Bu 1 CY2003

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/ - Division of - Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ro6by I r3 / / 5 CERTIFICATION Nana s.
JCQ n1rS We( WELL CONTRACTOR COMPANY! NAME r` ri PHONE or -Ago G �Q/tlI ,K$J -9 5' y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
01/
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ [f Other, List Use
9
WELL LOCATION: ,{t��
Nearest Town///orf /r%OJ/1 /4/A/County BOA! 0,-, Le
,, Mad Liu cr/ ny
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Row &i //,iawl
Address I 11- k Limy or tx(,nel i3r. Td
-61al)( _!ereerLSorRpu[No.) as-iII
City or TownState 1` Zip Code
( 4- L .0Q'77W
Area code- Phone number
4. DATE DRILLED l 22%3
5. TOTAL DEPTH: ,? oS /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO al
7. STATIC WATER LEVEL Below Top of Casing: /o FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): o? S METHOD OF TEST :f /
.
Topographic/Land setting.' /
❑Ridge ❑Slope ❑Valley arlat
(check appropriate box)
Latitude/longitude f well location
N3S30teees/ i3 .2°/6.043'
(dgrees/m ut tends)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To, Formation Description
�
0 - 32., NIL/rand/
3x- aas ,cAoAlie
10. WATER ZONES (depth): //D - 1Ales
I2Rr-R 9On
11. DISINFECTION: Type tab I Amount () 62.
12. CASING: Wall Thickness
298581
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From a To ?) a- Ft. LP • an `a I (p,J dr EVCSDRr9 )
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a6 Ft. cc7iCVe-Fe 7 JV3&J
o
ciaa
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:
-broad `diver / Pt 9
t1ack Thou t-cu'n,NG
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND
/THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4r/
l
SIGNATURE OF PERSON CONSTRUCTING THE WELL JTE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 73,01112)y �
W)t P6 5 CERTIFICATION A5?
WELL CONTRACTOR COMPANY NAME rC I"9idelt (DNh/Lt9 (p. PHONE in
298580
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IS Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: // /
Nearest Town: l3/RCS{ /1/00Atili, / County 11o/1C, i .6c
3ronri ILA) re, /Nwpe 9
(Street Name, Numbers, �Com—,muni tL, Subdivi ton, Lot No., Zip Code)
3. OWNERlete. k.Vy1C
Address 'b1-1 to c H q
4(Street or R!"-tNe.bitn
N
in‘ri. NC
City or Town State Zip Code
(421)- tua5-LIP 0
Area code- Phone number
4. DATE DRILLED 1003
5. TOTAL DEPTH: gore
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: °' . VI) 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 accordan a with ISA NCAC 2C .0118.
9. YIELD (gpm): y� METHOD OFTEST13(OWr//L)�
10. WATER ZONES (depth): ?JD
7-Topographic/Land setting
Midge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/lougl a of well location
A/ 33°a�.7Y9 /ivosa°Ibeib!'
de re s/minute
( g s�/ conds)
Latitude/longitude source: fE'GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To / Formation Description
-- /07 014-
Aav—$or' 6:nan)'7tr
11. DISINFECTION: Type 4-G.b \M 5
12. CASING:
Depth Diameter
From To ION FL ID.aFJ
From
To Ft.
From To
13. GROUT: Depth
From 0
From
14. SCREEN:
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Amount 11 pl. S
Wall Thickness t
or Weight/Ft. Material n
uo. l'd5 7vcsVF7g
rbYoQd ?fiver/yw(y y9
Material Method
To 2,0 Ft. cone.re }-Q Torre GI
To Ft. f
Depth Diameter Slot Size Material
in, in.
in. in.
Size Material
Ft.
Ft.
tin CI
LOCATION SKETCH 3
cP
how direction and distance in miles from at least t..) n'J
wo State Roads or County Roads. Include the road Q
umbers and common road names. 0 Z
"bIACID 1lovitcuin , NC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO Y OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
/gi
SIGNATURE OF PERSON CONSTRUCTING TILE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

