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268536
WELL CONSTRUCTION ' : r t RD
North dueling -DominionofEnviramaot andNatonl Raomcea-Dlvidoa etWakrQrdhy-Onadaater Section
w�a exwartecroaptarnamerastras woo rliMtae 4-11 F Kl r . rrl . cranprCATBOtrtr3lL 3
WELL CONTRACTOR COMPANY NAME Fck(t aY1rJ p. o rr-.p 4- c 1JF J / , room a Jn/AgaLi-8E
STATE anC Taucn NIM MTZO 'ABBOCIAT1mwomanla
litseplecble) (ifmalicableT
1. WEILUSE (Cheek Applicable Bo* Reahia6alMiSapal/Pr lic ISMS! Agihmffirai0
Monitoring CI Recovery f] Heat Pomp Water) Woolen 13 Other CI IfOther„ Lift the
2. WELL LOCATION:
Nearest Town: t )ci_14- LA t1 County
LII (C Cnnsocc)c4:or, Clime veI
anxtliare,Meth" Ono* Sodbidoe.IatHa, Zip )
3. OWNR`rrc r4:n Pr111Lc-cue (-
Address LI ((a 5 C r'net n_ a.4:r to n r%mp 9 r I
Min oParts No)
�1nIdP`,Z nCCA 0
Oyer Tam Sate Zip Catle
(2Z4- ?-3clU- ( ,4e(
Ana estrP6msrember
4. DATE MILLED \- a5 C1 3
5. TOTAL DEPTH; cif)
6. DOES WELL REPLACE E)0S'TING WEIL? YES VNO O
7. STATIC WATER LEVEL Below Tep°M acing FT.
(Use '4"ifAbcraTap afesig) -
S. TOP OP CASINO IS. / FT. Above Land Snr&ec*
*Top date tanYadetStar below had sins nais a
waken aunts ISANCAC2C.Nr6
9. YEELD(gpmx JAY METHOD OF TEST A l2
10. WATER ZONES (depth):
TepognideAemd Setting
11111thrt Malley OM
Otteduppvpdsie biz)
Latiltsktiongliride dwell location
Okilmndeitalasank)
Latiedellaagirrdeaor<onfOPSEI opograpNoany
both
ascription
ZEN
From To
0 4(3
vp 26
d o 9 0
11. DISINFECTION: Type ?tie- S
12. CASINO:
From Q To 9D FtD1,11l 1
Depth
Frsn_To Ft
To Ft
Amami .5- ref/4
WalThidmat
a/
itet
Show direc6ao and ditece in tones from at but
two State Roads ("Vainly Roads balm!.Ore mad
numbers and cannon mad mines.
13. GROUT: Method atFrom /1 TTo�.7U Ft, l�yl,Xec� CJC --,
Fromm To FL
14. SCREEN: Depth Diameter Slot Sirs McSal
Rom—___ To__ Ft—io. in.
Front_To Ft____jo in.
15. SAND/GRAVELPACK.:
Depth Size Material
Fro�To Ft. //)
From�To R. t'rC -
c
r.�
cJr
0
CER11FYlHATTHISWEILWAS CDNSTRUCIEDINACCORDANCE WII'ii15ANCAC2C,WELL
ANDARDS, Ic c: A •,a OThB xSX)uu HAS BEN PROVII)WIO THE WELL OWNER
— Attirree�d „ the Dirkin(nder gC4Seeltao,16Mf8eMteCeler.RddtiNC
No. ALM 7333221. within 30 rave. OW-1 RBV. 07/2001

2"i0226
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Res Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtat) u2 I Utv i`-i critTIF1CAnoN i'g 0
WELL coNTKACroacOMrANYnAatt PRICE WELL Da ILLING, INC. Paorma?2i 327 02E3
STATE WELL CONSTRUCTION PERMIT, _„AacOC1ATED WQ PERMIT#
Of applicable) (if%pliable)
r
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 ledushial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N( i IC el 5 Sc n 111
K u�[/t
(Soya Name, Numbers, Commmiry. Subdtbis m. La No., t. Code)
3. OWNER: Tomes /1 ✓e-eoFF
Address 7 6 9 is i9 or sr. Pr�
(Saws ae Roues No.)
(104, v// 5por10 o s Tyr, 6 /a
rV ) 25 vp Cade
Area coda Those mother .
4. DATE DRILLED / —O 5
5. TOTAL DEPTH: '2p0 ,c,t
6. DOES WELL REPLACE EXISTING WELL? YES IAO 0
7. STATIC WATER LEVEL Below Top of Casing:T.
(the -4," itAbove Top deaf
8. TOP OF CASING 1S / 2- FT. Above Land Surface*
'Top of cSag teeadaated ater below land surface require
variance A awrdaa ISA NCAC 2C.01II. -
Q VLrLP (gpm): fY r.LSme° OF msT JrP/Owf1
10. WATER ZONES (depth): S—j f 0 r9
LOCATION SKETCH
11. DISINFECTION: Type n / L 1 ".1 Amount . D/ Show direction and distance in miles from at least
12. CASING: �%r/d Cs Wall Thickness 7 two State Roads or County Roads. Include the road
Depth Diameter or Wdghvlk mashers and con®on road Dames.
Fro1 To. /P') Ft C 6 r/e c-
From_ To Ft
From To Ft _
13. GROUTk Depth Material
From t^1 To a�lJ Ft inYYrP�c
From To Ft.
14. SCREEN: Depth Diameter
From To Ft ice.
From To
15. SAND/GRAVEL PACK:
Depth Size
Frort__To Ft.
Front To Fe.
Topographic/Land setting /
Midge °Slope Malley tHflat
(cheek appropriate box)
Latitudellaaigitude of well location
16. REMARICS:
CtLi
Slot Sim Manorial
in
(aperwmiamabe own)
Latttudellortgitode somee:CIGPS°Topographic map
(cheek tax)
DRILLING LOG
From To F on
Material �..
\\
0 /c °
"7)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT' .)S7ANDA ,AND [AT A PY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWKR
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/-cP C3
DATE
Submit the original to the Division at',later Quality, Groundwater Section, 1634 Man Service Ceaaer - Raleigh, NC
29699-1636 Plume No. [phone], within 30 days. GW-1 REV. 07o001

Mar. 21 2003 05:55PM P5
Paiuj C.
FROM : MORETZ WELL R. PUMP FAX NO. : 7044621322
K/215/205.2 UUNti_ll xKI.Pict
271005,
WILL CONATRUCTION R&CQRP
Nord' Caraaiss • NeuIS S et larnaltin NN. SIM hiss. • ISMS of Wom 57.531, • O..- 4t r SnfloS
_ friar, is. awrincsnone?sage
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runnn W LI. OOIMn1YCT:OM many ANOC' mall
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'S
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3 Will LOCATION:
N...* towo: Ate, Oser t)t tir a
taoaAiYw(Mrs+awaaI.«/N.,WCe //
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1. STATIC WATT& LIP/M. IUow Ta f at Swat 59 }T.
ter a YAW* CS.
I. TOP OF CASINO IS - / PT. AMMLM UAW
otoo dr alas tttmla wS We Weiiimpi aim maim
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12. CASINO, WU Ilea
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two SI..P Lust a Cawty late.. I eW4. dw tad
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S
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ccurra%&'f1ON tuts, rtea TMAT w OOre[.Osstte RSCORD HAS RSIN leova = TO THY WILL OWNtR
Y!
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Swat a►ir erten* a Oe .-.am.a ar Mile gang. Or snows r sass. rata lt.o Snip Car . UW yl., NC
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' ILNi CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME HICKORY WELLTRILIZZ (0. PHONE # Imo) 324-0035
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
271860
1. WELL USE (Check Applicable Box): ResidentialU Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ICARD
3969 .XI-NrN MITT Rn
County BJRKE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PNTX CLINE
Address 3%A JOINS N ERICGE RD..
HTGUW r %ftLY1
City or Town Stale
(828 )- 397-7092
Area code- Phone number
4. DATE DRILLED 01-03-03
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of cuing terminated attor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type HIH TAPS
12. CASING:
Depth Water
From 0 To 83 Ft
From To Ft
From__To Ft.
13. GROUT: Depth Material
From O To 20 Ft GROUT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From______ To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From_ To Ft.
Amount 70
Wall Thicmess
or Weight/FL PLA TIC
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degieethninutestseeonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
c.�
16. REMARKS:
$Qi%IE1iEBY CERTIFY THAT
CONSTRICTION STANDA1p$
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF ii'iii RECORD HAS BEEN PROVIDED TO THE WELL OWNER
01-07-03
Submit the original to the Divisio
27699-1636 Phone No. (919) 733-322
IATURE OF PERSON (INSTRUCTING THE WELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
, 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) 14UNE LC CERTIFICATION it 2343
WELL CONTRACTOR COMPANY NAME HICKORY WTI. TRTTI.TDDE m. PHONE # [phone]-(X)35
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialf Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M)IRFNAIV County BURKE
1633 HENDERSON MIL IDD
3. OWNER:
Address 1b3U ftN1 EICYLIV MILL I R AD
(Street or Route No.)
MAIN, NC 28655
City or Town State Zip Code
(.228-)- A.37-1991
Area code- Phone number
4. DATE DRILLED 01-12-03
5. TOTAL DEPTH: Ka
6. DOES WELL REPLACE EXISTING WELL? YES l (NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface require a
variance Su accordancewith iSA NCAC 2C .atla.
9. YIELD (gpm): 1 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
(Street Nam; Numbers, Community, Subdivision, Lot No., Zip Code)
BURR N BERRY
271858
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Hill TARS Amount 75
l2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft 64' FCC MASTIC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. MIT
Method
FCURED
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.
Frorn_ To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least:=
two State Roads or County Roads. Include road
numbers and common road names.
S
`(e41 � (u
-o
16. REMARKS:
I DO HEREBY CBI2TI1rY Th1A' -1TH
CONSTRUCTION STANDARDS,
LL WAS CONSTRUCTED
A
PY OF THI
CCORDANCE WITH 15A NCAC 2C, WFI I
HAS BEEN PROVIDED TO THE WELL OWNER
01-14-03
OF PERSON CONSTR&TING THE WFI I DATE
Submit the origipal to theD ' ion o Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
76994636 Monello. (910014221, Rhin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
CERTIFICATION# 2343
PHONE # /8281 324-0035
2. WELL LOCATION:
Nearest Town: Valdese County Burke
3957 Conversation Camp Rd.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Russell Bridges
Address 3957 Conversation Camp Rd.
(Street or Route No.)
Valdese NC 28690
271804
illing Co.
City or Town State Zip Code
( 821- 437-5899
Area code- Phone number 03-13-03
4. DATE DRILLED
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LX
7. STATIC WATER LEVEL Below Top of Casing: 76 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
*Top of casing terminated attor below land surface requires a
varianceaccordance
with Is
9. YIELDIELDa
(gpm): METHOD OF TEST BY
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Wayne Long
Hickory Well Dr
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/L.and setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
AIR TEST
HTH TABS
Depth
From 0 To 87
From To
From To
13. GROUT: Depth
From 0 To 20
To Ft.
From
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frotn_ To Ft.
Diameter
Ft 6
r
Ft.
Ft
Material Method
Ft. GROUT POURED
Amount 69
Wall Thickness
or Weight/Ft. Material
PVC PLASTIC
Slot Size Material
in.
in.
16. REMAR•KS:--.
r I DO HEREBY CERTIF1'L'1
CONSTRUCTION STAND
LOCATION SKETCH
Show direction and distance in miles front at least
two State Roads or County Roads. Include e road
numbers and common mad names. w
THIS WELL WAS CONSTRUCIEI
, AND TRW COPY OF t S a 4elart
ACCORDANCE WITH 15ANCAC2C, WELL
RD HAS BEEN PROVIDED TO THE WELL OWNER
04-02-03
SIGNATURE OF PERSON CONSTRUE LING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No..(919) 73' -3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 718 0 3
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE LONG CERTIFICATION #_Z3h.3
WELL COMPANY NAME HICKORY WELL DRILLING CO. PHONE # 8281?24=0D35
ASSOCIATED WQ PERMrr#
STATE WELL CONSTRUCTION PERMTT# (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential a( Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: VALDESE
3950 ABEE VALLEY RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SHAWN ABBE
Address PO BOX 667
(Street or Route No.)
VALDESE, NC 28690
Zip Code
City or Town State
(328 )- 874-2329
Arca code- Phone number
4. DATE DRILLED 03-05-03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WFI T ? YES 0 NO (I X
7. STATIC WATER LEVEL Below sopo Caassing:�ofCa5si0FL
ng)
B. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 75 METHOD OF TEST
10. WATER ZONES (depth):
County Bi1RKF:
11. DISINFECTION: Type HTH TARS Amount
Wall Thickness
or Weight/FL Material
PVC PLASTIC
12. CASING:
Depth Diameter
From 0 To_ -68 FL 6 } "
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. GROUT
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
41
Method
POURED
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
rCRt'Cto
L Submit the original to tb
27699-1636 Phone No: (919
Ft.
Ft.
Size
Material
T THIS WELL WAS CONSTRUCTED
i s. AND TH,AC,IZOF THI
SIGNATURE OF PERSON CONS
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
RY ATR TFST
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includ gte road
numbers and common road names.
S
iltra
f12
i t
r MT g,
CCORDANCE WITH 15A NCAC 2C, WFT r
HAS BEEN PROVIDED TO THE WELL OWNER
CTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001
733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE LONG CERTIFICATION it 2343
WELL CONTRACTOR COMPANY NAME HICKORY WELL DRILLING CO. PHONE /fR%035
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential EK Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: County BURKE
Nearest Town: MORGANTON
138 DOGWOOD RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
KENNETH PENNLEY
3. OWNER: Address 138 DOGWOOD RIDGE
(Street or Route No.)
MORGANTON. NC 28655
City or Town State Zip Code
(828)- 584-2556
Area code- Phone number 4. DATE DRILLED 02-14-03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO II
7. STATIC WATER LEVEL Below Top of Casing: 19 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. BY AIR TEST
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
271801
Topographic/Land setting
Midge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
HTH TABS Amount 81
�rqer Wall Thickness
0 Depth_
75 DrgrgyjorGAL t STEEL
From To FL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. GROUT POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name . o ,
/)rll.r`o
a -: ,1vtLl/
T
0
S
:WO _HEREBY CERTIj if t THIS WELL WAS CONSTRU
CONSTRUCTIONSTAND , AND THAT A COPY OF
tar
��----�
SIGNATURE OF PERSON CON t UCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (91-9) 73:-3221, within 30 days. GW-1 REV. 07/2001
ACCORDANCE WITH 15A NCAC 2C, WELL
ORD HAS BEEN PROVIDED TO THE WELL OWNER
03-18-03

