Ru 1 CY2002

WELL CONSTRUCTION RECORD 247789
North Carolina - Department of Environment and Natural Resources - Div sign of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James
WELL CONTRACTOR COMPANY NAME C,R mh' c Wa1
Camr, Jr
1 k Pnmr+ Cr-) Tnr
CERTIFICATION #__7138
PHONE #62R) AS1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOC1tTED WQ PERMIT#
(Tapplicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/P'ubl.0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 19, If Other, List Use
2. WELL LOCATI
Nearest Town: 1P
cv/lAtv
(Street Name, Nuggets, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FJ
CountyLW
Address &ol\ (I 5 sV0 Y 7
(Street or C utc No.) � /- i
n
Cityor?owo State Zip Code
( )-
Area code- Phone numbFF
4. DATE DRILLED \' k-
5. TOTAL DEPTH: 4 0
6. DOES WELL REPLACE EXISTING WELL? YES MNO 0
7. STATIC WATER LEVEL Below Top of Casing: %D 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): `v METHOD OF TEST s, i r
10. WATER ZONES (depth): a 7 0
11. DISINFECTION: Type t'hl nri run
12. CASING:
Depth Diameter
From_ To_ Ft. 6 1 / 4
From To I US Et.
From _ To Ft.
13. GROUT: Depth Material
From p To 20 Ft.
From To- Ft.
Amount (^Aal(
Wall Thickness
or Weight/Ft. Material
cDg21
N .at Ccmcnt
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in
in.
Size Material
Topographic/Land setting
❑Ridge 0-Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminutesdseconds)
La tude/longitude source:❑GPS❑Topographic map
(check box)
ED PTH DRILLING LOG
_tie c
F 1m `10 5 ;V>,-t') Dh tion_
11_
�10. Cs ,l` L-A
fN3
LOCATION SKETCH
Shw direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4,00
I DO HEREBY CERTIFY THAT THIS WELT tugs rQN
CONSTRUCTION STANDARD ,( ' AT -A C,OP1'hhhF�,?,IH1
J
the original to the Di
Phone No. (919) 733 3
CCO .DANCE WITH 15A NCAC 2C, WELL
t HA. BEEN PROVIDED TO THE WELL OWNER
TURF 1
TUREtDF PERSOIICONS U
L L .
Submitision f Water Quality, Groun wate
27699-1636221,ithin_3..0.das.—
Olu�n t,5r mot'
1NG WE WELL DATE
Sedtion, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J amens
Camp, Jr
WELL CONTRACTOR COMPANY NAME ramp' q Wa11 R Pump ('n Inc
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
247791
- Groundwater Section
CERTIFICATION # 2 1 3 R
PRONE #$2Rl 45-A-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential qd Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATIO
Nearest Tom
re county Rnit er'tord
are/-J--kes
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .Do Kai i M•
vt 5Ot
Address AID /t 4 I St Pie.
city or Town State Zip Code
Area code- Phone number
4. DATE DRILLED i - '50 _ Od
5. TOTAL DEPTH: 57 S
6. DOES WELL REPLACE EXISTING WELL? YES O/� NO
)/
7. STATIC WATER LEVEL Below Top of Casing: AFC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 15-0 METHOD OF TEST a i z<
10. WATER ZONES (depth):
11. DISINFECTION: Type r h l n r i n a
12. CASING:
Depth Diameter
From 0 To 76- Ft. 6 t / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From__ To 2 p Ft.
From Ta Ft.
Amount akLUDS
Wall Thickness
or Weight/Ft. Material
eE114.21 PVC
Material
Neat Cement
Method
Hand
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 QS1ope OValley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To f ormation Des ription
��11 �S i/t errA✓e I
'7S 3?5 conseytdated rock-
0tr
n-
O
-� 0
LOCATION SKETCH cn 0
Show direction and distance in miles from at teas(
two State Roads or County Roads. Include the road
numbers d ommon road names.
1,-LAY e
Hs
cad,
puotei
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC-11tD IN ACCORDANCE WITH 15A NCAC 2C, WEI r
CONSTRUCTION STANDARDS, AND TH or'. 0 11I .,EEN PROVIDED TO THE WELL OWNER
SIGNA
Submit the original to the Division of rt
27699-1636 Phone No. [phone], with n 30
ERSON CONSTRUCTING I'4
uality, GSurtdwatei' Sea ,
ays.
S I-'1 El ii.
G ON
idlU'/ATEk SEGlION
A LE REGIONAL OFFICE
DATE
636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

247791
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Camp, Jr.
CERTIFICATION# 2 1 3 R
WELL CONTRACTOR COMPANY NAME ('amps q Wp11 & Pump Crt TnC PHONE #87R) 453-7322
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential !E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO i r
Nearest To U1DYL I' II)iGCountyRIAl11e( Zvi
aYrlesRA.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: y4nCe Z • ri k
Address ,2✓l f Arne-, Rd
//I n,� 11eet1or� Rout E Np� �!o
'// 7
1�N
City or Town State Zip Code
Area code- Phone number !,
4. DATE DRILLED / I 0 -
5. TOTAL DEPTH: r'v95
6. DOES WELL REPLACE EXISTING WELL? YES 6NO 0
7. STATIC WATER LEVEL Below Top of Casing: Sc. 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 accordant with 15A NCAC 2C .0118.
9. YIELD (gpm). 10 METHOD OF TEST p ir
10. WATER ZONES (depth)•
11. DISINFECTION: Type
12. CASING:
DepthS
From_q To
From To
From - To Ft.
13. GROUT: Depth
From_--0 To 2 p Ft.
From To- Ft.
('hl nri np Amount 9, cups
Wall Thickness
Diameter or Weight/Ft. Material
Ft.6 1 /4 SDR2l PVC
Ft.
Material Method
Neat Cement Ha
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
Midge ❑Slope ON/alley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To formation Description
p 7S r't 4i
'7S Y,9D5 ('.bNsolrriJed rock
rn
Ca
-ra
LC
o E1-
LOCATION SICETCH IV 2
Show direction and distance in miles from SReas6
two State Roads or County Roads. Include the roa3d
numbers and common road names.k /j '
j6 1 (AY(VI'-
X
aYnes
1 DO HEREBY CERTIFY THAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, BEEN PROVIDED TO THE WELL OWNER
SI
Submit the original to the Divisi
27699-1636 Phone No. (919) 733-322
OF PERSON CONSTRU
ater Quality, Groundw
, wi[ In 30 days.
-/1-o„2_
DATE
tion,1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 4 7 7 97
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jani s 1st_Camp, Jr- CERTIFICATION # 71 ifl
ramp a Well R Ptimr r'rL Tnr PHONE #&7A) dc'1-7322
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERh11T#
(if applicable)
1. WELL USE (Check Applicable Box): Residential2Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIN: n �J ` 4
NearestTown: C, .(t r-County Qc,c,ii.r.. ,-,...
(Street Name, Numbers, Community,.Zubdivisionyl.ot No., Zip Code)
3. OWNER:Cdt t (ILL
Address 1 L\"3
trees or Route No.)
City or To a , State Zip Code
( )-
Area coda- Phone number
4. DATE DRILLED I • 15 D �-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (�
7. STATIC WATER LEVEL Below Top of Casing: U 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 113 METHOD OF TEST Air
10. WATER ZONES (depth):
Togo �g aphic/Land setting
❑Ridge NJSlope ❑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 Forrnatiog Description
D Y F
2 % a s-
11. DISINFECTION: Type ('h 1 nr i na
12. CASING:
Depth Diameter
From__ To Ft. 6 1 / 4
From______ To Ft.
From To Ft.
13. GROUT: Depth Material Method
From,_g._To 20 Ft. N 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
Amount 1 C•Ail
Wall Thickness
orWeight/Ft. Material
SDR21 PVC
From To Ft.
From To Ft.
16. REMARKS:
rn
w en!'
(I
CO
n Wu
n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nu t1 rs and common road names.
tHIS WELL WAS CONSTRU(:IED IN ACCORDANCE WITH 1 NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVID 0 THE WELL OWNER
INNTNO
' 0 SI ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to_tge Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
#6:0L, P R41`7b. 9i9) 733- 221, within 30 days. GW-1 REV. 07/2001

247794
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jdm@S w Camp, Tr -
CERTIFICATION # 71 -i R
WELL CONTRACTOR COMPANY NAME Camp'G Wn11 /L Primp Cn Tnr PHONE #$7Rl 451-7322
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 0 If Other, List Use
2. WELL LOCATJON1'. �
Nearest Town: Aa I
County 4)z.1 4A6s
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: A C. \fi 3'
Address \ \ & kL' l-u q IM'„
(Street w/ACteNo.) J
UCkA \VI
City or Town State Zip Code
( )-
Area code- Phone numbs(g
4. DATE DRILLED d{ - l�
5. TOTAL DEPTH: .9.(1)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: LAQ 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): a 1) METHOD OF TEST A l r
10. WATER ZONES (depth): \9 U'
11. DISINFECTION: Type ch 1 nr i nn
12. CASING:
Depth Diameter
From_(,)_ To Ft. 6 i / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From__ To o 0 Ft.
From To- Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
Neat Cement Hain,-
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
Midge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
us s-9P(
a- AA-4, A°
` N
-n
W
LOCATION SKETCR 1;1
Show direction and distance in miles from at leas-2
two State Roads or County Roads. Include the road
numbers and common road
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCIBD IN ACCORDANCE WITH ISA NCAC 2C, WFI r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J SIGNATURE OF PE rTh
DATE
fl �L i
Submit the original to the Division of Water Qu J yiC;roundwater Section;1616-i Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 da4s. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
247802
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 ('amp t
STATE WELL CONSTRUCTION PERMITS
(if applicable)
Well
Camp, Jr-
R Pump CO ,
CERTIFICATION # 21 3 8
Inn PRONE #SOA) 451_7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 'Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: `.r1Ya WAa
County-eJ
ezui
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:k e1 "-- `\ 0GA�
Address W A
of 1) VCQMN-4.1- -s i 12,PE
t� ( S t or Rpate No.) 0S c q c City
or .TTown State Zip Code
$LR}. S5Q _ k-1 a
Area code- Phone number
pp
4. DATE DRILLED cat —IC.' b
5. TOTAL DEPTH: 3 0 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M
7. STATIC WATER LEVEL Below Top of Casing: too 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 accords ce with 15A NCAC 2C .0118.
9. YIELD (gpm): j MET J OD OF TEST 8i r
10. WATER ZONES (depth): D-ifi0
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From Q To E 0 Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_0_ To 30 Ft. Neat
From To _ Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Froth To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
eBR21 PVC
Ccmcnt
Method
Hand
Slot Size Material
in.
in.
16. REMARKS:
GEINSqpI S'tANP
ubmit the original to th
7699-1636 Phone N
l F 0L,RED. WATER. ;EC CM
i____„c Pt t E i r CFECE
Topographic/Land setting
f1�Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTI� DRILLING LOG
From To Formationaiesc Lion
0 SOS.(�%. y
r-
0 77
r n E5'--'
COr,
a
O r,^
rn,
LOCATION SKETCH ry
Show direction and distance in miles from itrieasto
two State Roads or County Roads. In lude the roa!
numbers and common r• • • es.
IS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Divi on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3 21, within 30 days. GW-1 REV. 07/2001

247801
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James nr Camp, Jr- CERTIFICATION# 21 3R
WELL CONTRACTOR COMPANY NAME Camp' G nip, 11 R Piimp f n Tnc PHONE #(9Ft) 453-7322
STATE WELL CONSTRUCTION PERhIIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t' 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:
Nea{est 'oiwn:7li1OAT to: \ County___
d
(Street Name, Numbers, Community Sub 'vision, Lot No., Zip Code)
3. OWNER: Vtvk'
Address 1- OAS
-
(Street or Route
City or Town State Zip Code
L Area code- Phone numbef
4. DATE DRILLED 1- 9i ' 0 1
5. TOTAL DEPTH: S O .S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lY
7. STATIC WATER LEVEL Below Top of Casing: %D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Air
10. WATER ZONES (depth): CIO
11. DISINFECTION: Type r h 1 n r i no
12. CASING:
Depth Diameter
From__ To 8 • Ft. 6 1 / 4
From To Ft.
From - To Ft.
GROUT: Depth
From_0 To 20 Pt. Neat
From To- Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
ubmit the original to the Divi
636-Rhonalsie. fll9}733-3
Amount Lt ..�
Wall Thickness
or Weight/Ft. Material
gBR21 PVC
Material
Method
Cement H
Slot Size Material
in.
in.
Material
Topographic/Land setting
;Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To FRrmatien Description
S
s
Ie r
LOCATION SKETCH C c
Show direction and distance in miles from at leasC
two State Roads or County Roads. Include the road
numbers and common road names.
IS WELL WAS CONSTRUCThD IN ACCORDANCE WITH 15ANCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G A
COF PERSON CONSTRUCTING THE WELL
DATE
on of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

270872
11. DISINFECTION: Type Ch l nr i in in, Amount ,2 'j p
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_ To 9 f) Ft. 6 1 / 4 S DR 01
From To Ft.
From To Ft.
13. GROUT: Depth
From_0 To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From T
16. REMARKS:
Camp
' G Wel 1 R Pnmp In
7. STATIC WATER LEVEL Below Top of Casing: VV 1) 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 accordagse with 15A NCAC 2C .0118.
9. YIELD (gpm): METH OF TEST
10. WATER ZONES (depth): \A M e (1"_ 'u 1 U (Air
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
PVC
Material Method
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James It_ Camp Tr- CERTIFICATION# 21 i8
PHONE #ai7R1 415R-7322
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
Tnr
1. WELL USE (Check Applicable Box): Residential 1217 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATi��[tpJINS 4 //��, -eil�
Nearest Troxm' VA 1(41i..t ,Y..Li/v- County
Dit (OX ki. dal G✓een. R.iI/CV
(Street Name, Numbers, Community, Subdivision,Lot No., Zip Code)
3. OWNER: \ MS -ire l� Glial ` `r`\ U tii-
Address f. 0 l'S.(�1 `)GODS
( et or Route No.) 1
iA.t i- C -g �1 \ .1(I O lJ
t or own S Zip Code
(Ivry /-16iS
Area code- Phone number n
4. DATE DRILLED I i - d..0 . O 1
5. TOTAL DEPTH: iQ 0 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l .;.
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 fis)i ion Description
O 7U
9u toos'_
Size Material
Ft.
o Ft.
FI-DOHEREBY -
CONSTRUCTION STANDARD
-
Submit the original to the Division
27699-1636 phone No. (9I9) 733-3221
Ui
Q
P3
LOCATION SKETCH .r -
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
z ($,r„ U.) (
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI i
THAT A COPY OTHIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001
-)a O
,/
DATE

2708'70
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ramp, Jr- CERTIFICATION #__213,$
WELL CONTRACTOR COMPANY NAME ('amp' R Wa1 1 R. Pump ('n TnC PHONE #$42R) 451-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential EY Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA ON�t:, �I o
Nearest Town: cYJ �Zv�.i, ,County *
Lot (� Goldept Val ei L4 aces
(Sweet Name, Number's, Community, Subdivision, Lot No., Zip Code)
3. OWNER:V//.»t'- =,V..-r..-..�yry ),.,
Address tap() it C &A
(Street or Route No.)
N' L
('o clin- 0in
2$.213
Zip Code
Area code- Phone number
4. DATE DRILLED - \ 3 • 0 1
5. TOTAL DEPTH: `-I U C
6. DOES WELL REPLACE EXISTING WELL? MIL)
7. STATIC WATER LEVEL Below Top of Casing: JC)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
variance In accords ce with 15A NCAC 2C .0118.
9, YIELD (gpm): MET OD OF TEST pis
10. WATER ZONES (depth): \ ILA"
11. DISINFECTION: Type ('h
12. CASING:
Depth
From 0 To
From_ To
From_ To
13. GROUT: Depth
From_0_To 20
From To
14. SCREEN: Depth
"
lnrina Amount 2 Ll....staft-
Wall Thickness
Diameter or Weight/Ft. Material
Ft.
Ft.
Ft.
Material
Neat Cement
6 1/4 SDR21 PVC
Ft.
Ft.
Diameter
Slot Size
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From_ To Ft.
Method
'land
Material
in.
in.
Size Material
Topographic/Land setting
Uidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seaonds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formati . n Description
dJ A.. �
ED PTH
From To
0 St)
6o 1Os'
O
PJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
-I D0 HEREBY CERTIFY THAT
CONSTRUCTION STANDARD:
Submit the original to the Diiyision
27609-1636 Phone No. (9I9),733-3221,
YELL WAS CONSTRUCT ED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
�1 d- tJ 1O-o3
1TURE OF PERSC)N CONSTRUCTING THE WELL ✓ 7 DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD#47OtI!8S25 9 4 77
North Carolina - Department of Environment and Natural Resour cs - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ut} eta CERTIFICATION/4p2!M
/
N I Bra/4&i PHONE # (nth rit1 / rt4
WELL CONTRACTOR COMPANY NAME
STATE \VELI. CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public /Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIIO�O//N: yy��
Nearest Town: Chl+t- 104k County K
(Street Name. Numbers, Communit�bdiv�� Lot No., Zip Code)
3. OWNER: £ 1e & PArk
Address �f Maim $1'
(S eet or Route No.)
it me.
City or iown State Zip Code
(228)- QZ-C—`�� 16
Area code- Phone number
4. DATE DRILLED B•26•bL
5. TOTAL DEPTH: IQJp r /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9"
7. STATIC WATER LEVEL Below Top of Casing: ^&— FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS F2.0 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
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From-l-24) To 9S Ft. 8 .312
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Material
Scsi
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(L _ j \7
IrO HER
INSTRUCTION STANDAR
Ji
('r:Ol. IAIA
T
E
c �,„
bireat 2�u'at, y{ �yj� t�'®�.�Acf���''�9,.1 Divisi
27699-1636 mt - 67-k "433-3
Topogra c/Land setting
❑Ridge LY51ope ❑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/ Tio Formation Description
0 — q0 Otxp_ &roes)
QD'/004 r ` �� qrw �c
LOCATION SKETCH
Show direction and distance in miles from at least_
two State Roads or County Roads. Included road
numbers and common road names. ry "
Fri
*O
N
c.�
xe--we K
74.A a,:,.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g«L Par_
g-2`-02_
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

261274
WELL CONSTRUCTION RECORD *47051ISS
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)MAW AW E �(erts
WELL CONTRACTOR COMPANY NAME NLVt C]YOL✓ erS
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 7 s57
PHONE it(04 39%/.O
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential D Municipal/Public EKIndustrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION(: n
Nearest Town: (Spinney Rock &rkCounty wlvt*4'n
/
1� ibe "Medals
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Chainaey Rock Prick
481 WIRIn Sfred-
(Street or Route No.)
3. OWNER:
Address
Cisnon
Ktr� wiC
City or State Zip Code
�n
T
(828)- ro2S-genb
Area code- Phone number
4. DATE DRILLED q 3-02_
5. TOTAL DEPTH: 120D'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO le
7. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS h 2, O FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): t2 METHOD OF TEST %loin
10. WATER ZONES (depth): .357) •
4,9
11. DISINFECTION: Type 14-7I Amount 1 cv)o
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
r
From +2D To 60 Ft. 8 t3Z2 Sfee 1
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To s/ 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:
Topographic/Landd etting
❑Ridge 0Slope RV -alley t Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - f titer quteOa t/
53- 365' is hfrc fe'J ne.k.
34.r- aga' aecale fist flak
38d'- 12ca' I1241-gry rich,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include 8 road
numbers and common road names. t*��
x
74A/424-
tp
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
Aftrar
SIGNATURE OF PERSON CONSTRUCTING THE WELL
,3 row
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

2. WELL LOCATIta
Nearest Town: [[// t
4 Route No.) e
City or Town State
Area code- Phone number 5- . ;2 /J !7 p(
"7
4. DATE DRILLED J f
5. TOTAL DEPTH: I I PO
6. DOES WELL REPLACE EXISTING WELL? YES _
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Usee "+" 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 accordanseyith 15A NCAC 2C .0118.
9. YIELD (gpm): HOD OF TES 4-
�..
10. WATER ZONES (depth):
°-/11,05/118
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ttural Resourc - Di ion of W to Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1D� „�5 fie ! � PCERTIHONE #IC N�• ,�
WELL CONTRACTOR COMPANY NAME 2'i /3 fli
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
253399
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic 111<idustrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
Zip Code
11. DISINFECTION: Type /-t L l7 Amount
12. CASING: Wallll�Thicknesss
m Fro�To h(/ Crp ,�Ft Diayter orS e3gh3 t. Ma
From To Ft. �!
From To Ft.
13. GROUT: Depth atrial
To hier 3 Ft. CPd/7� l
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
in.
From
14. SCREEN:
From
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
'al
From
From
I DO HEREBY
CONSTRUCTION ST
Material
Mtod
(de8.tes/minutes/scouds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEFT
From To
/ 8�� `?'/p Cf�1 Gt
Op
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. In lude the road
road
numbers and common road names. V?" akifilitfi yrC4f
at 74
c
0 0
N)
c_ "-
m
"HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL _" m
AND THAT A CaYj7JOF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNelt
`•✓7 DATE COo
ATURE OF PERSON CONSTRUCTING THE WELL
GRoLJrm :ATER SECTION
AS &think tti atrigipal[to 4he Dis ision of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl Raleigh,
V gh, NC
27699-1636 Phone No. (919) iii-3221, within 30 days.

247087
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] IW E t I'
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
�✓,. fretdel e Nenser�'.
WELL CONTRACTOR CERTIFICATION if:a19/
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResIdentialN1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CA-i Win' 7 ti C. • County
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER C.FriSiopttr Gilbert
Address !35(a Lei_cud Ra -
(Street or Route No.)
Grce..&WC, t%)L
City or Town State
4. DATE DRILLED 1 - 31- 2'
Zip Code
5. TOTALDEPTH ?..00
6. CUTTINGS COLLECTED YES El NO®
7. DOES WELL REPLACE EXISTING WELL? YES n NO1V1
8. STATIC WATER LEVEL Below Top of Casing: a0 FT.
(Use if Above Top of Casing)
9. TOP OF CASING IS —+ — FT. ove Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): S n METHOD OF TEST F11P-
i 1. WATER ZONES (depth): I lo0 44
•
12. CHLORINATION: Type
13. CASING:
Ru11,vho,a
DRILLING LOG
From To
6R12. 1-) (Arm
115
t�tl�b a t L.L1 10'
AS' 57
s'1- 5ct -
s 5 - 159
I Lc) -
l l a S
I -?-&DO
µ
Amount ✓ID22f
Wall Thickness
Depth Diameter or Weight/Ft. Material
From + ) To SCI Ft Col)b, PVC
From To Ft
From To Ft
14. GROUT:
Depth Material j Melhgd
From O To a• 0 Ft t-Mt rJ44k
From To- Ft
15. SCREEN:
From'
From
From
Depth Diameter Slot Size
To Ft in
To Ft in
To Ft In
16. SAND/GRAVEL PACK:
Depth Size
From / To Ft
From To Ft.
17. REMARKS:
Material
in
in
In
Material
DEPTH
Formation Description
1S'
IJC �I.eyed ?Soft Rock
!Lela attic
C41 Q4Cxl (
131 ruD Dociu
Gray �ocJL
c
-r-I
CO
rn
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Stale N
Roads, or other map reference points)
r7
0
(r it i IH
I DOHEREBYC� ++FYTF PTTIi1S WE WAS
CONSTRUCT D TANDARDS, AND THAT A C
�LY1ti
FOR OFFICE U
Quad No:
GiJi
C
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ECORO,HAS BEEN PROVIDED TO THE WELL OWNER.
SIGI
Submit original to
IATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
G'N-1 REV. I2/99
Serial No.
GROUNNA✓A[LR SECTION
�S�L-�'•6L_ REGIONAL OFRCF

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" Ice yeiS'�rs11Y� Nn{
WELL CONTRACTOR CERTIFICATION #: Z- 3 2 0 11
STATE WELL CONSTRUCTION PERMIT#:
246091
1. WELL USE (check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Fore 4, ('.4y County
IIIk (zcr cQ
(Road Name and Numbers. Community. or Subdivision and Lot No.)
TTK 3. OWNER v v\vkt C, to. (Sc,v, From To Forma5m DescripUo-
Address I I I f 14 r1 e. I +. O 1 (4,y -Sint t/
(Street or Route Non 1 / 2 - r
City or Town 1 State Zip Code r 6-S
4. DATE DRILLED /" y/rc -6 Z
5. TOTAL DEPTH , - 5"
6. CUTTINGS COLLECTED YES n NOn
7. DOES WELL REPLACE EXISTING WELL? YES in NOM i21 - It, SS
8. STATIC WATER LEVEL Below Top of Casing: / r, FT.
(Use -.' if Above Tap of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 'ISA NCAC 2C .0118
10. YIELD (gpm): j_U METHOD OF TEST .41 Z- 1--1 F T
11. WATER ZONES (depth) 2 9 1 do
12. CHLORINATION: Type 1+ % 14 Amount 5 [-. If additional space is needed use back ef-kam -1
r
•12cci-tcr 4 rcJ
DRILLING LOG DEPTH
7c / / 0
:rl
N o
3 n
N
N •'
-
13. CASING:
Wall Thickness
Depth Diameter cc WeighVFt. Material
From C To 121 Ft (-.(i is" NZ 1Z pvc.
From To Ft.
From To Ft.
14. GROUT:
Jlo - /2.(
LOCATION SKETCH
(Show direction and distance from al least tnq$}a e IAE Lt.
•
Roads, or other map reference points) 5 i
$ 1L2 rfo.-k
Depth Material Method
From () To 10 Ft Pk , Cevv./-i pie5s J ^c/tre 4trcL
From To Ft
15. SCREEN: A) I4.
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK: 10 f a
Depth Size Material
To
To
From
From
17. REMARKS:
I DO HEREB
CONSTRUC
FOR OFFIC
Quad No:
Serial No.
Ft
Ft
n
ry
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WE.1_10iPIEP..
NAT OF PERSON CONS
TRUCTING THE WELL
Submltlongtn 1 o Division of Water Quality. Grourowater Seacn .Nithin 30 d*y9
ni?nIL*EV =rER
SEC7IOJ
REGI6NAL OFFICE
Graf GEV. 17.91

258030
WELL CONSTRUCTION RECORD
Department of Environment and Natural Resources - Division of Water
jU
North Carolina -Dep 5 (: CERTIFICATION a, C '/`,
MDUAL)NAME (plot LI.J 7 D
WELL CONTRACTOR (INDIVIDUAL) PHONE 0
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIC# if livable
if livable cultural 0
Residential Municipal/Public ° Industrial 0 Agri
1.
WELL USE (Check Applicable Box):
Quality Groundwater section
Water Injection 0 Other 0 If Other, List Use __--
Monitoring 0 Recovery 0 Heat Pump
2. WELL LOCATION:
Nearest Town:J e
(Street Name, Numbers, m Co muely, Subdivision, LotNe., Zip Code)
3. OWNER:
Address
Are
( u t or Route No.)
Code
CirywT On State rl zip
nn ''JJ v Topo d setting
U)-' County f�Vr!' °Ridge ope °Valley OF1at
Latitude/longitude of well location
( /mtdmclsemads)
Latitude/longitude source:OGPSOTopographic map
(check box)
nn tr r tU(i r OG
DEP
From To Formation Description
Area cede- Phone number � ` _ �,L
4. DATE DRILLED ! JS
NO 5. TOTAL DEPTH:____
_
6. DOES WELL REPLACE EXISTING WELL? YES 0 t ---
7. STATIC WATER LEVEL Belowop of Cu gTop of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
flop of wing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): —METHOD OF TEST...—_
10. WATER. ZONES (depth):
11. DISINFECTION: Type CL D_ 2�e_
12. CASING: Diatgeter
From T° FL .. 1 11r_
From_T° P,1 FL--cr' 7
From TO FL
13. GROUT: Depth Material
From TO Ft
From 0 To 10 Ft— --
(check appropriate box)
. rnS•rrnit cKETCH
a 2 e 73 , Show direction and distanceles from at ast
de theroad
Amotmt two State Roads or County Roads. inc
Wall eight/Ft numbers and common road names.
orweigbt/FL Material
Method
U 3' :_
14. SCREEN: Depth
Diameter Slot Sine Material FroFL in.
m TO in.
From
To Ft. in.
15. SAND/GRAVELPPACK: Depth size Material
To.
To.
From.
From.
16. REMARKS:
D 1E01 R}�B ° est i
ONSTRUCTION ST 1++y
:i
Lf^ d Mgit,ise teigitaEto the
FsHE21 -dgfd(
Ft.
Ft.
0
Ltrig is r
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
S1 ATURE JF PERSON CONSTRUCTING THE WELL DATE
ivision of W atet.Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3.3221, within 30 dais. GW-1 RE

25405
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)r. C'}A ' fin) 11�tt CERTIFICATION /St
WELL CONTRACTOR COMPANY NAME 3oS4, (C t� .n C L A1 C t PHONE # ( ) �Ly-�/•r�1 E
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential G 'ivfunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: `
Nearest Town: I4 (t 6 County e4-4 %1.
Pc 3ok tknke Litr_6
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jl'/CliefSCr-O}?tlo �
Address ✓ ,t d j-€ to
(Street or Route No.)
LAre Loki it)C
City or Town State Zip Code
//7/
Area code- Phone number - ZU�j2
4. DATE DRILLED 5 J-7`
5. TOTAL DEPTH: 2LS^
Topographic/Lan4setting
❑Ridge ❑Slope iVa11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
7. STATIC WATER LEVEL Below Top of Casing: 1/o FT. , po- Zn y
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1' METHOD OF TEST n/K
10. WATER ZONES (depth): Weitem /'L0
5r& winks
,k hnks
,
fiki
data Jerk
O n
LOCATION SKETCH a c='
M c•-
11. DISINFECTION: Typedic/1+N e Amount b 02 e i3)> Show direction and distance in miles from atleast!I -
12. CASING: Wall Thickness two State Roads or County Roads. Include thb road rn
M ti me
Depth Diameter or Weight/Ft. Material numbers and common road names. �
From U To�_Ft. /U" yo�fri,i� ^'r
lJbfl P v.
ri
From O To ,� W Ft. %Y' !�r m
From/06, To /0 f Ft. d>_ a
TV---i
13. GROUT: Depth aterial Method,G
From To Ft.
From 2 To 'kJ' Ft. .1Ei
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:
I f?O I Yl.i;R
GR
AS HE
j!`-«ev 1:v—Il(,t
THIS WELL WAS CONSTRUCTED IN ACCORDAN E WITH 15A NCAC 2C, WELL
S, ANQ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIQNATURI JF ON CONSTRUCTING THE WELL DATE
Ito the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4119) 733-3221, within 30 days. GW-1 REV. 07/2001
—7

WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL ring 0 (Check App
licable Box): Residential Q6 I�lunicipalPublic 0 Industrial 0 Agricultural ❑
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topo c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degca/minutes/secooda)
Latitude/longitude source:OGPS0Topographic map
(check box)
DEPTH r EJL LOG
From To Formation Description
4 DATE DRILLED
WELL CONSTRUCTION RECORD
Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/ S -
North Carolina - Deg CERTIFICATION Mgt_ /e
(INDIVIDUAL) (print) ` \�5 { (" ±45t
WELL CONTRACTOR (QiD PHONE M
2. WELL LOCATIO
Nearest Town: mau
(Street Name, N R a Co oity Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
City or Town State
Area code- Phone number 2
` 7
5 TOTAL DEPTH: 34
Z
Zips
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Jac) —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 //1K
10 WATER ZONES (depth):
OC T10N ¢KFTCH
U Amount f C 2 _73 . , Show direction and distance in miles from at least
11.2DISINFECTION: Type L 02 r r two State Roads or County Roads. Include the road
12. CASING: Wall eit�t� numbers and common road names.
Depth Diameter or Weight/Ft. Material _
Frog^ _ To Ft. y7—
From 0 To .Z FL
From (/l'c To4_92_Ft. OYUI
13. GROUT: Depth Material
From To Ft.
From 0 To 0 G' Ft. , E 1 Let- .8-cl-
Diameter
Ft. in.
Ft. in.
Method
14. SCREEN: Depth Slot Sue Material
From_ To in.
in
From To
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft. _ From To Ft.
Cotmtye--
16. REMARKS:
RE ,7 Ii itE9Y
L fliiEffei1
i
GROUND
ASHEVILLE
ASSOCIATED WQ PERMIT*
(if eu0licableZ
255975
c
o
Y THATSTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF TINS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
0./% •
Si ATURE JF PERSON CONSTRUCTING THE WELL DATE
Ina! o the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrI RBVgh, NC
i�e�Qe No.l(919) 733-3221, within 30 days.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
248727
DRILLING CONTRACTOR: it it—?' �%�eu� NMI
DRILLER REGISTRATION #: _ S50
STATE WELL CONSTRUCTI N PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial E Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: t9G,9 /5/Ef County
/77/ Can 41
(Road, Community, or Subdivision and Lot No.)
3. OWNER \gir/
ADDRESS Efi�b' e//,'0771
gsk(Street or Route No.)
City or Town State
Zip Code
DEPTH
From To
DRILLING LOG
Formation Description
/75 ,o i27a_da* r1C/Sf1G'�G
4. DATE DRILLED,9`G2 Ora, 75^. PS .84emmtl 4i _feed
5. TOTAL DEPTH ��
6. CUTTINGS COLLECTED YES [ I / NO[f Q`,5�
7. DOES WELL REPLACE EXISTING WELL? YES n NO[ - 5 D?, _4,4-Aac, tie.
8. STATIC WATER LEVEL Below Top of Casing: ,»p FT.
a (Use "+" if Above Top of Casing)
9. TOP OF CASING IS /(2 FT. Above Land Surface*
Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118 .�
10. YIELD (gpm): 3L) METHOD OF TEST g/7z.
. 11. WATER ZONES (depth): sal/,1J0 6:1 r Amount kp UZ i 3 . If additional space is needed use back of form
12. CHLORINATION: Type /24.4/4.24
13. CASING:
Depth
From 0 To ,-5_ Ft
From 0.5-5- To--�J-- Ft
From J5- To 7 Ft
14. GROUT:
Depth
From To - Ft
From 0 To ry.1& Ft PQ PCP2.4117a
15.SCREEN:
Depth Diameter Slot Size Material
From To Ft in
From To Ft in
From To Ft in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
Wall Thickness
Diamet r or Weight/Ft. Material
_ 94 r//e.
Rc') Al/L
77
Material Method
Size
in
in
in
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
i � I
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT ,ANDA DS, AND THAT A l� F THIS RECORD HAS t5E-E91 PROVIDED TO THE WELL OWNER.
FOR OFFICE any,
Quad No
Serial No:
E QYCONTRACTOR OR AGENT
mit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE
ASHEV LLE REu10':'P4_ Ci irtuE

252122
Topographic/Land setting
❑Ridge ❑Slope ❑Valley It
(check appropriate box)
nn A ( Latitude/longitude o well loca�n
3. OWNER:S,44R/if4 /v /IR tµ-i 3J 0 2 /h ds) Oy 35
(degrees/minutes/seconds)
Address /n2— ( Latitude/longitude source:❑GPS❑Topographic map
meet ar Route No.) (check box)
3 LA-1-fit E t2 2D-F0 N u C. zg(3 7 DEPTH DRILLING LOG
City or Town rate ' .Zip Code From To Formation Description
6?2n- 2-geo - 4qy f a - 70 j7,/2 f--
Area code- Phone number 70 - 20 /] I7/'Jgpo/7r7_
4. DATE DRILLED Z - / 3 - 0 2-
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section —
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a /Z ///}L(/s—/ 6173 / CERTIFICATION 0 2 5 2/
WELL CONTRACTOR COMPANY NAME CTI r /e n Ral-a r \Np Pu,rrl p C O PHONE # (727) C. 9 3 -120D
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI //11 n
Nearest Town: J/h/F/2}ni?cJt4- /t county V then }giNeife,„
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
cLENrurn
c
5. TOTAL DEPTH: Z O 5_
O `c-
6. DOES WELL REPLACE EXISTING WELL? YES Cr NO ❑ cr
me 7. STATIC WATER LEVEL Below Top of Casing: /, 0 FT. Orr'
(Use "+" if Above Top of Casing) z rn
8. TOP OF CASING IS / FT. Above Land Surface• 1 �<
CJl -c
*Top of casing terminated at/or below land surface requires a ]p
variance In accordance with 15A NCAC 2C .0118. -0 4-4�
9. YIELD (gpm): % METHOD OF TEST /7. m
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To G L Ft. < <{ 27� C Pl/L
From / 2- To 92- Ft. L 4 2 /, 6 PI/C-
From To Ft
W cn2
LOCATION SKETCH r
Show direction and distance in miles from atil:1st 2
two State Roads or County Roads, Include the road
numbers and common road names.
13. GROUT: Depth Material Method
From ,0 To 20 Ft. bnkR/=tr- M,`y ac-Pp0/2
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNITURE OF PERSON CONSTRUCTING THE WELL
2-/3 DZ
DATE
ubmit the original to the ttGieion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
7699-1636 Phone No. (919)I,733-3 21, within 30 days. GW-I REV. 07/2001
)
n_ OrC T...
Al OF`::

