Mi CY2002

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL p Y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) {� -Tf% CERTIFICATION #,-2 7 ro
WELL CONTRACTOR COMPANY NAME �,.t-�—P.�
t A l PHONE #8L e O D
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
444
irA
249522
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA'I I� % Cotmtya�
Nearest Town ��',a�'-0 ',,J� � 4' C
(Street Name, Nu,nb�ers C m Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address /.1 3 41 !K
(Street or Route No.) �7 `Y D
r� N.c.
City or Town f State _ , n 7 Zip Code
anti"
Area code- Phone number �e�--7D y
4. DATE DRILLED // C---
5 TOTAL DEPTH: 7/7 D
6. DOES WELL REPLACE EXISTING WELL? YES NO 121
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
1,
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 ISA NCAC 2C .0118.
9. YIELD (gpm): e2 METHOD OF TE/STd,�2C
10. WATER ZONES (depth): ,202� r LDJ b
11. DISINFECTION: Type
12. CASING:
Amount aZ
Wall Thickness
or Weight/Ft. Material
From_n_To\.7r b Ft. 4fr'•2/ Pile
From To Ft.
From To Ft.
13. GROUT: Depth .in,tMateri
From 0 To DV ) Ft. C
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To ,t, Ft. p in. in.
FromrTo /Y A.
/1�in. 7a-in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ¢To
From / Y �To Ft.
m
Depth iameter
ethod
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
16. REMARKS:
a L
Submit the original to
i ,;-7699-1636-Phoned
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r• . d
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND A COPY OF THIS RECORD HAS BEEN PROVIDED TOTH WELL 0 R
/ f
ATUILEOPERSON CONSTRUCTING THE WELL DATE
e Dltision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
OHem
H

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Natural Resources - jJDivviision of Water Quality - Groundwater Section r� /7
WELL CONTRACTOR (INDIVIDUAL) NAMFn(prtnt) R OM a/C. J?,7 -L CERTIFICATION
/#t�pg�/ �/�p'5,
WELL CONTRACTOR COMPANY NAME �Cil/A edf-- 2 w $i/�t - f.{.fleO' PHONE # ts/Kl �Oy�L� /26 O 3
STATE WELL CONSTRUCTION PERMIT# N lar ASSOCIATED WQ PERMIT# N 4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential N Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO Ii��
Nearest Towli: {i"-���County
74
/ ,w- 4/.0.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1Z� ataa t �Id
Address 21.?i r(S !/f
(Street or Route No.)
vicecu 4(, C • a 74/D
City or Town State Zip Code
249521
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)
DEPT DRILLING LOG
From To Formation Descriptiot2
Arcode- Phone number 1-4 r/D y
4. DATE DRILLED / C�
5. TOTAL DEPTH: 3 '2 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO jPi
7. STATIC WATER LEVEL Below Top of Casing: t..2 0 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): Je`l, M 7 THOD OF TEST-VGf2ea
10. WATER ZONES (depth): 5i I `2sb I
11. DISINFECTION: Type 1QP
12. CASING: VV
Depth Diameter
From r% To.40,10 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To obi 0 Ft.
Ft.
Slot Size Material
in.
Amount /,,2 DL
Wall Thickness
or Weight/Ft. Material
;o vG
From To
14. SCREEN: Depth Diameter
From A/hob
FroFronta_a To Ft�_in.
15. SAND/GRAVEL
Depth Size Material
From f/1/iTo
From i T /'j To Ft.
S.:trttroil Method w /
16. REMARKS:
Submit the original to the
27699-1636 Phone No. (919)
r•3
0
-9
LOCATION SKETCH
Show direction and distance in nil from
two State Roads or County Roar •. Inclu
numbers and common road n
0
tT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEEW� OW E
_'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE Y lJ
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

3. OWNER
Addres
City or Town
4. DATE DRILLED /-1,5-"62 ���� �eeptn
5. TOTAL DEPTH 2-66 /fr
6. CUTTINGS COLLECTED `'F F l ^'+'(
7. DOES WELL RLPLA,lr`
6. STATIC WATER I.I VI , •
9. TOP OF CASING IS
'Top of casing terminator] nUor hni.-�.� 1•-•
dance with 15A NCAC 2C .n11F
10. YIELD (gpm)• _5 F'"TI'
11. WATER ZONES (rloc'h)
12. CHLORINATIC' -ly;' /fihl-
13. CASING:
From
From Tr
From t r
14. GROUT:
Ucl•;Ih
From To Ft
From To Ft
15. SCREEN:
North Carolina - Dor v^•r n• ! — —
1636 Mall Servic.. r.
WELL CON:
249451
&sjal�e1/,�1�°J
rig i r_n1rltlu:ie fag.
1. WELL USE (u,,
Recovery LJ I �. , .. �J_.: Un...
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 4 i+u ce 4iu e County ,
(Road Name and Numbers. Comm ire. or end t ni
441/
,11•C' c J777
3cili
Depth Diameter Slot Size Matodal
From To Ft in. _..__ _. in
From To
From
16. SAND/GRA''".
From
From .
17. REMARKS: _god .f9 Pal m 1- 5lar 43
I DO HERE©Y CTNii.
icHH:il Li Monitoring El
nRILLING LOG DEPTH
-r- Formation Description
;et zja6 yeas./; /� a dcht,um.+/s
is n c /v leF%it, is lei
v
fV
a
O
is ncn'cd me back of ithP Et
rinp' SKETCH
. nne from at least two State
an roterenoc paints)
`:%I II 1:;A. NCAC 2C. V/ELL
CONSTRUCTION STANDARDS. AND THAT A COPY iii- l HH S REC,QRD HAS L, N PROVIDED TO THE WELL OWNER.
7— �"�
-$y? A 9E t'' ERSON CONSTRUCTING THE WELL DATE
Submit original m 01 on el Water Quarry, Groundwater Section within 30 days
FOR OFFICE USE C Y ;_,
Quad No: �-
Serial No,
rll
•
Li Li--
GW-I REV. 12/99
Cr: .TER SECTION
A(E'i prcIC OFFICE

OWNER let/E1;;;ig3ES4,& %✓- From To
D— /8
North Carolina - Department of Environment and Natural Resn,rrr- - inn nt Water nnntrrj - Groundwater Section
1636 Mail Service Center - Raleigh, N O. ; ;nnn-1 ra5-Phnnn (p I 51 7:12 2,^ 1 _
WELL CONSTRUCTION RECORD WLLLCON ERACTOR: 1S2ASI-A1=I/ ILeJ/ rI/r01,G
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential [Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring'
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use: f-; vo /co
WELL LOCATION: (Show sketch of the location below)
Nearest Ong,'
ELC e ^ County:
(OLg' CA' /i o.0 Af
(Road Name and Numbers, Community, or S bdivision and Lol No.) �.�.0..� DRILLING LOG
Address to. act t C L (e.
(Street or Route No.)
- C. air'77'I
ity or Town Stele Zip Cod.
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES LJ NO[ 1.4 _
7. DOES WELL REPLACE EXISTING WELL? YES ] NO[i
STATIC WATER LEVEL Below Top of Casing: S
8. FT.
(Use -a- it Above Top of Casino)
9. TOP OF CASING IS FT. Above Land Surfaco'
-Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST _LEA'
11. WATER ZONES (depth): 70 73 0 9ef
/SO /5-3 594', 4/I/)b ISO
12. CHLORINATION: Type 1/'/ Amount 3 0Z
13. CASING:
FOR OFFICE US
Quad No:
Serial No.
From
From
17. REMARKS:
From
14. GROUT:
From 6
From -7
15. SCREEN:
Depth
From To
From To
I-/ 9 -02
ao 0
L
Depth
From —(—To 41 Ft
From To Ft.
To Ft
Diameter
Wall Thickness
orWeight:Ft.
/88
Material
(•Q /D
/ 8- -57
S7— pia
yo- r3
93— /Sa
/53-/78
/7 2-/ Bo
/f6- 8oa
Depth Material Method
To 5 Ft GC.,'""d14' ra onq
To d•2 Ft Ce.vc.u-yc /ocv^e?
Diarnetnr Slot Size Malerial
Ft in in
Ft in in
From To Ft
16. SAND/GRAVEL PACK:
Depth
To
To
Ft
Ft
in in
Size Material
249455
DEPTH `'&
Formalloe Desul
"et
g rov%7'f
9 ae�`fe
*/i-t, yArepd f.c45 :
q nasi; it
s6 /P ecr-R f/a
re r /v; /Le
J
II additional space is needed use back origin =
r
rV rn .r
LOCATION SKETCH �°d. X
(Show direction and distance from at least tw tate
Roads, or other map reference points)
PPP
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOW,$ZANn/kans, ANn THAT A rnpv rip.THIS RECOR,P HAS BEEN PROVIDED TO THE WELL OWNER.
;,,,L; 1\inE
Submit origina
GROUNDWATER SEC11ON
ASHE\ILLE REGIONAL OFFICE
N
J
JRE OF PERSON QbNSTRUCTING THE WELL DATE
aion of Water Duality, Groundwater Section within 30 days
GWt1 REV;12/99,L

249454
North Carolina - Department of Environment and Natural Rcsn.rrcns - D
1636 Mail Service Center - Raleigh, N C. ^ 15?9.1 n'3F-nhnn,' m I nt 7"7
inn or Writer Qunhty - Groundwater Section
'I
WELL CONSTRUCT ION Iis_COI(D \el I-t. CON Ii
v'rl I cONTR ACTOR CERTIFICATION (/ta r1 07E69.
1Ac Jolt l&i'A''r-<kmi/ /C eJ/ IA, //003
STATE WELL CONSTRUCTION PERMITS,: /
WELL USE (Check Applicable Box): Residential Ur Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection
��❑ Other 0 I( Othor, List Use:
2. WELL LOCATION: (Show sketchofhe local ttielovch ,Ns
Nearest Tow 9: �/t - JJ'''f�cfr in/ /�r' is II
Cuti
Agricultural ❑ s
pit vet fe
(Road Name d Number# Community. or Subdivision and Lot No.) DRILLING LOG
3. OWNER J/_%come/ 4r eJP�
Address Q - i"� /33
(Street,.to o, -"7-) . G, d 8777
City or wn St3Ip Zip Cn'b'
4. DATE DRILLED /- /7- 0 a
5. TOTAL DEPTH 33E. 6. CUTTINGS COLLECTED YES r_. _i NOriii"
7. DOES WELL REPLACE EXISTING WELL? YES Li MG[Si
8. STATIC WATER LEVEL Below Top of Casing: _ 3 FT.
(Use'.- it Above Top of Casino)
9. TOP OF CASING 15 L FT. Above Land Surface'
-Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .111
10. YIELD (gpm): /'J METHOD OF TEST
From To
-a 9/
,ON>
av7- 025(
as/- 3 eAd
Pin
11. WATER ZONES (depth):
,Ay> - 2-SI
12. CHLORINATION: Type f{ L/F Amount 3n=
13. CASING:
Depth Di,meler
From 'J To Ft 64
From To Ft.
From To Ft.
14. GROUT:
Depth
From 0 To 3
From 3 To a/
15. SCREEN:
From
From
From
FOR OFFICE USE
OW�
Quad No:
Serial No.
Depth
To
To
To
16. SAND/GRAVEL PACK
Depth
To
To
From
From
17. REMARKS:
Walt Thickness
or Weight/Pt. l.taterial
/8S __ _4SJJO
Material Methodrued)
Ft cent Pti ued
Ft bu,o,s.rit le /fel" /to ar 4
Diann
Ft
Ft
Ft
Size
Ft
Ft.
;lot Size
dnrinl
Mont rng''L,
DEPTH
Formation Descdpuon
d,t/sZ%rcrt
/ 7S734jL^ ...
9r mlife.
N
II additional space is needed use back of (Qhr1
LOCATION SKETCH " r �-
(Show direction and distance from at least two State A4'/�
Roads, or other map reference points) J c/ot hie
t,0 Kb .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION DARD A 1 AIr CL -'Y Sett IS RECORD HAS B NPR VIDEE WELL OWNER.
ER. -2'.:
S
- Submit orlainal
A
uNi .
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
1WIE Or PERSON CONSTRUP(NG THE WELL DATE
n of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

FOR OFFICE USE
Quad No:
Serial No
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: J3t/9Sis, ell LAelluy
WELL CONTRACTOR CERTIFICATION #: 2 3 S J
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential lEr Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring E.
Recovery ❑ Heat Pump Water Injection ❑ Other ri If Other, List Use:
2. WELL LOCATIW: (Show sketch of the location below)
Nearest Town: !.5/9 kers 1, ;Pe County
RD. orfF6rk I17T•y
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER gel r— Ric' -Z/vC, I,1Je)M 9
Address
dd" City or Town State
4. DATE DRILLED
5. TOTAL DEPTH 40 12—
6. CUTTINGS COLLECTED YES D NO®
7. DOES WELL REPLACE EXISTING WELL? YES n NOFRI
8. STATIC WATER LEVEL Below Top of Casing: Q n FT.
(Use '+' 11 Above Top of Casing)
9. TOP OF CASING IS / 92 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15.4 NCAC 2C .0118 10. YIELD (gpm)•. % .0 METHOD OF TEST iGJO LA.1 hJ
11. WATER ZONES (depth): (n .S - d 3t7 = l�
DRILLING LOG
From To
() go
/Y!/fchel/ Br/1 s ZNC,
200
Zip Code
DEPTH
Formation Description
rtd-ijr/AI/e
ue �
cc N/rci 1.31 k
12. CHLORINATION: Type N 77/ Amount / 7,9,01 -s If additional space Is needed use back of form
13. CASING:
Wall Thickness
From 0 DTolh .� / e Ft Dia e� r or Wgigh�(
/ lhihh�/Ft. AQ/v
From To Ft
From To Ft.
14. GROUT:
From
Depth
0 To _Ft
Material , Method
re net e A,P Poo rend
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in In
From _ To Ft In In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
Depth Size
To
To
Ft
Ft
Material
Material
LOCATION SKETCH
(Show direction and distance from at least two Stale
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED•IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION , mrvt¢,] HAT A Euf'Y Vp'r S RECORD HAS BEN PROVIDED TO THE WELL OWNER.
g-Q2.
SI(��pT E OF PERSONONSTRUCTING THE WELL DATE '
Submit original td',',{{SSi�s cn of Water Quality, Groundwater Section within 30 days
248931
c
GWl REV. 12199
;RCUia`
ASF,.... 'F
EC110Ai
C*RC.

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]
55
WELL CONSTRUCTION RECORD WELL CONTRACTOR: srv3swe11 IA)ell Li rill toy
WELL CONTRACTOR CERTIFICATION #: 2 3 87
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ®-- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : (Show sketch of the location below) ��--yy�� �( /
Nearest Town: A(lrr° rut ) / e j County: 0 i/ C. f tali
�rkt")v v l n u e %:r^,l .
(Road Name and Number's, Camay/Illy, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER OU5 70CI y %7e ///.vJer From To Formation Descdption
Address U .5-1 -2pq 0 2,7 i(-�irj.-
.re r • 'Qum •' o1- Q' 0CT O / as- N i 2,2 n il/l / P /C n C /C"
City or Town State Zip Coda
4. DATE DRILLED /— n2
5. TOTAL DEPTH aQ, n
6. CUTTINGS COLLECTED YES NO�
7. DOES WELL REPLACE EXISTING WELL? YES n NO(�
8. STATIC WATER LEVEL Below Top of Casing: /2 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 .0118
10. YIELD (gpm): 7 METHOD OF TEST Phi (A) ttf
11. WATER ZONES (depth): ton 70 / Lt n QCZn
12. CHLORINATION: Type // 74" Amount r3 70,13/ea J.s II additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weightift, xaterial (Show direction and distance from at least two State
From n To 62 Ft. rn f/U l big h1 Roads, or other map reference points)
From To Ft.
From To Ft 0
14. GROUT:
Depth Material -,I�. 1 Method
From 6 To.�.C2Ft Iefl\e )I POt)r&c�
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft _ in in
From To Ft in In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
0
r-
CO
CD
0
I DO HEREBY CERTIEYIHATIJHIc WFI I WAS CONSTRUCTED•IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU T wilsOsellits; _ANc THAT Ate a " THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE LS210fiLY � ' �*l / (5-*- d�
Quad No: iIr. N4TURE OF PERSO ONSTR CT1NG THE WELL DATE
Submit ori LI vision of Water Quality, Groundwater Section within 30 days
GW4 REV. 12/99
Serial No.
CT:XIsn'.".ATER. SECTION
ASH VPQLE REGIOLI/L OF HOE

North Carolina Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mal Service Center• Raleigh, N.C. 27699-1636-Phone [phone] _
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /I l✓'/3.S w e 11 Lodi ,1,7 rr 1! f u�
WELL CONTRACTOR CERTIFICATION Oh 3 g q --
STATE WELL CONSTRUCTION PERMIT#:
24.89:54
1. WELL USE (check Applicable Box): Residential [ Municipal ❑ Industrial D Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : (Sow ,sketch of the location below) /1J
Nearest Town: 5i1 //�.Ue19N County: /7;/C12e
igtAnls'CY"Rd ShnnttIT y)') jell.
(Road Name and Numbers, Convnunity, or Subdivisia and Lot No.) DRILLING LOG
3. OWNER n Sh 61/4/)r%1' rj
Addressl
tre et. rQ_Route No`,r') ag 1 a
City or Town State Zip Code
4. DATE DRILLED 2
5. +: TOTAL DEPTH $n
6. CUTTINGS COLLECTED YES El NO®
7.DOES WELL REPLACE EXISTING WELL? YES NO©
'8. STATIC WATER LEVEL Below Top of Casing: fin FT.
(Use •+• 11 Above Top of Casing)
9 r: 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 0116
10. YIELD (gpm): ' /2. METHOD OF TEST /C%M LAO A/
11. WATER ZONES (depth): / y S - ! Sn - 2 7 .1
0 Fro%dom
DEPTH
Formation Description
M r "-
Blue Rnc/c
12. CHLORINATION: Type / / TN Amount If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Dla�jnet r or WeighVFl. terial (Show direction and distance from at least two State
From — To Ft. (f7i41 SCA riLD 1/ C Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material • Method
From () To % Ft l e N-7e n.' Po u rrr
From To Ft
15. SCREEN:
Depth Diameter. Slot Size Material
From To Ft in " _ in
From To Ft in in
From To Ft: In in
16. SAND/GRAVEL PACK:
?' = Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY C
CONSTRUCTIO
FOR OFFICE US : LY
Quad No: .1I Ili
Sella No.
ARDS, AND THAT A COPn
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORQ HAS BEEN PROVIDED TO THE WELL OWNER.
1-
RE OF PERSON COIQSTRUCTING THE WELL DATE
v slon of Water Duality. Groundwater Section within 30 days
GW-1 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 WELL CONTRACTOR: ,3vv3.swell Lodi kit Iltu5
WELL CONTRACTOR CERTIFICATION #: 2 3 87
.. , STATE WELL CONSTRUCTION PERMIT#: -
248943
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring D.
Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) J //
Nearest Town. 430 %N �) e A k/ County C f'
e
° FF f-{ tint Z 02, C,
(Road Name and tubers, Community, r Subdivision and Lot No.) DRILLING LOG
3. OWNER MO O t VYI /i AJ '// p /U From To c Formation Description
Address J R
�S 32 a, i7/fi✓ /c7/UPRnC�
DEPTH
it a or ouzo o.)-71 ,.
City or Town Stab Zip Code
4. DATE DRILLED /—/2/-62
5. TOTAL DEPTH Q C
6. CUTTINGS COLLECTED YES n NOB-
7. DOES WELL REPLACE EXISTING WELL? YES B NO
S. STATIC WATER LEVEL Below Top of Casing: 3n FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated Wor below land surface requires a variance In actor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 9/O METHOD OF TEST ,Q/O 4.r A/
11. WATER ZONES (depth): 70 — 9O •- a 90
12. CHLORINATION: Type %7y re Amount 4 74vi3/��S II additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From Q To y/ Ft Z.- '>V SCH VO PO C Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From (5 To _ Ft CPsierv* Al tl/tI
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft irf in
From To Ft in In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
PO
Ea
O n
rn
17. REMARKS:
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED'IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND - •' `- IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
INC
2
FOR OFFICE USk;Ry��IIItt�!!! -A _ 'LA'S/ /-/ 27 d;
Quad No: !..'j r� Sl r • E OF PERSON ..NSTRUCTING THE WELL DATE
Submit original a •.n of Water Duality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No
_ _
ER. SECTTJ
ASh V LE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
2r46214
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION it
Le-iie Reeee
010782 STATE WELL CONSTFF ICTION PERMIT#:
Dewey Wright Well Pump Co
2dot'
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal I Industrial 1 Agricultural El Monitoring
Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RAKEF,'SVILLE County MITCHELL
H.aZFN E: LEDFORD RD. OFF STAGGER WEED RD. OFF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BARBARA A. PITTMA1
Address 112,2 HAZEN LEDFORD RD. ,
E3Ar:ERSftL raoUte"n.l NC 28705 42 184 GRANITE
City or Town State
2ip Code
DRILLING LOG DEPTH
From To Formation Description
0 i2 DIRT
1F:d 185
S!i4LE
fI
4. DATE DRILLED 1/21/2002 185 200 GRANITE
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES fI NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below and surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): METHOD OF TEST AI`
11. WATER ZONES (depth!:1 qpr, 1S2-195 0 Rprn
0 horn 0 porn
12. CHLORINATION: Type HTH Amount `"'
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 4u Ft 6 1'd .12E
From To Ft
From To Ft
14. GROUT:
I XI
Material
GAL V.
Depth Material Method
From 0 To 20 Ft Cement Gravity Flew
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To F
17. REMARKS.
I DO HEREB
CONSTRUC
FOR OFFICE
Quad No:
Size
Material
O
r—
—ea r7
Cr! C>
r�l —
—lam
If additional space is needed use ba1f fo`p
9)
u
lO
LOCATION SKETCH
0
(Show direction and distance from at least two State
y s.4 t\\t$oads, or other map reference points)
�0.
e4Eek k .
r, o --�
IFY THAT THIS WELL W C1 STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND TgAT •� (.0 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
APR 2 9 LODZ
Serial No.
ATER SEgT
GGIONAL'&FH>;E
Reeu 0--) 7-0
NATURE 1 ' ERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
1/7

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]
248215
WELL CONSTRUCTION RECORD
WELL CONTRACTOR:
Dewey Wright Well Pump Co., Inc
WELLCONTRACTOR CERTIFICATION #:
20to
020316 Leslie rteec=_
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential ••� Municipal � I Industrial
Recovery 1 Heat Pump Water Injection 1
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _ SPRUCE FINE
HOOT OWL RD. OFF f1A>TY 1DE
Agricultural
Monitoring
I
Other 1 1 If Other, List Use:
County
MITCHELL
(Road Name and Numbers, Community, or Subdivision and Lot Nod
3. OWNER FLOYD T. W!LSOV
Address 450 HOOT O" 11.. RD.
SPRUCE Irfdr q r Route No
NC 28777
DRILLING LOG
From To
0 4n
DEPTH
Formation Description
DIRT
40 253 GRANITE
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NO D
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
1/14/2002
0005
Zip Code
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.0110,, Air10. YIELD (gpm): _ " '' METHOD OF TEST
1 bt I : 253
-L5d' 0 , m
11. WATER ZONES Idepth): �•- nCr" ��� �-� p:="'
0 ppm 0 pprn
12. CHLORINATION: Type HTH Amount 11R
13. CASING:
Depth Diameter
From 0 To 43 Ft 8 1/4
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Material
Gil.
.18E
Depth Material Method
From 0 To 20 Ft DEr':Ynt dra:it-i Fic�.
From To Ft
15. SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in
16. SAND/GRAVEL PACK:
Depth
To Ft
From
From
17. REMARKS:
ti Ft
Size
i ij
Material
I DO HEREBY C
CONSTRUCTNOI
S
253
254
QUARTZ
254 605 GRANITE
Na 0
CA
rV
ry
v
3 —
If additional space is needed use backcf forrrn r:
'
O
LOCATION SKETCH o
(Show direction and distance from at least two State
Roads, or other map reference points)
r tiLi
f7 (1
THAT THIS WELL WAS CON$fRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NDA S, AND THAT A Cbp"bbbbbOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I J
APR 2 9 2002
FOR OFFICE USE ONLY
SIG
Quad No: GROUNDWATER %{{nri inal
ASHFVII L' PFG10NAL OFFICE
Serial No
4ATURE OF PERSON CONSTRUCTING THE WELL DATE
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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
248216
WELL CONSTRUCTION RECORD
020027
WELL CONTRACTOR' Dewey Wright We'd Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• LtfBb
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential [ XI Municipal Industrial Agricultural Monitoring
Recovery Heat Pump Water Injection ( Other
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: EAKERSV!LLE County: M!TCHEL.L
STAGGERWEED RD OFF CANE CREEK OFF r." by 226 G
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER LE ELLA COOKE
Address 1398 STAGGER WEED RD ,
aAk.
Frdn�aveetror Route No.)
En.z�.�c ..�
City or Town State Zip Code
4. DATE DRILLED 1/17/2002
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
28705
DRILLING LOG DEPTH
From To Formation Description
0 80 MUD GRAVEL
80 132 GRANITE
I >1
132 3S FLEDSFAR QUARTZ
134 185 GRANITE
0
9. TOP OF CASING IS ' FT Above Land Surface* rnn
*Top of casing terminated at/or below land surface requires a variance in actor I
dance with 15A NCAC 2C.0115 [iirV
10. YIELD (gpm): b METHOD OF TEST r ro
clPrp
11. WATER ZONES (depth):" cyNm 132-134
0 Qom
t_1am
12. CHLORINATION: Type `"H
Amount
If additional space is needed use bagl`yf form
O C_
13. CASING: LOCATION SKETCH 'D r_?
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 85 Ft b 1!a .18 GA_ V Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From .0 To 20 Ft Cement 39r2Ld`',' Atari
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARK
I DO HE ti
CONSTP
EcnO q.E
"ERTIFY THAT THIS WELL
DN STANDARDS, AND TI-
APR 2 9 2002
FOR OFFICE USE ONLY
Cn Cvec--k Wo(
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No:
!'Rrl 'mpvvATE
Serial No
SECTi0r ubmit c riginal to Division of Water Quality, Groundwater Section within 30 days
r., r°F!f E GW-1 REV. 12/99

