Av CY2003

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
284057
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687
030566 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential Municipal I I Industrial InAgricultural Monitjo?irrg 1
Recovery n Heat Pump Water Injection n Other n If Other, List Use:
Ixl
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOSCOE County: AVERY
ELK HILL DR. OFF HWY 184 OFF I -WY 105
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER ROBERT B WILKINSON/RICHARD J. SAILORS
Address P.O. BOX 1832 .
BANNER (tutor Route "° ) NC 28604
City or Town State
4. DATE DRILLED 11/18/2003
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 120 FT
(Use'4" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 25 METHOD OF TEST Air
11. WATER ZONES (depth)•20.00 ppm 133-137 5.O0gpm 218-221
0.00 ppm 0.o0ppm
DRILLING LOG
From To
0 50
50
133
137
218
721
DEPTH
Formation Desctipti3n
DIRT
133 GRANITE
137 SHALE QL.IARTZ.--
218 GRANITE
221 QUARTZ
300 GRANITE
C �m
1-11
fA
Zip Code
12. CHLORINATION: Type HTH Amount 37
13. CASING:
From
From
From
xl
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 64 Ft 6 1/4
14. GROUT:
15
To Ft.
To Ft
.188
GALV
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in. .3
bo
ciS
t o -c
J. C]
As 2J,
If additional space is needed use back= forte v
LOCATION SKETCH O
0
(Show direction and distance from at least two State
Roads, or other map reference points)
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
/'jt
17. REMARKS: U 1r.AeXc3 l4 ioS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
37� ghoeL ja-5263
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
284055
WELL CONTRACTOR. Dewey Wright Well Pump C6., Inc.
WELL CONTRACTOR CERTIFICATION #• 2887
030593 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
xl
Municipal Industrial
Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County: AVFRY
SUGAR MAINTENANCE LANE OFF BOYDEN LN OFF NO
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER STANLFY S NORWOOD
4.
5.
6.
7.
8.
Address PO BOX 1408 .
BANNER (iL nrRomalloI
City or Town
NC 286
State Zip `Ode
DATE DRILLED 11/17/2003
TOTAL DEPTH 300
CUTTINGS COLLECTED YES
NO
DOES WELL REPLACE EXISTING WELL? YES NO
STATIC WATER LEVEL Below Top of Casing: 120 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 15 METHOD OF TEST Air
11. WATER ZONES (depth).15.00 ppm220-223 0.00gpm
0.00 qpm 0.00gpm
Agricultural Monitoring
DRILLING LOG
From To
0 44
D PTH
FormatiortLDeseription--
DIRT SHALE
44 220 GRANITE
220 223 SHALE QUARTZ
223 300 GRANITE
12. CHLORINATION: Type 14TH Amount 37
13. CASING:
From
From
From
0
Depth
To
To
To
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
50 Ft 6 1/4 .188 GALV
Ft
Ft
Depth Material Method
From 0 To 20 Ft Cement Gr49ti Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
If additional space is needed use back. for m
LOCATION SKETCH —
rna
c,
O E.
(Show direction and distance from at least two 9Fete
Roads, or other map reference points)
/v5
Nowooct V l
1)1-://)
G—"
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQPY OF THIS RECORq.{1AS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
APACtl, /o — /Jr— D)
Quad No
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (/ 'C-�' 1/�
L �,�
\\'ELCONTIRACFOIt COMPANY NAME .6,R4 e-toe' // . (,KI /� I PHONE #
STATE \PE I,1. CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use EIlti✓a fC
2. WELL LOCATION: Topography Land setting
NearesiTown�bA{�i"C.'2 Elk CountyJd'te ❑Ridge CdSlope ❑Valley ❑Flat
,o• .2,,c4Q -
275590
CERTIFICATION # r-259 1
7) • C (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER:( O Jfr 1bty lL%.xj SWIy Co,
Address • rC1-el d{ ✓v /
(Street or Route No.)
•C • d$CoO4
City or Town State Zip Code
Gaz)- 3ci -036i
I
Area code- Phone number
4. DATE DRILLED 3'-1 I 'C'j
5. TOTAL DEPTH: I42a7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J3
7. STATIC WATER LEVEL Below Top of Casing: 5CD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /�
9. YIELD (gpm): ,S O METHOD OF TEST •r I`A
10. WATER ZONES (depth): fj se
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ^'% To 98 Ft. a•4-- 511411 %t
From To Ft.
From To Ft.
13. GROUT: Depth Material
From C5 To O Ft. Ceac•,-/—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Format on Description
0— 4#. te1 i -
�/ bt0li'N 3$s4
T3— :. JI 9q'fi' 0
/Re 9_3
vJ— fF
i-F— ja
C
O
i
LOCATION SKETCH fl
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:
DO HEREBY CERTIFY THArF:-.4\F IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION. STAN 00S }VND T COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)9�ICNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divisi n of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-I636 Phone. No. (949) 733-32 1, within 30 days. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
r.flfnnn
LJJUUU4
WELL CONTRACTOR. Dewey Wright Well
WELL CONTRACTOR CERTIFICATION q. 2687
268026
Pump Co., Inc.
STATE WELL CONSTRUCTION PERMIT# JLeVe rcer:e
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
X,
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAND
BRYAN DR OFF HWY 105/2,1
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER DORIC SWOP
Address & F&K C NSTR 241 THE GI ENNS RI VD
BANNER( ieeSur Route N0.) NC 288Q4
City or Towne 4I'S� State Zip Code
4. DATE DRILLED 1/14/2003
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES NO
Iri
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use'4" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST. Ar
Municipal ❑ Industrial n Agricultural 0 Monitoring CI
Other If Other, List Use.
County. AVERY
XI
DRILLING LOG
From To
It 1p
DEPTH
Formation Description
DIRT
1p RR GRANITE
33 35 SHALE
35 70 GRANITE
70 73 SFIALF
73 470 GRANITE
11. WATER ZONES (depth)5 PPm33-35 15 ppm 70-73
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 84
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 75 Ft 6 1/8 350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From - To
Ft
Ft
Size Material
17. I DO HER EY'CEFiTIFYTHATTHISWELEN1 t
CONSTRUCTION STANDARDS, AND THAT'A C
I '
FOR OFFICE JSE ONLY
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
k0
fY 0� 7
Y
W
C
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-n3
Quad No:
Serial No
SIGNATURE OF PERS N CONSTRUCTING THE WELL DATE
Su)jinit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ey.N �6.12cr.,(U CERTIFICATION #
WELL CONTRACTOR COMPANY NAME pfifs‘S._Na It UieI I 1)(2,, `1\ z PHONE # gait) 753-- C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ ARM1T#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ErMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Z)A init'n F)/< county y
„�AveR
'Mk VA)Jey f1i.aR u,sa -1-t ly 1
(Street Name, Numbers, Cdnmunity, Subdivision, Lot No., Zip e)
3. OWNER: 5 eA, i! kcfjy3-k
Address ! /r r) CR, {-,/h91
.--] > (Street o R ute No.)
/ ttDz /& 7,c&yo
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
)-03
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXI TING WELL? YES ❑ NO t/
7. STATIC WATER LEVEL Below Top of Casing: 60 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): Cit METHOD OF TEST A: 2
10. WATER ZONES (depth): 1-1' !Ted V. 5-0
11. DISINFECTION: Type chtOR(30-
12. CASING:
Depth Diameter
From 0 To 33 Ft. 611
From To Ft.
From To Ft.
13. GROUT: Depth Material
From d To O Ft. c0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: ' Q .-A,.. kit. Cotusi, Cot
Amount Co c, Z.
Wall Thickness
or Weight/Ft. Material
:SPR L
_(\ Method f
Slot Size Material
in.
in.
1 ri
44r a:l •�43
tIopographic/Land setting
dge ❑Slope ❑Valley ❑Flat
• (check appropriate box)
i /Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - at d>p..4 /posy .ock
75— 520
TJc
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.
?,efwxC. FaK
I DO HEPERY CH[T'FY TWAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
<Cb$2'R J �ON',STAND AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
<P -;i
ul,, is
Submit the original to thf
27699-1636 Phone No. (919)
�- I
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
co
PP}
c)
co
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

II.
(2.
WELL CONSTRUCTION RECORD
269160
North Carolina - Department of Environment and Natural Resources: Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4/0 Robe2sco. CERTIFICATION#254®
A
WELL CONTRACTOR COMPANY \'A\IE�YZ�O.SLJ e) !A-C_1' I 1 PHONE # Zr2W.;.Z
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ 1' MID/
Of applicable) (if applicable)
WELL USE (Check Applicable Box): Residential flunicipal/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:
Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C---0021
Address -5cd(Nlt"la .<tiyt
?fig E /C County 4 uekV
sie (Street or( Route No.) 4,23601
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX TING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: GO FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant ith ISA NC.AC 2C.01 IS.
9. YIELD (gpm): METHOD OF TEST /+-)
10. WATER ZONES (depth): /70,, -2 PC
DISINFECTION: Type r11 frap'lPC'- Amount 6 e'C
Zip Code
CASING:
Depth Diameter
From 0 To (2% Ft. 6 `Cr
From To Ft.
From To Ft.
13. GROUT: Depth Material ``A` Method. •
From ® To �> C Ft. C_e,v '- -e_ - e.a2C
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
Wall Thickness
or Weight/Ft. Material
From To Ft
From To Ft
Topogra is/Land setting
❑Ridge Li'lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
©-7cs
`ye - i ao
)p,ch- �60
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
! DO HEItLI3Y1C{LTI'ThrHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
o
CONSYRUCTI'S11\NARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
_Submit the original] o th Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone' p. [phone], within 30 days. GW-1 REV. 07/2001

269164
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�aResources - Division of Water Quality - Groundwater Section
hit
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i( Atfe4 Ij "TO •lefelks
isO•lefQti CERTIFICATION #
WELL CONTRACTOR COMPANY NAME AC/ i'✓G 1( PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential fB"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use Ar, tJa'+ C.
2. WELL LOCATION:
Nearest Town: £Pc.lzoo t e
Ray Arow,- ZA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: q J.
Address S Y
LeAziec (Str�ret or Route No.)
County htUCry
LitK
a8cs7
C'ty or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ‘,..7
-1tl _ 03
5. TOTAL DEPTH: �O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1— FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance withA NCAC 2C .0118. A
9. YIELD (gpm): a METHOD OF TEST !i i
I5r
10. WATER ZONES (depth): 7C z/3 4ry c l
37c-- .3 93 /9-4
11. DISINFECTION: Type 11 T ZI Amount 3 OZ
12. CASING: Wall Thickness
Depth Diar�tteter or Wei t/Ft. Material
From -t To S rf Ft.
From To Ft. f7)R021 P31C
From To Ft.
13. GROUT: Depth Material Method
From 0 To at? Ft. C-0me. "1 po.LA^CCP
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.
r---I-BCti�1$R_EB Y C 5RT
CONSTRUCTIONS P
Submit the original to t
-2a699-1636.Phone7•Fo. (91
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
Fonpation Description
"Cc! b/'CwA.�e 'ram
rot, e
Jiggle r'or.<
C'C. e5 {1A174
DEPTH
From To
5 5(3
1v — 4 3
93 -- 35c
Jgo 3Y3
3t $ rfap
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r6d
numbers and common road names. 1 w c
—,- r
rrq rarr,7
CD c_m
frote
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERS
42 /9 - 6 3
CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
272326
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2687
030083 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
J'1
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE
BRUSHY CREEK RD. OFF HWY19E
Municipal
Other
Industrial 0 Agricultural Ti Monitoring
If Other, List Use• _
County AVERY
Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER GEORGE E. PITTMAN
Address 54 SKYHOOK LANE ,
SPRUCE l6°'Romallo.l NC 28777 18 25 GRANITE
City or Town State
4. DATE DRILLED 2/26/2003 27 40 SANDSTONE
5. TOTAL DEPTH 360 40 360 GRANITE
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO El
DRILLING LOG DEPTH
From To Formation Description
0 18 DIRT
25 27 SHALE
Zip Code
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm): .5 METHOD OF TEST Air
11. WATER ZONES (depth): 1.5 itpm 25-27 0 qpm
0 qpm 0 gprn
12. CHLORINATION: Type HTH Amount 71 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
f1 0 A,d Ann
From Lt To 4UFt U' irw .ioo vJALv
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To F
17. REMARKS•
I DO HEREBY
CONSTRUCT
1IT
IFY THAT THIS WELL WAS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
N STANDARDS, AND THAT Ai0O V OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE LSE ONLY
�s—
_ S GG HE WL
Subthiit original to DivisionNATUREOF of WaterPERSON Quality,CONSTRUCTINGroundwater TSection ELw
c
DATE
Quad No:
Serial No
hin 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020807
272323
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2687
STATE WELL CONSTRUCTION PERMIT#. Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal 0 Industrial E Agricultural fl Monitoring
Other n If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County ,AVERY
MTN. MEADOWS OFF HICKORY NUT GAP RD. OFF HWY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER
Address
KENNETH D. PEELER
2683 ENOLA RD. ,
MORGANNONi r Route No.) NC 28655
City or Town State
4. DATE DRILLED 3/20/2003
5. TOTAL DEPTH - 600
6. CUTTINGS COLLECTED YES I NO
I>I
Zip Code
7. DOES WELL REPLACE EXISTING WELL? YES I NO
X
DRILLING LOG DEPTH
From To Formation Description
0 32 DIRT
32 100 GRANITE
100 103 QUARTZ
103 540 GRANITE
540 544 QUARTZ
544 600 GRANITE
8. STATIC WATER LEVEL Below Top of Casing 50 • FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011,0
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth)' .5 ppm 100-103 2.5 pprn 540-544
0 pprn 0 pprn
12. CHLORINATION: Type HTH Amount 113 If additional space is needed use back of form
13. CASING:
From a To 3' Ft Li 1f
From To Ft
From To Ft
14. GROUT:
Wall Thickness
Depth Diameter or Weight/Ft.
-r,
JJU
Material
P IC
Depth Material Method
From 0 To 20 Ft Cement Gravity Flaw
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ftin in
From To Ft in in.
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
17. REMARKS' �
I DO HEREBY C
CONSTRUCTIO
Ti IAT THIS WELL WAS W
NDARDS, AND THAT A
FOR OFFICE US bMY
Quad No:
pi
SIGN
Subm1-original t
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
yx
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CD 3
TURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
ICA
Serial No
I'

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]
272370
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
02045E--2
WELL CONTRACTOR CERTIFICATION #. 2887
STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal I I Industrial
Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVFRY
WOODLAND MEADOWS OFF F DFRRFRRY RinCiR RD
(Road Name and Numbers, Community, or ubdivision and Lot No.)
3. OWNER M & V DEVELOPMENT
Agricultural ❑ Monitoring
DRILLING LOG DEPTH
From To Formation Description
Address PO BOX 532 n 2 D)RT
BANNER (Er_ pnr Route No.l NC 28604 2 33 GRANITE SHALE
City or Town State Zip Code
33 35 SHALE
4. DATE DRILLED 3/5/2003 35 500 GRANITE
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO
I xl
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 4 METHOD OF TEST Air
11. WATER ZONES (depth)-4 pPrn 33-35 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount g8
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 22Ft 61/4 188 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS
I DO HEREB'lC f� {FXT+4A;<TH SWEEntrA�1 ti�1STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT Q TANDARDS, AND THAT A ' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) eat"'
y\Je/ 044'
9.r
C
0
FOR OFFICE U
Quad No:
E ONLY
V.
0
S eNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suhre$,toriginal o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No _.

