Po CY2002

259311
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SHYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE SHEILDS
Address 10 SHYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 863-4343
Area Code Phone number
4. DATE DRILLED 08/22/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 80 Ft.
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QULKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/
County POLK
CHLORYTE Amount 17
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR21 PVC
From
From
16. RE
Method
POURED
Slot Size Material
in. _ in.
in. in.
l o 1i1Ztj
l _ R.
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. STRAIGHT ON PRINCE RD.
2ND. HOUSE ON RIGHT.
0
rJ
CID
Fri
rP
al
c�
0
I DO HEREBY CFERTw 5 U$ 4 k 'LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRLCTI(BN TAN33AFt1013 (HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF ERSON CONSTRUCTING LL
Pr-—o
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

259310
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SHYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE SHEILDS
Address 10 SHYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4343
Area Code Phone number
4. DATE DRILLED 08/23/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Frc
Fr
16.
TopographicfLand 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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. STRAIGHT ON PRINCE RD.
2ND. HOUSE ON RIGHT.
9Z :Z Ud S- d3S ZO
I DO HERE :�,,�M . S LL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONI;IJ. +Ito, ,#fi (r ID T T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
aay
SIGNATURE OF PERSON CONSTRUCTING THE LL
3 -o aN
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

259309
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural El
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SHYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE SHIELDS
Address 10 SHYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4343
Area Code Phone number
4. DATE DRILLED 08/27/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
* Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth
Diameter Slot Size
From To _ Ft. in.
From _ To Ft. _ in.
15. SAND/GRAVEL PACK:
th Size Mate
16. REMA
I DO HERE
CONSTRUC
Ft.
in.
in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
POORS FORD RD. FROM SHILOH. STRAIGHT
AT STOP SIGN ONTO PRINCE RD. 2ND HOUSE ON
RT.
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
- a -2-6 -71
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

259308
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
SCOGGINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HELEN GREGG
Address 241 SCOGGINS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
828 — 863-2311
Area Code Phone number
4. DATE DRILLED 08/28/02
5. TOTAL DEPTH: 110
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 2
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Depth Diameter
From 0 To 110 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
F
15. S
GROUNDWATER SECTION
I DO 1 RE�i *'1 ( e
B`0 ! : L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON SUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j,7 Y92,,,edS-a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Method
POURED
Slot Size Material
in. in.
in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RIGHT ON RADAR RD. LEFT ON
SCOGGINS RD. 1ST HOUSE ON LEFT.
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

259307
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
WHITESIDE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RONALD SHEHAN
Address 1600 WHITESIDE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-5085
Area Code Phone number
4. DATE DRILLED 08/29/02
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft. 6-1/4" SDR.21 PVC
From To _ Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size aterial
I.I I
RKS:
in. in.
in. in.
0
NST
,ASHEVIL.E REGIO
S Ltd
REBY CERTIFY THAT
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY, #9 S. FROM MILL SPRING. LEFT ON
JOHN SHEHAN RD. LEFT ON WHITESIDE RD.
RIGHT ON DRIVE AT BOX 81600.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A 1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(a 4 nL/fin-Q 8 ,a 7-0 a
SIGNATURE OF PE ON jCONSTRUCTINELL DATE
FE
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

259303
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: COLUMBUS
HWY. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN BLACKWELL
Address 8475 HWY. #9 SOUTH
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4896
Area Code Phone number
4. DATE DRILLED 08/09/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To F . in. in.
From To
15. SAND/GRAVEL PACK:
Depth Si
From _ To _ Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
DRIVE AT BOX #8475.
0
ry
c/a
rat
-D
Cn
"o
NV
N
rr
16. REMARKS:
GROUNDWATER SECTION
I DO HEREBY CERTIFY TF AT *54 `i41...tkifRiPec9itikehtuc"ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA URE OF PERSON ONST CTING 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

259301
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
CHESNEE RD,.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TINA GRAGG
Address 970 CHESDNEE R.D.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4680
Area Code Phone number
4. DATE DRILLED 08/26/02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARID
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Dep
From _ To
From To
16. REMARKS:
I DO HEREBY CE
CONSTRUCTION
SIG
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RIGHT ON DRIVE AT BOX #970>
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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

259300
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural Ei
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
PRINCE RD/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEVIN SCRUGGS
Address 1439 PRINCE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
8( 28) — 863-2919
Area Code Phone number
4. DATE DRILLED 08/28/02
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 14.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 160 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From To Ft. _ in. _ in.
15. SAND/GRAVEL A,CI .,
Depth
From _ To
From To
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. STRAIGHT AT STOP SIGN
ONTO PRINCE RD. LEFT ON DRIVE AT BOX #1439.
APPROX. 3/4 MILE.
9? :? {;d S- d3S zC
I DO HEREBY CEP TIFY THILIIINPHTSE 6ELT)M AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S. TANWsit tl 'i k'3FXIQfOPYOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/710
SIGNATURE OF PE ON 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

259299
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # .ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
COLD SPRINGS DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TINA CONSTANCE
Address 59 COLD SPRINGS DR,
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828-) — 859-0431
Area Code Phone number
4. DATE DRILLED 08/29/02
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 10
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To ______ Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From _ To Ft. _ in.
From _ To _ Ft. in.
15. SAND/
I DO HERE
CONSTRU
Material
in.
Topographic/land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON CHIMNEY ROCK
RD. LEFT ON COLD SPRINGS DR 1ST LOT ON
LEFT.
0
S CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
psi i . 4F7nW
SIGNATURE OF PE 0 CONSTRUCTING THE LL
-9-e
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

259298
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
TABLEROCK DR.. (RIXHAVEN)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRUCE WIDEMAN
Address TABLEROCK DR
(Street or Route No.)
TRYON NC 28722
City or Town State Zip Code
(828) — 894-2698
Area Code Phone number
4. DATE DRILLED 8/30/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in.
From _ To _ Ft. in.
15. SAND/GRAVEL PACK.
From
From
16. REMARKS
I DO HEREBY
CONSTRUCT
in.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON OLD
HOWARD GAP RD. RT. ON HOWARD GAP RD. RT.
ON INDIAN MTN. RD. LEFT ON RIXHAVEN DR.
LEFT ON TABLEROCK DR. LOT ON RT. AT CUL-
DE-SAC.
ONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

257318
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ (i�applicable) PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK Topographic/Land setting
IROQUOIS TRAIL 0 Ridge 0 Slope 0 Valley 0 Flat
Name, mbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: BARBARA KELLER Latitude/longitude of well location
Address 310 IROQUOIS TRAIL (degrees/minutes/seconds)
(Street or Route No.)
COLUMBUS NC 28722 Latitude/longitude source: 0 GPS 0 Topographic map
City or Town State Zip Code
(828)(Street 863-2563NuDEPTH
(check box)
Area Code Phone number From To
4. DATE DRILLED 07/17/02
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9_5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _____ To_Ft.
_
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To
From To
Ft. in. in.
16. REMARKS:
Ft.
Ft.
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
COLLINSVILLE RD. LEFT ON PHILLIPS RD.
RIGHT ON IROQUOIS TRAIL. HOUSE AT #310.
rn
CD
n
-
G
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELE
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRU TING THE WELL DATE
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
g;.;2769W 634 P1(64'419o. (91') 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGAL OFFICE

257317
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality— Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
HIGHLAND VIEW DR. ❑ Ridge 0 Slope ❑ Valley ❑ Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
1AdOWNER: PEGHLANDTE BELLAMY Latitude/longitude of well location
drI(degrees/minutes/seconds)
(Street or Route No.)VIEWDR
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑Topographic map
City or Town State Zip Code (check box)
(866)ess — 67H8 9315 DEPTH
Area Code Phone number From To
4. DATE DRILLED 07/18/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount A
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From_ To Ft. _ _
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From ____ To_Ft.
_
From _To_Ft.
_
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From _ To _ Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON LAKE ADGER RD.
LEFT ON HIGHLAND VIEW DR LOT #31/44MILE
ON RIGHT. CD c
__
c, erTh
c
0
r*;
C
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COON RA7U(I O tS' DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GR1
ASHElILLE REGIONAL OFFICE
-2 -_/ef- 6 a
TUI(E OF SON CONSTRUCTING WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
o. [phone], within 30 days. GW-1 REV. 07/2001

rlr
257316
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaLPublic ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
SCRIVEN'S HILLS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LUCY STROUD & TOM JONES
Address SCRIVWEN'S HILLS
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(404 ) — 847-4036
Area Code Phone number
4. DATE DRILLED 07/19/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QIIIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. LEFT ON
CAPPS RD. RIGHT ON GUNNING RD. LEFT ON
SCRIVEN'S RD. LOT ON LEFT AT CUL-DE-SAC.
LOT #8.
0
IV
CZ
0
0
c-n
c
r.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C't4/EL •
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
STA
Lk c-7
1 i I SIOF PERSON CON TRUCTING WELL DATE
L LI
Stnit the original to the t ision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27 99pI 34 none No, (tt?9 733 :221, within 30 days. GW-1 REV. 07/2001

257315
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LAKE ADGER PARKWAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VIRGINIA HARDIN
Address LAKE ADGER PARKWAY
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(864) — 457-*2561
Area Code Phone number
4. DATE DRILLED 07/24/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
Ft.
Ft. -
From To
From _ To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From _ To _ Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. RIGHT ON LAKE ADGER
PKWY. NEW DRIVE 1/10 MILE ON RIGHT.
L S : I I WV S- Sfiv u0
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
C
Submit the original to t
27699-1636 Phone No.
C7'li dg!`, t `:tiOI
A FV t Ep : DFHC:F
S, AND
�THAT
AA COPY OF THIS RECORD�FIA�S�BEEN PROVIDED TO'THE WELL OWNER
AT OF PERSONRUC ` WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

25'7;� '8
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ® Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
365 HWY. #9 N.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CANE CREEK BAPTIST CHURCH
Address 365 HWY. #9 N.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4442
Area Code Phone number
4. DATE DRILLED 07/04/02
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LAST
CHURCH ON RIGHT BEFORE YOU GET TO LAKE
LURE.
t
CJi
cn
1.0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
mit the original to the D
276p9-1636 Phone No. (919) 733-
RE OF PERSON CONSTRUCTING fentc
ELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

25'7336
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
OSTINE CREEK TRAIL LOT #17
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY O'NEAL
Address OSTINE CREEK TRAIL
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-2410
Area Code Phone number
4. DATE DRILLED 07/11/02
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
GARRETT RD. RT. ON GREEN HILL RD LEFT ON
LAKE ADGER PARKWAY. GO ACROSS COVERED
BRIDGE & LOEFT ON OSTINE CREEK TRAIL. 1ST
DRIVE ON LEFT. (LOT #17 ON RT.)
c
c;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Su mit the original to the D
27 9-1636 Phone No. (919
GROLINDV.IATER SECT 0
ASHEViLE H OVAL OFf1C'E
733-
)�f RU Iri /h� D % /l O �.
JRE OF P RS CONSTRUCT G THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

257335
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
FALL TREE LANE - LOT #22
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SY STANLAND
Address FALL TREE LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(704) — 752-8884
Area Code Phone number
4. DATE DRILLED 07/15/02
5. TOTAL DEPTH: 585
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From _ To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Ft. _
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
16. REMARKS:
in. _ in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. GO PAST LAKE ADGER &
TURN LEFT ON N. HILANDS VIVE. TURN ON
FALLEN TREE LANE. LOT ON LEFT THRU BRICK
COLUMNS DEAD END.
0
(NJ
o)
Ut
ua
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, ND THAT A COPY OF THIS RECOHAS BEEN PROVIDED TO THE WELL OWNER
1
Pt"s
GRouNOVVATE'SE b
ASHEVILLE REGIONAL OFFICE
<S7t1 1-/S D a
TURE OF PERSON CONSTRUCTING THE WE L DATE
Diviion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001

2)'7332
r_
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ f aPERMIT #
applicable)
(if applicable) (i
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ® Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Landseiting
Nearest Town: TRYON County POLK 0 Ridge El Slope ElValley El Flat
RED FOX RD. check a ro riate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: PACOLET HILLS BAPTIST
CH.
Address RED FOX RD. (degrees/minutes/seconds)
(Street or Route No.)
TRYON NC 28782 Latitude/longitude source: ❑ GPS ❑ Topographic map
City or Town State Zip Code (check box)
828 —894-8001 DEPTH
Area Code Phone number From To
4. DATE DRILLED 07/03/02 DRILLING LOG
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES CO NO ❑ From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface' LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Include the road
9. YIELD (gpm): 6 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY.#9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON RED FOX RD.
11. DISINFECTION: Type CHLORYTE Amount 11 PARSONAGE APPROX. 1/4 MILE ON RIGHT. BLUE
12. CASING: Wall Thickness SIDED HOUSE ACROSS ROAD FROM CHURCH.
Depth Diameter or Weight/Ft. Material
From 0 To 160 Ft. 6-1/4" SDIL21 PVC
From To Ft.
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED 0
From To _ Ft. IN,
14.SCREEN: Depth Diameter Slot Size Material
L
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in. i
15. SAND/GRAVEL PACK: cn
Depth Size Material 17.
From To_Ft. _
From _ To _ Ft. _ c.rt
lD
16. REMARKS:
u
r1 z
G
QIi1S$
uU I REfYI�DTI
£omit the origiunito tea Divia
21699-14**p{`etN0.0 19) 73
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
T OF PERSON ONSTRUCTING THE WELL DATE
ion of Water Quality, troundwater Section, 1636 Mail Service Center — Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

255368
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
ASHLYN LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HUBERT METCALF
Address ASHLYN LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-4905
Area Code Phone number
4. DATE DRILLED 06/03/02
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size
From 30 To 50 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. LEFT ON ASHLYN DR. LEFT
ON ASHLYN LANE. LOT ON LEFT AT DEAD END.
0
W
\f VERTWY !I_7
Cc STR TIONLSTANDA
7
S
-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
FP
CONSTRUCTING THE WELL
%., f2-.3
DATE
SubildertRtiSti wlprvtsion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2769$+ ¢_ehC9LOC1 AI9j 7'33-321, within 30 days. GW-1 REV. 07/2001
Oa

255367
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: TRYON
ASHLYN LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM METCALF
Address ASHLYN LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
828 — 288-6913
Area Code Phone number
4. DATE DRILLED 06/04/02
5. TOTAL DEPTH: 60
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 42 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING:
Depth Diameter
From 0 To 60 Ft. 24"
From _ To Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To Ft.
I4.SCREEN: Depth Diameter
From To Ft.
From To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 42 To 60 Ft. 78M
From To Ft.
16. REMARKS:
Wall Thickness
or Weight/Ft. Material
CEMENT
Method
POURED
Slot Size
in.
in.
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. LEFT ON ASHLYN DR,1ST
NEW CONSTRUCTION ON RIGHT, o 0
N
n,
c
CO:IIWV S-1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON RUCTION STANDARDS, AND THAT A COPY OF TUTS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
u '.
S
v
OF PFR$ON CONSTRUCTING THE WELL
/77/ .12 - 6- V-oa
DATE
;Lbt the on idal to the Div gt " ilipdcf Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
i;7699 1636 Phone No. (919) 7? 3-3221, within 30 days. GW-1 REV. 07/2001
F,0/ I I II
r,Si' "111 fil 'i ':i-

255360
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LAUGHTER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EUGENE PASSMORE
Address LAUGHTER RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 657-9621
Area Code Phone number
4. DATE DRILLED 06/11/02
5. TOTAL DEPTH: 85
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 67 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
From 0
From
From
13. GROUT:
From 0
From To Ft.
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 85 Ft. 24" CEMENT
To Ft. _
To Ft. _
Depth Material Method
To 20 Ft. CEMENT POURED
14.SCREEN: Depth Diameter Slot Size
From To _ Ft. _ in.
From To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth
From 67 To 85
From To
16. REMARKS:
Size
Ft. 78M
Ft.
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
LAUGHTER RD. NEW LOT 4/10 MILE ON RIGHT.
0
N
r—
t
cn
c
o`
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS RUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA T
L �i
ub it the original to the Di ision 3f Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
2769-1636 Phone No. 9 3-3221, within 30 days. GW-1 REV. 07/2001
C-10111!Lw. rf.SECTION
,sHL' ii LE r ir -, oa ICE
County POLK
n;
Pa �(�P�n�J/� ilaT1/4P / - 7/ - C7 a
OF P N CONSTRUCTING THE WELL DATE

255349
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
PHILLIP HENDERSON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DELBURN EZELL
Address PHILLIP HENDERSON RD
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864 ) — 576-4853
Area Code Phone number
4. DATE DRILLED 06/03/02
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 500 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 15
12. CASING:
From
From
From
13. GROUT:
From 0
From
14.SCREEN:
From
From
Depth Diameter
0 To 40 Ft. 6-1/4"
To _ Ft.
Depth Material
To 20 Ft. QUIKRETE
To _ Ft.
Depth Diameter
To Ft.
To Ft.
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
15. SAND/GRAVEL PACK:
Depth Size
From To Ft. _
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
POORS FORD RD. FROM SHILOH. RT. ON
PHILLIP HENDERSON RD. 1/4 MILE ON LEFT.
0
C-
r—
o 0
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
v - D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JL
ubm t the original to the Div
7699
I
Ih
SIGN
GROUNDWATER SLCTI N
'`'.SHEVILI OFFICE
ion
3-32
OF PE
ON —CONSTRUCTING THE WELL DATE
U 2
Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
, within 30 days. GW-1 REV. 07/2001

255345
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
BLANTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LOIS HUEN
Address 526 BLANTON RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-2744
Area Code Phone number
4. DATE DRILLED 06/13/02
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or WeightlFt. Material
From 0 To 110 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To _ Ft.
Method
POURED
Slot Size
in. _ in.
in. in.
16. REMARKS:
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RFTN. LEFT ON ROCK
SPRINGS. CH. RD. RIGHT ON GRASSY KNOB RD.
LEFT ON BLANTON RD. HOUSE ON RIGHT. (526
ON BOX)
zo:ii„d S-inrzo
nT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S AND THAT A COPY OF THIS RECORD HAS BEENvPROVIDDED TO THE WELL OWNER
E WELL
Of: LE
SIGN
Subnt�it the original to th
27699-1636 Phone No. (919) 733-32
OF` PERSON CONSTRUCTING THE
DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

255338
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2O1160 # (828}453 0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, INTL�LDC WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT # _ (
(if applicable) if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MILL SPRING County POLK ❑Ridge 0 Slope 0 Valley ❑Flat
OSTIN CREEK TRAIL ro note alle
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude (checkcappropriate
riowell location
ox)
3. OWNER: RICK PRIVEE
Address OSTIN CREEK TRAIL (degrees/minutes/seconds)
(Street or Route No.)
MILL SPRING NC 28756 Latitude/longitude source: 0 GPS ❑ Topographic map
City or Town State Zip Code (check box)
(864) - 486-9705 NN DEPTH
Area Code Phone number From To
4. DATE DRILLED 06/26/02 DRILLING LOG
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Include the road
9. YIELD (gpm): 35 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY. #9N. FROM MILL SPRING. LEFT ON
GARRETT RD. RT. ON GREEN HILLS DR. LEFT ON
11. DISINFECTION: Type CHLORYTE Amount 9.5 LAKE ADGER PKWY. LEFT ON OSTIN CREEK
12. CASING: Wall Thickness TRAIL.
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-' STAND 11a AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
O G
r_ n�
C 2
r
rn
PS T1OP1'i `rani •
Sub it the original to the D vis'o
276 ' �Sv i'ns!I 33
ASHEV _._.
IE-
�i OFFICE
FP
4,1
„tee
ON CONSTRUCTING T
1'
WELL DATE
O
4
of Water Quality; Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

c.55;;39
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
OSTIN CREEK TRAIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK PRIVEE
Address OSTIN CREEK TRAIL
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(864) — 486-9705
Area Code Phone number
4. DATE DRILLED 06/27/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material
Ft. QUIKRETE
Ft.
Diameter
Ft.
12. CASING:
Depth
From 0 To 100
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To
From _ To
15. SAND/GRAVEL
Depth
From _ To
From To
16. REMARKS:
County POLK
Method
POURED
Slot Size Material
in. in.
Ft. _ in. _ in.
PACK:
Size Material
_Ft._
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
GARRETT RD. RT. ON GREEN HILLS DR. LEFT ON
LAKE ADGER PKWY. LEFT ON OSTIN CREEK
TRAIL. HOMESITE AT END OF DRIVE.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF 'ERSON CONSTRUCTING THE LU DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

255340
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BIG LEVEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KARIM SHIHATA
Address 5911 BIG LEVEL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-8770
Area Code Phone number
4. DATE DRILLED 06/25/02
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To _ Ft. _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. TURN RIGHT
ON MCGUINN RD. AT STOP SIGN. TURN LEFT ON
BIG LEVEL RD. 2ND. HOUSE ON LEFT. #5911 ON
BOX.
0
C-
r—
cn
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRI ICTION CTANn,4R.0 AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S mit the original to the rvtsic
277999-1636 Phone No. 919 733-
r , i!ii.,/ F R <FICTION
r' i' HUE. F ": 1(2-
imot" /ti . iJ7'3. o
OF PERSON CONSTRUCTING THE WEL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

255319
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
HENRY THOMPSON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GARY MALDANER
Address 230 HENRY THOMPSON RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-2736
Area Code Phone number
4. DATE DRILLED 06/19/02
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 Ft. 6-1/4" SDIL21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. LEFT ON HENRY THOMPSON
D. 1/4 MILE ON RT. (230 ON BOX)
CO :INV S-1nr 3O
I( �D-O HFRFRV �(`�P{PTIF
nlG v ErClSfA
3`
Submit the original to te Di
rkf>ia6TFhtef4)N0N(919)
ASHEVILLE REGIOIt It FI_E
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
�S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
... �ti �iJ7// (-/ t . Q n
A OF PERSON CONSTRUCT G THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

255320
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION #3114
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC WQ PERMIT #
STATE WELL CONSTRUCTION PERMIT # _ (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipallPublic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
EQUESTRAIN ESTATES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LISA COLON
Address EQUESTRAIN ESTATES
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 625-8581
Area Code Phone number
4. DATE DRILLED 06/18/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To
From To_
13. GROUT: Depth
From 0 To 20
From To_
14.SCREEN: Depth
From _ To
From _ To
15. SAND/GRAVEL PACK:
Depth Size
From _ To
From To
Ft.
Ft.
Material
Ft. QUIKRETE
Ft.
Diameter Slot Size
_ Ft. _ in.
Ft. in.
County POLK
16. REMARKS:
Ft.
Ft.
Material
Method
POURED
Material
in.
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT PENIEL RD. RIGHT
ON RED FOX RD RIGHT ON HAMILTON DR.
WELL GOES ON LOT IN THE FORK OF THE
ROAD.
0
0
Q
n
aT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
!DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
AlUOpRSON CONSTRUCT
ING HE WELL
�o — /cf O �—
DATE
§ ��� Ehe-ertgrnal ° 19 Division733 32o1 water Quality, 0 da ,.Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2/$194636-Pebut'N,r4,�( ) Y GW-1 REV. 07/2001

255321
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality— Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREENFIELDS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RHONDA LOCKHARDT
Address GREENFIELDS
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864)— 616-8776
Area Code Phone number
4. DATE DRILLED 06/18/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Z
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope D Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. LEFT INTO GREENFIELDS DEV.
LOT AT DEAD END.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
VIITASITUS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEE WELL OWNER
ArcA,,-A,
C3N l RyCL}u
[
final tot a Div
19) 7.
tCiiUi
',I (OFFICE
P SON CONSTRUCTI G WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
13-3221, within 30 days. GW-1 REV. 07/2001

255323
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
COUNTRY CLUB RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NANCY SCHULTZ
Address 1433 COUNTRY CLUB RD.
(Street or Route No.)
TRYON NC 28722
City or Town State Zip Code
(828) — 817-1634
Area Code Phone number
4. DATE DRILLED 06/12/02
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 23
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
12. CASING:
Depth Diameter
From 0 To 60 Ft. 6-1/4"
From To Ft.
To Ft.
Depth Material
To 20 Ft. QUIKRETE
To Ft.
From
13. GROUT:
From 0
From
Method
POURED
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
0 Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #176 N. FROM TRYON. LEFT ON
COUNTRY CLUB RD. CROSS RR DRIVE ON LEFT
(1433 ON BOX)
O
0
r no t-WI? PBY CFRT!FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
O S ICI A S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.11 LI SI URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Yvisian of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
2769946361131iOfieSNbTI(919) 733.3221, within 30 days. GW-1 REV. 07/2001
ASHEVI,.LE FiECIG"'P'i. OFFICE

255324
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SPRING COURT (LOT #14)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ANDY METCALF
Address SPRING COURT
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 625-4820
Area Code Phone number
4. DATE DRILLED 06/10/02
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 165 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
WALKER ST. FROM COLUMBUS. RT. ON
PENIEL RD. APPROX. 1-1/2 MILES. RT. ON SPRING
BROOK INTO STONEYBROOK SUBDV. LEFT ON
SPRING COURT. 1ST HOUSE ON LEFT. (LOT #14)
0
N
r—
i
crt
O
0
c
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Cin 4/Ct� 4/7711L0 In - / 6 U
THE WE L DATE
OF PSON CONSTRUCT
ING
E`1 I
Subtirit the original to the Di ision of Water Quality, Cioundwater Section, 1636 Mail Service Center - Raleigh, NC
276994636TP14dYieFNii 733-3_21, within 30 days. GW-1 REV. 07/2001
SI:IV'LLt RLC,IUi,F,'_ Ori C

253515
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
BIG LEVEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DARREN MILLS
Address 4285 BIG LEVEL RI)
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(_)—
Area Code Phone number
4. DATE DRILLED 05/30/02
5. TOTAL DEPTH: 51
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 36 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 51
From To
From To
13. GROUT: Depth
From 0 To 20
From _ To
14.SCREEN: Depth
Diameter
Ft. 24"
Ft.
Ft.
Material
Ft. CEMENT
Ft.
Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 36 To 51 Ft. 78M
From To Ft.
16. REMARKS:
CHLORYTE Amount 6.9
Wall Thickness
or Weight/Ft. Material
CEMENT
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWU. #108 E. FROM MILL SPRING. LEFT ON
BIG LEVEL RD. NEW DRIVE 7 MILES ON LEFT.
(4285 ON BOX)
8S:1 Nd S-Nit z0
Q
rn rn
U<
rn
-o
_i
n
corn
zr
rn 0
m�
n
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RtUCT1011 S NILA -v , AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
#'. OFP' QNCra STRUCTINWELL DATE
L
Submit the original to �t"h"e",�
2769� 4tihmr fffrd) 733:221, within 30 days. GW-1 REV. 07/2001
r f VL OFFICE
visiop of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC

253514
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
LANDRUM RD,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: EVELYN DUKE
Address LANDRUM RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) — 439-6086
Area Code Phone number
4. DATE DRILLED 05/30/02
5. TOTAL DEPTH: 76
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 61 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
CountyPOLK
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 76 Ft. 24" CEMENT
From To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 61 To 76 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
ID
• .I
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley D Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD,1-4/10 MILE ON LEFT.
,41
tis
S9WU''FPER"
:4
Su . mit the on•nal to the 1 ivisi
27. 't 1417inknitit NitTE91191733-
ASHEVILLE REGIONAL OFFICE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
CON
CTING THE WELL
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

253507
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
iu
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
JOHN SHEHAN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SUSAN BLACK
Address 1180 JOHN SHEHAN RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 223-2823
Area Code Phone number
4. DATE DRILLED 05/15/02
5. TOTAL DEPTH: 42
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft. 24" CEMENT
From To _ Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 30 To 42 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
JOHN SHEHAN RD. RIGHT ON DRIVE AT BOX
#1180.
S S :1 Wd s- Mr ZO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I
Ar
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL
DATE
Suinmit the original to the ivisien of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27 r L Ql�" 9 733 221, within 30 days.
GW-1 REV. 07/2001

253506
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ f aPERMIT #
applicable)
(if applicable) (i
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
CROCKER LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GENE CROCKER
Address 15 CROCKER LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-8459
Area Code Phone number
4. DATE DRILLED 05/15/02
5. TOTAL DEPTH: 35
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To _ Ft.
14.SCREEN: Depth Diameter Material
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 25 To 35 Ft. 78M GRAVEL
From To Ft.
County POLK
Method
POURED
Slot Size
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. NEXT DRIVE ON RIGHT. PAST
CROCKER LANE.
-D
Ut
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
_aiit Stc77,]!e'sa' S, AND THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S- 5-
OF Y3' • CONSTRUCTING THE WELL DATE
(s
'Submit the original to t a Di
776g9-1636 Piton. No. 19)
GROULIONWATER SECTION
ASHEV!L_E REC!C AL OFFICE
ATU
sion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

253520
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
STEADMAN DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICKY BUSH
Address 146 STEADMAN DR
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 863-2364
Area Code Phone number
4. DATE DRILLED 05/03/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
Diameter Slot Size Material
14.SCREEN: Depth
From To _ Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
County POLK
in. _ in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-IS, AND THAT A f OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILLSPRING. LEFT ON
GREEN CREEK DR STRAIGHT AT STOP SIGN ON
GREEN CREEK DR. LEFT ON STEADMAN DR
SINGLEWIDE M/H AT DEAD END.
C.T1
c
-c
0
c>_
c^
cs
of
—1
m^
rn
m
O
LTI� §T
ubmit the original to th Divv
. faf#fhPFgtrn 9) 73
ASHEVILLE REGIONAL OFFIC_
TURE OF PERSON CONSTRUCTING THE LL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

253541
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATIONHONE # [phone]
# 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING,
RIING, LLC WQ #
STATE WELL CONSTRUCTION PERMIT # _ (if PERMITE)
(if applicable)
1. WELL USE (Check Applicable Box): Residential N Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
NearestTown: TRYON County POLK1 ❑ Ridge 0 Slope ❑ Valley 0 Flat
BEEEEIl HIVE RD. check a ro riate box
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well 1 ation
3. OWNER: A.Y. BROWN
Address BEE HIVE RD. (degrees/minutes/seconds)
(Street or Route No.)
TRYON NC 28782 Latitude/longitude source: ❑ GPS 0 Topographic map
City or Town State Zip Code (check box)
(404) — 350-8030 DEPTH
From To
Area Code Phone number
4. DATE DRILLED 05/09/02 DRILLING LOG
5. TOTAL DEPTH: 325
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO N From To
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated atlor below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Include the road
9. YIELD (gpm): 25 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY. #9S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. LEFT ON JACKSON GROVE RD.
I I. DISINFECTION: Type CHLORYTE Amount 8.5 LEFT ON SILO RD. RIGHT ON BEE HIVE RD. LOT
12. CASING: Wall Thickness ON RIGHT AT DEAD END. BESIDE THE STATE
Depth Diameter or Weight/Ft. Material LINE BAPTIST CHURCH.
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
u t A
✓c
• n0
3 it) r�
F CI' "
ma
C!t --I
16. REMARKS: �' c
2
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. AND THAT A COPY FF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PEYiSON�C`ONSTRUCTING THE WELL DATE
ion of Water Quality, -Groundwater Section, 1636 Mail Service Center —Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001
7699-1636 Ph ong No. (919) 7
GROUNDWATER SECTION
ASNEVILLE REGIONAL OFFICE

253539
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
BEAR CREEK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GEORGIA ALTMAN
Address 730 BEAR CREEK LANE'
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(912) — 437-3941
Area Code Phone number
4. DATE DRILLED 05/07/02
5. TOTAL DEPTH: 865
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 23
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
12. CASING:
Depth Diameter
From 0 To 90 Ft. 6-1/4"
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. in.
in. m.
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #176 N. FROM TRYON. APPROX. 4 MILES
TURN RT. ON BEAR CREEK LANE. DRIVE 1 MILE
ON RT. (730 ON GATE)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ubmit the original to th Divi
76 to PF 9) 73
GROLINOWAIER SEC 10
ASREVILLE REGIONAL OFFICE
TURE O1F PER
s--2-ea
ITL DATE
ion of Water Quality, ,Groundwater Section, 1636 Mail Service Center —Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

253537
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ (if applicable)
PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: C' e/22
Nearest Town: COLUMBUS County R Topographic/land setting
LITTLE MTN. RD. ❑ Ridge ❑ Slope 0 Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: GARY GARSIDE Latitude/longitude of well location
Address 1636 LITTLE MTN. RD: (degrees/minutes/seconds)
(Street or Route No.)
COLUMBUS NC 28722 Latitude/longitude source: 0 GPS 0 Topographic map
City or Town State Zip Code (check box)
(828) - 863-2171 DEPTH
Area Code Phone number From To
4. DATE DRILLED 05/30/02
5. TOTAL DEPTH: 605 DRILLING LOG
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0 From To
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* LOCATION SKETCH
*Top of casing terminated at/or below land surface requires a Show direction and distance in miles from at least
variance in accordance with 15A NCAC 2C .0118. Two State Roads or County Roads. Include the road
9. YIELD (gpm): 2 METHOD OF TEST ARD number and common names
10. WATER ZONES (depth): HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON LITTLE MTN. RD. LEFT
11. DISINFECTION: Type CHLORYTE Amount 16.5 AT BOX #1636 INTO VESTAVIA FARMS.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft. o
I4.SCREEN: Depth Diameter Slot Size Material r.. Q
From _ To _ Ft. _ in. in. C 5."a
From_To_Et._ innar.
n
15. SAND/GRAVEL PACK: t
Depth Size Material r
rl
From _ To _ Ft. -0x as
From To Ft. .c- ' =
ma
CD
CI --1
O
2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION S, AND(�THAT A COPY
�OF%THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I� � , ILA /111� e t,. 7) ��k�,"�� Zl - C �.
�ni» S'
J �-
TURF OF PERSO CONSTRUCTING THE WE DATE
LIs
Submit the oEiginalto t ry Sion of Water Quality,_Groundwater Section, 1636 Mail Service Center -Raleigh, NC
7699-1636 Phone No. ( 19) 7 3-3221, within 30 days. GW-1 REV. 07/2001
16. REMARKS:
GR.OUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

253535
12. CASING:
Depth Diameter
0 To 110 Ft. 6-1/4"
To Ft.
From
From
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC . PHONE # [phone]
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 LOCATION:
Nearest Town: MILL SPRING
FOWLER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TIM HADEN
Address FOWLER RD.
(Street or Route No.)
MILL SPRING
City or Town State Zip Code
(864) — 322-9277
Area Code Phone number
4. DATE DRILLED 05/23/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
From To _ Ft. _ —
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RFTN. RIGHT ON
FOWLER RD. GO THROUGH GATE AT DEAD END.
WELL AT BOTTOM OF HILL..
Cr1
c
0
• _ BR( ry. T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Mil hl '4- 'PIONS a It�;t DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pi
as
TURE OF PERSCONSTRUCTING THE WELL DATE
c, , , (®t a Div
N6.F(999
�3-61
ion of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
7.3-3221, within 30 days. GW-1 REV. 07/2001

253532
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Muuicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ® If Other, List Use SPRINKLER SYSTEM
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK Topographic/Land setting
WILL GREEN RD. ❑ Ridge 0 Slope ❑ Valley 0 Flat
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (check appropriate box)
3. OWNER: A&L LUMBER Latitude/longitude of well location
Address WILL GREEN RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
828)— 863-2778
Area Code Phone number
4. DATE DRILLED 05/16/02
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. _ in. in.
Ft. in. in.
12. CASING:
Depth
From 0 To 60
From _ To
From To
13. GROUT: Depth
From 0 To 20
From To
I4.SCREEN: Depth
From _ To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON WILL
GREEN RD. 1/2 MILE ON RT.
V
2
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 - oa
OF PERSON C6NSTRUCTING THE WELL DATE
ivis on of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
afr) 733-3221, within 30 days. GW-1 REV. 07/2001

252069
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: MILL SPRING
FOX MTN,. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEE PRESTON
Address FOX MTN. RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 859-6500
Area Code Phone number
4. DATE DRILLED 04/04/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
I DO HFRFRV CFPTPFY
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. LEFT ON
FOX MTN. RD. TRAILER PARK ON RT. JUST PAST
GEORGE PARKER RD.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-a- �iH G 2� �- 24_ 0 D
OF PE SO
N CONSTRUCTING T WELL
DATE
SuItmit the original to the 1ivision or Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
276 41i4bi34Ph6M Nt£T(919) 733-3221, within 30 days. GW-1 REV. 07/2001
IEV''ALLE i » NAL OFFIC-

