groundwater Section wlthln 30 days
GW I NEV. 12199

2. WELL LOCATION: /'Show s etch of the location below) , __,//ems ems(,'•^
N� rest Town: 1 r Q "" County: J'/ •+�
ati
(nos Name and Numbers Communll or Subdlvi a and Lot No.)
3. OWNER YYla��fc1N.� (rnaitS If, j
wmm C�,a.QA,�I2
Shea or Itoule No.)
,u nE a27r7
Ciy or Town Slate
4. DATE DRILLED 0-a3_6
5. TOTAL DEPTH
CUTTINGS COLLECTED YES
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1638-Phone [phone],
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
1
WELL CONTRACTOR CERTIFICATION if:
STATE WELL CONSTRUCTION PERMIT#:
269124
e imAN Z. 2,49L(
,70.-;%
WELL USE (Check Applicable Boa): Residential L Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other II Other, List Use:
Address
Zip Code
DRILLING LOG
From To
DEPTH
Formation Description
o v - 074'5 BE -check
DOES WELL REPLACE EXISTING WELL? YES f I NO171
3. STATIC WATER LEVEL Below Top of Casing: 35 FT.
/ (Use ".' II Above Top of Casing)
9. TOP OF CASING IS ! FT Above Land Surface'
'Top of casing terminated ado( below land a urlace requires a variance In accor-
dance wllh 15A NCAC 2C .0118
10. YIELD (gpm): n METHOD OF TEST �. a -_:=;
0
11. WATER ZONES (depth):
12. CFILORINATION: Type
.SING:
H 7N
Depth Diameter
From 0 To FI .e • ; 5
From To
From To
14. GROUT:
FI,
FI
Amount1IS
Wall Thickness
or W IMaterial
all •,br�5
Depth Material
From Q To 920 ri rtricn-
From To Ft
15. SCREEN:
Depth Diameter Slot Size
To
To
From
From
From
FI In In.
Ft In
To Ft In
16. SAND/GRAVEL PACK
Depth
To
To
From
From
17. REMARKS:
Size
Ft
FI
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map reference points)
Mot; Iood11\.,J Qt, C L. a--Q1
Material
In
In
Material
w
n
0
crt
I DO HEREDY•'E
CONSTRUCT 1
Dh3PSL7rNID1 TIOT
r T OFFICE
-ad No:
Serial No.
t pNLY
L
SUlkhll o
RUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
• THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/0_23-a/
S 9 NATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Ivlsion of Water Quality, Groundwater Secllon within 30 days
CW.i nEV, 12/99
•
6r,
AS HE''d;LLE
ICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raielgh, N.C. 27699-1636-Phone [phone] / r
WELL CONSTRUCTION RECORD WELL CONTRACTOR.RIAW k�i ti Wf/✓ES
WELL CONTRACTOR CERTIFICATION If:/90
STATE WELL CONSTRUCTION PERMIT#:
2701 ^ 11
1. WELL USE (Check Applicable Box): ResidentialE Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: how sk cli of ire location below)
Nearest Town: I _county.
(Road Name and.yumb r q s, Community. o ubdl iy alon aQd Lot No.) DRILLING LOG
3. OWNER JV�.JL.[JIi 6lL.LJ�-A From To
Address
City or own Slate
4. DATE DRILLED.? 910 a•
5. TOTAL DEPTH 5
6. CUTTINGS COLLECTED YES f NO(u,
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOl Vri
6. STATIC WATER LEVEL Below Top of Casing: �LQ FT.
(Use 'i if Above Top of Casing)
9. TOP OF CASING IS L FT Above Land Surface'
•Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): /OO METHOD OF TEST li)) q
11. WATER ZONES (depth):
DEPTH
Formation Descdpllon
6 a - 34S BeAq,,eS
ee or
ag�5�
Zip Code
12. CHLORINATION: Type - � Amount la 1113 If additional space Is needed use back of form u1
1 ASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Maledal (Show direction and distance Irom at least Iwo State
From O To 4:;* Ft L. D5 alga` I5 PYC-5D11 Roads, or other map reference points)
From To Ft fir` a� &A�()
From To Ft ��`'�'�
14. GROUT:
From 0 To Qliod
Depth Material Mel!
� Ft GD!l GP 1��P
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In, In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Slze Malerlal
From To Ft
From To Ft.
17, REMARKS:
I DO HEREOY 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.
:�A-z l4scw cc' a y o
SI3J4T skin
OF PERSON CONSTRUCTING THE WELL DATE
Submit original to tPly sign of Water Quality, Groundwater Section Within 30 days
.al No. I GW-1 REV. 12/99
FOR OFFICE USEIONLY
Quad No:
CO
—n
Liz C
N

I FOR OFFICE USEONLY-; -
Quad No.
)
Serial No.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. N RmAN Z. 2.41.7(.
WELL CONTRACTOR CERTIFICATION #: a7D-37
STATE WELL CONSTRUCTION PERMIT#:
270143
1 WELL USE (cheekAppllcabte Box): Residential2r Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other I] If Other, List Use:
2. WELL LOCATION:�(Show,sketpp of the location below)
Nearest Town: kY hd,7� C
(Road Name�ndd fibers, Gmmuu , or Subdivision and Lot No.)
3. OWNER -/RP C/J! 1
Address
or
ty or Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NOV'
7. DOES WELL REPLACE EXISTING WELL? YES n NO 1I
8. STATIC WATER LEVEL Below Top of Casing: /2 FT.
(Use N.' 11 Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated .Vor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011g
10. YIELD (gpm): 17 METHOD METHOD OF TEST Il. . 3
11. WATER ZONES (depth)•
' CHLORINATION: Type 7N Amount
. CASING:
775iY
DRILLING LOG
From To
DEPTH
Formation Description
- /,C5 PAIR
7/ ,ems B d izoc k
From
From
From
14. GROUT:
0
Slate
Zip Code
Wall Thickness
Depth Diameter or W ight/R. Material
To 7/S Ft G . a 5 a71 � r1,5 PW.SDR
To Ft.
To Ft
Depth Material Method ,
From Q To FZ-0 FI CIvNGP.EfE 7.i1_pt,`e.&�L
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In -In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
w
c
IV
IV cr'
If additional space Is needed use back of loan U1
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
Y6 if
Tam
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEENROVIDED TO THE WELL OWNER. --y�J�
6723`i 2
I'5111rIATURE OF PERSON CONSTRUCTING THE WELL
SubmIIodg vial Icj plvlslon of Waler Duality, Groundwater Section within 30 days
I i
DATE
GW-I REV. 12r99
r>

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ACV CONSTRUCTION RECORD WELL CONTRACTOR. 7rd RMAA/ 4' 2A"LL.
WELL CONTRACTOR CERTIFICATION S: aDA7
STATE WELL CONSTRUCTION PERMITS:
270140
1. WELL USE (Check Applicable Box): Residential Er Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Sho rs vh of the locallon below)
Nearest Town i7 l7T/rr7 County
(Road Nam�[q�nd Nuera, Co unl Subdivision and Lot No.) DRILLING LOG DEPTH
/��/v ��� From To Formation Description
.2U
3. OWNER
Address !�� %paO
y J/ (S)reiLof 7 e N
City or Town ,e �.
�
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOvi
7. DOES WELL REPLACE EXISTING WELL? YES �_ NO[V(
8. STATIC WATER LEVEL Below Top of Casing: ( FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of easing terminated .Uor below land surlece requires a variance In accor-
dance with 15A NCAC 2C .0118 �;
10. YIELD (gpm)• 9&' METHOD OF TEST
11. WATER ZONES (depth)•
Code
/fb ?li"5 3L fritoc k
•
0
N
01—
CHLORINATION: Type Th Amount 1 tl additional space Is needed use back of lorm
. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
Wall Thickness
Diameter or W Ight/Ft. Matedal
FI if•a5 alter;s pve-sDK
Ft.
Ft
Depth Material
From 0 To a o ri C1i7NCEEiE
From To FI
15. SCREEN:
Melhod
Depth Diameter Slot Size
From To FI In
From To FI In
From To Ft in.
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
In
In
In
Malarial
Size Material
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Road2, or other map reference prints)
p/l1l�na 'dr
/�
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CON UCTED IN ACCORDANCE ITH 15A NCAC 2C, WELL
CONSTRUCTIGH-STANDAT L55 dtaD THAT A'CO'� 4a
FOR OFFICE U$E'.dlJt-Y
Quad No: 1
ISerial No.
THIS RECORD HAS BEEN ROVIDED TO THE WELL OWNER.
507
,$ O URE OF PERSON CONSTRUCTING THE WELL DATE
Submit odoirialj i Islon of Water Qualliy. Groundwater Section within 30 days
GWI REV, 12/99