15. SCREEN:
I>I
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To TL Ft
17. REMAR SJ,
I DO HE i �10ERTIFY THAT THIS WELDtW
CONSTR —(ONSTANDARDS,ANDTFAT
FOR OFFICE U4E ONLY
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 272311
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020924
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2t186
STATE WELL CONSTRUCTION PERMIT#
Leslie Reece
1. WELL USE (Check Applicable Box): Residential >1 Municipal [ I Industrial n Agricultural ❑ Monitoring I I
Recovery 0 Heat Pump Water Injection I I Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below) -
Nearest Town: BANNER ELK County AVERY
HICKORY NUT GAP RD. OFF HWY 194/184
(Road Name and Numbers, Community, or Subdivision and Lot No.l
KEVIN DONALDSON DRILLING LOG DEPTH
3. OWNER From To
Formation Description
Address P.O. BOX 130 0112
i2 DIRT p
VI LAS (Street or Route No.) NC 28692 112 503 GRANITE
City or Town State Zip Code
4. DATE DRILLED 3/5/2003 504 545 GRANITE
5. TOTAL DEPTH 545
6. CUTTINGS COLLECTED YES fT NO
7. DOES WELL REPLACE EXISTING WELL? YES FT NO ICI
8. STATIC WATER LEVEL Below Top of Casing 100 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011 0 Air
Or T'fEEgg
10. YIELD (gpm) 20TH Pm50TE5
UT
11. WATER ZONES (depth)•ppm U
ppm
12. CHLORINATION: Type HIFi Amount >d1
13. CASING:
503 504 QUARTZ
U ppm
Wall Thickness
Depth Diameter or Weight/Ft. Material
in From a To °Ft1V 1f0 .35 PVC
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
`i
Depth Material Method �-k hK� /I
From 0 To 20 Ft Cement Graait� Flo v �°ry lxe.
From To Ft c7 �-' o
0
"a
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
:OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Quad No' CR Jh; t
A rLV!L.I-± NFL
E.F.C1i011
Crrh
Serial No
SIGNATURE OF PERSO ONSTRUCTING THE WELL DATE
mit original to Division of Wate ality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
272298
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
000300 STATE WELL CONSTRUCTION PERMIT#. Steve Petty
1. WELL USE (Check Applicable Box): Residential Xt Municipal
Recovery Heat Pump Water Injection I I Other
Industrial n Agricultural
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County AVERY
HICKORY NUT GAP RD. OFF HWY 184 OFF HWY 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
Monitoring
DRILLING LOG DEPTH
3. OWNER MIKE HUDANICK From To Formation Description
Address % BURTON CONSTR. , P.O. BOX 24 0 65 DIRT
LINNVILLICreetoraoeteNo.) NC 28648 85 90 GRANITE
City or Town State Zip Code
90 92 SHALE
4. DATE DRILLED 3/13/2003 92 130 GRANITE
5. TOTAL DEPTH 145 130 135 SHALE
6. CUTTINGS COLLECTED YES I I NO I X 135 145 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES FT NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 100 METHOD OF TEST Fir
11. WATER ZONES (depthl:2 qpm 90-92 98 qpm 130-135
0 gprn
Cl
pprn
X
12. CHLORINATION: Type HTH Amount 26
13. CASING:
Depth Diameter
a
From 0 To 3 Ft u'
8
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
.350
If additional space is needed use back of form
LOCATION SKETCH
Material (Show direction and distance from at least two State
PVC Roads, or other map reference points)
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
%8e
15. SCREEN: • �ltft, Iue![C,lDbfS
Depth Diameter Slot Size Material cociAke.
From To Ft in in '
s t.-
From To Ft. in in • �. no�;
From To Ft in in p ,(, cal EA
EA
• rnr 'ly�1W
16. SAND/GRAVEL PACK:
Depth
From To Ft.
17. REMARKS
I DO HERE
CONSTRU
Size
Material
-t
k
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ziz
SIGNATURE OF PERSON CONSZRLCTING THE WELL DATE
nal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
272297
WELL CONSTRUCTION RECORD
030059 STATE WELL CONSTRUCTION PERMIT#' Steve Petty
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
X
Municipal
Other
Industrial
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: VILAS County. AVERY
3. OWNER
Address
STONEY HOLLOW RD. OFF FLATSPRINGS RD OFF I -(WY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
ROBERT LYNN HICKS
294 STONEY HOLLOW RD.,
ELK PARRrest or Route No.) NC 28822
City or Town State
4. DATE DRILLED 3/11/2003
5. TOTAL DEPTH 125
Tip Code
Agricultural fl Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 40 DIRT GRAVEL
40 90 GRANITE
90 92 SHALE
92 115 GRANITE
115 118 SHALE
6. CUTTINGS COLLECTED YES NO X 118 125 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "." if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm)' 6U METHOD OF TEST Air
11. WATER ZONES (depthh 20 ppm 9042
0 ppm
X
10 ppm 115-118
0 qpm
20HTH If additional space is needed use back of form
12. CHLORINATION: Type Amount P
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45Ft 61/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
From
From
17. REMARKS "
I DO HERB"
CONSTRLCL I
o
RTIFY THAT THIS WELL
ST,Pgy,4ARDS, ANPITHA.
FOR OFFICE USEPPILY —
Gr
Quad No:
1OP1tal
WNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH• (,
L.
direction and distance from at least two State \(td 1okl
Roads, or other map reference points)
1. "MOTION SIGNATURE OF PERSON C Pl RUCTING THE WELL DATE
_. L'SUtit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
2'72292
WELL CONSTRUCTION RECORD
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.2681
030057 STATE WELL CONSTRUCTION PERMIT#• Steve Hefty
1. WELL USE (Check Applicable Box): Residential Municipal
Recovery I I Heat Pump Water Injection Other
Industrial I I Agricultural I Monitoring El
If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County' AVERY
3. OWNER
Address
EDGAR TUFTS RD. OFF H\YY 194 OFF HWY 184 OFF H
I Road Name and Numbers, Community, or Subdivision and Lot No.)
EARNEST M. SHOEMAKER
% STACY L. BURGESS , P.O. BOX 1788
DRILLING LOG
From
D
To
DEPTH
Formation Description
CS DIRT
BANNER tL:Cor Route No.) NC 28604
City or Town State Zip Code
4. DATE DRILLED 2/25/2003
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
XI
68 120 GRANITE
120 121 SHALE
121 186 GRANITE
186 187 QUARTZ SHALE
187 205 GRANITE
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth):1 ppm 120-121 4 ppm 186-187
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 39 If additional space is needed use back of form
13. CASING
Depth Diameter
From 0 To 72Ft 61/4
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Material
.188 GALV
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
r'• �S l o -�
I
17. REMARKS
I DO HERE .CERTIFY THAT THIS WELL VAS "ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU tIOW STANDARDS, AND THAT ",.:53)'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Size
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Ks
Imo`^,ice' ler
FOR OFFICE USE tNLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SA' t original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
272289
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020758
WELL CONTRACTOR' Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 28E7
STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal I I Industrial 0 Agricultural Monitoring
Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town- BOONE County. AVERY
RUSS NORRIS RD. OFF BUCKEYE RD OFF HWY 321
3. OWNER
Address
(Road Name and Numbers, Community, or Subdivision and Lot No.l
ALICE WELDON
282 CHARLES STREET,
BOONE (Street or Route No.) NC 28807
City or Town State
4. DATE DRILLED 3/6/2003
Zip Cade
I I
DRILLING LOG DEPTH
From To Formation Description
0 35 DIRT
35 50 GRANITE
50 53 SHALE
53 90 GRANITE
5. TOTAL DEPTH 125 90 93 SHALE
6. CUTTINGS COLLECTED YES NO 21 93 125 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
I xl
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• J0 METHOD OF TEST Air
15 qpm 90-93
11. WATER ZONES (depth) 15 qpm 50-53
0 Qom 0 qpm
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING:
Depth Diameter
r_ r ra
From L' To 8t Ft u 114
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
. 1oo
Material
r•nr
Uv.LV
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY
CONSTRUCT
E T,IPYT ATTHIS'WP11 t�aSCd
TTANDARDS, AND THAT 4,CC
FOR OFFICE LSE ONLY
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ti
0
0
iJ
::J
%CCC L bF e K
1
aT\
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-� t-t u — y — o3
ioriginE to Division of Water Quality, Groundwater Section within 30 days SQG NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit
•
Quad No
Serial No.
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL('ONTIt.ACTOR (INDIVIDUAL) NAME (print) /d ��W.a.1 „✓ — CERTIFICATION#.�w6?J
wEL(. CONIR,ACrOR COMPANY NAME NPQ eve-/ PHONE # J )
STATE \YELI. CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
275597
I. WELL USE (Check Applicable Box): Residential Dr' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use /�ii_ Ye
2. WELL LOCATION:
Nearest Town: etast!/e:O, C County
TA-erni3 rAN c- h
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 1_ _
Address ��c&rnkk-U
(Street ok Route No.)
INUO
City or Town State Zip Code
Arca code- Phone number
4. DATE DRILLED 6,-a%'aj
5. TOTAL DEPTH: / %U
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 4-
7. STATIC WATER LEVEL Below Top ofCasing: Cif, FT.
(Use "+" if Above Top ofCasing)
8. TOP OF CASING IS Z 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): 3& METHOD OF TEST 41i i.
I O. WATER ZONES (depth): 70 -97 (5„,'
/go vSJk.f
I I. DISINFECTION: Type 1/4/7M Amount L36
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From -/ To X. Ft. 65 5 Aei
From To Ft
From To Ft
13. GROUT: Depth Material Method
From O To 070 Ft. GCC* r /70x,. t."
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
eidge ❑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 Des ri/g❑.tion
-9 6 `'90
9P— /46
9
/6o y63 Lortcso.45 f-/..d—
/IY A70 tc..v e
U�
() c
LOCATION SKETCH r - -
Show direction and distance in miles from aS.ast off=
two State Roads or County Roads. Include the roacE4
numbers and common road names. -a n
O
I DO HEREBY ' ' IS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
FM-
,,\ CONSTRUCT ION STANDAi ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I ll
J' �f l� a�
II J GNATURE OF PERSON NSTRUCTING THE WELL DATE
`Submit the original to thelnivis`on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
I, within 30 days. GW-I REV. 07/2001
76997166 Phnne A0-0Lo) 1733-3
rya
:
G
J

Jai /6 /
WELL CONSTRUCTION RECORD 275596
North Carolina - Department of Environment and Natural Resour es - Division f Water Quality - Groundwater Sectionn
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �N/✓ �� CERTIFICATION # cafe
WEI.I. CONTACTOR COMPANY NAME Srr#scor/i 1Ultda'; PHONE a ( )
STATE WELL CONSTRUCTION PER,IIT# ASSOCIATED WQ PE RSIITN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential L Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use fel ivi,Yee
2. WELL LOCATION:
Nearest Town: ,4 et/' ��k County lT✓
g Sa, �'i+...J e.ai 7 c
(Street Name. Numbers, Community.
Community. Subdivision, Lot No_1ip Code)
3. OWNER:
Address 88A,
(Street or R�ou%a No_)
City or Town State Zip Code
607'
(
Area code- Phone number
4. DATE DRILLED ,'-/'-ll.j'
5. TOTAL DEPTH: 3 L7 t^
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -
7. STATIC WATER LEVEL Below Top of Casing: /S" FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 4 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 `r^
10. WATER ZONES (depth): S') /94 / ! 10 60/
/SO*9a/ an: aye/
I I. DISINFECTION: Type //f// Amount 3 ei
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Nnlaterial
From --/ To /.2 Ft. 6 S PiAc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From d To aes Ft. Cen,e.. Pr)Lr✓ety
From 10 Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge DSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
dles�
-"Per mn .2.,)/'o%
/oe2 -/ Id g{.fr�i fe
F//b iON S /ro /t°
5YIT e/
Penenr ilw/e
�ecw+ /C
<Aej$i'tae1 Y/regv{c cn'e tJ
✓ /t�,y t 71e
DEPTH
From To
a.- -'
i(r f/
72— too
/Ye) -/as
/3s--/sn
Afo —asp
A5t7 - 3c0
LOCATION SKETCH cA
Show direction and distance in miles from atdeast
two State Roads or County Roads. Include tt
numbers and common road names.
rrrh✓sm
h'/K
N
C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGN.ATURE OF PERSO ONSTRUCTNG THE WELL DATE
I
Submit the original to thgl i4ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919)i733-3 2I, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
275595
North Carolina - Department of Environment and NaturalraResources - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) �c e-Am €?I ,/nCERTIFICATION # 2419
PHONE # ( )
WELL COVI RACrol COMPANY N,UIE
Y6grv.--e/l tie it lliNi
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural C3�
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use f Isle* fit
2. WELL LOCATION:
Nearest Town: / Kt-',`rt, e County /Ives-)
fS-9N
(Street Name. Numbers, Communityy Subdivision, Lot No., Zip Code)
Co.zngc
3. OWNER:
Address f5a.
(Street or Route
J Lrt�
City or Town State
144o ier y/
Zip Code
( Area code- Phone number
4. DATE DRILLED 4 /%'Qi
5. TOTAL DEPTH: Xe: - O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E'
7. STATIC WATER LEVEL Below Top of Casing: /5 FT.
(Use'4" 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): /d METHOD OF TEST ///s'
10. WATER ZONES (depth): //O /
023 3,99/ s° /
I I. DISINFECTION. Type //ti Amount 96Z
12. CASING: Wall Thickness
Depth Diameter or Weieht/Ft. Material
From "/ To /60 Ft. 14-5-,4r?/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From G To $o H. (Ywti re:,4/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From
To Ft.
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
c - 93 fed /r caw "get
43—/DD 9rely,%Y
/ta `aid 9/'a.v,'7"(
.L3G- 02.33 '71/rJ
233- 3S0 Jr4.141'
Yee /ffr//. C-u/.,^2/1
3 15 sa O 4- AQ / {G
Jib — err
LOCATION SKETCH t�
Show direction and distance in miles from acteas
two State Roads or County Roads. Include t�roarF,r„
numbers and common road names.
LA A-4
1
16. REMARKS:
I DO HEREBY CERTIFY TkA
CONSTRUCTION STANITA
G
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JATURE OF PERSON CO RUCTING THE WELL DATE
Submit —thee origin icTW:.Divisio \ of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No, (919)73t-322„ within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 275593
North Carolina - Department of Environment and Natural I(esou cc - Uislsion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �rHN� /J OZ-� CERTIFICATION„ 19
1Vf LL CONTRACTOR COMPANY N nMt: 1l F'S«'Y.7I
(it LL ri l Pi AcIpHONE 0I 1
STATE WELL CONSTRUCTION PERMIT a __ __. ASSOCIATED AVQ PERM ITN fr
(if applicable) lif applicable)
1. WELL USE (Check Applicable Bost Residential DsNIunicipal'I' ublic 0 Industrial 0 Agricultural C
Monitoring 0 Recovery 0 Heat Pump Witte: Injection 0 Other ❑ II Other, List Use
2. WELL LOCATION:
Nearest Towne 4P9 t.� iQ1� OilUIY a
(Street Name, Numbers,
�Community, Subdi viion, Tat , Zip stile
3. OWNER:
Address
(Street cuieNr, o't
City or Town
Area code- Phone number
4. DATE DRILLED c-5 P d 3
5. TOTAL DEPTH: at
6. DOES WELL REPLACE EXISTING WELL?
State
Zip ( ode
YES 0 NC) Er
7. STATIC WATER LEVEL Below Top of Casing: 3gr FT.
(Use -+" if Above Tup of Casing)
8. TOP OF CASING IS LFT. Above Land Surface'
*Top of casing terminated artur below land surface requires a
variance In accordance with ISA NCAC 2C .0118
9. YIELD (gpm): METHOD OF TEST*3.,‘
10. WATER ZONES (depth):3✓oI
egraphic/Land setting
dge LOSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
f ue gram/m i cones/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
/6 o /e2$—
/AY-sot
gel --3/o
3/d-360
340 -- 3G I
.fif k/c`e_)f 'V,e, lac
7i'ra-i fG
W
' ,,Go 622Tq% LOCATION SKETCH, L -tat
II. DISINFECTION: Type4 l l�jlL�-- Amount Cat Show direction and distance in miles froze at IeistS.-
12. CASING: Wail Thickness two State Roads or County Roads. Include -the ro`adi
Depth D'ameier or W eight/f:. Material numbers and common road names. CD _—
'% Ft 2t WC,�'- From 0 ToFrom To Ft.1.'
To Ft.
Depth Matflria( 1).:ethoJ
To 2&_ Ft. / edien4L in°ri/n
From To Ft.
Depth Diameter Slot Size Maio: ial
To Ft. in. in
From
13. GROUT:
From /7
14. SCREEN:
From
From To Ft m.
15. SAND/GRAVEL PACK:
Depth Size
Frorn To Pt.
From To Ft
iN I:geoid
!6. REMARKS: Grp , II (� C-OL
—:_
fV ro
uP.7.2
Ca
.Cr
ap, rO o
.� I
i 4a
-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION, STAND. AND THAT A COPY OF TIBS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I ti II
!i I ) SIGNATURE O (SON CONSTRUCTING THE WELL DATE
_.., !
Submit the original to thireiN ision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733 t221. within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
275592
North Carolina - Department of Environment and Natural es revs - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 CERTIFICATION #1,,g3 L 51
%YELL CONTRACTOR COMPANY NAME S SCJGt i— I ` N 7 PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
2
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use 1 c-.r7e
WELL LOCATION:
Nearest „ wn: < A K
TLC •
County
(Street Name. Numbers. C.hmunity. Subdivision, Lot No.. Zip Code)
3. OWNER: /� 4'CA c - .
Address I( d - G'• .
06441_02` (Strct tCor_Route No.) 4
eJ i�//C a� U
City or Time State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED (y --,5 — 05
5. TOTAL DEPTH: 3 6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: / U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-. FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.1 NCAC 2C .0118.
9. YIELD (gpm): !S' METHOD OF TEST /7 r r
10. WATER ZONES (depth): 511:5- / .- / Aze, 'i . /
f? S el
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To 9- 3 Ft. G-.•. JD'.}/ At'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To v.;.: Ft. Cro,."�t //e e/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope (Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6— 31` rc/1 D/c/neiffe
e;
J / ,
f
/3r -/37
/7c+ — o2) 7
,r)G—
P/ 3D.
//n
fN7;,, tI-4 {f'C'"JKw fJ
/, ,v% r /cCecil"
LOCATION SKETCH C r r
Show direction and distance in miles from feast
two State Roads or County Roads. Include groadc-1S
numbers and common road names. gc
v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS ONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
r-.--E111)td3TKUCTIA JDAfND THAT A Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIkiNATURE OF PERSON CONSTRUCTING THE WELL DATE
iJ.
Iilitibmit the original to the ivisl in of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2 699-1636 Phone No. (919) 33-32 1, within 30 days. GW-I REV. 07/2001