252083
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mtmicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
RIXHAVEN DR.
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACK STORY
Address RIXHAVEN DR
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 859-9749
Area Code Phone number
4. DATE DRILLED 04/25/02
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 23
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. QUHCRETE
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
Method
POURED
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON
HOWARD GAP RD. LEFT INTO RIXHAVEN GO
ALL THE WAY TO THE END OF RIXHAVEN. TURN
RT.. GO THRU GATE. OLD HOMESITE ALL THE
WAY AT THE END.
r
Q1
0
a,l
o�
z^
o<
>o
—t
mo
m
CO
rn
—4
�-i
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON S, AND THAT A�COPY
%OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI4 NATURE OF PE SON CONSTRUCTING THE WELL DATE
`ULi C
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919) 733-322, within 30 days. GW-1 REV. 07/2001
UNDWATEF SEC7!Gf,i
LLE REGIONAL OFI roE
aeniz- -V -29oez

252082
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: COLUMBUS
COUGAR LANE - RIXHAVEN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT STEIN
Address COUGAR LANE
(Street or Route No
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 859-7637
Area Code Phone number
4. DATE DRILLED 04/22/02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 14
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOT #72
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON OLD
HOWARD GAP RD. RT. ON HOWARD GAP RD. AT
STOP SIGN. TURN RT. & GO OVER I-26. LEFT
INTO RIXHAVEN ON RIXHAVEN DIL RT. ON
COUGAR LANE. 1ST DRIVE ON LEFT. (LOT #72)
-17
w
r
Cr.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ii // Si IN • t Ore /��`1/!- '-- —lil�2� 'V- a - oZ
TURE OF ERSON CONSTRU TING THE WELL DATE
bmit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
[ Phone.lYo (A1B) 73 -3221, within 30 days.
GW-1 REV. 07/2001
674TF^ ^116N
Arty 'II LE Rr" ,

25210.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # __ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
SANDY PLAINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRANK LILLY
Address 2012 SANDY PLAINS RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-4098
Area Code Phone number
4. DATE DRILLED 04/18/02
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From ____ To_Ft.
_
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _____ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From _To_Ft. _
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. RT. ON DRIVE AT SIGN THAT
READS "LOMA-LINDA FARM"
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
iTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
P-oa
NATURE OF PE SON CSNSTRUCTING THE WEL
DATE
Submit the original t fin/ t ivision of Water Quality, groundwater Section, 1636 Mail Service Center - Raleigh, NC
-1636 Phone N'. (91') 733-3221, within 30 days. GW-1 REV. 07/2001
GROLNDWATi';.-- -;;d
AS' F' -- I IR —:

252148
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
COOPERS GAP RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BERTHA BYERS
Address 1358 COOPERS GAP RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4059
Area Code Phone number
4. DATE DRILLED 04/16/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 170 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriat:. box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
COOPERS GAP RD. RIGHT ON DRIVE AT BOX
#1358>
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
SuI ii it the original to
27699-1636 Phone
GROUNDWATEN GP ON
ASHENU.E p, SCE
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSOWCONSTRUCTING THE
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
19) 33-3221, within 30 days. GW-1 REV. 07/2001

252144
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
H W U. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL DAY
Address HWI. #9 S.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 693-1333
Area Code Phone number
4. DATE DRILLED 04/05-02
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. CROSS OVER
74 BY-PASS. 1ST DRIVE ON LEFT.
-o
w
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI4 WN URE IrF PERSON CONST
TING T WELL DATE
Su¢¢mit the original to the ivisi i n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
276 3€ Phone Np (W) 733-:221, within 30 days. GW-1 REV. 07/2001
"FADE

252142
U
1Submit the original to tie Div
127699-1636 Phone-No.-(919)
J,.
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
LANDRUM RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEFF FLYNN
Address 1111 LANDRUM RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4276
Area Code Phone number
4. DATE DRILLED 04/03/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EZI
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 150 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
County POLK
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
LANDRUM RD. LEFT ON DRIVE AT BOX 1111.
LEFT AT FORK LEFT AT LAKE.
L'vC Wd 9— AVW ZO
r
c
c
I DO HEREBY CERTIFY THAT 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
ih /
t ✓i Pt / )l. Ya %�%a�'>�� �/- 3-o a
ATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality,Groundwater Section, 1636 Mail Service Center —Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

252170
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREEN CREEK DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MICHELE MULLIS
Address 2020 GREEN CREEK DR.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2651
Area Code Phone number
4. DATE DRILLED 04/23/02
5. TOTAL DEPTH: 60
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 24" CEMENT
From To Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 40 To 60 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RFTN. RT. ON POORS
FORD RD. RT. ON EAST GREEN CREEK DR. LEFT
ON GREEN CREEK DR. 1/4 MILE ON RT. AT
WOOD FENCE.
ZC
w
r
01
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTat trTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
,
ubmit the original to -the t
27599-1636 Phone No. (91') 733
GROUNDWAT-P SLCIION
ASHEVILLE.?'` rICE
.e /'L /��:e� �/�G Flo . v- a 3 - n ,a
F PE O CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

252166
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HWY. #108 E.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NEAL JACKSON
Address 7400 HWY. #108 E.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-3491
Area Code Phone number
4. DATE DRILLED 04/10/02
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Egl
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in a cordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 24" CEMENT
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 30 To 50 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RFTN. NEW DRIVE
APPROX. 1/2 MILE ON LEFT PAST PEA RIDGE RD.
W
r
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
mit.thie original ttiilhe
2769-1636 Phone No. (919 733-
N CONSTRUCTING WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
ION
OFFICE

AS',,.
252163
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SOUTH WILSON HILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRIAN MILLER
Address SOUTH WILSON HILL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4459
Area Code Phone number
4. DATE DRILLED 04/08/02
5. TOTAL DEPTH: 80
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LEI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 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): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 60 To 80 Ft. 78M
From _ To _ Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWU. #9 N. FROM MILL SPRING. RT. ON
MCGUINN RD. RT. ON BIG LEVEL RD. RT. ON
SOUTH WILSON HILL RD. NEXT DRIVE ON RT.
PAST BRIGHT GREEN HOUSE. THERE WILL BE
TWO CEMENT BLOCK COLUMNS AT DRIVE.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'TIS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
bmit the original to thelDivi
-Ehgnei
P ICE
) 73
F Ps+: 3 CO TRUCTING T
' (/A 3/4 f- 6
WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

252161
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: COLUMBUS
GLEN WENGER RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LORENZO URIBE
Address GLEN WENGER RD.
(Street or Route No.)
COLUMB28722
Cityor TownUS State Zip Code
(828) - 863-2103 NC
Area Code Phone number
4. DATE DRILLED 04/04/02
5. TOTAL DEPTH: 52
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 32 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 52 Ft. _ CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From 32 To 52 Ft. 78M
From To Ft.
16. REMARKS:
in.
in.
Material
GRAVEL
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. LEFT ON
FOX MTN. RD. LEFT ON BILL COLLINS RD. LEFT
ON GLEN WENGER RD. 2ND. DRIVE ON LEFT.
S;)
c0
2 rr
CD
>o
rr
r.rro
c rz
-4
v
.,.
0
N0
S
-C
c
-0
S
W
I DO HEREBY CERTIFY THAT 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
STRUCTING THE WELL DATE
S bmit the original to thejDivis on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2699-16i6 Phone No ) 73 -3221, within 30 days. GW-1 REV. 07/2001
GRODUCI'! F: S'-C116N
AS1'n.;,tL OFFICE

250280
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality— Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
COXE RD.
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: JOHN MATHIS
Address 2096 COXE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-4609
Area Code Phone number
4. DATE DRILLED 03/28/02
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. RT. ON FLOYD BLACKWELL
RD. LEFT ON COXE RD. 1ST DR. ON RT. (2096 ON
BOX)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
UErIQNr{cyrr .'1O , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�F�IIEE
Sibmit the original to the Divi
276,0dkntOPR'N94QMt9) 73
ASI'r1 I :.E R , ir' L IFICF
TURF OF PERSON CONSTRUCTING WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

250276
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
HWY. 9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RAY GASPERSON
Address 6673 HWY. 9 S.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 683-4604
Area Code Phone number
4. DATE DRILLED 03/27/02
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
1 I. DISINFECTION: Type CHLORYTE Amount 20
12. CASING:
Depth Diameter
From 0 To 130 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From To Ft. in.
From _ To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
From
From To Ft.
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. 3RD. DRIVE
ON LEFT PAST DEBS MINI -MART AT SANDY
PLAINS.
I DO HEREBY CERTIFY THAT 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 OF PER
ON CONSTRUCTING THE WELL
DATE
Submit the original to tbe Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
ILrAfER .._NEC JIC,N�-�919) 33-3221, within 30 days. G W-1 REV. 07/2001
ASHEVILLE REGIONAL Oi
1

2$0 fl6
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
BULL HOLBERT RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAUL MULLET
Address BULL MULLET RD.
(Street or Route No.)
COLUMLBUS NC 28722
City or Town State Zip Code
(828) — 894-2754
Area Code Phone number
4. DATE DRILLED 03/11/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 17
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
12. CASING:
Depth Diameter
From 0 To 95 Ft. 6-1/4"
From To _ Ft.
From To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QULKRETE
From _ To Ft.
14.SCREEN: Depth Diameter
From To _ Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM MILL SPRINGS GO DOWN HWY. #9 S.
TURN RT. ON PENIEL RD. THEN RT, ON BILL
HOLBERT RD. GO TO DEAD END. GO STRAIGHT
ON PAVED DRIVE INTO NEW SUBDIVISION. NEW
LOT APPROX. 1/4 MILE ON RT.
0
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II iII
Saib st t the n igiitali tot li&Divg�_�
276941636 Phone No. (919) 7jf332
II
OF PERSON CONSTRUCTING THE WEL
DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001
GROUNDObTER SECTION
ASHEVILLE REGION)! OErICE

250275
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
GREENFIELDS DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAY LICHTY
Address GREENFIELDS DR.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-9292
Area Code Phone number
4. DATE DRILLED 03/06/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 160 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From _ To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To_
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Material
Ft. QUIKRETE
Ft.
Diameter Slot Size
Ft. in.
in.
16. REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
LANDRUM RD. LEFT ON GREENFIELDS DR. LOT
#8 APPROX. 1/2 MILE ON RT.
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rnNSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OFPERSOTTCD UCT HE LL DATE_ 6,4
SIG
u it the ongmal i6'fhe DI
276 9-1636 Phone No. (919)1733
jj/GROUNOWATEIP SECTIOId
ASHEVILLE REGIiTh4,t [inn-
J
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

250274
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
EQUESTRIAN ESTATES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BUD CLEGG
Address EQUESTRIAN ESTATES
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-6445
Area Code Phone number
4. DATE DRILLED 03/07/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 35 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
1 1. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
PENIEL RD. LEFT ON RED FOX RD. RT. ON
HAMILTON RD. LEFT AT FORKS, NEXT DRIVE
ON LEFT PAST BOX #645.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• tt : ; DS AND THAT • COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S[1 JRE OF •ERSON CONSTRUCTING THE WELL DATE
VU.1 2 6 cic:
Su mit the original to the t
27 - Phone No. (919) 733
GROUNDWATER SECTION
ASHEVILLE REGICNI' H:ii;r
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

250273
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
GREEN FIELDS DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JUDY HEINRICH
Address GREEN FIELDS DR
(Street or Route No.)
COLUMBUS N C 28722
City or Town State Zip Code
(903) — 876-2606
Area Code Phone number
4. DATE DRILLED 03/04/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
LANDRUM RD. (HWY. 14) LEFT ON GREEN
FIELDS DR 1/2 MILE ON RT.
0
?EBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T $T S S
-Fitt THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F RSON CONSTRUCTING THE W$LL DATE
Sub it the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27695Ga Plickir rN,O: ( ) 33-3221, within 30 days. GW-1 REV. 07/2001
ASHEILLF

5O272
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
HWY. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JEAN HILL
Address 5515 NC HWY. #9 S.
(Street or Route No.)
TRYON NC 28722
City or Town State Zip Code
( ) — 863-2231
Area Code Phone number
4. DATE DRILLED 03/01/02
5. TOTAL DEPTH: 130
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 2.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 130 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. in.
From _ To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. HOUSE ON
LEFT STRAIGHT ACROSS ROAD FROM PENIEL
RD. INTERSECTION.
O
O
rip
rr.o
n
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
/44 :� �3 / �o a
edit) 99nn�'',9SIGIt
Su it tlfE Sri in�1 ro Dij'isiti of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2769: -1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
J
GROUNDWATER SECTION
ASHEVILLE REGiON41 OFFICE
RE OF PER ON CONSTRUCTING THE LL DATE

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
250217
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BIG LEVEL RD.
(Street Name, Numbers, Community, Subdivision,
3. OWNER: FAYE ODEL
Address 5101 BIG LEVEL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4786
Area Code Phone number
4. DATE DRILLED 03/26/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Lot No., Zip Code)
II. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
I4.SCREEN: Depth Diameter
From _ To Ft.
From To Ft.
Slot Size
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
Material
in.
(ra rim
(i
G R 0 f'
l DO HEREBY CERTIFY THAT THIS WELL WASSG1t@NSILliteyft000t!, I
CONSTRUCTION STANDARDS, AND THAT A COPY •t - '. = 4%
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m i nutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SICETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RFTN. RT. ON BIG LEVEL
RD. LEFT ON DRIVE AT BOX #5101.
0
uv —
—77
O
ANCE WITH 15A NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
SI ATURE OF PERSON CONST UCTING T WELL
27.
0
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

250216
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
OLD HWY. 19
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. O:ATiER: TERRY KURKENDALL
Address 1427 OLD HWY. 19
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 859-2241
Area Code Phone number
4. DATE DRILLED 03/14/02
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use.., `.f Above Top of Cs =g)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance " ith I 5A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
Cu.., � FOLK
11. DISINFECTION: Type CHLORYTE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From
—T^—Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To
I4.SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft_
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑'Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 FROM COLUMBUS. LEFT ON OLD
HWY. 19 (AT KFC) LEFT ON PAVED DRIVE AT
BOX #1427,
DWATER SECTION
1 DO HEREBY CERTIFY THAT THIS WELL WAS L jai+c A'61EOREINNCE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS B
rG(
?NAT RE
O . ERSON CONSTRUCTING THE WELL
0
1TH 15A NCAC 2C, WELL
OVIDED TO THE WELL OWNER
3-/Vow
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

250215
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 [(Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
OLD HWY. 19
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BETTY HARNESS
Address OLD HWY. 19
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
County POLK
(_)—
Area Code Phone number
4. DATE DRILLED 03/11/02
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in.
From _ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To _ Ft.
16. REMARKS:
in.
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. LEFT ON
OLD HWY. 19 (AT KFC) 1 MILE ON LEFT. NEW
SUBDV.
0
0
.c7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONgFREKIIVpEr��r,�D� DANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A Coeatil1iI$ Rnvrfrc1{NSEBEEN PROVIDED TO THE WELL OWNER
iozker.
t- yi
SI NATU OF PERSON CONSTRUCTING HE 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

250213
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
MCQUINN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WALKERO'DUGGAN
Address MCQUINN RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-1009
Area Code Phone number
4. DATE DRILLED 03/08/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING 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 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 14
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To _ Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
MCQUINN RD. IN SUNNYVIEW. DRIVE GOES
STRAIGHT AT DEADEND. CROSS 2 WOOD
BRIDGES. ROAD TO RT. AFTER MAILBOX #1546.
r
ULH
, - 2002
GROUNDWATER SECTION
1 DO HEREBY CERTIFY THAT THIS WELL WAS r^ '�S�FiHi ��6ilGNHI�Pf�IG� " WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
id
SI ATU OF PERSON CONSTRUCTING T E 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

250211
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
4015 HWY. #9S.
(Street Name, Numbers, Community
3. OWNER: ROBBIE PRICE
Address 4015 HWY. #9 S.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 590-0849
Area Code Phone number
4. DATE DRILLED 03/05/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use ..+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Subdivision, Lot No., Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size
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 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LAST DRIVE
ON LEFT BEFORE WILL GREEN RD. (4015 ON
BOX)
UiaE C 6 D 1j E
J U N - 4 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATU E OF PERSON CONSTRUCTING HE 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
250210
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
HWY. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE WILLIAMS
Address HWY. #9 S.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) — 4657-2028
Area Code Phone number
4. DATE DRILLED 03/05/02
5. TOTAL DEPTH: 325
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use'.+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
1 1. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 170 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
I4.SCREEN: Depth Diameter
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LAST LOT ON
LEFT (GREEN SINGLEWIDE) BEFORE TURNER
RD. BESIDE OLD STORE BUILDING.
Slot Size
in. inItTalC S 2O p,V pin.in
Material c t' 4 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
r_
C)
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
A COPY OFTHISRECORDECjHAS BEEN PROVIDED TO THE WELL OWNER
C1 /L 6-77 42 i - 5--0 �.
S NAT RE OF PERSON CONSTRUCTING'THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
250208
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SKYUKA MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LESLIE PERKINS
Address SKYUKA MTN. RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 859-9981
Area Code Phone number
4. DATE DRILLED 03/04/02
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES Z NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
1 I. DISINFECTION: Type CHLORYTE Amount 2.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size
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:
Material
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HOUSTON RD. FROM COLUMBUS. LEFT ON
SKYUKA RD. RT. ON SKYUKA MTN. RD. 2ND
DRIVE ON LEFT AFTER PAVEMENT ENDS.
C E 0 V E
J U N - 4 2002
GROUNDWATER SECTION
ASHEGMIL-17FRUbiu AL urrm.c
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
o I dSI/ F PERE CONSTRUCTING THE WELL
2- Y- 6
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

250201
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
COXE RD.
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: CECIL MILLER
Address 1709 COXE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(704) — 391-2898
Area Code Phone number
4. DATE DRILLED 03/25/02
5. TOTAL DEPTH: 78
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 63 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
or Weight/Ft. Material
CEMENT
Depth Diameter
From 0 To 78 Ft. 24"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To _ Ft.
I4.SCREEN: Depth Diameter
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 63 To 78 Ft. 78M
From To Ft.
Method
POURED
Slot Size
in.
in.
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RFTN. RT. ON COXE RD.
2ND DRIVE ON RT. PAST FLOYD BLACKWELL
RD.
U S V
L
JUN - 4 2002
'JNDWATER SECTION
'IF REGION4L OFFICE
0
r
0
en
n
C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N 5"-(
IGNAT RE 0 R ON ONSTRUCTING 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

248468
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(i f applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipallPublic 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
GLEN WENGER RD.
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: HAROLD EDWARDS
Address GLEN WENGER RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828)— 894-5014
Area Code Phone number
4. DATE DRILLED 02/19/02
5. TOTAL DEPTH: 42
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 42 Ft. 24" CEMENT
From
From
From
To _ Ft.
To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From 30 To 42 Ft. 78M
From _ To _ Ft.
16. REMARKS:
in. in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM MILL SPRING. LEFT ON
FOX MTN. RD. LEFT ON BILL COLLINS RD. LEFT
ON GLEN WENGER RD. 2ND. DRIVE ON LEFT AT
DEAD END.
kid S- ZO
ca
0
+1
n a
0
0
I DO HEREBY CERTIFY
RLICTIQNi'STAwN A
S GN
Sub it the original to the Di ision
2769 - p# g{ 33-3
FELE L OFFICE _
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SsN CONSTRUCTING THE WELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

248455
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(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: MILL SPRING
FOX MTN. RD.
(Street Name, Numbers, Community, Subdivision; Lot No., Zip Code)
3. OWNER: DEE PRESTON
Address FOX MTN. RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828-) — 859-6500
Area Code Phone number
4. DATE DRILLED 02/13/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 600 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. 4108 W. FROM MILL SPRING. LEFT ON
FOX MTN. RD. JUST PAST GEORGE PARKER RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A ESPY •F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN
4a' r9 _ /3 _r
F PERSON CONS ' UCTING THE WELL DATE
Subm t the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699 .-e J(919 3-3221, within 30 days. GW-1 REV. 07/2001
Gr., , u.+-`_ . o[C 1 N
ASH[ -ILLS RELENOidL OFFICE

248454
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
FRANK WILSON RD.
(Street Name, Numbers, Community, Subdivision, Lot Na, Zip Code)
3. OWNER: HABITAT FOR HUMANITY
Address FRANK WILSON RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-7822
Area Code Phone number
4. DATE DRILLED 02/15/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RFTN. LEFT ON FOX MTN.
RD. LEFT ON BILL COLLINS RD. LEFT ON HAGUE
RD. RT. ON FRANK WILSON RD. HIOMESITE ON
RT.
90 :C Wd S- dVW 3C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN
jl
bmi the original to the Divi
2h699-1636Yhone No. 919 73
CRI.:11.D' 'eF=E"'IC''
OFFICE
on o
-322
OF PERSON CONSTRUCTING THE WELL
irna /C -6 a
DATE
Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
, within 30 days. GW-1 REV. 07/2001

248453
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
LAKE ADGER
(Street Name, Numbers, Community, Subdivision, LA No., Zip Code)
3. OWNER: JOHN EDNEY
Address LAKE ADGER
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 894-2119
Area Code Phone number
4. DATE DRILLED 02/19/02
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From _ To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From
14.SCREEN:
From
To Ft.
Depth Diameter
To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in. in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM COLUMBUS. LEFT ON
HWY. #9 N. LEFT ON SILVER CREEK RD. RT. ON
LAKE ADGER RT. RT. ON PARKWAY NORTH. 1.2
MILES ON RT.
n1'RFRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TPOC1k014 S'4:N AR
fed
SILVE
Su mit the original to the Dtvisiol
276994636=Plfdfie N c{SA9) 733-:
ASHEVIL'LE REGit7INAL. OFFICE
(IRE
OF PE SON CONSTRUCTING THE WELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

248452
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(i f applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
GARRETT RD.
(Street Name, Numbers, Community,
3. OWNER: CALVIN BRADLEY
Address GARRETT RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-2624
Area Code Phone number
4. DATE DRILLED 02/20/02
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 150 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Subdivision, Lot No., Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Material
From _ To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
16. REMARKS:
Slot Size
in. in.
in. in.
Size Material
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM COLUMBUS. LEFT ON
HWY. #9 N. LEFT ON SILVER CREEK RD. RT. ON
GARRETT RD. 1ST. HOUSE ON LEFT.
a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
['ON, TRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
mit the original to the
27 99-1636 Phone No. (91
GROU'd _^;';aEr', SEOI or
ASHEVIL'_E R-,,G1GP,r,L Of i; E
OF PERSON CONSTRUCTING THE WE DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
733 3221, within 30 days. GW-1 REV. 07/2001

248451
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
TALLY HO LANE
(Street Name, Numbers, Community
3. OWNER: MIKE AGARD
Address TALLY HO LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(864) — 587-3133
Area Code Phone number
4. DATE DRILLED 02/25/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ei
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Subdivision, Let No., Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
Depth
From _ To
From To
16. REMARKS:
Ft.
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
WALKER ST. FROM COLUMBUS. RT. ON
PENIEL RD. LEFT ON SMITH DAIRY RD. LEFT ON
HUNTVIEW LANE. LEFT ON TALLY HO LANE.
NEW HOME SITE APPROX. 1/10 MILE ON LEFT.
90 :£ I d S- dVW ZO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S TLS
DS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Y. 4TURE OF PERSON CONSTRUCTING THE WELL DATE
J
:t c3 S6 0L
ubmit the original to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

248449
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
CHESNEE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEO PRICE
Address CHESNEE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2451
Area Code Phone number
4. DATE DRILLED 02/28/02
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 160 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well Location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEEM RD. APPROX. 3/10 MILE ON RT. PAST
POORS FORD RD.
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0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
Suhmit the original to the 1 ivisi
27499
SECT ON
OFFICE
733-
OF PERSON CONSTRUCTING THE WELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
R

248446
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CHESNEE
ADAMS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ANDY SAMPSON
Address 275 ADAMS RD.
(Street or Route No.)
CHESNEE NC 29323
City or Town State Zip Code
(561) — 468-3045
Area Code Phone number
4. DATE DRILLED 02/14/02
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR21 PVC
From To _ Ft.
From _ To _ Ft.
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To
From To_
15. SAND/GRAVEL PACK:
Depth 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
STR D ' i j' i D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
County POLK
Material
Ft. QUIKRETE
Ft.
Method
POURED
Diameter Slot Size
Ft. in. _
Ft. in. in.
Material
in.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
CHESNEE RD.CROSS INTO S.C. LEFT ON ADAMS
RD. NEW DRIVE AT DEAD END
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ubm$t the original to the Div
27699
IRE?0`dAL OFFICE
CONSTRUCTING THE WELL DATE
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 Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
248444
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
GREEN CREEK DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RITA NELSON
Address 1340 GREEN CREEK DR.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-1280
Area Code Phone number
4. DATE DRILLED 02/18/02
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
Ft.
Ft. _
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
From _ To
From _ To
13. GROUT: Depth
From 0 To 20
From _ To
I4.SCREEN: Depth
From _ To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth
From _ To
From To
Size
Ft.
Ft.
in.
in.
Material
in.
in.
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
GREEN CREEK DR (?a VOL. FIRE DEFT. GO
STRAIGHT AT COXE RD. ON GREEN CREEK DR.
7/10 MILE ON LEFT. NEW DRIVE (1340 NOT UP
YET)
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
3, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEpWELL OWNER
1R�/ H_ r 4 e>� _, d - /6 - 6 a
OF PE SON CONSTRUCTING THE`�'L DATE
Sp�U 'ION STAND
TURF
Submit the original to the t ivision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2 _ ) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

248480
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaLPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
HWY. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WANDA JACKSON
Address 8520 HWY. #9 S.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4267
Area Code Phone number
4. DATE DRILLED 02/01/02
5. TOTAL DEPTH: 47
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 27 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 47 Ft.
From To _ Ft.
From To _ Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
CHLORYTE Amount 9.2
Wall Thickness
Diameter or Weight/Ft. Material
24" CEMENT
Material
CEMENT
Method
POURED
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 27 To 47 Ft. 78M GRAVEL
From _ To _ Ft. _
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. 9 S. FROM MILL SPRING. HOUSE ON RT.
JUST BEFORE GREEN CREEK FIRE DEPT. (8520
ON BOX)
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I DO HEREBY CERT
:ar'rrWI ST,H
Air
hi PA, ti
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
i' •FPEk•5' •NS
Sub i it the original to the Di ision
2769g.E MO 733-3
ASHEVILLE REGIONAL OFFICE
TING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

247146
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaL/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
LOT #15-FOXWOOD HILLS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BILL HENRY
Address FOXWOOD HILLS
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 698-8590
Area Code Phone number
4. DATE DRILLED 1/14/02
5. TOTAL DEPTH: 325
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR27.6 PVC
From _ To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth _ Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. CROSS BY-PASS
& RT. ON HUGH CHAMPION RD. RT. INTO
FOXWOOD HILLS SUBDV. LOT #15 ON RT.
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL, OWNER
'/ / /
DATE
SIGNATURE OF ` RS
T
�)I
Submit the original to the Division of Water Qua�if•'Groundwater Section, 163
27699-1636 Phone No. [phone], within 30 rhiyyl
'1WATER SECTICIF
REGIONAL OF.'-E
Aa
it Service Center — Raleigh, NC
GW-1 REV. 07/2001

247144
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
CHIMNEY ROCK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JERRY STEPP
Address 131 CHIMNEY ROCK RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-5802
Area Code Phone number
4. DATE DRILLED 01/22/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 605 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR27.6 PVC
To Ft.
To Ft. _
Depth Material Method
To 20 Ft. QUIKRETE POURED
From
From
13. GROUT:
From 0
From To
14.SCREEN: Depth
From To
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _ Ft. _
Ft.
_ Diameter
Ft.
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH •
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108E. FROM COLUMBUS. LEFT ON
HWY. #9N. LEFT ON SILVER CREEK RD. RT. ON
CHIMNEY ROCK RD. 3RD. DRIVE ON RT. PAST
END OF PAVEMENT.
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0
_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAI3,DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER . f ONSTRUCTING THE
Submit the original to the Division of Water Q li, Groundwater Section,
27699-1636 Phone No. [phone], within 0 da .
i -tea-c a -
DATE
ail Service Center —Raleigh, NC
GW-1 REV. 07/2001

247143
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ® Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SILVER CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MILL SPRING V.F.D.
Address SLIVER CREEK RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-2454
Area Code Phone number
4. DATE DRILLED 01/22/02
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR27.6 PVC
From _ To Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth _ Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
SILVER CREEK RD. FIRE DEPT. ON RIGHT JUST
BEFORE CHURCH ENTRANCE TO LAND
O'LAKES.
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 PE
Submit the original to the Division of Water
27699-1636 Phone No. [phone], within
DATE
ail Service Center — Raleigh, NC
CW-1 REV. 07/2001

247140
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
PHILLIPS DIARY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DENNIS LANAHAN
Address PHILLIPS DIARY RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(904) - 260-2341
Area Code Phone number
4. DATE DRILLED 1/2/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 8
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR27.6 PVC
County POLK
From _ To _ Ft. _
From _To_Ft.
_
13. GROUT: Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth _ Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic m_ ap
(check box)
DEPTH •
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221S. FROM RFTN. RT. ON COXE RD. RT.
ON PHILLIPS DIARY RD. GREEN METAL GATE
1/2 MILE ON RT.
tV
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CO
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CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-a-a
S GNATURE OF
Submit the original to the Division of Water Qindity, Groundwater Section,]
27699-1636 Phone No. [phone], within 30 days.
DATE
ail Service Center - Raleigh, NC
GW-1 REV. 07/2001

r38
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
TURNING LEAF LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES H, HENSLEY
Address 624 TURNING LEAF LANE
(Street or Route No.)
MILL SPRING NC
City or Town State
(828) — 625-0750
Area Code Phone number
4. DATE DRILLED 1/14/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1-1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR21 PVC
From _ To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth _ Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft. _
From To Ft.
County POLK
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
28756 Latitude/longitude source: 0 GPS 0 Topographic map
Zip Code (check box)
DEPTH •
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9N. FROM MILL SPRING. RT. ON GRASSY
KNOB RD. RT. ON TURNING LEAF LANE. RT. AT
FORK. RT. AT SHARP CURVE. LOT 1/10 MILE ON
RT. AFTER CURVE.
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c
SIGN TURE OF PE'
Submit the original to the Division of Water Qu
27699-1636 Phone No. [phone], within 30
C
."2UNUWATEH :
V LLE REGip;<,
DATE
it Service Center —Raleigh, NC
GW-1 REV. 07/2001

247136
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
TURNING LEAF LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JANICE EDWARDS
Address 776 TURNING LEAF LANE
(Street or Route No.)
M28756
City or TownSPRING StateNC Zip Code
(828) ILL - 625-0750
Area Code Phone number
4. DATE DRILLED 01/17/02
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 11
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR 21 PVC
From _ To _ Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RT. ON
GRASSY KNOB RD. RT. ON TURNING LEAF LANE.
RT. AT FORK. RT. AT SHARP CURVE. LOT 1/10
MILE ON RT. AFTER CURVE.
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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
- / 7 - 6
SIGNATURE OF P
Submit the original to the Division of Water I
27699-1636 Phone No. [phone], within
Groundwater Section,)
s.
GROI,1`JOP:WATER SECI
ASRF''' REGIONAL f'-
DATE
Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

247130
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
HORNE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHAVIS SIMPSON
Address 185 HORNE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 863-4085
Area Code Phone number
4. DATE DRILLED 1/10/02
5. TOTAL DEPTH: 50
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 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.9
Wall Thickness
or Weight/Ft. Material
CEMENT
12. CASING:
Depth Diameter
From 0 To 50 Ft. 24"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. CEMENT
Method
POURED
From _ To _ Ft.
14.SCREEN: Depth _ Diameter Slot Size
From To Ft. in.
From _ To Ft. _ in.
15. SAND/GRAVEL PACK:
Depth Size
From 35 To 50 Ft. 78M
From To Ft.
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH •
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON HORNE
RD. HOUSE ON LEFT. (185 ON BOX)
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
Submit the original to the!
27t99-1636.Phone Nos (9_19) 73
URE
F PE' . e ONS ' UCTING THE WELL
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

247129
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SILVER CREEK RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: JIMMY & NINA SEARCY
Address 477 SILVER CREEK RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-3736
Area Code Phone number
4. DATE DRILLED 1/10/02
5. TOTAL DEPTH: 48
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 28 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
Zip Code)
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 48 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth - Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 28 To 48 Ft. 78M GRAVEL
From _ To _ Ft.
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RFTN. RT. ON #9N. LEFT ON
SILVER CREEK RD. WHITE HOUSE ON LEFT (477
ON BOX)
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16. REMARKS:
I DO HEREBY CERTIFY THAT 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
C / �1�/,�Z��-oYG� i��//�►P� %/0-da
I j $1 ATURE O RS t VNSTRUCTING THE WELL DATE
:Li I
Submit the original to tt' Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
i7f9,9-1636 `4one No. (919) 7b3-3221, within 30 days. GW-1 REV. 07/2001

247121
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 ❑ [(Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SMITH DAIRY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JUAN CONTRERRAS
Address 1871 SMITH DAIRY RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-3332
Area Code Phone number
4. DATE DRILLED 01/18/02
5. TOTAL DEPTH: 65
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft. 24" CEMENT
From To _ Ft. _
From _ To Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To _ Ft.
14.SCREEN: Depth _ Diameter
From To _ Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 50 To 65 Ft. 78M GRAVEL
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
PENEIL RD. RT. ON SMITH DAIRY RD. NEW
DOUBLE WIDE 1/4 MILE ON RT.
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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
a`O
S
Submit the original to the B'w(s
27699-1636 Phone No. (919) 73:
TU OF N NSTRUCTING T WE L
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

247120
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
POORS FORD RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY REID
Address 8241 POORS FORD RD.
(Street or Route No.)
RUTHRFORDTON NC 28139
City or Town State Zip Code
(828) — 863-2578
Area Code Phone number
4. DATE DRILLED 01/28/02
5. TOTAL DEPTH: 65
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 65 Ft. 24" CEMENT
From _ To _ Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth _ Diameter Material
From _ To Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 50 To 65 Ft. 78M GRAVEL
Method
POURED
Slot Size
in. _ in.
in. in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RFTN. RT. ON POORS
FORD RD. LAST MOBILE HOME ON LEFT
BEFORE CHESNEE RD. (8241 ON MAILBOX)
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1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r_ONSIRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ao.
AT OF
SbN CONSTRUCTING HE WELL DATE
Submit the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. (919) �33-3221, within 30 days. GW-1 REV. 07/2001

252084
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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:
Nearest Town: COLUMBUS
PHILLIPS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAR.'? ANN HAYMON
Address PHILLIPS RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-2728
Area Code Phone number
4. DATE DRILLED 04/26/02
5. TOTAL DEPTH: 325
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check apprepriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
COLLINSVILLE RD. LEFT ON PHILLIPS RD. 3RD
FARM ON LEFT (BOX #855)
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 / . Slfe: URE OF PERS t CO TRUCTING T WELL DATE
VV n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
GRGUfti)'dyATER S
P
LGIOIdAL OFFICE

26G4F8
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
HOG BACK MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT TOBEY
Address HOG BACK MTN. RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828)— 859-9499
Area Code Phone number
4. DATE DRILLED 12/03/02
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 16- METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM HWY. #176 W. IN TRYON. RT. ON
PACOLET ST. LEFT ON CHESTNUT ST. RT. ON
MELROSE AVE. RT. ON LAUREL AVE. LEFT ON
HOGBACK MTN. RD. GO TO THE TOP OF MTN.
1ST DRIVE ON RT. AFTER PAVEMENT ENDS.
DRIVE IS OVER 2 MILES LONG.
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I DO HEREBY C
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Sub it the original to the Di4ision4of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
2769 tiliN@.(9191)' 733-3 21, within 30 days. GW-1 REV. 07/2001
/c In r f eiU,__ f)WL
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N CONSTRUCTING THE WELL
DATE

266464
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: TRYON County POLK
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: COLLEEN MAGIN
Address GOLF COURSE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) — 457-3855
Area Code Phone number
4. DATE DRILLED 12/02/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING:
Depth Diameter
From 0 To 120 Ft. 6-1/4"
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From _ To Ft.
From To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Method
POURED
Slot Size Material
in. in.
in. in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
LANDRUM RD. RT. ON GOLF COURSE RD.
APPROX. 1-4/10 MILE ON RIGHT.
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MAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
213S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-lieZ
TURE OF PERSON CONSTRUCTING THE WELL DATE
itit,.7yy1�4f�, r l to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
AS . O`€ RP@I Ih e0(6919) 733-3221, within 30 days. GW-1 REV. 07/2001

266463
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
MEADOW CREST RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHANE JACKSON
Address 780 MEADOW CREST RD.
(Strect or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 223-7927
Area Code Phone number
4. DATE DRILLED 12/03/02
5. TOTAL DEPTH: 465
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. GO APPROX. 3.1 MILES & RT.
ON MEADOW CREST RD. GO 6/10 MILE & RT.
AGAIN. 2ND DRIVE ON RT.
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ri�
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
S m• Rio TANDA$DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
QTI
SIGN
RE OF PERS N CONSTRUCTING THE WELL DATE
Submit the original to the Division
276994636-PhoneNo. .(919) 733-32
f Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