2'71'7 9 5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print), ' i. i CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME fTr(WVf UFIT MIMIC SI C m PHONE # 18 35
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ FERMTT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IX Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ICARD
1861 Q-I.RQLL ST.
County ERRE
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: � � AMR
Address
(Street or Rare No.)
QTNEIIY S€RTnI,S, NC 28612
City or Town State Zip Code
( 828)- 874-5357
Am code- Phone number
4. DATE DRILLED 01-20-()3
5. TOTAL DEPTH: 245 to 445
6. DOES WELL REPLACE EXISTING WELL? YES IM NO 0
7. STATIC WATER LEVEL Below Top of Casing: 75 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of wing terminated at/or below land surface regnirea a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 1 METHOD OF TEST BY AIR IESI
10. WATER ZONES (depth):
11. DISINFECTION: Type KITI '1N S
12. CASING:
Depth Diameter
From To Ft.
From To Ft
From To Ft.
13. GROUT: Depth Material
From To FL
From To Ft.
14. SCREEN: Depth
From_ To
From To
15. SAND/GRAVEL PACK:
Depth
From_ To Ft.
Amount 26
Wall Thickness
or Weight/Ft. Material
Method
Diameter Slot Size
Ft in. in.
FL in. in.
lfi .
x C,s.43(5
ONSTRUCTION STAND
Size
Material
Material
From To Ft.
Topographic/Land setting
❑Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depealminuoa/seconds)
Latitudellongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH -)
Show direction and distance in miles fronfat least'
two State Roads or County Roads. Include ie road
numbers and common mad names.
/V / cdvefvrb.✓ >'T/
y izp,=
oEGOr> c?
caatitk
cask
ca.,„ .ZiO66
Act
tOC p.
5*46)
cog dew/
S
FO
. _ WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
01-30-03
SIGNATURE OF PERSON CONSTlj fil\G THE WELL DATE
3
1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919)J#33-32.1, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #2343-
WELL CONTRACTOR (L'1DIVmUAL)NAME (print) WAYNE Imo' PHONE # B R-0(135_
WELL CONTRACTOR COMPANY NAME l-TI(K(IY WFTT. FRTTTTN; M.
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residentialf Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
1.
2. WELL LOCATION:
Nearest Town: � County BRKE
(Sweet Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FfMF. R, WART. MTRE
Address 12(6 CARTTTT CITY RD.
(Street« Route No.) 245
,NC
City or Town State Ttp Code
(82R )- 5R4-4927
Area code- Phone number
4. DATE DRILLED OI-20-03
5. TOTAL DEPTH: 3055
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO ZN
7. STATIC WATER LEVEL Below Top of Casing: `n FT.
(Use"✓' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated at/or below land surface require a
variance In accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type RIIH'
12. CASING:
Depth greet
From To 76 Ft
From_ To FL
From To FL
13. GROUT: Depth Material
Frotn____Q—To 20 FL (RITE
From To Ft
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To FL in. in.
15. SAND/GRAVEL PACK:Depth Size Material
From To Ft
From _To
Amount 54
Wall Thickness
or Weight/Ft. Material
WC
PLASTIC
Topographic/Land setting
❑Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH 11RiT r rNG LOG
From To Formation Description
Method
_FCURED
Material
167ii
EMSi .—.
YGERTIFY INA,
CONSTRUCTION STANDARD
Ft.
WELL WAS CONSTRU
THAT A COPY OF
Are-
S
TORE OF PERSON CONSFRGCTING THE WELL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. IncludeAle C road
numbers and common road names.
0
1" 5
ACCORDANCE WITH 15A NCAC 2C, WELL
RD HAS BEEN PROVIDED TO THE WELL OWNER
01-33-03
DATE
Submit the original to the Divisi n of Water Quality, Groundwater Section, 1636 Mail Service CGWrl R- REVgh, C01
-27699-1636Phone No. (919)733- 1, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACtOR (INDIVIDUAL) NAME (print) y%7At / 33ixil GCERTIFICATION #.;2IJ<%
WELL CONTI2:\ C'FOR COMPANY NAME PHONE # ( )
271737
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:..I
Nearest -town: /I /6i fit C N
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
g0)1K
I
Count\ eiViEEK
3. OWNER: 1,
Address
Gcaz
5670 NC /2c">
(Street or Route No.)
j11e r /1/6 „2 eX•/
City or Town State Zip Code
Pia): .5 4l- i037
Area code- Phone number
4. DATE DRILLED S--B-c 3
5. TOTAL DEPTH: y05.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FAY
7. STATIC WATER LEVEL Below Top of Casing: I/O FT.
(Use "c" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): .� METHOD OFTESTJ9itt
10. WATER ZONES (depth): 37,0+» @ 2J{-))
11
12
t
DISINFECTION: Typeder:n[[.ac-L Amount 2202.&7.91:
CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From To 6 S Ft. 6Yr' 4/6From (v.S To Lai Ft. (JYg l e%i
13. GROUT: Depth Material
From To _ Ft.
From C To Z 2 Ft.
14. SCREEN: Depth Diamr Slot Size M serial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
VC
( ,4L 1./
Method
From
From
Depth
To Ft.
To Ft.
re/
Size Material
16. REMARKS:
d q)H:REIY' CERTIFY THA'1TtI
ObdSTRUC Bows STANDARD A
UL
Topographic/Land setting
DRidge ❑Slope ❑Valley H41at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O — C.4*E5fNJ
!u2 - `%Dr
41/` .7.9; -&-a.
LOCATION SKETCH
Show direction and distance in miles from a .ast c
two State Roads or County Roads. Include tharoadr
numbers and common road names.
-0
567
-o \ l0
l�N.
S WELL WAS CONSTRUCTED IN AOIC�i.TH-15A NCAC 2C, WELL
\IDDffHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE f,CF PE
SON CONSTRUCTING THE WELL
DATE
Skbmit the original to the",ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27099-1636 Phone No.((9.19)733-32: I, Within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
272345
WELL CONTRACTOR: Dewey Wright. Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2878
030100 STATE WELL CONSTRUCTION PERMITW Steve Prate
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
II
Municipal
Other
Industrial Agricultural P1 Monitoring P1
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I FNCNP County: PI lO«F
PA:K Hil L F) fFF OFF HARTI AND RE) OFF HWY 18 OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER MA(IRICP C REACH
Address 122.0 PAX HI I Rn
(Sttret or Route No.)
MORG,AN I UN Ni : 7R6a5
City or Town State Zip Code
4. DATE DRILLED 3117/?002,
5. TOTAL DEPTH 16F.
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES FI NO
8. STATIC WATER LEVEL Below Top of Casing- 40 FT.
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 4 METHOD OF TEST
11. WATER ZONES (depth)''' gpm85-86 porn 110-111
1 ppm 130-131 2 ppm 155-156
Amount 26
I A
Air
fxl
DRILLING LOG
From
To
Oil
DEPTH
Formation Description
f(❑T
P4 Pfi GRAI`JI T P
PR Q.P. GR„AAIITC
86 110 GRANITE
110 111 QUARTZ
111 130 GRANITE
130 131 QUARTZ
131 155 GRANITE
155 156 QUART-)
156 165 GRANT
=r7
12. CHLORINATION: Type HTFI
13. CASING:
Depth Diameter
From 0 To 100 Ft 5 1/8
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN
From
From
From
Material
n5n PVr
Depth Diameter Slot Size
To Ft in in.
To Ft in in t
To Ft in in '/1
Method
Gravity: Pio-a
CD
If additional space is needed use (Sack of#grm
Ce)
LOCATION SKETCH= —
jShow direction and distance from at'fast t 9 State
\� Roads or other snag
erence points)
16. SAND/GRAVEL PACK:
Depth
To Ft
To Ft
From
From
Size Material
17. REMARK+
I DO HEREI
CONSTRU
[i Ii`;/I
iIC TIFY H � THIS 1/4E1 t
STANDARDS, AND THA
FOR OFFIC
Quad No:
Serial No.
ONtt
['CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�52—
*2-ci3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
R,u-mit original to Division of Water Quality, Groundwater Section within 30 days
SROUNOWNf A SECTION
ASHEVILLE REGIONAL OFFICE
DATE
GW-1 REV. 12/99
Loos

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -2 72 3-2, 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone];rryl,'4,5)r1,
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2887
030048 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery
Municipal E Industrial El Agricultural n Monitoring
Heat Pump Water Injection El Other If Other, List Use:
I xi
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County: BURKE
JOE B0WIvA4N RD. OFF HVVY 183 WEST OFF HWY 181
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JAMES D. LLOYD
Address 2300 EAST PROVIDENCE DR.
CHARLoin°`°`R°°t°N°) NC 28270
City or Town state
ZIP Code
DRILLING LOG DEPTH
From To Formation Description
0 85 DIRT
85 170 GRANITE
170 173 QUARTZ
4. DATE DRILLED 2/26/2003 173 200 GRANITE
5. TOTAL DEPTH 200
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
I)1
S. 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): 5 METHOD OF TEST Air
11. WATER ZONES (depth):5 ppm 170-173 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 28 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To a2 Ft. 8 1/4 . 88 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
From To Ft.
From To Ft
Material
17. REM
I DO
CON
FOR O =
Quad N
Serial No
GECiU'"Pl.. VATER S_CTION
ASF,C';ILLE RF..CIOU'tL OFFICE
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