I . WELL USE (Check Applicable Box): Residential L147 Municipal fI Indusirlal [ 1 Agricultural ❑ monitoring Li
Recovery ❑ Heat Pump Water Infection ❑ Other El If Olhor List Use:
2. WELL LOCATION: Show sketch o tie location below)
rest Town: a LCouniy.
1S.-.)
(flood Name end Nurnberg. CooJrnm`unlly, or Subdl slop snd Lol o.)
3. OWNER �C mar„a� cS From To Fom,nlIon Oescdpllon
-11 j Tti of or
27 0137 •
North Carolina • Department of Environment and Nolurnl Resources - Division of Water Duality • Groundwater Socllon
1636 Mall Service Cooler - Ralolph, N.C. 27699-1636-Phone [phone] - ( (�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 30 bhrs ✓.1J . Pff1 �S
WELL CONTRACTOR CERTIFICATION 0: 0c7 8
STATE WELL CONSTRUCTION PERMIT.:
DRILLING LOG
DEPTH
Address
City or Town Slate
4. DATE DRILLED -rid -ba'
5. TOTAL DEPTH f
6. CUTTINGS COLLECTED YES I I NOI �I
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •r' it Abovo Top of Cnsinp)
9. TOP OF CASING IS l FT. Above Land Surface'
•Top of cesinq let mingled at/or below land surface requires a edance In accor-
dunce wllh ISA NCAC 2C iI
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (dopih)'
Zip Code
0
3S - tooask
0
U1
1' ILORINATION: Type ..111N Amount D II additional spats Is needed use back of form
13. CASING:
Wall Thickness
Depth plarncg fq V[J Material
rrom�To,IS_-Ft .(p rI�J. II jj
From To P1
From To FI.
14. GROUT:
From Q
Depth -Materiel Metlied
Frorn To FI.
15. SCREEN:
Depth Diameter Slot Size Material
From To F1 In. In
From __. To __ Ft In In
From __ To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From * To FI
From To FI.
LOCATION SKETCI1
(Show direction and distance from nl least Iwo Stale
Roads, or other map rolaror e points)
17. REMARKS: 11
I DO HEREBY 4ERT)IfY.THAT THIS WELL WASr{7I UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUCTIDNISYANDARDS,-AND T1 FAT A-e F THIS RECORD HAS BEEN PROVIOTO THE WELL OWNER
I • 1 1 11/// lj — -. 0 `0
,A OFFICE USE ONLY
Quad No: I . steri lunE or RSON CONSTRUCTING TIIE WELL OATS
Submll odolgal is D ,lslon al Wnler ouellly, Groundwater Section within 30 days
I GW 1 REV. 12/99
Serial No. �—,.
--a.

North Cnrollnn • bnpertmont of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Cantor - Osloloh, N.C. 27699-1638-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 3a hints CAL t'efk
WELL CONTRACTOR CERTIFICATION 0: _ Oa g
STATE WELL CONSTRUCTION PERMITH:
270133
1 . WELL USE (Check Applicable Box): Flesidenllal [2/. Municipal ❑ Induslrlal ❑ Agricultural ❑ Monitoring n
Rocovory ❑ Heal Pump Water In)eclIon ❑ Other [] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
_County'
Ne4rest Town:
,{2ri. �o2r c-,mil • p�7�ti` -�a�
(nosd Name a Numbers, Community, or Subdly slan and L No.) DRILLING LOG
3. OWNER ��qf`.9 \JCL�/\ 5 sw} From To
Address )� ((p� 11 `�,rV` 1 I bu.-.1��'1�r-it+p`T•,
'- iSITEoI o1 IIOuIq` � 1 CALrL s 0 - a 1
14‘icily o owls a s 1'1,-�' Slala Zip Code `�` 1 - ci. ASS
c - 5 n n
4. DATE DRILLED —) '� �'
5. TOTAL DEPTH '7
6. CUTTINGS COLLECTED YES [ 1 NO vf
7. DOES WELL REPLACE EXISTING WELL? YES a NO[ 4
8. STATIC WATER LEVEL Below Top of Casing: �� FT.
(Use's" II Abovo Top of CesIng)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of cesing lermineled Nor below lend surface requires a variance In accor-
dance wllh 15A NCAC 2C .9110
10. YIELD (gpm): /?— METHOD OF TEST
11. WATER ZONES (depth).
•
1' ILORINATION: Type 41 T N Amounta
13. CASING:
DEPTH
Formation Description
J
1
0
If additional space Is needed use hack of form
Wall Thickness
Depth� �b1 r+l�rn,1a1lodVg Material
From ((, To I FI. •
From To FI
From To FI
14. GROUT:
Irk Topth Material
Mol Iwd
From d To 10_ FI Qor�R Ei 6 rn
Frorn To FI
15. SCREEN:
Doplh Diameter Slot Size Malorlol
From To FI In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
1 DO HER
CONSTRU
Size
FI
FI
Material
LOCATION SKETCH
(Show direction end distance from nl least Iwo Stale
Bonds, or other map reference polnts)
he 0-6119
De,t)JraLiki
)(0-irSIP tr
f)TIFY'THAT THIS WELLW%$ STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STAND:RDS, AND TIIATAI0O ` OF THIS RECORD HAS BEEN PR VIDEO VIDEO TO E WELL OWNER.
a OFFIC USE ONLY
Owed No:
!'.Ij11
--�S ONATURE OF
Submlt'adginal to Division of
ERSON CONSTRUCTING TIIE WELL DATE
Water evenly, Groundwater Section within 30 days
GW.l nEv. 12/99
Serial No,

270116
North Carolina • Departmont of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /'; RMAN L • A'LL,
WELL CONTRACTOR CERTIFICATION f: 0R0.. 2'
STATE WELLCONSTRUCTIONPERMIT":
1. WELL USE (Check Applicable Sox): Residential IO" Municipal r1 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION: (Show sk-tcll o the location below)
crest o n: ii �. County'
(Floe 'W me and ub: s. Corr ly, or Su.division �and Lot No.)
Xrn
3. OWNER CG—r s (, "Q /rX-L'JL-
h g
1..,/1 V<
�r c _(S( aoroulen (� c ai 1 5 -3
1Cityor Town-� Slate Zlp Code
4. DATE DRILLED 070F
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO4
7. DOES WELL REPLACE EXISTING WELL? YES I NOl vf
8. STATIC WATER LEVEL Below Top of Casing: SS FT.
/ (Use -•' it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated eVor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .9118 'D;
10. YIELD (gpm): Le', METHOD OF TEST
11. WATER ZONES (depth):
Address
CHLORINATION: Type Fr 7H AmountS
. CASING:
From
From
From
14. GROUT:
Wall Thickness
O �GI
Depth r/�/ Diameter(o
or }IghVFI. Material
PvtsDC
To / / Ft
To Ft.
To Ft
From 0
From
15. SCREEN:
Depth Material
To 0 Ft CIO/YCPkit
To Ft
Method
7D ,
ckde—
Depth Diameter Slot Size
Frorn To P1
From To FI.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
In
In
In
Size
Ft
Ft.
In
In
In
Material
Material
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
-Pil•d<A0 ,pot
gdyLuzu,
U1
0
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.
FOR OFFICE USfONLY
Sedal No.
Clued No:
SIONA
Submit odglnat (d DIv
RE OF PERSON CONSTRUCTING THE WELL DATE
lon of Water Ouallty, Groundwater Section within 30 days '
GW-I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Wafer Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] y//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /1DRmAN L. 2A/L
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
I
270115
1. WELL USE (Check Applicable Box): Residential la Municipal ❑ Industrial ❑ Agricultural LJ Monitoring ❑
Recovery ❑ Heat Pump Wafer Infection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: ( I ow k- tch oLthe location below) / �/'
Nearest Town. County: Pia ram, l�
need Name and
3. OWNER
Address
r'1
ere. Community, nu•divlslon and of No.)
Clt or Town Stale
4. DATE DRILLED '01 .0 o`t
5. TOTAL DEPTH i5
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES Q NOI71
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'? 11 Above Top ol Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with ISA NCAC 2C .0 a
10. YIELD (gpm): METHOD OF TEST R. J
11. WATER ZONES (depth):
0
Zlp Code
DRILLING LOG DEPTH
From To Formation Descdptlon
D -
4.C.2 -ns t3Ede oCk-
c)
r.)
- ^ CHLORINATION: Type 7N Amount If additional space Is needed use back of form =_
CASING:
Wall Thickness LOCATION SKETCH
Depth ��11 Diameter or W Ight/FI. ;1Maledal (Show direction and distance from at least two Slate
From D To ` 2._ FI I,• a 5 PveSD� Roads, or other map reference points)
From To FI '*
From To Ft 7) (" /� , !Act aU 9
14. GROUT:
Depth Malarial Method ii � • ?
From 0 To �C1v/
_ FI YCPL4 E �u,lE�f�,_. /
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
Ram To FI
17. REMARKS:
tJ1 -
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PR IDEDD TO THE WELL WNER.
FOR OFFICE ONLY (M L-A--, 6 -a ve Q;-
luad No: 1 'JATURE OF PERSON CONSTRUCTING THE WELL DATE
Submll oddlta g
Jlo Division ol Wafer Quality, Groundwater Section within 30 days
Sedal No. r I i ', GW.I REV. 12/99
L1