266462
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Other
From _ To
13. GROUT: Depth
From 0 To
From To
I4.SCREEN: Depth
From To
From _ To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From _ To _ Ft.
Monitoring ❑ Recovery ❑ Heat Pump Water Injection El If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING County POLK
RUFF LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JESSE RUFF
Address 95 RUFF LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-8633
Area Code Phone number
4. DATE DRILLED 12/10/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
Ft.
Material Method
20 Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft in. in.
in. in.
16. REMARKS:
Material
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. GO APPROX, 2
MILES. LEFT ON RUFF LANE. 2ND HOUSE ON
LEFT.
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LIC
Cri
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS Ifl VTTONi SSTANQ • ''®S,j4N 1 -AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�1 I 1
r_✓ C
SIGNATUR3
/ / a - o ,
ERSON CONSTRUCTING THE WELL DATE
Submit the 4r_iginal to the Division o Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699 1636 Pbq O j 3 , within 30 days. GW-1 REV. 07/2001
ASrEVILLE REG' ./ CE

266452
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
TOM JOHNSON RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY REID
Address 220 TOM JOHNSON RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2578
Area Code Phone number
4. DATE DRILLED 12/12/02
5. TOTAL DEPTH: 52
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 32 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
l 1. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 52 Ft. 24" CEMENT
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. in. in.
From _ To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 32 To 52 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. RIGHT ON CHESNEE RD.
LEFT ON MELVIN HILL RD. RIGHT ON TOM
JOHNSON RD. 2ND HOUSE ON LEFT. #220 ON
PORCH POST.
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c_e.,..,7 __,,,„,4_, ,„kr, ,,,, _,,
I ' SIri1'it• RE F PER N ONS RUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
276994636-Phone-N9,-(912 33-3221, within 30 days. GW-1 REV. 07/2001

266449
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
TURNER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE HIGGINS
Address 144 TURNER RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-2420
Area Code Phone number
4. DATE DRILLED 12/19/02
5. TOTAL DEPTH: 70
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
1 1. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From To _ Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 50 To 70 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
TURNER RD. 1ST HOUSE ON RT.
0
tV
L
z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNAtL
Su it the t U naf to the Divisiotref"
27699-1636 Phone No. [phone],
DFPkfLtSO7�ICO IN WELLie DATE/�//2/4 ra
Vter Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
within 30 days. GW-1 REV. 07/2001
A S"',

265636
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
WINDING CREEK LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LISA CONLEY
Address WINDING CREEK LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-2658
Area Code Phone number
4. DATE DRILLED 11/26/02
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 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): 5 METHOD OF TEST ARD
10. WA'TER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 110 Ft.
From To Ft.
County POLK
CHLORYTE Amount 14
Wall Thickness
Diameter or Weight/Ft.
6-1/4" SDR.21
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter Slot
From To Ft. _ in. _
From To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size Material
Material
PVC
Method
POURED
Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
PENIEL RD. RIGHT ON SMITH DAIRY RD. GO
APPROX. 4/10 MILE AND TURN LEFT ON
HUNTVIEW DR. GO TO END OF HUNTVIEW AND
TURN RIGHT ON WINDING CREEK LANE. 2ND
DRIVE ON LEFT.
O
0
rn
N
0
0
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Do I I REJ3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
QI!S IIUPtIdN fA(DA n, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�!J
Sjthmit the original to the Divis
277i40`1/1it8nbRG310A19) 73:
H. lI i_L REGIQIU?! OE iOE
URE OF PERSON CONSTRUCTING THE WELL
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

265634
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
PENIEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DORIS WILLIAMS
Address 1859 PENIEL RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 859-6123
Area Code Phone number
4. DATE DRILLED 11/05/02
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth
From 0 To 80
From To _
From To _
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To
From To
County POLK
ype CHLORYTE Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft.
Ft. _
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
_ Ft. _ in. _ in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From _ To _ Ft.
From To Ft.
Material
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT PENIEL RD.
APPROX. 1.9 MILES ON LEFT (1859 ON BOX)
0
N
0
ri
N
0
W
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDSLAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CO
/ i?-r-rig // - D 5- O .a
SItN r.E OF PERSON CONSTRUCTING T WELL DATE
it the original to the Divi
-1636 Phone No. (919) 7)3-32
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
f Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

2 V lJ 6 1 \l
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
JACKSON GROVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY STOTT
Address JACKSON GROVE RD.
(Street or Route No.)
COLUMBUS NC 28782
City or Town State Zip Code
(828) — 894-3291
Area Code Phone number
4. DATE DRILLED 11/18/02
5. TOTAL DEPTH: 57
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 57 Ft. 24"
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
Material
CEMENT
Method
POURED
14.SCREEN: Depth Diameter Slot Size
From _ To _ Ft. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size
From 37 To 57 Ft. 78M
From To Ft.
16. REMARKS:
Material
GRAVEL
Material
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
LANDRUM RD LEFT ON JACKSON GROVE RD.
1ST LOT ON RIGHT.
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS,AND,THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i' Aix l l Q'.
IGNA
Submi t ht original to the Division o
27699- 636 !hone No. (919) 733-322
L0f.7-r//—i', o
RSON CONSTRUCTING THE WEL DATE
r Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
in 30 days. GW-1 REV. 07/2001
t3PCU
p�17(,li

265611
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ADRIENNE OTTO
Address 2409 GOLF COURSE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(843) — 883-5056
Area Code Phone number
4. DATE DRILLED 11/26/02
5. TOTAL DEPTH: 77
6. DOES WELL REPLACE EXISTING WELLS YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 57 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 77 Ft. 24" CEMENT
From _ To _ Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 57 To 77 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON HWY.
#14. RT. ON GOLF COURSE RD. 1ST DRIVE ON RT.
1ST BUILDING ON RT.
S£:OIWV Z1330Z0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
" T AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I I I SIGNAT
L J
ubmit the original to the Diviiion o Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
7699-1636-Pheu4 pipj9_322 , within 30 days. GW-1 REV. 07/2001
iF
_CI it_, l F
OF P
7.:, . // - a (; -G a
ON CONSTRUCTING HE WELL DATE

265606
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
. Nearest Town: COLUMBUS
JACKSON GROVE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JANE GALLAGHER
Address 1855 JACKSON GROVE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 894-2607
Area Code Phone number
4. DATE DRILLED 11/15/02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. RT. ON HWY.
#14. LEFT ON JACKSON GROVE RD. HOUSE 2
MILES ON LEFT. (1855 ON BOX)
0
Ps.)
0
m
fV
0
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RiT, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 C.-t-, 1 C emu. // - / 9(74—n'll 0 // - / 5---- O -2
SIG t ` ' ; OF PERS CONSTRUCTING THE WELL 111 DATE
Sub it the original to the Di ' ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2769 Mk 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEV LLE RFCIONJAL OFROE

2G'5i93
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
GOLF COURSE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: COLLEEN MAGIN
Address GOLF COURSE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(864) — 457-3855
Area Code Phone number
4. DATE DRILLED 11/13/02
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1/2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 19.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 130 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S, FROM MILL SPRING. RIGHT ON
LANDRUM RD. RIGHT ON GOLF COURSE RD.
APPROX. 1-4/10 MILE ON RIGHT.
O
N
0
rn
O
rO
J
&TINE
STRI
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
Subrjtit the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699G'106\PIPfA76ri96Ep31tn 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OF ECr
Pr_n r{
IG
OF PERSON CONSTRUCTING THE WELL

12. CASING:
Depth Diameter
From 0 To 50 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From _ To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To _ Ft.
From To Ft.
263369
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
FOWLER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TIM HADEN
Address FOWLER RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(864) — 322-9277
Area Code Phone number
4. DATE DRILLED 10/16/02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
Topographic/Iand 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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM RUTHERFORDTON. RT.
ON FOWLER RD. GO THRU GATE AT DEAD-END.
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
SI
miR"1he origina?CiPthe
27699-1636 Phone No. (91S
OF PERSO CONSTRUCTING THE WELL
k� /b-/6 - n
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
733 3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

263366
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
WILLIE B. LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK MCFALLS
Address 101 WILLIE B. LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-3378
Area Code Phone number
4. DATE DRILLED 10/19/02
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 14.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHCRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. in.
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in. in.
16. REMARKS:
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RIGHT ON
PENIEL RD. APPROX. 1/10 MILE ON RIGHT. PAST
PENIEL BAPTIST CH. TURN RIGHT ON WILLIE B.
LANE. MODULAR HOME AT DEAD END.
0
0
I DO HEREBY CERTI . a HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Sub it the original to the D isio
276733-3
ASHEVILLE REGIONAL OFFICE
RE OF PE ON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

263363
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Dearest Town: CO U,YIBUS
HWY. #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JHJVN SCHLABA\,ri
Address 8636 HWY. #9
(Street or Route No.)
COLUiM':BUS txl. LO/LL
City or Town State Zip Code
(828)— 859-9768
Area Code Phone number
4. DATE DRILLED 10/24/02
c TOTrkl DEPTH: 3n5
.. 1V1l11 1111. JV��
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"; A4rase nip of Casing)
8. TOP OF CASING 1S 1-1/2 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
nrda„re with 15A NCAC )r 0118
9. YIELD (gpm): 10 METHOD OF TEST AItD
10. WATER ZONES (depth):
Cuuiit UULil
i i. DISINFECTION: Type CHLORITE Amount 7.5
12. CASING: Wall Thickness
i•1.i;u1 Diameter G1 ._1 11:; 11. Material
From 0 To 100 Ft. 6-114" SDR.21 PVC
From _ To Ft. _
From T- rv11.
.GROUT: Depth Material :Method
From 0 To 20 Ft. QUarDETE POURED
r__�
11Vn3 1 t., ll.
14.SCREE : Depth Diameter clot Size Material
From To Ft.
;-,i", 11. ;t. in.
SAND/GRAVEL L PACK:
Depth Size Material
in. in.
From To Ft.
From To Ft.
T upugraphic/Land seithig
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
r� GPS r—,
Latituue. wuLJ ngiiuue source: U Z L_i Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. include the roar
number and common names
HWY. #9 S. FROM MILL SPRNG. NEW DRIVE
()N RIGHT 1/10 MILE PAST GREEN CREEK VFD.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELT,
OTt T 17 A c ANT) THAT A COPY OF THIS RFCORD PAC RFFN PROVIDE[) TO THE WFI I. OWNF_R
y,/- 6 a
DATr
Su�mit the original to the l ivisir
27 '. ',!trTilttb1v?w MG1009) 733-
A6REVILLE REGIONAL OFFICE
4"L /Nr n f_ncr\Al r•/1wlcmnv`TlAv• ml to n ,r; L
VI .__.''. I „-.-.
n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3221, within 30 days. GW-1 REV. 0712001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
263364
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LYNN
HOOKER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE FRENCH
Address 389 HOOKER RD.
(Street or Route No.)
LYNN NC 28750
City or Town State Zip Code
(828) — 894-3500
Area Code Phone number
4. DATE DRILLED 10/23/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
1 I. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Depth Diameter
From 0 To 80 Ft. 6-1/4"
From _ To _ Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUHCRETE
From _ To _ Ft.
I4.SCREEN: Depth Diameter
From To Ft.
From _ To _ Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in. in.
in. in.
16. REMARKS:
Topographicaand 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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. LEFT ON
OLD HWY. #19. RT. ON HOOKER RD. 3/4 MILE ON
LEFT.
Cm
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
ej.,4(;)
ub4iirthe brigiti io th
7699-1636 Phone No. (9
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
/0 - 6
TURE OF PERSON CONSTRUCTING THE LL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

263356
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
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 1
2. WELL LOCATION:
Nearest Town: RUTHERFORDOTN
GREEN RIVER HIGHLANDS•LOT #15
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MICHAEL JACKSON
Address GREEN RIVER HIGHLANDS
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 287-2246
Area Code Phone number
4. DATE DRILLED 10/14/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From _ To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft. _
16. REMARKS:
in.
in.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORDTON. GO DOWN HWY.
#221 S. RIGHT ON COXE RD. GO DOWN COXE RD.
INTO POLK CO. TURN RIGHT INTO GREEN
RIVER HIGHLANDS ONTO RIVER CREST
PARKWAY RIGHT ON BEECH TREE CIRCLE. !ST
DRIVE ON LEFT. LOT #15.
_3
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT ACOPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//9"— G
OF P RSON CONSTRUCTING THE LL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
263358
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 121
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON County POLK
COXE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRUCWEDWARDS
Address 1565 COXE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-4338
Area Code Phone number
4. DATE DRILLED 10/4/02
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 15.5
12. CASING:
Depth Diameter
From 0 To 120 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size
From _ To _ Ft. _ in.
From _ To _ Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
16 REMARKS:
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. LEFT ON COXE RD. LEFT AT
BOX 1565. APPROX. 1/2 MILE.
I THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• . tr •P a 3, AND THAT A COPYg���OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 //., ...a, ti7,---,--2.42_ /0- y- aS #A URE O PERSON CONSTRUCTING THL DATE
y tl } Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3 °® 9) 733 -3221, within 30 days. GW-1 REV. 07/2001

263359
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
SANDY PLAINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRUCE EDWARDS
Address SANDY PLAINS RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) - 863-4338
Area Code Phone number
4. DATE DRILLED 10/02/02
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 12
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDIL21 PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
SANDY PLAINS RD. 1/4 MILE ON RT. THROUGH
GATE
0
0
I DO BERERY CFRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
SA , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2002SI
URE OF PERSON CONSTRUCTING
/env /o- - o a
T WELL DATE
Suimit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276 tr 16F3b(idbawloc(% 9) 733-3221, within 30 days. GW-1 REV. 07/2001
ASNFVILLE REGIONAL OFFICE

27699- r�4 O�uvvAiK.7�
ASHEVILLE REGIONAL OFFICE
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
263360
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
PENIEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BARRY & BILL HOLBERT
Address 5045 PENIEL RD.
(Street or Route No.)
TRYON NC 28782
City or Town State
(828) — 894-8131
Area Code Phone number
4. DATE DRILLED 10/31/02
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
Zip Code
11. DISINFECTION: Type CHLORYTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 90 Ft. 6-1/4" SDR.21 PVC
To Ft.
To Ft. _
Depth Material Method
To 20 Ft. QUIKRETE POURED
To _ Ft.
Depth Diameter Slot Size Material
in. in.
From 0
From
From
13. GROUT:
From 0
From
14.SCREEN:
From To Ft.
From _ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in. in.
16. REMARKS:
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING.M RIGHT ON
HUGH CHAMPION RD. RIGHT ON PENIEL RD. 1ST
DRIVE ON RIGHT PAST BILL HOLBERT RD.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
QiTIQIj STA!ARD�""hND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LL P /0' 3' - /] J
OF PERSON CONSTRUCTING THE WELL DATE
MUV 2
Subm the original to the Diviion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
322 , within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 263361
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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: COLUMBUS
PENIEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DIANE TERCIERA
Address 2936 PENIEL RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-7091
Area Code Phone number
4. DATE DRILLED 10/30/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 70 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT PENIEL RD. 2ND
HOUSE ON RT. PAST RED FOX RD. YELLOW
HOUSE BOX #2936
0
Lin
_-4
LE
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
SIC\ 1 JRh OF PERSO CONSTRUCTING THE WELL DATE
/A - 3 4 - O
orilgialtri the D a of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27499-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFIC

263341
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: COLUMBUS
RED FOX RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DIANE TERCIERA
Address RED FOX RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-7091
Area Code Phone number
4. DATE DRILLED 10/31/02
5. TOTAL DEPTH: 645
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 18
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
n.
Size Materia
.4411
From
From
16. RE
nP
I DO HEREBY
CONSTRUCTI
•
lth
IVljr .. /Litz
CERTIFY THAT THIS WELL
J.14PVPARCW THA
A EV LE REGIONAL OFFIrE e
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM COLUMBUS GO OUT PENIEL RD. RIGHT
ON RED FOX RD. APPROX. 2/10 MILE ON LEFT.
1ST DRIVE ON LEFT.
0
r.+
0
01
WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C/Z/7, /D 3 /- 6
S NAT OF ERSON CONSTRUCTING T 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

263342
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
SALEM WILLIAMS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WILLA MILLARD
Address 932 SALEM WILLIAMS RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-4897
Area Code Phone number
4. DATE DRILLED 10/28/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To
14.SCREEN: Depth
From _ To
From To Ft
15. SAN
From
From
16. RE
IDOHE
CONSTR
Ft.
Diameter Slot Size Material
Ft. in. in.
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORDTON. GO DOWN
HWY.#221 S. RIGHT ON POORS FORD RD. RIGHT
ON E. GREEN CREEK DR. RIGHT ON SALEM
WILLIAMS RD. 6/10 MILE ON LEFT. (932 ON BOX)
0
(11
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�G THE WELL
IGNATURE OF PERSON CONSTRUCT
/0 ' ,2 2- D d
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

263343
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: MILL SPRING
FIRE TOWER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT BROMWELL
Address 334 FIRE TOWER RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-2265
Area Code Phone number
4. DATE DRILLED 10/24/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft 6-1/4" SDR.21 PVC
From To _ Ft.
From To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN- Depth Diameter Slot Size Material
From To Ft. in. m.
From
15. SAND/GR
From
From
Size Maier
Ft.
h ';, 1 2002
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. LEFT ON
FIRE TOWER RD. 1ST DRIVE ON RIGHT -PAST
THE SHARP CURVE. (334 ON BOX)
16. REMARKS _
GROUNDWATER SECTION
I DO HEREBY CEitsivikimtiIiwthafroifi WA S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATUR'E OF P ONSTRUCT�1 DATE
EI n
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

263335
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
SOUTH WILSON HILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WALT BRAND
Address SOUTH WILSON HILL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 625-8842
Area Code Phone number
4. DATE DRILLED 10/10/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
County POLK
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter
From 0 To 70 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. OUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From _ To Ft. _
From To Ft.
or Weight/Ft. Material
SDIL21 PVC
15. SAND/G
D
From
From
16. REMARKS
I DO HEREBY
CONSTRUCTI
Method
POURED
Slot Size Material
in. _ in.
in.
RAC
L5 fria
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY, #9 N. FROM MILL SPRING. RIGHT ON
MCGUINN RD. RIGHT ON BIG LEVEL RD. RIGHT
ON SOUTH WILSON HILL RD. APPROX. 1-1/2
MILE ON RIGHT. 1ST NEW DRIVE ON RIGHT
PAST BOX #4694
CD
Eat.
tN ST�LL
4RD3, WALASN THAT ACOPYNOF THIS RESTRUCTED RD HAS EEN PROVED TO THE WEIN ACCORDCE WITH 15A NCAC 2C, LL OWNER
�. J �A t k9 �%,nn' - /O- /d - 6
SI ATU OF PERSON CONSTRUCTING T[HEE``�WEELL 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

263336
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT, CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
TABLEROCK DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRUCE WIDEMAN
Address TABLEROCK DR
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 894-2698
Area Code Phone number
4. DATE DRILLED 10/09/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 6-1/4" SDR21 PVC
From _ To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From To Ft. in. _in__
Depth III 15. SAND/GRAVEL .ti f� , 's' ;I 1 if; ��
er
i
From _ To
From To
16. REMARKS:
9C2
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON OLD
HOWARD GAP RD. RT. ON HOWARD GAP RD. RT.
ON INDIAN MTN. RD. LEFT ON RLXHAVEN DR
LEFT ON TABLEROCK DR LOT ON RT AT CUL-
DE-SAC.
0
c11
I DO HEREBY CERTIFY J '1t kC Ii4 S ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST JUNJJAIWS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
— f - U a.
NATURE OF PERSON CONSTRUCTING ITIE 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

263330
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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:
Nearest Town: COLUMBUS
SMITH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE BURGESS
Address SMITH RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) - 894-8320
Area Code Phone number
4. DATE DRILLED 10/4/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ Tn Ft fr --in.
15. SAND/GRAVcl0II 1111 —'
D � iao`� Matcrtai
From _ To -�l Ft.
From 1
16. REMARKS:
L
FR
Topographic/Land setting
❑ Ridge ❑ Slope D Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM COLUMBUS. RT. ON FOX
MTN. RD. CROSS BY-PASS.LEFT ON SMITH RD.
1ST HOUSE ON LEFT.
GROUNDWATER SECTION
I DO HEREBY CERaTUNBE HISNNEUIICWAS rONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a�� cr>-r--c7 /4-
GNATU[tE 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

263331
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential ® MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
MEDICINE MINE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROBERT F. BARBER
Address MEDICINE MINE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 894-8705
Area Code Phone number
4. DATE DRILLED 10/01/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 35 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 60
From To
From To
13. GROUT: Depth
From 0 To 20
From _ To
14.SCREEN: Depth
From To_
From To
Ft.
Ft. _
Ft.
County POLK
CHLORYTE Amount 4.5
Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Material
Ft. QUIKRETE
Ft.
Method
POURED
Diameter Slot Size Material
Ft. in. _ in.
in. in.
Ft
15. SAND/GRA
From
From
16. REMARKS:
C
I4fatia
Ft. _
Ft.
ry; y j .. cs&
I DO HEREBY cEmitEV
CONSTRUCT th
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #18 E. FROM COLUMBUS. RT. ON FOX
MTN. RD. APPROX. 2 MILES ON LEFT. FARM
SHED ON CORNER OF FOX MTN. & MEDICINE
MINE RD.
0
r ,1
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
' r JPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS CONSTRUCTING THE LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service �Center
e REV. 0aRaleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

263332
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
FOX MTN. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ERIC SPLAWN
Address FOX MTN. RD.1
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
828) — 894-8875
Area Code Phone number
4. DATE DRILLED 10/01/02
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From Tn _EL in.
15. SAND/GRA
—9. in \-Maitria
From
From
16. REMARKS:
Ft.
itCr.: :011
County POLK
{D
V
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM COLUMBUS. RT. ON FOX
MTN. RD. GO OVER BY-PASS. 1ST DRIVE ON LEFT
PAST SMITH RD.
sRn
I DO HEREBY CE�L` € IJOWAILt{ P WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANLr - rOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-
c�0%h[_r..�rJ
�
x
SIG ATURE OF PERS CONSTRUCTING TWELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

263329
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BLESSED VALLEY LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD LINDSEY
Address BLESSED VALLEY RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(803) - 799-7233
Area Code Phone number
4. DATE DRILLED 10/4/02
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From _ To Ft. _
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From _ To Ft. _
From To Ft in
15. SAND/GRAVE_-FipC
Depth
To 1 Ft.
To Ft.
From
From
16. REMARKS:
Slot Size Material
in. in.
in.
Method
POURED
aWriaH
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM LAKE LURE. LEFT ON BIG
LEVEL RD. RIGHT ON S. WILSON HILL RD. LEFT
ON POWELL RD. RIGHT ON HARMONY LANE.
RIGHT ON BLESSED VALLEY LANE. 1ST DRIVE
ON RIGHT.
I DO HEREBY CIIRTI$t`$N t 111M rOW4FFYFftS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA t A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
wtre: - /ate- o
URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

263328
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
MANUS CHAPEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK BLACKWELL
Address 149 MANUS CHAPEL RD.
(Street or Route No.)
MILL SPRING NC 28156
City or Town State Zip Code
(828) — 288-8119
Area Code Phone number
4. DATE DRILLED 10/07/02
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 14.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From To Ft. _Jo
15. SAND/GRA
Dep
From _ To
From To
16. REMARKS:
P
Ft.
+},'1
"
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. RIGHT ON
MANUS CHAPEL RD. 3RD HOUSE ON LEFT. #149
ON POST ON PORCH.fp2
/�PP,T,ER SECTION
I DO HEREBY CERT16MAi t EIWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST UCTION 1ANDARWS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n J rihe� / D— - O
SIGNATURE OF PERSON CONSTRUCTING THE WEEL 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

1
L.
263390
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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:
Nearest Town: COLUMBUS County POLK
GREEN CREEK DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK BARBER
Address GREEN CREEK DR
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 429-9130
Area Code Phone number
4. DATE DRILLED 10/09/02
5. TOTAL DEPTH: 58
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 38 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 58 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 38 To 58 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
GREEN CREEK DR STRAIGHT AT STOP SIGN ON
GREEN CREEK DR. APPROX. 1/2 MILE ON RIGHT.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the originaf4o t
27699-1636 Phone No.
Lf7i/C.�
ATUREPERS9hGCONSTRUC� WELL
ernes jn - 5—a
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
GRDW.TIVI TER SECTION
a HFbR H: F'GIQN! L OFFICE

263385
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
HWY. #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE WHITESIDE
Address 6958 S. NC HWY. #9
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2045
Area Code Phone number
4. DATE DRILLED 10/18/02
5. TOTAL DEPTH: 76
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 56 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Ft. 24" CEMENT
Ft. _
Ft.
Depth
From 0 To 76
From To _
From To
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 56 To 76 Ft. 78M
From To Ft.
16. REMARKS:
Method
POURED
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. APPROX. 3/4
MILE ON RIGHT PAST HWY. #14. (6958 ON BOX.)
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ve /0/ (/a 2
CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

261212
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mtmicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
POORS FORD RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: MADISON DEYOUNG
Address 5494 POORS FORD RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828)- 863-2800
Area Code Phone number
4. DATE DRILLED 09/11/02
5. TOTAL DEPTH: 71
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 51 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 71 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 51 To 71 Ft. 78M GRAVEL
From _ To _ Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. 1/10 MILE ON RIGHT. PAST
MEADOWBROOK RD. (5494 ON BOX.)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
. 41e-:) 0
S NATURE OF PER : 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

261204
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: COLUMBUS'
HWY. #9 S,.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LARRY SHYTLE
Address 9365 HWY. #9 S.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4667
Area Code Phone number
4. DATE DRILLED 09/23/02
5. TOTAL DEPTH: 45
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45 Ft. 24" CEMENT
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 25 To 45 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To _a
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. 2ND HOUSE
ON LEFT PAST OLD CHESNEE RD.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATLIREOF P N CONSTRUCTING THE WELL `" DATE
,rii n (7 - o(3 -o
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

261203
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS' County POLK
LANDRUM RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROY TESSNER
Address 1491 LANDRUM RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-0492
Area Code Phone number
4. DATE DRILLED 09/30/02
5. TOTAL DEPTH: 53
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 33 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 53 Ft. 24" CEMENT
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 33 To 53 Ft. 78M
From To Ft.
16. REMARKS:
Slot Size Material
in. _ in.
in. in.
Material
GRAVEL
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
From To ..
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. RT. ON
LANDRUM RD. 1/2 MILE ON LEFT. (1491 ON BOX)
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
C
SIGNATURE O PERS
ONSTRUCTING THE WELL
Wt-€. J'- 36-QZ
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

261199
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CON 1 RACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural
IZ
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
PENIEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HUBERT MCENTYRE
Address 3344 PENIEL RD.
(Street or Route No.)
TRYON NC
City or Town State
(828) — 894-8853
Area Code Phone number
4. DATE DRILLED 09/11/02
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
28782
Zip Code
11. DISINFECTION: Type CHLORYTE Amount 6.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft. _
Slot Size
in.
in.
Material
in.
in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To �.
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #98. FROM MILL SPRING. RIGHT ON
PENIEL RD. 4.2 MILES ON LEFT. BOX #3344)
—o
N
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST UCTION STANDARDS, AAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1!/t a%�n
3 J/ lir � Xf"--r/M? . 9 - // - D
SIGNATURE OF P RSON CONSTRUCTING THIS WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service
a REV. 07 eigh NC
27699-1636 Phone No. [phone], within 30 days.

261198
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATIONPHONE # (828)-453 0662
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ (if PERMIT #
(if applicable) applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
BAKER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOY BAKER
Address 245 BAKER RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
828 — 859-0144
Area Code Phone number
4. DATE DRILLED 09/18/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDIL21 PVC
From To Ft. _
From To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From To Ft.
From _ To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
County POLK
16. REMARKS:
Ft.
Method
POURED
Slot Size Material
m. in.
in. in.
Material
w
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 W. FROM COLUMBUS. RT. ON
HARMON FIELD RD. RT ON HWY. #176. RT. ON
WARRIOR RD. RT. ON BAKER RD. LEFT ON
DRIVE AT BOX #245. HOUSE AT DEAD END.
co
ry
o
Ca
v
N
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
%1Odo 41 THE WELLirletE / DAT 9 ~ / O
SIGNATURE OF P RSONECONSTRUCTING
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

261186
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
CHESNEE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN RICKMAN
Address CHESNEE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
8( 28) — 645-6009
Area Code Phone number
4. DATE DRILLED 09/19/02
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUHORETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
a
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
CHESNEE RD. DRIVE ON RIGHT APPROX. 1/10
MILE BEFORE GREEN CREEK FARM SUPPLY.
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
esIGNA RE OF PERSO 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

261185
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
BIG LEVEL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARSHALL MCGUINN
Address 5609 BIG LEVEL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4005
Area Code Phone number
4. DATE DRILLED 09/20/02
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 3.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
Ft. _
Ft. _
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. _ in. in.
Ft. in. in.
12. CASING:
Depth
From 0 To 60
From To
From _ To
13. GROUT: Depth
From 0 To 20
From _ To
I4.SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
-a
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RT. ON
MCGUINN RD. RT. ON BIG LEVEL RD. 1ST DRIVE
ON RT. (5609 ON BOX)
0
ry
0
c—)
C)
N
N
N
n
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
irw'k_s2--- 9 - 2. O -O a —
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

261184
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
S. WILSON HILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARTY MCGUINN
Address 4444 S. WILSON HILL RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4005
Area Code Phone number
4. DATE DRILLED 09/23/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft. _
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RT. ON
MCGUINN RD. RT. ON BIG LEVEL RD. RT. ON S.
WILSON HILL RD. APPROX. 2 MILES ON LEFT.
(BOX #NOT MARKED)
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
d SIG
ATURE OF PE ON 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

261172
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERTIFICATION # 3114
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: CCOLUMBUS County POLK
HUNGRY NECK HOLLOW LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GORDON PAYNE
Address 43 HUNGRY NECK HOLLOW LANE
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 859-5006
Area Code Phone number
4. DATE DRILLED 09/19/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 15
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
From To
From To
13. GROUT: Depth
From 0 To 20
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:
in. _ in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY, #108 W. FROM COLUMBUS. RT. ON OLD
HOWARD GAP RD. RT. ON HOWARD GAP RD. RT.
Ca, TOP & CROSS OVER I-26. LEFT INTO
RIXHAVEN. LEFT ON HUNGRY NECK HOLLOW
LANE. HOUSE AT DEAD-END.
c
w
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
CS/ I¢A - OF PE CONSTRUCTING WELL
9-/ 9- 0 a
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

259312
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
MCDOWELL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KENNETH WALKER
Address 1155 MCDOWELL RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2131 '
Area Code Phone number
4. DATE DRILLED 08/20/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORITE Amount 4.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDLL21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
TopographicfLand 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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RIGHT ON MCDOWELL RD. 1-2/10
MILE ON LEFT.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
ON r CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
stet V1&rn - P- n - n a.
THE LL DATE
CONSTRUCTING
SIG )V'URE OF ERSON
IOmit the original to the ion of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
21699-1636 Phone No. (91 ) 733-3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

259311
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CON TRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
W
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED _ PERMIT #
applicable)
(if applicable) (if
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SHYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE SHEILDS
Address 10 SHYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
828 — 863-4343
Area Code Phone number
4. DATE DRILLED 08/22/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDIL21 PVC
From _To_Ft.
_ _
From _To_Ft.
_ _
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To _ Ft.
14.SCREEN: Depth Diameter
From ____ To_Ft.
_
From _To_Ft.
,__
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From ____ To_Ft._ _
Method
POURED
Slot Size Material
in. _ in.
in. in.
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. STRAIGHT ON PRINCE RD.
2ND. HOUSE ON RIGHT.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Fi. C,ONS,1 Rt1CTION STANDA)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Div
19) 7:
OUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
-
tTURE OF ' ERSON CONSTRUCTING r LL DATE
lion of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

259310
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
SHYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE SHEILDS
Address 10 SHYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4343
Area Code Phone number
4. DATE DRILLED 08/23/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 80 Ft. 6-1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUHCRETE
From _ To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
County POLK
CHLORYTE Amount 5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Method
POURED
Slot Size Material
in. in.
in. in.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. STRAIGHT ON PRINCE RD.
2ND. HOUSE ON RIGHT.
Lt
v;
r z
G
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
g—a 3
TURE OF PERSON CONSTRUCTING THE LL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
V3-3221, within 30 days. GW-1 REV. 07/2001

259309
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Ej
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS County POLK
SHYTLE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAYNE SHIELDS
Address 10 SHYTLE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-4343
Area Code Phone number
4. DATE DRILLED 08/27/02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of lasing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 7.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
From _ To
From _ To
13. GROUT: Depth
From 0 To 20
From _ To
14.SCREEN: Depth
From _ To
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft. _
Material Method
Ft. QULKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. _ in.
in. in.
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
POORS FORD RD. FROM SHILOH. STRAIGHT
AT STOP SIGN ONTO PRINCE RD. 2ND HOUSE ON
RT.
0
N
Fri
-o
:n
0
N
cn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATER SEi;TION
ASHEVILLE REGIONAL OFFICE
OF PERSON CONSTRUCTING
WELL DATE
Sion of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

259308
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
SCOGGINS RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HELEN GREGG
Address 241 SCOGGINS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 863-2311
Area Code Phone number
4. DATE DRILLED 08/28/02
5. TOTAL DEPTH: 110
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR.21 PVC
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
0 Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RIGHT ON RADAR RD. LEFT ON
SCOGGINS RD. 1ST HOUSE ON LEFT.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i((CTION STAID I ,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
il
311,RE OF PERSON CONSTRUCTING THE WELL DATE
u
Submit the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27691GASpIwpg 33-L21, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
^f.._
County POLK
SIG

259307
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
WHITESIDE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RONALD SHEHAN
Address 1600 WHITESIDE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 894-5085
Area Code Phone number
4. DATE DRILLED 08/29/02
5. TOTAL DEPTH: 165
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 35 Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14.SCREEN: Depth
From To_
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To _ Ft. _
From To Ft.
Ft.
Diameter
Ft.
Slot Size Material
in. _ in.
in. in.
Material
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY, #9 S. FROM MILL SPRING. LEFT ON
JOHN SHEHAN RD. LEFT ON WHITESIDE RD.
RIGHT ON DRIVE AT BOX #1600.
_>
16. REMARKS:
O HER,E(��BY. CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S Cie -kr �,,� D THAT A¢CO�OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v � ) (td 0 to 4flnn
IOF PE ONCONSTRELL DATE
Subr tit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699A8M6i'BIrolttNOEt '33-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

259303
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: COLUMBUS County POLK
HWY. #9 S.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN BLACKWELL
Address 8475 HWY. #9 SOUTH
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
828 — 863-4896
Area Code Phone number
4. DATE DRILLED 08/09/02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARD
10. WATER ZONES (depth):
I I. DISINFECTION: Type CHLORYTE Amount 17
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To _ Ft. _
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From _ To _ Ft.
14.SCREEN: Depth Diameter
From To _ Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in. _ in.
in. in.
16. REMARKS:
I DO HEREBY
• tTKFJC1Le`OVSTAl
� J
la/ree
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9S. FROM MILL SPRING. LEFT ON
DRIVE AT BOX #8475.
SEP 10
/b2 SI
HIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r5.'l1
I l.e
Su • it the original to the D visio
276 MtGQ9a8) 733-
ASHEVILLE REGIONAL OFFICE
E OF PERSON
ONST
0
CTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

259301
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
CHESNEE RD,.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TINA GRAGG
Address 970 CHESDNEE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
828 — 863-4680
Area Code Phone number
4. DATE DRILLED 08/26/02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR2I PVC
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RIGHT ON DRIVE AT BOX #970>
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO I8 RU :, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
S
1 SEP 1 i L 0' V
•bmit the original to the' ivis
2' 699-1636 Phone No. (91 ) 73?
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
o � came- �/ '.� -a a.
OF P CONSTRUCTING THE WELL DATE
ERSON
on of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

259300
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
PRINCE RD/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEVIN SCRUGGS
Address 1439 PRINCE RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2919
Area Code Phone number
4. DATE DRILLED 08/28/02
5. TOTAL DEPTH: 525
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 14.5
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Material
From 0 To 160 Ft. 6-1/4" SDR.21 PVC
From To _ Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box).
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #221 S. FROM RUTHERFORDTON. RIGHT
ON POORS FORD RD. STRAIGHT AT STOP SIGN
ONTO PRINCE RD. LEFT ON DRIVE AT BOX #1439.
APPROX. 3/4 MILE.
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRIICTRIN STANDAT;DS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
U E
Submit th, o�righal to the
27699-1636 Phone Nunt1119)
GROUNDWATER SCOTION
ASHEVILLE REGION ,! iOE
ATURE OF PE ON CONSTRUCTING"7T� WELL
c- aP-n a
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
,33-3221, within 30 days. GW-1 REV. 07/2001