WELL CONSTRUCTION RECORD 252140
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ��5 �/
IZ r,k° 1YJ i }-L1 CERTIFICATION # -
WELL CONTRACTOR (INDMDUAL)NAME (print)/ yry74i (e rl '�-120D
WELL CONTRACTOR COMPANY NAME G-i C9A RN/ �N'7 li S PLAmp ([t PHONE #
STATE WELL CONSTRUCTION PERMIT,/ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Id Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI?N: // rr) p :/ nn
Nearest Town: 'Ui-ht- OAd iVit1 County Rl7/NY21Y�Rclronci
(Street Name, Numbers, Community, , Subdivision, Lot No., Zip Code)
r I el /( / o 4G 5(degrees/minutes/seconds)
3. OWNER: ( / 6 Latitude/longitude Source:l iPS❑Topographic map
Address �� �55 � (check box)
n�J (Street or Route No.) DEPTH pRILLING LOG
JityorTown /tG Zi��e Formation Description
City or To rate .Zip Code Fropl bT�
//0 - a87 4 /
Mu code- Phone number O 2_.4. DATE DRILLED
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? YES firNO FT.
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .01111.
9. YIELD (gpm): / 2 METHOD OF TEST 4/22.,
10. WATER ZONES (depth): /6 2- 6'141
3(5"— /0(3Pm
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To .7 /7
From 5'7 To //7
From To
13. GROUT: Depth Material Method
From 0 To 0 Ft. ,5A%Rri,- A;y e,,,
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft. G 2.7.
Ft. L y 2,! < P c
Ft.
Topographic/Land setting
❑Ridge QSlope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
35"O zit' 07A/ 082c 02 376>
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commgn road names.
/,0
-o
-v
lJ
J
CONS-'RUgtTItLz j 5..,
Submit the original t the
27699-1636 Phone No. ' 19) 7
OROU v SECTION
ASH'.EVILLE E'iAAL OFFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
S, THAT r COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
a 3221, within 30 days. GW-1 REV. 07/2001

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
254234
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• i1�`���24/'Y
17.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Ea --Municipal ElIndustrial IDAgricultural ElMonitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
r
2. WELL LOCATIO.4N: (S ow sketch of the location below)
Nearest Town: C— � SC County:
(Road Name and Numbers, Comm ni or Subdivision and Lot No.)
3. OWNERiQif/ �.��
Address 3,,y`
Route g)oar-j j q
JJ State �j ZipCodeCode4. DATE DRILLED .Ct J —6
5. TOTAL DEPTH de)
6. CUTTINGS COLLECTED YES NOD
7. DOES WELL REPLACE EXISTING WELL? YES © iJOf
8. STATIC WATER LEVEL Below Top of Casing: , / FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .01 8
10. YIELD (gpm) METHOD OF TTEST Jes
11. WATER ZONES (depth): /J_I'sn
City or To
DRILLING LOG
From To
lOSTR
Ai-
47'
12. CHLORINATION: Type /�. c244'-c ')
13. CASING:
Amount %g%�
Wall Thickness
/ Depth Diameter or Weight/Ft. Material
From / To Ft. G /y fz'EQ) .2iC
From To Ft.
From To Ft
14. GROUT:
Depth Material
From Tod Ft /->�4'�
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in
From To Ft in.
From To Ft in
16. SAND/GRAVEL PACK:
Depth
From To Ft
To Ft
From
17. REMARKS:
I DO HEREB
CONSTRUC
Size
ethod
Material
in
in
in
Material
DEPTH
Formation Description
etgit-Afkig
neer„v secA'
c
N o
� fl
am'
o
—cr
H0
t 0
N
If additional space is needed use back of rn
m,
r7
LOCATION SKETCH
(Show direction and distance from at Least two State
Roads, or other map re erence points)
gel.
we
O
tV
i/1N12�,e.fo SC n
w
tO
CI) .7_
0
IFY TYd7tT THISWELL WAS
ANUAHUS, ANU IHAT-C
G
Submit or ginal t
R2E
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

OWNER- rt1-Q�� �,�r vc.ee
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural urces - ivision of Water Quality - Groundwater ection
249507
WELL CON'I RACTOR(INDIVIDUAL) NA l8t111.S et 1.7 i i1/44. �-1 . CERTIFICATItVY2I-
4 NAME
(print) ` 1- ' s
!1 kdk. ��--IA II 1..JTI�I I �j _PHONEY �t5 CI
WELL CONTRACTOR COMPANY NAME
SFA rE WEI.I. CONSTRUCTION PERMIT#
(if applicable)
ASSOC( WQ PERM!
(if applicable)
E. i1 " act)
an011IMIN
I. WELL USE (Check Applicable Box): Residential I" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:, ' /^
Nearest Town:_I 1 \I l 1 - `f i v<J County C.0 f'};•-k. )'d
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3.
Address L y 3 H. I CkC'. .C1
(Street or Roul No.)
Crr . e (`5
City or Town Siete Zip Code
)-
Arca code- Phone mmmbcrz _ `/ _ t�
4. DATE DRILLED 1.
5. TOTAL DEPTH: ) T /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G]/
7. STATIC WATER LEVEL Below Top of Casing: (n< ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated Wor below land surface requires a {
variance in accordance wi ISA NCAC 2C.0118. w ( ^tan--'FStILL 4i 1
9. YIELD (gpm):• METHOD OfTEST
10. WATER ZONES NI. 111) 3'C
�/1
II. DISINFECTION: Type et_ Et
12. CASING:
Depth !! Diameter
From V To 7l� Ft._`_
From To Et.
/Topographic/Land setting
DRidge ❑Slope ❑Valley C Flat
(check appropriate box)
Latitude/longitude of well local nn
(degrees/minulcs/seconds)
Latitude/longitude source:❑GPS❑Topc raphic map
(check box)
DEPTH DRILLII G LOG
From To Formation 1 escription
From To FT.
Amount Z
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Matena (I,` Met
From _ To Ft.e&fl("U Tt -PG
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. _ in.
From To Ft. in. _ in. --
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From _To_ Ft.
16. REMARKS:
—4
LOCATION SKETCH =
Show direction and distance in miles frt n at least
two State Roads or County Roads. Inch ie the road
numbers and common road names.
/" -
Submit the original to the Divia
33-3i
GROUNDWATER S-
ASHEVILLE REGIONAL OFFICE
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D TH21/..1/4„..93PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 (NER
;NATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Qua Bty, Groundwater Section, 1636 Mail Service Center - Ralel h, NC
1, within 30 days. GW-1 REV 117/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural �, urces - ivision of Water Quality/ - Groundwater ection
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ir�YrYsU1 RR'`ww'`��asJJppei ��'jPy r��1 L7_a CERTIFICATI< V Y GL�O
3
r'T �zi(.ItiSV ILL!. ^1 1.11I fl i4AL PHONE .03D5--Iz-T-3
O'EI.I. CONTRACTOR COMPANY NAME IIIII ��'' 11 - ZAc5 Z
STATE WEL.l. CONSTRUCTION PERMITS ASSOCIATED WQ PERMI
lwe
i if applicable) pfa licabie)
I . WELL USE (Check Applicable Box): Residential E� Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2_. WELL LOCATION: r
Nearest Town: YLc1 t1\ Y3\L1V(
ri:49306
ttttttst�
id /Topographic/Land setting
County \V_ )�-.'� '�%�1 - °Ridge DSlope ❑Valley C Flat
(check appropriate lox)
Latitude/longitude of well local DTI
(Street N:nnc, Nunbeis, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: /
4
5
6.
7. STATIC WATER LEVEL Below Top of Casing. _CQ —FT
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface require a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): \I t . METHOD SZF TET
10. WATER ZONES (depth): �C
I I. DISINFECTION: Type TAmount 1/
12. CASING: Wall Thickness
(. Depth Diameter or Weight/Ft. Material
From \_ To '�6 Ft.
From To Ft. From To_ Ft. ---
13. GROUT: Depth Material /I-- Mft
From To Ft.69nci-e`F'c ��/
From To Ft.
---
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Address
City or Town State Zip Corte
Area code Phone mmniser
DATE DRILLED
TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL? YES 01)
From To Ft.
From To Ft.
6. REMARKS:
(degrees/minutcs/seconds)
Latitude/longitude source:OGPSDTopc
(check box)
DEPTH DRILL!'
From To Formation
raphic map
l escon
N
LOCATION SKETCH 0
Show direction and distance in miles in n cleast,:
two State Roads or County Roads. Inch ke'tR'e rot
numbers and common road names. U o
Jai
?Ltt)Q Cc
I DO HEREBY CERTIFY THAT TH
CONSTRUCTION S DARDS, A
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 (NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAT
Submit the original to vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Relel h, NC
27699-1636 Phone'tio,
GROLINGV/AT[
ASHEVILLE REG
SECTION
AL OFFICE
-322I, within 30 days. GW-1 REV 07/2001

2671.72
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
'/_fy7 ,(I CERTIFICATION N�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Ke U eth /rte�f my 81 I N 2066 3
WELL CONTRACTOR COMPANY NAME barker Well and flA -f) fl PHONE N
B71 ASSOCIATED WQ PER.V ITil
STATE WELL CONSTRUCTION PER.VIITN (if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential Ely-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topogr ic/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION: �
Nearest Town: Nr7.XP County
'Boys Cur Doti
Num
(Street Name, be Community, Subdivision, Lot No., Zip Code)
3. OWNER: aYl-es E'l(i /O 16 &to -prt
Address co2s North ?mitt Drive
/ y� (Street o Route No.)
takeL1ArE g 1�t
ity or Town State
)- 67a -ag6
Area code- Phone number
4. DATE DRILLED I I,Z.—OZ
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES /❑'� NO V
7. STATIC WATER LEVEL Below Top of Casing: J.&O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.3 3 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
Yin accordance with ISANCAC 2C .ot METHOD OF Timed.
med
9. YIELDIELD (gum):
10. WATER ZONES (depth):
$y /Dury mutates
l 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Material
From To_Q Ft. (0 74 sv&z 1 pvc
From To Ft.
From To Ft.
13. GROUT Depth A Material M th d
From Li To.2O Ft. COncrett
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.
G
1 UU HEREBY CER
CONSTRUCTION S
Zip Code
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.
Fan bo_ke_ tu.l'e go up &o(s
eanvo Road ¥PPro' 0
1paJtr°andtes. Take a_ri ,'t
-f h,° W rk C Cut- Rd
lAj )
slot Size Material -ra-Ye a_right on X der
in. slwre Driv,e. Will
Fi)'s- drive rn the r�
Material
(degrees/minutes/seconds)
Latitude/longitude souice:❑GPSJTopographic map
(check box)
DEPTH DRILLING LOG
From - To Formation Description
_ ,3A��riN� T�
SIGNATURE OF PERSON CONSTRUCTING IE WELL DATE
AT R SE iiON
GROUNDWATER S6;lO
ASHEVI�������Q�rl�iFiCtEto th Division of Water Quality, Groundwater Section, 1636 Mail Service Center
REV�07- Raleigh, /?001
27699-1636l'hone No. [phone], within 30 days.
3
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL Na <n-
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1- 13 z

11
L.
i Sultmit_the_urigival to the Di
270g7' `1636 Pilot r iNor,(019) 733
257?_7S
WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)'Irhard/%leeraY CERTIFICATION # 0/(1
✓ f�%�
VA'ELL CONTRACTOR COMPANY NAME � Well and///��� PHONE # 8�9 42� 13
STATE /�A �WELL CONSTRUCTION PERMIT# / ✓'f /
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
L WELL USE (Check Applicable Box): Residential l9e--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT
Nrest Town:
BeTOYS C'_aip
(street Name, Numbers, C�ommuunity, Subdivision, Lot No., Zip Code)
3. OWNER:1�` L Ix/fi/.��Wtar ��
Address rl `h( Mars
itim (Street or Rot o.) cw541
CitycirTown Smote /.. Zip LICVIC ��
Area code- Phone number
4. DATE DRILLED
2.
5 TOTAL DEPTH:
N
CotmtyR/ lhei U'l -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L'7
7. STATIC WATER LEVEL Below Top of Casing: FT.
q 2 (Use "+" i r Above Top of Casing)
8. TOP OF CASING IS I• -Ea 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 1 1 reed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ifterCI
(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
13PumInstaller-
II. 11. DISINFECTION: Type
12. CASING:
Depth Diamet r
From 0 To 6 Ft. �p '/�
From To FL
From To Ft.
O
(J
G
yi
ctt
0
0-
`
ram' L
cn
LOCATION SKETCH
Amount Show direction and distance in milts from at leasq' z
Wall Thickness two State Roads or County Roads. Include the road
or W'eight/Ft. atenal numbers and common road names.
4DC2I d& Front_ 0.-kimney RocX kale
beftjyw aroorz ss#76/ 6s a�e. Roadat
head of j - W& oh
cYOSSI K-d C 1 P
�_���./
L C%7VelV wej/ Is li r Cte-e -
iC rear Qf 6tause.
13. GROUT' Depth,‘,„, ///I Matcria1l�
From 0 To t l/ FL('Q✓IOIZit
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
Metho
pour
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16.REMARKS:
Size
Material
' Dcy( Efy613cOtrIo
14ST I211I-TI ONt STA$4 D
HIS WELL WAS CONSTRUCT
PY/OF TH
SIGNATURE
D IN ACCORD
CORD H
CE WITH ISA NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
O Ste.
DATE
SON CONST
ision of Water Quality, Groun
3221, within 30 days.
CTING THE WELL
eater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM (print
WELL CONTRACTOR COMPANI' NAME .(y[AA )QO
260160
ural Resources - Division of Water Quality - Groundwater Section
n CERTIFICATION ttk.2 / ry�7
/
(l_J,94 (J-I./PHONE # ("Q In 9 098Z
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 0 If Other, List Use
2. WELL LOCATIfajVD
Nearest Tow ,/ CountyS/7,Y i n ,/
(Street Namee/, Numbers, InnCommunity, Subdivision, Lot No., Zip Code)
f 3. 0WNER:t , 1 ,t Qiy/ qyf
Address $3 a 7f8-d&/ red OO
(reet or Route No.)
City or Town State
(—) A/4.l
Zip Code
Area code- Phone number /�
4. DATE DRILLED
5. TOTAL DEPTH: /7,..S
6. DOES WELL REPLACE EXISTING WELL? YES Ai NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /' [) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,j FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth): /73-
11. DISINFECTION: Type!!//ypei Amount %/o 67-
12. CASING: Wall Thickness
Depths_ 9iameter or WeiehUFt. Material
From 0 To /—r F
From To F
From To
13. GROUT: Depth qq
From [i To rQ/7 Ft. /eal! J. Ithk-1
Frorn To Ft.
#.zr Fee -
Ft.
Material Method ,
14. SCREEN: Depth Diameter Slot Size Material
From /To Ft, in. in.
/
From / To Ft. in. in.
15. SAND/GRAVEL PACK:
Dep�th Size Material
From Ft.
Fromm To To Ft.
tu•
RKS
Topographic/Land setting
DRidge ggSlope ❑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
ro
0,
'D
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AS
Y Ef IFY
CONSTRUCTION STA P • •I�.
SF
8�y
/46tt-
u6 0 Cad
D
gr
-ro
6n ILLS ®o-
�tl
1
tzt
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
,ND/ HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g// Y21 a t—
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
• • • 'Pi1fkTit9Ouerp4 e Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
.. it • !; i'b4& % 733-i 221, within 30 days. GW-1 REV. 07/2001
2

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)L eN 8 h o d�%e �5 .i.2.7 • CERTIFICATION*1 gq
W ELL CONTRACTOR COMPANY NAME lie—yj�L -O- La-ZP Ai/4 PHONE it gal 4i overa
STATE WELL CONSTRUCTION PERMIT# N/j ASSOCIATED WQIPPERMIT# AI/#
(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 LOCATI
Nearest Town: County XtlLAP
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Me .7 � & tnt,LvC
Address y'
C/,b4./�K(lera (Stre or Route No.)
t
City or Town State Zip Code
fl)- 6 7-?SP?
Area code- Phone number
4. DATE DRILLED .J//%/D
5. TOTAL DEPTH: 3 DS
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing.
(Use "+" if Above Top oT Casing)
8. TOP OF CASING IS 7 s FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0I18.
9. YIELD (gpm): S METHOD OF TEST_T: �
10. WATER ZONES (depth): . /1S I
NO Al
FT.
11. DISINFECTION: Type -�i i . Amount ' DZ.
12. CASING: I% Wall Thickness
Diameter or Weight/Ft. Material
From © S' t. tIZ Pa &
From
From
13. GROUT:
From O
Depth
To O F
To Ft. /
To Ft.
Depth Material
To Ft (
From To Ft.
14. SCREEN: Depth Diameter
From To Ft
From To
15. SAND/GRAVEL PA
De
From
From
16. REMARKS:
�tDO L#ER[1BY,CEI1
LJ I PTA r
Fm. A,I Li
D
o the
r .. -27419%*t1436'tittarerNpp:L(919)
Method
114.5/
Slot Size
in.
in.
Material
255782
Topographic/Land settin
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
3
LOCATION SKE CH O o
Show direction and distance ' miles from at least
two State Roads or County ' oads. Include the road
numbers and common ro : names.
2aa,,y
..
At ea.
A. Rom
mu, L ylagq
ow Riyb/T
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
:DS, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF P
t
ON CONSTRUCTING THE WELL
60,1/4
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
133-3221, within 30 days. GW-1 REV. 07/2001

253448
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
L/
ed�5 T.
CERTIFICATION #OG/ p 7
WELL CONTRACTOR (INDIVIDUAL) NAM U�+nt>I�L<eN %/ /Dyge)1
I ate/ r�l PHONE # fPES
CONTRACTOR COMPANY
WELL CONTRA NAME
STATE WELL CONSTRUCTION PERMIT#, JAf-- ASSOCIATED WQ PERMITS *(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential pi Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: 71
Countyd2alkead
(Street Name, Numbers, Community, Subdivisi . Lot No., Zip Code)
3. OWNER:
Address 9*i
( t or Route No.)
4,.. i2 j ihr .
City or own /[ Zip Code
r� fff
4. DATE DRILLED 3/L /0 Z-
5. TOTAL DEPTH: "O. C
6. DOES WELL REPLACE EXISTING WELL? YES M NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2 C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % S FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
vardance in accordance with ISA NCAC 2C .ells. -
9. YIELD (gpm): ____C____ METHOD OF TEST 7T Z-nte
10. WATER ZONES (depth): /4.0 I
11. DISINFECTION: Type Amount Zia_
12. CASING: Wall Thickness
Depth �f��fmf� Diameter or Weight/Ft. 1vJry _Aerial
From�TolaFt. G4 # .i/ (V C
From To Ft. 7
From To Ft.
13. GROUT: Depth �t �fMateeriall ethod,
Frome_ To Ft. &s.n1e ..e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frotn_ f To Ft. in. in.
From /YET To Ft. in. in.
15. SAND/GRAVEL PACK:Depth Size Material
From Al To Ft.
From N/If To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Wlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
IV
Arca code- Phone number
16. REMARKS:
L; ,H1L H 1 YcR
CONSTRUCTION S
r
1I '.i
tr
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Inclu
numbers and common road names.
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
.1/z/o z—
SI NA OF PERSON CONSTRUCTING THE WELL DATE
$stpuut the jg 1 to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REV. Raleigh, 2001
27600-1636 Phone No. [phone], within 30 days.
n

249735
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
/- Division of Water Quality - Groundwater Section ' /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �4L L C LA/ /' b b D e `5 Tr CERTIFICATIION 7po g'7
WELL CONTRACTOR COMPANY NAME �.(12E .ter l.Q.r�. 1.tJ. Lig,tiC.of PHONE # (�aati L 97- .*
STATE WELL CONSTRUCTION PERMIT# 4//q ASSOCIATED WQ PERMIT# 07
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential cm Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI ai :
Neares_ own:
mHUi+e**�ergze
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERFd' V
9214t f[riLLct-/
Address
(St or Route No.)
� C.
City or Town State Zip Code
021)- L sr7 -Co 7-5-
Area code- Phone number , r.D �.
4. DATE DRILLED /
5. TOTAL DEPTH: ..Z 3c r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. .S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
valiance In accordance with 1SA NCAC 2C .0118.
el It 7.5,2-
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
9. YIELD (gpm): yA METHOD OFTEST T.Gn4t
10. WATER ZONES (depth): //O d D
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To 7.S Ft. /i
From To Ft. /
From To Ft.
13. GROUT: Depth
From_ To Ft.
From To Ft.
Amount /02 `p
Wall Thickness
or Weight/Ft. Material
gra' Pv c.
aterialMethod .
Lr m-ty
14. SCREEN: Depth Diameter
From__,(/. To Ft. in.
From ////t To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From /YtYr//'t To Ft.
16. REMARKS:
GROIMay
ASKEVIEL
Slot Size Material
in.
in.
Size Material
r"'"N
-v
ti
LOCATION SKETCH o
Show direction and distance in miles from at least z
two State Roads or County Roads. Include the road
num, , and co on road�names.
0o
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
nS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.4, o2/A2/0
IGD7ATURE OF PERSON CONSTRUCTING THE WELL DATE
o the Division of Water Quality, Groundwater Section,1636 Mail Service Center -Raleigh, NC
agr(919) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an aatturrall Resources//- - Division of Water Quality - Groundwater Section
/�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) v-hO- dAtr V7itV CERTIFICATION Qf/(0
line 647 -7S3
WELL CONTRACTOR COMPANYNASIEZarKee-
�'P 11 and RiMp PHONE #
STATE WELL CONSTRUCTION PERMIT# 1 8 / / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264677
1. WELL USE (Check Applicable Box): Residential ['Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCADQN.
Nearest Town
County kikeheiCti
6 Rd.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER' : "VV1 5�Q
Address C P2 ia-S11Wi2 L)fi `Lc-
I� ifivn
(Str7ieet or Rsiand ute No.) G4'/Zb end
City otT wn State Zip Code
( 3)- 3�4-5a31
Area code- Phone number
4. DATE DRILLED i A5'09d
5. TOTAL DEPTH: /o05
6. DOES WELL REPLACE EXISTING WELL? YES __NO E"
7. STATIC WATER LEVEL Below Top of Casing: b FT.
I. 53 (Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordan with 15A NCAC 2C .0119.
9. YIELD (gpm): METHOD OF TEST7Th1ed
10. WATER ZONES (depth):
�y pump irtsialfer-
11. DISINFECTION: Type
12. CASING:
Depth, pipter
From_D___To 644 Ft. (p
From To Ft.
From To Ft.
13. GROUT: Depth n Material
From 0 Tob_ Ft. lAneY
Amount
Wall Thickness
or Weight/Ft. oblate al
Stne z I �JLS_
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Yawed
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
<,3
N -
LOCATION SKETCH `'a
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ywrrL 3a+ e.aue. -La Pc . 71t
ast l.41.,e Lure -I-o l eft- on
l s re2- Zoa_a• 0, �F
Wks Liek on Cod a_r &eat
12oad . G)-o 3.7 Wiles 4-b end_
of pavern€nf. Oo ojto her .8
riu Les ovr_ dirt rood. C°rbss
3 Crre.ek"K.oad. Tllow &1be,
brows -}o lead 6L-Voa.d
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIOY.SZA�11�t LDS, AJ1ID H T PY OF THIS RECORD HAS BEEN PROVIDED T/CQTHE WELL OWNER
SIGNATURE OF P SON CONSTRUCTING THE WELL DATE
Submit Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /cJ/Z ye k%1rcSal / k1 CERTIFICATION rr R5'7.I
WELL CONTRACTOR COMPANY NAME el r9.11 n RN*r �nlr II \ Pu.In 0 Cr) PHONE N D'ZFI (d' 3' 1200
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
276080
1. WELL USE (Check Applicable Box): Residential El -7MunicipaVPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Ne est Town: L--O4-C
Otte.' is
J'I tte.'Of Sfzt
County Rif }10L).-- Dvk
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Irk (-I.cu /12t.+
Address Po Rn x r{ 9d
(Street or Route No.)
rnidl S9110c11ICCa?7slo
City or Towr Stad _ . Zip Code
05,2S)- 217 - 24 Les
Area code- Phone number
4. DATE DRILLED // - 2, 7 —O L
5. TOTAL DEPTH: 5 OS'
6. DOES WELL REPLACE EXISTING WELL/ YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: lid FT.
(Use "1" 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 I5A NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST Alta
10. WATER ZONES (depth): / 85-
11. DISINFECTION: Type /t rR
12. CASING:
Depth
From 0 To 3 7
From 3 /J To 57
From To
!3. GROUT: Depth
From_12_ To 2 0
Amount
Wall Thickness
Dianeter or Weight/Ft. Material
Ft. z 7 e
Ft. ) /. / P✓C.
Ft.
Material
Ft. /i;k/tt,fiY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Method
/N, y 94-15.0c2
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size Material
Topographic/Land setting
Qthcclge ❑Slope ❑Valley ❑Flat
(check appropriate box)
35�titudellon tude of well location
4' 50/�, USab 09' a2.3(-4-)
(degrees/minutcs/seconds)
Latitude/longitude source:l3GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
t—
/l l?cc.dk
From To
©— 6,0
ti o - 5 0
3*-0 - 5 03-
S
LOCATION SKETCH
Show direction and distance in miles from at least
two State ' o ds or County Roads. Include the road
numbers ana &o on road names.°
(nJi do - IIIO/.d!'r }" aL') —'
v;slzL
•
rl -
r
.1-
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,
Submit the orlg n'Pi
27699-1636 PhOo
J
SIGNATURE OF PERSON CONSTRUC l ING THE WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL OWNER
LIS Oat
DATE
to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
[phone], within 30 days. GW-1 REV. 07/2001
GROUND R SECTION
E kt-_'.f,L OF!'iGF

267073
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J a m n
C"mp, Jr
WELL CONTRACTOR COMPANY NAME ("amp' s telP 1 1 & Pnrnp,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
CERTIFICATION # 21 i 8
(if applicable)
Tnr PRONE #g7R) CR3_7322
1. WELL USE (Check Applicable Box): Residential COY Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
Y� Counry �LII YII�Y YJ
C>,�K — yocksliKe—
(Street Name, Numliers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(tV l r bore
176, ¢ii-ayt elf L� )'f
tree('Route No.)/
L�J K. !V
RAleit
City or Town State /
( )-
Area code- Phone number
4. DATE DRILLED J Z o<.Y — D?
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES El/NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1* 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): lge
Zip Code
11. DISINFECTION: Type r h 1 n r i n
12. CASING:
Depth _ Diameter
From p To 6f5 Ft.6 i/4 eDR-2l
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 20 Ft.
Material
Neat Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
JAN
S bmtt the_ori¢inal s I • tivisi
2 OVI7 -322
ASHEVILLE REGIONAL 0 1
Amount ,91 c-mp 5
Walt Thickness
or Weight/Ft. Material
PVC
Method
Hand
Slot Size
in.
in,
Material
Material
). 7 y O �, i nIS1^)
PEPTIj
From To
__C_ 9h
Topo phic/Laud setting
DRidge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS ❑Topographic map
(check box}
DRILLING LOG
Formation Description
Yaffe/ dint
c 5— 705 B1(5c% 1at�) Yock
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road el
numbers an common road names. o
W
L E
1 el 5
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i-p
NATURE OF PERSON CONSTR
HE WELL
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
, within 30 days. GW-1 REV. 07/2001
sr
rn
tn=
r
G

267075
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J mA s t•' C arn-p, Jr
CERTIFICATION # 2 1 18
WELL CONTRACTOR COMPANY NAME Camp' s Wal 1 R Pnmp r'rr, Tnc PHONE ng7R) d59-7122
STATE WELL CONSTRUCTION PERMITB ASSOCIATED WQ PERMITI
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION): // / y
Nearest wn: (-(/ ' 61 (le County �K �l fiftAY
TGl/ -fsl e FsPa- es
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ad_ li l��/me6
Address 13O}( �e /
'(Saeet or E. ute No.)
Nic
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED a -:17 - D�
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES e NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4,0 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 1SA NCAC 2C .0118.
9, YIELD (gpm)' •METHOD OF TEST A-i r
10. WATER ZONES (depth)• co 0
11. DISINFECTION: Type Ch 1 nri np Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
eDP21 PVC
Depth Diameter
From__ To / I Ft. 6 1 / 4,
From To Ft.
From To Ft.
GROUT: Depth
From__ To 20 Ft.
N at
From To Ft.
SCREEN: Depth Diameter
Fram To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
Cement
Method
H,1
Slot Size Material
in.
in.
Material
Topographic./Lan/setting
❑Ridge ❑Slope OValley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box).
DEPTH DRILLING LOG
From To FormtionDescription
IID 5cc.nU
Ho o 27 rop(7clt dated ✓c ck
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or Counl
numbers and common rot
Roads. Include the road
i names.:T
r'D
0
W
1
fV
GI
a)
Suptttit the orieinal_to the1ljvisio
276994441361PliMiiNoS i M33-322
ASHEVILLE REGIONAL 0 FICE
WELL WAS CONSTRU(;IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/i >
ATURE OF PERSON CONRUC G THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001
c
0
c-)

267074
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jam ms LL Carpi, Jr- CERTIFICATION #__213.3
Camp'' Wall R Primp ('n Tnr PHONE #ffi7R) a54-7322
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential 12' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELLLOCATIONt
Nearest Town:
� 1 \
(Start Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C, IN\ ^i)✓'NA4
Address .)-1\ \-\Vt`t-Q/1°(/‘- ,
Street or outelao.)
i�Na. L 2Y 13 9
City or To o State Zip Code
( )'
Area code- Phone number
4. DATE DRILLED 0 - \f. 0'L
5. TOTAL DEPTH: 1p 4S
6. DOES WELL REPLACE EXISTING WELL? YES 0 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): 1 oL METHOD OF TEST Air
10. WATER ZONES (depth): \ A �x
11. DISINFECTION: Type rhl nri np Amount ,D LAA.iO
12. CASING: Wall Thickness
or Weight/Ft. Material
eas21 PVC
Depth Diameter
From 0 To -Ft. 6
From To Ft.
From - To Ft.
13. GROUT: Depth
From_p To 20 Ft.
Material
Ncut Ccmcnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
C
t
Ft.
Ft.
Slot Size
in.
in.
Material
Method
Hand
Material
County \\AA'tnil
Topographic/Land setting
Midge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING LOG
From To Formatkon Description
a- V C1/4-. 1 � /�iL4M Xa
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
w
c_
gas
.s I 0'1
es
IVs
ra
p I�RE8I�EI��F
NSTRUCTION STAI
the
A HE#LL"�E c�IY�:'."nr�.,'"` 119)7
T THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH I5ANCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Lex
IGNATURE OF\PERSON CONSTRUCTING THE WELL
DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamns c,r Carrt�j, T� CERTIFICATION" 21 38
WELL CONTRACTOR COMPANY NAME Campt c Mall R Primp r'n_ , Tnr PHONE 1/89R1 4cV —7322
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
267078
1. WELL USE (Check Applicable Box): Residential Pr Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towg: County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cab A I'Ii
Address , ` (y�'
(Svc Route N
City or Town State
( )-
Area code- Phone numbeq
4. DATE DRILLED 1 2 - \ O 2
5. TOTAL DEPTH: S DE
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tYll
7. STATIC WATER LEVEL Below Top of Casing: 5-FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
' 'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 ME OD A
OF TEST ix
10. WATER ZONES (depth): C S 0
S C.
Zip Code
11. DISINFECTION: Type rh l nr i n a
12. CASING:
Depth
From IDTo
From To
From
13. GROUT:
From p
From
14. SCREEN:
Diameter
Ft.6 1/4
Ft.
To Ft.
Depth
To 2 0
To
Depth
Front_ To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
To
To
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
QDR21 PVC
Material
Neat Cement
Ft.
Diameter
in.
in.
Slot Size
Method
Hand
Material
in,
in,
Size Material
From Ft.
Topographic/Land setting
idge ❑Slope Walley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)-
PEPTH FRILLING LOG
From gib forma[on DY,n (Ltp
1%0 SDS
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.
CO D
c2 t
Ct
fi
—0=�
r'o
cnm
m
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
ATUREA OF PERSON CONSTRUCTING THE WELL
—
DATE
05_
Sub h pridelrivision et Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC '
2769 0,19I;78131,5221, within 30 days. GW-1 REV. 07/2001
From Ft.

267080
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James to Carpp, Jr
CERTIFICATION # i 1 3 8
WELL CONTRACTOR COMPANYNAE Camp' R Wa11 $ Pnmp Pn TnC PHONE #817R) d54-732i
M
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LieMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAT ON
Nearest Tckim
(Street Name, Numbers, Comm ,ty, Subdivision, Lot No,, Zip Code)
3. OWNER S &COR
Address r
(Street or Route No.)
is C—
)4s14b
Ciry or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED \ a - , a - D a
5. TOTAL DEPTH: -9aS
6. DOES WELL REPLACE EXISTING WELL? YES I'NO 0
7. STATIC WATER LEVEL Below Top of Casing: L\ O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
'Top of casing terminated atfor below land surface requires a
' variance In accordancq yvIth 1SA NCAC 2C .0118.
9. YIELD (gpm): ME HOD OF TEST r
10. WATER ZONES (depth): rL ai DO
11. DISINFECTION: Type rh 1 nri np Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To \ 3O Ft.6 1 /4 eDp21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft._Nea_t__Gefeent
From To Ft.
tx-
Material
PVC
Method
Hand
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Size Material
Topographic/Land setting
❑Ridge `laSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boxy
PEPTIj PRILL1NG LOG
From To rmatio Des 'pti
n I3l)
j3t; ,2D-5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r9a
numbers and common road names.t`,✓-
11
16. REMARKS'
tV
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WFT I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I
t thelpriginal tathe Dii{i i
9-iM Phofte No.^(919) 7331-13411,
o-�
OF PERSON CONSTRUCTING THE WFT T DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001
GML Ji\

267076
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamin 5 ur Camp, Jr
CERTIFICATION p 7 1 3 8
WELL CONTRACTOR COMPANY NAME Camp' c Wal 1 R Pomp ('n Tn r- PHONE #67R) d SI_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 ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION(\ pp
Nearest Town: QAAX XuD. iM own
(Sweet Name,` Numbers, Commum Subdivision, Lot No., Zip Code)
3. OWNER: .9J\ /Sl n& lq VI
Address ) a I4 �,
(Seca or Route No.)
a 0 .rt. ScAI,Ax, s . c acn \ �
City or Town l tate 6 Zip Code
( )-
Area coda- Phone number
4. DATE DRILLED 1.4 - \ 0 C a
`
5. TOTAL DEPTH: l
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 5)
7. STATIC WATER LEVEL Below Top of Casing: (p 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): \ b-4tvIETHOD OF TEST n it
10. WATER ZONES (depth): 'A 1 0
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth
From p To
Froth To
From To
13. GROUT: Depth
From_a_ To 2 0
Diameter
Ft.6 1/4
Ft.
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
eDR2l PVC
Material
Neat
From To Ft.
14. SCREEN: Depth Diameter
Front_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Cement Hand
Slot Size Material
in.
in,
Topographic/Land setting
❑Ridge 9Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boxy
PEPTF-1 PRILLING LOG
From To FgrrQatyon Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbersand common road names.
/
f..
M;
7
d
CA)
L
-.._-----V--- `
cuA
16. REMARKS:
1DOHERFRVrt
JAI
mit the original to the D visi) t of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9-1636 Phone Nnlglq) 7' -3221 withia 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C, WFI I
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON CONSTRUCTING THE WELL
DATE
-11),C)3

267077
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t.>, ['a rn{y, Jr
CERTIFICATION # 21 3 8
WELL CONTRACTOR COMPANY NAME (2amp' s Well R Primp rn T n c PHONE #&2R) 453-7322
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 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Neare t own:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
kp
Countyli,'
3. OWNER:
Address P -c"k- L)) `1
trocwritoppro No.)
�1 Q;Y\MA1 4- 1VC
City or Town State
( Area code- Phone number
4. DATE DRILLED \1 - q • (�
5. TOTAL DEPTH: -1 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0
(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 2C .0118.
9. YIELD (gpm): \ C METHOD OF TEST n i r
10. WATER ZONES (depth): a U
FT.
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From p To `) O Ft. 6 1/
From To Ft.
From To Ft.
13. GROUT: Depth
From A To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Zip Code
Amount \ L P
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
N at Cement Hand
From Ft.
From Ft
Depth Size
To
To
16. REMARKS:
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge 081ope 0Va11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source; ❑GPS ❑Topographic map
(check box)
DEPT1i DRILLING LOG
From Too Foorrma_[jpn Description
n
u 3 4I S- r�k,7cl
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. /
1 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
-5 t8APAN
S NATURE
�.1btnitAN ortipaVto the 11 vts'�
199-1636 Phone No. (919) 7 3221
GROW:MA ER SEJTIGN
ASHEVILLE REGIONAL OFFICE
a
OF PERSON CONSTRUCTING THE WELL
C-1()-�
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J amp. s tar_ f'a rD l?, Jr
266288
CERTIFICATION p 2 1 3 R
WELL CONTRACTOR COMPANY NAME Camp a Wa11 R Pttmp f n Tnr PHONE #8%7A) dS3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential I,C Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATr0 t
Ne rAesI�rtrr'�ry�yttown: OAA County MS. �.D ..Q.A
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
M$ t o '—
3. OWNER:
Address
\ fist
(Street
1or Route NO 4/4 r Y V
City or Town State Zip Code
Area code- Phone number, r�
4. DATE DRILLED 1�' S. 0 I
5. TOTAL DEPTH: \ 2 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 411.
7. STATIC WATER LEVEL Below Top of Casing: t0 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 1SA NCAC 2C .0118.
9. YIELD (gpm): l Q METHOD OF TEST Air_
10. WATER ZONES (depth): l OU
11. DISINFECTION: Type (-hi nri na Amount a
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From G To FL 6
From_ To Ft.
From To Ft.
13. GROUT: Depth
From To 2p 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.
1 i 4 xXvi' _ 0Ct
Material
Neat Cement
Method
Hand
I II(flBY CERTIFY THAT
Il"QI)ITRUCTION STANDARDS,
It!�
Topographic/L setting
❑Ridge ❑Slope galley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
_yoForma{jon De ri tton
joke. anfr�*
DEPTH
From To
0 U Z
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. In�ude road
��
numbers and common road names. }%JJ
\U�...
(aq —7q
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFI I
AT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WFI I OWNER
OF PERS6N CONSTRUCTING THE WELL / DATE
0
fV
ubtnAE. a krigihal--t6 tbg p1S3S�oa efW,ater Quality, Groundwater Section, 1636 Mail Serrice Center -Raleigh, NC
i789SLIGS e No. [phone], within 30 days. GW-1 REV. 07/2001
c
u