North Carolina - Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]�/%�' -y
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Are R/T)RN Z • 2 LZ(�y.
WELL CONTRACTOR CERTIFICATION IS:e D.
: a
STATE WELL CONSTRUCTION PERMIT#:
270089
1. WELL USE (Check Applicable Box): ResidentialE. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) yy�,. �f
N rest Tov�_/ County 1 CJ� +�._rn
Road a e and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG
3. O W N E Glyn e /e-s I2n-//e y
b51 (,(mom 125�'r' Rd
rn // S rea oyl �. 287R)
City or own Slate Zip Code
4. DATE DRILLED 7 /a OR
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES f] N014
7. DOES WELL REPLACE EXISTING WELL? YES n NOt vI
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
*Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .�8 fp
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
Address
From To
D -55
55 d
19 CHLORINATION: Type T-T TH Amount Rp'1II%
ASING:
B RgdJc
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Walgh.V-FII. ;1Maledal (Show direction and distance from at least Iwo Slate
From 0 To 55 Ft b • a 5 . )6.1sD5 Pve•Sk. Roads, or other map reference points)
From To FI. "`
From To FI,
14. GROUT: 7 p Depth Material Meth
od trod 112 � `//, l,c 7 ,
From D 7o vZ o FI f ONC2ki E 1.7p11.B,�.dr (i �.1c
From To Ft
15. SCREEN:
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Dlaineter Slot Size Material
Ft In In
Ft In In
Ft In In
FI
Ft
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYSHIS RECORD HAS BEEN PR�/IDE� THE WELL WNER.
FOR OFFICE US ON4V%l��/�%�l.�ilti/ (�iJy /'"`G —0..?Ouad No: S, 1 1'A`T11f1E OF PERSON CONSTRUCTING THE WELL DATE
j -- Submit original 1b Oils on of Water Quality, Groundwater Section within 30 days
pedal No.
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section 2 7 0 0 8 J
1636 Mail Service Censer - Raleigh, N.C. 27699-1636-Phone [phone] y/jam' /
4
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /I RMAN • 2A-Z(.
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT'S:
1. WELL USE (Check Applicable Bon): ResidentialZ Municipal ❑ Industrial ❑ Agricultural LJ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other Ej If Other, List Use:
2. WELL LOCATION:
:(Show sketch of the locallon below) r ld�,�-�n
w rest TownCounty : ,-/11sa County
(Road me akd Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER rtidy IPA -Fond. From To Formation Description
albtei:P2 eK4a2 Q - 7y f"Address
pl4rsJJ// 12.0 ;VS 3 77 -"Of, '(t pr k
City or Town Slate Zip Code 6-"v
4. DATE DRILLED
5. TOTAL DEPTH GCS -
6. CUTTINGS COLLECTED YES n NOI4
7. DOES WELL REPLACE EXISTING WELL? YES n Not
8. STATIC WATER LEVEL Below Top of Casing: R.5 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): /0 METHOD OF TEST
11. WATER ZONES (depth):
1 0. CHLORINATION: Type 711 Amount 5. If additional space Is needed use back of form
CASING:
Depth ry Diameter
From To " / Ft Is • a 5
From To Ft.
From To Ft
14. GROUT:
a'
Wall Thickness
or W IghvFt. Material
Pvc-sndC
Depth Material Method ,
From b To OS_ Ft InvI C2.Ef E� u 2Eri-
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
rmrshQll, o9•G•
W
rn
rV
rn
cn :r
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONCTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIDN-STTlANDAROS, AND:THAT A GO THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FOR OFFICE U1Stt O-V- � Cf .3 7^i� �.7 .
Quad No: I' .;� �! URE OF PERSON CONSTRUCTING THE WELL DATE
Submit (piglet d I Islon of Water Dually, Groundwater Section within 30 days
1 serial No. I GW-I REV. 12/99
i
•
2;

1
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1636-Phone [phone] - Al;WELL CONSTRUCTION RECORD WELL CONTRACTOR. ijD @TIAN L L. 24«.
WELL CONTRACTOR CERTIFICATION 0: ofDA 9J
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential2 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) yy� _
County road iSen
ti,aut V\C./
nd Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Ycrry J0446rid• From To Formation Description
Address
73(b`gs Grove Rd' D -q8 �),R
Ire° or oule No.
f1arAo// 11.G• 9,g 753 48 -a2.5 BE-clIzork
City or Town �G..n Slate Zip Code
4. DATE DRILLED �J_ [1__as_
5. TOTAL DEPTH �-1'
6. CUTTINGS COLLECTED YES n NOVA/I
7. DOES WELL REPLACE EXISTING WELL? YES Q NO(IA
8. STATIC WATER LEVEL Below Top of Casing: J O FT.
(Use 'i II Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated aVor below land surface require• a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 10 METHOD OF TEST
11. WATER ZONES (depth):
0
W
0
--1
V
10 CHLORINATION: Type J'i 71-1 Amount ep r JlS II additional space Is needed use back of form
CASING: "
01
Wall Thickness LOCATION SKETCH
Depth Diameter or W IghvFt. Material (Show direction and distance from at least Iwo State
From O To FI L • aZ 5 .PVGSDrC Roads, or other map reference points)
From To Ft. 9:a
From To FI
14. GROUT:
Depth Material Method
Iwd
AO n To � Ft CI�NGEEiE
From To FI
15. SCREEN:
Depth Diameter Slot Size Malarial
Frorn To Ft In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
mor5/261/, 6-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FOR OFFICE UEQMLY /n'� �-� ��
'luad No: �, "-.-- ISt A ORE OF PERSON CONSTRUCTING THE WELL DATE
Submit odginal o Di islon of Water Quality, Groundwater Section within 30 days
1 Serial No. I GW-I REV. 12199
1
270078
a-)

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
2700R0
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
BD 6i-, C.l�. P0*k
WELL CONTRACTOR CERTIFICATION 0: e9a Q
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable soak Resldenllal l vl Municipal ❑ Industrial ❑ Agrlcullural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ - Other Ej If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) C unp ly: I r' ii{ �., ,,/I
C / C.YJ+���rl
rest Town:
.6
N e and Numbers C rnmunny or Subdivision and Lol No) DRILLING LOG DEPTH
(Ro 3. OWN
derp
IcI -//
From To Formation Dascdpllon
Address
r5h1 A Str¢01 er ou 10. No
.) 9976, I
Clly or TownStale Zip Code
4. DATE DRILLED 5—/ 7 dr
5. TOTAL DEPTH /'E'5
6. CUTTINGS COLLECTED YES ( I NO[ Vf
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: tin FT.
(Use •: If Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of closing terminated aVor below land surface requires a variance In accor-
dance wllh ISA NCAC 2C . 11a
10. YIELD (gpm): METHOD OF TEST I q
11. WATER ZONES (depth)•
D - 6%4
-165
0
0
1V
19. CHLORINATION: Type Amount 3,l._5 If additional space Is needed use back of form
CASING:
Wall Thickness
Depth
�la30tp.r ,Ull"�a Ig
UA. Material
From ill ToFt 91.5i�yC'SDIz
From To Ft
From To Ft,
14. GROUT:
Depth Malarial Method
From 0 To AO_FI a FjQ E"{ E �IiR.eed,__
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Fl
From To Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least Iwo Stale
Roads, or other map reference points)
era
n.(•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1 FOR OFFICE U$E ONLY
uad No: - ' URE OF P RSON CONSTRU TING TIIE WELL DATE
Submit odginel to pletston al Wal er Ouallty, Groundwater Section within 30 days
Sedal No. I GWt REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 7 0 it J A
1638 Mall Service Center - Ralalgh, N.C. 27699-1636-Phone [phone] SKI Oil
�.I �k
WELL CONSTRUCTION RECORD WELLCONTRACTOR• LJRIAW kE/LW A 1NE5
WELL CONTRACTOR CERTIFICATION II:14/'D
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water InJectlon ❑ Other ❑ II Other, Llst Use:
2. WELL LOCATION Slow ske li of e location below)
Ne. re Town: Stt 1 •e�.t,,/1 County' CcatiJ
414.1 /4ISL< / 1
_ ...
(Road Name and
3. OWNER
Address
e Community. or Subdlvlsl n and Lot No.)
Wati l o f
lea or •0 17..
Zip Code
FOR OFFICEIUS 'ONLY-
Quad No: I
Serial No
City o Town -11 -b
DEPTHStale
5. DATE '
5. TOTAL DEPTH 17f
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NOI (
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -r' if Above Top of Casing)
9. TOP OF CASING 15 FT Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011e
10. YIELD (gpm): 1 0 METHOD OF TEST �r
11. WATER ZONES (deplh):
DRILLING LOG DEPTH
From To Formation Descdpllon
12. CHLORINATION: Type
13. CASING:
I
ru
1 { T N Amount 34L1L5 II additional space Is needed use back of form
rs
Wall Thiiqckness-yam
ial
From DToIt� FI ts.D. .Z)%Ilhe MIQSh c.
From To FI
From To FI
14. GROUT:
Depth Material Melhod
.2_
From 0 To AO Ft LfilVCpEf'�_
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
From To FI In. In
From To Ft In In
From To Ft. In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
O
CO
—n
rn
Q
N
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC ION-STANDAtfuS,ANO-71-MT*6@2Y-0F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
quilNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odofri Division of Wale( Ouailty, Groundwater Section Within 30 days
GW-I REV. 12/99
.71

North Carolina • Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] y//�'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /f N RnAN L • 2g«.
WELL CONTRACTOR CERTIFICATION If: o?D47
STATE WELL CONSTRUCTION PERMITN:
270046
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other I] II Other, List Use:
2. WELL LOCATION: ow sket h of the location belo/w)' ,,
Nei nt Town.IA71 Lty.
YGal. ALI ithze.
(Road Name and Number Comrity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER C�0-h�..QhA)
Address (
\Tety, AA reel or Rouln D�'cLi
TLiJI � r �
Ci y or Town Slate Zip Code
4. DATE DRILLED I 0- 9-0
5. TOTAL DEPTH 3 S 5
6. CUTTINGS COLLECTED YES I I NO 4
J
7. DOES WELL REPLACE EXISTING WELL? YES In NOIVI
8. STATIC WATER LEVEL Below Top of Casing: to p FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
• Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.01 a
10. YIELD (gpm): METHOD OF TEST TN' I
11. WATER ZONES (depth):
From To Formation Description
DU 32S 't ork
• CHLORINATION: Type 117N Amount( ,Its
CASING:
0
0
O
J COr-
rn'-
If additional space Is needed use back of form
.G"
Wall Thickness
- Depth Diameter or WpighVFt. Maledai
From L To o Ft. U. a 5 c)t.1a5 PVGSD42
From To Ft
From To Ft
14. GROUT:
Depth Material Method ,
From 11)To
To 0 FI C1tg1YCP.EiE �7QiLB.�d�
From To FI
15. SCREEN:
Depth Dlarneter Slot Size Material
From To Ft In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
rit6A-s
I�C
0
CO
-n
O
CO
rs
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION_STANDARDS AND THAT A COPY F THIS RECORD HAS BEEN PR iOED TO THE WELL WNER.
FOR OFFICE U•$O
Ouad No: - r— -7 1URE OF PERSON CONSTRUCTING THE WELL DATE
Submit originalAston of Water Duality, Omundwater Section within 30 days
Serial No. GW-1 REV. 12/99