275588
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /7jGJ//YZ%}t'/ Ye; e�itiri CERTIFICATION # 0`46
WELL CONTRACTOR COMPANY NAME (/IOft/e// PHONE # f )
STATE: WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) • (if applicable)
I. WELL USE (Check Applicable Box): Residential rre Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use O i' s_t. /-r
2. WELL LOCATION:
Nearest Town: LOCATION:,
County
r� 4/'ka..,* 4 ,, e<
(Street Name. Numbers. Community, Subdiivisiion`,'LL94y'o., Zip C
3. OWNER: n qr0 /4/o otY.i
4.
5.
6.
7.
Address /
w"i--NeN(trees Route 'o.) Xot /z
City or Town twiit.frat. Zip Coda vG 57
C.
Area code- Phoneenumber
DATE DRILLED —%t) "'63
TOTAL DEPTH: a1 o e
DOES WELL REPLACE EXISTING WELL? YES 0 NO Fe
STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .L FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance,.s7ith ISA NCAC 2C.0118. y�
9. YIELD (gpm): J METHOD OF TEST /t/>'
10. WATER ZONES (depth): /7-/3° zgfr/
/G/ //3 --5:5</
//T/f Amount -7
Wall Thickness
Diameter or Weight/Et. Material
Ft. 64 /13 602'
I I. DISINFECTION: Type
12. CASING:
Depth
From To //a
From To
Front To
13. GROUT: Depth
From 6 To gO F'L
Ft.
Ft.
Material
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To FL in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
es
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ((Formation Description
a — //.0 F1ealidie 4;1-6 fit/
//e
on
/P //7n Xrcce e7, -,%• /•
/3-a —/cr/
/L=/—/G3
/G3 �'0
flratsi Pt.(
LOCATION SKETCH
Show direction and distance in miles from atdmst
two State Roads or County Roads. Include ttoad'
numbers and commo road names. `-'
r
6
16. REMARKS:
1 DO HEREBY CERTIFYlf{hf{��
�£6NS-TRUC9fONST 1�2lt
�I
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY DF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sttbrpit he oriL;LI rnitmthe Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699.1636 Plnxte No 0.1.9) 73313221, within 30 days. GW-I REV. 07/2001
/

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274843
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
Dewey Wright Well Pump Co., Inc.
zd7b
WELL CONTRACTOR CERTIFICATION #:
030149 "er2 rnce
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection
ea
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK
HWY 184 OFF HWY 105
Municipal
Other
County:
Industrial ❑ Agricultural Monitoring
[I
If Other, List Use:
VERY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER APPLE ORCHARD WAY
Address % GOB INGALLS , P.O. BOX. 1959
DRILLING LOG
From To
0 68
bANIVEmISITger Route No.)
N� 2'6504
DEPTH
Formation Description
DIRT
bb 120 lirtAl I t
RED GRANITE
City or Town State
4. DATE DRILLED 4/11/2003
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: I FT
(Use "+" if Above Top of Casing/
Zip Code
I 'I
IAI
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm): �� METHOD 9F2FFGGT1 0
Air
11. WATER ZONES (depth): gPm r12
OP rn 17U-1T'I
120 121
121 Zhu VKA1Nilt
150 151 GRANI I E
151 170 GNANIIe
170 171 GRANITE
171 205 LttA`JI it
gPm 'tOU-1b'I
0 cIPfn
4U
12. CHLORINATION: Type Amount
13. CASING
Wall Thickness
O Depth _, Diajnete or I, iphVFt.
From To 4 Ft LC++ JJ
From To Ft
From To Ft
14. GROUT:
Mdter..W l
Depth Material Meghq
From C To Ft `.emtn: Gra•.,.y , low
From To Ft
15. SCREEN
From
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
or,rh
FF'"�r. !Front 7 fl),,/ To ^ Ft
I1L 17. jj(nMAR6Sr-
J L, AA HE EFWCERTIF
CONSTRUCTION S1L4
FOR OFFICE USED
Quad No:
Serial No.
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
Size Material
c
CD Li) O
6 -_
If additional space is needed use back dlRormri.=
NLe Ir.
rn
LOCATION SKETCH ca
(Show direction and distance from at leasttuida Stale
Roads, or other map reference points) G
\ ti,
\u
-�• 9
e
ISq
nr.ar
�(K
¢ ( IOItccaj (^1
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 0
WNER.
,/ -// vim'
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Writer Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274913
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
030215
Dewey Wright Well Pump Co., Inc.
2/ al
WELL CONTRACTOR CERTIFICATION #•
STATE WELL CONSTRUCTION PERMIT# r,czr, date
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
II
Municipal
Other
Industrial
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town BANNER ELK County. AVERY
BEECH MTN ESTATES OFF WILD DAISY LN. OFF SFRiN
(Road Name and Numbers, Community. or Subdivision and Lot No.)
3. OWNER GEORGE F''YKE' MARK ENGLISH
Address PO BOX 871 ,
ANNia, tvtack or Route No.)
t-L 3421i
Agricultural
Mon
oring
DRILLING LOG
From To
0
DEPTH
4l° rmation Description
Dl .
1 1 G GiiANI
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO fl
7. DOES WELL REPLACE EXISTING WELL? YES LI NO
8. STATIC WATER LEVEL Below Top of Casing: aauu FT.
(Use "+" if Above Top of Casing)
State Zip Code
5/8/2003
400
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor•
dance with 15A NCAC 2C.01113
10. YIELD (gpm)• I IETHQOpD O3F TEST Air
11. WATER ZONES (depth):
L(
porn u OPM
u Porn
18 3n MUD
30 a1 SHALE
41 t30 GRANITE
60 85 SHALE
85 100 GRANITE
100 102 CKbvlCE
102 3+5 UKANIIE
330 ,o3b C:KtvICt
33b 40U GRAN! IE
12. CHLORINATION: Type Amount
13. CASING
Depth
From To
From To
From To
0
14. GROUT:
Wall Thickness
DianQty yyE or•�ght/Ft.
Ft CC ''II a�l�
Ft
Ft
fv�yte!i@I
Depth -n Material „Mt
CEma^,, ��,, 3'4
From To Ft
From To Ft
15. SCREEN
h
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS'
I DO HEREBY CERTI
CONSTRUCTION S
FOR OFFICE USE Of•+ILY
L_
Quad No:
Ft
Ft
RDS, AND THAT A COPY
Size
Material
0
C
If additional space is needed use back oilorm '-'
LOCATION SKETCH
CO
—v
(Show direction and distance from at leasttt ro Sf<a(e
Roads, or other map reference points) r`-'�O
E AWAS.CQN a TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r,a6- to -03
K1
SIG NAT RE OF PERSON CONSTRUCTING THE WELL DATE
;SebnuLorioiij tobi Ision of Water Quality, Groundwater Section within 30 days
rp! GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 7 4 9 0 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR Dewey Wright Well Pump Co., Inc
2801
DSD216
WELL CONTRACTOR CERTIFICATION #•
aye
STATE WELL CONSTRUCTION PERMIT#•
cuY
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
2. WELL LOCATION: (St19kk;c iof the location below)
Municipal
Other
Industrial I I Agricultural Monitoring E
If Other, List Use-
At`ERY
Nearest Town' County;
'vVtL »r''LC UK. Orr rl`t V't z21 Urr 1i_iL L!+,V A cvt+i•!
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ROBIN HENDRICK
^8 4YtLSON FARr:l F.G
Address Brti=Li r (Street or Route No.) ivt,. .b;
City or Town State
5/15/2003
4. DATE DRILLED 405
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES
7.
8.
Zip Code
NO
DOES WELL REPLACE EXISTING WELL? YES L_anl NO
STATIC WATER LEVEL Below Top of Casing: FT
1 (Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011 Air
10. YIELD (gpm)• I\fF�QET�Fi�E>cyyy D (,
11. WATER ZONES (depthlarr
: t II II
12. CHLORINATION: Type illAmount If additional space is needed use back M4ornn
DRILLING LOG DEPTH
From n To
IJ 1
DI F{flrmation Description
is
L5At C
I t I 4Uo F\rc
C
W
N ; rt::
13. CASING:
Wall Thickness
Depth u. Diacngtjr arJyght/Ft.
1IV .J4
From To Ft
From To Ft
From To Ft
14. GROUT:
sr
rWatquaI
In Depth 20 Cerr:Njaterial .n,_,M,Qth1o,,�
From To Ft
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
Size Material
From To Ft
17. REMARKS:
I DO HEREBY CERTI
CONSTRUCTION ST
FOR OFFICE USE ON
Quad No:
W
LOCATION SKETCH
(Show direction and distance from at least two State
�� Roads, or other map reference points) �
Lbr,
TTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG111M-laR OF PERSON CONSTRUCTING THE WELL DATE
Submit originall Divisi n of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.
;PRUNE* .t.',TER SEC[LCN
;EVI��E REGIO/ A'L UFPIGE

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]
274900
WELL CONSTRUCTION RECORD WELL CONTRACTOR-
0301B2
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #P
oat
STATE WELL CONSTRUCTION PERMIT#. Steve retry
1. WELL USE (Check Applicable Box): Residential h. Municipal Industrial I I Agricultural ❑ Monitoring Ill
Recovery Heat Pump Water Injection 0 Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLA County: AVERv
MORTIMER RD OFF JONAS RIDGE RD OFF HW''f 1u5
(Road Name and Numbers, Community, or subdivision and Lot No.)
3. OWNER LYDIA W. HALL
Address PO BOX 87 ,
HI NtfiuAttreet or Route No.)
26002
DRILLING LOG DEPTH
From D T,o0D 0 F_prmation Description
ity or Town state
Zip Code
4. DATE DRILLED 4/28/2003
5. TOTAL DEPTH 2db
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: ' FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS
'Top of casing terminated at/or
dance with 15A NCAC 2C.o11s
10. YIELD (gpm):
( FT Above Land Surface*
below land surface requires a variance in accor-
ETHOD f(.11F EFST Air
clpml4 '
U i. pm L' 13prn
11. WATER ZONES (dept
HTH-
10U 14o iuNAWilc
145 146 SHALE
146 23U iibtANI I t
2bU 252 SHALE
232 Lab iiMANI I t
C
it
gpm 2oU-2“
12. CHLORINATION: Type Amount
13. CASING
Depth
From To
From To
From To
14. GROUT:
0 108 Ft
Depth
From U To
From To
15. SCREEN:
fin
Diaemet1/aer
Ft
Ft
Wall Thickness
or Weight/Ft.
.18E(
Material
CiAL V
Material Method
Ft Cemzn. Gray .ow
Ft
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
Material
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS: I
I DO HEREBY CE T FIX l-us WELL WAS:CO S
CONSTRUCTION 4, ARDS, AND THAT A CO F
it 1 j I
I_ FOR OFFICE USE CAIALN1 I
0
O
—0 rri r..
If additional space is needed use back oaf forrp L,_
LOCATION SKETCH m E
(Show direction and distance from at least two State
Roads, or other map reference points)
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
da
L7��;III.
Quad No.
Serial No.
� IGN
origi
Submit alto
uL NERIATER SEG NON
LE REGIONAL , r5Irr
URE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274879
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#.
1. WELL USE (Check Applicable Box): Residential Municipal
Recovery Heat Pump Water Injection D Other
Industrial fl Agricultural El Monitoring El
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County_ _
C.L000LANU UR. Ut-F I (NEOAS T LE DR. OFF rf '•it LOC
(Road Name and Numbers, Community, or Subdivision and Lot No.l
SALLY SC'.A.:SOROUGni
3. OWNER
Address oP.wTTHEWNS. 921EH',Pv`r ;0 S SUITESA
2 Ee04
,y;yi. ER (Eree(or Route No.)
DRILLING LOG
From To
DEPTH
Formation Description
JiG r.
00 GRANITE
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
State Zip Code
1ra 7OI13
6. CUTTINGS COLLECTED
7. DOES WELL REPLACE EXI
8. STATIC WATER LEVEL Be
YES NO
STING WELL? YES I I NO
low Top of Casing:'l, FT
(Use "+' if Above Top of Casing)
I I
9. TOP OF CASING IS FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011$in ,; it
10. YIELD (gpm): METHOD 1:#1TEST
ppm
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
From
From
From
Depth
To
To
To
14. GROUT:
From
From
Fil
SHALE
5.3 Vr4'0d
90 83 SHALE
170
3ANITE
1 ; lUART7
7 u 0 GrLP ITH
irLT
O
t
clOrr
Amount '
Diameter
"` Ft
Depth
To L-
15. SCREEN:
From
From
From
To
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS: I--�
I DO HEREBY CEFRtr� THAT THIS WELL WAS €ONSTiUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION 3TA ARDSr-ANb THAT A rfF" qF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Ft
Ft
Ft
Ft
Ft
Wall Thickness
or Wej htiFt.
cbEi
Material
Ft
Ft
Diameter Slot Size
Ft
Ft
in
in
in
in
in
in
Material
Size Material
If additional space is needed use bacrkdf form 4
'D r,_,
LOCATION SKETCH r„:-
1V r„
(Show direction and distance from at least two State
Roads, or other map reference pjsl I� rS,..,R-
V
�0.1�7rdt Qr.
FOR OFFICE USE f:1104Y
Quad No:
Serial No.
I
Submit orig
I^ ATER. SL ih^N
LE ,l ;p:L L i-ICE
JJ,c2
-//- 03
CP
cte
Ioaskald
TURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
L1