266290
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James to camp, 'Jr
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ramp' S Wa1 1 & Pnmp _Crt_ Tnr
ASSOCIATED WQ PERMIT#
(if applicable)
CERTIFICATION en
1 n R
PHONE 8842R) 451-7322
1. WELL USE (Check Applicable Box): Residential Ql Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name, Numbers
3. OWNER
Address 1 Li lctl lac
N:.
lien {fin YD
IN4[(itce PYl•
, Community, Subdivision
De Yin
County gu I her Ii'(1
, Lot No., Zip Code)
( jj (Street or Ro to No.)
4E/IeYliiOy'o �C.. L: t�O
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED � � — cig —0 ;I'
5. TOTAL DEPTH: ',J O C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: `-) FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 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): ri METHOD OF TEST n 1�
10. WATER ZONES (depth): 2, #) 0
11. DISINFECTION: Type rh l
12. CASING:
Depth Diameter
From_0 To EAZ Ft. 6 1 /
From To Ft.
From. To Ft.
13. GROUT: Depth
From_0 To 2 p Ft.
nri nn Amount
Wall Thickness
or Weight/Ft. Material
DP21 PVC
Material
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 Ma 'al
inr'
in.
From To Ft.
From To Ft.
Tope hic/Land setting
ORidge elope OValley 0F1at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
�gp/race)) dirt
4a .3c J mast)); rickeft Rock.
DEPTH
From To
LOCATION SKETch
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers andconimon road names.
Ali/
I Q I�Y-CERT1Fl�-TttkTTHI . WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
C UCTION STANDARDS, AIT AT A COPY 0 THIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
Gtzyb �d l (/) , (1 61
SIGlATt OF PEN CONSTRUCTING THE WELL ✓ DATE
Su nut the original'ta the )Division of water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27d243d6-P-hone-Nnr(919j733BT£I; Within 30 days. GW-1 REV. 07/2001
IX

266291.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVI➢UAL)NAME (print) James m Carpp, Jr -
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
C .mp' s Wa11
1. WELL USE (Check Applicable Box): Residential 0"Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
UAAA
NearestTown:9t
(Street Name, Nunibers, Community, Subdivision, Lot No., Zip Code)
ounty \W
3. OWNER: Ak.o.j T^ \n1a)r..vs j p
Address
�{� (Sam or Route No.)
a(1)1b.,t C 01k
City or Town State Zip Code
( Area code- Phone number
4. DATE DRIJiFD \I.' 0 01
5. TOTAL DEPTH: in 0 S
6. DOES WELL REPLACE EXISTING WELL? YES (I14PO ❑
7. STATIC WATER LEVEL Below Top of Casing: 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
- vpriance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): < MET}OD OF TEST a it
10. WATER ZONES (depth): -k1>C-UU.AM-
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)
JEPTI-1 DRILLING LOG
From To Forma&ton Description
n l 10 bn -.X
\ \ 0 kooS' , t
11. DISINFECTION: Type f'}t 1 nr i na
12. CASING:
Depth
From_p_ To
From To
From To
13. GROUT: Depth
From _.p_ To 2 0 Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
tF nna.r 6-: — ---s
, i_l11,9-HEPe B-Y CERTIFY-1114 o$ WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
\rc- ONSTRUCTION STANDARDS • + THAT A COPY 0 THIS RECORD HAS J�EEN PROVIDED TO THE WELL OWNER
i1 _, �1` � (t41 d w , v� �. l,2 — C D 9
�, SIGr-ATURE OF PERSGiN CONSTRUCTING THE WELL f 7 DATE
i Submit the original to than visionjof Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
--27699-t636-Phone-No1919J'133-3221, within 30 days. GW-1 REV. 07/2001
Ft.
Ft.
Ft.
Diameter
Ft.6 1/4
Ft.
Ft.
Material
Neat Cement
Amount a Cu. D
Wall T ie10 ess
or Weight/Ft. Material
GB17.21 PVC
Diameter
in.
in.
Slot Size
in.
in,
Method
Hand
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
number- and common road names.
CERTIFICATION 0_213$
R PnmP ('n Inc-, PHONE /4DR) d53-7322
( pp " o
u._
0
crt
rn
rn
0

266287
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James Carnp, Jr
CERTIFICATION N 71 3 8
WELL CONTRACTOR COMPANY NAME ('amp' a Wa11 R Plimp en` Tnr' PHONE #$?A) d 5"1-7322
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ej Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:,, (r f l
Near Town: i_L1"175lCI(-' County i\U4l (Y�71Cl
L )i{f5;At e-(f lie
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /r t t( +y f lt, ine 1
Address P lidk G,I
( treet or Rdute No,)
LI)1151de N c ;LSe��
Zip Code
City or Town State
( Area coda- Phone number
4. DATE DRILLED II ,.l l /l6
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )11
7. STATIC WATER LEVEL Below Top of Casing: /IC FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): -40 METHOD OF TEST
10. WATER ZONES (depth). 110
A 1 r
11. DISINFECTION: Type rh l nr i np
12. CASING:
Depth Diameter
From__ To 14-4- Ft. € 1 / 4
From To Ft.
From_ To Ft.
13. GROUT: Depth
From_0_____ To 20 Ft.
Amount 1 c a p
Wall Thiclmcss
or Weight/Ft. Material
SDR21 PVC
Material Method
hI at Cement Hand
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front__ To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r 1et
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley Et,}Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRILLING LOG
From To Formation pescription
4-4 (I n Ti ScA� I\.(C[1�J
+4'f IC.3 (LI15DI,th1Jr(I Ic(k
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
h.
1HER$BY CERTIFYTEATTIISI
TRUCT1ON STANDARDS,
_ ✓
�Lr.J
Sub t #tq;q flp(na1:to tihe ttiyiSion od' Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
'-Y9699 16a6rnone No. [phone], within 30 days. GW-1 REV. 07/2001
'ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI f
THAT A COPY O THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
Gt J 164- (,�(/) , [14
IGNATURE OF PERSON CONSTRUCTING THE WELL
l a— b...- ij
DATE

266265
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t•t CamN Jr,
CERTIFICATION If 21 4 R
WELL CONTRACTOR COMPANY NAME Camrt s Wr l l R Pnmp f n Tnr PHONE #i(42A1 d5"i-7"i22
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fit Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION `` ,f,�
Nearest Town: .+.1rift bYdeYt County RtA / Y(ecc rid
D yane Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAC( tort)io
I t h Iel
Address , 1O I %mot n e kIcc
y� 7� ( (SugetorRoute #9.)
Rtt I fke✓YC1'�v n N ag 39
City or Town State ) Zip Code
( )-
Area code- Phone number
4. DATE DRILLED _I- O at.
5. TOTAL DEPTH: h �
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 'O FT.
(Use "t" 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): i' ME HOD OF TEST air
10. WATER ZONES (depth): RD
11. DISINFECTION: Type r h 1 n r i n a Amount ) 'WA UP12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
nn Fro0 To 13l Ft. 6 1/ 4 c RR21
From To Ft.
From To Ft.
13. GROUT: Depth
From or To v 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
Front To Ft.
Material
Neat Cement
PVC
Method
Hand
Topographic✓L d setting
❑Ridge ❑Slope 1 alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRII LING LOG
From To Fo tion Description
130 ni ) oa
ronsi I (Lied rtc k
/3D
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
rn
)ZS N
0
LL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WET
THAT A COPY Ok THIS RECORD HAS (SEEN PROVIDED TO THE WELL OWNER
am yL L.. 'SION• TORE OF PE CONSTRUCTING THE WELL DATE
Subic 1n14 4iiglparte thel3tvisionof Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
276994536 Phone No. (919i733:3221,4ithin 30 days. GW-1 REV. 07/2001

266286
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m ('amp'r 1L-
WELL CONTRACTOR COMPANY NAME Camp' s W0=11 R Pnmp Crt
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 2 1 3 R
Tnr PHONE # l2A) d 5 "2-7 322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential (Y Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATIO (( NearestTownn: 11 S1 a County 1v'`7
ulheVl Y
C/t l St r € a €5 D{j /lvvy, l2o
(Street None, Numbers, Community, Subdivision, Lot No., Zip ode)
3. OWNER: O t111. b-17 �<1Vi te&
Address p 0 Box In
(Street or Rtute No.) �/
C )I 441de Ni C, ,ZgU_2Y
City or Town State Zip Code
Area codo- Phone number
4. DATE DRILLED 1 - 15-- 0,11‘
5. TOTAL DEPTH: h (
6. DOES WELL REPLACE EXISTING WELL? YES 0_NO J"l
7. STATIC WATER LEVEL Below Top of Casing: �,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 1SA NCAC 2C .0118.
9. YIELD (gpm): 7¶-7 ME HOD OF TEST Air
•10. WATER ZONES (depth): CO
11. DISINFECTION: Type C h 1 n r i n P
12. CASING:
Depth Diameter
From 0 To 9D Ft. 6 1 / 4
From_ To Ft.
From To Ft.
13. GROUT: Depth
From_p To 20 Ft.
Amount -Z cups
Wall Thickness
or Weight/Ft. Material
eDB21 PVC
Material
Neat Cement
Method
Iland
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.
Ctli:.YnRn\.
NSTRUCTION STAND_
I;h
I
Su
bs[ t�ua iitv�€n+aP; a OtIO'cRivisio
27K99tr363S �.�hnE.ZWW ,:. -
Topogtphic/Land setting
DRidge I�Slope ❑Valley 0F1at
(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
0 g04,Vf Ya
.✓r�
eio 4-05_ rop15cr�dAtea reek
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1'
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WFt r
THAT A COPY 0 THIS RECORD HAS SEEN PROVIDED TO
HE WELL OWNER
U/I
441- a1.41/1-4 i
ATURE OF PER$9N CONSTRUCTING THE WELL
of Water Quality, Groundwater Section, 1636 Mgt Service Center -Raleigh, NC
, within 30 days. GW-1 REV. 07/2001
c
O r
N
n c=
1 to vX
DATE

266267
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James to Cam)-, Jr
WELL CONTRACTOR COMPANY NAME ('amp'. wa11 R Pnmp C'n Tne PHONE #&7A) d54_7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential @Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATION:op j '7'44 1 1
arestTown: LJGS j I c1 C}ountyi*
1 '7�Js 6)L'Clt U'rd v )-i ±�e5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
fhh f�)er1t �CK
i(Stre��ft,or/
7Rouse No.)
1'
City or Town Stare / Zip Code
( )-
Area coda Phone number . l
4. DATE DRILLED /+ - Q "' >.
5. TOTAL DEPTH: a 70 Cr6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: q C
(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)' cr METHOD OF TEST
3. OWNER:
Address
i )A(04, I)1'
)tc� I Iti'ls, n 4C_ , 1I-5
10. WATER ZONES (depth): 64
Air
11. DISINFECTION: Type f'h 1 nr i n p
12. CASING:
Depth Diameter
From p To 470 Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 0 Ft.
Amount A. (1514
Wall Thickness
or Weight/Ft. Material
eBRa1 PVC
Material
Neat Cement
From To Et.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in
in.
Size Material
CERTIFICATION # 7 1 3 f)
Topographic/Land setting
IIRidge ❑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 orm FationDescription
(1 g1 At 1 C`tr:J.'I
Ri r;
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
m
r-1
(N
A
3
0
c-n
16. REMARKS:
W
I _ CERTIF.� T. T"PI-I
(r R N Ja `t a
IU (
SI
ill
S1irrz�bmit[he original tQ theLDi�n
2j699-1636PhoneNbi(919)733 �2,1,
L
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI
AT A COPY 0 THIS RECORD HAS 18EEN PROVIDED TO THE WELL OWNER
(Vila �iP�fv�� 4. fu�-3—c;4Z
OF PERSON CONSTRUCTING THE WELL ✓ DATE
of ater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
wit in 30 days. GW-1 REV. 07/2001

266285
Diameter
Ft.6 1/Q
Frorrr_ To
From To
13. GROUT: De
From p To
From To
14. SCREEN: Depth Diameter Slot Stu
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarn s w Camp, Jr
WELL CONTRACTOR COMPANY NAME
CERTIFICATION # 2 1 4 $
Camp Wp11 R Primp Cn Tnr PHONE#Q(72.1 d59-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential VeMunicipal/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: t), MA.Nn `MA
FQA-t,\t L(fr.
(Street N e, Numbers, Communt , Subdivision, Lot No., Zip Code)
3. OWNER:
Address
\ 1 ^. � ,( �(�r Roue No.)
County et-f t' p%
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED I I • (. 0
5. TOTAL DEPTH: S n S
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 FT. Above Land Surface"
`Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. Y1$LD (Rpm): 1() MET OD OF TEST n it
10. WATER ZONES (depth): Ur--
11. DISINFECTION: Type rh 1 nr i np
12. CASING:
Depth
From 0 To 1 l0
Amount 0 �z ticll-
Wall Thickness
or Weight/Ft. Material
gDR.21 PVC
Ft.
Ft.
pth Materiel Method
20 Ft. Ncat Ccment Hand
Ft.
16. REMARKS:
Topographic/Land setting,,_/j
❑Ridge ❑Slope ❑Valley I�Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fprmagon Description
0 111� {�1 C
llo so.s.
jI
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common re ad names.
N
O =.
Y CSRTI1tY THAT
TrANDARDS,
tubmil I c ats tiataion of
7699-63ErPh4Uepio+,(9!4 7s3-'3 .. .
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY 0 THIS RECORD HAS clEEN PROVIDED TO THE WELL OWNER
titOF PERSON CONSTRUCTING THE WELL 1 DATE
ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
hin 30 days. GW-1 REV. 07/2001

266284
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) Jam ct ut
Camp-, Jr CERTIFICATION # 91 RI8
WELL CONTRACTOR COMPANY NAME Camps s Well & P umr fn_ Tnr PHONE #g9 Ai d5'I-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELLLOCATION:r.
Nearest Town: UYlle r Mt 116 County kithet
�J0 .) f} . f &Wl felt Pr' .
(Street Name, Numbers, Commune, Subdivision, Lot No , Zip Code)
3. OWNER: lwar() l n, ke!l
Addressf-� 'G0 . �) A. Yt'JAk a Rd .
/� iA Yte ✓ is/trc r yteuEe No.) c r/ d o i
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED_ %)1-1
5. TOTAL DEPTH: 45-
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing:
(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 1SA NCAC IC .0118.
9. YIELD (gpm): PO METHOD OF TEST 4; r
10. WATER ZONES (depth): 3,?.0
11. DISINFECTION: Type rh 1 nri rip
12. CASING:
Depth Diameter
From p To `y. ,
From To
From To
Ft.6 1/4
Ft.
Ft.
13. GROUT: Depth
From_O—_To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Amount 1/2, ctyls
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
N at Cement
Method
Hand
Topographic/Land setting
❑Ridge ❑Slope MiValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OOPS ❑Topographic map
(check box)
2=1 DRILLING LOG
From To F rmation Description
65— Rs"345 %or lid4Td rock
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.
Slot Size Material
in.
in.
Material rr' J^
/417
Li L. �IGNA
Submit r ps7p t o I-Mision 0
7699tWfi PlLgnbl'Fo..(91' 113
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY 0 THIS RECORD HIAASIEEN PROVIDED TO THE WELL OWNER
G41d- wv '� 7� l 4, - O Z
OF PERSON CONSTRUCTING THE WELL ✓ DATE
Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
thin 30 days. GW-1 REV. 07/2001
c(
csTS

283767
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalResources /t- Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J0.lvte, L0.�W.fl CERTIFICATION,jj��it c I3 S
WELL CONTRACTOR COMPANY NAME (krieS �e.!t t PiLPap CD. TIkt, PHONE #16•�+It 453-73,22
STATE WELL CONSTRUCTION PERMIT# r ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agnculture! 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other of Other, List Use waste u )&te✓ 1 r e<'Cncer(t 1d /ctni
2. WELL LOCATIAN. rt� �
Nearest Town: K �ter'tord'fnyi Cotmty RIl(eraY�
as Nr.2al 5
(Street Name, Numbers(Community, Subdivision, Lot No., tip Code)
3. OWNER:DrVad RI'l?Y kit5fe
Address It 5 a a i 5
') 1 (Street or Route No.)I
hL( PYar /�— � N�Zg131
City or Town State Zip Code
[Jett v'
Ares code -Phone number
4. DATE DRILLED ./ - 'DcC
5. TOTAL DEPTH: . 4& 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 78 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 FT. Above Land Surface"
*Top of easing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): alo METHOD OF TEST vt4 fig P UM)
10. WATER ZONES (depth): 1 go test
11. DISINFECTION: Type-('k
12. CASING:
Depth
From 0 To 55
From To
From To
13. GROUT: Depth
From e To SS Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Topographic/Land setting
0iidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
i realmevt Plat( - (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
0 55
Drrne.
Ft.
Ft.
Ft.
Amount 1 %a cot
Wall Thickness
Diateter or Weight/Ft. Material
2/4 l
al. Qa�.
Material Method
eervte.tt (lum�t
Slot Size Material
in.
in.
From
From
Formation Description
Sand rock
CvlaSo'l i dater' r c ck
LOCATION SKETCIj
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roadr
numbers and common road names. RIA-ar roYd to
It _.
recta1Ri Jar
16. REMARKS: 5 . (-
$SS CERTIFY TH?T
UCTION STANAIp5
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFT 1 OWNER
kit), (.it.I /
GNATURE OF PERSON CON .=
—3-0z
G THE WM I DATE
klunith_te original to the Diva ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
#� r699463'6 Plhii ate., (91,9) 733-3 i21, within 30 days. GW-1 REV. 07/2001
A rL.LE RcGrTRAL 0,F Ic;:

263768
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ma S 'L C amp-, Jr CERTIFICATION # 21 3R
WELL CONTRACTOR COMPANY NAME Camp' a Wm. 11 E Primp Cn Tnn PHONE #817R0 AS1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NrMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N
Nearest Town: aid
^�A
3AI,tvvinkf Mhi•
(Stint Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C 1_
Address 1 A JetJr LA t.&
el\ 4 n oart or Rou[a No d
rr City or Town State Zip Code
Area code- Phone number et
4. DATE DRILLED i �' a 2. 0
5. TOTAL DEPTH: 1 Lk
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: auFT.
(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): '�j 0 MET OD OF TEST ;I
10. WATER ZONES (depth): 1 J U
County I AA fi Mn Lk.
Topographic/Land setting
❑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 LOG
From �TJo� F math Desc ' tion
0 �AdYv�
11. DISINFECTION: Type rh1 nri np
12. CASING:
Depth Diameter
From_ To ? S Ft. 6 1 /
From To Ft.
From To Ft.
13. GROUT: Depth
Frorn_0 To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21
Material
Ft. Neat Cement
Ft.
Diameter Slot
Ft. in.
Ft. in.
Size
in.
in.
LOCATION SKETCH(
Show direction and distance in miles from at least
two State Roads o County Roads. Include the road
numbers and Fob
:AppmfA
PVC
Method
Hand
Material
16. REMARKS:
on road names.
a)
Jrn
I)
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
. .�/ . I(- g —o0
NATURE OF PE e CONSTRUCTING THE WELL
DATE
Sjrbmit the original to the ivisi n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
619iresFla:(91111733 32
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
2637.76
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r r _ Caml-, Jr
CERTIFICATION # 21 i R
WELL CONTRACTOR COMPANY NAME Camp' R 1,0a11 R Pomp en Tnr- PHONE 0i09A1 d51-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Fd Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
3. OWNER:
Address
(Ih«K M�tls, 1'c-)aeIL.7
City or Town Stale Zip Code
Area code- Phone number
4. DATE DRIJTFD /o—a Ud'
5. TOTAL DEPTH: / t S
6. DOES WELL REPLACE EXISTING WELL? YES R(NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 4 S FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
' varlance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 6i o METHOD OF TEST D i r
10. WATER ZONES (depth): 1 4 o
2. WELL LOCATI �7
Nearest Town: 0.YIOri Cou1n�tr�y fitk yol
ht u rt Loop White F{ouse Comm•
(Street Name, NOlnbers, Community, Subdivision, lut No., Zip Code)
gl// S± l—
'777 77 tit Rvn.
Succt"or Rout No.
Topo�gr�aphic/Land setting
i ❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
Formation Description
San ?o&n(
P 1Aafeci ycc
From To
Jn
s-
11. DISINFECTION: Type C'h 1 nr i na
12. CASING:
Depth Diameter
From 0 To Ma_ Ft, 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From o To 20
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 1 r. uP
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Ft. nl ram-,} C'nran
From To Ft.
Front To Ft.
16. REMARKS:
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.
N
IS WELL WAS CONSTRUC'1ED IN ACCORDANCE WITH 15A NCAC 2C, WEI
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL
n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

263779
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp Tr.
& Primp rn Tnn
ASSOCIATED WQ PERMIT#
(if applicable)
James
('amp'
Wall
ra
CERTIFICATION # 71 1$
PHONE #i32H) 4151-7122
1. WELL USE (Check Applicable Box): Residential lir 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:
st Town:
L
County \uAX.NL.,a.t7.
(Street Name, Numbers, Community, Subdivision Lot No., Zip Code)
3. OWNER: I< 42_���''� C-'Q ish 1lR
Address y ,>c kjt ),5�*A
(Streetor Route No.)
City or Town State
Area code- Phone numbert1
4. DATE DRILLED I D— . O el
5. TOTAL DEPTH: .3.9,'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: v. b 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. YIELD (gpm): 0 METHOD OF TEST ki r
10. WATER ZONES (depth): \ SU
11. DISINFECTION: Type Ch 1 nr i na
12. CASING:
_
Depth his
To
From To
From__To
13. GROUT: Depth
From_ To 2 0 Ft.
Amount f/a cup
Wall Thiclmcss
Diameter or Weight/Ft. Material
Ft.& 1/4 SDR21 PVC
Ft.
Ft.
Material
Neat Ccmcnt
Method
Hu
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tat
(check appropriate box)
Latitude/longitude of well location
_ (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING I.OQ
Foxznationn Description
DEPTH
From T R
0
St 6
Si 't t.t., 13tAiiiti3
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road
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. ee.__-,n S
From To Ft.
rl�
(51 —
16. REMARKS:
THIS WEI i WAS CONSTRUL IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
StRUCTION STANDARd'3, THAT A COPY 0 THIS RECORD HiffiEEN PROVIDED TO THE WFI I OWNER
ravi
ATURE OF PERSON CONSTRUCTING THE WELL / DATE
Submit the original to the Dips on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-16a p A ea,A919) 734-3221, within 30 days. GW-1 REV. 07/2001
GROUAJ[)V.1:TER SECTION
ASkEY LE REG :P:1L CFHICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t^t Camp,
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
TCERTIFICATION # 21 3 R
Camp a Wa11 & Pump C'n Tnn PHONE #a2R) d .3-7922
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT N:
\-tr-31 i h\ Uf>i1u Attu
(Street Name, �N,,uupyymbers,Community, Subdivffis��io(��27, Lot No.,.,pZip Code)
3. OWNER: dMA ku N C OCULC9 J
Address II , +.( t pp
cAA,(streetS. C ute No.) rt� � q W�
City or Town State
Area code- Phone ntunbch
4. DATE DRILLED N . elS- D
5. TOTAL DEPTH:
Zip Code
C�gry �^
Gk
263777
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 pRILLTNG LOG
From ; S Forr (tionDevption
15. jAb
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eg
7. STATIC WATER LEVEL Below Top of Casing: k L d 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): 2 METWVQD OF TEST a i r_
10. WATER ZONES (depth): \1.h S'.ar-
11. DISINFECTION: Type rh 1 nr i n a Amount o&Y? £ 0.f
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From n To 1 Ft.6 eR1:t71 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth
From_0 To 2 0 Ft.
From To Ft.
Q/QIA1 >J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
N attCement Hand
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:
SubnlII
iLtgna o i
276994 �i�
.AS'ri�r'it_
JtA.I.
LtiJO.
LL WAS CONSTRUCTED TN ACCORDANCE WITH 15ANCAC 2C, WELL
HAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
N CONSTRUCTING THE WELL
DATE
Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
ithin 30 days. GW-1 REV. 07/2001

263740
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ani in sW
WELL CONTRACTOR COMPANY NAME ('amp' q Wa11
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
Ca'p, Jr CERTIFICATION* 7118
R Pnmp r n_ Tnc PHONE *$7R) 4'SI-7122
ASSOCIATED WQ PERMIT*
(if applicable)
1. WELL USE (Check Applicable Box): Residential Li 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 O
Nearest Town:
GO, Sucty�r �?
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: %ti
Address lg. V 1Aic) 7
1IArM r (Seat or Route kki No.) �d I Ll
County Rkt -tt
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 44, .4. 0 1
5. TOTAL DEPTH: a 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Jr 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 la accordance with 15A NCAC 2C .elig.
9. YIELD (gpm): J 0 METHOD OF TEST D jr
10. WATER ZONES (depth): i g0
11. DISINFECTION: Type rill 1 nr
12. CASING:
Depth
From 0 To L\ S
From To
From To
13. GROUT: Depth
From p To 2 0
From To Ft.
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. :Sou\-v�n.f^^�
Diameter
Ft.6 1/4
Ft.
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
'DR21 PVC
Material Method
*oat Cement Hun
Slot Size Material
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 DRILLING LOG
From To
0 45
w)-0s
ILrmat ri Ddsc{iption
Lei 7
40.
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.
Diameter
16 RFMA.Rxc__
r= r= Ir'f1 S
grCFtf'rirY �i.t e'er
I::
RUCTION STANDARDS, A
S
-d
NA
i I WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COPY 0 THIS RECORD HAS )SEEN PROVIDED TOTHEWM/ OWNER
Le' ill
, Ca�1� , �r . I I 0 2
OF PE
CONSTRUCTING THE WFI
DATE
ubmit tifdUYl (♦I@8 t}FiCtlai n of , ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
76994.8#'U A43-4144 t, wl bin 30 days. GW-1 REV. 07/2001

262122
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 'L Camp Tr CERTIFICATION # 21 38
WELL CONTRACTOR COMPANY NAME
Camkta Wall R Pnm� r'n_
Tnr
PHONE#ffi2R) dA3-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Id Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I
Nearest Town: rIle rt. bo✓o
/jnPv hr).
(Street Name, Numb , Community, Subdivision, Lot No., Zip Code)
County RU1l1Pry-peA
3. OWNER: Do J0.k)15
Address /iney Rd •
I-^ (S eet or Ratite No.)
r7 eRho(e N C :Ag04D
City or Town State ' Zip Code
Area code- Phone number
4. DATE DRILLED '- . `i D ;—
5. TOTAL DEPTH: ,aZO S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: li- ' 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 1SA NCAC 2C .0118.
9. YIELD (gpm): "3-0 METHOD OF TEST
10. WATER ZONES (depth):
Ail_
Topographic/Land setting ,
❑Ridge ❑Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/minutcdseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Depeription
0 95 dl✓73 Saud
1 S ..r05 rort6C/I(ht'Pd rock
11. DISINFECTION: Type ('hl nri np
12. CASING:
Depth
From 0 To 9S
From To
From To
Diameter
Ft. 6 1 /
Ft.
Ft.
13. GROUT: Depth
Fronn o To 2 0 Ft.
From To Ft.
Amount 1 c
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ncat Ccment
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in.
16. REMARKS:
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.
yP
r_J
A, THIS WELL WAS CONSTRUC'lED IN ACCORDANCE WITH 15A NCAC 2C, WFI
.f AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- CerA /a / A . /D —,Z - D�
SIGNATURE OF PERSON CO TRUCTING THE WELL DATE
gt,hmit the origjnal to t e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
R® tioffiiNTd 19) 733.3221, within 30 days. GW-1 REV. 07/2001
ASc E®,IL L � 0IOiNAL OFFICE

262139
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James rJ Camp, Jr
WELL CONTRACTOR COMPANY NAME
CERTIFICATION ® 7 1 4 R
ramp' c UPI1 & Pnmr rn Tnc PRONE at 7R) d5i_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential crMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT O \ ^�
Nearest Tort. -UM County XhV1A
\
\--1111lA0N i-
(Street Name, Numbers, Co(mmtmityjubdiivis' pp, Lot No., Zip Code)
3. OWNER:°La CZ --
Address I 1
(Sued or Route No.)
City or Town State Zip Code
Area code- Phone numb
4. DATE DRILLED Lt a 3. D a
5. TOTAL DEPTH: A V S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14
7. STATIC WATER LEVEL Below Top of Casing: Fr.
(Use'',' if Above Top of Casing)
8. TOP OF CASING IS T FT. Above Land Surface'
•Top of casing terminated actor below land surface requires a
variance lu accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): \U MXTHODOFTEST Air
10. WATER ZONES (depth): D
11. DISINFECTION: Type rh 1 nr i nP
12. CASING:
Depth Diameter
From_ Tot Ft. 6 1 / 4
From To Ft
From To Ft.
13. GROUT: Depth
Fronl__o To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Amount
Wall Thiclmess
or Weight/Ft. Material
QBR.21 PVC
Material
Neat Ccmcnt
Depth
From To
From To
16. REMARKS:
Method
Hand
Slot Sire Material
in.
in.
Midge
Topographic/Land setting
Qttidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTU DRILLING LOG
From ^T (Srmat�n Description
1% 4 ° -
LOCATION SKETCI[
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers an commpn road names.
U
•
—72
r,)
1 DO HEREBY CERTIFY THAT THIS WF,.LL WAS CONSTRUCTFn 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAR'OU@f n'reB Tan I' : CORD HAS BEEN PROVIDED TO THE WELL OWNER
ASHEVILLE REGIONAL OFFICE
6 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Set"
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

263373
WELL CONSTRUCTION RECORD
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jamaa ur Camp,Tr CERTIFICATION SO 21 3R
WELL CONTRACTOR COMPANY NAME Camp' c Wa11 R Pump Crt Tne PHONE #87R) d53_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I)Y MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATJO:
Nearest Town: 1_..4
L.o±" /a. lariycl 1-a ke5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 9.b( .t omt1)aS�.".
civiA or tiRoute o.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED q- a O 0 D
5. TOTAL DEPTH: \ $ S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I41
7. STATIC WATER LEVEL Below Top of Casing: b FT.
(Use --r".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): \ NO METHOD OF TEST 4-i r
10. WATER ZONES (depth):
tA. m County ktXfl&4 p.Jl
Topographic/Lan . setting
ORidgc ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
PEPTH PRILLING LOG
From To gatiot),Des gtion
n 4\
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth Diameter
From_o To \G \ Ft. 6 1 / i-
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 O 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
Wall Thickness
or Weight/Ft. Material
cuR21 PVC
Cement
Method
Hand
Slot Size Material
in.
in.
S
LOCATION SKETCH w
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI r
R 11VN Si Aill�IAiiJh L THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
) 'a l� D_
Silt mit tthe original to the Di
276g9-1636 Phone No. (919) 73
OF PERSON CONSTRUCTING THE WELL DATE
1n of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER 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) Ja me S ry Camp, Jr- CERTIFICATION# 2J $
ramp'e Wa11 R. Piimr T n r
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
263376
PHONE#$7R) d53-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential IY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:. w - p
Nearest Town: 1� t��JF , CountylA.r JA %y..It
Z4 001L=herr y Lane d on( (Zt�er}7i' �le
(Street Name,nNumbeerrs, C munity, Subdi ' ' , Lot No., Zip Codf)
3. OWNER:
Address r40y lam � &siA At‘,
or Route `o.) dd2-$13 9
City or Town • State Zip Code
Area code- Phone number
4. DATE DRILLED 9 - \ 1 O Z.
5. TOTAL DEPTH: 3 0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Elk,
7. STATIC WATER LEVEL Below Top of Casing: Lk 1.) 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): 1 0 MWPOD OF TEST Air
10. WATER ZONES (depth): 144 0
11. DISINFECTION: Type r h l n r I n a
12. CASING:
Depth Diameter
From n To 9 Ft 6 7/ 4
From To Ft.
From To Ft
13. GROUT: Depth Material Method
Amount
Wall Thickness
or Weight/Ft. Material
DR21 PVC
From p To 20 Ft. Ncat Ccment 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:
S
27649 U tli
ASHEVILL EG
NATURE OF PERSON CONSTRUCTING THE WELL
Topographic/Land setting
❑Ridge ❑Slope CjWa11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTIC PRILLING LOG
From Lib
Fo41ga[ionn`Dy�cription
y
0
C
Show direction and dis
two State Roads or Coun
numbers and common ro
o —
ce in miles from arfdeast=
Roads. Include the road
d names
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0 R
l0•a. 1.
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Wirr&Ec' 322L 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
CERTIFICATION p 21 3 R
WELL CONTRACTOR COMPANY NAME ("Amps s W.c11 & Pump f'rL Tnr PHONE ilffi7Rl 4151-7322
STATE WELL CONSTRUCTION PERMITp ASSOCIATED WQ PERMIT/.
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Camp, Jr
262138
1. WELL USE (Check Applicable Box): Residential a's-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: MX
iserve Dr.
(Street Name, Numbers, Community,opSubdivision, Lot No., Zip Code)
3. OWNER:CFSYX
Address CS
(yva[t �or Rou No.)
City or Town State Zip Code
( Area code- Phone number r�
4. DATE DRILLED Q i ' l0 L
5. TOTAL DEPTH: L1
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO
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 accordap a with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST Ai r
10. WATER ZONES (depth): \ LA 0
11. DISINFECTION: Type r
12. CASING:
Depth
From_ U.STo
From To
From To
13. GROUT: Depth
From p To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
h1 nrI nP Amount
16. REMARKS:
Wall Thickness
Diameter or Weight/Ft. Material
Ft.6 t/4
Ft.
Ft.
Material Method
Neat Ccmcnt II,i zG
Ft.
SDR21 PVC
Ft.
Diameter
F.
County 9.4.ti lit ku...
Slot Size
Material
Topographic/Land setting
❑Ridge Metope :Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
PEPTH DRILLING LOG
From To For niopDescription
to S l `t 5 �� �C /o�c�f a�'
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.
GROuNDAATER SECTION
ASHEVILLE REGIONAL OFFICE
I DO HEREBY CERTIFY THAT 1 In wr.LL WAS LuN51 RUL Ihl IN ACUORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 �. 2
1 1 SIGNATURE'OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 0 21 "t A
PHONE 0$78) 451-7122
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James Camp, Jr -
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITII
Of applicable)
ramp'
Weal
R Primp Crt
T n r
_ASSOCIATED WQ PERMITS{
(if applicable)
I. WELL USE (Check Applicable Box): Residential lt7 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest To e.5 C County lc(' hev 1)Y
0 ,ree-k rl .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pa rid g (Ye o r y
Address ¥ 2ts0 L v e 10 �/
emme✓tor�-er..feN�)/C a8/39
City or Town State / U Zip Code
Area code- Phone number
4. DATE DRILLED g - 30 - 6 2
5. TOTAL DEPTH: i 145
6. DOES WELL REPLACE EXISTING WELL? YES 02/NO ❑
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 cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): SOD METHOD OF TEST a i r
10. WATER ZONES (depth):
11. DISINFECTION: Type r h 1 nr i na
12. CASING:
Depth Diameter
From, To 7o Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From__p To 2 0 Ft.
Amount 1 r u r
Wall Thickness
or Weight/Ft. Material
gDR21 PVC
Material
N a.t Ccmcnt
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:
Rs l F r n 2002 f
ti&a.;.11Q4fubmit the original to the Divis
;f9) 733-3
ay
C S1.:U4u1
Method
IIu
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Slot Size Material
in.
in.
Material
DEEDI
From To
170ric
0L,Soh'Ott ttd PO 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.
L.r'n<
1-et nth; r)/)
ca
CO
CO
S
260025
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT AQQPY OF THIS RECORR HAS j EEN PROV W TO THE WELL OWNER
)GNATURE
PERSON CONSTRUCTING THE
y-/0-002,
DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
0

260032
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELLiCONTRACTOR(INDIVIDUAL)NAME (print) James m Ctmp, Jr CERTIFICATION # '1 71R
WELL CONTRACTOR COMPANY NAME tamp' c Wp11 & Pump f n TnC PHONE pal9R1 d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural Ci'
Monitoring D Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
/ 5LfSV&v
(Street Name, Numbers, Comm ty, Subdivision, Lot No., Zip Code)
3.OWNER: phlI 5heItem
Address 1 P.54 Gay R1.
RK1I1CY
(Sgt✓GI orltR to hNo.) )39
City or Town State ) Zip Code
Area code- Phone number n.
4. DATE DRILLED o` 0,2
5. TOTAL DEPTH: Li ����((((
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: I}r
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1, FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I METHOD OF TEST air
10. WATER ZONES (depth):
ounty RLL//te✓4 rd
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 38 dirt .3g 3O.J eons, //dated rnrk
11. DISINFECTION: Type rh 1
12. CASING:
Depth
Ft. 6
From______ To Ft.
From - To Ft.
13. GROUT: Depth
From_ To 2 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
1 I d
nri np Amount
Wall Thickness
Diameter or Weight/Ft. Material
QPVC
Material Method
Ft. Neat Cement Hand
Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers an Common road name!.
6.[ REMAkiilfJ.Lib LL:r; '1/
DO HEREBY CERTIFY THAI T S WFI T WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'CONSTRUCTION STANDARD'S, AND THAT AA OPY OF THIS RECORD HAS EN PROVIDED 0 THE WELL OWNER
-L02
%Z4 W4--
SIGNATURE !F 'ERSON CONSTRUCTING THE WELiJ " DATE
' 1 Fr, h�V
Submit the original; tot tbepivisim of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
(No
CO
N
or- il-az

