Sw CY2002

WELL CONSTRUCTION RECORD
249694
North Carolina - Department of Environment and Natural Resourrces(- Division of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ClovervG/ Q lk, CERTIFICATION �#pp%3g7
WELL CONTRACTOR COMPANY NAME Fbf//yf- 1�/p.1/ kin. Pt J�IYG PHONE # R.wl 'rp S— /�
STATE WELL CONSTRUCTION PERMIT# 1,1 7 ASSOCIATEDUUWQ 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
Nearest Town: .;Y.L
V1'e+vd 1t
(Street Nang. [NU tubers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 44Y S411C.c,
Address PIA 11R`{ P1
County SWAIN
(Street or Route No.)
ethILON c,47 N,L .ag7l3
City or Town State Zip Code
)- 4 gg 3119
Area code- Phone number
4. DATE DRILLED o7��—j\i'-O:�
5. TOTAL DEPTH: Sh
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): lC METHOD OF TEST
16. WATER ZONES (depth):
1 1. DISINFECTION: Type Amount
12. CASING:
Depth
From ! To 72-,
From To Ft.
From To Ft.
13. GROUT: Depth Material
From j To 2-.o Ft. Sevid-Ca.n,J
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
Di meter or Weight/Ft. Material
Ft. (1t i�'ck,✓y/f ��/G
Topographic/Lan setting
❑Ridge ❑Slope IN Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
aIAYG4
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
I6.REMARKS:
�� l l l_ I1 t' h
0
��, I �O F$'6RFj13Y�ER F
CONSTRUCTION STA
Miff ! 7
t-.
fV
—a.
A -
IV c_-
0JI o=r.
LOCATION SKETCH o 1-
Show direction and distance in miles from eleast—n n
two State Roads or County Roads. Include Wr roa
numbers and common road names. C./1 --t
o
to A
Ciq A,3
dit
aniv
rn
cal 44i
rictih
11 Co
✓ T e T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D K)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LJ
C'.pmkt..r../ 41Alikv
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GR AWO{q glit POto the Hivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ASHM699-FYtl6 Pti(ihc'ue11(§191733-3221, within 30 days. GW-I REV. 07/2001

266195
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirownent and Naattt rall ResourcesDivision of Water Quality - GCroundwater
Section •y63
WELL CONTRACTOR (INDIVIDUAL) NAME (print) // "-- (,0011
.x of I ^ (II IIr 9 PHONE N f� LBy� Z �?f/�.,
///y/ ((( ASSOCIATED WQ PERMITN
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/1 if applicable)
(ifap cable) . i
I. WELL USE (Check Applicable Box): Residential €YMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other L7 If Other, List Use
2. WELLLOCATION:i� Nearest Town: cne�Iae e County
45 Co ✓t
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /*y-c/ gal?
Address J2 Trf'6N/ Ca„J/•
(Street or Route No.)
n
n
City or Town State Zip Code
f vi//6r//7
Area code- Phone number 4. DATE DRILLED Z+2 _ // a L
5. TOTAL DEPTH: 260
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO F❑--
7. STATIC WATER LEVEL Below Top of Casing:
f.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / 2- FT. Above Land Surfaces
• *Top of cuing tertnlnated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .01I13.
9. YIELD (gpm): S METHOD OF TEST �L
10. WATER ZONES (depth): ,>Z VT
11. DISINFECTION: Type //t4'
12. CASING: Diameter
From G� Depth To /2 L Ft. G-.S"
From To Ft.
From To Ft.
13. GROUT: Depth Wit`
- Ft. ,o ui/�
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Amount 79 [.�
Wall Thickness
or Weigltt/Ft. Material
/3'Y floe
From To
14. SCREEN: Depth
Front To
From To
15. SAND/GRAVEL PACK: Depth Size Materiel
To.
To
4ethod
Sfare
Material
From.
From
16. REMARKS: ��
prir� �'
JL N G A` t rt
CONSTRUCTION STAN
iti
I
n r)
C,30Ut a t1t crtillC41 e DI
ASH' :''. rr
a
145
F1.
Ft.
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source:❑GPS❑Topographic map
(check box)
ULMDRILLING LOG
From To Formation Description
U - rD
£so—/z0
/.2o - .Ze0
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
O
rn
0
N
tb
THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF TI11S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Z-1\O�
IGNA RE OF PERSON CONSTRUCTING THE WELL DATE
Is1on of Water Quality, Groundwater Section,1636 Mall Service Ceenter' RRHVgh, NC
3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalufResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�(prinpt),ffQT re_ Y.y J-Jy diE. CERTIFICATION* an SO
WELL CONTRACTOR COMPANY NAME 61AZitAs rin W,t QL D/Lz.LGi
266416
PHONE Al f428)t%'i 9-4145'
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 ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: 6/!4 Countyfi.br.,
(Street Name, Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: Rc&4 /3r
Address .ay._C'ar .- Fiatoirin.
(Street or Route No.)
F yt.e,,.. Crt� 1 .0 a i?/ 3
City or Town State Zip Code
(754 )- 296- 354.7
Area code- Phone number
4. DATE DRILLEDl7�3�000-.
5. TOTAL DEPTH: 53a'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cal
7. STATIC WATER LEVEL Below Top of Casing: ) J0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST /7
I0. WATER ZONES (depth): 40.O'
11 DISINFECTION: Type HTa Amount 0.74
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 5 7 Ft. 6//9- Sneat PNc
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a.o Ft. C¢.r„a.,d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
numbers and common road�names.
1
M� fibnIciS 6Jea/
Q /ltejA a xt28s
�� NMet Gn J 50 Y1�t..x-ate 'LUVY� L
From
From
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeilongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH C3 ,_,
Show direction and distance in miles from @t leasn
two State Roads or County Roads. Includeroad;
I
�o
tin. n-
)44145watn7 , tr z3i n
ho/ - l - L Cn �
V,a%. Fio.ta- to . c y. 'No yr_LteA) .
vt°>,n. Lt f 0n '--e-rJumJL- Cuu4- R •
rbc E/o YrLd Zn. '-tLwr., dui cd,t, /0 'M
aw
LC0.4 es. rad ) . tom
16. REMARKS: O_
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I�^^-`'jj 7wroLz /a/23/3,ao'i.
I�ATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
tE9)731-3221,within 30days. GW-I REV.07/2001

266198
WELL CONSTRUCTION RECORI e
North Carolina - Department of Environment and Natu l Resourc5s Division of Water Quality - Groundwater Section �0
�tt/ /C�C CERTIFICATION 8
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WELL CONTRACTOR COMPANY NAME PHONE 1/ t_ ���'zS5 Z
ill l/er ( I' P\\ �l i t\\(((1�
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential o. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION
/
Nearest Town: C4 fV County 36124'r
Colic
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /1h,%71e^4%Ovip. -
Address Cop fri e". COn;t
CAMQ-CC -Q- �--
City or Town State
(Street orroute No.)
2 i \`-i
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /2 -/» 02-
5. TOTAL DEPTH: /4 0
6. DOES WELL REPLACE EXISTING WELL? YES g NO 10--
7. STATIC WATER LEVEL Below (Use Top of asCasing:
FT.
ofCasing)
L
8. TOP OF CASING IS / z FT. Above Land Surface`
*Top of cuing terminated at/or below land surface requires
variance In accordance with 15A NCAC 2C .0118.
(
9. YIELD (gpm): , > METHOD OF TEST / l
10. WATER ZONES (depth): /f 0
11. DISINFECTION: Type
12. CASING:
Depth
From To or
From To
From To
13. GROUT: Drpth
From 0 TOaD
Diameter
Ft. G-.l5
Ft.
Ft.
etfgrJal ethod
3-4
Ft. Cie7c�eSSUi=
T"/�r
From To Ft.
14. SCREEN: Depth Diameter
Front T^ Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount i �WQ
Wall Thickness
orl� ghUl't. 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
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
Z7A./7. A.e._
o-ss
- /60
16. REMARKS:
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common toad names.
0
N
CD
rn
r7
PO
CO
r
4.2
T THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH I5ANCAC 2C, WELL
AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ Z 13 0Z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center
Raleigh,
C
733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division) of Water Quality - Groundwater Section // �
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C').e h h 15 /-xi /11n,A A, CERTIFICATION/n/#`°In s'
WELL CONTRACTOR COMPANY NAME J)n s FTC, JO AAA Ilea I k)'fi JJ Tt( )�Yt e � PHONE # @ r�%iS) —J o2 Li —3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ld---Municipal/Public 0 Industrial 0 Agricultural 0
,Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATIO :
Nearest Town:WI)It7ie, (/%
g el t% ID? )4erneocs pc! -
•,S:rc; Kane. N smbers, Community, Subdivision
1-1 CZ. alLopk—
e e jf<LU,Idern ?cc UP,'
(Street or Route No.)
CC%h; H %er1_ N�
3 OWNER:
Address
City or Town State Zip Code
)- L 7-- 933I
Area code- Phone number r,
a. DATE DRILLED / /— i—
5. TOTAL DEPTH: .5-03'
County cSILD61. t "YL�
(D h,
, Lot Nu., Zip Code) 7 p-
2646 3
Topographic/Land setting
DRidge ❑Slope DValley ❑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
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: /(i FT.
(Use "+" if Above Top of Casing)
S TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordan with 15A NCAC 2C .0118.
9. YIELD (gpm): (7 METHOD OF TEST /02/167te em
10- WATER ZONES (depth): fG1 -�0 (I
i DISINFECTION: Type
12. CASING:
Depth Dia'etter
From 0 To Ft. /_--
From To Ft.
From To Ft.
3 GROUT: Depth
From n To
Amount TAk3 S
Wall Thickness
or I/FFt. Matt
772
Material
Ft. CQ�yyrD.71
From To Ft.
[4 SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
f� p1ew
Slot Size - Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c)
16 REMARKS:
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THCORD HQS BEEN PROVIDED TO THE WELL OWNER
//-! —6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

264870
WELL CONSTRUCTION RECORD
Tyro Resources • Division of Rater Quality • Groundwater SeCtli n
riwr.s
NDr''1 Carolina • D:pzt�tte-.t D; Environment and Na, 1 Re' CERTIFICATION =�5
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `lames B. BYOkTI
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, IRC. PHONE M (�°'lf �9591
ASSOCIATED WQ PER'11TA
STATE WELLCONSTRUCTIONs on:a le) PER111Ta (if a:clicable)
(ifsooiicablel
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public G Industrial G Agricultural ❑
Monitoring 0 Recovery 0 Heat Punip Water Injection ❑ Ocher G If Other, Lis: Use
2. WELL LOCATION:
Nearest Towt,: Bryson c'i ty County Rw
(9—a Name, N,:::*:n, CCM...—Ty, 6adlvlslor" Lot No., 2.7 Cza)
(de,:.u'rrdou_i secder..$)
3. OWNER: Floyd ZWCC lnvP Ladttdelongimde source:OGPSGTcpogea�hi: map
Add: es9 (ohxi bcz)
(Sr^ea<rRoute N1.) pEPTP • DRILLINGLOG
Walhalla SC 29691 From. T39 Flo,-; ,action Descripthn
Ci:/<r Town 4 Zip cote
Cana). 39' 300' grate
Ar:a<e•Pb<ne nW, bee
4. DATE DRILLEED —
5. TOTAL DEPTH: 'Inn'
6. DOES WELL RE?LACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 700 FT.
(Use "+" It Above Top of Casinz)
S. TCP OF CASING 1S 2 FT, Above Land Surface'
'Top of cuinz terrainetad at'or blow lend surfaca requires •
variance in accord ante with 15A NCAC 2C .e118. El -ad
9. YIELD (gprn): F METHOD OF TEST
10. WATER ZONES (depth): 717'g 2Rn 1.0CAT1ON SKETCP
Show direction and distance in miles from a: least
11.1DISINFECTION:INTyre A:cunt 1sS �S
Wait two State Roads o.^ County Roads, lnacce the road
2. CASING; our ;burs and convmon road names.
p�,5 D:a.:.e:e•. Cr W'e.,y-=r Material
From n To_ 1 Ft._A" —.188 .-�
From To Ft.
Fro'L To Ft.
13, GROUT: Depth Material Method
From 0 Tor' 20 Ft, te & P11F
From To It.
14. SCREEN: Depth Diameter Stet Sloe Mate=a!
FrorL. To r ._in.
From To Ft _�in.
I5. SAND/GRAVEL PACK: ry
Depth Size . Material .
From ' To Ft.
From Tc Ft.
Topog:aphiC Lard setting
:Ridge OSlope DValley
(check e�rf:.pda_ Sox)
L atir.delongir.:de of well location
l6. REMARKS'.
2
i-f=A„SY G=iit:"ii:.. WAS CONSTRUCTED TN ACCOR. ANCEWiT-.'. I5ANCAC 2C'WELL
NES- (1C' 1' S,TA.,l7A."' i• yT A COPY OF T'r•�i5 ?RECORD HAS BEEN ?ROV'IDED TO TKO WELL OW* R
// 7/'/Pion
DATE
— I \C
J
ATUKE OF PERSON CONSTRUCTING T'v WELL
Quality, Groundwater c:,..i,.., s R.a Mall cmiee Ceete: - Aalei2h,
Su mit the original to the DI ion 3f Water
001
17o99 163fi Philp ' o,` i2) 713 32'.11 relthln 30 days,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Waterr,Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (plat) � �e)(e. rig Ir.:1p -I aje CERTIFICATION ac�O•5L)
WELL CONTRACTOR COMPANY NAME Afri-a {? 1IV 'l &1t I 1-.'-e Litt/ PHONE a(N1ri1 4-7gT-8'c+%Y"
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 00 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: /_' 2,c A t' County 511.0 n nn-.
(Street Name. Numbers. Community, Subdivlesion, Lot No., Zip Code)
3. OWNER: uct� 'r'rwl pn i
Address Sa-7r- rf'<Liran, Rd .
(Street or Route No.)
I I.r.-ttn.cn ('to yl.L k`7!3
Qfry or Town 1 State Zip Code
(B )-'TA9 27
Area code- (hone number
4. DATE DRILLED (/— will- -
5. TOTAL DEPTH: at., ,L
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS I FT. Above Land Surface*
•Tep el cubs. teratlnted atror below lead surface requires a
enflame In accndsece with ISA NCAC SC .01la.
9. YIELD (gpm): ID METHOD OF TEST LI: /L-
10. WATER ZONES (depth): a a..
I I . DISINFECTION: Type 1-7 7 H
12. CASING:
Depth
From 0 To ISO
From To
From To
13. GROUT: Depth
From 0 To ,1D Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount 0' 32
Wall Thickness
Diameter or Weight/Ft. Material
5hQJ1 lout
Ft.
Ft.
Material
Ft.
Slot Size
in.
in.
264864
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degree s' m ew iet/aeconds l
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING 1 (N+
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.-C,ar_
leaf«r,z��aS�r,r/, :tom
Method �i9�•s!'rn�-
From To Ft.
Material / va-AC'1iutic — %L
Cyl, he, cZ D-'I%G.L <xy Nc <�?tC�GCbY•
c{
. > Mt,r-L'�. z tom. ;^Zcfti t (eft
1,74 Zal - Nc-r.-�2t,,x+1. &kil !!'o'-.
Cif-ri- LGf: c2 t' t
s2- %C1>
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER •-d)
A16- TU'I!/!
OF PERSON CONSTRUCTING THE WELL DATEo Z
of Water Quality, Groundwater Section, 1636 Mull Service Center - Raleigh, NC
, within 30 days. GW-1 REV, 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

264863
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of1Water Quality - Groundwater Section
4,(['1L CERTIFICATION 00-2637."
WELL CONTRACTOR (INDIVIDUAL) NAME (pfn�ty)� e r �' r
,jyC.cr7a�xZJ
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITM
(if applicable)
p{Ace&ay- PHONE M j4za1 499.8•1.5:y
ASSOCIATED WQ PERMITM
(if applicable)
WELL USE (Check Applicable Box): Residential ka Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: a,
Fa 0. g_.
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
County-.H-G�7Lc%U
F o,2'2,2713
3. OWNER: 7w.#41, T/L.v r'
Address ` d'-)t.,%t'rect- dC�-arir,'Giy
IStreet or Route No.)
61.47‘.. 92.G ‘2871.3
dry or Town State Zip Code
(Na(?)• 2-1-gg /040
Arcs code- Phone number
4. DATE DRILLED 1I- 1(- 3002
5. TOTAL DEPTH: to n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ta'
7. STATIC WATER LEVEL Below Top of Casing: i ' D FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of cuing urmloaud at/or below land surface requires •
variance in accordance with ISA NCAC 2C MIL
9. YIELD (gpm): 1 METHOD OF TEST j -v
lc. WATER ZONES (depth): 1+ eJS
I I. DISINFECTION: Type 14 t 14
12. CASING:
Depth Diameter
From fl To R er PI: Ft. U %+
From To _ Ft,
From To Ft.
13. GROUT: Depth
From r : To -1 f ; Ft.
From To Ft.
Amount D. S{
Wall Thickness
or Weight/Ft. Material
ST 3 1 'P Vc
Material
-1tX
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
tw& l )
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)
DRILLING LOG
Formation Description
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road namesd&t, 626ticnve
£t /,f -'rrul-:Y $L&vrr, LK // a 74' Pa
turd- ht. 3
C4v d Lt•11ih -4z ft rL t ,, rC -' -IP t c ,Gcf-
C�rcZz )74,t ja.d,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL r,)
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CiN� k(CC 1 /1) /13.00
it NATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

From (D
From To -
From To
GROUT: Depth
From 0 To -1 e)
From To Ft.
WELL CONSTRUCTION RECORD 2 6 4 8 6 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME at) ^
WELL CONTRACTOR COMPANY NAME Y ZLtnr I /l'G! .fit, ie nj..-
STATE WELL CONSTRUCTION PERMITS
(if applicable)
CERTIFICATION SaOSO
PHONE a idyl /♦ -9-g5-i.
ASSOCIATED WQ PERMITS
(if applicable)
I . WELL USE (Check Applicable Box): Residential Ili Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: j �a ll l4 County 9zv7Gt.iz
Fa-nlmr �t� 4' 4cnj rit'1I3
(Street Netts, Numben, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
y or Town o State zip code
(i(z()• f179 4,11,4
Area code- Phone number
4. DATE DRILLED //•-
5. TOTAL DEPTH: .SC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: /4 FT.
Wee "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of cuing terminated atlas below load solace requiem a
varlaaee In aeeordaace Ma ISA NCAC 2C .0111.
9. YIELD (gpm): G, METHOD OF TEST Qz
10. WATER ZONES (depth): _3i,e
I I DISINFECTION: Type /-1 %� f, Amount 0._&A
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
13
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:
To ' C} Ft. _SDR.1 P JG
Ft.
Ft.
Ma
terial al
Ft. -n1
Slot Size
in,
in.
Material
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dearees/minutes/seeands)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOQ
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common roe names. Y ca,F-�--_
it
Jp'
ivy 1 i 'AI�n; "'et% .�u,c.,L .Zs " GS- t- fl Ltt``1"
� � pctmt" � .;� �/6mci-�w..r 1��r Not :I
Method 7�
Milano! Cl • / 16)1 -, _ . ii __ �J! _ f j 'mil'
�ft.(. !-<���bLtC6C-f1/t,Ytr� (,UCu . - /p
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
•
d�-L. 1�DATE
SIGMANA RE F PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

264861
WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pglot) Ye 9 Pc rH yr..l E. CERTIFICATION MLA D.0
WELL CONTRACTOR COMPANY NAME (l},.ry() 7, e r PHONE S�'.1 fit if J`l- fr)y.5 y'
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT*
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EVMunicipal/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 Tounty �Zi-cnAt n- �T7)S
(Street Naine, _Numbers, Community, Subdi i ion, Lot No.. Zip Code)
3. OWNER. V"(l.f 2 Alaza-trtY
44
Address 4 tem t"n.wit. ,-,\`)/(.4se—
Y' 2Zv
It t or Route No.)
'n 4 ne -_i87f3
C or Town State Zip Code
(..Ti)- 14&9 i b 2 a-R
Ares code. Phone number
4. DATE DRILLED l r _ ._I ' ._ 0 rL..
5. TOTAL DEPTH: SS S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7 STATIC WATER LEVEL Below Top of Casing: J.v20 FT.
(Use ""' if Above Top of Casing)
8. TOP OF CASING IS C FT. Above Land Surfaces
*Top of castes tsrnimeed at/or below land unlace respires a
nelson 1* aeeoduce with t!A NCAC 7C .al IS.
9. YIELD (gpm): -3 METHOD OF TEST (U..a-
10. WATER ZONES (depth): .if:. 5
1 I DISINFECTION: Type_ CI 7- H
12. CASING:
Depth
From D To j)'>
From To
From To
13. GROUT: Depth
From 0 To C
From To
14, SCREEN: Depth
From To
From To
15
Ft.
Ft.
Ft.
Material,
Ft. ad.rn.: y..0
Ft.
Diameter
to
TopographiciLand 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 1,0Cr
From To Formation Description
LOCATION SKETCH
Amount C;Ft Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
C Matenal and common ro .
d
names.
or Wei ht/Ft. numbers�9
-SDR,11 P VG is CI�^'�� j /L- -zr
�- '�/ '� '�fi �. IG
itt
mL�v. - »4- E
Method
Diameter Slot Size Material
Ft. in. in
Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
car
9 /
VL `'1O Lt aqa-. o %%fi �O 44,
%YL 4 it bc�y 4, . O y iJ7b.€_ -crte 14-
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
O (! SI NATURE OF PERSON CONSTRUCTING THE WELL
hit
D 6Lr114P�Jnr��.'o,',I
I —r--- � fh l�
tJ
DATE
of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
within 30day a. CW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL. O=FlCE

WELL, CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�(/ L CERTIFICATIONpjYOi
WELL CONTRACTOR (INDIvIUUAL)NAaIE (print) /.GupIIONE 118(� 8� ZyS�
WELL CONTRACTORCOa1PANY NAME 07///'� ��`\, , )fit\\�� `
STALE WELL CONSTRUCTION PERMIT"
(ifapplicablc)
I. WELL USE (Check Applicable Box): Residential ter hlj rniic paOlheric Industh,trial Oc Agricultural 0
Monitoring ❑ Recovery Pump
2. WELL LOCATION �,//c G County -5-Warn�/G/IhG
Nearest Town:
(Street Name, Numbers, Common , Subdivision, Lot No., Zip Code)
�jG L1-/ a wf (de grees/minutes/secends)
3. OWNER: 0I /// 7 / i� Latitude/longitude source:OGPSOTopographic map
Address t>L (check box)
(Street or Route
e No.)
Zip Code i DDEPTH.URIIINGIOG
r _
Ci b
City or Town State
Front To Formation Description
(-E
AD e
Arta ado -Rhone number a L _ orne iCe-
4. DATE DRILLED //-/5
5. TOTAL DEPTII: 1 `/ 6—_-------
6. DOES WELL REPLACE EXISTING WELL? YES O NO D'
7. STATIC WATER LEVEL Below Top of Casing: —Ff.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / . FF. Above Land Surface•
'Top or easing terminated •Uor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): P METHOD OF TEST /� r
10. WATER ZONES (depth): i16 ' L00CATi0N SKETCtI
a /2Tf% Amount / c Show direction and distance in miles from at least
1 I. DISINFECTION: Type T -- Wall Thickness two State Roads or County Roads. Include the road
12. CASING:numbers and conunon road names.
Depth Diameter o �W�c�ghUFt. Materialt
Prom 0 To �° Ft. C•�
From To Ft.
From To Ft"
alerial tlhod
13. GROUT: Depth �ri From 0 To .Z2 FL D c
From To Ft. O c
Diameter Slot Size Materiel N �-
14. SCREEN: Depth in p _
From To — Ft.
in. rTl
In. n c-,,
From To R. its. —
I5. cnND)GRAVELFACK: ?'
0
r.
Depth Size Material a m,
From To Ft. ------ = zm
From
To Ft. Si m�
16. REMARKS: CO z
SSOCIATED WQ PERMIT"
(ifapplicable)_
264755
�Th !h it
1 ` I DO HEREBY CERhb�\
CONSTRUCTION STAN
GP011 Strlrndt t iCr
276ea_it
1. nal to
F C
Topographic/Land setting
[Midge DSlope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
}IATTIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
ARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGMA / OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mall Service Center
l REVgh, NC 1
9)733-3221, within 30 days.

WELL CONSTRUCTION RECORD
266277
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) GCJ[I/1✓d idoC CERTIFICATION
WELL CONTRACTORCOMPANY NAME YA1142 L✓i,(I Ar`1f1rr PHONE # crag) 4r8-113#
SLATE WELL CONSTRUCTION PEIC%IIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ft' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: &ISM'
tzar C`noa+47•41
County Sow i
(Street Name. Numbers, Coinmunny, Subdivision, Lot No., Zip Code)
3. OWNER: ' &11 u.:n/AaS
Address it g'7 044ny&t H
(Street or Route No.)
&ifs r/,c• 0713
City or Town State Zip Code
(t)- m0cl
Area code- Phone number
4. DATE DRILLED It_ fg_c4--
5. TOTAL DEPTH: ,ZaY
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO WI"
7. STATIC WATER LEVEL Below Top of Casing: itt-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Rat
(check appropriate box)
Latitude/longitude of well location
(deuces/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
1 I. DISINFECTION: Type Clop' WC Amount $ Q:.u1r1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To T.- Et. PQC. 'tx-r.M Pie
From To Ft.
From To Ft.
13. GROUT: Depth Material
From i To o1D Pt. Soh' 4-@mcZP
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Portni
I,(5;: REMARKS: - r=h
I DO HEREBY CERTIF
CONSTRUCTION STA
T
I / O
(
iv
i> I CSC A rr*rn
p.(1n
1113 fn`h~ CD
/11Y 3
SaN city,
C!1
C4
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/L3o- oy
DATE
ASF4L' 6bhlifitie:UNig t tll'wl the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-I636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

26019E
WELL CONSTRUCTION RECOR
North Carolina - Department o[ Enviroruncnt and Natural Resources/�- Division of Water Quality - GCroundwater
Sectlon N 0 io S` 0 .
�.Gir, /r,LL�� 1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -\n l 1 [ i� l I YlPHONE 0 (�%�) �1-�1 - Zrr�.1'�
WELL CONTRACTOR CONSTRUCTION
COMPANY NAMEP77ASSOCIATE» WQ PERMIT.
STATE WELL CONSTRUCTION PERMIT. Ira l'cable
do 'cable
I. WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Putup Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:/ tialLG�
Nearest Town: LG ----
Y
(Street Name, Numbers, Com nity, Subdivision, Lot No., Zip Code)
3. OWNER: F
Address e
ZI
City or Town Stale P Code
(—od
Area code- Phone number 4 L
4. DATE DRILLED /l 26
5. TOTAL DEPTI I: 6 0 U '
6. DOES WELL REPLACE EXISTING \VELL7 YES DNO `1F
7. STATIC WATER LEVEL Below Top of Casing:
i f.
(Use "4" If Above Top of Casing)
B. TOP OF CASING IS ' / "- Er. Above Land Surface*
• Top of rising terminated Woe below land surface requires
variance In accordance/with I5A NCAC 1C .0118. fro
9. YIELD (gpm): v METIIOD OF TEST
10. WATER ZONES (depth):
II.'1DISINFECTION: Type /fT
12. CASING:
From To
ethod
13. GROUT: Depth Molerial
r wed rem/��-6
From 0 To %B F1. C 7��
From To Ft.
14. SCREEN: Depth Diarneter Slot Size Material
From
'pn FL in. in. From To rt.. tn. in.
15. SAND/GRAVEL PACK: Depth Size Material
To Ft. — To Ft. —
County St-Qu•/2
Diameter
Amount lV G✓�
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(decrees/minutes/secends)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRJLLING LOG
From To Formation Description
r O
-a -6a0
Depth
Frorn D Tom_
FL
From To Ft.
Ft
From
From
16. REM
V�a t
Dt IEtE�. ar
CONSTRUCTION S
- ?11�,iCi
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.
0
ro
0
n
CO
c.)
MAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
. S, AND THAT A COPY OF T11IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
NC
Division of Water Quality, Groundwater Section,1636 Mall Service Center' 1Rtaalleigh, N001
733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\\ ELT. CONII't CIOR COMI'AN\ NA\IE,44-46—rreA% C. 1)
S I ATE \\ EI.I. CONSTRUCTION PERMIT#
(ifapplicable)
267097
j C CERTIFICATION 0577
�15t
rft S- a)ri 1 r- c
fIIiC�'-loNt: # ea,Irs_fr.533t
ASSOCIATED W'Q PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential 11lblunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring g 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ IFOther, List Use
2. WELL LOCATIQN:
Nearest Town: f` L' SO /J �\ }� C,JuntV it?r.. t /J
6r-54-aIark& /icy
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'R of I-1-a_II eeAi /� ff
Address C-QO:a, I S CCU NC' C-• t ✓1 %t1C-(`
(Street or Route No.) `�
1L n�; SSC f/or,Ja, 3tit1y3'
Cin or 5 Z Q r Zip Code
t 1- ?%
Topogr ic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate boll
Latitude/longitude of well location
(degrces:minutes seconds)
Latitude longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To For ialion Description
Area code- Phone numb 'r
a. DATE DRILLEL 04-f1b»ra2, et-� i 7 - 7 05
5. TOTAL DEPTH: 00
6. DOES VYELL REPLACE EXISTING WELL? YES ❑ NO V 7 D. j '7 0 t7
7. STATIC WATER LEVEL Below Top ofCasine:300 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance spit I5A NCAC 2C .0118.
9. YIELD(gpm): / a METHOD OF TEST a + t-
10. WATER ZONES (depth): 7 v.5
1 I- DISINFECTION: Type
'12
13
II
I5
CASING:
Depth �1 Dian 'ter
T�
From l To 9'.- Ft. (j `1
From To Ft.
Front To Ft.
17 D'7 - ?c-d0
grat3t'te_-
q rC(tJt } L
v
LOCATION SKETCH
%-1- %// Amount 3 1, '773C'3- Shov+ direction and distance in miles from at least
W"all Thickness two State Roads or County Roads. Include the road
or \j'tcikllt'Ft. Material numbers and common road names. o e_
cc.k_ st,TR- Cl-I c rht
GROUT: Depth �1 Material
From 0 To _2O Ft. Cc.m P A)
Front To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SANDGRtAVEL, PACK:
Depth Size Material
From To Ft.
To Ft.
Method
From
I6. RENIARKS:
CI ti-..,
,/ itF;
5 . ra ou` �;
.�-- (� C 11)(
i 1
N o
rfit; 1P9 F1/2CRELj3v `rlEREhF
I^ r {{}tigTitL'C •. A.
H tr$pCY4uNn the
ASH_, 1-11PArithAte N'6Fk(969 73
T THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THI/SftECORD HAS BEEN PROVIDED TO THE WELL OWNER
/71 /— ?- () oe 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
-
VA'ELL CONTRACTOR (INDIVIDUAL) NANIE (print) 6:1 CADV
w ELL CON"! RAC I OR CO\I PAN Y NAME 4 a -
.Sr .-ATt: w'ELI. CONSTRUCTION PERMIT#
(if applicable)
267096
Division of Water Quality - Groundwater Section
MCLA11 CERTIFICATION f� �(�7 /
��yy
L,II r1Y- PHONE#Va,i) S _ 3156
ASSOCIATED w'Q PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
IVELL. LOCATION:
Nearryst Town: n 0.r
Il\r,sr,AL) )9rc.,_Nch
(Street Nano. Numbers. Comtvunity. Subdivision, Lot No_ Zip Code)
3. OWNER: C-424-1 G c r,3
Address ) 1/ (i1 Cc rt) b r h
7 (Street or Koury o.) t
h r� s r iJ L. t L� n C, P. 2-7/ 3
City or T 'n State Zip Code
(52Sr)- y 6 e1.5.3
Topogr lie/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
Area code- Phone number
T. DATE DRILLED&O4-ch e r95,6?bc 37-5C1
TOTAL DEPTH: 3!','O - - 6--
DOES WELL REPLACE EXISTING WELL? YES 0 NO �- ,;3 r
5
6
7
11
•I2
Countv �(4 )Ci
STATIC WATER LEVEL Below. Top of Casino: 3 U FT.
(Use.-+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated atior beton land surface requires a
variance in accordance, li IS.A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST CV t !�
I0. WATER ZONES (depth): / -50 ? 1 - .�h
DISINFECTION: Type fr/ 0 Amount i , 5-662-
CASING: Wall Thickness
D I tl
W' i ht'rt M1iat gri d
(degrees moat SSeconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To io mation Descriptio
<� — 3'7 (fft i1 / - 10/
c-.ra11 t*t
)•-i-t-
(� r a f.;
.935 •-237
-23 7- 3r-o
Carr tie_
or ^
�' e, r
From G To E{ rig
From To
Front To
DiamJr
Ft. CP L}
Ft.
Ft.
13. GROUT: Depth Nlaterial Method
Front b To i9 p f ..' / p
From To Et.
IT. SURE.EN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Etin. in.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
r %'Q > /g
C.i�(C;u:Ct Jr,
c 17,iltit) n.lc, r/! L e1
r-LC
5f',I)39 0)cc�C??U
O
IS. SANDGRAVEL PACK:
Depth Size tNlaterial N.)
From To Ft.
Rom
To Ft.
16. REMARKS:
DO F�ERcm' _C IF f �T
N 2UbTICN At. A2D66
tFEE �_J
ubntit the original to th Divi
GB0UNDV/ATE `SEbTIUR) 733_
ASHEVILLE REGIONAL OFFICE
FIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COr OF THIS CORD HAS BEEN PROVIDED TT THE WELL OWNER
7C (�`��
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 3lail Service Center- Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
k

267772
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME � (print)��"�/Y i I(_ //'/'tJV{� CERTIFICATION #3 d2'
WELL CONTRACFOR COMI'.AN'Y NAME{,.OMA— en& t/ep .-tts. e-. PHONE # 6R05/,
STATE WELL CONSTRUCTION RUCI lON PERVIIT# ASSOCIATED WQ PER.AIIT#
(ifapplicable) (ifapplicablc)
I. WELL USE (Check Applicable Box): Residential}" Municipal/Public ❑ Industrial ❑ Agricultural 0
\loniloring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: &yid/J C_,• .
3ruak Cree-k
County SA/A-: tJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AfriptI, Eel wkis-is
Address u/A Drive
(Street or Route No.) p'
Nice Vr ale .FJ 3.25-'
city or own State Zip Code
Area code- Phone number
4. DATE DRILLED /o ;IS— VZ
5. TOTAL DEPTH: /d3 6
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7
STATIC WATER LEVEL Below Top of Casing: 3C6 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): - METHOD OF TEST /MY
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptio
DEPTH
From To
4- 7a
%D - /63 6
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diaper or Weight/Ft. Material
From To 76 FL
From To Ft.
From To FL.
13. GROUT: Deptt-h�� Material
From t) To -•cam Ft. e,"
From To Ft.
Method
/)d4n'irq
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To I-'t, in. in.
U. SAND/GRAVEL PACK:
Depth Size Material
From "fo Pt.
From
To Ft.
16. RH.N1ARKS
:
LEI%
fY»N1
A
— m
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.
SO :E kid Z 1330 ZO
0
0
c-lYr)
cm
r
o-c
o`
DC
>a
rnc
wz
r7
-y
G
f THIS \
S, AND
SIGNA FUR
OF Iik.Rtt,ON1CQNSTIIA14CTI
vision of VVa fr Quality, Groundwater
-3221, \ ithin
t_1kJNDtAATER SECTION
ASHEVILLE REGIONAL OFFICE
,tS
ecli
NCE WITH ISA NCAC 2C, WELL
'EN PROVIDED TO THE WELL OWNER
/2-to- az_
E WELL DATE
1, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

267768
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ��
\WELWELL COSTIb\CIOR it (INDIVIDUAL)
L) NAME (print Ir Vi4NL CERTIFICATION
6
th�✓ . LCh4' 1n% itiler'C. PHONE # (Wr(/1VdJ1,24
STATE NN IAA. CONSTRUCTION PERall't# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. AVELI. IJSE (Check Applicable Box): ResidentiallrMunicipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Tovn:_g7SJIJ G1..�r County 5SE14/ Ai
(Street Name, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: H 1 e
Address D 1/2) y
(Street or Route N )
cerysb J P:{*/ Nt-
C ity or Iowa State
a 8'1 0i
Zip Code
Area rode- Phone number ,.
4. DATE DRILLED /t-f'- v Z.
5. TOTAI. DEPTH: r0,5—
6. DOES WELL REPLACE EXISTING WELL? YES 9}� O ❑
7. STATIC WATER LEVEL Below Top of Casing: :: l &' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): a.5— METHOD OF TEST ..4 V
10. WATER ZONES (depth):
I1. DISINFECTION. Type
12
CASING:
Topographic/Land setting
DRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes,hseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
Formation Description
ny
"1'
0
T
J
S
CD
m -,
Depth Di m9ter
From O To QV El. �Tl
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
13. GROUT : Depth Material���
From 6 To 3-� Ft. etacad'
From To Ft.
14. SCR KEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
0v�
Method
Material
in.
in.
Material
To Ft.
LOCATION SKETCH 0 i
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
90 :C Wd Z 1330 30
16.REMARKS:
SIGNNAilt
Submit the original to he D vision
GR R34G40 .1iSEC'SIC f0919) 73. -3221,
ASHEVILLE REGIONAL OFFICE
f Watt A;L. SECTION
itlliIp,QPLttgyfSeE REGIONAL OFFICE
ecti
NCE WITH I SA NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER
/a-(o-O2
WELL. DATE
n, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