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ry 4 862
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] I
WELL CONSTRUCTION RECORD
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 1G8G
C3015C STATE WELL CONSTRUCTION PERMIT'S-
Leslie Fleece
STATE
1
WELL USE (Check Applicable Box): Residential 71
Recovery I I Heat Pump Water Injection
Municipal n Industrial
Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County- AVERY
DOBBINS RD. OFF HWY 184 OFF HWY 105
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER CATHY PURSER
Address 0/0 EAXTER NORRIS CONSTR. , 194 SHOP DR.
Zi ONVI LUEEreet or Route No.l INC 28G98 99
Agricultural FT Monitoring
DRILLING LOG
From To
0 99
DEPTH
Formation Description
DIRT MUD
183 GRANT T E
City or Town State
4. DATE DRILLED 4/28/2003
Zip Code
183
184 SHALE
4181
277 GRANITt
5. TOTAL DEPTH 300 277 278 (QUARTZ
6. CUTTINGS COLLECTED YES 0 NO 71
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011it_
10. YIELD (gpm): NjETHOD C�F r T Aar
11. WATER ZONES (depth): �1prn 33-�f4 .,
D mini
HTH
12. CHLORINATION: Type Amount
278 30U GRANITE
c
O
w ci .
e_
C
C..
f 1prn r-.de
thin
PrP
13. CASING:
Depth
From To
From To
From To
0
14. GROUT:
Wall Thickness
Di�n e[�7 or ht/Ft. edal
103 Ft 6 11i L�
Ft
Ft
n Depth `,1 M terial Methosl
From To Ft CEmer Gravity Ion
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
17. REMAR
I DO HE
CONSTI
BMCSTI"FNTHATI-H W€LL wais
NN S I AINUANUS, AND TrfT P
FOR OFFICS
E citd8
If additional space is needed use backI torn*'=J
W
—J o
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Ds
ti
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
WO c{ /r1 P_ ,,1 L2. (.4
6 /-03
SIGNATURE Of•ftRSON CONSTRUCTING THE WELL DATE
riginal totivision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
nut foh'w)()%
T
eAnd
)k
Quad No:
Serial No.
Ac"cv' I F Prr+-
Sibmit
GROUNDWATEF SECTION
NAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274855
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc..
WELL CONTRACTOR CERTIFICATION #: 2a8a
030130 Leslie Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
I I
Municipal El Industrial I I Agricultural
Monitoring Ti
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
BANNER ELK AVER,''
Nearest Town: County
HORSESOTTOlvi RD. OFF DOBBINS RD OFF HWY 184 C
I Road Name and Numbers, Community, or Subdivision and Lot No.I
3. OWNER LEE ANN SNYDER
°ro t,/IRGIL FREEMAN . P.O. BOY- 22g2
DRILLING LOG DEPTH
From To Formation Description
0 138 GRANITE
BOONS (Street or Route No -I
NC 28607
138 139 SHALE
City or Town
4. DATE DRILLED AF
5. TOTAL DEPTH ""
6. CUTTINGS COLLECTED YES f I NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: ' FT.
(Use "+" if Above Top of Casing)
State Zip Code
4/3/2003
n
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01143Air
10. YIELD (gpm): METHOD 9F3=
�F"'�
11. WATER ZONES (depth): nom
139 245 GRANITE
C
O
U ppm
U iiurn u AGM
12. CHLORINATION: Type I-ITH Amount '0
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0To 21 Ft S 1,`. .130 3.A:L\
From To Ft
From To Ft
14. GROUT:
n Depth „r, Material Method
From - To Ft
Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From
17. REMARKS:
IDOHEREBY fdE?Ij-1(THATT ISYUELL-WAS¢
CONSTRUCTION TANDARDS, AND THAT A LQ Y
To
Size Material
Ft
Ft
FOR OFFICE USE' ONLY
Quad No:
C
W -`
rn�
If additional space is needed use back c arm -if,"
n
LOCATION SKETCHci
(Show direction and distance from at least two State
Roads, or other map reference points)
4- IDS
0i
Lbi r,-,2d
7-3
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SI
Submit-8rigina
NATUREPERSON CONSTRUCTING THE WELL DATE
:o'Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
274845
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 1kilFs
03012E ',eve F'rtce
STATE WELL CONSTRUCTION PERMIT#
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal El Industrial I 1 Agricultural ❑ Monitoring C
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County: AVERY
OLD JONAS RIDGE RD. OFF HVVY 221
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JAMES L. RODGERS
Address P.O. BOX 475 ,
PI NEOLA(5treet or Route No.)
NC 28662
DRILLING LOG DEPTH
From To Formation Description
0 170 DIRT
11 O Lbp loKANI I t=
Icy or Town State
4. DATE DRILLED
5. TOTAL DEPTH 285
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 00 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011a-. ME (�E 7E,gT
10. YIELD (gpm): (c ".11iTHODm2Dh-L[+G � u qpm
11. WATER ZONES (depth):
4/14/2003
Zip code
265 266 GRANITE
266 285 GRANITE
CJ J
C—
va
c:
17 'r1
U qpm U fi pm
n ta-
12. CHLORINATION: Type t-llrl Amount
If additional space is needed use back otform cY
J G
Y
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
0 61/8 .350 PVC: -
From To 175 Ft Roads, or other map reference points) \\\2
From To Ft 4.° ZZI �(`1
From To Ft
14. GROUT:
Depth Material
From To " Ft
From To Ft
15. SCREEN:
Method
Gra.eity.Flay;
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY
CONSTRUC-
Size
Material
r.
IFY THAT THIS WELL WAd 00VSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
TANDARDS, AND THAT 4 CO'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
C.la r k Ln,
t �7
FOR OFFICE I SE ONLY Quad No:
A
J c
',Submit origin
/ —/l 63
MATURE OF PERSON CONSTRUCTING THE WELL DATE
I to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

272535
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / CV**eT A -^e-eci CERTIFICATION# 9_4 ti Z/
WELL CONTRACTOR COMPANY NAME // PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ge-Municipal/Public ❑ Industrial 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIONS
Nearest Town: / i'ri✓r %/o County /7t'/"J
-e Cn alit fa a,o 11
(Street Name, Numbers, Community, Subdivision, Lot No,, Zip Code)
3. OWNER: F�a,c,K )L z /A iN•c /`
Address 12„;,: z*- ' '=+- adxt-C
Street ors-Ryottl ut. No,)s �c
City or Town State lvC Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /2 1-.P3- C.2
5. TOTAL DEPTH: 3 Et !)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E7-
7. STATIC WATER LEVEL Below Top of Casing: .3 ,, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS L- 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 71
10. WATER ZONES (depth): /97 -/S/ - j u/
II
12. CASING:
From --
From To
From To
13. GROUT: Depth
From 0 To ,JIri
From i2C
To ( >
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
From
From
16 REMARKS:
REBY CLY
ONSTRUCTION STANDA
DISINFECTION: Type
Depth
%11/74 Amount • 7 d/
To f(-. Ft.
Ft.
Ft.
Wall Thickness
Diameter or Weight/Ft. Material
G 1. 3T,c ij
Material Method
Ft. C,':nc'.: - "cif. -/
Ft. ✓'cie--, It f` /l'f
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
L
T
ISIC
J
Submit' theoiigrnattdOit Divisii
—1764191636 Phane No_(4t9)711-UU'
Agricultural 0
I/'i ,e
Topographic/Land setting
❑Ridge ❑Slope Willey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
4r5, ,F',c,6-44z,
/
J_.
DEPTH
From To
(0— Yo
/9➢—/.i/
/5'1 - - 3n,
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.
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
OF PERSO STRUCTING
3
NATURE THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I, within 30 days. GW-1 REV. 07/2001

U
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
£YELL CONTRACTOR (INDIVIDUAL) NA E (print) �e
wELL CONTRACTOR COMPANY NAME-2/1-0e--I
272533
rat Re5cources - Division of Water Quality - Groundwater Section
CERTIFICATION #P- 14`n
PHONE # (» 1 73.5 ^<'rQ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1
2
WELL USE (Check Applicable Box): Residential la Municipal/Public D Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCH
Nearest Town:: AftM_ 1 IL C
.5"4-AP c ( LAD.
(Street Name. Numbtrs. Community. Subdivision!
ancy
3. OWNER:
Address
St
City or Town
State
( )-
Area code- Phone number
4. DATE DRILLED 3-26- OS
5. TOTAL DEPTH: f 20 .t e
6. DOES WELL REPLACE EXITING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: DC) 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): 50 METHOD OF TEST ,4i 1t
10. WATER ZONES (depth): 4I0,1.4-,,
II.
12.
From
From
From
13. GROUT:
Front e)
From
14. SCREEN:
From
From To Ft.
15. SAND/GRAVEL PACK:
Depth
To Ft
To Ft.
DISINFECTION: Type chlterd Amount `S b ti.r
CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
O To TO Ft. 6 iL! Spit 41
From
From
To Ft.
To Ft.
Depth Material Method
To -(v Ft. re - <7:
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
in. in.
Size Material
16 REMARKS
l'
_HEREBY
,CONSTRUCT
ographic/Land setting
idge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninntes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
KD
'to -q
- F,a. •
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
A i D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
GNATURE OF PEItS
261O
STRUCTING THE WELL DATE
SGbirilt Ihetu 4�idal ihG[hc Divi,
a2i601)SV)-1hal-i1a--(I0INE733 3
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

272521
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res es - Divisionviof Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) /42v;i0 I 1 ' j�-/r^S_�f CERTIFICAA-T�I,ON# 7590
WELL CONTRACTOR COMPANY NAME UfACPAe-I I Di `�' / I l I /1 PHONE # 17"a )%33- a6'C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CJ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ,��,```��,
4.,
Nearest Town?i—t-vL / `-St-ti2eCounty �<:/
/ y as(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c 401Z
Address %J O • ,dNL 3
. (Street or Route No.) P G , a
City or Town State Zip Code
( )-
Area code- Phone number, i
4. DATE DRILLED 7' /C' c)
13. Method
To FL �u� ran L9 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.
5. TOTAL DEPTH: %tIC) b
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LEI
7. STATIC WATER LEVEL Below Top of Casing: ? O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST A'rfl
10. WATER ZONES (depth): f1I5 f ag0 7A
11. DISINFECTION: Type Gikt.e r17�'.Amount (i,or
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Rye._
From To f 10 Ft. c2 SD2 R( ' T C
From To Ft.
From To Ft.
GROUT: Depth Material
From (.5C� �„�'jC
jF6. ilgEN'
A(S Lr
I DO HEREBY CER
CONSTRUCTION
JUN 1 0 ,Lw -
topographic/Land setting
e ❑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// rrnn
Ai c- so a- 3c cif
DEPTH
From To
0 leo
&O- ,tr)
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.
TAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y_16 63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
GROUNDWATER SECTION
AS' Fth 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

z7A.. 4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 2V./V-, Jet? '-TO CERTIFICATION #r 7e)
WELL CO\'IRAC'I OR COMPANY NAME }7FCASC (( t I D2: I//,PHONE 8 i) 733- a
STATE \VELI. CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED \VQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential RMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town::Ct ea y'i K. County R-1
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code) i
3. OWNER:
Topographic/Land setting
❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
elanrsAa.-el--1etanted 7) / ' " n (degrees/minutes/seconds)
f
Address _ 15: 0, rg a 1 C Latitude/longitude source:❑GPS❑Topographic map
/J (Stror Koute 21 I C RC, a'7
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED % -a -o
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXIS ING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 2C5 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 wit 15.A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST +1,YL
10. WATER ZONES (depth): 3�/ 55, So ) 2ID
I I. DISINFECTION: Type A--VbRj/..(1' , Amount
12. CASING: Wall Thickness
Depth Di t to or Weight/Fe Materyal
From FJ To R( Ft. n•� % D� Cult
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft. c ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Zip Code
From To Ft.
From To
16. REMARKS
yb
7`0
Ft.
DEPTH
From To
0 — 3 :�,,
3j- 5'; '3��, sl it
3CS'
-0..D
spa -'las
(check box)
DRILLING LOG
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.
m k _p rice-T
•
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�12 t —� -/2 S- ©3
RE OF PERSON CONSTRUCTING THE WELL
DATE
SubnittptInftoftsitnOtttentpl ision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2763M66'6 PhtvhtN6;(91tYy11 221, vithin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I1\eyt -3 cRe)b 2 to
' j.oce�troei1 `7a II ti.e-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
272515
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR COMPANY NAME
CERTIFICddATION#M'aS l�
PHONE # ) 75'3-acc'a
I. WELL USE (Check Applicable Box): Residential Q i4unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
N rest Town: -J , a t 4I i5
(Street Name, Numbers, Community, Subdi ision,
3.OWNER: 0-14gI 5 i
Address 6-.3414i0Rio4Nj Len,
Pep)Ar(Stfeel or Route No.)
City or Town State Zip Code
( )- '
Area code- Phone number
4. DATE DRILLED -I" 3°" ` -
County A- ge-5- 1
r ( jfl$Fc f1t: (CT)
Lot No., Zip Code)
P'1c.bRu ,-_j & 74).5e4.35
Topogr9hic/Land setting
DRidge it' Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(d egrces/m i n u tes/seconds)
Ct Latitude/longitude source:❑GPS❑Topographic map
5. TOTAL DEPTH: a(o0 .
6. DOES WELL REPLACE E ISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: )0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST /b& i=
10. WATER ZONES (depth): IKS, I'3li
11. DISINFECTION: Type r-hjnQ:_52. Amount ti33
12. CASING: Wall Thickness
Depth Diarae er or Weight/Ft.Material
From C7 To'9 Ft. yThf, /$' € -'IN,
From To Ft.
From To Ft.
13. GROUT: Depth
From C' To 3C) Ft.
From To Ft.
14. SCREEN: Depth Diameter Material
From To Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Nlethod
PO —AO('
DEPTH
From To
(9'- /0
f0—(o.3
(check box)
DRILLING LOG
ormption 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.
Slot Sizc
in.
in. in.
Sizc Material
16. REMARKS:
rH 1 1-IERE YCERTIFYTHfIT-
I I / C uGT1QN.STANDAI;gS
7,1
L_
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D 1 AT A COPY9BIS RECpORD HAS BEEN PROVIDED TO THE WELL OWNER
i
NATURE OF PERSON CONSTRUCTING THE WELL DATE
S.iDivisn of Water Quality, Groundwater Section, 1636 Mail Service Conter-
733-31, within 30 days. GW-I
thibmit the original to th Raleigh, INC
27699-1636 Phtiue Nb. (919) REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tural Resources --Diivissiion of W/yter Quality - Groundwater Section
WELL CONK RACTOR (INDIVIDUAL) NAME/(print)
NG/�/✓'C,r //rj . o d,4-fV"� CERTIFICATION#��ifoq
WELL CONTRACTOR CONIPANYINAME eigASalCti' ,VtLL —DR.; lisA'3 PHONE # ( )
STATE %VELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
277027
WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
4/K
Nearest Town: County A t7
th eFar,'
(Street Name Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address td • y o (o
e Aa Ae.n274 d
Q (St el et pr Route No)
City or Tow n State Zip Code
( )-
Area code- Phone number 11
4. DATE DRILLED W _/r —d�j
5. TOTAL DEPTH: J a O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO D'
7. STATIC WATER LEVEL Below Top of Casing: 3J FT.
(Use "*' ifAbove 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): d. METHOD OF TEST 4/ R
10. WATER ZONES (depth): /a77 -/30 t..; ti /
.2D S'- � J iz' i`jn /
I I. DISINFECTION: Type //- tH Amount 3 C 2
12. CASING: Wall Thickness
Depth Diameter or WeiehL'Ft. M terial
,!
From To //2 Ft. 4-5 +fl / Material
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
bra. k l,:•ts/o/r.4,1
rrc' ifs+
d /e
DEPTH
From To
d - z
vs'? ja7
I17 -lie
/30 ae)2
zn� aia-
1%Y — Sit.
LOCATION SKETCH
Show direction and distance in miles from ackast
two State Roads or County Roads. Include tht road
numbers and common road names, S
rl) I b0 HEREBY CERTIFY TF(AT,TpLIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
2ir.CO.NS_ZRUCFION STAND yrp \,!AND THATA CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
"I .S.ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r7699 1636 Phone No, [phone], within 30 days. GW-I REV. 07/2001
/ : SIGNA'5AtE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resou
r'f is - Division of Water Quality - Groundwater Section
277n26
wEL1. COA1RACiOR (INDIVIDUAL.) NAME (print) C. Jntu(� 7
CERTIFICATION #42 Ye)?
Ate, ZN.Leci.
3. OWNER. IL � CAA
WELL C(1 N-FRACrOR COMPANY NAME /)/`Gs!✓L // W
STATE: \CELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
PHONE # ( )
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use /,.; vi //
2. WELL LOCATION: �J
Nearest Town: OZUUNa/= ' 1 K County /T✓Pr
topographic/Land setting
�%��iJiI) Ridge ❑Slope OValley ❑Flat
(check appropriate box)
(Street Name, Numbers Community, Subdi cisioo, Lot Np...Zip Code) Latitude/longitude of well location
W
Address
/ /Oa(degrees/minutes/seconds)
�� � �.
zfe,,an) (StroveRouteNo_)
y�. Latitude/longitude source:❑GPS❑Topographic map
. C . d' a' `Q / (check box)
City or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED d—?5 o.
5. TOTAL DEPTH: 2o0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Et'
7. STATIC WATER LEVEL Below Top of Casing: a0 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 ,4-'r
10. WATER ZONES (depth): jib ai,. /
/70 — 02891/
II. DISINFECTION: Type hi7'/j4 Amount 7O,4'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
'
From / To lrFt. E •� /FP
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Front h To 7? Ft. Ltest e.0 VejrP,/
Front To Ft. /_lJ
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
DEPTH
From To
t ' 70
%C — //O
//0--//3
7/7— /%b
DRILLING LOG
Formation Description
fJicic, kt J4i/e
LC P -.
r4//u: /t
'jctf/afc tune"/
CD
n
0
LOCATION SKETCH
Show direction and distance in miles from east~'H
two State Roads or County Roads. Include !ilia roaizEi
numbers and common road names. tEa
:J G
afreERT-HFY T-H4T-THIS. WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
STItUCTION ST.ANDARDS!A THAT•A C�O�F(J\}Y OF THIS REC,RD HAS BEEN PROVIDED TO THE WELL OWNER
t SIGNrATURE O- RSON CONSTRUCTING THE WELL DATE
Sugmit the original to the Division/of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2761)-iii ItoneINo,(919)a-33-3221within30days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
277022
North Carolina - Department of Environment and Natural R rces - Division of Water Quality - Groundwater Section
R'EhL CONI RACI-OR(INDIA'IUUAL)NAME (printr inUe/A. f(���i/dn.� l CERTIFICATION #/�o3 ? is'
WELL CON7R:\C'TOR COMPANY NAME
Ora'i-c /f WG II Jr� t l 1 1
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1
PHONE # ( )
WELL USE (Check Applicable Box): Residential (Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use p r) Vet f e
2. WELL LOCATION:
Nearest Toyvn: eyy , et 5I
c A-rN( a
(Street Nance, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
q-rk he
/
Q IStreet or Route No.)
County /c/is`
-3obbi-NS la 4,
City orTown State Zip Code
Area code- Phone number,
4. DATE DRILLED G `/GS - c!3
5. TOTAL DEPTH: 54Ap
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO WI-
7. STATIC WATER LEVEL Below Top of Casing: ,..16 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. NN
9. YIELD (gpm): / /T
METHOD OF TEST rth
10. WATER ZONES (depth): /50-17 2 - /,,r/
I I. DISINFECTION: Type beT/7/ Amount 4 OG
12. CASING: Wall Thickness
Depth Diarrisjer or Weight/Ft. Material
From —/ To 20 Ft. G ,,p,.,2/ P�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From GT To 620 Ft. lGrr7r4,7c foci 2q
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
F[31Zidge ❑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
blacke •,sl�o/Grock
e r'a4✓ 1' ie
(.7
{/.caf
A' ra-✓i �'�'
DEPTH
From To
c> - 73
7,3— /7c;
J'o /sy
/> .9- Ago
o2of'_I/o
H2O #2
CO
f c`
LOCATION SKETCH — ---
Show direction and distance in miles from at fneast AL:-
two State Roads or County Roads. Include thZoadr-i=
numbers and common road names.
tV t
rn .
� c'
Agr
f
DlDO HEREBI CER7IFY TI T,HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
I CONSTRUCTION STANDAIR AN N T A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER
L.
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Div
276991636 Phone No..(919) 733,
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Qual
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
y - Groundwater Section 2 7 6 9 31
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2881
030273 STATE WELL CONSTRUCTION PERMIT#- Steve Petty
WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection
Municipal
Other
Industrial Agricultural Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County AVERY
APPI ETCJCF DR r1FF m w mAAAp pll (lG'G I ITn E COW
1 oad emean um ers, o• mmu rty, r ision o o.l
3. OWNER ROYCF L WHITE
Address lido NF 11 FS 5IfGP PD
1 trees or oute o.l
PANNIER FLK NIP 2p�f1� 80 17n GRANITE
City or Town State p ode
12n 171 SHAI P
DRILLING LOG DEPTH
From To Formation Description
n fin nIRT
4. DATE DRILLED R/17/711n4 171 7Rn GRANITF
5. TOTAL DEPTH 4n5 780 261 4HAl F
6. CUTTINGS COLLECTED YES NO 781 win GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES fl NO n 7p0 2Q7 SHAI F
8. STATIC WATER LEVEL Below Top of Casing: 1n FT 9go 3115 GRANITE
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0119
10. YIELD (gpm): 1n METHOD OF TEST Air
11. WATER ZONES (depth) 1 nnm 1711-171 2 pnm 71111-761
7 nnm 7P11-7P7 n nnm
12. CHLORINATION: Type HTH
Amount 57
0
L
N) -
If additional space is needed use back of fortrc
13. CASING: LOCATION SK N Ta=_
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance ft�/at e»t twftate
From 0 To 64 Ft 6 1/8 'SO PVC Roads, or . -r rr\ap refe -nce pants)-(3
From To Ft \r.nt.
From To Ft r_.----/
14. GROUT:
Depth Material
From 0 To 20 Ft Cemant
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
17. REMARKS: I ,
I DO HEREBY CERTIFY THAT-TkIIS WELL WAS CONSTRUCTIEI IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARFS, AND THAT A COPY OF THIB RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
:,I1.
FOR OFFICE USE ONLY
Quad No:
Serial No
SIGNATUBE OF PERSON CONSTRUCTING THE W LL DATE
Svbrnl[ original ToircliVision of Water Quality, Groundwater Section within 30 days
--J
GW-1 REV. 12/99