249734
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) g6 Al Al l c ` 13g /'-/��lQG�+�f�J' CERTIFICATION #c1 S 27
WELL CONTRACTOR COMPANY NAMEZ8rw L A La -al 1LE v PHONE ti ti LN9-,vV716
STATE WELL CONSTRUCTION PERMIT# ,j" it ASSOCIATED WQ PERMITS' /I .1
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI
Nearest own:
County' U-4 M'
v
(Street N e, Numbers, Com ity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 1�Pe,,o 4 f s4Ls4 � �d
(Street or Route No.)
To .
City or To State
00f)- 7&r- oZf f-1
Area code- Phone number
4. DATE DRILLED a2 �/ ? 4 Z
5. TOTAL DEPTH:. '3o.ri
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IN
7. STATIC WATER LEVEL Below Top of Casing: 3o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2_� FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires ■
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 7r METHOD OF TEST Going
10. WATER ZONES (depth): /L S
11. DISINFECTION: Type Amount /2 �'_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To c t2 Ft. L � #L�l / Dye_
From To Ft.
To Ft.
From
13. GROUT:
From O
From
14. SCREEN:
Depth
From/f„I To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From /4T
To
Depth
To cs2 b
Zip Code
Material
Ft. (ibrne.AW
To Ft.
Slot Size Material
in.
in.
``Method .
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Size Material
Ft.
Ft.
E B C
Topographic/Land setting
RIRidge ❑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 Formation Description
0
• s
.eC IaN ICET H ND
Show direction d distance in miles from ataast c5
two State Roads o County Roads. Include the road`
numbers and co rn road names.
0
;1
MIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUL IING THE WELL
DATE
Submitthe ndpinalto-tie Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 filiot)e N ) 733-3221, within 30 days. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
248206
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey r ght ,':=11 F ".-r'"
WELL CONTRACTOR CERTIFICATION #•
020028 LF5i1e meece
STATE WELL CONSTRUCTION PERMIT#•
1. WELL USE (Check Applicable Box): Residential 0 Municipal F I Industrial 0 Agricultural I I Monitoring
Recovery Heat Pump Water Injection I I Other 1
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BURNS M" LE
P.tivr SG OFF H-SA,c1 22C
If Other, List Use:
County '=1i' -�L`
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER
Address c, - 2ux 27
C _ .'(Street or Route No.)
City or Town State Zip Code
DRILLING LOG DEPTH
From To Formation Description
n r):RT
IE
—
17R QUARTZ
4. DATE DRILLED 2”5
5. TOTAL DEPTH 2='S
6. CUTTINGS COLLECTED YES NO n
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 _ _
10. YIELD (gpm): METHOD OF TEST
0 ;-)pm
11. WATER ZONES (depth)•2 2-' c"-'r"' -7-17E
0 CtQm - CItr;,
Ae,' Tr
rV c
rn
t77
ry
rn
12. CHLORINATION: Type HTH Amount
If additional space is needed use bactof for"F71;
fV v
13. CASING: LOCATION SKETCH — c�
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at le9t twi6tate
From - To 51 Ft 6' lid 1`E Roads, or other map reference points)
From To Ft Ale 80 (✓r-
From To Ft 0115 ,/,lie
`�0
14. GROUT:
Depth Material Method
From - To Ft - '-` _.....o;
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
I DO HEREBY CE
CONSTRUCTION
FOR OFFICE USE
Quad No:
Serial No.
Ft
Ft n�iS
Y111G \
Size Material
LU
t 92Lo
q
Submit on
GROU DWATER SECTION
VIL E REGIONAL OFFICE
nal to
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r
TURE OF PC3fSON CONSTRUCTING THE WELL DATE
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 Sec
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
on
248208
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
O200E6
Drawee Wright 'Nell P'..::7ip Co.. Inc-.
WELL CONTRACTOR CERTIFICATION #. `e-V
STATE WELL CONSTRUCTION PERMIT# _e'312 r eece
1. WELL USE (Check Applicable Box): Residential n Municipal
Recovery n Heat Pump Water Injection Other
fl
Industrial
Agricultural f I Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUr7,F FIN; County. f=)•TONE'
HL=.J`r 8n, fFF Mft• = C-RIPEl.1. OPP r J'( 2O
(Roaa Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER IFCFRF . GR_ _,RY
Address :ERR,, y,dLSC:.:. eE
—.rlStree r Route No
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: E•D 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.011$._
10. YIELD (gpm): o`t METHOD OF TEST "'-
11. WATER ZONES (depth1• /13 P5m 133_1.31
D c(cim D c1:-:r:;
2302
545
" i7 705
Zip Code
12. CHLORINATION: Type HTH Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft. 138 AiG
From To Ft
From To Ft
14. GROUT:
From
From
Depth Material Method
To 20 Ft Clement _..t, , .,,=.,ai
To Ft
15. SCREEN:
From
From
From
Depth
To
To
Ft
Ft
To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS•
I DO HEREBY CE
CONSTRUCTION
Slot Size Material
in
in
in
Diameter
in
in
in
Size
DINATER SECTION
LE REGIONAL OFFICE
Material
DRILLING LOG
From To
DEPTH
Formation Description
ITDRT
1 183 GRAN.TE
188 1$3 QUARTZ
Sr1 GRA.JNiTE
i
QUARTZ
j9:2
c
GRAN! E O
T r.
rn
r\1
co
— J
c m 321.-JCIi
IV
r,l
— y
If additional space is needed use back"'tf for
LOCATION SKETCH
(Show direction and distance from at least two State
i,\.Roads, or other map reference points)
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Act_ —t y — o a
URE OF SON CONSTRUCTING THE WELL DATE
ivision 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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
250337
WELL CONSTRUCTION RECORD
020079
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
STATE WELL CONSTRUCTION PERMIT# Jerry Wilson
1. WELL USE (Check Applicable Box): Residential I X Municipal I Industrial ❑ Agricultural n Monitoring
Recovery I Heat Pump Water Injection n Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County MITCHELL
CRABTREE CREEK RD. OFF CRABTREE RD. OFF HWY
(Road Name and Numbers. Community. or Subdivision and Lot No.)
DRILLING LOG
3. OWNER CHARLES HEADINGS From To
Address % RICHARD YOKUBINAS , 598 WASHBURN RD. 0 37
SPRUCE ISYSE'r Route No.) NC 28777
City or Town State Zip Code
4. DATE DRILLED 3/1/2002
5. TOTAL DEPTH 545
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES NO 0
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casingl
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.01 tt
10. YIELD (gpml' 7 METHOD OF TEST Air
11. WATER ZONESIdepth):10 ppm520-521 0 ppm
0 ppm 0 ppm
I
DEPTH
Formation Description
DIRT/SHALE/GRANITE
37 520 GRANITE/QUARTZ
520 521 QUARTZ
521 545 GRANITE
x
12. CHLORINATION: Type HTH
13. CASING:
Amount 98
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 47 Ft 8 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
From
From
Depth
0 To 20
15. SCREEN
From
From
From
To
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
To
17
From
Material
Ft Cement
Ft. CEMENT
If additional space
r1
IV
s needed use back of form
Method
Gravity Flow
GRAVITY FLOW
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
Ft
Size
Material
I II
c
REBY CERTIFY THAT THI
RUCJ1J flNQ41573S,
F. " OF
TarrnIM
sta
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
aste
IS✓�r
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIAED TO THE WELL OWNER.
Qu'd NobG ROUNDWATER SECTI
Serial No
rr
SfGNATURE OF PERSON CONSTRUCTING THE WELL DATE
bmit original to Division of Water Quality, Groundwater Section within 30 days
4W 1 RE\ 12Vn

WELL CONSTRUCTION RECORD 25115-4
North Carolina,. Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
(
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A1P/fe ec_ t.Z rf,rc l CERTIFICATION # ..74#47
WELL CONTRACTOR COMPANY NAME PHONE #! )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential ❑/Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use fretilt „ti`
2. WELL LOCATION: //�///// /d„' /
Nearest Town: hiTT/Y'Ja./Witrslrr unty g/ J
,', (Street Name; Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Moor
Address �Pa/e. XDS /On
(Sttre/e) or Route No.) ;#2 F
•.) s CityorTown ` State .Zip Code
Area code- Phone number
4. DATE DRILLED 3 -02
5. TOTAL DEPTH: -7/0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO —
7. STATIC WATER LEVEL Below Top of Casing: _5-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordancs with I5A NCAC IC .0118.
9. YIELD (gpm): METHOD OF TEST nip
10. WATER ZONES (depth): 90 -9ZL /d4,4-„ f
ion —in
11. DISINFECTION: Type / 7—% e Amount .3 & ze
12. CASING: Wall Thickness
Depth Diam ter or Weight/Ft. Miterial
From "1 To 254 Ft. C 4noi /'c'C
From To Ft.
From To Ft.
13. GROUT: Depth Material' Method
From 6 To 3 Ft. (C.d/eea'/
From 3 To 22, Ft. BZ.f.Crr/ilet n er
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:
YKTR
C STRUCT101V StAl
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)
*4 DRILLING LOG 4,<
ormation Descr tl ,
h
�ecf 'Ctr ��n
"h%/eAtc.k) nee,yrcw,tbri et"
DEPTH,
From To
0'— ro
-r.z- 7 tL
— 9r)
1d-9v
73- 3ao
iotv-3o 2
Jog —Y,Q-)
LOCATION SKETCH
Show direction and distance in miles from leasg ,
two State Roads or County Roads. Includ ro@rn
numbers and common road names. PO o{
N Do
Xis m�
vT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF, HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Jfj — 302 V SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
Submit the original t the L ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
G({7L§1113V1(9pl019) 723-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
am

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]
251455
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
020156 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential X Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
BAKERSVI LLE :MITCHELL
SPRING HILL Nearest Town: __ _ County_ _ ____
. OFF REDWOOD
DRILLING LOG DEPTH
3. OWNER From To Formation Description
Address 272 COOK TOWN RD. , 0 58 DIRT/MICA
(Road Name and Numbers, Community, or Subdivision and Lot No.)
EVEREI I E D. HOBSON
BAKEI SVIEL'l°"teNo.) NC 28705
58 315 GRANITE
City or Town State zip Code 315 316 SHALE
4. DATE DRILLED 3/22/2002 316 345 GRANITE
5. TOTAL DEPTH 345
6. CUTTINGS COLLECTED YES ❑ NO I X
7. DOES WELL REPLACE EXISTING WELL? YES In NO In X
rn
iV
p as
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing) rn
N CD
lD 4m
9. TOP OF CASING IS 1FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C 0118
ye�ra
-0rn
10. YIELD (gpm): 20METHOD OF TEST Aar S a0
11. WATER ZONES (depth)• 20 ppm315-316 0 ppm r3 mT
as0
0 ppm 0 ppm
12. CHLORINATION: Type HITH Amount 58
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To P. 61/8 .350 PVC
From To Ft "5
l9 C
[l
From To Ft , o>"
14. GROUT:
Depth Material Method
From OTo 20Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft. in in
16. SAND
From
From
Depth I'
I To
To
Ft
Ft
17. REMA'KS•
I DO HE'EBYop y�
CONST'UCTFEl?';1r
'tae
Material
^r�r WA
mF �..
41-�AT A
FOR OFFICE USE ONLY
If additional space is needed use babflof farm
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) GQ'
SPA();,,-0
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECQRD HAS BEEN PROVIDED TO THE WELL OWNER.
f
0
SIGNATURE OF PON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

253164
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
C US`� ` CERTIFICATION #
WELL CONTRACTOR (INDMDUAL)NAME (print) .-J r C
C�,�yJ 1,�..tQ�I Q f TLC: Is t^t PHONE R (0,'^'1 )Z �i�.i�P
�/ ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMrr#
(if applicable)
1. WELL USE (Check Applicable Box): Residential IRK-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.y:
Nearest Town: L i 4- kef lli ud' County "kit tts
(Street Name, Numbcn, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RO N N i i " 0 r Le SO i3
Address (5'I f U UL.4 N b ✓
(Street or Route No.)
ity or Zip Code
Area code- Phone number
4. DATE DRILLED �/� / L
5. TOTAL DEPTH: % 4' S
- DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (,o FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordancewithISAMETHOD OF TEST !1-(f-
AC 2C .0118.
9. YIELD (gpm): �—
10. WATER ZONES (depth):
(CSO /Sb.
11. DISINFECTION: Type c(-O2r/t1e Amount `A2 1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and common road names.
( F
0 To t. �9 (/U G
From�� O II £
7f—To Ft. J uf_
From ll__ To Ft. (u I
13. GROUT: Depth
From_ To FL 4
m 0 To Ft.
Material
Fr
om 2 3
14. SCREEN: Depth Diameter Slot Size Material
Front.._.._..To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Materal
To Ft.
To Ft.
Method
From.
From
gocuilP
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 •-80
© c,
r OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
0
CO
v
N
v
-azdy
0
c r)
Hiyo
0-5
I DO HEREBY CERTIPV THAT THIS
CONSTRUCTION STANDA.XDS, -"
L
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�J
ATURE OF ' ON CONSTRUCTING THE WELL DATE
GROUNDWATER SECTION
ASH E\rsd1GnihdhdN4Miglopi the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl REV. Raleigh,0NC
27699-1636 Phone No. (919).133-3221, within 30 days.

253158
WELL CONSTRUCTION RECORD
North Carolina - Depestment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
rc
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2 ` `� 0Sf / < CERTIFICATION # vyrr
ic7S7'r'cl /56
LzJe6 DrrWN4 PHONE # J `la /Z4,--q_SrVg
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAaf/
-
Nearest Town:: .1,�-� County
� ,21
(Street Name, Numbers, t Lunity,�Suubbdivision,, Lot No., Zip Code)
3. OWNER: 4P lii 9#4— c
Address Prw[I teat oueo NMGT0 AI
( No.)
sr/C1R e dlie f 8717
City or Town S Zip Code
(2S} 9 dS- il2G
Area coda Phone number. ^ „S-O c
4. DATE DRILLED
5. TOTAL DEPTH: 2{/ Sr 36 - 3 YSr Ky giew L
6. DOES WELL REPLACE EXISTING WELL? YES ❑ pro
7. STATIC WATER LEVEL Below Top of Casing: /O FT. n -'
o
(Use "+" if Above Top of Casing) Na
8. TOP OF CASING IS or FT. Above Land Surface' r "�
'Top of wing terminated at/or below land surface requires a -< `
variance In accord ce th ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TE /4//e ao o
z- n
J
10. WATER ZONES (depth): do� 3/0' c
.CATION SKETCHx a
Show direction and distance in miles from at ist ,, E2
two State Roads or County Roads. Include thpoad n
Depth numbers and common road names. rG
� .nOliYi�,v i
opographic/Land setting
ErRidp ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTR DRILLING LOG
From To Formation Description
11. DISINFECTION: TypeeWaNd
12. CASING:
Fro To
Fro (5 To
FroTo
Diameter
Ft.
Ft.
FL 43
Amount & 6' 9,
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Matenal
From To Ft.
From 0 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 RFMARICC.
Riami,LNXAONSTRUCTIOSTAND
1UL 2 2
is
•
S
Divi
J
WAS CONSTRUCTED IN
THATACOP
Au
ATIIRE OF P RS
•
ock
N rn
pi IVA rd
CU}W kNGEsW1TH 15A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(cheek appropriate bor.)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map.:,:,,.
From To
D— 3
s - so
So — 9'0
90 Y9
97—/9r
Ms- /9 y
/97— 3so
DRILLING LOG
;Formation Descnptton
i rcl cQt o { rAr.ts
cf42 le -co de"
rot,/it
5.1q/e•. at•
to•v:
3so-3[�sl vf,71Ce-uor'f variance in accordance with 15A NCAC 2C .0118. 4 es a 33I — 98,7 -
9. YIELD (gpm): /o 0 METHOD OF TEST %ir`/' !/SS-�}34S )y�,� f�,
I O. WATER ZONES (depth): 7D-y-, —, / /95--/r`7, �L 7 ff J j J 00 �r�w /lee
kE'fCH
j'- WELL CONSTRUCTION RECORD 2531
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectieon''
CERTIFICATION #/4'49
PHONE # ( ) - -
\YELL CONTRACTOR (INDIVIDUAL)NAME (print) 4c,rr/C7/ s
WELL CONTRACTOR COMPANY NAME`- 4Z'fa-t// /r/b// ✓///�/, A-t
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I WELL USE (Check Applicable Box): Residential ❑ Municipal/Public I�lndustrial 0 Agricultural,
Monitoring ❑. Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use /o ri.✓er,U
2 WELLLOCAT
Nearest Town; /-t&. County 1t��...-
(Street Name, Numbers, Community,Subdivisioo 1, Lot No., Zip Code)
3 AWNER:. 1
�1
Address ,�r��fi(/,�C.le
(Sheet or R67-2-te o)) a 7O
�<acl�/le.. .G. _ lJ
d Cay or Town State / Zip Code
)- _
Area code- Phone number
4. DATE DRILLED .9 `/ 8 — O 2
5. TOTAL DEPTH: So
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7 STATIC WATER LEVEL Below Top of Casing: Qr 0 FT,
(Use••+•• if Above Top of Casing)
8 TOP OF CASING IS . - FT. Above Land Surface*
*Top of casing terminated at/or below land surface dequires
74G
356 ` j-57ft) (//.35-9.36 `Sie v LOCATION S
t 1. DISINFECTION: Type__ /f7/1- Amount Y OZ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material lumbers and common road names.
From_ ^ / To 5 a Ft. �v 1 P 2/U
From ' To - Ft. - , s ,)'caal� `.
Prom To Ft. --- ✓
3. GROUT: D=ptit MutErial _ -
Method i!sP /'
..�
From L To 0 -: •i
From 'To Ft.
14. SCRIM:!: D
,:p:ll Duran G:e S!oLS%c 7:latcrie1
.,I
r AP Lli Dr'w,- ; EPTIUv _ •
SI.i UILi,K } ,,.:�'NA CFi'laiS.‘: ,
y)
r'c
.UAtA C. ^PY.,)'17)LS RECORD AS 3FEi 4 F. CJL):..r! C) Tri.:.
- TLIR G OF PE ON CONSTRUCTING THE `i'EL1-
rTj
rr V'.iler'4 lilt. Uia dIt'atel c..;a, lii q„:
u
i
3
O
Ol

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]
251454
WELL CONSTRUCTION RECORD
020179
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2686
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential n X Municipal ❑ Industrial In Agricultural n Monitoring 0
Recovery I I Heat Pump Water Injection n Other 0 If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHFLL
PRIVATE RD. OFF MINE CREEK RD. OFF HWy.228 OFF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER BRUCE D. BUCHANAN From To Formation Description
Address 212 BU Ke�{`ttEYaEeuHOLLOW RD 0 44 DIRT
Wire
eN0'I NC 28705 44 108 GRANITE
Zip Code
City or Town State
108 109 QUARTZ
4. DATE DRILLED 4/2/2002 109 500 GRANITE
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES 0 NO n x
7. DOES WELL REPLACE EXISTING WELL? YES I NO ❑ x N p
8. STATIC WATER LEVEL Below Top of Casing: 10 FT a 0
(Use "+" if Above Top of Casing) 17 co'
9. TOP OF CASING IS 1FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• "METHOD OF TEST Air
11. WATER ZONES (depth): 1/4 Qom 108-109 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 98
IN) o,<
1r�
Dr-1
rn
-v —f
3 ^tc
m
rn73
n
If additional space is needed use bacf fog
e
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To ff. R 1/8 R5fl PVC' Roads, or other map reference points)
From To Ft V��� I E-
From To Ft 'l
14. GROUT:I
Depth Material Method
From 0To 20Ft Cement Gravity Flow
From To Ft ,1 O
15. SCREEN: .t '-' _p
Depth Diameter Slot Size Material ,-6RP
From To Ftin in cy n
From To Ft in in o 3�� ILry'
From To Ft in in -9-
16. SAND/_.:.
De
From IlJ To Ft
From 1� To Ft
17. REMAR S•
I DO HE"EBY tl r
CONST-UCTIO$ .
ASHEVILL�
vs
Material
FOR OFFICE USE ONLY
Quad No•
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A t OPY OF THIS REQORD HAS BEEN PROVIDED TO THE WELL OWNER.
KO, V "'"4I A- 'tit
SIGNATURE OF SON CONSTRUCTING THE WELL DATE
Submit original to Division of ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
7
2� 0 P\
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
251453
WELL CONSTRUCTION RECORD
020177
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.2888
STATE WELL CONSTRUCTION PERMIT#' Leslie Reece
1. WELL USE (Check Applicable Box): Residential E X Municipal Industrial 0 Agricultural Monitoring Ell
Recovery 0 Heat Pump Water Injection I I Other
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County' MITCHELL
FORK MTN RD OFF HWY 228 OFF HWY 19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
MICHAEL L. PETERSON DRILLING LOG DEPTH
3. OWNER From To Formation Description
Address 1150 FORK MTN RD. , 0 77 DIRT
BAKEFISVIWE' No,' NC 28705 77 110 GRANITE
cry or Town State Zip Code 110 243 GRANITE
4. DATE DRILLED 4/1/2002 243 244 QUARTZ
5. TOTAL DEPTH 286 244 266 GRANITE
6. CUTTINGS COLLECTED YES NO fl X
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 X
8. STATIC WATER LEVEL Below Top of Casing: 30 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 (ppm)* 2 METHOD OF TEST Air
c
0 0
238 Tsts
v om
N o
tO m
11. WATER ZONES (depth): 1.25 ppm 110 111 3/4 ppm 243 244 S
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 47 If additional space is needed use bacR forte
e
z
13. CASING:
Depth
From 0 To
From To
From To Ft
14. GROUT:
Depth
From °To
From To
15. SCREEN:
Wall Thickness
Diameter or Weight/Ft. Material
?t 61/8 .188 PVC
Ft
Material
20Ft Cement
Ft
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/
From
From
-RAVFI PACK:
17. REMA
I DO H
CONS
KS.
RE
RUC
'Ft'!
Ft
Material
1
B
uMR
ASHEVILLE REPS
FOR OFFICE USE ONLY
Quad No:
LW
HAT
5 CTICH
AL OFFICE
,7 mz
LOCATION SKETCH
(Show direction and distance from at least two State
t5Roads, or other map referencerpoints)
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
• .1 r I
SIGNATURE OF PE WSN CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
251452
WELL CONSTRUCTION RECORD WELL CONTRACTOR -
Dewey Wright Well Pump Co., Inc.
020173 WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
2686
WELL USE (Check Applicable Box): Residential ❑ X Municipal Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
BROAD BRANCH RD. OFF HWY' 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
EARL TROUTMAN
3. OWNER
Address
457 BROAD BRANCH RD. ,
DRILLING LOG DEPTH
From To Formation Description
0 37 DIRT
BAKE PILI-FreN°'I NC 28705 37 54 GRANITE
City or Town State Zip Code 54 55 SHALE
4. DATE DRILLED 4/3/2002 55 108 GRANITE
5. TOTAL DEPTH 126 109 100 SHALE
6 CUTTINGS COLLECTED YES ❑ NO ❑ x 109 125 GRANITE
0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C X
8. STATIC WATER LEVEL Below Top Casing: 40 FT IV 0
(Use
" A +" if Above Top of Casing) e,?
�
O
9. TOP OF CASING IS 1FT Above Land Surface* Si an
Top of casing terminated at/or below land surface requires a variance in actor- NI oC
dance with 15A NCAC 2C.0118 12 Air -SO
10. YIELD (gpm): ME-LHOD OF TEST �-�
11. WATER ZONES (depth)• 6 Rpm 54-55 7 aom 1D8 109 r —110
0 qpm 0 qpm N inz
12. CHLORINATION: Type H IH Amount 18 If additional space is needed use bacl g,f form"
01 0
z
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To it? 61/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From _ DFo 20Ft Cement Gravity Flow
From To Ft
15. SCREEN:
From
From
From
17. RE
I DO HERE3Y CERTIFY THAT THIS ELL AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO '.TRU �5;,YAiI4DTHA
ASHEVILLE REGIONAL OFFICE
Depth Diameter Slot Size Material
To Ft in
To Ft in
To Ftin
in
in.
in.
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
aalo fl ± 2
FOR OFFICE USE ONLY
Quad No:
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
✓r PArt
SIGNATURE OF PjON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
-2a o2
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 J 1 4 (1 0
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
Zip Code
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION #• 2686
020201 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
Dewey Wright Well Pump Co., Inc.
1. WELL USE (Check Applicable Box): Residential fl X Municipal
Recovery El Heat Pump Water Injection Other
Industrial
If Other, List Use.
Agricultural D Monitoring El
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County. MITCHELL
PRIVATE DR. OFF BRUSHY CRK RD OFF 01 D 19E OFF
I Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER SPRUCF PINE MOOSE_LODGF From To Formation Description
Address P.O. BOX 458 , 0 38 DIRT
SPRUCfetft°OLe No.) NC 28777 38 131 GRANITE
City or Town State 131 132 QUARTZ
4. DATE DRILLED 4/9/2002 132 205 GRANITE
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES I NO 0 X
7. DOES WELL REPLACE EXISTING WELL? YES I NOE I I X
8. STATIC WATER LEVEL Below Top of Casing: 30 ET
(Use'4" if Above Top of Casing)
9. TOP OF CASING IS 1FT 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): 11 METHOD OF TEST Air
11. WATER ZONES (depth): 11 qpm 131-132 0 qpm
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 36
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 4? 61/4 .188 GALV.
:O^
2nj
4./ZO crn
R
3
4 ti
If additional space is needed use back of felikn z
From - To Ft
From To Ft
14. GROUT:
Depth Material Method
From °To 20Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in ci
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
gaci
17. RE KS: L„J
I DO HEREBY CERTIFY THAT THIE WEL - WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTFIUCTION STANDARDS, A\ID TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
GLnL;l',:,liiTeR SECTION ,- j li_ —a u� -O o'er
FOR FGI�.c W
Quad No:
SIGNATURE 9PE SR ON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
2514t 9
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
020198 STATE WELL CONSTRUCTION PERMIT#• Levlie Reece
1. WELL USE (Check Applicable Box): Residential 0 X Municipal Industrial 0 Agricultural n Monitoring 0
Recovery El Heat Pump Water Injection 0 Other I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
3. OWNER
Address
PRIVATE DR. OFF HWY 226 OFF HWY 19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
SCOTTY R. GOUGE
2218 SOUTH 228 ,
DRILLING LOG DEPTH
From To Formation Description
0 58 DIRT/MUD
BAKE S%eLtne No.) NC 28705 58 283 GRANITE
City or Town State Zip Code
4. DATE DRILLED 4/9/2002 264 365 GRANITE
5. TOTAL DEPTH 385
6. CUTTINGS COLLECTED YES 0 NO I I X
7. DOES WELL REPLACE EXISTING WELL? YES n NO 0 X
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "*" if Above Top of Casing)
9. TOP OF CASING IS 1FT 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): I —METHOD OF TEST Air
11. WATER ZONES (depth) 1.5 ADM 263-264 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 65
263 264 SHALE
c
CD o`
Saw
Cl
�
o"r
=-1
to *m
m�
F y
�4 If additional space is needed use back of forig
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From O To Q. 81/8 .350 PVC
From To Ft QQc��,�jA�
From To Ft M -`fS'
14. GROUT:
Depth Material Method
From OTo 20Ft Cement Gravity Flow From To FtT4-15. SCREEN: 4Depth Diameter Slot Size Material U
From To Ft in in. .-z--•
From To Ft. in in 1 t c) c)-(p
From To Ft in in
Roads, or other map reference points)
t'Fi
16. SANDJGRAVEL PACK:
From
From
17. REMAPKSI
I DO HERE
CONSTRU
I�Depthll; ;1 'Il I�\
To
Material
Y CERTIFY THAT THIS W ELL W
1 ANDEHARDSSFC71UN ANn[FHAT
L!L!V/AF
ASHEVILLE F'=51nir'rL UFHICE
FOR OFFICE USE ONLY
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Division of ater Qualit Groundwater SIGNATURE THE WELL DATE
Submit original to y, Section within 30 days
GW-1 REV. 12/99
URE OF SON CONSTRUCTING
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
25147'8
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Ca., Inc.
WELL CONTRACTOR CERTIFICATION* 2686
020195 STATE WELL CONSTRUCTION PERMITS!. Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 X Municipal 0 Industrial n Agricultural Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
FORK MTN RD. OFF HWY 261 OFF HWY 19E
Mead Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER _ DOUGL.AS A. HOBSON From To Formation Description
Address 3836 FORK MTN RD. , 0 100 DIRT/MUD/GRAVEL
BAKEF!VILLr eN°1 NC 28705 100 118 GRANITE
City or Town Stale Zip Code 118 119 QUARTZ
4. DATE DRILLED 4/5/2002 119 222 GRANITE
5. TOTAL DEPTH 265 222 223 SHALE
6. CUTTINGS COLLECTED YES I I NO n X 223 265 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES LJ NO 0 x
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1FT 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)• 2 METHOD OF TEST Air
11. WATER ZONES (depth) 1/2 qpm 118 119 1.5 qpm 222-223
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 49
0 0
c
b ct�
0 Cn
Cm
N ro_
>c
v rr
S o
-1•t
If additional space is needed use ba
oc n
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 1g 6 1/4 .166 GALV. Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT: T
Depth Material Method
From OTo 20Ft Cement Gravity Flow
From To Ft
15. SCREEN:
-II--
Depth Diameter Slot Size Material �}e,+5✓iilf:
From To Ft in. in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
From
From
I— Ta^_
To
17. REMA9SS
Ft� Ir.
Ft
JJ
Material
I DO H _REB\ CERTIFY THAT THIS WELL W
CONS —RUCTION STANDARDS, AND TNT
GROrilln'Ali P. SECTION
FOR OF�t ` I LICE
as co
CFI a-
t
y .a
0 v << V.-idti1. RcA
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Quad No
Serial No
SIGNATURE OF (iiSON CONSTRUCTING THE WELL DATE
Submit original 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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
255193
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2686
020255 STATE WELL CONSTRUCTION PERMIT#: Le�6e Reece
WELL USE (Check Applicable Box): Residential X Municipal Industrial ( I Agricultural 0 Monitoring n
Recovery I I Heat Pump Water Injection 0 Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE
PRIVATE DR. OFF HWY 261
(Road Name and Numbers, Community, or Subdivision and Lot No.)
County MITCHELL
DRILLING LOG DEPTH
3. OWNER MARVIN S. MILLER From To Formation Description
Address 4051 FORK MTN. RD. , 0 37 DIRT/MUD/GRVL
BAKERS'ttE Route No.) NC 28705 37 481 GRANITE
City or Town State Zip Code 481 482 QUARTZ
4. DATE DRILLED 5/30/2002 482 545 GRANITE
5. TOTAL DEPTH 545
6. CUTTINGS COLLECTED YES NO ICI
7. DOES WELL REPLACE EXISTING WELL? YES 71 NO17
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if 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.011
10. YIELD (gpm): I METHOD OF TEST Air
11. WATER ZONES (depth):1 ppm481-4820 0pprmtl
12. CHLORINATION: Type HTH
13. CASING:
Amount 107
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft. 6 1/8 .350 PVC
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMAR
I DO HE
CONSTI
-,l
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
fie
_ C9i
0 O
r.+
0(•
�1 RSTAND�ARDS AN HA OP OF TH SIna CONSTED RECORDINCORDANCE HHAS BEEN PROVIDED WITH 15A ITOAC TH WELL OWNER.
FOR OFF
E ONLY
SIGNATURE PERSON CONSTRUCTING THE WELL
iriginal to Division of Water Quality, Groundwater Section within 30 days
DATE
Quad No:
Serial No.
S bmit
F= ATEF SEC?ION
�.., ,;rcIrNAL C..-,.iCE
GW-1 REV. 12/99