266276
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources - Division of Water Quality - Groundwater Section lr�
\\EI-L CONTRACTOR (INDIVIDUAL) NANIE (print) Cfeudaxf curia CERTIFICATIION##_
WELL CONTRACTOR CO\IPANV NAME ;Ws Ler IAA Atif(1 NJ. PHONE # (KM) PS't7:3a
STATE \VELL CONSTRUCTION PER\1IT# ASSOCIATED WQ PE12I\IIT#
(if applicable)
(if applicable)
2
WELL USE (Check Applicable Box): Residential Pi Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: P41I(Pni
C is & , Rtj1sc L
County Setiegi
(Street Name, Number. Community, Subdivision, Lot No., Zip Code)
3. OWNER: < Y noa\Q4GN
Address Ca4Cth eanAki, 261
4
5
6
7
(Street or Route No.)
D18'113
City or Town State Zip Code
(gag )- yea _1909
Area code- Phone number
DATE DRILLED 10-0.q-02-
TOTAL DEPTH: j$D-
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: j FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): % METHOD OF TEST/'7t CRdf.Y
10. WATER ZONES (depth):
Topographic/Land��/setting
y� ❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/nti nuees/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type C/ot/,rC Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/R.
From 1 To -2D Ft. /O116 1/4-W U
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 1 To zo Ft. .tau LPoa l-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
10dv
Meth d
Ate
Slot Size Material
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
3
3
0
Co ✓zQ A4�
13 a 7
41,9 S,.t!/i
16. REMARKS:
�� H 1tEf�Y Ct K"�Vi�Y tj�f
-bh'SIST["" ..
11.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL DATE
SII nut tl r , iivisio�l of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276�'j_1&' r Ylhult>i;`Nn3M+,'i}�2' 322 , within 30 days.
GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 02teUn'`L/J(Wile
WELL CONTRACTOR COMPANY NAME
5tf(eyt. heel( /fir, rl-`AI-
266275
- Groundwater Section
CERTIFICATION # 36 %
PHONE # (.24) 1/437-/W3c
STATE \VE.LL CONSrRUCI'ION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential II Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IrOther, List Use
2. WELL LOCATION:
Nearest Town: ,g[j.PeN Cllf County ScvNN
Nq, '74
(Street Nantc, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: /DDm by //.ere
Address /go Cr sr O ESift/r
(Street or Route No.)
City or Town State
(r8 )- 'tV6 q t —i
Area code- Phone number
4. DATE DRILLED i 0 -/7-D
Zip Code
5. TOTAL DEPTH: Sac
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO €3'
7. STATIC WATER LEVEL Below Top of Casing 8-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
Edge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1I. DISINFECTION: Type Cfo.i#c Amount /X LEnmt
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To /3e Ft. (J4,' -%'d email PiC'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From / To is Ft. S%,t4JCIn faun-/
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'
Gd , Ii,RL I' ere R"It - :'Ili
i 2UCTION STANDARDS,
.
LA 4
G
LOCATION SKETCH 0 0
Show direction and distance in miles fro Nt le
two State Roads or County Roads. Inch'
numbers and common road names.
rn.4r(
IV
G.n •
3
0:c‘1h
a r,
f ys-04' "�y J ,Item`
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COI'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL
DATE
Subml a07)t[jg.6n4Nt QFa,e')siilhston otlWater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r,
7699463'6
within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
265054
North Carolina - Department of Environment and -N�i�aturaall /Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /2/� 1"Y,'�e ry �(F-�-I-yd e. CERTIFICATION M:20627
WELL CONTRACTOR COMPANY NAME jvcz_ vc—itL LL t° .0 4-L6 PHONE M 'T t:ra 24 J 1i
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED WQ PERMIT./
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 6/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL 1 ,t
'ice( C(inn qA. �%c4 �t n ;-h-ern rrnr-k-r) -
(Street Naine, N uuumbers, Co#tunity/, Subdivision, Lot No., Zip Code)
3. OWNER: c�-t&—n-CV,�I C,1,C &n r (degrees/minutes/seconds)
Address ILQ?L�LL1t.p 7t �q.L Baca_..+ .7v &es' ear,Latitude/longitude source:❑GPS❑Topographic map
(Street or Route N ) (check box)
{ Q
Nearest Town: tA4 .O41. L-vL�� County ,�-YLtQZLC.W
i,,.Hyl- { 91 <1 2 l�7 / 3 DEPTH DRILLING LOG
ty or Town r State Zip Code From To Formation Description
(K2ss)- 9-g2-3.2- C)
Area code- Phone number
4. DATE DRILLED IO--.2S_ Off.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: J.2S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface•
•Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST (2.(iL
10. WATER ZONES (depth): 1-1.-
DISINFECTION: Type
12. CASING:
Depth Diameter
From b To 44 Ft. LiFrom To To Ft.
From To Ft.
13. GROUT: Depth Materials.
Front i,) To ,Q (> Ft. l:2 .cm��rr�t
Amount D, Flo
Wall Thickness
or WeightIFt. Material
5.DRxl PVC -
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Et.
From To Ft.
16. REMARKS:
Method
LOCATION SKETCH tr j
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers d c (ninon road names.,a ec�- aCmc
to ppL # 9.sv� =, 4
.2ci�.(vT aft--64 V, il� ,0.�f' n.pt,
` 1.G72
/ 9 lit l,,pvp ryll(,L':. J'v�un.+�Jv / � �j 'u
L pi. Jr%O _j 4/t- ��a2,-- -e-uvx- .' ,1 2 aCLGGRJV
L /C l,J ,'f e r o �J/ t.u�- : )''c ..6CJP4'L ,
Material C'r- 1`d-e *.yruf). c� Qc� &
'J a fit / anr' -21-tvta
Slot Size Material
in.
in.
Y
am,
)ited'-A-.
1 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
q
Submit the original
27699-1636 Phone No.
I,GyG In - a$ .am'
SIGNJT. E OF�ERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
[phone], within 30 days. GW-1 REV. D7/2001
GRO'0` SECTION
ASHEVILLE REP(. II._ OFFISE

WELL CONSTRUCTION RECORD
263084
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ( .t) PPe r N rI-C7 qP CERTIFICATION a a 03�
WELL CONTRACTOR COMPANY NAME 2CYi/f. Zi.�7 1J,r�.et,,5 PHONE a j429)/f 79- g/F-s /-
ASSOCIATED WQPERMIT.
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
( if applicable)
1. WELL USE (Check Applicable Box): Residential D' Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: /1 t (�
Nearest Town: I :2.c County-vhtnLvir2
6krt'at6J— /b y e L1. C7
(Street Name, Numbers, Community, Subdivision, toot No., Zip Code)
3. OWNER: ' 4 Q11q1
Address
(Street or Route No.) O
City or Town State Zip Code
( )- s tI4,q
Area code- number
4. DATE DRILLED In- _ 0-2.
5. TOTAL DEPTH: 1 coo r —/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fd
7. STATIC WATER LEVEL Below Top of Casing: I) FT.
(Use "+" if Above Top of Cosine)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top er cutag tsrukated Wee below Ind aartaee regains .
variant la ateedaaee wire ISA NCAC IC .al U.
9. YIELD (gpm): - 0:. , METHOD OF TEST (( lit
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Depth
From f> To ? Ft.
From To Ft.
From To Ft.
13. GROUT. Depth Material
From_() To a () Ft. aim,vh:
Diameter
low
From To
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
Wall Thickness
or Weight/Ft. Material
51) P,j "P v
Ft.
Slot Size Material
in.
in.
Method
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check sppropriste box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS0Topographie map
I check box)
DEPTH DRILLING LOCI
From To Formation Description
t,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. jyy
6/o /inc( , za (Th L
ra
J
.t
Iv
16. REMARKS: ni
N
Submit the original to lht
Ro(l,ri l)i,NAER SECTION
'ne Y1
ASH ! ILLE R 61:! ICE
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
er.�' 1D-3_U2
'fUREOffPERS"NCONSTRUCTING THE WELL DATE
Div ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Rakish, NC
733- 221, within 30 days. GW-1 REV. 07/2001

263544
WELL CONSTRUCTION RECOIU)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Q \A,,\Se,(� CERTIFICATION 0 .�.Uii<-i
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �iGmP 51 „11` PHONE N sky �6��-2q4�
WELL CONTRACTOR COMPANY NAME VV.'S\10f 1 A9PAk NC,\1, nO al
WQ PERb11TN
STATE WELLCONSTRUCTIONON PEMIITN ifa„licable
(if applicable
1. WELL USE (Check Applicable Box): Residential n! Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery LI Ileat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
County 7(1.Y'i/n'l
(Street Name, Numbers, Community, Subdivision, tot No., Tip Code)
3. OWNER:
Address
City or Town State
Arta code- Phone number
4 DATE DRILLED
(Street or Route No.)
5. TOTALDEPTII: a6�
6. DOES WELL REPLACE EXISTING WELL? YES Cl NO O
Z8'l 13
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(de greeslminutestseconds)
Latitude/longitude source:DGPSOfup ginnhicmap
(check box)
FRILLING LOG
Formation Description
DEPTH
From To
\6-- <,`
7. STATIC WATER LEVEL Below Top of Casing:
FT.
(Use "+" It Above Top of Casing)
8. TOP OF CASING IS _ FT. Above Lnnd Surface•
•Tap or cuing terminated at/or below land sus Nee requires •
variance In accordance with ISA NCAC 2C .01I11.
•
9. YIELD (gpm): Q.__—_ METHOD OF TEST 4F 2
10. WATER ZONES (depth):
II. DISINFECTION: 'Type1JM ASPit Amount s
12. CASING: Wall Thickness
Depth Diameter or Weiglrt/Ft. Material
aerial
Front rri To.-i Ft. 6,jT
From To Ft.
From To Ft'
DepUr�r�t Matc al,.',�_/
13. GROUT:
Froin 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size
lir Material
Front_To---Ft. in.
From To - Ft.
Method
15. SAND/GRAVEL PACK:
Size
From
From
Depth
To
To
I DO IIEREBY CERTIF
CONSTRUCTION STAN
Ft.
Ft.
in, in.
Material
1 nrn rla y_ ON SKETCI►
Show direction and distance in miles from a least
two State Roads or County Roads. Include:the road
numbers and common road names.
3
r)
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
GROUNESAIATER SECTION
AS VLL R GIO['A 0 FICE r vision of Water Quality, Groundwater Section, 1636 Mall Service Center
Raleigh, NC
07 2001
27699-1636 Phone No. [phone], within 30 days.

263543
WELL CONSTRUCTION RE .AnD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
n-i (�,1Spn CERTIFICATION Pa
WELL CONTRACTOR (INDIVIDUAL)NAaIE (pr(print)AMPS�,.f f) �3-1-2Q5�1
WELL CONTRACTOR COa1PANY NAME ,11PC (nip-l\\ PHONE A its ` "Ctlt tt-OD
ASSOCIATED WQ PERMIT"
STATE WELL CONSTRUCTION PERMIT" if a s licable
(if applicable )
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ (feat Pump Water Injection ❑ Other ❑ If Otter, List Use
2. WELL LOCATION:
Nearest'fown: County„SuoCri+n
Nn nk(),-. a C-,nCC\P
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or Town ' Stale
Area cede- Phone number
4. DATE DRILLED
5 TOTAL DEPTII-_1/
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO l -
7. STATIC WATER LEVEL Below Top of Casing: 3D t FT.
(Use "f" If Above Top of Caring)
E. TOP OF CASING IS FT. Above Lnnd Surface'
•Top of taring terminated .Uor below land outface requlree •
variance In accordance with I5A NCAC IC .0118. TEST - ,I. n
9. YIELD (gpm): _(v_— - F /1
10. WATER ZONES (depth):
1I. DISINFECTION:'fype
12. CASING:
Depth
Topographic/Land setting
❑Ridge ❑Slope ❑Valley plat
(check appropriate box)
Latitude/longitude of well location
(degrees/minulcUseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRILLIN OG
From To ,jormation Description
4//0' - /i/S,
I 0 ATION SKETCH
Amount i Show direction and distance in miles from at least
te ro
Uad
Wall Thickness two State Roads or County Roads. Include
numbers and common road names.
Dimnelcr or Wei it/Ft. Material
Frorrt__(2.___To FL 6, ED _Lk -1-c Z__ %-
From To Ft. —
From To FI. Material
Ma '-
te
13. GROUT: DepthhI 1Method
From !r) To • a0Ft. �-%Or1-6V(ri
From To Ft. 14. SCREEN: Depth Diameter Slot Size. Material
Front To _ Fi. ill. in.
From To - Ft. ht. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft. From To Ft. _--
16. REMARKS:
v
ion S
s11:�1
1
S bird( the original to the Ivisi
2if( p(.[b)L6JMBBIQE•((o))733-32
ASHEVILLE REGIONAL OFFICE
ca
W
S WELL WAS CONSTRUCTED IN ACCORDANCE WITIT ISA NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/r .2
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Guiltily, Groundwater Section, 1636 Mali Service Ceenteer' RLaalleigh, NC
1, within 30 days.

North Carolina - Department o ovum t CERTIFICATION a
WELL CONTRACTOR (INDIVIDUAL) NAME (print).i:A e.�. \Ali c-rAm rATION 11_122 -4_�
1 T71
WELL CONSTRUCT1ON RECORD
f E u tent and Natural Resources - Division of Water Quality - Groundwater Section
NO \A'iP \( AC.„1 ln5 PHONE $ 6—
tVELLCONTMCTORCOMPANYNAME YVII ASSOCIATP,b WQ PERMIT"
STATE WELL CONSTRUCTION PERMITH if a IWQ P
if a licablc
icable
I. WELL USE (Check Applicable Box): Residential Fit—Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Ileat Pump Water Injection CI Other ❑ It Otter, List Use
2. WELL LOCATION: County sWC+S/A
Nearest'1own:
(Street Name, Numbers, Community, Sub
3. OWNER
Address
City or Town State Zip Code
(--)
Area cede- Phone number
4. DATE DRILLED
TOTAL DEPTH 30_6
7. STATIC WATER LEVEL Below Top of Casing: _CPf2.____Ff.
(Use "t" If Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
•Top or using terminated .tor below land surface requires •
variance In accordance with IS AE rIIOD OF C 2C .0118.
Le_i —
9. YIELD (gpm): — --
I0. WATER ZONES (depth):
1I. DISINFECTION: Type e Amount
12. CASING:
Depth Diameter or Weight/Ft. Material
Front To
From To Ft. —
From To Ft.
13. GROUT: Depth Ma anal
From_ To�0_—Ft.
From To Fl.
14. SCREEN: Depth Diaineter
from To. —.._Ft. in.
From To Pt.
15. SAND/GRAVEL PACK: Size
Depth
From
To
From To Ft.
263542
5.
6 DOES WELL REPLACE EXISTING WELLWELL7 YES ❑ NO
Topographic/Land setting
❑Ridge CISlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudo/Iongilude source:OGPSCITopographic mop
(check box)
DEPTH DRILLING�G
From To Formation Description
Method
Slot Size' Material
in.
in.
Material
I OCATION SKETCII
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:
IIMP�F�ApY CERTIFY TI AT T IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
p..L Kr g11ANBA�9, AND TIIAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO THE R
1lJJ LsS DATE
,RO
GIN
Submit theoriginalto the I)v1
r�rTIM .AfW1 EC1119N9
ASHEVILLEE REGIONAL OFFICE
IGNATURE OF PERSON CONSTRUCTING THE WELL
Ion of Water Quality, Groundwater Section,1636 Mall Service Center, REVg07 2001
221, within 30 days.

11, DISINFECTION: Type
12. CASING:
From 0 Toy 58
From 98' To 67
From To
13 GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Ds? Lh
From To
From Tc
263691
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and haeanl Resources Division of Water Quality • Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NAME (Print) James B Brown cERTre"ICATtoNs 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc. PHONE tl 13281 369-9591
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT'S
(if acolinable) (if acolicabl:)
1, WELL USE (Check Applicable Box): Residential CE; M'unicipaV?ublic ❑ Indus ial ❑ Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson C'i ty County Swa i n
296 Mountain laurel DrjVB
(S nt Nsme, Numbers, Ccmm''.iy, Subdiv sior Lc: No., Zip Cote)
3. OWNER: David Skinner
Address 1 653 North Nancy; 1 1 a Tarrare
(5 rrt cr Route No.)
Ft N)jfe_rs FT, 119in
Citycr Toum Sut: Zip Cate
(239 )• 415-1311
Area code. Phone ou nber
4, DATE DRILLED 10-22-02
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "t" If Above To; of CuLL;)
8, TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of cuing terminated err betow lead surface requires a
variance In actor dance w!:h ISA NCAC 2C .0113.
9, YIELD (pm): 6 METHOD OF TEST h1cla
10. WATER ZONES (depth): 270 & 305'
Amount 16az
Wail Thickness
Di6:.eter cr Weight/Ft.. Material
F' 6 prvr
Ft 6„ 1Ml steel
Ft.
Material • Method
Ft.tm:ni`a & cere-t punpaS
Ft.
Di arnete7 S;ot Sine Material
Ft. In. In.
Ft. in. _ in.
Ft.
Ft.
Siu Material
TcpographiciLaad setting
CRidge °Slope °Valley Flat
(check arcropriate eon)
Latitide/o.^.giride of well location
(der:a'minuteshecands)
Latitude/longitude so'u ce:OGPSOTopcgraphic cap
(oneck Sox)
DEPTF; • DRILLTNO LCG
From - To FormattionDescription
0 60' al nD
60' 400' granite
JOCATION SKETCH
Show direction and distance in piles from at least
two State Roads or County Roads. Include Lie road0
numbers and con. —,on road names.
16. REMARKS:
1 DO HEREBY CERTIFY Tr:AT THIS WELL WAS CONSTRUC i ED N ACC07-stANCE WITH ISA NCAC 2C, WELL
:AT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 TEE WELL OW,ICER
t the originalto the DM, of
1636 Phone No. (919) 733.3 21, wl
GROUND ''AJER SEC?ION
ASHEVILLE RLGIOiVAL OFFICE
/!S a
JRE OF PERSON CONSTRUCTING THE WELL DATE
Water Quality, Groundwater Section, 1636 Mall Senice Center • Raleigh, NC
hin 30 days, GWi REV, 07/2001
-a
0

263690
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and N'a?u'al Resources • Division of Water Quality • Cnouodvlater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTITICATION p 2045
WELL CONTRACTOR COMPANY NA -NE Haden Brothers Well Drilling, Inc. pHONE >' $23) 369-9591
STATE WELL CONSTRUCTION PERMMIT% ASSOCIATED WQ PER.'vIIT4
(if aovtinable) (if aoolicabis)
1. WELL USE (Check Applicable Box): Residential Municipab'Public ❑ Indus 1a] 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson Ci ty County Swai n
445 White flak
(Sr. Ns.-e, Numken, dir'siar, L.^r No., Zip Cc4e)
3. OW'h^R. Phillip Williams
Ad'•ess 455 White Oak
(S: rt or Route No.)
Bryson City, Nr 7u71'
Ciycr Town State Zip CoEe
(828)- 4RR-79FF
Area code. Phone number
4. DATE DRILLED 10-25-02
5. TOTAL DEPTH: 750'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 600FT,
(Use "t" If Above Top of Cu:ig)
8. TOP OF CASINO IS 2 FT. Above Land Surface'
Top of cuing terrnlnattd it,or blow land surta ce requires a
variance In accordance with ISA NCAC 2C ,0113. 1z.CXa
9. YIELD (gpm): 1 METHOD OF TEST
10. WATER ZONES (depth): 600'
1 1, DISINFECTION: Type
12. CASING:
Depth Diaraete:
Fron 0 To 20 Ft 6"
From70' To 24
Front To Ft,
13 GROUT: Depth
From 0 To 20
From To
Material
Amount 16oz
Wall TrJcbess
or Weiigbtlrt. Material
parr
_,1fl8 steel
Ft. mite
Ft.
14. SCREEN: Depth Dia...eter
Fromm To
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size . Material
Method
purpled
Slot Size Material
in.
From To
From To
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check er,roprate box)
La:inlde/longitude of well location
(d epees:r.l w•ss.9eca.:Gs)
Latirdd::longitude say ce:OGPSOTcpographic ;.tap
(check box)
• QRILLI GG LOG
Fo,-naticn Description
r1 ay & sand.
granite
DEPTI;
From To
0 22'
22' 750'
LOCATION SKETCP
Show direction and distance in miles from at least
two State Roads or County Roads. Include the read
numbers and con -non road names.
0
rJ
0
16. REMARKS'
ELL WAS CONSTRUCTED rN ACCORDANCE WIT: ISA NCAC 2C, WELL.
RAT A COPY 07 THIS RECORD HAS BEEN PROVIDED TO Ti-3 WELL OWNER
Su t the bri2lnal to the DI sion c
27699CFd3Mt4sf N7, (1tY9,1 - 221,'r
FSHE'1LLE REGIGP;AL OFFICE
TITRE 0P PERSON CONSTRUCTING TF3 WELL
c27-5:-02.—
DATE
f Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
'thin 30 days, GW-i REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resouroe$ - Division of Water Quality • Grou:ditter Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION p 2045
y-
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc. PHONE p 8) 369-9591
STATE WELL CONSTRUCTION PER1t1TA ASSOCIATED WQ PERMIT0
(if aoolicable) (if apclicable)
I, WELL USE (Check Applicable Box): Residential 21 Municipal/Public ❑ Industrial E Agriculodal ❑
Monitoring 0 • Recovery ❑ Heat Pump Water Injection. ❑ Other ❑ If Other, Lis: Use
2. WELL LOCATION:
Nearest Town: Bryson City County Swain
Wiggins Branch
(SL:ei NL.-e, Number', Cce.r.'.- t', Subdividcrr, Lot No., Zip Cole)
3 OWN R• - Regina Vamvakias
Ada•ess 615 Pine Edge Drive
(Srnt or Route No.)
Spring; TX 77380
City or Town Sat Zip Code
(281 ). 367-7866
Arta code• Phone number
4. DATE DRILLED 10-28-02
5. TOTAL DEPTH: 300'
6. DOES WELL RE?LACE EXISTING WELL? YES ❑ NO nc
7. STATIC WATER LEVEL Below Top of Casing: 195' FT.
(Vae "t" If Above Top of CasiN)
8, TOP OF CASING IS 2 FT. Above Land Surface`
*Top of cuing terroln ated at'or below land surface requires a
variance In accordance wl:h ISA NCAC 2C .0118.
9, YIELD (gpm): METHOD OF TEST blow
10. WATER ZONES (depth): 143' & 205'
11, DISINFECTION:TYpe F?DH
12. CASING:
Depth DiaMeter
From Q To 20 Fe.- f "
From To Ft
Frorn To Ft.
13. GROUT: Depth Material.
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Sin
From ` To Ft.
Amount 18zz
Wall Thickness -
crWeightrt. Material
P''c
Ft,bercnite & LatrsiL
Ft,
Diameter Slot Size Material
Ft_In. in.
Ft. in. _ in
Method
P-111:ed
From Tc Ft.
Material
263686
Topog;aphic/L.aad setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check er?roptiat box)
La;in:de.1o.^.giodde cf well location
(dep.:s'rniouti upends)
Latia:de/1ongirude soyce:OGPSDTopographic map
(check box)
DE?TH DRILLING LOG
From • To Formation Description
0 18' ay sand
18 i 300' gcanate
LOCATION SKETCH
Show direction and distance in rniles from at least
t' o State Roads or County Roads include the rcad
,,umbers and common road names.
16. REMARKS:
-
S4mit the original to the DI �islon
27 9k e541t4IMPA° 9PiC7P3.3221,
ASHEVILLE REGIONAL.OFFICE
•
Efiz Y'GEe'r Tn -j}±JT r
W LtCiIIbNSTAN
-ELL CONSTRUCTED
LL WAS CONSTRUCD TN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO TF3 WELL 0V =R
/il
JRE OF PERSON CONSTRUCTING TF' WELL DATE
(Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
within 30 days, GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
261961
North Carolina - Department of Environment andNatural Resources - Division�(of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / t7Pe,�/P. 4-(co j CERTIFICATION Sol lJ {rD
'
WELL CONTRACTOR COM PANT NAME z W A wl PHONE a ed$)-Y 79- e4 --H'
STATE WELL CONSTRUCTION PERMITS ASSOCIATED Q PERMIT,/
(if applicable) (if aplicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Putnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: (�
Nearest Town: County,9 GL' ail&
Cos
(Street Name. Numbers. Commun ty, Subdivision. Lor No., Zip Code)
3. ✓i
OWNER:
R2n
Address ( an all.Q�S v„, `tP
:4. Route No.)
'3
City or Townte Zip Code
( )-
Area code- Pbone number
4. DATE DRILLED g 00,2
5. TOTAL DEPTH: co D S
6. DOES WELL REPLACE EXISTING WELL? YES; NO El
7. STATIC WATER LEVEL Below Top of Cuing: g FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing tenanted sUsr below land surface moires a
variance in ueodnnee wltb ISA NCAC 2C EIS.
9. YIELD (gpm): 1 . METHOD OF TEST G vz,
10. WATER ZONES (depth): J ! 7
11. DISINFECTION: Type l T}-i
12. CASING:
Depth
From 0 To cn
Ft.
From To Ft.
From To Ft.
13. GROUT: Depth �1 Material
From b To D Ft. OPQ'Ao.t 7
Amount ii . q 3
Wall Thickness
Diameter or Weight/Ft. Material
bid St)pte
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:
Method
Slot Size Material
in.
in.
Material fJ p
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minute✓aecosdsl
Latitude/longitude source❑GPS❑Topographic map
(check box)
DEPTH DRILLING LO('(
From To Formation Description
r.�
0
J
c)
LOCATION SKETCH N
Show direction and distance in miles from at least-
two State Roads or County Roads. Include the road
nu bees and cos"'f on road nam _2
X/�,rtic 428.0 1 be,/X
t, 42. 4
{E1 m0 HkEilY
CONS I RUC 110N S J A..
GOT 2 2
ASHE 'L°i"
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)S, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9fr/ e .2—
GNAWRE OF P RSON CONSTRUCTING THE WELL ' DATE
o• I to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
(� 19) 713-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME fprf.r)�j�I-PeR 4 y� /P/�7
WELL CONTRACTOR ,ZJ�I,fJ�t fLm `... / 4 IDc l Y 4
261960
- Groundwater Section
CERTIFICATION 0 . 0 3 d
PHONE a 0.7.0 k74 R:#-5H-
'IRA OR COMPANY NAME - )L .e nl/QI
STATE WELL CONSTRUCTION PERM ITN ASSOCIATED WQ ►Q*MITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT p
Nearest Town:) "at, ULL'j nCounty 44n4.M-
6c4t (Jcllr KA•
(Slrcet Name. Number, Communi�ry,,SSubbdiirreaon, Lot No.. Zip Code)
3. OWNER: ad)
Addressf h s� 'L Q Q z�Jl 144.
S or Route No.4
]gun t, n- e
tIiyorTown iState Zip Code
(818)• 1kRR-Sip la`3
Area code- Phone number
4. DATE DRILLED 9- w — ;002
5. TOTAL DEPTH: d2 Sib
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 81) FT.
(U"+" if ow Top of Casing)
S. TOP OF CASING IS PissAb
FT. Above Land Surface'
*Top of codas terminated atrer below load anises requires a
variance la aeeodon with ISA NCAC 2C .0113.
9. YIELD (gpm): 3 I'.2, METHOD OF TEST tn.
10. WATER ZONES (depth): c2 00
11. DISINFECTION: Type fi H
12. CASING:
Depth
From f) To $8
From To
From
13. GROUT: Depth
From a To a D
To
Amount O.36,
Wall Thickness
Diameter or Weight/Ft. Material
Ft. -SD12d1 P v&
Ft.
Ft.
ali244)atlerj:Itij
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.
Method
Slot Size Material
in.
in.
Material
TopographidLand setting
❑Ridge °Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(aga✓minuteasxotdrl
Latitude/longitude source: ❑GPS°Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description-
tV
0
--1
J
ry
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roams ,, L
numbers and on road442- of gip 1 % 4vc.L/>
Lilt sit-Y, 14-74.SD 8t'o-g .'ar
,u� a -ey.-t G 7. 4
y r x aE. 4c0 4 �-4 2f 'i n" a
(QK %K6vc .ace; if, .arra-� L.t..vmer. i-1
'L`e 4U 7)/ii „ rujihtt fat cc _en./
16. REMARKS:
C CT 22 2-H2
LSubmit the original loilthe
t7g99,t636. , eg3'l�-(919) 7
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/6%aooz
SIGMX'TURE F PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Rakish, NC
I-3221, within 30 days. GW-1 REV. 07/2001

i OCT2 2 2002 1Iu
Su mIt the original to the D TIo
27499-1636 Phone No. (919) 7311-322
GROIJNC,^L'JER SECTION
ASHEVILLE FH-L7iHCLAI OFFICE
WELL CONSTRUCTION RECORD
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
261959
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
s, �e F"nr e R t +-I 9 (1 e CERTIFICATION act DSO
PHONE !PR) tj79-g462L
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W(}i PERMITS
(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:
Nearest Town: V UM [rr l «La\ County &UMf<yt:G
ALL Or.
(Street Name, Numbers. Community, Subdivialon, Lot No., Zip Code)
3. OWNER: A
Address /6n
�Xa-t Tf�
or Route No.)
(77D)- 1#77- 08&9 Zip Code
ty or Town 0 State
Area code- Phone number
4. DATE DRILLED 9 Jam- tea
5. TOTAL DEPTH: 40
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 63
7. STATIC WATER LEVEL Below Top of Cuing: i,n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 15 / FT. Above Land Surface*
*Top Mesabi ttralasted at/or below lad attaa meals a
variant la aecordome with ISA NCAC 3C MIS9. YIELD (gpm): % METHOD OF TEST tom.
10, WATER ZONES (depth): Viz} C
I . DISINFECTION: Type
12. CASING:
N 7 N Amount C7. L0 a
Depth
From f: To ' G Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_Q_ To .1 h Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
to%r _$V2.1( 'P
Ft.
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Ideareea/minuuet/sewndt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOQ
From To Formation Description
0
.I
-J
tV
N 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.,i y -4� -2 42X,
Ado / `�, v 47/ iZI2reit- z�
Method lit ,& . 'v a7Ltisdad, /f
�.,f dl sue. -.,,Q 4 i
ta
Size Material /jJ7
e441-eiZ---117
16. REMARKS:
FIFY THAT Tut S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AbAAD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r i
of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
within 30 days. OW-1 REV.07/2001

WELL CONSTRUCTION RECORD 262007
North Carolina - Department of Environment and Natural Resources - Divisionsiof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Txat- yI' /e/1•� Lee is?),
t� llW q,r�f�( � CERTIFICATION L,i O-SZ%
WELL CONTRACTOR COMPANY NAME >u LAX, JJ(WX r PHONE a fQ,.24)I.L•7 �I- '-
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMITS(
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential Z 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:
County sd?rZtb[z-
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER:
Address
(}S.t7rF,�,tt or Route No.
City ✓Stan Zip Code
(12,8)- — IC9ri
Area code- Phone number
4. DATE DRILLED 9-/3- 60,2
5. TOTAL DEPTH: S05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /lac FT.
(Use"+' if Above Top of Cuing)
S. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terWeted auar below lead surface requires a
variance Is searhaee with ISA NCAC 2C .a11a.
9. YIELD (gpm): 5 METHOD OF TEST alit
10. WATER ZONES (depth): 380
l I. DISINFECTION: Type N T H
12. CASING:
Depth
From 0 To 3 rJ
From To
From To Ft.
13. GROUT: Depth n Metena
From To .-Q D Ft, lR+�t�nt�
Amount f). b R
Wall Thickness
Diameter or Weight/Ft. Material
Ft. Co k. S17 Q 7 I 'jy ye -
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.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(deareesiminutp/seconds)
Latitude/longitude source.❑GPS❑Topographic map
(Check box)
DEPTH DRILLING LOG
From To Formation Description
r
J
N -;
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
num era aid core on odd names a,aw�ir.,('7 Peczt
Method , r i P' 'o• dam-^ t ,Cc- (`d
tot' q 4t-a r,C Aftr rr fC rt.'re
tintig% &.tea '�tvit.i�Yt-,�,� f% lfd
acit-ft, _-,t.cn oudna z-g-244wx )ref; a.
ciL
� 4e 7104);2:6.' Gr�lyr 2c4
Slot Size Material
in.
in.
Material
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
o -- S, AND THAT A DOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E`IYJ, UfitrV
Agri 12tI o;al
27699-1636 Phone No.
GROUNDWATER SECTION
ASHEVILLE REGIONAL, OFFICE
SIGNATURE
9//3A(105i
F PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
19)7)3-3221,within 30days, GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C(Qw(-A
WELL CONTRACTOR COMPANY NAME /-NIItIL VA/ t�
263102
- Division of Water Quality - Groundwater Section-,o
%N((4t CERTIFICATION # aJ07
l�/i I f i NI PHONE # (p19 qg&_g9) O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERIIIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residentialllf Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: irYmti
JK�titW UWNCi1 ad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
County S4q,N
Address .Cr%rhai•StMe acsivo,
T(Street or Route No.)
.2.8 713
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ci
5. TOTAL DEPTH: 1SS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO '
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): So METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type C/cr ie_
12. CASING:
Depth Diameter
From ( To ii 1 Ft. (+ 7
From To Ft.
From To Ft.
13. GROUT: Depth
From 1 To 02 d
Amount "1 Gtw.f
Wall Thickness
or Weight/Ft.
Vick taw
�� Material
Ft. ,r'/4 6C2.7,44.1.
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.
L
`,Stibtrpt the original k vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
Material
pv
Topographic/Land setting
DRidge ❑Slope ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Method
Pe&cia4
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from aiteast
two State Roads or County Roads. Include tberoad --
numbers and common road names.
�N\vL'� 7
XPPIS
1'bo9
(5'(U4 n''
spit- p441/4 t tl ©/AEj gJ(AX iJ
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
te$1
SIGNATURE OF PERSON CONSTRUCTING THE WELL
?-.20- Q.2--
DATE

WELL CONSTRUCTION RECORD 263101
North Carolina - Department of Environment and Natural R�esources(- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((ppr"int) Ge.t 114/4 Pt4HtlL-- CERTIFICATION # OZ387
WELL CONTRACTORCOMPANV NAME nMtj we II :hint PHONE # (3/2) lit 4930
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential se Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: l%ryser/ County ;a/oi
sl eptiL,vtcN Rd. P° &ry /girl
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ita NN+C
Address ep/trwS&AI P2svek &4
(Street or Route No.)
6g1sor( Ai. C.> ag./R
City or Town State • Zip Code
(Gt )- `fBB. a )
Area code- Phone mmnber
4. DATE DRILLED 9-40- cv
5. TOTAL DEPTH: pZ 3tv
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ♦�J
7. STATIC WATER LEVEL Below Top of Casing: 36 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /f o METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope G2V'alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type (or-/,u&:_ Amount lb crCn..S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To'1 S Ft. /o''-/ in S132 L
From To Ft.
From To Ft.
13. GROUT: Depth Material L p_ oMeethhod
From 1 To a 0 Ft.S34.1-60,,+IL t ver{
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.
H\
CONSTRUC LION STANDAF1,
7 L.9
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. `ll?)1
S�»
131) b /1n r 1)
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNDpVq�TER� $$ C
ASHLBUCdBEIliCa6Y0fd�he Dwision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27�-16sb Mine 1 rf J3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
263100
North Carolina - Department of Environment and Natural Resou1rce(s-� Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print){CIebQL4wd itllk - CERTIFICATION # 4387
WELL CONTRACTOR CONIPANY NAME M+Al1Q((, WeAj I)�.+�. PHONE # f a28) 8930
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential VJ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Po_6 _r_ n! C.7 County Si -opt r
£ si 14
(Street Nance, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,t1441-14 ~CAL
Address ( e-t c'/i7
City or Town State
(31? )- 139, 4149
(Street or Route No.)
Zip Code
Area code- Phone number
4. DATE DRILLED 9 - — ol-
5. TOTAL DEPTH: aCS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): $ METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
cl<idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
I1. DISINFECTION: Type C/OY; N2
12. CASING:
Depth Diameter
From I To _ Ft.________
From To Ft.
From To Ft.
13. GROUT: Depth
From 1 To2p
From To
14. SCREEN: Depth
From To
From To
15
Amount roCc,,kg.
Wall Thickness
or Weight/Ft. Material
fjiuCk tlna f
Material Method
Ft. sAm4462,4- awe/
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
16 REMARKS:
Material
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
list N
c),N,wke-
tiS
1
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NATURE OF PERSON CONSTRUCTING THE WELL
-Y-OY
DATE
Su1mmojB1R'qaRtFi'd®ltlmbl Divisi of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
MIREURREPliihGe WAI(liAlifFt-1» , within 30 days. GW-t REV. 07/2001