FOR OFFICE USE ONLY
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
030293 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
WELL CONTRACTOR. Dewey Wright Wefl
WELL CONTRACTOR CERTIFICATION #• 2681
276924
Pump Co Inc
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
X4 Municipal I I Industrial 0
I Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: INVERSHIRLD County- AVEPV
PAPA! I FI Rn nF€ NI CKOI YN11 7GGAF,Rr1 frr HW'i 18
(Roa. Name and Numbers, Community, or Subdivision and Lot NoTr
3. OWNER C'ARnI YN gnnlTu
Address Fn PAPA�I FI
treeTorARn d outNo.l
RANNFR FI K NC`
City or Town State
4. DATE DRILLED 611Q17nn:
5. TOTAL DEPTH 145
6. CUTTINGS COLLECTED YES I f NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 1n FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 60 METHOD OF TEST
11. WATER ZONES (depth)• 2 mom 53-54 58 gpm 130-133
0 Qpm 0 qprn
12. CHLORINATION: Type HTH Amount 27
'ZLode
1d
Air
I XI
Agricultural I I Monitoring
DRILLING LOG
From To
0
75 54 fPAN.IITF
DEPTH
Formation Description
25 nIPT
Fd HAI P
14n GRANITE
1„ SHAI
1d5 GRANITE
C
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To SnFt 61/t 1511 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft CPmr'nt Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in. in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
I DO HEREBY CERTIFY PNAnf RIS WELZWAS CONSTR
CONSTRUCTION STANDAR S, AND THAT A COPY OF'
'J
�l
oRi
If additional space is needed use bacit%f form;'
LOCATION SKETCH
(Show direction and distance from at least twoState
Roads, or other map reference points)
CT=D IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/7-0
Quad No:
Serial No
SIGNATURE
i 6upmitodginpll1gDivisio
• pr,„ Url'I''.E.
OF PERSON CONSYRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
276877
WELL CONTRACTOR. Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #. 2686
030242 STATE WELL CONSTRUCTION PERMIT#' Leslie Reece
Inc.
WELL USE (Check Applicable Box): Residential I Municipal
Recovery 0 Heat Pump Water Injection I Other
Industrial I I Agricultural Monitoring
If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: r RoSSNnFP County AVFRY
umbers,Zornmunity or a ivisio�d Lot No.)
3. OWNER TAMES FRYE
Address eh, MOl INTAIN CONRT FNT 144E POPI AR GRt 1VF R
(Street or Route No o C
RNi 7 6 7
City or Townn State ode
4. DATE DRILLED 5/28/7001
5. TOTAL DEPTH 265
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 5n FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0119
10. YIELD (gpm): 20 METHOD OF TEST Air
11. WATER ZONES (depth): 1 ppm 01-92 19 ppm 226-227
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 44
DRILLING LOG
From To
11 5R
DEPTH
Formation Description
IIIRT
5R Al GRANITE
Al A2 QUARTZ
A2 726 GRANITE
726 297 SHAI F
777 965 GRANITE
13. CASING:
IN
XI
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To M Ft 61/R 35f1 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flew
From To Ft
15. SCREEN
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•C` 1
I DO HEREB E L4FY THAT T-H S-WELL-WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT( 0~ S`FANDARDS, AND THAT A QOIP," OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I1 ,
FOR OFFICE ONLY
is C1i
Quad No: SI
0
C_
G
r
N
9 r-,
If additional space is needed use backlallforrrZT'"
4'
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
n
CAt
GNATURE
Sabmii-original to Division
SLCIION
purl r E 3EG 1 OFFICE
L_
I'act 7-lg`03
ERSON CONSTRUCTING THE WELL DATE
Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
278104
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
030377 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection.
Municipal Industrial n Agricultural I I Monitoring I 1
Other n If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NFWI AM') County. AVERY
DRILLING LOG DEPTH
3. OWNER OR ORRPSTFS RORREGO From To Formation Description
Address %AMFRI,f:AS HOME PI ACF P1 n TATF RI Vll !1 An DIRTHICKOR `reetor RouteNo.) NC 2R#R1 An 190 GRANITE
City or Town State Zip Code
170 121 SHALE
RAI R() OFF RAI SAM B OFF 1PF
I oaadRAM D
ame and umbers, ommunity, or subdiv) ision an of N'C o.
4. DATE DRILLED 8/8/2003
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO rI
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 12 METHOD OF TEST Air
11. WATER ZONES (depth):5 ppm 120-121 7 aom 187-189
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 39
121 187 GRANITE
1R7 1RP SHALE
189 205 GRANITE
If additional
J
pace
16HL ntrirtria,
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 85 Ft 8 1/8 .350 PVC mac. Roads, or other map reference points)
From To Ft V
From To Ft 60 I e
14. GROUT: O.-.. • 1E1 Pe-4.
Depth Material Method \ q d ByFrom0 To 20 pt CementGravity Flow4/ jFrom To Ft CEMENT GRAVITY FLOW tryL”I'si Al
"3�
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in.
From To Ft in in
4
x
s.
16. SAND/GRAVEL PACK: L,,Q
Depth Size Material
gti
From To Ft (7
From To Ft oySo
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
CD
N
C71 a
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
DATE

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
278118
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2888
030301 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal El Industrial I I Agricultural 0 Monitoring 0
Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNPR El l.c County AVERY
Fd _AT cjpaln�r�q RQ nr10 null F F BlI9 YE RC�i1309 O
1 oad Name and um ers, ommumty, or Sub stun an Lo o.l
3. OWNER WILT JAM A JARRETT/ANGFLA ESTEF
Address 115 I C7NC9j qT APT #ffi
(Street or Route No
fl(lC)NF
City or own State
NIC 21P
p oQ7
de
4. DATE DRILLED RJRf1171)f)4
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 5t1 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 7 METHOD OF TEST Air
11. WATER ZONES (depth):3 gpm 97-98 4 ppm 141-142
0 ppm 0 ppm
DRILLING LOG DEPTH
From To Formation Description
0 80 Jr -ART
80 97 GRANITF
C17 98 _gl-1ALF
9H Id GRAMTF
1,11 142 RHAI P
1n2 IRS S-PANITF
I4
12. CHLORINATION: Type HTH Amount 27
I xl
',,E
If additional spac- - --. -. use .ac o orm
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To RR Ft 6 1/8 350 PVC oads, or other map reference points)
From To Ft (5 L/Z
C13
ci
From To Ft \�JT
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft CEMENT GRAVITY Fl OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
fireitt
SIGNATURE O RSDN CONSTRUCTING THE WELL DATE
Submit original to Division o ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
278161
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
030255 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
WELL USE (Check Applicable Box): Residential Municipal 0 Industrial Agricultural Monitoring
Recovery n Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNFR El K County' kt_ERY
THE FARM !)FF I RPn iIS Rr) f1FF V-IWV 1Rd r1FF tdtklY
oa Name an317um ers, ommunity, or ub ivision an o[ No.
3. OWNER IOHN WFSTPR
Address °fir SFGI IF -I I C PC) ROX 371d2
lane or Route No.)
CHARLOTTE Ni( 7g71'7 1fin 171 GRANITE
City or Town State Zip Code
171 172 SHALE
DRILLING LOG DEPTH
From To Formation Description
11V) OIRT
4. DATE DRILLED 7/17/2003 172 205 GRANITE
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES NO
IA
7. DOES WELL REPLACE EXISTING WELL? YES I NO
I v`
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface* N�
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST Air
11. WATER ZONES (depth):20 ppm 171-172 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 31 If additional space is needed use back of form '
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 107 Ft 6 1/8 350 PVC Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
From
From
From
Depth
To
To
To
n(`° 135
c.� u
C /
7 E
Method tv
Gravity Flow • .
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
.Z;
16. SAND/GRAVEL PACK: 111
Depth Size Material
From To Ft.
From To Ft
Dobbin, RA,
Tem
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
SIGNATURE OF PyaiSON CONSTRUCTING THE WELL DATE
Submit original to Division o ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
278937
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2681
030375 STATE WELL CONSTRUCTION PERMIT#- Steve Petty
1. WELL USE (Check Applicable Box): Residential I
Recovery I I Heat Pump Water Injection
Municipal ❑ Industrial ❑
Other ❑ If Other, List Use
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNFR PI K County. AVFRY
OFF I FF GWAI TNFY RD OFF GWAI NFY RD OFF 194
(Road Name and Numbers, Community. or Subdivision and Lot o.)
3. OWNER KAREN STARNES
dyr 1
}tiyraE1 --I----Monitori HI
Agng
i
DRILLING LOG
From To
Address % BUSTERS LOG HOMES 9024 BOYD DR 0 75
MATTHEVI'et orRoute No.l NC 28105
City or Town tW~ State Zip Code
4. DATE DRILLED 8/14/2003
5. TOTAL DEPTH 205
bEPTH
Formation Description
DIRT SAND
75 93 GRANITE
93 94 SHALE
94 186 GRANITE
1R8 188 SHALE
6. CUTTINGS COLLECTED YES ❑ NO IA 188 205 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
I xl
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 60 METHOD OF TEST Air
11. WATER ZONES (depth): 10 nom 93-94 50 nom 186-188
0 glom 0 nom
12. CHLORINATION: Type HTH Amount 39
m �r
If additional space is needed use back'f for1_1
tm
>0
13. CASING: LOCATION SKETCH —0 �--
Wall Thickness mC
Depth Diameter or Weight/Ft. Material (Show direction and distance from at letwo-cAtate
��
From 0 To RO Ft 8 1/8 350 PVC \�J�fh ) oads, or other ap reference p&) ts) J=
From To FtAt. —
W 5
From To Ft it-1� "r,Lc �\K-
14. GROUT:
1Depth Material Method J
From 0 To 20 Ft Cement Gravity Flow
From To Ft. CEMENT GRAVITY FLOW 4(44
•C o
15. SCREEN: �& „ ona-¢-
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
co-
yV
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OFONSTRUCTING THE WELL ' rDA©
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
Groundwater Section
278901
WELL CONTRACTOR: Dewey Wright Wen Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687
030401 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential I XX Municipal
Recovery I I Heat Pump Water Injection I I Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER El K
(Road Name and
umbers. Community. or su
3. OWNER fA\flfl f .IFNNINGR
Address PO R!]X 3R4
er Route No.)
RANNFR El K
City or Town State
NC
4. DATE DRILLED Rh15/7nnf
5. TOTAL DEPTH 220
6. CUTTINGS COLLECTED YES I NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 10 METHOD OF TEST
11. WATER ZONES (depth)10 gpm65-67 0 nom
0 gpm 0 ppm
I I
Industrial 0 Ag
If Other, List Use•
County: AVFRY
28RL`oae
I>d
Air
X
TU
DRILLING LOG
From To
tt 55
ss:
�Iralr I Monitoring
GROUNCI',Nt[ER SECTION
ASHEViLLE CEO O;I/t.L C(rI.ICE
DEPTH
Formation Description
fIRT
55 R5 GRANITE
R5 67 CI-IAI F
R7 92n GRANITE
C
O Q
Cf) —
rn cm
12. CHLORINATION: Type HTH Amount 36
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
R7 Ft 6 1/8
Ft
Ft
.350
PVC
Depth Material Method
From ` 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft
From To Ft
From To Ft
in in
in in
in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NACT WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Rrrot- 9-5 -03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days Gw-t REV. 12/99
m.mida m
aa mo
If additional space is needed use bac=f forget
t,t
LOCATION SKETCH N o
(Show direction and distance from at least twoctate
Roads, or other map reference points1: d
j 9g /off\
<— I. C. -�
sr;
c71
FOR OFFICE USE ONLY
Quad No:
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectio2 r-f p 0 p O (1 t'1
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] (a7 1
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687
030421 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery 7 Heat Pump Water Injection
�1d
LI
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MARION
HAL FRANKLIN OFF HWY2211dOFF
ivision and nt No )
(Road Name and Numbers, ommunit or
3. OWNER RRIAN A RI JCHANAN
Municipal
Other
Il
II
Industrial I I Agri
If Other, List Use•
County: AVFRY
Address 805R HAI FRANKI IN Rf1 p�
I INVII I F(rXI Ir oute teta o.l NC' 98ipc`ode
city or Town
4. DATE DRILLED 8F28/7003
5. TOTAL DEPTH 7n0
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES [ I NO
8, STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
11d
I xl
DRILLING LOG
From To
n 35
Lk
j1
Ito C
on( onng
DEPTH
Formation Description
CURT
14,5 7n GRANITF
70 73 SHALF
73 120 GRANITE
17n 172 QUARTZ
172 200 GRANITE
-,l
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 Air
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth)'4 CIPm35-70 1 ppm 73-120
0 ppm 0 ppm
Amount 37
12. CHLORINATION: Type HMI
13. CASING:
Depth
From 0 To
From
From
14. GROUT:
From
From
Diameter
43 Ft 8 1/4
To Ft.
To Ft
Wall Thickness
or Weight/Ft. Material
.188 GALV
Depth Material Method
0 To 20 Ft Cement
15. SCREEN
To Ft
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in.
From To Ft in. in.
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
0
O o
en C
If additional space is needed use back Egfornc"
LOCATION SKETCH
(Show direction and distance from at lease
Roads, or other reap reference pony)
es
ccC0-
Low E5.4
0 N
4
0
�uiSe-
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS B 4N PROVIDED TO THE WELL OWNER.
DATE
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No'
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
Soria! Nn.