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]
255192
WELL CONSTRUCTION RECORD
020341
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 1tl8ti
STATE WELL CONSTRUCTION PERMIT#: Leslie Keece
1. WELL USE (Check Applicable Box): Residential I XI Municipal I I Industrial Agricultural 0 Monitoring D
Recovery 0 Heat Pump Water Injection
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
SPRING HILL RD. OFF MCKINNEY COVE RD. OFF CANE
(Road Name and Numbers,Community, or subdivision and Lot No DRILLING LOG DEPTH
3. OWNER LINDA WOODY From To Formation Description
Address % SANDY JOHNSON , P.O. BOX 204 0 18 DIRT
SPRUCE M19tMEr Route No.) NC 28777
tate Zip Code
City or Town
4. DATE DRILLED 5/28/2002
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES In NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use'+" if Above Top of Casing)
18 83 GRANITE
AI
83 84 SHALE
84 157 GRANITE
157 159 QUARTZ
159 185 GRANITE
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.01Wh
10. YIELD (gpm): `LIMETHppDIOF TEST �r18 ppm 157-1461
11. WATER ZONES (depth) 0 ppm 83-84 0 ppm
12. CHLORINATION: Type HOH Amount 26
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 8 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY
CONSTRUC
-
-Ft[AT'FHIS N L iNA3tCt
FOR OFFICE U
Quad No:
3E
LY
Submi
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State !/
Roads, or other map reference points) -f<
1`> v
5Q
JSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
e Ice 6-27-0 2
SIGNATURE OF PER N CONSTRUCTING THE WELL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
f
Serial No
(UND \AJP:i;'IUN
HIFFE;E OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2b tf
020312
STATE WELL CONSTRUCTION PERMIT# Leslie Fleece
255t90
1. WELL USE (Check Applicable Box): Residential I Xl Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery I 1 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
CANE CREEK RD. OFF HWY 226 OFF HWY 19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER RUSSELL J. DILLER
Address P.O. BOX 817 ,
BEAUFOIVIrreet or Route No.)
SC
29901
City or Town State Zip Code
4. DATE DRILLED 5/28/2002
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
XI
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.01UU '18_ pF TE9T Air
10. YIELD (gpm)• LT 0D 185-186 0 ppm
11. WATER ZONES (depth):
X
DRILLING LOG DEPTH
From To Formation Description
0 4 DIRT
4 185 GRANITE
185 188 SHALE
186 205 GRANITE
U ppm U ppm
12. CHLORINATION: Type HIH Amount 31
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft. 6 1/4 .188 GALV.
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement
From To Ft.
15. SCREEN:
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in
From To Ft. in
From To Ft in
in
in
in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS
I DO HEREB
CONSTRUC
RSV ',TM/M-0
FOR OFFICE
Quad No:
ONLY
Submit orig nal to Division of W
L`1/
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
19E
C CA1.1
k.
it
Pr
W
U
)NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL k
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PE N CONSTRUCTING THE WELL DATE
er Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.
C OUNDWA
..:LV;LLE R'
ER SECTION
SciNAL OFFICE

WELL CONSTRUCTION RECORD.
".Fir, rcs
Department o['Environment and Natural Resources - Division of Water Quality-Groundwatei S
e /
OR(INDIVIDUAL)NAME (print) I� ��'�YkD � ..=CER7IFICATI
rRACTOR COMPANY NAME rtR¢1$ts_Je.11 Oct( PHONE
4 CQNSTRUCTION PERMITS - ASSOCIATED %V PERMITS k'.> a£ ,fv `
if applicable)'`
ee m' umbers, _Common
i (if applicable)
k 1
SE'(Check Applicable Box): Residential t�Municipal/Public 0 Industrial ❑ Agricultural O'
ng 4aRecovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use sS,.
Topogra ic/Land setting
DRidge lope ;iOValley
(check appropnete box)-•
Latitude/longitude ot~well)ocatio
(degrees/minutes/seconds);,.[.,,.
Latitude/longitude source:OGPSOTopogra
"(check'box)
v1 - County pvcirl l
y, Subdivision, Lot No., Zip Code)
e. c�
i9
(Leto
H.(Street or Route No.)
rJ: \e < vvc. 2Z 1o$
T gt` N rc State .Zip Code
fodo'Phone number
P, FRILLED ( O
Towel PEE.TH. • 9.Ot J-}—
o • 1CDQHS.'WELL REPLACE EXISTING WELL? YES 0 NO if(
TAT C+WATER LEVEL Below Top of Casing: a?O FT.
(Use"+" if Above Top of Casing)
O'
9 ,CASING IS 1 FT. Above Land Surface*
Topofpasing terminated at/or below land surface requires a
arlance in accordance with 15A NCAC 2C .0118.
IELD, jgpm)i" ' /O METIA1D OF TEST_A-1 2
W+ ERZONES (depth): .55 j qq tg�
tSINFECTI,ON. Type_' X}.,p t\a--e- Amount e• �> +
CASING i Wall Thickness '
e M r Depth D me r Weight/Ft.Ft. Mat rial
Ft. f0 A-
rmm�l^f"V14 ..'T.. c. l '
av
Yx nYu
From To Ft:
GROUT ar';;,Depth- Material!
Fromm Ft. C-en..a.-«-�'
From,:: -.:;To Ft.
Method
SCEN (Deth p Diameter Slot Size Material
From ' To Ft. in. in.
From `- To Ft in. in.
15;5SAND/GRAVEL PACK: a
- Size Material
To Ft.
To Ft.
From;c':;
From'",
16:'.REMARKS:
gifeare
41100,
. -SI NN Ura_ �.
u al to the Division of Wat
0 0. [phone], within
'i OROUSipiyATER SECTION
SHEVILLE REGIONAL OFFICE
From To"
7;20
LOCATION SKETCH
Show direction and distance in miles from atleas
two State Roads or County Roads.7nclud(tha
numbers and common road names
,tc,We(�
is
TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL'r�
TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 01i
7—e r r•
SON CONSTRUCTING THE WELL DATE '" - 4i
lity, Groundwater Section, 1636 Mail Service Cctifer Ralelgh,'NC
GW-1 REV,,07/ 00,

WELL CONSTRUCTION RECORD
NoDepartment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WE Carolina - Dep 5 U
Cc
WELLLCONTRACTOR (INDIVIDUAL) NAME (print) ()! - 2 -Ll S �%�
WELL CONTRACTOR COMPANY NAME 5U Sf .ZG E \ 3 USA+ C CERTIFICATION g ttQ b f t i L L (N `I PDONE R
STATE WELL CONSTRUCTION PERMITB __tSSOCIATED W Q PERMIT#if licable
ifs liceble /
1. WELL USE (Check Applicable Box): Residential I7 Municipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Topo hic/Land setting
❑Ridge Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION // n/N�countyA/CAett
Nearest Town:
CAayAutry- LCS
(Street Name, Numbers, Cammuoity, Subdivision, Lot No., tip Code)
Kpti ,f (degrees/minutes/seconds)
3. OWNER: ri tip
�1 Latitude/longitude source:❑GPS❑Topographic map
Address /', (check box)
(Streeetet or Route No.) DEP r1Rif T LOG
SrtWrfi.g, / From To Formation Description
City or Tow9, State Zip
�Code
( )_ '/$G-7W'77 yy /g J QA
Area code- Phone number
4. DATE DRILLED 5--11- 04
5 TOTAL DEPTH: 2 cJ
(AA
2544t79
r»-ays
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O
7. STATIC WATER LEVEL Below Top of Casing: Q_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 regdres a
variance In accordance wltb ISA NCAC 2C .0118.
9. YIELD (gpm): _ METHOD OF TEST 4(4-'
10. WATER ZONES (depth): goo e 4vr/J.r, la ON SICFTCH
11. DISINFECTION: Type C L D2 Al c- Amount 3 `) , Show direction and distance in miles fro
12. CASING:
Wall lbiclmess two State Roads or County Roads. Include
Depth Diameter or Weight/FL Material numbers and common road names.
Fro To Ft.
From 0 To al - Ft..
From To _ Ft
13. GROUT: Depth
From To Ft.
From 0 To n 0 Ft. ,� c f (7Uvi2k.
14. SCREEN: Depth Diameter Slot Size Material
Frorn To Ft. in. in.
From— To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From_ To Ft.
16. REMARKS:
GRCU1;311hOlit tlLef6tdgf' nalto
ASHEVILI_it* y; Pit6ii6Sto. 9
Material
Material
r_s
t s
= T
(=I<
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
SI ATURE PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REV. Raleigh, NC 1
9) 733-3221, within 30 days.
kr'
1

Uk
9-
WELL CONSTRUCTION RECORD
Qnality Groundwater Section
2544'78
eft it
Tud
North Carolina - Depatiment of Environment and Natural Resources- Division of Water
WELL CONTRACTOR (INDIVWUAL) NAME (mint G 2y __l ^V^/�S"t'I 1't=- CERTIFICATION 8J21= l)_ .-L�Sy�
b (Li t-IA N I- PHONE I
WELL CONTRACTOR COMPANY NAME, ASSOCIATED W Q PERMITM
STATE WELL ON PERMIT.
CONSTRUCTION
if liable
if a liable
1. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topo�gr�aphic And setting
MidgeQslope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(des(minutedsecoadr)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
nun r TNr3 i.OG
Formation Description
Nearest Town: e County ryl is L litit
2. WELL LOCAT2
(Street Name. Numbers, Community, Subdivision, Lot Nu, tip Code)
3. OWNER:
Address
jZye' CptPENkkr IZd
(Street or Route No.)
5 ife 7
City orTown State Zip Code
)-- 7(o5=-7r/77
Arm code- Phone number
4. DATE DRILLED I' t O Z
5. TOTAL DEPTH: �4k v YES ❑ NO
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below <49
x "+" of Casing:
Top 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. L�.(.
9. YIELD (gpm): �— METHOD OF TEST A
.in Q Ct
10. WATER ZONES (depth): 0
EP
From To
ar
faV
FL
ION SKET
2 C 73 , Show direction and distance in mi
12. CASING: . CISINFECTION: Type L 02 fit) W oThiclmess two State Roads or County Roads.
Depth Diameter a Weight/Ft. Material road numbers and common names.
From _ To Ft.
From 0 To FL C*
From y3 Tom -- Ft. r
13. GROUT: Depth
From To Ft.
From To a O Ft. ,t I
Diameter
Ft. in.
in.
14.
SCREEN: Depth
From _ To
From o
15. SAND/GRAVELPACK: SizeDepth
From To Ft._
From To Ft._.
(QQ
et
Mate
16. REMARKS:
O kt6iC10,
AD
CONSTRUCTIO,
GR0UPIE\S$b l6iL1l4 rIginalt
ASHEVILLE tlf49944136RitioiNo.
Ft
Method
Slot Size Material
in.
in.
Material
aA
NI 0
Z
Ln
�72:
at Ie4t:o
e tvdd
'D
14,40 (2 ' r„
po
i
cfrogifrii
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,
a . • a S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
ATURE
F PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrl - RREEVg07 2001
19) 733-3221, within 30 days.

254763
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
/ • J urces - ivision of Water `Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print))dk'VK7wZ� l� I I�.v\Ci II CERTIFICATION # 2(e o3
WELL CONTRACTOR COMPANY NAME f'f '/
,C"t!del.\I....'R. 11 DV'iiii,t -
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ FERMI
I ifapplicable) (if applicable)
t(
PHONE # flD C D�- -IZ/'^Z3
11 11-ZlcSZ
1. WELL USE (Check Applicable Box): Residential Q./Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:/C Q
�(f
� --
TI Nearest Town: 4 t'\\
county \ C-01Q\\
(Street Name. Num�bers, Community.
Subdivision, Lot No.. Zip Codc)
3. OWNER: t'/6?o 7*
(C N
-erv,vS Iil 11i6 .00-e'
Address
City or Town
Area code- Phone number
4. DATE DRILLED `i ZZ -C 7--
5. TOTAL DEPTH: 3Cl 'T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fi]/
7. STATIC WATER LEVEL Below Top of Casing: (5O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
Ircel or RopIS
) �I
tate
Zip Codc
Topographic/Land setting
tlRiddge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
*Top of casing terminated atlor below land surface requires a
variance in accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Gib.' • Ceili t
10. WATER ZONES (depth): 3C 0, �U
LOCATION SKETCH -'
Show direction and distance in miles from at @ st
two State Roads or County Roads. Include thcc oad
numbers and common road names.
0
1V
.J
1 I. DISINFECTION: Type 11:1 L T-
12. CASING:
From
From
From
13. GROUT:
From
From
14. SCREEN:
V
Depth
To 7``-
To
To
Depth
To
To
Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To
Ft.
Ft.
Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Material Met
FLA9nCY-e
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
No Y $ k, \011
)4-\\\
16. REMARKS:
I DO HEREBY CERTIF
THAT THIS WELL WA
CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, A AT A CO
SIGN
�/
the original to the Divisi3R7�f
7699-1636 Phone No. [phone], wi
GFALAFLLAHA ;LbH
ASHEVI LE EF 1(1H
RE OF PERSON CONSTRUCTING THE WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(.1 -(t
DATE
ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
in 30 days. GW-1 REV. 07/2001
p
y.�
r_•
rn 7-
r7

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and(( Natural�Resourcesur- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)``\7{L: 1 \/� S tA_SN:\ e` CERTIFICATION # Z14r�. ,5f0 r7-�/
WELL CONTRACTOR COMPANY NAME�i1ST\ G-€ \)� Q \\ k \\\ C.C.\ PHONE # (&.gir 2-T"7 S� re
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER
(if applicable) (if applicable)
259398
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: G--�
Nearest Town: NC u {e 'r 11�`-P County m (�p tk
¶uTCt ex —VA C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
k �\a' r(�d3. OWNER: FrP er\co-)c.
;Cti Address Qj0 3 �t �� jl aoJ P
(StreFt or Route No.)
L-CNVe Vne' \V\a. -3�%53-345
eta
�City or Town State p �) Zip Code
eta- t.9n(A? 1
Area code- Phone number
4. DATE DRILLED W U-8re.
5. TOTAL DEPTH: Lk C 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ 'NO' j
7. STATIC WATER LEVEL Below Top of Casing: 4 O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. yy�\
9. YIELD (gpm): 2-- METHOD OF TEST -F\ C
10. WATER ZONES (depth):
11
12. CASING:
Depth ry Dia
From 0 To `7 f Ft
From 'j To 9 2- Ft.
From To Ft.
13. GROUT:
From (3
Depth
To 9.0 Ft.
Material
topographic/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)
DEPTH DRILLING LOG
From To Formation Description
0 — ?5 Q,/clff /rc>✓k_
7C- Ooc-
O
0)
DISINFECTION: Typce 101"\ 1s e
Amount$nz pr1'f10
Wall Thickness
ter or Weight/Ft. Material
4'0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
16. REMARKS:
\ ,
I
LJI'
( 1 DO HEREBY CERTIFY Trig THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
if\ CONSTRUCTION STANE41 , AND H T A COPY QL THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I /n
Method
eVOLA,
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from mast ;1,1?
two State Roads or County Roads. Include the road..
numbers and common road names.
e
ZZ4
GROUNDWATER
ASscw a:6�VHI Uri
CONSTRUCTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
259394
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CC mil- 7Q 40A C_-e CERTIFICATION # Q-A
'5Q
WELL CONTRACTOR COMPANY NAME 3 t5\21 c-e ttie`\ `JC. \\\ 'tNq PHONE# %9a�-�I16 5�l)-4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMU4\
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Ott
Nearest Town: A) CtlrfeR\ e.P County 1_\s'�r�PA`
Wci*e5kse\\r ye\r,Va,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
nbb�UeceeAn
175 l Ocvee\or) c I J e
3. OWNER:
Address
(Street or Route No.)
N Cc\yc\e. bPaC\ 15C aq
City or Tovn State Zip Code
t n5(e—y(P 3
Area code- Phone number
4. DATE DRILLED (P 6 a
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: ?_5On 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 accordanc with ISA NCAC 2C.0118.
9. YIELD (gpm): _ j"� METHOD OF TEST \
10. WATER ZONES (depth):
-�7� LOCATION SKETCH
11. DISINFECTION: Type \O t \ n e . Amount nz .®r 7/0 Show direction and distance in miles from mast ,'_';
12. CASING: Wall Thickness two State Roads or County Roads. Include road-
Li
or Weight/Ft Mfle 'al numbers and common road names.
Topographi nd setting
❑Ridge ope ID Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O 3c(
fV
Cr) ZO
Depth t`
From 0 Tog
From To
From 34 To'; fv
13. GROUT: Depth
From 0 To 0-O Ft.
Diameter
Ft.
Ft.
Ft.
vl
kgb s0,=
Ul '-
1)
aterial Me
D-+- QauCta
From 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.
16RE((MARYSI
L-, 1 1)
SI
W L WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PER
STRUCTING THE WELL
DATE
R�}} �I��,pp`��vAgEt )S CT l visio of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
NL� �E�R! e 'o C fIBN Q Y,g
r ne o 33-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
255187
WELL CONSTRUCTION RECORD
020254
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 214811
STATE WELL CONSTRUCTION PERMITLeslie Kee
#
1. WELL USE (Check Applicable Box): Residential FT Municipal
Recovery ❑ Heat Pump Water Injection ❑ Other
Industrial ❑ Agricultural ❑ Monitoring ❑
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ROAN MTN. County: MITCHELL
MITCHELL VIEW RD OFF VALLEY ROAN OFF HWY 261
(Road Name and Numbers,Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
From To Formation Description
0 98 DIRT MUD
3. OWNER WARREN EDWARD
Address % MOUNTAINEER BLDRS. , P.O. BOX 572
BAKERS'1HttEr Route No.) NC 28705
98 841 GRANITE
City or Town State Zip Code 041 842 QUARTZ
4. DATE DRILLED 6/3/2002 842 705 GRANITE
5. TOTAL DEPTH 705
6. CUTTINGS COLLECTED YES I I NO
Xl
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: B0 FT
(Use "+" if 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.011.
10. YIELD (gpm): 1/2 METHOD OF TEST Air
11. WATER ZONES (depth)• 1/ Qpm841-642 0 ppm
X
12. CHLORINATION: Type I-M-1
Amount 124
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 105 Ft B 1/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back of for,
1V —
LOCATION SKETCH �- n
c
(Show direction and distance from at lea4tTwo S iW
Roads, or other map reference poir!ts) !,
9C
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow 9
From To Ft q
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
From To Ft.
Size
Material
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CS"; li✓h , r ,t_ 4 -27-0 a
SIGNATURE OF PE CONSTRUCTING THE WELL DATE
Submit original 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 Section2 6 ! 0 9 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2b86
02045. L=1
STATE WELL CONSTRUCTION PERMIT#: =(` *eec
1. WELL USE (Check Applicable Box): Residential I I Municipal I I Industrial
Recovery I I Heat Pump Water Injection I I Other I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: EA)'•ERSVILLE
H` o'Y 261/ 143 OFF ENVY 1GE
County: `'=fITCHELL
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER RICHARD M. SGUEGLiA
Address P.O. BOX 530129
DEBAR/ (Street or Route No.)
FL
327 30122
Agricultural El Monitoring
DRILLING LOG DEPTH
From To Formation Description
n 78 `IRT MUD SAND
78 ao GRANITE
City or Town
4. DATE DRILLED 7/25/2002
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO 21
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "a" 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.011,8
10. YIELD (gpm)' METHOD OF TEST
1 onmu1__1.'1
11. WATER ZONES (depthl"
0 corn0 :gGrn
State Zip Code
I AI
9:3 gn
SHALE
94 210 GRANITE
210 211 QUARTZ
211 245 GRANITE
?. JAN 3 12003
t. ray.,T 21,i-21
12. CHLORINATION: Type HTH
13. CASING:
Depth Diameter
From - To o_, Ft e 118
From To Ft
From To Ft
14. GROUT:
Amount 13
Wall Thickness
or Weight/Ft. Material
3F0 PV_
Depth Material Method
From 0To 2^_ FtCement .=r_ty n _-.....
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16 SAND/GRAVEL PACK:
D tlt—
From --%-1
1 , REMARKS*
F
—1
Size Material
DO HEREBY CERTIFY AT
CONSTRUCTION STANDIARD
UPIS
GRO0WATE'r, ELC,ION
—#'.( -I t iYrkI'' i `vEICE_
NC tliuf
If additional spa�ifar oTc�
'FRVIILE gminfor nFEK"F
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1,7
C7
w
G.i-)J 2z'
-IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 264605.
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2888
020731-1 STATE WELL CONSTRUCTION PERMIT#• Lesiie Reece
1. WELL USE (Check Applicable Box): Residential 1 XI Municipal I I Industrial E Agricultural I I Monitoring
Recovery I I Heat Pump Water Injection I I Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County MITCHELL
UPPER HANGIN ROCK RD. OFF BEAVER CREEK RD, OF
I Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER HOMER W. MURDOCK
Address P.O. BOX 2175r eopte Nol
MORGANft I NO 28880 35 700 GRANITE
City or Town State
4. DATE DRILLED 7/12/2002
5. TOTAL DEPTH 700
6. CUTTINGS COLLECTED YES { I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO a
8. STATIC WATER LEVEL Below Top of Casing 100 FT.
(Use "+" if 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 ZC.011108 Air10. YIELD (gpm)' METHOD OF TEST
11. WATER ZONES (depth)'0 pipm DRY HOLE 0 gprn
0 cIPm 0 PPm
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State 1.01(li
Wall Thickness
From 0 To
38 Ft 6 1/8 .350 PVC Roads, or other map reference points) /'!l��/`rp,w
DRILLING LOG DEPTH
From To Formation Description
0 35 DIRT
From To Ft
From To Ft
14. GROUT:
I xl
Zip Code
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft. in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
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.
� Ae �� Ii,/q4 �
SIGNATURE OF SON CONSTRUCTING THE WELL DATE
Submit original to Division of ater Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secti26 0 7 2 0
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] r/..•.•
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Purnp Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2787
020474-1 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential I XI Municipal ❑ Industrial Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 1 1 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County. MITCHELL
LOT#48 SKYLINE OFF PINE TREE OFF LONG BRANCH
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER GARRY OSSURN
Address P.O. BOX 798 ,
WAYNE (Street or Route No.)
WV 25570
City or Town State Tip Code
4. DATE DRILLED 7/15/2002
5. TOTAL DEPTH 745
6. CUTTINGS COLLECTED YES f I NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if 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.0118
10. YIELD (gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depth):1 qpm unknown 0 qpm
0 Ppm 0 qpm
DRILLING LOG
From To
0 18
DEPTH
Formation Description
DIRT/SHALE/GRANITE
16 415 GRANITE/QUARTZ
415 416 GRANITE
416 745 GRANITE/QUARTZ
I XI
12. CHLORINATION: Type HTH Amount 70
13. CASING:
Depth
From 0 To
From To Ft
From To Ft
14. GROUT:
Diameter
21Ft 61/4
Wall Thickness
or Weight/Ft. Material
.168 O.ALV
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft.
15. SCREEN:
From
From
From
Depth
To
To
To
Diameter Slot Size Material
Ft in
Ft in
Ft in.
in
in
in.
If additional space is needed use back of -form:__ -
LOCATION SKETCH
Gi -"'a
/Tr
(Show direction and distance from at leasNyvo State
Roads, or other map reference poirr4) _
k.
O
(�`,1- CJ7
l�V CUK1?d if
r
n
Cro
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D TH T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ASHEVILLE REGIONAL OFFICE
FOR OFFICE USE ONLY
gaL
trams
-7/5V',7ODc?
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original 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 Sectitl2 60719
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2787
020474-2 STATE WELL CONSTRUCTION PERMIT#• Jerry Vlilson
WELL USE (Check Applicable Box): Residential n Municipal
Recovery El Heat Pump Water Injection I I Other
Industrial IE
Agricultural D Monitoring 0
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County MITCHELL
SKYLINE OFF PINE TREE OFF LONG BRANCH OFF CRA
(Road Name and Numbers, Community, or Subdivision and Lot No,/
3. OWNER GARRY OSBURN
Address PO BOX 788
WAYNE (Street or Route No./
LW 25570
DRILLING LOG
To
30
From
0
DEPTH
Formation Description
DIRT SHALE
30 805 GRANITE QUARTZ
City or Town State Zip Code
4. DATE DRILLED 7/20/2002
5. TOTAL DEPTH 805
6. CUTTINGS COLLECTED YES 0 NO El
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
8. STATIC WATER LEVEL Below Top of Casing: 800 FT
(Use "+" if 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.01 a
10. YIELD (gpm): u METHOD OF TEST Air
11. WATER ZONES (depth)•° ppmPrn DRY HOLE 0 0 ppm
12. CHLORINATION: Type HTH Amount 149
13. CASING:
Wall Thickness
Depth Diameter or WeighVFt. Material
From 0 To 34 Ft 8 1/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cernent Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SA
Fro
Fro
17. RE
I DO
CON
ERE
TRU
To Ft.
Material
( L^i
Y CERTIFY THAT THIS LL
THA
ASHEVILLE REGIONAL OFFICE
FOR OFFICE USE ONLY
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at leastavo State
Roads, or other map reference poiri
) c-
r1
N
4_ Cato +tee__ RI
\cb
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ov IQ-
2, 7- /z/-296'
SIGNA URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