259250
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: MILL SPRING County POLK
OLD CHESNEE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHIRLEY MCCELLAN
Address 3776 OLD CHESNEE RD.
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) - 863-4133
Area Code Phone number
4. DATE DRILLED 08/29/02
5. TOTAL DEPTH: 57
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 42 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 6.9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 Ft. 24"
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 42 To 57 Ft. 78M GRAVEL
CEMENT
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
POORS FORD RD. FROM SHILOH. LEFT ON
OLD CHESNEE RD. BEIGE HOUSE W/GREEN
SHUTTERS. 1 MILE ON RT. (3776 ON BOX)
From To _ Ft.
16. REMARKS:
I DO HEREBY CE 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
0 PERSO TR
CTING THE WELL
1-,4 9- 0 a
DATE
ubmit the original toj$ Diviion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4636;Fhtme Nj (,919) 7 c-3221, within 30 days. GW-1 REV. 07/2001

259256
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: TRYON
ABRAM MOORE RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEO PRICE
Address ABRAM MOORE RD.
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 817-1278
Area Code Phone number
4. DATE DRILLED 08/22/02
5. TOTAL DEPTH: 59
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 39 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 59 Ft. 24" CEMENT
From _ To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To Ft.
14.SCREEN: Depth Diameter Material
From To _ Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From 39 To 59 Ft. 78M GRAVEL
Method
POURED
Slot Size
in. in.
in. in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM F.C. GO DOWN HWY. 74 BY-PASS W.
TURN LEFT ON PEA RIDGE RD. RIGHT ON
ABRAM MOORE RD. GO 2-2/10 MILE . NEW
DRIVE ON LEFT AT BOX #2197.
CZ :3 lid S— d3S 3(
ri
0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE(PE
Submit_ theoriginal 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
/l2 a - 6
ONSTRUCTING THE WELL DATE

259255
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 LOCATION:
Nearest Town: MILL SPRING
NELON DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN NELON
Address NELON DR
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4442
Area Code Phone number
4. DATE DRILLED 08/22/02
5. TOTAL DEPTH: 54
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 34 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54 Ft. 24" CEMENT
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _ To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To _ Ft. _
15. SAND/GRAVEL PACK:
Depth Size Material
From 34 To 54 Ft. 78M GRAVEL
Method
POURED
Slot Size Material
in. _ in.
in. in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. LEFT ON
OWL HOLLOW RD. LEFT ON NELON DR 1/4 MILE
ON RIGHT.
I DO I y{' - =- T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
;CONSTRUCT tfgN T ' o'• ' �S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e
S 4<< AT ' •F PE ONSTRUCTING ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. (919) /33-3221, within 30 days. GW-1 REV. 07/2001

259266
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Grotmdwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
COOPERS TRACE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVE MARLOWE
Address 19 COOPERS TRACE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-9448
Area Code Phone number
4. DATE DRILLED 08/14/02
5. TOTAL DEPTH: 69
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 51 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 69 Ft. 24" CEMENT
From To Ft. _
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 51 To 69 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 N. FROM MILL SPRING. RIGHT ON
GRASSY KNOB RD. RIGHT ON BLANTON RD.
LEFT ON COOPERS TRACE. 1ST HOUSE ON LEFT.
0
N
Fri
-D
N
t
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A 1l. OF P N CONSTRUCTING THE WEL DATE
6u mit the original to the Diu of Water Quality, Groundwater Section, 1636 Mail Service Center —Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

25927E
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Mtmicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TRYON
TRICYCLE HILL LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WILLIAM CRIDER
Address 35 TRICYCLE HILL LANE
(Street or Route No.)
TRYON NC 28782
City or Town State Zip Code
(828) — 863-0523
Area Code Phone number
4. DATE DRILLED 08/01/02
5. TOTAL DEPTH: 75
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 75 Ft. 24" CEMENT
From To Ft. _
From To Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From _ To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 55 To 75 Ft. 78M GRAVEL
From To Ft.
16. REMARKS:
Topographic/Land setting
0 Ridge ❑ Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
TURNER RD, RIGHT ON TRICYCLE HILL LANE.
1ST DRIVE ON LEFT.
0
1 J)O HF.RF.Rv ('PRTt _ • T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THI. RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
\___$ TURF
i
tubmit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
$W1636'Phoglf No o(919) 7 -3221, within 30 days. GW-1 REV. 07/2001
PE' J` • STRUCTING THE
LL DATE

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
259272
1. WELL USE (Check Applicable Box): Residential ® Mtmicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MILL SPRING
HONEYSUCKLE LANE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J.B. OGLE
Address 86 HONEYSUCKLE LANE
(Street or Route No.)
MILL SPRING NC 28756
City or Town State Zip Code
(828) — 625-4346
Area Code Phone number
4. DATE DRILLED 08/07/02
5. TOTAL DEPTH: 80
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County POLK
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 24" CEMENT
From To Ft. _
From _ To _ Ft. _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To _ Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size
60 To 80 Ft. 78M
To Ft.
From
From
16. REMARKS:
Material
GRAVEL
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #108 E. FROM MILL SPRING. LEFT ON
BIG LEVEL RD. LEFT ON POWELL RD. LEFT ON
S. WILSON HILL RD. 1ST DRIVE ON LEFT.
1 Dn 1-IFRFRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
YTJC
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI WIRE`6F PE
11-1
Submit the original to the 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
276994030YlrORelskw ) 733.3221, within 30 days. GW-1 REV. 07/2001
REThurif _ OFF ICE
e/mac . ��''��i _ t 7- o a
ON UCTING T WELL DATE

259312
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: COLUMBUS
MCDOWELL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KENNETH WALKER
Address 1155 MCDOWELL RD.
(Street or Route No.)
COLUMBUS NC 28722
City or Town State Zip Code
(828) — 863-2131 '
Area Code Phone number
4. DATE DRILLED 08/20/02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST ARD
10. WATER ZONES (depth):
County POLK
I I. DISINFECTION: Type CHLORYTE Amount 4.5
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
6-1/4" SDR.21 PVC
Depth
From 0 To 80 Ft.
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. QUIKRETE
From To Ft.
14.SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAV
Dept
From _ To
From To
1 DO HEREBY C
CONSTRUCTIO
Method
POURED
Slot Size Material
in. _ in.
in. in
AS C(
A -COP
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
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #9 S. FROM MILL SPRING. LEFT ON
CHESNEE RD. RIGHT ON MCDOWELL RD. 1-2/10
MILE ON LEFT.
0
0)
t
cal
NSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF 'ERSON CONSTRUCTING THE
LL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarn 5 Ar Camp, Jr, CERTIFICATION_ 21' 8
WELL CONTRACTOR COMPANY NAME ramp s Wel 1 & Primp r'rt Tnr PHONE #,82R) drii-7322
STATE WELL CONSTRUCTION PERMIT?! ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
267082
1. WELL USE (Check Applicable Box): Residential &T Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Ne est T(��1�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S-0 c.) Address -2) l) W.PnOn 7(��
(Street or Route No.)
Ci or Towo State
County__ i1
Zip Code
( Area code- Phone number
4. DATE DRILLED t.) - - D a
5. TOTAL DEPTH: (OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: \ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordan e with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOInD OF TEST n i r
10. WATER ZONES (depth): ULMMA\U.r--
11. DISINFECTION: Type C'h 1 nri na Amount 2- L.-L.4Ja-
12. CASING: Wall Thickness
or Weight/Ft. Material
gDR? 1 PVC
Dep Diameter
From p To X U Ft. 6 . / 4_
From_____To Ft.
From To Ft.
13. GROUT: Depth
From_ To 3 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Diameter Slot Size Material/
Ft. in. in.
Ft in. in,
Material
Neat Cement
Method
Hand
Size Material
Ft
Ft
Topo phic/Land setting
❑Ridge VSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
R n
co \so.S
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th'ehroad
numbers and common road names.
C1}
0
w
L
rn
16. REMARKS:
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL
DATE
ubmit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t i, f ybeaelYa.( 33-3 21, within 30 days. GW-1 REV. 07/2001
i J L'r
c
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James "L Carnl.r Jr CERTIFICATION If 21 •I8
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp'¢ Wa11
266294
R Pnmp_J'n Tnr• PHONE #$2A) dS3_7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential tr.-Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town:a
1 Q.Az
M
rsi
County
(Street Name NiEnbets, Common Subdivision, Lot No., Zip Code)
3. OWNER: t OA,) P Afit. �,n
Address 1 4, \ (&it ?.aLt \r-tv•
p (Street or Route No.)
`MA3Q AA NA tJ(
City or own State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 11- 0C4, b .
5. TOTAL DEPTH: `l n S
6. DOES WELL REPLACE EXISTING WELL? YES O ai
7. STATIC WATER LEVEL Below Top of Casing: t0 U 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
• •varlance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST L i r
1Q. WATER ZONES (depth): (S D
11. DISINFECTION: Type rh 1 nri np Amount
12. CASING: WallThiclmess
Depth Diameter or Weight/Ft.
From p To_ Ft. 6 2/ 4 c gRa
Froth To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 p Ft.
Material
PVC
Material Method
N at Cemcnt Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
Front_ To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting
€idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fo tion Description
DEPTH
From To
a 3�
31 9G3
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
t7
rn
n
N
O
or
C.11
cw
16. REMARKS:
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO 1 , A
CERTSTANI AMSND A I A COPY 0 THIIRY THAT THIS WEIL WAS SIRECORD HAS EPR
OVIDED PRO ED TO THE WELL OWNER
ahta "•A�) l2. -(, -o,t
SIGN I OF PERSON CONSTRUCTING THE WELL / /� DATE
i U
Sub t th4gmatu the DiJiiatk of waf orter Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
2769-1636pReNa.(919)73dr3214,Oa 3odays. GW-1 REV. 07/2001
r;ipi
0

266293
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Tr
CERTIFICATION # 7 1 4 fi
WELL CONTRACTOR COMPANY NAME ramp R Win 11 R Ptimp On_ Tnr• PHONE #$2A) d C 1 7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O7Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATION:
Nearest Town: i ji SI?Vvnlq County Pell Pk
(Street Name, Numbers,_muniityy.&Subdivision, Lot No., Zip Code)
3. OWNER:,\\} 4MAt JX9 �SL
Address 945S ('r-4.(
n (Suctt or Route No.)
City or T wn State Zip Code
( Area code- Phone number
4. DATE DRILLED it • 1c6- 0
5. TOTAL DEPTH: I S /
6. DOES WELL REPLACE EXISTING WELL? YES lyt NO Q]
7. STATIC WATER LEVEL Below Top of Casing: (p 0 FT.
(Use''" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
• variance In accords ce with 15A NCAC 2C .0118.
9. Y1' LD (gpm): METHOD OF TEST i, i r
10. WATER ZONES (depth): 110
11.DISINFECTION: Type rh1nrinP Amount / C a 4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_q To t )l Ft.6 1 /4 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Front n_ To 20 Ft.
N at Cement IIand
From To Ft.
14. SCREEN: Depth Diameter
From__To Ft. in.
From- To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
16. REMARKS:
i 1541IH1`sREs)? C;rRT1PY THAT'
RUCTION STANDARDS,
L L' rl',
9 g� f'�)4� '4
Topogta,,PPhic/Land setting
ORidge U'Slope DValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Form4ion Description
(> amAD ttnk9
DEPTH
From To
n IV)
k11
1'UI
kcg5 A.a/n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
WAS CONSTRUCPED IN ACCORDANCE WITH 1SANCAC 2C, WELL
HAT A COPY 0� THIS RECORD HAS )SEEN PROVIDED TO THE WFI 1 OWNER
C I1�441 la LL/) e
OF PERSON CONSTRUCTING THE WELL
- -bQ.
DATE
ubtn t hp r1 ]r{al to the 7Tirision otiI Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
7699-163S1Utan Nof9 t, 21,wlthin 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) Jam eS Camp, ?L
WELL CONTRACTOR COMPANYNAME ('amp' ❑ Wa11 & Pnmp f n
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
266292
CERTIFICATION # 2 1 3 ft
Tnn PHONE #S2R1 d51-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town' ML\ \ S?Vn q �CountyP p i
11)6 Ccopt-- G4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ) L tYr:�,,�
Address \ \."( V ` {ea)
(Street orkkkR ute No.)
f' AJJ se'u/rMA V -C
City or Town d State Zip Code
Area code- Phone number
4. DATE DRILLED 1 i - 0
5. TOTAL DEPTH: a 1c
6. DOES WELL REPLACE EXISTING WELL? YES 171/NO 0
7. STATIC WATER LEVEL Below Top of Casing: i 0 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YI$LD (gpm): I METHOD OF TEST Air
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Slat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
n
Q Foorma(ion Description
c1 `) onxic Sik
11. DISINFECTION: Type rill nri na
12. CASING:
Depth
From_g To { tCA
Diameter
Ft.6 1/4
From To Ft.
From To Ft.
Amount / C+-t11
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
13. GROUT: Depth Material
From n To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
Hand
Slot Size Material
n.
n.
Froth To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least ,
two State Roads or County Roads. Include the road
numbers and common road names.
a
U1
CO
16. REMARKS:
CEIiT1FY T1 AT TH
A ICT10N STANDARDS,'
16
S bmit the original to the Diyisiiin of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
2 6. ¢-P 99 1631 No, (919)1334121, within 30 days. GW-1 REV. 07/2001
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
am amy
OF PERS(7N CONSTRUCTING THE WELL
/a -G -A)
DATE
-4
G
z

266289
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam n S w C a rr p Jr CERTIFICATION # 7 1 4 8
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
Came s Wal 1 R. Munn f'n TnC
PHONE #(87A1 45t-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential l ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONI\ ^ f�
Nearest Town: .� l rltmt), County `F C
(Sweet Name, Numbers, Community, Subdivision, Lot No,, Zip Code)
3. OWNER: \-OU XV
Address I�tun--
\
tub � N�c�
n (I C Q'A(o.)
^S'ttre0.4ct /xr RoBc�C
City or own �te
Zip Code
( )-
Area code- Phone number
4. DATE DRIJ J FD I'&•" -) • 1� 2
5. TOTAL DEPTH: CI 5% S
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: R 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 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST a i r
10. WATER ZONES (depth): 5-5 0
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From p To Ft. 6 l / 4
From______ To Ft.
From To Ft.
13. GROUT: Depth
From_0_ To 2 0 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.
rh1nrina Amount A
Wall Thickness
or Weight/Ft.
g9R-21
Material
Neat Cement
Material
PVC
Method
Hand
Slot Size Material
in.
in.
/TopographicJLand setting
Mltidge ❑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 F nnat n Description
0 g�
d3 S 5-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
173
Cr
[V
0
rn
0
NI
Oi
-CERT{F
,RUCTION STANDARD
1I�
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFt f
AT A COPY O$ THIS RECORD HAS 13EEN PROVIDED TO THE WELL OWNER
ak !mac/ ,( l c- 6 6 a
SS NA Z OF PERSON CONSTRUCTING THE WELL 7 DATE
VJ
ubluip ieL 04 i 41 tit +000ton of ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
tie-Nd -(�S ithin 30 days. GW-1 REV. 07/2001
ri
0 c,I, 9,, 1D

263774
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t.r Camp, Jr.
WELLCONTRACTOR COMPANY NAME ("Amp' c
CERTIFICATION # 21 3 R
Wa11 R Primp rn.. r Tnr PHONE #$2R) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential [12 Municipal/Public 0 Industrial ❑' Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
LOCATI N:
2 Nearres t Town. o um YiL45 County POI
Rea x S �h
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 8 re4 J LA-5 l i Le_
Address I T 1,-aKe5 ko✓o Dr,
�tlnrl Y orStreet c No.)
tin& .2113 1-7-6
Ciry or Town State Zip Code
Area code- Plume number
4. DATE DRILLED D - 2 - a
5. TOTAL DEPTH: 3o5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 6,8
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
' variance in accordance Ith ISA NCAC 2C .0118.
9. YIELD (gpm): t ME1j10D OF TEST n jr
10. WATER ZONES (depth):g
11. DISINFECTION: Type rh l nri na
12. CASING:
Depth Diameter
From p To / I.S Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Neat
Amount I Ia. c mid
Wall Thickness
or Weight/Ft. Material
SDP.21
Method
Cement Hand
Slot Size Material
in.
in.
16. REMARKS:
I DC) HFRFRY CPRTIFV TPkT TUT
$9 - N TkC'f—€
ubmit the original to the Ilivisio
27(,99-1636 Phone No. (919) 733-322
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley MFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
.5,eC Kd / ro (-IC ?only lidated rock
DEPTU
From To
IIS
n
11 5
LOCATION SKETCH
Show direction and distance in miles from at least
`r3wo State Roads or County Roads. Include the road
JJJ mbeyCfi i common road names.
WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
- ,( ;n
ATURE OF PE R$ N CONSTRUCTING THE WELL
0
I -8-6A
DATE
of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
, within 30 days. GW-1 REV. 07/2001
a
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

263772
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Cam[, Jr
WELL CONTRACTOR COMPANY NAME Camp G Wa11 R Pnmr Cn Inc PHONE #$7R1 d5"1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town:
S.u.,vtu.9
veer Name N ers Comm
County
(g - unity, Subdivision, Lot No., Zip Code)
3. Q I.. �v�C�
OWNER: ,t`
Address \ \a S S tr` — l� \a.Y
(Sweet or Route No.)
tTft2AA;tr), WI (-
City or Ta o tote
S`I5
Zip Code
Area code- Phone number
4. DATE DRILLED \0' 013, 0
5. TOTAL DEPTH: y (1 G
6. DOES WELL REPLACE EXISTING WELL? YES Qii'NO 0
7. STATIC WATER LEVEL Below Top of Casing: i 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
4. *Top of casing terminated at/or below land surface requires a
Variance in accordaup with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST p i r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IB�lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T ToFFoormatipn Description
g % OS 'QX)..�a�✓ .tf✓`T
11. DISINFECTION: Type rh 1 nr i na
12. CASING:
Depth Diameter
From 0 To g)J Ft. 6 1 / 4
From______ To Ft.
From To Ft.
13. GROUT: Depth Material Method
Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
DF21 PVC
FrorrLp To 3 0
16. REMARKS:
CERTIFICATION # 21 3 R
J,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C c1t �1
AnE( 47
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SANCAC 2C WELL
AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WFl I OWNER
a , r I1-q-
1GNATURE OF PER N CONSTRUCTING THE WELL / % DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mac by_ Cam Jr CERTIFICATION # 71 3f3
r.Rmp' c Wall R Piimp f n Tnr• PHONE N$7RI d53-7322
ASSOCIATED WQ PERMITN
(if applicable)
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
262140
1. WELL USE (Check Applicable Box): Residential It Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:,
Nearest Town: U\X
CtM 'MJa,
County-f-(jak—
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
�j n _
Address �-Ql}� c OA�.tADA Cl
`n ^ t, p (Street or Route No.)
V V\M1tyyl`orx City State
(1i C �R15 b
Zip Code
Area code- Phone number
4. DATE DRILLED �. 3 D-
5. TOTAL DEPTH: 4
6. DOES WELL REPLACE EXISTING WELL? YES 1ZYNO �❑
7. STATIC WATER LEVEL Below Top of Casing: \ 0 FT.
(Use '4" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accor once with 'SA NCAC 2C .0118.
9. YIELD (gpm): • TIAOD OF TEST air
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From_0____ To -1 01. Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
Frorn p__ To 2 0
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Ft. Neat Cement
Ft.
Diameter
in.
in.
Slot Size Material
in.
in.
Size Material
P
Topographic/Land setting
❑Ridge S6lope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degreedminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To FFo 'on fDescn ion
.a tl 7 1 - l 11 AJO
i
JOCATION SKETCFj
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numb eits •mmon road names.
IDS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
0
ry
CONSTRUCTION STANDARDS AND BRAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c
GROUNDWATER SECTION
FEVILLE REGIONAL OFFICE
SIGNA OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jatnas r'atnp, Jr
WELL CONTRACTOR COMPANY NAME ramp' s Wa11 R Piimp f'rL Tnr
262136
- Groundwater Section
CERTIFICATION % 7 1 3 R
PRONE 1$7R) d51-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ile-MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION(
NneaArestr,�TTown: CQ Uk County
I XAak ' VA:E\ a.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0 el
Address `%b \ Ak
( nett or Route No.)
L Cnk 3 ti
City or Town State O Zip Code
( Area code- Phone number
4. DATE DRILLED q- 1 I• 0 1
5. TOTAL DEPTH: 1 0 .S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO al
7. STATIC WATER LEVEL Below Top of Casing: \ .S b FT.
(Usc "t" 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 accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): \� METj-jhOD OF TEST n i r
10. WATER ZONES (depth): `.1/wA uviL�ai
11. DISINFECTION: Type r h 1 nri na
12. CASING:
Depth Diameter
From_n To` 0 Ft. 6 1 / d_
From To Ft.
From To Ft.
13. GROUT: Depth
From—aTo 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
Amount
Wall Thickness
or Weight/Ft. Material
gAR-21 PVC
Material Method
Nctiat
Ccmcnt Hand
From
From
16. REMARKS:
To
To
1 DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, AND THAT
GROUNDWATER S
ASHEVILLE REGIONAL OFFICE
Slot Size Material
in.
in,
24+
c) uTMn`' �
SIG
WAS CONSTRUCtED IN
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 Forma on Description
0 uo AAA
\o 1ot
LOCATION SKETCF{
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
COR
HAS
1.0
CD
iV
J N
M
DANCE WITH 15A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
ATURE 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
262135
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mac Tar f a rape II --
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R Pimp t,rt TnC
CERTIFICATION # 7 1 3 fi
PHONE #(7R1 d51-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential I't- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
Ikr Couyn�tSiS
y_
t.UtjG
r v
(Street Name, mbersLCommunity^Subdivision, Lot Na Zip Code)
3. OWNER:
Addre
City or Town
Street or Royte N C
State ��77
an on
Zip Code
c J-
Area code- Phone number
4. DATE DRILLED Q - h? 1
5. TOTAL DEPTH: \ 2 r
6. DOES WELL REPLACE EXISTING WELL? YE IkNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
`Top of cuing terminated at/or below land surface requires a
variance in accord with 15A NCAC 2C .0118.
9. YIELD (gpm): 6— METHOD OF TEST Air
10. WATER ZONES (depth): 1 y u
11. DISINFECTION: Type rh 1 nr i na
12. CASING:
Depth Diameter
Fromm_ To Q ?) Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frorrt_p To 20 Ft. Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount
Wall Thickness
orWeight/Ft. Material
gDR21 PVC
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridgeope ❑Valley ❑Flat
(Zlicck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTI-j DRILLING LOG
From To FRrmoQ a>,(iescription
0 3
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road navies.
(i..v, (AO-
CNaP)Ai
I DO HEREBY CERTIFY THAT THIS WELL µ.cwCORJANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATMECIPIIICIFERDRAW HAS BEEN PROVIDED TO THE WELL OWNER
5).
SIGNATURE OF PERSON CONSTRUCTING THE WFI
Ib j 'D2
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camp, Jr CERTIFICATION,/ 71 3R
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 & Pnmp ('p Tnr PRONE #I7R) AST-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
262134
I. WELL USE (Check Applicable Box): Residential W Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
1St,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
W O s WAY Q \a4 J '«4)
ty
(Street or Route No.)
Sr21.u�v1, V C. ,)k l5le
City or own 0 State Zip Code
( ) Id3-S- l\/to5
Area code- Phone number
4. DATE DRILLED 9 . 3"Q.).
5. TOTAL DEPTH: 6 U
6. DOES WELL REPLACE EXISTING WELL? YEStrNO 0
7. STATIC WATER LEVEL Below Top of Casing: U f) 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): 5METHOD OF TEST air
10. WATER ZONES (depth): at, b
11. DISINFECTION: Type rh 1 nri np Amount
12. CASING:
Depth
From_0____ To St) F
From To F
From To F
13. GROUT: Depth
From_g To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Wall 'Thickness
Diameter or Weight/Ft. Material
1.6 1/4
t.
t.
Ft.
Ft.
Diameter
Ft. in
Ft. in.
gDR.21 PVC
Material
Neat Ccmcnt
Method
Hand
Slot Size Material
in.
in.
IIM 1'/
27
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)
PEPTF-1. DRILLING LOG
From \TTo Formation sc ' tion
b
6,) a t15
LOCATION SKETCI-j
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. WPI 1 WAS CONSTRUCTED lb ACCORDANCE WI
CONSTRUCTION STANDARDS, ANIVIPutn/0211riten 4s RECC RD HAS BEEN PROVI
SHEVILLE REGIONAL OFFICE
A,,.,,v".n-'
'J SIGNATURE OF PERSON CONSTRUCTING THE WFI t
15AJJNCAC 2CC,,�WELL
WN
10 T .l txzX �` V R
En 02.02
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Deparmrent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James cr, Carpr Jr CERTIFICATION,/ 71 3A
WELL CONTRACTOR COMPANY NAME CampWa11 R Primp fin Tnr PHONE I87R) d53_ 7922
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential W'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL Town 4,ON:n O `�
Nest Town•�� J(J( County
/hA1,AAAl�3. SSI uor hie le).
(Street Name, Numb , Community. Subdivision, LotNo., Zip Code)
3. OWNER: 5'�A
Address \ s 5 \ tLt N`2
X)
Street or Route No.),
City or Town ' State
c�-
Zip Code
Area code- Phone number
4. DATE DRILLED — :.2)• 0
5. TOTAL DEPTH: I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eft
7. STATIC WATER LEVEL Below Top of Casing: I FT.
(Use "t" 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): METHOD OF TEST ai r
10. WATER ZONES (depth): \ 0 Ci
11. DISINFECTION: Type cm n r i n a Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To 14 S Ft. 6 1/ 4 cDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From_a___ To 2 0 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
From To Ft.
From To Ft.
263377
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 L1 To
n S
MI5- I v-
Forinatio ascription
J
o
LOCATION SKETCH _
Show direction and distance in miles from at least
two State Roads or ounty Roads. Include the road.
n be and co . road names.ri
--.
16. REMARKS:
O0E 6YREI.
x.8T.. N cT TD
4
TI1 T.
Q
TTh WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE 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

_ to 2
Su t the original to the Div
2769-1636 Phone No. (919) 733
WELL CONSTRUCTION RECORD
263375
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James t& Camp, Jr._.
WELL CONTRACTOR COMPANY NAME Cs mu)' s We11 & Pnmp re, Tnr-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 2 1 3 R
PHONE #$7R) 451-7322
1. WELL USE (Check Applicable Box): Residential'" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO : n
Nearest Town:.
HOula✓t4 Gall) Rd.
(Street Name, Numbers, Com unity, Subdivision, Lot No., Zip Code)
`
3. OWNER: AD' N,� (t1pVI'�1��,�p^
Address 46 S hhaV.th / /�
County P o .,\e-
`y.1li�.11llA-lakuImo'joule No.) C 2lq t
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED q • 10- t) 1
5. TOTAL DEPTH: 112 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI,
7. STATIC WATER LEVEL Below Top of Casing: q 0 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 (gprn): 11) M TROD OF TEST n ; r
10. WATER ZONES (depth): J ka
11. DISINFECTION: Type C'h 1 nri np Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From p To Ft.6 1 /4 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From_g To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
Neat Ccmcnt
Material
Method
IIand
Topographic/Land setting
0/edge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From T, Fibmait,ti Description
iJ
LOCATION SKETCH
Show direction and distance in miles from atdeast -_'
two State Roads or County Roads. Include file road
numbers d common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r-)
SIRUiTIM StAli3DAITS THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L�11 eLLSS�. - TURE OF PERSON CONSTRUCTING THE WELL
s o of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
�'DZ
DATE
1
GFWO D WATER SECTION
ASHEViLLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr CERTIFICATION if 2118
WELL CONTRACTOR COMPANY NAME ('ampc Wa11 R Primp r'rt Tne PHONE N 2R1 d5"t_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
263372
1. WELL USE (Check Applicable Box): Residential 1 ' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONS
Nearest Town: t��A�^ X) County T L
(7reett K l✓eY 12v4.
(Street Nye, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `� f M-10 1)
Address 10004 to slap
4/ iv\ (S torR ute lJ,q.)
i` ,l�Ci�tyiX�orrTown C State
S.c .29\b
Zip Code
Area coda Phone number
4. DATE DRILLED et k 9 • D
5. TOTAL DEPTH: \ L1 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: a- t) F L
(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 accords e with 1SA NCAC 2C .0118.
9. YIELD (gpm): t) METHOD OF TEST 8; r
10. WATER ZONES (depth). \ 3 d
11. DISINFECTION: Type rh 1 nr i na
12. CASING:
Depth Diameter
From_ To 4S Ft. 6 7 /
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Material
Amount
Wall Thickness
or Weight/Ft. Material
gDB21 PVC
Method
Ncat Cement Hand
16
ID
C
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) , ._
DEPTH DRILLING LPG
From To Frgrn�tjon D trip • n
n `1 S
0
LOCATION SKETCI-&
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
YI CERTIFYIRAT" THIS JLL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
CT1ON STANDARDS, a THAr A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WI f OWNER
ASHEVIL LE R t TONAL
OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja me s w Ca mr .Jr _ CERTIFICATION # 21 1 R
WELL CONTRACTOR COMPANY NAME ('amp' a We11 & Pump f`n Tnr' PHONE #i7R) 4151-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
260029
1. WELL USE (Check Applicable Box): Residential r" MunicipaUPublic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
(e
Nearest Tot/QId�e�YRit CountyO
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: _L S� RAIl'IC
Address 1 7.30 /,.et ke /fdge ✓ R.A.
Ai; I Sp✓(Street or Route o.) J
, vw C- AS') 5-4
City or To .State Zip Code
Area code- Phone number
4. DATE DRILLED �1D
5. TOTAL DEPTH: : ot5
6. DOES WELL REPLACE EXISTING WELL? YES41NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 57 FT.
(Usc'W' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
flop of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): `0 METHOD OF TEST n 1 r
10. WATER ZONES (depth):
11. DISINFECTION: Type r h l n r i n a
12. CASING:
Depth Diameter
From_o _ To Ft, y 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0 To 2 0 Ft.
From To Ft.
Amount r G it F) S
Wall Thiclmess
or Weight/Ft. Material
gDP21 PVC
Material
Neat Cement
14. SCREEN: Depth Diameter
From, To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Method
Hanel
Slot Size Material
in.
in.
Topo 'c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPT$ DRILLING LOG
From To FormationDescription
75 - 10`150/ ay is
rack
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.
Rd
ooper<
G'- f
WFI i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A OF THIS RECORD BE N PROVIDED O THE WELL OWNER
lr� �
ATURE O. RSON CONSTRUCTING THEW I, DATE
Subut iybi aYi i � Y I itision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27643 73 - , 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) T am 5 w Camp, 3r- CERTIFICATION it 21
WELL CONTRACTOR COMPANY NAME Camp a Wa11 R Pnmp r n T n r PHONE #67R) dS5-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential szi MunicipallPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION
Nearest Tows; � o l U mitil 45 County 00 K
Wkife oak
(Street Name, Numbers, II Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pn;II;p DYP55Ph/jc e{
Address tij 1/(et" St•
(Street orR uto No.)
COI �)ikb�5 it c g fact
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED gi ' „ThD —0a
5. TOTAL DEPTH: 620 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 178° FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
• `Top of casing terminated ator below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST D i r
10. WATER ZONES (depth):
11. DISINFECTION: Type r h l n r i n n
12. CASING:
Depth Diameter
From_ p To /D5 Ft. 6 1 / 4
From To Ft.
Ft.
Material Method
Neat Cement I•Iand 5
From To
13. GROUT: Depth
From. 3 To 2 0 Ft.
From To Ft
14. SCREEN: Depth
From To Ft
From To Ft
15. SAND/GRAVEL PACK:
Depth
From, To
From To
Amount <a Cap
Wall Thickness
or Weight/Ft. Material
'BR21 PVC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(ds/m egreeinutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n los dirt
/oC 6055 pp n�lido d rock
Diameter Slot Size Material
in. in.
in, in.
Size Material
Ft.
Ft.
LOCATION SKETCIi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nard1`es. x
45
�r/lt�-fc
pa):/mN.
I
rr. ,WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15ANCAC 2C, WELL
STRUCTION STANDARD y fW+}r THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i,ii,y/Le - N , 9 lD 0�1
TF1E R'ELL
SIGIb ATURE 0i PERSON CONSTRUCTING DATE
G k'C,�,''€ R 1Qi`bivisio of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
` 4 y GW-1 REV. 07/2001
�Z7699-T636-PhonelVo: E919)-'�a'4-3��t, within 30 days.
260019
0
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Fri
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oe
V C.P _ r 'fl2 i

WELL CONSTRUCTION RECORD
258122
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J amass ri_ Camp Jr CERTIFICATION # 71 3R
WELL CONTRACTOR COMPANY NAME Camp' c Wal 1 R Pump Cc' Tnr PHONE CPR) d54-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION t� I'
Nearest Town: Co ) k nl D tt5 County Y C I l<
�2.1 a &Xr Rd.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: Re.VI Se'/ W(o U Y
Address . / 4 a Coke Rd •
(Street or Route No.)
fry0n. C_ X9$'2
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED % — / J "cm..
5. TOTAL DEPTH: g40 5
6. DOES WELL REPLACE EXISTING WELL? YES 02(NO 0
7. STATIC WATER LEVEL Below Top of Casing: 442- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS '1 FT. Above Land Surface'
• *Top of casing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (pm): ) OD t METHOD OF TEST A i r
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road �/
numbers and common road names. -he, Gyeert Ch
.
Topographic/Lagd setting
❑Ridge ❑Slope CaValiey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING LOG
From To formation D scription
0 %3 CM/ , Sit ft
'73 k5 (o4sol/dg c.d rock
11. DISINFECTION: Type rh 1 nr i na Amount % cu,a
Wall Thickness
or Weight/Ft. Material
cnp'1 PVC
12. CASING:
Depth Diameter
From 0 To 73 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_0 To 20 Et. Neat CCmcnt Hien;r—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material nn''
From To Ft. CcXe. Kd.
From To Ft.
N 'J
u;c:
O ,\,
Pea�la ce'R
16. REMARKS.
IO` T CTON ST DRr
Submit the original to the Divis'c
2+6994636 Fbetae;N4.p33-322
1FFICE
WFI I WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2E OF ER OSONCO STRUCTIN THB
DATE
n of Water Quality; Groundwater Section, 1636 Mail Service Center -Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

258121
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sa mac "L Camr Tr
WELL CONTRACTOR COMPANY NAME ramp' c Wa11 R Pump ('n TnC PHONE a$7Rl tr 3_7'322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
CERTIFICATION p 21 3
1. WELL USE (Check Applicable Box): Residential 02 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION, :n
Nearest Town: 1' I11J S�YIngcounty pnjk
,�oyla5 jzr1.T4�'un.deyvieW
(Street Name, Numbers, Community, Subdivision, Eat No., Zip Code)
3. OWNER: JOP 1IloM/gq1L
Address 707 Jinnk' J0o4 ,Ur.
(Street or Route No.)
IAn/Liam SC, q�SG
City or Town State Zip Code
Area code- Phone number A.
4. DATE DRILLED / — o
5. TOTAL DEPTH: //2-i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /j0 METHOD OF TEST
10. WATER ZONES (depth):
nir
11. DISINFECTION: Type rh 1 nr i na Amount / cup
12. CASING:
Depth Diameter
From_ To ,-20 Ft. 6 1 / 4
From To Ft.
From______ To Ft.
Wall Thickness
or Weight/Ft. Material
qpF_71 PVC
13. GROUT: Depth Material Method
From,_0 To 20 Et. Neat Cement Ha
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
i;R1i6jY t RF
G
Topographic/Land setting
❑Ridge ❑Slope ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Fortgatign Description 02o l05 rmisol;da ed ✓ock
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.
Coope6S
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7.40a G).
.TURE OF PERS
CONSTRUCTING THE WELL
DATE
Sublult-thuTorlpia1turrchesip,ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.•(Ri9;)711221, within 30 days. GW-1 REV. 07/2001
o,
N r'