WELL CONSTRUCTION RECORD
263099
North Carolina - Department of Environment and Natural Resourcesr- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C i4C4.444 ltcn- CERTIFICATION## a.337
WELL CON1 RAc'IoR COMPANY NAME itIce- wets Or; f(hv8 PHONE # (8Z3i J gtt Q'3t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Vi Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 l f Other, List Use
2. WELL LOCATION:
Nearest Town: 6114SoNL'r�., County Suwev
Gr45) N
(Street Name, Numbers, C nimjunity, Subdivision, Lot No., Zip Code)
3. OWNER: 3;t PANN't-
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED CI- 1$,9l-
5. TOTAL DEPTH: 13o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Et'
7. STATIC WATER LEVEL Below Top of Casing: SS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface"
*Tap of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST
10. WATER ZONES (depth):
Address 6,--spi frgitrrLD P rnnc(7 Rd
(SSodC is RouteNo.) mc.•d87�
!V Zip Code
Topographic/Land setting
❑Ridge fr7Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type lIoa— rvt Amount L Caitir4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To n2I Ft. Ir ki "it tic cind Pv&r
From To Ft.
From To Ft.
13. GROUT: Depth Material ��yyMethod
From 1 To 10 Ft. SAn..�Y('p,ai..f- ry 4ra
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
Fro in
RKS:
EVTIFET
CONSTRUCTION STAN
7
' u/bpi irl the ortt iBTd'pp the •Di
L
27694- {G3G I'hnnc. Nk:-() F9) 73
LOCATION SKETCH
Show direction and distance in miles froin&Qeast
two State Roads or County Roads. Includetthe road
numbers and common road names.
IAA\X
V
fV
CO
•
? yI jncr.
IF32Azvc t ,P.1
1311
ivdt
� 3
t �� ct EOM)
t
410,E uSt9
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0AcxY anal ctticl�t,� a� _ p x,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \t[OQ2,04, CERTIFICATION # .'{337
WELL CONTRACTOR COMPANY NAME S.NI((( tA-'tt) I,rrilt: NL PHONE # (2)d) "FBy-t4`i3r'
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
7,
263098
WELL USE (Check Applicable Box): Residential d Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Q on, el Co itity']SWA 1 �
� i— /erf6rel Jc ( e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /h:KC QtAM4'
Address r-4N- t /,
(Street or Route No.)
cfi _N.c. 3-k113
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED of -R-o -
5. TOTAL DEPTH: 1$6 -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ
7. STATIC WATER LEVEL Below Top of Casing: .26 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /L METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope [Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
to
ry
11. DISINFECTION: Type Opt/ HL
12. CASING:
Depth
From t To rf2-
From To Ft.
From To Ft.
Amount '1 CAomf
Wall Thickness
Diameter or Weight/Ft. Material
Ft. C. y IRY (geev
13. GROUT: Depth Material Method
From 1 To :.o Ft. SHivd rfC¢.thi. ' Po'crW
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Material
LOCATION SKETCH
Show direction and distance in miles from at 144st two State Roads or County Roads. Include the road
numbers and common road names. -
(,EKtoti c1J 1
13w
"r6t
��G
jos%1 Ls(C+/� �9•
s14
QL. ^ I
}t' K/1
4 No,.'
(i ST ('YION S F$- Y
ILJ
Submit the Dngmal.t2'the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
G r2P7400.03-011wge'No.1019) 733-3221, within 30 days. GW-1 REV. 07/2001
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4I. S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e0�z•4.0 _d ° " 2--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) d€ueip4 ((@tl. CERTIFICATION kiala
\\'ELL CONTRACTOR COMPANY NAME T((1184, will Or, lI; PHONE # (`$ O ¥f(g'13o
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
263104
1. WELL USE (Check Applicable Box): Residential 21- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:SotJ
County .S(N4; N
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -.S4€DhaIle Con/
Address CRASS(' g2µveh
,v
City or Town
( )-
(Street or Route No.)
State
2g1(3
Zip Code
Area code- Phone number
4. DATE DRILLED _ fir --c 5-
5. TOTAL DEPTH: OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 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): Iy METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope 1$Da11ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Clor/d& Amount `b CM.'S
12. CASING: Wall Thickness
Depth Diameter or WeightFt. Material
From 1 To 3Y FL (0 19
From To Ft.
From To Ft.
Ihici Arm'
13. GROUT: Depth r- Material Method
From 1 To an Ft. ,v4S ('c....wF fov-r
From To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
14. SCREEN: Depth
From To
From To
LOCATION SKETCH o Show direction and distance in miles from atlleastl
two State Roads or County Roads. Include tWi road -
numbers and common road names.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. Bib/44W C1I41
From To Ft. (/vli
132e ctS/1
16. REMARKS:
-r-lIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_, (24>bildtw 9,2 v— 01—
I
he oriailial to the Div
:#1i4LN6t4r6115Ntiiiiiaso: 19) 733
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
263107
North Carolina - Department of Environment and Natural Resources dkl. - Division of Water Quality - Groundwater Section
�,yy
‘CELL CONTRACTOR (INDIVIDUAL) NAME (print) Ge✓ti-Am' CERTIFICATION #023
WELL CONTRACTOR COMPANY NAME HAItait. LW/ ,t_yY Misi PHONE # 1 poo l Orl'QJ30
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential er" Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: rr�
Nearest Town: �iC6A) County ,.`LLLi41
7 Oi-7Amis fete
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code')
3. OWNER: InACK IllykJ-.g4 st
Address l4,0 WA4t')Njf Can,?JLJ7 Rd
(Street or Route -No.)
�graN -C.
City City or Town State
(rag )- /-1V3- 46 So
aK7/3
Zip Code
Area code- Phone number
4. DATE DRILLED 9 - 1'— 0 2--
5. TOTAL DEPTH: /4/0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ef
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OFCASINGIS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with t5A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST
10. WATER ZONES (depth):
LOCATION SKETCH '72)_ Show direction and distance in miles from at least -.-
two State Roads or County Roads. Include -The road
Xi
Topographic/Land setting
DRidge ❑Slope ❑Valley dlat
(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
II. DISINFECTION: Type C/w-;Nt
12. CASING:
Depth Diameter
From I To °tO Ft. 6kI
From To Ft.
From To Ft.
Amount t Ceay
Wall Thickness
or Weight/Ft. Material
j[n:a tilt11 PJe.
13. GROUT: Depth Material L
From ( To old Ft. S.� A,W.n ¢cM
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
ebut✓2i
Slot Size Material
in.
in.
Material
rf-D01-firTCEBY C.ERIIbYTt
CONSTRUCTION STANDA
L.
numbers and common road names.
yutfl-
N
N
w
-IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
It
Lea 1 /D-4f- o 2
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Anima theorigjpmi ttnEDivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636PIitini Nio. [phone], within 30 days. GW-1 REV. 07/2001

264456
- WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesy
r0.
-Divisioonof Water Quality - Groundwater Section
WELL CONTR.ACTOR(INDIVIDUAL)N.A\IE (print)61 CN/J Ms 1"-T�J CERTIFICATION p�� 9?
D\R\
\\EI.t. CONTRACTOR COMPANY N.A\IE4M- AG-rp rn)C. VJrc.S 1.0(0A °- - i vet PHONE a ) 51(0 -5563
STATE WELL CONSTRUCTION PER\Irr# ASSOCIATED \\'Q PERMIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (Municipal/Public 0 Industrial 0 Agricultural 0
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other., List Usc
2. WELL LOCATTION:
Nearest Town:`1},ThSotJ County 1. 10
ots_m eV' ( ctrKc.
(Street Name, Number. Community. Subdivision, Lot No.. Zip Code)
3, OWNER: ( c-ri Neuw mwN
Address a o'_t\\ \ec&A CLVC
(Street or lute No l
CU\oro SQC?rJ93S Co1ara.4o DEPTH
GtyorTotsn Stale Zip Code r �_ From To
(714)-67& -sa 1 5-1
Area code- Phone number
d, DATE DRILLEDS T�em\Der 4Yacoa
5, TOTAL DEPTH: SOU
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1Th---
7. STATIC WATER LEVEL Below Top of Casing: 3 q o FT.
(Use'-+" it Abose Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
'7 op of casing terminated at/or below land surface requires a
variance in accordance With I5.\ NC AC 2C .011S.
9. YIELD (gpm): ( NIETHOD OF TEST 1 r
I0. WATER ZONES (depth): Lia0
1 I. DISINFECTION. Type RT ♦ -
12. CASING:
From b
From
From To
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Lt1'Flat
(check appropriate box)
Latitude/longitude of well location
(decrees:minutes3econds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Det, cription
51 - 4 at,
1/4-1a yaa.�;+y
4aa- Too
�r`atit'Ft
LOCATION SKETCH
Amount 3 I . 5-o7-.. Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads, Include the road
Depth Diarter orYVV'eight'Ft. Material numbers and common road names. �y\llfl`-� I
(� ly
To�(n Ft. to L1 tiO-
t I
To FLf '`/ L{ ry soN 0-i a
SIB • 13 b9 d—pc Cr atetrKq
Sk. I Bit 6-f'aSSydr A
Ft.
13. GROUT: Depth u\laterial
From 0 To Q.0 Ft. 0-efiN
From To Ft.
14. SCREEN: Depth Diat
From To Ft.
From To Ft.
Method
IP
:r Slot Size Nl aterial
n, in,
in. in.
15.SAND'GRAVELPACK:
Depth Size Alaterial
From To Ft.
From
To Ft.
t-arcs+ IA- l l S,
3
16. REMARKS:
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I �NCAC
CONSTI "j1Q).V SSTAND.ARf)S D Tp'.j1 A COPY OF THIS RECORD HAS BEEN PROVIDED THE YELL OWNER
--7J7Oo'
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

STATE \\'ELI. CONSTRUCTION PERVFF#
l ifapplicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res
sou
�rces - Division of Water Quality - Groundwater Section
WELL CONT I2.\CT 012 (IN UI VIDC:\L) N.A>IE (print)�I(�(\7" � �171 \ 1rrng0.-�, t CERTIFICATION 4.51"7
\\'EL.LCONTRACIOR COMPANY NAME 4A-A- G-rp raNY:
te ):5. KJelk Up-'i� 100.-- PHONE # gi.21 SS'G-4'7.5D
ASSOCIATED \\'Q PERMIT
(if applicable)
WELL USE (Check Applicable Box): Residential (�b1unicipaVPublic ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: c'yton) Q'4'%County SLit_s0.tn1
\ do, cC �=nre��
3. OWNER:
Address
(Street Name. Numbers. Community. Subdivision, Lot No.. Zip Code)
e Gr toll rou.>0
7o M: r ‘c•cx. e \ V<\x-c A- t of
(Strew or Route No.)
I b 11- e e \y t�l 43V:-4A-t r r 4vC
City nr Town State Zip Code ,) Q 9,:n
(fir- 4 97 - (Da73
264455
Topogrt is/Land setting
❑Ridge C'3"Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutesiseeends)
Latitude/longitude sourer.❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
m To Foit(ticn Description
- 367
:? (o ^ I O QttitU rl4-C
Ito _ IL aoc-t-y
it "a- - 135 re7N;+e-
135-131 Cav;t-`(
13'1 - Ito 5 yr4tor�1 e_
to 5' ) to
l �a0e'+Y
Ito rl — 1 l_ tN4L Al r\—i '. —
I i{ 5 - cif?
'? n l� t' --
14'1 �5C> %raNrt
LOCATION SKETCH
I I. DISINFECTION: Type 1-t -r 1-t Amount r 95oz.. Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
numbers and common road names.
Area code- Phone number
4. DATE DRILLED.Se9keensDer5,,c cO
5. TOTAL DEPTH: Q5c-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9.-
7. STATIC WATER LEVEL Below Top of Casing: 3 d FT.
(Use `s" if Abuse Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Tt of casing terminated at/or below land surface requires a
to rian ce in accordance It ith I5A NCAC 2C .0118. �?
9. YIELD (gpm): 45 METHOD OF TEST a i
0. \VATER ZONES (depth): )-/)b /
-I35
i—)to5 4o-(9S
Depth ' Diameter o AVeight'Ft. Material
From (i To f 'l I Ft. (i `-1 V 1r0 '.
From To Ft.
From To Ft.
13. GROUT: Depth Material I . Vethod
From 0 To (9: Ft. C.e FA e/JT 1 a p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Et. in. in.
From To Ft. in. in.
15. SAND/'GRAVEL PACK:
Depth Size Naterial
From To Ft.
Front To Ft.
V \ ck
1311 e < et Zr,
d\cLQ 1` 0ret+-
3
3
0
16. REMARKS_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT! NDAE 5, A T A CO F THIS RECORD HAS BEEN PROVIDED TO THE OWNER
RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GAW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 f 12 3 8
North Carolina - Department of Envirotunent and Natural
Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) 2-Aj�-Y / 1 141 CIA--
WELL CONTRACTOR COMPANY NAME Art Oy,mmn At CCF T/ttl t�
STATE WELL CONSTRUCTION PERMITS
(if applicable)
CERTIFICATION a L aro
PHONE a £2,2 -iiR-5 qs-f
ASSOCIATED WQ PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential IN Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN.
Nearest ToT:
palac0(luvr /Alay f(ct
(Street Name, tubers, Community, Su division, Lot No.. Zip Code)
County SZL\f+-ln.
AW NE0.
Ctlnu i a.i.c
OWNER:a Address ' R FA7r:o
y
(Street or Route No.)
6
City &Town Su te' Zip Code
()66)- 27R- 3744
Area code- Phone number
4. DATE DRILLED 9/ / 7/61oo„a
5. TOTAL DEPTH: A'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5 3 FT.
(Ue. “+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of caabg taral.ated at/or below Iaad metes revokes •
variance 1a acardua with ISA NCAC 2C .0116.
9. YIELD (gpm): 4- METHOD OF TEST A AAM
10. WATER ZONES (depth): 3 O
t 1. DISINFECTION: Type
12. CASING:
Depth
From 0 To 4 7
From To
From To
13. GROUT: Depth Material
From 0 To ? t Ft. CQt� ryc�}
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 0,.54
Wall Thickness
or Weight/Ft. Material
SDR2) TV < o
/11.rr�t,t.D« (J
Method !0l
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutn/eecondr)
Latitude/longitude source:❑GPS❑Topographic trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
J4 7"N
Disnaeter
Ft. L /4
Ft.
Ft.
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
t tm 1,-1,1 en, vel i? if
Material Yo )TiiA.n / Gr.
y 33Jion""aeo-
�9 / I Q YTK-�<Y di Lacy. bit /i.t_ JLe V
JJ
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IG A URE PERSON CONSTRUCTING THE WELL
4 CA
9d1.7/ace2_
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2261 23
7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectio
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
ASSOCIATE Tf WQ PERMIT*
(if applicable)
CERTIFICATION * a f o
PRONE * fY tn9-&4Su
I. WELL USE (Check Applicable Box): Residential'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Infection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name, Num• er
3. OWNER:
Address F
County 5 Lt) )-
Community, Subdivision, Lot No., Zip Code)
n (Street or Route No.l
�td�t-�1/11- C
p City arI'own State
Area code- Phone number
4. DATE DRILLED 9 ) 19th o o a...
5. TOTAL DEPTH:_ o S
6. ESTWYEl7. STATICDOESWELL WATERRLEVEL BelEXIow TopING of CasiELL?ng: ES ❑ f�NO __FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. •Top of cuing terminated at/or below land surface Above
equirnn Surface*
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth): 0
11. DISINFECTION: Type
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeilongitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
r
Depth
From 0 To S
From To
From To
13. GROUT: Depth
From 0 To k n
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Ft.
Ft.
Ft.
Material,
Ft. Clirrrxf
Amount
Wall Thickness
6 ipeter or Weight/Ft. Material
I6.REMARKS:
Method
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
LOCATION SKETCH
Show direction and distance in miles frotn at least
two State Roads or County Roads. Include the road
numbers and common road names.
14- of #aS (14)
lip c ,,4'a
bT`f{`ia v.eft7oynast.Nm
t.-t.
ht)J ey . Fei-4 `emu %-e_ Fri�.#kv�
Ch �(/a%7 o uuw ,Lea cut ce, e f4 o ei
4.34)1a L r �) .Lt,.akcie d
kt n K9 z3comiAxt
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS
AND TH
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU
Zip Code
9-21 � ° Ai 64 91/ 9p.00
OF7P RSON ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001
O

WELL CONSTRUCTION RECORD 261236
North Carolina - Department of Environment and Natural Resou esDivision of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (plat O�JJY
WELL CONTRACTOR COMPANY NAME r} iL C _DrvA.a
-
CERTIFICATION S as 3'°
'w��) PHONE 0 nYa�74N 45y.
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fill Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:
Awn
(Street Name, Slumbers, Community, ;atheism'', Lo No., Zip Code)
3. OWNER:J C ��"
Address FaTtarrw'tc.rvc t to:tt ,.
e
(SSt.t « Rowe No.)
fur11 4 C., s
County 5Wcuiy.,
City 8r Town Zip Code
(tafr)- 4S8-9R&8
Area code- Phone number
4. DATE DRILLED 9/a3 b.o a a
5. TOTAL DEPTH: 4.0S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: ail FT.
(Uu "+" if Above Tee of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
*Top of csalag termlaated suer blow Ind surface moires ■
variance In setosaoee wit& ISA NCAC IC .011S.
9. YIELD (gpm): R METHOD OF TEST /J '
10. WATER ZONES (depth): 1 43
I I. DISINFECTION: Type 11T1a Amount O. 9S
12. CASING: Wall Thickness
Depth D;uneter or Weight/Ft. Material
From d To )3o Ft. 6/4 ShRa1 TV
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To 2.0 Ft. Ctrrr,knc
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(chick appropriat box)
Latitude/longitude of well location
(degreesiminutcnseconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Description
a.-
),OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
,OLt
tif;-:),R.Locui.1Method ntry m/t/r._ ,i.t/JOYN. /TcfPwc y
''hItA 1 ion t.c.t.vr. I
7-4-Y4-Cvmc,,, L"%e, Cea c-Cary
3 / d n L-11, $i- nie R, " en.
w a`1 rLA, I'JLC -tkL t
16. REMARKS:
1 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
ijui tit �/a.3r -002-
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
R F PE SON ONSTRUCTING THE WELL DA
SIGNA �1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Pone No. [phone], within 30 days. GW-I REV. 07/2001

260206
WELL CONSTRUCTION RECORD
Noi (':uoliva - Dcpal Mien! of Environment and Natural Resources - Division oI' Wntcr Quality - Groundwater Section
('ON I lt.\l'I Olt (INDIVIDUAL) NAME pHal) szt\ 1/ JoN eS CERTIFICATIONq -ZS6p6
I .c l:l.I. ('ON It..("I Olt COMPANY NAME f ,l J
'(c"P 4 ?ell_b i i_ -35 I'IIONE a 1 5g) es-r -4300F
S I \ 1 I: wt:LI. CO,\SI ItU(-I ION VE1)MITN ASSOCIATED \cl) I'I:RNIITM
1 i 1' applicable l (if applicable)
\YELI. II SE (Check Applicable
Mnnilnt ing ❑ Recovery ❑ I
2. WFI.I,LOCAIION:
Nearest TnWn:_,,,,
41-NRK1) _ro �2r
130x): Residential I�" Municipa/Public ICI
teal Pump Water Injection El Other I
2\/So -) CI7�/Conniy StV/1
J it) sb,N S CPPPt
(Street Name. Namhci . Couononily. Subdivision, Lot No., Zip Cade)
3. OWNER: MAR'u9 'Re() fil A
Addiess 15•o • Box / 30368
hued or Ronne No.)
)7LL-3i-I4ssee 3231$
R{ thy in 1 own Scam 7ip Cade
�c..l- 37G — 27159�
Arca Hale- Phone 'umbel
d. DATE DRILLED
9
5. 1 OTAI, DIET('((: /% S ' �h
6. DONS WELL REPLACE EXISTING WELT? YES 0 NO II_I'
7. FIC WATER LEVEL- Below "lop of Casing: 5C) Fr.
(Use". if Above 1 rap of Casing)
R. .1 OP or CASING IS / FT. Above land Surface'
'lop of rasing terminated at/or below land surface require. a
sartancc in accnrdau"�rc Cnilb 15,1 NCAC 2C.0118.
9. YIi*I) (Lptii): _PS___ MEI IIOD OF TEST /7�I
/E.
10 WA-LER ZONES (depth): 70 r) 90' r130 r
II. DISINFIIC'IION:'f\pcC)UI-f1{Z Amount
12. CASING: Wall Thickness
Depth Dian, to or Weight/II. Material
nom D To GAO Ft `I -573R.a 1 P`/i-
Ptom-_---____ To I 1
now To rt.
11. (iRt)tit: Depth --�---Nlatcri:l Method
Itoln ( l "I Go It. G 3e2 _( gamy
11n111 le it.
11 SCRIM N'. Depth Diameter Slot Size Material
I toolto II. in. in.
From To I I. in, in.
15. SAND/GRAVEL TACK:
Depth Size Material
I low To II.
I runt In FI.
16.REMARKS:
LI -a
Industrial ❑ Agricultural ❑
I' Other. List Use 1.77,
O
Fs.,"
Fopogra Inc/Land selling f�
❑12idge .'lope OValley ❑IlatO
(check appropriate her) fV
Latitude/longitude of well location w
Id,grecalmilwcs/sccondsl -
latilude/longitude source:❑GI'S❑TopograjsJ c m lji;j
(check Into cri --i
DEP'lIll DRILLING LOG R
Flom To Formation Descriptioli
Q Cad. a; s�—
j )' —iG�ST ITC
LOCATION SKETCI
Show direction and distance in miles from at fei?sl
Iwo Stale Rands or County Roads. Include lIl road , --
❑UIIIICIS and common road names.
r)
<.)
Snlrmil the original ter) rct\ivisio
27iO4:I616d'11mYe N(r.'(H I�0)01-3221
IS WF.II, WAS CONSTRUCII',U IN ACL:ORDANCI: AVl I I1 I SA NCAC 2C. WELL
D Il TAT A (L31'Y OF 11IIS RI CQRD I IAS BEEN PROVIDED IOTIIE WELL OWNER
NAIUI
9-43-01
ItUC I ING 11IL \b EL_L. DA"IL
of \\'aler Qualify, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
.vi(hin 31) Clays. (iW-I REV. 07/20(I1

255205
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division off Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) )r ) IQ m \\ :`kjr, \t y�� CERTIFICATION q�5q?
WELL CONTRACTOR COMPANY NAME /VA- Gr-rCt3 C.L e)Ctakhr•-ram O S99IOc._ PRONE n1520Th 5s-6,-5.�-�
STATE WELL CONSTRUCTION PERMIT#
(if applicable) -/ (if applicable)
L WELL USE (Check Applicable Box): Residential 112 MunicipaUPublic 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
a
WELL LOCATJQN:
Nearest wn: \\S otJ C_ ' 9 County e _�-
N e S7leaAmos,
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k e \\NC,(" 3t' S' ((f \
Address 2i j L -a eKS S5 7
(� (Street or Route No.)
1Jfy se,N LDC .2S
City or Town State Zip Code
?fl)- 4 s-S-e5?
Area code- Phone number
4. DATE DRILLEDSc`-k-cA)ev' a5/ pock
5
6
7
TOTAL DEPTH: 5-7 S
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casino.: 5 0 FT.
(Use "+" if Abose Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A N CA C 2C .0118.
9. YIELD (gpm): I METHOD OF TEST Y-
10. WATER ZONES (depth): 115-
ASSOCIATED \\'Q PERMIT#
Topographic/Land setting
DRidge DSlope ❑Valley i r t
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From— r,% 3 ala.tlSa
_Formation
Description!
(/
rl 3 - 115 c(`a ro
ITS-I1ri ack_ Cry
I I `1 - S t75 o('gw
LOCATION SKETCH
1 I. DISINFECTION: Type 'I4i-V Amount a5.t6-)._ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dian eter or Weight/Ft. Material numbers and common road names.
-*I 9 - 7 N SrLfsc,c, ,,+y /^/ati -cr hat
Goc.5
N W LI I er-9 seta C'r+y /
o ro_ hk&
S f� / 319 J cL c o d 6 Tr_tu" G
s��0_�
PcL
'Ne rnecP oL I �<
>o
--ice
mr
From 0 To r) 8 Ft. to `t _f_ eCieC i
From To Ft.
From To Ft.
13. GROUTT' Depth Material Tnte thod
From- lJ To ` l7 Ft.CJ f"ct\3t J 6 P
From To Ft,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16 REMARKS:
Ft.
Ft.
-D
W
rya
rfir.
c-i
i G
�COH�}�}iiR�`i1��' C.R fi ( THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
STil 1("" If7V c-AN CARDS, AND THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
41 Crit% - -� -duo
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Siihrnit the or'oinal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GRDU 1[ ktiht� l%ia" (91e)733-3221,within 30 days.- GW-I REV. 07/2001
ASHEViLC_ CiUNAL

7. STATIC WATER LEVEL Below Top of Casing: % FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS / .— FT. Above Land Surface*
' 'Top of cuing terminated at/or below land surface requires a
varlance In accordance with ISA NCAC ZC .0118.
9. YIELD(gpm): !D METHOD OFTEST A'/
I0. WATER ZONES (depth): / 70
11. DISINFECTION: Type //r"`
12. CASING:
Depth
From To /+ZE Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2 Ft
Diameter
Amount 'If C
Wall Thickness
or Weight/Ft. Material
/,Mat al ,,Method "
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Front To ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
266081
WELL CONSTRUCTION RE(ORIJ
North Carolina - Department of Environment and Natural Resourcesso- Division of Water Quality - Groundwater Section.
WELL CONTRACTOR (INDIVIDUAL) NAME q((p,,rrintt))//art/ "e eC£ �(� CERTIFICATION .ZIEQ:
WELL CONTRACTOR COMPANY NAME ///diet t4J41I "' f t tc 1 —\ PHONE N f'N 13.--eff/
STATE WELL CONSTRUCTION PERMITN ASSOCIA ED WQ PERMITN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑- MunicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ileat Pump Water Injection ❑ Other (7 If Other, List Use
2. WELL LOCATION:
Nearest 'town: C:/Jero /'et County (5-4/4/ ./7
_ No, v
(Street t Name, Numbers, Community, Subdivision, Lot ., Zip Code)
3. OWNER: C4.4v 03.4/
Address 0,17 rthf i 0,,0(1>>t
(Swee�t or �RRute No.)
OOY®YQQ 1LJ. Z`611�t
City or Town State Zip Code
( )-
Arta code- Phone number aC—Dz
4 DATE DRILLED
5. TOTAL DEPTH: /5'2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
.l
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑TopogJhic m?p
(cheek box) t.)
DELTE DRILLING 'LOG
From To Formation Description
O — //7
/77- lTD
C/a -G/ave
ir, /-fi
0
LOCATION SKETCH
Show direction and distance in miles Rom at (east
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 I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenlleerl RREVgh, NC
27699-1636 Phone No. [phone], within 30 days.

City or Town State
LIRA )- C%B - e12.44
WELL CONSTRUCTION RECORD
263097
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Clity e3 A.4 putt., CERTIFICATION #Q ?Si
WELL CONTRACTOR COJIPANY NAME '(M1iv t,Jltl 44411.1 PHONE # fan) ` gt- 030
30
SATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential la" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: hsrsscrr2 Ci4 County_c&AIN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 5.r+7 in el -ALL
Address s.frith---AIrPodt.- A'^'e--/ 90^1c ,e
(Street or Route No.)
R,eystr C,y15 {V.C•
Zip Code
Area code- Phone number
4. DATE DRILLED 8-
5. TOTAL DEPTH: .. . - - Soo'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: )SD FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS ! FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
Oi�dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Cloj-/An_ Amount Zo61A+s
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To 94, Ft. 64 %1.0 III !V C
From To Ft.
From To Ft.
13. GROUT: Depth Method
From 1 To ,20 11"f"d
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
To
To
From
From
Material
Ft. Segr,4 d- Cew,✓F
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
J
Show direction and distance in miles from at-lieast
two State Roads or County Roads. Include the"- oa
numbers and common road names.
LOCATION SKETCH
r6
10
WL(
L �r
( II
Lr3�rr���lk-
(k
N
W
RDANCE
NSTRUCTED IN
WITH
CONSTRUCTION STAN d � ,, AND THAT A COPY OF THIS RECORD HAAS BEEN P OV D5A NCAC 2C, WELL
IED TO THE WELL OWNER
THIS WELL WAS
edC''
Sla®hliit�Yfihli*41itke Div'sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
AS}} j i. 1,-- � ,, -3221, within 30 days. GW-1 REV. 07/2001
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-of.
DATE

WELL CONSTRUCTION RECORD 2 6 310 3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0.1083/2t4iv4 f c/(eL. CERTIFICATION #a7
WELL CONTRACTOR COMPANY NAME )-NIIQC Lc%t(I D1 /It+1 PHONE # ftfl) ia5-813
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2. Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SV' O 1' County Su) atN-
A' ae amMw.11 £eva- Cocc £J.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (loikN:G I�f.
Address ,Q etv: IA.
(Street or Route No.)
1441Se„r N • S. alai 71Z
City or Town State . Zip Code
(`'Zt )- 1st `ill(-
Area code- Phone number
4. DATE DRILLED 8-a.3 ,oi
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q'
7. STATIC WATER LEVEL Below Top of Casing: `%fl FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*'fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1S METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 13fIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Oor.'Nt,. Amount e1 GRdn r
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ( To 43 FL (t =4 la /t$: 2et..
From To Ft.
From To Ft.
13. GROUT: Depth MaterialeMethod
From 1 To aII Ft. £44tvii 402.rs[dTJ foil Yaf
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
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.
rt., d
STRl1Ct
Ht�?Ect C R
'O
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9 7_04
NATURE OF PERSON CONSTRUCTING THE WELL DATE
S bmlt the origlt 1Lto the-I9ivisi n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
69 GW-1 REV. 07/2001
27h99';.T 6116 PhoilcflA o: (i)I(%y'i33-322 ,within 30 days.

263105
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Clew c.%w Ca_ CERTIFICATION i�-�a7
WELL CONTRACTOR COMPANY NAME
S-Hf1cuK. (A-A2-0 V-1(1%d
PHONE # owl/Ay-Mc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
c
Nearest Town: ,e of Cot my .SL+JA.,
Gal6,� ; 1 Gee' Al
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C.,1,4 f4 R a
Address Q/giCJ,ra4N rjktek red
, (Street or Route No.)
Q rP✓C�y ry.c. 0487/3
City or Town State Zip Code
(gas )- `+ii 4 - ]Y
Area code- Phone number
4. DATE DRILLED g-s 3- v2-
5. TOTAL DEPTH: arc"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7
STATIC WATER LEVEL Below Top of Casing: RO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley h3Flat
(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 L DISINFECTION: Type Coo✓/NZ- Amount j't 6IWt
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To'Fi Ft. /off 9vcri 4 p vc•
From To Ft
From To Ft
13. GROUT: Depth Material Method
From / To.2O Ft. SaN4-LCe..p4 Pa rA vei
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
LOCATION SKETCH o -
Show direction and distance in miles from east _.
two State Roads or County Roads. Include tails road:
numbers and common road names.
vlr` c i
lh
(911
Cj
taaj
L{5t°t
t Sw hEIce13 t Cr6.T9 t AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA C • 2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
% _ ✓- _ , 9_ 7— o 2--
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
GROLI,NOWAJLFS SECTION
ASFIFV LtP II§Etu trip gm.So the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
[/699-16361111one No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
264462
North Carolina - Departlnent of Environment and Natural Resoyy�urr\cesy- Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) Glen N r s l ` 1 ` \o -\c sy
\\ELI. COST ItACTOR COMPANY NAME 4 AAC-rr C'PNf tO Yi]�.. �7t'k,‘ '11 V4
S'l A T E \CELL CONSTRUCTION PER\IIT# ASSOCIATED \VQ I'ER\TIT#
(ifapr licable) (if applicable)
CERTIFICATION k.25 99
PHONE
I. WELL USE (Check Applicable Box): Residential Ii\lunicipal/Public ❑ Industrial D Agricultural ❑
Ntonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other; List Use
2.
WELL LOCATION: �7
Nearest Town: % - s 0 s) _Ck'M County Jx1ea. IC)
P-4- 3 '3 ('0.r.\r✓�
(strat Name. Number, Community. Subdivision. Lot No., Zip Code)
3. OWNER:A ; m ;�
Address 1` r? Lee. � c rncrP+nr?1/43e.
(Street or Route No.)
\4 S 51 ft\ n c c* j I on a. B 4744
City or Town State 1 Zip Code
)-
Area code- Phone number
4.
6.
7.
Topoeraa hic/Land setting
❑Ridge Lr7Slope ❑V'alley ❑Flat
(check appropriate box)
Latitude' longitude of well location
( decrees'minutes seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo mation Description
;5i C.10.y,S4Nd
DATE DRILLED CI A,,Si-38; agoa /51 -
TOTAL DEPTH: �(?'S '% 'a.
vie -
STATIC WATER LEVEL Below Top ofCasinu: ¥O FT. al 5 _ al 7
(Use "-(' ifAboee Top of Casing) f.- Ir7 -,PS' 5
S. TOP OF CASING IS i FT. Above Land Surface* 095 -aA 1 i
-Top of cuing terminated at/or below land surface requires a
variance in aceordanci with I5.-A NCAC 2C .0118. 0 9 7 - 4
9. YIELD (gpm): 3 METHOD OF TEST a t C
10. WATER ZONES (depth): I - 1'7 b 1 - al 5r
ITh,_A95
i-L-T H Amount I ga` a3 en -
DOES WELL REPLACE EXISTING WELL? YES ❑ NO �rj . - f l 5
11. DISINFECTION: Type
12. CASING:
Depth Dialer
From ) To ) Ft.
From To Ft.
From To Ft,
1 /
roc no r'1-z.
c73 Cat.)
C c )Ls - 4- -t
Al 1 f C
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or AA'eieht'Ft. material numbers and common road names.
13. GROUT: DepthNlaterialerial
Erorn_C) To90 Et. CA_ef\e,Jt
_-,]luthod
0P
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 Nlaterial
From To Ft.
From To Ft.
16. RENIARKS:
�i , 133 to cb, e 2 0--r e ei�
R, i 3 .39 L`etcF pee( CreeiF
3 "13 63 el-+s i ro.f,c k
J ceN ; C- - C LI fr'i v e_
r.\
r�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL '"
CONSTRUCTION STAKDARUS, THAT Q COPY OF HIS REC RD HAS BEEN PROVIDED TO THE WELL OWN
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 259368
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTIUCTOR(INDIVIDUAL)NAME G(.pirlat) 2ritt JAI d.(_. - CERTIPICATION a 2-O-'cO
WELL CONTRACTOR COMPANY NAME li trrra,rn L M,LI illitZU o-.d PHONE 0 52/31 (f-?9—$/{S'cf-
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ7ERMITP
(if applicable)
(ifnpplitable)
I. WELL USE (Check Applicable Box): Residential ID Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection (3 Other 0 If Other, List Use
2. WELL LOCATI N: .t_.
Nearest Town: OcItu!, -, CJ1( County-S(AI CJ-p.
(Street Name. Number., Community, Subdivision, Los No., Zip Code)
3. OWNER. eft Car—L-)
Address t2i) alco-
Zip Code
cam)- L1-9?--a3 64
Area code- Phone number
4. DATE DRILLED $'J/Jao oZ
5. TOTAL DEPTH: 'Rd
S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ca
7. STATIC WATER LEVEL Below Top of Cuing: o FT.
(Um "+" If Above Top of Cuky)
8. TOP OF CASING 1S ! FT. Above Land Surface*
'Top of easing tutalaeted ally below Iasi sachet regales a
variance la mordaeee wnh ISA NCAC 2C .01111.
9. YIELD (gpm): 0 METHOD OF TEST A
10. WATER ZONES (depth):
�/ty�A� ^��. (Street or Route No.)
OI«'7own state
11. DISINFECTION: Type C9
12. CASING:
Depth Diameter
From ('� To_ L 7, Ft. y
From To Ft.
From To
13. GROUT: Depth
From f) ,To j20
Amount 0
Wall Thickness
or Weight/Ft. Material
SD14%l) pvC
Ft.
Material,.
Ft. C@/7yl2-rt,y
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
From To Ft.
From To Ft.
Method
*
Topographic/Land setting
❑Ridge 0Slope -❑Valley ❑Flat
'check appropriate boa)
Latitude/longitude of well location
(degree.Iminutuhecondt)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH RBfl1INSi1S)t-t
From To Formation Description
0
rn
1
16. REMARKS:
Material
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. t0.h�,
yti.W/r\ 'it 6h 441...4.00411 .9 a./
to .-}Y Scrn.-twrn ceytt Y14-U4
Material - cc, Oa nN
Giu l.•n`r1, 13'.t' lict
cjc 9Yft L ✓� d Wr .d%
ltr-
-tofu-, ii-l tin at1 q
/LK. y.z, riff0
Awytm
c.y,_ ILO- Sl obtu A)L,
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
„,H,„ psi,,
t toriginal to-else-.lvl
he $on f Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
Ira 1636 Phone No. (919) 733 322I j (thin 30 days. GW-1 REV. 07/2001
EF?ER ONCONSTRUCTINGTHEWELL
811/aooa
DATE
GROUNDWATER SECTION
ASHEVILLE REGION -AL OFFICE

WELL CONSTRUCTION RECORD 259367
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME e (,print) -ER-��,ppr)41I'�r/1.t CERTIFICATION 0,a0S-0-.
WELL CONTRACTOR COMPANY NAME 'O /Oat_/)!sLIitimgt PHONE kpL cpL
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIQ$:
Nearest Town: t/a/ij/ ` -eA.ttj Countyc5wQL'N
(Street Name, Numbers, Community,�Subdivision, Lot No., Zip Code)
3. OWNER: Kk1rV ALA. i1.7Y1.tVt"i-/
Address
(Street or Route No.)
a me.
>pCity Town State Zip Code
(83 )-_L.42e X330
Area code- Phone number
4. DATE DRILLED R) a/a Oo a
5. TOTAL DEPTH: Jan'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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 cuing terminated ator below land surface requires a
variance la accordance with ISA NCAC 2C.al1g.
9. YIELD (gpm): METHOD OF TEST 7l A/L
10. WATER ZONES (depth): / aS
1 I. DISINFECTION: Type N711 Amount O •3
12. CASING: Wall Thickness
Dixter or Weight/Ft. Material
t7 To R Ft. L5DR1/ "PVC,
Depth
From 3
From To
From _ To
13. GROUT: Depth
From 8 To 2.0
Ft.
Ft.
Matena
Ft. 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
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
Ft.
R
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
r.)
Cl)
t�7
tT
0
t
LOCATION SKETCH 0�
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nu bers and common road names.
ke..._c_afirne-A Btu ` j4-Lc "Plc
lk y9tass,szAt l_r) /6rta.ia )
-t WVY W dyiar -1 74 2e) S i n
rtscer. FiLy it #} 6 t
hit Q-n kt-tgaC/IL Lam) 1gn.F.p.4.,
AA • dL. 3 rru.lt o. n YL L-te,yew,
Buhr i,Rct r 3
ery �rtya.iT2nu.a+t� /3 fed r r
o.Jaz4 nck. -Lyn. AetvaAf ivc/St'!O
Nd - <a "bp )12--EC. �l
HA_h-IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
' 1I AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ c I:NATU ERS NCONSTRUCTING THE WELL DA E
! ubmit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27131KAIISlL6 Af irf 6GaC79iD9D 733-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
cn.