WELL CONSTRUCTION R‘CORD
North Carolina - Department of Environment and Natural Resources - Division o\,Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
7�(print)/<yt�f Cu �(zcp/N CERTIFICATION #
WELL CONTRACTOR COMPANY NAME be4%LQa(I LIia e,`/.i{ I Jb� # . PHONE 8 '733-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259351
1. WELL USE (Check Applicable Box): Residential L'l Mwlicipnl/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIIII :
Nearest Town: '(�Aket2Sy i 110 County 7i1
( L c61,44.b&4LN otfcAk
(Street Name, Numbers, Community, Suallyision, Lot No , ip Code)
3. OWNER: StO
Address aG ?
15044`'a-Jlraeeio1Ro-ute
l , NyoJ�.a
City or Town State Zip Code
(ba )- (2)/S gqM g
Area code- Phone number
4. DATE DRILLED 1 0 Z
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX TING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: r e,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST AU
10. WATER ZONES (depth): 9 - J 37
fd
FT.
11. DISINFECTION: Type c ii/p
12. CASING:
Depth r
From Cri To "IS Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From (9 To 0,E3
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
Amount Bz,
Wall Thickness
Diameter or Weight/Ft. Material
SnR 7 l ?l( c
Ma:el Method I
Ft. pr")',Peet
Slot Size j-' Material
in.
in.
Size Material
Ft.
Ft.
�epagraphic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuses/seconds) ..
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description >.
DEPTH
From To
rep 'GO ask
ply—'zO
50 — 2
75..2J 020
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
RKS:
iffix-
ERTI
SuliPfna�N���ng6R6E�T Ivisio
i,r[ E , , • i, " W44.+ ()Off M-322
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A CO IS ECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL
- 31-0
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
2'58534
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
020492 STATE WELL CONSTRUCTION PERMIT#* Jerry Wilson
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial [ 1 Agricultural I I Monitoring 0
Recovery Heat Pump Water Injection Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
ROSES BRANCH RD. OFF HWY 80 OFF MINE CREEK OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER GARY N. SETZER
Address P.O. 80,X 946
SPRUCE fa(PeE'rnonceNO.) NC 28777
City or Town State Zip Code
4. DATE DRILLED 7/17/2002 99 190
5. TOTAL DEPTH 305 190 191
6. CUTTINGS COLLECTED YES 0 NO 191 205
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if 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.01 ta
10. YIELD (gpm): d METHOD OF TEST Air
11. WATER ZONES (depth)'15 taPm 98-99 1/2 ppm 190-191
0 ppm 0 gpm
12. CHLORINATION: Type HTH Amount 46
DRILLING LOG
From To
0 88
DEPTH
Formation Description
DI P.T/GRVL/SHL'GRNT
88 98 GRANITE
98 99
GRANITE
205 305
GRNT/QUARTZ
GRANITE
GRANITE/QUARTZ
GRANITE/QUARTZ
13. CASING:
I XI
I XI
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 91 Ft 6 1/4 .188 GALV.
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
15. SCREEN:
From To Ft
From To Ft.
From To Ft
16 S
Fr
Fr
1
Depth Diameter Slot Size Material
in.
in
in.
in
in
in
17. RE
ID
CO
�s(ep1[1''I
ism
1 1
To Ft
A S.
HER BY CERTIFY THAT THIS ELL
STR ;,itJ11. r 1er,-s.s 1DTH
ASHEVILLE REGIONAL OFFICE
FOR OFFICE USE ONLY
Quad No:
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
C
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0
r-J
:�
rN.)
V1
Iv
U9
7 �7 A-2, 2-ez spat)
SIGNATURE OF PERSON CONST TING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
258636
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
020475 STATE WELL CONSTRUCTION PERMIT#: Jerry Wilson
WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial 0 Agricultural ❑ Monitoring 0
Recovery I I Heat Pump Water Injection I I Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE DR. OFF STEWART DR. OFF PENLAND RD. OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DAVID C. BURLESON
Address 568 STEWART RD
BAKERS\riiir Route No.) NC 28705
City or Town State Zip Code
4. DATE DRILLED 7/16/2002
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO EI
8. STATIC WATER LEVEL Below Top of Casing: 90 FT
(Use "+" it 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.0118
10. YIELD (gpm). 20 METHOD OF TEST Ar
DRILLING LOG
From To
0
DEPTH
Formation Description
90 DIRT/SHALE/GR.ANITE
90 145 GRANITE/QUARTZ
145 146 GRANITE
146 205 GRANITE/QUARTZ
11. WATER ZONES (depth)•20 qom 145-146 qpm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 23
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 102 Ft 6 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
17.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
-PC4Li&b,cr Ka( . ru
it
T
Material
In
'Di .. KS:
•OH:REBYCERTIFY THAT THI.
C•NST'UCTION STANDARDS
bi t�.-PJJ� Er ECTIDN
TTSa4-PSefs7V-:14Viica FIC`-
Quad No:
WE L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND T AT A COPY OF THIS RECORDHASBEEN PROVIDED TO THE WELL OWNER.
7t fr7 Q / �f}-?i( O / S �0aR
S ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
)
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
Groundwater Section
258640
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2797
020476-1 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential Municipal Industrial 0 Agricultural 0 Monitoring n
Recovery 0 Heat Pump Water Injection I 1 Other 0 If Other, List Use•
x
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County' MITCHELL
PRIVATE DR. OFF KONA RD. OFF I-NVY 80 N OFF SNOW
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JIM H. PLEMONS
Address 3210 HALLS CHAPEL
BURNSVI LLtt or Rome No.)
City or Town State
NC 28 ZipCode
4. DATE DRILLED 7/24/2002
5. TOTAL DEPTH 800
6. CUTTINGS COLLECTED YES NO 7
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if 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.0118
10. YIELD (gpm)' D METHOD OF TEST Ar
11. WATER ZONES (depth):0 qpm DRYHOLE 0 qpm
0 morn 0 qpm
x,
DRILLING LOG
From To
0 63
DEPTH
Formation Description
DI RT/SH.ALE/GRNT
63 800 GRANITE/QUARTZ
12. CHLORINATION: Type HTH Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft. in
From To Ft in
From To Ft in.
16 SAND/GRAVEL PACK:
17
[E Yw I4T
ARKS. �I
I DO HEREBY CERTIFY THAT HIS
CO '.TRUCTION STANDARD AN
GP,ur i 'iLl S ' InDN
myritravrars
in
in
in
Material
ze Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
C$f
Jq 6
ELL WAS CONSTRUCTED IN ACCORDANCE WIT FI 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original 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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
258639
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2 /g/
020478 2 STATE WELL CONSTRUCTION PERMIT#- Jerry Wilson
1. WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial n Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
PRIVATE DR. OFF KONA RD. OFF HWY 80 N OFF SNOW
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JIM H. PLEMONS
Address 3210 HALL CHAPEL RD.
BURNSVILLEt or Route "e l NC 28714
DRILLING LOG
From To
0 15
DEPTH
Formation Description
DI RI/SHALE
15 285 GRANITE/QUARTZ
City or Town State Zip Code
4. DATE DRILLED 7/25/2002
5. TOTAL DEPTH 265
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
IAl
I A I
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.0118
10. YIELD (gpm)' METHOD OF TEST Air
11. WATER ZONES (depth)' ppm DRY HOLE 0 ppm
Li- ppm 0 ppm
12. CHLORINATION: Type HTH
13. CASING:
Amount
Wall Thickness
Depth Diameter or Weight/Ft. Material
From U To 21 Ft P 1/4 .188 GAD/.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
REMARKS:.
I DO HEREBY CERTIFY T
ONSTRUCTION STAND
nrAp �e4`,- ' crq,1
F F,I Si EISEDNUYFICE
Quad No:
RDS
Size
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
19E,
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�Cl /. ce
SIG URE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

nrryn rI _
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020423
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2787
STATE WELL CONSTRUCTION PERMIT#: Jerry Wilson
1. WELL USE (Check Applicable Box): Residential I XI Municipal D Industrial 0 Agricultural Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PAINE County MITCHELL
PRIVATE DR. OFF HALL TOWN RD. OFF ALTAPASS RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER KENNETH D. MCCURRY
9 OLD HALLS STORE RD.
Address
SPRUCE (I'"InCr Route No.)
City or Town State
4. DATE DRILLED 7/3/2002
5. TOTAL DEPTH 485
6. CUTTINGS COLLECTED NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
9 TOP OF CASING IS 1 FT Above Land Surface*
YES 0
NC 28777
Zip Code
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1.5 METHOD OF TEST
11. WATER ZONES (depth): 1.5 ppm 447-448 0 ppm
0 ppm 0 ppm
Air
12. CHLORINATION: Type HTFI Amount 73
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 29 Ft 6 1/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft in. in
To Ftin in.
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. REMARKS.
I DO HEREBY
CONSTRUC—
Size
Ft
H 11 J
Material
DRILLING LOG
From To
0 25
DEP H
Formation Description
DIRT/SHALE/GRANITE
25 447 GRANITE/QUARTZ
447 448 GRANITE
448 485 GRANITE/QUARTZ
I
1FY THAT THIS WELL WAN
TANDARD,,;AND THAT A pp.
FOR OFFICE USE ONLY
GROUNDWATER SECIICN .
ASIIEVILLE REGIONAL VPI-'torigi
Quad No:
a
r
G*) EP
cr1
If additional space is needed use back of form to
DC .--+r,i
LOCATION SKETCH " rr".,
(Show direction and distance from at least/No Ste
Roads, or other map reference poi)
Alt -Pas
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN P OVIDED TO THE WELL OWNER.
..,.ATURE OF PERSON CONSTRUCTING THE WELL DATE
I to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
Serial No.

17. REMARKS•
Amount 87
From To Ft a(.0
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To rI Ft.
i_ l9 r `\ i bii
I DO HEREBY
CONSTRUCT
FY THAT THIS WELL W4
ANDARDS1 ANDTHATA
AU''
}i,i
FOR OFFICE USE 0
LY
0
NATER S ppjjyy��
REGICNA FTICEigiSI
na
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PRO IDED TO THE WELL OWNER.
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]
257251
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
0203913
WELL CONTRACTOR CERTIFICATION A. 2797
STATE WELL CONSTRUCTION PERMIT# tin
1. WELL USE (Check Applicable Box): Residential Il Municipal n Industrial n Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (SgviIStchlof tube location below)
Nearest Town:County.
Vai E'...i
vu„iv.�ri��� COU nty' a r l I
PENLAND RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
AARON D. BAILEY DRILLING LOG DEPTH
3. OWNER Formation Description
Address P.C. 8CX 197 , From V To 15 DT SHALE GRANITE
BAKERS I 197,Rovte No.) DIi,TGV—JYITE
NC 28705 15 60 GRANIETSH.ALE
City or Town State Zip Code
4. DATE DRILLED 7/12/2002 CO 81 GRANITE
5. TOTAL DEPTH 505 81 470 GRANITE QUARTZ
470 471 GRANITE
6. CUTTINGS COLLECTED YES 0 NO n 471 505 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 17 NO n
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use '+" if 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.011B
10. YIELD (gpm)• 1 METHOD OF TEST Air
11. WATER ZONES (depth)'1/2 ppm 80-81 1/2 ppm 470-471
0 ppm 0 ppm
12. CHLORINATION: Type HTH
13. CASING:
a 4.)_
ELZJE
If additional space is needed use back form
N_
Wall Thickness LOCATION SKETCH cc! n
Depth Diameter or Weight/Ft. Material (Show direction and distance from at leOst twotate From 0 To 21 Ft 6 1/4 .188 GALV Roads, or other map reference points) ���C,,/
From To Ft
%_7 3-7pd 2
Quad No•
Serial No
GROUND
ASHEVILLE
URE of PERSON CONSTRUCTING THE WELL DATE
Ito 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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
261791
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2888
020690 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential El Municipal I I Industrial I I Agricultural 0 Monitoring n
Recovery ID Heat Pump Water Injection n Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
DRILLING LOG DEPTH
3. OWNER JOHN W. SIDES From To Formation Description
Address P.O. BOX 22 , 0 57 DIRT
BAKERS lt�lttWr Route No") NC 28705 57 88 GRANITE
City or Town State Zip Code 88 89 QUARTZ
4. DATE DRILLED 8/30/2002 89 305 GRANITE
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES D NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO 71
REDWOOD RD. OFF CANE CREEK RD. OFF HWY 228
(Road Name and Numbers, Community, or Subdivision and Lot No.)
Xl
8. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use'+" if 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.0116
Air
10. YIELD (gpm). 1/4 METHOD OF TEST
0 qpm
11. WATER ZONES (depth)'0'25 Apm9 88-80 qpm
12. CHLORINATION: Type HTH
Amount 57
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH --
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least v o State
From 0 To S1 Ft 8 1/8 .350 PVC Roads, or other map reference pointli - -,
From To Ft �p[VQYn ` j
From To Ft 7..t1�1
14. GROUT:
Depth Material Method
From 0 To 20 Et Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CER
CONSTRUCTION
FIAT 1i1IS'WFII1 WAS 'F.il
ARDS, AND THAT A CO
FOR OFFICE USE dl✓F Y1
4
)cb
94.
ICTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
"Cock 10 -19-oa
EIGNA1URE OF RSON CONSTRUCTING THE WELL DATE
Suhmit nriain9l to Dreision of Water Quality, Groundwater Section within 30 days
GRCUNDWATER SECTION GW-1 REV. 12/99
ASHENILLE REGIONAL OFFICE
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sect
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
260717
WELL CONSTRUCTION RECORD
020868
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential Municipal fl Industrial fl Agricultural 0 Monitoring ❑
Recovery fl Heat Pump Water Injection Other I I If Other, List Use:
I xl
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILI E County. MITCHELL
ROBERT PHILLIPS RDeOFF , NO.W CRFEKand LotfRD OFF HWY
or
DRILLING LOG DEPTH
3. OWNER BEN L ROBINFON From To Formation Description
Address 373 ROBERT PHILLI„PS RD . 0 98 DIRT MICA
6A}( ��" NC 2870,5 98 421 GRANITE
City or owo State Zip ode 421 422 SHALE
4. DATE DRILLED 8/29/2002 422 465 GRANITE
5. TOTAL DEPTH 465
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if 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.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth)40 gpm421-422 0 gpm
0 gpm 0 gpm
I xl
12. CHLORINATION: Type HTH Amount 88
X
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material Cyj (Show direction and distance from at IeastQaao State
From 0 To Ins_ Ft 6 1/8 350 PVC n �y , Roads, or other map reference poi
From To Ft
From To Ft.
14. GROUT:
Mikka
Depth Material Methock ,t� i ki
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
17.
IIiN Dpthi
Po
To
Ft
KSr=
DOH REBY CERTIFY THAT TH S W
ONS •L II -:I •ND
GROUNDWATER SECTION
rnrr r ICE
A
in
in
in
in
in
in.
Material
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PF, ON CONSTRUCTING THE WELL DATE
Submit original 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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] 260716
�f1 �
ARKS:
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2688
020635 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
WELL USE (Check Applicable Box): Residential xl Municipal Industrial n Agricultural 0 Monitoring
Recovery D Heat Pump Water Injection C:1 Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE DR. OFF WILSON RD. OFF HWY 228
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER PAUL R. KENYON
Address 231 WILSON RD.
BAKERSaLtEr Route No.)
City or Town State
DRILLING LOG
From To
0 42
NC 28705 42
Zip Code
DEPTH
Formation Description
MUD/SAND/GRVL
67 GRANITE
67 68 SHALE
4. DATE DRILLED 8/22/2002 68
5. TOTAL DEPTH 145 115
6 CUTTINGS COLLECTED YES P NO X 116
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 7
8. STATIC WATER LEVEL Below Top of Casing• 10 FT.
(Use "+' if 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.0118
10. YIELD (gpm): 20 METHOD OF TEST Adr
11. WATER ZONES (depth)•4 ppm87-68 16 ppm 115-116
0 ppm 0 ppm
12. CHLORINATION: Type 14TFI Amount 27
115 GRANITE
118 QUARTZ
145 GRANITE
13. CASING:
From
From
From
Depth Diameter
0 To 45 Ft 6 1/4
14. GROUT:
From
From
15. SCREEN
To Ft.
To Ft
Wall Thickness
or Weight/Ft. Material
188 GALV
Depth Material
0 To 20 Ft Cement
To Ft
Depth
From To
From To
From To
Diameter Slot Size
Ft in
Ft. in
Ft in
GgLAVEe PI C' % I
4:Pe.th�'
To
To
Method
Gravity Flow
Material
in
in.
in
ize Material
tAN
AL
THIS ELL WAS CONSTRUCTED
CES, A D THAT A COPY OF THIS RI
FOR OFFICE USE ONLY
Quad No:
g-sdc`i
SIGNATURE 0
Submit original to Division
If additional space is needed use back of form
LOCATION SKETCH O
(Show direction and distance from at IeastJ io Sjate
Roads, or other map referen a poittf3)
E,Y54 reference
cr1
T
�aviceif Frt.
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER.
rRSON CONSTRUCTING THE WELL DATE
o Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 260715
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co-, Inc.
WELL CONTRACTOR CERTIFICATION #: 2886
020696 STATE WELL CONSTRUCTION PERMIT#- Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
X
I I
Municipal Industrial n Agricultural ❑ Monitoring El
Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
FORK MTN RD OFF HWY 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER HARLEN HARRELL From To Formation Description
Address 721 FORK MTN RD . 0 10 DIRT
BAKERs&tt Route No.) NC 28705 10 128 GRANITE
City or Town State Zip Code 128 129 SHALE
4. DATE DRILLED 8/29/2002 129 205 GRANITE
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES 7 NO ❑
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use'+" if 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.0118
10. YIELD (gpm): 2.5 METHOD OF TEST Alr
11. WATER ZONES (depth):2.5 qpm 128-129 0 ppm
0 qpm 0 Wm
Ix]
12. CHLORINATION: Type HTH Amount 35
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To --31Ft. 61/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To Ft in in
From To Ft in in.
From To Ft in in
Diameter Slot Size Material
THIS
3f<(Nf9ARDS, Al
AL OFFICE
FOR OFFICE USE ONLY
Size Material
If additional space is needed use back of form
0
fV ^-
LOCATION SKETCH
(Show direction and distance from at leasrtYivo State
Roads, or other map reference poky)
•g_ca
For ti i?
ce
Ga
C r'1
�0iczusi lII e-
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,efl t / fiat 9 -I a -o 2
SIGNATURE PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
260704
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020609 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection n Other 0 If Other, List Use.
I XI
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County. MITCHELL
PRIVATE DR. OFF JARRETT RD. OFF HWY 226 OFF HW
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BILL W. JOHNSON
Address 165 JARRETT RD.
BAKERVILCEI °t Ro01e NO') NC 28705 76 98 GRANITE
DRILLING LOG DEPTH
From To Formation Description
0 78 DIRT
Crty or Town State Zip Code
4. DATE DRILLED 8/19/2002
5. TOTAL DEPTH 165
6. CUTTINGS COLLECTED YES I NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+' if Above Top of Casing)
XI
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.011a
10. YIELD (gpm): a METHOD OF TEST Air
11. WATER ZONES (depth):8 apm98-99 .: 0 ppm
0 PPm 0 gpm
88 88 SHALE
99 165 GRANITE
XI
12. CHLORINATION: Type I-ITH Amount 23
13. CASING:
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two;S)ate _1 _
From 0 To 83 Ft.8 1/8 .350 PVC �� Roads, or other map reference points) —r3 - .1-‘
From To Ft Y 19 [, - i �.'�
From To Ft.�
14. GROUT:
Depth Material Method
From 0 To 20 Et Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft.
From To Ft
From To Ft
16. SAND
17
GRAVEL PACK:
Drth
To Ft
KS°C j _COL
REBY CERTIFY THAT THI
in
in
in
in
in
in
Material
WE L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ASHEVILLE REGIONAL OFFICE
FOR OFFICE USE ONLY
Quad No:
Serial No.
0
?-)a -o R
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit original 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 Sectii n^ 0� O �}
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] r(fll..b ( J
Material
.350 PVC
st
Q v`A-'
Material Method
Ft Cement Gravity Flow
Ft
Diameter Slot Size Material
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Leweyrvnyntnee rumptv:;nlc.
WELL CONTRACTOR CERTIFICATION #: 2686
020610 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential I XI Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection I I Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location.below)
Nearest Town: BAKERSVILLE County. MITCHELL
PRIVATE DR. OFF JARRETT RD. OFF HWY 226 OFF HW -
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER EVEREI it D. GOUGE
Address 153 JARRETT RD.
BAKERS\MtEr Route No.)
City or Town State
NC 28705
Zip Code
DRILLING LOG
From To
0 51
DEPTH
Formation Description
DIRT
51 80 GRANITE
80 81 SHALE
4. DATE DRILLED 8/19/2002 81 125 GRANITE
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO P1
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+' if 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.0118
10. YIELD Igpm): 12 METHOD OF TEST
11. WATER ZONES (depth) 12 ppm 80-81
0 gam
Air
0 ppm
0 gpm
12. CHLORINATION: Type HTH Amount 18
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 57 Ft. 6 1/8
From To Ft
From To Ft
14. GROUT:
From
From
Depth
0 To 20
15. SCREEN
From
From
From
To
Depth
To
To
To
Ft
Ft
Ft
To
77, � To ret_
ARKS:
FOR OFFICE USE ONLY
Quad No:
in
in
in.
in
in.
in
Size Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least tw
Roads, or other map reference points) rn
19 E., o
ate
0
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
L&6 Aeza 9-I 2 -o
SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
260701
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020538.
WELL CONTRACTOR: Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #: 2688
STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
XI
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
HWY 226 NORTH
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER JEFFREY E. FREUND From To Formation Description
Address 105 PELICAN CT.. 0 39 DIRT
MOORES,ItttERoute N" NC 28117 39 371 GRANITE
City or Town State Zip Code 371 372 SHALE
4. DATE DRILLED 8/26/2002 372 405 GRANITE
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES ❑ NO 0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 150 FT
(Use "+" if Above Top of Casing)
X1
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.01W 8
10. YIELD (gpm): ° METHOD OF TEST
11. WATER ZONES (depth):9 gpm371-3 2 0 qpm
0 qpm 0 qpm
12. CHLORINATION: Type HTN Amount 53
13. CASING:
Depth Diameter
From 0 To 43 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
or WeighVFt. Material (Show direction and distance from at least twoState"
.350 PVC
Roads, or other map reference points)N
ceP Lea-CVS G/c!t
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
L
f{bm To
Ftrr ih1 r,
tom'
17. REM ARKS:
I DOH,E RM,GEt�AIf?rE0'H®(T THIS ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRKTIONBTANZARDS, AN 1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
fe2Lco %SON 2 0
SIGNATURE OF CONSTRUCTING THE WELL DATE
Submit original to Division of ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Size Material
o-
C6
CO
FOR OFFICE USE ONLY
Quad No:
cn
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
260700
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2886
020636 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential I XI Municipal n Industrial n Agricultural El Monitoring
Recovery n Heat Pump Water Injection 0 Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
FORK MTN. RD OFF HWY 261
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG
3. OWNER FLETCHER GARLAND From To
Address 1694 FORK MTN RD. , 0 76
BAKERS(htt Route No.) NC 28705 76 147
City or Town State zip Code 147 148
4. DATE DRILLED 8/27/2002 148 189
5. TOTAL DEPTH 205 189 170
6. CUTTINGS COLLECTED YES I I NO El 170 205
7. DOES WELL REPLACE EXISTING WELL? YES n NO n
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
DEPTH
Formation Description
DIRT GRAVEL MUD
GRANITE
QUARTZ
GRANITE
SHALE
GRANITE
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.01
10. YIELD (gpm): METHOD OF TEST AIR
11. WATER ZONES (depth):2 ppm 147-148 3 ppm 168-170
0 ppm 0 ppm
12. CHLORINATION: Type HTHI Amount 35
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flory
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
1Ti MARKS:
I D!0 HEREBY CERTIFY THA
Cq
i,=.076,D�ER SECTION
` E VI LLE F K; I
D ptIV
n u
To
Diameter Slot Size Material
Ft in in
Ft in
Ft in
in
in.
Size Material
FOR OFFICE USE ONCP—
Quad No:
Serial No.
THIS
S, A
If additional space is needed use back of form
LOCATION SKETCH
*\qvg direction and distance from at least two State
oir
SV oads, or other map reference points)
tv
T
10
on
4-
c<
a31y �Q
:)Vt. ICA fTn f ��
O{
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(441 tt
URE OF PE ON CONSTRUCTING THE WELL DATE
of Wa er Groundwater Section within 30 days
Division
SIGNATURE
Submit original to Quality,
GW-1 REV. 12/99

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] 260690
GR
ASHES
WELL CONSTRUCTION RECORD
99689
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: LGt{tf
STATE WELL CONSTRUCTION PERMIT#: Leske Keece
1. WELL USE (Check Applicable Box): Residential X Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
WING RD. OFF HWY 226 OFF HWY 19E
(Road Name and Numbers, Community, or Subdivision and Lot Nod
ALLEN V. GARDNER
3. OWNER
Address
1389 WING RD. ,
BAKERERSV1ELS'eNOl NC 28705 6 81 GRANITE
DRILLING LOG DEPTH
From To Formation Description
City or Town State
4. DATE DRILLED 8/20/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if 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.01
10. YIELD (gpm)' METHOD OF TEST Air
11. WATER ZONES (depth)0/8 ppm 81-82 0 ppm
Zip Code
0 ppm
X
0 6 DIRT
81 82 QUARTZ
82 305 GRANITE
12. CHLORINATION: Type HTH Amount 57
If additional space is needed use back of form
13. CASING: LOCATION SKETCH ,` 11�
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State ,cV t
\,C
From 0 To 21 Et. 6 1/4 .188 GALV. Roads, or other map reference points)
nit
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in.
D1€LSAID`(�H/�vtPrm
LL�S, I� � l e
...) From To Ft
Size Material
From To Ft
OCT1 tic2
'7. REMARKS.
BY CERTIF` THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
a 4•�SE 7 Tt9F1ANDAP DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
:31NAL OFFICE40— 9 -Id� V a. MCC
if _OR
w �'^.-C_
SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Submit original to Division o ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
- ?d•
Do
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
260698
15. SCREEN:
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• berrey vrnytn nen runty
WELL CONTRACTOR CERTIFICATIONS. 2886
020643 STATE WELL CONSTRUCTION PERMIT* Leslie Reece
WELL USE (Check Applicable Box): Residential I XI Municipal El Industrial El Agricultural 1 Monitoring n
Recovery Heat Pump Water Injection El Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
PRIVATE DR. OFF WING RD. OFF HWY 226 OFF HWY 1
{Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER JUNICHIRO BABA From To Formation Description
Address 1417 WING RD.. 0 38 DIRT
eAKERsOYItr Route No.) NC 28705 38 96 GRANITE
Cityor Town State Zip Code 86 87 QUARTZ
4. DATE DRILLED 8/21/2002 97 315 GRANITE
5. TOTAL DEPTH 340 315 316 QUARTZ
6. CUTTINGS COLLECTED YES D NO 0 316 340 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES P1 NO 0
8. STATIC WATER LEVEL Below Top of Casing 40 FT.
(Use "+" if 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.0118
10. YIELD (gpm): 5 METHOD OF TEST Aar
11. WATER ZONES (depth):o/3 Rpm 0 PIPm 98-97 4.67 Rpm 315-316
APM
12. CHLORINATION: Type HTH Amount 63
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft 6 1/8 .350 PVC
From To Ft
From To - Ft.
14. GROUT:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points). L
fir,\
Depth Material Metho. k , t\
From 0 To 20 Ft Cement Gravity Flow f�
From To FtL
0
Depth Diameter Slot Size Material
From To Ft
From To Ft
From To Ft.
16. SAND/GRAVEL PACK:
17.
FO
To Ft
KS C7 :302
in
in
in
in
in.
in.
Material
H:REBYCERTIFY THAT THI. WE
•NST'U ND
GR0UN0WA
■ir471
vw7
IONAL OFFICE
y
5500
SC acq
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0
ra
cn
r'o
0
(J1
Auct -i a-0a
SIGNATURE OF PASON CONSTRUCTING THE WELL DATE
Submit original to Division of ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
CS
Quad No:
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] 4
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2797
020564 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
WELL USE (Check Applicable Box): Residential 0 Municipal I I Industrial 0 Agricultural El Monitoring El
Recovery P1 Heat Pump Water Injection I I Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County MITCHELL
PRIVATE DR. OFF RABBIT HOP RD. OFF PENLAND RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER PHILLIP C. GRACE
Address 1987 RABBIT HOP RD.
SPRUCE 'rfter Route No.l NC 28777
Zip Code
City or Town State
4. DATE DRILLED 8/7/2002
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES I I NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO In
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+' if 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.0118 Air
10. YIELD (gpm): 8 METHOD OF TEST
11. WATER ZONES (depth):8 ppm
0 ppm 0 ppm
DRILLING LOG
From To
0 40
DEPTH
Formation Description
DIRT/SHALE
40 45 GRANITE
45 48 GRANITE
48 405 GRANITE/QUARTZ
12. CHLORINATION: Type HTH
13. CASING:
0 ppm
Amount 73
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
Material Method
Et Cement Gravity Flow
R6rflbND/rPtEVAK
a}}4
1
From To
From To
REMARKS:
G
ASHY
i (r,
. L
j
Ft
Diameter Slot Size Material
in in
in in
in in
Ft
Ft
Size Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) AO1 '‘'N
dace
"11
N
�.1
11
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.
//
FOR OFFICE USE ONLY
Quad No:
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section C.',1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] O
WELL CONSTRUCTION RECORD
020560
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.LfHI
STATE WELL CONSTRUCTION PERMIT#•
Jerry Wilson
1. WELL USE (Check Applicable Box): Residential I XI Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection
11
Agricultural E Monitoring
Other 0 If Other, List Use:
2. WELL LOCATION: (Show BA sketch of the LLE location below) MITCHELL
Nearest Town: County:
PRIVATE DR. OFF HWY 226 OFF HWY19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
CHARLES A. ELLIS
3. OWNER
Address
P.O. BOX 4305 ,
DRILLING LOG
From To
0 109
ONEIDA (Street or RouteNo.l TN 37841
City or Town State Zip Code
4. DATE DRILLED 8/7/2002
5. TOTAL DEPTH 225
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 11 O NO
8. STATIC WATER LEVEL Below Top of Casing:• FT
(Use "+" if Above Top of Casing)
I XI
1 Al
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.01'l8_ Air
10. YIELD (gpm)• SSUU METHOD OF TEST
11. WATER ZONES (depth).30 gam210-212 0 gpm
1 1
DEPTH
Formation Description
DIET/SHALE
109 210 GRANITE/QUARTZ
210 212 GRANITE
212 225 GRANITE/QUARTZ
0 ppm 0 Om
HTH Amount 26
12. CHLORINATION: Type
13. CASING:
Depth
From 0 To
Wall Thickness
Diameter or Weight/Ft. Material
112 Et 8 1/8 350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Et Cernent Gravity Flow
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
LS -7From i to f T
R
OM
r
Diameter Slot Size Material
Ft in. in
Ft in in
Ft in in.
1&CllEMARKS^' —�
I DO HEREBY CFI IFY
CON • 'TAN
GROUNDWATER SECfI01
ASH 40NAL Orcir.F
Size Material
Ft
Ft
Quad No:
tei
I
If additional space is needed use back of form
LOCATION SKETCH _
(Show direction and distance from at least State
Roads, or other map reference poinM9
.n
r-1
N
0
C71
N
y RV4- Drct
0
Vtd6' \fit
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVI ED TO THE WELL OWNER.
S NATURE OF DATE
PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
Serial No.