WELL CONSTRUCTION RECORD
267071
North Carolina - Department ofEnvirontnent, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION-0 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT Al ASSOCIATED WQ PERMIT-0
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 21 Municipal 0 Industrial]] Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
160 WANDERING LANE
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER GORDON WOOD
ADDRESS 160 WANDERING LANE
(Street or Route No.)
LAKE LURE
City or Town
828-625-2224
NC
State
Area Code - Phone Number
4. DATE DRILLED 12/20/02
5. TOTAL DEPTH 400
6_ DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
65 FT.
(Use "+' If Above Top of Casing)
8. TOP OF CASING IS 2 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): 2 METHOD OF TEST
10. WATER ZONES (depth): 380
ARDM
Zip Code
Topographic/Land setting
❑ Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.25.355 / 82.11.378
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS El Topographic map
DEPTH DRILLING LOG
Front To Formation Description
0 85 Clay
85 400 Consolidated Rock
n. DISINFECTION: TYPE HYPOCHLORITE
I . CASING:
From 0
13. GROUT:
From 0
Depth Diameter
To 90 Ft. 61/4"
Depth
To 20 Ft.
t 4. SCREEN
From
Depth
NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Amount 11
Wall Thickness
or WeighrFt. Material
SDR21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft.
Size
Slot Size
in
Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads.Include the road
numbers and conunon road names.
WANDERING LANE
GOLF COURSE RD
HWY 64/74
tV
ra
CO
(/
r
0
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Su
27
GROUNDINATERR SECTION
ASHEVILLE REGIONAL OFFICE
12/20/02
Date
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
n 30 days.
GW-I REV. 07/2001

Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
WELL CONSTRUCTION RECORD 2 6 7 0 6 9
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 21 Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: SPINDALE County RUTHERFORD
WINDY HILL SUBDIVISION LOT 9 CROWE DAIRY RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3 OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74 BYPASS
(Street or Route No.)
FOREST CITY
City or Town
828- 286-3647
NC
State
Area Code - Phone Number
4. DATE DRILLED 12/18/02
5. TOTAL DEPTH 260
6. DOES WELL REPLACE EXISTING WELL? YES f NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" If Above Top of Casing)
s. TOP OF CASING IS 2 FT. Above Land Sin -face"
'Top of casing terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gym): 12 METHOD OF TEST ARDM
10. WATER ZONES (depth): 250
28043
Zip Code
Topographic/Land setting
)� Ridge 0 Slope ❑ Valley X Flat
Latitmde/Longitude of well location
35.19.063 / 81.55.167
(degrees/minutes/seconds)
Latitude/longitude source: 21 GPS [] Topographic map
DEPTH DRILLING LOG
From To Formaticm Description
0 80 Clay
80
260 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount 6
12_ CASING: Wall Thickness
Diameter or Weight/Ft. Material
90 Ft. 61/4" SDR21 PVC
Oz
Material Method
20 Ft. GRAVEL MIX GRAVITY
15. SAND/GRAVEL. PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft. in.
Ft,
Slot Size Material
in
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
OAKLAND RD
WINDY HILL SUB
5/10 MI
CROWE DAIRY RD
0
CD
cn
ti
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 off¢3s
e 91 o. �11
JAN 31 2003
ASROU
HEVILLEE REGIONALOTION OFFICE
12/21/02
SIGNATURE OF PERSON 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 2 6 r1. r' 6 2
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. CIATED WQ PERMIT 434 7277
STATE WELL CONSTRUCTION PERMIT # (if applicable)
)
(if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ hidustiial 0 Agricultural ❑ Monitoring
Recovery ❑ Heat Purnp Water Iiijectioii 0 Other 0 If Other, List Use'.
2. WELL LOCATION:
Nearest town: SPINDALE
County RUTHERFORD
WINDY HILL SUBDIVISION LOT 6 CROWE DAIRY RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Cdde)
(degrees/minutes/seconds)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HWY 74 BYPASS Latitude/longitude source: ® GPS 0 Topographic map
(Strtit or Rout No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City or Town State Zip Code 0 80 Clay
80 200 Consolidated Rock
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley X Flat
Latitude/Longitude of well location
35.19.129 / 81.55.110
828: 286-3647
Area Code - Phone Number
4. DATE DRILLED I 1 /22/02
5. TOTAL DEPTH 200
e DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO El
35 FT.
(Use "+" 1fAbove 'Top of Casing)
s. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface rewires a variance in
accordance with 15ANCAC 2C.0118
9. YIELD (gpm): 8 METHOD OF TEST ARDM
10. WATER ZONES (depth): 190
t 1. DISINFECTION: TYPE I II'POCIILORII'E Amount 6
oz LOCATION SKETCH
12 CAStNG: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight'Ft. Material two State Roads or County Roads. Include the road
From 0 To 88 El. 6 114 " SDR 21 PVC numbers and common road names.
13. GROUT:
From 0
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Sizc Material
From NA To Ft. in. in.
15. SAND/GRAVEL. PACK:
Depth
From NA To
16. REMARKS:
Ft,
Size Material
OAKLAND RD
I
WINDY HILL SUB
5/10 MI
CROWE DAIRY RD
I DO IIEREBY CERTIFY TIIAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE 1FTTII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
or' 12/1/02
If J Ls L \lli
9-1636 Phone No. (919) 73I
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
n r Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
t .r. , within 30 days.
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASFiFv/LEE REGIONAL OFFICE

WELL CONSTRUCTION RECORD ? U 4 ry ) 8
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 si• Municipal ErIndustrial Q Agricultural Q Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
687 CHILI BOWL RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RICK TOMS
ADDRESS 687 CHILI BOWL RD
(Street or Ronne No.)
RUTFIERFORDTON NC
City or Town State
828-287-7854
Area Code - Phone Number-
4. DATE DRILLED 11/8/02
5. TOTAL DEPTH 180
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES ® NO ❑
40 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated aUor below land surtece requires a variance in
accordance with 15A NCAC 2C 0118
9. YIELD (gpm): 15 METHOD OF TEST ARDM
10. WATER ZONES (depth): 175
DISINFECTION: TYPE HYPOCFILORITE Amount 5
2 CASING:
From 0
13. GROUT:
From 0
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 63 Ft. 61/4" SDR21 PVC
Cs
Depk Mate•iar hbdnnt
To- 2& Ft: GRAVEL MIX CrRAVFFY
14. SLRLLi
Depth
Diameter Slot Size Material
From NA To Ft. in.
15. SAND/GRAVEL PACK:
Dcpthr `ur- Mattel.
From NA To Ft,
16. REMARKS:
Topographic/Land setting -
El Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well loe*tion
35.25.511 / 81.57.699
(degrees minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
50
180 Consolidated Rock
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inchlrle the road
numbers and common road names.
GILBOA LHURLH RD
CHILI BOWL,
0
0
I DO IIEREBY 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.
S
2
irtthebrgilta,_to t piyisl
-I63�Pgoite 14®.
LC(.Ili]/I
I2/Z/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
r Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
in 3Q iTays.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 264757
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Secticr
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANIT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC��H lNll (7Q PERMIT #
4)434-7277
STATE WELL CONSTRUCTION PERMIT # (if applicable) 1
(if applicable) ❑
I. WELL USE (Check Applicable Box) : Residential Er Municipal 0 Industrial Er Agricultural II Monitoring
Recovery ❑ Heat Pump Water Injection ❑ other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: UNION MILLS
210 FERGUSON RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ®Flat
Latitude/Longitude of well location
35.40.078/ 81.97.391
3. OWNER MIERA CRAWFORD (degrees/minutes/seconds)
ADDRESS 210 FERGUSON RD Latitude/longitude source: ® GPS ❑ Topographic map
(Street or Route NO DEPTH DRILLING LOG
UNTIONr MIMES- TIC' Zola/ From To Formation Description
City or Town State Zip Code 0 125 Clay
828 28 -0858 125 500 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 10/25/02
5. TOTAL DEPTH 500
6 DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 120 Er.
(Use "+" I[Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'.
•Top of rasing terminated at/or below !awl surf requires a variance m
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 2 METHOD OF TEST ARUM
10. WATER ZONES (depth): 460
DISINFFrCT1ON: TYPE HYPOCHLORITE Amount 12
12 CASING:
From 0
13. GROUT:
From 0
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 136 Fr 61/4" SDR21 PVC
Oz
Depth Materiat Method -
To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
ptir
From NA �To
R.
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16 REMARKS:
in.
Sizc
Slot -Sire- Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the load
numbers and common road names.
HUDLOW RI]
2/10 MI
C
0
FERGUSON Turg RD,m
rrl c
nCD :zE
Sr'i
—• or.
yc
rn
_ _ o
^'rt
crs
I 1)O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
c
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER. co
tIJ1i/u2.
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
r Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
hin 30 days.
n
G
GW-1 REV. 07/2001
GFfL'N;`\'J:'iEF SECfi01'l
ASF E,IL LE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUNIFrorn: ALAN S. GANTT 704-434-7212 11/05/02 22:31:46 Page 10 of 11
Sent by the Award Winning Cheyenne Bitware
263194
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (1NDIVIDUAL)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 ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: UNION MILLS
210 FERGUSON RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER MIERA CRAWFORD
ADDRESS 210 FERGUSON RD
(Street or Route No.)
UNION MILLS NC
City or Town State
828-286-0858
Area Code - Phone Number
4. DATE DRILLED 10/25/02
5. TOTAL DEPTH 500
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28167
Zip Code
YES 0 NO 0
110 Fr.
(Use's" If Above Top of Cuing)
8. TOP OFCASINGIS 2 F.. Above Land Surface"
'Top of casing temdnated anor below land surface requires a variance in
accordance with I5A NCAC 2C.0118
9. YIELD (gins). 2 METHOD OF TEST ARDM
10. WATER ZONES (depth): 485
11. DISINFECTION: TYPE HYPOCHLORITE Amount 12
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.48.926 / 81.97.302
(degrees/minutes/seconds)
Latitude'ongitude source: GPS X Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 125 Clay
125 500 Consolidated Rock
12. CASING. Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 136 Ft. 6 1/4 " SDR 21 PVC
U. GROUT:
Oz
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. SAND/GRAVEL PACK:
Depth Size Material
From NA To
16. REMARKS:
v
CD
0
LOCATION SKETCH --
Show direction and distance in miles from at leastO
two State Roads or County Roads. Include the roadt
number and common road names.
3/10MI
3/10 N
HUDLOW RD
FERGUSON RD
Ft, HWY 221
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. 10/27/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the ori:inal to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
D�36 Ahon!o. O12J33n22 in 30 days.
GW-1 REV. 07/2001
GROUNLWATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 11/05/02 22:31:00 Page 9 of 11
Sent by the Award Winning Cheyenne Bitware
263195
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 ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: SPINDALE County RUTHERFORD
WINDY HILL SUBDIVISION LOT 1 CROWE DAIRY RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 H W Y 74 BYPASS
(Street or Route No.)
FOREST CITY
City or Town
828- 286-3647
NC
State
Area Code - Phone Number
4. DATE DRILLED 10/23/02
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28043
Zip Code
YES ❑ NO 12
35 Fr.
(Use'+" If Above Top of Casing)
a. TOP OF CASING IS 2 FT. Above Land Surface*
'Lop of easing temGeted atior below land surface requires a vaeianee in
accordance with 15A NCAC 2C.0I18
9. YIELD (gpm): 5 METHOD OF TEST
10. WATER ZONES (depth): 370
ARDM
Topographic/Land setting
D Ridge ❑ Slope ❑ Valley X Flat
Latitude/Longitude of well location
35.19.042 / 81.55.190
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 95 Clay
95 400 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE
12. CASING'.
Depth Diameter
From 0 To 106 Ft. 61/4"
13. GROUT:
From 0
14. SCREEN
Depth
To 20 Ft.
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Amount 12
Wall Thickness
or Weight/Ft. Material
SDR2l PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Size
Slot Size Material
in.
Material
n
:J
ti
LOCATION SKETCH
CD
Show direction and distance in miles from at I ast "
two State Roads or County Roads. Include th roams 11
numbers and common road names.
OAKLAND RD
WINDY FULL SUB
5/10 MI
CROWE DAIRY RD
r;
(T.
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.
6t16$ P
GROUNDWATER SECTION
ASHEVILLE REGiEtEAL OFFlGE
11/2/02
SIGNATURE OF PERSON CONSTRUCTING THE WFJ I Date
ter Quality, Groundwater Section, 1636 Mall Service center - Raleigh, NC
thin 30 days.
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 11/05/02 22:30:14 Page 8 of 11
Sent by the Award Winning Cheyenne Bitware
263196
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)
1. WELL USE (Check Applicable Box) : Residential ❑K
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: FOREST CITY
660 COUNTY LINE RD
(if applicable)
Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ESTELENE BEAVER
ADDRESS 660 COUNTY LINE RD
(Street or Rowe No.)
RUTHERFORDTON
City or Town
828-863-4471
NC
State
Area Code - Phone Number
4. DATEDRILLED 10/19/02
5. TOTAL DEPTH 180
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES E NO 0
65 FT.
(Use "a^ If Abovc Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated aFor below land surface rcquhcs a variance in
accordance with I5A NCAC 2C.0118
9. YIELD Capm)'. 35 METHOD OF TEST
so. WATER ZONES (depth): 170
H. DISINFECTION: TYPE HI POCHLORITE
]c. CASING'.
From 0
13. GROUT'.
ARDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.12.423 / 81.33.465
(degrees/minutes/seconds)
Latitude4ongitude source: ® GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
50 180 Consolidated Rock
Q
Depth Diameter
To 58 Ft. 6 1/4 „
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To Ft.
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16. REMARKS:
Amount 4
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Oz
Diameter
Material Method
GRAVEL MIX GRAVITY
in.
Size
Slot Size Material
M.
Material
FJ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10/20/02
SIGNATURE OF PERSON CONSTRUu ILNG THE WELL Date
Submit the original to the Division ofWater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
one, o. (919)'734:3221T in 30 days.
it
GW-1 REV, 07/2001
arty
„SI,1IrSEc I

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 11/05/02 22:28:40 Page 6 of 11
Sent by the Award Winning Cheyenne Bitware
(if applicable)
1. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
319 BALMY LANE
263198
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCO1T GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, LotNo,. Zip Code)
3. OWNER
ADDRESS
CHARLES DILLION
319 BALMY LANE
(Street or Route No.)
RUTHERFORDTON
City or Town
828-286-9484
NC
State
Area Code - Phone Number
4. DATE DRILLED 10/12/02
5. TOTAL DEPTH 520
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES ❑ NO El
80 FT.
(Use "✓" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Laud Surface'
'Top of casing terminated at/or below land surface requires a variance in
accordance wide 15A NCAC 2C.0118
9. 'HUD (gpm): 2 METHOD OF TEST ARDM
10- WATER ZONES (depth): 490
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.42.664 / 81.95.171
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ® Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 40 Clay
40 520 Consolidated Rock
I1. DISINFECTION: TYPE HYPOCHLORITE Amount 13
12. CASING:
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
Wall Thickness
Diameter or Weight/Ft. Material
48 Ft 6 1/4 " SDR 21 PVC
0
fsa
J
r1
lIrwr
r,7
°z 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
20 Ft. GROVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft. in.
Size
Ft,
Slot Size Material
in.
Material
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.
10/14/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Subunit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service center - Raleigh, NC
22t'�Cf44�ti1 'n 30 days.
GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 11/05/02 22:27:52 Page 5 of 11
Sent by the Award Winning Cheyenne Bitware
From
263199
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR QNDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE County RUTHERFORD
RIVERBEND SUBDIVISION LOT 256 SWAN WAY ST.
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ALAN TANNER
ADDRESS 112 COCOPLUM CIRCLE
(Street or Roam No.)
ROYAL PALM BEACH
City or Town
561-798-2729
FL
State
Area Code - Phone Nmnber
4. DATE DRILLED 10/9/02
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL''
7. STATIC WATER LEVEL Below Top of Casing:
33411
Zip Code
YES ❑ NO El
180 FT.
fuss "cif Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
`Top of casing tcnninated at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gprt0: 4 METHOD OF TEST
1o. WATER ZONES (depth): 325
11. DISINFECTION: TYPE HYPOCHLORITE
12. CASING:
From 0
13. GROUT:
ARDM
STATE WELL
Topographic/Land setting
❑ Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.25.397 / 82.10.265
(degrees/minutes/seconds)
Latitude/longitude source: X GPS Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 179 Clay
179 400 Consolidated Rock
Depth Diameter
To 188 Ft 61/4"
Depth
From 0 To 25 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
NA To
16. REMARKS:
Amount 7 oz
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Diameter
Ft. in.
Ft,
Size
Material Method
SAND MIX GRAVITY
Slot Size Material
in.
Material
O
LOCATION SKETCH
CJ1
Show direction and distance in miles from at least+'
two State Roads or County Roads. Include the road
numbers and common road names.
SWkN WAY
HWY 64/74
RIVER
BEND
RESORT
BILL'S
CREEK
RD
2 Mr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IDA 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
10/30/02
Dale
Submit the on ' sjotraP}PaierE i I[ty, Groundwater Section, 1636 Mail Service center- Raleigh, NC
276 6 rhoneNo. [phone], µlbhin4, days.
IJ I ,.
nW-i REV. 12.99

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 11/05/02 22:27:06 Page 4 of 11
Sent by the Award Winning Cheyenne Bitware
263200
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTC 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 N Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: FOREST CITY
215 TIMBERBROOK DR
County RUTIIERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOMES OF RUTHERFORDTON
ADDRESS 342 US Hwy 74A By -Pass
(abcct or Rohe No_)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4. DATE DRILLED 10/5/02
5. TOTAL DEPTH 400
28139
Zip Code
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO 0
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 aVor blow land surface requires a variance in
accordance with I5A NCAC 2C.0118
9. YIELD (gpm). 1 METHOD OF TEST ARDM
10. WATER ZONES (depth): 350
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.14.263 / 81.49.146
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65 400 Consolidated Rock
11. DISINFECTION: 'TYPE HYPOCHLORITE Amount 10
12. CASING: Wall thickness
Depth
From 0 To
D. GROUT:
From 0
IA. SCREEN
Diameter or Weight/Ft. Material
73 FL 6 1/4 " SDR 21 PVC
Gl
7—
or 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.
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16. REMARKS:
Diameter
Ft in.
Size
Slot Size
in
Material
Material
TLUIBERBROOK DR.
GOODES GROVE CH RD
FERRY RD
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.
it i6e o[lgina'; to the D(yrsioirbf
10/8/02
SIGNATURE OF PERSON CONSTRUCTLNG THE WELL Date
uality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
11Z36Fhone tia(4j2 33i422 , w� I� n 30 days.
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 11/05/02 22:25:34 Page 2 of 11
Sent by the Award Winning Cheyenne Bitware
263202
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)
1. WELL USE (Check Applicable Box) : Residential
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest Eason: RUTHERFORDTON
506 ARROWOOD RD
(if applicable)
Municipal, ❑ Industrial 0 Agricultural 0 Monitoring ❑
Other ❑ If Other, List Use -
County RUTHERFORD
(Street Name, Numbcrs, Community, Subdivision, Lot No,. Zip Code)
3. OWNER MANUAL HILL
ADDRESS 506 ARROWOOD RD
(Stmct or Routc No )
RUTHERFORDTON
City or Town
828-287-7268
NC
State
Area Code - Phone Number
4. DATE DRILLED l0/l/02
5. TOTAL DEPTH 300
28139
Zip Code
6. DOES WELL REPLACE EXISTING BELL'? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing. 85 FT.
(The "cif Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
"Top of easing tcnninuted odor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (¢inn). 10 METHOD OF TEST
10. WATER ZONES (depth): 285
11. DISINFECTION: 'TYPE HYPOCHLORITE
12. CASINO:
From 0
13. GROUT:
From 0
14. SCREEN
ARDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.47.744 / 82.07.989
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ® Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
50 300 Consolidated Rock
Depth Diameter
To 60 Ft. 6 1/4 "
Depth
To 20 Ft.
Amount 7
Wall Thickness
or Weight/FL Material
SDR21 PVC
oz
Material Method
GRAVEL MIX GRAVITY
Depth Ditunetcr
From NA 'To Pl. in.
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Size
Ft,
Slot Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I MI
ARROWOOD RD
4 7/10 MI
HWY 64/74
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.
9 1-6361Phone-No.[i(910it73 2
10/5/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
in 30 days.
GW-1 REV. 07/2001
rI RE SIC 0!LFICE

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 10/19/02 16'4522 Page 11 of 14
Sent by the Award Winning Cheyenne Bitware
26219G
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 E Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
532 GRASSY KNOB RD
County RUTHERFORD
(Street Narne, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RAY FAGAN
ADDRESS 2731 COVE RD
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.39.572 / 82.13.299
(degrees/minutes/seconds)
Latitude4ongitude source: ❑ GPS ® Topographic map
(Street or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 90 Clay
828-286-0750 90 400 Consolidated Rock
Area Code - Phone Number
4. DATE DRII 1 ED 9/25/02
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing'.
YES ❑ NO ID
35 FT
(Mc "t" If Above Top of Casing)
8. TOP OF CASLNG IS 2 FT. Above ]and Surface*
'Top of casing terminated at/or below lard surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (epn0: 2
I0. WATER ZONES (depth):
it. DISINFECFION: TYPE HYPOCHLORITE Amount 11
12. CASING:
METHOD OF TEST
380
ARDM
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 97 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
Oz
Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Etin. in.
15. SAND/GRAVEL PACK:
Depth
From NA To
Ft,
Size
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road „7-3
numbers and common road names. -`1
4/10
GRASSY F - 0B RD
CO
CO
ROCKY SPRINGS RDD
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10/17/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
llrr, ivi on of ater Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
AfCC€ NF[`
(3N$)ff733-322 within 30 days.
OFFICE
GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 10/19/02 16:44:36 Page 10 of 14
Sent by the Award Winning Cheyenne Bitware
262195
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
# (704) 7ERMIT # 434-7277
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1- WELL USE (Check Applicable Box) : Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION:
Nearest town: ELLENBORO
269 GRICE DR , ELLENBORO, NC
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,Zip Code)
3. OWNER DOUG MELTON
ADDRESS Saudi Ararnco Box 9258
(Sued or Roma No.)
Bliahron
City or Town
SAUDI ARABIA
State
Area Code - Phone Number
4. DATE DRILLED 9/21/02
5. TOTAL DEPTH 300
6. DOES WELL REPLACE EXISTING WELL? YES X NO
7. STATIC WATER LEVEL Below Top of Cosine, 25 FT.
(us( ," If Above Top of Casing)
A. TOP OF CASING IS 2 FT. Above Land Surface°
"Top of casing terminated atter below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9- YIELD ((gpm): 3 METHOD OF TEST ARDM
to. WATER ZONES (depth): 280
I. DISINFECTION: TYPE
12. CASING:
31311
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ® Flat
Latitude/Longitude of well location
35.35.657 / 81.78.968
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 30 Clay
30 300 Consolidated Rock
Depth
From 0 To 45
13. GROUT:
HT POCHLORITE Amount 9
Wall Thickness
Diameter or WeightPt. Material
Fr 6 1/4 " SUR 21 PVC
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
NA To
From
0,
Diameter
Ft.
Material Method
GRAVEL MIX GRAVITY
Size
Slot Size Material
in.
Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road o
numbers and common road names. C
-V
PLNEHURST RD
GRICE DR
12/10MI
OLD US 74
NJ
CO
ubmit the original to the Divi ion of
3-322
,i uJ
ASHEVILLE REGIONAL GFFCE
'ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9/25/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Vater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
, within 30 days.
GW-1 REV. 07/20011

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 10/19/02 16:43:50 Page 9 of 14
Sent by the Award Winning Cheyenne Bitware
262194
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 E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
269 MELROSE RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER JASON WILLIS
ADDRESS 269 MELROSE RD
(Street or Route No.)
LAKE LURE
City or Town
828-625-2899
NC
State
Area Code - Phone Number
a. DATE DRILLED 9/18/02
5. TOTAL DEPTH 600
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 280 FT.
(Use ✓' If Above Top of Casing)
s. TOP OF CASING IS 2 ET Above Land Surface*
'Top of casing nmdnated at/or below Land surface requires a variance in
accordance with I5A NCAC 2C.0118
9. YIELD (gpm): 1 METHOD OF TEST ARDM
to. WATERZONES (depth): 450
Topographic/Land setting
❑ Ridge © Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.30.092 / 82.07.197
(degrees/minutes:seconds)
Latitude,/longitude source: ® GPS ❑ Topographic map
DEPTH
From
0
DRILLING LOG
To Formation Description
62 Clay
62
600 Consolidated Rock
H. DISINFECTION: TYPE HYPOCHLORITE Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
68 Ft 6l/4" SDR21 PVC
10 oa LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road it
numbers and common road names.
C7
.J
Depth
From 0 To
D. GROUT:
Depth
From 0 To
11. SCREEN
20 Ft
Depth
From NA To
15. SAND/GRAVEL PACK'.
Depth
NA '1'o
m
Ft.
Ft,
Diameter
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in. in.
Size
Material
MELROSE RD
f--1 4/IOMI
0
1ONNOR RD ry
w
BILL'S CREEK RD
THX T TAIS
RUCTION STANDARDS, AN
07 2
SubuwsNR[yy
L /69Y-a6n6 l ... 1.e.
Tij
J
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS REEN PROVIDED TO THE WELL OWNER.
9/20/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
n 30 days.
OW -I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 10/19/02 16:47:42 Page 14 of 14
Sent by the Award Winning Cheyenne Bitware
From 0
GROUL
262199
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 ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town. SPINDALE County RUTHERFORD ❑ Ridge ❑ Slope ❑ Valley © Flat
260 PATE RD Latitude/Longitude of well location
(Street Name, Numbers. Community, Subdivision. Lot No,. Zip Code) 35.33.557 / 81.94.099
3. OWNER HORTON HOMES OF RUTHERFORDTON (degreesrminutes/seoonds)
ADDRESS 342 US Hwy 74A By -Pass I.atitude/longitude source: ❑ GPS Topographic map
(Sweet or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 60 Clay
828-287-3366
Area Code - Phone Nmnbcr
4. DATE DRILLED 9/16/02
5. TOTAL DEPTH 200
6. DOES WELL REPLACE OUSTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Cuing: 40 FT.
(Use "+" If Above Top of Casi b)
8. TOP OF CASLNG IS 2 FL Above Land Surface`
a Top ofcasingtar wetted at/or below land surface requires a varanve m
accordance with 15A NCAC 2c.0118
9. YIE;IA(gpm)'. 8 METHOD OF TEST ARDM
10. WATER ZONES (depth)'. 95 190
60 200 Consolidated Rock
11. DISINFECTION. TYPE HYPOCHLORITE Amount 3 0. LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Dept Diameter or Weight/Ft. Material two Stale Roads or County Roads. Include the roadr-2
To 70 Fe 6 1/4 " SDR 21 PVC numbers and common road names. i -,l)
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To FL in.
15. SAND/GRAVEL PACK:
Depth Size Material
F-nm NA To Ft,
9
7/10 MI
PATE DR
POORS FORD RD
-MY 221 S
DO HEREBY CERTIFY THA
ONSTRUCTION STANDAR
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
0 TIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER.
9/16/02
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 Phone No. (919) 733-322 , within 30 days.
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 10/19/02 16:42:18 Page 7 of 14
Sent by the Award Winning Cheyenne Bitware
2. WELL LOCATION:
Nearest town: UNION MILLS County RUTHERFORD
3677 HWY 221 N
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
I. OWNER ESTALEE WATERS (degrees/minutes/seconds)
ADDRESS 3677 HWY 221 N Latitude/longitude source: ❑ GPS Z Topographic map
DEPTH DRILLING LOG
28167 From To Formation Description
Zip Code 0 75 Clay
262192
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 ❑ Other ❑ If Other, List Use:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.48.266 / 81.98.161
(Street or Route No.)
UNION MILLS
City or Town
NC
State
Area Code - Phone Number
4. DATE DRILLED 9/12(02
5. TOTAL DEPTH 500
6. DOES WEI.1. REPLACE EXISTING WELL? YES ❑x NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 260 FT.
(Use "4" If Above Top of Caving)
8. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in
eacmdunce unit 15A NCAC 2C.0I16
9, YIELD (gpm): 1 METHOD OF TEST ARDM
to. WATER ZONES (depth): 295
1l. DISINFECTION: TYPE HYPOCIILORITE Amount 7
11. CASINO'
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Wall Thickness
Diameter or Weig}¢/Ft. Material
80 Ft 6 1/4 " SDR 21 PVC
oz
20 Ft.
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size
From NA To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From NA To Ft,
16. REMARKS:
m
Material
Material
75
500 Consolidated Rock
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road cp
numbers and common road names.
0
0
*N0
HWY 221 N
4/10 MI
OWENS CHAPEL
NJ
IIkEKYCF$'flF' TOUT -MIS ft-
•. ,.�•-i-, T-
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9115/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Subm td,1ipmistrAcfpEthelltiptpiof Waret Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
2769089RNHkinAH6J0.401708F3e11, wit in 30 days.
[GW.1 REV. 07/20011

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANT( 704-434-7212 10/19/02 16:40:44 Page 5 of 14
Sent by the Award Winning Cheyenne Bitware
2E2190
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTC CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE
# (704)7E434-7277IT #
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑' Industrial ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest tor.: RUEHERFORDTON
990 CENTENNIAL RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
J. OWNER JOE McCURRY (degrees/minutes/seconds)
ADDRESS 990 CENTENNIEL RD Latitude/longitude source: 0 GPS ❑ Topographic map
DEPTH DRILLING LOG
28167 From To Formation Description
0 70 Clay
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.28.051 / 81.54.613
(Sven or Route No.)
UNION MILLS NC
City or Town State
828-286-4103
Area Code - Phone Number
4. DATE DRILLED 9/7/02
5. TOTAL DEPTH 480
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing'.
Zip Code
YES ❑ NO ID
60 FT.
(Ilse "+" If Above Top of Casing)
8. TOP OF CASINO IS 2 FT. Above Land Surface*
*Top of easing terminated at/or below land surface rcgnbes a variance in
accordance with 15A NCAC 2C 0118
9. YIELD (gm): 0 METHOD OF TEST ARDM
1o. WATER ZONES (depth): 260
70 480 Consolidated Rock
tt. DISINFECTION: TYPE HYPOCHLORITE Arnomtt 13 Oz LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or WeightPt. Material two State Roads or County Roads. Include the road
To 80 Ft. 6 I/4 " SDR 21 PVC numbers and common road names.
From 0
❑. GROUT:
From 0
Depth Material Method
To 20 FL GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. m.
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Ft,
Size
Maeriet
1 9/l0 NE
0
CENTENNIAL RD
HWY 64
c%7
I D0 H ai r' r ITr H
CONS �9 • &'. T DD , A
Submit he orilinal to the Division MN uality,
27699-1 36 Ph0BRpltli U9d '3S +Lifhin 30 da;
ASHEVILLE REGIONAL OFFICE
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
E OF PERSON CONSTRUCTING THE WELL
9/10/02
Date
Groundwater Section, 1636 i\lail Service center- Raleigh, NC
s-
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212
10/19/02 16:38:26 Page 2 of 14
Sent by the Award Winning Cheyenne Bitware
262187
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - GCERTTwater Section
ICATTON # 2584
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,, INC. PHONE
# [phone]
77
STATE WELL CONSTRUCTION PERMIT # ASSO(if PERMITI#
(if applicable) Agricultural ❑
1. WELL USE (Check Applicable Box) : Residential El
Recovery 0 Heat Pump Water Injection 0
r. WELL LOCATION:
Nearest town'. HARRIS
452 JONAS RD
Municipal 0 Industrial 0
Other 0 If Other, List Use:
County RUCIIERFORD
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER MARK BROWNSWORD
ADDRESS 452 JONAS RD
(Street or Route No.)
RUTHERFORDTON
City or Town
828-248-2069
Area Code - Phone Number
4. DATE DRILLED 9/3/02
NC
State
5. TOTAL DEPTH 400
28139
Zip Code
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 2 FT. Above Land Surface'
'Top of casing terminated ar/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD(apitO. 2 METHOD OF TEST ARDM
10. WATER ZONES (depth). 260
u. DISIN FECI'ION: TYPE HYPOCHLORFI'E Amount 11
12. CASING: Wall Thickness
Diameter or Weighat. Material
105 Fr 61/4" SDR21 PVC
Depth
From 0 To
13. GROUP:
Depth
From 0 To
14. SCREEN
Depth
From NA To
Monitoring 0
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.11.612 / 81.54.658
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 90 Clay
90
400 Consolidated Rock
oz LOCATION SKETCH
Show direction and distance in miles from at least o
two State Roads or County Roads. Include the road
numbers and common road names. .7
20 Ft.
1s. SAND/GRAVEL PACK:
Depth
NA To
From
Material Method
GRAVEL MIX GRAVITY
Diameter Slot Size Material
Pt. in. in.
Ft,
Size Material
16 REMARKS:
JONAS RD
'I
IMI
JACK McKINNEY RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
V
Submit the • ilia' to the Division of Water Q
27699-1636 P 1 a Np1 I939) 733,,3221,-within
L
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
9/15/02
RiE OF PERSON CONSTRUCTING THE WELL Date
roundwater Section, 1636 Mail Service center - Raleigh, NC
[GW-1 REV. 07/20011

To: DENR DIVISION OF WATER QUALITY, GROUN[From. ALAN S. GANTT 704-434-7212 09/15/02 20:03:22 Page 13 of 15
Sent by the Award Winning Cheyenne Bitware
259864
WELL CONSTRUCTION RECORD
North Carolina - Department of Environlnent, 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 ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearesttowtr. LAKE LURE County RUTHERFORD
LOT 23 PHEASANT ST RIVERBEND ESTATES
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ALAN TANNER
ADDRESS 112 Cocopluni Circle
(Street or Route No.)
Royal Pahn Beach
City or Town
FL
State
Area Code - Phone Number
4. DATE DRILLED 8/30/02
33111
Zip Code
5. TOTAL DEPTH 600
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing: 75 FT.
(Use' *" If Above Top of Casing)
8. TOP OF CASINO IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2C0118
9. YIELD (gpm): o METHOD OF TEST ARDM
10. WATER ZONES (depth), 550
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.25.118 / 82.09.965
(degrees/minutes/seconds)
Latitude/longitude source:® GPS ❑ Topographic map
DEPTH
From
0
DRILLING LOG
To Fomation Description
67 Clay
67 600 Consolidated Rock N
t1. DISINFECTION: TYPE HYPOCHLORITE Amount 16
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 73 FL 61/4" SDR 21 PVC
U. GROUT:
C)
f 1
-� Lr
Jl
G
Oz LOCATION SKETCH
Show direction and distance in miles from at least
two State Road or County Roads. Include the road
numbers and common road names.
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
1s. SAND/GRAVEL PACK'.
Depth
From NA To Ft,
16. REMARKS:
Material Method
GRAVEL MIX GRAVITY
Diameter
FL in.
Size
Slot Size
in
Material
Material
PHEASANT ST
RIVERBEND
ESTATES
Y 64/74
BILL'S CRK RD
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.
9/9/02
SIGNATURE OF PERSON CONSTRUCILNG THE WELL
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
221 within 30 days.
n -P 1
GW-1 REV. 07/2001
GROIUNLW4; r:P -rn IO^!
ASHLN'..LLF it (JOi