From To Ft. .�-. L - i J.`. p , _ . ttli .h6a . $get 5a
Ft. �-c_/����� .1� d_
13. GROUT: Depth Materi Method ) ! » -�L� N, #
From e`) To .cD Ft. CSSJ/Yc �O -(�."` i
From To Ft. 0 s / 9 y l t `*/O "ilia' ` 4-2;y r.- hi_r
14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. &it W0-p
W42-"v At-4. 5.4 y' ?7.,ornate
From To Ft. in. in. wry hp- a- W Znct-?A stitZ-LaiRS
I5. SAND/GRAVEL PACK: qr, �0TL ; - yn, .,vYal f
Depth Size Material $�7,
From To Ft. 2o.. . 6twn L. i'ci y�, ke 15'fi Rtg1 -
From To Ft. P`m`12._"^`e5it, Rct, / it yuu'iC e_„,-L .,_ aty'i,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J7A�eft��pAfric�q.
WELL CONTRACTOR COMPANY NAME (� AII 0� `rshrV ILt11)41;a1_'n-a.
259366
- Groundwater Section
CERTIFICATION # .ZOSO
PHONE # ie29 tt79-g4Sy
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 LOCATION:
Nearest Town: gVar
County 512) tti)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address T
ctinfai= lane No )
City or Town State Zip Code
(zaz-SUP-o7o9
Area code- Phone number
4. DATE DRILLED 2/47Tao o
.5. TOTAL DEPTH: :tip 1 �'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ri)
7. STATIC WATER LEVEL Below Top of Casing: 443 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)• 8 METHOD OF TEST hZiti/t_,
10. WATER ZONES (depth): .a3 7
Il. DISINFECTION: Type )trk) Amount t7.h43
12. CASING: Wall Thickness
Depth Diajneter or Weight/Ft. Material
From e) To WZ Ft. L t'i% Shg,s PV G
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Form
ation To Descri�t'on
N
C):
C/)
—o
m
▪ r•_
0
C)
CTh c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
nypthrorsI catm, pon ro• names, t
From To
16. REMARKS:
R Y (pER'tlF\1'HAT j WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RI L`TI6N STANDARDS,,A� 0 THAT A COPY OF
J.THIS RECORD�HAS BEEN PROVIDED TO THE WELL
_I - - S_GIVATURE O PHR$ON CONSTRUING THE WELL DA E
Subjpit the original to the_Etibision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699r1B!A "lO41I E3221, within 30 days. GW-I REV. 07/2001
ASHEVILLE R L,Nr+-
Ado

WELL CONSTRUCTION RECORD 259365
North Carolina - Department of Environment and Natural Resources - D''vision of Water Quality - Groundwater Section
WELL CONTRACTOR (tNDIViDUAL) NAME (print) //{R rLt'j AL/ t-7�-�'p CERTIFICATION Aa0SO
WELL CONTRACTOR COMPANY NAME M `D )70LLQ /1DPVALCt
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED StI PERMIT# _
(if applicable) (if applicable)
PHONE N 1q%a Lt�%eI—l{Lte$�-
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: g
Nearest Town: (ll/rJ.y cn C County 6LO&ln.
(Street Name, Numbers. Community,`'Subdivision, Lot No.. Zip Code)
�t 3. OWNER:S11QI,L071 tr TULAn
Address li eit 4ia/t�0.. Rd-
(� "�(Sttrreeett or Route No.)
1Lt-jaCY1/4.
cig or Town tate
Zip Code
(St).)- 964-472,.
Area code- Phone number
4. DATE DRILLED 2/ S/-o o V--
5. TOTAL DEPTH: 3.OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: .59 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS i FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC SC .0118. d •
9. YIELD (gpm): $ METHOD OF TEST arAft,
10. WATERZONES(depth): it
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To Zo
From To Ft.
From To Ft.
13. GROUT: Depth
From r, To ,fin
Matena
Ft. Ce
Amount r) • 4.4
Wall Thickness
Diameter or Weight/Ft. Material
Ft. £/y SnR?_) PVC.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
tar
m
V
m
4.
47`fy ! " 5 D }Tt1.1_U+y -tutu)._
lV/ o�' �'if 3k 4,1r �c S
- ,1.wr.- 'tJs' "` u,. A2An-Mu AA,
I}��� L r. � -
h#CU,0-t car. "tap 7 ;fat,
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads Include the road
numbers and conmmon road names)
Rate-L 0407 r - Q os+
1-0)?s /, lii.wo 1 WAS' Smx-
/�,�l�/0 77u-Lta' ILtA en. /,`t.Wo-t-/ y�,
/ sty sr
16. REMARKS:
S dbmit the original to the
rrettleraittrin
ASHEVILLE REGIONAL OFFICE
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,1 dt s/ffaC0
F P RSON CONSTRUCTING THE WELL DATE
ivisien of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
259364
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
��CERTIFICATION #20S'o
WELL CONTRACTOR COMPANY NAME /�'r.csc(Nr�jry� C.U.F-QQ �Mtivsa, PHONE # JS ag-47 9- H>rSif
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential µa, Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION:
Nearest Town: gn-N in G 1 County 5//0p-tiy�,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (j�,',,`'
Address v'a/ ,f em q anq, )S__
(Street or Route No.)
al-krerC,i-ty "MC --
City or Town State Zip Code
(94/)- 79s-a�fi8
Area code- Phone number
4. DATE DRILLED '09/aooa.
5. TOTAL DEPTH: 7oS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO HI
7. STATIC WATER LEVEL Below Top of Casing: > 2 o FT.
[Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated attor below land surface requires a
variance is accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Ya METHOD OF TEST
10. WATER ZONES (depth): 5 $'S
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To
From To
From
13. GROUT:
From
From
14. SCREEN:
To
Depth
To 0
To
Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
1477)
Diameter
Ft. 4 r/4
Ft.
Ft.
From
From
16 REMARKS:
1D 100 HEREBY CCR ll-1' T✓AT'
CONSTRUCTION STAND?, DS
U
Amount c,lOS
Wall Thickness
or Weight/Ft. Material
SbR F -pv
Materiall
Ft. &IL/Dril-m-f
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. ir..
Method
Size Material
Ft.
Ft.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
Icheck 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
Cr)
Iv
m
c
n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
EGke g h7.-UU.LI'r'w g Sean-cik v / Y.j0
makrA) 2.1-14 /SI. )44.eat..c)(1 # 7 ¥
24, 5 32'0 tru Ztsv tun,. Ala cd
# 6 y 2" st4T
11 fat-, -Lath R%
(2taAf cn 4.64L ) X e
Y1, e J L)-kWAknp- LCJJF C tm t9' 9hat .
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN U F PE SON NSTRUCTING THE WELL DATE
566,t�KI��Yi�PF Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4 AzS%Fo�4 17 K.��Vl .'/33 3221, within 30 days.
> GW-1 REV. 07i2001

258751
Method
Po
Slot Size Material
in.
in.
Size Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NANIE (print) C/evt)_FW( P41(t2 CERTIFICATION #.Q7
%TELL CONTRACTOR COMPANY NANIE �ult(V I,JLII 5"/II; lCo PHONE # (;a) h ig-813
SLATE \VELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: A2 ScN- County So -WV
f'cepetael
CLt tt.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Lei:itHt t.1DaNj
Address CLtSs pp4ch Cx.2r egad RI
(Street or Route No.)
Be-14.SGN tv c d*g713
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 340 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 46 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth):
12
2-6_ el -
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesdninutes/seconds)
Latitude/longitude source:❑GPS0Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
DISINFECTION: Type CA lor;
CASING:
Depth
From_ To Tif
From To Ft.
From To Ft.
13. GROUT: Depth
From j To 26
Amount IP CLA°tS
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61'f 764'Law PC.
Material
Ft. Cris- 1 Caatat
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Diameter
Ft. in.
Ft. in.
0
LOCATION SKETCH
Show direction and distance in miles from iPeash-c:;
two State Roads or County Roads. Includedtto rot
numbers and common road names. o c
Ceyt
(
13SS
ti
Cl tijk3L tp� CCU°t ttei
`-/ F'DrL7k c
A.a Nye
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j9
fn'
It
>IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subnii[ the original Di\}sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) /33-3221, within 30 days. GW-1 REV. 07/2001

262329
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na%$prat Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Aft/ ,4ec-e CERTIFICATION p c2 Zo3
WELL CONTRACTOR COMPANY NAME 97/l¢ PHONE 8 f )
STATE WELL CONSTRUCTION PEINIITB ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential nunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Town: Cheriee County --Cwa'/l
Y\CMAT P C 4 -?_)C3A f
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Z;f4 evc vak/-
Address 21, %h:c( CoriSf'
(Street or Route No.)
x OS& (lam. 2`4`1 Y�1
City or Town State Zip Code
( )-
Area code- Phone number(�
4. DATE DRILLED , O Z
5. TOTAL DEPTH: l6 O
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑FIat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DIME DRILLING LOG
From To Formation Description
0 — r c 4y
Y-76O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO D
7. STATIC WATER LEVEL Below Top of Casing: %r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 2- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /Y METHOD OF TEST g�
10. WATER ZONES (depth): 42 D
11. DISINFECTION: Type
12. CASING:
Depth // Diameter
0 From To o2b Ft. G�
From To Ft.
From To Ft.
13. GROUT: Depth a` al
From C To « Ft. )1-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL in. in.
Amount 4, cv�
Wall Thickness
or Weight/Ft. Material
s4fz I Part✓
ethod
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
I..)
0
0
0
0
11S WELL WAS CONSTRUW RD IN ACCORDANCE WITH 15A NCAC 2C, WELL
WD THAT A.COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rn-I6-oz
Submit the original tot e D v
i 7t6®. l ) 733-
ASREVILLE REGIONAL DEFOE
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
I221, within 30 days. GW-1 REV. 07/2001

L
North Carolina - Department of Environment and Nat/u/ral Resources -
Muert/"
WELL CONTR
ACTOR (print) / /
$72/lei'
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMITM
(if applicable)
262378
(if applicable)
WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
e- CERTIFICATION $ 2C1613
PHONE 0 fiel09S7-2 ' F 2
1. WELL USE (Check Applicable Box): Residential ErMunicipal/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 'fawn: C'/7P/h14e-e- County S"✓J/'I
,4
2aihrt franc/
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J & 07el -Se%U.eyc /-
Address %p +&"/4 efoil" y
(Sweet or Route No.) I C►
CXIPrnI IOC!c�
Zip Code
City or Town State
Area code- Phone number
4. DATEDRILLED 7'12-o/i
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D'
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopograpltic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4(n - /20
7. STATIC WATER LEVEL Below Top of Casing: /S'd FT.
/ (Use "+" If Above Top of Casing)
8. TOP OF CASING IS / z- FT. Above Land Surface*
nap of casing terminated actor below land surface requires a
variance In accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): SD METHOD OF TEST /i/
10. WATER ZONES (depth): 360
11. DISINFECTION: Type
12. CASING:
Depth
From e To /
ie
//7-#
From To
From To
13. GROUT: Depth
From 6' To
From To Ft.
14.-SCREEN: Depth Diameter
Froth To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Diameter
FL 6-
Amount k'/co,'
Wall Thickness
or Weight/Ft. Material
16. REMARKS:
GROUN
SHEVILLE7(Lo914
Ft.
Ft.
tc9a l
Ft. eirlA2-(
¥cthod
/ter e-
Slot Size Material
in.
in.
Material
61/4, t
C/V --6.-an, /le
/-e-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
—HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Let --
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ral to 1 he Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
4o. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001

262942
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na�,ural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
�
nt) rer/7 Zee tC �1 CERTIFICATION cedidi
WELL CONTRACTOR COMPANY NAME -97
i l 1 /ri j I in i3 PHONE 8 IS%Z%f 823 %'7 5F 7
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential D-vtunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONJ.'
Nearest Town: ('6e.-n6e-e-
County JW4,7n
(,-T4 Sf 1/ 1ia7Li
(Street Name,Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: &r,t:e Lo,s/4/
Address Gin 7 - Col?'
2 1 e O{ iP (Street or Route No.)
'\G- S.lei
City or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED 7—oa 0 v
5. TOTAL DEPTH: 3rfo
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
'(use
8. TOP OF CASING IS /' FT. Above Land Surface'
•Top of cuing terminated u/or below land surface requires a
valance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): r METHOD OF TEST /52/
10. WATER ZONES (depth): 3)
11. DISINFECTION: Type /77# Amount 4-ec
Wall Thickness
Depth Diameter or Weight/Ft. Material
12. CASING:
From D To 5-6 Ft. L2s
From SCo To 6fri Ft. 6-2-5
From To Ft.
13. GROUT: Depth
From (5
f4t!2/ `e/c
/SY 5fez
To-2-0 Ft. -
From To Ft.
14. SCREEN: Depth Diameter
Fronr To Ft. in.
From To Ft. in.
Depth Si
From To Ft I
From To Ft.
IJ
16. REMARKS: ,
1 DO HEREBY CERTIFY THAT THIS ,•'g4ELL WASCONBTR
CONSTRUCTION STANDARDS, AND T#IAT AL'MOY OF THIS RE
15. SAND/GRAVEL PACK:
,Method
west✓� e
Slot Size Material
in.
in.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sorce:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Cr--7 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.
I%)
0
0
0
ANCE WITH ISA NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
max. e SIGNATURE OF PERSON CONSTRUCTING THE WELL
rn—OzO%
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesr- Division(N�_of Water Quality - Groundwater Section qr�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) le rU M 1,1 r"\ �"r\tS CERTIFICATION Rocs/
�'r
\\Tt.L coNTRAcroR compANY N:\MEANNC- V CCA e �)r'ot, lC %X r,' - S yi va-HONE # Wafs) Sr.-555a
STATE \\'EI.L CONSTRUCTION PERMIT# ASSOCIATED WQ PER)IITR
(it -applicable) (if applicable)
C19z,?ecONi4�
263304
WELL USE (Check Applicable Box): Residential LW Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: NCv'(-':�County
6 \ CA rkJ_ 0-11- ' K ' n1 Z c cO
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: tJ0 (l, t`+�
Address 3'1/4-) en e \',-� r y e S`t-.
(Street or Route No.)
fJprQ-vr>osS. GDoti l
City or Town tare Zip Code
( )- 6 LA — v
Area code- Phone number
4. DATE DRILLED-Sv& \ x( ,71
5. TOTAL DEPTH: tab /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO DI
7. STATIC WATER LEVEL Below Top of Casing:. C) CO FT.
(Us • "+" if Above Top of Casing)
E. TOP OF CASING IS 1 FT. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .011S.
9. YIELD (gpm): A NMTHOD OF TEST CL z r
10. WATER ZONES (depth): '-( - I LA'S/ 4 - 34 5
I I. DISINFECTION: Type -
12. CASING:
Depth } Pla icter
From C3 To L( 1 Ft. Lc '{
From To Ft.
From To Ft.
13. GROUT: Depth
From (t> To au
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Amount -3G Q
Wall Thickness
R'eio it.'Ft. Material
�ur
tNlaterial Method
FtCtm eto-t- 1 Q
From
From To Ft.
Depth Size
To
Ft.
Slot Size Material
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS COL
CONSTRUCTION STAND.A; : AND T AT SPY
SIGNATURE OF PERS
Submit the original to the Division of Water Quality
27699-1636 Phone No. [phone], within 30 days.
Topo_graaPhic/Land setting
DRidge L-Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes./seconds)
Latitude/longitude sourer:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From — T.�oI' Foytngti11-A� Description
kt
rA 1L1 r'4 e-
C't`ntitf
`1 — Iy5
f4c t4?
/ y 7 — a, 5-
- 357
"39 7 - C:C)
a v t`�-t�
'eta<
icy\ cv rJ t 4 L
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.
/"7L` 3(-yso,c)0, y/ Nq&^icckccict
n r, cla
c< }r
�1`�*sF\ ceel( -0 GA
NCAC 2C, WELL
TO THE WELL OWNER
// 5 _ e9)
STRUCT1NG THE WELL DATE
Fa4dBsem Ir54
ice Center - Raleigh, NC
GW-1 REV. 07/2001

258747
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
M ELL CONTRACTOR (INDIVIDUAL) NAME (print) CJ4 t'L1.Adf S 4ilc - CERTIFICATION# 02—X7
\YELL CONTRACTOR COMPANY NAME
Role Wed( a-tutnt- j rj
PHONE # ($28)-f�84979
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2,
WELL USE (Check Applicable Box): Residential lu Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: R 41(cr+) 2-147 County S W a1 r
D UJ QL AI
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Qo6Ar S,✓;dt+t-
Address L)k/44t41. r✓
City or Town Sine
( )-
Area code- Phone number
4. DATE DRILLED 'J-t, r "+-
5. TOTAL DEPTH: 9.1eC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: log FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /S METHOD OF TEST
10. WATER ZONES (depth):
(Street or Route No.)
6124./Cod r1 c. 3"113
Zip Code
I . DISINFECTION: TypeChiard Amount /IGRa..c
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ( To 72- Ft. 4%4 hCL r+x.R Pvt.
From To Ft.
From To Ft.
13. GROUT: Depth
From 1 To ,4D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Sizc
From To Ft.
From To Ft.
Topographic/Land setting
Fi}Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Material Method
Ft. 5,44 J- CiLrwul' PorJ24
Ft.
Diameter slot Sizc Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Material
O
rV
LOCATION SKETCH = Show direction and distance in miles from aast
two State Roads or County Roads. Include toad.cc:
numbers and common road names. r _
O E
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.-j iP-
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
(\N�att{u�n�-�` Natural Resources -
Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) YVf CERTIFICATION#�� SO
Jd UUU pr'
WELL CONTRACTOR COMPANY NAME
.aQLn, w,LPL�,iti
257267
PHONE # 1Z.ACF!1 SµSI,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
sr,
County SwcL4.,-..
(Street Name, jNumbers, Community,y,Subdivision, Lot No., Zip Code)
3. OWNER:W t�U7r�r- O/2-QJ'A
Address h9.a-e&rn4 -5L IZ4 -
(Street or Route No.)
`71-C—
ty Town CiSt to Zip Code
(SZSf)-Y2&-6s77
Area code- Phone number
4. DATE DRILLED 7) 30/%...60
5. TOTAL DEPTH: 4230
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO HI
7. STATIC WATER LEVEL Below Top of Casing: / L o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/a METHOD OF TEST R '-&
10. WATER ZONES (depth): - S_3 O
11. DISINFECTION: Type 4-78 Amount 0•9S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From fl To 0 Ft. C'/L} S»K xi 1 V C-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From T] To 7 f) FL CA-rrVVr¥
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 DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c.
0
c
CJl _ —.
UT 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
'Y ym��✓ �.C�rrAa+Y�Ck e
.6411
14o4Lrr o_':s._ /Q. r 2`f/0 mz.r� ' i wr
(Usfi Un tc cry ems. etA , 5�
6/o »JQ ±t„2 rtAt Ij F.,-vra' 2 .
s,tai erg 211 ni Yit.trl , (1.2 P`t
-t<.w)., n,t< CT- w i try
I
Darn WElj C TI AY
CONSTRUCTION STANIfr
R
—J
L smmuithM(6f' hl4IlN he Di
qcF ' 99-163'6E91in4 Nro I(9i 9J 733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/F c� 7%Jy6' -)n2_
SjC.,)VA E OF PERSON CONSTRUCTING THE WELL ATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days.
GW-1 REV. 07/2001

257257
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 1 i2s. S
PHONE # fila 4-79-•Q454
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ ERMIT#
(if applicable) /
I. WELL USE (Check Applicable Box): Residential [d Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLTown If1�l: n ,,
Nearrestst Town n1 County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: � ,kULS) JL
•
Address taut'Detp en k, Rei•
(Street or Route No.)
Cc2j Ji
Cit or Town tare Zip Code
(ga9) Y�-_9)33
Area code- Phone number
4. DATE DRILLED Zi1._D2_
5. TOTAL DEPTH: SOK
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top Of 6 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 laud surface requires a
variance In accordance wltb ISA NCAC 2C .0118. r
9. YIELD (gpm): ) METHOD OF TEST alit,
10. WATER ZONES (depth): 4 (him
11. DISINFECTION: Types t
12. CASING:
Depth Diameter
From D To { ti l Ft. to kt
From To Ft.
From To Ft.
Amount . Sh
Wall Thickness
or Weight/Ft. Material
soy zt P V C.
13. GROUT: Depth Material i
From D To /I Q Ft. l oirnvnif
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:
�DQJjIE C6TI '
Method
}./-
-6"JA deC
"-cokra�_- - .rit01/wJI
%aaf
ff
Gzr0,3.5iLdtim,2c/rD
Putt.— lila* 0.4L, .r
Slot Size Material
in.
in.
Material
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
DATE
SI NA i RE O5 ERSI' CONSTRUCTING THE WELL
iQir a Di ision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
(if applicable)
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 pRILLic Lao
From To Formation crion
-
� _.
To m
r z
cn —+
LOCATION SKETCH
Show direction and distance in miles fro;n at least
two State Roads or County Roads. Include the rod tixf
nu hers and common road na es.. 0 1 a.
bd6 ,tom as. t 175 dwr
.Ra41-, tout a,-,:40 f w n ru fret t o7
--to eitJ apt 'tap : "
ts� t klot
221, within 30 days. GW-1 REV. 07/2001

258750
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CkicLaric c41k& CERTIFICATION#.43a7
WELL CONTRACTOR COMPANY NAME pIkt IP'z"t D;iclli ✓b. SAfc PHONE # {(18) `W3-f130
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential I ' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Q&alCca C>I'y County .illAtrJ
_dtaq ftzA t.(
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Doh RAJ Cod Ya%f✓
Address 02..A04.4 2./ &Z.ISon"
(Street or Route No.)
4
6
7
City or Town State
(<74 )- 94a ni
Area code- Phone number
DATE DRILLED 1-3-ni.-
al 711
Zip Code
TOTAL DEPTH: ?cc
DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
STATIC WATER LEVEL Below Top of Casing: FT.
(Use `+" if. Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): aO METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope G3{/alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Q,1nr:N
12. CASING:
Depth
From / To 91
From To
From To
13. GROUT: Depth
From i To.2.O
From To
14. SCREEN: Depth
From To
From To
15.SAND/GRAVEL PACK
Depth
To
To
From
From
CONSTRUCTION STA
Amount i t rzanac
Wall Thickness
Diameter or Weight/Ft. Material
Ft. /, r/ I ere
Ft.
Ft.
Material Method
Matt re*{
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
C.)
r.Y
V
O
LOCATION SKETCH
Show direction and distance in miles fromn Ieaie
two State Roads or County Roads. Include the road
numbers and common road names.
fit\\
ik. _
l4 In'
cfrI
5 PY
4�0
01,iLf-1
,Ay 19 Svµo-ly
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Ir $'UUhti[ "G Vinik Cr Q ( e ;i v the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1B3n Phone No. [phone], within 30 days. GW-I REV. 07/2001

256030
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater r SeNction
2045
WILL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Heiden Brothers Well Drilling, Inc. PHONE ae28) 369-9591
WQ PERMIT,/
STATE WELL CONSTRUCTION PERMIT ASSOCIATED(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Indust:iai 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley :Flat
(check appropriate box)
Latitude/longitude of well location
Submit the original to th
ASIE REGMNAL
2. WELL LOCATION:
Nearest Town: Ela
Jonathan Walk RD
(Sceet Name, Nunben, Cemrwnity, Subdivision, Lot Nc,, Zip Cede)
3. OWNER: Regina Vamvakias
Address 615 Pine Fclge Thrive
(Street or Route No.)
Spring. TX 77380
City or Town State
( 28)- 367-7RFF
Area code- Phone number July 9 , 2002
4. DATE DRILLED
5. TOTAL DEPTH: 125'
6. DOES WELL REPLACE EXISTING WELL? YES SalcNO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST ]aloe
10. WATER ZONES (depth): 95' R 115'
County Swain
Zip Code
11. DISINFECTION: Type HIH Amount 16ce
12. CASING: WallTnic)tness
Depth Diameter or Weight/Ft. Material
From 0 To 5 Ft. 6" .188 steel
From "_To 77' Ft. S"
From_ To Ft
13, GROUT' Depth Material
From 0 To 20 Ft•ba- n to & wrest
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size
Ft.
Ft.
pvr
Method
Slot Size Material.
in.
in.
Material
(degas es:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTE • PRILLTNG LOG
From To Formation Description
0 75' clay & sand.
75' 125' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include Lhe road
numbers and comrnon road names.
0
N
C—
r—
J
a
0
N
01
.S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND ice' A COPY OF THIS RECORD HAS BEEN PROVIDED TO Tim WELL OWNER
/ i S ONATURE OF PERSON CONSTRUCTING TIC WELL DATE
DM len of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733.3221, within 30 days, GW-1 REV, 07/2001
ctut

WELL CONSTRUCTION RECORD
263303
North Carolina - Department of Environment andNatural ResourcesM1
- Division of `Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(//1 ePJ AI 11
M11. 1 \ 0...* i S CERTIFICATION # 955'7
�V U3e\\
WELL CON"t' AcroR COMPANY NA E�-+pr �}Grer P.)t? caC-0 S. KISVnr oc s II OAP HONE #fiat 6glo,' �Sa
STATE \YELL CO.NSTRUCIION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (ifapplicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Nionitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 1f Other, List Usc
3. OWNE
Addres
-Ne- .-*9( 3
City or Town State Zip Code
( )-
Area code- Phone number
4. DATEDRILLED—.C"tl.tc.0 (cl acca 55 - IS`C)
5. TOTAL DEPTH: .5Sc, 180 1g
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C9 (;da — y 3 b
7. STATIC WATER LEVEL Below Top of Casing: 1 (o O FT. 9 30 ,_L( 3 a
(Use "+" if Above Top of Casing) - S-
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (nom): 3 METHOD OF TEN 0 i r
10. WATER ZONES (depth): — 180 a — 4 3 C
- t[ 55 LOCATION SKETCH
I I. DISINFECTION: Type - r (-rr Amount a t{, %j pz Show direction and distance in miles from at least
12. CASING: Wall Thickness
To Ft. D_ ian)eter oVeigVFt. Material
Flom
JQ,ti 4 ct h cd
Topoggr3phic/Land setting
❑Ridge LriSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees lminutes/seconds)
Latitude/lonnitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descript on
f 4_01�� 1t
i^et -
CS t"Cttii e-
00.vt41
eft cLo 'E
2. WELL LOCATION:
Nearest Town: Vy--�SOrJ�t-it"Lf County §LCc tsj
Q 0 C aN--�' c` c
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
R:V.:ieoc&-1dr(o.
fJ 'V\Qea (Je,-�S0/\)
s Q'.�. Ian•Jc 5tk
(Street or Route No.)
Depth
From To Ft.
13. GROUT: Depth Material Method
From r:To 0o Ft. C_er\e,Ut t n p
From To Ft.
14. SCREEN: Depth . Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To Ft.
From To Ft.
L4 c'f') —
two State Roads or County Roads. Include therrg2d
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS \V LL WA
CONSTJ.VJ TION STA ,)S, A' HAT A
SEZUCTEIENgRikk
Itt*T' A BE
,fr. 1 9
SIGNATURE OF IEEE&N eONFSTRTUCTING THE
Submit the original -to the Division of Water
27699-1636 Phone No. [phone], within 30
}b 144t1"
ays. Asu:\n i_LE REGION
\\}}K�ITH 15A NCAC 2C, WELL
P R�OVIDED TO THE WELL OWNER
Imo!, 1636 N
OFFICE
DATE
ail Service Center - Raleigh, NC
GW-I REV. 07/2001

13. GROUT: Material
From 0 Ft. Cemen) ¥
From Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resoouurcess�-- Division of WaterCQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)inGI eN (�/// // er- ( 1 .S CERTIFICATION #rsQ_J 1 i
1. ELL CONTRACTOR COMPANY NA\1E)'1 /4 P 6-rreme. (3 )s, ti ♦,.JIC3 zy/l &t PHONE # C) 5o fp 555G
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IV/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCA-r N:
Nearest //Town: x,&Dt) 0..).A1 County S V : 1.1
�l IJ\ C5-k NVVIND
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1-1J5`'e\ o o C tf
Address S .t� . oy,c 3€in
2 (Street or Route No.)
V JC,.( S L5IJcLAt-�.f i�i a�7 t
City or ihsown State ` Zip Code
(MC)- '-/ Y.—.S — 7 ?r 2
Area code- Phone number
4. DATE DRILLEIi.) 3v. C ass) acoa
5. TOTAL DEPTH: 2- S O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO BI"
7. STATIC WATER LEVEL Below Top of Casing: 11 b FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,) METHOD OF TEST C\--.% r
10. WATER ZONES (depth): rr4 le 5-
1 I. DISINFECTION: Type \-Vt VA
l2. CASING:
Depth Diameter
From 0 To Jao Ft to ak
From To Ft.
From To Ft.
Toporaa.c/Land setting
❑Ridge l!?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
its—ac 5 c.�\oJ.+e-
a•(o `j — aG, `-/ CcLU ; 41
0 —85b �^aN,rf
LOCATION SKETCH
Amount 3 ),5 Az- Show direction and distance in miles from at least
Nall Thickness two State Roads or County Roads. Include the road
or Weight Ft. Material numbers and common road names.
p vc;
Method
10e
Slot Size Material
in.
in.
Depth
To
To
From To Ft.
259840
S!q IL-11J ma,N®�re�
SR !39"7 l I)am$S jctte7
SR It9'3o0,in--occt-c*�
S R 1 1.? C o ti) s C-rcek
Sty I(gErSo w
(r R�
S(�II�� e a
16. REMARKS:
CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL OWNS
; = 2002 _
Submit the original t the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROg,Kj[t(asP1 6643A 1(919) 733-3221, within 30 days. GW-1 REV. 07/2001
AS',EViLLE REGIONAL OFFICE
SIGNATUI2E OF PERSON CONSTRUCTING THE WELL
DATE

258749
D
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) (kdatArl 1-u (kt. CERTIFICATIONS/ 02317
PHONE # fkrAS)'FBS4730
WELL CONTRACTOR COMPANY NAME fNAtit Wtd AtI I (!n4 17 ac.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: f2,Ci:.tt/ CountyS(4MA)
Ca? P-)I( c..14eL
(Street Name. Number, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Pakl- hMrnF
Address 42S3
Set
- (Street or Route No.)
City or Town State
f_)- t14- ga-
Area code- Phone number
4. DATE DRILLED 6-i1-1,l-
5
6.
7. STATIC WATER LEVEL Below Top of Casing: 2,a 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): METHOD OF TEST
10. WATER ZONES (depth):
19R4s
Zip Code
Topographic/Land setting
❑Ridge fiSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreestninutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
TOTAL DEPTH: %1SS"
DOES WELL REPLACE EXISTING WELL? YES ❑ NO e
0
II. DISINFECTION: Type Clio r:rd
12. CASING:
Depth
From 1 To 13e Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 1 To at,
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
ES�i\I�S
0 HEREBY CERTIFY
1 CONSTRU TJ,UOMLLORND
Amount /2 toaan6
Wall Thickness
Diameter or WeightiFt. Material
FB CM, L.-
Material
Ft. £nr'd .-Cz.n4,k
Ft.
Slot Size Material
in.
in.
Method
(iirad
Vlaterial
v=J
LOCATION SKETCH - --
Show direction and distance in miles from IeaSti_'
two State Roads or County Roads. Included}le row
numbers and common road names. 0 o
sat , —
iisod
C;
Nl
1/tp1'l
�� �yufly
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(_oe-•
DATE
— T MIR tSE
S9V3fii♦3! �ut;m if 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
S GNATURE OF PERSON CONSTRUCTING THE WELL

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONl RACTOR (INDIVIDUAL) NAME (print) CJL4JtLA4'I -4 d- CERTIFICATION #232'
V\ ELL CONTRACTOR COMPANI' NAME Pt111C(, LIJtlt L1-rt It M.. ZnC PHONE # (Y1a)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
258798
I. WELL USE (Check Applicable Box): Residential f' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: QrS?.✓ Countv S,t:r&t'd'
Co Cb,n owtv:h
(Street Name. Number. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: CUHIL '%/jc.npboiJ
Address Sr I
(Street or Route No.)
R R4 Cc./
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED G-04-ca.
5. TOTAL DEPTH: 4So�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ere
a$ )I'&
7. STATIC WATER LEVEL Below Top of Casing: lot) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): g METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From I To 41
From To Ft.
From To Ft.
13. GROUT: Depth
From I To a-c
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REM
lol-:N Amount iaCi¢,Y.0
Wall Thickness
Diameter or Weight/Ft. Material
Ft. L. 14!ck_)si .pot,
Material Ft. SO7N9 1 t.9,'neVy
Ft.
Slot Size Material
in.
in.
Method
Qiure,/
Size Material
Ft. ., i_ t✓oK`L
Ft. (f
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C✓JF lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
CD
v
LOCATION SKETCH =�
Show direction and distance in miles fromaleasE
two State Roads or County Roads. Include the roams
numbers and common road names.
1%<: C.
L� arc
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
‘-/%oa—
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
sion of Water Quality, Groundwater Section, 1636 Dlail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/200I
lek-
s.—y