274082
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CONLEY SPRINGS County BURKE
FARAWAY DRIVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WILLIAM BENSLER
Address FARAWAY DRIVE
(Street or Route No.)
CONLEY SPRINGS NC 28612
City or Town State Zip Code
(828) - 437-4894
Area Code Phone number
4. DATE DRILLED 05/28/03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 13.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SD1L21 PVC
From To Ft.
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. in.
From _ To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
['Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
GO UP 10 FROM CASAR. LEFT ON WARDS GAP
RD. LEFT AT SHARP TURN ON WARDS GAP RD.
(TOWARD SOUTH MTN. PARK) TURN LEFT INTO
PINE MTN. ESTATES ON PINE MTN. RD. GO
APPROX. 1 MILE. TURN LEFT ON FARJWAY DR.
1/10 MILE ON RIGHT. w C
c— `-,-
i
LO
-a
Co
for)
16. REMARKS:
rrn..1-DO-HEREBY-EERFIE
fl'F 2NSTRUCT1ON,5T[�""
M. THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
u- S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�*PP iv9 >a
TURE OF PERS N CONSTRUCTING THE WELL
6. "S
DATE
Sbrbmitm�S
.the.ori' o_thd Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t _
27G0436 Pk6de-$ t+9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
275598
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/ ✓-55- C/
WELL CONTIi.-AC'1'OR(INDIVIDUAL) NAME (print) / G,VA/e'f/1 d �p/_, CERTIFICATION # /
WELL CONTRACTOR COMPANY NAME !J/'C/?ft-de tacit^t III PHONE # ( )
STATE \WELT. CONSTRUCTION PERMIT# ASSOCIATED WI) PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential L9-aMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ If Other, List Use 9t i✓G/e
Other ❑
2. WELL LOCATION:
Nearest Town: 41.0r//��: /f¢ , //6 County 14# �e
G'(, i;,d✓.If.NoQcjoo 7ik)Vc.
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ca.: seson.;:
Address SAS I $ & do cJ rbX
(Street or Route No.)
Ker/JSJ Ile Nro-• e7nAPI
City or Taun State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 7-'/-03
5. TOTAL DEPTH: 3ar
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f[a'
7. STATIC WATER LEVEL Below Top of Casing: LaO 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_.4 r+
10. WATER ZONES (depth): /r0 *f.
I I. DISINFECTION: Type
12. CASING:
/F7'4- Amount in
Depth
From `/ To >7 D Ft.
Front To Ft.
From To Ft.
13. GROUT: Depth
From 6 To 4L0 Ft.
Front To Ft.
Wall Thickness
Diameter or Weight/Ft. laterial
5 6 if? i 12'e-
Material
14. SCREEN: Depth Diameter
Front To I t. in.
Front To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16_REMARKS' _--
! pa -Ttt i T
['4NSTRUCTION STANDARE`�
,t
t
Method
foci me
Slot Size Material
in.
in.
Material
Topographic/Land setting
L}ldge ❑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
7J— /v9L
/Po -/a?
[23 3aa
Formation Description
Per/ bre red 1-
%!/cw-v > t'l F /,�>
ecvurr
Ind"; �
C)
L
r
r—
LOCATION SKETCH �'"
0
Show direction and distance in miles from at least
two State Roads or County Roads. Include thelad C.'
numbers and common road names. IV en
T
0 Aet,/s,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY O THIS RE,OR HAS B'N PROVIDED TO THE WELL OWNER
'ATURE OF PERSON CONSTRUCTING THE WELL DATE
SIG
Submit :tint om inallq t,)},elpivisio of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
276046-1g ahuueeitoc 0-147i3=T'221, within 30 days. GW-1 REV. 07/2001

275342
WELL CONSTRUCTION RECORD
Nwt(Swollen -D effEstakeetagait sad Natural 3 oma- Midas of Water hut.- Gooandwater &Won
wgt.annukcmapternnstwaraz@somraeFKtt►rug commestrAN8L4.3.
WELL CON18ACCIACOMPANY NAME t tt4t t A.nri pt i " l " 4- c OF J I . MONS a dritsie ti-8�
STATE WELLOD1W'r6VCTIONFlea0D1'a . ABSOC1A1m WO MOWN
(ifapplicable) Cafapplicable)
1. Mlle USES `C Applicable Boy Residential e( Idttaicipaldeoblio0 Iodosttlell 0 Apiadonal
Monitor*0 Recovery 0 Hest Pomp Water lagestion0 edger 0lfOtheratUse
2. WELL LOCATION: ,/
NearestTown: 14 1 r .icnnrt Cq�mty L' c rK
—rqI cespv i4fry nal(
(SS Camp,S vitio;tattio,ZOCodb)
3. OWNER: •t n: c.hp.rt \ -c t I nr, r h-4-
Addless `14 I. C'rt„Tht t-\iC t?rl
41;c._icnrt' rtC Fa? lo01
CityarTeil Skate
- n zrpcade
Anscada-Phaaemmber
4. DATBDRILLED l- n3
5. TOTALDt�TH: f _—
Topostaplia/Land setting
Midge 0Slope Malley Mat
lodindeRoggitidei 1 motion
neaeaa)
Ladaddloogitude sootac0QP80Tapegfaphro mai
From To
n o
9r
�.-- 7(r.;
6. DOES WELL REPLACE 1013ST1NO WELL? YES 0 NO Er
7. STATIC WAIT/ROWEL Below Tap iPCaslog -:A FT.
(UierifAbove Tap otter
8. TOP OFCASINO 18 FT. Above Land Surface•
*rap ofcuing ta WstetaaleradawLaneaastter flank=e
whine 6 aawadaaw wei 115A NCAC 2CA101.
9. MILD ( ); IS" METHOD OF TNT T11Z
10. WATI112. 0Na (depth): ? c/ (�
»RLLLINCLOG
FommtionD on
'>n-s s PC on
S - i -P Rc lkt
P-le-Ck dtj\ l-e
11. Type Amami Show dimotion and diepmxiinWks Matt least
Wan'imdoteae two Rate Roads orCoady Ronda. includethe rood
manager arW ets% Agawam wmabe sand emanate toadeameas
cr
ca
12. CASINO:
Depth
Froml _To
From__ To Ft
Pcan{_To Ft.
13. (ROUT: Depth Normal McBmd
Ft »Je��
Front_To Ft
14. Sat1iBN: Depa Dieter 8lot&7e Mdedol
From To Ft it is
From_____ To in.
15. SAND/GRAVEPACK:
DtFAt Size Metedal
Pmm_ To Ft-
Twont To Ft
16. REMARKS.
1 1
I DO EMMYCERTIFYTHATT WWEILWASWNSIBIIC®D1$
CONSTRUCTION NSTANDARDl9„ ANDTErATACOPTOFTHSRECOMINASBB@e
gr
iNj1$13A.NcAc
MONAT MEOFPERSON WISSYRt!C1UWTIM WELL
Sabarttiieodgloalto*kRidden ofWater Qu Sty,Gram
nentaniostwo.81191933•,H21.wl1in30dose.
EIMITATIMENRINniettenter
c�v1r-
Raleith,NC
REV. 07/2001

North Carolina - Department of Environmint and Natural Resources - Division of Water Quality- Groundwater Section 2 7 j 2 9 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: 2522
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Residential x Municipal Industrial
Recovery Heat Pump Water Injection Other If other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Glen Alpine County:
138 River Breeze Road
Burke
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Statesville Housing Center
Address 115 Moorehead Road
(Street or House No.)
Statesville NC 28677
City or Town State Zip Code
4. DATE DRILLED 0414/03
5. TOTAL DEPTH 185ft.
6. CUTTINGS COLLECTED YES NO X
7. DOES WELL REPLACE EXISTING WELL? YES NO X
8. STATIC WATER LEVEL Below top of Casing: 20 FT.
9. Top of Casing is 1 Ft. Above Land Surface*
(Use "+" If Above Top of Casing)
"Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5A NCAC 2C_0I18
10. YIELD (gpm): 10 METHOD OF TEST air
11. WATER ZONES (depth): 100, 128
12. CHLORINATION: Type Amount
13. CASING:
Wall thickness
Depth Diameter or Weight/Ft
From 0 To 81 Ft. 6.25 sch 80
From_0_ To_ _ Ft. sch
From To Ft.
14. GROUT:
Depth
From 0 To 20
From To
Material
Ft. bentonite
Ft.
Material
PVC
Agricultural
Monitoring
DRILLING LOG
To
0 ft. 80 ft
80ft. -185 ft.
DEPTH
Formation Description
sand & Rock
rock
C
C—
C
If additional space is needed use back of fafir'
Method
pump
15. SCREEN:
Depth Diameter
From To Ft. in
From To Ft.
From To Ft.
Slot Size Material
in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. Remarks:
4-
Z( 4v fl&4
I DO HERBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO ANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD EEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY c---_ �a
Quad No: SIGNATURE OF PE ON CONSTR CTtI�GTHE }YELL_ _.. DATE
Serial No: Submit original to Division of Water Quality, Grnno.lwdro. 0,.n....within :n daysr_vvIire 12/99
hci

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section t-t n n C
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] r a �j O
Dewey Wright Well Pump Co., Inc.
2081
030207 STATE WELL CONSTRUCTION PERMIT#: Steee Petry
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLA
HWY 181 OFF HWY 105 & 221
Municipal Industrial ❑ Agricultural Monitoring
Other If Other, List Use.
County.
BURKE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ALEX SMITH
Address 3586 SIMPSON CREEK AVE. ,
NAUKoAANJstx.3Wior Route No.) NC 28655
DRILLING LOG DEPTH
From To Formation Description
0 15 DIRT SAND
15 40 GRANITE
State
5/8/2003
125
X
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO I '1
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 1 o FT
(Use "+" if Above Top of Casing)
Zip code
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.011,00
10. YIELD (gpm): ETH 9 QFn I T
'11. WATER ZONES (depth)',. c1piY1
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:
40 42
SHALE
4L 110
110 112
GRANI Tt
SHALE
112 120
OKAVI I t
c
Air
nprn ;10-1 .t2
U ppm
12. CHLORINATION: Type Amount �s
13. CASING:
HTH
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To `1 Ft. 6 1/4 .1e G.�'.:..'.
From To Ft
From To Ft
14. GROUT:
Depth Material
�^ Cement
From To Ft
From To Ft
15. SCREEN
Metho
Gra4ty
Lc;
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: r'—•\ r;.
I DO HEREBY CERiI V THAT THIS WELL WAS CON
CONSTRUCTIQN-gmANDARDS, AND THAT A OP?
&&SLY
FOR OFFICE US
Quad No:
CO
N v'
If additional space is needed use back QJorrn2
ua o
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference porgits)
�v�
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
G�`�VI'ATURE OF PERSON CONSTRUCTING T;�� DATE
SAHA ginal fotivision of Water Quality, Groundwater Section within 30 days
1ftnap`°'
6 70 -S?
GW-1 REV. 12/99
Serial No.
OUtei.
pp'=n,li' f
o•2ArER SECTION
REGiOr AL 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]
274850
WELL CONSTRUCTION RECORD
03095E
WELL CONTRACTOR:
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION St.[68a
Leslie Reece
STATE WELL CONSTRUCTION PERMIT#•
1. WELL USE (Check Applicable Boxl: Residential
Municipal
Recovery I I Heat Pump Water Injection I I Other
I
Industrial I I Agricultural fl Monitoring El
If Other, List Use.
2, WELL LOCATION: (Show h of the location below)
LENOIR gJP.KE
Nearest Town: County: OFF HILL RD. OFF HARILAND RD OFF H`rvY 18 OFF N.
(Road Name and Numbers, Community, or Subdivision and Lot No.l
DRILLING LOG DEPTH
3. OWNER WARREN .BEACH From To Formation Description
Address 4229 FAY: HILL RD. , 0 165 DIRT SAND
MORGAN ett.ior Route No.) Ric 28655 165 261 GRAVITE
City or Town State Zip Code 261 262 QUARTZ
4. DATE DRILLED
5. TOTAL DEPTH 32
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
S. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011c Air
(gpm): YIELD ( m): METHOD 8 n rqp.
I npm, n
11. WATER ZONES (depth)'L ANNi L, ytu:r.
L62 325 lircANi II E
0 a
t
C
v r-i,-
�.
r "'
12. CHLORINATION: Type �H Amount JG If additional space is needed use back oIrm -o
W
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From To Ft (1„ni`� 3Z-1
From To Ft V''
13. CASING: Wall Thickness
Depth Diameter or Weioht/Ft. Material
q 7•1 P itn 'D OW,
From 0 To "Ft--
3/17/2003•
I
14. GROUT:
Depth 2f Cement
YMaterial CMet:hodravity _
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 Size Material
From To Ft
From To Ft
IT=S-
17. REMARKS
I DO HEREBY CyRbillrNIN\TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A p iY �F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
C
\A rttanA (2j,
�3oof+—'V
FOR OFFICE USEf OPtY
Quad No:
— w y
SIGN
Submit ogginal t(
r
Reexaroe
w , .fx< E l/-0 3
ATURE ERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