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
030068
278396
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2686
STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential L
Recovery n Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNFR FI K County' AVERY
riFFR CRFFK FALII S f1R OFF pPFf ision a Lot No, hATN PARKWAY O
(Road Name and Numbers, Community, or 3. OWNER Rl1MR1 F RFF RI f7R
City or Town State
4. DATE DRILLED 8/19/2003
5. TOTAL DEPTH 145
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing 70 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 Air
YIELD (gpm). 20 METHOD OF TEST
Address 550 DEER CREEK FALLS DR
BANNER( IS e¢7,orRouteNo.l NC 28694
Zip ode
iH
I
11. WATER ZONES (depth)' 20 nom 125-128 0 ppm
0 nom 0 nom
12. CHLORINATION: Type HTH Amount 15
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To __42 Ft 8 1/4 168 GALV
From To Ft
From To Ft.
14. GROUT:
15
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in.
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
To Ft
To
From
From
Ft
Size Material
Municipal I I Industrial 0 A
Other I I If Other, List Use:
DRILLING LOG
From To
0 38
'I
ri
ivtnn tnrnna. r
--�
Grt^U1!D t i4
ASHt 1.-r-_DrEPTH iICE
Formation Description
ntRT
38 129 GRANITE
125 126 SHALE
176 145 GRANITE
1
IXI
rn
n
If additional space is needed use bac cf"qf for
V-c
rn
LOCATION SKETCH —0 mo
(Show direction and distance from at lea36two.tgte
Roads, or other map reference pkttilts)
91Pi
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
41.-1; k/z t�l - l e 9 -g -�, 3
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit original to Division of Wd er Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No•
enrinl Nn

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]
278895
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2888
030410 STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal Industrial El Agricultural MoLig
itori g
Other El If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town. BANNER ELK County' AVERY
THE FAQtuj fFF D QPGINR Rn nFF MAN 1RA OFF MAN I
oa Name an un, ers, ommum y, or ub ivision an o No.
3. OWNER BARR`, BUXTON
Address ear PFAC CK RliDGE oJNC , 202 PEArOCK DR
trees or to .
BI OWIN Rn('1 NC 283895
City or Town fate p ode
4. DATE DRILLED R/90t2Of14
5. TOTAL DEPTH 210
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: d0 FT.
(Use "+` if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm) 10 METHOD OF TEST Air
11. WATER ZONES (depth) 2 gom 100.101 8 ggm 142-143
0 ggm 0 gom
12. CHLORINATION: Type 14TH Amount 28
DRILLING LOG
From To
0 55
DE
Formation escr Lion
Fr
55 100 GRATaTE l`
100 104 4H41 F
101 1A2 _S'RANITE
162 143 SHAI F
143 21n SPANITE
13. CASING:
I)4
X
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 83Ft B 1/8 350 PVC
From To Ft
From To Ft
14. GROUT:
15
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
c-T
O
�—,
rn ^m
:rn
_zm
If additional space is needed use baalgif foRihrrr
c)
LOCATION SKETCH
(Show direction and distance from at least two-spp
ate
Roads, or other map reference points)
�
V1., o� I
'05
O
1:;obeiing
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
421&2 IA/ a 'Z
Quad No'
Serial No
SIGNATURE OF
Submit original to Division of
RSON CONSTRUCTING THE WELL DATE
ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

268027
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
021021
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 288/
STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential
Municipal
Recovery I I Heat Pump Water Injection I I Other
I XI
Industrial 0 Agricultural I I Monitoring
I I
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAND County AVERY
PRIVATE DR. OFF GEORGE WHITE RD. OFF CAMP CRE
I Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER WAYNE R. WHITE
Address 4197 WHITE RD.
VALE (Street or Route No.) NC 29168
City or Town State Zip Code
4. DATE DRILLED 1/14/2003
5. TOTAL DEPTH 320
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+' if Above Top of Casing)
I XI
I XI
DRILLING LOG DEPTH
From To Formation Description
0 70 DIRT
70 240 GRANITE
240 243 QUARTZ
243 295 GRANITE
295 298 QUARTZ
298 320 GRANITE
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 10. YIELD (gpm): METHOD
D QTE7
240-2437 Alr
43 ppm 205-208
11. WATER ZONES (depth):
U ppm U ppm
12. CHLORINATION: Type HIH Amount 48
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 76 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back of form
Depth Material Method \a
From 0 To 20 Ft Cement Gravity Flow -4.)
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CER'tFIFY THAT THIS WELL WAS.Ci*lp CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION $`FANDARDS, AND THAT A COPY 0 HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I,IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit-origial to Division of Water Quality, Groundwater Section within 30 days
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
G c94
(Pt
T f*7 a
n1
yCM
i
Carw o
h (' C� eC IC'
° 512, icz2' t
44
FOR OFFICE USE c NO L
Quad No:
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
280269
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pumo CO„ Inc.
WELL CONTRACTOR CERTIFICATION #• 2888
030430 STATE WELL CONSTRUCTION PERMIT# Leslie Reece i
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitloring ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER Et K County: AVERY
9Fara°pnilkm'oepLomn, y baysonaCnLFFNC?OBWNRDOF
3. OWNER GREGORY 4 K17JAN
Address 2n0 TIMPR�RP1 NIANP
I ree or au a o.
City orroGR4NITE FALI S' rate NC 291LPde
4. DATE DRILLED 8/2g/2n03
5. TOTAL DEPTH 3115 '
6. CUTTINGS COLLECTED YES r I NO Hi
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 4 METHOD OF TEST Air
11. WATER ZONES (depth). 4.00 porn 214-215 0.00aom
0 00 aom 0 00aom
12. CHLORINATION: Type HTH Amount 54
DRILLING LOG DEPTH
From To Formation Description
0 B0 DIRT
80 214 GRANITE l .
214 215 QUARTZ
215 305 GRANITE
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To R3 Ft R 1/R '450 PVC Roads, or other map reference points) /p[ 5h$
From To Ft aor \f��"
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement fdravity Flnw
From To Ft f FMFNT GRAVITY PI OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
.�U
1
Its-6-b3
51G VflE OF PERSON CONSTRUCTING
SIG URE OF CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
Serial No.
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
280251
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it: 2878
030378 STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal 0 Industrial El Agricultural ❑ Monitoring { r
Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I INVII I F F �p�� County: AVEIZV
(Road Name I FRANK[ IN I NvOF$uhdivl' o and Lot NCF LN DFF 221 0
DRILLING LOG DEPTH
From To Formation Description
Address PO ReX 12FR n An fIRT
S An 17n GRANITE
3. OWNER fANIFI
I 1-1r1NFYCIITT
I tcEet or Route No.)
Ity or owe cafe IpTode 17f1 171 QI UART7
4. DATE DRILLED 9/1B/2003 171 79n GRANITE
5. TOTAL DEPTH lin 2An 201 OIlART7
6. CUTTINGS COLLECTED YES 0 NO 1G 701 af1N GRANITF
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: +0 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 2 METHOD OF TEST Air
11. WATER ZONES (depth)' 1.00 Apm 170-171 1.00Apm 290-281
0.00 Apm 0.00Apm
12. CHLORINATION: Type HTH Amount 53
X
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From n To 115 Ft. ft 1/P RFn PVC Roads, or other map reference points)
From To Ft �t3% $5
From To Ft
14. GROUT:
Depth Material Method
From 0 To 70 Ft Cpmpnt WOW
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material NL�
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,2.yr/ /.Jcz. /0 9 o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No'
420
(05
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J.i>m .2. t 1�` . C LYnL/ / /4///V CERTIFICATION # !./ / d
WELL CONTRACTOR COMPANY NAME Oa i /Y N rS Wa �'-/'l f f /` Jp- PHONE # (IO) LEI
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential [8'" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO • rtX L t 5h /j
Nearest Town: •ft T t' County�ojig'
17 F' D ctlfi�u%!C7e4 D i rS7f�
(Street Name, Numbers, Com i Y / 1 Subdivision,LotNo., Zip Code) g
H '� vJury .. 1 or y
3. OWNER: T e W ( % f'
Address t7Pa
^ n Street or Route No.) � L ..-7 ; Z.
v Ss'�inR X�C, 3 J
City or Town S e Zip Code
- tit -- e 4 WG
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lflat
(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 v (4) _ / 7
4. DATE DRILLED / .2- 3"" Li 3 / 7 — i -5
5. TOTAL DEPTH: ,3 (' `/ ZS - 2_- r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fd' 2.-- 2 0
7. STATIC WATER LEVEL Below Top of Casing: / 2- r/a-- FE 1 p - 3 G'
(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. /pJ
9. YIELD (gpm): � 5 METHOD OF TEST ULU cil
10. WATER ZONES (depth): Jo ' 3 4,
11. DISINFECTION: Type et, 4/ .?e" Amount 4- Pile 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From U Tom Z /
From To
From To
13. GROUT: Depth Material Method _._.
From U To 10 Ft. Cr'n//.1/ rticvda
Trout To Ft.
14. SCREEN: Depth Slot Size Material _ —
From-3/ To.3 L' Ft. /5— in. r1,
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth, Size f
From. 5'C) Tot 4' Ft. /)J.�s!
From To Ft.
n
16. REMARKS:
Co n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELE c -a
.THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL (MITER
IV
r,e
Material
Ft. z 3e 4/c Pb
Ft.
Ft.
Material ,/
S 9-I..--(
28097'7
C4civ
le(
ciz-y
ttJi ?,2 Signd
LOCATION SKETCH cce
Show direction and distance in miles from at east r -
two State Roads or County Roads. Include th�bad
numbers and common road names. — � ''
' no
17L
2 "f 2-
cn
�oS�d`L�
CONSTRUCTION STANDARDS
Diameter
2- in.
in.
�-- /:-3 —zJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE z cn
rm
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Ra
27699-1636 Phone No. [phone], within 30 days. GW-1 RE
0
0
NC
2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
1?8 053
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2667
030459
STATE WELL CONSTRUCTION PERMIT#' Steve Reece
1. WELL USE (Check Applicable Box): Residential I XI Municipal I I Industrial 0 Ag
Recovery CI Heat Pump Water Injection I I Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FANNER ELK County: AVER
OFF HICKORY NUT GAP OFF HWY 184 OFF HWY 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER CALVIN M. JOHNSON / CAROLYN V. JOHNSON
Address 3855 HARMONY CIRCLE
SOUTHP&rt or Roete No.l NO 284131
City or Town State Zip Code
4. DATE DRILLED 10/8/2003 93 500 GRANITE
DRILLING LOG
From To Formation Description
ujvtJra1
n&orAlo Fy j�I
_ j
AC E:'iJ_EDEPLW1l F7n-,E
0 10 DIRT
10 90 GRANITE
90 93 SHALE
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES NO h
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 5D FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): ' METHOD OF TEST Air C j ^r
1 on prim 90-1o3 0.00 npm
11. WATER ZONES (depthl: _'
LI.00 btpm 0.00pprn
xI
r-
O 7-2
n
r`'s - rn
12. CHLORINATION: Type NTH Amount 92
13. CASING:
Depth Diameter
From 0 To 21 Ft. 6 1/4
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Material
GALV
.168
Depth Material Method
From 0 To 20 Ft Cement Gravity How
If additional space is needed use bao (pf fo;mST.i
From To Ft CEMENT GRAVITY
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
Size Material
From To Ft
LOCATION SKETCH
(Show direction and distance from at le twoctate
Roads, or other map reference points)
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD JLgS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
r'1
Cl) .�
r =u
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
, � A /rD-aI -O3
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
282054
WELL CONTRACTOR: Dewey Wright Well Pump Co Inc.
WELL CONTRACTOR CERTIFICATION #• 2687
030485 STATE WELL CONSTRUCTION PERMIT#:
ve Reebe
V
1. WELL USE (Check Applicable Box): Residential ❑i Municipal
Recovery Heat Pump Water Injection ❑ Other
I I
Industrial
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: EANNEP EaX County A\rEpy
oaf frame and N umbers,'Cornrnurity, or Su division an LotNo.l
3. OWNER THE GI FNNR RI ORS LLS-
Address 47R THE rrl FNNd RI y/r?
RANNFRIrtlekor outs o. NC
City or Town State
4. DATE DRILLED 1f /7/7lf1Z
5. TOTAL DEPTH ^nQ 1AO VI Stl IAPT7
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 115 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): R METHOD OF TEST Air
11. WATER ZONES (depth): 3.00 opm30-32 5.00gom 140-143
0.00 gom 0.00oom
12. CHLORINATION: Type HTH Amount 20
2g8 Code
Agrjduktpral
DRILLING LOG DEPTH
From To Formation Description
0 18 DIRT, SHALE
18 30 _GIPANITE
40 12 QNAI F
^+2 140 SRANIITF
143 "00 GRANITE
C
13. CASING:
IId
x
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To ;It; Ft fl t1I -tr t
From To Ft
From To Ft
14. GROUT:
Depth Material
From n To 7n Ft Campnt Gravity Flew
From To Ft CEMENT GRAVITY Fl O
u c
GJ
O -r—
.,
N E5--'
If additional space is needed use back offluorm
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
Method
Material
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
1
..,t
LOCATION SKETCH — N 4
r;
(Show direction and distance from at least t Stare 1
» Roads, or other map reference point r h*Iii\
5
T1..t41I4nna.. -Gyeark)
(-4)14}er
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HA BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SA- I - 0_3
Quad No:
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] 282055
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2887
030498 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential XI Municipal I I Industrial
Recovery n Heat Pump Water Injection I Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town' LINVILLE County: AVERY
OFF CLARKS CRK SUB RD OFF RICHARD CHILDRESS R
(Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER JOHN T HICKS From
Address 1802 BEECH MTN RD. , 0
ELK PARhreetorRoute No.l NC 28822
City or Town State Zip Code
4. DATE DRILLED 10/7/2003
5. TOTAL DEPTH 220
6. CUTTINGS COLLECTED YES I NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing) 200 ()CO QUARTZ
9. TOP OF CASING IS
1 FT Above Land Surface*202 220 GRANITE
*Top of casing terminated at/or below land surface requires a varianceeinin accor-
dance with 15A NCAC 2 0118
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth): 3.00 ppm 60-54 1.00 ppm 90-94
0.00 ppm
DRILLING LOG
To
48
ricul6ural I I Monitoring
DEPTH
Formation Descr
DIRT
48 60 GRANITE
80 84 SHALE
p
on
84 90 GRANITE
90 94 SHALE
94 180 GRANITE
180 183 QUARTZ
183 200 GRANITE
2.00 ppm 1 80-183
xa
II
W `.
12. CHLORINATION: Type HTH Amount 3'
13. CASING:
Depth
From 0 To 53 Ft.
From To Ft
From To Ft
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
61/8 350 PVC
If additional space is needed use baQYryf fotmt
_r71
N =—
LOCATION SKETCH —.1 =
(Show direction and distance from at le twcf$te
Roads, or other l. map reference poAn1ts) ;',-,1
N+
rn JJ
Depth _ Material Method
From 0 To 20 Ft Cement 'Gravity Flow
From To Ft CEMENT GRAVITY FLOW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECOQ HAS BEEN PROVIDED TO THE WELL OWNER.
CO
N
FOR OFFICE USE ONLY
- - 0 3
aa-1
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
282052
WELL CONTRACTOR: Da'fay Wrioht'xb'eil Furop Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2687
030517 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
I I
Municipal Industrial I I Ag
Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: R;11?lNJP FI u• County: ''rmv
r,ac=:. •A AnQ'A/S c-, rice Q CI -I r,1Thl
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER tAAP/ !,. r-J3ki
Address — r' '2q1.1
(Street or Route No.)
RAr..,N.li=F cI �r
City or Town State
4. DATE DRILLED 1 !l/Pjll11
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO I •*I 17; Jnll 1=-ili\llTR
7. DOES WELL REPLACE EXISTING WELL? YES I NO
DRILLING LOG
From To
n
i���yrral ILorDtog
L
DEPTH
Formation Description
rI GT
Inn T.
Inn „APT7
ILA I?n f;'PANITP
8. STATIC WATER LEVEL Below Top of Casing: do FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depthl' S,00 „^pm 100-1101 2 00 corn 120-122'
0.00 ❑om 0.00ppm
12. CHLORINATION: Type HTH Amount 32
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To -" Ft 19'112 _cr,. -.
From To Ft
From To Ft.
14. GROUT:
ii I'7 ^I Id GT7
0 0
n
If additional space is needed use bactc4f foFrri
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GR=.VIT` R; _r,t./
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in in
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC C 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
79.
-sh
LOCATION SKETCH CP-
(Show direction and distance from at leelt twdfate
Roads, or other map reference p ts) a
voo¢. I D5
&Le
E/K
-COOY-
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
430W]0
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co. Inc
WELL CONTRACTOR CERTIFICATION #• 2887
030525 STATE WELL CONSTRUCTION PERMIT# Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery
Heat Pump Water Injection
Municipal
Other
I
Industrial 0 Agricultural
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER pELKCounty AVERY
Frtd3d N�hE ffsgmb€Fs,FoM nglr58Gd4iSidn`eminYNtr'pF I -WY 184 0
3. OWNER
Address
RUSS STARKEY
oia BRADiwan1
P.O. BOX 1257
ow or T 'JNER ELK state NC 2W4de
4. DATE DRILLED 10/1n� 2003
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 2n METHOD OF TEST Air
X
11. WATER ZONES (depth)an nn onm inn -ins n nfppm
n nn nnm n nnnnm
12. CHLORINATION: Type HTH Amount 25
X
Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 40 DIRT
40 100 CRANITE
103 200 GRANITE I
100 103
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material
From 0 To F5 Ft B 1/8 550 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 2n Ft Cement Gravity Phu
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
(Show direction and distance from at least two State
Roads, or otherp Dint
reference points)
UA
°--Ya�A
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD H BEEN PROVIDED TO THE WELL OWNER.
,ir' �a�� l/- 7- 0_3
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
283047
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687 _ --
030538 STATE WELL CONSTRUCTION PERMIT*Steve Ree4e � l 'J
1. WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection
Municipal I Industrial El
Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
atl a e n u o iT- ub s o a t .I 184 0
3. OWNER BANNER ELK WINERY
Address
Str or Route No.)
city orTBtNNF&-P K
State
r>c
2El 44de
4. DATE DRILLED 1n11 worn
5. TOTAL DEPTH 7n0
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 4n FT
(Use '4" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 40 METHOD OF TEST Air
11. WATER ZONES (depth) 0.00 Clam 78-81 30.00aom 120-123
DRILLING LOG
From To
Agricultural El
0 49
as 70
70 78
78 81
P_ H
Format OR DescriptC2 i.
DIRT
GRANITE
SANDSTONE GRANITE
girl ALP
e1 120 _SPANIITF
1211 SHAI
171 Inn GRANITE
0.00 aam
12. CHLORINATION: Type NTH
13. CASING:
0.00aom
Amount 34
XI
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 5Ft 6 'UR Will PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From n To 7n Ft t prnpnt Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H BEEN PROVIDED TO THE WELL OWNER.
l/- 7-
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
`! ;e0 Roads, or other map reference points)
e 44 m i •--�'
FOR OFFICE USE ONLY
3
Pol.
Quad No'
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sec
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
on 283037
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Downy Wright WPII Pump Cn Inr
WELL CONTRACTOR CERTIFICATION #• 76RH
030551 STATE WELL CONSTRUCTION PERMIT#' I PGliP RPPnP
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal Industrial
Other El If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _E_Liu� / < County
TR BdN'mee9dmb9Cc1,9.gyFF and Lot No.)
3. OWNER FRAZIER PI IRS Ff1R CHRISTMAS
Address 7d7 Nnl
city or Town F
treet or Route No
State
tlC
4. DATE DRILLED 1f1/7a/7lf14
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 75 METHOD OF TEST Air
22ipL de
11. WATER ZONES (depth)' 0.75 aom 348-349 0.00aom
0.00 aom 0.00aom
12. CHLORINATION: Type HTH Amount 86
13. CASING:
AVERY
xl
Wall Thickness
Depth Diameter or Weight/Ft. Material
From Il To 47 Ft f11/d IRS CIAI V
From To Ft
From To Ft
14. GROUT:
Agricultural El Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 35 MUD, GRAVEI
35 3d6
GRANITE
3A B 3A 9 _PI JAR1Z
349 d25
If additional space is needed uaba
u
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CFMFNT GRAVITY Fl OWL
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in /
From To Ft in in UV'`/ i //G'
From To Ft in in —�
16. SAND/GRAVEL PACK: ic
Depth Size Material
From To Ft Size
��t,y5
From To Ft ��W 5411
' J r 6 Ql''
L��_pp I't
17. REMARKS' j4i w' 1j,f,Y5
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
LOCATION SKE SKE ICH
(Sh direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
Quad No
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
Groundwater Section
283035
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
030567 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELK PARK
Municipal 0 Industrial 0 Agricultural Monitoring 0
Other I I If Other, List Use -
County: AVERY
3. OWNER
Address
in aM Thblfftbni 1'u Frly`dt 9ubdiMshfi and Lot No.)
ALLEN HOUSTON
FQ B0(SFFeet br Route No.)
I
City or TowwLLIhA TREE State r C
4. DATE DRILLED 10fl020in
5. TOTAL DEPTH 1'5
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: —5 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 9__ METHOD OF TEST Air
11. WATER ZONES (depth)' 4 nn nnmdl-07
X
n nnnpm
n nn np[m n nnnpm
12. CHLORINATION: Type HTH Amount 74
13. CASING:
Lx
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 91 Ft a 1/a 188 CAD,'
From To Ft
From To Ft.
14. GROUT:
DRILLING LOG
From To
0 15
DEPTH
Formation Description
_DIPT
15 11 r=RAAATF
41 42 SWLF
42 125 GRANITE
t,
Depth Material Method
From 0 To 70 Ft Cement Gravity Flnw
From To Ft CEMENT GRAVITY El OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
If additional space is needed ube-Gal k of form 1
LOCATION SKETt H
(Show direction and distance from
wo State
Roads, or other map referepje points)
a
fi
C
c
C ^
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
/l-l0 - 03
S of ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