WELL CONSTRUCTION RECORD 259387
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LB-rtj J4S'#1 CC��,.- CERTIFICATION #G���,"
'1:57^K PHONE# ( ) 9 '?-''C g
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential li Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATSA&) n, ^
Nearest Town: C � / z County I!
(Street Name. Numbers,s,LCommunity, Subdivision, Lot No., Zip Code)
3. OWNER: AO/Z/C /Vlf l�S/osin2
Address 3(o1/ 9 rock 'n f
(Street or Route No.)
Ci4/60P NC 7oe<
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED g - /ZI e3 2
5. TOTAL DEPTH: /675"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eire
7. STATIC WATER LEVEL Below Top of Casing: PC) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfacer
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): r9c METHOD OF TEST.4//Z-
10. WATER ZONES (depth): C2
��ll0 9g1., ..2-777.d'
11. DISINFECTION: Type claim,. Amount .*ki2c.'74'7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From O To 57 FL (D'j< 4/6
From 57 To / FL Cai'R eo pP(
From 7/ To Ft._____ -/88 ff4L-U
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topograph ic/La_n�'setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude Source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description /�
/pSF 4Ytf react.
5,-/-¢ A f/3eJ
ef,"
DEPTH
From To
- 3Q
A? — `'e
(lei- 4, 8
6S- i-r
LOCATION SKETCH
Show direction and distance in miles from ateast ;
two State Roads or County Roads. Include its road,':
numbers and common road names. r r,"
U7
16. REMARKS:
Q.HERbaycERTIRY THAT
TRt1E-T
Su n
a'P
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF T�.RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ii,,"',',f,
NATURE PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I-10-3221, within 30 days. GW-1 REV. 07/2001

GROuRW9doP. C•(919)
ASHEVILLE REGL'iNAL OFFICE
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) y*ty D� Sv ItonCO
CERTIFICATION O
WELL CONTRACTOR COMPANY NAME 3-041-i/ ( t/�/ e LC. I r 1 <-vU Q PHONE # 724-y24t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259385
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: gA((PrsniL%-e County M/ kict t
Act/ 64Q 6Allr j,.,%Gr
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: POE) /a-L'e
Address SDX64Q
(Street or Route No.) P 7O 5T h �lC liSihLC� ,,wVVA`/
City or Town State Zip Code
( )- !p1 -g129
Area code- Phone number
4. DATE DRILLED 8 — (3- 02_
5. TOTAL DEPTH: 34 1-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Ad
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST /1 / K
10. WATER ZONES (depth): fkfim Cr' a PSU
I1. DISINFECTION: Type(110 '1Aie Amount53OZ C'r%? ,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From 0 To /a Ft. rD 1/6 f' M_
From ,/7? To //V Ft.[ ,/$Q 04/ (f
Method
FT.
13. GROUT: Depth
From To Ft.
From O To 26 W ....91/ AUg« se L
14. SCREEN: Depth Diameter Slot Size Material et
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - /ate A:K;
/08 - 34C C po awl
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and copugon road names.
j/Ifiedi t/eN cAns/H+.0S IzotP
ff;Viers7d 01 c,
16. REMARKS:
Material
Size Material
eyY
/1et&c /,J//le O/Ce Vic`
/Z 02
PR{LihRO HEREBY (E-R9IkT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
LL aONSt-R CTION $TA'PS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
WJ
Submit the original {o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001
IGN
RE OF PERSON CONSTRUCTING THE WELL DATE

2. WELL LOCATION:
Nearest Town:
WELL CONSTRUCTION RECORD
Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section J U
North Carolina - Dep CERTIFICATION a_
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_PHONE n
CONTRACTOR COMPANY NAME
WELL ASSOCIATED W Q PERMITS
STATE WELL CONSTRUCTION PERMITS((if applicable)
if livable
1.
Applicable Box): Residential B' Municipal/Public ❑ Industrial ❑ Agricultural ❑
259384
WELL USE (Check App t e J Water Injection 0 Other 0 If Other, List Use�—
Monitoring 0 Recovery 0 Heat Pump
Topographic/Land setting
Midge ❑Slope
(check appropriate box)
Latitude/longitude of well location
(degreesuninuudsecoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
EP nB1t r OG
From To Formation Description
County4D. iT0
(Street Name. Numbers, Community. Subdivision, ln*No., Zip Code)
3. OWNER:
Address
ty orTustin gState 6/ Zap Code
Area code- Phone number
nunber
4. DATE DRILLED��- O ZDr 0 2
���
5. TOTALgVi
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FT
7. STATIC WATER LEVEL BelowTo p of Casing:� otc
8. TOP OF CASING IS ' FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In aecordanc with IS�THOD OF TEST /K
9. YIELD (gpm):
10. WATER ZONES (depth):
11. DISINFECTION: Type CL02LN2 Amount C2C73
12 CASING:
ess
Material
Weight/Ft.
Depth Diameter or
From To Ft.
From_Q__ToFt
From To Ft.
13. GROUT: Depth Material
From To .. Ft 9 ! t7oJYl-P- L�
From _ To Ft .--Siu Material
Diameter Slot
14. SCREEN: Depth
From To_
From To_
15. SAND/GRAVELPACK:
Depth
To
To_.
From.
From.
16. REMARKS:
GBCUNLHeta E•_ r N
ASHEIILLE REGIONAL OFFICE
al to
o. (9
Ft in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Method
l ru'ATION gn-C I
�., 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 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service CeenteREVrl Rg07/2001
9) 733-3221, within 30 days.
9

WELL CONSTRUCTION RECORD
Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / Su
North Carolina -TOR (INDIVIDUAL)
CERTIFICATION #
WELL CONTRACTOR (INDWWUAL) NAME (priori C R " ` t L , (Y11 PHONE # 1=5 112±.L, 51/g
-r• t � r_T. � VU D tZ.
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PBRMIT#
STATE WELL CONSTRUCTION PERMIT# if liable
livable
I. WELL USE (Check App
licable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name, Number,
3. OWNER:
Address
259383
/ D ��//� T gaphie/Lan alley ❑Flat
IXO / county �� �""'"" ❑Ridge ❑Slope
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
TDrr TINGT_OG
Formation Description
ty or Town State
Area code- Phone number 0 - O
4. DATE DRILLED
5. TOTAL DEPTH:CV-
6. DOES WELL REPLACE EXISTING WELL? S El NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
'Top of wing terminated at/or below load surface requires a
valiance In accordance.fII ISA NCAC 2C .0118. Yi.-
9. YIELD (gpm):—METHOD OF TEST
10 WATER ZONES (depth):
EP
From To
/IZ E
2/9"e ti
/ LOCATION SKETCH
, Show direction and distance in miles from at least
11. DISINFECTION: ION: Type CG02rN Amount two State Roads or County Roads. Include the road
12. CASING: Wnumbers and common road names.
Depth Diameter or n Weight/Ft. Material rt/glrfLv,.5W
From To Ft.
eG
From_ Tom— FtCo / �— _
F.
From To Method13. GROUT: Depth Material
From To Ft._ OJt't-P
Fromm — To a O Ft. £ —_ Material
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From_..._— To Ft. in, in.
15. SAND/GRAVELPPACK: Sue��
Depth
From To Ft. From To Ft.
16. REMARKS:
r ', LIDor HE jf CF,g17F
SON
SGOJignhmift the orienrt� t
ASHEVILLEgttIG,IIfALL OFFIGE.(915
0
1,0
cn
1-72
CD
0
c=-
:
E5
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
ATURE PERSON CONSTRUCTING THE WELL
DATE
SI
e Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREEVg07 2001
) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD
259371
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ..
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - 1 i 131/ cc
I t -y- c
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
evl rzy CERTIFICATION # d#1/,�A
pvre PHONE # (�!T /L� ���7�j
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
.GL�C AC/ County .eI: -lam
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ctic/-e OL//S
Address
(St o,-r r.Rautee No.)
.4-l� it�(F v/.-OG
r99777
ity or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED CoQ S
Topogra /Land setting
❑Ridge 0Srlope ❑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
-off
5. TOTAL DEPTH: t /Z Z �_ ��� t ;
6. DOES WELL REPLACE EX/TING WELL? YES 0 NO a� T''
7. STATIC WATER LEVEL Below Top of Casing: / 5- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a )
/ variance in accordance with ISA NCAC 2C.0118. ,ter ;nin _ - ,�
9. YIELD (gpm): METHOD OF TEST /C. �jJ1'`�� iv `�
10. WATER ZONES (depth): /C//D/17 .4 3 C
,,/,
LOCATION SKETCH
DISINFECTION: Type C'6LLu-C Amount 8 02 67. Z, how direction and distance in miles from atvleasGE
Wall Thickness two State Roads or County Roads. Includehe roil:=-
or Weight/Ft. Material numbers and common road names. E -
a4-6 dry
&mt ,c -
A>C T�/c
ty�fir�ar-!
1l
12. CASING:
Depth Diameter
From To Ft.
From e? To 7 FL
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
)
16. REMARKS:
r
C
2Z,
S' '2ceg
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THUS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATVkE'p%ETLSON CONSTRUCTING THE WELL DATE
nit the nr'e final to t e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
jd,nhEl9blpA119) 733-3221, within 30 days. GW-1 REV. 07/2001
FS a liJAL OFFICE

259347
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
(NN tural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / `e[JI � (n Obr7^R_SC2/., CERTIFICATIONg�# ga 90
WELL CONTRACTOR COMPANY NAME fkSX+r () a--- "P`) f t'2y j 1 L-JS PHONE #`f"') -n3- t7O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residentiald"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOC ON
Nearest Town: _ t Countynil
9a4a vs CRe_e
(Street Name, Numbers, Community, Subdivision., Lot No., Zip Code)
3. OWNER: �QS rie,-6/Ark
Address 3') L` - 2 R
,--. sul (fire or Route e. c; ric
•L</nIe City Town State
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXI ING WELL? YES g1 O
--Ain
7. STATIC WATER LEVEL Below Top of Casing: " FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS k. FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST A-
10. WATER ZONES (depth): S 7D (t 5-
1 1. DISINFECTION: Type CM Je' h i pe, Amount 6
12. CASING: Wall Thickness
Depth
From (<) To 'lbFt.
From 95 To 5 `L.Ft.
From To Ft.
13. GROUT: Dept
From 0 To 30 Ft.
From To Ft
14. SCREEN- Depth
From To Ft
From To Ft
15. SAND/GRAVEL PACK:
Depth
To
From
From
Diameter or Weight/Ft.
Vz) sn
Diameter
in.
in.
Slot Size
Material
in.
in.
Size Material
Ft.
To Ft.
r—v
1.
r--FB91STRUCT STA T COPY OF THIS RECORD HAS BEEN PROVI
#LR- cE Tin
E• T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DEDDTTO THE WELL OWNER
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
F9rmafon Description ,C
DEPTH
From 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
rD
1%1
0
J
SIGN
ASHE��{ IV ,rT R SECTION
n-c`""'p��lfd the P 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
one No. [phone], within 30 days. GW-1 REV. 07/2001
RE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NCI Resour Division of Water Quality - Groundwater Section �
(print) I—'FT,r��I ``1 CERTIFICATION # 75/e
WELL CONTRACTOR COMPANY NAME ta'I✓k (Yc .oj auk
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMIT,*
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM YJ
2593415
PHONE # 1f9 733- Q
I. WELL USE (Check Applicable Box): Residential LJ Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATION: �(_
NearestTfwvn: e.IL' (L'e_ County at$el i
(Street Name, Numbers, Community, Subdi�n, Lot No., Zip Code)
3. OWNER: Sa �(Z.v�S p--)0
Address "575 C.Ro4 44u
`�c5., eet or RouteOl
I 1 tV,'e Q`z-
Cit Town State Zip Code
(Mt3>_"A3`1— `93(ff
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: J
6. DOES WELL REPLACE EXIS NG WELL? YES 0 NO LO
7. STATIC WATER LEVEL Below Top of Casing: c2 is FT.
(Use' +" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0l I8.
9. YIELD (gpm): (' METHOD OF TEST rA-ti R.
10. WATER ZONES (depth): Cf, ( 1-10 . 186
11. DISINFECTION: Type !(J'11Qf2, iC Amount it, 0"'e-
12. CASING: Wall Thickness
�r Depth Dia e r or W Ft. Material
From (2 Tore Ft. 6'h r ) ., 1/
From To Ft.
From To Ft.
13. GROUT: Depot _
From To r-C--) Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Method
ps'a Rect.
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 30 ct - /01°84
R� ct<
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Li:01NV 9-d3SZO
16. REMARKS:
IrJ
f�gJ(y� [p1�F�,��JJNNo to t
ASHEVILCE"AEGII7IJ'P.L QFFIf;t' (91
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
VZDS, AND THA &COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g-is
-tea
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

Init
WELL CONTRACTOR(INDIVIDUAL)NAME print) KexiiJ C.142
�Sor'-)
WELL CONTRACTOR COMPANY NAME g{✓Q-4\ ta_)o-L� -DZI \` : ati
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259344
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # PSQ O
PHONE # gglti 7s3-z c
I. WELL USE (Check Applicable Box): Residential L9' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: County °VA^ lrtl I
)2% rp e�. # Ies f
�
(Street Name, Numbers, Communi , Subdivision, Lot No., Zip Code)
3. OWNER: StrRM Qk .
Address 14x ree..QQ1 S -a ks ?c:.
(Street or Route No.) jf
` ecv; Ile- cc- at 70{
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: _
6. DOES WELL REPLACE EXIST G WELL? YES ❑ NO Er-
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I METHOD OF TEST j&.tit„.
10. WATERZONES(depth): r/O-473 I S2) IctO
1 I. DISINFECTION: Type ch11P: e Amount 07_,
12. CASING: Wall Thickness
Depth Diam�e}er or Weigh�VFt. Mate 'al
From C7 To din Ft., (o< it'?
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft. G c) e
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. SCREEN:
From
Topogr3piticiand setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
tic
-- o2w
LOCATION 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:
G RvUwuvvtilEH SECTION
ASHEVILLE REG(GPIAL OFFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
19) 7 3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
259343
North Carolina - Department of Environment and N tural Reso ces -` Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print)/�eVtJ ��O d7W2$CJa-� CERTIFICATION#-2S9°
WELL CONTRACTOR COMPANY NAME 17R&,GJ-L4 u— // DR, 11%\-q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # �) 733—az
1. WELL USE (Check Applicable Box): Residential 19"--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:cockttsut )2 County y he I L
`?R, C&AtrdePlJ`
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER:t�CRK4 )`1eNS\eq
Address 'G o'X WA -re ('Zook" t
(Street or Route No.)
CACtakCt_sti>)k42. Mc 2S(105/
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED ) -0 a
5. TOTAL DEPTH: ilin0
6. DOES WELL REPLACE EXI ING WELL? YES 0 NO ter
7. STATIC WATER LEVEL Below Top of Casing: 0CG 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�y)th 15A NCAC 2C .0118.
9. YIELD (gpm): —` METHOD OF ST dcalc
10. WATER ZONES (depth): 75" 1 2
11. DISINFECTION: Type e h four Ira— Amount Q "t
12. CASING:
Depth Diameter
From C To S( Ft. G
From To Ft.
From To Ft.
Wall Thickness
or Weieht/Ft. Material
r)g v
13. GROUT: Dep Material
From O To O Ft. C rzrhe.+�}-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
T graphic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From So -- Formation ation Description
O `j
�o •- HO
4-10 - a-c�
L1S-- (po
Rs), bet,, I(legs
d• 1 Mese_ &tot
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
bmit'the original to the �y�y{{tvieita
27 99-1636 Phone No. (919) 733 322
GROUNDWATER SECTION II
ASHEVILLE REGIONAL OFFICE
ATU
E 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourC�`e���D vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Keutf� I,sRSd� CERTIFICATIZ�
CERTIFICATION
WELL CONTRACTOR COMPANY NAME j 4SCJCfl We'll Da; Il/tCC PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCA)12 dGL)1
Neares[Town: cJJt County t
y<% +'uG 5G0 CCleeek'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `U" Y&* c
Address l ,5
eiZS
($ytrget
rl1e_ /�Route No.)%G ?8,70.J
Zip Code
)-&Vg— 9.3gol
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:-
6. DOES WELL REPLACE EXIS ING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '2 C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated aUar elow land surface requires a
variance in accordance with ISA NCAC 2C .0(18.
9. YIELD (gpm): / < METHOD F TEST A-i /Z
10. WATER ZONES (depth): J ate-*:
City or Town State
259337
�epographic/Land setting
cgidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeflongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O—
IC- /60
ti
Cp
rn
ZTE
_
LOCATION SKETCH CI
11. DISINFECTION: Type Chi lam -Amount G or Show direction and distance in miles from atleist
12. CASING: Wall Thickness two State Roads or County Roads. Include th`e3oadi
Depth Diameter or Weight/Ft. Material numbers and common road names. O
From C-7 To r 2 1 Ft. 6 VC{ S_A�% ?VC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method r
From 0To o`�D Ft. CQ i�_�'/'`,_d.t-Q-CW�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16 REMARKS:
CONSTRUCTIO
SEP 1 0
17 ='Y
CO
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
YARDS, AND THAT SCU Y 9 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF
ERSON CONSTRUCTING THE WELL DATE
GROUND fidataTifiltinal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHEVILLE rENn (19) 733-3221, within 30 days. GW-1 REV. 07/2001
r,_

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resgtrrr s - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �'�r \�U' do CERTIFICATION #47596
WELL CONTRACTOR COMPANY NAME `�'S t--1QI) tue' bRi 111 Nn PHONE *I ) Cf33- XeD,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential i3 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:'OA t n
Nearest Town: CRSv.. %%42-- County i Per 1
Iort© 1/4-02.z6 M olader.* 40
(Street Name, Numbers, Comnimity, Subdivision, Lot No., Zip Code)
3. OWNER: Sod
Address )1-72> Y -0 �� rah
(Str a Route No.)
9 a->-O{2su t f it -
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: L9 r /
6. DOES WELL REPLACE EXI TING WELL? YES 0 NO fE
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
r . (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): o`Z.� METHOD OF TEST i44 R
10. WATER ZONES (depth): ho D f /0
11. DISINFECTION: Type C-rI/ORM.N- Amount (c:' CSZ
12. CASING: Wall Thickness
U Depth Diameter or Weight/Ft. Material
From To Ft.1,' S , )' g ✓a/V.
To
From Ft.
From To Ft.
13. GROUT: Depth Material i Method
From 0 To 3D Ft. CtPD
From 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.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Formation Description 1
Da. 35
3 = )42.
—1Ho
LOCATION 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:
SEP 1 0 2002
Submit the original to
he D
9) 73
GROUNDWATER SECTO"
ASHEVILLE REGIONAL OFFICE
Topogra ic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
259336
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

Depth Di ter
To oo(t t Ft.
From To Ft
From To Ft. _
Depth To Material p ethod
�`r) Ft. C e w ` From To Ft.
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department Of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA tint) 1 r CERTIFICATION
rt9 `L'['p�
LV
WELL CONTRACTOR COMPANY NAME �\�C II ? ) PHONE # (8 t
) 53—PeiD^L.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
259353
1. WELL USE (Check Applicable Box): Residential life-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: i Nearest Town: uc.E _ TL'?C 'e County fiVdr he 1 (
'3 es r`keR ;2b
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: v). - •p SY-3[nn
Addrests s3A 3 \f • 1/4.1J AL •
(Street or Route No.)
l.e-. c:50777
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXI TING WELL? YES 0 NO Le
7. STATIC WATER LEVEL Below Top of Casing: )O FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01I8.
9. YIELD (gpm): a METHOD_OF TEST df-i R
10. WATER ZONES (depth): rig„ t�( D5v
11. DISINFECTION: Type O).--� Amount e
12. CASING: Wall Thickness
orb ehUFt Matgria]
0
From V`d Alt/,
13. GROUT:
From 0
Topogra • and 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
Fojanatpn Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
ERTI Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND T COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to
GRbLINDWATER SECTIONS
ASHEVILLE REGIONAL OFFICE
SIGNATUR •F PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Div�ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) P s//2N cb- ROILmoIV
(
WELL CONTRACTOR COMPANY NAME DttiAreSa+%-11 oJeU ,1'����
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: {9{25yiIle— County iNcicielei
3)27 -tcx. q
(Street Name, Numbers, Commurtity, Subdivision, Lot No., Zip Code)
3. OWNER: 1101 c—hs. oacej
Address 3 /a 7 fit- O
jaa•(Sleet or Route
From
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
•c,_ o2yTo S
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED e'' O
5. TOTAL DEPTH: 1C., 1
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO YJ
7. STATIC WATER LEVEL Below Top of Casing: .2 00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan with ISA NCAC 2C .0118.
9. YIELD (gpm): ' - METHOD OF;EST hT:Z
C 10. WATER ZONES (depth): 9 (5
I I. DISINFECTION: Types- Iljo(ta- Amount Co a--
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (3 To CFI Ft. Q •-( a3rt a1 `''
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To •06' Ft. ce "
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
To Ft. in. in.
Method
259352
CERTIFICATION # D610
N
PHONE # "+)
�Opographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Form 'on Description
DEPTH
From To
D •- 4/5
—5W
5Lc— Cc:4:2)
•-CO
0)0 76c->`
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
5-
16 REMARKS:
WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OF T1-IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E OF PERSON CONSTRbCTING THE WELL DATE
Su bmi the original to the Divisio of ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27h99- 63iiiiMie014(.T 9$&631ID22 , wit in 30 days. GW-I REV. 07/2001
ASHEVILLE REGIONAL OFFICE

263664
2 G
L39 `�
3.OWNER: Ilf/RQi 31p\Yell
Address I �3JL{rJ� f4} N Z L Q H Wit
Street car RoutteNo.) z�2es
City or Town State
( )-
Area code- Phone numb
4. DATE DRILLED
5. TOTAL DEPTH:_
6. DOES WELL REPLACE XISTING WELL? YES NO 111
7. STATIC WATER LEVEL Below Top of Casing:) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
Zip Code
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME(print)
WELL CONTRACTOR COMPANY NAME
pa
atural Resources
/ - Di(y�jsion oJf W • ter Qua lity - Groundwater Section/ �/� /,
Q(ISn I "L( < ff r CERTIFICATION/I/ :2(003 ci `GL1'2
a� I G ✓I ( ell I't r ✓E6\ PHONE # VA{ (a 5(3—92.?-3
t 1 /r .26.62—
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERM
(if applicable)
I. WELL USE (Check Applicable Box): Residential l3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
_ yy•
u4ek'e1
Nearest Town: !! Count
2z ,c�s✓.'d�.
(Street Name, Numbers, Communit , Subdivision, Lot No.. Zip Code) j 875J
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 6FTt
(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
-pL
variance in accordance with ISA NCAC 2C .0118. nn --f
9. YIELD(gpm): 115 METHOD C�FTEST(rzi/ear N.. (
10. WATER ZONES (depth):
11. DISINFECTION: Typet_6.1EL Amount �-
12. CASING: Wall Thickness
Depth or Weight/Ft.
From To 3�
From To
From To
13. GROUT:
From
From
14. SCREEN:
Diameter
Material
Ft.
Ft.
Ft. �cthod
Depth Material M
TooFt. 0 mere (.l. t`v
To Ft.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL _
AND THATCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNIR
n
LOCATION SKETCH
Show direction and distance in miles from at let
two State Roads or County Roads. Include thelnad
numbers and common road names. --
Submit the-0 "iginal to th rvi
27699-1636 Phone No. (919 733-
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE 't —
on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
1, within 30 days.
GW-I REV. 07/2001

263663
WELL CONSTRUCTION RECORD
North Carolina - Dcparttnent of Environment and
/Naaturral Resource$/ - Di sion{oof W tern (Qu lity - Groundwater Section/ /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
y/ir%1 4 `- If�tA-� CERTIFICATION
/#� �( 03 q- _2cc02
WELL CONTRACTOR COMPANY NAME ,TT/ { n+ lU fO ( iL t 4 PHONE # S�01 tU k 3'-'J 2.23
STATE%YELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERM II Ir .2 G9(J.2-
(if applicable)
of s �I
etl
(if applicable)
I. WELL USE (Check Applicable Box): Residential 1E Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2,
WELL LOCATION: -��ti1
Nearest Town: County
1� Ri(s iNtikvt t5 4
(Street Name. (Numbers, Community, Subdivision, Lot No., Zip Code)
um
3. OWNER: t✓O Y4Y6 3
Address I O7-0 91.1 t 1 ICCI
w - .47itlRoute No.1 ,l: 7A- 1Qs
City or Town State 1 Zip Code
( )-
Area cede- Phone number
4. DATE DRILLED R' ZCs— b t_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: LO 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
5. TOTAL DEPTH: 7-1.9 f
Topo_graa hic/Land setting
[Midge PSlope ❑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
variance in accordance with ISA NCAC 2C .0I I8. //i�
9. YIELD (gpm): -5 METHOD OF TESTI ZI /POI Qin PC
10. WATER ZONES (depth): 7.-CS ' 1
11. DISINFECTION: Type j 6ip-I-, Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
n
LOCATION SKETCH
Show direction and distance in miles from�at least.
two State Roads or County Roads. Includc1te road_-.
numbers and common road names. ctt (,
(� 'L3 �l �l I.F
From To FL t{j"1 Z.Z.
From To Ft. �,� t ('� Y�
13. GROUT: Depth /1 Material JTC am, Method Yri
From To Ft. l mere u r �a.(t i.} ‘11 .
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size Material C7
From To Ft. in. in. t'J
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
crx F,
C D IE14BR' CW T I'
frti4
c.rl
THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL J
,i&ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
R• 711-0 Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
pt�,'• g e Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASC!7�ETDP�) 733 3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
262458
WELL CONSTRUCTION RECORD
020729
WELL CONTRACTOR: Dewey Wright Weil Pump Co
WELL CONTRACTOR CERTIFICATION #: 2686
STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
Inc.
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
x
Municipal 0 Industrial
I
Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
STAFFORD RD. OFF SULLINS BRANCH OFF BUS 226 0
(Road Name and Numbers, Community, or Subdivision and Lot No.(
3. OWNER BERNICE WARREN
Address % MITCHELL CO. SCATTERED SITE . P.O. SOX 1820
BOONE (Street or Route No.) NC 28607
City or Town State
4. DATE DRILLED 9/20/2002
5. TOTAL DEPTH 605
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 0-' FT
(Use "+" if 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.0118
10. YIELD (gpm)' 0 METHOD OF TEST Air
11. WATER ZONES Idepth):0 ppm DRY HOLE 0
0 S1pm 0
Zip Code
xI
qpm
PPM
X
DRILLING LOG
From
0
To
Agricultural ❑
Monitoring El
DEPTH
Formation bescription
10 DIRT
10 605 GRANITE
0
0
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING:
Web Thickness
Depth Diameter or Weight/Ft.
From 0 To 21 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
Material
.350 PVC
Depth Material
From 0 To 20 Ft Cement
From To Ft.
15. SCREEN
Depth Diameter Slot Size
From To Ft in in.
From To Ft. in in.
From To Ft in in
16. SAND/GRAVEL
D
From
From
17. REMARKS:
I DO HEREBY CE
CONSTRUCTION
FOR OFFICE USE ONLY
Method
Gravity Fiow
Material
MBL9BU1t060NST
IVEG72INAT @R€i41EY
erial
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
aiv
la La
r—�
0
w an;
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
e
16-/s1-oa
SIGNATURE OF l?iSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
\tEYs�,IIE
Quad No:
Serial No.