258115
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James tv Carp, Tr
CERTIFICATION # 21 18
WELL CONTRACTOR COMPANY NAME ramp' c Wall R Pump Cn Tnr PHONE#t7R) 451-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: n/
Nearest [�M' 1I
`5 r; � County �011l
go Nfi, RankiqIe. Rrl
Name, Number CommWi Subdivision, Lot
3. OWNER:
Address L o M+, g t Rq e. }
(Street or Route No.) J
Mi II �Qfi4c INC gf{%5G
City or Towd� State Zip Code
Area code- Phone number /y
4. DATE DRILLED / -I.2 - 0;
5. TOTAL DEPTH: 15-0 C /
6. DOES WELL REPLACE EXISTING WELL? YES Q NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 2W 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): E METHOD OF TEST A i r
10. WATER ZONES (depth):
(Sheet N ty. No., Zip Code)
))ei
11. DISINFECTION: Type (-1h 1 nri na
12. CASING:
Depth Diameter
From r) To IA0 Ft. 6 1 / 4
From.._ To Ft.
From To Ft.
13. GROUT: Depth
Frozz p To 2 ()
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
Amount Caps
Wall Thickness
or Weight/Ft. Material
GDF21 PVC
Material Method
Ncat Ccmcnt Ha
Slot Size Material
in.
in.
It lA K
DU HEREBY CERTIFY T
ONSTRUCTION STAND
L T_ r
S ,-0TIO!V
Saba* tlteiorlglnalt@RHfDivisior of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699=1636 Ptione No. [phone], within 30 days. GW-1 REV. 07/2001
Topoggaphic✓Land setting
❑Ridge &Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ormation Description
n /moo cL
A0 5-0 S forts!) P_ Yo ck
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
y 10SY
"",-,IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S AND THAT 4 COPY OF THIS RECORR HAS BEEN PROVIDED TO THE WELL OWNER
0
r—
to
0'
( A - 0 - 02
SIGNATUB#OFPERSON CONSTRUCTING DATE
r
lv R771'

258110
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camr, .7r
CERTIFICATION 8 7 1 3 A
WELL CONTRACTOR COMPANY NAME Camp' ¢ Wa11 R Pump f•n T n r PHONE 8g2R1 d 5 3 - 7 3 2 2
STATE WELL CONSTRUCTION PERMITS __ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Tqwn: 5 1 >1 CountyPo�L
IV or arK hire D
(Street Name, Numbers, Community, ivnSubdivision,lLot No., Zip Code)
3. OWNER: J) QIt1 Rbwx'. L-011r<�
Address In 7) Tohn Smid-� Fri
to
`a..04(u5 for Rout No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED %5-l7a
5. TOTAL DEPTH: 24 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �S
7. STATIC WATER LEVEL Below Top of' Casing: 1�-1 F 11
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 1C .0118.
9. YIELD (gpm): ,9,49 METHOD OF TEST a i r
10. WATER ZONES (depth):
Topoggrr1�pphic/Land setting
❑Ridge 6dSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
From To
a5-
11. DISINFECTION: Type rh 1 nr i rip. Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_p To •36 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To 2 0 Ft.
Material
RDR21 PVC
Method
N at Cement II
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.
16. REMARKS: I0V
Slot Size Material
in.
in.
(check box)
DRILLING LOG
ormation Description
(t • . e
eost`A 1 rt ecj 110
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Road . nclu�e the road
numbers and common road names.
La�<e
CO f u rk}1 5
THIS WELL WAS CONSTRUCtbD IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING TIiE/WELL DATE
t_Submit -the ,original -With Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2$44—Ea¢'Pholtt )Ve: (AV 733-3221, within 30 days. GW-1 REV. 07/2001

258109
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Tar Camp-, Jr
CERTIFICATION # 21 3 fl
WELL CONTRACTOR COMPANY NAME ramp' G !Alp"! 1 R Piimp Cn Tnr• PHONE #a9R0 459-7322
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION I I I�
Nearest Town: II S! Y'lq p YCounty PC'
R LtA 9 2Jd.
(Street Name, Numbers, Community, ubdivision, Lot No., Zip Code)
3. OWNER: -1 l a it JAuk'nIP.Y
Address '�93 Min. Kettle PSI.
(�/� (Set or Routo o.) 11 75
-6
1'/Ci�Ior oSo111 treAIssasc Zip Cade
Area code- Phone number
4. DATE DRILLED /9 `Oa
5. TOTAL DEPTH: ' 5 /
6. DOES WELL REPLACE EXISTING WELL? YES I$t NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1±0 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): 10 METHOD OF TEST n i r
10. WATER ZONES (depth):
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 , JTToo or lion
Y Description
i
r afifiaie Yrr'
11. DISINFECTION: Type rh l
12. CASING:
Depth Diameter
From_p Ft. 6 1 / 4-
From To Ft.
From To Ft.
13. GROUT: Depth
From ci To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
nri np Amount 17A Cap
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
16. REMARKS:
Material
N at Cement
Method
H.1
LOCATION SKETCI-t
Show direction and distance in miles from atjeast
two State Roads or County Roads. Include ifd road, _,
numbers and common road names.
/Vl1l1sP9t
n ET
0
0
CP
yvtI auq E
10P
C 1D0 lliE10EBllf,'1'F THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS IRU( l lUtil ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TI-I W DATE
GRGUfVjruji*€ gic g nal t the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHEVILLE 11699i+16361Pber No. 19) 733-3221, within 30 days. GW-1 REV. 07/2001

256342
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION On
1 9 A
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sumo S Carp, t_.
WELL CONTRACTOR COMPANY NAME Camps a Wal 1 R Pnmp r'n Tnn PHONE #$7A) IIC1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ly Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: D r I /
Nearest Town• [ o l.. 11 tl 5 County o I I�
1 i fl le lYhh, . 2,-1.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i Lively� PA Le_
Address rgS l. Binge 1)r-
(Str or Root* No.) J
�a✓P)Prs lest SG 296yo
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED (p ` 7 - �.2
5. TOTAL DEPTH: *7-3D j
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: etc 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): c METHOD OF TEST air
10. WATER ZONES (depth): SQ4D
11. DISINFECTION: Type r'hlnrina Amount fk2 cui1
12. CASING: Wall Thicicness
Depth Diameter or Weight/Ft. Material
From Q To Ft.6 1 /4 SDR21 PVC
Front_ To Ft.
From To Ft.
13. GROUT: Depth Material
From# To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Ncat Ccmcnt Hand
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation ?Description
Sand 4((-ri
Coils° �idA. ed rock
c
c-
t0
DEPTH
From To
n 120
1a
•
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
\iv-4
co-
Cr IRy
Pei
16. REMARKS:
I DO HEREBY 'CERTIFY:I
C F44TRUCTIUN S1ANDf
-GRCrQFt4Th
TINTS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
THAT A COPY 0THIS RECORD HAS PROVIDED TO THE WELL OWNER
L. S GNATURE OF PE
CONSTRUCTING THE WELL f / DATE
Divi ion of Water Quality,_Groundwater Section, 1636 Mail Service Center- Raleigh, NC
733-3 21,within 30 days. - GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 256345
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Camp,1S CERTIFICATION# 71 "iR
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam
WELL CONTRACTOR COMPANY NAME ramp' q Wa11 k Pimp rim Inn PHONE #$2R) 45"2-7322
STATE WELL CONSTRUCTION PERMIT/4ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery El Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9 N
Nearest/Town: /)//1/ �(1YiIl
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 17 Ye� i
Address /54 5inra`itC✓N Li0.K5
(Su or Route No.
5ryy6o/I✓lIIP Sc
County PO
Ciry Town State Zip Code
Area code- Phone number j
5. TOTAL DEPTH: iv4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '
lc
(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 3i r
4 DATE DRILLED - 0 i
10. WATER ZONES (depth): AJ.2 G'
11.DISINFECTION: Type rh1nrina Amount e c:u/I3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Fromg To 7� Ft.6 1 /4 eDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From_.p To 20 Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
Neat Cement
Method
Ha
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH (check
LOG
From To Formationpescription
pp °%S 64/l(IV tyJ'k✓z�
/ti ✓{ l C%if(S li k11eel Yctk
LOCATION SKETCR 2
Show direction and distance in iniles from atleast ^'r}
two State Roads or County Roads. Include tha?road",
numbers and common road names. Xl:--
�AYk-
3;)dev CIS g
bg
l QTiS O t S AItID�S', IS THAT A CCOPOY OF THIS RECORDBEEN PROVIDED ACCORD TO THE WE OLL WNER
��i ,,' Cti � 7-Iso�
i� OF PERSON CONSTRU IidGTRiE WELL DATE
s f CLj{L°J- /kh�(�
L . 1 ATURE dT
}.,'., — J
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
fnti ft 4'.l'Pt1RN,pg0 J 33-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILI_E REGIONAL OFFICE

WELL CONSTRUCTION RECORD 252542
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #_-21313
WELL CONTRACTOR COMPANY NAME Campy c Wa11 R Primp f n T n r PHONE #al _AS1-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J am in s w C am[�, Jr-
1. WELL USE (Check Applicable Box): Residential CI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI '/
Nearest Town: i (J SP (I ru County O I k
[t0.'Rtdcu Rd,-
(Sweet Name, Numbers, C ,unitnty, Subdivision, Lot No., Zip Code)
/V 3. OWNER: DYlf ac t IDD re
Address S01 Crest ?d •
Street or to No.)
flat flock. f%G ag93I
City or Town State Zip Code
Area coda Phone number
4. DATE DRILLED 7 ' i - P A
5. TOTAL DEPTH: 6-0 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pit
7. STATIC WATER LEVEL Below Top of Casing: 6171 FT.
(Use 'Y" if Above Top of Casing)
8. TOP OF CASING IS - FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires ■
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): f 0 METHOD OF TEST D ;
10. WATER ZONES (depth): 48D
11. DISINFECTION: Type rh 1 nr i n a Amount 2. cup
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
Fromn-To 9/> Ft. 6 1 / 1 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_o To 20 Ft. No -at Cement Hand
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:
Material
PVC
/ Topographic/Land setting
&Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
n 110 riayy—dift
010 SD5"CO)t4511da Cd rock
LOCATION SKETCF(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Al;
Spy
Iog
}Pe a, R i RA.
cn
Elt}T1FT�fdnT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL 3
I
ION $$TAN)
i SIGNATURE OF PE
't the original jo the Division of Water Quality, -Groundwater Section, 1636 Mall Service Center - Raleigh, NC
GRr, GW-1 REV. 07/2001
YH�'94'1d33 Eh(ui!(Nb. [phone], within 30 days.
ASHPJILLE R[GIGP'hL Oi-i9GE
S, AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO TILE WELL O WNERe,,l
CONSTRUCTING THE WELL ✓
_79-7cn
DATE
— hT

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 4t Caxpp, ZS'- CERTIFICATION# 71 38
WELL CONTRACTOR COMPANY NAME ('amp' m Wa11 R. Prtmp f n Tnr PHONE Y$2A) d51-7122
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 4✓ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;A(� I k
Nearest Town: 'Dec I �a 0— County PO I
I7avt iris O.c.k. Rr\
(Street Name, lbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ;ff
Address T5- 11a(1gq[v(q Roc-K K .
SekI vlel e\- or 55dC-WS rtd) Q 713
City or Town State Zip Code
Area code- Phone number
5. TOTAL DEPTH: 45-
4. DATE DRILLED 21 a
/
6. DOES WELL REPLACE EXISTING WELL? YES H NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 2,r,- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST air
10. WATER ZONES (depth): 3'7 D
252556
Topographic/Lan setting
❑Ridge ❑Slope I?alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation 1 Description
0 pi0 II oaWt/ ri t
�o 40 _ consoG,d4 Yca for_k
11. DISINFECTION: Type rh l nri n a
12. CASING:
Depth Diameter
From_q To ,2,-0 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 p Ft.
Amount a. cu.f5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Method
Pleat Ccmcnt Iland
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
ra
GIe
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County ads. Include the road
numbers and common road
tzcne.
Dr.
C fl
�o j-jdrtF �� .q
=CI, (Z 4K-)RA.
ADO HEREBY CERTIFY al' AT TH.S WELL WAS CONSTRUCThD IN ACCORDANCE WITH 15A NCAC 2C, WELL
iCIONSTRUCTION STANDARD), AND THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNEIg m o
�vla_ 2 �l g 21 _ern
_
'� `—'SIGNATURE OF PE CONSTRUCTING THE WELL ✓ DATE) at 2
10 G
u,6m Fe ciriglnsfitot... )ivisi3n of Water Quality, groundwater Section, 1636 Mail Service Center - Raleigh, NC `
21699 ti636 Phone INa. (911;133-3211, within 30 days. GW-1 REV. 07/2001
Ac

252553
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sarne a w Ca'pe Jt CERTIFICATION N 21 'i R
WELL CONTRACTOR COMPANY NAME Camp' s Wa11 $ Primp en Tnr PHONE N$2Rl dr,1-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION, : II ``
Nearest Town: (;010. ka 5
County R I k
lax Mtrn. RA.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t h l l l l
eSse 1'
Address % I a t4 r+k R
I (Street or Route No.)
�Gtndrw)~\ 6c- ,P.9354
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED - I - o a
5. TOTAL DEPTH. I W 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �Q
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 'I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 0 METHOD OF TEST
10. WATER ZONES (depth):
air
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Wflet
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To forrnptionDescription
n TT
as floc C,rt5o/;dated t-ock
11. DISINFECTION: Type rh 1 nr i tip
12. CASING:
Depth Diameter
From r) To rt� Ft 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_— To 313 Ft.
Amount I cu.r
Wall Thickness
or Weight/Ft. Material
c9R.21 PVC
Neat Cement Hand
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.
Slot Size Material
in.
in.
Size Material
16. REMARKS:
JOCATION SKETCI-I
Show direction and distance in ••. es from at least
two State Roads or County 'cads. Include the road
numbers and common ro names.
Y CER1p
OTIST1it1C t 1OlSI ST:
1 I
L.
iu
Submit the original to the
I 27b99-T636 Phone.Ftu.,(S19)1733-322
=1:m
WFr r WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL — o
THAT A COPY O. THIS RECORD HAS EEN PROVIDED TO THE WELL OWNO ri
am �'r ` y `
NATURE OF PER$C,�N CONSTRUCTING THE WELL % DATE W gilt
al --1
n of Water Quality,_Grouadwater Section, 1636 Mail Service Center - Raleigh,t)it E
I, withln 30 days. GW-1 REV. 07/2001 =

252550
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
J�(priot) 0,1\A P `S kAj C t\ `INK 'Q CERTIFICATION Ida.9
WELL CONTRACTOR COMPANY NAME OWN WevMf Co PHONE Or Jt Do U13. g)3b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential q 'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town1Vt6. Q G County V. 0
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: @I M
Address n�1n�pp1%C
C > tree[ C
S�No.) r)_A Zi
City or Town State Zip Code
Area code- Phone num
4. DATE DRILLED — L\ 0 a-
5. TOTAL DEPTH: y 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 9 d FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface"
' *Top of cuing terminated at/or below land surface requires a
variance in accordance with 13A NCAC 2C .0118.
9. YIELD (gpm): .3. 0 METHOD OF TEST (k-\
10. WATER ZONES (depth): 3 0
11. DISINFECTION: Type (`O.%
12. CASING:
Depth, Diameter
From_ To { _ U Ft. 11 i$
From To
From To
13. GROUT: Depth
From U To o
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft.
Ft.
Topographic/Land setting
IC2Mdge ['Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T9 Fonnstiop Description
0 I a 6 f1A
a la 4 ei C ✓it-11.44-'t^
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Wei t/Ft. pititerjlit numbers and common road names.
Material , Methpd
Ft. h ea CC.irietc ha-n//
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
1130 IIERB13Yr4R
CONSTRUCTION S
Submit the original t
17699 4 4;Ahanp 6.
_ L'-FICE
Size Material
T THIS WELL WAS CONSTRUCTED IN AC
�S, AND THAT A COPY OF THIS RECORD
'� r AT(E OF PERSON C U NG THE WELL
c
r
0
sae^ m
—< cm
z
o�_
L
>0
-o —'-,
tg p ANCE WITH 15A NCAC 2C, LL S 73 c
BEEN PROVIDED TO THE WELL OWNER W N m
m
rI
H
DATE i
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q�1WIc3w Ca N'l� 1 •I V. CERTIFICATION # 3
WELL CONTRACTOR COMPANY NAME L0. it1 p 5 W <1 i V pm vs 11 1. c . Ike
I
STATE WELL CONSTRUCTION PERMIT# PI I 00 001 _ASSOCIATED WQ PERMIT#
(if applicable) (it -applicable)
PHONE # (b ij53' g2a
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 1 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: Co l u mliI(5 County Po I 1<
S/namvLc.k roves`
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7Lt)R f
n Colv(w,b u5
Address
e(Street nriRoute No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED g G — OJ
5. TOTAL DEPTH: Act, 5 �,{
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO S°t
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2/ L 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): 4o o METHOD OF TEST in U top
10. WATER ZONES (depth): Sao 4 3,70
11. DISINFECTION: Type e-
12. CASING:
Depth
From To h.2 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Mate 'al Method
From O To h Ft. Crwlen ow fluni pl nit
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.
oy1ytQ Amount —A rides
Wall Thickness
Di r or Weight/Ft Material numbers and common road names.
SS
Topographic/Landsetting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
From To
o Formation Description
0all
rf f
P.oKSol;dated rock
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
jai ✓antkeA
Col, lour ka; H st. (40)1 tog,
Pelt k St.
SkelIwvock
�ate5f
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CI 4Sf1J IOR) Sythl h$ 4ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
15 lUJ la O lr1 LS /Met Qzi„- 10 ('3-15 D�
�N&YURE OF PERSON CONSTRUMNG WELL DATE
APR 11 2002 „—A
ubmit the original to th _rvis
7699-1636 Phone No. (919) ' 3-32
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

Size Material
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
fao lrt gra t���I
/ao 4oS n5ufirktrA rock,
c
O
9
o\
c
=m
°
rn �
nv
,
LOCATION SKETCH p r=
Show direction and distance in miles from atiast n x
two State Roads or County Roads. Include denoado
numbers and common road names.
mAck
Cc
Ft.
Ft. —> 1 62 4
T'rorx ht,CL-, Mt Witt 16. REMARKS:
Dz0.tC
D r,
I1
Si-lj'ctr
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Tames la Cam{ Jr - CERTIFICATION # 21 3 R
WELLCONTRACTOR COMPANY NAME f'amp' a Wa11 R Pump f`n Tnr PHONE #$2R1 AS3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Oil 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: 57 tt I t.t f��7 a County C o I k
Orr -an Vi r I nr.
(Street Name, Numbers, Community, Subdivision, Lot No.
Zip Code)
3. OWNER: Pp a l,l�n• Lard llndert
Address P D Bc'X /093
(Street or Route No.)
Salina He 2g213
City or Town State Zip Code
( )-
Ares code- Phone number 4. DATE DRILLED 3 - pa
— 1 1
5. TOTAL DEPTH: 4 OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 'i
7. STATIC WATER LEVEL Below Top of Casing: 70 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): ca S METHOD OF TEST p i r
10. WATER ZONES (depth): ."3 Cs'
11. DISINFECTION: Type eh 1 nr i n in Amount cup S
12. CASING:
Depth
From p To /c 0 Ft. 6 1/ 4
From To Ft
From To Ft.
13. GROUT: Depth Material Method X
From_a____ To 20 Ft. Neat Cement Ha
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material- _ —
FromTo Ft. in. in.
Froth To Ft. in. in.
Wall Thickness
Diameter or Weight/Ft. Material
SDR21 PVC
15. SAND/GRAVEL PACK:
Depth
From To
From To
1 D0 Mn'R� O,.,Y.j �C&PT1F'V TM 4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTH 15A NCAC 2C, WELL
1,1
L l'�..N31� 7DSIGNATURE OF PERSON CONS1R1JTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
! JU"I 2 6 '' , U
I` Submit the original {o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
»gqo lff62lw teNo.1(919) j33-3221, within 30 days. GW-1 REV. 07/2001
6ROUNL)Wt:1LR
ASHL nl i rrr
8
L
NG THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamr's w Cam[>. Jr -
WELL CONTRACTOR COMPANY NAME ramp' a (Alin 11 8, Pnmp ('iD T n r. PHONE #$t7R) 4:1S-4-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT('
(if applicable) �/ (if applicable)
1. WELL USE (Check Applicable Box): Residential fa Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: .0/ t.( ttti U 6 County
IA.)00ri col) FS-ates
munt ,Subdivision
Polk
(Street Name, Numbers, , Lot No., Zip Code)
I t l
3. OWNER: it hI ry, a '1 ) WOOdrt.t)aY�
Address 65 ; coX RA.
(Street or ktoute No.)
T7yorl c as7Ra
Ci or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 15 —oa
5. TOTAL DEPTH: go 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �Q
7. STATIC WATER LEVEL Below Top of Casing: 6S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ai r
10. WATER ZONES (depth): 3 to C
CERTIFICATION # 71 'i R
Topographic/Land setting
❑Ridge ❑Slope ❑Valley mFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
%
Consolidated rock
From To
JAD
) 20 6-
11.DISINFECTION: Type rh1nrirun Amount Cuffs
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From r) To ao Ft.6 1 /4 SDR21 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From_0_To 30 Et. Neat Ccment IIand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Hjr EBYq`ER'FYI
b$nhtnit tha4)4 •' he D
G36MLE 1L M9)73
ASHEVILE u
Show direct
two State -
numbers an common road names. O� o
c
0
0
SSP
C.,
n
CO c1-1m
a
and distance in miles from WleasI
ds or County Roads. Include -the ro2
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 5A NCAC 2C, WELL
S, AND HAT A COPY OF THIS RECORD HAS BEEN PRO a ED TO THE WFI 1 OWNER
0
SIG ATURE OF PERSON CONSTRUCTEN r• T t LL 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 251075
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r.r Camp, Jr_ CERTIFICATION 21
WELL CONTRACTOR COMPANY NAME Camp ts WP11 & Pump rn_ Tnr• PHONE */g�R) d5T-7322
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IV 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:(r /� '' //
Nearest Toyys� 1 t t ,$J1 t t 5 County Poi K
(�feevt CV. ,lr.
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: nx y Do U»ts
Address ,i �/ .`I u ii It d i nq Rose Let. K e.
(Sate or Route No.) �1
4awtnee cTA 3002_4
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 - O.a-
5. TOTAL DEPTH: 4-n S ' /
6. DOES WELL REPLACE EXISTING WELL? YES' 'lyCf NO ❑
7. STATIC WATER LEVEL Below Top of Casing: T� FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /0-/5 METHOD OF TEST pit
10. WATER ZONES (depth): -23g0
11. DISINFECTION: Type rh 1 nri na Amount cups
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft.
6 1/4 SDR21 PVC
From__ To Ft.
From To Ft.
13. GROUT: Depth Material Method
Front_g To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
N at Ccmcnt Hand
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley WFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
dirt
eons°,r dJrn Ynck
DEPTH
From To
Ro
fo 4oci
N)
LOCATION SKETCH — u m
cn.Show direction and distance in miles from ar leas('; ?
two State Roads or County Roads. Include road
numbers and,ptlquryonrroad names. z
C �CS.'
Hwy.
T THIS WELL WAS CONSTRUChD IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WFI I OWNER
Gtl C -/2-
UCoff
SIGMA OF PERSON CONSTRT (4 T WELL DATE
GROgg4�iQ1��11�,' 4��p�egN�r�r(I} ' 1 Yo the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - RaleighNC
ASHEVkt'P�I IVR_c e{[phone], within 30 days. GW-1 REV. 07/2001
cAL Dr'

,25-002 s y
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 / Wlei `^)' `-r^Pey1T7.. CERTIFICATION'r#.A IS
M
WELL CONTRACTOR COMPANYNAE l'A WII S LOQ-II v !(')UW p `�L , 1nr' PHONE # (Q�Z S) `t51-73'1,1
STATE WELL CONSTRUCTION PERMIT#S4)A((l 0U bog ASSOCIATEDapplicable)
e)RMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 1 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: o I i A.wt i Coapt 6 unty POI K
S tk run V a ck 1'a V e St
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -FI.t)K n IniCo) EAtwid 1.45
Address
(Street orRoute No.) eo)u)ttous g n
IV CA.
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 - G - O1
5. TOTAL DEPTH: �,(
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO S°t
7. STATIC WATER LEVEL Below Top of Casing: / D FT.
II// (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 212- FT. Above Land Surface*
' *Top of casing terminated at/or below land surface requires •
variance 1n accordancg with 15A NCAC 2C .0118. •
9. YIELD (gpm): 4o C METHOD OF TEST 0 U wt/) i Vt9
10. WATER ZONES (depth): a o d
11. DISINFECTION: Type C It
12. CASING:
Depth Diam er
From (7 To h 7 Ft. S,' S8
From To Ft.
From To Ft.
13. GROUT:
From 0
Topographic/Laud setting
❑Ridge ❑Slope Galley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTii FRILLING LOG
From To Formation Description
0 C 0i/'(-
51, arcs rDR6CI;44R rock
c
0
0
0
D 0rn
cm
0<
CO *rn
c
TAB m,,
LOCATION SKETCH 3 zCD
Wall Thickness two State Roads or County Roads. Include the -read ...r
AaiVaniked
Amount -, 1 /+s Show direction and distance in miles from at et m�
or Weight/Ft. Material numbers and common road names.
Depth, Material Method
To h „Z Ft. CHmen:1 ycut pump/ rtq
From To Ft. J J
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.
9413 4fib01FShSlftOrtheDivi
'376 16-46:+1 utiii iti 7 ) 733-;
I.
�o�wk. ,u5
Ka; Sf,
IIS WELL WAS CONSTRUU1hD IN ACCORDANCE WITH 15ANCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/tirnoA- l 3. Cayittil 3 15 D�
IGN9'URE OF PERSON CONSTRUCIING WELL DATE
Peak St.
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
.221, within 30 days. GW-1 REV. 07/2001
SkLLM- cc
'rest

•
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Id_ Camp, Jr- CERTIFICATION # 21 9R
WELL CONTRACTOR COMPANY NAME Camp c We11 R Pimp CO Tnr PHONE Si 2R) d' —7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
249397
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 LOCATIONn ' /
Nearest own: l r' 1)1 ✓ County PC )K
N✓l hj4c�Chleli
(Street Name, / Numbers,( Community, Subdivision, Lot No., Zip Code)
3. OWNER: ���r UJf0. RNA/y
Address G nX %oo
J ' Ctd (Street ore_ No.)S 9'I3
�A 0. N
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED '0AD`63-
5. TOTAL DEPTH: .14 6"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 4 ' 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 wttb 15A NCAC 2C .0118.
9. YIELD (gpm): I S METHOD OF TEST /I i t
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 nri na Amount tkk cup
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To 3 Ft. 6 '1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
GDR21 PVC
From p To 2 0 Ft.
From To Ft.
N at Ccmcnt Ilnnd
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
7,YEXSB ".CE*Tl�
TRucTYioN �+T/�+
Su i mit the orjgmal to
2769 2 6,ThenedCto441
A?M.VH E htLblCiJ'iL
Size Material
Topographic/Land setting
PRidge ❑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
C--/aJ — cit t
cntlsol,do.tea rrrk
434,3
C
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t o t n
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
TEAT A COPY OF IS RECORD HA(S/�jB�EEN PROVIDED TO THE WELL OWNER
-,
ATURE OF PERSON CONSTRU INGoitHE WELL DATE O
W o
of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC Z
within 30 days. GW-1 REV. 07/2001
m

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame S t+L Ca mh, lc
WELL CONTRACTOR COMPANY NAME Campc Wa11 8, Pump Cm_, Tnc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
249393
- Groundwater Section
CERTIFICATION # 21 3 8
PHONE #$t2R) dSi-7i22
1. WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIODL
Nearest Town: ,)10 MLitt 5
County PDik
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ion
3. OWNER: 00>,{ I3al Iel l oNSt, Co -
Address 7// -tall{ ('e.'iJHe IZri
K( (Street(VC Route No.)
City or Town State
a7/3 q
Zip Code
Area code- Phone number
4. DATE DRILLED aCa
5. TOTAL DEPTH: CO S 1
6. DOES WELL REPLACE EXISTING WELL? YES fit NO ❑
7. STATIC WATER LEVEL Below Top of Casing: ri--h 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): I METHOD OF TEST Air
10. WATER ZONES (depth):
Topo�phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
87 rock- d i r±
D55- 50.5 (7?✓50/i da fe(>T ✓o cl<<
11. DISINFECTION: Type rh1 nri nP
12. CASING:
Depth
From 0 To Dn_-)
From To
From To
13. GROUT: Depth
From_ To 2 0
From To
Diameter
Ft.6 1 /4
Ft.
Ft.
Ft.
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. ,1 j
G
Amount cct f s
Wall Thickness
or Weight/Ft. Material
�DR.21 PVC
Material Method
Neat Cement [land
Slot Size Material
in.
in.
16. REMARKS:
S1
J °CATION SKETCIi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
xs
)
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWI
iG1) - O—2,
OF PERSON coNsmucr1hG4t'wELL WELL DATE
_J W
O
=a
rl
0
2
S Ibmit he original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2 6994 rhgarl va.:M73s 21, witlin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
247803
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr
WELL CONTRACTOR COMPANY NAME Camrt a WP11 & Plump Cn Tnr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 7 1 3 R
PHONE #$7R) 453 7322
1. WELL USE (Check Applicable Box): Residential 1$ MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:I II I /
Nearest own: EA on.b o l u s County Po I k
��niel
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
0tie' ) IQCktde/I
Address 13)130X g5
(Street or Ro e No.)
Iuwthus NIC H?aa
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 2 n `i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 4o FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 1 FT Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ai METHOD OF TEST air
10. WATER ZONES (depth):
11. DISINFECTION: Type ("hi nr i n in Amount t C RP
12. CASING: Wall Thickness
Depth orWeight/Ft. Material
From (1 To 65 qr)5221 PVC
From To
From To
13. GROUT: Depth
From
Diameter
Ft.6 1./4
Ft.
Ft.
Material
Y1r
Method
p To 20 Ft. Neat Cement Ha
From To- Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
Material
16. REMARKS:
/ Topographic/Land setting
141Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation D scription
0 45 ✓jL ✓f.5 n
65- ao5 Coytgo// aied Yoe.*
N
m;a
J.00ATION SKETCH N
Show direction and distance in miles from at 1eaR
two State Roads or County Roads. Include the road uyvAtt,.,A.,-
numbers and common road es.
a
tTh
T THIS WFI 1 WAS CONSTRUCtED IN ACCORDANCE WITH 15A NCAC 2C, WFI f
THAT A COPY OF THIS RECORD HAS B _ EN PROVIDED TO THE WELL OWNER
1&141--
NATURE OF PERSON CONSTRU IN T `I WELL
DATE
God
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja meS na Camp, Jr_
WELLCONTRACTOR COMPANY NAME Camp' s We11 & Primp Cn
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
247800
CERTIFICATION #_2_],_18
Tine PHONE#>g7R) dS3-7122
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest TownI:�r�1Jar I )Al County Po I IC
ec1T0Yr Rr�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (i I e VL 1/1 13 t.)11 I VIC+
Address R
n II(Street or Rout No.)
( �lY1�lS SIC aZ`I&b
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED f ` I + D )-
5. TOTAL DEPTH: 2 0 ;
6. DOES WELL REPLACE EXISTING WELL? YES MNO ❑
7. STATIC WATER LEVEL Below Top of Casing: `PC 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 •
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4..) METHOD OF TEST p it
10. WATER. ZONES (depth):
11. DISINFECTION: Type eh 1 nr i na Amount l r tLp
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From O To AO Ft.6 1 / 4 GDR31 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 O 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
Ncat Ccmcnt
Method
H a:.a
16 REMARKS:
Topographic/Land setting--//
❑Ridge ❑Slope ❑Valley �iPlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation DQscription
5a ryd
rnttQjirla1cA
DEPTH
From To
n oZ 0
go 205
rock
c
0
r-rt
co _Fri
Dc
0 LOCATION SKETCH fV 2
Show direction and distance in miles from crilleas
two State Roads or County Roads. Include the road
numbers and common road names. y,
II1ERhEY ERT
STRUCr1ON STANDARD
ISubintri iOlfli'ie_k6rtk(t'#iir
27615EIii8l4oue.Tla.
LL WAS CONSTRUC IED IN ACCORDANCE WITH I5A NCAC 2C, WFI
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
w 1 —44i7 //
TURE OF PERSON CONS UCTI
o
THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ithin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mec m Camp, Jr CERTIFICATION# 21 38
WELL CONTRACTOR COMPANY NAME Campr s Wpl 1 R Pnmr f'n Tnn PHONE #$2R) dC3-7322
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
247'795
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest T. kij Ali 7 ✓
Darn�ry 00 l k
rmv'f"hpet r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !f/74;d jzo Ut) e-
Address t• a 0 X I %a0
(I t.lYvl 1.U (Streett5o^ff\\1I11Rpu�No.) a8,7aa
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / - -Joa-
5. TOTAL DEPTH: 50 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 4
7. STATIC WATER LEVEL Below Top of Casing: SO
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ID METHOD OF TEST k i r
10. WATER ZONES (depth):
11. DISINFECTION: Type Ch1 nri np
12. CASING:
Depth Diameter
From_(_ To Ft. 6 1 / 4
From To Ft.
From - To Ft.
13. GROUT: Depth
From_n To 2 0 Ft.
From To. Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Noat Cement
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Frotn_ To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in.
16. REMARKS:
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)
RILLING LOG
Formation Description*14 ✓el, GI a/
/
`-c,Drsvhda'fed ✓bc.k
r
r�r
DEPTH
/FSOS.
To
J
CO
x
c• ? cn=
LOCATION SKETCH tit o
Show direction and distance in miles from at leaaf
two State Roads or County Roads. Include the road
numbers and common road names.
T THIS WELL WAS CONSTRUC1tD IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PURE OF PERSON CONSTRUCT!
G s' WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

247792
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w
WELL CONTRACTOR COMPANY NAME Came' c
STATE WELL CONSTRUCTION PERMITS
(if applicable)
We11
Camp, Jr.
CERTIFICATION 21 4 R
R Pimp Cr_ T n r PRONE i$37A) d53-7322
ASSOCIATED WQ PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town' C0 I14 W1 t4 5 County I D'
/-JD M 5 { v EL IZd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1:1P Vl e 3, 1'Nsda_ le
Address tk5fo R Rri •
I street or R7wyb vs \ C ' 70Z
City or Town State Zip Code
( )"
Area code- Phone number
4. DATE DRILLED L - I `t - D 'd-
i TOTAL DEPTH: 'YJ S
6. DOES WELL REPLACE EXISTING WELL? YES IC
❑
7. STATIC WATER LEVEL Below Top of Casing: ¥ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 `5 METHOD OF TEST A i r
10. WATER ZONES (depth):
11. DISINFECTION: Type rh l n r i n a
12. CASING:
Depth Diameter
From_ To Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From p To 20 FL Neat
From To_ Ft.
14. SCREEN: Depth Diameter
FromTo Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in.
in.
Amount
Wall Thickness
or Weight/Ft. Material
ct1&.21 PVC
Method
Cement IIand
Slot Size Material
in
in.
16. REMARKS:
Topohic/Land setting
❑Ridge WSlope ❑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 ormation Description
i JF,z 3D r solidstedicon*
o =�
fV .�
rn
r
rni
LOCATION SKETCH Cfl o
Show direction and distance in miles from at leastz
two State Roads or County Roads. Include the road
numbers and c moron road names.
co tILYn-bA.6
tA
uslr fl !a .
MH1 Sp{'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND - s • e is 91 N PROVIDED TO THE WELL OWNER
•% -bat
SIGN" 1 '�� tr '1 )TELL
Submit the original to the Division of
27699-1636 Phone No. [phone], wit
PERSON CONSTRUCTIN
Quality, Groundwater S
days.
ERN EECTruN
Si-E`,i! t E REGO.; _ OHL"
DATE
1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

250493
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural (Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Te_SPpl t I (t O (NS CERTIFICATION H
np i �
WELL CONTRACTOR COMPANY NAME 1,_Pe P Sr M S- We f ( D ()I (1K{ 1-Kr. PHONE tt (6O 2-y 3 -26 yr
STATE WELL CONSTRICTION PERNIITP ASSOCIATED WQ PERMIT#
I if applicable) (if applicable)
23/9
I. WELL USE (Check Applicable Laos): Residential, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other, List Use
2. WELL LOCATIO :
Nearest Town: -01G ..tiU S County PO 11L
n1Md;aa Sirle Rd• tu6L k Oak ntt,t<41+n to R ;t(id9
(Street Nmu2. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: Lin ((ean IPCle
0..1
Address (2_, C f 1 «f u-nc RA -
(Street or Route No.)
entt{uVt I C 25 3a3
86t1)- 57R-S5Z3
C - or Town
State Zip Code
Area code- Phone number
4. DATE DRILLED 3J —2 U Z
5. TOTAL DEPTH: 7 0 5 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO_W
7. STATIC WATER LEVEL Below Top of Casing: ZG 0 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS i .3 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .5 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
5Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo1{n4{ion Description
z 0 i �� Veal] yr fics--
77 leo 624der£
11 DISINFECTION: Type 14 •141 Amount c' cz .
12. CASING: Wall Thickness
Depth �t Diameter or Weieht/Ft.
/�
From l' / To 2 / FL 6,1tr
From To Ft.
From To Ft.
13- GROUT: Depth Materal Method
From O To 2C...) Ft. AUPai' Um 4cf
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.
Material
From To
1 DO HEREBY C
CONSTRUCTION
JUN 2
GROUNDWATER SECTION
ASHEV LLS i6b16NM'u OF%l'tial t he 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
Ft.
0
-o
CJ
LOCATION SKETCH _--
Show direction and distance in miles from aeast`C, j
two State Roads or County Roads. IncludeAire rota:
numbers and common road names. c
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
.ARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L oC °`i, 3/a 2—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

247982
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesf- Division of Water Quality - Groundwater Section 31
WELL CONTRACTOR (INDIVIDUAL) NAME (print) hi;) Se r in j + Li; ilin on S CERTIFICATION It / r/
W )I i.x e . PHONE # AY) 2St 3 zbb Z.
�reLLcoNTaacTORcoMPANVNnnIE r In,s �11 �fr ;.�,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Q
Nearest Town: (Jot dm8 i County bt14
LoT L' 2'C. %r£Rstm..,r. N/L& (Cht5*Aid; c.rc)
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: :Tax kara Qi ccl
Address P D r5t'F a 37
(Street or ttoute No.) 2816
8 1 5 2-
I N To N C
/� �jCitydr Town Sta(te� Zip Code
(t2Si)- 'r i - C) LE tl
Area code- Phone number Z
4. DATE DRILLED 2 - / S- ✓J
5. TOTAL DEPTH: .5/) S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO»-
7. STATIC WATER LEVEL Below Top of Casing: ie el FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 r S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth): 1 © 2-CC' / � 33_ -1
/ et, lib • 1I. DISINFECTION: Type *Ft, Amount to o'',
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To SW Ft. 6,zS Pv. C.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (% To %-' Ft.
From 'fo Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
To Ft. in. in.
From
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
Topographic/Land setting
,Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F rmationDescription
hit
9S 8 << e
yl Sec rec,n !!x.
n rep'
Ol/`
c;
fV c
n
CO
IV
--0 —I.,
LOCATION SKETCH ^'
rn._
Show direction and distance in miles from efleas =e
two State Roads or County Roads. lncludie row
numbers and common road names.
cd
t nn MFRERV CPPT(FV TuAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
[ Ol TI2C-�CT OLV Te D• ' IS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r�J S
�I
IlJ
Submit the original to t ie Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
110uc_N4.42.U)) 733 3221, within 30 days. GW-1 REV. 07/2001
GPOWPIVA?EP, SECTION
ASITHIL r S ITEIS Orr J
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
252845
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ck.s K to.0 tc5 CERTIFICATION#
n.. i
WELL CONTRACTOR COMPANY NAME -
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
SacJat e_cS dSOn Wetl tD o FriG PHONE # (2'M c255 748g
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential le Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: \
Nearest Town: Tr 0 rJ
0
s
County Qn/ K-
Mt.\15 Sec:.
(Street Name, Numbers, mmunity, Subdivision, Lot No., Zip Code)
3, OWNER: Rudy Ftv4aan
Address t1
(Street or Route No.)
City or Town State Zip Code
(gag)- 6B1.4 ot4g1
Area code- Phone number
4, DATE DRILLED Lk-2T.-a2
5. TOTAL DEPTH: 5e15
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m
7. STATIC WATER LEVEL Below Top of Casing: 91) 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 .0l 18.
9. YIELD (gpm): 3 METHOD OF TEST 6.15_
10. WATER ZONES (depth):
Topograc/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1 o(1 fiver $et-ritn
1 5a5 Graaae
11. DISINFECTION: Type ? \IS
12. CASING:
Amount TO
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4-1 To .21 Ft. � A21 riesh.e
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From (7 To 20 Ft. Cement 'cure d
From To Ft.
14. SCREEN: Depth
From To
From To
15, SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
16. REMARKS:
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
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
IV
see
N
DC3 HQREB CB1ZT)'fP( �HA
Opinecti'IONII'STAN DAtt
I3 WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL DATE
Stjbmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699463611PhAHeFNbf(91i19?jV733-322I, within 30 days. GW-I REV. 07/2001
ASH ilL -t OFHCE ...