292436
WELL CONinuC ION,pzcORD
Natal Oman -De t orEnvitnottent andIbtand 8matmesa- Divides eeWataegmTity Otoundunteraniton
"'u' comitscratanvottassis(pil mneF Ku Anr( az3.
unnit.annite,ca+oaaaa temneafe; K VA. nanrd r t rrip 4- tkf J / . man sJ'ayatatl-$4
sum vvaara � Aswan=want
fffaplicable)
2. W IL IDE Omsk APPliathIe Bon1eRetidentiall NfroleipagipatorteD Induadalt] AciaandE Monitarkal Reaova<yD HeatPampWater Woman 0 Other 1sWOib LiatUae
2. WEILL(1CA110N:
Nearest Town: a t .. _�, u
- y k
o J r wLowe, 27p�ode)
3. OWNBR:1n U �.S ('ao-nc,o lPi
nagansdounassakto
Addrest pot: Rnmrno tE l�6 rlRc _ni i METH MUM LOG
Qp°Bay'htoaml
¢ T "aac Zipa Was To 'On
4.DATE DRUM lD-I''a-C>3 0G tC��� ?ST
5. 1DTAL�r'�S
6. DOES W&Z.RSnaanl ctsr awmu2t 11133 13 No if
7. STA7ICWATERLEva Baby, Top ocCaa?a,_3n FT
enceritsonTititorcninD
8. TOP OF CASING IS I FT. AInv LandStakes
stop nm a.unfaorerNHaw 2asaeflesmakes.
urea, harem itoidfi 1QANCAC2CAt1a.
9. YEIDD(Ipm); MET&p'DOFTEST
it WATER Z(depat): / t
Toposuchic/Land setting
tights. 0Slope OValkty Mat
(thocktopoptine tax)
latiintleBengitdd6ofwelllo on
•
IL
Type p,rlt@d-c Amonnt Cl C >
allThidmess
F,QU.J_TToo J l OI 1� WMinor cs9 aleaea 11
FinaL_To Pk __ ( ['
Froth_ _To Ft
13.OROVl: Dept_ bletedd
FmnLCL_To iPt. YY1 itE.-ri
Ern____To_ It
14. SCREEN: NA Diemetx SloeSiat
> _To Ft —in. in.
Fimqs__Tat__Pt s._ in.
15. SANDIGRAVELPACE:
Rost- Tom Size Ft._,_„_ Material
Faont___To Ft
Mandel
t
Showdbxdoccalltrtstmcespueimintatleast
two Nate Ronda or CotadyRost ligkillsthatosa
nmb=aad etunmen toad stem <t-
o
� s�
CO ;C.
m�
O �
/us" `0
16. IIBMARK& I'j
IDOffiB6BYDIRINTINAT7I0SWEILWAS WNSTRUcJwDw& W71E
C01451 1/CITONSTANDARDS,ANa9ATAalt7'IDSR110011 IAs1N8RF WVIDEDTOTBBWELLOwNER
u V
lij I ; JJUN 2 5 2004
r ON
ASHEVILLE REGIONAL OFFIC
77449 OFPERSONCONSTIWCONGTOBwpjy n&.Th
SAMSoSSW to McMilks flahrQuality,GtondnaterSeelite,.163611MSinksOutr-Ra1eI86,NC
2769,4636PUSS G19173 11.wilds30dava. ow_imy. O7/26r

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]
292359
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
030618 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Municipal El Industrial ❑
Recovery I I Heat Pump Water Injection D Other CI If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: • • BANNER ELK County AVERY
HICKORY NUT GAP RD. OFF HWY 184 OFF HWY 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER SHERWIN VAUGHN HUGHES
Address P.O. BOX 1751 ,
Arts rt
¶ lo�it g
s L
JUN 2 5 2004
v
DRILLING LOG DEPTH
From To A..� .Formation Description
0 79 DIRT
BANNER I e or Route No.) NC 28804 79 118 GRANITE
City or Town State Zip Code 118 119 SHALE
4. DATE DRILLED 12/1/2003 119 248 GRANITE
5. TOTAL DEPTH 285 248 247 QUARTZ
6. CUTTINGS COLLECTED YES 0 NO I X 247 285 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD Igpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth): 1.00 qpm 118-119 4.00gpm 246-247
0.00 qpm 0.00qpm
12. CHLORINATION: Type HTFI Amount 47
c
O
a�
Zc7,
N nm
tD grn
If additional space is needed use bacloef fob
m
NT
13. CASING: Wall Thickness LOCATION SKETCH CA C3
Depth Diameter or Weight/Ft. Material (Show direction and distance from at lei twr Late
From 0 To 83 Ft 8 1/8 .350 PVC Roads, or other map reference points) z
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From ' 0 To 20 Ft Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
`�K
Io5
9)r
17. REMARKS: "t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
. i.'X LLts
FOR OFFICE USE ONLY
Quad No:
—0
SIGNATURE SIGNATURE OfERSON CONSTRUCTING THE WELL DATE
Submit original to Division o Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
292355
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
030006 STATE WELL CONSTRUCTION PERMIT#- Leslie Reece
1. WELL USE (Check Applicable Box): Residential KI Municipal El Industrial 0
Agricultural ILI Monitoring El
Recovery n Heat Pump Water Injection El Other LI If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: - SPRUCF PINF County AVERY
GREEN OAK'S LN. OFF )ERRYS CRK OFF ROARING CR
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER NATHAN L. OAKS
Address 134 GREEN OAKS LANE .
N^,Y.VLl,, .VVU"i$ireetorRouteNo.) NC 28657 80 96
City or Town �State Zip Code
4. DATE DRILLED 11/14/2003
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES 1E1 NO I >V 182
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO n
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
DRILLING LOG
To
80
From
0
96
97
181
97
181
182
200
DEPTH
Formation Description
JI ID GRAVEL BOULDEF
GRANITE
SHALE
GRANITE
SHALE
GRANITE
C
Ca
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD Igpm)' 10 METHOD OF TEST Air
11. WATER ZONES (depth): 3.00 gpm96-97 7.00cpm 181-182
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH
13. CASING:
From
From
From
Depth Diameter
0 To 84 Ft. 6 1/4
14. GROUT:
From
From
To Ft
To Ft
Amount 28
Wall Thickness
or Weight/Ft. Material
.188 GALV
Depth Material
0 To 20 Ft. Cement
To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in.
From To Ft. in in
Method
Gravity Flow
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Material
Size Material
= Cm
IV o`t
DO
ma'
If additional space is needed use ba crff fourix
W 2.
LOCATION SKETCH CO oZ
(Show direction and distance from at least two State
Roads, or other map reference points)
1LC.)"
Cites,
vee9s
T La
^„ e
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH•
1., L'
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF
Submit original to Division of
ON CONSTRUCTING THE WELL
er Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
292356
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
030608 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential ?d Municipal 0 Industrial 0 Agricultural 0 Monitoring D
Recovery I 1 Heat Pump Water Injection El Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:• SPRUCF PINE
ROARING CREEK RD OFF HWY. 19E
oad Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER VON OAKS
Address 739 ,JFRRY'S CRFFK RD
NEWT reetor Houleoute No.)
City or Town State
County' AVFRY
NC 28657eZip e
DRILLING LOG
From To
0
DEPTH
Formation Description
6 DIRT
6 101 GRANITF
101 102 QUARTZ
4. DATE DRILLED 11/18/2003 102
5. TOTAL DEPTH 205 184
6. CUTTINGS COLLECTED YES D NO H 185
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0115
10 YIELD (gpm)• 2 METHOD OF TEST Air —v
184 GRANITE
185 SHALE
205 GRANITE
0
F
x-J
y. Qm
11. WATER ZONES (depth)' 1.00 [(pm 10-102 1.00ppm 184-185
t�n^z
If additional space is needed use batpf fo24T
tD
2rn
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH
13. CASING:
From
From
From
0
Depth
To
To
To
14. GROUT:
Amount 40
Wall Thickness
Diameter or Weight/Ft. Material
21 Ft. 6 1/4 .188 GALV
Ft
Ft
Depth Material Method
From' 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To
From To
From To
Diameter Slot Size Material
Ft in in
Ft in in.
Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
a
u
z
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
&
Creek-
n
=;' n
s,
-< z
- _ N
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2CJWEL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W I OWNR.
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF
Submit original to Division o
RSON CONSTRUCTING THE WELL
ater Quality, Groundwater Section within
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qual
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /eY I,yef A 4�/e4t
WELL CONTRACTOR COMPANY NAME IP6 Sw t'le/ t/r/,Ot /'4 ite
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
y
I. WELL USE (Check Applicable Box): Residential gr. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use`'r :a+r /e
2. WELL LOCATION:
Nearest Town: I 4t'pt County A rJr
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: �'rr de {F}
115 mike ,4d. se. /non
Address
(Street r Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED // /t2 -03
5. TOTAL DEPTH: A7cZO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9'
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /• f METHOD OF TEST Ain
10. WATER ZONES (depth): (O" G r + S
Ada -da( /14/
II, DISINFECTION: Type ff7Y? Amount idX
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To SO Ft. G>/a /8f loalN
From To Ft.
From To Ft.
13, GROUT: Depth Material Method
From 0 To nto Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth
From To Ft.
Grrnre�7L— !/ityr ev!
Size Material
From To Ft.
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
P.O 3 bl4tie d;.,�
3 - 40 >S oc_i/r
It ` lva✓ arocarp-s itck
2r36 4 z-I /`/r es- S
2 al 720
LOCATION SKETCH .0
Show direction and distance in miles from at Igt
two State Roads or County Roads. Include the-t d
numbers and common road names.
S'lz5ot✓Uttice
- Groundwater Section
CERTIFICATION # DJ67
PHONE # ( )
r
C rt
r1Tj'
pC
—Orr'
O
gran
3 —
p 0
wt
on
Jf
µ; Hk0ty 14,4
6aegd
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TjIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CON4'lfRUCTING THE WELL
d
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. Q7/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resourc s - Division of Water Quality - Groundwater Section�'r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V;D) CERTIFICATION #R•S1C
0
y.
WELL CONTRACTOR COMPANY NAME CrIt t /' t PHONE # p) —XCZ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
303060
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:�
Nearest Town- County
1 g, c4 VtlR le r'-N4-&+gar-
-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Nu
3. OWNER: f'IA.I' CARD
Address 20h 172rC45 Fa K 7Nt.
(Street or Route No.)
100AXAm0 Al c. OW
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX STING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 120 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 ith 15A NCAC 2C .0118.
9. YIELD (gpm): II METHOD OF TEST Al g,
10. WATER ZONES (depth): of I ICE
I I. DISINFECTION: Type leaL—e Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
D ToSp' Ft. 'Ai 5DR at ?VC.
To Ft.
To Ft.
Depth Material
Too :2r j Ft.
Zip Code
From
From
From
From
13. GROUT:
From
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 i
Slot Size Material
in.
in.
Material
Topogr is/Land setting
❑Ridge ttSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F(gr.`nation Description
8
B
LOCATION SKETCH cD
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the wag
numbers and common road names.
Gt'N
Olt.;�
Nam=
'sJ Cri
racy'
S
tv PO
t� c:
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRUCT19z➢C STAND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9-a5—c0:
C
SI
cm
NATURE 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