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 09/15/02 20:00:16 Page 9 of 15
Sent by the Award Winning Cheyenne Bitware
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
535 OLD MORGANTON
2598F8
WELL CONSTRUCTION RECORD .
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
wICATION # 2�83
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, IN.PHONE
E # (704) 7ERMI# 77
ASSOCIATED
STATE WELL CONSTRUCTION PERMIT # (if PERMIT
(if applicable)
e)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.28.777 / 81.53.375
County RUTHERFORD
(Street Name. Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RALPH MILLER
ADDRESS 535 OLD MORGANTON RD Latitude/longitude source: (X] GPS ❑ Topographic map
DEPTH DRILLNG LOG
From To Formation Description
(Street or Route No.)
UNION MILLS
City or Town
828-287-3838
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/15/02
28167
Zip Code
5. TOTAL DEPTH 305
6. DOES WELL REPLACE EXISTING WELL? YES Q NO 0
7. STATIC WATER LEVEL Below Top of Casing'. 0 FT.
(Use "*" If Above Top of Casing)
8. TOP OF CASING LS 2 FT. Above Land Surfaces
*Top of cabin tenmmnated at/or below land surface requires a variance in
accordance with 15A NCAC 2C 0118
9_ YIELD (gpm): no
METHOD OF TEST ARDM
to. WATER ZONES (depth): 305
al DISINFECTION: TYPE HYPOCHLORITE Amount NA oa LOCATION SKETCH
12. CASING. Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
To 77 FL 61/4" SDR 21 PVC numbers and common road names.
(degrees/minutes/seconds)
0 70 Clay
70 305 Consolidated Rock
O
cn /
rr
0i
CO
U
rn
so—
From 0
13. GROUP.
From 0
Depth
To 20 Ft.
u. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK'.
Depth
From NA To
16. REMARKS:
Diarnetei
Ft.
Ft.
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in. in.
Size Material
ARTESIAN WELL, CAPPED OFF.
9/10 MI
OLD MORGANTON RD
HWY 64
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
E',L Gubi;4or�ina�Tott1
SEP i 7 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
8/15/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
sion of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
33-3221, within 30 days.
[GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 09/15/02 20:04:54 Page 15 of 15
Sent by the Award Winning Cheyenne Bitware
259862
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 © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON Couny RUTIIERFORD
4600 MAPLE CREEK RD
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
a. OWNER LAMES GENTRY
ADDRESS 4600 MAPLE CREEK RD
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3061
Area Code - Phone Number
4. DATE DRILLED 8/13/02
NC
State
28139
Zip Code
5. TOTAL DEPTH 180
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATERLEVEL Below Top of Casing: 55 FL
(llse "+" If Above Top of Casing)
8. TOP OF CASNG IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface rcquires a variance In
accordance with I5A NCAC 2C0118
9. YIELD (gpm): 12 METHOD OF TEST ARDM
t0. WATER ZONES (depth): 96 165
Topographic/Land setting
❑ Ridge Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.24.215 / 82.02.951
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 85 Clay
85 180 Consolidated RgdS
tV
w
m
L
Gl
1.0
c
CI ;az
11. DISINFECTION: TYPE HYPOCHLORCI'E Amount 4
12. CASLNG:
Depth
From 0 To
12. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
Diameter
95 Ft- 61/4"
Wall Thickness
or Weight/Ft. Material
SUR21 PVC
or 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
20 FL GRAVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter Slot Size Material
in. in.
Size Material
Pt,
MAPLE CREEK RD 7/10 MI
HWY 64/74
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.
ECEOWE
Submit the original 1
S E P 76”).63L UJ{pne N
1
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
8/15/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
vision of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
733-3221, within 30 days.
GW-t REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 09/15/02 19:59:30 Page 8 of 15
Sent by the Award Winning Cheyenne Bitware
2598F9
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
# (704) 7ERMIT # 434-7277
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential El Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: FOREST CITY
205 MONTIETH LANE
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,Zip Code)
3. OWNER CRAIG HEMINGSON
ADDRESS 205 MONTIETH LANE
(Street or Route No.)
FOREST CITY
City or Town
828-245-1803
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/12/02
5. TOTAL DEPTH 227
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 20 ET.
(Usa "4" rf Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing tetniuted at/or below land surface requires a vaianee in
accordance with 15A NCAC 20.0118
9. YIELD (gpm)'k 20 METtIOD OF TEST
to WATER ZONES (depth): 225
11. DISINFECTION: TYPE
12. CASING:
From 0
13. GROUT:
Depth
From 0 To
O. SCREEN
Depth
From NA To
ARDM
Depth
To 35
HYPOCHLORITE Amotmt 7
Wall Thickness
Diameter or Weight:Ft. Material
Ft. 61/4" SDR21 PVC
28043
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.17.481 / 81.54.857
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 30 Clay
30 227 Consolidated Rock
cn
-7 1
T
c
Ol
lfJ C;_..
oe LOCATION SKETCH CIT
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
20 Ft.
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Slot Size Material
Size Material
SHILOH RD
GODFREY RD
'/a MI
0
MONTIETH DR
HWY 221
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
R E QinIheIbril .
2 /699 lb36 Ynone No. (,
SEP 1 7 2002
8/14/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
on of Water Quality, Groundsater Section, 1636 Mail Service center - Raleigh, NC
{-3221, 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 09/15/02 19:58:42 Page 7 of 15
Sent by the Award Winning Cheyenne Bitware
259870
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOFF 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 D Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Ilse:
2. WELL LOCATION:
Nearest town: FOREST CITY
126 LILAC CI'
County RUI'HERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER CHARLES HARRIS
ADDRESS 126 LILAC CT
(Street or Route No.)
RUIHERFORDTON NC
City or Town State
28139
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.16.638 / 81.57,793
(degrees/minutes/seconds)
Latitude/longitude source: ❑X GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 70 Clay
828-863-4220 70 350 Corlsoldated Rock - Area Code - Phone Number 0
4. DATE ORH I FIT 8/9/02 <17 =
I'I
5. TOTAL DEPTH 350 —O �'
6. DOES WELL REPLACE EXISTING WELL? YES Ei NO 0
7. STATIC WATER LEVEL Below Top of Casing: 70
(Mc "+" If Above Top or Casurg) �•*
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing mmwnated at/or below lard surface requires a variance in t.O
accordance with 15A NCAC 2C.0119
9. YIELD (gpm): 30 METHOD OF TEST ARDM
10. WATER ZONES (depth): 340
u. DISINFECTION: TYPE HYPOCHLORITE Amount 9
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 77 FL 61/4" SDR 21 PVC
13. GROAT'.
Vl cs
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.
Depth Material Method POORS FORD RD
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From NA To FL
16. REMARKS:
LILAC CT
9/1OMI
OUNTY LINE RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/11/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
_, rv�jt he 'igihal/the,$iv' o F'Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
D7 II-3221, within 30 days.
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEViLLE RFGIGnif:, nfri.l[

To: DENR DIVISION OF WATER QUALITY, GROUN[From. ALAN S. GANTT 704-434-7212 09/15/02 19.57:56 Page 6 of 15
Sent by the Award Winning Cheyenne Bitware
2598'71.
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 ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: BOSTIC
3384 HWY 64
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.27.095 / 81.53.230
3. OWNER MORRIS HARRISON (degrees/minutes/seconds)
ADDRESS 3384 HWY 64 Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
BOSTIC NC 28018 From To Formation Description
City or Town State Zip Code 0 65 Clay
(Street or Route No-)
828-287-4627 65 400 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 8/7/02
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL. Below Top of Casing:
YES ❑ NO ID
80 FT_
(Use +" If Above Top of Casing)
8. TOP OF CASINO IS 2 Fr. Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in
accordance with I5A NCAC 2C.0118
9. YIELD (glint): 3 METHOD OF TEST ARDM
10. WATER ZONES (depth): 360
I1. DISINFECTION: 'I'YPE HYPOCHLORITE Amount 10
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 78 Fr 6 1/4 " SDR 21 PVC
13. GROUT:
From 0
Depth
To 20 Ft.
14. SCREEN
m
c71
cn Tr.
or 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
GRAVEL MIX GRAVITY
Depth Diameter
From NA To Ft. is
15. SAND/GRAVEL PACK:
Depth Sire
From NA To Ft,
16. REMARKS:
Slot Size Material
in.
Material
US 64
PEARIDGE RD
4/10 MI
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.
tljeCori_sal ot1�iDi'^'sio
tone No. (Y19) ijjl3
GFDUNDVJAPER SECTION
ASHEVILLE REGIONAL OFFICE
8/9/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
ter Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
'thin 30 days.
GW-1 REV- 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 09/15/02 19:57:10 Page 5 of 15
Sent by the Award Winning Cheyenne Bitware
259872
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 ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest towne RUTHERFORDTON County RUTHERFORD
LEE RD
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER JEREMY WILSON
ADDRESS 614 LEE RD
(Street or Rowe No.)
FOREST CITY
City or Town
828-287-2052
NC
Slate
Area Code - Phone Number
4. DATE DRILLED 8/5/02
5. TOTAL DEPTH 460
280,13
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 Fr.
(Use's" If Above Top of Cuing)
8. TOP OF' CASING IS 2 Fr. Above Land Surface'
'Top of cashtg terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2CD118
9. YIELD (ghm): 20 METHOD OF TEST ARDM
lm. WATER ZONES (depth): 450
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.23.555 / 81.52.576
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH
Front
0
DRILLING LOG
To Formation Descti Ibtion
30 Clay fV
30 460 Consolidated Rockrn
u. DISINFECTION. TYPE HYPOCHLORITE Amount 12
12. CASING'.
Depth
Froth 0 To 38
13. GROUF,
Depth
From 0 To
14. SCREEN
Depth
From NA To
Wall Thickness
Diameter or Weight/R. Material
Ft. 6 1/4 t' SDR 21 PVC
rD c
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.
Material
20 Ft. GRAVEL MI
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Method
GRAVITY
Diameter
Ft. in.
Ft,
Size
Slot Size Material
in.
Material
IUDLOW RD
2 MI
LEE RD
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.
8/5/02
SIGNATURE OF PERSON CONSTRUCTLNG THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
, within 30 days.
cFO
hie (9
2002
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE RE'd ONAI ONCE

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 09/15/02 19:55:38 Page 3 of 15
Sent by the Award Winning Cheyenne Bitware
2F9Q7,,
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 Ei Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection E Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
114 BOLAND RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.29.933 / 82.06.124
3. oWNER RICHARD ISSACS (degrees/minutes/seconds)
ADDRESS 114 BOLAND RD Latitude/longitude source: ® GPS ❑ Topographic map
(Seca er Route No.) DEPTH DRILLING LOG
LAKE LURE NC From To Formation Description
City or Town State Zip Code 0 30 Clay
828-438-4665 30 520 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 7/27/02
5 TOTAL DEPTH 520
6. DOES WELL REPLACE EXISTLNG WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: FT
(use -4^ If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a variance in
acorndmme with 15A NCAC 2C0118
9 YIELD (gpm): 5 METHOD OF TEST ARDM
m. WATER ZONES (depth): 360 500
H. DISINFECTION: TYPE HYPOCHLORITE Amount o2 LOCATION SKETCH
12. CASING: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 37 FL 6 1/4 " SDR 21 PVC numbers and common road names.
13. GROUP:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY BILL'S CREEK RD 2.5 ME
14. SCREEN
Dept: Diameter Slot Size Material
From NA To FL in. in.
a s. SAN /GRAVEL PACK:
Depth Size Material
From NA To Ft,
1e_ REMARKS''
3/4 MI :OL-AND RD
COVE RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7/27/02
SIGNATURE OF PERSON CONSIRUCITNG It5E WELL Date
Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
n 30 days.
GROUNDWATER SECTION
ASHEVKLE REGI'i'JrL. LEE'DE
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 09/15/02 20:04:08 Page 14 of 15
Sent by the Award Winning Cheyenne Bitware
259863
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) : Residenfial 0 Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION'.
Nearest town: RUTHERFORDTON
140 TAYLOR RD
County RU1'HERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
�. OWNER PAUL MORROW
ADDRESS 140 TAYLOR RD
(stun or Rome No.)
RUTHERFORDTON
City or Town
828-288-9962
NC
State
Area Code - Phone Number
4. DATEDRILLED 7/18/02
28139
Zip Code
5. TOTAL DEPTH 340
6. DOES WELL REPLACE EXISTLNG WELL? YES ❑ NO (21
7. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(nu `*" If Abevc Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
"Top of casing terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 5
10, WATER ZONES (depth):
u. DISINFECTION: TYPE
I2. CASING:
METHOD OF TEST
180 320
ARDM
•
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.22.367 / 82.00.509
Latitude/longitude
DEPTH
From
0
(degrees/minutes/seeonds)
source: E GPS ❑ Topographic map
DRILLING LOG
To Formation Description
35 Clay
35
340
Consolidated Rock
O
tV
G7
rTl
CI
t-b Co 2:-
HYPOCHLORITE Amount
Wall Thickness
Diameter or Weight/Ft. Material
61/4" SDR21 PVC
Depth
From 0 To 45 Ft.
13. GROIJT:
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To ' Ft.
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.
Diameter
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
GREEN RD
LI
TAYLOR RD
MAPLE CRK RD
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.
7/18/02
SIGNATURE OF PERSON CONSTRIJCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
-3221, within 30 days.
CI-P 1
dr02
GROUNDWATER SECTION
nEt E.E
GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 08/13/02 22:43:36 Page 13 of 13
Sent by the Award Winning Cheyenne Bitware
258013
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)
1. WELL USE (Check Applicable Box) : Residential ® Municipal (if applicable)
RecoveryP ❑ In, List ❑ Agricultural ❑ Monitoring
❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
z. WELL LOCATION: Topographic/Land setting
Nearest owrc RUTHERFORDTON ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
DARLINGTON RD Latitude/Longitude of well location
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RYAN HENDRICKS
ADDRESS
(Street or Route No.)
City or Town
NC
State
Area Code - Phone Number
4. DATE DRIII ED 7/12/02
5. TOTAL DEPTH 220
Zip Code
6. DOES WF2 T REPLACE EXISTING WFI L ? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 55 FT,
(Vsc "+" If Above Top of Casing)
8. TOP OF CASING IS 2 Ff. Above Land Surface*
"Top of raring terminated at/or below land surface requires a variance in
accordance with ISA NCAC 2C.0118
9_ YIELD (8pm): 12 METHOD OF TEST ARDM
10. WATER ZONES (depth): 120 150 210
11. DISINFECTION: TYPE HYPOCHLORITE Amount 6
(degrees/minutes/seconds)
Latitude/longitude source: El GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 115 Clay
115 220 Consolidated Rock
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 123 FL 6 1/4 " SDR 21 PVC
13. GROUT:
oz
Depth
From 0 To 20 Ft.
14. SCREEN
From
Depth
NA To
15. SAND/GRAVEL PACK:
Diameter
Ft.
Material Method
GRAVEL. MIX GRAVITY
n.
Slot Size Material
in.
Depth Size Material
From NA To Ft,
16_ REMARKS:
O
]V O
m c:
G-2
Co 777
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.
COVE RD
DARLINGTON RD
1MI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORDyHAS BEEN PROVIDED TO THE WELL OWNER
IS .
7/12/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
in 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 08/13/02 22:42:50 Page 12 of 13
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD r r 8014
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Sectio`r
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 0 Agricultural, 0 Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: ELLENBORO County RUTHERFORD
681 SHIRES RD
(Street Name, Numbers, Community, Subdivision, Lot No,Zip Code)
a. OWNER MIKE GREENE
ADDRESS 681 SHIRES RD
(Street or Route No.)
ELLENBORO NC
City or Town State
28040
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.22.154 / 81.45.648
(degrees/minutes/seconds)
Latitude/longitude source: El GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0
35 Clay
8208-453-0017 35 220 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 7/10/02
5. TOTAL DEPTH 220
6. DOES WTI 1 REPLACE EXISTING WFS 1 ? YES El NO 0
7. STATIC WAIhR LEVEL Below Top of Casing: 52 FT.
(Vsc "*" If Above Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated ut'or below land surface requires a varivme in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm). g METHOD OF TEST ARDM
to. WATER ZONES (depth): 180 210
H. DISINFECTION: TYPE HYPOCHLORITE Amount 5 oz
12. CASLG: Wall Thickness
Depth Diuneler or WeighUFt. Material
From 0 To 40 FL 6 1/4 " SDR 21 f PVC
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. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
0-
f_,
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.
WALLS CH. RD.
4/10 mi
7/10 mi
SHIRES RD
1111 HOLLIS
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.
7/10/02
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 PhoneNA (010) 734 3 within 30 days.
r).) \\,7 --N)
JJ
Ifs
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 08/13/02 22:42:04 Page 11 of 13
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)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RIJFHERFORDTON
NEW CASTLE RD
County RUTHERFORD
(Strett Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
s. OWNER ROGER VANCE
ADDRESS NEW CASTLE RD
(Street or Route No_)
RCITHERFORDTON
City or Town
828-287-3282
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/8/02
5. TOTAL DEPTH 485
6. DOES WELL REPLACE EXISTING WELL'
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES ❑ NO 0
FT.
(Vic "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing tcrosinated at/or below land surface requires a variance in
accordance with UA NCAC 2C.0118
9. YIELD (2pru): 25 METHOD OF TEST ARDM
10. WATER ZONES (depth): 481
it. DISINFECTION: 'TYPE HYPOCHLORITE Amount 13
12. CASLVG:
Depth
From 0 To
13. GROUT:
25Jii15
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.25.567 / 82.00.287
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
50 485 Consolidated Rock
Wall Thickness
Diameter or Weight/Ft. Material
62 Ft. 6 1/4 " SDR 21 PVC
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
0z
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Size
Slot Size
in
Material
Material
O
Pc)
c_
A
—A.
LOCATION SKETCH uJ o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4/10MI
NEW CASTLE RD
MOUNTAIN CRTC RD
1 2/1O MI
HWY221N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CON STRI ICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS RUN PROVIDED TO THE. WR1.L OWNER.
7/8/02
SIGNATURE OF PERSON CONSTRUCFING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
n 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 08/13/02 22:39:44 Page 8 of 13
Sent by the Award Winning Cheyenne Bitware
258018
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 ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: UNION MILLS
245 ROBERTSON RD
County RUTHERFORD
(Street Name, Numbers, Cmmnunity, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.28.172 / 81.53.087
3. OWNER PAUL OWENSBY (degrees/minutes/seconds)
ADDRESS 245 ROBERTSON RD Latitude/longitude source: ® GPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
UNION MILLS NC 28167 From To Formation Description
City or Town State Zip Code 0 35 Clay
828-288-0844
Area Code - Phone Nlunber
4. DATE DRILLED 7/1/02
5. TOTAL DEPTH 280
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 80 Ff.
(Ilse "+" If Above Top of Casing)
35 280 Consolidated Rock
O
INO
8. TOP OF CASLNG IS 2 FL Above Land Surface° G7
•Top of easing Iemu„atcd at/or below lard surface requires a V advwe in C=
accordance with 15A NCAC 2C 0118 _ 1' ) A--.
9. YIELD (gem): 2 1/2 METHOD OF TEST ARDM 23. r•+
10. WATER ZONES (depth): 180 250 - r H
-
n. DISINFECTION: TYPE HYPOCHLORJTE Amount 6 0z LOCATION SKETCH -' r; ^7
n
12. CASING: Wall Thickness Show direction and distance in miles from at least.°
c
Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
FL 6 1/4 " SDR 21 PVC numbers and common road names.
Depth
From 0 To 40
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
ROBERSON RD
0
400 YDS
HWY 64
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.
7/2102
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
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 08/13/02 22137:24 Page 5 of 13
Sent by the Award Winning Cheyenne Bitware
258021
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
# (704) 7ERMTT # 77
STATE WELL CONSTRUCTION PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential © Municipal ❑ industrial ❑ Agricultural ❑ Monitoring 0
Recovery 0 Pleat Pump Water Injection ❑ Other ❑ If Other, List Use:
a. WELL LOCATION:
Nearest town: GREENHILL
LOT 35 GREENHILL FARMS SUBDIVISION
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOMES
ADDRESS 342 HWY 74A BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
a. DATE. DRILLED 6/19/02
28139
Zip Code
5. TOTAL DEPTH 385
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 75 FT
(Use "+" If Above Top of Casing)
a. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated atlor blow land surface requhes a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 20 METHOD OF TEST ARDM
10. WATER ZONES (depth): 380
D. DISINFECTION: TYPE HYPOCHLORITE Amount 10
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 40 Ft. 61/4 " SDR21 PVC
From 0
D. GROUT:
Depth
From 0 To
VI. SCREEN
Depth
From NA To
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.23.502 / 82.01.294
(degrees/minutes/seconds)
Lafitude4ongitude source: ® GPS 0 Topographic map
DEPTH
From To
DRILLING LOG
Formation Description
0 35 Clay
35 385 Consolidated Rock
^tom
1
G7
oe LOCATION SKETCH —"
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roach)
numbers and common road names.
Material Method
20 FL GRAVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft. in.
Ft,
Slot Size Material
in.
GREEN HILL FARMS
MOUNTAIN CRY. RD
Size Material
5/10M[
HWY 64/74
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.
7/1/02
SIGNATURE OF PERSON CONSTRUCTLNG lHt: WELL Date
on of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh,NC
3221, within 30 days.
GW.1 REV. 07/20011
GROUf.DV/A R SEC; ^ei
ASHEVU..LE I f U'QP _

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212
08/13/02 22:36:38 Page 4 of 13
Sent by the Award Winning Cheyenne Bitware
25802?
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater
wICATIOtion N n 2583
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANIT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE
# [phone]
#277
STATE WELL CONSTRUCTION PERMIT # (if PERMIT
e)
(if
(heckapplicable)
Industrial ❑ Agricultural ❑ Monitoring ❑
1. WELL USE (Check Applicable Box) : Residential ® blunlapal ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use:
2. WELI. LOCATION: Topographic/Land setting
Nearest town: GREENHILL County RUFHERFORD ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
LOT 4 AUSTIN CIRCLE Laborde/Longitude of well location
35.26229 / 82.02.098
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code) (degrees/minutes/seconds)3. OWNER RICKY JACKSON
ADDRESS LOT 4 AUSTIN CIRCLE Latitude/longitude source: ® GPS 0 Topographic map
(street or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 130 Clay
130 400 Consolidated Rock
828-286-1016
Area Code - Phone Number
4. DATE DRILLED 6/18/02
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
El
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use's" If Above Top of Casing)
8. TOP OF CASING IS 2 Fr. Above Land Surface'
°Top of casing terminated actor below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 3 METHOD OF TEST ARDM
10, WATER ZONES (depth). 354
11. DISINFECTION'. TYPE HYPOCHLORITE Amount 10
oz
12. CASING: Wall Thickness
Depth Diameter or WeightiFt. Material
From 0 To 137 Ft. 61/4 " SDR 21 PVC
13. GROUT:
From 0
Depth
To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Malarial Method
Depth Diarnetei' Slot Size Material
From NA To FL in. in.
15. SANDiGRAVEL PACE:
Depth Size Material
From NA To Ft,
16. REMARKS:
N
+tea [X
G7
m
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roady
numbers and common road names.
OVERD AUSTIN
CIRCLE
1MI
CD
300 YDS
DARLINGTON 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.
rlsbbiwit thr, orlgina, In 1
769 16.16 PhbneNo. O
7/1/02
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL Date
rLq(iw,'- ,lt▪ sfon of Water Quality, Groundwater Section, 1636 Mati Service center - Raleigh,
NC
99 733-3221, within 30 days.
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

22:35:52 Page 3 of 13
To: DENR DIVISION OF WATER QUALITY, GROUN[From'. ALAN S. GANTT 704-434-7212 08/13/02
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD 258023
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater
CERTIwICATIOSectiNon # 2584
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANi-h
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE
# (704) 7ERMI# 434-7277
STATE WELL CONSTRUCTION PERMIT # ASSO(if apERM IT
(if applicable) ❑ Agricultural 0 Monitoring 0
1. WELL USE (Check Applicable Box) : Residential 0 Municipal ❑ Industrial
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest town: BOSTIC County RUTHERFORD 0 Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
1051 DEPRIEST RD
35 26.356 / 81 49.080
(Street Name, Numbers. Conunwdty, Subdivision, Lot No,. Zip Code) (degrees/minutes/seconds)3. OWNER CHRISTY GETTYS
ADDRESS 1051 DEPRIEST RD Latitude/longitude source: ® GPS 0 Topographic map
DEPTH DRILLING LOG
(so -ea or Roan No.) Formation Description
Boo
NC 28018 From To
City orr Town stale Zip Code 0 88 Clay
88 145 Consolidated Rock
828-245-0690
Area Code - Phone Number
4. DATE DRILLED 6/17/02
5. TOTAL DEPTH 145
6. DOES WELL REPLACE EXISTING WELL? YES © NO ❑
7. STATIC WATER LEVEL Below Top of Casing. 80 FT.
(px P' If Abave Top of Casing)
8. TOP OF CASING I5 2 FT. Above Land Surface'
"Top of ca.mg terminated aUor below land endue requires a variance in
accordance with ISA NCAC 2C.0118
9. YIELD (ppm): 15 METHOD OF TEST ARDM
l0. WATER ZONES (depth)'. 125
IL DISINFECTION: TYPE HYPOCHLORITE Amount 3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 97 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
0
`=m
n
oe 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.
Depth Material Method
From 0 To 20 Et. GRAVEL MIX GRAVITY
Ia. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in
IS. SAND/GRAVEL PACK'.
Depth Size Material
Front NA To Ft,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7/ 1 /02
Date
DEPRIST RD
0
4/10MI
Go
SUNSHINE HW Y
WHITESIDES RD
SIGNATURE OF PERSON CONSTRUCTING THE WELL
iginat to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
t 27609-1d13b Phone ISo. (t19f 733�221, within 30 days.
L 'gym. :
GROUNEAAIATES
ASHEVILLE R C CP
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 08/13/02 22:35:06 Page 2 of 13
258624
Sent by the Award Winning Cheyenne Bitware
D ,LSuS it ISe oti ginat to
lone 'o.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - GroundwICATION # 2583
ater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
CERTIFWELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC.
PHONE
# (704)
# 434-7277
STATE WELL CONSTRUCTION PERMIT # PERMIT
applicable)
(if applicable) (ifAapplicaultural ❑
1. WELL USE (Check Applicable Box) : Residential ® [-iU
Recovery 0 Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: DYSARTSVILLE
CANE CRK MTN RD
(Street Fame, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER LOWELL FRANCIS
ADDRESS 1016 LOCUST RIDGE DR.
(Street or Roam No.)
UNION MILLS
City or Town
828-287-7329
Area Code - Phone Number
4. DATE DRILLED 6/14/02
5. TOTAL DEPTH 24C
6 DOES WELL REPLACE EXISTING WELL?
NC
State
Municipal 0 Industrial 0
Other 0 If Other, List se:
County RUTHERFORD
28167
Zip Code
YES 0 NO 17
7. STATIC WATER LEVEL Below Top of Casing:
87 Fr.
(Uae ""^ If Above Top of C
8. TOP OF CASING IS 2 FT. Above Land Surface'
',Top of casing tem,inatcd at/or below land surface /quires a vain ce 6r
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 11 METHOD OF TEST ARDM
10. WATER ZONES (depth): 225
,y)
It DISINFECTION: TYPE HYPOCHLORITE Amount 5
12. CASING Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Depth Diameter
From 0 To 95 Ft. 61/4"
13. GROUT:
Depth
From 0 To 20 Ft
14. SCREEN
Depot
From NA To
15. SAINT/GRAVEL PACK.
Depth
NA To
From
16. REMARKS'.
Monitoring ❑
Topographic/Land setting
❑ Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35,32.181 / 81.48 889
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 80 Clay
80
240 Consohdated Rock
lV
Pet
o: LOCATION SKETCH
Show direction and distance in miles from at leas.'
two State Roads or County Roads. Include the r
numbers and common road names.
Diameter
Ft.
Ft,
Material Method CANE CRK MTN RD
GRAVEL MIX GRAVITY
Slot Size Material
in.
Size Material
CO
l.5MI
HWY 226
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TT ITS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
6/14/02
SIGNATURE OF PERSON CONSTRUCIE9G-THE WPI 1
Date
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
221, within 30 days.
cn
rn
0 -
G
GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212
06/11/02 7:35:08 Page 10 of 10
Sent by the Award Winning Cheyenne Bitware
254125
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
ERTIwICATION # 2584
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,, INC. PHONE
E # (704)
PERMIT #
77
STATE WELL CONSTRUCTION PERMIT # (if PERMIT
(if applicable)
e)
1. WELL USE (Check Applicable Box) : Residential El Municipal ❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: Topographic/Land setting
Nearest WWII: LAKE LURE ❑ Ridge ® Slope ❑ Valley ❑ Flat
LOT 117 RIVERBEND ACRES Latitude/Longitude of well location
35.23.344 / 82.10.067
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER CHARLES BILLINGS
ADDRESS 116 Governors Grant Blvd.
(street or Route No.)
LEXINGTON SC
City or Town State
803-356-5879
Area Code - Phone Number
4. DATE DRILLED 5/29/02
5. TOTAL DEPTH 740
29072
Zip Code
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 5 Clay
5
740 Consolidated Rock
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing. 325 FT. Cif —7,77
C
Oast 't"If above Top of Casing) IV C
8. TOP OF CASING IS 2 FT. Above Land Surface* C „7.57-7.357:7-
"Top of easing terminated actor below land ado.requires a variance in �.
aecordum<wit6I5d NCAC 1C m16 _..4peti
O �
9. YIELD (gpmb 4 ME I1OD OF PEST PUMP 1",a�
a
10. WATER ZONES (depth): *
II. DISINFECTION: TYPE HYPOCHLORITE Amount 13
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 Ft. 61/4" SDR 21 PVC
13. GROUT:
oz LOCATION SKETCH
Show direction and distance in miles from at least N
two State Roads or County Roads. Include the ro
numbers and common road names.
Depth Material Method
From 0 To 20 Et. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/(+RAVE!. PACK:
Dept, Size Material
From NA To Ft,
16. REMARKS: WELL WAS BLASTED, WATER ZONE NOT KNOWN
—.G
aro d
Cro
CI)
0
RIDGECREST
CIRCLE 0
HICKORY NUf LN
EDAR CRK RD
BILLS CREEK 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.
glrmrtlihe angina` tan divisioTV
r1612 1 6 P' foly_,_19; ',2it
,
I
6/01/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
ater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
within 30 days.
GW-1 REV. 07/20011

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212
06/11102 7:34:22 Page 9 of 10
Sent by the Award Winning Cheyenne Bitware
254126
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - GERTIwater Section
ICATION # 2584
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS INC.
PHONE
# (704) 7@RM T #277
ASSOCIATED
STATE WELL CONSTRUCTION PERMIT # (ifPER IT
(if applicable)
le)
1. WELL USE (Check Applicable Box) : Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
DOVES COURT
County RLTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER JIM CRAWFORD
ADDRESS 190 FINCH ST
(Street or Route No.)
LAKE LURE
City or Town
828-625-1233
Area Code - Phone Number
4. DATE DRILLED 5/24/02
NC
State
28746
Zip Code
5. TOTAL DEPTH 125
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATERLEVEL Below Top of Casing: 55 Fr.
cure J.- If Above Iop of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated a✓or below land surface requires a variance in
accordance with 15A NCAC 2C.01lt
9. YIELD (epm): 25 METHOD OF TEST ARDM
10. WATER ZONES (depth): 120
it. DISINFECTION: TYPE HYPOCHLORITE Amount 2
12. CASING'
Depth
From 0 To 72 Ft.
13, GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
From
Depth
NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. 32EM.ARI(S:
Wall Thickness
Diameter or Weight/Ft Material
6 1/4" SDR 21 PVC
Topographic/Land setting
['Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.25.370 / 82.10.445
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
To Formation Description
60 Clay
From
0
60
125 Consolidated Rock
c
O
—
—r—
D ~�
Nro
9 ut
mom:
oz LOCATION SKETCH tD
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
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Slot Size Material
in.
Size Material
0
DOVES CT
BILL'S
CREEK
RD
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.
5/28/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
f Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
21, within 30 days.
IGW-1 REV. 07/20011

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 06/11/02 7:32:48 Page 7 of 10
Sent by the Award Winning Cheyenne Bitware
254128
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 0 Other 0 If Other, List Use:
2. WELL LOCATION'.
Nearest town: RLTHERFORDTON
3741 HUDLOW RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER TODD THOMAS
ADDRESS 3741 HUDLOW RD
(Street or Route No.)
RUTHERFORDTON
City or Taw.,
828-287-4347
NC
State
Area Code - Phone Number
4. DATE DRILLED 5/17/02
5. TOTAL DEPTH 360
28139
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Belo» Top of Casing. 65 FT.
(Use "_" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing laminated atior below land surface requires a variance in
accorda,'c widr 15A NCAC 2C.0118
8. YIELD (gpm): 0
10. WATER ZONES (depth):
it. DISINFECTION: TYPE
12. CASING:
METHOD OF TEST
325
ARDM
Topographic/Land setting
❑ Ridge ❑ Slope D Valley ® Flat
Latitude/Longitude of well location
35.26.011 / 81.55.374
(degreeshninutes/seconds)
Latitude/longitude source: ® GPS ❑'Topographic map
DEPTH DRILLING LOG
From To Fommtion Description
0 105 Clay
105
360 Consolidated Rock
HYPOCHLORITE Amount 9
Wall Thickness
Diameter or Weight/FL Material
61/4" SDR21 PVC
Depth
From 0 To 112 Ft.
13. GROUT:
n
C
oe 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.
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Slot Size Material
in.
Size Material
ROY COINS RD
HLJDLOW RD
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.
6/ 1 /02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
?21, within 30 days.
r,Sub$( llrporigin:(1 to thrtDi
I' 2769'9a163/h' �o Pltene. (919)
GW-1 REV. 07/2001
GROLli'LL,±,c\ER. SECTION
ASHE LL`E REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212
06/11/02 7:30130 Page 4 of 10
Sent by the Award Winning Cheyenne Bitware
2541.31
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater
ndwICATIOtion N 14 2�84
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANIT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, ,IIN . P O E # (704) 7@RM1T #277
STATE WELL CONSTRUCTION PERMIT# Of PERMIT
(if applicable) Apiculture applicable)
al ❑
1. WELL USE (Check Applicable Box) : Residential
El Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
664 HWY221S
Municipal ❑ Industrial ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision. Lot No,. Zip Code)
3. OWNER BRENDA PRICE
ADDRESS 664 HWY221S
(Shunt or Renee No.)
RUTHERFORDTON
City or Town
828-287-4386
Area Code - Phone Number
4. DATE DRILLED 5/9/02
NC
State
28139
Zip Code
5,'lOtAL DEPTH 485
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"," If Above Top of Casing)
8, TOP OF CASING IS 2 FT. Above Laird Surface'
'Top of easing terminated at/or below lard surface requires a variance in
accordance with ISA NCAC 2C.0118
9- YIELD (gpm)- 15 METHOD OF TEST ARDM
10. WATER ZONES (depth): 481
1i. DISINFECTION: TYPE HYPOCIILORITE Amount 13
12. CASING:
Depth Diameter
From 0 To 75 FL 61/4"
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Monitoring ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.32.937 / 81.95.749
(degrees/minutes/seconds)
Latitude/longimde source: ❑ GPS ® Topographic map
DRILLING LOG
Formation Description
DEPTH
From To
0 70 Clay
70 485
Consolidated Rock
O
tV
atm
rn
ca
-r —t
en E
2
or LOCATION SKETCH
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names.
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
15, SAND/GRAVEL PACK'.
Depth
From NA To
16, REMARKS:
Material Method
20 Ft. GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Slot Size Material
in.
Size Material
2MI
HWY 221 S
HWY 74 BYPASS
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.
Submit the or
6.„
27699L1036PPhgl'e1*(9
---
CAn
CTION
AL OFFICE
5/9/02
SIGNATURE OF PERSON CONST'RUCIINV G THE WELL Date
on of Water Quality, Groundwater Section, 1636 Mali Service center - Raleigh, NC
221, within 30 days.
1GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212
06/11/02 7:29:44 Page 3 of 10
Sent by the Award Winning Cheyenne Bitware
254132
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - GERTIwater Section ICATION # 2585
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GAN1T
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS,
INC. PHONE
# (704) # 434-7277
STATE WELL CONSTRUCTION PERMIT # (if PERMITEab
le)
(i(heckapplicable)
Municipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
1. WELL USE (Check Applicable Box) : Residential ® Pr
0Other 0 If Other, List Use:
RecoveryHeat Pump Water Injection 0
2. WELL LOCATION: Topographic/Land setting
Nearest town: BOSTIC 0 Ridge ❑ Slope ❑ Valley ® Flat
597 SALEM CH RD Latitude/Longitude of well location
35.40.290 / 81.80.317
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER RONNIE HAMRICK
ADDRESS 597 SALEM CH RD
(Street or Route No.)
BOSTIC NC
City or 'town State
828-248-2187
Arca Code - Phone Number
4. DATE DRILLED 5/7102
S.TOTAL DF.PTH 160 —O iv
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ©
7. STATIC WATER LEVEL Below Top of Casing: 66 F. C m C
rA
(Um"+' If Above Top of easing) OG
8. TOP OE CASLNG IS 2 FL. Above Land Surface' -- 0
r C;
"Top of easing terminated at/or below land surface reydves a vmiace in TO. —tom
aceordaee with 15ANCAC 2C.O1l8 = >, c'
1
20 METHOD OF TEST ARDM raa N ad
ad
CT
to WATER ZONES (depth). 155 r
• G
2
28018
Zip Code
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ® Topographic map
DRILLING LOG
To Formation Description
DEPTH
From
0
58 Clay
58
160 Consolidated Rock
O
u- DISINFECTION: TYPE HYPOCHLORITE Amount 3 Or LOCATION SKETCH CO
12. CASING- Wall Thiclmesa Show direction and distance in miles from at least
Diameter or Weight/Ft. Material two State Roads or County Roads- Include the road
63 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
Depth
From 0 To
U. 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.
I5. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
to. REMARKS:
6/10 MI
SALEM CH RD
BOSTIC / SUNSHINE HWY
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.
5/7/02
SIGNATURE OF PERSON CONSTRUCTNG THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699- ono ' o 221, within 30 days.
L- l 'r l
..=L OFPI F
I GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 05/05/02 9:34:04 Page 11 of 11
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD 251975
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONI RACTOR 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 D
Recovery ❑ Ileat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFODTON
354 AYDLOTTE RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.26519 / 81.58.677
3. OWNER ANITA RATLIFF (degrees/minutes/seconds)
ADDRESS 354 AYDLOTTE RD Latitude/longitude source: ❑ CPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
RUFIIERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 120 Clay
828-286-8667 120 400 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 4/30/02
5. TOTAL DEPTH 400
c
6. DOES WELL REPLACE DUSTING WELL? YES Q NO ❑ CD
N
7. STATIC WATER LEVEL Below Top of Casing: 80 FT MC 9�
(Use "s"I(Above Top of Casing) CD we PI]
8. TOP OF CASING IS 2 F t. Above Land Surface" -� ran
-cm
r ~rt r
9. YIELD (Rpm): 2 METHOD OF TEST ARDM 3 rm
10. WATER ZONES (depth): 120 380 l0 CO 2
m�
'Top of casing terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
tt. DISINFECTION: TYPE HYPOCHLORITE Amomlt 10 or
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 127 Ft, 6 1/4 " SDR 21 PVC
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. SAND/GRAVEL PACE:
Depth Size Material
From NA To
16. REMARKS:
O
LOCATION SKETCH O —d
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
OAKSPRINGS RD
HWY221N 9
4/10 MI
AYDLOTTE 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.
�'11 6 / ,,t I/1 1 ,
l�7 ll V .D
l3Ubmlt ike or lglnat ro the Dh
27699-1636 Phone No. (919) 7
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
4/30/02
SIGNATURE OF PERSON CONSTRUCTLNG THE WELL Date
Vater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
1, within 30 days.
GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 05/05/02 9:33:18 Page 10 of 11
Sent by the Award Winning Cheyenne Bitware
251974
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)
1. WELL USE (Check Applicable Box) : Residential ❑
Recovery ❑ Heat Pump Water Injection ❑
c. WELL LOCATION:
Nearest town: CAROLEEN
215 C.H HAMRICK RD
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
a. OWNER JANET HAMRICK WEBB
ADDRESS POD 1413
(Street or Route No.)
FOREST CITY
City or Town
828-247-0364
NC
State
Area Code - Phone Number
4. DATE DRILLED 4/29/02
28043
Zip Code
5. TOTAL DEPTH 180
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 50 ET_
(lise "r" If Above Top of Cuing)
8. TOP OF CASINO IS 2 FT. Above land Surface"
"Top of casing tnminated Woe below land surface requires a variance in
oecordance with 15A NCAC 2C.0118
9. YIELD (gm): 10
lo. WATER ZONES (depth):
u. DISINFECTION. TYPE
12. CASING.
METHOD OF TEST
160 175
ARD6f
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.18.155 / M.48.183
(degrees/minutes/seconds)
Latitude/longitude source: El GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65
180 Consolidated Rock
HYPOCHLORITE Amount 4
Wall Thickness
Diameter or Weieht/P1. Material
61/4" SDR21 PVC
Depth
From 0 To 72 Ft
13. GROUT:
From 0
Depth
To 20 Ft.
14 SCREEN
Depth
From NA To
II. SAND/GRAVEL PACK:
Depth
NA To
From
16. REMARKS.
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Sizc
Slot Size
in.
Material
Material
C
IV �
a
-c
Q)
Ai
ma
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.
IVY 74
OLD CAROLEEN RD
ti
0
CHARLES HAMRICK RD
3/IOMI
BAXTER CEMETARY RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSI'RUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
27699-1636 Phone No. (9191
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
4/29/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL. Date
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
21, within 30 days.
GW-1 REV. 07/2001