WELL CONSTRUCTION RECORD
252844
North Carolina - Department of Environment and +Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)l.1.rtda K SaulµCry CERTIFICATION # aM lte
WELL CONTRACTOR COMPANY NAME l e act SOn- +Will 1'O �_. PHONE # (2VS3 a55 Vogy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential es Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: % P' y D County
/AI S 5�/c:r
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 96-n't bG•1v:e
Address q 454 NC '►S.,S' Qoq I
(Street or Route o.)
Hot 5s)ct vvjs A)t
r12,'i 3
City or Town State Zip Code
(tit)- 054 %(%SG,
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 3`t 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 1:143155e ❑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
.Af 8eo Over ilerieon
8G, 3415 6ran;te
11. DISINFECTION: Type 7 tt S
12. CASING:
Depth Diameter
From I -I To $ b Ft. C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Cement fbure 4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount D
Wall Thickness
or Weight/Ft. Material
21 rI4.56�
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
N
c
0
cr
c
0<
o<
rn o
^ern
rnz
ma
c1
G
I p9 H.ryt@ox ttTyr r.-
R,,uqi,,odyti,,NAA1S"?p
OURCM i' otGi
ASHEVILLE REGIONAL OFFICE
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND Tk1AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NAT
E OF PERSON CONSTRUCTING THE WELL DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur R\ jtt�ces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l�T�j/,,�f}.—.��"�'/���/ jJ CERTIFICATIII�ON N alt91 (y
WELL CONTRACTOR COMPANY NAME ( 1� f�Y-1�ac(h/�'y.—'—'4IJ PHONE # gag t0(/0'?4a t
STATE WE.I.I. CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: County ./>
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERHt>' hoc(\ ¶ CR..)e1 t D
Address 5%S k \'evx\\Q \-k-cog
(Street or Route No.)
1 ,\\ n c aVlq
City or Town State Zip Code
8)- (0%( "cp.,3
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES/0 NO L�}�
7. STATIC WATER LEVEL Below Top of Casing: YDr FT.
(Use "+•• i f Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanc • h ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
CIlB,idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
For{{n�alion Description
(ix V
From To
c
n>
C-
c.__
'Tr
� � LOCATION SKETCH 'F.
I I. DISINFECTION. Type .v —1., Amount Sr Show direction and distance in miles from atd rst
12. CASING: Wall Thickness two State Roads or County Roads. Include the road6
Depth Di meter or etg VR. nal numbers a d om r�on road names.
From--�-- To Ft.
l
From
From To FL
13. GROUT' Depth Materi
From_ To_ - Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
CvI
15. SAND/GRAVEL PACK: (�'
Depth Size Material �(J
From To Ft.
From To FL
16. REMARKS:
/45,
nQ r?J_Qp-s,,b4 f+di
254642
rn S
m
-1
-i
c
L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ^ • • • •• Ct 2C, WELL
A COP OF THIS HAS BEEN PROVIDED a1�F '%'EL OWNER
'ORE OPERSON COUCTING THE WELL CATE
�I^ ).
bmii thi onglna 4 he li o
99-1636 Phone No. (919) 7:3-322
n of Water Quality, GroundwaAg e ,4t 4L(t .4Lu�Ce Cer ter- Raleigh, NC
, within 30 days. OW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
254389
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION N 2809
WELL CONTRACTOR COMPANY NAME D Plowman We11 fri 11 ing, Tnr PHONE If B7A 992-7779
STATE \VELL CONSTRUCTION PERMITh ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EX Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Columbus County Polk
Robertson Road Columbus NC 28722
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Linda Gordon
Address P n Rose 1151
(Street or Route No.)
Flat Rpck NC 28731
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 5/21/02
5. TOTAL DEPTH: 500'
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 1 00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST rotary air
10. WATER ZONES (depth): 320'
11. DISINFECTION: Type tablet
12. CASING:
Depth
From p To 50
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.fi1 /8 Srh Rfl PVC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
-D
N
4-
lL1
c
16. REMARKS:
�D HEj� C�t
�¢OMST NC IO .
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the on ii(, to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r R 1 F.49, hen . 919 r33-3221, within 30 days. GW-I REV. 07/2001
,FCL4 -� C > Y
ASNPIILLE REGIONAL OFH

264668
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Q Natural Resources�d- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAh1E (print'll�d a ro rV CERTIFICATION #doll)
WELL CONTRACTOR COMPANY NAME �Q[lo rrKe_r We l ( avid Pure/ p
STATE WELL CONSTRUCTION PERMIT# Ig ! ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f8[r7I IW'!-[L,b7
1. WELL USE (Check Applicable Box): Residential Q' Municipal/Public ❑ Industrial O Agricultural O
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:I1
NearestTown✓i�.l County'QiK
tat alaJK s S diy(sinn
(Street Name, Numbers, Communion , Subdivision, Lot No., Zip Code)
3.OWNER: {„ rerleto Earl
Address 1 eio ThovrF(w lnl 1DriV
(Street or ' oute No.)
City . Town State Zip Code
(ate.)- :qI-as'+-a,
Area code- Phone number
4. DATE DRILLED ID`II-OL
5. TOTAL DEPTH: 3g5 —/
6. DOES WELL REPLACE EXISTING WELL? YES O NO tX
7. STATIC WATER LEVEL Below Top of Casing: J5 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS • FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0119. --,�
.9. YIELD (gpm): METHOD OF TEST l l Med.
10. WATER ZONES (depth):
Y parry iytstaUer
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. jwtatzrial
From 0 To 54 Ft. (Of/t°) "5nt.2/ V/
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(Check box)
DEPTH DRILLING LOG
From To Formation Description
�.1
LOCATION SKETCH t_o -
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road
numbers and common road names.
c Franc eaIuntbus -follow ,4uy. ►D' D
lli fl prinor , -turn left on dlwy• q. Go
%, mile and 1.urn lei on Z t' l er Creek
13. GROUT: Depth nn e Pot Material Method
From To Ft.l'°neses( Road• Co approx(►xakey 4 miles
and turn rg ft+ on B iskop k,a.ne into
l,ancl@FLakes Subdivision, Go 4-0
ice of NH I and turn- left. Go I block
anti turn iris kt orLDeefPield Dri fe,
altct proper-9 ovu h2 r3ikt
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.
Size
Slot Size
in.
in.
Material
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IIS RECORD HAS BEEN PROVIDED T9 THEVELL OWNER
s
SIGNAT
E OF PERSON CO,
/t( 7--
TRUCTING THE WELL f DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

2646E5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and � N/Natural Resources
�s- yD,� ivision of Water Quality - Groundwater Section
//�� /n�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)' JCharcLi CerQrV CERTIFIC�A.T�pIO/Nq#�rt((/IO
.__n PHONE Pn/A)1)g1-r265
WELL CONTRACTOR COMPANY NAME Qry
STATE WELL CONSTRUCTION PERMIT# I A 1 I
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential It 'Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATISN:
Ne rest Town.
County
(St eet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address 15 W /I'i'lon7Lir
nyJd r.wSheetsattee No.) 2g14.01
f
City or Town
State
Zip Code
022)-1'+1-2c o
tie am
Area code- Phone number !pt
4. DATE DRILLED .-/k.
5. TOTAL DEPTH: I'I'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: a0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan e with 15A NCAC 2C.0118.
9. YIELD (Rpm):METHOD OF TEST ! I Y)9n°d
10. WATER ZONES (depth):
Bypwnp rnstalMer
l 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth Diameter ,r),�
From 0 To a f Ft. ( / 6 SUR 7,J Y YC
From To Ft.
From To Ft.
13. GROUT: Depth/� �j Material
From -0 To .- Ft.( Qntpka
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge DY3%pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/iongitude source:OGPS❑Topographic sap
(check box)
DEPTH DRILLING LOG
From To Formation Description
:a
LOCATION SKETCH ry
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
numbers and comrnon road names.
From_ SaLLucta-qo south. on I176 +0
'Pearson- Fa) r s • 7W rL right amigo
n Method ILnd err RR tresti e `rjn (e)ce_
uc d Fol K Cr :koad . Co -to kop of
lltouRtain Tura left at 4 ma.i(hrie
Do_ Austin Lane - Olin road. Stay
5traiqht 4o orK in_ road. 3.0(2r
+D -f'iSe left. Ldek is on_ the_ Iee
sid QJ:Otriveu tj
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO�ANS, AND THAT A COPY OF T}dFS RECORD HAS BEEN PROVIDED TO THE WELL, OWNER
SIGNATURE ¢'�/'PERSOONN CONSTRUCTING THE WELL /DATE
Submit the original to the Division of Water QuaTity, 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 tural Resources - Division of Water Quality - Groundwater Section
WELL
ACTOR
NAME
ay
\\ELL CONTRACfOR COMPANY NAME Banks Nei anti PHONE
# 10
Q.y PHONE # p.L(,7 ��q� 7Z63
SI ATE WELL CONSTRUCTION PERMIT# 18 / / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
257282
I. WELL USE (Check Applicable Box): Residential fd-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: �
Nearest Town: DQI([�``,//�,,,,
t ►.m'n0. n-, o!teet'c
(Street Name, ((umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
County Po IL
piZl�i eric3
Sall Ada (SIT Route No.) as 73
City or Town State Zip Code
923)-710-3617
Area code- Phone number
4. DATE DRILLED 7- I Z -Oz
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fir
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 a(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l • a FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I O METHOD OF TEST I mei
IO. WATER ZONES (depth):
�Dfslt�ur
ION:
11. Type
12. CASING: Wall Thickness
/-\ Depth i a ter
From To a8 Ft.
From To Ft.
From To Ft.
13. GROUTj..\� Depth //�� Material
From (2 To� FL(oneyett
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.
Topogra c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
ry
1
cJT
LOCATION SKETCH
c.71 ---.
Amount Show direction and distance in miles from at least o
two State Roads or County Roads. Include the road
gt_WneiigghZUFt. ater'al numbers and common road names.
1 v
Front Sak Ld4 fake )k .
n Method I7o Seudh apprt imaiey
Ko(t — 02 it l (es . Tate a_ I eS Oh
'Tito mpson Ij'+I-ree* . ta.ke
a left ck 1st drive.
Ie600 `Tilompsa) car e..ek
16. REMARKS:
REBY CERtIFY TH11(T 7rm
7TI0 1-,STANA A$DS fiCiVt
ELL WAS CONSTRUCTE IN ACCORDANCE W H I5A NCAC 2C, WELL
AT A CAPY OVTH IS E G RD,4AS BEEN EKOVIDED TO THE WELL OWNER
CONSTRUCTING
Sub njttfte on inwI to the-Biv.ision )f Water Quality, Groundwater Se
2761490. 634 piiin eliNo kiI9(1 fr` 33 3221, vithin 30 days.
WELL
DATE
on, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
c

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur(a�lt Resources - Division of Water Quality - Groundwater Sectiioon/�
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print)�irhard j4IC. rev CERTIFICATION /#�OC.O10
WELL CONTRACTOR COMPANY NAME emir Ker We) I l) ram ,J PHONE # g2OI6617-1273
STATE WELL CONSTRUCTION PERMIT# ) ✓ 7/ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
256551
I. WELL USE (Check Applicable Box): Residential I12'"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 1/
Nearest Town: ei2( PRrini //e County PO) k
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
F V S.- Fl atree1AoCe3o.JN l i .22726
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 6 �o{ 4 -6 t
5. TOTAL DEPTH: 465"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO NV—
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I •30 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords a with ISA NCAC 2C .0118. —�+I
9. YIELD (gpm): o METHOD OF TEST limed
0. W,QTER ZONES (depth):
urn
nStalkr
12. CASING:
ISIN 11. DYECTI N: Type Amount
Wall Thickness
0
Depth Diameter or Weight/Ft Material
From To Q7 Ft. 1WS
From To Ft.
From To Ft.
13. GROUT: Depth �1 Material
From 0 To 9D Ft. (IQrlere) ,,
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.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IBFIa
(check appropriate box) C
Latitude/longitude of well locatiop)
(degrees/minutes/seconds) C '
Latitude/longitude source:OGPS❑Topog arphic tptl
(check box) IN)
DEPTH DRILLINELOG' rc-
From To Formation Datription
r
CJl
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.
sDRzt lovC, Frorn,I'endersomille ta& 176 -fa
Upward Rd. Go ape(ox.a /Y)il€S -
cross over i et i-ers tale , 7�/R on
13J fg 1Ju.n r l2.oad r5tay an �E./..i/�/
Material )1 cthgr + II you. Conie / • `e
,toot'if rf- beevrnes oc cud -
road . Con-inue or) dirt road_
for of proK. 2 mi I Los . 'OR 'dzwo
a t.rna./1 pond . Corr{inue up
hill fv Znd `t cuse on rry1d
Method
Pou I^od
I6. REMARKS
GROURW�i('d;
ASHEViLgg64p
I
eI�nail to t�e Division of Water Quality, Grou
6lniy�o.
�:.. I -.I (91 ) 733-3221, within 30 days.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY O HIS $'CORD HAS BE'• ROVIDED TO THE WELL OWNER
C l/.�/4 o-
SIGNATURE OF 2SON CONSTR ING THE WELL "hATE
ter Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

256548
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/ - Division of Water Quality - Groundwater Section
‘YELL CONTRACTOR (INDIVIDUAL) NAME (print)lUeh&rd .A(e erify CERTIFICATION#.0q0/0
WELL CONTRACTOR COMPANY NAME Barger Well f- Feting PHONE # 6126 h99-17Z63
STATE WELL CONSTRUCTION I'ERNIIT# I S ! / ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: l7/iYIUGS County'hIK
Sandy5'rinns'rnd
(Street Name, Nw ers, Conn unity, Subdivision, Lot No., Zip Code)
3. OWNER: W11G/I;a.- . 5t/�rneS
Address / 3 2G and y empr/n Rd-
`RukherThrd(Street or Route N )
f - N° a8Iq- 7032
Zip Code
City or Town State
(3)- a6&— 1594
Area code- Phone number
4. DATE DRILLED (o-1(-02i
5. TOTAL DEPTH: 41451
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0117
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use"+" if Above Top of Casing)
8. TOP OF CASING IS Is D'3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. —�
9. YIELD (gpm): 1 METHOD OF TEST I 1 yVIPri.
10. WATER ZONES (depth):
Topographic/Land setting
��
❑Ridge ❑Slope ❑Valley FRClat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Daiript�n
G
t—
c
N 11=
N
-o
N
(J1 —•
0 G
S y pump instaUcr
11. DISINFECTION: Type
12. CASING:
Depth Dian eter
From o To ,s Ft. c.% pitai From Columbus k. JIcu`c,. 711
From To Ft. Q stay on May
q
From To Ft. ••I'p %d(,1..(.(,�. 1 (. ✓ �/ �`V 'T
l3. GROUT: DepthFrom 0 To _ n Material ntirreee /jO(mod +III i./woJu_3e 4D O!t'd- Ch ee
n. kduJ G?o 4.2 miles. T/IZ
Method
Slot Size Material rkc/. aiyedga
in. p
ov�� Sri S
I mile • a.k�
ay
bf e r h± pa # 3coyihs Ede
LOCATION SKETCH
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. aterial numbers and common road names.
s I to
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LL) 1 pp bFI3 ERY,_EI
CONSTRUCTION
GRCUN
ASHEVILLEE
I I
v THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A$DJARDS, AND�TU4T A COPY OTHIS RECORHAS BEEN PROVIDED TO THE WELL OWNER
G
SIG' 'A RE OF PER
ON CONSTRUCTI
q 6Z
TE?
al to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
0p No. [phone], within 30 days. GW-1 REV. 07/2001

249092
I6yy pump ins&.aUer
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To rnn FL 6 1/6 DM1>Z.aL C-
From To Ft.
From To Ft.
13. GROUT: Depth n Material
Fromm To ao__ Ft. t't7nerPe-
From To Ft.
14. SCREEN: Depth
From To
Diameter Slot Size
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
POLIt
SI'AT E VWELL. CONSTRUCTION PERMITS/
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�(�,�,R,,�esources - Division of Water Quality - Groundwater Section
\YELL CONTR:\CTOR (INDIVIDUAL) NANIE (Print)Ri,Chardetc Cray CERTIFICATION kr4/�irg0/2
WE IA. CONIli:\CfO12 CON1PANY NAMEXKPr- W'eI) and P.( /./ PHONE # 8L(J)� (' 7/6J
1871
ASSOCIATED WQ PERMIT/1
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town:
10Lt F'o
(Street Name. Numbers, Community, Subdivi
3. OWNER: .0. /A ga5-
Address �.
County I o1 R
2d
on. Lot No., Zip Code)
eoi(Sheet o oute No.)
umbll5 N 2672z
Cip Town Stale Zip Code
�q>f-SrgS
Amu code- PI one number
4. DATE DRILLED —a I —Da.
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanc with ISA NCAC 2C .0118. —�
9. YIELD (gpm): 1 METHOD OF TEST I I yV]ea
10. AATER ZONES (depth):
LOCATION SKETCH — c�
Show direction and distance in miles from? IcaZ
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ininutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
0
IV
3
G
nT
—O
S �c
C.a) cn
From Colunabus°to I mile eas -
oo_ Nut. # I08. Turn ri ht oil
- 0 FoX. kountain Road.T+o
exaefly I mile a.nLL turn
Material r19ht Ott -FDA rosiel _I it way.
I04-2 Fox ounta Ir{Road
Well is jus+ beyond kouse.
From To Ft.
'Cyr.) LL ti
—1-f 11-BR TI. 42-
CONSTRUCTION
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4-
SIGNATURE OF PERSO ONSTRUCTING THE WELL DATE
GROU s V�AT,�^trte a igi aI to t e Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ASHEV LLftY<LL��� r°gl°t- Q y,
---- 2769`I-T6 5-Phtine No. [phone], within 30 days. GW-1 REV. 07/2001

247167
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VA ELL CONTRACT OR (INDIVIDUAL) NAME (print) l rha rd Ak Crary CERTIFICATION ''##q41r/5�l/o�/y
WELL CUNT It\CTOIt COMPANV NAMEf )orller Wel I4Purnp PHONE # (Z2(i) G41- 263
SI.'IE %TELL CONSTRUCTION PER.AIIT# ASSOCIATED WQ 1'ERVIIT#
((fappl icable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELI. LOCATION:`
Nearest Town: /n''`1IIs S
i t1 CountyTO I K
I�i1I( Tarrson
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3.OWNER: Ch (topper ufF _
Address
Q3OS (grain ri(�i'1.5 .ur,
Ai LkSpriy(�SrcetariouteNo) a875
City o Town State Zip Code
$1.5)- 685-aoµl
Area code- Phone number
4. DATE DRILLED I-7-3Z
5 TOTAL DEPTH: 40 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IF(
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I r 33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): (p METHOD OF TEST Mimed
10. WATER ZONES (depth):
By pumpinstaller
1 I. DISINFECTION: Type
12. CASING:
From
From
From To
0
Depth
To 4 7
To
Diameter
Ft. 6t4
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
.185 ,tr.e
13. GROUT: Depth Material
From 0 To 23 Ft. concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From
---fo It. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topographic/Land setting
DRidge DSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
pa,re
Slot Size Material
in.
itt.
Material
N
GI
0)
n
Cr)
▪ `'c
- ter:
- n;
N --
c-n 0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
From beach. i Lake. Lure, /`(G
10 3 3/to miles +o lilt Tap_ ISOl2
gala. Go 1 mile -fo - ie
cal - de —sac-Ullroaq h flies
l ecL Aces . -ake 4he lei►
fork.t them back -b -fine
rIkt.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
r4' yST31JC[I 1N/jS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T E W LL OWNER
t CJ S L'l / /�t� �c //��
� pt.--
SIG OF PERSON CONSTRU G THE WELL DATE
Submit the original to 11b
27699-1636 Phone No. (tt 19) 73
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

09/26(2002 1E:17 919-715-089
NCDESI,IPIWATER, OU:L
PAGE 01/01
WELL CONSTRUCTION RECORD
259883
North Carolina - Department of Environment and '' Natural Resources Division of Water Quality - Groundwater Section a
WELL Co:stetACTOR ;IV0141DCAL) NAME caring_
WELL COVTRAC1 OR COMPA. V NAME 1
STATE WELL CONSTRUCTION PERM IT# ASSOCIATED%V'Q PERMIT#
rira,5511cb7e) ife linable)
WELL USE (Check Applicable BOKp: Residential �ilnlicipal/PcblicQ Industrial AgricalturalO
Monitoring 0 Recovery' 0 Heat Pump Wet& Injection ID Mee ❑ it Other, List Usc
. a re 0 CERTIFICATION 0,2 -3 G
1
2. WELL. LOCATION:
Nearest Town!
v Ccurq'
�St n�o� l J l
$trey Nemo. Stott:, C,er(.�*/''J�n�ry. SaaJiv�,ii/e,r�ljWe�Ja,Zip
�=Cjod�e�)j[��--
3. OWNER: C /-(1 - Zr/ ib.— q^`�
Address i
a 272-Zi
City or Town Sao lip COCe
i5 roc-oj� .- fyc.;
Ales Cade- here nounhr ---,A +� ,yi a
4. DATE DRILLED ,f- < !/
5. TOTAL DEPTH' 4- �-
6 DOES WELL REPLACE EXISTING WELL? `YES ❑ NO r
7. STATIC W ATEK LEVEL Below Top of Casing. FT.
( iL se•'+•" if Atave Tap efOSine)
S TOP OF CASING IS - ( E i. Above Land Surfaces
*Top of curing terminated atror htlow una surfac: requirts
vnriunw in xeordante with 15A NCAC 3C Alta,
9. YIELD (gpn ): a[ 0 MEjaOD CIF TEST /V V1 GI --
I O. WATER ZONES (depth): 0 0 / _
Topog aphis l and setin
❑Bilge OSlope ❑Val'.ey gFlat
(c:tcck tppmaride h")
La-4tudeflongitudc M. well location
(dc; tes/r..iauathccoeds)
Laotudvlongitudo sourcc:DGPS0'Iopograpnic map
ich_ct Sdz)
DRILL'.NG LOG
formation Descriptityn
DEPTH
Fral^,. To
/_ �/ LQCATION' SKETCH
' '', C,� Ammo � YrCL/ /<11`" Show direction end dinzne_ in mills front at bast
E Y] • n'1
11. DIStNFECT10 Two " n wo Stets Roads or County Roads- Include the road
12. CASLNG: f Depth
wiwei,bcesa '1',12)
Depttt di rain: o._\vea t�. at_ numbers and common co names.
From To
From To Ft. ---
From To Ft. /�,,��77
3, fr ra Q�1 D:2 Q Ft N -E1 Cf,y6M1(f R1e(y dvt MIITtHit it
FrcntyL_ Tu..ei,— C�ae 1
Frcn To Ft.
<. SCREEN' Deptham/'\� ois a>r S.ctSix ',Astoria] •
1 Fromm Ti: t / F_ In.
From Tc n. �. in.
15. SAND/GRAVEL P.?CIC
D:?:n�,..jj
Frcn!__ ._D_ J q'�--�--
From To --(.
'16. REMARKS
IE 11C3ST
Material
SEP 1 8 2002
Submit the uri•eit
GROLINCWIATFR SECTION
ASHEVILLE REOICNA:. OFF.CF
TIFY TEiAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TANDA}?,DS, A/1NO THATICOPY THIS RECORD HAS BEEN PROVIDED TO Tie Watt Va'SR
SiGNAP.iR7. OF PERSOkONSTRLCTING THE WELL DATE
I to the Division of Y%ater Quality, Groundwater Section, 1636 Mail Service Conr:r-t.alcig'h, NC
'a. ;')19) 733-3121. within 30 Jays.
OW-1 REV.07'2001

ti_
26011:1
WELL CONSTRUCTION RECORD
North Ca-o:tna Deparmarit of Etibiroutucnt arc
fNatura oartes - Di'i`r of Water I Groundwater Section ion
ELLPJ�I'f ♦C10R'110i1 P , .Sa;c (?Kcti6_—__A CERTte , 1TIol a?
t Jtom% GVt7 44 2-71L0140NE .IYb�L+1
.r-i
ASEOCI TED WQ PEFSMIT.
STATE \':rLLCON TR:CTrtiY ?flitptl?p —.—_— (i�epoii:3lel
£4fcroh,:;aia, -
+ 1 �'.:uticipalL::bLt C Int-l:saiai C .J1P-
RSV Itallillasseellifeanaligle
ral III
i. WELL USE :�: v_ca AC•p ii;u�.e ti0%). Rc5i;.2nL•x. P�`'nC
:3th r 0 it n:}. List U-.,
hio%of!-eg 0 E:;o'+er. 0 Het Pimp l4 scar h:j=.[Kn C--
tnnL, aoi:isz;!a: i - �
"�Sr± e - CSlo?e ❑ a!'e `0``-lat
( I 7 1
Lvdude le gituatc u' I location.
t/it
tidlzss _1 atJ
ke
enti .:o 'ems - -)-*7
-i. «e
Are: ;ice Picre p
4. DATE DRILt,_D
I. Ti.TAL DEYTti'
DOES WELL REPLACE E5!STINO :k ELI.? YES C NO FT.
7. T.! TIC 'WAT, ER LEVEL Ee;nu Top cf Cu:ing. —
;Lie i` Ai: Top o:Ctsina)
j PT. A^o•.' Lard Sursa_]'
'Tap e' camp lrmil+: a<.'d uGCr Ce.nw ,_ad a_r'ac re9'aicv s
rnriencn h,act,rdn ne._ with l9,t !NCAC 3C .01LS. rF
e. rood'. tl� _MEI.HOD OFTr:1ST f` f ��
it. V: ATFR [O':ES f.'.aps`d; C (fi
it
-!�ry(�, jJ'r� --
•L �'
-l!y'`— 'ireccon anti 4/star/9
c- in ,oiler I..r. a ie),
eyy} ' b�. 0.NJ"�.h[,L /Y:. . i9 'rzi nor-betA artii
1.2
a
DRILL NG LOG
Partnadon Drs_riptitr,
're it
Onici _
LV !�' �I\I , Zrr
0 C;i
/ //VS4/— x h— 1
t-C l i(. ELT1--;
DiSiNH CTIOypcj)
Aclou:; _
kr V Via i.,,,. %t"'S sili,ep State; R0ads or ro r.t iconds hc.i;:,ie the. iond
Depth
Emir, To___.—_ r
Ernr, i ii__ Et, _.__ _-_ __
—
Merhud
i 1 G JL- D_„h r'' GA e APR H1Nr
Ftm Tc__-_.._ F_t
-
1SEEN ih h Di r - 6.., - ;a3l.riin
knm Tr / r' i } f,1 —� u
>.
,t Material
uor.I�
K;--
tors__--
r�'16.r RE^.'..AF.KS:
rr
2002
r
vomit the ur1g•�11
GRODND�jATL I SECTION~
ASHEVILLE REGIONAL OFFICE
Can
O
5V
CA
u
1 -6`
?0cLJIYAX i
lT "i RISa@L:. w. ;ici.STRI.•..IED:•i ALooRD'-,:. c'Cvl. t.. •:_--
DS,2ND MAT COPY �t FIL�S Rci.CattD r.tis0 E, PROVIDED TO 7I-E WELL OWNER
at
� "ki \+E-i
`?:G�- _'r II:? � Ip '_fiSp;K't,r=ll: iT^t: CTI. �G '. 'H
C DictSion ofVC 3SCr rh13I!,, Grtjuttdwat0r Section. I e.;n\II[' S::.ice t m
5) i•'.1. w ith It at) 03\ 5

259505
14. GROUT:
/��1 Depth Malorial
From 0 To .G/Ft Ceme
From To Ft
15. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Frorn
Iron
17. REMA
R1 _ .J
I DO L
CONSTRUCTION STANDARDS, ND T IAT A COPYOFTHIS RECORD HAS EEN PROVIDTED IN ACCORDANCE WITH ,A TO 1 HE WELL NCAC 2C, LOWNER. •- _
GROUNDWATER SECTION / /—O G--
FOR OrFICE4higdirgfeiGIDBAL OFFICE C.PatAt_i
Ouad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water (Duality. Groundwater Section Within 30 days G,/ I REV. 17J33
North Carolina • Department ol Environment and Natural Resources • Division of Water Ouality - Groundwater Section
1636 Mail Service Center • Raleigh. N.C. 2769e-1636-Phone [phone] , )
ran/ ./� . Y W U tGi'
WELL CONSTRUCTION RECORD WELL CONTRACTOR: °� J L`� 1 �e7j
WELL CONTRACTOR CERTIFICATION #: d i 9 ) sl �L7/ i �(/
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential NT Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION• Sho/ysketch 91 the to lion below)
Nearest Town: dt CI u County.
(Road Name and Numbers. Commuglty)or Sybdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER tOr a- h" f� //) ) Q� S I DEPTH
Address �' art
/1L/
(Sueet o rRoyyo No.
Cityor Town State
4. DATE DRILLED
5. TOTAL DEPTH 2 O
6. CUTTINGS COLLECTED YES l NO1
7. DOES WELL REPLACE EXISTING WELL? YES N0�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -+' It Above Top ol Casing)
9. TOP OF CASING IS /' S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 154 NCAC 2C .913.3
10. YIELD (gpm)• METHOD OF T ST A� e
11. WATER ZONES (depth). 390 79,o/"/
12. CHLORINATION: Type Amount ount ie Z
From To n .. scriplyon
/S
in o
13. CASING:
Zip Code
II additional space Is needed use back of form
LOCATekl SKETCIti-
Wall Thickness l.},-
p Depth d� Uia nylor /. or Wei ,h I. c' I (Show direction ond,di;��ce Irom at Ica th o State tiC
(•) 8 d lh rl'rDGap le.rence point? O 9
VFrom To Ft 2j From To Ft. !-,� Roads,
or o re - �4 Na ,
\•\
From To Ft V 1
l 4
si Method,
Diameter Slot Size Malorial
in. in.
In In
In. In
Material
DATE
Serial No

3. O vj G�
w
let ore
Ca �d5
Address
City or Town ,/ter. State ,-,D_ ,1� Zip Code
4. DATE DRILLED _L.. ee ,S C/
5. TOTAL DEPTH / 3 s
6. CUTTINGS COLLECTED YES ( j NO( k
7. DOES WELL REPLACE EXISTING WELL? YES ® NOn
8. STATIC WATER LEVEL Below Top of Casing: �/� FT.
(Use •: II Above Top of Casing)
9. TOP OF CASING 1S / S FT. Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In scoot -
dance with ISA NCAC 2C.0119 �'�"j
10. YIELD (gpm): %.S METHOD
OF TEST GPm
11. WATER ZONES (depth)•
North Carolina •Department of Environment and Natural Resources - Division of Water Duality -Groundwater Section
259504
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phony [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR•itit4ili Lev -
ELL CONTRACTOR CERTIFICATION It: 42 /cs7�"cCa/'ca/'l
STATE WELL CONSTRUCTION PERMITf:
1. WELL USE (Check Applicable Box): ResidentialIV Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 II Other, List Use:
2. WELL LOCATIOJ�: (Show sk,tch of the location below) ��/K
Nearest Town: c o7n .m.,49 & s County
(Road Name a� jq Numbers. Cnm[nu3uy. or Subdivision and Lot No.) DRILLIiJG LOG
WNER A'c ��'✓A/��' From To
Z
2-
/CS'- 93CV
DEPTH
Fonrati n sciatica
Y✓✓
ra.- fL J�O G
12. CHLORINATION: Type A7 T/`7 Arnount g-- 11 additional space Is needed use back of form
13. CASING:
LOCATION MFETCH
Wall Thickness
Depth Dii metes. or WeighUFt. Material (Show direction and distant 4m at least two Stale
From To /0 Ft ..A.4 _ may, P�G Roads, or other map rq� e`nce points)
Frorn To Ft
Si2,7/
From To Ft
14. GROUT:
Depthr• Material Method
From r� To GO Ft C€"'tC6 ThfCrLovri
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
3F..mI
,,m,,,, `� T
REMARKS:
1 r I��
'I DOHEREBYCERTIFY TF1A 4-IIS WELL VMS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY T IS RECORD HAS BEEN PRO TIDED T THE WELL WNER a v
T ONSTiCC SDATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days G.r/-1 fILV. 1231
�w
Jv
Faig € Wn8gCF
dual r-o.
Soda, No.