270028
North Carolina - Daperimonl of Envlrnnmonl and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOn• BD MI( OS. P +s
WELL CONTRACTOR CERTIFICATION 0: Da g
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (Check Applicable Boa): Flesldenttal LtO Municipal ❑ Industrial Agricuilurai l I Monitoring
Rocovery rHoat Pump Water infection [1
II
Other ri II Other, List Use:
2. WELL LOCATIO Show ske cl of the location below)
Nearosl Town:, Q�.S ��I Q 1 County' Q
03� lu' c s auks- �V ems l my
(Road Name and Numbers Corn unity, or Subdivision and Lot No.) DRILLING LOG DEPTH
From To ForrnMlon Da scdpilon
3. OWNER 0-3310 , I 1 S
Address
or o eo.
OC
Clly Or Town Stale
4. DATE DRILLED Id' IA'b�
5. TOTAL DEPTH )45 , NO( �r
6. CUTTINGS COLLECTED YES I
7. DOES WELL REPLACE EXISTING WELL? YES I I NO if
6. STATIC WATER LEVEL Below Top ol Casing: %S FT.
(Use'r' If Above Top of Casing)
9. TOP OF CASING IS i FT Above Land Surface'
•Top of c a elnq terminated aVor below lend surface requires a vedence In accor-
dance with ISA NCAC 2C I1a
10. YIELD (gprn): (% METFIOD OF TEST T Q
11. WATER ZONES (depth): j
ay. - 1y5 rzyk.
c2,'S 75 Lt
Zip Code
0
6J
r
r
12. CHLORINATION: Type a Amount If additional space Is needed use back ol form N
13. CASING:
LOCATION SKETCH
Wail Meknes,
Depth pin Drill. p rU {��M�ate(daaI Q (Show direction and distance Irorn nt least two State
From —^ i 7--I I. p° n �"r rill '--'-"-"-"'•' Floods, or other map tolerance points)
Flom 0 To �f FI� e1g5$ sS-1C.�1 I Qy/q
From To F1. / t ! L e-C- /
,../,�-�1
I4. GROUT: /
Depth ��TT,, ikElMaterial Method
r
Flom Q To .�L�FI L}+�E{F�b(1 KEd4
Frorn To Ft
15. SCREEN
Depth Diameter Slot Size Materiel
From To Ft In in
From To FL In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
Frain To Ft
From To Ft
17. REMARKS:
I DO IIEREDYTtFY TH4TTHIS WELL WATC TIUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUCTI N R5.111At OARDS, AND TI IAT A C1l' O - THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
II
FOR OFFICE USE`QNLY
t.TUNE OF P • ON CONSTRUCTING TIIE WELL DATE
Quad No: } IL, Subnill odpl Division of Writer Duality, Groundwater Section within 30 days
ICE
CJ
lb- o -6 2
Serial No,
GW. I NEV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 270020
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] - 7(//,'
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /1 dv RmAN Z • 247(.
WELL CONTRACTOR CERTIFICATION R: - 41)a 7
STATE WELLCONSTRUCTIONPERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I( Other, List Use:
3o
(Road Name
3. OWNER
Address
1 ' \LIk ree or ou .� 'DSO C ( �, `� l_or k
City or wn SI la dZip Code
4. DATE DRILLED b--
-b
5. TOTAL DEPTH .�
6. CUTTINGS COLLECTED YES [ NO4
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing:--ITcJ— FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface•
•Top of casing terminated aUor below land surface requlrea a variance In accor-
dance with lSA NCAC 2 0119
10. YIELD (gpm): f) METHOD OF TEST !NI 5
11. WATER ZONES (depth): 12. CHLORINATION; Type HTH Amount41al;I1
1 \SING:
DEPTH
Formation Description
2. WELL LOCATION: how sketc s of the location below)
Nearest Tgwn: County.
S kaki—
n.
umbers,
bersr Community, or Sgbdll Islonr and Lot No.)
11 A�J
rV
If additional space Is needed use back of (arm
Wall Thickness LOCATION SKETCH
Depth Diameter or WpaighVFt. Material (Show direction and distance from at least two Stale
From To IQ FL L • a 5 o7)b J.,S Pi/GSDc Roads, or other map reference points)
From To FI.
From To Ft
14. GROUT:
Depth Material Method ,
From 0 To eZn� Ft l >D�CP_.E•iE '-]�)p_tr'eE_r{_
From To Ft
15. SCREEN:
Doplh 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:
O
CO
TI
rl
c
r‘1
01
N
w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
- •' •F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
CONSTRUC
FOR OFFICE
Ouad No:
al No
i-)O,F -8 FANGIAR9
Submit original
JATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• NeRn1An/ L L. 2-LL.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential I' Municipal ❑ iridustrlal ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: SI ow sket 1 of the location below)
Nearest Town: \a%T-� County:
1111 GJ mn,5 IY"�CL7,s Maas(
(Road Name and Qk mbar,. Common or Subdivision and Lot No.)
3. OWNER ' 1 \ A
Address
Cily or Town Slate
4. DATE DRILLED " ),3-0 7.
5. TOTAL DEPTH I 5
6. CUTTINGS COLLECTED YES I I NOFV1
7. DOES WELL REPLACE EXISTING WELL? YES O NOE-VI
8. STATIC WATER LEVEL Below Top of Casing: FT.
I(Use •+• If Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
-Top of casing lerminalod st/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
W. YIELD (gum): RO METHOD OF TEST 2,r J
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
5 - 12 ff JB E-ci20c k
1 lree of r Iloule No )C? s
Ct1. Sl�al�A n a 2 15 3
Zip Code
0
n,
0
-0
rV
12. CHLORINATION: Type Tr 7 H Amount 3. ill-5 If additional space Is needed use back of form
1: USING:
Wall Thickness
Depthe� Diameter or W IghVFt. Material
From To "—L- Ft is • c 5 ah)4./ Puc.svc
From To FI
From To Ft
14. GROUT:
Depth Material Method ,
From b To it 0 FI C1a/YCP�li 7_il � Ou eE,{- �
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Cy-.; a-5
mar
N
Ol
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
FOR OFFICE USEF NLIYi_,
Quad No:
,I No.
Submit odginal IQ
F THIS RECORD HAS BEEN PR
IDED THE WELL
270006
c
-a3.0a
E OF PERSON CONSTRUCTING THE WELL GATE
n of Water Duality, Groundwater Section within 30 days
GW-I REV. 12/99

269996
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /RJ4W kE/4-n W rNED
WELL CONTRACTOR CERTIFICATION 0: .3/1740
STATE WELL:CONSTRUCTION PERMITS:
1 . WELL USE (Check Appticeble Box): Residential l.gMunicipal ❑ Industrial ❑ Agricultural LI Monitoring D
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOp(/(Show etch q the location below)
Nearest Town•
County'
mwal pa, red..
(Road Name a Numbejr , Comm Hy, or Subd Isl�0 nd Lot No.), UHILLING LUG
3. OWNER 011 Uv r� r��=%il
Address
a[424i ea or'ou9/7
Clly or Town Stale
4. DATE DRILLED
5. TOTAL DEPTH
6, CUTTINGS COLLECTED YES I NOR/
7. DOES WELL REPLACE EXISTING WELL? YES NO F-
8. STATIC WATER LEVEL Below Top of Casing: C�j FT.
(Use •t• II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
-Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm) METHOD OF TEST R) q
11. WATER ZONES (depth):
Zip Code
12. CHLORINATION: Type +tT {-f
13. CASING:
L
-a
IN)
Amount 8 If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Dlameler or WelghvFl. Material (Show direction and distance from at leas) Iwo State
From O To 3 ¥" Ft be. D5 a)la• PvC-SDf Roads, or other map reference points)
From To FI
From To Ft.
14. GROUT:
Depth Material Method
Frorn To aO FI rank(r Pi ere -(fin I. £.l p
From To FI 1 CO
15. SCREEN: r*T
CO
Depth Diameter Slot Size Material
N
Frain To FI In. in, Crt
From To FI In In -v
From To Ft. In. In Z
16. SAND/GRAVEL PACK: no
Depth Size Material CO
From To Ft
From To Ft.
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE{US ONj.YY.
Quad No:
Serial No
Submit odgleal l(
�i
lATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

i
( oad Name anp Lumbers, Common)
3. OWNER
Address
�_ k ,(Street or Ho�
r Town f State
4. DATE DRILLED -) -9 • b �
5. TOTAL DEPTH LLD 5
6. CUTTINGS COLLECTED YES [ I NO��/ I
7. DOES WELL REPLACE EXISTING WELL? YES [fl NO[(
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use •+ II Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2 116
10. YIELD (gpm): 0 METHOD OF TEST
11. WATER ZONES (depth)•
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] y//_' L.
-y1
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /161 imm)AN C • JA-Z(.
WELL CONTRACTOR CERTIFICATION #: O C.S 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential2J Municipal ❑ Industrial Li Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water injection ❑ Other (� If Other, List Use:
2. WELL LOCATION: Show sk toll of the location below) yr^YnI - _I
Nearest Town: County l CYO
Near "2-A*L ftS_
sr Subdiv s an and Lot No.) DRILLING LOG DEPTH
269986
From To Formation Description
D - 5 siz
5 7- at?5' Br-cLepck
•
131 c a- C Eca
L. a%/53
Zlp Code
12. CHLORINATION: Type TT 7H Amount 4S-lots
1 \SING:
O
=r
N)
V
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
From D
Depths. Diameter or WelghVFt. ;\Material (Show direction and distance from et least two Stale
To ".i Ft L • a 5 al4 .b l r I!C•SDc Roads, or other map reference points)
From To FL ... tr . _ a dw T/ t
From To Ft I I �
14. GROUT: In ll"`v'�Q �.n
Depth Material Method • O
From b To A FI Clopere_fr¢E apougatiL 0
From To Fl n
w
15. SCREEN: ry
Depth Diameter Slot Size Malerlal rn
From To FI In In. v
From To FI. In in
From To Ft In In N
16. SAND/GRAVEL PACK: CO
—
Depth Size Malerlal
From To Ft
From To Ft
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FOR OFFICE USE ONLY-•. ! '>�(�YLGLti/ .�3 ��_ 9 - 9 -o
Quad No:
No.
SI NAT
Submit odglnal to Div slorf
jI
F PEDSON CONSTRUCTING THE WELL DATE
Water Quality, Groundwater section within 30 days
GW-1 REV. 12/99