274574
2. WELL LOCATION:
Nearest Town: GT EN ALPINE County BURKE
CONLEY BUMGARNER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MANUEL' & ROSA GUZMAN (degrees/minutes/seconds)
Address , TRENE WATKTNS 168 CT.FI) DRTVE Latitude/longitude source: ❑�
MARION, NC 28752 GPSD oPograPhic map
(Street or RouteDEPTH_ DRILLING LOG
From To Formation Description
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE. T nNG
HICKORY WELL DRILLING CO.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
CERTIFICATION IS2 34'1i
PHONE # (82`i 324-0035
1. WELL USE (Check Applicable Box): Residentialfl Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
City or Town State Zip Code
(- 738-0924
Area code- Phone number
4. DATE DRILLED 05-15-03
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Xi
7. STATIC WATER LEVEL Below Top of Casing: 70 Fr.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Hill TABS
12. CASING:
Depth ter
Frott( 0 To 109 Ft. 6 §F e
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. GROUT
From To Ft.
Amount 75
Wall Thickness
or Weight/Ft. Material
PVC PLASTIC
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Size Material
Depth
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in.
in.
16. REMARKS:
ff
1-1 'TDO-HEREBM CERTIFY
CONSTRUC. ClON St
lj L,
C
CA)
Et
N c
LOCATION SKETCH - me
Show direction and distance in miles from east m
two State Roads or County Roads. Include 1112 roa` �'
numbers and common road names. r t
W
N
S
y ,iJ?R n$rhe DI
5:-27699t3636TNont 404 (9 9) 73'
THIS WELL WAS CONSTRUCIE)
, AND THAT_A COPY OF IS 411
Vi
ACCORDANCE WITH I5A NCAC 2C, WFI
RD HAS BEEN PROVIDED TO THE WELL OWNER
05-21-03
SIGNATURE OF PERSON CONs1 l?CTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION: BURKE
Nearest Town: HILDEBRAN County
4143 WHITENER RD.
(Steel Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: WAL1ER GANTT
Address 4143 WHITENER RD.
(Street or Route No.)
HICKORY, NC. 2RFiO7
City or Towa State Zip Code
(828 - 397-2286
Area code- Phone number 05-15-03
4. DATE DRILLED 05S
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7. STATIC WATER LEVEL Below Top of Casing: 200 Fr.
2 (Use N." 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 vdth ISA NCAC 2C .0118. BY AIR LEST9. YIELD (gpm): • L METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type HTH TABS Amount 85
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 _To 68 Ft. Fitt PVC PT ASTTC
From To Ft.
From To Ft
13. GROUT: Depth Material
From 0 To 20 Ft. GROUT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
274572
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater 'eSection
N # 7 4 3
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE TANG �28 7 'IA
35
HICKORY WELL DRILLING CO. PHONE # )
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential c4 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
[Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
Method
POURED
Slot Size Material
in.
in.
Material
C
C
.... �.
s
N.) "-
LOCATION SKETCH ya m�
Show direction and distance in miles from at32ast 2.'
two State Roads or County Roads. Include tFroat
numbers and common road names. .r _ �
� G
z
N
IT THAT THIS WELL WAS CONN
ANDARDS, AND THAT A
..UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
05-20-03
SIGNATURE OF PERSOITCZ3NSTRUCTING THE WELL DATE
iU
Submit the o4ginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
G R 0l1 fJ O SN:7i'C6T$10,i¢-yhooe Na [phone], within 30 days.
GW-1 REV. 07/2001
ASHEVIiJ_E REGIONAL OEEIrr

North Carolina -Department of Environment and Natural ROa011
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
��rtFlT !'RTIITN
WELL CONTRACTOR COMPANY NAMEASSOCIATED WQ PERMIT#`"—�---
STATE WELL CONSTRUCTION PERMIT# ifa,.licable
ifaylicable _ - 1. Agricultural 13
R d tion) Municipal/Public ❑ Industrial 0 Agn
272610
WELL CONSTRUCTION RECORD
es - Division of Water Quality - Groundwater Section
CERTIFICATION # 2343
PHONE # �2-�5'
WELL USE (Check Applicable Box): esien t
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest646 To LEE
FILER ST.
(sneer Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
RULER
cv
(Street or Route No.)
Area a code- Phone phone number,/
nber / nn 3
4. DATE DRILLED (4- — ----
5. TOTAL DEPTH:_
6. DOES WELL REPLACE EXISTING WELL? YES& NO 0
7. STATIC WATER LEVEL Below Top of Aasingopot '
2 8. TOP OF CASING I FT. Above Land Surfaces
_____--
*Top of casing terminated
ed at/or below land surface requires a ��
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST B AIR
10. WATER ZONES (depth):
11. DISINFECTION: Type EH TABS
12. CASING:
County BURKE
Zip Code
From
From
From
13. GROUT:
From 0
From_____
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
To Ft..
To
From.
From
Depth
To 75 Ft..
To Ft_.
To Ft.
Depth
To p
To___
Depth
To
To___.
Amount 68
Wall Thickness
or eight/Ft.
Material
Ft. GROII
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
Size
Method
POURED
Slot Size
in.
in.
Material
Material
AND THAT &COPY OF THIS -- 0j-01�
G
IGNATURE OF PERSON CONSTRU .' , T I WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mall Service Ceen`tterl RHVgh, C01
221, within 30 days. G.
Topographic/Land setting
[Midge ❑Slope ❑Va a ❑Flat
(check appmP e
Latitudeflongitude of well location
(degrees/minutes/seconds) 8 hic map
Latitude/longitude source:0GPS0Topogr p
(check box)
T ID 4 TT TN(', OG
DEPT
From To Formation Description
CH at o
Show direction and distancemites
s from
de atlat
two State Roads or County Roads.
the road
numbers and common road names.
C�A90/T.�AN/F.�
U)
r
;N9.
AP AUL), 6
FUP' )Zp,
IS WELL WAS CONSTRUCTED IN ACE WITH 15A NCAC 2C, WELL
AS BEEN PROVIDED TO THE WELL OWNER

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION tkos�
WELL CONTRACTOR COMPANY NAME 74,LJ@-N I)ii . iJelt_N\ PHONE # t`alS) 733-E—e.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
2'72a26
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1400 F,Jx2PSdhix)
2. WELL LOCATION: �V elf)
Nearest Town: C ni ij4' County :'�cE-.J
j7 5j lJ� lfw1/4l�Cp
(Street Name, Numbers, Community, Suhdi ision, Lot No., Zip Code)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other P1 If Other, List Use es£+Z`/ucL___
Topograc/Land setting
ORidge MSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:21•t;Q 'FNA C',gy.m, a,n Cl kC
Address h,5�j-( WC,rv-.7 a�D
(Street or Route No.) /
Ptbo iv -- vc74. Ni
City or Town State Zip Code
( �) 5(4 - i7y-7, 8t-i •- 3a97
Area code- Phone number
4. DATE DRILLED .3-/e) -c 3
5. TOTAL DEPTH: .260
6. DOES WELL REPLACE EXI TING WELL? YES 0 NO l�
7. STATIC WATER LEVEL Below Top of Casing: /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 ith ISA NCAC 2C .01(8.
9. YIELD (gpm): METHOD OF TESTA,
10. WATER ZONES (depth): t& / ICo �� -•
I I. DISINFECTION: Type (2.1 fa+2,NC. -- Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From CS To 16 Ft. Geri ./n.
From To Ft.
From To Ft.
13. GROUT: Depth. �/
From 0To /e Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Material Method
(Lf� "'k
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
Ft.
Ft.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Form Lion Description
o -30d „
DEPTH
/6c7 goo
ROOO-- ACCO
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
S
San
I
C
0
C,
om
cr,
ern
Q6
>o
—1
rn
am
rnx
m�
n
O
rO HEREBY CERTIFY TF a(T TF
NSTRUCTION ST DAtDE,F
S
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Grr , „ �, r r /3
b-M t the, otiginal to the`Divis on 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 Natut�l esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C. Ad 73RASWcLL �13YS)
n CERTIFICATU �
19 r4Jrt/O// JVe /% //r: Moos PHONE # ( )
%YELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential E+J..Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use P n . ✓O f -e
2. WELL LOCATION:
Nearest Town: />> o,ve.//q County
(LANwrScP.
(Street Name, biumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tOorYif/� ("////(z/hf'
Address i5rf5 I<, o10i
{"R(Street or AN -iron to Na.)!Y
City or Town State Zip Code
( )-
Q.
Area code- Phone number t
4. DATE DRILLED —&/ 6_g
5. TOTAL DEPTH: f %
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1-
7. STATIC WATER LEVEL Below Top of Casing: /i` elligit FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance3ith ISA NCAC 2C .0118.
9. YIELD (gpm): li METHOD OF TEST /ii r
10. WATER ZONES (depth): / p - / p,9 ;2 y a t
3-j0 E—,5"/j 6 ,2':/
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ' / To /aa FL 6 4-
S' ;4/".,C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .28 Ft. G.rrs, /.
�tr., wr�
From To Ft.
14. SCREEN: Depth Diameter Slot
From To rc
Ft. in. in. nip:.
From To Ft. in. in. '
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
V t.
cf'`rs
Topographic/Landsetting
C9'�idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
/slotr vl.✓cileno' i•vie
.YA/ /
K 'Itr.k.
r a. ✓) ee
DEPTH
From To
b'- / / V
iia-/9v
/go -/93
a; •5"a
sere?—.37I
o
/i f- sy
c
o
LOCATION SKETCH L �'---
Show direction and distance in miles fropat le3f8t,
two State Roads or County Roads. Includelhe { :
numbers and common road names. O -
fV
0
c
x
16. REMARKS
Size Material
d
277025
1 DO HEREBY GERTIE` 14i AT THI WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
r�l CONSTRUCTIONSCO,DS THAT A COF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�f
1 ! SIGNATURE OF • RSON CONSTRUCTING THE WELL DATE
Submit the Qriginafto the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
72776994636 Ph ine Wli ,(r419) 7 3-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTIt.ACI Ott (INDIAIDIIAI.) NAME (print) ICY SCVoirA c-.{J CERTIFICATION p, 2_9pq'jjj
\\LI.L(-IIN-I lt.\C!OIt CO\tl'SNa N.\Nt '—.Y-`_S-. r'Y.'�-- k Di�_I�. r-e d l..'^'"� S __ _PRONE s f y)�4"6/.Ju
t \ I F. \\ EI.t. CONSfIC CTION I'tat\IITu 1v/ to AssoCI A 1TR \\Q I'EItMI 1p IY A
(if applic )-del (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipalll'ublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL. LOCATION: pp
Nearest Town: Mor rsr\C v. County ptnr
IN{ c Nw 16� rl )•
IS!mc; Nonce, N^.m;bo(s, -L-Commmn-l-llv.. SS•ubdrc awn, Lot No- Zip Code)
3. OWNER: 3gyrrr S t,,.‘n\o�w {'
Address 111 { 1 YP �1PNL P�.-+
++JJ Y, Sired or Route No.) - vvv2A617-2-
City or Tow() Stain Zip Codc
(tS)- 294-1-370
Area code- Phone number
4. DATE DRILLED 7/I)/03
5. TOTAL DEPTH: IS9'
6. DOES WELL REPLACE EXISTING WELL? YES EftNO❑
7. STATIC WATER LEVEL. Below Top of Casing: _ET.
(Use,..., it -Above Top °(Casing)
S. 'FOP OF CASINO IS
"fop of casing terminated at/or below land surface requires a
yarivtce in accordance tsith ISA SCAC 2C .0118.
9. YIELD (gpin): SC) METHOD OFT EST i1Ne).
It). WA ill( ZONES (depth): 'lb' -1-� I00'
I I. DISINFECTION: Typey-a,w t,.-no-- _ Alltount j Cht
12. CASING: Grc.r44111* Wall Thickness
Depth Diameter or Weight Ft. Material
From -3' To i rL G =4 P29 G`a";'
From To
)4
Ff. Above Land Surface*
Ft.
13. ( IB)U I . Depth Material MI iht d
c
0..__ LL Son:/Cc trv� % <.c N<:,t�
17a n, -2.V To -
Front To
Prom To FL
14. NCI:ILEN: Depth Diameter
Front
Tn Et. _.
From To_ Ju.
IS. SANDGRI SEE PACK:
Depth Size
From_ _ Io__. I't.
Front A. To rt.
16. ItENIARKS:
Slot Size Material
N n N
\ in
t?latcrial
276869
TopographidLand setting
❑P.iclue M'slope ❑Valley ❑Flat
(check opi boy)
Latitude/longitude of well location
Ij3S <JOa?OQ 33-TS3
( degreesm in a tes'sccon dsl
Latitudellongitude source:❑GPS❑Topographic map
(check host
DRILLING LOG
r�Formation Description
Brown CIe'A
1. -d t3lnck R0 K
qbw n r 1,3%A:1c-9cas
CTYcN`t %VA i
k- <Tvtr e -
DEPTH
In —Si
et D
?S'— 7ci'
79' -1Tn
►1o'
CD —
CAD
LOCATION SKETCH L
Show direction and distance in miles front at leET
two State Roads or County Roads. Include the
numbers and common road names.
O
51.c/1u1 �b
7
I DO III:RI(BY (. FR] WY I I IA 11111S VA HA, WAS C(1)ty'S`i I' (UC 7 I) IN ACCe-ROIA-1•ZnerrIllif I 5A NCAC 2C WELL
CONSI RUC I I STANDARDS. AND THAT A COPY LIF (GIws R C01w HAS BEEN, POVIIJED TO'HIE WELL L OWNER
17 % ! 5S /o'3
� DATE
Submit the original to the Division of Water QI alit\, �G.r(wndwaler Section, 16{t6 Ma
27699-16,16 Phone No. [phone], within 31) tl, vs.
SIGNATURE OF PI IfA($yCONS'IRUCTING THE AVE�.Ig�l ;
I Service Center - Raleigh, NC
GW-I REV.0712001