2. WELL LOCATION: (how slsetch of the location below)
Nearest Town: CO ! LLr+. #7 11 5 County.
S7/ � ,t al-firy €al •
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER .7;t et.A/ 0
• 28(i�
DRILLING LOG
From To
Address /g7 / otr✓p:, r ,lr!/
(Street or e )
ezda,x.6ws 1. 7� Z20
City or Town SWe tZ Zip Code
4. DATE DRILLED ' - 2/-
n
5. TOTAL DEPTH Via"
6. CUTTINGS COLLECTED YES in NO® 7. DOES WELL REPLACE EXISTING WELL? YES in NOIIST
B. STATIC WATER LEVEL Below Top of Casing: S6 FT.
(Use'+ if Above Top of Casing)
TOP OF CASING IS /i� FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C . 118
10. YIELD (gpm). 0 METHOD OF TEST
11. WATER ZONES (depth): 2 0 7. 20 f 1
12. CHLORINATION: Type h// Ai Amount bZ
9,
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Grounddw�atef Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]n p Sh-tiG l-Gt�.l rra-U� �
L 19 We,a�e/I J. he G 2r0/c93
WELL CONSTRUCTION RECORD WELL CONTRACTOR• 2/9
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential I Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Po I k
13. CASING:
Depth .-1
From d To 7J
From To Ft.
From To Ft
14. GROUT:
Dept
From 0 To Q Ft
From To Ft
15. SCREEN:
Wall Thickness
Di met�er�- or Weight/FL vac_
Ft (P
258624
DEPTH
LatiFo on escription
r_` is 7
. Grvit. �/
11 additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance fro aat least two State
Roads, or other map retererrC: points)
Material Melpod ,1l J/
Material
h.,Afire auI/7a °
-- /a4uS
Depth Diameter Slot Size
From To Ft in.
From To Ft in
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size
Fro
Fro
17. RE
Material
in
In
In I L
Materialrl
�
o) 0
ID• 'T::YCERTIFY THAT THIS
CO STRUCTION STANDARDS AND HAT
E ; n,
FOR a FFICE 5, piry
Quad N •'
Serial No.
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY - 'IS REC,:Pr "PEN.rTrY!IDED TO THE
W//$jj�L OWNER.
V N ,
.._ sot, ::ONST G THE WELL
Submit original to Division of Water Quality, G undwaler Section within 30 days
DATE
GW-1 REV. 12199

254931
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] W ..1 e,oDetL alert wed
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Se-a-Y1cA 7i)C1
WELL CONTRACTOR CERTIFICATION #: / let I
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResIdentiallg Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection (1 Other El If Other, Llst Use:
2. WELL LOCATION: (Show sketch of the location below) 1.
C
Nearest Town: o tic ut County OI
(Road Name and Numbers, Community. or Subdivision and Lot No.)
3. OWNER 32Y rut }II 0.u) ti InL%r �A7is X 'IZa -
Address
(Street or Houle No.)
City or Town State Zip Code
4. DATE DRILLED le- i 9" O2
5. TOTAL DEPTH afl 0
6. CUTTINGS COLLECTED YES in NO VP t 4c - ado
7. DOES WELL REPLACE EXISTING WELL? YES n NO pa
8. STATIC WATER LEVEL Below Top of Casing: co FT.
(Use'+' it Above Top of Casing)
9. TOP OF CASING 15 a 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)• ia- METHOD OF TEST A F'Q
11. WATER ZONES (depth)• I4JC - ti5 1a(oPb----
12. CHLORINATION: Type 44ht Arnount _�i.__
DRILLING LOG
From To
0 c),v
a0 - L►•D
Lit) - to
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Mnate'rial
From -t) To (e 1- Ft. la •1S PVC -
From To FI.
From To Ft
14. GROUT:
Depth
From .0 To o1J Ft
From To Ft
15. SCREEN:
From
From
From
epth Diameter Slot Size
Ft in
To
16. SAND/GRAVEL PACK:
Depth Size Matetlal
To,
Ft
In
In In
Material C.-ern` Metledi
WJD
Material
ARKS:
14o- 1141
DEPTH
FOnnation Description
.$). Clay
nowa_gekd
sa--b -
a.tom_ R O&
soH Walk go( IC
GRS-1 ROGIL
If additional space is needed use back of form
LOCATION SKETCH
(Show direction end distance from at least two Stale
Roads, or other map reference points)
•
,Y
❑.
1 DO HEREBY CERI IPY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER.
leEUS'E ONLY
Quad No: -----..
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality, Groundwater Section within 30 days
G7/-i REV. I2/99
1I
3
4

North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section 5 2 4 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �1
4'1 C6a Cl
WELL CONSTRUCTION RECORD WELL CONTRACTOR: QU'2 e,ELL CONTRACTOR CERTIFICATION It al91
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential)
Recovery ❑ Heat Pump Water Injection
Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Other El II Other, List Use:
2. WELL LOCATION: (S{iow sketch of the location below) �r)�
Nearest Town: C,OIU�� r.wS County:
1-1* l a Rom„) ).a,,e
(Road Name and Nu`vbers, Community. or Subdivisi n and Lot Na.)
3. OWNER A)0440101 (flor',I1
Address )a /NLCQ -
01� (Street or ouIOCt;No.) af'cX)-
City Town State Zip Cade
4. DATE DRILLED S-8-02
5. TOTAL DEPTH Q00
6. CUTTINGS COLLECTED YES fl NO
7. DOES WELL REPLACE EXISTING WELL? YES n NOrr
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '4-* it Above Top of Casing)
9. TOP OF CASING IS 4:1 FT. Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance in accor-
dance with 1SA NCAC 2C.0118
10. YIELD (gpm): -LO - METHOD OF TEST A cn
11. WATER ZONES (depth)• (9.$0
12. CHLORINATION: Type
13. CASING:
►.4l
DRILLING LOG
From To
O- go
go - lao
ix) -)43
i'R- ago
-.frS
DRs- 3bD
Amount h 5
Wall Thickness
Depth Diameter or Weight/Ft.
From 1i43 To g0 Ft UN
From_i - To — Ft.
From To Ft
14. GROUT:
Material
pvc,
Depth Materialr Method
Ft t � U^
From O To SO er-nv
From To Ft
15. SCREEN:
From
From
From / To Ft.
16. SAND/GRAVEL PACK:
Depth
From
From
17. REMARK
ll�II III
I DO HERE: CES
PTIFY THAT THIS WELL W
CONSTRUSTION TANDARDS, AND THAT AICOP
_
i;ON
FOR OFFICUSEON3.Y tL OFi-icr-
+ Submit original to Division el Water (Duality. Groundwater Section Within 30 days
DEPTH
Fonnalign Description
Rni del
fotrir
4- xerJt.
&pes4.J ReC.dc
@Gk G rail (�� -
G � -
-t cn
=rn
II additional space Is needed use back o$Jrm mz
Depth Diameter Slot Size Material
Ft _ In. in.
Ft..__ In. — In
In In.
Size
Material
LOCATION SKETCH r z
(Show direction and distance from at least two Stale
Roads, or other map reference points)
hrl eivi a )41 ))
•
O STRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OFT ECORD A` BE PROVIDED TO THE WELL OWNEpf.
Ouad No:
SIGNATURE OF PERSON CONSTRUCTING THE WELL
tit; Ark'
DATE
G7/-1 REV. I2/99
Snriai No

252446
North Carolina • Departrnent of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Qie- CA.I L&
WELL CONTRACTOR CERTIFICATION 0: / et /
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residenliad Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Llst Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: C0\ t1mSUS County. .?elk
1.04 S UtSSPte- )Jwy ' kob1� kit,-'e
(Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER m0.Y1•E 'Des 201))J.tY
Address Sri °Act eaodb
(Sirepr Houle No.) 3} Y4
RDco R� OP' ]?
City or Town State � Zip Code
4. DATE DRILLED 5- - bi
5. TOTAL DEPTH atop
6. CUTTINGS COLLECTED YES rl NO
7. DOES WELL REPLACE EXISTING WELL? YES I I N0I-
8. STATIC WATER LEVEL Below Top of Casing: 3..o FT.
(Use •+• If 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 MAC 2C.0118
10. YIELD (gpm): 1 S METHOD OF TEST AI r2
11. WATER ZONES (depth)• qs
•
Ix!
DRILLING LOG
From To
.O 0 ReDC1Gt1
tc0- 14)0 sAPis 1 SECT'
1.00 ,,q salt/ eta_
1�+5 - sco R/a<k I2cxAC
alto -'foo Caw! Poch
DEPTH
Fonnation Description
12. CHLORINATION: Type Nni • Amount /0 eat
13. CASING:
Depth Diam�ter
From 1'� To Ft to S1
From 8 0 To 41 Ft. �T
From To Ft
14. GROUT:
Depth
From a To a ° Ft
From
15. SCREEN:
To
Wall Thickness
or WeigtWFt.
Matoriall1
CRnuzvC
Ft
Material
�VC.
PVC.
Methgd
h Diame • lot Size Material
From To - in. RI
From o Ft in
From
To Ft
16. SAND/GRAVEL PACK:
o lh
From
From
17. REMARKS:
11
Fl l
Size
IDOHEREB` dEktlFY THAT mis WELL WA
CONSTRUCTION StANOARDS, AND THAT A
FOR OFFICE
Ouad No:
JSEONL:Y' '•'
Material
O <�
S �
b 8 "nn
C
rn
II additional space is needed use back of lord
LOCATION SKETCH v
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
u,il Pd
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THI. ECORDIIAS BEEP' PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Duality. Groundwater Section within 30 days
GATE
n
N0
m
<na
m
c-r
ti
0
GW-I r1EV. I2)99

251726
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
i1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ''`
WELL CONSTRUCTION RECORD WELL CONTRACTOR. t-II GLSQ Weil Se1\4`e4($l c ej"-i+)
WELL CONTRACTOR CERTIFICATION #: din I
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection (1 Other ri If Other, List Use:
(r
2. WELL LOCATION: (Sow sketch of the location below)
Nearest Town: dCth.'t �t SCE• County
?ilk
C.00skrrc,0 Pa 0* Fox Rt^a LP. go . ,NtOodes
(Road Name end Numbers,i3
Community, or Subdivision and Lot No.)
t
3. OWNER tCS'Uar� tlIi� s
Fox 1-0 •
Address
(Street or Route No.)
Nc-•
City or Town State
4. DATE DRILLED 1-1' al-- OD,
5. TOTAL DEPTH lbo
6. CUTTINGS COLLECTED YES ❑ NOIX1
7. DOES WELL REPLACE EXISTING WELL? YES 1 NOI5a
8. STATIC WATER LEVEL Below Top of Casing: 3D FT.
(Uso •+ If Above Top of Casing)
9. TOP OF CASING IS'•1' a, FT. Abovo Land Surface'
*Top of casing terminated et/or below land surface requires n variance In accor-
dance with 1SA NCAC 2C .0110
10. YIELD (gpm): .aD METHOD OF TEST A I R
11. WATER ZONES (depth): Zoo 14,
Zip Code
DRILLING LOG
From To
o av
_2e - c2 t
too -Igo
)eia- *We*
.1.00 • R40
12. CHLORINATION: Type FAA W'
13. CASING:
Amount Mae
Wall Thickness
Depth Diameter or WeighVFt. Mate
From '4a To (moo Ft C^'yg
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To aO Ft
From To Ft
15. SCREEN:
From
From
From
16. S
Depth Diameter Slot Size Material
To Ft in. in
To Ft in In
To Ft In In
FOR OFFICE USE ONLY
Ouad No:
Material
DEPTH
Formation Descriptor
$raulrO C,kAj !• £1 R-
F162r1./ 2or44.
Sots 13Iwck. Rock
6Ray Rod(
0
0
a.a
Cm
_ 0
Do
gold
If additional space Is needed use back dtrirm rn,g
—f
LOCATION SKETCH ._
(Show direction and distance from at least two State
Reyds, or other map reference points)
laws 17t,
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF IS 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
GUI REV. 12/33
Serial No.

WELL CONSTRUCTION RECORD 267072
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERIIFICATION# 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQPERMIT-#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box) : Residential 1M Municipal fir Industrial JJ Agricultural .0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MILL SPRING
CHIMNEY ROCK RD LOT 216
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3 OWNER DON STANFIELD
ADDRESS POB 1381
(Street or Route No)
COLUMBUS
City or To.m
828-894-5256
NC
State
Area Code - Phone Number
4. DATE DRILLED 12/2/02
5. TOTAL DEPTH 460
28722
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" If Above Top of Casingl
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 2 METHOD OF TEST ARDM
10. WATER ZONES (depth): 450
11 DISINFECTION: TYPE HYPOCHLORITE Amount 11
12. CASING:
Depth
From 0 To
13. GROUT:
From 0
14. SCREEN
Diameter
96 Ft. 6 1/4 "
Monitoring
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.19.594 / 82.12.916
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 90 Clay
90 460 Consolidated Rock
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Oz
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the toad
numbers and common road names.
Depth Material Method CHIMNEY
To 20 Ft.
Depth
From NA To
15. SAND/GRAVEL 1'ACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft.
Ft,
Size
GRAVEL MIX GRAVITY ROCK RD
Slot Size Material
in.
Material
o
co
SILVER CREEK RD
HWY 108
C71
fV
CO
Ca)
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.
12/3/02
SIGNATURE OF PERSON CONSTRUCTING THE WELI. Date
ti e g1 Io- lit rvrr m ate! Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
1.2 6 o o. 9 7 32 thin30da s.
JAN 3 1 2103
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 10/19/02 16:46:54 Page 13 of 14
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box) : Residential E Municipal E Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MILL SPRING
118 McGUINN RD.
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOMES OF RUTHERFORDTON
ADDRESS 342 US Hwy 74A By -Pass
(Street or Rome No.)
RUTHERFORDTON NC
City or Town State
28139
Zip Code
262198
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.21.615 / 82.10.415
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 142 Clay
828-287-3366 142 300 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 9/2/02
5. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTLNG WELL?
7. STATIC WATER LEVEL Below Top of Casing
YES ❑ NO
75 FT
(Use "t" If Above. Top of Casing)
S. TOP OF CASNG IS 2 FT Above Land Surface'
'Top of caging terminated actor below land surface requbes a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (_gpm)}. 5 METHOD OF TEST ARDM
to. WATER ZONES (depth): 180 220
11. DISINFECTION: TYPE HYPOCHLORITE Amount 7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 148 FL 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
Material Method
o' LOCATION SKETCH 0
Show direction and distance in miles from at least N'
two State Roads or County Roads. Include the road =?
numbers and common road names.
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Et,
16. REMARKS.
McGUINN RD
5/IOMI
HWY 9
SO
CO
IN ACCORDANCE WITH I5A NCAC 2C, WELL
AKTR I STANiA I,A HAT A COPYNOF THSFRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
24
9/8/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Su emit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
276`914311$ UIR0EFD.S@!7()lOV-3221, within 30 days.
ASHEVILLE REGIONAL OFFICE
GW-I REV, 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 10/19/02 16:39.58 Page 4 of 14
Sent by the Award Winning Cheyenne Bitware
2621139
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOT? GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use:
2. WELL LOCATION:
Neat eat COLUMBUS
111 FOX BRIAR DR.
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER CHARLES SEARCY
ADDRESS 111 FOX BRIAR DR.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.16.677 / 82.10.636
(degrees/minutes/seconds)
Latitude/longitude source: © GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
COLUMBUS NC 28722 From To Fomlation Description
City or Town State Zip Code 0 55 Clay
828-894-2433
Area Code - Phone Number
4. DATE DRILLED 9/6/02
5. TOTAL DEPTII 200
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO i]
7.ST.ATIC WATER LEVEL Below Top of Casing: 85 FE
(Use'*" If Above Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of easing terminated at/or below land surface requires a variance in
acnordaicc with ISA NCAC 2C.0118
9. YIELD (gpm): 20 METHOD OF TEST ARDM
10- WATER ZONES (depth): 120 195
55 200 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 Ft. 6 1/4 " SDR 21 PVC
oz 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.
13. GROUT.
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft, in. in.
15. SANDRiRAVEI. PACK:
Depth
From NA To
l6- REMARKS
Su unit th
27e99-160
Ft,
Size
Material
n
3/10 ME
FOX BRIAR DR.
HWY 108
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/8/02
GNATURE OF PERSON CONSTRUCTLNG THE WELL Date
wilycn ater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
(per t7433-3®QFI11thin,4) days.
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN1From: ALAN S. GANTT 704-434-7212 08/13/02 22:40:32 Page 9 of 13
Sent by the Award Winning Cheyenne Bitware
258017
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial Agricultural
❑ gri ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: COLUMBUS
LOT 8 TURTLE DOVE CREEK SUBDIVISION
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER LARRY CALLAHAN
ADDRESS POB 433
(Street or Route No.)
COLUMBUS
City or Town
828-859-7699
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/2/02
5. TOTAL DEPTH 260
28722
Zip Code
6. DOES WELL, REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 ET.
(Use "t" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of easing terminated at/or below Iond surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 20 METHOD OF TEST ARDM
10. WATER ZONES (depth): 250
n DISINFECTION: TYPE HYPOCHLORITF Amount 6
12. CASLCG:
Depth
From 0 To
13. GROUT
Wall Thickness
Diameter or Weight/FL Material
90 Ft. 6 1/4 " SDR 21 PVC
Depth
From 0 To 20 Ft.
I4. SCREEN
Depth
Front NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
o2
Diameter
Ft.
Ft,
Material Method
GRAVEL MIX GRAVITY
Size
Slot Size Material
in.
Topographic/Land setting
❑ Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.20.145 / 82.09.244
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 85 Clay
85 260 Consolidated Rock
o
IV o
4-
Two
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.
SOUTH WILSON RD
LOT 8
WHIPPOORWILL RD.
Material
MTN RANGE RD
HWY 108
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7/2/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 P ,. . - . hiaiddays-._..._.
I-`
GROUNDWALR
ASINE ILL r GI( L Or } CF.
GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 08/13/02 22:41:18 Page 10 of 13
Sent by the Award Winning Cheyenne Bitware
258016
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial 0 Agricultural 0
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Neared town: MILL SPRING
328 McGUINN RD
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER NICK CARSWELI.
ADDRESS 328 McGUINN RD
(Street or Route No.)
MILL SPRING
City or Tows
828-625-9272
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/3/02
5. TOTAL DEPTH 320
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
8. TOP OF CASING IS
28756
Zip Code
YES 0 NO ❑
80 FT.
(Use "-" If Above Top of Casing)
2 FT. Above Land Surface"
°Top of casing terminated actor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 4 METHOD OF TEST
10. WATER ZONES (depth): 260
tl. DISINFECTION: TYPE HYPOCHLORITE
12. CASING:
Depth
From 0 To
U. GRolrr:
Depth
From 0 To
14. SCREEN
ARDM
Monitoring 0
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.21.596 / 82.11.166
(degrees/minutes/seconds)
Latitude/longitude source: E GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 35 Clay
35 320 Consolidated Rock
Diameter
41 Fr 61/4"
20 Et.
Amount 8
Wall Thickness
or Weight/Et. Material
SDR 21 PVC
Oz
Depth Dimneln
From NA To FL
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16. REMARKS'
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in. in.
Size
Material
0
nrsL7
C
rt
O_
-0
a—,
JT m„.
Ca
LOCATION SKETCH
5.0 -
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3/10
McGUINN RD
HWY 9
HWY 108
5ME
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.
cfy—� 7/3/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
27699 1. .... , .
GW-1 REV. 07/2001
GROLNDV AL 5 SECTION
ASHE'VILLE REFIO AL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 05/05/02 9:27:52 Page 3 of 11
Sent by the Award Winning Cheyenne Bitware
•
From
251982
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: MILL SPRING
176 POWELL RD
ASSOCIATED WQ PERMIT #
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER LORI GILBERT
ADDRESS 176 POWELL RD
(Street or Route No.)
MILL SPRING NC
City or Town State
828-625-2667
Area Code - Phone Number
4. DATE DRILLED 4/4/02
5. TOTAL DEPTH 180
28756
Zip Code
6. DOES WELL REPLACL EXISTING WELL? YES ❑ NO I(]'
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use `+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (g)nt): 12 METHOD OF TEST ARDM
to. WATER ZONES (depth): 150 170
H. DISINFECTION. TYPE HYPOCHLORIPE Amount 4
12. CASING'.
Depth
From 0 To 57 Ft
13. GROUT'.
Depth
From 0 To 20 Ft.
In. SCREEN
Thigh
From NA To
15. SAND/GRAVEL PACK:
Depth
NA To
16. REIIARKS:
Diameter
61/4"
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.212 15 / 82.08.578
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
From
0
DEPTH
To
50
DRILLING LOG
Formation Description
Clay
50 180 Consolidated Rock
Wall 'thickness
or Weight/Ft. Material
SDR21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Size
Ft,
Slot Size Material
m
Material
0
0
i1 r-,tl
— Cro
I >nr
orm
rn
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.
POWELL RD 1.5 MI
BIG LEVEL RD
HWY 108
O
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.
4/9/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Dale
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
221, within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 05/05/02 9:29:26 Page 5 of 11
Sent by the Award Winning Cheyenne Bitware
251980
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑< Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection E Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town COLUMBUS County POLK
171 RADAR RD
(Street Name, Numbers, Community, Subdivision, Lot No„ Zip Code)
3.OWNER GENE GREGG
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.12.566 / 81.59.273
(degrees/minutes/seconds)
.ADDRE: S 171 RADAR RD Latitude/longitude source: ❑ GPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
COLT iMBt is NC
City or Town State Zip Code
28722
828-863-2406
Area Code - Phone Number
4. DATE DRILLED 4/16/02
5. TOTAL DEPTH ISO
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES 0 NO 0
35 FT.
(Use "' If Above Top of Casurg)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing tenninmted actor below land surface requires a valiance in
aveordatme with 15A NCAC 2C.0118
9. YIELD (gym). 20 METHOD OF TEST ARDM
10. WATER ZONES (depth): 100 160
From To
0
Formation Description
75 Clay
75 180 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weigld'Ft. Material
From 0 To 86 Fr 6 1/4 " SDR 21 PVC
13. GROLT:
Oz
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Sire Material
From NA To Ft. in. in.
15. SAND/GRAVELPAC' .:
Depth Size 1faterial
From NA To FI,
16. REMARKS:
0
o
N C
_ 0a
a o'_3
Qb rr
>O
s �c
m
LOCATION SKETCH O
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
RADAR RD
n
3/10 MI
r-ryl
o.0
(n
h
1
0
z
CHESNEE HWY
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 lt6C16pPijne�ot()
JUL 16 2002
5/2/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
5fWater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
21, within 30 days.
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 03/06/02 23:16:40 Page 10 of 10
Sent by the Award Winning Cheyenne Bitware
248754
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial ❑ Agriculhiral ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: MILL SPRINGS
169 RADAR RD
County POLK
(Street Name, Numbers, Community, Subdivision, Lot No,Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.20.95 / 81.99.31
3. OWNER DANNY PAINTER (degrees/minutes/seconds)
ADDRESS 169 RADAR RD Latitude/longitude sour: e: ® GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
MILL SPRINGS NC From To Formation Description
City or Town State Zip Code 0 80 Clay
828-863-2507
Area Code - Phone Nmnber
4. DATE DRILLED 2/12/02
5. TOTAL DEPTH 260
6. DOES WELL REPLACE EXISTING WELL? YES © NO ❑
7. STATIC WA LEVEL Below Top of Casing: 70 FT.
(Use "+" IfAbove Top of Cas ng)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated attar below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gym): 8 METHOD OF TEST ARDM
10. WATER ZONES (depth): 160 240
80 260 Consolidated Rock
tt. DISINFECTION: TYPE HYPOCHLORITE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 87 FL 6 1/4 " SDR 21 PVC
13. GROUT:
From 0
Depth
To 20 Ft.
14. SCREEN
Oz
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Sire Material
From NA To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
O
'NJ
M CI,'
s
r,) C
lD o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CHESNEE HWY
3/10 MI
RADAR RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
miheigi to the vi f ,' r Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
9 3 ho N. (91 7 2 hin 30 days.
GW-I REV. 07/2001
GROUNDWATER SECTION
ASPEVILLE REGIONAL OFEICE-

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• ///i'. 1� e-
WELL CONTRACTOR CERTIFICATION #: 075-�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential 1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sow sketchof the location below) /%
Nearest Town: rid 4 2lt CGd/ County ✓"�ee
(Road Name and urr ers, Community, or Subdivvi,isi'oo and Lot o.)
3. OWNER iA//l7.ri /��// 22//4
Address f es,
f reel or
l/�1�il�niv uw dcP7a
City or Town✓o '_ State Zip Code
4. DATE DRILLED _ - � Oe2
5. TOTAL DEPTH �!/!/
6. CUTTINGS COLLECTED YES r NO❑
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOf'
8. STATIC WATER LEVEL Below Top of Casing: f7 Ff.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS '1' / FT Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST .AZt
11. WATER ZONES (depth). Y2frIesie, /SO'
DRILLING LOG DEPTH
From To
y2'
//Z ,dot
.f2ri
Formation Description
.tom/ Ca /
12. CHLORINATION: Type 1'r�1 '2�ti Amount afri 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 .../_To 41- Ft 1 W %De 7/ s7VC- Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 1G Ft airan Uteri. re own--
From To Ft Ceinscit//
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:
7
Ln
0
rV
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT! kern TIakT a r•n'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
e `I' J
FOR OFFICE US
Quad No:
Serial No.
I
G$'WORE OF PERSON CONSTRUCTING THE WELL DATE
Submit oriole t Division of Water ouality, Groundwater Section within 30 days
GW-1 REV. 12/99
/Df>
GROUND'," 9 SECTION

256349
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• 4/Or• C•r'-r-e/'
WELL CONTRACTOR CERTIFICATION #: 07s cP
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential a Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATIO •�: (Show fr
ketch of the location below) c I P<
Nearest Town: (�7�YLC�f'i7il/il92 se County:01411-1
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER 77e,740-- /9 4'P;4'
Address /m/t( /OM'oe'eci- ,d
71/11 * greet or Ire
City or City or Town State
4. DATE DRILLED 2JES-do�
5. TOTAL DEPTH %>
6. CUTTINGS COLLECTED YES 121 NOn
7. DOES WELL REPLACE EXISTING WELL? YES v NOD
8. STATIC WATER LEVEL Below Top of Casing: hp, FT.
Zip Code
DRILLING LOG
From To Li10
Woe' //,d'
///D ' Jae,'
(Use -.' II Above Top of Casing)
9. TOP OF CASING IS t/ 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): L METHOD OFTST/91.(/
11. WATER ZONES (depth): <y / 7e /
12. CHLORINATION: Type Amount /l/m
13. CASING:
Wall Thickness
Depth / Diameter or Weight/Ft. Material
From �To..a Ft. A*z14 SO,92/ ,oYG
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 4 To Ft pile /'fn/,F,tir T' ANT!
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
From
From
KS:
HEREBY CERTIFY THAT, Till
'iCONSTRUCTION STANDARDBJt
(('� �'IC. - h�
L./FtiR OFFICE USE ONLY
Ft
Ft
Ft
Diameter Slot Size
in in
in in
in in
Size
Ft
To Ft _
Material
Material
DEPTH
Formation Description
4',On/sTt
C
r-�
PO 0
c=
(0
If additional space is needed use back of twat
LOCATION SKETCH • cnt-
r7
(Show direction and distance from at least twdtate -+
Roads, or other map reference points)
Ou4d No:
Seaabald,,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7x,-����gz��
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I p c Le Submit original to Division of Water Duality, Groundwater Section within 30 days
i R-E GW-I REV. 12/99

254745
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: AP�/�e tdese` . !CPS
WELL CONTRACTOR CERTIFICATION #: ? CP,
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ar Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (S w sketch the location below)
Nearest Town: C- County: Pelle
(Road Name an Numbers, Co
3. OWNER "SO. /y
w„ry, ur ouboivision and Lot No.)
Address 3651
(St et or outs off) C
City or Town Slate �!
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Q NOE
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
DRILLING LOG
/JJ�.,C°X..e o .
Zip Code
NOQ'
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 118
10. YIELD (gpm): d METHOD OF TEST :farg
11. WATER ZONES (depth):_ ..54,740107
12. CHLORINATION: Type adsolae Amount/Worn
13. CASING:
Wall Thickness
!
From / Depth�A. Di;mgter or WeighVFt.
To 77 Ft �iYy fly€tf
From To Ft.
From To Ft
14. GROUT:
Mi _
/"
Depth Material Method
From __O___ To t' Ft e'ascvr Tnfikte
From To Ft
15. SCREEN:
From
From
From
Depth
To Ft in
To
To
Ft
Ft
16. SAND/GRAVEL PACK:
F
Fr
17. R
I Do HER
CO STR
FOR
Quad No:
Serial No.
Diameter Slot Size Material
in
in in
In In
aepth Material
To Ft
IJJ
From To 0
/6
"s
fV o�
Do
Z rn
rnz
w
ui G
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)
M
BY CERTIFY THAT THIS ELL AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
"NO THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(RCA
r aEt i '+; '.L OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

254744
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- JVre4er2 2- gin�
WELL CONTRACTOR CERTIFICATION #: optrePeP
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sk tch of the location below) b
Nearest Town: 7 • Vo4f County: Pez 6
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER .sT.f02/✓ia'� �.�E,{� From To
Address ,I47g ��O �� J
7a e,i (Street or QC Intl
City er Town State Zip Code
4. DATE DRILLED G a 'a2
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES E NOD
7. DOES WELL REPLACE EXISTING WELL? YES []' NOE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated .Vor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1 METHOD OF:413ST Any
11. WATER ZONES (depth). /5i&M' /7e
12. CHLORINATION: Type /t.'/6ZtWt Amount /A»eint
13. CASING:
• Depth Diam ter
From - �To 1/7 Ft G t��
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
2/
pria
Depth Material Method
From 0 To 20 Ft e. 'tr,vr T,'EN1rr'
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From _ To Ft in in
From
16. SA
Fro
Fro
17. RE
ID
CO
To Ft in
Sli
I I
FOR OFFICE USE ONLY
Quad No:
Serial No
DEPTH
Formatio. Descri."on
I3 °
rT
o r
yC
rn
fin•
,
.• rn c
CO --i
CO
If additional space is needed use back of form z
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
in
Material
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
e'lase-7,1 C /S/- o a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12r99

/? 0'-
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 248485
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• .."1 /' Oo7. e
WELL CONTRACTOR CERTIFICATION #: al 5-�.,C)
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ErTvlunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (S ow sketch W the location below)
Nearest Town. C :,,—-/-e-e21 County
(Road Name an Numbers, Community, or Subdyi ision and Lot No.)
3. OWNER rni M'n .O2i
Address
dY # y �
(Street or //G )
DRILLING LOG
From To
9
City or Town State Zip Code
4. DATE DRILLED _— _
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Qr NO
7. DOES WELL REPLACE EXISTING WELL? YES Q NO V
8. STATIC WATER LEVEL Below Top of Casing: «7 FT.
(Use'+' if Above Top of Casing)
TOP OF CASING IS / FT Above Land Surface'
9.
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm)• 4/i METHOD OF TEST a�
11. WATER ZONES (depth) 3GD Zoo,
DEPTH
Formation Description
12. CHLORINATION: Type [�y.�n/1i,�ei Amount "7- fr..on If additional space is needed use back of form
13. CASING: i
Wall Thickness
/ Depth Diame/tyr, or Weight/Ft. Material
LIT. To _ Ft G% 54,7?.?!
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From I'% To Ft /ll- t?- esd%P�darzcr=1
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 HEREB
CONSTRUCT tJANDA'n
(Show direc
Roads
riff
LOCATION SKETCH
and distance from at least two State
her map reference porn ).22-60-42
c•
0
fV
FOR OFFICE SE 11NLY
Quad No: I LI
Serial No.
THAT THIS WELL WAS
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
at-o1d'-42
- = N ' TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to •ivislon of Water Qualify, Groundwater Section within 30 days
--f GW-1 REV. 12/99

264264
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �J %�/5,7
CERTIFICATION w -
WELL CONTRACTOR (INDIVIDUAL) NAME (pr(peon(�L4k7L �!h! ! t
WELL CONTRACTOR COMPANY NAME Cirt'e rl 1S1%14 VAv ll \ PtATY\P (O PHONE a gi 27)(/ q1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: J k
Nearest Town: � GGa.-D't-p ---• County PO �
(Street Name, Numbers,v�/ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: IOny RhricI Yr
o�a-Oa � i
Address PO Pr1Y o
(Street or Route No.) 3
`cduda7 Hr. aq�
City or Town State . Zip Code
($Z%).'7t14 . c VI9
Topographic/Land setting
❑Ridge 10Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesiceanda)
Latitude/longitude source:31GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
— 30
Area code- Phone number
4. DATE DRILLED IO �% - 2--
5 TOTAL DEPTH: 3 D5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lei
7. STATIC WATER LEVEL Below Top of Casing: G 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top or cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3O METHOD OF TEST tii<
10. WATER ZONES (depth): 240
11. DISINFECTION: Type // %il
12. CASING:
Depth Diameter
From To 440 Ft. L i
From 4,0 To 6 C9 Ft. 6 Jq
From To Ft.
13. GROUT: Depth Material
From c9 To 2-0 Ft. -34(RR17y
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 SMaterial
iu
From To Ft.
From To Ft.
Amount
Wall Thickness
or1 t.
L
16. REMARKS:
Submit the origl
t CTi7/{?9i1
Method
/[t/% s-/bts
30 — 0
CO — 5 f 641./6/ S fo,...c
h � - 303 Isr?e te:
9,r2>`
54 ilia
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
al to
No. (9
.00
jrl:1,.F
T THIS ' ELL THAA�OPYNSTRUCTED TN ACCORDANCE WITH I 5A NCAC 2C, WELL
OF THIS RECORD CORD HAS BEEN PROVIDED TO THE. WELL OWNER
�
D-1/) ('Z
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
9) 733-3221, within 30 days.

264262
WELL CONSTRUCTION RECORD
D' f Water Quality - Groundwater Section
PHONE M N791 00
North Carolina - Department of Environment and Natural Resources - iv
o
CONTRACTOR (INDIVIDUAL) NAME (print) 13,Zyanti
% 6M,rh
CERTIFICATION w
WELL
WELLCONTRACTOR COMPANY NAME Cit"9.t \ Mg? .11 \ PtArnP (o
CONSTRUCTION PERMITB ASSOCIATED WQ PERMIT#
STATE WELL
ifa
pplicalicableif licable
)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �G 1 I iL
Nearest Town: County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (�,rVe (
Address I. f n (CO pc) v5 Girt gh
(Saect or Rbute No.)_ �S
nk:I\ 5PYlni N
City or Town S r .Zip Code
J_ eas - LfaR i
Area code- Phone number r C%
4. DATE DRILLED / 2 _
5. TOTAL DEPTH: 2, L 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top o f Casing: np orO
t6Casing)
8. TOP OF CASING IS / - FT. Above Land Surface`
*Top of cuing terminated at/or below land surface requires a
variance In accordance__with ISA NCAC SC .0118.
9. YIELD (gpm): o METHOD OF TEST M+ tZ
10. WATER ZONES (depth): 2 G'O
er
11. DISINFECTION: Type // TH
12. CASING:
Depth
From / To /Y . Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_1.._ Tom- Ft.
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
G i / 0'4 5 rr-b:l
Material
54-1c13111/°
Diameter
in.
16.REMARKS:
1I[D0:1-1EPLEBY E
CONS
c F ,L .f��l,p§,4�!nit_the
AS`i iEctinal
"y g' 4�qNone No.
( FICA
Topographic/Land setting
❑Ridge ❑Slope BGalley ❑Flat
(check appropriate box)
Latitude/longitu4e of we�l location
37°z3' 2/ /_ ,oaIw
(degrees/minutes/seconds)
Latitude/longitude sour ce:OGPS❑Topographic map
(check box)
DEPTH
From To
c� — G O
I:30 - 1/40
/LAO - 24,
DRll I iNG LOG
Formation Description
r
SAN
Sn„ $h
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
M,y xt-PocR,
Slot Sire Material
in.
in. in.
Size Material
(THAT THIS TFIAT AS COPOYOF THIS NIED TN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HBEEN PRO DED TO THE WELL OWNER
QDARDS, �' C _
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentteer, RRaaVgh, C
919) 733-3221, within 30 days.