71
255765
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C j teIa.Nst/i /i Rate'
Y
WELL CONTRACTOR COMPANY NAME fj IICY Well Qkr" ' iie
CERTIFICATIONpp- # 5rL7
PHONE # (garvse-s 3l'
STATE WELL CONSTRUCTION PERMIT# '1 V a Cie ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential GI' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: pjr ,»J f i-Yy County i9-ietl
A-t-Ka _124
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1)421Q . 2 AY'rJ
Address f ;C;IN Crhea-
(Street or Route No.)
Sorg r'"' a8l1S
ity or Town State Zip Code
( )-
Topographic/Land setting
❑Ridge ❑Slope QC/alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED 10 *4'D2..-
5. TOTAL DEPTH: P
6. DOES WELL REPLACE E ISTING WELL? YES ❑ NO Fd
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): i`+ METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type C)tlo✓//✓ Amount q et *Al
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To in FLa %rtcJL4lt PvC
13
14
15
From To Ft.
From To Ft.
GROUT: Depth
From / To 2. D Ft.
Material
SAnd -4
Method
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16 REMARKS:
(Lot FI HEREBY CTBR
CONSTRUCTION S
F
O
L
f'-
o
0
m
0 Tn
Nfri
Na
LOCATION SKETCH W —+
Show direction and distance in miles froraleas
two State Roads or County Roads. Include the road
numbers and common road names.
--HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Li
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Cn'lUig'tMiiEFt662f igihal to t 1e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
�- �32d ia�'k�f Fk1Gk Tura) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
255a764
North Carolina - Department of Environment and Natural Resources - Division//'�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Gt✓e LNtwC� rai( Pa IIL/( CERTIFICATION#3g1
Fuutr Wet( Drr)ft Sao
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
1. WELL USE (Check Applicable Box): Residential la' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:r�,,"
Nearest Town: r'xrg{oT1 County Sw'41N
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROL CYAt✓G:t.cl
Address 644 4vre.-
(Street or Route No.)
Boito r N-c-• s.8713
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 6—f5-O"L
5. TOTAL DEPTH: $0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E
7. STATIC WATER LEVEL Below Top of Casing: p' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST
10. WATER ZONES (depth):
Amount 1 ae,"C
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From-1 To 15' Ft. Vet 14roc wag NC"
From To Ft.
From To Ft.
13. GROUT: Depth Material 1 Method
Froni_L To an Ft. Sea 4-CCA,,.v4' lout/e,c(
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
PHONE # f32f1+fRg-fe 730
Topographic/Lad setting
❑Ridge ❑Slope IValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION:. Type all /OKM -
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
UR.II
stok
�VC
09f+ CRtet 2.1
to
O
N
L
C
t—
O
16. REMARKS:
IpO ;_ERoW;tEtilF
ONitrizIyCTIONSTA
D
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
!DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
&LIGW rkiih
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
-Submit the original]to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
i7699-1t46 P$ntl o. [phone], within 30 days. GW-1 REV. 07/2001
c
c
ylc,✓
Cray

255388
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)r—P Qt.P y DUI' PHONE
CERTIFICATION R�-.Z 050
WELL CONTRACTOR COMPANY NAME l,rVCQ mt Z& J/ DUI' PHONE 11 (A 7LI S _i S4
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W PERMIT('
(if applicable) (if applicable)
I. 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 LOCATI N:
Nearest Town: Q,ro n- l.f. County 140
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:it part(
Address
trees or Route No.)
p, Y1g.
ity or Town v State
Zip Code
(S2$)• S07 OrJIS
Area code- Phone numbee
4. DATE DRILLED to - //- Oa-
5.
6.
7. STATIC WATER LEVEL Below Top of Casing: 6 2 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated attar below land surface requires a
variance in accordance with ISA NCAC IC .011g.
9. YIELD (gpm): 9 METHOD OF TEST (ILL
10. WATER ZONES (depth): 4- /n 2
TOTAL DEPTH: S?0 /
DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
11. DISINFECTION: Type N t fi
12. CASING:
Depth Diameter
From 0 To /,32 Ft. Co %}
From To Ft.
From To Ft.
13. GROUT: Depth aterial
From b To 0
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft
Ft.
Amount O. R 3
Wall Thickness
or Weight/Ft. Material
sbtzzl PVC.
Size
Method
Slot Size Material
in.
in.
Material
E {EIRYiIS:
1 DO HEREBY CERT
CONSTRUCTION. ST
GROUNDWATER SECTION
ASHESI hfnRalieil . e : i ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
c
O `p
C
~ LOCATION SKETCH O 2
Show direction and distance in miles from at -least o
two State Roads or County Roads. Include the road` 2g
numbers and common oad names.- • 624-
44144-1,1,44,
g-D h -
gv a,3 tputo t,vtov jeji
Aie, S. S,Smt:044, turnt
11�x ✓S/r a- °-a-73 , p �e �
n
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF T IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNAT
RE OF t ERSON
NSTRUCTING THE WELL DATE

255.89
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nattural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ) C � UI k lL e, CERTIFICATION #,20, 0
PHONE f fg7P)4 79—gtf S4'
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential
Monitoring 0 Recovery 0 Heat Pump Water
2. WELL LOCATIQN
Nearest Town:
car Municipal/Public ❑ Industrial 0 Agricultural 0
njcction 0 Other 0 If Other, List Use
ounty .h/2Z16,fro
can- Y2 a,"i4i
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER
Address
°Id
ity or Town V State
Street or Route No.)
CP - 'Al I 3
(At )- J-SS 4IL gi
Area code- Phone number,
4. DATE DRILLED (o-
Zip Code
5. TOTAL DEPTH: 7OS 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOY�I
7. STATIC WATER LEVEL Below Top of Casing: 3 2 (o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1/1 METHOD OF TEST (}L
10. WATER ZONES (depth): -3 % el
I L DISINFECTION: Type 1-4 t N Amount Or (n R
12. CASING: Wall Thickness
Depth
From 0 To iic
From To Ft.
From To Ft.
13. GROUT: Depth Material L
From 0 To a 6 Ft. �wtitnt�7
Diameter or Weight/Ft. Material
Ft. (o%i. S R al ;Pg.-
From To _ Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
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 c
From To Formation Deso�rtiorc
I
r e
Crl
o=
=c
St. r^ 3
a_
G
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.Sfr /
R,r,
oJL
,� a // o �2a�, � yip
*Ant de. - ,m,t- 4 4a »e-
eddki,, El 3 'nt bti, iiI4n 7 %h
Lth.rr Qaa�n g0 O, 7 .
el i
l6PEMARKS•
SHE 6BY CERTIFY THAk THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANIARL1a, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG.
A OF R'p.RSON
(2_I _0),
NSTRUCTING THE WELL DATE
S 684iitWhiEd c ( e Di lision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS 2FytF F �C�{ �\R F ( ) 7aa3221, within 30 days. GW-I REV. 07/2001

255390
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcTets - Division of Water Quality - Groundwater Section�t
WELL CONTRACTOR (INDIVIDUAL) NAME (print)e,�7]R�,��/pp/ ((�����y��dQQ CERTIFICATION Mal 0-Sr)
W' ELL CONTRACTOR COMPANY NAME 'LQMt� &Let 2/t.l-teli PHONE # On) a. 74-8-1-1-5.11
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS,
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Q3" Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 if Other, List Use
2. WELL LOCAT N: �I �-
Nearest Town: --eit- County
d'o 17
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
R:c� >
Address w-uvak
(Street o-No.)
1K.. C,-
f713
y or Town State Zip Code
Itia$) ct-gR 97R9
Area code- Phone number,
4. DATE DRILLED 17 — ) 8 _ 001
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
C o
L
1
5. TOTAL DEPTH: ,SOS r-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO'
7, STATIC WATER LEVEL Below Top of Casing: %D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS j FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST,
10. WATER ZONES (depth): 4- if C
11. DISINFECTION: Type Hi H
12. CASING:
Depth Diameter
From 0 To 13 3 Ft. 6 Y,\
From To Ft.
From To Ft.
13. GROUT:
From D
Depth
To a D Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Amount O. A d
Wall Thickness d �.�t�r�,t�
n�a- ' Vnt' oav 0 01gat-n'
a
rnx
O
or Weight/Ft. Material
SDR2t }�Vd
oet I�a� cur n A " 9n, lit �d
io,ntcb4' 2t-- 'rIli t 7.
Ma[erial
r_sn'nant.t.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From
Slot Size Material
in.
in.
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
mbers and common roa names..
,�� p A,Q- Nam' C �t /a,/'
441. t�v r-du✓L ddt J, ,rJO 'N c
�� Ate" o„"
&v,#— �o / ,�b !n� 6L
• m
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL V
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
IGNA'IvURE 0 ERSOONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

255391
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesRnq- Division of Water Quality - Groundwater Section
��-TJ�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ZYo 4"F1° i.3 1-4ElAa CERTIFICATION#aL�_V
WELL CONTRACTOR COMPANY NAME LUGZ, aL :ftPHONE 0 itotatj-79-SII'SH-
ASSOCIATED WQ FERMIT#
(if applicable)
STATE WELL CONSTRUCTION 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 1f Other, List Use
2. WELL LOCATI
Nearest Town:
County --1/4M442.-
(Street Name, Number , Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
I
j
ff 4"04 a sr I t kW/Liv
C(Sireet ardCoyte No.) 67/3
City or n State U Zip Code
(SI_ZQ)- 4YR 4oys
Area code- Phone number II
4. DATE DRILLED (D — D a
5. TOTAL DEPTH: -3 S.5 ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d1
7. STATIC WATER LEVEL Below Top of Casing: (., 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS f FT. Above Land Surface.
*Top of cuing terminated attor below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): l i+ METHOD OF TEST a .uz
10. WATER ZONES (depth): e2
11. DISINFECTION: Type (-I T %I Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To !0 Ft. laIrkspa-alPVC',
From To Ft.
From To Ft.
13. GROUT: Depth Material .t,. Method
From n To ,2 ('7
L Ft. `D.Vh cn,
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:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSr7Topographic map
(check box)
pEPTH DRILLING LOQ
From To Formation Description
O
PO
LOCATION SKETCH
CD
--1
Show direction and distance in miles fromtrbleasE
two State Roads or County Roads. Include the road
74 ho 3 47i1,c4; rieffitt
aiL. O- e2 e- io-etZ%,I go 4T .
/L �� (S _ e7/evcL�v.¢i�n c_ce %
O'" 4
D; HEREd.Y 11IIRT,pY717.\T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN AR AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI A OF P ON C TRUCTING THE WELL DATE
!Mt prigtnilefp the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASH27/686€1686P./M1te NhFel9) 731-3221, within 30 days. GW-I REV. 07/2001

255392
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �F' ,isJ CERTIFICATION #cl6 4'0
WELL CONTRACTOR COMPANY NAME �,4tL^ GU gta9P.q.(4L PHONE M fA2,04—i9.-X4S/f-
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /.,�— / ,
(? Nearest Town: � tij County,�lmle_..e&
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. Oddress j9 DJ
Address G -een./Ytz
(Stre for Route No..))
.e/fit &4r-2.f"-
or Town tate
(Aa8) 43S-2S90
Area code Phone number _
4. DATE DRILLED (o_ .� 5 _ D.2"
5. TOTAL DEPTH: a gn r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO II
7. STATIC WATER LEVEL Below Top of Casing: / lf-e FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 3 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): -3Q METHOD OF TEST V I.
10. WATER ZONES (depth): /
Zip Code
11. DISINFECTION: Type i-} T Ei
12. CASING:
Amount D. a .5
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To t7 Ft. Lo-- SDI2( P V G
From To Ft.
From To Ft.
13. GROUT: Depth Matn erial Method
' From n To _ FL l_2il11-grw
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.
6CtE!AI{K
Slot Size
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 DRILLINGkOG
From To FormationDes4ptiog_
L
9<
r*m
r
rrti 245
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.
l p 'nLf-L, .tc r„t Afi 91, it -
Material ,-, _ „ 1 �,�,-, �,^ ,�y
tw�CJJ�/ a- rss�""`� o`U /try
Material
I DO HEREBY CERTIFY! rHA
CONSTRUCTION STANDAR
lil IJ
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N, iTf)RE OFtRSON
CONSTRUCTING THE WELL DATE
GROUNDWATER SECTION
ASHSUbtratfilleOldginnilflic he D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

255393
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ( rint) L // � CERTIFICATION #ao6/)
WELL. CONTRACTOR COMPANY NAME . 2i ,e /r�r-�"s M ,LIP- , 5 PHONE # $2 ') I-r)4.ki .ct
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERTIIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: oo
Nearest Town:trty I Countye92lJ-(Liin,
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. O W NER:t,Ctp nt.,(?i�'r7
Address a .C�.p n don track.
(Street or Route No.)
(BMAerx �� , '1�l .G �g9 /3
C or Town S Zip Code
(flit)- t{g8 89if
Area code Phone number
4. DATE DRILLED 1, _ 27 - D.2. •
5. TOTAL DEPTH: Si) (a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ld
7. STATIC WATER LEVEL Below Top of Casing: fhb FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS J ' FT. Above Land Surface*
*Top of can terminated at)or below lad surface requires a
variance In accordance with ISA NCAC SC .011S.
9. YIELD (gpm): / A, METHOD OF TEST Q A
10. WATERZONES(depth): IF DCo
l 1. DISINFECTION: Type
12. CASING:
{'(1- Tr
Depth Diameter
From Q To c 7 ' Ft. Le Pkt Sb&a/ {j- V!_
From To Ft.
From To Ft.
13. GROUT: Depth Material y
From Q To 0 Ft. `'Oi7rtp,H A._
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Amount ().'7 i
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commonn��� road nnames.,,-1 /M Ai Q�
•
fro/%7Lf-� 1� .- Lvrit, .C'a. r'9't� - c'
From
From
16. REMARKS:
j_ 7 /l- lir 6-
; . ("a '
IL
FgRE (QERTIFYt' Li'aH IF`
unatRuCTIO DS
!S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
am,
N EOF P(PSON Sf0.0
N E OF P ftSON d NSTRUCTING THE WELL DATE
Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
)133-3721, within 30 days.
GW-I REV. 07/2001

255387
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalatr'Res/ourcess - Divisioniof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME QQdn1L_., --f e Pc.ph�P� f`t'I['� Y7n'� d a CERTIFICATION a .2 0 Sep
WELL CONTRACTOR COMPANY NAME L ag {at rttL'ee: PHONE aJR2AAit)q-S+IS-y'
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
/ (if applicable)
1. WELL USE (Check Applicable Box): Residential 13Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIQN.
Nearest Town:
County .Jt n.
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Codc)
3. OWNER: 9� Address
c1 ueet or Route No.)
a8713
Clyor Town State Zip Code
(62.8_)- .4.-Q7 Cr21
Ana code- Phone number
4. DATE DRILLED (o _ 7 _ ( 1
5. TOTAL DEPTH: 7 D 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO'(b
7. STATIC WATER LEVEL Below Top of Casing: 1a L FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 ' FT. Above Land Surface'
*Top of casing teralaatsd at/or below land seem requires a
variants In accordance with ISA NCAC IC .0110.
9. YIELD (gpm): a)'a METHOD OF TEST wit,
10. WATER ZONES (depth): '. 14
I I. DISINFECTION: Type i) '/'
12. CASING:
Depth Diameter
From__ To /.2 f Ft. /o II -
From To Ft.
From To Ft.
Amount D. IO5
Wall Thickness
or Weight/Ft. Material
sfl. ) "PVC
13. GROUT: Depth Material
From (2 To 3 A Ft. acin yr J
From To Ft.
14. SCREEN: Depth Diareter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idegreeskninutedeaconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILL LNG t OQ
From To Formation Description
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road numbers..(,
co ad eme . a on_ xi/ _ Q al
8sbv) l fr41L004', ,u�rgt, Y.ZlT. 612yL
av 74 -eat _,� a o m 4ea
(9'11.,��/,u„&xt, ..6o % .rn:c,L uAm
411:4-Q.ed . ter rfl t- Q.. -to � slew, >7a4'
a.�,./�'D flo A.w+�r. rGt/�-L„( (Dn- tp J.2art
,(�
1/ rfthn,1 , A/e kn-pus' a-c- stag#
o n
m L E' --
THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL r- e
,i
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER ..!L, c
Cll
, r r,�
V n .�
SIGNA�'JR F PE ON C 'STRU'CTING THE WELL DATE 3 N cm
cn z
G INRifefo6feiiilNo the Division of Water Qualky, Groundwater Section, 1634 Mall Service Center - Raleigh, NC "^'
ASHASHE244 iicii.14il1np0iik1419)7'3-3221,within30days. GW-I REV.07)01 c
z
16�R A K,$ S
I DO IICRCDY CERTIFY
CONSTRUCTION STAN

256016
WELL CONSTRUCTION RECORD
North Carolina - Departnent of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION p 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc. PHONE# [phone]
STATE WELL CONSTRUCTION PERNITN ASSOCIATED WQ PERMIT#
(if applicable) (if acolicable)
1. WELL USE (Check Applicable Box): Residential CS Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town' Br\s1I aty
356 RJLti Ctse
County Stain
(Stet: Name, Nurnben, Community, Subdivision, Lot No., Zip Code)
3, OWNER: R,lr>hi C;lve Ctxmtnity Assxiatim
Address 356 F khi Oast
(Stint or Route No.)
Brys n City. IC 28713
City or Town State Zip Code
(828 ). 488-6071
Arta code• Phone number
4. DATE DRILLED are 25. 2002
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I$
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
•Top of casing terminated at/or below land surface requires a
variance In accordance wlth ISA NCAC 1C .0118,
9, YIELD (gpm): 1 METHOD OF TEST lalaa
10. WATER ZONES (depth): 130'
11. DISINFECTION: Type HIFI Amount 16Ce
12. CASING: Wall Thickness
Depth DMmeter or \V,fieght/Ft. ate 'al
From_0_ To 4 Ft. 6 ao
From 4' To 24'Ft.6" Pic
From To Ft
13, GROUT: Depth Material Method
From 0 To 20 FtbEnZnite & ot. 1?2T1B3
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 Site Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(de ates'mi nuts s/seccnds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH PRILLtNG LOG
F0omTo �222 y Formationad.d. Description
22'—300' granite
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names,
CD
N
CJT
16. REMARKS:
SY'CERTWt THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH ISA NCAC 2C, WELL
=LON ARDS; AND THATOPY OF THIS RECORD HAS BEEN PROVIDED TO T -t".. WELL OWNER
'--t9 J - O 1 -
',.SfiNA'I`URE OF PERSON CONSTRUCTING THE WELL DATE
Sumithe o groat to th�ni' slon of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27 9@6 3.8bTlibitiE1 o A .3-3221,Iwithin 30 days. GW-1 REV, 07/2001
ASNE.T.LE REGLONi-L E

255031
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ad? K SLUd`iiess
WELL CONTRACTOR COMPANY NAME ()1 e `-+auytr•Satio rt.Weil i^O ThC- PHONE # fI2St) G55 768y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # d{ afo
1. WELL USE (Check Applicable Box): Residential Pi Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 / Other El le Other, List Use
2. WELL LOCATION: I( fry
Nearest Town: gel be„ di h� County
(Street Name. Nutnbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
San C4 It
6ece-.
Address fl e% 1i:n RC1
(Street or Route No.)
eicsasnh3 40C. act 7!3
City or Town tate Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 5'4-02.
5. TOTAL DEPTH: go T
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
3. 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 (epm): IS METHOD OF TEST Rt
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slone ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-i 44 0vrr Attr.Inn
144 CO5 Granite
11. DISINFECTION: Type p•(/S Amount e
12. CASING: 1 Wall Thickness
Depth Diameter or Weight/Ft.
From 4-1 To 44 Ft. 142I
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CemQ4# floure_d_
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material
(1 5i in
Front To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
8S:01WV LZNAP ZO
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CnNSTRI CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S�9-v.2
r
• Submit the original to t
27699-1636 Phone No. (91
1GNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

255769
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ "Weak- 1'1 CI- Otte> e. d1 Et'
11 tteCERTIFICATION # 2-39 7
WELL CONTRACTOR COMPANY NAME Fb II CW t-
Y 1 I VIX4 I). t ) 5 R . PHONE #
STATE WELL CONSTRUCTION PERMIT# (ha ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
flats
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 2ro1 sari) t 441
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IV' KP
Address / Arvk Ceee.0
County S4)9 .r'
(Street or Route No.)
&San/ N4:r flhI
ny or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 54 Lr67i
5. TOTAL DEPTH: 2 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lig
7. STATIC WATER LEVEL Below Top of Casing: (o b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST
10. WATER ZONES (depth):
1 1. DISINFECTION: Typeflh/ahld
12. CASING:
Depth Diameter
From —To 3o Ft. _-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From I To %o Ft. 5404i e r r-4,-
Amount I1 GAGA
Wall Thickness
or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
Slot Size Material
in.
in.
From
From
To Ft.
16. REMARKS:
Ii
CONSI RUu l lUN S
debutlIRE6 CRT
Topographic/Land setting
@midge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o _ n
t-
C
r �m
i_D +`
;7c
LOCATION SKETCH is?
z
Show direction and distance in miles from ategast 2
two State Roads or County Roads. Include ttintoado
numbers and common road names.
joy i,kle
�10
13�
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0211
Ga(;Li: ,SFd 11t24rt„ed'F�ta ell to t a Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AsF ly76gg1'Yfl36,IPtt7Natilo. (91
733-3221, within 30 days. GW-1 REV. 07/2001

255768
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ,y
WELL CONTRACTOR (INDIVIDUAL) NAME(print)CIC ✓9J Q Did tle_ u.I AI f U-4tV CERTIFICATION # 2317
,r
WELL CONTRACTOR COMPANY NAME Le.kitY t Li rJQ ywe PHONE #
fSt'7st_ ^gel="S7d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6/ Municipal/Public ❑ Industrial Cl Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: g„- co. / r f ,� County 3c3 . ; ..S
--wPi s c -eeL
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: vi 11 MC C,1.0.-1)
Address /q,,.e(C ate, VA
(Street or Route No.)
Nzif-d4v ry L• C2K113
Zip Code
City or Town State
( Area code- Phone numberr
4. DATE DRILLED -2b mot
5. TOTAL DEPTH: i S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (o D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1 Z, METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
eRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
rn
O err
1 J
" c
3 T
LOCATION SKETCH IV refs
Show direction and distance in miles fron leas�L'
11. CIS ION: Type C�r1or. N Amount ne Want,: Show
State Roads or County Roads. Include`4:k roa
12. CASINGING:: Wall Thickness
Depth Diameter or Weight/Ft. aterial numbers and common road names.
From 1 To -7/ Ft. 10 fly 2v `_ uM'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From / To ZO Ft. 03 . - tii t ' el tic)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Firm
9,f
16. REMAP KS'
I DO IICfioBY CERTTIFit
CONSTRUCTION STAN
Rh the D
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
,CAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERER
9
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE v
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME
(r'(print) ClL✓e-Lrtnai Plata cline'?
CERTIFICATION #
WELL CONTRACTOR COMPANY NAME
rN I 14r - Wel( DY,'I(4NS cria PHONE #(Sta y8Y—fl 30
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
25570-
1. WELL USE (Check Applicable Box): Residential IsS Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 6Ytlbn „,/ Ujc7
i9nsaV,Ja,7 al and
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (/lILfone ✓C�LI tS
Address Cn%rNnrS J&44,I
(Street or Route No.)
QrySol✓ rU.C.
City or Town State Zip Code
County SLOAit\1
a If713
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: Lilo FI'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I 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): /!°F METHOD OF TEST
10. WATER ZONES (depth):
�! Topographic/Land setting
L1Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Ch/or" N
12. CASING:
Depth. , Diameter
From J To *--7 Ft G k/
From To ' FL
From To Ft.
13. GROUT: Depth
From I To ao
Amount /g Gcsr/S
Wall Thickness
or Weight/Ft. Material
TA.'?k WiV PVC'
Material Method
Ft. SAN/ etm, eauveof
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.
Slot Size Material
in.
in.
From
From
16. REMARKS:
K
N
o<
CD
331,0
LOCATION SKETCH ca0 0
Show direction and distance in miles from at least`
two State Roads or County Roads. Include the road
numbers and common road names.
ill
vow
I
1
ldtt27 19 Sow.Pi
inDd MEliiE611' dRTIF'4` AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS I ILUL I !UN o IFkNm RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
pblJm tg qri tot Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
_2.764441636.1'h(rficl0jp. (91 733-3221, within 30 days.
GW-1 REV. 07/2001

255766
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) &t VQ: a-N%d-uka(!,1u-�i tr CERTIFICATION# 2587
WELL CONTRACTOR COMPANY NAME Fet II t Y'- Lit-!' Drs/1Tf`%5 /91t, PHONE # 0154it7'30
STATE WELL CONSTRUCTION PERMIT# 1V. C. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential yr Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
4-I aJYK a RA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: P i- ccti--0--e-1")
Address ?: G.bN P,/ao L.
j ffc of f`I+fI_County St.18-iN
(Street or Route No.)
eigisoel rI.C- a'c-//3
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 5-24-0Z
5. TOTAL DEPTH: 3is, D 6d'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LB
7. STATIC WATER LEVEL Below Top of Casing: 2- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type CA/6Y:d Amount 3CQ.pC
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To eil Ft. G %ri Mg lfec'i
13. Depth Material
To 20 Ft. Sep/ etr
To Ft.
14. Depth
From To Ft.
To Ft.
To Ft.
From
From
GROUT:
From /
From
SCREEN: Diameter Slot Size Material
in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
C 2,1,..e&Yf Powna.d
16 REMARKS
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O o
IV
L n�
— oc
U rrl
r p
-"..,
rnt
s �
T
w -t
LOCATION SKETCH • z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I�p��`-fFRFRY:(7 Rif IFtFTHRI HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
^` I CONSTRUCTION STAND,wBDSI AND PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sl-.6mtt the drigfi4lf toithe Div sion of Water Qual [y, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
711-1221, within 30 days. GW-1 REV. 07/2001
•
21�94-16�1b Pltunc:fSu.-(1-W }' .

North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) y air tom/
jI I an
\YELL CONTRACTOR COMPANY NAME tLLL
253583
WELL CONSTRUCTION RECORD
�p
[vision of Water Quality - Groundwater Sectionio
CERTIFICATION N•s 0
PHONE N jg _q79 S-41-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential $I Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:y�
d -
Nearest Town: t8XL{ County 54-1.50.-l.1-.
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: % -Its F u
Address F enTwrv6 £ Aitt Fiaiatt a
(Street or Route No.)
/3.1A, Yt r: t1
Gt' r Town State Zip Code
( sozi- 111) .- 6'3
Area code- Phone number
4. DATE DRILLED 5/3J/�00
5. TOTAL DEPTH: ail
�--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 'O FT.
(Use "+•• if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01IS. 9. YIELD (gpm): ? 0 METHOD OF TEST tia
10. WATER ZONES (depth): 3 SS
11. DISINFECTION: Type 14-7-I-1
12. CASING:
Depth DSarneter
From__ To Ft. 4 /'f
From To Ft.
From To Ft.
13. GROUT: Depth Matena
From 0 Togo_ Ft. t.
Amount 0 . G `i
Wall Thickness
or Weight'Ft. Material
CnR 3,I .PV C
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. _in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
E 06.[SREMARiCS', h
�1
1 DO HEREBY CERT) •Y
CONSTRUCTION STAN�I
,
Material
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
N
0
n iz
6)
Cm
Ql
3
c<
srn
10
rri
rn 2
LOCATION SKETCHlf 3o
Show direction and distance in miles from at leas`
two State Roads or County Roads. Include the road
numbers and commonmroad names.
�R-ct_ttC /•l,�imsz e» E�J-LcsL�4��
u # a.? s�tl. �/y.tc, 1s.s
er(d` `(it79 a3/o
.}
uor), itiftealtduc. pot.
kag.t, £n th c,�E l`a mJ-3, AAvY� n
zo `)Co- -Cw �� ..9`r'Q az'�l
e I� o ntLIA_TD twm tty¢T Lruht- crttk Red.
-etc_ irr,17 tdxc cl14A-C..
1AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,L e S/ 40 t
SIGN/+IWREJFPERS N CONSTRUCTING THE WELL DAT
SECTON --
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

253593
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
I'� (print C (- - tc. Q �(t� �i J CERTIFICATION N O ..S 0
WELT. CONTRACTOR COMPANY N AME 914.. titmi kb) Q.0 bo) It/ c�.r'�t n�Q PHONE N mg 1174- R 4 $4f
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:n•
Nearest Town::IlrUt&,X lYn ,41 County .1f2In3Ln.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
^�')`x''/ (Street or Rout' No.)
Q tyt Town State
(1)LR)-4RR -o$`79
Area code- Phone number
4. DATE DRILLED 5- 1 - h n
Zip Code
5. TOTAL DEPTH: '7 T h'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la'
7. STATIC WATER LEVEL Below Top of Casing: Ion FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC SC .0118.
9. YIELD (gpm): I+ METHOD OF TEST tT,
10. WATER ZONES (depth): & 30
11. DISINFECTION: Type
12. CASING:
Depth
From ( To le, n
From To
From To
13. GROUT: Depth
From "D To O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To
�a-ru
Diameter
Ft. to
Ft.
Ft.
Material
Ft. e.e..mt.rt.t
Amount 0.1 1 3
Wall Thickness
or Weight/Ft. Material
5nj73i pVQi
Method
Ft.
Diameter Slot Size
Ft. in. in
Ft. in. in.
Material
16. REMARKS:
Ft.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
atitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomtation Descrriiptioii
Do a
c-. a
n,
m
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
+- & A,Lnr) esoi /l i.. tc+ “-
11-4zva t` a.:seam: r / WO�i Ley
'�t"vtrr 7- lss� AI LWot-I tl74 y-e 5 t4a
9-`r two-. Li -Pt . 11-0-Da sit,p
dLe&J.443Lct.t1 #/9y�, / Flo
Act at, 3/1.,yract ari-to-An
2 .,.r�Yyy.,,RcE r $yfolni_L -� Lyn, L}L�O))-'7�''. Git
Gr\:'eY.AQ/TfLe �..L.- .y $`. f(d Fwr, tt t
do itrr"in, d..,.�
6O��ERFY...EIMIFjT
_♦ CONSTRUCTION STAND/
A
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PE SON �NSTRUCTING THE WELL
j-ct ea
DATE
Sollimotgotpflegglug)jhe Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
A9}jg17011631d5EliehlA i&kfilf3s 733-1221, within 30 days. GW-I REV. 07/2001

253592
WELL CONSTRUCTION RECORD
North Carolina - Depanment of Environment and Natural Resources-1Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint)' }r0A119 /l�.t NM 4P
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
n n..
CERTIFICATION a afkS-LJ'
PHONE a jg23.1. LOT-H 59-
ASSOCI kTL& WQ PERMITS
(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:
County atn70-v-
(Street None, Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: )5o.QQ
Address mn.LC yawn -stc4 •
(Streetreeor Route No.)
ar. Cr-�/
Cit or Town state Zip Code
)- Ins' -g567
Area code- Phone number
4. DATE DRILLED 5!4/aco
5. TOTAL DEPTH: if SS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: a 6 7 Ff.
(Use "*" if Above Top of Cuing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of cuing terntlusted atlor below had surface renting a
variance In Recordaate with ISA NCAC 2C .a11a.
9. YIELD (gpm): .3 o METHOD OF TEST ALL -
a). WATER ZONES (depth): / �S
11. DISINFECTION. Type )1 i ii Amount O. 3 41
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From fD To I) Ft. _ KAR 7,1 P V C
From To Ft.
From To Ft.
13. GROUT: Depth
From n To ao
From To Ft
14. SCREEN: Depth
From To
From To
15. SAND/ORAVEL PACK:To Ft. re -
ten Ton • Vic
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) mapLatitude/longitude source:❑GPS❑Topographic map
(check box)
TH DEPDRILLING LOG
se c
From To Formation Detiofg
cSci
o<
i 0
rnrn
^'m
tJ m`
rV 4
w G
j OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/ tct-)o.N%'7t.
s/o ta%� FAY c1-lt 67 6 In��cC
From
From
Depth Size Material
16. REMARKS:
Ft. in. in.
FLP
Material Method �1 .}
e rr.L 0 - is 5 2 $ t` ry��wvr T e nV- t
Diameter Slot Size Material g,N+--•&O /1t i StfF,��,to
Ft. in. in. Yt 14.4.4 . Cam.,. C•c5'��t, t ,,A.,r�•k.�,�. LL
"-"•--tinekC
A$ / % 4-.Q, tors,,,.
R WN R UL1 ION TIFST1 A LL WAS R S,, AND THAT A COPYOSTRUCTED IN FACCORDANCE
WELL
OF THIS RECORD HAS BEEN PROVIDED TO TUE WELL AI
-Lit d� '��1 /�,��eD�
1 TU OF RSO CONSTRUCTING THE WELL DATE
GR
ASHE o rk9
o the Divbloa of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
E919) • 33-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) eF,p ii rit,
/9
WELL CONTRACTOR COMPANY NAME . r(s aem/
STATE. WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P7CRMIT#
Of applicable) (if applicable)
253591.
Groundwater Section
CERTIFICATION # -2 O.SO
PHONE 0 NV) 4 7Q R I C -
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION: ' y
Nearest Town: _vl )iY@nt., County /4/7f./.n,
(Street Name,
Numbers, Community, Subdivision,
, Lot No., Zip Code)
%Y 3. OWNER: dCCint. f7 ten)
Address .Q n 13-03.4- I r7 i
�r n (street or Route No.) �7 ,y
lAXi)YI /!,i➢. dTf 7O02_.
City or Town State Zip Code
0324i 1- y84— 6 g'f a
Area code- Phone number
4. DATE DRILLED .ri- g- 1r70 L
5. TOTAL DEPTH: IoOr, t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO sr
7. STATIC WATER LEVEL Below Top of Cuing: I Rh FT.
(Live "t" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of easing terelaated at/or below Ind surface regains
rodent 1n accordance wkk ISA NCAC 2C .al la.
9. YIELD (gpm): I 0 METHOD OF TEST 6
10. WATER ZONES (depth): f) `77
11. DISINFECTION: Type N
12. CASING:
Depth
From 0 To I I)
From To
From To
13. GROUT: Depth
From 17 To a D Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
I,5 SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
T H Amount
Diameter
Ft.hk,
Ft.
Ft.
Wall Thickness
or Weight/Ft. Material
snail pvt
Material Method
Slot Site Material
in.
in.
Material
c6ouc aZm cn-0. 9ot
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dews e$fminutu/secoode)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH QRII LINO LOG
From To Formation Description°
Lj
N Lj
cs
vT
c<
numbers and common road names.
LOCATION SKETCH.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers common names.
g 4424 t tk, . AID . g . .. 7t4f tint
16. REMARKS:
at•(f
I T'THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
A P RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PE
4At 5/8iaa0�
SON CONSTRUCTING THE WELL D TE
Submit the original to the Div slon of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
{ Q@fib+6Airhone eeit$49) 733 : 221, within 30 days. _ OW -I REV. 07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
/I - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print le.00 lIH JA CERTIFICATION a.2 lfl 6O
PHONE I j$i9)I4s1F .R4 S4
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED W'Q PERMIT#
(if applicable)
253589
1. WELL USE (Check Applicable Box): Residential IV 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: 121/LLfi a4n-
County
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: '06 /CILQQ/
Address Rznz st
(Street or Route No.)
a P„I!. ,.l �/ c.
City or Town State Zip Code
(WLS)- 459- o'7y
Area code- Phone number
4. DATE DRILLED 6 - iS_ a DO,2
5. TOTAL DEPTH: 7 3 0'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO e
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "*" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated aVor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST 6L't
10. WATER ZONES (depth): 3"3 D
11. DISINFECTION: Type 147 N Amount n, ciS
12. CASING: • Wall Thickness
Depth Diameter or WeighVFt. Material
From 0 To g3 Ft. L'/t!- SORC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a n Ft 0_42.4t1nn
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
ry
L
C
-r
0
rV
CO
).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. y'2
=-CLU-t'i aJ a t/ "" W —e-e< &ad,
From To Ft. 7ef14.a., GLn p, g .fr;ct ..v, P-4--o.Q cQ n-
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 RC MARKS:______
LS 'n FIFR-R•FRTI
CONSTRUCTION STA
D
J
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
UREOF PERSON CONSTRUCTING THE WELL �/ATE G 1
GROSb16WRTAfb SErCgTil6l�l o the Division of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHEVhki iakiPilkair 1FjQ j919)' 33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resour es - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print ,_. L..1 -. ♦r _, 1n . CERTIFICATION* .0 •S'0
1 'f. I /u(-(.C�l. PHONE M jUsnj}7�l S 45
WELL CONTRACTOR COMPANY NAME AC -STATE WELL CONSTRUCTION PERMIT* ASSOCIATE Q PERMIT*
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery E Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI IN:
Nearest Town: Or- t N CL,b{
County S.u.o..4n.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:I 1 •ria
Address cu°tt aJa-.
(Strlglet or RouterNo.)
*et Cit,c I l • �-
Town
CI or state y Zip Code
(31 )_7Z3-,S17q
Area code- Phone number
4. DATE DRILLED <Si7 Jab a
5. TOTAL DEPTH: 3 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO li
7. STATIC WATER LEVEL Below Top of Casing. 1 a 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): g METHOD OF TEST A ALA.
10. WATER ZONES (depth): a70
11. DISINFECTION: Type Wry i.J Amount 0,315)
12. CASING: Wall Thickness
Depth Direter or Weight/Ft. Material
From 0J To 86 Ft. 6 /9 SDR a/ 'pic_
From To Ft.
From To Ft.
13. GROUT: Depth Materiak Method
From 0 To 2.0 Ft. tt'm&
From To
14. SCREEN: Depth
Ft.
Diameter Slot Size
From To Ftin. in
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Material
From
From
253588
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
c
O r,
c� __
C '"t
oc
rn -�
yG
m
Z -- I
„
LOCATION SKETCH O cn
Show direction and distance in miles front least
two State Roads or County Roads. Includpmhe red
numbers and common road names. ^) Z
-14-1-t /Y� r wei 's-1CC-t-ttJJJk Ov
1 5/0 Mi. ✓-D- n-, tL ' OT l y
zy �3io tu-a. Lc4
H2 �10 YnL to-0, tcwr.
nc-rn escjL, RAct fe j SY cvr,ttie
kc (lefraL d 4 2 ctn: u _
16. REMARKS:
D
Jn
S U I
1tt,
0(
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TUR
411E fp -07 )zoo�-
OF P SON CONSTRUCTING THE WELL ATE
Submit the original to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GRalretiG9P nt'M TON(4I9)7)3-3221,within 30days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