276458
3 OWNER
Address I r1(�G,
Nor.h Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh. NC. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELLCONTRACTOR' I S Vvel''III brf ( j
•
WELL CONTRACTOR CERTIFICATION #: ,3(7`t-0
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ElAgricultural Monitoring ❑
Recovery n Heat Pump Water Injection in Other ❑ If Other, List Use:
2. WELL LOCATION: (Show /sketc of the location below)
1 I li
Nearest Town: r to inN County
A(.1_4 Y E
c)\A \a,_.sym. v9) v�nu,mt v1 (cnu !,-v
d- (Road Name aaNumb s. Counity, brr Subdivision and Lot No.) f DRILLING LOG
e
O
or autdN
tree: for out t 1
City or Tb4+n State
DATE DRILLED 1•`U
TOTAL DEPTH 0
b. CUTTINGS COLLECTED YES I NO
Ei.
DOES WELL REPLACE EXISTING WELL? YES
STATIC WATER LEVEL Below Top of Casing:
Zip Code
q
From To
DEPTH
Fonnat,on Descnptiu,
NOD
FT.
l ( (Use'' if Above Top of Casing)
g. TOP OF CASING IS I9+
- FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
t0 YIELD (gpm): L METHOD OF TEST
", , .: r;l _R ZONES ;depth): (T
. CHLORINATION: Type hi �'` Amount .y h -
,3. CASING.
11 Depth
Front.' To
From To
From To
14. GROUT:
6
Diameter
Ft Dial;
Ft.
Ft
Walt Thickness
or WeighiFt. }talery'.I
Depth Material Method
From To Ft
From To Ft
15. SCREEN
v
C,)
L
iss
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in
From To Ftin. in.
16. SAND/GRAVEL PACK:
Depth Size Material
Frorn To Ft
From To Ft.
17. REMARKS:
F
C
If additional space is needed use back of to Cc
LOCATION SKETCH O �'
(Show direction and distance from at least two 9fe c,
Roads, or other map reference points)
O
W
N
OI I HEREBY CERTIFY THAT THI$
L;ONSIE(UGI LST.ANCAa9S-AtUq
pFFICE USE ONLY
4➢d M9
enal NrL_
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A O9PY OF THIS RECOD HABEEN PROVID D TO THE WELL OWNER.
SIGNATUF#E OF PERSON CONSTRUCTING THE WELL
bmil original to Division of water (duality. Groundwater Section within 30 days
DATE
Owl REV. 12/99
t

276365
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ini VNE IOC CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME HICKEY WELL MIME CD' PHONE # j328) 324-0335
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable (if applicable
I. WELL USE (Check Applicable Box): Residential EX Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
BU
Nearest Town: HKICEY County - -
7RX) PIWF. CCINW Pill
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CAVID AR4IFR
Address FO PIE M CO
(Street or Route No.)
HICKEY, IC 28603
City or Town State Zip Code
(328 )- F,12-P!)75
Area code- Phone number
4. DATE DRILLED 45-25-03
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL) YES ❑ NO S3
7. STATIC WATER LEVEL Below Top of Casing: 5O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/sxonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type FTiH TARS Amount 79
12. CASING:
Depth
From 0 To 55
From To
From To
Wall Thickness
Diameter or Weight/FL PLASTIC
FL 61?. FVC
FL
FL
13. GROUT: Depth Material
From 0 To 70 FL (JXt Tr
From To FL
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
RI1RF7)
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16 _ 14 RKC-
uxatatariaow
CONSTRUCTION ST
C_
r
-"O
—,r
LOCATION SKETCH r-
Show direction and distance in miles from atTeast
two State Roads or County Roads. Include the road
numbers and common road names.
T THIS WELL WAS CONSTRUCTED
S, AND THAT A COPY OF TEl
_
CCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
07-02-03
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
----- 47699-1636 Phone_Ss,19_19) 733-3221, within 30 days. GW-1 REV. 07/2001

276364
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE T(TTJ CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME EIIQURY WFiI )nIII 1 ' m. PHONE # VS) 1%-CIM
STATE WELL CONSTRUCTION PERMIT# 1cSOCIATED WQ PERMIT#
if applicable) (if applicable) .anED=
PHDS
1. WELL USE (Check Applicable Box): Residential tic Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
1w LINDA WAY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KAIFY ItNELL YAMM HIES
Address 319 CARBON CITY RD.
(Snit or Route No.)
NfT AVFV PT' 7P6,95
City or Town State
(828 } 433-4979
Area code- Phone number
4. DATE DRILLED 06'25-03
5. TOTAL DEPTH: 365
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 48 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
GLEN ALPINE County BURKE
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type HIH TABS
12. CASING:
Depth Diameter
From 0 To 58 Ft. b4
From To Ft.
From To Ft.
Amount 67
WallaThickness �1,ytgli
Y /dghtVFt. Ylt\Sl
13. GROUT: Depth Material
From 0 To 20 Ft QUIT
From To Ft.
Method
FIRED
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
v
t_
r c::
LOCATION SKETCH ca
Show direction and distance in miles front l leak i
two State Roads or County Roads. Include the road
numbers and common road names.
N ut 4 t24%
u/
y 7o
S7%10 A"°1-(2
1 DO HEREBY CERTIFY 1AT THIS WELL WAS CONSTR
__fONSTRUCTIOP1STA$D *3S, ANDT COPY
eta
SIGNATURE OF PERSON CUq STRUCTING THE WELL
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
07-02-03
DATE
Submit the original to they Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919)i733-3221, within 30 days. GW-1 REV. 07/2001

278287
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-QDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C'fA/'P f1' Y0S+1 (1 CERTIFICATION# /�itS° , J['
WELL CON7 RAC'r012 COMPANY NAME JQJ"r( C L''-'ar D✓k(ent" PHONE # ( ) 77 CV— 7O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential II Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: � a.( e-
Nearest Town: /�%l Ll'L G ' / ° County � �/"�L
I
(Street Name. Numbers, .mmunity, Subdivision, Lot No., Zip Code)
3. OWNER: /��
Address SQZJM 13) r%) 1 f'r; k /7 J fry
4 r�'/Street or Ro Jo/.1
desc jell ��t✓ 2e5
33-( 1
city or,Town - State Zip Code
ti01
Area code- Phone number 2
4. DATE DRILLED ,�-27-o3
5. TOTAL DEPTH: / 220
6. DOES WELL REPLACE EXISTING WELL? YES []' NO 0
7. STATIC WATER LEVEL Below Top of Casing: 30o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TESTI%U Q
10. WATER ZONES (depth): ��//
I I . DISINFECTION: TypeP/JYLLf1Y Amount
12. CASING:
Depth
From U To 5 6 Ft
From,6 O To i z- Ft
From To Ft.
13. GROUT: Depth
From To
From 0 To Zc'
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Diameter
Material
"Topographic/Land setting
Fd72idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 « A i 2�
'l0/22o Otreditg4 Lfi
Wall Thickness
or W i ht/Ft. Material
Method
LOCATION SKETCH
73':how direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ft.
Ft. F'UP1P'E flip/ �,
Diameter Slot Size Material ,)Utl Ir
In.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON C
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
I' f. ELL,
ater Section, 1636 Mail S
DATE
enter - Raleigh, NC
GW-I REV. 07/2001

27 969
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N. ral
Reso
ce - DDivisio f at r Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (.p/rint):p�T/�%D/I/�F/1C� J� CERTIFICATION�/TI/#- XJYd�/�
WELL CONTRACTOR COMPANY' NAME / 4 t / /fir l�C,(�"! / Z/�%3/7l(l; PHONE # LA 1 4 j7;•.11 C0
STATE WELL CONSTRUCTION PERMIT/1
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other. List Use
WELL LOCATION.
Nearest Town: fOf /t County
L:.tfe T.i:/ ri
(Street Name, Numbers, Co
rY
unity, Subdivision, Lot No.. Zip Code)
3. OWNER: Ai? f ,t�1 Address 1.�✓✓ 1 i �i/ot -/C1 { �/e.�/ / 5G
(t
(Street r Route No.)
/Vergr7 tt 4,e, c9k055
ity or To Slate Zip Code
-,5"y- say
Area code- Phone number
4. DATE DRILLED '/� 03
5. TOTAL DEPTH: , .1 H
6. DOES WELL REPLACE EXISTING WELL? YES li3'VO ❑
7. STATIC WATER LEVEL Below Top of Casino: .55 FT.
disc if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD(gpm): 45 METHODOF.TEST al tier j}'tE?tee)
10. WATER ZONES (depth): (12o ¥ S6
LOCATION SKETCH
Amount Ic- 15 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight Ft. Materta numbers and common road names.
c rHEhUJ!1 PCC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(dearees; minutes, seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptionn�
Tj 45 Cat t S� I.03
5 S5 J3/ue (Tray
II. DISINFECTION: Type eh for �A%i
12. CASING:
Depth Diameter
From L To .5& Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Materjial /Method ,L e
Front O Toj i Ft. nu &Pmeil * Gm of I t-{ 1 fct^'
From To Ft. •J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Materials
From TtiS� Ft. , kv-68,,(I t7
Front To Ft.
16. REMARKS:
026 E4571 0' ib-
t-)
(MC sit? N c.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TJ,iAT A CO OF THIS RECORD HA EE PROVIDED TO THE WELL OVs NER
S IGNATUR
PERSON CONSIR
TING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 163
27699-1636 Phone No. [phone], within 30 days.
DATE
r,ROUNOW TEP.. LECION
)PEKE
I F RIG'',..' "__

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
278394
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2888
030300 STATE WELL CONSTRUCTION PERMITS. Leslie Reece
1. WELL USE (Check Applicable Box): Residential I %,,`'I Municipal I I Industrial P1 Agr
Recovery Heat Pump Water Injection I Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I INVII I F. County RI IRKP
HWY 1B3 OFF I-M,(Y 1R1 OFHWY 771
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER GARY,I MOORE
Address 8300 BUCKEYE HOLLOW RD
JONAS RiiSNE1 Route No.) NC 7R1357
city or Town State Zip Code
4. DATE DRILLED 13/21/2003
5. TOTAL DEPTH 4n5
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES P1 NO
8.
I)4
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.0118
10. YIELD (gpm): 4 METHOD OF TEST Air
I xl
11. WATER ZONES (depth):4 apm261-262 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 63
13. CASING:
DRILLING LOG
From To
0 Inn
GROUNDWATER�,SEOV)ON
ASHEil.TFL{rErp-t »_ r,LrlrF
Formation Description
DIRT
inn 781 GRANITE
7(91 967 SHALE
7R' 405 GRANITE
W n
rr't '4m
O
zm
U -ig
+ m
c
If additional space is needed use bacIC+Mforrftaj
n
LOCATION SKETCH N o
Wall Thickness -.Z
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 10@ Ft 6 1/8 350 PVC Roads, or other map reference points)
From To Ft LI Jj Ile
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
Material
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:
SPnw. fit/ % 9 - 8 -03
SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
Submit original to Division of W ter Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

271'796
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYAF TMI; CERTIFICATION #224,1
WELL CONTRACTOR COMPANY NAME MICR{ WFTT jRIIJJN CD. PHONE # [phone](T35
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E( Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use.
2. WELL LOCATION:
Nearest Town: NOPCANTON
REMIT RD.
County PURFE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FAIRVIEW (IC
Address % WIILTPM AU1CW 135 W.A. HARRIS RD.
tan) 28655
City or Town Stale Zip Code
( 828)- 433-0350
Area code-Phonenumber
4. DATE DRILLED _ �-17
5. TOTAL DEPTH: - +5
6. DOES WELL REPLACE EXISTING WELL'/ YES)12i NO 0
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "e" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface°
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST BY AIR USE
10. WATER ZONES (depth):
11. DISINFECTION: Type _
12. CASING:
From 0 Depth T184
From To
From To
13. GROUT: Depth
From,_ D To 7()
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
Diameter
Ft. 6V'
Ft.
Ft.
Material
Ft. (Ft. MCITT
Amount 51.
Wall Thickness
orWeight/Ft. Material
GALV. SILL
Method
WI 1RFIl
Ft.
Diameter Slot Size Material
FL in. in.
Ft. in. in.
Size Material
From To Ft.
From
To Ft.
Ib. REMARKS:
I DO }Emily CERTIFY TH.4
CONSTRUCTION STAND S,'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from atjeast_
two State Roads or County Roads. Include I3 road
numbers and common mad names.
LA/
S WELL WAS CONSTRUCTED IN
THAT A COPY OF THIS
ifigt
RDANCE WITH I5ANCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
01-27-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to theJDivisi
27699-1636 Phone No. (919) 733-32
n of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