1
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1630 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
//,'p 269984
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /1rd zT %Y)AN 4 • 2A(�.
WELL CONTRACTOR CERTIFICATION It: o?DA 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Q- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION, : jSltp s I of I) hIchcallon below)
Near 1-7own:
County
Near
/M'a s ia c�L_
(Road Na a anc JTpn\bera. Communitr, qr Subdivision and Lot No.)
3. OWNER
Address
WISIACid
City Town dale Zip Code
4, DATE DRILLED 7"O �'
5. TOTAL DEPTH Orbr
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES 01 NO[IA
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -+' if Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): _5.fl METHOD OF TEST R.: 3
11. WATER ZONES (depth):
DRILLING LOG
-
,ADD 13Ite_ock
DEPTH
Formation Description
D 6-53
O
C-)
_L-
Iv
.c-
12. CHLORINATION: Type Tt 71-1 AmountSi+1111.5 If additional space Is needed use back of form
1 \SING:
N
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. ;1Maledal (Show direction and distance from at least Iwo State
From Li To DO Ft. 1a ' 01 5 ,2) 4.h1 PVC-so4c Roads, or other map reference points)
From To Ft. .. From To Ft. / iUlli � iu-
nd
14. GROUT:
Depth Material Method
From b To � FI (DPI CP.EiE Q,��
From To FI
15. SCREEN:
Depth Diameter Siot Size Material
From To Ft In In
From To FI. In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17. REMARKS:
7 c.
O
ram)
n171
CD
r .)
0-1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA ARDS, AND THAT A COPY F THIS RECORD HAS BEEN PR IDEO TO THE WELL WNER.
FOR OFFICE USE ON Y AX.--4ti/
� 9-1- 2
Quad No SI NATt) E °PERSON CONSTRUCTING THE WELL DATE
Submit original to DIvISI n Naler Quality. Groundwater Section within 30 days
GW-1 REV. 12/99
al No

North Carolina - Doperlmont of Environment and Natural Resources - Division of Water Dually - Oroundwnlor Section
1038 Mall Service Center - flelelph, N.Q. 27699.1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 30 Lihlali Life YEik
WELL CONTRACTOR CERTIFICATION A: , r1 A
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential I Municipal n Industrial n
Recovery [—IHoel Pump Water Infection ❑ Other l It Olhor, List Use:
WELL LOCATION:LSJ low sk I t 61117o location below)
ALs. rest Town_ /�iL County Meicitocni
moo Name and N
3. OWNER
Address
City or Town Sla e
4. DATE DRILLED 9-4--e 2-
5, TOTAL DEPTH c; Rs
6. CUTTINGS COLLECTED YES [ I NO14 er
7, DOES WELL REPLACE EXISTING WELL? YES n NO tM
0. STATIC WATER LEVEL Below Top of Casing: _L FT.
(Usa'.' II Above Top ol Casing)
9. TOP OF CASING IS I FT. Above Land Surface• CD
0
•top of c., Ing terminated .Uor below Tend surface requires a variance In accor-
dance with ISA NCAC 2C .QI18 —0
10. YIELD (gpm): 0 METHOD OF TEST fa _ ^a
DEPTH
Fo mnllon Den cripllon
c-:
11. WATER ZONES (depth):
Agricultural [ I Monitoring n
DRILLING LOG
1 From To
• A8 7 CC/ 9-12//
Zip Code C-/ 85
a
12. CHLORINATION; Type Amount SO' 7 s If additional space Is needed use hack ol form
13. CASING:
Wall Thickness
Ooplh Diameter Slot Size Material
From To PI In In
From To FI In In
From To Ft In In
16. SANO/GRAVEL PACK:
Depth Size Malarial
From To FI
From To FI
17. REMARKS:
LOCATION SKETCH
Depth „ plammelor sir/ Weir, k1a S I (Show direction and distance from al least Iwo Stale
From To C) -FI. IW JL /W `1 Bonds, or other map tolerance points)
From To F1. t 1 , a
From To Ft�t l�
14. GROUT: r '-
From a To n
269977
Depth _ _ Matedol _ Molhod
co
Frorn To Ft
15. SCREEN:
IV
(51
iDOHEREDYC j}T YTHAT THI$WELLWASCU'iSy�
CONSTRUCTION $T N6AR S, AHD TI TAT A CtOPT
FOR OFFICE US
Quad No:
Serial Nc.
$
Submit odpirjrl
JCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HIS REQORD HAS BEEN POVIDED THE WELL OWNER.
pfirT
GU
9 4716 a,
URE OF ERSON CONSTRUCTING TIIE WELL DATE
elslon ol Water Ouellly, Groundwater Section within 30 days
,., GW,I FIEV. 12l99

North Cnrollnn - bops/talon' of Envlronmonl and Nolurnl Flesaurcaa - Division of Wnler Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.O. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR' BO bh(
WELL CONTRACTOR CERTIFICATION0: 2
STATE WELL CONSTRUCTION PERMIT/I:
269973
1. WELL USE (Check Applicable Box): Residential LYJ Municipal ❑ Industrial I ) Agricultural l I Monitoring ❑
Rocovery r1 float Pump Water Injection 011ier IIOlhho�or,,. List Use:
^^
I
2. WELL LOCATION: ow skel•h of the locallon below)
Nearest Town:o�d -s f a A County
(hoed Name an Numbers. Cormny Ily, or Subdivision end Lot No.)
3. OWNER
Addres
Cliy or Town p? Stale ZIp Code
.1.. DATE DRILLED 0�3 .
S. TOTAL DEPTH �D S
6. CUTTINGS COLLECTED YES 1 NO(vj
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ ✓j
d. STATIC WATER LEVEL Below Top of Casing: !�. rj IT.
(Use' t' II Abovo Top of Cnsi(1g)
9, TOP OF CASING IS 1 FT Abovo Land Surface'
•Top of ca s ing lerminnled at/or below land surface requires a variance In accor-
dance with 15A HCAC 2C I16
10. YIELD (gpm): _ METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To
Form/Mon Dnscdpllon
.r
I2. CHLORINATION: Type _Amount cell (LS
13. CASING:
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
(Th Depth / Pia IOI rf eieyg. Moed and (Show direction and distance born nt least Iwo State
From , l To _ `Qn •Fl. (p• f5J j L-L-�- Bonds, or other map reference polnls)
From To Ft.
From To Ft.
14. GROUT:
_Ili
M3lMaterialMol_ Trod ,
From_ TO h - �nRPfE Tly_�attsc_
Frorn To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
From To PI In In
From To Ft In In
From _ To Ft In In
I6. SAND/GRAVEL PACK:
Depth Size Maleilal
From ' To Ft
From To Ft
17. REMARICS:
I DO HEREDY CERTIFY THAT TILTS WELL WQ$
R
CONS RUC`TIgjN S(7AN9ARDS AND TIIATf,�J
FOR OFF,ICH USE ONLY
Quad No: i
1.1 L. MAR 2 5 'I:2 scoSie
r
Serial No.
I
CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
JPY of° THIS,RECORD HAS BEEN PRRVIOED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTNUCTINO TIIE WELL
ginal to Division of Water Quality, Groundwater Section within 30 days
... GW-I f1EV. 12/99
DATE
6'
AS'r'I (r ICE