0-P 303059
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourccees//- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /Ct,VA/t7LQ JJU aloA�rCo I CERTIFICATION # pqy,`gy
WELL CONTRACTOR COMPANY NAME /. rg1.Y /CtG/� /VL�I �n�I NJ' PHONE # I )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential arMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 1 P %t. a 7 te
2. WELL LOCATION
Nearest Town: //onzri//4 County // UZn 1
c716T2i itt,4 Qd-
(Street Name. Numbers, Community, Subdivision, Lot No_ Zip Code)
3. OWNER: I o sG.7 Address yed
(Street o Route No.)
/llew/two c-
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED IQ-l`o3
att'6,s1-
5. TOTAL DEPTH: ..3 6 O
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I'
7. STATIC WATER LEVEL Below Top of Casing: 41. 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 L/roi
10. WATER ZONES (depth): 65— 79 yq/
11. DISINFECTION: Type ifrol Amount JO r
12. CASING: Wall Thickness
Depth Dia,,," �eter or Weieht/Ft. Material
From �/ To Gn Ft. SPeo, /LC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To ,PO Ft. eri.. as,ar"e4%
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
lildRidge ❑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 Descnp}}ion
redler
�1/na<ra nIi 7�
DEPTH
From To
t1- , r
s4— FS—
�;r- 9:
71 i 6o
CD
LOCATION SKETCH
CD
n
GO
Show direction and distance in miles from at leafy
two State Roads or County Roads. Include the rr5d
numbers and common road names. c
t-7
cP
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL:. J.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
zet
/ /4'
SIGNATURE OF PERSON C i STRUCTING 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 RE V.D3/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) #/SNNt'7//7 (7(wearp. CERTIFICATION#p2/i/1/
\VELI. CONTRACTOR COMPANY NAME
/l/b$4'e/( !✓vi/gel //iss PHONE # f )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential e Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use "Pi weYf r
2. WELL LOCATION:�/AA
Nearest Town: /(/eat./q. d County /i✓ea^7
(Street Numf, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
// (Street or Route No.)
Lt1�Ie N /`r
City or Town State
)-
Area code- Phone number
4. DATE DRILLED //- 2 2 -03
5. TOTAL DEPTH: 4'Ot)
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO er
7. STATIC WATER LEVEL Below Top of Casing: EG FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST $!
10. WATER ZONES (depth): ISO I. 5' 4G S 4.5
11. DISINFECTION: Type HTI-I Amount W O Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From '—/ To y4 Ft. 6t fop./ As'c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To ego Ft. eta...-7- /904rArt
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
( idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a •— ihmr II
70— fv .r.4Ce.rocK
7B /3et) nes--r''le
/so-- /sr s4.4
IflJGoi. 9 Mew II
-na - 345" c 4 /reauK
3LS you
LOCATION SKETCH '"
077
Show direction and distance in miles froiSleast C n
two State Roads or County Roads. Includege roadr*+!
numbers and common road names. rn
�rn
1 Aa
tp
QO
}i 06
�—z,/ —t
lee
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS
BEEN PROVIDED TO THE WELL OWNER
'7r //-G f--ea
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /- Division of/Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) We,y,yc-f% rc/i9 '2W CERTIFICATION # G9
WELL CONTRACTOR COMPANY NAME he' we /'evter /irr/q PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ire-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use Ar i iitq.f >`
2. WELL LOCATION: n
Nearest Town: /Jgttd.0 C. c/NeD Countyjue-r
fi/vt,�$hglupj Ed Jut. +e72
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address pm- 60i( Z./09
Airor Rp/Futp,No.)
City or Town CL /s`l State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED // - / 3 - 03
5. TOTAL DEPTH: i/ AO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LL]-
7. STATIC WATER LEVEL Below Top of Casing: 49 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): IL-- METHOD OF TEST 4/14
10. WATER ZONES (depth): /.30 -/3.r 23c/
3/7-38o /ox}o/
a f d t'f
II, DISINFECTION: Type
12. CASING:
Depth Diameter
From_: To /2.9. Ft. G;
From To Ft.
From To Ft.
tz''f Amount e302
Wall Thickness
or Weieht/Ft. Material
SORB/ Pvc
13. GROUT: Depth Material Method
From 6 To ?o Ft. Ceti tori- Agree/
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
Lfigdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/n inutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6- //R r hMk-e.0 A ri
/ do J 3t tag N 77.As.c. /e
/35 3/7 rauifes
31,— 3026 `4Cj Qt tr fr
San 49,7to jnn �'fe
LOCATION SKETCH O
Show direction and distance in miles from at lst
two State Roads or County Roads. Include the ad
numbers and common road names.
tV
O,
p yea
at
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL -
CONSTRUCTION STANDARDS, AND THAT A CO .Y THIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER'
OF. //— / 3 - 03'
SIGNATURE OF PERS ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,NC
-
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ri/f 1
J/KW/VC.
WELL CONTRACTOR COMPANY NAME /J'itlj t1!/-C// &)N/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ. 'ERMIT#
(if applicable) (if applicab e)
CERTIFICATION # ca4 "y
PHONE # ( )
I. WELL USE (Check Applicable Box): Residential CA" Municipal/Public 0 Industrial 0 A',ricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use /J/I ti--44 ft
2. WELL LOCATION: palYt ,J �J
t'{eajest Town:ON .el / OAL eoeo County /dee /t!/ wryPd. ✓
use LCFT Nd646
(Street Name, Numbers, CommunittyLy, Subdivision, Lot No.. Zip Code)( I
3. OWNER: "K /74i-//e JtM Stitc�nex.
Address 231 fASi Fa fern
R u11016OrRoy��o.> �ayNyl
City or Town State 1' Zip Code
( Area code- Phone number
4. DATE DRILLED /o'P o i
5. TOTAL DEPTH: /v O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13-
7. STATIC WATER LEVEL Below Top of Casing: 70 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. r�
9. YIELD (gpm): 3D METHOD OF TEST
10. WATER ZONES (depth): PC, —'7 27 70.,2/
• 11. DISINFECTION: Type
12. CASING:
From a
From
From
N T/L- Amount -3e7
Wall Thickness
or Weight/Ft. Material
521/0.I ©/iC
13. GROUT: Material
From 6 Ft. 4tt.m.rc. t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Depth Diam ter
To /, D Ft. a
To Ft.
To Ft.
Depth
To o2e
Method
&de'
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
Mir (check appropriate box)
Latitude/longitude of well location
303055
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
YO % G /jrta• JAY'
7n 7 2 cie`'9/7:t_reZ 5-4,
7/' /GO /bv/ ft(
O
n
LOCATION SKETCH
Show direction and distance in miles from at Iasi
two State Roads or County Roads. Include theltsad
numbers and common road names.
0
to
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
>yr /6' O4 f
SIGNATURE OF P ` ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Crn
1,cn
m
Ani
,O
r'rim
.nab
00
nCI

Depth
From —/ To #/, Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material i Method
From e To cp Ft. Lfs9i` rr9✓F*/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural /R/esources - Division of Water Quality - Groundwater Section //Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /[-4/Ne'I/1r COTD'>-6 , CERTIFICATION#d�1‘ lt /
WELL CONTRACTOR COMPANY NAME NraJ6t'C/I ('t'� � �^`^^"t'S! PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
303056
I. WELL USE (Check Applicable Box): Residential 2J" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use pm fe_ c'7 t
2. WELL LOCATION: /J
Nearest Town: f%b County /Eve
ule6 ec4t44 i
(Street Name. Numbers, Community. Subdivison. Lot No., Zip Code)
3. OWNER: r.i/Grr?lsi fY�r/,tGAQ,4
Address PO. got 1y?
(Street or Route No.)
/rb/4ezanQ .et clUZ,57
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9 36 "C3j
5. TOTAL DEPTH: 'IEaln
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ZI-P
7. STATIC WATER LEVEL Below Top of Casing: G 0 FT.
e ( Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): ale METHOD OF TEST .4/r
10. WATER ZONES (depth): it 6 7 941
2IP (991/
II. DISINFECTION: Type /frii Amount .Po.(
12. CASING: Wall Thickness
Diameter or WeiehtlFt. M terial
From
From
16.REMARKS:
Topographic/Land setting
Phridge ❑Slope OValley ❑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 Form ti n Description
o — 96 r 7,4
50-60 nt
�R..-'fe
60 A7 sfoie
'}5) "3640 Ore✓%f
3Gv VVPO r% nutF` )It,
LOCATION SKETCH
O
en
Show direction and distance in miles from at lepst
two State Roads or County Roads. Include the48ad
numbers and common road names.
SP
Grr'
-no
0
me
2
Co
tf (7
0)
iatec
Vest/ r Z7
cr(t. ?Sy_
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
SIGNATURE OF PERSON CONST
ING THE WELL
30 —o3
DATE
Submit the original to the Division of \\ ater 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) /'1; Mit/d1'-i kJ, CERTIFICATION CERTIFICATION# ce
WELL CONTRACTOR COMPANY NAME Otte; -e // 4 -/!,a / //i it, PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 A )ricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use i' iwce .
2. WELL LOCATIO
AA
NearestTown: 2o�/t r./�R County irYi"7
DLO Jtv'0s fickle Per.
(Street Name. Numbers. Community. Subdivision, Lot No.. Zip Code)
3. OWNER: /v,42Ge
Address la timer &mk, pyt ksy
• I ($lreeAire No.) 45
//ylw �^�•1/ O
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED hi--7 3
5. TOTAL DEPTH: r 26
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO le'
7. STATIC WATER LEVEL Below Top of Casing: e" 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. �p7
9. YIELD (gpm): / METHOD OF TEST IT as
10. WATER ZONES (depth): //p //3
11. DISINFECTION: Type hf%7� Amount Yea
12. CASING: Wall Thickness
Depth Diam er or Weight/Ft. t�qateriAl
From "/ To 7 % FL If -0 f44ji /'v (-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From es To oZ6 Ft. CC// ra it 00 e wren'
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 OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
®— 70 re,,,/din
7o- in
/as-. 70 6F11:,,,t Stir
/i3- 1IC> "re. -bee
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r 9d
numbers and common road names. O
$
} d t
/dc
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY [ THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone Nn. 1919) 733-3221. within 30 days. GW-I REV. 07/2001
30305'7
C)

WELL CONSTRUCTION RECORD
303093
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J \/ttL) (j�CeN) CERTIFIC�ATTION//RS9�
WELL CONTRACTOR COMPANY NAME goV-4....1.4:'II c''t`JO PHONE # ttbra )-M- Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 1 "Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest To tf Count teat
/ylt2d ,spat
(Street Name, iu iers, Common i uhdivision, Lot No., Zip Code)
3. OWNER:
Address ,by
Pit,-N { (S1reet or Rout`Nn, a�j
City or Town State
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX TING WELL? YES 0 NO C.
7. STATIC WATER LEVEL Below Top of Casing: 5e) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 40 r FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanstabith ISA NCAC 2C .0118.
9. YIELD (gpm): O METHOD OF TEST ,-t(t
10. WATER ZONES (depth): CR
11. DISINFECTION: Type chi YhQi_cAmount 6 r, -r
12. CASING: Wall Thickness
Depth D meter or Weight/Ft. Material
From [ri To �{ Ft. 4 zti sckal (('
From To Ft.
From To Ft
-?N Bu cA ilAblAt
Zip Code
3
13. GROUT:" Depth Materiiaa�/�
From '- To J Ft..-�
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0.=
Material
pographic/Land setting
idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
o tion Descript;.n
DEPTH
From To
ten— /oc6
n
rat
LOCATION SKETCH r c
Show direction and distance in miles frorp3t IeaS2'-
two State Roads or County Roads. Include the rapt
numbers and common road names. -�rn
To e
)I 6ocd N
:-
0
I DO HEREBY CER IFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION�TANDARU.-*N9Zg3ATtR COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6._ f 5
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

30309t
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division /oJf "Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)1{Jc'e NNcth J/bJJ..S.. CERTIFICATION e. 13-3
WELL CONTRACTOR COMPANY NAME bats t/tit /l/ U/t%f// uc PHONE q f
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WO PERMITH
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 23-"Iclunicipal/Public ❑ Industrial ❑ A yLrrricultural❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other IDIf Other, List Use /1 Sv4 /'1e
2. WELL LOCATION:
Nearest Town: Wr-eletwe County
JifiteP a a
(Street Name, Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: (TK/-i14tjrmet.
Address Yr/ Plea sentht/1 !./),
(Streets Route No.)
/ r&M.I nd S
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED poi -/ -03
5. TOTAL DEPTH: IA
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E -
7. STATIC WATER LEVEL Below Top of Casing: 3 co 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 ith ISA NCAC 2C .0118.
9. YIELD (gpm): ,._ METHOD OF TEST gin
10.WATER ZONES (depth): , S60At /4e/8.??O
I I. DISINFECTION: Type /j'%/jam Amount .707
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To at. Ft. IC AO cqf//
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From /i To �` Ft. ccnc iL "ex,- at
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
From To
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope Okalley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation D scrl ti n
,rove �/ Or fora,
f ' g Arog-lie
lfis %
y,?d/lee
5 a,iegi-
7.t2c to
DEPTH
From To
D - IS"
s-
a13 -fiat0
LOCATION SKETCH
y.
Show direction and distance in miles from at least t
two State Roads or County Roads. Include the road e
numbers and common road names.
tt
>fbt-.s4cok
td-A
came,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•--
SIGNATURE OF PERSON CONSKOCTING 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