270721
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturaly�Resourrces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) G/�- A Li 3 uS i is r CERTIFICATIONS-#v5/54
WELLCONTRACIOR COMPANY NAME :SUStie.G VJCLL p(Zi[-Ci NV PHONE# P20 92eit-7D
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ifs Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ,/�
Nearest Town: Meggj/> tit) County P.SUe .
j& J cm- T 90
(Street N e Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 544.1 /1 S' n a/ ey
Address3q20 13' ) e / ec't' 7o pale gbil CI
(Street or Route No.) r, l C.c)
ity or Town State ZipCode
3 z 7— 1/4/ 17„?3
4
5. TOTAL DEPTH: 4T)5 �/ /
6. DOES WELL REPLACE EXISTING WELL? YES 1f NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated agar below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 00 METHOD OF TEST /)/2
I O. WATER ZONES (depth): 4 „Oivtto 3 �SQ
Area code- Phone number
DATE DRILLED 3 — P 3
I I. DISINFECTION: Type GLc'7/"-„Le-
12. CASING:
Depth
From C To % / Ft
From W. To / f/ Ft.
From /./ To /%S Ft
13. GROUT: Depth
From To Ft.
From 6 To 9cl
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Diameter or Wet ht/Ft. Ma eri 1 numbers and c mm r names.
1/0 et-eat�cnal/-� Niet.hod
Ft. -if / l'io,lf ei
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 HEREBY-CERTtFY—
r
t,r F, - 7
,Submit the original to th'le Div
27699-.1636 Phone Nu. (91,9) 733
friitgily
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-I REV. 07/2001
Amount r/£`?OZ -736how direction and distance in miles from a[least in
Wall Thickness two State Roads or County Roads. Include tngtroad:
c.
�Tvpographic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
S1'43'ZCS„ / S(°36's-I.S"
(degrees/min tes/seconds)
Latitude/longitude sourceXGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
—//a D.r_gCS:red
/10- yo5 6/'444
03
LOCATION SKETCH =—
90

280165
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) gARV 31541,2E CERTIFICATION#'2
WELL CONTRACTOR COMPANY NAME 3USi'iOE uifr.<-a ri LC;PHONE # (Sze) 72y-QsT/e
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Cdr Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
`n'm��'o''/tt ifr'4-$114N,u�,, County Dureic
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge CJ31ope ❑Valley DPW
(check appropriate box)
Latitude/longitude of well location
3 OWNER: Kurile rKe CO 1-)44- Cohn en UN; t-y b odeLcrmep-+ (degrees/minutes/seconds)
Address fro 60X 21H ZW,9✓e,e1 /}utP,utie
(Street or Route No.)
MO46Ati'hoN we
City or Town State
( )- u3` - 4' 34' z
2f3.9C 0279
Zip Code
Area code- Phone number
4. DATE DRILLED 9- 22-03
5. TOTAL DEPTH: dl a5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Nre
7. STATIC WATER LEVEL Below Top of Casing: 4/b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /5 METHOD OF TEST Ai//Z
10. WATERZONES(depth): /5 2/0/VI CO /C'J
11. DISINFECTION: Type CLeRiNGr Amount 90ZC 799e
12. CASING: Wall Thickness
Depth Dia eter or Weight/Ft. Material
From (0 To Ft. 1/0 Of
From Li Z To Ft. 40 Yri /08 (4LV
From To F
13. GROUT: Depth
From To Ft.
From 0 To Z2 Ft..type, I i2aAA/eV d
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
Method
From To Ft.
From To Ft.
Material
16. REMARKS: 4,0-#31-
Pjw4e klie‘ley
Latitude/longitude source:❑GPS❑Topogra
(check box)
DEPTH DRILLING
From To Formation Description
6 jr pint''
21'5- 9 26-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. t?, `ititi 110.4
6AOkiA D %1
Q7
O
W
O
0
rn
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
22
SIG 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
o
x
5
ft

WELL CONSTRUCTION RECORD
280163
North Carolina - Department of Environment and Naturally Resources�f- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) @lay Tug*F1 C-4
CERTIFICATION #�//��r- rr�
WELL CONTRACTOR COMPANY NAME JOS+)LLc ,p/i/,j ; fr; PHONE #8j ?2y-�1�T�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable) ! L__
/c
I. WELL USE (Check Applicable Box): Residential KI Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:,�`
IN
`
Nearest Town: \� Countyl3ue r-k
�W3 Oct'JC, t05
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ear/o/li etl"
f
Address 1\t4 ova .e. t��
(Street or oute No.)
ny Vogt T Stye, ) Zip Code
Area code- Phone number -
4. DATE DRILLED 9 25— N! 3
5. TOTAL DEPTH: cai 915-
6. DOES WELL REPLACE EXISTING WELLS YES M' N0 ❑
7. STATIC WATER LEVEL Below Top of Casing: d%° FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): 30 METHOD OF TEST /64/ /2
10. WATER ZONES (depth): 305Q,r.t e 2 go'
II. DISINFECTION: Type e4OtroNe
12. CASING:
Depth
From 0 To /02 Ft
From /O.Z To 1 Ft.
From / 7% To r79 Ft.
13. GROUT: Depth
From 0 To&Q_ Ft.
From To Ft.
Amount /J o2
Wall Thickness
Diam ter or Weight/Ft. Material
/n lt/ Uo
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
16. REMARKS:
Depth Size
To Ft.
To Ft.
1 DO HEREBY CERTIFY THAT TH
CONSTRUCTION STANDARD
Slot Size Material
in.
in.
Material
In
Ippegraphic/Land setting ' ',
tiRTdge ❑Slope ❑Valley ❑Fiat.
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr3iic
(check box)
DRILLINGLLOG
DEPTH
From To
p- /20
/h5 - 2 /O
2/o -az f31-
Formation Description
tow,t/ CC,47
ymfJLc. /2ir1
Slue eew>^- ,i o (i
netit-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0\WC/ o U e
WELL WAS CONSTRUCTED IN ACCOI r ' - WITH 15A NCAC 2C, WELL
D THAT A COPY OF THI$RECORD HAS BEE PROVIDED TO THE WELL OWNER
IGNA
E 0 ERSON CONSTRUCTING THE WELL DATE
c�
=n
oC
m
0
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 Nan:ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),.,-ASHL.E T. MORETZ CERTIFICATION SF 2586
WELL CONTRACTOR COMPANY NAME ,,ppn'R i'1G rviELL DRILLING PHONE s [phone]
STATE WELL CONSTRUCTION PERMIT# atikA s ASSOCIATED WQ PERMIT#
(if applicable if . •licable)
1. WELL USE (Check Applicable Box): Residential V MuaicipaVPubiic 0 Industrial El Agricultural U
Monitoring ❑ Recovery ❑ Heat Pump Water In_jetction ❑ Other ❑ If Other, Last Use
2. WELL LOCATION• r'%
Nearest To Mt oat "m t e- �
(Street Numc, Numbc �Community, Subdivision, Lot Ne.., Zie Cote)
n 3.OWNER:
Address Sr-(?n.e. rdrssevi-.
-4A (.4`l
K (T 7
(Siren or Route No.)
Ci or Town &ate Z'n Cm",
Area code- Phone number
4. DATE DRILLED s-a-0 3
5. TOTAL DEPTH: 20 d' /
6. DOES WELL REPLACE EXISTING W ELL? YES 0 NO El/
7. STATIC WATER LEVEL Below Top of Calms:
(Ilse "+" u Abnv:Tv'y of Casa:a)
8. TOP OF CASING IS / PT. Above Lan: Surfaces
'Top of casing terminated st/or below land suriVe rc"iloirs a
variance rn accordance with ISA NCAC 2C .011S. ,-
9. YIELD (gpm): 3 O METHOD OF TEST : •r it 1+
IO. WATER ZONES (depth): Z.C.0 i _/
11. DISINFECTION: Type pi/4 0 2_
Trail Tt Sres
12. CASINO:
�j Depth D.
or ;;;:. Ft. Malarial
From % To 0 Ft. ,. �tL';T ? enN'L.
From To Ft. 1
Fmm To, Ft.
13_ GROUT; Depth
From ± To -a. Ft.
To Ft.
14. SCREEN: De th Di mute: ,,,SAD:' Sire 1-4.at:eria1
Floc, o Ft. .-.r:, r..,
Frorr To t."--- i-:.N--1
15. SAND/GRAVEL PACK:
From
M-aterial
!
(�es&jf
Topogr £iic/Land setting
L]Ridge lope ❑Valley ❑Fla'..
(check appropriate boa)
Latitude/longittide of well location
(degrecs/mieutes/secotids)
Latitude/longitude source:❑GPSDTopoZ.aphic map
(check box)
QUITE DRILLING LOG
From To e Forma.tion Dcscri do
.s:s° —goes' _6_,,,..itzr
etbod
Gt•/e d
d
Fro
Fro
16. REMARKS:
th
Ft
Size
;Material
u
U)
m
as
LOCATION SKETCI{
Show direction and distance in miles from at leaf?
two State Roads or County Roads. Include the 951
numbers and common road names.
/CIS F
42.0°jetS_
P4' t cJ5t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDSTHAT A COPY OF irliS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIo7v.ATU12.'F.CIF PERSON .,,,NsTRUCTING THE WELL DATE
r
Submit the original to the Division of Water Qualir3, Groundwater Section, 1636 Mail Service Center -Raleigh, Eq
27699-1636 Phone No. [phone], within 3O days. GW-I REV. 07 )2Q0I
od WbS£:90 £00E 8T 'da8
EEZIE9wP02_ : 'ON XC
dWfld R 113M ZL2?JCW : kLHH

3. OWNER:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE LCM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
280837
- Groundwater Section
CERTIFICATION tl _
E1LCICRY WELL DRIIIIM CO. PHONE it [phone]
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential lid: Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WFII LOCATION:
Nearest Town: RI -Minh a I FTT County BUREE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
I2xD ii/n0Inair aJ. /F r I TOT
Address H) RIX 2935
(StreetDERGANIu ,telVC) 2
City or Town State
(828 )- 437-7354
Area code- Phone number
4. DATE DRILLED 0941-03
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO K
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use r'+^ if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Zip Code
Topographic/Land setting i.
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
11. DISINFECTION: Type Hill TABS
12. CASING:
Depth pf�eter
From 0 To 105 FL b'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From ) To 70 Ft. M(1IT
From To Ft.
Amount 138
Wall Thickness
or WWeigbt/Ft. PVC PLMaterial
ASTIC
Method
HOED
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 FL
From To Ft.
16. REMARKS:
C
O
c.)
n
--D
3
0
LOCATION SKETCH tv `" n.7D
Show direction and distance in mites from ttjjeasC
two State Roads or County Roads. Include (82 roaa
numbers and common road names. - /
\a N Fi wEu
`S y'+
J I�P
Iv' Pi*E
5
I DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARD,AA AND THAT A CO)`Y
free
SIGNATURE OF PERSOBaRUCTING THE WELL
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
09-11-03
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) WAYNE T.CN CERTIFICATION # 2943
WELL CONTRACTOR COMPANY NAME HT(T(IRV IAFI I TRH TIT: M PHONE le 828) 324-0035
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial/0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: &1RKE
200
NearestTown:MIGANICI\I County QUARRY RD.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
VULCAN MATERIALS
Pi pa( h9
(Street fraraANICN,e No.NC) 28655
City or Town State
( R7R)- 4R7-7hlh
Area code- Phone number
4. DATE DRILLED (9-16-03
5. TOTAL DEPTH: 235
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ix
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 2 FT Above Land Surface`
`Top of casing terminated at/or below land surface requires a
varianceaccordance with 13N
9. YIELDIELD(gpm): 2 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type MP TARS Amount 213
12. CASING:
Depth Di ter
From 0 To 36 Ft. 4
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. (-Tr
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 Thidmess
or Weight/Ft. Material
GALV. S�-
Method
liA?[ JED
280838
Topographic/Land setting
ORidge ❑Slope ❑Valley Cf'lat!
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogmpl}ic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft.
From To Ft.
16. REMARKS:
r-
W
—t c
IN2 o
O
LOCATION SKETCH
Show direction and distance in miles front atalast
two State Roads or County Roads. Include tie roam.,
fo1jt
numbers and common road names.
N
a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUUIbD IN A
atale
CONSTRUCTION STANDARDS. AND THAT �1THIS RE
SIGNATURE OF PERSON CONSTRUCT HE WELL
RDANCE WITH 15ANCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
09-18-03
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) %AI E HEE CERTIFICATION a 2343
WELL CONTRACTOR COMPANY NAME
I]IQKEY WELL ERILLINE CO. PHONE a f828) 324-0Q35
STATE WELL CONSTRUCTION PERMIT# JSSOCIATED WQ PERMITt
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential° Municipal/Public 0 Industrial gt( Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M RGANIW County RWE
200 CAUSB'Y QUARRY RD.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
VUf CAN P'YTEMAI S
Address FO EC( 69
(Strut or Route No.)
lvfTC NTCN, N' 7Ff,5S
City or Town State Zip Code
(828 )- 437-2616
Area code- Phone number Cf3-16-03
4. DATE DRILLED
5. TOTAL DEPTH: -395
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )121
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
2 (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. BY AIR TEST9. YIELD (gpm): 1 METHOD OF TEST
10. WATER ZONES (depth):
3. OWNER:
2 8 O'3 n,
Topographic/Land setting
DRidge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou ce:OGPSOTopograph,ic map
(check box)
DEPTH PULLING LOG
From To Formation Description
11. DISINFECTION: Type 1{IH TABS
12. CASING:
Depth Diameter])
From 0 To 24 Ft. 6Z 1
From To Ft.
From_ To Ft
13. GROUT: Depth Material
Front_() To 7(1 Ft. art Tr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 43
Wall Thickness
or Weight/Ft. Material
Cf1LV. S1E1L
Method
IUD
Frot»_ To Ft.
From To Ft.
0
C)
(v
v
LOCATION SKETCH t
Show direction and distance in miles from caster'-, —
two State Roads or County Roads. Include lid roag
numbers and common mad names.
v
MptyeJioN
pti i€1�'Ar,l /r
\lobar
�j
ba
Hwy,70
5
F
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIED IN ACCO NCE WITH 15A NCAC 2C, WFI
CONSTRUCTION STANDARDS, AND THAT A COPY QF THIS RECO N PROVIDED TO THE WELL OWNER
CA- 8-03
!
SIGNATURE OF PERSON CONSTRUCTING '1Qt1'' 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