254254
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
S
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JateS B. arm CERTIFICATION204E369-9591
WELL CONTRACTOR COMPANY NAME ITT1 Wiling s W=11, 711C PHONE tr f�l
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if aoolicable) (if acolicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Stain
Town: Priam. CitY County
Ehst DAT aSc4431te1 Rzd
(SCeet Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER. Tact Bxxxck
Address 1E0 Walden Rrtl 1D
(Swett or Route No.)
BLys:n City, IC 28713
City or Town State Zip Code
(828 ). 488-6416
Area code- Phone number
4. DATE DRILLED h'L3V 16. 2002
5. TOTAL DEPTH: BOO'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C$
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "v' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST hlaa
10. WATER ZONES (depth): 1q1'
11. DISINFECTION: Type
HIH
12. CASING:
Depth
Frorn 0 To 4 Ft
From_4_ Tom' _ Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GP.
From
From
16. REMARKS'
LPA
Diameter
6"
6"
Amount 16oz
Wall Thickness
or Wr.188 steel
Material
1V
Material Method
FtbEnznite & oamtt PmSai
Ft.
Diameter Slot Size Material
Ft. in.
Ft. in.
1:1!
Ft.
Ft.
701
rial
Topographic/Land setting
:Ridge 0Slope :Valley :Flat
(check appropriate box)
Latitude/longitude of well location
(degreesimioutes/secends)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo& atioonn Description
graniteclay
PEPTE
00From T25'
25' E00'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
L
I DO HEREBY :ERTIFL TNATTH18-WELL WAS CONS
CONSTRUCTlOtAR IS, AND 1'1 T A_C,`an 0
RUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO TI-M WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
C/G -0�--
DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW 1 REV. 07/2001

WELL CONSTRUCTION RECORD
255202
North Carolina - Department of Environment and Natural Resources����- Division of Water Quality - Groundwater Section
WELL CONTR:ACTOR(INDIVIDUAL)NAy
SIE (print) G/CA/AJ /(I I/ IQ 15 CERTIFICATION 49577
//�\ �/t� [] e t Uri //,'A-�
WELL CONTR:\cTOR COM PANT NANIEAA 146-re rm.- a-c1kers �4 S�II)a PHONE # Pe) Sr( -555C
STATE w'ELI. CONSTRUCTION PERMIT# ASSOCIATED \\Q PER\IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L9--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. \VELL LOCATION:
Nearest Town: COk ('{—I e
C GNeirokr C
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J C"S- e c T\`O1ttiJ
Address 54 11 Hu, A 1 `t N
(Street or Route No.)'
Cin or Town State Zip Code
( )- at7-5/q/
Area code- Phone number
Topographic/Land setting „.„
❑Ridge ❑Slope ❑Valley L9flat
(check appropriate box)
Latitude/longitude of well location
(degrees/in inutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH - DRILLING LOG
From To Formation Description
D — ,S>D SGNC
4. DATE DRILLED ape,/ //) a00 ? - %00
5. TOTAL DEPTH: /')!j
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO /n — / AO
7. STATIC WATER LEVEL Below Top of Casing: 5 FT. /
(Use"+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
County Se On. ((IN)
'Top of casing terminated at/or below land surface requires a pin - / z/.a2
variance in accordance with IS:A NCAC 2C .0118. /yQ - /9_5
9. YIELD (gpm): 9. 0 METHOD OF TEST C.-t' r
10. WATER ZONES (depth): / Cie _ 5 /020 - 5
U rLOCATION SKETCH
11. DISINFECTION. Type NTH -N Amount 1 %-R OZ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weieht'Ft. Material numbers and common road names.
From P To Ft. t- Jy
From To Ft.
From To Ft.
arm.) r'1 C-
y A)1
ttl7
13. GROUT:
From
1gg ,c+ce 1
a //24 S y/Val /etyscNil ,t-71y
S PI155 1-ko y l 9A- N
i 0 (� �-
C t
F— ern
17 /fork)) 6-/4- R I c
Dc
CJ rr:
rn :xo
cp
4--
Depth Material Method
TO.-�r) Ft.S,//1� rfn t"Nl
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5.SAND,/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.RE.\IARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Oily.? I ROC II
Stdpmit the original to the D b1
27499-1636 Phone No. [phone]
6-a7-aooa
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GWV-I REV. 07/2001
GRE-ILI DWATEr SEC IiJid
ASHEV/ILL' E E 01?A- Oi F Or

255770
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) U'edeL4nS tslzw1ff ygf(Gl CERTIFICATION #o2'7 3B
WELL CONTRACTOR COMPANY NAME r-rf ((eY rut,(/ Driff/el S?IG PHONE # (gag) (Fgg-g93°°
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential " Municipal/Public O Industrial O Agricultural D
Monitoring 0 Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: 0N Wilt CountySfrAfnit
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ThAL , Z,CSOt-
Address (>'Zgey 4&44C4
lStreet or Route No.)
(24-1„/Conli N.Ce
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: LP-o
6. DOES WELL REPLACE EXISTING WELL? YES D NO Er-
7 STATIC WATER LEVEL Below Top of Casing: /420 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS r FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): e'L METHOD OF TEST
10. WATER ZONES (depth):
02e7/ 3
Topographic/Land setting
Elftidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation D�script�t
N p
r
Cr*
0<
0 'A c
--tom
-o
N rj:
m=
11. DISINFECTION: TypeClttoKd Amount /Q64..t-r
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To go Ft.1k/ /ACEW94 Prc-
From To Ft.
From To Ft.
Depth Material
To .to Ft. g434,2 1 &L.ita
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in
13. GROUT:
From (
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 (1
La✓14'�AG-r},�KA
M'
Me hod
`144
it
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
l'91 H
RI4Y R
CROON kl-k alto
ASFEVILL27%9 +o6 fiROPFIrN'n.(9
Material
hop
✓ ryes
4 to
Ge
Baal 4
/ 3f&
Cm& 8A,44d
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`71 //-01-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
he Division of Water Qualify, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ISTtv
rin//�� l e^j (J,,((]] � � \ \ 6 \��Sg CERTIFICATION kra( 57
WELL CONTRACTOR CONIPANVN.-\\IEA{N11 eNe VJfOSr �>lell e SitttN-PHONE R ( )
STATE \\ ELL CONSTRUCTION PERMIT". ASSOCIATED WQ PERAIIT#
(ifapplicable) (if applicable)
255963
I. WELL USE (Check Applicable Box): Residential LN- Nitmicipal Public ❑ Industrial ❑ Aericuhural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL LOCATION: \\ -
Nearest Town:Ne tc k-w.l`Gi,\r�C'r�rSCounty Sula t to
5;1Vef re t-4Q
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
. 3 OWNER: ca
�C Ov„
a
5. TOTAL DEPTH: '- a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top ofCasihe:Ovcr-A-c(�FT.
(Use "r' i'Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
'Top of casing terminated atter below land surface requires a
variance in accordanei with 15.A NCAC 2C .011S. MCL r 9. YIELD (gpm): I METHOD OF TEST \
10. WATER ZONES (depth): 1 R C
t\
Address S L o - t l ocrYY\ 4r aC €'ir4
(Street or Route No.)
C r,sa.J0t+y rvc �a-rn 3
)
City or Tan State Zip Code
Arca coda- Phone number
DATE DRILLEDQQt; \ a9,ao0a
11. DISINFECTION: Type \$ r -sc
12. CASING:
Depth DianVter
From To O Ft. 64 Ll
From To Ft.
From To Ft.
13. GROUT: Depth
From -0 To a.o
From To
14. SCREEN: Depth
From To
From To
15. S.AND.'GRAVEL PACK:
Depth
From To
From To
Topogra /Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude./longitude of well location
(degreesabiautes'sccends)
Latitude longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forn ation Description
,1ay
5 - 135 Fran) -V
IP"'13ES- 13'1
V 1' 4
► 6 - drat) i-c
LOCATION SKETCH
Amount 1 °( l 3 Cs-x Show direction and distance in miles from at lease=
Wall Thickness two State Roads or County Roads. Include road
ori`7,eieht'Ft. Dlaterial numbers and common road names. c_ 2—
w
Material Method
Ft. ette i+. nTkt- i _cli
Ft.
Diameter Slot Size Material
Ft. n. in.
Ft, in. in.
Size
Ft.
Ft.
t\laterial
3/74 8,41/364)6.GArrech)%
S110 3 Saver/'J
cep
n :
0
U1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C
CRNST, R la cTI O
I, `I ,
Submit the original to the
2E699-1636 Phune_No. (919
V'STRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- / cook
NATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Senice Center -Raleigh, NC
31-32: 1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
252284
North Carolina - Department of Environment and Natural Rpseurces - ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/Et ((print))G��(Frr Ul eJ L10Ifc�. I tt4 `C CERTIFICATION ti-age O..
5
WELI.CONTRACfOR COMPANY NAME 14O iegi-k kJi II �t it PHONE #C.D aD3 —Iz"zc3
STATE WELL CONSTRUCTION PERMIT# r ASSOCIATED WQ PERM! "'rllf��� t I _ ZAc `�
(if applicable)
(if applicable)
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 0 If Other, List Use
2. WELL LOCATION:
Nearest Town *%(rSO1ll 1�L( County 1tJ�I w
(Street Name. Numbers. Community Subdivision, Lot No.. Zip Code)
3. OWNER: \1VtA_ I Y re.
Address ,3U. C j AYY 1 1J1/40 LC'
/
��1or RoWgNo.) zi���
City or TownFT.� State Zip Code
Area code- Phone number it
4. DATE DRILLED ''f'- I 1-C Z
5. TOTAL DEPTH: TOYS 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12
7. STATIC WATER LEVEL Below Top of Casing: WS" 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 aceorryapee wit ISA NCAC 2C.0118. n �y
9. YIELD (gpm): 1T . METHOD OF TEST gat . l trthr
10. WATER ZONES (depth): 7--14-0
,.t
LOCATION SKETCH
11. DISINFECTION: Type T� gLer Amount 1,, Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ° To 5.44/Ft. ✓ I ray 1Ca kx (*-
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft.
13. GROUT: Depth �9 Mattcctn_al /,, Met The.(
From To Ft.0 tU'()`7-Q`tc�0�� ��� �� vl
From To Ft of
14. SCREEN: Depth Diameter Slot Size Material
15. SAND/GRAVEL PACK:
Depth
From To Ft.
CD
From To Ft. in. in. N
From To FL in. in. _
a
-t
t
uP
Size Material
From To Ft. a
O
to
I DO HEREBY CERTIFY THAT THI WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL O
CONSTRUCTION STAN a RDS, »D THA- A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
16. REMARKS:
Gam/' 4--a -6 z
hIra 11URE OF PERSON CONSTRUCTING THE WELL DATE
IIdpt Water Quality, Groundwater Section, 1636 Mail Service Ccntcr- Raleigh, NC
636 Phone No. (919) 733-32R1, kt thin 30 days. GW-I REV. 07/2001
JUL:,09„ I.J
VU� LU J�
GROU"<'DWATER SECTION
ASHE F E W-';,.:JNAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)STEP r FR9 HYbr
)14/ .Mr, /,J 1bniet_P y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
I. WELL USE (Check Applicable Box): Residential 14 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: a
Nearest Town: v� C
County 5a o nn,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r.b,��p�p.�A
Address
r Y (S1feet or Route No.)
-7L—c
CM, or Town -State
Zip Code
(82,8)- 474- 4464
Area code- Phone number
4. DATE DRILLED t}//S/too 2-
5. TOTAL DEPTH: boS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I9
7. STATIC WATER LEVEL Below Top of Casing: / 9 b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): 7.o METHOD OF TEST A �.
10. WATER ZONES (depth): 50S
I1. DISINFECTION: Type HTN
12. CASING:
Depth
From O To 34 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From e, To L0 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.
Amount O. CI /
Wall Thickness
Diameter or Weight/Ft. Material
Grr4 SDR 7-1 -PVC-
Material Method
��mm7 3E 7I- e 5y S 3 YT`c/C , AA;
a• 1 x i,'1 tt 411- y tZ sty s rLt A,,,
2y.iy- LT, (VS a i' t( VG L7`tka,
6 the.., snR sticiect-
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation DescriptiS
O n
MP 0
Z 0ni
m
CERTIFICATION #„D-0__&0
PHONE # ea) 4?9 -%Nc-1
01 gn
Yu
—f�
am
e'
rn0
H
[J o
Slot Size Material
in.
in.
1� R MFRI3,*.
lI
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.
R-.Qrrne- Qr24",-
/ 4l *�� 2slT , r / jd
vN•i-L j . Wf- v gi:eitQaci
1 DO HEREBY CERTIF
CONSTRUCTION STAI
T Nf THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
e!c
T r, OF PERS N CONSTRUCTING THE WELL DATE
6R7'..NDV'JATER SECTION
/ SHESHEStili.itiiiiiiKeWigiUfillatheLivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3'FCpFeV //yDF CERTIFICATION # 70TO
WELL CONTRACTOR COMPANY NAME ✓eI-)16-k.fl 1.0/4 1//UA.[Mv/ PHONE # (n) 474-% 4.rf
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IN Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: NM dji County 5.0 owry
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (i ur.'11\ run
Address F 4 'ata&o.
(Street or Route No.)
03421
Ci9j or Town • State Zip Code
(gze)- so 7 _ 0 7 /.-
Area code- Phone numb
4. DATE DRILLED 7 / 7/.16 o 2-
5 TOTAL DEPTH: galaC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IN
7. STATIC WATER LEVEL Below Top of Casing: / 3-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0119.
9. YIELD (gpm): a METHOD OF TEST el Irv.
10.WATER ZONES (depth): r-1S'5
11. DISINFECTION: Type /Frei
12. CASING:
Depth
From 0 To %O8
From To
From To
13. GROUT: Depth
From 0 To 9-0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Diameter
Ft. r/14,
Ft.
Ft.
Material
Ft. e-e/rivrt
Amount o.87
Wall Thickness
or Weight/Ft. Material
? VC.
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
DO HEREBY CERTIFY THA
-��ONSTRUCTION STANDARDS, A
Ir. ij
SI
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
"o
LOCATION SKETCH
m
t-' NT
t -I
Show direction and distance in miles from Seast o
two State Roads or County Roads. Include the roaF
numbers and common road names.
Method t4Nh 07'➢�uJ�e/-
7 4 6 52, a 3/1 0 Yy e tilt)" _ kr
ihomu_c_a tat.
wcy.tevpik_kerp Noi�Ld' c '3hiorn.flLs.
t14V. � h��LBn WArC R4-
tuna • fe rn4.,JJciep clviia.t
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Tl, OF ERSON CONSTRUCTING THE WELL
��f7/ oo-
ATE
SuWglltIthe.oflgibat?ifttM Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
24800-4 011(ii&Na 4a-z I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) "Tr -PARRY N d CERTIFICATION #. OSm
WELL CONTRACTOR COMPANY NAME j M2..Q„)..-u-u,W(.'1Kj
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
252058.
PHONE # j8Z81479-RSI,S-2i
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 6.14.rr, County Sivain.)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
Ci orTown State t.
(f29)- 9 8 v. 6 9o/
Zip Code
Area code- Phone number
4. DATE DRILLED 9/a.S1a0o2-
5. TOTAL DEPTH: 5So'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lig
7. STATIC WATER LEVEL Below Top of Casing: a a o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): % METHOD OF TEST /9 aird
10. WATER ZONES (depth): R 3
1 I. DISINFECTION: Type /lt/)
12. CASING:
Depth
From 0 To aS Ft
From To Ft
From To Ft
13. GROUT: Depth Material
From 0 To a Ft. CC ate. -
Diameter
6!`7
Amount Q . S
Wall Thickness
or Weight/Ft. Material
SbR at ?VC
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-C
or
-'
cm
D cm7
av
W N
LOCATION SKETCH ^ao
0
Show direction and distance in miles front;Iea4C
two State Roads or County Roads. Include the rid
numbers and common road names.
01
-('0,44-, //Uri- 4:4-atS Sm.d%, �b ) et)
V 7114'
yd.cL) (Jf.va4 bp trr
9dm v )3n.evrcJe Rd. C o / jo
tjLL-D) N ti Mein- err` -092. 4k.
16. REMARKS:
F-� I QO HEREBY CERTIF.1 _ CONST'RUCtiON S1'AN
LIU
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F RSO
ATU E OF ERSON CONSTRUCTING THE WELL
JIL
DATE
Submit the original to he D vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
eg7099LIr8ab itiocN1611019) 73 -3221, within 30 days. GW-1 REV. 07/2001
<E' bEG10NAL OTHGE

252002
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. BrCwn CERTIFICATION p 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling Inc PHONE pii281 369 9591
STATE WELL CONSTRUCTION PERMITS, ASSOCIATED WQ PERMITS,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential*: Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Bryson City
Johnson Branch
County Swain
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Johnny Fortner
Address PO Box 199
(Street or Route No.)
Bryson City. NC 28711
ytry or Town State Zip Code
( 82 - 488-3665
Area code- Phone number
4. DATE DRILLED Agri 1 19, 7002
5. TOTAL DEPTH: 225'
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 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST h1 nar
10. WATER ZONES (depth): 107' z 7n5'
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 57 Ft.
From To Ft.
From__To Ft.
13. GROUT: Depth Material
From 0 To 17 Ft. cement
From 17 To 70' Ft. l-snnni to pur,psd.
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,
HTH Amount 1 Anv
Wall Thickness
Diameter or Weight/Ft. Material
6" _188 steal
Method
Dnmlwri
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 57' clay & sand
57' 225' granite
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.
-0
W
16. REMARKS: N
LY
CtHHEREBY CERTIFY. IS WELL WAS CONSTRUCTED rN ACCORDANCE WITH 15A NCAC 2C, WELL
INSTRUCTION 11 ARDS,D THA2 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Su mlt the original to the D4vlsior
27 00.1616 Phone No. (919) 73 -3221
GROUNOIVOMIR SECTION
ASHEyiLLE f IO AL CiFICE
TURF OF PERSON CONSTRUCTING THE WELL
1-/ 9 0 a --
DATE
of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001
0
rn
corn
on
cm
o<
m
Do
mo
VIZ•
rnz
rn
0

250941
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andTNatural Resources - Division of Water Quality - Groundwater Section /'
WELL CONTRACTOR (INDIVIDUAL) NAME (print,' I efV11 S I It 1)�,,cd CERTIFICATION7 :'
I, # .2 / /
WELL CON'TRACfORCOMPANY NAME- rr)�C ��njlA r11tE�)I � )^, )�? letIt z', PHONE # �/-n .5��%` 3g-'p0
STATE WELL CONSTRUCTION PERJIIT# ASSOCIATED WQ P RYHT#
(if applicable)
if applicable)
I. WELL USE (Check Applicable Box): Residential D--Nfrecipal/Public D Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: �i2y $!Sh- i-✓- /t County 5 (.f1C)�; x j
(Street Name, Numbers, Community, Subdivision, Lot No-. Zip Code)
3. OWNER: Cf il/`, no fit, l�fYlytim J CoX �/ z
Address -_7
(Street or Route No.) ((' y SG'h d A C- �2 A ! i .3
`CJR9 or Town ate _ Zip Code
��
- Zf ct — G7 e9 7 3
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Area code- Phone number
4. DATE DRILLED 4/ - Z2 Z
5. TOTAL DEPTH: 40
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E --
7. STATIC WATER LEVEL Below Top of Casing: 'r>7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): `f METHOD OF TEST /27(l12'/hr9.
10. WATER ZONES (depth): /11 1
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type Amount ,2 to
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth
From /') To 73 Ft
From To Ft
From To Ft
13. GROUT: Depth
From CI To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Diameter
' ,f__g P y'C,
Material Method
Ft. PPaolrivT pDz�'L
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From To Ft.
io. cvwvi rsnn,� -, r
rrR H
n' 1 CONSTRUCTION STANDAk
h
0
F
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
IL il
$tiUmit 1Nc orlmtinyl to 2hg Pivis on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-- 27699-F636 Phone Nu. [phone], within 30 days. GW-1 REV. 07/2001
0
0
m
c^,
c•-
rn
cc
Div
m0
am
NZ
rvi
0

252648
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Natural Resources{rc�\\- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N'.A%lE (print)?) e N N Moor -Ix Al c111.- h\S CERTIFICATION#, )97
�x �^ ,Q 1iSe\ 1 r�p�
WELL CONTRACTOR COMIPANVNA)IFAAA.G't ee Nr Oros 0* S.t .)Ci
PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I]i' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 1D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: tIr ys6Ne -A-1 County SL'atN
h0.r\es+ot.-) Oo err I oo l�
(Street Nang Numbers, Community, Subdivision, Lot No Zip Code)
.� c.Lm s0
3. OWNER: Zeb v---t orb So •4 n
Address c VQ wt�'\- K \`N S F': on eJ
(Stree(or Route No.)
fir. c.cfcoI 3
City or Toren State Zip Code
(l&)- I-1 S-S- (0 (Y 2
Area code- Phone number
4. DATE DRILLED (4Q(`i [ tof a -cot
5. TOTAL DEPTH: ) 000
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: % 9' O 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 accordagce with 15A NCAC 2C .01I8.
9. YIELD (gpm): 11 METHOD OF TEST Q. v r
10. WATER ZONES (depth): 19 5
11. DISINFECTION: Type \ T\-\ Amount 'k'k \\j]-
12. CASING: Wall Thickness
Depth Diameter or Wei_ht'Ft. Nlaterial
From 0 To_5'1 Ft. teirC Q C-
From To Ft.
To Ft.
Depth Material _ Method
To a�.0 Ft. Ce.tne(JA' 1 0 1' n
Front To Ft.
SCREEN: ' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From
GROUT:
From O
SAND/GRAVEL PACK
Depth
From To
From To
16. RENIARKS:
Size Material
Ft.
Ft.
Topogra is/Land setting
❑Ridge ESlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesseconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
;a-195 cre, Nt\tom
Caur'�M
Iet?-iooa %rc,.3t'+e_
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ul:1y �5
q 131,9 v erC- H S +r ee *
S (R 131.'t I�eJ-\a w)a-
SR,131ei «-t- Oyler
cis
ei1Qr\eS-kor' `Olen IooN
.AT THIS \VELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D T • T A CCSS''/%� THIS F ORD HAS BEEN PROVIDED TO THE WELL OWNR
`Frig
OF PERSON CONSTRUCTING THE WELL DATE
L---Srrfttnj f{i` ftq�tte to the l i\ ision of Water Quality„ Groundwater Section, 1636 plait Service Center - Raleigh, NC
ASh e?699�2li'ut�httn*'k`Fb�'f919 33-3221, within 30 days. GW-I REV. 07/2001

262332
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na I Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tt/ ��'t°c� CERTIFICATION 4.Z ��
WELL CONTRACTOR COMPANY NAME "71er eh/el( 0t//'9j PHONE # LAY) f/%—Z'S 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E<Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:1 Nearest Town: CA"r0lZz County S'v'`t;/i
Cot-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /-D /e IL }-� teue e/2
Address PO 1410v, F5I-11
okot
c/o Tr; 6n(Sueet ( coo
Route - ChR rah I el
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .3 - 22 ` 0 Z
5. TOTAL DEPTH: no
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lY
7. STATIC WATER LEVEL Below Top of Casing: ---- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS " / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST 62/'r
10. WATER ZONES (depth):
11. DISINFECTION: Type //T/f Amount Vic/
12. CASING:
Depth Diameter
From 0 To 3 rl Ft.-15-
From a5 Tom Ft. G. zr
From To Ft.
13. GROUT: Depth
From 0 To 34- Ft.
Wall Thickness
or Weight/Ft. Material
54t2/ p✓e
Sfer/
atetJ al Method
eneb/76( /'e SI vi C
From To Ft.
14. SCREEN: Depth Diameter - Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 —
yo - s 40 / rare. f2
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-a
w
16. REMARKS:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
^�J/�I -,Z Z
: O <�JJ :IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1 (�G�1tt�� al tI/o HI Divi
„0104 Q# fS �tF n733-3
;ion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

IIorI Mail ling • DCenlment ole nol Evironment and
Natural Re (ur e - iv221n ol Wale/ Ouality • Oroundwatar Section
h
Caro
1636
Ser
•
WELL CONSTRUCTION RECORD WE:LLC0NTI1AC1oR:
% //ler-
STA E WELL CONSTRUCTION PE OAITII: Ye
3
❑ Industrial ❑
Agricultural ❑ Monlloriry
Residential U Municipal
1. �
WELL LOCATION: (Show sketch of the location below) ScJar�
EJ
County:
Nearest Town;
6r Jan Gil WELL USE (check Applicable
pWale lnlocllon 0 011lor ❑ 11 Other, List Use:
Recovery D
2.
inoad Trams end numbers. Cononmdly. or Subdlvlslon and Lai Ito 1
3. OWNER Alfa 3-DOe.5
Address C/O Tni,/ Co»5/-�---
ea or o
�1� (� lgl---1—I1 ula Nn
City or Town Slate
A. DATE DRILLED 3-!3-UZ�---
5. TOTAL DEPTH LIOL�
6. CUTTINGS COLLECTED Yr.S ETI IO _
7. DOES WELL REPLACE EXISTING WELL? YES U 110E-' -
B. STATIC W ATER LEVEL Below Top
(Useos 1 O
Abo a ToolCa'inul
g. 10P OF CASING IS Ff. Above Land Sunoco' _
•Top of ea slip terminated .Uor below land 'wimpsrequites 1 variance In eccor-
10. YIELD (gpnl) 3D ME1110D OF TEST
dance with 15A IICAC 2C .e118 __._ ------
11. WATER ZONES (depth): 90
12. CIILORINATION: Typo
T Ainounl y �"
13. CASING:
Zip Coda
DRILLING LOG
Nan to
o 620
Depth
�ILFrom To F
To FI.
10 F1.
Front
From
14. GROUT:
Flom
From
15.SCREEN:
Depth
To FI
To Fl
Wall Ihir•ness
Diameter or WO1.elple/ 1. a�� t
r.,iIhod
Dlanlnlor Slol Sizb Malodal
DepthF1
Flom To In.
To __ FI. In. ..—
Rom __-- In.
From _-- To
16. SAND/GRAVEL PACK:
FOR OFFIC
Omd No:
Size Malodal
262364
DEPII I__
Fonum Descriptio-
11 additional s,eace h needed L_-se back or Ivm
LOCATION SKE I Cli
(Slow direcilon and des" -ante Iran 21 loos: Teo S:tle
rlaade, or other rr<7 tele,trce Polo!
WELL
R
WELL WAS COIISTIIUCIED (N ACCORDANCEVlITN -
1SA p1CAC .
01IIAT A COPY OF 111IS RECORD I(AS DEEfi PROVICEo 101I1E WET-1- OEF.
SIOI1A t1E €130N CDlrSlll Et� -E
IH Oro,I10..1lu Sacco widen,/ ripYS to I FIE y r_n
Suborn adplri to Division ol WOE Du:• Y••
CJ
0)

N6 rd) Ca16na • D parlerennol EnvIrNnoteni end en1Nat ral Ile (urco - Division
ol Water Quality • Oroundwatnr Section
6
1
e
•
21
iller
WELL CONSTRUCTION RECORD WELLCONFJlACl nccnTlicmt litl: °�roa
STALE WELL CONSTRUCTION PEIUAITM:
r—�/ Industrial 0 Agricultural 0
1. WELL USE (check Heal Pump Water cable Pox)! Injectio1r 0 Municipal Other 0 II Other, List Use' Recovery
2. WELL LOCATION: (Shot' sketch ol the !acanthi below) pU ,ly sW i ail
Nearest town: c,h _.
u977 hC:L_ ibnLk__---------L Dr BRING LOG
(noad!lame end Ilunbers. Community. or Stialslon and Lot Ito ) From to
3. OWNER /<hfie T S 4J7 )/ 0
Address S
erap Tnji p r_o— �--aG1vl —D_31
ZippCoda-1,_r‘el •
City orown
Stale
3 -l1-o z
4, DATE DRILLED �-
--
5. TOTAL DEPTII 50'
6. CUFtIIJGSCOLLECTED Yr.SEl L I10� ----
7. DOES WELL REPLACE EXIS11NG WELL? YES II
0. STATIC WATER LEVEL Below Top (Use°. Casing: Above Top of C 1-00
9. TOP Or CASING IS FT. Above Land SurInce•
'Top of catinp terminated eVor below land surface requires a variance In accor-
dance wllh 1SA NCAC 2C .011E
10.YIELD (gprn):_______ I°1EIHODOFTESTSit-
11. WATER ZONES (depth):
�S
12. CIILORINATION: T}'pew Amount
13. CASING:
Wall lhlclmess Naledo
Depth Diameter or WeIphUFI.
To ±D ri. io x ✓L
From —
Rr 5Leel
From
From l°�1-- P1..�2•-----
lo F1.
14. GROUT:
Millohrlal olllvd
Depth o res_r___
From To ie FI.
From to PI.
15. SCREEN: Depth Diameter Slot Size Material
To _— FI _- In. _— In.
Prom -_— In.
To_PI.— In. _—
From -- In.
From _ To _—
FI.—_-- III. —
16. SAND/Gf1AVEL PACK: Material
Flom
From
17. nEMAnK
I DO 11E11
CONSIRU
FOn OFFIC
ouad Ito:
BY C:RJIry MAT 1111E WELL A9 C
110T •"fie E, ,pCllfitfNTACO
__pSE1DIItF B-GIONRL OFFICE
C
262362
Monllorirg ❑
DEPTH_
FonrJJM Descriptio'
'F
Graz, fe
11 additional space is ncadrd r_-se heck al Icrr^
LOCATIOtJ SKc I C i
(Slow direction end d'stance Iran z1 load •ao
Iloade. or other a7 tolerance points`
)NSInuc1E0111 ACCOnoM10E WRIT 15A 11JCAC r:.'/✓ELt.
Y OF 11119 RECORD 1IAS BEEN PROOFED 10111e- YI;=L'REF
✓.Zl.(i De'F
SIOFIAT W IE or POISON C011SI OCIilm 1it ,rylnitllln Y) coy!C
e1ll orourv3••eler Seen,PeiFIE Y. I`n
SuM,JI odQlnal to Uivldon of SYaer Ou I.
a
Serial lo.

WELL CONSTRUCTION RECORD
262944
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME .(print) K'YY1.\ ece__ J -CERTIFICATIONp ZVa3
WELL CONTRACTOR COMPANY NAME miller (IlPI Ort)ItrQ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
PHONE ea)
1. WELL USE (Check Applicable Box): Residential IW1Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION* Topographic/Land setting
Nearest Toowwn: /i^/j`1f0/7 C // County SweiYZ. ❑Ridge ❑Slope ❑Valley ❑Flat
t iue 11 Itt- 1 IITn. hJ +Pc (check appropriate box)
Latitude/longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
crt@rN(oo nY �a
_ a��
City or Town State Zip Code From To
/r / C 4- 5 fig /7 Z np de of (degrees/minutes/seconds).
Tnb.a/ CeoSf. PO PUY Fi(-4---1 Latitude/longitude source:DGPsDTopographic map
(Street or Route No.) (check box)
DEPTH
Area code- Phone number
4. DATE DRILLED 3 `!5-0 Z
5. TOTAL DEPTH: r'/O '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0--
7. STATIC WATER LEVEL Below Top of Casing: — FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i - FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): (i METHOD OF TEST /52/7--
10. WATER ZONES (depth):
0 -
11. DISINFECTION: Type //T/t Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 2- Ft. 1 -2) 5V/1.z/ fGG
From To Ft.
From To Ft.
13. GROUT: Depth terial Ivjethod
From (2 To 7--12 Ft. Or n,-22 f¢CSSc4.--G
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
in.
in.
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, AND
COPY OF THIS RECORD
QRILLING LOG
Formation Desc1�p ion
IV
c_.
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.
ANCE WITH 15A NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
.12—CZ
SIGNATURE GF PERSON CONSTRUCTING T
Submit the original to the Division el
27699-1636 Phone No. [phone], wlthhi2343days.
f�Secti
WELL DATE
n, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

r 17
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural}Ytu�Resources - Division of Water Quality - Groundwater Sectiono[�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rYClt or
an_c �t CERTIFICATION #,✓/D'/7 /
WELL CONTRACTOR COMPANY NAME &-Cil-I 4Q&4r+.r_ ,J-_— PHONE # fK01�Y�1' 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT
Nearest Town:
N
County V In
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address (.
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: lQC'S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 'el 0 METHOD OF TEST L2.4.,v,
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6— tole
Lott -
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To kq to Ft. ID 9
From To Ft.
From To Ft.
13. GROUT: Depth
From_ Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
From
From
Depth
To
To
Amount
Wall Thickness
or Weight/Ft. Material
Material Mettthod�,
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
GROUNDWATER SECTI
AS HEENIbintlIMION,5Egl31t og the
27699-163 mac . 9t9)
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.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COP` ' - -.< °w 'a - D TO THE WELL OWNER
!; J 0 1'
SIGNATURE OF PE
.IQONSTRUCT1NG THE WEL
ivision of Water Qual y,IGroundwater Section, 1634 4ei1
3-3221, within 30 day
L-27-0-2
— O
DATE
T
ervice Center - Raleigh, NC
GW-1 REV. 07/2001
ATER
t Ir_t;-

WELL CONSTRUCTION RECORD 252g13
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section` /�
\FELL CONTRACTOR (INDIVIDUAL)t\A\IE (print)& AM) 1r+a(%-U'S cpf-f y\k $ CERTIFICATION #I 69 /
rI�� �e C
\\ELL CONTRACTOR COMPANY NA\IE/Ti1At&-CPdoe VPOS, O T C�� 00. PHONE #
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
Of applicable)
I. WELL USE (Check Applicable Box): Residential Municipal./Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOt t C
Nearest Town: \e...4-KG-- Count Lc,os.J
Q ea0 CTQtN [�f�
(Scree( Name. Number, eommunity`y, Subdivision, Lot No., Zip Code)
Topogra /Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: /�`� 1 N q, (degrees/minutes/seconds)
Address ab (o? V3 e �-O l-vc y R p Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No..) (check box)
®rMSo^t C Zr-4 15(i -s>r) 3
01). or Town Stat Zip Code
(iatt")- 4 (a. to
Area code- Phone number
4. DATE DRILLEDfT nSn t. t aOQa
5. TOTAL DEPTH: '3 O b
6. DOES WELL REPLACE EXISTING WELL? YES NO B�
7. STATIC WATER LEVEL Below Top of Casing: -e_ FT.
(Use --a" if Above Top of Casing)
S. TOP OF CASING 1S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.\ NCAC 2C .01I8.
9. YIELD (gpm): 5- METHOD OF TEST G; C-
10. WATER ZONES (depth): 8-0
DEPTH DRILLING LOG
From Tq� Formation escriptipn
3 ' / C—ka_m I Scoacit
3 7 —fro cr3 rctn., e.
et,•- ra,
ga- 3o �j tC,`te
LOCATION SKETCH
I I. DISINFECTION: Type 14 T H Amount "' (n r k\c Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or \1'eight'Ft. Material numbers and common road names.
From 0 To L\ a Ft. to \ W4 S+CGI
From To Ft. .�3 /� �� Spty 11Z)LA
From To FL / Lcul eL
13. GROUT: Depth Material blethod GD rS �-
From L To an Ft. Cer\e lc) 4 1 V q\ J 1� n r\J
From To FL S (> (( tit) e� `'S (j
14. SCREEN: Depth Diameter Slot Size t\la[sizl �Snn p e
•
From To Ft. in. in. 1� I I 3 ems\ 1V �7
From To Ft. in. in. .. n
15. SAND'GRAVEL PACK:
�
Depth Size Material -C cn
To Ft. v qC
To Ft. >o
Z m
=:)o
16, REMARKS: rnz
naA
y
J ACCORDANCE WITH I5ANCAC2C, WELL •C' O
RD HAS BEEN PROVIDED TO THE WELL OWNER 2
From
From
r"-N 1,DC HEREBY10EITIhSl
n LtONSTRUCTION STAND
L
i
Submit the orittinal tclie Div
r7c491946 MPbSirkf1n.'(9j9)733-
ASafyc, (, l:I k I
l'L
THIS WELL WAS CONSTRUCTED
AND T,I-IAT A S=OPYAF. U-{IS RFC
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 blail Service Center - Raleigh, NC
3221, within 30 days„ GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 5 2 6 4 2
North Carolina - Department of Environment and
/Natural Resourcess(1y��11 - Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6-\ eNN OVA 4-1 r`[19�f>�
WELL CONTRACTOR COMPANY NAME A A A C-eeeNe CSr Os. O - lva
CERTIFICATION 42697
/
PHONE # f$.26Y -SS4, S.S,3o
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ IrOther, List Use
WELL LOCATION:
Nearest Town: `\\0.P kQ-
County
• � eec Creop 9'
(Street Name. Numbers, Coi\nnunity, Subdivision, Lot No., Zip Code)
3. OWNER:n-6..r`,-L-mrtr'C�r` Dc(V N \Al SS
Address a t-iO f e- G-
(f]� (Street or Route
CA,
C)a r•-tiSeN C. tJ c- ai-7( 3
City or l own State Zip Code
CM- 1/44g—S-— SanI
Area code- Phone number
4. DATE DRILLED ('no-CcS\ -I 1 2.CX-) en.
5. TOTAL DEPTH: ?, J`t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Q.S' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Tap of casing terminated at/or below land surface requires a
variance in accordance vith 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST G. C r
10. WATER ZONES (depth):) -i O 0 1 l a . I D
Amount to 91 i 11 S
Wall Thickness
11. DISINFECTION: Type 4 T FA-
12. CASING:
Depth Diateter or Weight/Ft. Material
From 0 To ?2- Ft. L -4-t In S4cc-\.
From To Ft.
From To Ft.
13. GROUT: Depth Nlaterial
From 0 To_aO Ft _ P rh an "
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft. in.
Method
1>Q
Slot Size Nlaterial
in, in.
in.
15. SAND/GRAVEL PACK:
Depth Size Nlaterial
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEI
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L7FIat
(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 - '77 0....10a, I Ca bob
17i - I OO a flak): } �
Ioo- ioa Co—))
(oa- alb t-
a10- at a
0-0...„ 1-AA
ate-3so op.k e_
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.
G golJ CR-
SR )14o
SR113i
OQe-p
N0,NA-co-\0.1q
Gory @
Ct,Ic rKcL p CQ & F
C9S/STRUCT10t' ST:AN
bmit the original to the
699-161f PI wa-0,{,Hj
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL •r
T.AT A COPY AFHAS BEEN PROVIDED TO THE WELL OWNIAT
5-g-07ooa
NATURE 0
PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. --- GAV-I REV. 07/2001
ASEE IL EELL,I-0', I 0FrI0b