To, DENR DIVISION OF WATER QUALITY, GROUNIFrom'. ALAN S. GANTT 704-434-7212 05/05/02 9:32:30 Page 9 of 11
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD 251.976
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. T.LI, USE (Check Applicable Box) : Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
163 CONNOR LANE
County RUTHERFORD
(Street None, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well localidn
35.34.50 / 82.04.680
3. OWNER KIMBERLEY GREENE (degreWminuteslseconds)
ADDRESS 163 CONNOR LANE Latitude/longitude source: 0 GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 60 Clay
828-286-2445
Area Code - Phone Nurnber
4. DATE DRILLED
5. TOTAL DEPTH 400 C
0 0
PO
?
1-9
01 firn
✓O
ti�
9. YIELD (tent): 15 MEOF TEST AROM 3 D pi
10. WATER ZONES (depth): 80 360 rn Y
rn.—.�
it DISINFECTION: TYPE HYPOCHLORITE Amount 11 oz LOCATION SKETCH 0 0-4
12. CASING: Wall Thiclmess Show direction and distance in miles from at least O
z
4/25/02
60 400 Consolidated Rock
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO 0
50 FT.
(Cu `+" IfAbovc Top of C
a. TOP OF CASING IS 2 Er Above Land Surface*
"Top of casing marinated at/or below land surface requires a variance in
accordance with I5A NCAC 2C.0116
e)
Depth Diarneter or Weight/Ft. Material
From 0 To 65 Ft- 6 1/4 " SDR 21 PVC
13. GROUT:
From 0
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
Ft.
Diameter
in.
Slot Size Material
n
IS. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
two State Roads or County Roads. Include the road
numbers and common road names.
CONNOR LANE
PLEASANT HILL CH RD
PLEASANT HILL
CH RD LOOP
HWY 108
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
5/2/02
SIGNATURE OF PERSON CONSTRUCTING THE WEI.I. Date
rater Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFEICE
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNEFrom: ALAN S. GANTT 704-434-7212 05/05/02 9:31.44 Page 8 of 11
Sent by the Award Winning Cheyenne Bitware
251977
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCO1T GANTI 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 D Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: GREENHILL
1848 HWY64/74
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER STEVE STOWE
Topographic/Land setting
❑ Ridge 0 Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.25.550 / 82.05.639
(degrees/minutes/seconds)
ADDRESS 340 JOHN LOGAN LANF. Latitude/longitude source: ® GPS ❑ Topographic map
(Strew or Rote No.) DEPTH DRILLING LOG
GASTONIA NC 28056 From , To Formation Description
City or Town State Zip Code 0 90 Clay
704/824/3703
Area Code - Phone Number
4. DATE DRILLED 4/24/02
5. TOTAL DEPTH 400
6_ DOES WE13. REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top QC Casing:
YES ❑ NO El
80 FT.
(Use "*" If Above Top of C
is TOP OF CASING IS 2 FT. Above Land Surface*
"Top of easing unninatcd attar below land surface requires a vananee in
accordance wid,15A NCAC 2C0I18
9. YIELD Lgpm)}: 2 METIIOD OF TEST ARDM
10. WATER ZONES (depth): 180 390
90 400 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 9
12. CASING'. Wull'lhickne s
Depth Diameter or Weight/Ft. Material
From 0 To 104 FL 6 1/4 " SDR 21 PVC
13. GROUT:
Q\
O
m
LO n
Or LOCATION SKETCH O ❑
Show direction and distance in miles from at least v i
Depth Material Method
Fron, 0 To 20 Ft. GRAVEL MIX GRAVITY
14 SCREEN
Depth Diameter Slot Size Material
From NA To Ftin. in.
15_ SArD/ORAVFI. PACK:
Depth Size Mate ial
From NA To Ft,
16. REMARKS:
two State Roads or County Roads. Include the road
numbers and common road names.
JERICO RD
HWY 64/74
1 DO HEREBY. CERTIFY THAT TIIIS 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 original to tl
27699- 636 Pltgge No.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
4/24/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
ion of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
3-3221, within 30 days.
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 05/05/02 9:28:40 Page 4 of 11
Sent by the Award Winning Cheyenne Bitware
251981
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: LAKE LURE
LOT 99 PHASE I RIVERBEND ACRES
ASSOCIATED WQ PERMIT #
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER ALAN TANNER
ADDRESS 112 COCOPLUM CIRCLE
(Slicct er Route Nu.)
ROYAL PALM BEACH
City or Town
561-798-2729
FL
State
Area Code - Phone Number
4. DATE DRILLED 4/ 11 /02
5. TOTAL DEPTH 500
33411
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 148 FT
(Ise "r" If Above Top of Casing)
P. TOP OF CASING IS 2 FT. Above Land Surface'
'Tap of casing terminated actor below land surface requires o variance in
accordance with l5A NCAC 2C0116
9. YIELD (gem): 3 METHOD OF TEST ARDM
to. WATER ZONES (depth): 475
Monitoring ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.42.186 / 82.16.534
(degrees/minutes/seconds)
Latitude longitude source: ❑ GPS E Topographic map
DEPTH DRILLING LOG
From To Formation Description
0. 30 Clay
30 500 Consolidated Rock
It DISINFECTION: TYPE HYPOCHLORITE Amount 11
12. CASING:
From 0
u. GROUT:
From 0
Depth
To 36
Diameter
Et. 6 1/1 "
Depot
To 20 FI.
14. SCREEN
From
Depot
NA To
15. SAND/GRAVEL PACK'.
Depth
From NA To
16. REMARKS.
Ft.
Ft,
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
o.
Diameter
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in. in.
Size
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
DOVES WAY
O
IV
1
Ql
IIwy 64/74
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 Ufl
g76 16Nr n
o.
6 2002
5/2/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
21, within 30 days.
GW-1 REV. 07/2001
GROUNDLVATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212
Sent by the Award Winning Cheyenne Bitware
05/05/02 9.27:08 Page 2 of 11
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 D Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Ileat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION.
Nearest town: FOREST CITY
256 EASTWOOD DR
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
251983
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley Flat
Latitude/Longitude of well location
35.16.033 / 81.51.975
3. OWNER WILKINS HOME CENTER (degrees/minutes/seconds)
ADDRESS 1920 HW Y 74 BYPASS Latitude/longitude source: ❑ GPS ❑ Topographic map
(sheet or Romc No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City or Town State Zip Code 0 75 Clay
828-286-3647 75 560 Consolidated Rock
Area Code - Phone Nmnber c
4_ DATE DRILLED 4/2/02
5. TOTAL DEPTH 560
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO ID
60 FT.
(�V o
(Usc"s" If Above Top of Casing) D c'
8. TOP OF CASING IS 2 FT. Above Land Surface* a -I
am
"Top of casing tciminmed at/or below land surface rcquimt a variance in
a.rordance with 15A NCAC 2C.0118
9. YIELD (gam): 3 METHOD OF TEST ARDM
10. WATER ZONES (depth): 480
n DISINFECTION: TYPE HYPOCHLORITE Amount 16
12. CASING: Wall Thickness
Depth Diameter or 4VeightiFt. Material
From 0 To 80 6 1/4 " SDR 21 PVC
13. GROUT:
Depth Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Materi al
From NA To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS.
e2T
0 Cr
Z
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.
1]
DOGGETT RD
IMI
EASIWOOD
LN
DOGGETT GROVE RD
MORROW MOTOR RD
I DO HEREBY CERTIFY THAT'I'HIS 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.
• original to the
27699-1636 Phone No. (91
JUL1 6 2Cu2
GROUTER SECTION
ASHEVILLE REGIONAL OFFICE
4/12/02
SIGNATURE OF PERSON CONSTRUCTING THE. WELL Date
of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
21, within 30 days. .
GW-1 REV. 07/2001

To. DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 04/05/02 21:41:46 Page 9 of 9
Sent by the Award Winning Cheyenne Bitware
250460
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 ❑ Ag icuttural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
z- WELL LOCATION:
Nearest town: RUTHERFORDTON
186 BLACKBIRD CIRCLE
County RL:THERFORD
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER LEE CAMP
ADDRESS 186 BLACKBIRD CIRCLE
(Street or Route No.)
RUTHERFORDTON NC
City or Town State
828-286-9541
Area Code - Phone Number
4. DATE DRILLED 3/29/02
5. TOTAL DEPTH 330
28139
Zip Code
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7, STATIC WATER LEVEL Below Top of Casing: 85 FT.
(rise `+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
°Top of casing terminated aCor below laid surface requires a variance in
accordance with L A NCAC 'C.OI I8
9. YIELD( pm): 95 METHODOF'IEST ARDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.24.687 / 82.04.050
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formahon Description
0 125 Clay.
125 330 Consolidated Rock
V —
_a
1
10 WATER ZONES (depth): 180 325 a'
II. DISINFECTION: TYPE HYPOCHLORITE Amount 8 oz LOCATION SKETCH O
W
It. CASINO: Wall Thickness Show direction and distance in miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 137 FL 6 1/4 " SDR 21 PVC numbers and common road names.
13. GROUT:
Depth
From 0 To 20 Ft.
IJ. SCREEN
From
Depth
NA To
Material Method
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Slot Size Material
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS'.
7/10 MI
CLARK RD
HWY 64/74
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.
err
3'29/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
1, 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 04/05/02 21:41 00 Page 8 of 9
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD 250 4 r 1
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOIT 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 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use.
2. WELL LOCATION'.
Nearest town'. ELLENBORO
681 SHIRES RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER MIKE GREENE
ADDRESS 681 SHIRES RD
(Steer or Room Na.)
ELLENBORO NC
City or Towat State
28040
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude!Longitude of well location
35.22.154 / 81.45.648
(degrees/minutes/seconds)
Latitude.longitudc source' © GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 80 Clay
8208-453-0017 80 640 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 3/26/02
5. TOTAL DEPTH 640
6. DOES WELL REPLACE EXISTLNG WELL?
7. STATIC WATER LEbE1. Below Tap of Casing:
YES © NO ❑
235 FT.
(Vie "*" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of cosine tenninomd at/or below land surface regwree a variance in
accordance with 15A NCAC 2C0118
9 YIELD(epm}. 1 METHOD OF TEST ARDM
10. WATER ZONES (depth): 250
It. DISINFECTION.TYPEHYPOCHLORITE Amount 13
12. CASDNG Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 87 FL 6 1/4" SDR 21 PVC
13. GROUT
oz
Dept( Material Method
From 0 To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
Rom NA To Et. in. in
15. SAND GRAVEL PACK:
Depth Size Material
From NA To FL
16. RE\LARKS'.
—75
LOCATION SKETCH
Show direction and distance in miles from at least LI
two State Roads or County Roads. Include the road;?
numbers and common road names.
WALLS CH. RD.
4/10 mi
7/10 mi
SHIRE S RD
HOLLIS
I DO HFRERY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC AC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF "THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
3126/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
ater Quality, Groundwater Section, 1636 Mail Service center- Raleigh, NC
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 04/05/02 21:40:14 Page 7 of 9
Sent by the Award Winning Cheyenne Bitware
250462
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) (f applicable)
1. WELL USE (Check Applicable Box) : Residential 0 Municipal ❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION.
Nearesttown. UNION MILLS
202 NANNYTOWN RD
County RUTHERFORD
(Street Name, Numbers, Community. Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley E Flat
Latitude/Longitude of well location
3529.255 / 81.59 878
3. OWNER VIRGIL HALL (degrees/minutes/seconds)
ADDRESS 202 NANNYTOWN RD Latitude/longitude source: 0 GPS ❑ Topographic map
(street or Rome No.) DEPTH DRILLING LOG
UNION MILLS NC 28167 From To Formation Description
City or Town State Zip Code 0 80 Clay
828-288-0167 80 250 Consolidated Rock
Area Code - Phone Number
4. DATEDRILLED 3/23/02
5. TOTAL DEPTH 250
6. DOES WELL REPLACE EXISTING WELL?
7. S FATIC WATER LEVEL Below Top of Casing:
YES El NO 0
95 Ff.
(U,e If Above Top of eating)
8. TOP OF CASNG IS 2 FT. Above Land Surface'
'Top of eati ng temwuIcd ace, blow lad norac< rup,un a vain ce ui
accordance with 15A NCAC 2C.0118
9 YIELD (gpml: 1 a METHOD OF TEST
10. WATER ZONES (depth : 230 240
—71
ARDM
—
u_ DISINFECTION: TYPE HYPOCHLORITE Amount 3
12. CASING: Wall Thickness
Depth Diameter or WeighGFt. Material
From 0 To 86 Ft. 6 1/4 " SDR 21 PVC
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.
Oz
15. S.AND/GRAVEL PACK:
Depth Size Material
From NA Tu Ft,
16. REMARKS.
LOCATION SKETCH
44..7
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
NANNYTOWN RD
1.2Mi
221 N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OP TIIIS RECORD HAS BEEN PROVIDED TO TIfE WELL OWNER.
l'I
o thid Dalaionptl1 ter Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
-) 3-31 j22' 'thin 30 days.
4/03'02
SIGNATURE OF PERSON CONST IJCTLNG THE WELL Date
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
GW.I REV. 0 .2001 i

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 04/05/02 21:39:28 Page 6 of 9
Sent by the Award Winning Cheyenne Bitware
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater
oundwICATIOtion
N n 27. 84
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
WELT, CONTRACTOR COMPANY NAME CAROLINA WELL DRII,T RRS. INC. ASSOCIATED PRONE 0 ( PERMIT 434-7277
STATE WELL CONSTRUCTION PERMIT #(if PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential © Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: UNION MILLS County RUTHERFORD
201 BOBBY McKINNEY RD
(Street Name, Numbers, Communiry, Subdivision, Lot No,. Zip Code)
3. OWNER LARRY CONNOR
ADDRESS 201 BOBBY McKINNEY RD
(Street or Route No.)
UNION MILLS
City or Town
828-278-4189
NC
State
Area Code - Phone Number
4. DATE DRILLED 3/19/02
28167
Zip Code
5. TOTAL DEPTH 500
6 DOES WELL REPT.ACE EXISTING WELL? YES © NO 0
7. STATIC WATER LEVEL Below Top of Casing: 70 FT_
(Gee "*" If Above, Top of Casing)
8. TOP OF C.ASLNO IS 2 FT. Above Land Surface°
'Top of casing cominatcd atior below land swfact requires a vonanea in
accordance with 15A NCAC 2C.0118
9- 'YIELD (gym). 1 METHOD OF TEST ARDM
lo. WATER ZONES (depth): 485
u. DISINFECTION: TYPE HYPOCHLORITE Amount 13
12. CASINO' Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 127 Ft. 6 1/4 " SDR 21 PVC
13. GROUT.
From 0
Depth
To 20 Ft.
14 SCREEN
From
Depth
NA To
15. SAND/GRAVEL PACK:
Depth
NA To
From
16. REMARKS'.
250463
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley El Flat
Latitude/Longitude of well location
35.30.735 / 81.59.285
(degrees/minutes/seconds)
Latitude,9ongitude source: 9 GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 107 Clay
107 500 Consolidated Rock
O
rJ
L
CJ
Q
!De LOCATION SKETCH CO
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
GRAVEL MIX GRAVITY
Diameter
Ft. in.
Ft,
Slot Size Material
in
Size Material
3110 vII
CRUTCHFIELD RD
BOBBY McKINNEY RD
3/10 MI
THER:VLAL CITY RD
0
I DO I IEREBYCERTIFYTHAT 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.
3/19/02
nIv(L; rir' llf� l
s 9 lS
ESummIT me original to the Di+14 Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
1 27699-1636 Phone No. (919) 781- fl 1, within 30 days.
GROU L„1'ATER. SECVON
ASHEViLL Rr CFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
GW-1 REV. 072r,01

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 04/05/02 21:36:22 Page 2 of 9
Sent by the Award Winning Cheyenne Bitware
250467
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)
1. WELL USE (Check Applicable Box): Residential ❑
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: LAKE LURE
16 YONDERS WAY RD
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No. Lip Code)
3 OWNER JAMIE WILLS
ADDRESS 269 MELROSE RD
(Street or Roma No.)
LAKE LURE
City or Town
828-625-2899
NC
State
Area Code - Phone Number
4. DATE DRILLED 3/1/02
5. TOT.AL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEJ. Below Top of Casing:
YES ❑ NO
Ff.
(Use •v' If Above Top of Caning)
8. TOP OF CASINO IS 2 FT. Above land Surface"
'Top of casing involuted actor below land surface rcgwrr a vanancc
accordance with 15A NCAC 2C.0118
9. YIELD (gym): 3 METHOD OF TEST ARDM
to. WATER ZONES 1deptbI: 380
DISINFECTION: TYPE HYPOCHLORITE Antowu 6
12. CASING:
From 0
13. GROUT
Depth
To 92
Ft. 6 1/4 "
Depth
From 0 To 20 Ft.
SCREEN
Depth
From NA To
13. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
28746
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.50.800 / 82.12.310
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Fomlation Description
0 85 Clay
85 400 Consolidated Rock
Wall Thickness
Diameter or Weieht/Ft. Maerial
SDR2I PVC
n
-J
r..�
oa LOCATION SKETCH cq
Diameter
Ft.
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
in.
Size Material
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
MELROSE RD 3' 10 MI
YONDERS
WAY RD
CONNOR RD
I5 MI
BILLS CRK RD
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
submit the original to thei
27699-1636 Phone No. (91
JUN 2 6 2002
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
3/2/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
n of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
3221, within 30 days.
GW-t REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 03/06/02 23:14:22 Page 7 of 10
Sent by the Award Winning Cheyenne Bitware
2487 5'i
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 ❑ Agricultural ❑ Monitorir
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town LAKE LURE
RIVERBEND LOT 96
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
g ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley El Flat
Latitude/Longitude of well location
35.42.93 / 82.16.38
a. OWNER MARY MOORE (degrees/minutes/seconds)
ADDRESS 206 KIMROD LANE Latitudc/longitude source: © GPS ❑ Topographic map
(Street or Route No.) DEPTH DRILLING LOG
CHARLOTTE NC 28270 From To Formation Description
City or Town State Zip Code 0 60 Clay
Area Code - Phone Number
4. DATE DRILLED 2/27/02
60 460 Consolidated Rock
5. TOTAL DEPIII 460
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E 1.'
7. STATIC WATER LEVEL Below Top of Casing: 140 FT. '— ..
(Use"+- If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Laid Sulfate" �
"Top of casing terminated at/or below land surface requires a variance in —
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 3 MEFHOD OF TEST ARDM m c.51.
10. WATER ZONES (depth): 440
u. DISINFECTION: TYPE HYPOCHLORITE Amount 10
12. CASING' Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 66 R. 6 1/4 " SDR 21 PVC
13. GROUT:
Depot
From 0 To
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
20 Ft.
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter Slot Size Material
FL in. in.
Size Material
Ft,
LOCATION SKETCH tD c
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
BILLS CRK RD
RIVERBEND
RESORT
HWY 64/74
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.
3/5/02
Submit ih
27699-16
aHOi iv luiivFW M
e . ( }p) 3-321, Ith
SIGNATURE OF PERSON CONSTRUCTING THE WF7 I Date
Q3.a +tom(, oundwater Section, 1636 Mail Service center - Raleigh, NC
jv30 day).
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 23:15:08 Page 8 of 10
Sent by the Award Winning Cheyenne Bitware
248750
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 # 2Z=84
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 E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
123 LILLIANS CT
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ® Flat
Latitude/Longitude of well location
35.45.57 / 82.16,15
3. OWNER WILKINS HOME CTR. (degrees/minutes/seconds)
ADDRESS 1920 HWY 74 BYPASS Latitude/longitude source: El GPS 0 Topographic map
(Street or Route No.) DEPTH DRILLING LOG
FOREST CITY NC 28043 From To Formation Description
City or lawn State Zip Code 0 85 Clay
828-286-3647
85 260 Consolidated Rock
Area Code - Phone Number
4. DATEDRILLED 2/18/02
5. TOTAL DEPTH 260
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EI
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(the "e" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
c:
*Top of easing terminated at/or below land surface requires a variance in
accordance with 15A NCAC 2C.O118
9. YIELD (gpm): 8 METHOD OF TEST ARDM
10. WATER ZONES (depth): 140
ITI v
u. DISINFECTION: TYPE HYPOCHLORITE Amount 5 oa LOCATION SKETCH W
kD CD
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
12. CASING: Wall Thickness
Depth Diameter or WeiglmPt. Material
From 0 'I'o 92 Ft 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Depth
From NA Do
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Ft,
Size
Material Method
GRAVEL MIX GRAVITY
Material
SR 1309
BILLS CRK
RD
SR 1310
BUFFALO CRK. RD.
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.
Sub1n
27699
2/25/02
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
TORE OF PERSON CONSTRUCTING THE WELL Date
Groundwater Section, 1636 Mail Service center - Raleigh, NC
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUNIFrom: ALAN S. GANTT 704-434-7212 03/06/02 23:15:54 Page 9 of 10
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)
1. WELL USE (Check Applicable Box) : Residential lE Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
RIVERBEND ACRES LOT25
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER JANET BENNET
ADDRESS 18 TIMOTHY LANE
(Street or Rowe No.)
CANDLER NC
City or Town State
828-667-9888
Area Code - Phone Number
4. DATE DRILLED 2/15/02
28715
Zip Code
5. TOTAL DEPTH 200
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)
s. TOP OF CASING IS 2 FT. Above land Surface* 'O
°Top of casing terminated at/or below land surface requires a variance in 1 __
accordance with 1SA NCAC 2C.0I18
9. YIELD (gpm): 15 METHOD OF TEST ARDM - n -,
10- WATER ZONES (depth): 190
248'755
Topographic/Land setting
❑ Ridge E Slope El Valley ❑ Flat
Latitude/Longitude of well location
35.43.17 / 82.16.50
(degrees/minutes/seconds)
Latitude/longitude source: ® GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 79 Clay
79 200 Consolidated Rock
O
ya
CO =i
rr. DISINFECTION: TYPE HYPOCHLORITE Amount 5 oz LOCATION SKETCH W
12. CASING: Wall Thickness Show direction and distance in miles from at least Up
Dcp0i Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 86 Ft. 6 1/4 " SDR 21 PVC numbers and common road names.
D. GROUT',
From 0
Depth Material Method
To 20 Ft. GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To Ft,
16. REMARKS:
RIVERBEND SUB
IIwy 64/74
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2/20/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
uality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
30 days.
CROUND' "A,E' SECTION
cit1HILLE R_ui- �_E CE
GW-I REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 03/06/02 23:11:14 Page 3 of 10
Sent by the Award Winning Cheyenne Bitware
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
248761
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 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
155 CALTON HILL LANE
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER BILL CALTON
ADDRESS 155 CALTON HILL LANE
(Street or Route No.)
RUTHERFORDTON
City or Town
828-286-9734
State
NC
Arca Code - Phone Number
4. DATE DRILLED 2/9/02
5. TOTAL DEPTH 200
28139
Zip Code
6. DOES WELL REPLACE DUSTING WELL? YES ❑ NO ❑
7.STA'IIC WATER LEVEL Below Top of Casing: 85 Fh.
(the "*" rrAbove Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
`Top of easing ter mnied at/or blow land surface requires a valiance in
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 2 METHOD OF TEST ARDM
10. WATER ZONES (depth): 120 185
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.28693N / 82.01566W
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS El Topographic map
DEPTH
From To
DRILLING LOG
Fonnation Description
0 80 Clay
80 200 Consolidated Rock
D. DISINFECTION: TYPE HYPOCHLORITE Amount 4
12. CASING: Wall Thickness
Diametcr. or Weight/Ft. Material
87 Ft. 6 1/4 " SDR 21 PVC
20 It.
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter
Ft. m.
Ft.
Size
Material Method
SAND MIX GRAVITY
Slot Size Material
Material
0a.
LOCATION SKETCH
157 2.
W --
CO
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CALTON HILL LN
n
4/10 MI
UNION RD
0
2
COX 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.
2/8/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Qua ity, Groundwater Section, 1636 Mail Service center - Raleigh, NC
276 •e..., , �, �- . : days.
GW-1 REV. 12/99
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

To: DENR DIVISION OF WATER QUALITY, GROUN[From: ALAN S. GANTT 704-434-7212 03/06/02 23:12:02 Page 4 of 10
Sent by the Award Winning Cheyenne Bitware
2487E10
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 0 Monitoring 0
Recovery' ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest tam: RUTHERFORDTON County RUTHERFORD
COUNTRY MEADOWS ESTATE LOT 6, DEWITT OWENS RD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOMES CENTER
ADDRESS 1920 HWY 74 BYPASS
(Sam or Route No.)
FOREST CITY
City or Town
828-286-3647
NC
State
Area Code - Phone Nmnber
4. DATE DRILLED 2/4/02
5. TOTAL DEPTH 150
28043
Zip Code
6. DOES WELL REPLACE OUSTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 105 FT.
(Use •+" If Ahov< Top of Casing)
x. TOP OF CASING IS 2 FT. Above Land Surface*
'lop of casing terminated at/or ',clew land surface regimes a variance or
accordance with I5A NCAC 2C.0118
9. YIELD (gpm): 14 METHOD OF TEST ARDM
to. WATER ZONES (depth): 145
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑C Flat
Latitude/Longitude of well location
35.26.37 / 81.93.32
(degrees/minutesseconds)
Latitude/longitude source: ❑ GPS ® Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 38 Clay
38 150 Consolidated Rock
H. DISINFECTION: TYPE HYPOCHLORITE Amount 2
12. CASING:
Depth
From 0 To
13. GROAT:
Depth
From 0 To
14. SCREEN
From
Depth
NA To
Diameter
45 Ft. 61/4
Oz
Wall 'Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
20 Ft. GRAVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Diameter Slot Sizc
Ft. in.
Ft,
Size
in
Material
Material
'T
—
—O r-
1
rl
CO r"
LOCATION SKETCH (.D
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common roa9 natnes.
EWITT OWENS RD
4/1OMI
c
z
BIG ISLAND RD
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.
tstlrePtvtgraibP.V
4636 i,P4onelNo. 019) 734.32#,
J(i0h'
Id OHIO
2/8/02
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
n 30 days.
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 03/06/02 23:10:28 Page 2 of 10
Sent by the Award Winning Cheyenne Bitware
248762
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 ® Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: SPINDALE County RUTHERFORD
WINDY HILL SUBDIVISON LOT 7 CROWE DAIRY RD
(Street Nwne. Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER WILKINS HOME CENTER
ADDRESS 1920 HW'Y 74 BYPASS
(Street or Route No.)
FOREST CITY
City or Town
828-286-3647
NC
State
Area Code - Phone Number
4. DATE DRILLED 2/2/02
5. TOTAL DEPTH 160
28043
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Esc "4" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
'Top or easing temmuted at/or below land surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (_Spm): 8
M. WATER ZONES (depth):
I. DISINFECTION: TYPE
12. CASING:
METHOD OF TEST
150
ARDM
Monitoring ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.19.13 / 8455.15
(degrees/minutes/seconds)
Latitude/longitude source: E GPS- ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 100 Clay
100 160 Consolidated Rock �=
0
(V c=
Depth
From 0 To 106
13. GROUP
HYPOCHLORITE Amount 4
Wall Thickness
Diameter or Weight/Ft. Material
61/4" SDR21 PVC
Depth
From 0 To 20 Ft.
14. SCREEN
+J _.
rr
W
i.J
mom;
°' LOCATION SKETCH
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size
From NA To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From NA To Ft,
16. RENIARKS:
Material
Material
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CROWE DAIRY RD
OAKLAND 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.
2/8/02
SIGNATURE. OF PERSON CONSTRUCTING THE WELL Date
Sub' a Iiu gal �b4he�' ivition,'piWat tner
276991� ' -3i31, WithiYs.
Groundwater Section, 1636 Mail Service center - Raleigh, NC
GW-1 REV. 07/2001

To: DENR DIVISION OF WATER QUALITY, GROUN(From: ALAN S. GANTT 704-434-7212 02/10/02 19.24:42 Page 8 of 10
Sent by the Award Winning Cheyenne Bitware
247331
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Croundwater Section
ERTIFICATION # 2584
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GAN"IT
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE
E # (704) PERMIT # 434-7277
STATE WELL CONSTRUCTION PERMIT # (if EI
(if applicable) e)
1. WELL USE (Check Applicable Box) : Residential El Municipal 0 Industrial 0 Agricultural 0Monitoring 0
Recovery ❑ I Teat Pump Water Injection 0 Other ❑ If Other, List Use:
z. WELL LOCATION:
Nearest town: RUTHERFORDTON
291 HINES RD
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER BOYCE HINES
ADDRESS 291 HINES RD Latitude/longitude source: El GPS 0 Topographic map
(Street or Route No) DEPTH DRILLING LOG
Mooresboro NC 28114 From To Formation Description
City or Toes State Zip Code 0 60 Clay
60 240 Consolidated Rock
828-245-2808
Area Code - Phone Number
Topographic/Land selling
❑ Ridge 0 Slope 0 Valley ® Flat
Latitude/Longitude of well location
35.12.34 / 81.49.95
4. DATE DRILLED 1/11102
5. TOTAL DEPTH 240
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES E NO ❑
50 IT.
(Use t" If Above Top of Corrupt
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing tenuinmad at/or below land surface requires a variance N
accordance with l5A NCAC 2C.ol l8
v. YIELD (gpm)'. 6 METHOD OF TEST ARDM
Ili WAIEK ZONES (depth): 222
u. DISINFECTION: TYPE HYPOCHLORITE Amount 6 or
12. CASING: Wall Thiclutess
Depth Diameter or Weight/Ft. Material
From 0 To 67 Ft. 6 1/4 " SDR 21 PVC
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Material Method
GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To Ft. in. in
15. SAND/GRAVEL PACK'.
Depth Size Material
From NA To Ft,
16. REMARKS:
(degrees/minutes/seconds)
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.
HWY 221 S
HDIES RD
nINH
I DO HF.RERY 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.
Submit
27699-1
1/13102
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
roundwater Section, 1636 Mail Service center - Raleigh, NC
GW-1 REV. 07/2001 I
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

UCTION RECORD
260024
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 21 3 fi
PHONE #S2R) d53-7322
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J amm g uL Camp r TT" -
WELL CONTRACTOR COMPANY NAME Camp'
Wa11 R. Pump Cr-)
T n r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O Municipal/Public 0 Industrial 0 Agricultural CST
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �J
Nearest Town: F YC6 1 C t CountyG f eY fn
Lawt n% 6 r, I .
(Street Name, Numbers, Community, Subdivision, Lot No., - Zip Code)
-�b1i
3. OWNER: WlpsoK t ✓el'Ak t"r (VUY5ey
Address ,j �i I i( Mai ri St. /
(Street or Route No.)
Cq/'�aYlaIIbt�(ri Sc �930a
City Of Town State Zip Code
Area code- Phone number
4. DATE DRILLED ' — 01 —O 9-
5. TOTAL DEPTH: 44- S 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
_ *Top of casing terminated at/or below land surface requires a
variance In accordan a with ISA NCAC 2C .0118.
9. YIELD (gpm): -— METHOD OF TEST
10. WATER ZONES (depth):
Air
11. DISINFECTION: Type r h 1
12. CASING:
Depth
From_ To_4Q_ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To 2 p Ft.
From To Ft.
nri na Amount c2 Cupi
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4 SDR2l PVC
Material
Neat Cement
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topoggphic/Land setting
❑Ridge dope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formptio D�ription
?pp ,sario I(
(on 140.5 .ON%ol A feJ Ynrk
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
Iland
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
A COPY OF THIS E ORD HAS BEEN PROVIDED TO THE WELL OWNER
Z442eA-- - 11- D,a
OF PERSON CONSTRUCTING THE LL DATE
of Water Quality, Groundwater Section, 1636 Mall 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) James ui Camp, Jr- CERTIFICATION# 71 "1A
WELL CONTRACTOR COMPANY NAME f amp' s wall R Primp rn Tnr PHONE #�2R) dS"1-7'i22
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if applicable) Of applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO^
Nearest Town: Pe IA Yi o Vl County Kk (/ter /e ra
.774 rol'
(Street Name{Number, Community, Subdivision, Lot No., Zip Code)
aro 1( Mr CLfrr
6, Greasy CK. <3.
r y (Street orflute NoJ ^ g 15-
Ir AYlovt IV C d 'I
3. OWNER: f
Address
City or Town State Zip Code
Area code- Phone number D of t _ Q
4. DATE DRILLED
5. TOTAL DEPTH: I Lis /
6. DOES WELL REPLACE EXISTING WELL? YES I!d" NO 0
7. STATIC WATER LEVEL Below Top of Casing: 35- 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):
260022
TopographicJL setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DIMLING LOG
From To Formation Description
��1l So t r7 5cLJ
3o (4S rS5o1I •aterg rock .
11. DISINFECTION: Type r h l n r i n a
12. CASING:
Depth Diameter
From_o_To Ft.6 1 /4
From To Ft.
From To Ft.
13. GROUT: Depth
From j To 2 0 Ft.
Amount 1 Cup
Wall Thickness
or Weight/Ft. Material
SDR.21 PVC
Material
Method
N cit Cement i —
From To Ft.
14. SCREEN: Depth Diameter
Fr. t ._-_ in.
in.
16. •
GROU,1 . ,. .
EVILLE REGIONAL OFFICE
THIS WFt t WAS CONSTRUCIhD IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAN q�CO�P�TH�� RECORD HAS BEEN PR VIDED TO THE /QOWNE�
SIGNATUj' OF PERSON CONSTRUCTING T DATE ! o�
Slot Size
Material
in.
in.
LOCATION SKETC$
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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
w
co
W

260020
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .Tame S rr Camp-, Jr CERTIFICATION# 71 3B
WELL CONTRACTOR COMPANY NAME ramp's Wp11 R Pump en Tnr PRONE #$9Rl dSR-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential dMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: (`
Nearest Town: L-a-KC L-L Ye_ County ��u 1e✓To ✓
goos'fer R de1c,-
(Street Name, Numbers, Community, SuMhvision, Lot No., Zip Code)
I
3. OWNER: k lO L.O. qa-Vt-
Address 1 d1r O Ron 51 -✓ ); d9 e
Lake_ LRrP_ome No.) c. p
al 1 4
City or Town State N Zip Code
Area code- Phone number 0,9
D J �) _ O ,�
4. DATE DRILLED
5. TOTAL DEPTH: ;s2Je
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
Clay, dirt I'
co a1e5 Con sofldate.d race
DEPTH
From To
n So
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
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 with 1SA NCAC 2C .0118.
9. YIELD (pm): ,.,20 METHOD OF TEST 4ir_
10. WATER ZONES (depth):
11. DISINFECTION: Type rh1nrinp Amount )�A- cur0
12. CASING: Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Depth Diameter
From_ To Co Ft. 6 1 / 4
Front._...._To Ft.
From To Ft.
13. GROUT: Depth
From_q 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.
Material
Nett Cement
Method
Hand
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. Rag
1405 1s.r
3161e Srkbnl tU
irn
5 (KRcl
LI 13
(N)
w
0
S WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
zvkritd- l c% - C114140
2002 L GN OF PERSON CONSTRUCTING/THE WELL DATE
$ubwitthe origivai itihA Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699463gt'Clolterl46 (911) 733-3:21, within 30 days. GW-1 REV. 07/2001
n
0

260027
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jatria S or Cain p, Jr
WELL CONTRACTOR COMPANY NAME rampm Wel 1 & Pnmp f'rL
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 71 3 S
TnC PHONE #837S) d51-7322
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 elf Other, List Use i' 11 U Yo h
2. WELL LOCATION• I
Nearest Town: 11K e
d iney JiIoh/Ch,
(Street Name, (Numb , Community, Subdivision, Lot No., Zip Code)
3. OWNER: I'I�( �{ (6 10 1V0 �a ar (5 I CYt -
Address \'1
1/1N I o 14 �tS
I I 5 Route No.)`` C 9,9
16?
CountyA /tit F k'o 4
City or Town State Zip Code
Area coda Phone number
4. DATE DRILLED 2— a D- D a
5. TOTAL DEPTH: `+ I D
6. DOES WELL REPLACE EXISTING WELL? YES 12/NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .1 FT. Above Land Surface'
`Top of casing terminated at/ur below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): I D 0 + METHOD OF TEST
10. WATER ZONES (depth):
Ait
Topographic/Land setting
[Midge ❑Slope ❑Valley EFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPT$ J)RILLING LOG
From To Formation Description
0 /.2 rl i f t
(A t{1D _CO h6/rrnreA rock -
11. DISINFECTION: Type Chi nr i n a Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_ri To 63 Ft.6 .1 /4 gDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From__0_____ To 2 0 Ft.
From To Ft.
Material
N at Cement
Material
PVC
Method
Hand
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:
1 4iER\jFtl3
l6NSTR ION STid�D
SEP 2 0 2002 IL /SIGNATURE OF
SOU
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.
X kau' ck
P1'ii `) r.,r
rl,t_�
HA1`HIS WELL WAS CONSTRUC1hD IN ACCORDANCE WITH 15ANCAC 2C, WFI t
4, AND THAT A COPY OF THIS RECORD HAS BEEN PROVID TO THE WELL OWNER
ERSON CONSTRUCTING THE WE
DATE
Divi. ion of' Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
33-3E21, within 30 days. GW-1 REV. 07/2001