City or Town i Slate
4. DATE DRILLED 7-_ Q"b
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO Vf
7. DOES WELL REPLACE EXISTING WELL? YES J J NO[yi
6. STATIC WATER LEVEL Below Top of Casing: cat FT.
(Use'.' 11 Abovo Top ol Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
'Top of casing terminated .Vor below land aurlace requires a variance In accor-
dance with 15A NCAC 2C.9 16 10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth)'
nand Name and Numbon. Corttrnrnli
Address 3. OWNER .� al
,^ / (SII�1 of i�oula o,� c 7r
!W �/+�A�n���-����L YA�A Zlp Code
•
North Carolina - Department of Environment and Natural Resource, - Dlvielon of Water Quality • Groundwater Section
1630 Meil Service Cantor - Raleigh, N.C. 27699.1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo Lint, o.
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
269972
DEfFiLs
� rya R
1. WELL USE (Check Applicable Box): Residentially Municipal ❑ Industrial I 1 Agricultural D Monitoring n
Recovery r1 !foal Pump Water In)eclIon ❑ Other if Olhor, List Use:
2. WELL LOCATION: (SI ketch o the location below) A
Nearest Tow - �� 0J�I ounly did(-0i'fe. .
shame ,, Ls4a,tc-
Subdivision and Lol No.) DRILLING LOG
from To
- <AD
DEPTH
Foml alloo Das crtpllon
1 R T
e k "
w
p r
12. CHLORINATION: Type Amount �O / } 1 S II additional space Is needed use back ol form
13. CASING:
Wall Thickness LOCATION SKETCH
Deplh� piameiotfDrtegcrg. Material (Show direction and distance Irom ni least two State
From 1 - To -Fl. '� J- ' iIJ Roads, or olher reap reference polnls)
From To FI
From To FI
14. GROUT:
Depth a Material Monirod ,
From AD_ To CFI ahREit _ �pc.L.g.�
From To FI
15. SCREEN:
Dopih Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
N
C"l
I DO HEREDYiCEIITIFY THAT THIS WELL WAS CON6-RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI IAT A COPY'i+F THIS RECORD HAS BEEN P OVIDE 0 THE WELL OWNER.
/ ' • _36-6a.
FOR OFFICE USE ONLY � Owed No: SIONAIUII F PERSON CONS1r1UCTINO TIIE WELL DATE
Submll odpinai fo plvblon of Welar Duality, Oroundwaler Section wIthIn 30 days
Serial No. _ _, OW.i nEv. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• kE!!i turi1VES
WELL CONTRACTOR CERTIFICATION ft: /- 7 0
STATE WELL CONSTRUCTION PERMITM:
269971
1. WELL USE (Check Applicable Box): ResidentialMunicipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other Ej11 Other, Llst Use:
2. WELL LOCATION: ow sketc) of the locallon below)
NO rest Towp� •Si'- County.
R& -flop@. eta
—
(Road Name and.Nu`5myb�ers Comm n , orI Subdivision and Lot No.)
3. OWNER t 4 CAa 1n
Address
(Theo � . 33117 e
by or Town Slab 21p Code
4. DATE DRILLED g-30-Oa
5. TOTAL DEPTH 5 C n
6. CUTTINGS COLLECTED YES j ) NOI
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: /s FT,
(Use 't' If Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
-Top of casing terminated odor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C . I16
10. YIELD (gpm): /�t METHOD OF TEST �) q
11. WATER ZONES (depth)'
DRILLING LOG
From To
DEPTH
Formation Description
CO
r+
0
fV
12. CHLORINATION: Type U 1 `'f " Amount Silas If additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth/ Dlameler or WelghVFI. Material
From 0 To ro 2 FI la. D5 a)(.. I5 PYC•SQq
From To FI
From To Ft.
14. GROUT:
From 0
From
15. SCREEN:
Depth Material Method
To _all_ _FI Golf f`PIP juilatead
To FI
Depth Diameter Slot Size Material
Frorn To FI In In.
From To FI In In
From To Ft In In
16.SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction end distance from at least two Slate
Roads, or other map reference points)
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANOTHAT A CGPV THIS RECORDREHAS BEEN PROVIDED TO THE WELL OWNER.
Z tZ j. - 30 •Q a.
FOR OFFICE I;ISE'd(dLY
Quad No:
Sedal No
bId
Submit odgina12b
TURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section within 30 days
GW-I REV. 12199

North Carolina - Dnpartman? of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1630 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
269963
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 1.34ERi% l-,e if Son/
WELL CONTRACTOR CERTIFICATiO1J 0: boa 9
STATE WELL CONSTRUCTION PERMITN:
1 WELL USE (Check Applicable Box): Residential®' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ II Other, List Use:
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION: , I.w sketcl .'vibe location below)
Nearest Town: ! _ r C.unty
(Rood Namo and bass. Coor/rnmunity, or Subdlviss}a/r�aand LotlJo.)
a JlZll 0 - T°W-
_atorRoca o fie emsy D 4�
City o Town ei
- � `-L;-�//- Slate Zip Code
/
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NOPI
7. DOES WELL REPLACE EXISTING WELL? YES O NOPV]' B. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use •.• 11 Abovo Top of Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C ..0110
10. YIELD (gpm): ) / METHOD OF TEST
11. WATER ZONES (depth):
12. CIiLORINATION: Type H T H Amount SApills
3. OWNER
Address
DEPTH
Formation Descrlpllnn
.IJrKK !
B ede-pck.
v
CO
:X - -
r
IN)
13. CASING:
If additional space Is needed use back of corm —
Wall Thickness
Depth/ plameioor or Weight/Ft.4Aaiieiial
From el To ! O 4"Ft (, ..� . i&.i Th' L'_L-. ac
From To Ft.
From — To Ft
14. GROUT:
Depth -
From D To . aQ-Ft
Flom To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft In.
From _- To Ft In
From To FI. In
15. SAND/GRAVEL PACK:
Depth Size
From To Ft
From _ To Ft
17. REMARKS:
Material Method
,ncrefe pnit_reA
Material
In
In
In
Material
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference polnls)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST
g
CONSTRUCT' \AIDARfiti-AND- -'
FOR OFFICE U yl(tLY - - "-1 r0
Quad No: irb
Submit prig 'l
Serial No. L.
RUC
IN ACCORDANCE WITH 15A NCAC 2C, WELL
S F CORD HAS
BEEN PROVI D TO THE WELL OWNER.
"( 1/,
d7-aa
1UnB%DF PERSON CONSTRUCTING T1 WELL DATE
vision of Water Ouailiy. Groundwater Section within 30 days
Gw.t REV. 12J99

North Carolina - Depanmenl of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
269954
WELL CONSTRUCTION RECORD
WELLCONTRACTOR• RIR'N ICEI Yl W 4E5
WELL CONTRACTOR CERTIFICATION 0: P740
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential LgMunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other If Other, List Use:
2. WELL LOCATION: Dhow sk Ich of ie location below)
rest Town. '�/'/J County'
_1(441,1AVIAL2; tad
(Road Name end.Numbers. Community? or Subdivision and Lot No.)
/
kkDA • k ) From To Formation Descdpllon
3. OWNER
Address
DRILLING LOG DEPTH
Tit
or Romp M1o.j'� ^-8 1�� Q - � .D hit
Cify or Town( (1/
iQ SIalel ryZip Code RO� �e""•/��i
4. DATE DRILLED G)-�0 D.
5. TOTAL DEPTH 3n5
6. CUTTINGS COLLECTED YES
7. DOES WELL REPLACE EXISTING WELL? YES I NOR'
8. STATIC WATER LEVEL Below Top of Casing: 0)`5' FT.
(Use'+' If Above Top ol Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• 0 METHOD OF TEST �) q
11. WATER ZONES (depth): •J
0
T
NOR
N
0
4-
n14
1 o CHLORINATION: Type 1 f Amount .9 II additional space Is needed use back of form
.ASING: -
Wall Thickness LOCATION SKETCH
From 0
Depth L,i Diameter or WeIghvFI. Maledal p (Show direction and distance from at least two State
To ` Ft tbk D5 V t . p5 Pitt-SDr/ Roads, or other map
/tolerance
� points)
From To Ft, y i�12XA��'s a�
From To Ft /i -
14. GROUT: )
Depth Material Method ,, /CSC-�=�', %[,
From 0 To ad PI !'.n►IGFtpre -(1nr.ited-(Jw�J-
From To FI. 11
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In.
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US
Quad No:
_.:dal No
4N Yit�
ARE OF PERSON CONSTRUCTING THE WELL DATE
Submit odoInal 1plI slon ol Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

269945
(
Nonh Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR•
N;RmAN L.�f L/t
WELL CONTRACTOR CERTIFICATION'S: c O 7
STATE WELL CONSTRUCTION PERMIT'S:
WELL USE (Check Applicable Boa): Residential ✓i Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other Ei If Other, List Use:
2. WELL LOCATI N. (Show sketch of the location below) ter„
Nearest Town„ n Idly JJ//ll//c // County (L/ir.44/
3Ja 5
FOR OFFICE USE
'tuad No:
Serial No.
t
t
(Road Name and Num els, Co unhty or Subdivision and Lot No.)
3. OWNER 7l°Ward f tdh/Q
Address
3tas `H ) �Y
S ree or o e o.
lit a /sha L I 98-153
City or Town Slate Zip Code
i -"
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO[�
7. DOES WELL REPLACE EXISTING WELL? YES NOI
8. STATIC WATER LEVEL Below Top of Casing: FT.
1 (Use'+' If Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated allot below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)- 2_ METHOD OF TEST r 11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
Fonnallon Description
4/3- 265 BE -ate ck
r
-n
•
1' CHLORINATION: Type 7H Amount 41111C
CASING:
Depth
From 0 To 1,3
From To
From
14. GROUT:
Frorn 0
To
Diameter
Ft L.a5
FI.
Ft.
If additional space Is needed use back of form
Wall Thickness
or W ight/Ft. Maiedal
a)&;d Pve5Dc
Depth Malerlal
To AO Fl C'CNC2k4-E
From To Ft
15. SCREEN:
From
Depth
To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Mel!
Diameter Slot Size
F1 In
Ft In
Ft In
Size
Ft
Ft
Material
In
In
In
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ea
3aucci'3?! i2r
y
l ' (av l 1, 1(C
1 DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPPYyF THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
TU'l
Submit odelnal Id vl 1
L.J
E OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Doparlmonl of Environment and Natural Resources - Division of Water Duality • Oroundwelor Socllon 2 6 9 9 4
1636 Mall Service Center - Raleigh, N.G. 27699-1639-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 30 bhr if. Poq-+s
WELL CONTRACTOR CERTIFICATION le: - , (0a Q
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Boa): Residential lvl Municipal ❑ Industrial( 1 Agricultural 1 I Monitoring
Recovery ri Heat Pump Water Infection n Other ❑ If Other, List Use:
•
2. WELL LOCATION: llonow ssAkel 1t tthee location
n) below)
�Nearest Town: (a - '{ ;'' 4/aS Count",
�4F�1ma and ,, tick , or Su
(Flood Name and Nurtj+p r3, C• mmnl ly, or Su�{Ivlelpn And Lol No.)
LjC /Sal
3. OWNER
Address
II
DRILLING LOG DEPTH
From To
.
�eo orTro
ula f�. e b ^�'�y
fie ,A87.5d3y - /y5
y or Town Sla e Zip Codee
4. DATEDRILLED �' a
TOTAL TOTAA L DEPTH
6. CUTTINGS COLLECTED YES I I NO[vI
7. DOES WELL REPLACE EXISTING WELL? YES I 1 NO t�
6. STATIC WATER LEVEL Below Top of Casing: / -T FT.
(Use'.' II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
•Top of cos Ing ler minaied eVar below land suriece requlree a variance In accor-
dance with 15A NCAC 2C. 11r1
10.YIELD (gpm)' 1C0 METFIOD OF TEST jar
11. WATER ZONES (doplh):
Fomiellon Descrlplion
a T
�FRyk.
n
W
J
O
s
12. CHLORINATION: Type — Amount eaSpi i
D. CASING:
PJ
If additional space Is needed use hack of form
Wall Ti lckne se LOCATION SKETCH
(� Depth lamelo r e e fV . }��/M�a't'e(ria(�l (Show direction and distance Irorn at least Iwo Slate
From�I1—.To -� -El. �'0 I 'I��-�'�"-"-a` Ronds, or olher map rolorence polnls)
Flom To Ft
From To Et
14. GROUT:
DeDerain/1 ' Maloriol
,,hh
From t1 To ____ FI tJi—E'7E
From To _ FL
15. SCREEN:
Dopih Diameter Slot Size Malarial
From To Ft In In
From To Ft In In
From To FI. In In
I6. SAND/GRAVEL PACK:
Depth Size Maleilal
From To El
From To Fi
7 c/Li /70/.
CJ
//ll//
•
v
aD
17. REMARKS:
I DO HEREBY CCF TLEY$4AT-Ti4ISWELL WA&.GQNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUCTIOh STtI>I0]c5RD' , AND TIIAT A CQPY'\T IIS RECORD HAS BEEN PROVIDfeD TO WELL OWNER
ONLY
SIC,N1 dRE OF PE CONSTRUCTII4G TI IE WELL DATE
E
Submit odpin4 I v sloe of Water Ounlliy, Groundwater Section within 30 days
FOR OFFICE US
Ouad No:
Serial No.
GW•I REV. 12199