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural si
Resourcese�_L- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 64 eNN Met r�-f nl r / I cri-k i s
k r1 We flPHONE # Q Th 5i7(<- S35o
Areu.coNTR:AcroRCOMPANY NAMe AIR frl^eewr Gros. c�-� sl��
STATE W\'ELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
252641
CERTIFICATION # Q.19 /
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Nlonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: QA ac %K_ County C
D ck
(Street Name. Nu tbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: CSNoS\es,+ (4 c`oVNe` MC Ga,tNa
Address 11 5 1 Ott° (re. �] f c
�I (Street or R ,te No.)
11rv4or. C;+y l..IQ a.8-213
City or Town State - Zip Code
(gal- 46-Er a / 2
Area code- Phone number
4. DATE DRILLEDJYIarc.h 1a7 ?W a
5. TOTAL DEPTH: 3 60
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 3 5
(Use "+" if Above Top of Casing)
S. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley G1Piat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From b _ 3 To Forration DeKcription J Q t� c
11
33-Vge
B-- 5v
—
FT. a
9— ic{S
I4S- Iy'7
grq�;t�
?IraIJ
Qrs.0
q1"a. u s 'f
CIaVi4Ls
94-1- RCs, �raw�ltc
9. YIELD (gpm): Ci METHOD OF TEST a; r a .5 a5'7
10.WATER ZONES (depth): I -yB, I --- 9 o I J-145 a sn - 350 9.1 tqi. '4t°
I -rp 55 LOCATION SKET H
I I. DISINFECTION: Type 1-% T 14 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
orj'eiiehUFt. Material numbers and common road names.
13.
Depth D eter -/ t
From To 32' Ft. nn C. /V `��r�)��a
From To Ft. �3�%y I'!"y 3G� -Ty/ /G�tr��'-
From To Ft. /)/ J/�° �I�r'I(li �tfJz
GROUT: Depth Material Method 1'� nn Pc;
/]
From 0 To au FLp
S / /3 �% Oe C'_Q �r[��1 C('
From To Ft. RR
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Nlaterial
in.
in.
Material
16. REMARKS:
-
O((FIER F3 Y,(-'E$J* 1 Ft:1
CONS-TRIICTIGN SSA: 3:
7% CD
O
r
a 0"
� ^
rri
v o—
n`^
yo
aac
HIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL r tiz
n
ND THAT A CO Ph:9F THIS Ij�CORD HAS BEEN PROVIDED TO THE WELL OWNiti --r
CkE
DATE
., IGNATURE OF PERSON CONSTRUCTING THE WELL
e Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
WHO RlianSE fiI ) 733-A221, within 30 days.- GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
Submit the original to

WELL CONSTRUCTION RECORD 252640
North Carolina - Department of Environment and Natural Resourcesr- Division of Water Quality - Groundwater Section p�7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) G-I r NA! f11ar41N //lg kL S CERTIFICATION #&5 /
/� W e Dr t `3
WELL CONTRACTOR COM PAST' NAME/—IRAGfecNe (o ro en-�WI1 \,n PHONE # (5 .tg4, -55.5t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
Iifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential G'Municipal/Public 0 Industrial ❑ Agricultural ❑
Nlonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 Ir Other, List Use
2. WELL LOCATION:
Nearest Town: CSI\e),,<' kiN 2
0.\c.c Kc 9c
Topogra tc/Land setting
County St&T0.i Ni ❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 2 t15 Z.ek d' �U (� j 1Vf t� 1 eeuNee (degrees/minutes/seconds)
Address � t- \ a S p t rts+ Lake- OrNic- Latitude, longitude source:❑GPS❑Topographic map
(Street or RouteNo.) (check box)
1/4.0:t_\—EX' i-kek en) ICItoe d&. 33g8'b DEPTH DRILLING LOG
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
City or Town State Zip Code
(8ae)- 4a- - a6, 0'7 - F- e\;iv1.3x1n✓zl
Area code- Phone number Q aPt}eUc e✓
4. DATE DRILLED 1t'csc , 13) aoo9,
5. TOTAL DEPTH: 160
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: IC FT.
(Use "+" irAbove Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (pm): y 5 METHOD OF TEST Q i C-
IO. WATER ZONES (depth): 1.75 - 1 O I d D -1 S
1 :�O-a0
I I. DISINFECTION: Type 1-yr \{ Amount Sip 1,1
12. CASING: Wall Thickness
Depth e� Diantjter or Weight/Ft. Material
From 0 To in t Ft. 01 L\ I &8
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To.D Ft. 0_e_fliNt Y- , O J
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:
!`;H DOH F{'-�E ' C'kaRTlY
•$STR21CtIO4)STIrN
Flom (3Too For ttion Desc,(iption
© — �Nt
lei DS
rjr _ 100
tea- loa
le, a -tan
1 a-c - 1 2 '�-
laa- ISo
qr ati,.- t-
-V o-v C 4-
r 4 P.)
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.
3u74 dryco,.> CtE`i/
Nh1J\1ala-
R IIYo calms(►« Rich
0 1
tn=
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL ,r. cc)
ND TA -I AT A COPY THIS RD HAS BEEN PROVIDED TO THE WELL 0110tER o
f'_ /C-7-AZ
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
1 S Irntit the ori«ina!piffle 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r HU0.11646 Ph£tncNo, K919) 7-1-3221, within 30 days. Y GW- I REV. 07/2001
ASt rt,i,L, 'f..

250409
CERTIFICATION #2osc
V` PHONE St(SL.i0 Lin4,'ISfc•.
STATE WELT. CONSTRUCTION PERMIT/4ASSOCLATED VQ PER.\IIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
� (print) 'EFF Fiz >_{ N1PE
W' ELL CONTR�J' ACTOR COMPANY NAME U:II-tars Wt.19_ /1.1.1wvi
7
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
WELL LOCATION:
Nearest Town:
ltrf �t County 5aNC111 .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:/'at-ic7nn,•
Address lAck-14" Aet,
(Street or Route No.)
032 4- crtL( `7I C.
City/or Town Stale
(p76)- 6L3 - 89ao
Area code- Phone number
4. DATE DRILLED VAS/ao
5. TOTAL DEPTH: 7 o S
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO al
7. STATIC WATER LEVEL Below Top of Casing: .1.O6 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 METHOD OF TEST el 1.'1.4
10. WATER ZONES (depth): So
11. DISINFECTION. Tvpe
12. CASING:
Depth Diameter
From a To 58 Ft. 6Yet
From To Ft.
From To Ft.
13. GROUT: Depth Maten 1
From 1'1 To a.O Ft.(f'rn4.>
t n-I
From To Ft.
14. SCREEN: Depth Diameter
From: To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Amount 0.9/
Wall Thickness
or Weight/Ft. Material
OtIR '1)YC
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
r,a
-1
N
LOCATION SKETCH
J
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AA d7L US 19 5s-atL c
I */o it-ctaa `Aar— Qsj !,cc L-cG Re4
y6-1(01r,.t. --�.� (c(.� do O t A
A
IZAe13,e �aTru-y/ e-
le� le'vrr RiaiNl
Le at mN '9
Method
Slot Size Material
in.
in.
Material
From To Ft.
16 RLNIARK S•
rr,4 F 1V'F
CONSTRUCTION STAN
.Ill
—`1
L I
l.6uLJmWkhtent i+4q6�G3l �he Division of Water Quality, Groundwater Section, 1636 Mail Scnice Center- Raleigh, INC
1 i7699-Ib367 kun:'--1-3-0-3221, within 30 days. GW- I REV. 07/2001
•
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� ,Qvck 3/..�/aoa-,
iN RE OF PER ON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL COVI k(2TOR (INDIVIDLAL) NAME (print) SE F F LRY H?- E
WELL CONTRACTOR COMPANY NAME fr{luL%Nett. Le Ut Matt
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
250408
CERTIFICATION #a;os0
PHONE # J5251) 44 7 9 - %%-Sf{
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Et Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (321-a,cr C•'�rj County Stt: m-'?
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: �7{-»�_.}✓�fl'AaArNE_2,
Address ncolt I�'
J_ 13'144n&) httn.
(Street t or Route Na)
l)f.T t4tj 1't - C
City 6r Town State Zip Code
( )-
Araa code- Phone number
4. DATE DRILLED 3n-5/a0o 7„
5. TOTAL DEPTH: loS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" i f Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
sariance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / ,a.. METHOD OF TEST H LI-,
10. WATER ZONES (depth): aa$
II. DISINFECTION. Type )1T)t
12. CASING:
Depth Diameter
From 0 To )a9 Ft. erV
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a b Ft. e FJrLtJn7
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 0.4/
Wall Thickness
or Wei eht,'Ft. Material
SDRvve.
Method
yts-tL i twl/T. /&j91-L,UaKsnn Md.
7'/ tiLtwa -tw,� dip m . sail.*
Rd, cin-W-52-
-u-u.- kg L32Ja2s)- "fl uaa0.lJr- 1„
. r tkc 6,,d Vitt_ R�
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
N
-J
Slot Size Material
in.
in.
6.11 ENfARItr;S
1 DO HEREBY CERTIFY 4
CON$TRL TI ON-5'J N0
GROUNDWATER SEC ION
ASIIPJabj�;`.t,'_ C+ICE
Jnhmif tine of Igin.it tithe Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
LOCATION SKETCH N r,
Show direction and distance in miles fromntleasE
two State Roads or County Roads. Include the way'
numbers and
f)�ir �r � n �je
s.
�yEn ��n
)-)-iaaiuua.� tk2,S Svc t1 c�e) x T/b t n
�xvr c2C. US/' Sa-•cY iipO
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LryL
IG AFURE
die a5/eo1,
JF PERSON CONSTRUCTING THE WELL DATE
27699-1636 I'honc No. [phone], within 30 days. GW-I REV. 07/2001

252646
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N:\\IE (print) GI et., pa f f
clip I fJ I ' LG�`lli S CERTIFICATIONa55.7
luc DN
f1
\\'ELL CONTRACTOR COMPANY N'ANIEFtRA-rrireff`!1S rJ S PHONE k I�1$) 6y'ly- 5SJr'l)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential "MunicipaVPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:k4 per CXXn.rk'- County S tnec\ : t3
(1>ec Qrn(.yr In
tSrreet Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: \f-(`tt,_,4-0._-\1Cts#te --3-010CS
Address V . p. (3 t x 13 mil, -
(Street or Route No.)
CV-OrtN Ne- a8')I4
City or Town State Zip Code
($nCT)- V4 a — 0 5 3
Area code- Phone number
4. DATE DRILLED Mci-cO'N 44 "a -co a--
5 TOTAL DEPTH: 3 51-3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO NV--
7 STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a A S� 5 U Q r Cy r e+�
variance in accordance with 15A NCAC 2C .0118. `
9. YIELD (gpm): to METHOD...OF TEST G.. C
10. WATER ZONES (depth): ? - ) J5 r U ^ a 4 g'
Topoggraphie/Land setting
DRidge LNSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees:1ninutes!seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 —ray SL1Ngl 10t4.y.
g ret IQ rt+
tas-155
C&VI
qtaro,\i
1 I. DISINFECTION: Type 1-4-1- t-{ Amount i0 ii pi Il 1
12. CASING: Wall Thickness
Depth Diameter or AAWeight Ft. Material
From b To_ri Cm Ft. lQ L\ Kris- SA-ctX
From To Ft.
From To Ft.
13. GROUT: Depth Naterial Nlethed
From 0 To 0..i1 Ft. CPMeI.YY'
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 :Nlaterial
From To Ft.
From To Ft.
16. RENIARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0.N -1-cUr ct\ o- C'cr3e-
S n l l k o G\alrKct- R cG
s� t137 Dee-pGat Rc�
Stsj t 3,5 e-S °_reek11i
SR k t 34 (3, rarvciAr
O
NI
3 c)n1
—C C= CM
-gym
(- -96ttLfR' IITL1EATt}'7,TH.
rI) STR UCT I Otl. STANDARDS,
v o-c
m
ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL yo
Fjf1T A CQPY 00fT S RECOjHAS BEEN PROVIDED TO THE WELL OWN*" ao
{ , •-�--_�- rri
ma,
S`GXI URE OF PERSO.N.CONSTRUCTING THE WELL DATE --I
z
Submit the original to the Diviion o \\'ater Quality, Groundwater Section, 1636 Mail Senvice Center- Raleigh, NC
',27699:1636-Phalle No [phone], w thin 30 days. > GW-1 REV. 07/2001

249689
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Can' 44,4rimkt-
\\Tn. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ROCA well brill %fr T-wc
CERTIFICATION # d3$7
PHONE # ell rgr - G9 30
I 57 ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 6' Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IfOther, List Use
2. WELL LOCATION:
''pp''""
Nearest Town:_x�,.I
CnteACtj RJut.ArJ-
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: Xot,iJzll OQf
City or Town State
(Rag )- �F SSS - 38'
Area code- Phone number
4. DATE DRILLED 3 -'Y -c' -
5.TOTAL DEPTH: f90
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO H.
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Zv METHOD OF TEST
10. WATER ZONES (depth):
County S&J4? N
Address C24C7 er4Nch
(Street or Route No.)
Rnisro✓ IY-c
Zip Code
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From I To 3/ Ft. L Thick w+4 f�✓G
From To Ft.
From To Ft.
13. GROUT: Depth Material Meth9d
From I To AO Ft Colmd j-(8mo4- .Thq rail
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.
Topographic/Land setting
DRidge DSlope fi3talley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
=
N
-bk.
w •Y—
cn�ry
Show direction and distance in miles fromttleast
two State Roads or County Roads. Include the rot
numbers and common road names.
LOCATION SKETCH
Size Material 250J✓ LOWS"
�'1 19 SOMA nub
a, /0/n.
16.REMARKS.
77\
'I� Hg.ESY eLR3t)FYTI{
I UOrvat I(Ut.,11UNSIAWPIAI.
II
L.J
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
�S, AND T�HATTA COPY OF THIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
'Lt✓td f'{ (4/4124/ J — ✓ i� 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I '
L Wttnj �,tdltRr LTrtibW the D vision of NVater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHV4PpP0610110L• 10bftOt9) 73' -3221, within 30 days. GW-1 REV. 07/2001
s1
totil

24994t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mi t['hel 1 Ti rank CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Hedden Brothers Wel 1 Dri 11 i ng, Tnr PHONE # (82j3 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. Almond
Round Top Rd Lot #31
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mark AlhPrtson
Address 4008 Bob Evans Drive
(Street or Route No.)
Valrir0, 13 33594
City or Town State
(313 )- 661-5969
Area code- Phone number
4. DATE DRILLED March 8, 2002
5. TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JP
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
*Top of easing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): • 5 METHOD OF TEST blow
10. WATER ZONES (depth): 420'
County Swain
Zip Code
11. DISINFECTION: Type HTH
12. CASING:
Depth Di9jneter
Fro 0 To 5 Ft. 6,
From To 5G Ft. b
From To Ft.
13. GROUT: Depth
Fromm To 20
From To
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To
To
16. REMARKS:
Amount i 607
Wall Thickness
o.18B Weight/Ft. Material
steel
pvc
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 50clay & sand
50' 1000' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
Ft.se. rtent & hennni to limped
Ft.
Diameter Slot Size Material
in.
in.
Material
Ft.
Ft.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 AP
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) GtUZL^ 'i PAW- CERTIFICATION ti rra1?, 7
WELL CONTRACTOR CO\IPANY NAME Fu1.1,C/L, (A-Iz1I o,-.�1l/1 ttfC' PHONE # 822T TEK-8930
STWELLATE ELL CONSTRUCTION PERMIT/4A/ t ASSOCIATED WQ PERMIT#
Of applicable) (if applicable)
249691
I. WELL USE (Check Applicable Box): Residential IR" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:r-cod
«Ap I h I4 QN pA
(Street Nu ne, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: GJAL&✓ wash
Address CAp SAW'C,s P)
(Street or Route No.)
rr.e• 018113
County &OA d
Clfy or Town State Zip Code
r 7aR - �IIK
Area code- Phone number _
4. DATE DRILLED �O - D L
5. TOTAL DEPTH: a.US
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: 46 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Z METHOD OF TEST
10. WATER ZONES (depth):
TopographicThart0 setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth,Diameter or Weight/Ft. Material
Jf
From ( To r" Et. & F ,C, P(ic
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 1 To ab Ft.594.F Cert44#
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Method
PL gra
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
C)
U2
LOCATION SKETCH v
Show direction and distance in miles from Er least-- c'
two State Roads or County Roads. Include C.ttl ro.`'tt i El:
numbers and common road names. Cfl 2
,t,jssti
41014
/ co t
lCi � ' I � S I • _
16. REMARKS:
.,, I --
TVD0W-HEF EBY CEVITIFY
CONSTRUCTION STA VD
1 1 2002
GR0usfru ltthg 1T M to th
ASH EVILj-"fs§tf,(pIJ-3Mh(Qfiftek (919
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
llt., ,414 .I-. . by
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 24 9691
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �i—CiJt Lone/ 5&idpt CERTIFICATION #&.?8'7
w'ELL CONTRACTOR COMPANY NAME
Fu I1 tL (Jul OH I l i �-1JC
STATE WELL CONSTRUCTION PERMIT# 6'7 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # fiat l66 "S,&,
I. WELL USE (Check Applicable Box): Residential Gar Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: PISo
Y7W 101i11 etttrfr'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ke-N SLO
County :thin/N
Address 709 L/ rtL Stpr'rtisi Qr!
n (Street or Route No.)
1t{SorJ N.C• 2g7/s
City or Town State Zip Code
q-88.- ol4k
Area code- Phone number,
4. DATE DRILLED 3-I-02-
5. TOTAL DEPTH: 14&1)
6. DOES WELL REPLACE EXISTING WELL? YES NI' NO J
7. STATIC WATER LEVEL Below Top of Casing: Ch 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): /kJ, METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
r942idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To $i Ft. 61y 'TJC[, / QWL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From ) To AU FLSq,vd,PCir'+,s,i Ahmed
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.
tars.EtjIARA:S
h ; I,,
1 Du htKEt3Y CERTIFY HA__TLLTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANC 4 RFC, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
UT c-,
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.
sett —
so Oh a8
MAY 1 7 2002
levy �cl1u-
SIGNATURE OF ERS N CONSTRUCTING THE WELL
3-1-6z
DATE
G,8QUNDWATER.SECTJ
4N�
AS rey pitiorTP parp7J re Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
7 -1636 I've No. (919j7_t3 3221, within 30 days. GW-I REV. 07/2001

251088
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat�u al Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)- I tree/
, ,`_y- CERTIFICATION S(
WELL CONTRACTOR COMPANY NAME /I J'.,//;Ng3tR✓C. PHONE k
STATE WELL CONSTRUCTION PERMITS( ASSOCIATED WQ PERMITS(
if a . r licable if a • . licable
1. WELL USE (Check Applicable Box): ResidentialN. 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: 8ry55n.) UA-y CountyCC2,11l-)fil
}iwy /9 W.s+
(Street Narhe, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c rho in re; p
k-
Address
(Street or Route No.)
City or Town State Zip Code
(--)"
Area code- Phone number
4. DATE DRILLED tp:)-13- O=
5. TOTAL DEPTH: 51.5- S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / O METHOD OF TEST A. Y
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
Ftom To Formation Description
(/A'y
jib- 4-cc 7/9461-e-
11. DISINFECTION: Type
12. CASING:
From
D Topta/I L Ft. Dim;
From To Ft.
From To Ft.
13. GROUT: Depth
From v To c2 J Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To " Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft. Material
f& c_
Material
(4/rnen/ -
Method
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
members and common road names.
0
IV
-V
CO
-v
IV
fV
c
0
23
nx
On
On
c
.c
oc
>0
m�
ac
rn
enZ
0
O
D L' rNt�ry,r���RCT13 E{�
NSTRLCTIN ST
1I
_ IU
T THIS WELL
S, AND THAT
lI �InI 2[
�tr - T) T1 ATrnR
t • OF THIS RECORD HAS $3
APR 1 0 ?002
f�
J
p WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
SIGNATURE OF P1RSON CONSTRUCTING T} WE DATE
Submit the original to9thhe Division of Water Qu ftf QILLE RAEGI a S 558E , 1626 Mail Service Center - Raleigh, NC
CRO2769941)11/6 g@Og9CNo. [phone], within 3n d ow-1 REV. 07/2001
ASHEVILLE RE i.OSJAL Or-RCE

WELL CONSTRUCTION RECORD 251078
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT'
'cab
(if appl le)
coral Resources - Division of Water Quality - Groundwater Section n
5.to
�(J'IM!!- tl� q�q�� �Ant- CERTIFICATION Sty
3�7
Kr Will �fN//f✓<.�NL PHONE M f�✓0)'�i!/L�
r�,atk / r. •
ASSOCIATED WQ PERMIT'
fa 1'cab!
((i pp e)
1. WELL USE (Check Applicable Box): Residential lid Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
Nearest Town: e,:+Y County lc ti
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: 131ll e e
Address
(Street or Route No.)
City or Town State Zip Code
LA -
Arta code- Phone number
4. DATE DRILLED a -04:-
5. TOTAL DEPTH: 55'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a G
� 9
- yus
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To ' ” Ft. & 7Y _
From To Ft.
From To Ft.
13. GROUT: Depth ;Material� Method
From J To 06) Ft. (061,4l 2oG✓ii+i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To " Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
T IR
IDS,
—13
IV
IV
0
ELL
t 'I 0 0I711 be O 4CORDANCE A BEN PROVIDED TO THE WEWITH I 5A NCAC 2C, LL OWNER
S OVA"hf JRE p);,'EASBN 6pDlSTR - THE WELL DATE
Submit the original to the Division of(il ateerr Quality,
GroundterSection, 1636 Mail Service Center - Raleigh, NC
ND
776QQ-l6gt Plume Na (919) 733-3:21, wi (,japUNuwATER SECTION
ASHEVILLE
GR,NATER SECTION REGIONAL f1NL OFFICE ASHEVILLE REGIONAL OFFICE
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 5 2 6 4 4
North Carolina - Department of Environment and �Natural Resources - Division of``Water Quality - Groundwater Section p
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) G' Pt'(.*\ w C� et\iXAS CERTIFICATION # d25/
WELL CONTRACTOR CO\IPANYN'A\IEPAA-GreeMr k1C(15 fs-Q $y1cY'O PHONE # 0.2S) �S�G SSa
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 19/ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2.
WELL LOCATION:
Nearest Town: G,,\ erlONfs5 County ce7 ^)
T.--ToFJ t.3es-\D:eLo'Qroper-1tesLe4r#33
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. O\VNERC.(`e,�.o i- �-1Afl1QrkA-�
Address it NFT3 aye
(Street or Route No.)
SI\ LoACeS r'Iors'At.. 3301lp
City or Town State r Zip Code
(90s)- sal-lo3
Area code- Phone nwnber
4. DATE DRILLED re-i1r1/4.A.ry a 62 oaa
5. TOTAL DEPTH: 8'St)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e
7. STATIC WATER LEVEL Below Top of Casing: 3 b0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a, METHOD OF TEST Q Z r
10. WATER ZONES (depth): ' ab
I I. DISINFECTION: Type I-: T A Amount ierceo: IrS
12. CASING: Wall Thickness 1
Depth Diameter or AVeiehtFt. �Material
From 0 To I O a FL (c y
From To Ft.
From To Ft.
13. GROUT: Depth Material •hod
From C.)To ..-t) Ft. e e Ne r3'r Ti-- ce
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:
1 DO HERLBA C!(RTJ1 Y T,LI,A
O(4STk LTtON ST.u;:'SID.kRD�;?V
ILl I�;
submit the original to the Eisisio
2764944636-$1.61t Ntm(914,77,-3k1 322
pographic/Land setting
idge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes.'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
y
)- Sat �rae�; Fe
3ab- 3aa
3 ^ 85 t) rat) e-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. n
1I O K). $cL i\) 0 I C LC)
z
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL rnA
D TW\T A COPY OF HAS BEEN PROVIDED TO THE WELL OW [2
NATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. _ G\V-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
w'ELL CONTRACTOR (INDIVIDUAL) NAME (print) G C.NN W\e. ,' \ N 't('A�V s
WELL CONTR,VCrOR COMPANY N.AMEAAk Gr ett e 1;)rnS `ub-k\ s...k
CERTIFICATION(#��1/
5'7 �
PHONE # Si 5p 6 -5556
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED w'Q PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Pt" Municipal/Public ❑ Industrial ❑ AL_ricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:9) '4S00 & re-'-'\ County
,AeLMs4n CrecK-? nla.rrQrcc1s
• (Street Nang. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r �i1CLy-C, `l-'�ei -a (
Address � ^.'7 5 rt%ae1
(Street or Route No.)
City or Torn State
�a-`t-o --• 043 5N) e
\rook I�awac_
Ior.`tlet_ 3Uc,4 s-
Zip Code
(271- 135— 65tin
Area code- Phone number 4. DATE DRILLED /=e`prUCU^t3 a7,/ ?- b 9.
5. TOTAL DEPTH: 3 b O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q�
7. STATIC WATER LEVEL Below Top of Casing: "3st FT.
(Use'+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /�
9. YIELD (gpm): 7 METHOD OF TEST a.. i.
0. WATER ZONES (depth): ' 7 5 - 3 / a 45 - 4
11.
12.
DISINFECTION: Type I4- 1 Fi Amount," Ap t' II R.
CASING: Wall Thickness 11
Depth Diairter or e�Ft. Material
From 0 To 4 ei Ft ` ({
From To Ft.
From To Ft
13. GROUT: Depth
From To 'D.A.)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
From
From
16. RE\IARKS:
Material ^Method
FL ern eiot 1 O
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Nlaterial
To Ft.
Topogra is/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesim i nutsiseconds)
Latitude'lonritude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From yTo Forrgratiion Description `
yL\ % 5 g renal te—
'7'7—A4S 0\x-0..toi#e_
245 a4'7
e1.wj- 300 ONI^atJt`i-e
LOCATION SKET H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
tv s o n.) cJ - /
Neu\\ \a\e, Coors Q
SR k33 931-,us1m.CrePK
s B I 13 I “\os e e_ r e P K R�
O
Xs.
cs;I twI R 31' EREF`�
J
T THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL -0
c
a
enz
era
m
>0
m
DS, AND T T OPYF THE :CR:
S BEENPROVIDED TO THE WELL ORTIE�z�SI NATURE OF PERS CONSTING THE R'ELL DATE F o
z
GRS?��I4tt ��t erpe;l, Fit the D
rill 9) 23
ivision of 1\'ater Quality, Groundwater Section, 1636 Nlail Service Center- Raleigh, NC
3-3221, within 30 days.._ GW-I REV. 07/2001

249191
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WEI.t. CONTRACTOR COMPANY N ANME Hedden Brothers Well Drilling, Inc.
CERTIFICATION # 2043
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential M Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Stecoah County Swain
Yellow Branch Rd
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: Rohert Bel
Address 746 SW 19f-Fj Street
(Street or Route No.)
Cape Coral , FT, 13491
City or Town State
(941 )- 458 8811
Area code- Phone number
4. DATE DRILLED 02-05-02
Zip Code
5. TOTAL DEPTH: 150'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO k
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 60 METHOD OF TEST hl nw
10. WATER ZONES (depth): 115' & 130'
11 DISINFECTION: Type
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 5 Ft. 6" 188 Steel
Front 5' To 58Ft.
From To Ft.
HTH
Ctt
13. GROUT: Depth
From 0 To 70
Front To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
Amount 16oz
pvc
Topographic/Land setting
DRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 56' clay & sand
56' 150' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
Ft. px trtl and & benonite pam_ped
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
16. REMARKS:
■
' r0 1!k,T
"t; iY 1 7 2?a:'
Submit the original to he D
GRLlMkt,i A TION . 9) 73
ASHEVILLE REGIONAL OFFICE
D
118
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

248821
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
Natural Resources - Divisionp__of Water Quality - Groundwater Section
\VELL CONTRACTOR (INDIVIDUAL) NAME (print)�e`.�D R 1lA/) 4/ P-IC CERTIFICATION #� OS O
WELL CO.\'I R,\CTOR COM PAN'Y NAME/V.LLhIrJn..�(/ I,() Ea _n PHONE # J$ZB' 47 7- QyS �.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDDVQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ,,�,,
Nearest Town: /2firer Cvt.) County $W Wry
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: - ettn.> ••D
Address O'u%-10 }}, &AJicv,
(Street or Route No.)
Citr Town State Zip Code
(SZ8)- 4YK-48%?
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
4e1-1-6Aki -Dut4L9Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Area code- Phone numby
4. DATE DRILLED!/$! as c a.
5. TOTAL DEPTH: JJ 8o5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: `f o o ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ''r/Lt. METHOD OF TEST f�.fN
10. WATER ZONES (depth):p'id S
11. DISINFECTION: Type 1-4T'N
12. CASING:
Depth Diameter
From 0 To 27 Ft. 6r'1`f
From To Ft.
From To Ft.
13. GROUT: Depth o Materiall
From 0 To 3�Ft. C{.vyLnrnJy
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 0+73
Wall Thickness
or Weight/Ft. Material
roezf - Vc
16. REMARKS:
DDOHEFEEI'CERTFFY {HA
.. 4 ONSTRUCTION STANDAI
Subitflr lit,oli kiliL o- j(R Divisit
163iS 9033-32:
Slot Size
in.
in.
Method
Material
From To Formation Description
IN)
N m;.
LOCATION SKETCH W —r
CO
Show direction and distance in miles from at least=
two State Roads or County Roads. Include the road
numbers and cornmon road names.
-9 L"' C ftt,,a e - Y 4
/ Q/ow.C�,vt ,icec -
49-k u" y 7 r 3% rrL Lvn
Material q, /a/1 or- Ciaff�� �' �'5 rvrr.r, �.
p �p yt,J.R,L.u�Jr- 6 1 dn. dl.ti R/l
/fM_A-
�/� ^_� / . 3 5/o rnc./st n) i6= n,.
T �u
✓3./cr�c-h. ��vei� ./-�r/el,aty�r.v..
in -nti a, to "ter s / Fio Ynt�i
cia
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
JD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,iz-wjt j-itj� W 8/a0d 2
IIURE 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

WELL CONSTRUCTION RECORD
248819
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) W I ` / / /✓" CERTIFICATION # g- OS-o
WELL CONTRACTOR CO:NIPANY:NAME p1-J (1 D. 0.123D PHONE # n9
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 ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: 3m
County S-Ucu.jv _
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: rr. 61U Address .-i•
(Street or Route No.)
Ci[ or Town Slate Zip Code
(7f7)- N518-o7o
Area code- Phone number
4. DATE DRILLED 4/ 9/aao2
5. TOTAL DEPTH: (o 0.51
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO &1
7. STATIC WATER LEVEL Below Top of Casing: / 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): R METHOD OF TEST A,w
10. WATER ZONES (depth): e/ 7s-
t 1. DISINFECTION: Type /fi/H
12. CASING:
13
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16. REMARKS:
Depth Diameter
From 0 To / 28 Ft. CA/ -
From To FL
From To Ft.
GROUT: Depth Material
From 0 To 2 o Ft. Cairnc.,st
Amount O. g6
Wall Thickness
or Weight/Ft. Material
SDR zl y vc-
FL
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description;
O c
iv
rj,
-4211
N co s_
.. it �:
co 2
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.
mQ
Method ) %, YYs `tu lnm-- 1�,d " -
htioncr
7 `Se r • /main.)mae) - ./vr i. l,t�
to AL.,. Ret , 9,6 41 % Y -ca.)
Slot Size Material
in.
in.
Material
AdaNd SDI QMJ.) P4'
5gq
Q z t vc rre„r�. »t eh°
miten' twvr bp)-picA,en, c4 -
arc ,141.
l� I 14615HREBLY
RTPY H4
CONSTRUCTION STAN
F
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
aIg
DATE
c00%
t SCttY(ttitPthe oYR;ihdlid the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS thane Na (9).7 3221, within 30 days. GW-I REV. 07/2001

North Cnrollna • Department of Environment and Natural flesources - Division o1 Water Quality • Oioundnalnr Section
1636 Mail Service Censer • flatelph, N.C. 27699. 1636d'hone (919i 733.3221
fy///er
WELL CONSTRUCTION RECORD WELL COW nAcTon. L CONTRACTOR CERTIFICATION H: -2 qO-3
STATE WELL CONSTIIUCTION PEflMITH:
262387
1. WELL USE (Chock Applicable Box): Residentiallf Municipal ri Industrial D Agricultural ❑ Monitoric9 ❑
flecovory ❑ Heal Pump Water Injection ❑ Olhar ❑ it Other, List Use:
2. WELL LOCATION: (Show sketch of lire location below) SC�a .�
Nearest Town: 15',y/:M C'// County:
Gre4fy iron( L
DRILLING LOG
invert !lame end Numbers. Community. or Subdivision and Lot Ito.)
rt/ ,Clh6er� From to
3. OWNER 2,�
Address _ 7n6u/ (c457' Ivn Y O'L _ L7
in
(SL'eaf or noula uo.l
(Yv011o9 _ 3 j 30 3`jO
City or Town
Slate Zip Code
4. DATE DRILLED /-'2,F-o2-.
5. TOTAL DEP111 300 ' 1�
6. CUTTINGS COLLECTED YFS CI IDOL—}i_I
7. DOES WELL REPLACE EXISTING WELL? YES I10
6. STATIC WATER LEVEL Below Top of Casing: V 0 Fl.
/ lure'•• II Above Top of Casing)
9, TOP OF CASING IS z FT. Abovo Lend Sullnco'
•Top of co ship terminated eVor below land eurlece requires • variance III accor•
dance with 15A IICAC 2C.el is
10. YIELD (gpm): 4' METHOD/ OF TEST //`r
11. WATER ZONES (depth): 21O
�7 Amount �r7
12. CHLORINAIIOfJ: Typo �-----
13. CASING:
DEPIII
Fonr.axn Descrtpeo-
C /mY
(rtun. /c
II additional space is needrl t_-se bad or I irn
LOCA I ION_SKEI Cli
\Vail l ldrime s s
Depth Diameter or Welphvrl. 'Ueda! 'C-
! (Shaw direction erd danco Iran zl to ae:no
6'25— 5fitV fec floods, or other rrz7 raterRce points`
thorn 0 To -}-`--' rt.
From 10 FI
From 10 FI
14. GROUT:
Depth
From 0 To'2O FI
From To Ft
15. SCREEN:
uh�
Itod
Depth Dlanrolor Slot Size Material
Prom To FI.-- In In
From To FI. In. In Ram _ To FI. In. In.
16. SAND/0
From
Front
17. REMAf
I I JELL
I D011E EDY L fitFTHIkTF� 3,W1,C,i11EIWA3 OtISlf1UCTEDIPI ACCORDANCE WITH 15A 10 TNr IWL 1. REF.
COIISin C11Q�j'f-t�`/QilJ74(lU �')1r Ax A L Pi0�11115 f� OFlD I IAS DEEll PROVICED —2-D
Material
0
—
_j
ry
o
CO
CO
POET OFFICE USE ONLY
Oved tlo:
Se ialllo
a-E
SIG! T r1E OF FEfISON CONSTf1UCTIrIo be ./v'ELL D
Submit original to Divielon o! Weser Gustily, oro,lydeella S•ccn within '.') fist'!
Ce.I ire Y. I `11
a