260018
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
,InmPs
NO Camp, Sr
CERTIFICATIONS' 2 1 3 8
WELL CONTRACTOR COMPANY NAME ramp I S Wa11 & Pimp Cn Tnr PHONE #$7R) 4c V-7322
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential bd' 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' + I
Nearest Town: tt✓e.5f Clry County PaMt oxA
131 C✓P e t< RA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l Y OYV S h0.Wtfl
Address / ) C� ✓ e e lC Rs.
%` u l Yl eriD v yp vtoute11.)( e;zi,
/31
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED —/5-O2
5. TOTAL DEPTH: i0 5-
6. DOES WELL REPLACE EXISTING WELL? YES VNO 0
7. STATIC WATER LEVEL Below Top of Casing: 4 S 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 accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST &i r
10. WATER ZONES (depth):
11. DISINFECTION: Type r h 1
12. CASING:
Depth
From_0 To ` P Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_a_ To 2 0 Ft.
nr i na Amount J� CiAll5
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4 SDR2I PVC
Material
Neat Ccmcnt
From To Ft.
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
Hand
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting�,�
❑Ridge ❑Slope ❑Valley I(dPlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
E From To
�0 d, tt
yo des" fees°l,14teta roc*
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.
Cesi4ec Hwy
YEElili'1aTia
WAS CONSTRUCfhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L
OF PERSON CONSTRU
—Oct
N S' WELL DATE
Subtglitbe oragin t$ t avision 1 f Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699446441ohe No: (919) 733=3221 . ithin 30 days. GW-1 REV. 07/2001

258111
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James la_ Ca ml', Jr
CERTIFICATION t 2118
WELL CONTRACTOR COMPANY NAME Camp sS Mal R. Pnmp en Tnr- PHONE #(62R) d51-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 07 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N: I , d
i ('
Nearest Town: tt�Ae/tio
✓tl n County8tlTke✓ini
t'QInA) j 41{es-/-ot /1
(Stint Name, Numbers, Community, Subdivision, Lot No., Zip Code)
f/
3. OWNER: l ot,Je I I prod a r
Address ) 3 I t10.1 j 51. Apt ail
t•C t Y ✓
R teet)'� � or Route t
)g139
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: d 45-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of' Casing: I{3
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a0 METHOD OF TEST Air
10. WATER ZONES (depth):
11. DISINFECTION: Type rh1 n r i na Amount / Czy
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From�__ToL_Ft.6 1 /4 SDR21 PVC
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From_ To 20 Ft. P1 at Cemcnt H,a
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in,
Froth To Ft.
From To Ft.
16 REMARKS:
/TopographicJLand setting
fHRidge ❑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 Formation Formationpescription
n 't8 diet S�,rrad
yt$ eft"-nfisolidrtted 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.
[Ho log
0
(J
Cr)
(n
CD rri
0
rn
IIZYaR�IF�JTF 1'
WELL WAS CONSTRUCIb.D IN ACCORDANCE WITH 15A NCAC 2C, WEI r
THAT A CiPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
Sub 9..X I,. es
27489463& t(4p&111
TURF OF : CASON CO
STRUCTINTHE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
i:313-3221 within 30 days. GW-1 REV. 07/2001

258107
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 21 3 R
PHONE tt 2R1 d53-7322
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 'a Camp Jr_
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT('
(if applicable)
1.
R Pimp rn
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential l/ 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 Town: LA I `15 /j e. County I l o YCY
I ;fps d e r5 AI1e,S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:IA i�`J/, e5
Address D O X 6 I Yl 1
C[f{st�(S eete or Route NoJ f 2g0074
I!� l-
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED ,210- O o1
5. TOTAL DEPTH: 4-5
6. DOES WELL REPLACE EXISTING WELL? YES 0NO
7. STATIC WATER LEVEL Below Top of Casing: 1{
(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 2C .0118.
9. YIELD (gpm): R METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 nr
12. CASING:
Depth Diameter
From o To IS.Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From p 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
From To Ft.
From To Ft
Amount 1/Z cur
Wall Thickness 1
orWeight/Ft. Material
S4-.21P.2-1 PVC
Material
PI at Cement
Method
Hand
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
5,,Ad gra✓e i rl;r
15- CtH6 4rdAl-erock
Slot Size Material
in.
in.
Material
16. REMARKS:
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.
X
Cif-fsidc
�Sl�t f.5
,2 2JA
=7
0
n
Cf{5ICICOI o
RE gArCIFLI3VCEkTI YT • T THIS WFL I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONa 1 RUI.I ION Si S, AND T COPY OF THIS RECORD HAS BEEN P OVIDED TO THE WELL OWNER
SIGNA DATE
�R� pgmtdleiiggt to the Division of Water Qualify, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
oc r; 27699-1636'RboliENZE(919) 733-3221, within 30 days. GW-1 REV. 07/2001
CamD's
Wa11
Air
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
Tnc
From To
OFPE d
OF PERSON CONSTRUCTING T

258114
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;IA Ine s. w Camp, 7x CERTIFICATION # 21 3A
WELL CONTRACTOR COMPANY NAME Camp' q Wa1 1 R
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Pump rn� Inr PHONE #t2S) d53-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOI/
Nearest Town: ke- La.
are] Leak&S
(Street Name, Numbers, Community, Subdivision, .Lot No., Zip Code)
3. OWNER: L-'retttleal l nnst
Address 111 re 1-.0..kc6. Pkto/.
(Stint or Route No.)
Lke_ Lufe N L ag1dto
City or Town State Zip Code
Area code- Phane number
4. DATE DRILLED 1 -AC' DA
5. TOTAL DEPTH: ,����////
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO si
7. STATIC WATER LEVEL Below Top of Casing: 76-
(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): A_ METHOD OF TEST Air
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 nr i n a
12. CASING:
Depth Diameter
From_( To jC Ft. 6 t / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From To 2 p
Amount (ACa05
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Ft. N at Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in,
Material
16. REMARKS:
County Ivu(rteY fo r(1 Ian
Lati
Topophic/Land setting
❑Ridge @Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrces/tninutes/seconds)
tude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 dirt, aY0.Ve-I
'TC 45 consol,ha e rork
LOCATION SKETCI-t
Show direction and distance in miles from at least
two State Roads or County goads. Include the road
numbers and common road names.
n C.
cs
AJ<e
HE RI;
CER-J1FYn TH-4 WELL WAS CONSTRUCIhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
ISTRUCTION STANDARDsl, Abt) WAT A COPY OF THIS RECORD HAS 1 EEN PROVIDED TO THE WELL OWNER
—, kit f
I 1 _
OF PERSON CONSTRU
Sl - II - 6a
WFT T DATE
Submit the original fo ti 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
258117
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James r+L Camp, Jr CERTIFICATION F 71 38
WELL CONTRACTOR COMPANY NAME Camp' a Wa11 & Piimp f'n Tnc PHONE It87Rl dc, 1-7322
STATE WELL CONSTRUCTION PERMITtI .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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LAKE Litre_ County I I I rLeY�Y Q
City or Town State Zip Code
Area code- Phone number 4. DATE DRILLED 7 — —v40( l
5. TOTAL DEPTH: / 4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 7 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1_ FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm):.367 METHOD OF TEST pit
10. WATER ZONES (depth):
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: eo
Address 9Ll/ Jc'tdcecrest Les
(Sareoxt tr R(ouwJ No,,,R
P 139
11. DISINFECTION: Type ('h 1 nri na
12. CASING:
Depth Diameter
From n To €O Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From __0__ 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.
Amount 1 thy
Wall Thickness
or Weight/Ft. Material
gBR21 PVC
Material
Neat Ccment
Method
Hand
ONSTRUCTION STAND
GTI
$u pul thefg>f�g nAttn Fpivisipn of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2169973E36 rnone No. (919) 7dd-3 11, within 30 days. GW-1 REV. 07/2001
Topo .c/Land setting
❑Ridge Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degreedminuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
From To
0 SD
'SD i 45-
9va✓o, (x' k
CUilso); rlaTea Ytac
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. a -
rJ
Lake
Lu Ye
6;1\5 CK
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PR VIDED TO THE WELL OWNER
// Tt 2")1-Da-
SIGNA OF PERSON CONSTRUCTING DATE
rs
3
O
0
cn
n
r,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 71 111
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James
WELL CONTRACTOR COMPANY NAME f'arnpic Wel1 8, Piimp rn, r Tnr PRONE#ffi7R1_451-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
'8'ro 8'
u Cam Tr_
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIfff��1��1...: I I
Nearest Town: t171�4fit '-nYO-Y-or. County ktiAitercrQ
CAI ff 1 a.r` Ra
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address l05;.;
Jo ti)
YIc 'lr<teY
Ia Str [ pr Route No.)-n
lthioa< i/I5 NC- I6 i
City or Town Stale Zip Code
Area code- Phone number /,
4. DATE DRILLED / - 1.J -6.2
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1�
(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 accordanawith 15A NCAC 2C .0118. ��
9. YIELD (gpm): — METHOD OF TEST air
10. WATER ZONES (depth):
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
,a
From To portion Description
rt
6O aoh O /;cia1ed rock
n 60
11. DISINFECTION: Type r h 1
12. CASING:
Depth
Fromr_ To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
Front_ To 2 0 Ft.
From To
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
From To
nri nP Amount I Ca"
Wall Thickness
Diameter or Weight/Ft. Material
6 1./4 S.DP21 PVC
16. REMARKS:
ASHEVILL
GROUN r1l
Material
N at Cement
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft.
Method
Slot Size Material
in.
in.
Material
LOCATION SKETCj-I
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
nf.
Ito
rI No.(9
HAT THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Mille-d- 2), r4mi
S1GNATURW F PERSON CONSTRUCTIN TDATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

258116
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ja mac m r'amp, Tr_ CERTIFICATION,/ 71 ifl
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
ramp 'c Wa11 R Pimp Co In PHONE I$9A1 d54_7322
ASSOCIATED WQ PERMIT,/
(if applicable)
1. WELL USE (Check Applicable Box): Residential IN Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: [-.a k e LR ve- County RIlAAe ytn r
I-aaye! 1_ake's
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
E/)ek<. R°ger,
Address 616 5 I Thht31adp Dr.
hat or Route No.)
r_heir�o e lNNC a82:0o-/441tf
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 'I - / I -
5. TOTAL DEPTH: /(, 0 c Y
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fy
7. STATIC WATER LEVEL Below Top of Casing: A7 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 1SA NCAC 2C .0118.
9. YIELD (gpm): h METHOD OF TEST &; r
10. WATER ZONES (depth):
3. OWNER:
11. DISINFECTION: Type rh 1
12. CASING:
Depth
From__-()— To An
From To
From To
Ft.
Ft.
Ft.
nri na
Diameter
6 1/4
13. GROUT: Depth
From___0 To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
Front To Ft. in. in.
From________.To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount . Gaps
Wall Thiclmess
or Weight/Ft. Material
SDR21 PVC
Material
Noat Cement
Method
IIut.—
From To Ft.
16. REMARKS:
gt',t(lF,-ras yji btu2 Divi�
9k4W6litiPuf a11E733-3:
Material
Topographic/Land setting
❑Ridge IE 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
day
, lay saKd
II-rl /105 CDn59);da ed rock
L-ure
LOCATION SKETCFL
Show direction and distance in miles from at lJgast :-
two State Roads or County Roads. Include t)i2•ioad„
numbers and common road name .
9.1 G
j 1
0
0
rn
c
0
g;l(s cK,zd'
IS WELL WAS CONSTRUCT l:D IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TTJRB ` .
GNA OF PERSON CONSTRUCTII4G TWFI T DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

258105
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,7 a ma g rr Camp, Jr- CERTIFICATION N 21 iR
WELL CONTRACTOR COMPANY NAME f'ampI s t4P11 R Primp r'n , Tnr PRONE # 2R) d53-7322
STATE WELL CONSTRUCTION PERMITS _,ARSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:, �r7�
NearestTow�pp� aKe �ttYe County RUitPryv
/-bra 9tiy •KK,0A RA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , e I 5Za'ti I O
Address L Slit; 10 k Dv CA b i rl l
(Street or Route No.)
7� iv n) 5415
City Town State Zip Code
Area code- Phone number
4. DATE DRILLED / — /o '
5. TOTAL DEPTH: 22
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 5 a FT.
(Use '4." 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 METHOD OF TEST
10. WATER ZONES (depth):
air
11. DISINFECTION: Type r h 1 n r
12. CASING:
Depth Diameter
From_p To r/5 Ft.6 1 /4 er)1 21 PVC
Amount 1 ( cv�
Wall Thickness
or Weight/Ft. Material
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_ To 2 0
From To Ft.
Ft.
Neat Cement Hand
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.
Topo phic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeelminutes/sreordc)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 7� 6a
4S a25 , t €alid8TP Yoc_k
LOCATION SKETCI-(
Show direction and distance in stiles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
La Kt
Lure
Material I/w�
16. REMARKS:
mod emi
Mann S
2 (, ..;�.'_'�
X
Gvassy Kilo 13
Y T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A\DS, AND THAT A COPY OF THIS RECORD 1HAS BEENnPROVIDED TO THE WELL OWNER
SIGNATURE OF ONCONSTRUCTING ONSTR /CTTING THE WFSS ' // DAB
Submit the on inal t the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GR9ti101163843fi6ifelft 919) 713-3221, within 30 days. GW-1 REV. 07/2001
ASHP/IL.LE REGOhF'_ OFFICE
r
K5p:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames TO Camp Jr CERTIFICATION #_11A
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
2581.06
f'amp' s Wp11 R. Pimp rn Tnr PHONE lin7R) 451-7122
- ...ASSOCIATED WQ PERMIT,/
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIOt
Nearest Town: etl51l
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RYe in/l�
County PN -hegyA
Address
csivy 50 1&.
671 e- M y/ (Street or outs Na.) AS(1 S0
City or Tow h State Zip Code
Area code- Phone number
4. DATE DRILLED -/
5. TOTAL DEPTH• ?i O fi
6. DOES WELL REPLACE EXISTING WELL? YES d NO 0
7. STATIC WATER LEVEL Below Top of Casing: Lir/ 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 .0I18.
9. YIELD (gpm): METHOD OF TEST Air
10. WATER ZONE (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IEFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Dkaii
From To
101
101 30S
11. DISINFECTION: Type rh 1 nri np
12. CASING:
Depth
From p To 1 f_ 1 Ft. 6
From To Ft.
From. To Ft.
13. GROUT: Depth Material Method
From—0-- To 20 Ft- Plot Ccmc-nt Hand
Amount (%a Cur
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Diameter
1/4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Vct r�
daed lock
LOCATION SKETCF
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road
�(ien Valley
mirlkOcrWia be Di
Pc470,2$636(7bOaQNg4t19) 732
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND TiJA;f A COPY OF THIS RECORD HAS BEEN PI VIDEO TO THE WELL OWNER
z, SO GNP -
SIGNA , OF PERSON CONSTRUCTING Tkli DATE
vision of Water Quality; Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. OW-1 REV. 07/2001

256344
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ry Cam( Jr.
CERTIFICATION S 71 S R
WELL CONTRACTOR COMPANY NAME Campc Wa11 R. Pimp Cs TnC PHONE S$7R1 d53-7322
STATE WELL CONSTRUCTION PERMITS _ASSOCIATED WQ PERMITS
(if applicable) _ (if applicable)
{�
1. WELL USE (Check Applicable Box): Residential 1H Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI 4 ) ( '-)
Nearest T wn: RI IAC i r' dig: it- County
y.30 vYleYAld / f)PS5
(Street Name, Numbers, Community, Subdivision, Lot Tto., Zip Code)
3. OWNER: I�L btki / t' I Y UVt( Ito lit)
Address r 2 :,2'I Keta— 1 s l2» Dr •
c RCidofie.orR�qµto No.)
� IBC .2R /IS
City or Town Sute tip Code
Area code- Phone number
4. DATE DRILLED _
5. TOTAL DEPTH: / if5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g., o 0
7. STATIC WATER LEVEL Below Top of Casing: "-;0 0
(Use "+" if Above Top of Casing) C
8. TOP OF CASING IS 1 FT. Above Land Surface' r— f•'-� i
Topographic/Land setting--//
❑Ridge ❑Slope ❑Valley 4dFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Dyscription
Rq
/'Kz /3 5- (t)I'olydaied ✓,;rk
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): it METHOD OF TEST Air_
10. WATER ZONES (depth): ) 1, O
11. DISINFECTION: Type r'h 1 nri na
12. CASING:
Depth Diameter
From_0_To /1{2 Ft.6 1 /4
From______ To Ft.
From To Ft.
13. GROUT: Depth
From To
14. SCREEN: Depth Diameter
From_ To Ft. in.
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Front$_ To 2 0 Ft.
Ft.
Amount / c " It
Wall Thiclmess
Material
or Weight/Ft. Material
SDR21 PVC
Method
Ncat Ccmcnt IIa
Slot Size Material
in.
in.
From, To Ft
From To Ft.
16. REMARKS:
lqsrliER
c
7—
LOCATION SKETCR o cr
Show direction and distance in miles from gjjeastt
two State Roads or County Roads. Include the roall
numbers and common road names.
fir_ (k RJ
71.CERTIFY Ti'HIS WFI I WAS CONSTRUCIND IN ACCORDANCE WITH 15A NCAC 2C, WELL
IIONSTANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF,PERSON CONSTRUCTING TH&�wE4
Submit the original to ttte Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2169R40bt oWtotaR19) 733'221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
DATE
��
R.

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, Sr-
256348
CERTIFICATION It 21 4 8
WELL CONTRACTOR COMPANY NAME ramp s Wa11 R Pomp Cn Tnr PRONE 887R) d5.1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITI
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 11 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIj ((� ,�
s Town: / tote✓-P,413 KCounty Kufh,}ev Y
/e45cLttf 14111 Ck. 1-ooti
Subdivision [
(Street Name, Numbers, Community,f\(( No., Zip Code)
3. OWNER: ('nee D5borne
Address
A P))e Sant Hill Ch . too/ Kd •
Rath(' ✓'kroisatelor/Route pNoi)C / ei
City or Tawa State Zip Code
Area code- Phone number
4. DATE DRILLED (O -01`f - 6 a-
5. TOTAL DEPTH: 4/ 9 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J$f
7. STATIC WATER LEVEL Below Top of' Casing: 7C FT.
(Use "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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST n it
10. WATER ZONES (depth): 4 6 C
11. DISINFECTION: Type rh 1 nri na
12. CASING:
Depth, Diameter
From r) To Oh Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
Fromm To 2 0 Ft.
Amount acctps
Wall Thickness
or Weight/Ft. Material
Gn&21 PVC
PI at Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From. To Ft.
From To Ft.
Method
IId
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/tninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
Formation Description
yed dirt- Saito'
(,5 ./$5 Con50/1rdafed ✓o ck
From To
n S
0
r C
C
LOCATION SKETCH �' n
Show direction and distance in miles from ttt�, eas n
two State Roads or County Roads. Included* roil
numbers and common road names. ---
C r_1l.
pi po
c
16. REMARKS:
WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER
4 I,J, L'.k1r . 7-
OF PERSON CONSTRUCT WFI1 DATE
bruit the original to the ivisio i of Water Quality -,-Groundwater Section, 1636 Mail Service Center -Raleigh, NC
topftigf4 N1/33-322 , within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

256337
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m Camp, Jr- CERTIFICATION# 71 38
WELL CONTRACTOR COMPANY NAME
Camp'a
Wa11 & Pump rn Tnc PRONE#$7R1115"1_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 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION; r r
Nearest Town: ' i! $/ Y rt4 County at P ft, yr
All Del K,Aen IIA17J,, A RA.
(Sneet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3cv71Surge55
Address /9 0 RDA , t/ 8
(Street or Route No.)
of sprin� AJC �u99/o
City or T ❑ State Zip Code
Area code- Phone number /
4. DATE DRILLED (p ` d
5. TOTAL DEPTH: G
6. DOES WELL REPLACE EXISTING WELL? YES IVNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 31 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)' /00 t METHOD OF TEST n i r
10. WATER ZONES (depth): .4/0
11. DISINFECTION: Type Ch 1 nr i na
12. CASING:
Depth Diameter
From r) To /00 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 0 Ft.
Amount (up
Wall Thickness
or Weight/Ft. Material
g9R21 PVC
Material
Neat Ccmcnt
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
Hu
Slot Size Material
in.
in.
From- To
From To
16. REMARKS:
Ft.
Ft.
Topogtaphic/Land setting
❑Ridge ImSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formjtion escriptionf qnd l �r
From�To
D oo
I Do /off % 6(50/01Se/ ✓o ck
rvl
L
L
r
w
LOCATION SKETCH
Show direction and distance in miles from at least two State Roads or County Roads. Include thioad rr;
numbers and common road names. co 2
5LAkl y
5unry
Mtn •
c-Afc
/ 0 8 }-Iw y
tthtttit the or' ' 1 tu_theiDivis'
kR�f;733-32
v I�AL �F
S WELL WAS CONSTRUe1hD 1N ACCORDANCE WITH 15A NCAC 2C, WELL
QD THAT COPY OF THIS RECORD HAS BEEN ROVIDED TO THE WELL OWNER
(tlifibect, il. revi,n4
4 . %— /S—oc ,
3NA OF PERSON CONSTRUCTING/THE LL DATE
on of Water Quality Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
256338
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 Camp' S Wall $ Pnmp en Trim
STATE WELL CONSTRUCTION PERMIT,* ASSOCIATED WQ PERMIT,*
(if applicable) (if applicable)
CERTIFICATION,* 7118
PHONE,*8)7R) IIS1-7122
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA: u-The
r /7 ,IJ E' ( I
Nearest To �' u e Yci K County of Y
To
f41 2Yliim4eic J.
(Street Name, Numbers, Community, Subdivision, tot No., Zip Code)
3. OWNER: 6colf 11. es
Address 14 l A✓(hY4D IA-
�r('(Str or Route NoJ a (et 4o 1 rl an eN. C- ),Sf S9
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 4 /3 -0-21,
5. TOTAL DEPTH: (00 .S /
6. DOES WELL REPLACE EXISTING WELL? YES IV NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 9D 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 METHOD OF TEST P i r
10. WATER ZONES (depth): S 90
11. DISINFECTION: Type Chi nr i na
12. CASING:
Depth Diameter
From__ To £7 2 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_p To 20 Ft.
Amount cg cap-5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
N ,at Ccmcnt IIs
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.
Slot Size Material
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:❑GPS❑Topographic map
(check box)
PRILLING LOG
Formation Description
dirt/ r`la/��j I
�nNSo/r /a'Tyl rnrk
PEPTU
From To
5S
S 6 oc
o c
LOCATION SKETCI;
Show direction and distance in miles from at INS
two State Roads or County Roads. Include tho-road a o
numbers and common road names. o ,c
-w L1'u cH ,� f l'-<r',
c
Gl kir'l LoVivY,
�AY\;111' r
zp.
WFI 1 WAS CONSTRUCLED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PfSSON CONSTRUCTING THE WEIL DATE
Stithmit the original to the�ivisi of Water Quality, -Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2769§-4836'?PhoueNe1M9),733-322 , within 30 days. GW-1 REV. 07/2001

256341
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;7ameS w CamD, Jr
CERTIFICATION # 7 1 R R
WELL CONTRACTOR COMPANY NAME ramp' c Wa11 & Primp rn Tnr PRONE fal R1 d"4-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential by Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Nearest To County 1
2. WELL LOCATI y(
- Dte Y�
p IMO At . ?d .
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PC V7p C I 1 o kne5
Address if- /A5 Hwy '7 4-4 l3ypa55
kiln_
f (Street qr Route NO.) g 134,
City or Town Slate Zip Code
Area code- Phone number
4. DATE DRILLED 1- I� -
5. TOTAL DEPTH: 6 rj
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 3C 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): /D METHOD OF TEST Air
10. WATER ZONES (depth): / 3C
11. DISINFECTION: Type rill 1 nr i n
12. CASING:
Depth Diameter
From 0.To (00 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
Frorn__QTo 30 Ft.
From To Ft.
Amount / !' u A
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Neat Cement
14. SCREEN: Depth Diameter
From. To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
hand
Topo hic/Land setting
❑Ridge )pope ❑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 FpprmationDe ription
0 60 claYy/ taut
60 /cC fn5011,1atr rock
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
BY CERTI wTHAT-T'FE
RUCTION STANDARDS♦ ;'`
'SIGNATURE OF PE
LOCATION SKETCH p
Show direction and distance in miles from at 1tast =
two State Roads or County Roads. Include the-aoad o
numbers an common road names.
. _LL WAS CONSTRUUIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS iSEEN PPROVIDED TO THE WELL OWNER
G�yv149, raAly. -1 S -c a.
CONSTRUCTING THE WELL DATE
Submit the original to the Di'isiotyof Water Quality,.Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27649;463611hohiNii;(9I5%7 i-3221 within 30 days. GW-1 REV. 07/2001

^56340
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) as ma s s^r Camp, Jr.
CERTIFICATION # 71 '1 f1
•
WELL CONTRACTOR COMPANY NAME Camp' S wp.11 R Pump C Inn PHONE #gt7£1) d51-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential its 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: 6 County u f t V Cl.
76 &rrY W n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I GIY Jr l i n
. l )1 0Ca-N
Address /Co ci n n ?o uoK 141
(Lit hfh n MI ptItswto C q g1 6f
City or Town State Zip Code
Area code- Phone number .
4. DATE DRILLED 4 —/I
5. TOTAL DEPTH: 05
6. DOES WELL REPLACE EXISTING WELL? YES ENO 0
7. STATIC WATER LEVEL Below Top of Casing: c7o FT.
(Use "r" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface'
• *Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): LS META-IOD OF TEST i,i r
10. WATER ZONES (depth): oC g 5-
11. DISINFECTION: Type rh 1 nri nn
12. CASING:
Depth Diameter
From___0__ ToSi_... Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
Frorr_a__-To 20 Ft. Neat Cement
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount t72-rvia
Wall Thiclmess
orWeight/Ft. Material
SDR21 PVC
Method
Hand
16. REMARKS:
Topo hie/Land setting
❑Ridge L 1oope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
pRILLTNG LOG
Formation Description
getV e (. C� � Y *
DEPTH
From To
qc
NSo iria e York
PO
c
L 77.1
ZS•
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th&oad
numbers and common road names. -.
AartAltotor N.
m
-'-c (/t Rt i o ft Mil if
T j r H RELY O RTIF1''I'H!*�' IS WELL WAS CONSTRU(:1hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
�J Th SYS%ND RJ9SI THAT A COPY
0gTHIS RECORD HAS PROVIDED TO THE WELL OWNER
I1eDGNATURE OF PER$g CONSTRUCTING THE WELL ✓ 'YJ DATE
Divisjion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
{jiikt) 733-3{21, within 30 days. GW-I REV. 07/2001

256339
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
Jaynes Camp, Jr
CERTIFICATION8 71 3 A
WELL CONTRACTOR COMPANY NAME ramp' S Wa11 & Pttmp Cn TnC PRONE #$7A) d53-7322
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 0 Other 0 If Other, List Use
2. WELL LOCATIOD�t
Nearest Town: /+Glut. E ✓ Ot d YtCouunc 2Y 17�✓
7D / �, Je ✓5 e Rd-.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SfP JC,vt ) /1/ex5
Address 3 1 ((street°{Route
t/P r��/
U.tk
e ✓ 'fro V- (DYve��>
(`t C
City or Town State
z/
�813
Zip Code
Area code- Phone number
4. DATE DRILLED 60 — t —O d
5. TOTAL DEPTH: 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1151
7. STATIC WATER LEVEL Below Top of Casing: hi-5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): ) C METHOD OF TEST
10. WATER ZONES (depth): j g�
Air
11. DISINFECTION: Type rh1 nri na Amount ) r ct lel
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From o To qS Ft. 6 1 / 4 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_ To 20 Ft. N ctt 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
Material
PVC
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
[Midge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesisecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILTSNG I.00
From To Vormtltion Description
/✓
6/5" 4,1o5 (tnctl/dateci rock
0
W
0
LOCATION SKETCH a
Show direction and distance in miles from at least ' c
two State Roads or County Roads. Include thE�,r ad (-1
numbers and common road names. 0
I DC FIERFBYCFBTIFKTHAT THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
� CONSTRUCTIONSTAN1"�A13D ,ANC -WHAT A COPY OF THIS RECORD HAS BE N PROVIDED TO THE WELL OWNER
II 1 /1 l�ti , A J 15 DA
ATURE OF PERSON CONSTRUCTING/1' WELL DATE
Submit the original to he D
L 27699-1616 Phone Nei (919) 73
CFOUi•D!?ATER SECTION
A3HFViLLE REGIONAL OFFICE
vision of Water Quality; Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

254463
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources t- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME;print) /l�L✓ i✓�- T CERTIFICATION
WELL CONTRACTOR COMPANY NAME t LI VN 5 e V Y N Wl0 .�.rtc•
PHONE # (?L7R[1J-S.3- �,3.7�
STATE WELL CONSTRUCTION PERMIT# ( ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 5/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest To •. `-a.<e )_use
"NI Ver end
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7 c ClTitOOKe✓
Address 62DO Arc kte✓ Lake Dr., Suite 110
(Street or Route No.)
60/LiDAIA sC 212fl
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3/- 02
5. TOTAL DEPTH: o 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lit
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I - FT. Above Land Surface*
' *Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118. n
9. YIELD (gpm): 1 0 METHOD OF TEST /7 i r
10. WATER ZONES (depth): 1
County Kulher-Pord
11. DISINFECTION: Type C-kln✓ine
12. CASING:
Depth Diameter
From 0 To 3 c Ft. 6:174
From To Ft.
From To Ft.
Amount Iii cup
Wall Thickness
or Weight/Ft. Material
5 D R 21 fJ
13. GROUT: Depth MMa�terial
From 0 To 20 Ft. nea7 Gem(xt
From To Ft.
14. SCREEN: Depth Diameter
Front To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From, To Ft.
Meth d
ha id
Slot Size Material
in.
in.
7
DO HhREsx c hinfr THAT 1t4IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
:ONSTRUCTION STANDAADSr (IND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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)
PRILLING LOG
Formation Description
DEPTH
From Toic y(J
3taS titAis ild&tea
Voc
cm 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.
J
0
nit
01
S
GNA
F PERSON C
NSTRUCTING T
WELL
DATE
GROQN.E1!"IATL;R,SE 10 N
F,Sµbinathgguguw Dwision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) /3J i221, within 30 days. GW-1 REV. 07/2001

254462
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME /,ijj7p�rint) ci W1. C5 - Kant JY. CERTIFICATION 0 \!�
WELL CONTRACTORCOMPANY NAME L.Gt YrtfY5 U)e_I V Piw.p C°. TYLC . PHONE # [phone] - 732g-
STATE WELL CONSTRUCTION PERMIT** ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 87 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONNearest r:^ yl
Town: roYesf CI /V County u(hey4 r
/q Do ettf Grove Rd.
Name, Numbers, uni ,Subdivision, Lot Ni.,(Street rs,, unity, Zip Code)
3. OWNER: M . Y/..5 UPI 'fed e& h ofGo
Address l %( DVlge1t %Yoi,r
re 0 rest " / a9? 01701i3
City or Town Stare Zip Code
Arca code- Phone number r
4. DATE DRILLED 7 - 30- Pas
5. TOTAL DEPTH: a S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: b b
(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): IC METHOD OF TEST 41 r
10. WATER ZONES (depth): �4 0
11. DISINFECTION: Type 2
12. CASING:
Depth
From 0 To ac
From To
Ft.
Material
Ft. Yleat Cement
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Poll tie Amount IhCup
Wall Thickness
Diameter or Weight/Ft. Material
Ft./o6DRai PVc
Ft.
From To
13. GROUT: Depth
From 0 To ?o
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
ham
Meth
Size Material
Ft.
Ft.
Topographic/Land settinggj
❑Ridge 0Slope ❑Valley htFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
»EPTI-( DRILLING LOG
From To Formation De cription
0 )�t7 dirt Said
f Lj at ci cnnsoli daaerl voc k
fV
L
t_
�1 'f i
ca
wC
LOCATION SKETCH 2_
Show direction and distance in miles from Oast
two State Roads or County Roads. Include tie` roag
numbers and common road names.
aa� A
55 r.ct
4C COYLrvI
t_L pthi EBY CEILTleit
I CONS1RU(,11UNS 1ANIOARb3
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT 4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LtiY ta- / • l . it% n . --l n - D 2,
SIGNATUI i/OF PERSON CONSTRUCTING TREFWE DATE
1!MPFor!yP6he Di Vision of Water Quality—, Section, 1636 Mail Service Center - Raleigh, NC
AS137S 94636.PbaaitNciAVS) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t+L Camp, Jr- CERTIFICATION % 71 3f1
WELL CONTRACTOR COMPANY NAME C'aopt c No, 11 $ Pttmp C'o Tnr PHONE %89A1 d51-7322
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (I}"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 Nearest To
'.yWELL : ZI,N1*er ! ✓d 10 County K t( 4e/�(a
6tr✓)5 - L1%LokAsol Rd.
(Street Name, Numbers, Community, Subdivision, Lot No., F.,ip Cpfe)
''// JJ 2 rnevirte
3. OWNER: D%(FIU)D0U !JOYYIPS - a4 riel )
Address ®()goy R a
(Street or 4outeNo.) 4
a��%
�}a✓✓ls NC
City or Town State Zip Code
Area code- Phone number t-
4. DATE DRILLED 1 ` f 3 -D ot-
5. TOTAL DEPTH: 3IF 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60
(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): if METHOD OF TEST p i r
10. WATER ZONES (depth): t3 f6
11. DISINFECTION: Type nil 1
12. CASING:
Depth Diameter
From._ To r Ft. 6
From To Ft.
From To
13. GROUT: Depth
From_II_ To 2 0
From To
14. SCREEN: Depth
From______ To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
nri na
Ft
Material
Amount Cup
Wall Thiclmess
or Weight/Ft.
QDR21
Material
PVC
Method
Ft. Noa -aunt HandFt.
Diameter
Ft. in.
Ft. in.
Slot Size
in.
in.
254452
Topographic/Land setting -�
[Midge ❑Slope ❑Valley [HFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n IDS /dirt (10.Y
loc. S4-5" Loj1so1/dwi-ed rock
0
o 0
ro D
LOCATION SKETCH
n;
C
m �
-mac
Show direction and distance in miles from aplgest 0
two State Roads or County Roads. Include tfiEkoai
numbers and common road names.
7 4mTs
Material
Df\
r�l
0 HERE'SYZ,EkTlpyTt12i,,'I�H� WFI i WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI L
NSTRUCTION STANDARD1',4A$ D THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
FL a*neit C�� ��'�7�J (yqI -' 6- 10 -JO
J
SIGNATURE OF PERSON CONSTRUCTING THE WELL / 1D DATE
UU
final to fl t;}Ilvision of Water QualityrGroundwater Section, 1636 Mail Service Center - Raleigh, NC
No. (.7d r) 7-33-322k, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionlofWaterQuality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME ,Sprint) �A wt e SDI ()• I.
Y
• Q WI/.1 it)Y CERTIFICATION #ii 13 R
WELL CONTRACTOR COMPANY NAME (a I'K� 5 �f �I Pump en l Tip , PHONE # J2as) I453-73074
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
254453
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:A
Nearest Town:
_gmP a/d �akese Cron.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
�e
3. OWNER slAe&wneVS ammelt
Address D I3eX 54'I
(Street or Ropte No.)
/. )e T.ure N c
City or Town State
(—)-
Area code- Phone number
4. DATE DRILLED -0�
5. TOTAL DEPTH: 305 y,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1"l
CountyVuthnr- e fc
Topographic/Land setting
❑Ridge ❑Slope ❑Valley SfFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
o ao n;r-r
20 3o5
Zip Code
7. STATIC WATER LEVEL Below Top of Casing: %S 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 accordanr with 15A NCAC 2C .0118.
9. YIELD (gpm): ! METHOD OF TEST 4i,
10. WATER ZONES (depth): 2 '1 S
11. DISINFECTION: Type Ck) o r i n
12. CASING:
Depth Diameter
From 0 To oZo Ft. 7o /d
From To Ft.
From To Ft.
Amount I/a Cu(
Wall Thickness
or Weight/Ft. Material
5nR,zl PVc
13. GROUT: Depth Material
From To 2 D Ft.. Nco- cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
Methgqd
Wet nid
Slot Size Material
in.
in.
Ft.
From To Ft.
16. REMARKS:
_ ,44rd terl re
L
r—
-o
0
my
LOCATION SKETCH f
Show direction and distance in miles from atast izt
two State Roads or County Roads. Include the roadj-"-'.
numbers and common road names.
efal
IraKes
ye"eY
1-6
DA.�1-6
Lyeek ,2a
,jEL lit t.
I BY-CE1th 1FY THAT THIS
UCTION STANDARDS,
C
SIG'
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI 1
YT A COPY OF THIS RECORD HAS B EN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL
DATE
S abmit ttte ortglnatto ihoPfvision of ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2' 699-1636Phone No. [phone], wit in 30 days. GW-1 REV. 07/2001
2aI