280832
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (R'tDW (DUAL) NAME (print) WOE ITN CERTIFICATION 117143
HIQQRi' FELL IRIfIC CD. PHONE N i t 324ZW35-
HSCOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITN
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0K Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town. KITAIaIWN County HERE
180 CAUSES? WW1 RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ABC C RLJNk
Address 113 CAI ' (II4R1n' 111
(Street or Route No.)
M CANIKN. M 28655
(828 City
433-9514 State Zip Code
Area code- Phone number
4. DATE DRILLED 09-15-03
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
7. STATIC WATER LEVEL Below Top of Casing: 129 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TESTBY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type HiH TARS Amount 16
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To .Y1 Ft. 6 CALV. STEEL
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_.___ To 70 Ft. fltilF
From To Ft
Method
F(I RFD
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box) i..
Latitude/longitude of well location
(d huiwtes/st emir)
Latitude/longitude sotnce:❑GPS❑Topogaphiq map,--,
(check box)
DRIL IN' .. LO
Formation Description
IDEPTR
From To
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
Front_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From__ To Ft.
Material
16. REMARKS:
c
0
C.)
r-,
o r=,
LOCATION SKETCH
Show direction and distance in miles from aI€teast-u
two State Roads or County Roads. Includer0e wed-
numbers and common road names. ry
co O
Ott-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED CCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT HAS BEEN PROVIDED TO THE WELL OWNER
09-24-03
SIGNATURE OF PERSON CONSTRICTING THE WFI.i 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

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
030526
283043
WELL CONTRACTOR. Dewey Wright Well Pump Cr'
2687
STATE WELL CONSTRUCTION PERMIT#• Steve Reece I
WELL CONTRACTOR CERTIFICATION #•
r-=
1. WELL USE (Check Applicable Box): Residential H Municipal El Industrial
Recovery Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I INVII LE County: RIIRKF
GRAGGS AVF OFF . IOF PQORE Rn OFF I- MY 181 OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DAVID NEAL MOODY
Address P.O. BOX 37 .
PLUM TR`et or Route No.)
City or Town state
4. DATE DRILLED 10/1`.'2003
5. TOTAL DEPTH 180
6, CUTTINGS COLLECTED YES
NC 78864
NO
X
Zip Code
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 60 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)' 40 METHOD OF TEST Air
11. WATER ZONES Idepthf0.00 ppm 120-123 0.00ppm
0.00 ppm 0.00ppm
X
I I
Agricultural n Monitoring
'r/
DRILLING LOG
�EPIT _
From To Formation Descrip foa '/ f,
0 85 DIRT
85 120 GRANITE
120 121 QUARTZ
173 ten GRANITE
12. CHLORINATION: Type HTH Amount 21
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 90 Ft 6 1/8 .350 PVC Roads, qr of r map reference points)
From To Ft _au.'�
From To Ft O
SZ/grC
c
S.
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACOY OF THISHAS BEEN PROVIDED TO THE WELL OWNER.
itC_ l/— % — D_-
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

284102
WELL CTRUCTION RECORD
North Caro ina - Department of Environment, u ;: Y t;.,-al Resources - Division of Water Quality- Groundwater See:ion
CEERTiFICA T ION
PHONE k (7QI:Fi'r4 F 2 --. .
WELL CO_TRRCTOR(.CNDIYTDVAL) NAME (pars:'( •'.JHLEY T. MORETZ
WELLCOsTBACIOR COMPANY NAME MORETZ WELL DRILLING
STAT' WE). CONSTFDCrION PERMIT#
(-fanoliceble '
471
-,,.,.ASSOCIATED WQ PERMIT#
if a• •liczhle
1. WELL USE (Check App'licablc Box): Municipal/Public 0 Industrial ❑ Ag ::cal(usal. C
1 Recovery C Heat P� r j _ciion ❑ Other 0 If Other, List Use
2. '?7t3 ,L LC:CATION
Nea1-es' -lo',n: A}tli-
,
(Stott Name. Numers, Community, 5ub�s3sic
3. O\ NEr: )(le Her
y s
I+is •nl\tp� J'e ( I
City p _.. Ciitt
L )-
fin a code. Phone number -,
4, DATE DRILLED F/. pZ<C=©
5. TOTAL DEPTH:- .�
6. DOES WELL REPLACE EXISTING WELL? `' S 0 NO
` (StNet o• ttOtitc No.) e..,
7. STATIC WATER LEVEL Below Top tf Ctt C:=: ..` .
,,sing)
S. TOP OF CASING IS / FT. . zface^
ioY t.-niowtrd a✓o• ittow land i-. :-
I low:clan with IS.lNCAC 2C, .�. L.
9 'Par) (. _ m); / 'l:.TH4� A , r," Ai-
10. WATER EF Ts ONES (ep h): /fit:
opographiciLand setting
QSiope DI/alley CFi t
(check appmp^.a+t box)
Latitudc/Jongitude of well locg45-.241
(deegt c'rttizu:e.lr r ds)
Latitude/longitude source:DOPSfTcpottz. :
(check
DEPTH U Irr i, r-
Fi o� ,�m - To Po, .ion
'79' CSC L c::
79'- 3_05' t __
-0
11. DIS NFE IQN: mac f;rtw p....;_' C :? O
12. CAS.tNG- Wall ! .:.^e5S
tzt
•
IQ--pth Diameter ':?.. Material
ro:m, ,." 61!q ,'VC
ert To
Frcr.t_ To
13. C,1.-KcRITii,DeathMSa. .>_ Method
Tren To Ft.
14. SCREEN: Depth a Diameter
From
,~:err, i'' T
IS. SAND/GRAVELPACK;
D:vth Size
0 ^1
16. R P :,ARKS.
J QCA.TION SKETCH CH — -4i
Show direction and distance in miles &c' o! -: '•:e
two State Roads or County Roads Itch!?-2.: .cad
numbers and common road names.
U, S
(f /
i+laterial
I
1 DO HERESY S . RTIFY THAT - r: iS WP.I i IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONgTc:,it:tICe;STANDARL`SFANDTHAT A t'= IS RECORD HAS BEEN PROVIDED TO TEE WELL Oh'_E:.
Snbmit c-rigi
27692.11 -..
ATURE OF Pr 'SON CONS'tRUcTING THE WELL DATE
to the i i tisiau of WRic7t =:7 - G-_ mmdwater Section, 1635 Mail Senice Center Fa:+i.r=, NC
(919) 72 -3221, within G v I P v 0
4d WdL?:Le Pea? LC
: 'ON XdA dk ld 'S -iTdcl ZLE OW :

284104
WELL CONSTRUCTION RECORD
Nock c a:e.i-.a - Department of £nviron rnt z ;d ia;m-ra Resources - Division of Water Qtality - Groundwater Ses_'ra
WELL CONTRACTOR (INDIVIDUAL) NAME e, AS iLEY T. MORETZ CERTIFICAaIONe b
L DRILLING
WELL CON L2d.0 OE COMPANY NAME
STATE WE L CONSTRUCTION PERMIT/0 —/4✓ /I'
�ii a?o scan ;]
tQ'.4.5L.tt 'f: f7TcE�Li� "�'ta Ta:-G.. 'Te•ur.. n... ..- +.. . -.: .. �: -..
1. WELL t: SE_ (Check Applicable Box): Rssid.-:.'-al;' Municipal/Public El Industrial ❑ . Agricultural Ci
Mio:Uto-ring 0 Recovery CI Heat Pump Watnn e ig t Cl Other D If Other, List Use
2. WELL LOCATION'
Ye..est own: ''' J 1 0.11
(St: ♦ti::, Nambats. Comm.'nrj S�Ldsrs;a,.,.t.- .,
3. C4^ R: a(a ��'I� ,//
Acdt._s i
os ao :c No.) !-
2i^ C,<;:
A.w nine nurnbr
4. DATE DP r..LED
5. TOTAL. DEPTH:
PHO.Nr ec j462-_ 322
ASSOCIATED WQ PERMIT#
if: y,licable
.l�
lc_
6. DOES WELL, L, REPLACE EXISTING by E.L:, 'Ls NO
7. S'i AT.:'CWATER LEVEL Below Top of C.„'-i-.v: = .
(Use '"'1ffccE'i. Trp classing)
FT. Abc-so 'Lunt! Srrface°
rice e: taming termlratd atter below land ccr-a:z n! qvi c
,a.i:: .c -accordance wife Ltlx NCAC 2C .Oi::3.
9. YIELD (4-_,. ): c°C f, I?..'fI�OD OF TIE ,((
8. TOP OF CASINO IS /
iv9
0pographic and sett •
idge ❑Slope Malley Li
(etwk ap^rronriat bon)
Latitudefiongitde of well Ixuic=n
(degcrdmitutcstsc=cntz)
Latitude/longitude sou;ce:QGPS❑Tcp ; prci
(ehwk tex) r
DEPTI,k DRILLING vC
From To Formation. D ,-. t gin
felt
If_
11. DI:., TE _ON: T+F.e ?It
12. C:a.7
Fror! Zy? Tocej a_� _
From To
From To Ft.
13GROUT: Depth Ma
77 To 2 i Ft Ce
14. Si. EN:
TO _.
Dsr.4.. Diameter
"fat
To :t Ft. :u
15. S A1I.: -RAVEL PACK:
From
Fro_r✓,f..._._ Tot
16. pP.e^
Cr tA. s d t . M rl
—7
Size ...r__..
n
G(^...
C
O
ca
r o rn
cm
_co_
A rn
a
LOCATION SKI14 (1x
CO rn
Show direction and disMacc in m
two State Roads or County Roads. r _
numbers and common road names.
QQ //
If) v <� -
,.,p,e• 'e
I
IDO`:ERERY CERTIFY THAT THIS WELL U L_-_;CIEEDINACCORDANCE WITH I5ANCAC 2C,s;'ELL
CONS:KD- : ,ON STANDARDS, AND THAT A C .: THIS RECORD BEEN PROVIDED TO THE WELL O .
eri
SIGNATtfirE07 E2°Cr; .CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water a aa`: ^r_. 0:roundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919)733-322I, within SC clop, GW-1 REV_ 07/2001
cd i,dec'Li 706c ZP 'def :i?9bPOL : 'ON XHd
-7-There EdO'Li :