UIIILLIIJG LUG
�. Y Sleall'gyetr flour to
9. Addres l C �n �,9 __
Address yv Tn6u/ 017`, r�x 1�1 Iy _y
151ieo1 ofll��ola Ito
C---teP—
City
Clly Or town Stale Zryl Coda
4. um E UnIL1.ED /___ v 02— —
5. lOIAL UEP111 30-- , F. CLIIl INOS COLLECT EU YpS I_ I 1101-}'__
IJU1.4- 7. DOES WELL nl LEVEL
Below 1 o WELL? YES �J I-I—___.—.--
U. STATICWAl[fILEVELuoloav (Uste°+l Casii'holvelop01�'n�l"0) _-_---
P. l OP or CASING IS ± — FF. Above Lend Sunoco'
•Top of whip lelnrhelnd ever below Land eudica caprices a valance In *cent- .------_
dance wllh 15e IICAC 2C .01111 // f%-
1 U. YIELD (gprlt): 0 IC1E 1110U Or TES F
1 1. WA1 En ZOIJES (depth):
/fT/% Amowi _if cr'�4
12. CIILOf11rIA11ON: typo -- r
LUCnh IOIJ_SKE_I ell.
V7all ellr WI . LlalrJ.I
(Slnw dlreclloa and di-s-:mrce litm 21 boa:! tro stale
Unpllt Ulamolor or Welphurl. or 004! II 7 ieIeerce pnlnti�
Pwm
D 10 ri. G,2J— SOQ2t AJG Roads.
rrom l0 Ft. —
Plonl to II. —
14. GI10U1: Depth ♦vial tlal
p70� f�
Prole D to 2 ri.
F I om _ 1 o Ft _--_-------
15. SCI1EE11: e. !AntoliniDepth Diameter ,,lot 5170
1o__—_—rI III. _Ill.
From�� In. _
10 —rl.— In.
I'wm . _— In.
From_lo Fl. In. —
16. SANOIGfIAVEL PACK: Malarial
Size
262353
r orn»or De >aignw
13. CASIIIG:
north Cnlnllna - Oe par lrnenl of Environment end rle lurnl Resew vie • lllvl+Ion of Walnr Du slily • (hound Al ntnr Section
15361.1ail Service Center • flnlelph, N.C. 27699. 1676•Phono [phone]
WELL CONSTRUCTION RECORU Wt i c c IIIM;I Ulfl cE1111p1CAlIOII n' ,2903
SFAIE WELL. COIIS111Uc11o11 PEf11A11tit
1. WELL USE (cheek npplleeble boa) DesIderlllalE<Mtndelpal U
Indusldal U AgrlcuhNral U TAonitoerg U
Decovory U Ile al Pump Water In(ocllon LI Olhor 0 if Other, List Use:
2, WELL LOCAl10 (Shoo ��Ich of Ilia Iocallun below) Sw4 `I
Meares! -Town: Connly:
/be 7?//ft_9/1f s ti GS__.._._-------- -...--
I Toad Ilene nod IIwr.Lan, Con.punlly. nr Suhdlvl sloe and lu1 Ilu )
rtonl 10 FI.
From
17. f1Er•1AI1KS:
I DO I IEfEUY
co11SInUC1t
' Fos OFFICE U
Ovid Ilo:
Se hlllo.
T11119WELL WW1
JDAl1D5. ArJU 11IA[;A L.
I4JJ Ihod
./'/'•c ltvr-e.
II ndd010nn1 s,^^ace is tie rr!rl CS : bac: el Ivrn
11001E0 lit AGCOI10A110E Y111111SA F1CAC r, yrEtt
1111S IIECOIID I IAS UEEII Pf1ONCED -10111E'71E_l Oir EP
�3 —��
tUI it or rrlls011 Cons1111):111 in Ut'r'FI I.
hlonol TYete( Opellly. Urepeced er Srcce trvlUdn Y) Ca YS Y `71
Ee 1 FIE I

WELL CONSTRUCTION RECORU
1636iib Ca I ling • VCe nlinernn eE01 ,llo ii ni 8 11Bat PlrIle ul o 79:1I9221n of Wain( Gu nlity • (boundwnt nr Ser-!ion
e
WELL CON ILIAC I UII' —/7/. //Cr
WELL COIIIIIAC1011 CEnI1CICA11011 n
sIAIE WELL CONstll(1C11011 PEllrnitn:
zVO3
262386
1• WELL USE (Clock Applicable Bow)! nasldonual 0 Municipal U
Illdushlal U Agrlcuilural U IAonlloricy U
Necovery 0 I leas Pump Water In)ocllon U Other U II Olhar, list Use:
2. WELL LOCA110t
Neatest lowre
&e4s fits�C/•
o Tr td
L�./ Ccyvs74'
j� � a�6r1_lG
(Show skald] of the locallun below)
Coonly ��-12ei -4
Woad name and Huebert Convotolty. or Subdivision nod lot Ito I
3. OWIIEU
Address
1511eol of 116E16 1161
Zip Code
City or town Slate
4. DA1E MILLED /-4-0Z
5. 10IAL UEP111 6.70
6. CLII11110S COLLEC1 ED YfS El IlU l -
7. DOES WELL nEPLACE EXISI1110 WELL? YES
O. SIAIICWA1Ell LEVEL Below lop.
ol i sIg:nAboveI_6p.i.1-1
P. 10P OF CASING IS _Y_ rF. Abovo Lreet Sullnce
•iop of cniny Indn.led .Vor below land auil.ce tequhee a v.,I.nce In .Cron
d.nce with ISA IInCAC 5C .011e
I O. YIELD (gplo)• ME I I10D or TES 1-
11. WAIEilZONES
AHI0UIl 12. CIILOFIIIJAlIOrJ: 'lypa �-----
13. CASIIIG:
Wee 1 blrbon 1(
Depth Diameter
(
Diameter or WeIUI,Ui I. Melee:I
d-(
rrmlt 10 rl.
FIo111 10_ rl.
rlan, 10 ri.
14. UI1OUI:
now 6)
glom --
15. SCIIEEII:
Depth p l
r
10 � PI. 7
10 rt._--
Ueplh
lion( _-10-
rite,
Eton
TO
10
16. SANOIUI1AVEL PACK:
moot
rron,
17. REI.IAfICS
El.
r1.
Diameter Slot slru
_ In.
Ill.
in.
In.
In.
I DO I IEIIE eY CEI11IFY 1I IAT 1111S WELL W
COI ISInuclloli �IAWt?ApB'S.i:
lAf
Foil OFFICE
outdIra'
cedar lo.
Method
IAal011al
Metall:11
0I1111111U LUG
rum to
__OE_P)II-------
raft J[O' net ri!tlre
11 nJJitlonal stace is nr rr!rd cse hack of IVrn
LUGAIIC)N.SKE.ICII_
(Show dlrecllon and cJ s once han 21 Ina:: !no S tole
Ilondl, or other u27ICI tiro! ("ohm!
ISIHOC IEUIIIACCorIOAIICE WI1111s& rimr.'(tFtt
F 11119l1EC0110I IAS DEEM PUOVICEO 10 HIE WELL OW'E
IN—
.�� - -_ g=
SI01 1 U11E OF P p115O11CU115111tntine t1t 'N EIt D. r
SubiJ1 odvinil to [Pillion of Weier Uialliy. ()wide. Cu S.ccn wlUtln y) C.9 y5 re I FIE V I' n
e
1:(
COI'

O I I 1 6svlmnnle111 rind rlolurnl Decorum',. Ulvlflon of Wolof Duality • (ltoundnnlor Section
WELLc0NIIIAC1011: Lej'Y(er ---
WELL CUII UTACI011 CEII I IrICA11011 If:.
s fAl E WELL coilsl11[Icl l0l1 PEnrAI111:
LJ LJ LJ
1. WELL USE (Check Appllcabhp oos): flosldonL� llairll�tlhalra[Ubldushlal II Other, Llsl Use:
Agllcuhulal IAonllolicg
hecovory Li heal PumpWalor In)ocllon
2. WELL LOCA11014t(Sllov skald] of ICDite.e- llo location below)
) Su 2r{I
—
Neatest town' � �
UrIILLII IG LUG_ Uc?II I
North Carolina -epllman o
1636 Mail Sorvlca Center • nnlelph, N.C. 27699 1636 r'uonn [phone]
WELL CONSTRUCTION RECORD
262384
(load llama and numbset f. Community, or Subdivision .rid lot no I
3. UWIIEll Ctit-dee 7i'vr C f
Address
stair zilr Gnio —
Clly or 1o.a+ —
4. UA1 E 00IILI.E0 /,17-DY —
5. 10IAL UEP11I NU
G. CLI I11I1OS COLLECTED YVS Ill Il Lam►' 7. DOES WELL nEPLACE EXIS1ING WEI 17 YES IJ IiUt_4—
U. SIAIR; WAlEnLEVEL Uolowlot'olLIIAhoy^:1- tca'il))I
9. l OP Or CASING IS — I'E. Abovo I.mld Sutlncn'
-tor of cooing in minalnd poor below land 'urine tequilas • variance Ili scum
dance —
dance with 15A 1ICAC 7C.011E � r
10. YIELD 'goutyD SMEIIIOUOFTESf
11 WA1EnZONES(depth):
Etom to
,2 gal
r onucol Ue fallpiv
It nJdtdonnl sr$c! ' rt d t-s� bah 011%1.1_
12. GIILonINAIION: typo �
13. CASIIIG: LUCA11011SI E_ICII-
Wall Ibk4nnff
Of W elphVl 1 Idaledat (Slwrw direction rut' Jzcanca Ilan 21 (rips: t"o `''I!
!load,. or o9.er ❑r.s21ererrce (mints`
ROMRout
trout 14. G110U1:
From
nom
15. SCI1EEII:
flour
rlont
rtonl
16. SAND)U11AVEL PACK:
��/ Allle 111 ll
Uoplll
10 —1— 11
to rl.
_lo PI.
Ulamolor
C,zs'
/bb Slea/
No 11h 1al Ilaf IrlylhoJ
To 2B ri. �? ---- -
to
glom
nom
17. IIEMAfI(S:
I DO IIEnEUY :Ent 'Y MAT 11119 WELL WA`
collslnuclion saUeSIMPI `i,
Depth
10_
10.
lo.
ri
Ulantolar Slot She
In. ht.
r 1 _-- -
FL_- b1. _____
El. In. In.
IAnladal
I11UC1EU Ill ACCortof)ICE WIIII IsA r1CA.c Y'. YVELL
P' Ills IIECUFIU I IAS UEEII rfONCEO No 1tiE Vlc' L QW'EI
�i-
L—
' 02-
no name sOli Srnc
SuWtJlodpinalloUivldonol Wile( OVlly.UtuvraJoalle1.ccn W01In�yE Cob FIEV.I`71
Foil orricE USE U11LY
Ovid Ito:
5031110

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- N3n&S uitil L��r (r'` ^y5
WELL CONTRACTOR CERTIFICATION #: 7 •; & 7
STATE WELL CONSTRUCTION PERMIT#:
246282
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 setch of the location below) _ j
Nearest Town: 0,119 S D cS 1-,County S�u�R rA)
1613; ,z,StrJ Cam-'-P
(Road Name and Numbers, Comm„u.nity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �6 N p l c 1°F 4- Cr o,- kra-- From To Formation Description
Address
(Street or Route No.)
City or Town Sate Zip Code
4. DATE DRILLED I lI 7-
5. TOTAL DEPTH -2- Pr
6. CUTTINGS COLLECTED YES n NOT!
7. DOES WELL REPLACE EXISTING WELL? YES D NOn
8. STATIC WATER LEVEL Below Top of Casing: `rj FT.
(Use': it Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated aVor below Land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm)• METHOD OF TEST
11. WATER ZONES(depth)•
12. CHLORINATION: Type
13. CASING:
.4R1
Ga
0
-71 y-
o
r>.
CJl rn z
rn-
o `a
Amount If additional space is needed use back of form z
LOCATION SKETCH
/ Depth Diam ter or WeighVFt. Material (Show direction and dislancctirom at least two Stale
From / To / 6 0 Ft LC 7 y Pia-s Roads, or other rr rence points)
a From To Ft
From To Ft.
14. GROUT:
Wall Thickness
Depth Material Method
From / To 2 D Ft .Sr-jWc r C etor:w}1
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in In
From To Ft
16. SAND/GRA
From
From
17. REMARKS:
I DO HEREBY C
COI4STRUCTIO
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON COt1STRUCTI,/THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
•�vy N;
7an,i
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. /
C" b /// 7i
DATE
GW-1 REV. 12/93
Serial No.

FOR OPFIC
Quad Ne:
*Wei Ns.
Noro+Carothr • Department of Environment and Natural Resources • DaAron of Water Quality • Groundwater Section
1leaMell $sMoe Center • Relslgh, N.C. 27999.1a39•Fla,r (919) 73942E1
2 4'718 7
WELL CONSTRUCTION RECORD WELL CONTRACTOR' y.'Lai-o.m 14?'t�
WELL CONTRACTOR CERTIFICATION 0: a 0 5 0 f
STATE WELL CONSTRUCTION PERMITS,:
1. WELL USE Mai APF 1sa W Ms): Raaldan sl El Municipal Industrial❑ Agricultural ❑ Monitoring ❑
Recovery DI Heat Pump Water Injection ❑ Other p It Other, List Uw:
2. WELL LOCATIQf4: (Show sk of the location below) G
Meerut Town: 1/71 L)4. - Q I Corey: SW 0S %,
(Rood Name ery,NunWr, Corrvnunity, or *4b6VSbn and Lot No.) DRILLING LOG DEPTH
iom
3. OWNER �' tivu5 y From To rdorl Deer+tsaon
Address / �cO
1%uv-j�C-r. C- 1 11 C
ON Or ifOle 1 Stela Zip Code
4. DATE DRILLED I Zoo `
5. TOTAL DEPTH "1 n
6. CUTTINGS COLLECTED YESQ NO®
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO® w c'
6. STATIC WATER LEVEL SeloW T of op Casing: 4,S FT.
Rue.•.• II Ara Top of canal rn `'r
9. TOP OF CASING IS I f?. Above Land Surtsoe• 1 i
'Tee et eeehrg Mwhrlse seer Mau lend oaten 'nano • ware In aeeer
erne with /M NCAC IC .91111
10. YIELD (gpm): a. METHOD OF TEST I) I.J
t 1. WATER ZONES (depth). al s
12. CHLORINATION: Type tYfl4
13. CASING:
v
r-,
rrt
Amount b . < if additional space Is needed use beck otterm
LOCATION SKETCH
Depthrnsointes
DI•nrter or «Welp/*n tame) (Snow dlmotbn and distance from at least two State
from 0 To .3 Ft 6 %4 SDR a1 •J)v C Rpada, or o9w mop reference points)
From To Ft. V �r.41A-- Ai, ,Yncn& 614-47E 2 )1 1-C-e_:
From To Ft
is. GROUT: 1aLx, J� IAILW4-��-*kn& s6.ak. 56 / SA
From To _3 L_ Ft CC'rna�5e• Depth Method �)% 110 1-1.1A:r.- � i} et, 4-1.1 Sue ay to 7 --
16. FFrom To Ft t S ';o )n lx . i . c EA ,*s y
Depth Dawns Slot Sin Material
�m �,}� kit0
From To - Ft In _ Iniu-AfF5 hp 5Ase _. t- v>, k e,-, �n
From To Ft. In In ew'tit 6-L —L-f4 Rtd. 5,6 }l,i Eel.,
From , To Ft In _ In ti,iri n �o
16. SAND/GRAVEL PACK:
c, t �X�la y) iC�'��
Depth Sl2s Material -34a rrt-: Luc" ,,..r. Lc,) - ti)Lu ;t4%..�c
From o F . 4y`c•:l`t Rua(,f o �i1u>.f `�, tom_ xjp rniCa_
17. REMARKS: r 09 ti tiCL. • A:i `e',.•-1 ,7 cbu r1/43 ;.
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION aTANflawea . • - Y OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
r-rc
GROUNOVIATER SECTION
ASHDOLi.E f OFFICE
at)0
PE • CONSTRUCTING THE WELL DATE
n al Wotse Duality, Groundwater Section within 30 days
*WA Rev. ILW

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Gr wundwater Section
1536 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 41-13-V'rn LULU M ttkie e
WELL CONTRACTOR CERTIFICATION #: O-SO ��
STATE WELL CONSTRUCTION PERMIT#:
247186
1. WELL USE (Cneck Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI N: (Show sketch of the location below)
Nearest Town: tiL County: 1-` Cl t en
(Road Name and Numbers, CommLnity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER -1-4:-in �' rwJ�., Mkt From To Formation Description
re
Address
�1 S or Route No.)
L"7�1ae» C e C
City*. Town State Zip Code
4. DATE DRILLED lhRhnn 2,
5. TOTAL DEPTH 7 a s
6. CUTTINGS COLLECTED YES D NOE,
7. OOES WELL REPLACE EXISTING WELL? YES ❑ NO [-CI
8. STATIC WATER LEVEL Below Top of Casing: /sci FT.
(Use'*' if Above Top of Casin/)
9. TOP OF CASING IS / FT. Above Land Surface*
'To l of casing terminated at/or below land surface requires a variance In acc9r-
dance with 15A NCAC 2C .0118
10. YIELD (gpm). It,- METHOD OF TEST A 'mot'
11. WATER ZONES (depth):
12. CHLORINATION: Type J4Tfj
13. CASING:
Depth
From 0 To f S Ft
From To Ft
From To Ft.
14. GROUT:
Diameter
/9.
CO c
r c
N T
J o
Amount b -9 9_— is additional space is needed use bacf. of . orm
Wall Thickness LOCATION SKETCH
or WeighVFi. Materal (SInw direction and distance'.cm at least 'NO Stare
SbVR 2,1 -P-1'C Roads, or other map re erence points)
1cavi-c a{.LRrcreJ 11.,ki-Ce 1 arc_
/IF-w' LVa.,'4:; .& S&rc-tki d"t. / o a11.41 •-,
Depth Material Method t vr. LLJ71 On y Lcatrit 7 34/ r
From �_ To .?. Ft C•G'+1taIrc e-SarTh
ynt....>-Lt.t.'LY. r v, Cs LcQ. 5�2e.ntinj Pc° .
From To Ft aic mtc' O
15. SCREEN: -
Depth Diameter Slot Size Material N taakt �I 3 10 n- tLt tc�v' yr e
From To Ft in in »'`cvJ.w, /3na'ncLt. ta,t, 3jYr,cLtc ti!I,
From To Ft in in Gr�t� jcjct.:-LCt., i
m 3rta< < ncQ . r / &�e �w.ti1e;i
From To Ft in in terra /� 1
16. SAND/GRAVEL PACK: -tein � r1,c„ p o"T nolo j`a• `a 110 %h-c�'
Depth Size Material t E' ` �.cLii De) • r 14041' L°y
From To Ft o � ��7h✓u�� fti1�r'rLRi,
From To Ft ro h4 co-: 3 'tef CtLIL''LC e . f
�.�A7
17. REMARKS:
WAS CONSTRUCTED IN A;CORDANCE WITH 15A NCAC 2C, WELL
Ce� • - `s •1- S, AN a�Jat A COPY OF THIS RECORL HAS BEEN PROVIDED TO 'HE WELL OWNER
X2LI WtL/cJf' fl2P•002.
E OF PERSON CONSTRUCTING THE WELL DA rE
t original to Division of Water Quality, 3roundwater Section within 1 days
GW1 PE1. 12/99

From
17 REMARKS:
From
15. SCREEN:
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] jr
WELL CONSTRUCTION RECORD WELL CONTRACTOR• f L't-4s..T1\ (k) «P b--t
WELL CONTRACTOR CERTIFICATION It: ',OS- 75
STATE WELL CONSTRUCTION PERMIT*:
247185
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 1-5. 1 ita tT- C c Zi-( County
L1 CL L ys
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER j)CU (esimf\iC C.SI-2P From To Formation Description
Address fZCT o•r•.Q:7 1 p p- i 2Io
(Street orAoul8Noj'
an t /Lt.. 6 t tk.i 7) _ C _
City o/Town I State Zip Code
4. DATE DRILLED Ill iV-Riao7-
5. TOTAL DEPTH E-r;S-
6. CUTTINGS COLLECTED YES f NO❑X
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOn
8. STATIC WATER LEVEL Below Top of Casing: Aa o FT. - 1
(Use'+' if Above Top of Casing)
9. TOE- OF CASING IS I FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0119
10. YIELD (gpm): / METHOD OF TEST fl a-'t:
11. WATER ZONES (depth): S iv
c
rp
hl O
o
m
12. CHLORINATION: Type Fir H Amount O •7
13. CASING:
Depth
From /) To
From To
From To
14. GROUT:
If additional space is needed use backTSliforng
LOCATION SKETCH
(Show direction and distance from at least two State
5 cj Roads, or o,ner map reference points)
AL-'/LC4# S' SC,c:.CL q_t) %iTLLita
Depth Material Method 1,c LCI-7- OP-
)1C /Lt-L10-1/ tt 7y a 3 /o
1 1
From O To an Ft t tiThir:rirSava yiar.cu -- cctrn_ Le en. calk 5Pu,n',u� .
To FtO. �o riikLto- ccvr. LLpi- ay. ye.Vj,�.,Lrt
R (Lit )acv rctil cr 3 3, ttK Us,-t ivn &
Diameter Slot Size Material �c,L, t.Z )-
c ) �'
Ft in in '� ) .9/io hi:IA--
in in "Loth:\- ilVilM• ens ik 3.6- arKt , R,ctYaZ. Rd.
n in 10 y7w&, •. t,.rm Lc),3- dam' 3 O,yi,. ire
2Cd/u C--
Wall Thickness
Diameter or Weight/Ft. Material
G ''4. S RP. a I p1L4—_
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
To
Ft
Ft
Ft
Ft.
Ft
Ft
Ft
Size Material
SCAN bAIWbS
FFICE USE ONLY
GROUNDWATER SECTION
ASHEVILLE REGIONP_- f " E
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-LAM Ic /// R l� o 0 2
SI AT OF PERSON ONSTRUCTING THE WELL DATE
Submit original to Division of Water Ouatity, Groundwater Section within 30 days
GW-i REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quaky - Groundwater Section
1636 Mali Service Cemer - Raleigh, N.C. 27699-t636-Phone [phone]
247184
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Ter- 1+c+rm LA) U1 ��ELv
WELL CONTRACTOR CERTIFICATION 0: .2 in Sr.)
STATE WELL CONSTRUCTION PERMITS?:
1. WELL USE (Cheek Appkeab4 Sox): Residential ® MunroIpal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other (l If Other, List Use:
2. WELL LOCATION (Show sketch off, the location below)
Nearest Town: .¢.+-ti.*rt CtItl County: Sall &Lett
Agricultural ❑ Monitoring ❑
(Road Name and Numbers Community, or Subdivision and lot No.) DRILLING LOG DEPTH
3. OWNER 7,i:ki )t.4,114.2r� C } From To Fo maNan Dese ptlon
Address FE,tt0.- «o Igo,) C AZA"'lt 'i+
I..u. 2al C• `i1,C..
City 4 Town Stall Zip Code
4. DATE DRILLED 1!///,2ao
5. TOTAL DEPTH 7 <2o'
8. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES [] NO®
8. STATIC WATER LEVEL Below Top of Casing: / zo FT.
of
9. TOP OF CASING IS 1 FT. Above Land Surface')
'Top of casing terminated aUor below lend surface requires a vad.ncs M accor-
dance with /eA NCAC 2C .1011a
10. YIELD (ppm). 1 /O, METHOD, OF TEST /) Ut,,
11. WATER ZONES (depth) S S; 7
12. CHLORINATION: Type Mil Amount O- /oY.
13. CASING:
Depth
From O To 7 •s
Wail Thickness
Dimmer or Weight/Ft. Material
Ft &/'# . SDf -I plc
From To Ft.
From To Ft
14. GROUT: •
Depth Material Method
From o To ao Fr, i4yn"t-3c,.��
From To Ft
15. SCREEN:
From
From
From
Depth
To _
To
To
18. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Diameter Slot Size
Ft In
Ft In
Ft In
Ft
Ft
Size
ty
m
T.
N
11 additional space is needed user back of form
LOCATION SKETCH
(Show direction and dietance from at least two State
Roads, or other rnapttrreference points)
LcA si'rnn- ea-4 ey_LC�
`
b.c- lS� W't4A 7K ^ S v..�t�.la/pod� 1 Sc o
1/ ,
7`f alomath, tir 1c3.
Material O '. tt)''J rest& tU I
Ptntcwnrc. Lekc £w�4c',
d 9/ 7. O Y1+ti d,:
1 1t->7''Zia
d o
Material :cc l.e.Zii vul.t. ufn..,1 , �,j-,L. il-
1`
ick c+L £•.,ea 9 cit uvv-L.
In
In
In
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARD AN
IL,
SECJIO
r rGiO ICE
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
- THAT A COPY OF t").THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,►.} hll AA__I/1 a,00 a. OdPERSO CONSTRUCTING THE WELL DATE
original tof Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

WELL CONSTRUCTION RECORD 249692.
North Carolina - Department of Environment and N//att1u�ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(��CLe✓Q- '^^'� RflkG CERTIFIC'ApTION#r2;3Z
\YELL CONTRACTOR COMPANY NAME /,n')Lt� i.01—( ° Ililt4. Lric • PHONE #�+.q isb - Q /3D
STATE WELL CONSTRUCTION PERMIT# 1 S7 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential NJ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: 1411.ior/
t 1 04 Ler/hi CAM_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address Les. 1 erL C.atit 22
(Street or Route No.)
briSON N a-8713
City or Town State Zip Code
021 )-
Q%il (Y)oN-l-et h
County SGOalrll
Area code- Phone number
4. DATE DRILLED I'3l—er
5. TOTAL DEPTH: I Z6 - —/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I�G
7. STATIC WATER LEVEL Below Top of Casing: % FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): ' METHOD OF TEST
10. WATER ZONES (depth):
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1 To �z Ft. 6i'`P ihlckfuvr P✓C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 1 To ao Ft. .a-)4 to nsArL Aqt.,/
From
14. SCREEN:
To Ft.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Topographic/Land,�,,�setting
❑Ridge f lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
—r-
t 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.
t,JAikt,„ C0"L
`�
up --
co.It'
Beisod
CjN ko- / e2/4,
16. REMARKS:
S I19AI IIiRdI3YVCEItmF 71 T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I QF` S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
MAY 17 002 J �,� ,��� 3LD2-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LUNS I KULI 'UN S
GRI!tlpP grL%o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ARH“2769946,36-PliflneNu:t919) 733-322I, within 30 days. GW-1 REV. 07/2001

249690
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CieVtl-4,vJ j-tr Ha-- ! CERTIFICATION #oa 387
\\ELLCONTincrORCOMPANY NAME g90ca well Dr,'11 f/\L .Cnc PHONE # tp�) i00'8i3o
STATE WELL CONSTRUCTION PERMIT# /-17 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential /Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL. LOCATION:
Nearest Town: artpcn,u C4147
/3W-t J UNo414 Bit
(Street Name, Numbers, Community, Subd
3, OWNER: PAL X't9Ie4
Address I.tNRMAIIa dre al�&R-lek
County Sw144N
vision, Lot No.. Zip Code)
(Street or Route No.)
24-Itsco4 N‘G c —C7/3
City or Town State Zip Code
eau_
Area code- Phone number
4, DATE DRILLED )——OZ
5. TOTAL DEPTH: aa-a
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO er
7. STATIC WATER LEVEL Below Top of Casing: (60 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): jO METHOD OF TEST
10. WATER ZONES (depth):
t 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth DiNameter or Weight/Ft.
From I To49 Ft. L T 74'1CK f,.hil
From To Ft.
From To Ft.
13. GROUT: Depth Matelriia"l� f1 Meth d
al)From / To aFt. SW) CJ Rat,/
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
P Ve-
Topographic/Lad setting
❑Ridge ❑Slope EValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
IV
A C
LOCATION SKETCH al c'"`
Show direction and distance in miles froam�cileast'
two State Roads or County Roads. Includthe ro o
numbers and common road names. to
vjk
(V tr
So
�G 0 Znr
/9 So q
rs
UNAgAim
�/ 38
o 4,1
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�._...I jJa111, /-t23,02-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
v

248414
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION # 2045
WEI.I. coNTRAcroR COMPANVN.AME Hedden Brothers Well Drilling,' -Inc PHONE # [phone]
SATE \\'EL1. CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential IT Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Putnp Water Injection 0 Other 0 If Other, List Use
2. WEI..L LOCATION:
Nearest Town: Bryson City
'5 Battle Street
County Swai n
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: nerre, chnier
Address 85 Battle Street
(Street or Route No.)
Bryson City, NC 28713
City or Town State Zip Code
( n9u aaa aan3
Area code- Phone number
4. DATE DRILLED 01-29-02
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J1
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
FT. Above Land Surface*
8. TOP OF CASING IS 2
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST blow
10. WATER ZONES (depth): 205'
I I. DISINFECTION: Type
12. CASING:
HTH
Depth Diamewr
From 0 To 16 Ft. 6 t$
Amount 16oz
Wall Thickness
or Wei 'ht/Ft. Material
1$steel
From 16 To 114 'FL 6" pvc
Prom To Ft.
13. GROUT: Depth
From 0 To 20_ Ft.
From To Ft.
Material
cement
Method
go' gyred
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 112' clay & sand
112' 500' unite
C-11
-A
rr!
LOCATION SKETCH
Show direction and distance in miles from leas'
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
MNNL ROC1MOONk41A
FAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
LDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original o the
GROLIMMAIIIRSTRj o (919)
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

«'ELL CONSTRUCTIOiN RECORD 29389°
North Caroiiiia < Dopariment of _ ,i ment N_,r_i R:s:wcea Division ciVizater Qua / - Ground.cateo
E L JaT,es B. Ero)�n
L COVT�R:aCIOR(I VIDUAL)iMivIE (prinP CERTIFI.ATIO.N,', 20:5
EL.LCOmirs CTOR C01,1PA ,va>IEEedaz^. Brothers 'v;ell Drilling, Inc
PHOryE d FCd 1 309,-czo1
STATE 1V ELL CONSTRUCTION PER,1tTd - ASSOCIATED N'Q PERMIT;
(ifacnleabie) (if aoriicable)
I WELL USE (Check Applica Sex): P s aa: Mt cipah: u5hc 0 Industrial ❑
Moniicring ❑ R covery.0 Heat RIM:Waier N;.-tion ❑ Other ❑ ffOther, List Use
2. WELL LOCATION j1 -
Near/`' .vn, �� <�C.Gb�/'o
!0
(Sirni Name, 4ur—o s CCL1,111L1rJti, c _34s:ou, La.: NJ., Zip Code)
3. OWR .G 1
al 3 "ThOan �.r,�tf
c Ro_t: >la1
/JJIJt 4 f �
n 3 gab
: c- To.S • Zip Ccdt
( 263':" l43—5`jPf�
Arta code. Pilule m_a-_r,
4. DATE DRILLED^-irg-oa
5. TOTAL DEPTH&0O' •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. 'STATIC A'i =,TER LEVEL Below Top of Casing FT.
(LInn •:-" T ✓ c; Calla;)
5. TO? OF CASING IS 2 ET. Above Land Suria:e`
'Top o: os!ng tarrninate9 aFor below land surfa:e requires a
vurlan:e IC accordan.• ich ISA A'CAC 2C .0113, 9. YIELD (aaml. ,METH=on OF TEST blow
i0. WATER ZONES (,._rth):
Toggiztaginicilandsett:,
❑Slope ❑Valle'. ❑F I
(cheek apprapt:a! hc%)
L tulle-e ; of welll
io:.__
From Te Fcrrat nDes;r.,tloc.
0 yfji clay & sz:a
cra-n1te
LOCATION SKETCH
II DISINFECTION: Type Amount 16 oz .Show dire:iion and distance in miles .ricm at leas;
12. CASING, Wall ThiC':Cess two State Roads or Ccun::: Roads. lash:de the road
De :h Diame e e Weight, Ft. Ma numbers and c
From 0 To 407 Ft. PYi
at
Fron p ' To %.a a Ft. snit
From To Ft.
13. GROUT: Dept;r iMa!erial • Method
From 0 To 20 Ft. tzuiite & L.;. puro i
From To Ft.
14, SCREEN: Deb , Dla, e er Sig! Size D !atenal
Fa- To , .. it
From, To Ft. in, i-,
15. SAND'GR.-.VEL PACK:
Derib Si z• .Ia.eris
il
From To Ft.
From T^ Ft
16. RE1MARKS
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE SVITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, Nt THAT A COPY OF THtc RECORD HAS BEEN PROVIDED T3T::E WE L O `.NER
Si �h� L 'ale - 6,2
NATURE OF PERSON CONSTRUCTING THE WELL - DATE
Subm1t the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, !NC
27699-1626 ?him,: No. [phone], nithin 30 days. OW.: REV. 07i200
r

WELL CONSTRUCTION RECORD
N'or.:....,, 3'.Ica - Dc:n::rner1 of Envirormem and Natural Resources D!.,-.cn of %a:er Qc Ir
1`, ELL CONTRACTOR (INDIVIDUAL) AA!E (print) Kitchell D. CCOk
WELL CO,v'URACTOR co\IFA.m' NAME I Z T1 adYESrr anu--, Irn
886
Grourd..a:er Se.:ion
CERTIFICAT10\ 20(-13
PHONE. E25) 369-9591
STATE \A ELL CONSTRUCTION PERiNIIT* ASSOCIATED WQ FERN; (TA
(f abclicable) _.
(if a:olicahiei
\"ELL USE (Check Applicable Box). Residential Z :N _iFcbGC 0 Industrial
Ni:nit..rini: ❑ Redder:: ❑ I. -feat Pump AVa:er Injection 0 Other ❑ If Other, is: Use
2. WELL LOCATI
Ney»/:stTovn,
XM
iVl l
7L ((..ty County
(o:ree. Nn n e, N :., C .non Jnity S:c
3. OWNER.
A'drcr
No, 2.2 Ccde'
::<CJ� AC, c f7/3
- C,;' c(f'c',r. Ss:e
8 . y2R-u885
. DATE �DRILLED oc S'69-)
5. TOTAL DEPTH: r!riv501
6. DOES WELL REPLACE EXISTING WELL? YES C NO
Z:p Code
7. STATIC WATER LEVEL Below Too of Casing. FT.
(Use li -,: Top c'Casln_1
8. TOP OF CASINO IS 2 FT. Above Land Surface'
'Top of casing terminated at,or below land surface requires a
variance In ac:crdan-e h IS.A NCAC :C .0(13.
9. YIELD (zcm). NIETHCD OF TEST b-o«
10. WATER ZONES (ep:h),
II DISINFECTION: Tvpe F T v Amount 1 EZ
12, CASING:
De th Di —
et
),
From T . to 7 t Lo
From /-� To Ft. in" ,iQR
To Ft.
13. GROUT: Depth !Material Method
O To 20 Ftl. iiLite & w, aL tarc
From To Ft.
14. SCREEN: De::h Diameter Slot Size .._,e:Ial
Frr, To Ft. in, _ in._
From To Ft. in
15 S.AN'D. C-RAVEL PACK:
\ Yap.: Tn:cha-oo
or Weight/Ft.
) a
From To
ze MateriaI
uitura: ❑
T epogra:hic/Lanci Set. E
:Ridge 0S1❑Va11❑Flat:-
any pri -ox)
Lal'Jd ( ;u.'.,,.wallI...
, S f.
L_ . :j2 lonz.ituhie souEO?Sr_TT rhplic rh_oh
k box
DEPTH. DR!__ING LOG
i , orn; h.on Desoro o --
clay
(05CY cran.ite
LOCAT,IONSKETCH
Show direction and. divan:: in miles from a: least
two Stare Roads or Cc'.:nrr Roads. Jnc ode the road
nuc,:ers and common road names.
-10
0
From To Ft.
16. REMARKS:
1 CO HERESY CERTIFY THAT THIS \s; ELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WrL .
CONSTRUCTION STANDARDS, ANDT'r'.AT COPY OF T:IS?ECORD HAS BEEN PROVID cD TO THE WELL OWNER
2kFed % [.494k
SIGNATURE OF PERSON CONSTRUCTINOTHE WE'LL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1536 ,Vail Sarvice Center • Raleigh. NC
27099.1636 Phone No. [phone], within 30 days. GV'i-1 REV. C7 2:31