264245
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME, (print) 13/2y.4/19 t smith CERTIFICATION # ZS '//�'
WELL CONTRACTOR COMPANY NAME GI QiVfr Wa tl \ PL&mp (n PHONE N M241 • of i-IlOO
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential Er 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: At // ,pp i vs
L ZO—LICU ni i
County Wolf.
(S6abt Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:CIL4%TOK/ y(>'S7kF
Address f O. /3n K 9 S
(Street or Route No.)
A//s Spmys /VC- 287, B
City or own rate . Zip Code
(gJJ )- tzs — 7ssf
Area code- Phone number
4. DATE DRILLED 7—/2 — D .2_5. TOTAL DEPTH: 2. 57.5`
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er7. STATIC WATER LEVEL Below Top of Casing: /c O ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / 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): / .Z METHOD OF TEST /4%rZ
10. WATER ZONES (depth): 2. Z5_
11. DISINFECTION: Type
12. CASING:
Dept
Front/ To 90
From__E To DO
From To
13. GROUT: Depth
From 0 To 2 a
From To Ft.
Amount
Wall Thickness
Diar�teter or Weight/Ft. Material
Ft. L 271 1°dL
Ft. G 1f zLL P✓G
Topographic/Land setting
Fadge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 .2D7.V2/i/ ogee/9'2JLJ
(degrees/minutes/seconds)
Latitude/longitude source:2dPS❑Topographic snap
(chock box)
DEPTH DRILLING LOG
From To Formation Description
- 90 /2
' p — 265 /7 sk�if�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cpmmon road names.
Ft.
Material Method
Ft. &irkr?etc /l'l.c >F-,Fait
14. SCREEN: Depth Diameter Slot Size Material C
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
a
t3. 'REMARIfl:'L. LTh
1 DO HEREBY CERTIFY I- A —HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VEIL
CONSTRUCTION STAND AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO WEL OWNER
-mot % /3
CCh,�oo p, FF,3, SIGNATURE OF PERSON CONSTRULIING THE WELL DATE
ASRC:i�IU� ,4 I lithe Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
br 3221 within 30 days. GW-1 REV. 07/2001

Depth
From / To SIv Ft.
` From e) To /670 Ft.
From To Ft.
13. GROUT: Depth Material Method
From 67 To 20 Ft. Lif/C/f//rf %i1,5,2,-(Jocvf�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material rb
From To Ft. in. in.
From To - Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
264244
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NN ua1 Resources -^Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kV V,91t) fi c7/27 j j-VL
/ CERTIFICATION M /7 2 S /_/
WELL CONTRACTOR COMPANY NAME C1t'4,Pn RtV4r\j1V ll \ Pu.m2 (n PHONE. C121) (e 43 - 1200
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ MunicipaUPublic ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i%�.l\ \ 3c) t I /i-r1
(Street Name. Numten, Community, Subdivision, Lot No., Zip Code)
County PO
3. OWNER: te551E C—I t k IX..V t
Address 090) U.(4 q/1l
(Sweet or ROthe No.)
CitY r Tow! Sstlte i ts? a 0
e
c?,2 - gas-9/308'
Arca code- Phone number
4. DATE DRILLED fI—//—c22—
S. TOTAL DEPTH: 2 25
6. DOES WELL REPLACE EXISTING WELL? YES Cd"NO 0
7. STATIC WATER LEVEL Below Top of Casing: (i 69 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface•
•Top or cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): 7-- METHOD OF TEST 4. /2
10. WATER ZONES (depth): 2 2
I I. DISINFECTION: Type //rh Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
Diameter
Lv % /L
From
From
i6. RLtrIARKS:_
Material
Topographic/La4setting
❑Ridge ❑Slops Malley ❑Flat
(check appropriate box)
Lattude/lpngitude of well Inca jon
36 /O M 6-9 FZ // 33 r:J
(degreea/mi outer/ nds)
Latitude/longitude source:00PS❑Topographic map
(check box)
DEPTH DRILLING I.OQ
From �To Fo tion escription
/2
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includetrhy road
numbers and common road names.
IIuu, .L-, (r, l' i' ' REDY G. 4 A'1
'Th \ I CONSTRUCTION STANDA.
3
)— i
(b9Qiii1'fdl lte t71dgnii Fmi the DIF
ASIY8i 0-i68SAoWdlNGJ: )733-
At THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
2Da AND T A CO))JY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUL I ING THE WELL
// -(9
DATE
sion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

264243
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Div ion of LWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r� .//Zy zit/I 5,27 // `J CERTIFICATION I <._/ �7
/
WELL CONTRACTOR COMPANY NAME Cie-1%P n 1lialp \i4l* IU S P V, M P En PHONE M (Y2.fi (/ Cr - 1200
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M t 1 pi v9
County ?o I I<
(Stint Name, Number', Community, Subdivision, Lot No., hip Code)
3. OWNBRDO. cl KCLY cc he is K-t
Address lei P3Cti'nOf.JI
(Street pr Route No.) Iv\ l N C R 6 �-
S �� r t vicf 'f
City or Town State . Zip Code
?b)- ( zs- gJ-b i
Area code- Phone number
4. DATE DRILLED /
5. TOTAL DEPTH: Z 2, 9
6. DOES WELL REPLACE EXISTING WELL? YES VNO 0
7 STATIC WATER LEVEL Below Top of Casing: e1 f%' FT.
(Use "+" if Above Top of Cuing)
. 3. TOP OF CASING IS / FT. Above Land Surface•
'Top of cuing terminated aVor below land surface requires it
variance In accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): G METHOD OF TEST
10. WATER ZONES (depth): 2 r70
11. DISINFECTION. Type /1 %H Amount
12. CASING: Wall Thickness
Depth
From / To G
From G /2 To /70
From To
13. GROUT: Depth
From J To 2 z2
From To
Ft.
Ft.
Ft.
Ft.
Ft.
14. SCREEN: Depth Diameter Slot Size Material
1.From To Ft. in. in. 4
From To Ft. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter or Weight/Ft. Material
417,C4t 2.7 G Pi/L
# 2e.4 P✓
Material Method
cs /vkrzc7i= e
Topographic/Land etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35 1,2 "`TN U1,(`'/Z/-Z /c/
(degrea/minutes/seconds)
Latitudelongitude source:IDGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fo tion Description
L% / Z L
/20 -22) 4n;14-i'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
GROUNBWy412Rt4E °:1'..
ASHEVILL¢7E45/4a6EPM1r0°' (91
r-,
2
W
0
{]Br2NV w l l n ti/
L WAS CONSTRUL 1 ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COPY S THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ _// _C
SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 21 e-[
WELL CONTRACTOR COMPANY NAME GI rtf n 1S1 V4 r \/.14 II 5 (\A m p En PHONE # D'21) (.. Cf s - 1200
ASSOCIATED WQ PERMIT#
(if applicable)
1
WELL USE (Check Applicable Box): Residential L3 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Col - S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County ImIIC_
3. OWNER: F e rt, ��
Address �/•) Old �e '4�
a.d_4(Street or Route No_)
I I e n j visa
Zip Code
55229- L.tl-5312-
Area code- Phone number
4. DATE DRILLED 2- S - 0 2.
5. TOTAL DEPTH: if *)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lay
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST ,4-%rz OF
10. WATER ZONES (depth):
City or Town State
264242
r It IN
11. DISINFECTION: Type // / //
12. CASING:
Depth Diameter
From / To 45 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2 O Ft. SfikRrs fr
Amount
Wall Thickness
or Weight/Ft. Materialv�
2 7 c
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
Method
/0/18-$4920f)
Slot Size Material
in.
in.
Material
asHE����ii'itl&RINE®11� °al to t
plGife!«'{n. (91
T THIS
S, AND
SIGNA
opographic/Land setting
arth'clge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3s9 Hie?, .d 0g2C OGVOoc)
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
FormationyDescription
/
SS-
MEM FromTo
0 —TS—
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.
P.= R,
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rJ-g-c7 Z
OF PERSON CONSTRUL LING 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

264241
WELL CONSTRUCTION RECORD
North Carolina - Departrnent.of Environment and Natural Resources - Division of Water Quality - Groundwater Section �
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /3iZ f4#t ' Sal/ I f� CERTIFICATION M 2 5 ,C
WELL CONTRACTOR COMPANY NAME 61'Mt rl R'IM+r• \/It i{\ PLArr1P (n PHONE t pr2f1 G Cf' - 1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT!
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ��
Nearest Town: o40.Q---.Cc&'- County
o--.P r,1)nel,-1-r{ & aif
gel
(Street Name,
,tNumber, Community, Subdivision, Lot No., Zip Code)
3. OWNER:ft(A,Vvn 6)0ndeusdY
Address `+Ogle 1-1-0co cP kelt, Pe(
(Street or Route No.) I
A)(/ dSZ if 77 3
City or Town State .Zip Code
(S)_ 9(19-5a,a
Ana code- Phone number,
4. DATE DRILLED 1—,3 — O
5. TOTAL DEPTH: tf-g5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO H---
7. STATIC WATER LEVEL Below Top of Casing: e0 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): g METHOD OF TEST
10. WATER ZONES (depth): -! 4-5
11 DISINFECTION: Type
12. CASING:
Depth Di Crt
From r% Tom Ft.__
From H) To S'5 Ft. Z. ,e
From To Ft.
13. GROUT: Depth Material
From 0 To 2 0 Ft. Sistrr/F_
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
2 %C /'dG
2,LL Pic
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
Topoggr33Phic/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate box)
Latite/lon$itude of well location,
?Cu /4 2P11 oZz 1C 6Cw
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
- rl5
7S^ `f 6
gR7`
/a w; r,--
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.
LSubrolt_the original to th
GROUr2S§9,7 FP®f o. (919
ASHEViL.E I EGIGH'AI OFFICE
T THIS WELL W
, AND THAT A
SIGNATURE OF PERSON CONSTRUE I THE WELL
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF TI,jiS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'1-3_ —O2--
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

264228
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
l
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r�t /Ry/i K±� r�� �%1if ✓1 CERTIFICATION w z�✓ L
WELL CONTRACTOR COMPANY NAME -1rp-P t'l 1�tVf r �I‘IQ 1� \ Yt^(1")p (n PHONE ti fj253 Cr 3 -120n
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential f9---Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION: II
Nearest Town: Q19�l,(LLL
Off cck&u1-tt O Arh e-a)
County TO I IC
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IIn to fLL:?P oCGi
Address 'l t'1 A Harr Da gr,/ ri Rd
(Street or Route No.)
lrLion,AJc. ,237$ -
City or Town State . Zip Code
(g4)- 9v — a ra v6
Arca code- Phone number 4. DATE DRILLED S_ -z F - 0
5. TOTAL DEPTH: G 2 5--
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13"--
7 STATIC WATER LEVEL Below Top of Casing: / o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / - FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST 1412
10. WATER ZONES (depth): / (3
1I. DISINFECTION: Type »r/i'
12. CASING:
13
14
15
From
From
From
GROUT:
From O
Depth
To 5 4/ Ft.
To Ft.
To Ft.
Depth Material
To 2,0 Ft. c5A42r5=
Di meter
Gy
Amount
Wall Thickness
or W�ejight/Ft. Material
/- .t G
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
16. REMARKS.
Topographic/Land setting
QF�idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lgtitude/ongitude of well location
26 1`J' o7N osa`) /e' 38.9-(-I
(degroa/minutes/ nds)
Latitude/longitude source: PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo tion Description
l/ 5'6 / i? 1L
�fC 62i LRAwtf=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common ra.d names.
i
l7
to
D
4J
SkboigEi
hTRWCT1N -i
T THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JS. MW THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-Zf c
Submit the original ko the
;�GFQ-IW6 hXn No (919)
GROL.'t:,JF,tR, �E•.,'IOL'
.ASHEV;LLE i L
SIGNATURE OF PERSON CONSTRUL I ING 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
264229
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Sectioon1,� �} 7/
}- $ I ]"l�( CERTIFICATION X F�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Z �/
WELL CONTRACTOR COMPANY NAME Cir•Qt n ci'iVt r \MI 11 \ P\.m P (n PRONE # fy2Y) G rf'S - 1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
WELL USE (Check Applicable Box): Residential❑ MunicipaIPublic 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: &L1.C,Cd a-, County Palk
o f-Jr enree. \ A tr Co vs PC-1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ni M%nitz
Address O OjrX.5(5
(Street or Route No.) f.,
Sai�do, K(C al l73
City or To State .Zip Code
('b)_ 2v-9'2.
Area code- Phone number_
4. DATE DRILLED 5 `2, -12 L
5. TOTAL DEPTH: z ill
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0--
7. STATIC WATER LEVEL Below Top of Casing: iiL 0 FT.
(Use "+" if Above Top of Casing)
.8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '71 METHOD OF TEST f%/
10. WATER ZONES (depth): /00
I I. DISINFECTION: Type /7' //`t
12. CASING:
Depth
From / To L L
From To
From To
13. GROUT: Depth
From 0 To 2 D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 A .7.L %�✓r-
Ft.
Ft.
Material Method
Ft. SnAt? ifIA: Miry-Poo/Z
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley !Mat
(check appropriate box)
Latitude/longitude of well location
35 i7 aoN 0162- i7 aloes)
(degrees/minutes�/ econds)
Latitude longitude source: C3GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
aie 7`"
PEPTH
From To
(% o
GO Zvi Gro u�
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. •
CONSTRUCTION s ^�^'
6FOti PiS1sFfCn?t3MP!ginalto
>SOtt%IL E2FJ�699C1b36P'GbifiFNo.(S
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
ARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5129 -(2‘)
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
he Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentteerl Raleigh,
NC
9) 733-3221, within 30 days.

252137
ASHL`'L
WELL CONSTRUCTION R: _ ORD
North Carolina - Department of Environment and Natural Resources - Division o i Water Quality - Grotmdwater Section _ �zs 71
CERTIFICATION N_' ./,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 73AY rill/t 5/!r,. PHONE if N70_ a.°D
WELL CONTRACTOR COMPANY NAME GIt-ten�7R+u+ r-W e 11 \ PtAm P (n
STATE WELL CONSTRUCTION PERMIT" i F f f ASSOCIATEW '.VQ PERMIT"
(ifapplicable) fac _:able)
1. WELL (Check USE (Ch k Applicable Box): Residential Er Municipal/Public D Industrial O Agricultural O
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 1; Other, List Use
2. WELL LOCATION:
I Ud�
Nearest Town: -Si
rorKCxnV, Kd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /\ WneJJ Sm.`t-l'
Address Po Th'� 922?
(Street or Route No.) 2 7'73
5Alvdk , NC. Zip Code
City or Town State P
(52g)- 4if9- hO(
Area code- Phone number �7
4. DATE DRILLED '1 - / ' (,2 2
5. TOTAL DEPTH: /G, /
6. DOES WELL REPLACE EXISTING WELL? YES0 ONO l3
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS f FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 4 METHOD OF TEST /,(%rz
10. WATER ZONES (depth): /l
County Polk
11. DISINFECTION: Type lfTf/
12. CASING:
From / Depth
From _To CS'
From_ To
Diameter
Ft. G
Ft. 614
Ft.
Topogra c/Land setting
ERidge POSlope OValley ❑Flat
(check appropriate box)
L3titude/jongity ofwell�ocaton
55 /z ign' 052 x/
(degn:a/minutes/ nds)
Latitude/longitude source: GPSOTopographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
—
5-0 P,kt
S5'- /LS URratvirr_
r-
O
v
LOCATION SKETCH 9 m=y
Amount Show direction and distance in miles from@t lea
Wall Thickness two State Roads or County Roads. Include41e rc(si
or W ight/Ft. �t�G numbers and common road names.
2.
2/.6 PY -
13. GROUT: Depth Material
From1L_ To 2 0 Ft..3/}kRfb=
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Fro*n To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From_ To Ft.
Metho
Nl%X ova/Z
Slot Size
in.
in.
Size Material
Material
16. REMARKS:
HIIIREEY
b icoNstkudnoti S
Path Chtsk Prj
i
THISWELL THATA COASPOONF THIS RECORD HAS BEEN ACCORDANCECTED IN
Y PROVIDED TO THE WELL OWNER
6' - /g —OZ
SI
GNATURE
NATUR
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center
I REVgh, NC
F 1
i fis 9W519) 733-3221, within 30 days.
11 VIE

WELL CONSTRUCTION RECORD 252121
North Carolina - Department of Environment and Natural Resources -`Division of Water Quality - Groundwater Section
ELL CONTRACTOR (INDIVIDUAL) NAME (print)_ �%t� 5, r f h CEATTFICATION M
WJCS 7/
WELL CONTRACTOR COMPANY NAME Cit'V,4 t, R'tNir r \Ma II \ PNm P (n PHONE # (P2Y1 (.5 -1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential Br-Municipa1Public ❑ industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI ) p
Nearest Town: OI thmbu5 County / C/ k
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , V/ AJ !3 i 5es5
Address 0 8 oK l0 0
Street or Route No.)
Lc(OCXYt,<m / s029 3 s �
City or Town State . Zip Code
(g - WC/ - yf 0 S8
Area code- Phone number
4. DATE DRILLED 2- /5 0 2--
5 TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: L 0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface•
•Top of using terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST 4 )/Z
10. WATER ZONES (depth): / 00
11. DISINFECTION: Type 0 T H
12. CASING:
Depth Diameter
From / To `-/ 2- Ft. C. 4 27e PVC —
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2 0 Ft. 5nk/2/3fh
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
eas -
— ,,Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/1 ngitude of well location
•36 /6-' 4/ 032° /3' /3W
(degttes/minutes/seconds)
Latitude/longitude source:gGPS❑Topographic map
(check box)
DEPTH DRILLING I.OQ
From To Formation Description
—30 finf
30 — 3 1.5— 17ntvi9-12-
01
CD{
Ergi
>0
.13
rn
LOCATION SKETCH''
Show direction and distance in milegom aZ.'least
two State Roads or County Roads. Include ge road
numbers and common road names.
Method
y >t /' )/Z
16. REMARKS:
al to
GROUNLTIVrTj6)gli the No. (5
ASHEViLLE-REGIONAL OFFICE
THAT THIS WELL WAS CONSTRUL1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)ARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
iZru/ s,r C� O a_SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water -Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 5 21 , 0
North Carolina - Department of Environment and N tural Resour/ces - Division oyf, )Water Quality - Groundwater Section Ia
WELL CONTRACTOR (INDIVIDUAL) NAME (print) y» F S%%%/ / lS CERTIFICATIONFis7
ICATION N 2'
WELL CONTRACTOR COMPANY NAMEGImen Q'ij r Vic (l k PNrnp Cn PHONE # (p2Y) G43-I200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 1S Municipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO (�
Nearest Town: k.(.r)i the County Poi (C-
Lpure( 2(d4 e 2d•
(Street Name, Numbe Community, Subdivision, Lot No., Zip Code)
3. OWNER: tllcck--in S e-h Lr
Address PO Pins( l oO (>
(Street or Route No.)
Columbus, A/r.
City or Town State . Zip Code
( �94-Wa40
Area code- Phone number
4. DATE DRILLED 2. - 2. 0 - O Z
5. TOTAL DEPTH: -61D r
6. DOES WELL REPLACE EXISTINt LL? YES 0 NO 6
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" If Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0113.
9. YIELD (gpm): / ' METHOD OF TEST 4i i?
10. WATER ZONES (depth):
287,2
11. DISINFECTION: Type 11 Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To S Ft. 2gTeice 2 2 G P`G
From To 5) Ft e $ 2 /, C PVC.
From To Ft.
13. GROUT: Depth
From_ To 2 0
Topographic/Land ss sting
[Midge ❑Slope GWalley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35"/y 2.?N 022° /d' 47te,
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
/9- /0
/D - 2h-
2.7: 9
H 5 ;f°5
an
,t
vc
Ql fir*;
-to �,,
=m
CO (-1Z
ma
y
LOCATION SKETCH O0 z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
Ft. Stri /ZA-7re /1%/ HIV/ 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:
S 1„.HERpYCER
� D C NSTRICT16N S
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
/ ARDS, AND THAT A Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`� OF PERSON CONSTRUCTING THE WELL
Submit the origin 1 to t
9-1636 Ph o. (91
CRCiif2L1L11
ASI(E�JILLC F - _II FICE
a—zO—O2
DATE
he Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD 252119
North Carolina - Department of Environment and Natural Resources - Division[of Water Quality- Section
n—
WELL CONTRACTOR (INDIVIDUAL) NAME (print) !" Ry/,+Ail t sfY/ rrl-LI CERTIFICATION #_2 f2/
WELL CONTRACTOR COMPANY NAME GI rtth Q'itr\fit tlS PtA in O (n PHONE *(p2P)-IZOO
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;
Nearest Town: ate k%
County / O/k
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Robed* EL1tgn,2ds
Address 3 c94 //u.t) A hnfnp;oV Rd
(Street or Rollie No.)
rAyaA. NCr 2erg z
City or Town State . Zip Code
(gas)- R9'/- 352e
Area coda Phone number
4. DATE DRILLED 2 — 2 — O Z
5. TOTAL DEPTH:SHr
6. DOES WELL REPLACE EXISTING LL7 YES 0 NO le
7. STATIC WATER LEVEL Below Top of Casing: 1fO FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS ce FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
valance In accordant/ with ISA NCAC 2C .0118. s1
9. YIELD (gpm): /.L /ri METHOD TEST ll
10. WATER ZONES (depth): ea
11. DISINFECTION: Type // jlt
12. CASING:
Depth Diameter
Fron___/_ To 3 6 Ft.
From 3 f To 5 `d Ft.
From To Ft.
13. GROUT: Depth
From To 2, O
Amount
Wall Thickness
or Weight/Ft. Material
29,c pvC-
2 1. L PVe—
aterial
Ft. 64R,e/%
From To Ft.
Methodp
/ • tf� 4- /001T
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft.
From To Ft. in.
in. in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley BFlat
(check appropriate box)
Latitude/longitude of well location
35 O fl 44 /f OS'2° 07' /2 teJ
(degreearminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
From To
a-/0
/O - 2/9
o "r52 .w 5.
//,+tins-
c
0
2
a
z 1:n
Cn ern
-T7 -
LOCATION SKETCIF sm
Show direction and distance in mi omera Mast
two State R...: or County Road Mmude2le road
numbers an mammon road nam:.433 0
.s BY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND ; A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the origin-. . e Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
R99-1636 Phone .. (91 • 733-3221, within 30 days. GW-1 REV. 07/2001
GROLINOW76Airp LF:7 �
ASHE ILLE G" _: ,I Of.-FieE

WELL CONSTRUCTION RECORD 252111
North Carolina - Department of Environment and
d Natural Resources Division of Water Quality - Groundwater Section4791(e 43
PHONE # f--12OD
Nya
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
tJr Saw 'Li - CERTIFICATION M ' R 6.7
WELL CONTRACTOR COMPANY NAMECtrORn aiV+r \Ido 11 'S Pt,Amp (m
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential C9- MunicipaVPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County Po l K
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Stan f IIC
Address / 2 /o .3 PD 1QI'T 'OT
(Street or Route No.)iO3 /
City or Towil State . Zip Code
(isO3)- 3'PS- 4133
Area code- Phone number 5 _ t7 A.�
4. DATE DRILLED I - a
D. TOTAL DEPTH: (0%5
Topographic/Land setting
❑Ridge @dope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
36' /5'..; 7 / (2° /91 aba)
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
pEPTH DRILLING LOG
From To Formation Description
0 35 Dirf
5 6 ran 1
en/0
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO f3'
7. STATIC WATER LEVEL Below Top of Casing: IGD FT.
(Use ••+•• if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of wing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST Ai r
10. WATER ZONES (depth): I / 9 r m
640- S5pm
Amount
Wall Thickness
or Weight/Ft. Material
z7- b PVC,
11. DISINFECTIO(N: Type I4tYH
12. CASING: 40
Depth Diameter
From)�Nooce To 40 Ft. 6 •14
From To Ft.
From To Ft.
13. GROUT: Depth i Material ,Method
From 0 I To 20 Ft. 5A Crei - m • s b.r
you
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK Material
Depth SizeFrom To
From To Ft.
I CONSTRUCTION $
Ft.
e-,
pm
� Cm
al o
LOCATION SKETCH
Show direction and distance in miles frac at I241;
two State Roads or County Roads. Incl¢4e thee?
numbers and common
road
names.
2
-k
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S AND THAT A(CpPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE
ci _ NATURE E OF PERSON CONSTRUCTING THE WELL DATE
i —w }fi: hgaH�ivtal to t e Division of Water"Quatity, Groundwater Section, 1636 Mail Service CeenWr -1 RRaleigh, C
Ash. ii3$�� rr� ) 733-3221, within 30 days.
.; \I,1.!2'�699`-i :..

252110
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwate��ycton
yi
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i R yt>7`- S7y27 /T//k1 CERTIFICATION # 26
WELL CONTRACTOR COMPANY NAME C71 t-te n R1Vf r\NQ tk S PUrnP (n PHONE a (Yll) G rf -120D
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 6 A/JCI»
County Pe/is
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CDR/;.6 FTC. E-
Address P2 /r30i 'if'7
(Street or Route No.)
a s'773
City or Town State .Zip Code
(bL`a)- Q17-0303
Area code- Phone number
4. DATE DRILLED O/ - 2 '% - 0 2
5. TOTAL DEPTH: 7401-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO II(
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): 2- METHOD OF TEST 4/4
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING: l
Depth
From / To i; Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2. 0 Ft.
From To Ft.
AL of Amount
Wall Thickness
Dian3ter or Weight/Ft. Material
l 276 Fyn
Material
b/sk4 t,r
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topogra c/Land setting
❑Ridge SUSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From To Formation Description
0 - H i7 /y7 7Z r
'r/ C - Z O 2— (;Rn /vr
o r
IV
S ax
>— c
co
1 0<
LOCATION SKETCH Dc
Show direction and distance in miles froi t lego
two State Roads or County Roads. Incluthe rp#W
numbers and common road names. •• rn o
Method
M, n
Slot Size Material
in.
in.
v
16.REMARKS.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l/ -;Th
1,n O/ 02-
SIGNATURE OF PERSON CONSTRULII NG THE WELL DATE
Submit the original t
27699-1636 Phone No. (R
ail
]ivision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
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 WELLCONTRACTOR• J R2PiI/ f-Rjh on/
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
268886
1. WELL USE (Check Applicable Box): Residential V Municipal ❑ Industrial ❑ Agricultural D Monitoring ❑
Recovery ❑ Fleet Pump Water Injection EJ Other D jr Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)
earost Town:�4 \ U W1%Ug , County
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TE SIUdizir
Address to
Annie-) rreo
City or Town Stale
A DATE DRILLED
5. TOTAL DEPTH 4145
6. CUTTINGS COLLECTED YES Ll NOPF
7. DOES WELL REPLACE EXISTING WELL? YES NO[ IJ
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1 ET. Above Land Surface'
'Top of ceiling terminated atlor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): ea METHOD OF TEST 11,
11. WATER ZONES (depth):
0
-dT(1,161
Zip Cade
DEPTH
Formation Description
CD o
'2. CHLORINATION: Type H %H Amount-710I r /S
13. CASING:
Depth
From To 11D
From To
From To
14. GROUT:
II additional spaco Is needed use hack at form
s
n
Wall Thickness
Ft. 6ametor or Weight/FL aledai
,25 _cP16.1.75 YYC Z
FI.
FI
Depth -
From b To z-2D Ft
From To FI
15. SCREEN:
16
From
From
From
Malarial ��`"-' . Method
��
� he -?"
alLe A
Depth Diameter Slot Size Material
To F1 In In
To FI. In In
To PI. In In
SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Cr'Ppn r)Hvev Cove_
Col uvn bus, NG
E.
G7 -
CO
0
UT
r:
I DO FIERE OY CERTIFY THAT Tt-It3 WELL WA3 CpPaiti
CONSTRUCTION fr'I"�,t1DATIOS,. AND TRAY A COPY (ifs
IFOR OFFICE US
Ouad No:
Serial No.
ONLY
u L
CTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
IISi1ECORD HAS BEEN PROVIQED TO THE WELL OWNER.
a4P
Submit odoina$
RE OFmRSON CONSTRUCTING Ti WELL - GATE
on of Water Oualily. Groundwater Section Within 30 days
CW-1 REV. 12AS

276078
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources / Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) GAyt&k i7/n/tftkL CERTIFICATION r - 671
WELL, CONTRACTOR COMPANY NAME GIn RiV4r snit II \ PNrY1 p Cn PHONE * ft2fl t. 9 -I20C
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
l
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural a --
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: S A Lt-c tDA County of [C
eXA 0 4'%k t L4 )2 \
tmtName, Numbers, Com
(S ty,, Subdivision, lot No., Zip Code)
3. OWNER: U )Pg Fie A DLC4
Address To @ .nvC 3'2, /i12.1--1 %taL (241
(Street or Route No.)
SALLDA nlr, n773
City or Town State .Zip Code
ow- ? P7 -Litt
Ares code- Phone number
4. DATE DRILLED /1"/8-0Z
5. TOTAL DEPTH: / `f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qr
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated atfor below land surface requires
variance In accordance with ISA NCAC 2C .011a.
9. YIELD (gpm): 5 ' METHOD OF TEST 4 % /Z
10. WATER ZONES (depth): �a
11. DISINFECTION: Type 14TA Amount
12. CASING: Wall Thickness
Depth DJaeter or Weight/Ft.
From To itiO Ft ` 2 /%
From 913 To GO Ft. R/.
From To Ft.
13. GROUT: Depth Material Method
From 0 To - D Ft. S#/Qh_`tL M% o
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
�opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35°/i f 52WV o92'l9''au
(degrees/minutes/woods)
Latitude/longitude source:BGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
From To
0 — 30 0,»
20 - j^D sii-at Rook
So- /`FS Rr*w/'fre
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
num ers and common road names.
o%R±io [day`'
c-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS • UCTION STANDARD ' A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sainal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
� e No. [phone], within 30 days. GW-I REV. 07/2001
GROUNDIA,IVER SECTION
ASHEVILLEE REP:. ' ANTOS

North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME Git-$.P n aiV9 r \th Ii S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
276072
WELL CONSTRUCTION RECORD
dwater Section
CERTIFICATION w-°�Ib S7
- Division of Water Quality - Groun
P,.m( Co PHONE # I1271 G gg-1200
(if applicable)
WELL USE (Check Applicable Box): Residential I '7Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: au 0 O� county Po I K
cc�1 4 a_it4 U (y,� k)
(Scree ame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ! /m el TecUn me Aron
Address 3 3 Reem3 i ra—r,ft—
(Street or Route No.)
City or Town State , Zip Code
(F1%5- LA% 3/€s0-
Ara code- Phone number / a-//(0
4. DATE DRILLED
5. TOTAL DEPTH: 4/o5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /017 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. �t
9. YIELD (gpm): 1 METHOD OF TEST �r r/Z
10. WATER ZONES (depth): z G)
11 DISINFECTION: Type
12. CASING:
N T/f
Depth Diareter
From / To /.O Ft. 6 ri
From /.O To 3'O Ft. L' 2/.L p✓c-
From To Ft.
13. GROUT: Depth Material Method From 0 To .:2,0 Ft. 5akRehc /11i y i-Pot HZ,
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
Amount
Wall Thickness
or Weight/Ft. Material
z%G_
Topographic/Land setting
DRldge 0Slope DValley ❑Flat
(check appropriate box)
35°' 4ti eNeofCwegll2oato r04 33
(degrees/minutes/seconds)
Latitude/longitude source:L1 PS❑Topographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
O - yo /ZEC) Chry
0 - 6 O /7
to 7/,
Material
From To Ft.
From To Ft.
16. REMARKS:
E�-,
I i o HEREBY GER
f'— CONSTRUCTINU
L
LOCATION SKETCH o
Show direction and distance in milesom afleast
two State Roads or County Roads. Iny}'ide the road
numbers and common road names. —
Eo
FY THAT THIS
ANDARDS, AND
LL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COXY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ 41 0 (DL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
-Submit-thetriligina+to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
a GW-1 REV. 07/2001
2769h-1(>},ti'Phone � [phone], within 30 days.

276071
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources,,�- Division of Water Quality - Groundwater Section /7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r�/� J Rey , ' /YI 1*1) CERTIFICATION If25 /
WELL CONTRACTOR COMPANY NAME Cit-Otn1 ISsVtr \/.l'e 1l S Ptnrrlp (n PHONE s (12Y) Le et S-1200
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential C"MunicipaLPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (Yltl( S`�rrnej County-PC
/oluntyjCl,/-
C.C)rilCr' G-f rC5-I-eIr Co. lnC' t' `. l'l m✓Ie�1 l�CC IC ecI
(Street Name, Numbers, Community, Subdivision, Lot No., Zip ode)
3. OWNER: U cfor reter
Address r35,�o Sn Drl
1', (Street or Route No.)
fie -Kr -VC LSonu 11 (r drC' cRiSiNa
CityorTown State .Zip Code
('sj- Cak5=a6oS
Arca code- Phone number
4. DATE DRILLED /.3 ' i - G 2-
5. TOTAL DEPTH: 7 57
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1-
7. STATIC WATER LEVEL Below Top of Casing: QO FT.
" (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): } METHOD OF TEST A-, /Z
10. WATER ZONES (depth): 5C 5
11. DISINFECTION: Type / 777`
12. CASING:
Depth Diameter
From / To 5 5- Ft. l 1.y
From 5 4 To 21 Ft. C
From To Ft
13. GROUT: Depth
From 0 To 2 0 Ft.
Amount
Wall Thickness
or Weight/Ft. Material
27.< PAL
Material Method
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth
From To
From To
Siu
Ft.
Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting
alCage ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latjrude/longitude of well location
3� 79"35N092°/z'7yw
(degrees/minutes/seconds)
Latitude/longitude source:C36PS❑Topographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
- 5 2? tic! Chia y
25—— , Sntwd
f1 Cs //J
r
85- - 5 ys_
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. 715,-;
>� 71
r
c
ne-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL............''''''WAS CONSTRUCTED rN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone jia. [phone], within 30 days. GW-I REV. 07/2001
/ 2
SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
ces
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) J3/Z ys5E* +
./
WELL CONTRACTOR COMPANY NAME G,mPn RiVfr\Ids?
276070
- Division o/f Water Quality - Groundwater Section �7
Sm., f l l CERTIFICATION sr - �S 7 /
Pump fO PHONE#U2rI2 00
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 i unicipa1/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: fYl t I l 6prinG(
t-f i(\ iO&E ��11
(Street Nahise, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I—IACA Ile Flower
County Y CI -et
Address /gig ffult! (Ogg
($creel r Route No.)
rn/if Pr;nci, NC as7a '
City or To State .Zip Code
(S$)- cght-a ao 5"
Area codo- Phone number
4. DATE DRILLED / 2- — z - O L
5. TOTAL DEPTH: 6 L
6. DOES WELL REPLACE EXISTING WELL? YES C31 O 0
7. STATIC WATER LEVEL Below Top of Casing: e D FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated actor below land surface requires ■
variance In accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): / METHOD OF TEST 4i2
10. WATER ZONES (depth): 2 IC
11. DISINFECTION: Type Jt rfr
12. CASING:
Depth
From 2_ To (0
From L 0 To /2,0
Amount
Wall Thickness
or Weight/Ft. Material
Ft. 2z L PeC-
Ft. L x/.0 Pet -
From To Ft.
13. GROUT: Depth
From O To /2 0
From To Ft.
Material Method
Ft. a4kRE/Y
Topographic/Land setting
0iildge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well locatjon
a; °/9'a0/✓ 0924'6 H%�✓
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
METH DRILLING LOG
From_ G To O Formation eI4 pion
- 7r neval y
75 - 5`cs- a,aw/fk
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads. I
numbers and common road names.
/U,vs-/2ocrc
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
in. in.
in. in.
Size Material
3
from at least
lude the road
0
m
r_.—I-DO{ERED%.O, T1FY THAT THIS WELL WAS CONSTRUt.1 hD M ACCORDANCE WITH I5A NCAC 2C, WELL
I' I CONSTRUCT I TANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� 11-%elf _ i � 12 —4 —0
tJ �3
• u SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r. Submit the;origlnal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
L_

Oct 29 03 12:31p
p.1
1r Nona Cambia Dooanmont aSNimnrnand Nasal gpeu',a.Maim ofWuarQua/ro-Groundwater swion
Ralath. N.C. 27840-1636 Phone ens) 7334221 •
'WELT: CONSTRUCTION RECORD WEILCONTRACTOR: • Mt Clef(c loft(. hit t
Dr3 k/617
WELL CONTRACTOR CERTIFICATION a: 2 e' //
STATE WELL CONSTRUCTION PERMIT/: / .L 4
1: WELL USE Mack Yrases* Raldenbeir Municipal CD wistful CI
Recovery O Heat Puny Water Irgectbn D Other p U Other, List Use
AfFicultural 0 Isionkosing CI
WEliLOCH (Show sketch piths Iocaton beton°
warm' Tom ���— cats ral/�
• .' •e and mns*y.«SuleAdon anti taMo.) DRILLING LOG
OWNER Rom To
- 8: STATIC WATER LEVEL Below Top a/CaseQ S p
8.-' T0P OF CASING IS Ft AbotrrYtsad Sa
• ernes /clan maws -_-_- attar solar Modstn4atw-a ValWtot6taaor
Oaag11te115AIMAC2_
`.10. 1ELD (ppm): _ MEDIQOOFTEST (7'
` ` 11. WATERZONES (depth): fee/
yn
yn-/�o
/3n- 5nn
- ReyUi
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