283430
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res division of Water Quality - Groundwater Section
wu.LCorrraucroamanvinUAL)ram (pn.) /.41a ref L'C_ CnWICATIONOr) 7/-3
WELLCONTRACTCt COMPANYNAHL PRICF WELL DoILtI G, INC. rHoeft ig2 327 0263
STATE WELL CONSTRUCTION rERMITI ♦ ROCIATW WQ PERavra
(if applicable) (expellable)
1. WELL USE (Check Applicable Boa): Residential 0 Municipal/Public O Industrial 0 Agieulrunl 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other O If Other. List Use
2, WELL LOCATION: ,
Nearest Ton , ' /Iiirettli County .fit.
Apr- At
(Sweet Name. Number. Commmer. Subdialiae. Lot No.. 21p Code)
3. OWNER: Ste- /I
Address / `tfL GingB 51'7-
// (aunt er Racer No.)
c- 60,7
caym7
(3 - '7 6ici`4
HpCoM
Am code- fleas mamba
6. DATE DRILLED -% 3 • (53
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ff11O G}-
7. STATIC WATER LEVEL Below Top of Casing:
(um `✓ if Abort Tap of Casio)
S. TOP OF CASING IS FT. Above Land Surface*
7a if sash, tervalmed miler below Irad surface ngdres •
nrbeee h eearduenia ISA NCAC IC.611R r
o Yinp (gpm): .S ?.fETROD OF TEST /
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Malarial
From 0 To 33 Ft C' C '/ f( FG'
From To FL
From To Ft.
13. GROUT: Depth siamtial Method
From U To i) Ft. L2;a('-P �Dnu/ac/
From To Ft T n
14. SCREEN: Depth Daman
Slat Sim Msaerial / T Cfz SS /4r S
Fmk To FL _ .S. in. -fa (,.1. /� iT ' f g n
From -To FL it is ✓� �� G`� , f� l " � /c
1S. SAND/GRAVELPACK: v>`� I�. / /sue (� �e%'
Depot c.,.. lvimaul / /' J `' �4,4
d� L LJ,`/ G'�`�/`'`r y/c!l
From, To Ft. _GO % 73cAl•'Er`6 � Ot` , e / ' / ! ,
Topographic/Land setting
°Ridge °Slope Malley %Flat
(cheek write box)
Latitude/longitude of well location
tens aftimaeabaoaA)
Latitude/longitude smacer.OGPSOTopographie map
(•heck box)
DIEM DRILLING LOG
From To _ Formation
0
C
1,0
,.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from of iast �,
two State Roads or Canty Roads. Include the toad=
numbers and common mad anase�_
Li0 i,✓e 5 ✓E7 rr;f l a
/'Coy 4/,,eti
U / � 9 ¢f4 Tor" / A-7
St / ,fr, J,c-e- /e ye /Waken. s461
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARJJS. AND TUT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2-.2__
PERSON CONSTRUCTING THE WELL DATE
Submit the tart g al to the Division at Water Quality, Groundwater Section, 16.36 Mesa Service Ceuta - Raleigh
27699-1636 Those No. [phone], within 30 days. GW-I REV. 0'
r-
irico
_e
n00
3Th
1)ji

SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromneot and Natural Resources - Division of Water Quality - Groundwater Section
mrnitc TIONs _ r.V
ruoNE s $2i 327 02E3
WELL CONraACrus (n(DtvrnuAL) NAME (print) ✓Q I'�( «e / D€ /` os/icr
nu. coNTawcroacoMrANYNAara PRICF WELL DRILLING, INC.
STATE WELL CONSTRUCTION PERMITS .JcsOCIATED WQ PERMrra
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (riMtmicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, Liu Use
cam.)- 3 y' %- 7h 9 Zap Code
Arm cods Phone number
4. DATE DRILLED ,6 'ID- 6 3
5. TOTAL DEPTH: . CO ff
6. DOES WELL REPLACE EXISTING WELL? YES O NO le
7. STATIC WATER LEVEL. Below Top of Casing: Er_ FT.
(Use `+" if Above Top of Carte[)
8. TOP OF CASING IS / I /.2 PT. Above Land Surface*
'Tap of ening terminated Mier below lied eobce regdre
rubles A secerdeaccaltk ISA NCAC 2C.011/.
o YLFLfs (gpm): / 7 MET HOD OF TEST i
10. WATER ZONES (depth): ea OO l -' -
2. WELL LOCATION:
Newest Town: NOS9c2f( -6 fI county 19i/s- P C.
la(y h Pra k M i'fv Si4-I ' (r
(Sava Name, Numbers Camaanky. Subdivision. La No., Pap Code)
3. OWNER: ..�4-ev.efr) y^ �•,./���1 7Jf JMoflr
Address dC a" FF 7 �- 0Y7 VoLiciogE ttuut
/�(saeet or Rao No.) Ccr+aay 5C 9$ 7
I CVeig'1(pli /1/ C• 4/Cc/SI< /tire Urr'-
SesS
11. DISINFECTION: Type ''.e.A eillr= -tr i Amount 3 c' u f3
12. CASING: V' re "" I Co Wall Thickness
Diameter or Material
From? To �S 7 Ft / fly'�t 5bi-' VC
From______ To Ft _
From To Ft
13, GROUT: Depth bluely' rjMdhod
From 7) To - _Fa (nrrlcrrL' t-C.)reel
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Martial
From To Ft in. _ in.
From______ To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
Midge OSlope OValley OFlat
(check approPenae box)
Latitude/longitude of well location
(deresbnimum/asaadr)
Latitude/longitude source: 06PSOTopographic map
(check box)
DEEM pRILLING LOG
From To Formation Desmiption
C) 8 3 ntrfu<,a-P
y_3 /00 /41,-7
/09 ,VOP -1 , tC�/
6c-0 PiI Tr
2G'D 5-00
C
CD
c-
m
LOCATION SKErCU kiD %'-
Show direction and distance in miles from at least
two State Roads or County Roads. Include thtoad
numbers and common road names.
283440
.L� .l•f /OJ •
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 1--
: 4 lt1'O 1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC:
27699-1636 Phone No. (919) 7334E21, 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 C NTMACrost (INDIVIDUAL) NAMta (plat) SC1 H DG it c( L.C6 h er ce WiCATloN sO*d
WELL coNTMC7oacoMrANZNAMa PRICF WELL DRILLIN„ INC. PaoNt a?2 327 0263
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT►
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I'd Municipal/Public Cl Industrial 0 Agricultural O
Monitoring 0 Recovery Cl Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: //
Nearest Town: WI Cryan /0 /1 County /.vr/1 r
/leres i y4'cy! . isq rn 1y
(Street Name, Numbers. Comm*. Subdivision. La No., rip Cot)
3. OWNER: t'1 i r (1/44P%Jn
Address li3 j 7 I/nts Lv i i/ c✓ 1 I r'"/
friP,/oonil AFC .?,i-bh
&my or Town Stan Zip Code
c>rl- a44- t3iij
Ana coda- Phone number
4. DATE DRILLED 31 7,21- C 3
5. TOTAL DEPTH: YY SFt
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: 9O FT,
/ (Use -4-1' *ken if Top of Casio')
8. TOP OF CASING IS / /0L PT. Above Land Surface*
wrap of min temduted War below Mad sedate regdres s
mimes h aecerduce with ISA NCAC 2C MIL A
o YT_.LP (gpm): 7/2 ..O7HOD OF LEST/Tf rtliOu.r7
10. WATER ZONES (depth):
283433
Topographic/Land setting
@Ridge leSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
thereamioueahamdsl
Latitude/longitode sotuceOGPS❑Topographic map
(cheek box)
DRILLING LOG
�ormation ption
; f4-4- t-oelle
aMai
From To
30-n
'j on
epic
(Sawa or Route No.)
11. DISINFECTION: Type
12. CASING:
Depth
From C To S7 Ft.
From__ To Ft.
From To Ft.
13, GROUT: Depth Material
From Cl To .,%G Ft fin ncrtic
From To Ft
14. SCREEN: Depth themeter Slot Sim
From To Ft, in.
Diameter
„G,ahr&C
C
C
m
n
Amocmt Show direction and distance in miles from at lit '-' c-
Wall Thickness two State Roads or County Roads. Include the toad <n
to Weight/FL yrion roadors
numbers and comm. o C
6 r ✓l .r -� - L- u
&co(se itTioterben rA
Sc in Rd
Method
j-}e> f
Material
is
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Frtnt�_To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
k
3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIQNISTANDARDS, AND. jITAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO IRE WELL OWNER
3-�6— 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL. DATE
Submit the original to the Division of Water Quality, Groundwater Section,16.34 Mall Service Center - Raleigh, Not
27699-1636 Phone No. (919) 7333221, within 30 days. GW-1 REV. 07/2001
r
�1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N O1att� Dy . 'on of Watt Quality - Groundwater Sectionn
WELL CONTaACroa (nairvmusL) NAME (ptht) .le /j G� t/Jazyl . -'e CERTIFICATION s rh h�1
wELLcoNTaAcroacorpANYNAME PRICF WELL DoILLIN3, INC. norm 32"327 0263
STATE WILL CONSTRUCTION moan J WWOCIA= WQ PatafTaa
(dapplieabte) (rf applicablee
283425
1. WELL USE (Check Applicable Box): Residential EI MunicipaVPoblie O Industrial O
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use 'r • v-t d G
2. WELL LOCATI {{
Nearest Town: cat ALI County l t4 ft !!
141a%n,n v'Ot
(Streit Name. Nmbets. Cammmay. Subdivision, Lcl No.. asp Code)
3. OWNER
Address 2, (' L 1
(Savo or Roar No.)
(1)1‘�1\t. Sflri i1C1
Cay oNd 1 i
62 tr (ss - 3a(7- r79
Ana co* recto nuatba .�
4. DATE DRILLED fir- 6 -6.
5. TOTAL DEPTH: 'a,OLJ 4f
6. DOES WELL REPLACE EXISTING WELL? YES O NO E
7. STATIC WATER LEVEL Below Top of Casing: D FT.
(�ii( Nan •." if Above Top of Calais)
-
8. TOP OF CASING IS r (4( PT. Above Land Surfaces
`Tap dealt* terminal star Maw lap seine requiem s
virtue h reroardwewth 15ANCAC2C AtIR o Yt_FLn (m): 7 OD OF cti%G 64 ct./t
10. WATER ZONES (depth): V TEST
/ 3 6 F <
�- l hL' 1C1
I1. DISINFECTION: Type .-H/&)c Amount
12. CASING: Wall Thickness
Duerr or W 'ght/Pt. Material
Front ( i To S Ft. (0 lei% pvc?
Fromm_ To Ft
From To Ft
13, GROUT:
From ( To_ Depth, Ft. otre}r'
From To Ft.
14. SCREEN: Depth Diameter
From To FL—ia
From_ To Ft in,
15. SAND/GRAVEL PACK:
Depa Sin
From__To Ft.
From To Ft.
�opograpbic/Land setting
WRiidge OSlope Malley UFlat
(chid approptisa bars)
Laitudeslaogihtde of well location
oinw mim+Naemaaa)
Latitude/longitude sowctr.OGPSOI'opographie map
(cheat ben)
Lanz DRILLING LOG
From To Fmmati Desai
0 65
6'S 1cc
16. REMARKS-
Zip Cat
Slot Sim Medal
in.
Material
aOo 'o
LOCATION SKETCH (-;> ,
Sbow direction and distance in miles from at exist
two Stag Roads or Canty Roads. Include thaoad `c
numbers and common road name.
5 4-
G lcrd
116-t! Ie-F4- ;)"
red Lyh� ctJce rt�h*G,n
in .1 /Er-,br:5A ,(2J 9G' S/J)/ems
,1 r. 5A l ji. ) �lii! 5 h li . P Cam- �{ d
!off 0 A i / \ (e{ f Ea-i=
3ig
sP7 r/r 7'ai1p
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTIH{ 15A NCAC 2C, WELL
CONSTRU STANDARDS. AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r /`Z2 013
SIGNATURE OF PERSON CONSIRUCITNG THE WELL DATE 1
Submit the original to the Diviaioa of Water Quality, Groundwater SuNfoa,1634 Mill Sevin Cooler -
27699.106 Those No. (919) 73163221, within 30 days. GW-1

\YELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD 3 0 3 0 5 g
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
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//��ELL CONTRACTOR (INDIVIDUAL) NAME (print) /�C,Y/fefh i/A�aCQ/v CERTIFICATION # £44/
ASSOCIATED WQ PERMIT#
(if applicable)
PHONE #
I. WELL USE (Check Applicable Box): Residential ('Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use / //v4 Ye
2. WELL LOCATIOW: April(
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Nearest Town: fiewe/la County NN^ /(
Joe go w/r/ac XQ
(Street Name, Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: bet e I74/f ey
Address 15 25 Ovyis o A4 Z,I-
»j) 1 (Street or me No.)
mot r. an 7
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /ot-30 —0-3
5. TOTAL DEPTH: ,2c?
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -
7. STATIC WATER LEVEL Below Top of Casing: ti D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance IsSit I5A NCAC 2C .0118.
9. YIELD (gpm): JI J METHOD OF TEST AT-
10. WATER ZONES (depth): 70 9.1" 3;
11 DISINFECTION: Type
12. CASING:
Depth
From —/ To .57 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To 010 Ft. C rflrn..
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
7W Amount 3 D
Wall Thickness
Diam ter or Weight/Ft. Material
From To Ft.
Method
facet et/
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
Topographic/Land setting
Edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F9rmation Description
O — .i3 //.11c."-7ewe
o J— yo Jme.r.t7fr
90 — qs— J'`r, Jr
0
U
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the r
numbers and common road names.
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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
/d 3o - 03
SIGNATURE OF PERSON CO t UCTING THE WELL DATE
Submit the original to the Division of Water Quality. Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. 1919) 733-3221, within 30 days. GW-I REV.: 07/2001
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