262301
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/�Resources -`Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V �y MS44 ; CERTIFICATION #at?/SO
WELL CONTRACTORCOMPANY NAME 3( ,cC Lunt 0r;u-; A/CY PHONE # ( )7Zv-t598
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 5 prel f (z PrRJC County yvt 44,e( L
Nu0-c4K�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topogra is/Land setting
❑Ridgee ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: „Ter- (% 1./ � eE (degrees/minutes/seconds)
3
Address o 1a un, Aitck AAA r241 Latitude/longitude source:❑GPS❑Topographic map
(Street t or Route No.) (check box)
Stpr ANC N t .7e777 DEPTH DRILLING LOG
City or Town State` Zip Code From To Formation Description
as4)- ? s— {o Sic/ 0 - 5'l D/ Kd
3y-32 D;4Cr2ar.k..
39,-0'735 0yP ie-
Area code- Phone number
4. DATE DRILLED 9-5.G2
5. TOTAL DEPTH: zes
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: f30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / //2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /2 METHOD OF TEST A-) fL
10. WATER ZONES (depth): i2 bp et, tt j zkc ('June], 2L
LOCATION SK
1 I. DISINFECTION: Type 6LQIVW-L Amount 1602 6D 73�e Show direction and distance
12. CASING: Wall Thickness two State Roads or County
Depth Diameter or eight/Ft. Material numbers and common ro
From 0 To sin FL € Po es
From To Ft.
From 4r6 To c/Z Ft. �aL/i( i�8 Q1`��
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Material
1.1
ri
CH
miles from at least
oads. lnclude the road
names. -
f v,.,P 6 Ack s
0
c�
Ap 55RJ
vfv
16. REMARKS:
G R 0.1t19$1/17117 yuttqpi oche
ASHEV2216B9RENO18AC PY lt6919)
T THIS WE
S, AND T
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COPY OF TH < - i 71 HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAL i RE OF ERSO CONSTRUCTING THE WELL
DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
I�J/ttural Resources - Division of Water Quality - Groundwater Section ��
.LI.
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
tt(��1JJ]JJ D N! / G 15 �% `-- 2-- CERTIFICATION #Nn
WELL CONTRACTOR COMPANY NAME.CNET2 ULAYtdLOA-4.-p L ZLPLG_1 PHONE 0 1A7c2 1'4 4/9 6'18")
STATE WELL CONSTRUCTION PERMIT# 011 ASSOCIATED WQ PERMIT# N//%
(if applicable)
(if applicable)
263425
1. WELL USE (Check Applicable Box): Residential N,$ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest To
lam/ County &
�Sy /
(Street Name, Numbers, Cmunity, Subdivision, Lot No., Zip Code)
3. OWNER: /" +
Address
(Street or Route No.)
t .1- ,,f .fl7/1
City or Town State Zip Code
Ares code- Phone number /
4. DATE DRILLED 9/// / D Z—
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER. LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 5 FT. Above Land Surface'
*Top of wing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 D METHOD� OF TESTT-G4-r-c.
10. WATER ZONES (depth): SO 13
11. DISINFECTION: Type ie.n. ci
12. CASING: v
Amount /D Cr-
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 0 Ft. ->i-/ /Pt)e
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ..
From 0 To <2/5 Ft.
From To Ft.
14. FDiameter Slot Size Material
Froro o Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ..----to Ft.
From 7 To Ft.
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th
numbers and common road names.
EvAo .e rj 1.l.LE iTh y
16. REMARKS:
16D &R ETT
ckignix
N1�TA! i
DW
�l.
.,IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
g7M{{2,¢, (pi j p41j19) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
r rl

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020727-1
264615
WELL CONTRACTOR. Dewey Wright Well Pump Co., i nc.
WELL CONTRACTOR CERTIFICATION #. 2888
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I Heat Pump Water Injection
X
Municipal I I Industrial
Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County. MITCHELL
JARRETT DR OFF JARRETT RD OFF HWY 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JAMES F. BOYD
Address 120JARRE1T RD ,
BAKERSCntttrRouteN0.) NC 28705
City or Town State
4. DATE DRILLED 9/16/2002
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 425 FT
(Use "+" if 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.0118
10. YIELD (gpm)• 0 METHOD OF TEST Air
Zip Code
X
11. WATER ZONES (depth)•0 Pon DRY HOLE 0 pprn
0 PPM 0 pom
Agricultural
Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 30 DIRT
38 425 GRANITE
12. CHLORINATION: Type HTH Amount
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 42 Ft 6 1/8 .350 FVC Roads, or other map reference points)
From To Ft tivC.Z
From To Ft `-'( 9'tyw
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Row
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
as
gge(SV ui Ie-
el)
:v
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No•
Serial No
SIGNATURE OF PER ✓ CONSTRUCTING THE WELL DATE
Submit original to Division of Wate 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
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264613
WELL CONTRACTOR: Dewey Wright Weil Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2886
020727-2 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
WELL USE (Check Applicable Box): Residential I XI Municipal
Recovery 0 Heat Pump Water Injection I I Other
fl
Industrial 0 Agricultural 0 Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County tv1ITCHELL
JA.RRETT DP. OFF JARRE I I RD OFF Imo' 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JA.MES F. BOYD
Address 120 JARRETT RD. ,
BAKERSattr Rou
te Nol NC 28705 36 425 GRANITE
City or Town State Zip Code
4. DATE DRILLED 9/17/2002
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES n NO n
8. STATIC WATER LEVEL Below Top of Casing: 425 FT
(Use "+" if 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.0118
10. YIELD (gpm). 0 METHOD OF TEST Air
11. WATER ZONES (depth):° ppm DRY HOLE 0 um
0 qpm 0 qpm
DRILLING LOG DEPTH
From To Formation Description
0 36 DIRT
I XI
12. CH,LORINATION: Type HTH Amount
13. CASING:
If additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 1 To 43 Ft 6 1/8 .3Fi0 PVC Roads, or other map reference points)
From To Ft 5
a 1`y'�
From To Ft 1
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
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.
Po'etj, I/1/r Re,ect
SIGNATURE OF ERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 60 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020731-2
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #' 2886
STATE WELL CONSTRUCTION PERMIT#' Leslie Reece
1. WELL USE (Check Applicable Box): Residential I i I Municipal I I Industrial ❑ Agricultural I I Monitoring ❑
Recovery I I Heat Pump Water Injection I - Other ❑ If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County' fv1ITCHELL
UPPER Name and ROCK RDumbers, Community, orOFhF,RFon AV oRo RFFK RD OF
3. OWNER HOMER W. MURDOCK. SR
City or Town State
4. DATE DRILLED 9/13/2002
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES II I NO
8. STATIC WATER LEVEL Below Top of Casing' th:30 FT.
(Use "+" if 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.011108 Air10. YIELD (gpm)' METHOD OF TEST
11. WATER ZONES (depth)'0 p;;rn DRY HOLE 0 gprn
0 PPm 0 gm
Address P.O. BOX 2175
MORGANti or Route No_) NC 28680
Zip Code
I XI
I xI
12. CHLORINATION: Type HTH Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 23 Ft 6 1/8 2,50 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft in in
From To Ft. in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE of RSON CONSTRUCTING THE WELL DATE
Submit original to Division o Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
DRILLING LOG DEPTH
From To Formation Description
0 10 DIRT
10 400 GRANITE
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State f tt.
Roads, or other map reference points)
FOR OFFICE USE ONLY
Quad No:
j)-) -o 2
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
261815
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+' if Above Top of Casing)
WELL CONSTRUCTION RECORD
WELL CONTRACTOR Dewey Wright Weil Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: [tin
020708 Leslie rteece
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial n Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
CUB CREEK RD OFF H WY 261
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER CLAUDE GARLAND
Address 44 HIDE RD.,
BAKERS\TtEr Route No.) NC 26705
City or Town State Zip Code
9/9/2002
185
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.011B_
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth): gpma1-9
0 ppm
DRILLING LOG
From To
0 34
DEPTH
Formation Description
DIRT
34 91 GRANITE
91 92 QUARTZ
92 141 GRANITE
141 142 SHALE
142 165 GRANITE
Air
9 ppm 141-142
0 ppm
12. CHLORINATION: Type H FH Amount 3D If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To J7 Ft '5 1/3
From To Ft.
From To Ft
14. GROUT:
Depth
From 0 To 2U
From To Ft
15. SCREEN
From
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
I DO HEREBY C
CONSTRUCTIO
.350
Material
Ft Cement
Diameter Slot Size
Ft in in.
Ft in. in
Ft in in
Material
PVC
Method
Gravity Fiow
Ft
Ft
Size
Material
r t
THAT THIS WELL WAS
DARDS, AND THAT A C
FOR OFFICE US • ONL
Quad No:^OOI
ASHEVIL
MI
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map referey ce points)
.L9
U-GQ'
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
`V
SIGNATURE OF PE CONSTRUCTING E WELL DATE
,�)9'STEn StibnkiCdtiginal to Division of Wa er Quality, Groundwater Section within 30 days
E REGiI:I:AL OFFICE GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
261817
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
020748 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential El Municipal
Recovery 0 Heat Pump Water Injection I I Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE
WILSON RD. OFF HWY 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TED M CONNELLY
Address 241 WILSON RD. ,
BAKERSOttt'rRemeNo.l NC 28705 26 139 GRANITE
Industrial I I Agricultural Monitoring 0
If Other, List Use.
County MITCHELL
DRILLING LOG DEPTH
From To Formation Description
0 26 DIRT MUD
City or Town State Zip Code 139 140 QUARTZ
4. DATE DRILLED 0/1B/2002
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES fl NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if 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.0118
10. YIELD (gpm)• 20 METHOD OF TEST Air
11. WATER ZONES (depth)•20 PFm 139-140 0 PDT'
0 PPm 0 PPm
12. CHLORINATION: Type r Amount 30
xl
140 165 GRANITE
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 29 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
I DO HEREBY
CONSTRUCT!
FOR OFFICE U
Quad No:
Ft
Ft
Size
Material
NDARDS, AND THAT A
tLl
O\'.TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
U1
SIG ATURE OF PEA ON CONSTRUCTING THE WELL DATE
„feitiberd{p-iginal it Division of yW, riter Quality, Groundwater Section within 30 days
GP,OUNDAATER SEGIINN GW-1 REV. 12/99
ARNEVILL_ REGIONAL OFFICE
-©
•
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
261816
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc
WELL CONTRACTOR CERTIFICATION #• 2686
020747 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial 0 Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
xl
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
BRUSHY CREEK RD. OFF OLD 19E OFF 19 E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JUNIOR JONES/LOUISE RENFRO
Address 58 BURLESON BLVD. ,
SPRUCE'PRNEr Route N°NC 28777 41 63 GRANITE
DRILLING LOG DEPTH
From To Formation Description
0 41 DIRT
City or Town State Zip Code 63 135 GRANITE
4. DATE DRILLED 9/18/2002 135 136 SHALE
5. TOTAL DEPTH 145 136 145 GRANITE
XI
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+' if 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.011
10. YIELD (gpm): 0 METHOD OF TEST Air
11. WATER ZONES (depth) 2 ppm63-64 48 ppm 135-13C
0 C1pm 0 gpm
1XI
12. CHLORINATION: Type) Amount 22
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State \\�
From 0 To 45 Ft 6 1/8 .350 PVC Roads, or other map reference points) '4t
If additional space is needed use back of form
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft. in in
From To Ft in in
From To Ft in in.
IZ-f"kSL ( PC(aG
'8
Material rai I
0
16. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY C
CONSTRUCTIO
FOR OFFICE USEIONLI
Quad No:
Serial No.
Size Material
THAT THIS WELL WAS Q
DARDS, AND THAT A C
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/0"i 02-
jJ(�C SIGN TURE OF PMSON CONSTRUCTING THE WELL
LDViAT[RS �ti%clg alto
DATE
ivision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
µ ca

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]
261763
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.2645
020763 STATE WELL CONSTRUCTION PERMIT#• Dewey Wnght
1. WELL USE (Check Applicable Box): Residential I 'Xl Municipal Industrial 0 Agricultural ❑ Monitoring 0
Recovery [ 1 Heat Pump Water Injection El Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE DR. OFF LINVILLE LANE OFF HWY 80 OFF MIN
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ROBERT L. MCFERREN
Address P.O. BOX 1274 ,
BAKERS*LtEr flO01e No.) NC 28607
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO PC
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
City or Town State
9/24/2002
Zip Code
625
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.01
10. YIELD (gpm)• METHOD OF TEST Air
11. WATER ZONES (depth)•1 PPm320-330 0 ppm
DRILLING LOG
From
0
DEPTH
To Formation Description
15 DIRT
15 20 SHALE
20 320 GRANITE
320 330 QUARTZ
330 625 GRANITE
0 ppm 0 qpm
12. CHLORINATION: Type HTH Amount 118 If additional space is needed use back of form
13. CASING:
From
From
From
u
Depth
To
To
To
14. GROUT:
From
Diameter
c 118
2J Ft V
Depth
0 To 20
Ft
Ft
Wall Thickness
or Weight/Ft. Material
PVC
.35U
Material Method
Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Li , REMARKS:
I DO HEREBY CERTIFY
�CONSTRUC -
GRCIRtDWATER SECTION
Submit original to Di
Diameter Slot Size Material
Ft. in in.
Ft in. in
Ft in in
Size Material
t
LOCATION SKETCH
(Show direction and distance from at least two State
.t�N t��2. Roads, or other map reference points) _
°S'
Lan II;s Lt. c-
eacor
'.1
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COF THIS RECORD HAS-BEEN PRRVIDED TO THE WELL OWNER.
SIGNAOF PERSO'NSTRUCTING THE WELL DATE
on of Water Qua ity, Groundwater Section within 30 days
GW-1 REV. 12/99

261762
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION SP 2845
020780 STATE WELL CONSTRUCTION PERMIT#' Dewey Wnght
WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION' (Show sketch of the location below)
3. OWNER
Address
Nearest Town: BAKERSVILLE County. tv1ITCHELL
MINE CREEK RD. OFF HWY 228
(Road Name and Numbers, Community, or Subdivision and Lot No.)
EDWIN DAVID BOWDITCH
Agricultural E Monitoring ❑
DRILLING LOG
From To
1885 DREXEL RD. , 0 10
VALDESEs`ree` e` Route No.) NC 28690 10 185
185 168
4. DATE DRILLED 9/28/2002 188 380
5. TOTAL DEPTH 425 380 370
6. CUTTINGS COLLECTED YES ❑ NO 0 370 425
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
City or Town State
Zip Code
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.0118
10. YIELD (gpm): 1 METHOD OF TEST
11. WATER ZONES (depth)'1"2 pprr 155-188 1/2 ppm 360-370
0 Wm 0 gpm
Air
DEPTH
Formation Description
MUD/GRAVEL
GRANITE
QUARTZ
GRANITE
GRANITE/QUARTZ
GRANITE
12. CHLORINATION: Type NTH
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
Amount 85
Wall Thickness
Diameter or Weight/Ft. Material
21 Ft 8 1/4 .188 GALV.
Ft
Ft
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Method
Gravity Flow
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
STVOVSpR}/E, P,C11�((�� KL
r— --Mir 1,1 Size Material
Material
rom To
rom To
17 RE
C&NStfttL0
FOR OFFICE USE ONLY
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
- p Roads, or other map reference points)
viyreks 11t_
da-e
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A C _Y OF THIS RECORD HA BEEN PROVIDED TO THE WELL OWNER.
SIGNA U OF PERSON C I TRUCTING THE WELL DATE
on of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No.
Serial No.
Submit original to D

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]
261'792
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2B86
020704 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial n Agricultural I I Monitoring 0
Recovery 0 Heat Pump Water Injection Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County MITCHELL
SPARKS RD. OFF PITTMAN RD OFF PENLAND RD OFF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
14. GROUT:
DRILLING LOG DEPTH
3. OWNER HARVEY M. YODER From To Formation Description
Address 74 BAUGHN RD. , 0 10 DIRT
SPRUCE v1191E`Route
"°l NC 28777 10 43 GRANITE
City or Town State Zip Code
4. DATE DRILLED 9/11/2002 44 500
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES 0 NO El
7. DOES WELL REPLACE EXISTING WELL? YES lEI NO El
43 44 SHALE
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use'+" if 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.011
10. YIELD (gpm). i?2 METHOD OF TEST Per
11. WATER ZONES (depth):''2 ppm43-44 0 qpm
12. CHLORINATION: Type ' Amount 85
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 6 1/4 .188 GALV
v
From To Ft °Q (V
ft
From To Ft `
Depth Material Method ci
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CE �T�� HAT THIS WELL WAS C(; �jl'UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION * DARDS, AND THAT A COTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
GRANITE
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State_
Roads, or other map reference pointsln
r.>
0
FOR OFFICE USE
Quad No:
Serial No
'l L
(1
1/9-
URE OF P47 ON CONSTRUCTING THE WELL DATE
vision of ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
2

WELL CONSTRUCTION RECORD 261388
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT,
if applicable)
CyA2(� �U-c- CERTIFICATION,priJ0
Sus+)nr)/ti
PHONE N (
A.SSSHICIATED WQ PERMED,
(if applicable)
1. WELL USE (Check Applicable Box): Residential tl' Municipal/Pub)ic 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: T
Nearest Town: Sp/�JJLLyy�P MZ County f u.17'
(street Name. Numbers, Communitymunity, Subdivision. tot No., Zip Code)
1) n /) /1 _
3. OWNER:
Address r' �pj !t4ttxv (pv.4t n e-
(Strm or ii).)
, Q floS f> 11 2 - 9 Pe777
£ray or Town StateZip Code
492- 766-//zt
Area code- Phone numbe 2—
4. DATE DRILLED 7 ) -' d2
6. DOES WELL REPLACE 5. TOTAL DEPTH: ����
EXISTING WELL? YES 0 NO Si ���ror!
7. STATIC WATER LEVEL Below Top of Casing: /50 FT.
(Use "+^ if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST AI 9, smto
10. WATER ZONES (depth):
/Van (D Sj-f30 LOCATION SKETCH
l 1. DISINFECTION: Typn4GC Y/JF Amountvb2 OR inn Show direction and distance in miles from at least
12. CASING: Wall T ielmess two State Roads or County Roads. Include the road
thR graphic/Land setting
edge ()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
o- 35
Depth Diameter or WeighUFL Material numbers and common road names.
From To Ft.
From 0 To 9a Ft. % * -Pat
From T: To h/y Ft. � r/ag 5thT
13. GROUT: Depth tcnal ethod
From To Ft.
From co To Ft. J POG ael
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTI
CONSTRUCTION ST
Size Material
I HAT THIS WELL WAS CONSTRUCTED IN q' IANCE WITH I5A NCAC 2C, WELL
ARDS, AND THJINA COP F1I'iS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S NATU OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
Inctifb
0

WELL CONSTRUCTION RECORD 2 613 8 7
North Carolina - Department of Environment and NaturalnResources - Division of Water Quality - Groundwater Section
j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ( ''— . OS 7� CERTIFICATION #�0,'//✓ `�
WELL CONTRACTOR COMPANY NAME lyjory2 64-14c.& s / PHONE#.'� 72Y� S
STATE WELL CONSTRUCTION PERMIT# r / ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential [IL/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town
ti<rr--2 County /41-7. `G--
(Street Name, Numbers, Community, Subdivision, tut No., Zip Code)
3. OWNERgneetts-
Address Qr$� >6G.ue-c.'1ZS�4-�►
(SUeetar ante No.)
City or Town State Zip Code
(Pa > 6.99 -934/40
Area code- Phone number
4. DATE DRILLED 91-9'oz
5. TOTAL DEPTH: '7Z5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO OZ.
7. STATIC WATER LEVEL Below Top of Casing: /`/r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): - DlyTHOD OF
10. `r
10. WATER ZONES (depth):'� 29 1
11. DISINFECTION: Type (...(0ti;e1 Amoun
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From 0 To 4/9 Ft. 60,
From Q`O/ To lid Ft.
13. GROUT: Depth Material
From To Ft.
From 0 TtZU Ft. ;1111 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge WS1e6e ❑Valley ❑Flat
(Check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a -- <(//�l
va Method
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. IFD
�t,¢o43
rr igloo
DO HEREBY CERTIFY THAT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAR ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATU
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Diyifion o(W •ter Qu
WELL CONTRACTOR (INDIVIDUAL) NAME (print) It ��YY��b 1/;
WELL CONTRACTOR COMPANY NAME
S'FATE WELL CONSTRUCTION PERMIT#
(if applicable)
P
ASSOCIATED WQ PERN
(if applicable)
263748
y - Groundwater Section /� Z
CERTIFICATION If 2 /f/03 c -2(00
PHONE # yy�.tu�ill-A•1--7 ��--3
Li 1, 2652-
1. WELL USE (Check Applicable Box): Residential fi Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
s--
'Iyslu3 * ( Topographic/Land setting
2. NWELL eantT C� IO�N�: 1J'. j �lt edge ❑Sloe ❑Valley 0Flat
Nea estTownQ►KO.��O'ck~' Count l4 t p
Lio M`� (check appropriate box)
t N ` • Latitude/longitude of well location
ommunit Subdivision, Lot No., Zip Code) a 70fL
(Street Name, Numbers, Y.
Y" 1 (degreesees/scconds)
3. OWNER: � Latitude/longitude sourcrce:❑GPS❑Topographic map
Address (check box)
—j� ,f,1 (gpre�• outcNo.) ZcC/'lo� DEPTH DRILLING LOG
►Juet71� �'1t'* )� 'Li From To Formation Description
City or Town State Zip Code
( )-
Area code- Phone number ��_/� t
4. DATE DRILLED - i/
5. TOTAL DEPTH: T ii 1 f
6. DOES WELL REPLACE EXISTING WELL? YES NO FT.�
7. STATIC WATER LEVEL Below Top of Casing: 40
(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 syytk 15A NCAC 2C
�-. .011g.
9. YIELD (gpm): _METHOD OF TEST
10. WATER ZONES (depth): (+SrC, % con1
1 I DISINFECTION: Type'L— Amount
12. CASING: Wall Thickness
^^ Dep!� Diameter or Weight/Ft. Material
From t; l To lis Ft.
From To Ft.
From To Ft.
13. GROUT: Depth 0 Material I _
From To FL mere1-L
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY
CONSTRUCTION STAN
Submit the ors
27699-1636 Ph
nc No.
Method
Material
LOCATISKETOCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C9441ZZio
,tp,w I Y t lti C'r
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
7, fAD THT A COPY OF THIS RECORD HAS BEEN PROVIDED ,OATHE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri REVgh, C01
[phone], within 30 days.
GPOUNDVVAER SECJ ON
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264616
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION ft• 2686
020817 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential I i I Municipal I I Industrial 0 Agricultural I I Monitoring
Recovery 0 Heat Pump Water Injection I Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
JOHN SPARKS RD OFF HWY 226 OFF HWY 19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ROY W. BURLESON
Address 688 JOHN SPARKS RD ,
BAKERS1i✓1e.Er Rou
te Nip.)
NC 28705 23 41 GRANITE
City or Town State Zip Code 41 42 QUARTZ
DRILLING LOG DEPTH
From To Formation Description
0 23 DIRT
4. DATE DRILLED 10/18/2002 42 107 GRANITE
5. TOTAL DEPTH 125 107 108 QUARTZ
6. CUTTINGS COLLECTED YES I I NO I XI 108 125 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I. I NO I XI
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if 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.0118 Air
10. YIELD (gpm): 10 METHOD OF TEST
11. WATER ZONES (depth).5 ppm41-42 5 porn 107-108
0 GPM 0 ppm
12. CHLORINATION: Type
HTH Amount 23 If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 27 Ft 8 1/4
From To Ft
From To Ft
14. GROUT:
II
LOCATION SKETCH
ISahow direction and distance from at least two State
.188 GALV41N Roads, or other map reference points)
Depth Material Method
From 0 To 20 Ft Cernent Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
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.
e-Rt.i � 4, )/-fl —09-
DATE
SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Submit original to Division o ater Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
64617
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2686
020571 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery 1 I Heat Pump Water Injection
I xl
Municipal
Other
Industrial El
Agricultural Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SAKE&SVILIF County MITCHELL
PRIVATE RDS OFF LETF FORK TRAIL OFFSHOOT OUT
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JAMES E HERBERT
Address 772 WV 41 TFRR.
DEERFIELG`ee 4 FL 33442
City or Town State Zip Code
4. DATE DRILLED 10/23/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use ! " if Above Top of Casing)
X
DRILLING LOG
From To
0 75
DEPTH
Formation Description
DIRT
75 202 GRANITE
202 203 QUARTZ
203 260 GRANITE
200 261 QUARTZ
261 305 GRANITE
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.0118
10. YIELD (gpm)• B METHOD OF TEST Air
11. WATER ZONES (depth):1 qpm 202--203 5 qpn 250-261
0 qpm 0 qpm
12. CHLORINATION: Type Amount 46
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 83 Ft 6 1/8 _v-.50 FVC
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
14, Roads, or other mapLeference points)
Depth Material Method
From 0 To 20 Ft Cement Graviby Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
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.
Ait
SIGNATURE OF PE N CQNSTRUCTIIVG THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
st
0t2e(t
F
Le14r-k Tr,
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
264653
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION St.2886
0c7859 STATE WELL CONSTRUCTION PERMIT*Lesi a Reece
1. WELL USE (Check Applicable Box): Residential x Municipal
Recovery 1 Heat Pump Water Injection 1 1 Other
Industrial n Agricultural
If Other, List Use.
Monitoring
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAXERSVILLE County: MITCHELL
BEANS CREEK RD. OFF HWY 226 OFF )-{WY 19E
(Road Name and Numbers, Community, or Subdivision and Lot No
DRILLING LOG DEPTH
3. OWNER ALAN D. WAP.K From To Formation Description
Address P.O. BOX 1703 , 0 62 DIRT
WESTJEfrEt"NSINo) NC 28894 62 143 GRANITE
City or Town State
Zip Code
1.3 144 SHALE
4. DATE DRILLED 10/24/2002 144 218 GRANITE
5. TOTAL DEPTH 245 218 219 SHALE
6. CUTTINGS COLLECTED YES 1 1 NO 1 XI 219 245 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 1 1 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if 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.01 S 10. YIELD (gpm): METHOD OF TEST Ai_
11. WATER ZONES (depth):1 qpm 143-144 2 Apm 218-219
0 plpm 0 porn
12. CHLORINATION: Type HTH Amount 46
I XI
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 66 Ft 6 1(B .350 PVC RoaFts, or other map reference points)
From To Ft 'NN y
From To Ft se e
14. GROUT:
Depth Material Method
From O To 20 Ft Cement Gravity Harr
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS•
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 USE ONLY
t
SIGNATURE OF PPSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
264654
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2686
020915 STATE WELL CONSTRUCTION PERMITS,:Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery F I Heat Pump Water Injection
X
Municipal
Other
Industrial
Agricultural Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
TROUT POND RD. OFF HWY 261
)Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JOHN TIM CLARK
Address 1903 WILLESDON DR. WEST
JACKSOIWftL°Ef°nteNOl FL 32246 82 103 GRANITE
DRILLING LOG DEPTH
From To Formation Description
State Zip Code
4. DATE DRILLED 10/29/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES I I NO
7.
X
DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: B0 FT
(Use '4" if Above Top of Casing)
I Xi
0 82 DRIT
103 104 QUARTZ
104 280 GRANITE
280 281 QUARTZ
281 305 GRANITE
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.011180
10. YIELD (gpm)' METHOD OF TEST Air
11. WATER ZONES (depth):tl grim 103 104 9D opm
mom280 281
12. CHLORINATION: Type HTH Amount 46
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 88 Ft 8 1/8 .350 PVC Roads, or other map reference points) , f,R�
From To Ft. V'-
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft. in in ^�77
From To Ft in in. P1
16. SAND/GRAVEL PACK: Q
Depth Size Material
From To Ft
From To Ft.
4.fi
I�- ,1
SR iaa3
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
k21J.Le .e c 11-1K o R
SIGNATURE OF rJt SON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264614
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2688
020727-3 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
tx1
1. WELL USE (Check Applicable Box): Residential Municipal
Recovery 1 Heat Pump Water Injection I I Other
Industrial
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County ty1ITCHELL
JARRETT DR. OFF JARRETT RD. OFF I-M Y 228
(Road Name and Numbers, Community, or Subdivision and Lot Nod
3. OWNER JAMES F. BOYD
Address 120 JARRETT RD. ,
BAKERSUIt tE"r Route No)
City or Town State
4. DATE DRILLED 10/16/2002
5. TOTAL DEPTH 545
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 1 NO
8. STATIC WATER LEVEL Below Top of Casing: 545 FT
(Use "." if 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.0113
10. YIELD (gpm): 3/15 METHOD OF TEST Air
11. WATER ZONES (depth):3'18 gpm UNKNOV*IN 0 sppm
0 PPm 0 pprn
NC
I xl
28705
Zip Code
Agricultural
Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 82 DIRT
82 545 GRANITE
12. CHLORINATION: Type FITH Amount 0
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 65 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft ` 'face
�
From To Ft . t
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
iiTi;tLat �{
tCC
4-
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
-J , k/u iP f c ) h —1 &—O d
SIGNATURE OF PERN CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264606
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2668
020816 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential [ XI Municipal I I Industrial
Recovery I . Heat Pump Water Injection I I Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County' fvIiTCHFLL
JOHN CANIPE RD OFF SWEET CRK. OFF CUB CRK. OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BtI IY BLEVINS/MARY HOPSON/POLLY JONES
Address % BETTY BLEVINS , 2088 JOHN CANIPE RD
BAKERSOtec r Route No') NC 28705
City or Town State Zip Code
4. DATE DRILLED 10/17/2002
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if 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.0118
10. YIELD (gpm): 6 METHOD OF TEST
11. WATER ZONES (depth):6 Om 53-54
0 mom
12. CHLORINATION: Type `TH
13. CASING:
I xl
Al r
Agricultural I 1 Monitoring
DRILLING LOG
To
4D
From
D
DEPTH
Formation Descrip
DIRT
40 53 GRNAITE
53 54 SHALE
54 125 GRANITE
on
0 qpm
0 qpm
Amount 22
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft 6 1/6 350 PV"C
From To Ft
From To Ft
14. GROUT:
From
From To Ft
15. SCREEN
Depth
0 To 20
Ft
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
J�C�. Roads, or other map reference points)
t
Method
Gravity Flow
t•-•
4,
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
From To Ft
From To Ft
Size Material
n�,fti
t.
17. REMARKS:
kiCH
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
N CONSTRUCTING THE WELL DATE
Submit original to DivisionQuality,GW-1 REV. 12/99
SIGNATURE OF P 0
of ater Groundwater Section within 30 days
e
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
261CO7
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020764 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
X
Municipal
Other
Industrial
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _BAKFRSVILLE County MITCHELL
PENLAND RD OFF HVVY 194
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER NICK P. JOERLING
Address P.O. BOX 147 ,
PENLANbStreet or Route No.)
City or Town State
4. DATE DRILLED 10/11/2002
5. TOTAL DEPTH 385
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if 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.0118
10. YIELD (gpm): 4 METHOD OF TEST
11. WATER ZONES (depth):1/2 pQm 285-286 3.5 pprn 335 335
0 porn 0 gpm
NC 28765
Zip Code
I X4
Air
XI
Agricultural
Monitoring
DRILLING LOG
From To
0 42
DEPTH
Formation Description
DIRT
42 285 GRANITE
285 206 QUARTZ
286 335 GRANITE
335 336 SHALE
336 365 GRANITE
fl
12. CHLORINATION: Type HTH Amount 67
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 46 Ft 6 1/6 .350 PVC
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Ce>
• SRM
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
�yN
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Pi - W lair �H -p
FOR OFFICE USE ONLY
SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
,'1`j
-t
Oit
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR -
WELL CONTRACTOR CERTIFICATION #- Gil�Y�
C< STATE WELL CONSTRUCTION PERMIT#• L`
264608
ityi;4t Pur-Lo
WELL USE (Check Applicable Box): Residential I :1 Municipal
Recovery 0 Heat Pump Water Injection 1 I Other
11
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Ar`',-=G.,'�_L= County' '
%
(Road Name and Numbers, Comm pity, or Subdivision and Lot N .)
3. OWNER
Address Ocid
- .__,-,(Street-or Route No.)
City or Town
4. DATE DRILLED '7.-21-032
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing 2-2 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.01118..r
10. YIELD (gpm) METHOD OF TEST
11. WATER ZONES (depth)`
State
12. CHLORINATION: Type "I'
13. CASING:
From
From
From
Depth
To
To
To
14. GROUT:
Diameter
21 Ft e
Depth
From - To
From To Ft
Ft
Ft
15. SCREEN
I.1
I1
ip Code
Industrial 0 Agricultural I 1 Monitoring U
If Other, List Use:
DRILLING LOG
From To
DEPTH
Formation Description
r:iiRrity/T-E
xi
3RA�r'i'r_
I.1 7;
ti7 Jr 1.
72
QUARTZ
CiRAi\JTE
Ft
r i;rr_
Amount 1i
Wall Thickness
or Weight/Ft.
Material
Material
Method
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
From To
From To
Ft
Ft
Size Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
riI le -Roads, or other map reference points)
65,
�Lp
♦ ra
Cam'_ �p,yv
17. REMARKS. ? 15F VIL k e VCirn I l nett OFF r NCt.4 pPrc6ScttC; (3'/1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
/OOOF,THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. . ^
Wetyut
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE V
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No'
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264609
WELL CONTRACTOR. Dewey Wright Well Pump Co., inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020730 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential I XI Municipal I I Industrial 1 Agricultural Monitoring
Recovery I I Heat Pump Water Injection I I Other F I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County. MITCHELL
OFF GORDON SILVER RD OFF OLD KONA RD OFF VON
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JOSEF ZAENGERLE
Address 7320 FPW 80 NORTH ,
BAKERSOttEr Route N° I NC 28705 16 33 GRANITE
City or Town State
Zip Code
DRILLING LOG DEPTH
From To Formation Description
0 16 DIRT
II
33 36 SHALE
4. DATE DRILLED 10/14/2002 36 210 GRANITE
5. TOTAL DEPTH 300 210 211 QUARTZ
6. CUTTINGS COLLECTED YES NO X 211 255 GRANITF
7. DOES WELL REPLACE EXISTING WELL? YES I NO .XI 2558 256 QUARTZ
8. STATIC WATER LEVEL Below Top of Casing: 80 FT 256 300 GRANITE
(Use 4" if 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.0118
10. YIELD (gpm)• 6.5 METHOD OF TEST Air
11. WATER ZONES (depth)45 gPm210-211 2 ppm 255-255
0 qpm 0 qpm
12. CHLORINATION: Type H'TH Amount 45
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 43 Ft 6 1/9 .350 PVC sy t11e' Roads, or other map reference points) iSC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
17. REMARKS: 3 11tL14
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 11��
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
—' Ct W a.y�c2 JQi Pig 11 l R d
Quad No:
Serial No
SIGNATURE OF PPiSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if 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.01 J6
10. YIELD (gpm): 3 METHOD OF TEST
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]
264610
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Weii Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020707 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
xl
Municipal
Other
Industrial
Agricultural Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE DR. OFF HWY 261 OFF FM/Y 228
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DOUGLA.SJ.BURLESON
Address 4553 HWY 261
BAKERS1TLttEr Route No.l NC 28705
City or Town State
10/8/2002
305
Zip Code
IX1
Air
x
DRILLING LOG
From To
0 87
DEPTH
Formation Description
Iv1UD/ROCKS/GRVL
87 258 GRANITE
258 259 QUARTZ
259 305 GRANITE
11. WATER ZONES (depth):3 ppm258-259
0 ppm
0 glom 0 ppm
12. CHLORINATION: Type HTH
13. CASING:
Depth
From 0 To 90 Ft 5 1/4
From To
From To
14. GROUT:
From
From
Ft
Ft
Amount 57
Wall Thickness
Diameter or WeighVVFt. Material
.188 GALV.
Depth Material
0 To 20 Ft Cement
To Ft CEMENT
15. SCREEN
Depth
From To Ft in
From To Ft in
From To Ft in
16. SAND/GRAVEL PACK:
Depth
From To Ft
If additional space is needed use back of form
Method
Gravity Flow
GRAVITY FLOW
Diameter Slot Size Material
in.
in
in.
Size Material
From To Ft
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
GQ'
17. REMARKS:i'•$('‘
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.
e&; W fiat 11—)g o a
FOR OFFICE USE ONLY
SIGNATURE ERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264611
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020863 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box)' Residential
Municipal I I Industrial 0 Agricultural ❑ Monitoring
Recovery I 1 Heat Pump Water Injection [ I Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVIl I F County: MiTC HFI I
ROBFRT PHIU IPS Rn OFF SI AGI F Rn OFF SNOW CR
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
From To Formation Description
0 62 DIRT
eAKEPsOtetetE°r R°°te N°' NC 28705 62 488 GRANITE
City or Town State Zip Cade 4rs6 487 SHALE
3. OWNER CHRISTOPHER L. WARREN
Address 5 ROBERT PHILLIPS RD.
I XI
4. DATE DRILLED 10/10/2002 497 505 GRANITE
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES I I NO I XI
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if 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.0118
10. YIELD (gpm)' 30 METHOD OF TEST Aar
11. WATER ZONES (depth)''0 PPm488-487 0 ppm
0 Gpm 0 PPm
12. CHLORINATION: Type HITH Amount D2
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 66 Ft 6 1/R 350 PVC: Roads, or other map reference points)
From To Ft
From To Ft
6.l,"����
J 1 tn�5 �•
`•r �P (�L\i ltrl
14. GROUT: ?C o t ,y.
Depth Material Method
From 0 To 20 Ft Cement Gravity Fiow
I xI
If additional space is needed use back of form
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
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.
tRa4{: �wv1/�., >�-�Z /l-I S -b Q
SIGNATURE OF SON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
264601
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
020928 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery r I Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE
UPPER CUB CRK RD. OFF HWY '1'z6
Municipal
Other
Industrial 0 Agricultural Monitoring 0
If Other, List Use.
County' tvMITCHELL
DRILLING LOG DEPTH
3. OWNER SKIP WEIFORD From To Formation Description
Address % MLDRED TOtvMLINSON 218 UPPER CUB CREEK. 0 22 DIRT
BAKERSOLrtt°rR°uteN°.I NC 28705 22 279 GRANITE
4.
5.
6.
7.
8.
(Road Name and Numbers, Communfy, or Subdivision and Lot No.)
City or Town State Zip Code
DATE DRILLED 10/28/2002
TOTAL DEPTH 285
CUTTINGS COLLECTED YES I NO
Xi
DOES WELL REPLACE EXISTING WELL? YES NO
STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if 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.0118
10. YIELD (gpm): 100 METHOD OF TEST Air
11. WATER ZONES (depth):100 ppm 270-280 0 gprrl
0 ppm 0 pprn
12. CHLORINATION
13. CASING:
279 280 SHALE
280 285 GRANITE
Type HTH
Amount 433
If additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State ` V-1
From 0 To 26 Ft 6 1/8 350 PVC tali Roads, or other map reference points) 1'
From To Ft �\) +� jai n,L��y
From To Ft \ t �`T'
14. GROUT: S
Depth Material Method e6
From 0 To 20 Ft Cement Gravity Fiow vlS
From To Ft N\t,
15. SCREEN: /ti
`t
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in v
From To Ft in in �, mt
�(O•a\
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
t
a �w
( u.b Cyr is 1W(1
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
' / `) D _
SIGNATURE
OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