North Cnrollnn -'Department of Environment and Natural Flesourcee - Division of Water Oualiry - Groundwater Section 2 6 9 it 4
1636 Mall Service Center - Relolph, N.C. 27699-1638-Phone [phone] r (� 2
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 36 bhr UJ. t'o{ILS
WELL CONTRACTOR CERTIFICATION N: �� g
STATE WELL CONSTRUCTION PEFlMITN:
1. WELL USE (Check Applicable Box): ResldenllallYJ
Recovery ri Float Pump Water Injection
2. WELL LOCATION
rest Town:
Gtv�f�ch.
(Road Name and
3. OWNER
Address
I
Municipal ❑ Industrial ❑ Agricultural 1 1 Monitoring ❑
Other E) I(Olhor, List Use:
1•� w skelcl of the location below)
Xunty
a9
e._
Sera.Corm+uoJly, or ub vl. ton and No.) DRILLING LOG
GJI -oh From To
ea or ou a
Clly or Town Slate
4. DATE DRILLED 8' /d" Oa
5. TOTAL DEPTH .„5-6 S
6. CUTTINGS COLLECTED YES ( i NO1 ✓r
7, DOES WELL REPLACE EXISTING WELL? YES O NO tM
6. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' 11 Above Top of Cnalnp)
9. TOP OF CASING IS I FT Abovo Land Surface'
•Top of as ling terminated eVor below 1end surlece requires a variance In accor-
dance wllh ISA NCAC 2C.4116
10. YIELD (gpm) of METHOD OF TEST r
11. WATER ZONES (dopth):
:66 -9a
Zip Code — 5
12. CHLORINATION: TypeAmount n• i 5
13. CASING:
Wall Thickness Depth all n(rtaelpdp� MaT YS.le l
From ) To 7a.Ft..
From To FI
From To FI
14. GROUT:
Depth a Maternal
From LJ To ao FI a /Tut1 R_ETF
From To FI
15. SCREEN:
Method
/
DEPTH
Fommllon Oascdpllon
iV
r
II additional space Is needed usa hack of lorm
LOCATION SKETCH
(Show direction and distance Irom nl least Iwo Slate
Bonds, or olher map reference points)
'Paths i-d
16S°, 7C.
Ooplh Diameter Slot Sin.) Malarial
From To Ft In. In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK: --
Depth Size Material
From 1 To FI
From To Ft.
17. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS,_AND TI IAT A COPY or THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U
Cued No.
Serial No.
AShir_ it
II
Submit odglrlltl a
.III
RCE
ORE OF PEP(SON CbNSTIWCTINO TIIE WELL DAZE
lilon al Water Quality, Groundwater Section Within 30 days
GW.1 IIEV. 12l99
0 a
0

North Carolina - Depanmenl of Environment and Natural Resources - Division of Wafer Dually - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR-
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMIT":
269940
W�NE5
WELL USE (Check Applicable Box): Residential Municipal n Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ('h°,w �skCe�l hn off the//location below) �, �/
Nej�ra,se t Town: �* County' GCG%.!d>73t)
aPrn at. 3-cra &I !gad, s hri-1-C-
Road Name end. ben, Community,or Su{bd((vlslon and Lot No.) DRILLING LOG DEPTH
3. OWNER `i.Z/ QYid Y�2i»Q1tJ From To Formation Description
Address 7
l
Slr or ou tit o.
o�7cF(p� i7C
City or Town Slate
5. DATE DRILLED a 9Ty
5. TOTAL DEPTH 'uj �i
6. CUTTINGS COLLECTED YESI I NO
7. DOES WELL REPLACE EXISTING WELL? YES 4 NOF.'"
6. STATIC WATER LEVEL Below Top of Casing: .STS FT.
LJ� —.� s B ;fit
R�S
Zip Code
co
7
(Use •t• If Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface' --z
•Top of casing terminated el/or below land surface requires a variance In accor-
dance with 15A NCAC 2C A)]a
10. YIELD (gpm): ?f METHOD OF TEST �)
11. WATER ZONES (depth)• ✓ o
12. CHLORINATION: Type -itT{} Amouni5. l II additional space Is needed use back of form
ASING;
From 0
From To Ft
From To FI
14. GROUT:
Wall Thickness
Depth Diameter or Weight/Ft. Malerial (Show direction and distance from at least two State
PYc-SDI
To FI tb•D5
Depth Material Method
From a To �0 FI Go►IGpIpiP �p4RQ�
From To FI J
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
LOCATION SKETCH
Roads, or other map reference points)
evber
6/Lab, / Z C .
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE
114,
L
T
Submit original Iq�Clvi
il✓J
V-reta. 8.9 -o a
E OF PERSON CONSTRUCTING THE WELL DATE
n al Waler Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina • Department or Environment and Natural Resources - Division of Water Quality • Groundwater Section 2 C Cl (1 rJ
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] - 7�/j�' % 1.) Q c9 J
WELL CONSTRUCTION RECORD WELL CONTRACTOR' 7rd ijmAN �1 WA-"`
WELL CONTRACTOR CERTIFICATION 0: of 1)A 7
STATE WELL CONSTRUCTION PERMIT-0:
1. WELL USE (Check Applicable Box): Residential LJ Municipal ❑ Industrial ❑ Agricultural (] Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other El II Other, List Use:
2. WELL LOCATION::lShow sk tch91/the location below) /// r
Nearest Town: /*2 h L( County: /9" /�G�
.L�/4 tm ai 3 AS- " _
(Road DEPTH
/ Name and u era, /omrnunlly, or Subdivision and Lot No.) DRILLING LOG
3. OWNER ' f &.�iAi) A-I)r /✓ From To Formation Description
Address 4/4L1 /Yw . J 3
islreetorRautoNo ic8753
City or Town Stale Zip Code
5. DATE DRILLED J 8 5
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES In NOj4
7. DOES WELL REPLACE EXISTING WELL? YES Q NO1 A
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '✓ II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0/18
10. YIELD (gpm) (Q _ METHOD OF TEST TN r
11. WATER ZONES (depth): ,j
-
Ail LIP5 $ri-rf 12gck
0
J
0
' ^ CHLORINATION: Type TI 7N Amount n.Lils II additional space Is needed use back of lorm
CASING:
Wall
LOCATION SKETCH
Depth 4Diameter
...IS mr Weight/Ft.
gh%5 r
'/ Thickness ;1
�O�
From 0 To1 Ft. D Mat e(Show direction and distance from at least two Stale
. Roads, or other map reference points)
Fr m To Ft.
From To FI 1.4
� a' 3
14. GROUT:
Depth Malerlal Method �� /(/ /1 �Y%r
From 0
To vZ-0 Ft ODPICE14E u2E[� S C C.
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY 'F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
S NATURE OF PERSON CONSTRUCTING THE WELL DATE
Division al Water Quality, Groundwater Section within 30 days
FOR OFFICE
Quad No:
Sedal No
$E (NLY
1,
ASFiEVII_LE
Submit orinal r
ilia
J
I1E
GW-1 REV. 12/99