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) J a rap s 'r_ C amD, Jr CERTIFICATION #71113
WELL CONTRACTOR COMPANY NAME Camp R Wn11 8, Pnmp (`n Tnc PHONE #2S) dF4-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential LQ/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION-�' Oily
t
Nearest Town: 1—D Y e 5� (�l y I County gktA€Y nred
(Street Name, Numbers, Community, nSubdivision, Lot No., Zip Code)
ub
3. OWNER: /� C,If r K !' e Ci -(o Y
Address (n 5� Y t hp et. C. Re
11(Sueet or to o•) 2g0 O
Moo Yes born G
City or Town State tip Code
( Area code- Phone number
4. DATE DRILLED �D'D�
. 5 TOTAL DEPTH: 1JOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO PI
7. STATIC WATER LEVEL Below Top of Casing: 55— 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 (pm): "i D METHOD OF TEST air
10. WATER ZONES (depth): 2/ n
11. DISINFECTION: Type Ohl nr i n n Amount cups
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1 / 4 59R2-4 PVC
12. CASING:
Depth
From._() To I o s
From______ To
From To
13. GROUT: Depth
From_p To -sip
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Ft.
Ft.
Material
Ft. N cit Cement
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Material
16. REMARKS:
—,I9T1 IH'EitFSY �RTIPYL
J
lON S1aNDfc
254461
Topographic/Land setting
�itidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILTING LOG
From To Formation Dpscription
p J05 (jlri Sand
I0S 305 Consoliel ed
Y0Ck
0
tv
L
C
V
r-
J,OCATION SKETCH Tv
Show direction and distance in miles from at leastus
two State Roads or County Roads. Include the road
numbers and common road n4rrtes
1
rd
ONSTRUCI
S
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS 18EEN PROVIDED TO THE WFI i OWNER
GNATURE OF PE
CONSTRUCTING THE WELL
DATE
Sy Rik, e,BL4 " Divi. ion of Water Quality,Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Pthr99-33136'PtianeNo: ( 4733-3221,within 30 days. GW-1 REV. 07/2001

254460
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tamar tt _ camp, Jr CERTIFICATION # 21 18
PRONE it Rl dC"I 7'i22
WELL CONTRACTOR COMPANY NAME
ramp'
W1=11 & Primp r'n
Tnr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CS( Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
5 1 (i ]l countyKu.te4 ye)
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
ff I
3. OWNER: Cil/lrt-(( Me (ad
Address Tito r. /✓lain
(� (peel or Route N .)
St L// N L ag043
City or Town
Area code- Phone number
4. DATE DRILLED J ' D - D
5. TOTAL DEPTH: 1 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2i5) 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): 75 METHOD OF TEST air
10. WATER ZONES (depth): 14 0
11. DISINFECTION: Type f'h 1 nr i n P Amount I Cup
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
Ft.y 1/4
FromTo Ft.
From_ To Ft.
—
From_ To 9D
tate Zip Code
SDR21 PVC
nR
Topographic/Land setting
❑Ridge ❑Slope ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
rI;rfjl0.nd
a'n521ida(eJ rock
DEPTH
From To
cio
4o 15
r)
r_
J
c.
—p
s n�
m
N
LOCATION SKETCH
Show direction and distance in miles from at east
two State Roads or County Roads. Include the road
numbers and Fommon road names.
13. GROUT: Depth Material Method
Front_p To 20 Ft. N at 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:
v t.
0-HEREBY CERTIFY THA
IRUCTION STANDARI$M1$,
IL
Su'
ortg`tgalao t ivisio
270p-a 1' 6 ?Nine No., (919)'/Z(3-322
WELL WAS CONSTRULIhD IN ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
-
ATURE OF PE
CONSTRUCTING THE WELL
DATE
of Water Quality, -Groundwater Section, 1636 Mail Service Center -Raleigh, NC
, within 30 days. GW-1 REV. 07/2001

254455
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 'L Camp, Jr CERTIFICATION # 2 1 18
WELL CONTRACTOR COMPANY NAME Camp' a Well & Primp t'n r T n r PRONE #$7R) d51-7122
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 yI c ty K I i I
Nearest Town: a e Y OnColln a (heY 7ci
P/4)``fa-kon Dr. - (-lee {loon
(Street Name, Numbers, Community, fSubddiivia on, Lot No., Zip Code)
3. OWNER: Apvian_ VVIAI le l-,LoM t. Co.
Address l 0 goy 548
(Street R�wwto No.)
f�enwe7(� Ivc_ 2(096
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 5 - /0 - 0
5. TOTAL DEPTH: 5-0 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5S 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 (pm): i0 METHOD OF TEST ai r
10. WATER ZONES (depth): )F G 0
11. DISINFECTION: Type rh1nrina Amount nl/a cafe
12. CASING: Wall Thickness
or Weight/Ft. Material
SDP21 PVC
Depth Diameter
From_a_To 135 Ft.6 t /4
Front_ To Ft.
From To Ft.
13. GROUT: Depth
Froxmo To 2O Ft.
Material
Topophic/Land setting
❑Ridge QSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pRILLING LOG
Formation Description
PEPTH
From To
p 13S
)3S 505
Method
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:
C1iiETtBi CERTi
(pNSTRUCTION STANDARD
L.
Su i kihe oz%gysaL, ,{h9ivisit n of Water QualityrGroundwater Section, 1636 Mall Service Center -Raleigh, NC
276994636 Phone No .[phone], within 30 days. GW-1 REV. 07/2001
a
y0/-�
WELL WAS CONSTRUCTED IN ACCO
THAT A COPY 0Q THIS RECORD HAS
v
"VI
a
•
J
-D
N)
J.00ATION SKETCH 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commgn road names.
-fro •
4 lv a-
ANCE WITH 15A NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER
DATE
ATURE OF PE
CONSTRUCTING THE WELL
Fla N.I o-'
L

252557
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,=amps rY Caen r, Jr, CEBTIFICATLON#_71 .i.$
WELL CONTRACTOR COMPANY NAME Camp c Wo11 & Pnmp Cr" Tnr PHONE #$75:11 _d S"i-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL
2. Nearer wn:_j._&1/ I ftY County K L APYIQJA
NearerSS own: a !�
5 a, -
(StreetName, Number, Community, Subdivision, Lot No., Zip Code)
Sa y' LLt 5110.4- /e41 A
3. OWNER:
Address
(Sir ter Route No.)
Ciry or Town Suite Zip Code
Area code- Phone number
4. DATE DRILLED q Oa,
5. TOTAL DEPTH' a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
' `Top of casing terminated at/or below land surface requires a
variance In accordance wltb 1SA NCAC 2C A118.
9. YIELD (gpm): 15 O METHOD OF TEST
10. WATER ZONES (depth): 4).0 0
air
11. DISINFECTION: Type rh l nr i n a
12. CASING:
Depth Diameter
From p To fa— Ft. 6 1 / 4
From To Ft
From _ To Ft.
Amount Gi.lp
Wall Thickness
or Weight/Ft. Material
gDR31 PVC
13. GROUT: Depth Material Method
From_0___ To 20 Ft Neat Cement Hand
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting
[Ridge It lope ['Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desqription
4 hn dirt, eaJel
1, D fir, l'nnsoTldatrri Vor-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Slot Size Material
in.
in.
Size Material
16. REMARKS:
HEREBY CERTIFY THATtHI$
Mis RUGTi01.1STATItZARpst
I I I
I I' S•
l(i'1.
Sah,nit the angina to the Dlvislo
2704 4 shone No. (9 9),733-322
rI E
fo )-4f
lure
74
0
F
.,.LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNED
tt!! a-414U , (' Q� 5- 8 - D a
ATURE OF PER$arN CONSTRUCTING THE WELL % DATE
of Water Quality„Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001
•:Y

252547
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # aI38
WELL CONTRACTOR (INDIVIDUAL) NAME
�(print) V e5 ,L14./ /� T //�
WELL CONTRACTOR COMPANY NAME (A)v1D�5 L ell 1 P &wtp Il o. i L✓If . PHONE #Insagi 4-53-r13AA
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT1Qr' : r , i J
Nearest Town: k1 he�Y alto I County K u th e
(Street Name, Numbers, Coommunity,Subdivision,isio.r t r, ip
I 'Lot Na., Zip Code)
3.OWNER: Let' 1qq
Address sfi/a� / ia`tlk CC. Kd .
-r -kA(Street or Route No.) 2 E 131
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 4 -, S— 0
5. TOTAL DEPTH: 4' 0' /
6. DOES WELL REPLACE EXISTING WELL? YES 19I NO ❑
7. STATIC WATER LEVEL Below Top of Casing: .So FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
' *Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. q
9. YIELD (gpm): I b METHOD OF TEST 4'r
10. WATER ZONES (depth): 3 4 0
11. DISINFECTION: Type
12. CASING:
th
Frorn_(ZTo 13 C
From To
From To
13. GROUT: Depth
Fromm To an
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
P.k�cr)re. Amount ii% 4145
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G .11 50R.2i PVC
Ft.
Ft.
Material Method
Ft. neat ceMevtf bait r1
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
01i'l YY1.
Topo�g�Pphic/Land setting
[Ridge Ij7Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I.OQ
From To Formation Description
O 135- Sand cii r
I3C ''i05 eOh544irla er( rock
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.
LAYc
GYeen
�I
DS PO PO b
3 xm
n
o<
r.
G
rice
rn o
�m
cnz_
rn�
G
z
U2
1DQ HEREBY CERTIFY IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
EgONSTRUGT- 7-ST-ANDA4 , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g fnnd h). ( Aeyy��/� J — O.-
IGNATURE OF PERSON CONM'Rti G THE WELL DATE
LSubmit the or* nel to Ehe Di
H2?699-1636Phone No, 019) 73
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
Pc
03
C.f1
R-Fk

p0 HEREBYCCCRTIFY TkIA
f-$ONSTRUCTION STAND
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
James la Camp, Jr
CamrtS Wa11 & Pump Cn Tnr
252545
- Groundwater Section
CERTIFICATION # 2 1 3 i3
PHONE #$9F0 t1 3-7322
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 LOCATION: I /
Nearest Town: L d Ke_ La ✓ e
Bola NA DV•
(Street Name, Numbers, Community,
Community, Subdivision, Lot No., Zip Code)
3. OWNER: �( dl C Be`I
Address a &SS lte✓Iiner*it .Dr".
(Street orgRoute N{�) ��
Be R60Vt N C co
Li -
County R t hen r
City or Town State Zip Code
Area code- Phone numbu
4. DATE DRILLED — 17 — D 2
5. TOTAL DEPTH: r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 70
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
4. `Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): lh METHOD OF TEST
10. WATER ZONES (depth): 33 0
11 r
11. DISINFECTION: Type rh 1 n r i n
12. CASING:
Depth Diameter
From_0 _To CIO Ft. 6 t / 4
From_ To Ft.
Froth To Ft.
13. GROUT: Depth Material
From_0___ To 20
Ft Neat
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.
REMARKS.1 �l
TTF1
�s, ft
L J
SIC
Amount 1 a- Lars
Wall Thickness
or Weight/Ft. Material
S.9R.21 PVC
Method
Cement Ha
Slot Size Material
in,
in.
Material
Topograyiphic/Land setting
❑Ridge RifS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
n 10 oGvjetue 115awd
to 1 las /'/sy460 ITc1 at ea rcc-k
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
i WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
fD THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
NATURE OF PER$ N CONSTRUCTING THE WELL
Santa the original _to"�Bl'�i�g�1F1tvisim of Water Qualityr Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1596PtioneNa�i9mr)733 32 1, within 30 days. GW-1 REV. 07/2001
er<

252558
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JaTne5 '' Cam( Tr CERTIFICATION# 21 i8
WELL CONTRACTOR COMPANY NAME Camp' a Wall R Pnmp ['n Tnc PHONE #$2R' dS'q-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ili Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQNiN
Nearest Town: ,(2 3
County
(Street Name, Numbers, Community, Subdivision,
Lot No., Zip Code)
3. OWNER: 109
Address HAM
(Street or Route No
.).
S. /
e l 3City City or own State Zip Code
Area code- Phone number
4. DATE DRILLED y . )\,. 0--
5. TOTAL DEPTH: ZL4
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: A. 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): ID METHOD OF TEST n ; J-
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Va11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pRILLING LOG
Flrmiatn D_ cscFiption
From To
ci6
Q 0 SNnL
11. DISINFECTION: Type ('h 1 n r i n
12. CASING:
Depth Diameter
From p ToSli— Ft. 6 1 / 4
Amount i (
Wall Thickness
or Weight/Ft. Material
-SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From __n To 2 0 Ft.
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.
16. REMARKS:
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road,
numbers and common road names.
nS AID O HEREBY CERTIFY TBAIF WELL WAS CONSTRUL IED IN ACCORDANCE WITH I5A NCAC 2C WFI I
zku ,, THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER 23.
LAj
Stibmitthesriginalto. the lit ivisia
2709-16361°hone7'1 `(9I119t733-322
IL o ICE
c
O 0
0
m
o�
crq
a441t4- ra,ily # . (1. �� Ot
ATURE OF PE CONSTRUCTING THE WELL DATE 'ti o
=tom
of Water Quality,.,Groundwater Section, 1636 Mail Service Center -Raleigh, NC t,,:
, within 30 days. GW-1 REV. 07/21 "'za
0 ---I
0
G
2

252548
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J am ma's U C arp p r Jr CERTIFICATION # 91 1 R
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
Ciampi 4 Wall R Piimp On Tnr PHONE # 2A) d51-7322
ASSOCIATED WQ PERMIT*
(if applicable)
1. WELL USE (Check Applicable Box): Residential 113 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 -1I77 (
Nearest Twn: it iaf`Fb✓d�or County Au eY ✓
IKey
(Sneer Name, Numb , Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pin Hes �/1 vI IWliTe-A
Address �2: G, 77, Wls St •
(' (Sett_ t qr Route Nu.)
�2T N
;S139
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED - 1'1 -
5. TOTAL DEPTH: ac
6. DOES WELL REPLACE EXISTING WELL? YES VINO 0
7. STATIC WATER LEVEL Below Top of Casing: Li- 5- FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
• *Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST
10. WATER. ZONES (depth): 54,g U
11. DISINFECTION: Type nil 1 nr i n
12. CASING:
Depth
From n To 1SD
From To
From To
13. GROUT: Depth
From_a_To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diameter
Ft.6 1/4
Ft.
Ft.
Material
Neat Cement
D i.s
Amount 1 y2. ct p 5
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
I DO HERE Y CERTIFY) T
CDOoNSTRU iON STAND
1—
Lit
4ubmit the original to the Divis
27699406 Phone No.(919) 733-3
Method
Hand
Slot Size Material
in.
in.
Size Material
Topographic/Land setting� /
❑Ridge ❑Slope ❑Valley (Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH 'DRILLING LOG
From To Fomml�aatio Description
n / O 5A1<dx dirt qYA✓e)
/.30 ,ZS Patsoll'cieuteki rock
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.
'Ibex Ch Rtlo
IS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WFI t S
THAT A COPY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER,
ana- ( GLi1 >4 ; Yf • g
NATURE OF PE
CONSTRUCTING THE WELL f 'iJ DATE
on 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) James m Camp, Jr.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT,/
(if applicable)
ramp'ct WR11
2-3 si
CERTIFICATION,/ 7118
& Pimp Co Tnr• PHONE [phone]
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: jam, x
Countya
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:et
Address t a
LA
City or Town
\U
(SCt;r) aro.)
et
State Zip Code 1
Area code- Phone numb
4. DATE DRILLED V. -I I • 0
5. TOTAL DEPTH: 1405-
�-�/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FT
7. STATIC WATER LEVEL Below Top of Casing: t,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
• *Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .< METHOD OF TEST a
10. WATER ZONES (depth): a 0o
11. DISINFECTION: Type chi ter i na
12. CASING:
Depth Diameter
From 0 To Q.0 Ft. 6 1 / 4
From To Ft.
From______ To Ft.
13. GROUT: Depth
From,_/ To 2 / Ft.
From To Ft.
Slot Size Material
in.
in.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Neat Cemc.nt
Method
Hand
From To Ft.
16. REMARKS:
lop H$nE$Y CERT}FY(
' 'CONSTRUCt 1ON STAND
Li/
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 pRILLING LOG
From To F tign Descriptit t h\
0 qd Grp
t 1 4,Al.
Qet
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.
SIMS
c-n
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN
-Q1Rf \AA.. 4Y1_6- 0�
F Pw
SIGNATURE OERSON ON UCTING THE WELL DATE CJ1
UJ
Submit the original toithe Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
(17699-1636Phbuel f(919) 733-3221, within 30 days. GW-1 REV. 07/2001
n=11 E

WELL CONSTRUCTION RECORD
252544
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 7 1 3 A
WELL CONTRACTOR COMPANY NAME Campy a Wel 1 8, Pimp Tnr PRONE #a7A1 d5". 7 12 2
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jarnns r.r Camp,
1. WELL USE (Check Applicable Box): Residential ID( Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFr I LOCATIO�NN"J
Nearest Town: LAW I t7 14.jv1 1 I I S County
flgeoll S�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I
Address f n
(Sae1t 9
1Ln i 0 14.V
City or Town State ) Zip Code
S;,,,ApsoYI
ox
Ro to No.) � C Qg' e b r7
1 I�s 'r
YCi
Area code- Phone number
4. DATE DRILLED 4— I i— b a
5. TOTAL DEPTH: 6-05
6. DOES WELL REPLACE EXISTING WELL? YES Q" NO 0
7. STATIC WATER LEVEL Below Top of Casing: Coe 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 (pm): b METHOD OF TEST n 1 r
10. WATER ZONES (depth): 'f6 0
11. DISINFECTION: Type rh 1 n r i n a
12. CASING:
Depth Diameter
From a To R- R. 6 i/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From_0___ To 30 Et.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount a C-ar
Wall Thickness
or Weight/Ft. Material
QDR?1 PVC
Material Method
N at Cement Hand
16. REMARKS:
Slot Size Material
in.
in.
Material
TopogxS3�PPhic/Land setting
❑Ridge CJaSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
5o5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
O o
fV
n
0'
c
vr-
CFI te-r
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL >�
THAT A COPY 0 THIS RECORD HAS EEN PROVIDED TO THE WELL 0WNE�
,t-w OA 1 , t nAt A O
NATURE OF PERSON CONSTRUCTING THE WELL ! i4' DATE tit
aD o
x _
a of Water QualityrGroundwater Section, 1636 Mail Service Center -Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James lar
WELL CONTRACTOR COMPANY NAME ramp' a W P 1 1 &
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Calop, Jr.
Pump en Tnc
ASSOCIATED WQ PERMIT#
(if applicable)
252543
CERTIFICATION # 21 R R
PHONE#$2Rf 451-7322
1. WELL USE (Check Applicable Box): Residential fir/ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION_•] ( I f �j r,
Nearest Town: K.4*hPY'M f(iniaCounty Ru fit •
/✓f�� lP Ck. 1
(StreetZ1
Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CAY; 5 Elllott
Address y
ILuer �pydporNuteNJ)C �8139
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED n7 9 - O a
5. TOTAL DEPTH: P.O'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 4.1 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 p i r
10. WATER ZONES (depth): I g0
11. DISINFECTION: Type rh
12. CASING:
Depth
From_0___To qb Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_n To 2 0 Ft.
From To Ft
14. SCREEN: Depth
From To Ft.
From To Ft
15. SAND/GRAVEL PACK:
Depth
From To
Front To
nri na Amount 1 C-up
Wall Thickness
Diameter or Weight/Ft. Material
6 1/4 SDR21 PVC
16. REMARKS:
AGi''-114§9463612/4nf Ngc(919)
Material Method
Neat Cement IIa rd
Diameter Slot Size Material
in. in.
in. in.
Size Material
Ft.
Ft.
Tapo 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
D y r-p
qo „05 coln4ol�Jate4 rock
).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.
bible L.&ve-
Gretr<���
fV
b
THIS WFi 1 WAS CONSTRUCIbD IN ACCORDANCE WITH 15A NCAC 2C, WELL to > `ri
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNIJ( -i
rn
� 0 () i-/cz-per= �o
rn
MATURE OF PERSON CONSTRildIN THE WELL DATE ma,
t. H
lad G
ivision of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 2
3-3221, within 30 days. GW-1 REV. 07/2001
Sl

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James la_ Cam{ Jr- CERTIFICATION # 21 3R
WELL CONTRACTOR COMPANY NAME Camp' c WP 1 R Pimp rn Tnr PHONE #$2R) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 617 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI,,yIA� II II``''
Nearest Town: u I IneY4tYli1RV County KU
�d to v A s S f- Jx t.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
-1� 3. OWNER: %'t fe(14.a.ii1oRcd Teckyto fogy .tnc.
Address N o BO k 1 efri L 11
R11.. (SU-cc/ A(oato No.) ?5131
City or Towo State Zip Code
Area code- Phone number
4. DATE DRILLED 3- -
5. TOTAL DEPTH: 9 & ea
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4(o FT.
(Use 'W' 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 aecordanc with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST n ir
10. WATER ZONES (depth): c2-11-0
I
11. DISINFECTION: Type rh 1 nr i n a Amount i / cups
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From q To 14-0 Ft.6 1 /4 g914.21 PVC
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From_g_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,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. �`f/
16. REMARKS:
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)
DEPTH
From To
n )4-o
DRILLING LOG
Formation Description
I'e d c `a c
('0n6oltcste2 r�`ofr
2s r7
—0 S. "i
9 c�
zm
CO I<
3cD
01 o
LOCATION SKETCIi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I 0 2
JUN 2 6
Submit the original to toe Di4sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
w1 R@i(919) 733221, within 30 days. GW-1 REV. 07/2001
1
X
S WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
51
Gt�. C , l . 4- l� Oat
.TURE OF PERSON CONSTRU II'G HE WELL DATE
ASHEVII I

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELLCONTRACTOR (INDIVIDUAL) NAME (print) James tar_ Camp, Jr
WELL CONTRACTOR COMPANY NAME ramp' c Wel 1 & Primp rn.
CERTIFICATION ,/ 21 3 A
Tnc PHONE 889F0 d53-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ljd 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
Nearest Town: A Ce County R tAii •
Ln(o )) CK,RI-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Vsti*eV ,,JiAAe✓
Address y-o q a RI I CK • RA •
(Street or Route No.)
Lake Lure Nc- a8172410
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED ✓ " D04
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES SNO 0
7. STATIC WATER LEVEL Below Top of Casing: Sb 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 accordantp with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST ai r
10. WATER ZONES (depth):
11. DISINFECTION: Type rh 1 nr 1 n
12. CASING:
Depth Diameter
From r) To CIO Ft. 6 1/4
From To Ft.
From To Ft.
13. GROUT: Depth
From_g_ To 2 0
Amount / tint
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material Method
FL Neat Ccmcnt
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.
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)
DEPTH DRILLING LOG
From To Formation Description
(1 410 kSarv/ ((Ka JPI rii✓t
qn 24 (0001—tdated rock
0
0
D
y c�
oC)
zm
z_
•>0
Y0
am
V sn'
r*ta
tr
JOCATION SKETCH —+
Show direction and distance in miles from at least
two St• to Roads or County Roads. Include the road
numbers an. • • •• •n road names.
Lake
).-Jet✓c
`IA
EOI Rt(")7 t
II JUN 2
Submit the .origin Ito the
SR0tei }LI66 hehi ,gt(919)
ASHEVILLE Fila. r
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IDS, AND THA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
unitd_ ui C //� Cyr 1/-ia va
SIGNA OF PERSON CONSTRUCTING THt WgLLU DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 1.1 C amEt, Jr -
WELL CONTRACTOR COMPANY NAME Camp' Iginl 1 & Pump ('Z Tnc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
252549
- Groundwater Section
CERTIFICATION # 71 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 0 If Other, List Use
2. WELL LOCATIO �/ 1.44
Nearest Town: (i e
Ye County RA-hey-Q.
(Stint Name, Numbers, Community, Subdivision, Lot No., Zip Code)
95L j u> c�3u
\ .. (Street or oute No.) ^�
LUM 11l f c).-S /
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 ' 011. 0 3-
5. TOTAL DEPTH:45
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: of 0
(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 IC .0118.
9. YIELD (gpm): 16 METHOD OF TEST 2l it
10. WATER ZONES (depth): 3 60
11. DISINFECTION: Type rh 1 rtr i n P
12. CASING:
Depth Diameter
From n To R D Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From_q— 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.
From To Ft.
1/4
16. REMARKS:
L
I DO HEREBY CERTIF
CONSTRUCTION ST
Amount
Wall Thickness
orWeight/Ft. Material
SBR21 PVC
Slot Size
in.
in.
Material
Material
Topographic/Lansetting
❑Ridge 0Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslminutesfseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From gT To
Formation D�tssa Lion
se s J31.4".Sf,.
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.
CIi
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=
w
cil
cD
Sulrw t the O.r"tgipa. to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
.27699-1634 PhoheMA*19) 7,3-3221, within 30 days. GW-1 REV. 07/2001
VT\ if) W c.,(
SIGNATURE OF PERSON GbNSTRUCTING THE WELL
DATE
ern
rn
0<
zGrt
rn
yG
27Jo
rn=
mx
cq
G
2

56 0,6/
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jama s ut
WELL CONTRACTOR COMPANY NAME '[� mWP1 1 R
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camhr Tr - CERTIFICATION # i 1 18
Pimp en Tnr PHONE #$7Hi 451-7322
ASSOCIATED WQ PERMIT#
(if applicable)
1. 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 LOCATION:
altt , I ,
Nearest Town: puli erI rJ rt County kk
!ORE, Kdtu4rt 4 6t.
(Street Name, Numberss,, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /'f!'e (Qfv by
Address ID RIP gdulRvtlS SY Ext •
(Skin: t or Route No.)
Rf1. N c_ ".„2, 13,
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 oc6 - o a
5. TOTAL DEPTH: # D 5
6. DOES WELL REPLACE EXISTING WELL? YES EeNO ❑
7. STATIC WATER LEVEL Below Top of Casing: re FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
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 D ir
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.
Topographic/Land setting z
❑Ridge ❑Slope ❑Valley 117Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
cuff Yecl Clay r.
P.nn4)/r a te4 o i
DEPTH
From To
n !/5
)115 `t05
"m
tea+ 00
.rrn
CO<
rm
ri0
3
rtlo
cm
N=
r'•N
11. DISINFECTION: Type eh 1 nr i n e Amount tV cup 5
12. CASING:
Depth Diameter
From_ To PI 5 Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_ p To 20 Ft N at Ccmcnt Hu
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
�1 PVC
16. REMARKS:
--, II -O�ION�Y E HF TF
J NAI�A
1a�
C%
X
t?.THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND AT A COPY OF THIS RECORD HAS B EN PROVIDED TO THE WELL OWNER '
iIGNATURE OF PERSON CONSTRUCT1140+} WELL DATE
Submit the original to tt a Div
$169944-370P mite liot(Ai9) 733
sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
'221, within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 251077
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James m CAmp, Jr
CERTIFICATION a 21 3 8
WELL CONTRACTOR COMPANY NAME ['Amp I a Wa11 & Pnmr en TnC PHONE N87A) 451-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I$ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI(1N., h 1 (g j� k:j',h Nearest Town: tL Y Y it County. I` •
/Lho us ahoy 7`fA
(Street Name, Numbers, Community, Subdivis n, Lot No., Zip Code)
3. OWNER: Flea
Address Id'7o t45 el 4- ,4 nil tiwaft
R, (Street,o C Dote No.)� 8,13 1
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3- a s- D a
5. TOTAL DEPTH: . 3 R 6i
6. DOES WELL REPLACE EXISTING WELL? YES I� NO 0
7. STATIC WATER LEVEL Below Top of Casing: /pri 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 tit 1SA NCAC 2C .0118.
9. YIELD (gpm): �" METHOD OF TEST p fir_
10. WATER ZONES (depth): 3 4,0
11. DISINFECTION: Type rh 1 nr i n a Amount Caps
12. CASING: Wall Thickness
Depth
From Q To /,O Ft.6 i I Sna.21 PVC
Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 2 Q Ft.
Neat Cement H
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Slot Size Material
in
in.
Material
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley USFIat
(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 D scription
Q lac 'dirt 5an. 1 ao 3R6 i'oltdo f et ea rock
c
0
m
c
=m
r
CO Yc
>c
a
LOCATION SKETCH 9 frEi
Show direction and distance in miles from at -least -+
two State Roads or County Roads. Include tM'roac2
numbers and common road names.
Greer --
rem
v)iIKInS iv,)\\*`\-k
1 ,(ri Y°it 7
i\
/44
16. REMARKS:
DLFCOIWSTH
THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI I OWNER
I1JIp_&_
SIGNATURE OF PERSON CONSTRUCTING THE WELL / A DATE
Submit the on final to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
476.9$0.436plui Cej D 919) 733-3221, within 30 days. GW-1 REV. 07/2001
ASH[VILLE REB iTiril DFRCE

2511154
' 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 # 711a
WELL CONTRACTOR COMPANYNAME Camp S Wa11 & Primp C'n Tnr PHONE #$7R1 AS1-7322
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fld/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO II n ,1 I
Nearest Town: ke �L(✓e- County u
laurel L kcs
(Street Name, Numbers, Community, Subdivision,(�Lot N—.,o, Zip Code)
3. OWNER: YeeVql leaf Co KS I '
Address 117 L.aa re l / rAzCS Pgwv •
1 , uYe (StreetvcRouteC.,No.)-1014 1
e 7,
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED �'/'a`2 63
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 55 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): !j METHOD OF TEST p ir
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation D scription
ito
lt0 .t 05
11. DISINFECTION: Type rh 1 or i no
12. CASING:
Depth Diameter
From_#__ To ii-O 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 Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 9, Cap
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Material
Neat Ccmcnt
Method
H.i
From To Ft.
From To Ft.
16. REMARKS:
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
faKe
lkyt
Ifs cK•"
r
1 DOH Y R YfI-, P THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WPI
CONSTRUCT TUN STANL'k S, AND THAT A COPY OF THH2S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Cry d- IL) L? , Qr . �"l; - D�
SIGNATURE OF PERSO ONSTRUCTING THE WELL 0 DATE
•
;nq;
Li
GR G ES!1i>slYlfo the 1
ASHE27b99-Ec67bAM 3l llI919)7
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
COrtSo
O
0
O rem
co
J.00ATION SKETCH Cr.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jame c m - Camp, Jr. CERTIFICATION # 21 18
WELLCONTRACIOR COMPANY NAME Camp' S WP1 1 R Primp rn Tnr PHONE #87A) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IH Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WEIL LOCATION:
Nearest Town: f0 ✓e 51 l- i if County Ft/4
DArgCOY ner }KJ - 5A;10A Comm•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: T ck l adAer
RA
Address /Gao 6 and
(Street or Route No.)
Mooreshoro IVc- 2g I I
City or Towo State Zip Code
Area code- Phone number O
4. DATE DRILLED 3 - r _1-
5. TOTAL DEPTH. 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,g1
7. STATIC WATER LEVEL Below Top of Casing: /470 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
• *Top of cuing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST air
10. WATER ZONES (depth): ?SO
11. DISINFECTION: Type f`h 1 nr i n
12. CASING:
Depth
From—o To 93
Diameter
Ft.6 1/4
From To Ft.
From To Ft.
13. GROUT: Depth
From—p_ To 20
Amount Ida cups
Wall Thickness
or Weight/Ft.
SDR21
Material
PVC
Material Method
Ft• Ncat Ccmcnt 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:
Topographic/Land setting
&Ridge ❑Slope OValley ❑F1al.
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
#RILL LNG LOG
Formation Description
✓eddrrt- iaf.
e rnSOIIdAIPd" t-OC4
-n �r
_ c
co
-cr
DEPTH
From To
n 83
83 305_
O.)
Crs
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cow'
LIDO \tiCEieflE'
GUNS I RUCTION STA
r-nri lb)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFf 1
S, AND THAT A COPY THIS RECORD HAS BEEN PROVIIDED TO THE WELL OWNER
Gi/%1ad- kJ • ()7 3 -15"-007-
SIGNATURE OF PE
ON CONSTRUCTING THE W$LC // DATE
0 u fre iglP,q�to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Lr..27699=1636P410TOFN61E(919) 33-3221, within 30 days.
GFGW-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 4r Camp, Jr- CERTIFICATION# 71 3
WELL CONTRACTOR COMPANY NAME Ciampi G Won 11 R Primp rn. T n r"
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 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ((' II
NearestToWn: Rufher'MYdIyy,
dy.County R
3'77 Sfartieui IDr.
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: I�VeIgK-f- G�/JIelsill
Address 31117 Sfa r Vie ui n r.
T7, (Street or Rout
R u;� er r K C- 02913 IG
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 - I g ` 0 a-
5. TOTAL DEPTH: &2--5' /
6. DOES WELL REPLACE EXISTING WELL? YES M NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4-0 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 ISA NCAC 2C .0118.
9. YIELD (gpm): ID METHOD OF TEST Air
10. WATER ZONES (depth): Sao
Topo hic✓Land setting
❑Ridge aliSlopc ❑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
4S
;aas
11. DISINFECTION: Type r h 1 n r i np
12. CASING:
Depth .
From_ To 45
From To
From To
13. GROUT: Depth
From# To 20 Ft. N at Ccmcnt Ha —
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.
Amount I GuP
Wall Thickness
or Weight/Ft. Material
gBR21 PVC
Diameter
Ft.6 1/4
Ft.
Ft.
-n
_A m
txi -cm
Dp
3 zo
O ^Z
rn 7J
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.
eev FN)I CoMtn
Material Method g--f rl
Slot Size Material
in.
in.
ape
16. REMARKS:
2
PHONE #$7A) 4.51-7322
T
T THIS WFI 1 WAS CONSTRUCI,~D IN ACCORDANCE WITH 15A NCAC 2C, WELL
3, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0 ' ERSON CONSTRUCTING THE . / DATE
Stthmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Gi9lJ9I1T69 )If neNo4919) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGiri `F

249402
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w Cmp, Jr
CERTIFICATION # 21 4 R
WELL CONTRACTOR COMPANY NAME Camp' R Wa11 & Primp Cn Tnr PHONE #($7R) dS3_7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATIO[)L,u �,) f PY %r Y(� (i
Nearest Town: j` r "( bounty
l !!v rs /Pt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0v4I l e )QJj-ccj n'Its
Address C) el( U-OG -J-
eb0 (StreetgrCoute No.) Cat (tv!
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED - 2 1-
5. TOTAL DEPTH: / o 5
6. DOES WELL REPLA E EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing. 45-
(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 ith 1SA NCAC 2C .Olts.
9. YIELD (gpm): S METHOD OF TEST Air
10. WATER ZONES (depth):
I
11. DISINFECTION: Type oh 1 nr i na Amount 14 ci trs
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From f) To %U Ft. 6 1 / 4
From To Ft.
From To Ft.
13. GROUT: Depth
From-_ 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
na21 PVC
Material
Neat Cement
Topographic/Land setting
[Midge ❑Slope ❑Va11ey Oaf la
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
n `/o Sandy L'ji/
7o 40.0 r,;tsadaked rctk.
Method
Hand
From
From
To Ft.
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.
co
7 � 'ti
mz.`
WELL WAS CONSTRUCT hD IN ACCORDANCE WITH 15A NCAC 2C, WFT f L o
THAT A COPY OF THIS RECORD�HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUCTING TJT✓ WELL DATE
tgtQbwMivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
¢hgtld?Mt19(Al r.3221 ithin 30 days. GW-1 REV. 07/2001

249392
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James to
WELL CONTRACTOR COMPANY NAME ramp' S Wn11 &
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Camp, Jr - CERTIFICATION # 21 1 R
Pimp Cn TnC• PHONE #ffi2R) d5"1-7322
ASSOCIATED WQ PERMIT#
(if applicable)
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 0 if Other, List Use
2.
WELL LOCATION:
{ f
Nearest Town: herr o ✓D County pi t! p(N ✓d
f+vatow Tt-adt
(Street Name, Numbers, Community, Subdivision,lLot No., Zip Code)
3. OWNER. .J 2✓✓y Fra✓l k I e vvi
Address 19' %let o ieRi,1
(Street or Rout No.)
Agozio
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ea —0 a2
5. TOTAL DEPTH: 2-0 Li
6. DOES WELL REPLACE EXISTING WELL? YES 53/NO 0
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 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 &ir
10. WATER ZONES (depth):
11. DISINFECTION: Type rh1 or oc
12. CASING:
Depth Diameter
From_ To O Ft. 6 1 / 4
From To Ft.
From. To Ft.
13. GROUT: Depth
From _0_ _ To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
N ,i t
Amount
Wall Thickness
or Weight/Ft. Material
gBR21 PVC
Material
Cement
16. REMARKS:
r,•o
tat
fry bit
SUi
i
Slot Size
in.
in
Method
Material
Topographic/Land setting
❑Ridge ❑Slope Malley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
Forrnation Description
jJEPTIj
From To
0 lv D
6,0 aos
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
1 2f% C5 .
SIQ ATURE OF PERSON CONSTR CTIN HE WELL
DATE C J
0
Submit the original tt the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
GRFS1**A040I1 O'liilN(919) 7:3-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
c

249394
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,7a mete w Camp, Jr CERTIFICATION# 7138
WELL CONTRACTOR COMPANY NAME C'a mp
tS
min 11
R Piimp L'rZ
T n r PHONE it$22) d53-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CD' MunicipaUPublic D Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: ye LW if a County Pl-dit E' c ✓�
�-b J� I — hau ✓e %.a �e5
(Street Name, Numbers, (Subdivision, Lot No., Zip Code)
3. OWNER: Robert I eI
Address I ri /'I-i j k P
j� u1t(SneQ1 or Rouuttff No.)11
/Tllfp>t Fee �Slctrtd
City or Town State
ucri
c
Zip Code
( Area code- Phone number
4. DATE DRILLED aZ " l S —D
5. TOTAL DEPTH: .J D ?
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )81
7. STATIC WATER LEVEL Below Top of Casing: (DS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance 1n accordance with I5A NCAC 2C .0118.
9. YIELD (pm): h METHOD OF TEST Air
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. J 7)
b
Topo hic/Land setting
DRidge Onlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
•. `I9a 6 -I8 t3 DRILLING LOG
DEPTH
From To
N �$
SR 5T C
11. DISINFECTION: Type C'h 1 nri na
12. CASING:
Depth Diameter
From 0 To .C.4 Ft 6 1 / 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
Amount _.a cc?
Wall Thickness
orWeight/Ft. Material
SDR21 PVC
Material
Neat Cement
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Ha
Slot Size Material
in.
in.
16. REMARKS:
Submi a Di
2769.94016
ASHEVLi.E RE
R) 733
tion D scription
tir di (ter 4ty
Pal5tll a d ✓tcfc
{ V C.
tN A
cv
CJ
THIS WELL WAS CONSTRUCI ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0•
STRUCTING THE WELL
SIGNATURE OF P
0
DATE
R
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001