1. WELL USE (Check Applicable Box): Residential Municipal I I Industrial Agricultural [ I Monitoring
Recovery I I Heat Pump Water Injection Other El If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BA}(ERSVILLE
FORK MTN RD. OFF I-IWY 281
County: MITCHELL
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER KENT D. MCLAUGHLIN
Address 1782 FORK MTN RD. ,
BAKERSI'hLr9Er R°°te N°") NC 28705
Zip Code
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]
?64602
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2888
020706 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
City or Town State
4. DATE DRILLED 10/25/2002
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if 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.0118Air
10. YIELD (gpm): 5 METHOD OF TEST
11. WATER ZONES (depth):33/4 ppr'81-52 3/4 qpm 214'-215
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 44
I XJ
DRILLING LOG
From To
0 50
II
DEPTH
Formation Description
DIRT
50 61 GRAAITE
61 52 QUARTZ
82 214 GRANITE
214 215 QUARTZ
215 245 GRANITE
13. CASING:
From
From
From
0
Depth
To
To
To
14. GROUT:
15
From
From
Diameter
53 Ft 6 1/6
Depth
0 To 20
SCREEN:
Ft
Ft
XI
I X I
Wall Thickness
or Weight/Ft. Material
.350 PVC
Material Method
Ft Cement Gra itd Flow
To Ft
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
From To
From To
Ft
Ft.
Size Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Stag
Roads, or other map reference points) NrD •-
a vl
1 0 IZ ►L •-f fz4
0 - 7
of
ca
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1/ nu J/?Mg 11-18-0
SIGNATURE JERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
T
l4
(6
cc
0
1'
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
264603
WELL CONTRACTOR: Dewey Wright Weil Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2898
020647 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential I X1 Municipal' I Industrial 0 Agricultural I I Monitoring
Recovery 1 1 Heat Pump Water Injection I I Other 1 1 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 9AKERSViLLF County MITCHELI
HWY 228 OFF HUGHES GAP OFF COVF CRFFK OFF H
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER RICK D. MILLER�J
Address 3644 NC F{WY 197
GREEN hhtY PF.MII N°' NC 28740
Zip Code
City or Town State
4. DATE DRILLED 10/1 `2002
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use '4" if 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.0118
10. YIELD (gpm)' 7 METHOD OF TEST
II
I xl
Air
�1
'xi
DRILLING LOG
From To
0 20
20 41
41 175
II
DEPTH
Formation Description
MUD/BOULDERS
DIRT
GRANITE
175
176
QUARTZ
178
205
GRANITE
11. WATER ZONES (depth):7 QPm 175-176
0 ppm
0 ppm 0 CwPm
12. CHLORINATION: Type HTH Amount 3la
13. CASING:
From
From
From
Depth
0 To
To
To Ft
Wall Thickness
Diameter or Weight/Ft. Material
45 Ft 6 Vs; 18+; GALV
14. GROUT:
Ft
Depth Material Method
From 0 To G0 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
17, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFOlTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�j,
A.pn.(.c8 f�,% 4 tint,
SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

1
WELL CONSTRUCTION RECORD 265671
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .)Oe� 1'/' �'f L�ij CERTIFICATIONp 3/6-3
JuSf/gyp CizU
WELL CONTRACTOR COMPANY NAME
r ll/ry PHONE # (Yt& %L4-4/-YO
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 9Municipal!Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: S/ici,CQ. r 1etc— Count
Gears fray.X.
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: fJ D �� A v' //5
Address d9/'7 &rntfk Ctn vt/
(St for R
t r / Route / h2- C, (,) s 1-1.7
City or Town State Zip Code
(g)- 7c, cc �ci8/
Area code- Phone number
4. DATE DRILLED //— % —Q
5 TOTAL DEPTH. ? e S
112,4-lt//
6. DOES WELL REPLACE EXISTING WELL? YES c" NO ❑
7. STATIC WATER LEVEL Below Top of Casing: id FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): L/ METHOD OF TEST
O. WATER ZONES (depth): a? 6 /ft1 •/ F>
,2 (t,/J jy/ y5 LOCATION SKETCH
I I . DISINFECTION: Type C/o Jo <- , e Amount jr ; c 23 , Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
�bpographic/Land setting
Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
i3 ---2Se-G, „t
7,25 "7Y Q,-tt'"'oc&
c/[—fl5 6,--,, ,
From C To S 3 Ft. t 79 yv
From <3 To 5 S Ft. (o %y • /8f 6A i_G'
From To Ft.
13. GROUT: Depth Material Method
From li To ,11)0 Ft. e % Yirr-ircc(r 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
CCnit
/1211
Goole gd
W
I DO I IEft L¢Y CEWFtFt —1AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
- CONSTRUCTION 1'4 j S, AND
NDD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tq the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I-24699-1636{4xreNun{419)7$3-3221,within30days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
265670
North Carolina - Department of Environment and Natural/Resourcesop- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Vref),I, et,//�/'`)hai 4 CERTIFICATION 8 3/79
WELL CONTRACTOR COMPANY NAME ,3U S tic 1, )e. I (/r' I /1, 45 PHONE It (gm 7241 'yr vJ-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT!!
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Sil✓-ciec (�i'✓>1 County ✓i1if/
?-la I( Taw4 I(CA
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k;Lhv7
Address crr'nCt/✓IC ken y .l j
(StrrL)r Root e No.) r1 f1
'3 .xce 1 MI? N.\ n I l
City or Town State ) Zip Code
(sue)- 76 S-) O
Arca code- Phone number
4. DATE DRILLED / /- SC 02
5. TOTAL DEPTH: lir S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IW
7. STATIC WATER LEVEL Below Top of Casing: $O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): r-/ METHOD OF TEST At ✓"
10. WATER ZONES (depth): c2 GPM eJ aoD
a (Pt1 �65
11. DISINFECTION: Type (l, Ior• r.A_ Amount S w 73127
12. CASING: Wall Thickness
Depth Diameter
From U To 7s Ft. (JAI
From 3S To SS Ft.'
From 5C To St7 Ft. lc/fr
13. GROUT: Depth Material Method
From 0 To 2 0Ft. ye: if / nrn,.- e,/t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
4/0FC Fl.' to N O c ,7,
Topographic/Land setting M
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description t U .gyp eh,-
.2n- 3C Q; fCcoc±
S'n ., �fUSJ L re; r, • �c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rgad
or Weight/Ft.Material numbers and common road names O
+n ///;o�ee)
cea
z
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II
`b'tulltgit the original' to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2069 -' 63(rPfjpne Nq., p t9) 733-3221, within 30 days. G W- I REV. 07/2001
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
w,I(

133(p
cc;Vc.z
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) r'i A/C 5[jtr'�L4nCtn CERTIFICATION #,3)7/q
✓
WELL CONTRACTOR COMPANY NAME .>L15-✓•,'<< ('J2 �� r 11 Ne PHONE # f'32$)-I2U-(/547
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Qr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: y,�
Nearest Town: Sp(ULe 2' ne_ County Y�'I,4c he 0
Sv 5 Lc. kZ
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: goricke. got,n2
Address C? PS P.nerc)c
ZSG57
2C0 City or Town State Zip Code
(%2'i)- 7t-S- Sai,a Nr z
4
5
6
7
(Street or Route No.)
N12.nJ/9 r1(t C
Area code- Phone numbe{
DATE DRILLED II- to — O Z.
TOTAL DEPTH: 39<
DOES WELL REPLACE EXISTING WELL? YES 0 NO F'4
STATIC WATER LEVEL Below Top of Casing: XC' FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (, METHOD OF TEST A, r
10. WATER ZONES (depth): 6{2/0 by CSC
265669
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
F atllon Description
rf p
SDI-) Q,rcn'4t
Dr-} En(k
Lrtr -2
D'r4 krr
r cn,4z
DEPTH
From To
O UO
y(7 - y5
4- CLp
sn S�
S'3—
4lr- 3Ss
4 C Phl ),y 3cc LOCATION SKETCH
1 I. DISINFECTION: Type C "IQ Amount 'o; (. )92, Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To O S Ft. N, YY (k) pVC. 13,,K'rs b'-11Z
/
From (25 To (, 7 Ft. in %/
From To FL
13. GROUT: Depth Material Method
From 0 To 20 Ft. L / prrL+; and
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
2LC,:
S
4'd
O
O
r*l
n
Mcir
16. REMARKS
r^-�1rr 1D9BEI(EfYtCjRTfl3TIf AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
L) JI CONSTRUCTION STA14 RDS, AND THATIA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L
(� /r -02
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
_.-._. Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276904636 Phone No. (919 733-3221, within 30 days. GW-I REV. 07/2001

265667
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) k { CA -6 • Q. h it n'n CERTIFICATION # • i J % C/
WELL CONTRACTOR COMPANY NAME Sf 5'F' , 0 P L�' e 11 Dr: I) (�(3 PHONE # (3Y* TJ..,Q rl''
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I . WELL USE (Check Applicable Box): Residential C'� Municipal/Public El Industrial ❑ Agricultural ❑
Monitoring ID Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use
2. WELL LOCATLQN:
Nearest Town: SpkF F5P,) d( County/1Y1 -Fe. hPII
.mil nit\ `E rn (k S a 17 C c7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DO,i, A i %; Vet:.
Address 177 I:DI Fi'_ Oat( 2(1
(Street or Route No.)
G[fi
1/t.-i%(P N/t.
City or Town State Zip Code
(?7G)-.)S5-'1Cri
Area code- Phone number /
4. DATE DRILLED ii -) -
5. TOTAL DEPTH: 41 o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f
7. STATIC WATER LEVEL Below Top of Casing: 9 CI 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): cl METHOD OF TEST G •
'10. WATER ZONES (depth): I J P t1
eh rr 1 l5 O
yF,; by 310
1 I. DISINFECTION: TypeLi i Jc i q r Amount 3().--
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From To Ft.
From C ' To 1 Ft. I.:.
From U To (J 5 FL l• Fy . /55/
13. GROUT: Depth Material
From To Ft.
From (
To -20 FL ,1 E I
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
@Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 -- 5;J
5
0
,
-ref
5 P' 6 0 0 ri trRr: C k
b C' _ t� c 5 (rr•
LOCATION SKETCH
�a'), j%Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names. C
'. O p
\
r,
P
fi
-: i V
Method
Material
696
O �0
rn
c� rn
G <
N ==
—0 m0
c
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STIANDAi DS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-/ �.- / ()),Z
ifj SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to -tile rpntvision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.1(919) 133-3221, within 30 days. GW-I REV. 07/2001
HE)
n
G
Z

Area code- Phone number
4. DATE DRILLED I 1 - `i -U Z
5. TOTAL DEPTH: �(24
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 01
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ? METHOD OF TEST / i r
10. WATER ZONES (depth): C P )n by ln0
/ (pM byaHo
WELL CONSTRUCTION RECORD 265666
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ca'J11P (MI10 VfS CERTIFICATION # 3/Op 2
d
WELL CONTRACTOR COMPANY NAME ,) ( /1/C-P w/
'C. /7 r 11, 145 PHONE # f£a) 72I(-`1n/dam
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential BY-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: s County /4/ 24-w //
C at, C re Lk ecA
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
Topohic/Land setting
❑Ridge @dSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: AI be v- I- A O Lot, (degrees/minutes/seconds)
Address L/'70 r-,,.h (e t cfC Fr( Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
b L r-sv, /4 AlItc- 2 s'oos DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(1?1()- &in - `I( S3 n - 3 of;- -
3 - ) 5-- G , le_
IT- 070 O:rf-F-,Peck
9o- 30S
k
LOCATION SKETCH
11. DISINFECTION: Type C 1, ) Cr, ,,, Amount Yu2- co '137,; Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
12. CASING: Wall Thickness
Depth Diameter or Weight/H. Material
From rO To dS' Ft. (, 'Y '-/O UC_
From 3 g To 30 Ft. L /-, ,1 S5" /(AI ✓
From To_41,__ Ft.
13. GROUT: Depth Material Method
From To Ft. /
From 0 To a)O FL � FcJ / fr11 t✓c
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:
--1POlPrEREISY ER-TIF-y,,T'HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I~ L CONSTRUCTION STA!4I3ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
6R` ,4KF . [phone], within 30 days. GW-I REV. 07/2001
iJ
ASr; IL ILL HE FI1IL

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 6 6 9 9 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687
020978 Steve Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential
Municipal I I Industrial I I Agricultural I I Monitoring
Recovery I I Heat Pump Water Injection I I Other I I If Other, List Use:
I XI
II
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: OAKERSVILLE County MITCHELL
AARON BRANCH OFF B&B RD. OFF BEANS CREEK RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER SHELLEY BLUM From To Formation Description
Address 330 AARON BRANCH RD. , 0 55 DIRT
BAKERSOt ttEr Route No l NC 28705 55 187 GRANITE
187 190 QUARTZ
City or Town State
4. DATE DRILLED 12/4/2002
5. TOTAL DEPTH 220
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing(
I 'l
Zip Code
I XI
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.011&,
10. YIELD (gpml' METHOD OF TEST Jr
11. WATER ZONES (depth)'30 Ppm 187-190 0 ppm
0 qpm 0 PPm
12. CHLORINATION: Type HUH Amount 38
190 220 GRANITE
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 80 Ft 6 1/8 .350 PVC C1) Roads, or other map reference points)
From To Ft .01.n IqE
From To Ft \
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/
From
From
17. REMA
IDOHE
CONST
Material
—1\ iDedth
To-- ---Ft i 1
To Ft
43
3.1
ERTIFY. HALTMICW.EL..0 WACONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
N-TANDARDS ANEIDTHAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
Quad No.
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
266976
WELL CONSTRUCTION RECORD
020916 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2837
1. WELL USE (Check Applicable Box): Residential
Recovery I 1 Heat Pump Water Injection
X
Municipal
Other
Industrial 0 Agricultural E Monitoring
If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County MITCHELL
JOHNSON RIVER BEND LANE OFF JOHNSON CEMt1ER
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER HAROLD L. NOBEL
Address P.O. BOX 271
DRILLING LOG DEPTH
From To Formation Description
0 30 DIRT
WHITEHCStSE' R°°`° "°' FL 32220 30 90 GRANITE
City or Town State Zip Code 90 93 QUARTZ
4. DATE DRILLED 12/6/2002
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: _60 FT
(Use "+" if Above Top of Casing)
X
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.0118
10. YIELD (gpm)• METHOD 9ED OF TST Air
11. WATER ZONES (depth) 5 3 gpm
0ppm 0 0 pm
X
93 420 GRANITE
12. CHLORINATION: Type HTH Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 42 Ft 6 1/4
From To Ft
From To Ft
14. GROUT:
.188
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN
77
If additional space is needed use back of form
Material
GALV.
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
pepth Sjze rzz1 Material
From 1.30 �Ft -'
From � t To Ft 1
17. REMAR : L
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Y a
Luaus
I DO HE EBY CERTIFY THAT THIS WELLIWAS ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR CTIQN STANDARDS AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
GF :r S�
)IrlrF 7ti-L' � —_--03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original 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
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• �ReiPl
WELL CONTRACTOR CERTIFICATtON p:
STATE WELL CONSTRUCTION PERMITN:
268861
f-PQlr Soil'
1. WELL USE (Check Applicable !lox): Residential®' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Rocovery ❑ Heat Pump Water Infection ❑ Other II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ',,/ ,,I/
cares! Town:.-Qrh' Pine County. %%1/7�-//ci/
(Road Name and Numbers. Corn/nunily, or Subdivision and Lot No.)
3. OWNER ridpr5:sn Fu n;ly 'tine (2n,b Sob)
Address
reo or ou o No.)
Cily or Town Slate
A. DATE DRILLED a'I5-0.2
5. TOTAL DEPTH It".
6. CUTTINGS COLLECTED YES I I NOP1
7. DOES WELL REPLACE EXISTING WELL? YES ( j NO['
8. STATIC WATER LEVEL Mow Top of Casing: 26 Fr.
(Use'+' II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
•Top of casing terminated etfor below land surface requires a vnrtance In accor-
dance with 15A NCAC 2C.0110 �r,�
10. YIELD (gpm): /5 METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG
From To
Boa
Zip Code
DEPTH
Formation Dascrlpr'on
n
tv
fir
lV
m.:
12. CIiLORNATION: Type /-/ 7H Amounts/LS If additional space Is needed use hack of form
13. CASING:
Wall ThicknessLOCATION SKETCH
Depth Iamelor or WeIohWPI. Material (Show direction and distance Irorn nt least Iwo Slab
CD
From D To 2//J FI • 'IT`$ Sf Roads, or other map reiorenco points) (....)
From To Pt, / L t-n
From To Ft. �he�-�jypt'( %i I M �� ._
14, GROUT: J_he f (i` , n.�La
Depth - Matellel Method., 1 a%%/7L
From o To.�QFI Sphtrefe p nlkres%
From To It
15. SCREEN:
Depth Diameter Slol Size Material
From To FI In In
From To FI. In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth
From To
From To
Size
Ft
Ft
Material
0
0
0
17. REMARKS:
I DO HE'Ta CERTIFY THAT THIS WELL'„SNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTNI4)C IN STANDARDS,' AND THAT • Y OF TkkLL-0j3S IECbRD HAS BEEN PROVID , TO THE WELL OWNER.
FOR OFF
ouad No:
Serial No.
tE\OE ONLY
Su
J
a-5-o
SIONATURE eP ERSON CONSTRUCTING TI WELL DATE
1 to Division o Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina - Department of Environment and Nelurel Resources - Division of Water quality- Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
268860
From
From
SAND/GRAVEL PACK:
Depth Size
From To Ft
From To FI
REMARKS:
WELL CONSTRUCTION RECORD WELL CONTRACTOR- RIY1AIV Z. 2ALL,
WELL CONTRACTOR CERTIFICATION.: o749,.3
STATE WELL CONSTRUCTION PERMIT.:
i. WELL USE (Check Applicable Sox): Residential ✓� Municipal El Industrial D Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water In)ecllon [1 Other 1-1 If Other, List Use:
2. WELL LOCATION: (Show sketch of the Iocailon below) t��
N3�resl Town: G- • County. Ml-{-'C1-1ej[
oed NFme end Numbe:e Commu y, or $ubdlvislo pnd Lot No.y� / e 77 DRILLING LOG DEPTH
1, OWNER lAga1:'1(] �D'jyte Cen+.ar �r'r0(k�Cb� From To Fonneuon Description
Address 4, �� prt A✓onug
(Shea or I{ou a o. D (66
'1-77 /n0 - )4% E-die4(Jc
Zip Code
'Pruce -Pine NC
Clly or Town Stale
DATE DRILLED �J-, ±rrOG-
. TOTAL DEPTH s
CUTTINGS COLLECTED YES I NO[4
DOES WELL REPLACE EXISTING WELL? YES [ I NO17(
STATIC WATER LEVEL Below Top of Casing: in FT.
/ (Use -,' II Above Top of Casing)
TOP OF CASING IS ! FT Above Land Surface'
op of casing terminated aVor below land surface requires a verlance In accor-
snce with 15A NCAC 2C .0118
). YIELD (gpm): ra METHOD OF TEST tS V
I. WATER ZONES (depth): P.)
w --
=7
2 LORINATION: Type H TH Amount 7.Q_ rilLS II additional space is needed use back of form
1. SING:
Wall Thickness
Depth Diameter or Weight/Ft. Maaledall
_trap_l�
From �_ To L Ft L . a 5 a)G,l-71 Pvc.soe
From To Ft.
From To Ft
GROUT:
Depth Malarial Method From D To vZ-0 FI OQ 11 LLf i'E iTh2lr _
From To Ft
SCREEN:
Depth Diameter Slot Size Material
Frotn To FI In In
To Ft In In
To FI. In In
Material
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
dAD
Spruce Pi , Ivy
I DO HEREDY cE,{fi IFY THAT THIS WELL WAS d
CONSTRUCT ON SirrkNOghos, AND THATt
1 OFFICE
L No:
Serial No.
U
57E !ON LY
J l''
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
a tc 3-a5-(*)3
Iu�aunATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit od inal to Division of Wale( Duality, Omundwaler Secllon wllltin 30 days
GW-I fEV. 12/99

North Carolina - Department.of Environment and Natural Resources - Division of Water Quality - Groundwater Section L. 4 U ) 1
163gRMaaiil Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
�. �.{' S4i RUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
` �"` 2b8b
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: Leslie fleece
NOV 7 7 2002 Hbil,gS
em
R J.vvFI,LUSF ( '(4Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal Industrial 1 Agricultural I I Monitoring
Other If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SAKERSVILLE County MITCHELL
PRIVATE DR. OFF TOECANE RD. OFF H-!L°.Y 226 OFF H
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER EL AJNE MILLER
Address 53 TANGLEWOOD RD. ,
BAKERSU1tt r ROUte N01 NO 29705
DRILLING LOG DEPTH
From To Formation Description
0 10 DIRT
10 160 GRANITE
City or Town State z)n Code 160 161 QUARTZ
4. DATE DRILLED 10/21/2002 101 185 GRANITE
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES NO
XI
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "*" if 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.01
gb
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth):30 porn 160-161 0 C1pm
Li- gam
0 porn
a
12. CHLORINATION: Type H Amount 18
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 21 Ft 6 1/4 .18E GALV. Uf"
From To Ft C3Qn' vNk'
From To Ft
14. GROUT:
Depth Material Method
From _ 0 To 20 Ft Cement Gravity Flow
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1cl
15. SCREEN: rg
Depth Diameter Slot Size Material S1
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
1D NLE 'I U IG
I DO HERtbY LttsnrT 1
CONSTRUCTION STAND
MAR 14 2003
0
Al
R
OR OFFICE USE ONLY
OR
SECTION
ASHEVILLE REGIONAL OFFICE
vv
/v��ti,eJ--
Na-
aac,
CVO
r
as SAtUL t) Q
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL Ci cF�
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER ?ec4QLt.4Zw
co'‘
SIGNATURE of SON CONSTRUCTING THE WELL DATE
Submit original to Division oft ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