269934
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /IARMAN L. 2d4LL.
WELL CONTRACTOR CERTIFICATION 0: o?OA 7
North Carolina - Department of Environment and Natural Resources - Dlvlslon of Water Duality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residentlal IJ Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town'
C unthr�/sue'%
(Road aa�ou5 ,
(Hoed Name and Numbers, Community, or Subdivision and Lot o.) DRILLING LOG DEPTH
3. OWNER £L/ 5 r/ % r•�- / From To Formation Description
Address rsn n'vv feif2S U�(4X7 kt
/�^j Iree(or 000Te No.T3
City or Town Slate Zip Code
4. DATE DRILLED
5. TOTAL DEPTH kiEeB
6. CUTTINGS COLLECTED YES Q NOII
7. DOES WELL REPLACE EXISTING WELL? YES in NOl1,4
8. STATIC WATER LEVEL Below Top of Casing: 5Q FT.
(Use': If Above Top of Casing) r-D
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0116
10. YIELD (gpm): o- METHOD OF TEST ry t3
11. WATER ZONES (depth):
- eft4//11 ' yt25 T ias.k
0
19 CHLORINATION: Type / 1 Amount AWLS
CASING:
Ni
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth,/ Diameter or W I0hVFt, Material (Show direction and distance from at least Iwo Stale
From 0 To yy Ft G • 01 5 a?l �.1�5 PLGSAC Roads, or other map reference poFrom To Ft t
From To Ft
14. GROUT: ►��-S�-.y�y // yl
Depth Material Method ,
From b To a-0 Ft ConCP_.E•4 E 7,7ppd�D -
From To Ft
15. SCREEN:
Depth Diameter Slot Size Matedai
From To Ft In in
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY CF THIS RECORD HAS BEEN PR())/IDED TO THE WELL WNER.
H r �cpilrYnc�� 2 ,3 OR
NATURE OF PERSON CONSTRUCTING THE WELL DATE
I to Division el Water Duality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Doperimenl of Environment and Natural Fesources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - (Weigh, N.O. 27699-1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR. "gip// fFRIV! Soil
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITN:
269931
1. WELL USE (Check Applicable Box): ResldentialVI Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ R Other, List Use:
2. WELL LOCATION: (S,frtow sket9It of the location below) )
Test Tor
/ county
:(��¢✓ /Yv�LS�u�� DEPTH
Flm ao and N rs, C rnmunliy, o Su division and Lot No.) DRILLING LOG
3. OWNER .01t.A> From To Formation Description
AddroSs. - 3-1�, t
�. i87 3 /05 BEdg-Qck
0
Rocovery ❑ Heat Pump Wator Infection ❑
Cr Town ppp sialo
4. DATE DRILLED
5. TOTAL DEPTH
/0
6. CUTTINGS COLLECTED YES I I NO[1-
7. DOES WELL REPLACE EXISTING WELL? YES I I NOna'
8. STATIC WATER LEVEL Below Top of Casing: /r FT.
1 (Uso'+' It Above Top of Casing)
9. TOP OF CASING IS FT Abovo Land Surface'
'Top of casing terminated eUor helow land surface requires a variance In accor-
dance with 15A NCAC 2C .fill K^ ri
10. YIELD (gpm): /Q U METHOD OF TEST
11. WATER ZONES (depth):
2. CHLORINATION: Type HTH Amount /FIRMS
13. CASING:
0
c.
0
N
J
If additional spaco Is needed use back of (orrn
LOCATION SKETCH
Wall Thickness
Depth 9lametor or WelahVFI, Aaledal (Slow direction and distance from at least two Slate
From fr.)To FI £L...elLSXRoads, or other map rolerence points)
From To FI.
From — To Ft
14. GROUT:
Depth - Material Method
From b To r--20 FI phcreJe pnturerl
From To FI.
15. SCREEN:
'7
Iv
Depth Diameter Slot SIzo Material Z
From To FI In. In.
r\o
From To Ft In In ry
From To FI. In. In CO
16. SAND/GRAVEL PACK:
Depth Size Material
Frorn To Ft
From To Ft,
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT " "I� >,� " ,C'" TI j4S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
\FOR OFFICE
Quad No:
Sedal No.
0
0
L
ASHEVI'r ..
U F PERSON CONSTfll7CTING THE WELL DATE
Submit ad( hal c Divls n al Water Duality, Groundwater Section within 30 days Cev.t nEV. 12199
:.�N
"FICE

i
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 6 9 9 2 6
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] /IN //_' N J� /
WELL CONSTRUCTION RECORD WELL CONTRACTOR. RmAL • 2.. -((.
WELL CONTRACTOR CERTIFICATION It: 04®.3 7
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential 1r Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ . Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ,,r
arest Town: 1llc\V3ha.11 County• cd)serku
dal /auwia{ MaA sh0 to ,
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 70.SaYl ill From To
Address ?. o , i 71 -nn 4., ,StAtc
Sllar'Flte No.T Q$16-3
CiU Y6{'la 1 a
City or Town p Stale Zip Code
�r
4. DATE DRILLED 0" -n 2--
5. TOTAL DEPTH go
6. CUTTINGS COLLECTED YES n NOIif
7. DOES WELL REPLACE EXISTING WELL? YES n NO171
8. STATIC WATER LEVEL Below Top of Casing: ca—T FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
*Top or casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 9- METHOD OF TEST R1
11. WATER ZONES (depth):
Formation Description
t3 - 405 13E-di4c_k
0
Era
N
-o
ro
r
0
19_ CHLORINATION: Type H 7H Amount k3 If additional space Is needed use back of form
CASING:
Depth Diameter
From • To $? Ft &'oZ5
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness
or W IghVFt. Material
�.r�s Puc•sog
Depth Material Method ,
From b To ci•0 Ft C'a71YC214E ffiL2.rl-
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
a Cc &.
lticur,hal ( 17C
0
CO
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7
v
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I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY AF THIS RECORD HAS BEEN PRQj/IOED TO THE WELLWNER.
fFOR 0
Quad No
„edal N
=FILE USE ONLY
I r'� L,, �(7 c; lM
[0.4/11L44�i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
glnal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 269916
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• /rd RmAN L . 2R•L(.
WELL CONTRACTOR CERTIFICATION 0:®a 7
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOWShow ske`t ii o^f tithe location below) r✓'
Nearest J7own. 1 `\/�S S �'7 �� '^A/, County,:/,7 " h'
!mot//.9-7a i4cil sef-l• /�4 u3M J DEPTH
(Road Name and Numbers. Co{prrlu ity. or Subdivision and Lot No.) DRILLING LOG
7`F'`^1f•Jl. J•l C.l G- ) From To Formation Description
3. OWNER CL
Address
„ten%-`c�+ 1111 (S,,, eeLo ule No.) r\ C fc 5J, �
City or\ Town.Slate
Le •
4. DATE DRILLED 1&- D5-6 "
5. TOTAL DEPTH a n 5
6. CUTTINGS COLLECTED YES [ I NOIA
7. DOES WELL REPLACE EXISTING WELL? YES NOI VI
8. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C. 119
10. YIELD (gpm): �' METHOD OF TEST r 3
11. WATER ZONES (depth)• 'n. CHLORINATION: Type H TN AmounlS9- plc
CASING:
Zip Code
o :I:-
"Y.
J
N
If additional space Is needed use back of form
Wall Thickness
0 Depth I k. Ft s .l 5 er or yya71l .1i5 Pvt5DC
rlal
From To (t
From To Ft.
From To Ft
14. GROUT:
Depth Material Method ,
From D To AO Ft C1vNCEEit "-jjjpN'e—�j—
From To Ft
15. SCREEN:
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
s )1e1uL-, %L_C
Depth Diameter Slot Size Material
Frorn 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:
CONSTRUCTION S NDY T T THAT A S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I O S RUCT CERT N TMr RIDS,
ANDN WELL WAS
F--tab RECORD HAS BEEN PROVIDED�TTOO THE WELLAWNER.
I Rl
FOR OFFICE USE
Quad No:
Submit odpinai to { i �
Serial No.
OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99
,i N
FICE

271405
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION Y2809
WELL CONTRACTOR COMPANY NAME D Rnwrn n We11 bri111ng Tnr PHONE Y f37A 757-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IX 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: Burnsville County Madison
Br-AdforCd Road 28714
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Robert Harris
3. OWNER:
Address P 0 Box 183
(Street or Route No.)
Barnardsville NC 28709
City or Town State Zip Code
( )-
Area code. Phone number
4. DATE DRILLED 11/08/02
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" it Above Top or Cuing)
8. TOP OF CASING IS 1 • 4 FT, Above Land Surface*
'Top of casing terminated at/or below land mr(ace requires a
variance In accordance with ISA NCAC IC .01111.
9. YIELD (gpm): 40 METHOD OF TEST:: rotary
10, WATER ZONES (depth):
280'
-Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dc gree✓m inu tes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
air
II. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 1 93Ft..61 /8 Srh Rfl PVC
From To Ft.
From To Ft
I). GROUT: Depth
From 0 To 20
From To
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.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
Material Method
Ft concrete gravity -flow
Ft
From To Ft.
16. REMARKS: =�
O
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER C.,J
4�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
v �S IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ij/og les
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. OW I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JereNY H. BowmanCERTIFICATION Y 28 09
WELL CONTRACTOR COMPANY NAME D Anwmen We11 fir i111 Mg TM PHONE YR7R 252-7779
STATE WELL CONSTRUCTION PERMITY ASSOCIATED WQ PERMITY
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ct MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
NearestTown: Burnsville county Madison
Bradford Rom' 78714
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dewey Lawson
Address 3821 Vine Street
(Street or Route No.)
Hokes Bluff Alabama 35903
City or Town State Zip Code
( )-
Area code - Phone number
4. DATE DRILLED 1 1 / 1 3 / 02
5. TOTAL DEPTH' 1 60 r
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO I%
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use'4" if Above Top of Cuina)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top or cuing terminated actor below land surface requires a
variance In accordance with ISA NCAC 2C .01111.
9. YIELD(gpm): 17 METHOD OF TEST-b'rotary air
10. WATER ZONES (depth): 1 20 t
7(
I1. DISINFECTION: Type tablets Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From—_ To47 Ft.B1/B Snh RO PVC'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in
From To Ft, in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
271406
Topographic/Land setting
❑Ridge ❑Slope OValiey OFlat
(chock appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OOPSOTopographic map
(cheek box) e*
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.
concrete gravity flow
16. REMARKS:
CD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL C.J
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14. J3,rLa,-,-•--
ll/i3/o-=
ICNATURE 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