WELL CONSTRUCTION RECORD
"G89S
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) $(QVJflis''
7 'T'Ob! f CERTIFICATION# 75 O
WELL CONTRACTOR COMPANY NAME (]?t C.5(S_t ) i I w QI 1 DR' / 1, AXE PHONE # (Pa$) 733 'o6c-,R
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ,Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: II
Nearest Town: 4 KGRS ✓. County/4 t-17116 (/
'20 ReAb, ,C_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k
Address a
I 1<P k-7
. ea by C` [-A)
(Street Route No.)
b>Is�lt i(e :zitc
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ) 2 -G-oa
5. TOTAL DEPTH: 1 ` O - a
6. DOES WELL REPLACE EX STING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 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): / () METHOD OF TEST A, i✓L
10. WATER ZONES (depth): •T1
11. DISINFECTION: Type
eel
setting
dge ❑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
�— yo d;,2�/ IoatQ
`lam / go c(r bik
ttA, c C'iw4-
c.hir7R _ Amount (o et, 7-
, Show direction J
12. CASING: Wall Thickness
Depth Di ter
From 0 To `1� Ft. 6 k
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ref%
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.
on and distance in miles from least
or Wet
LOCATION SKETCH
two State Roads or County Roads. Includ6-the road
t/Ft. Mate ial numbers and common road names. -Tt _
�l 5 r I
rV c
J
Material •
Ft. LPnte
Method .
f>; 2
Slot Size Material
in.
in.
Material
O
cJ1
c.n
16. REMARKS:
tbNkSTROCTION STA
Submit the original to th
27699-1636 Phone No. (919
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r
SIGNATURE 0 PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 268990
North Carolina - Department of Environment and Natural Resources - Division oh Water Quality - Groundwater Section
ST
WELL CONTRACTOR (INDIVIDUAL)NAME?(print) 40/l� ISM. am)
�
WELL CONTRACTOR CONI l'ANY NAME `J 2 s%ce/( "—et I ,2>t'r'll`AXXIt
CERTIFICATION #-5-eir%
PHONE # trat9 alf�R
STATE WELL CONSTRUCTION PERAII'r# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l7 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: )tai-t`(.'-i25 V) I te-
County r✓C, -kk.t i
'c--r kelA-k_ -Psp /PI uv
(Street Nmne, Numbers, Community, Subdi tsion, Lot No., Zip Code)
3. OWNER: �k •�*I Q_.
Address I-1U3 "'Cr)cL #i11 (-Ade-
(Street or Route No.)
Plevogoe
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
Zip Code
6. DOES WELL REPLACE EXIS7FING WELL? YES ❑ NO B-
7. STATIC WATER LEVEL Below Top of Casing: 'j O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance yith 15A NCAC 2C .0118.
9. YIELD (gpm): ce., METHOD OF TEST Ar-+r^�
10. WATER ZONES (depth): ' Cvt tart, 1St
11. DISINFECTION: Type Amount 6 eti�
12. CASING:
Depth Diameter
From 0 To .2 ( Ft.a -
From To Ft.
From To FL
13. GROUT: Depth
From C To 2C) Ft.
From
14. SCREEN:
From
From
15. SAND/GRAVEL PACK
Depth
To
Wall Thickness
or \Veight/Ft.
C
Method
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
From
From
To
M atcrial
Cc�
�
IL�
Ft.
Size Material
Ft.
pographic/Land setting
BRidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) • •
Latitude/longitude source:❑GPSDTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
290
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AN4-Hi.3 A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ /
PERSON CONSTRUCTING THE WELL DATE
Submit the original to.the 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No-('19) 7 3-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD ..
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME.(print)t(a1/1'A_, qR `i
WELL CONTRACTOR COMPANY NAME 'lJ_s6'� -1 (3C� II ' V t% (IA tiv
268991
CERTIFICATION 4.24 1F'
PHONE 4 (�5'rs)73-cicr a?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPEIiMITt/
(if applicable)
(ifapplicable)
I. WELL USE (Check Applicable Box): Residential IJt' Municipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:9.04110 SVi 1 Co inty /n.Jcite I I
m at— iZ�. rnn1' Mc(0(
Numbers, Community, ,Subdivision, I No.. Zip
Code)
(Street Name, y )
3. OWNER:
Address- i
c
City or Town
( )-
o'I 3/ hs_ci Rl l4 40 R Pm
(Si t or Route No.)
sC- 2g1i4'`I
State
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 35- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): '7 METHOD OF TEST >1-1A2
10. WATER ZONES (depth): x5eST, 79 I Le._)/ /'?A /'3rrr�
ll. DISINFECTION:Type_r„k Jr..s _ Amount 6;car
12 CASING: Wall Thickness
Depthd Diameter or Weight/FL Material
From C) ToQ Ft. (c--;14 ( SYR-z 1 / C.
From To Ft.
From To Ft.
13, GROUT: Depth Malcriaf Mcioq
From O cw To *VC Ft. az. oRe ci
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To F. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
EdTopographic/Land setting
ge DSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH
From To
O 730
_7<
76 - g0
GO - 3:-Z)
DRILLING LOG
Formation Description .
ram& (c'c'st eod<
LOCATION 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
CONSTRUCTION ST�CNDARDS, ANDIA OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to ii c
27699-1636 Phone No. (1'
—/ -Ora,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

STATE WELL CONSTRUCTION PERMIT/4
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) j4V) A-i r,X-fCY-L-Dty CERTIFICATION#-259d)
WELL CONTRACTOR COMIPANY NAME
50 iP IAl�� b) ,• PHONE # �`b) 3-
ASSOCIATED VQ PERMIT#
(if applicable)
268992
1. WELL USE (Check Applicable Box): Residential 1unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI N: c-�
Nearest Town: iji�` S•"\tii[:ounty +fir�C
1'lo
(Street Name, Numbers, Conununity, Subdivision, t No., Zip Code)
3. OWNER:
Address )70 S et.'
(Street or Route No )
5p/2uce_ ?y :n-a- PLC,
• City or Town State
( )-
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ET
7. STATIC WATER LEVEL Below Top of Casing: 7° FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST —`(Z
10. WATER ZONES (depth): '7o
11. DISINFECTION: TypeChlPRtcr
12. CASING:
Depth
From 0 To q) Ft.
From To FL
From To Ft.
13. GROUT: Depth
From 0 To S':)
From To
14. SCREEN: Depth
From To
Amount r, oz
Wall Thickness
Diameter or Weight/Ft. Material
G t44 x?v
Material
Ft.
Ft.
Diameter
Diameter
Ft. in.
Ft. in.
Method
Slot Size Material
From To in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
opographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DRILLING LOG
!Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/SIGNATURE OF PERSON CONSTRUCTING THE WELL
•
DATE
Submit the original to the Div Sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733- 221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
kWELL CONTRACTOR (INDIVIDUAL) NAME (print) �e1l�ft.) RSr»J
WELL CONTRACTOR COMPANY NAMEeltip, sµ II tA)Zl( bR;11 ✓t-.
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
268998
Groundwater Section
CERTIFICATION # 75 °
PHONE # A)%53-c2COR
1. WELL USE (Check Applicable Box): Residential ErMunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: 1�
Nea'refst Town: €7-- alZ' Cs.J1 K' �
_� County :�[
AJ IAAA Da-V. &&Ace 1 oc-C rtAiiw� +�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: th� I �\ 1A_
Address 3 AinLO ii rsN r
dd
d"es"tee- � 2� 1t3C 2e'rh7
City or Town ; State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED J&-Ig- o
5. TOTAL DEPTH: ?3OCO ,
6. DOES WELL REPLACE EX STING WELL? YES 0 NO l3
7. STATIC WATER LEVEL Below Top of Casing: Q© FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST A -I
10. WATER ZONES (depth): $O j 1 t
11. DISINFECTION: Type Cl\bn_?A�- Amount Coot
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C5 Toad Ft. C54 1BV cc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 'S Ft. c-so ceso tom,..,, peck
From 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.
reef or Rout o.)
pographic/Land setting
dg❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH - DRILLING LOG
From To Formation Description
n - 3 c & I Rf:` ,0.4"
17---co 0R.- - 1<
O
rn
LOCATION SKETCH �j
Show direction and distance in miles from at least-
two State Roads or County Roads. Incb4e the-3oad
numbers and common road names. p
Cr7 n
16. REMARKS:
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
l'HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0-/S -Oa
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original tote Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No: (9I ) 733-3221, within 30 days. GW-I REV. 07/2001
E

269101
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 4;V;U ' €T he Sew&) CERTIFICATION 4 Z&`b
�rL'
WELL CONTRACTOR COMPANY NAME �L.r it tee II bRrll�t�t PHONE # (83) /733. 11,0Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) . (if applicable)
L+/
1. WELL USE (Check Applicable Box): Residential l Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other EirffrOther, List Use pfte Asft' i
2. WELL LOCATION: J
Nearest Town:S7 County PI t` c- 1
931 0 xkle.kg_ ?a, c�:y eye, )c
(Street Name, Numbers, Coo munity, Subdivision, Lot No., Zip Code)
3. OWNER: C-)40 c C> Qp-e N
Address /-t-ZI ,�,csc_lef tk c ?�
(Street or Route No.)
e /IJL—
ny or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED / U - 13-0 a
5. TOTAL DEPTH: L/00 C
6. DOES WELL REPLACE E STING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 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 ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST i, (Z .
10. WATER ZONES (depth): e('3yo
r r
11. DISINFECTION: Type !ji tepjta= Amount t e'z.
12. CASING:
Depth
From o To '33 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From L') To '�3> 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.
Wall Thickness
Diameter or Weight/Ft. Material
C>r� »ISY
e).4iy.
Material Method
16. REMARKS:
Topographic/Land setting
❑Ridge [3Siope ❑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 .- / a d-C*1- 1 pace /
!a- Roo L{,%•�/ spew
— i`w tee .'>1:C1 sc.het
TWO yoo e.A,, 5j942
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ad hZ 83d CO
c
F.7 Ida gQ,HFFtE Y(yFyilLl
CoNsT1t31CTI0
f — —}
Submit the original [(tithe
(:. 27699-1636 Phone No, (919) 7
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AN.am+T A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ai-S-c
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lipV)IJ fpc RS O(%J CERTIFICATION#YSCin
%YELL CONTRACTOR COMPANY NAME 7gI jt..t,e.1I 0.2.0 Do III pL'i-`
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
269117
PHONE #
2. WELL LOCATION: 1
INearest Town: IA\et eySI `e_
113`c r&4. Sj24tt1c' -q&
(Street Name, Numbers, Community, Subdivision, i.ot No., Zip Code)
3. OWNER:/fie//A Aea4.eu 4 n Y'
Address 34 r(teA SpA-a kS Ktl,
(Street or Route No.)
CtiAlal.e-SVIle_ NC.
City or Town State Zip Code
ass )- (cuss— 4 CC6
Area code- Phone number
4. DATE DRILLED l0-1 `T'O a
County (�11C-1 � l �
u311)4-e cal
5. TOTAL DEPTH: )
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LV
7. STATIC WATER LEVEL Below Top of Casing: ) 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ? METHOD OF TEST "Li K
10. WATER ZONES (depth): 7Q Gjo f 17e
11. DISINFECTION: Type
12. CASING:
From 0
From
From
Depth
To C.'7
To
Topographic/Land setting
❑Ridge DSrlope ❑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
O -- GO
cch-t7C)
Formation Description
cLA MVa1
lore's RC< (/G
r3R
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Diameter numbers and common road names.
Ft.
Ft.
hleP,3-..Z Amount C-ti t>-c
Wall Thickness
or Wei hy Ft. Material
� ICON may ,_
To Ft.
13. GROUT: Depth Material
From (� To ,'5.5 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method ,
Slot Size Material
in.
in.
16. REMARKS:
10;i Wd DJ CO
iADP 1))'H �RFR'Y #Ws "'HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
f �`' 1• IDARDc�.nrn
MA
CONSTRUCTIO
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�O7—Uiic)
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
G�r Submit theorig_itlal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASH(% 75t,F44-1636 Phone Na (el 5) 733-3221, within 30 days. GW-I REV. 07/2001

269119
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) )/lA,) (4Jnji)
WELL CONTRACTOR COMPANY NAME .4,C4-C-rax-.I l Lt 4 I , ) /
. it 1 PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION ii25z1n
enstxaczpz
1. WELL USE (Check Applicable Box): Residential 0' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: R:ia i \\' , County( -t
�-) PQ es CPpCiepsit i
(Street Name, Numbers, Community,rr��Subdivision, Lot No., Zip Code)
3. OWNER: 4 IPA' 14.Xike.
Address 3`7ibrie-'G G lage kd`y5)0{J
�(Street
J t or Route o.) Re e o s L-1 0
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /b
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX1 TING WELL? YES 0 NO El"
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
D. WATERZONES(depth): 254 )00/';Cs) 150
11. DISINFECTION: Type Ghler,n: toe_ Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate 'al
From To'2 C FLU-r--Q-A
From To Ft.
From To Ft.
13. GROUT: Depth Mate al Method
From (P To Ft. rat'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
Size Material
From To FL
graphic Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
16
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L1]
I DO HEREBY CERT
CONSTRUCTION ST
MAR 2 2203
L.
. -
AS the or(gip4JFto tht Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
£TS99T616-P1Tanr Yo-(91+) 733-3221, within 30 days. GW-1 REV. 07/2001
C
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND T OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C 2> /0-/`.I "OR
SIGNATURE iF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources -,Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ke I;j N rleJ be
WELL CONTRACTOR COMPANY NAME J7 AS-l. J ( -j ( D MA.13
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Pr.—Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT�ION��:���� �
Nearest Town: -rA4 g4j i le County QYii\it-bel(
0‘5t LeAR6 Lit"
(Street Name, Numbers, Community, Subdivisi , Lot No., Zip Code)
3. OWNER: gir�C' 3h
Address „a rj �-C�� VOR. ?AT 1-11/4-9t
(Sy -pet or Route No.)
x keRska;e jJC as105
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fir-
7 STATIC WATER LEVEL Below Top of Casing: 'ECG FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST 04-47,,
10. WATER ZONES (depth): Sb roc t :230
11. DISINFECTION: TypeCb W &e Amount 6 o Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To qc., Ft. 141 "CD2-?1 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To LAD Ft. cone
From To Ft. 11
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
269120
CERTIFICATION #i2Sc%r)
PHONE # 'PS) 7j3'-X4fQ
_Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O •— t 4 /ca e- a 2
)HLin
—
in - .5'O
0 5a
SD- 3?v
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
.c-
16. REMARKS:
L 1 ,11
'Submit thr_originaLto_t1L Divi.
2,649-1636 Phone No. (91I,1L733-3
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
H • A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�.. i©-l6 --CaR
G ATURE OF PERSON CONSTRUCTING THE WELL
DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

269121
- Groundwater Section
` '�,� \ CERTIFICATION #a 5C�
�'`1 -I Sys PHONE # $051 i33-26n(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesrc- Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lieV; IN-) Rc, b2Rc010
WELL CONTRACTOR COMPANY NAME
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: 17F rkt.RSV • 1 le
cr,‹0 �e�'k' Crl.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address Cnin CR
r Route No.) _trftkeRsvet(Slree yle tic_
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED O-' 1 I —p "2
5. TOTAL DEPTH: )'-EO ' t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: PO 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): I METHOD OF TEST /fit +\
10. WATER ZONES (depth): 't
,
11. DISINFECTION: Type CA 2i. tve_.Amount `ems
r 12. CASING: Wall Thickness
Depth or WVeiPht/Ft. Material
From 0 To 2 l , I W
From To
From To
13. GROUT: Depth Material _j__ Method
From (9 To -26 Ft. Ce-w-°^-�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Diameter
Ft. CCA
Ft.
Ft.
From To Ft.
From To Ft.
( f
CONSTRUCT
J !,+ ,71
y 11..�ChE I ` op6graphic/Land setting
Countl C3iCidge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
(it,* Joe5r,Q Anc JZ
DEPTH
From To
5— /o
rD-I
iS 0
!s2 0— /'IO
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Oat$-J I0 11-6L
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the origina4 to t e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2769W-T636 Phone N
733-3221, within 30 days. GW-1 REV. 07/2001
(7.
Cf:
770

WELL CONSTRUCTION RECORD 269161
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f VIL)
WELL CONTRACTOR COMPANY NAME AP�'-)( tijett
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
- Division of Water Quality - Groundwater Section
,RY'.svD CERTIFICATION,/
IPR (A � `L..1 ___ PHONE a firs)73's-�G,0'.Z
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Inc Municipal/Public D Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i3
Cj 1 'TZ.> 1 php Qck
(Street Name, Numbers,, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address 1')h�a- (r cl
(Scree of Rdd t
County �(4—C)1{__
e
ikt
3k�<V(.1e
City or Town State
( )-
Area code- Phone number
Zip Code
4. DATE DRILLED —0a
5. TOTAL DEPTH: /e0 4 ,
6. DOES WELL REPLACE E ISTING WELL? YES ❑ NO FY
7. STATIC WATER LEVEL Below Top of Casing: 25 ET.
(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 .0I18.
9. YIELD (gpm): (5 METHOD OF TEST A R-
10. WATER ZONES (depth):`J.'3,
11 DISINFECTION: Type r h (SRI iSQ Amount G OG ,
Wall Thickness
or Weight/ht. Material
183 e:sn1).4
12. CASING:
Depth Diameter
From To k Ft. iv64
From
From
13. GROUT:
From c
To Ft.
To Ft.
Depth Matbriaf
To Ft. ('camewt
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method.
Re c�
From To Ft
Material
From To Ft.
Topographic/Land setting
[dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From To
--/5
fS—�7
7— Del
(check box)
DRILLING LOG
Formation Description
�ul�r r x IC<
LOCATION 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
<SI
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AN T A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to I✓
27699-1636 Phone No. (9119) 73
SIGNATUR
G OZ
OF PERSON CONSTRUCTING THE WELL
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
269163
r
North Carolina - Department of Environment and N'p� aural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACI'OR(INDIVIDUAL) NAME (print) /&G't/tl r #'r S`JP.� CERTIFICATION#95g3&
� WELL CONTRACTOR COMPANY NAME 74S•II l/-ttLL l) PRONE # P3v?i173i-,3:Z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _.. (if applicable)
1. WELL USE (Check Applicable Box): Residential L'1 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IlOther, List Use
2. WELL LOCAT�,IO��`
Nearest Town: 3& c 'sn/'P County /1'.11-llzlL
e.A tC,\ kN, .- aiLczk\vr hlr1l6%, GU t*opk)
(Street Name. Numbers, Community, SubtliMitAii Lot Nn.. Zip Code)
3. OWNER:
Address
Q / GGNJ - _ reel or Route
-
A •
a870
' City or Town State
( )-
Zip Code
Arca code- Phone number
4. DATE DRILLED 1 .2../.1C —O
5. TOTAL DEPTH'
tdopographic/Land setting
Ige ❑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
CD
&c) - C,y
6y- &5
65 - l�ja
6. DOES WELL REPLACE EX STING WELL? YES ❑ NO Ei ) qo 2e
7. STATIC WATER LEVEL Below Top of Casing: i FT. .,?C12 _ R1li
(Use"+" if Above Top of Casing) ayr�i - 3w
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): )O METHOD OF TEST A-A`2
O. WATER ZONES (depth): 75 r X / 16/ AaS
11. DISINFECTION: Type e
12. CASING:
Depth Diameter
From 0 To 71 FL 6
From To Ft.
From To Ft.
13. GROUT: Depth
From O To '3C
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Amount C n;
Wall Thickness
or Woight/Ft. Material
5OR D t
Materia�l+
Ft. terwer^�C
Ft.
Diameter
in.
in.
Method
Slot Size Malarial
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
ca
n
W
1V
-D
0
U7
I DO HEREBY CE t TIFY THAT THIS
CONSTRUCT STANDAR
Submit the original [dr 1
27699-1636 Phone No. (9W
WAS CONSTRUCTED Ik1 CORDANCE WITH ISA NCAC 2C, WELL
COPY OF THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER
v5 r-75---C�
SIGNA +RE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Setion, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

I
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 WELL CONTRACTOR- 10 RnAN L . 2A-('L.
WELL CONTRACTOR CERTIFICATION M: cQDa 7
STATE WELL CONSTRUCTION PERMITM:
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: (Show sketch of the location below)
rest Tn:/(=✓�✓%I� County' m/ '71E-/4l°//
(RoadName and Numbers, Commonly, or Subdivision and Lot No.) DRILLING LOG
3. OWNER (/ki ltP$ l,Om& A Eenier Y)C547,0 ,hom To
Address Sd �/f - H g ft Are
!J (s ;aaf air Haua a.f �
.S y'yce Pine h.c. 28777
uy or own Stale Zip Co e
- y3
43 - )15
270081
DEPTH
Formation Description
4. DATE DRILLED ` `G 0.2 cco o
o
5. TOTAL DEPTH 1$5
6. CUTTINGS COLLECTED YESf NO14
7. DOES WELL REPLACE EXISTING WELL? YES n NOI 4' 1 -_
8. STATIC WATER LEVEL Below Top of Casing: .e5 FT.
J)a'R f
tB &dtQc k
(Use '4. 11 Above Top of Casing) -1 -
9. TOP OF CASING IS 1 FT Above Land Surface' ��r
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 r;
10. YIELD (gpm)•Q METHOD OF TEST rn
11. WATER ZONES (depth)•
•
1' CHLORINATION: Type W 7 H Amount f If additional space Is needed use back of form
CASING:
1
Wall Thickness LOCATION SKETCH
Depth Diameter or WpighVFt. Material (Show direction and distance from at least Iwo State O
From 0 To Y3 PI G . a 5 PVGSUo Roads, or other map reference points) `^'
From To Ft rri
From To Ft co14. GROUT: —
p CM Material
., Method
From 0 To AO Ft
Depth /� al rl ' h , J
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In ' In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
Co c/vfi/e, /7. C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY e F THIS RECORD HAS BEEN PRE IDEO TO THE WELL WNER.
FOR OFFICE USEr-ONLY
rluad No: SII �1 E OF PERSON CONSTRUCTING THE WELL DATE
Submit orlginalta Ivl l'n al Water Quality, Groundwater Section within 30 days
I
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 WELL CONTRACTOR. NeRmA/✓ L. 2A-LL.
WELL CONTRACTOR CERTIFICATION #: of�7 O.►.17
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentialLa Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show skelcl gf the location below) .�`P//
eared Town: 2 r,/rie
,naauc At re
Pam,
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER /Thvldn/ H-bmts (&///e&Joh) From To
Address 666 ,�./.. dy rz, -
4. DATE DRILLED 7 .a3- Oa
5. TOTAL DEPTH yil'�7
6. CUTTINGS COLLECTED YES El NOIa1
7. DOES WELL REPLACE EXISTING WELL? YES (l NOl vl
8. STATIC WATER LEVEL Below Top of Casing: � FT.
J (use •i II Above Top of Casing)
9. TOP OF CASING IS I 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): 3 METHOD OF TEST
11. WATER ZONES (depth): r�
1^ CHLORINATION: Type 7H Amount.64111.�
DEPTH
Formation Description
S reel or Route e. '� o -'IO �r'R -E
�i/!:° h !. '2S`777 70 2 TBFrcLRQCk
Slate Zip Code
Ily or Town
CASING:
W
0
N
0
II additional space Is needed use back of form
Wall Thickness
From D ToFt (t Depth0 Diameter• 55 or wplgnv_Fi. PVC.SD4,
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
- h
From Q To ai•0 Ft C1mNC2EiE
From To Ft
15. SCREEN:
Front
From
From
Depth Diameter Slot Size Material
To Ft In In
To Ft In In
To Ft. In In
16. SAND/GRAVEL PACK:
Depth
From To
From
17. REMARKS:
Ft
To Ft
Size Material
LOCATION SKETCH
(Show direction and distance from et least two Stale
Roads, or other map reference points)
e:1t
Spruce Pine, 19'C.
c�
ZaviLai &c k
269914
n
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO %STTDS-AND THAT -A 69RY IrIIS RECORD HAS BEEN PRQ)/IDED TO THE WELL
WNER.
lll A d- QX,e— '1' oZ 3 �a
3I4N frfiRE OF PERSON CONSTRUCTING THE WELL DATE
Submit original I Sion of Water Duality, Groundwater Section within 30 days
GW.I REV. 12/99
FOR OFFICE U
Quad No'.
Serial No
ASHEU;,.LE I '_

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] �y//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR' LORMA/✓ Z. 2A-7.
WELL CONTRACTOR CERTIFICATION N: aOA7
STATE WELL CONSTRUCTION PERMITN:
270411
1. WELL USE (Check Applicable Box): Residential Ik Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show ske It of the location below) b • `.-• // / _ I_�//
arest Town: Coun �(,/J
(Road Name and N tubers, Common y, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Pa4'7Ga J t_ C%,-49a From To Formation Description
Address r >/ /? CQ
EiSe �Y11l � real or �u eJ o.) %�5 /$1���j j� C
City or Town State Zip Code "v' ✓�D�
4. DATE DRILLED 1/-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES in Not�I
7. DOES WELL REPLACE EXISTING WELL? YES NOEVII
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use's' 11 Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST t2 : 3
11. WATER ZONES (depth):
CHLORINATION: Type T7 TH Amount ._134.11.5 If additional space Is needed use back of form
CASING:
Wall Thickness LOCATION SKETCH
From Q Depth
olh d0 Ft
Diameter 5 or .4l plg!'S M�,u tesa (Show direction and distance from at least Iwo State
([ 6 Roads, or other map reference points)
From To Ft
From To FI Cnab)-ree/2/.
i4. GROUT: ,�1 0
Depth Material Method 55t '6 Pipe /'?C. w
From .r"""""" —*1 c:
D To a7.0 Ft fbNCP,EiE om:
From To FI ��p
15. SCREEN: w�:',
c.)._.7-tcpc; :-.;L:1-:::: lt? :Li
oN cn E
Depth Diameter Slot Size Material
Frorn To FI In In
From To FI In in
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
I DO HER AT T(J)&1 JELL WAS CQ NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Ej N JS7A {UAri$S, AN( tHI%T OF THIS RECORD HAS BEEN PROVIDED T0.THE WELL OWNER
CONSTR
1 2OOSubm
ONATURE OF PERSON CONSTRUCTING THE WELL OATE
to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) gust 22,S #\)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
i��
(if applicable)
271152
CERTIFICATION # .�
PHONE # >r2S) 733* �e0
I. WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Neare�s/j�To�wn�:`V:frke-RS t �e— Coymy dni ti" l
a'.Y/t-�+iN /jat /I.G- ld y 02.24
(Street Name, Numbers, Community, Subdivision, Lot No., yip Code)
3. OWNER: ,.A CZ6?c,
Address t-4...1/41 24-.
I (Street or Route No.)
`�teets‘. I� ivL
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED /6 — $ — Ord
5. TOTAL DEPTH: P-1 b
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES O NO fa'
7. STATIC WATER LEVEL Below Top of Casing: 5 G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST Ai R.
10. WATER ZONES (depth): '575". 1C7E7
11. DISINFECTION: Type eh)cg is
12. CASING:
Depth Diameter
From 0 To y�
From To
From To
13. GROUT: Depth
From 0 To 90 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft. 6141
Ft.
Ft.
Amount Cn Ct.
Wall Thickness
or Weight/Ft. Material
5D1sQ1 PVC.
Material
Ce-r a k
From To Ft.
Method`
z
Slot Size Material
in.
in.
Typographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
I
Sc A i.-fN
DEPTH
From To
--
'la— /vim
LOCATION SKETCH
Show direction and distance in miles from atieast-
two State Roads or County Roads. Include the roa::J
numbers and cornmon road names. c�
rri
co
Cr:rri
.. rn
c-)
F 0
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F. CONSTRUCTION TANE(Al !)A[L>,THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the is
27699-1636 Phone No. (919)': 733-3
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
!21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 271160
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(p 14,0 �V bog.se=r
WELL CON'TRAC1'ORCOME] .\MPANY NAMSAI 10e.t1 �1 �y'� PHONE # f )-7g}-ace.
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PPERiL\IIT4
(if applicable) (if applicable)
CERTIFICATION N QSiC
1. WELL USE (Check Applicable Box): Residential ( Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CL2 v. 1 le— County e.
4��(�
(Street Name, Nw➢bers, Community, Sae visio+', Lot N i Code)
ITc_Iec vs
3. OWNER: , IV
Address
u�' ?
'kSStreet or Route lqo.)
City or Town State
( )"
Zip Code
Area code- Phone number
4. DATE DRILLED / —
5. TOTAL DEPTH:
6. DOES WELL REPLACE E7tISTING WELL? YES ❑ NO L9�
7. STATIC WATER LEVEL Below Top of Casing: 'jU` FT,
II (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 wit 15A NCAC 2C .0118.
9. YIELD(gpm): i7 METHOD OF TEST RJR
10. WATER ZONES (depth): ff (Q6
11. DISINFECTION: Type Amount (oc
12. CASING: Wall Thickness
Diameter or Weiyht/Ft. Ma erial
6`-% •�r �c•l �„�y
Depth
From (5 To 21 Ft
From To Ft
From To Ft
13. GROUT: Depth Material Method
From C To '2C--' Ft, en _ c fJJ From 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 Materiel
From To Ft.
From To Ft.
16. REMARKS:
1 DO"HEREBY CERTIFY TI
, CONSTRUCTION STANUA
Topograa /Land setting
PRidge S1 lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ..
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
�rs2 k- Iao4? c. U
r i
DEPTH
From
To
�_gy
it/ — 11-1
6 aT
r.1
LOCATION SKETCH —o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the Wadi -� '_
numbers and cotnmv
on road names. cc, I-
moo, tyi
M
_%
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THA-rAr Y OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
L27699,1636 Phone No. (9 733- 221, within 30 days. GW-I REV. 07/2001