Depth Diameter
From D To 76 Ft. 6.2T
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To D.0 Ft.
298578
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalraResources - Division of Water Quality - Groundwater Section -r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) UD b d y W • Potts CERTIFICATION #
WELL CONTRACTOR COMPANY NAME Fete osons U%4l/ oiti t/lf:s9 CO, PHONE nali) 69.3 -940Yr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water lnjection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:l9lte/d Yhntik1a/NrcountyB!Inca nobe
Rrnad River /7 /,'wy
(Street Name, Numbers, CommunitS Subdivision, Lot No., Zip Code)
3. OWNER: Hared LmWIarQ
Address Tf5 —66)( 31-1t4S
Street or Route No.
N. r7y Town -fie each sc aa --
Ci r
Area code- Phone number
4. DATE DRILLED 5/1/03
5. TOTAL DEPTH: a Vs' /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (B'
7. STATIC WATER LEVEL Below Top of Casing: 6 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): 75. METHOD OFTESTL3/Ou1wy�.C4
10. WATER ZONES (depth): ,2../0
11. DISINFECTION: Type +a lOS Amount 7 0Z.
12, CASING: Wall Thickness
or Weight/Ft. Material
.111 sterf
'broad `-'t fi ver
/I4w C
1t
'bad_ e �„aviMaterial Method
eenercle Pdurletty 9
Topographic/Landsettiig �
❑Ridge ❑Slope ❑Valley Pf'Iat
(check appropriate box)
Latitude/10 gitude of well location
/J 35° N ' AloY1°/b.S37t
( grees/minutes/}�+conds)
Latitude/longitude source: f!}GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Dry y' /S?.rrf
DEPTH
From To
n — 76
76, - 24's' C..wnrt/t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
g
5 ?n
.-
131
tJ
c.
-O ;Z.
LOCATION SKETCH 0 -
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNAT RE OF RSON CONSTRUCTING THE WELL
S�. ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

CONSTRUCTION STANDARDS, AND THAT A CO 0
WELL CONSTRUCTION RECORD
298577
North Carolina - Department of Environment and Natural Resources/ - Division of Water Quality - Groundwater Section
,'f
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,'fob by IV e Riffs
WELL CONTRACTOR COMPANY NAME rely Imo ores we(I D/Yt//%/�' Co PHONE yt I;$ 3 a?Y
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT(!
(if applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential LW Municipal/Public, ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:1 r '�f �
Nearest Town: FafY'V/CI.a) County&, COHit be—
L hW4e,ri Mee/ S /Karre& rrcek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Si rnm (i Lae
Address W
(Sneer or Route rm.) Etei nh-Fs
Fair rtPW NC a3730
City or Town State Zip Code
(%-toin-3(D5a
Area code- Phone number //
4. DATE DRILLED S/S7A
5. TOTAL DEPTH: 'D S r
CERTIFICATION °LAIR
yTopographic/Land setting
WRidge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N/3S 3/,)JS iIOSA°/LAYf'
(degrees/ inuts��a eeeconds)
Latitude/longitude source: 19"GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
0 - 44 D;et-
61- 3os 6nin,%c
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO WP77
7. STATIC WATER LEVEL Below Top of Casing: +V 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 ?C .0118.
9. YIELD (gpm): as METHOD OF TESTS (0u01 /i9
10. WATER ZONES (depth): iqg
11. DISINFECTION: Type 'fable /Is Amount 7 0L5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From a To b$ Ft. b,u
From To Ft.
From To Ft.
S
LOCATION SKETCH (.J
Show direction and distance in miles from at Ieastr.
two State Roads or County Roads. Include the roag
numbers and common road names.
aI4,/as RYE -sna z'
13. GROUT: Depth Material
From A To 20 Ft. fenrreft
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
foul
Li pt-t (e}In \ HO. hts/ Eza..y reh Cref
` aCrview / ►vC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
(5/03
D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

293375
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) Qotiby (Al. �O CERTIFICATION#_____'_ q
WELL CONTRACTOR COMPANY NAME Pe Ai an /V 5 Wei( �N�i,sr �, PHONE g� 3 `/� /
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 122' 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: Fq//s V/L co County franca wt be
eta r/fti rterfl'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Clehevl 1' Q(Srcea_orLoute No.)
Zip Code
(Easy- a7�-llnl
Area code- Phone number
4. DATE DRILLED 5//a/A3
5. TOTAL DEPTH: / 5 ' — /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID-
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 with 15A NCAC 2C .0118.
9. YIELD (gpm): /N0 METHOD OF TEST O//iv.;tv%*
10. WATER ZONES (depth): /490 / / ZO'
City or Town State
11. DISINFECTION: Type
12. CASING:
Depth
From Q Tom
From To
)(D6/e>
Diameter
Ft. 6, elS
Ft.
From To Ft
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C3Fta
(check appropriate box)
Latitude/longitude of well jocation
z/3S°3a,OM;/i�i7nu ,sYz'
(degree t�,inutes eeconds)
Latitude/longitude source: IPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description�
/
- /6S 1 6,4.1.,71e
LOCATION SKETCH
O r✓
-64 _ m
a
-rt �m
tV o<
N "o
o ar
rn
r�z
W m�
and
di Show direction stance in miles from at Kant 't Amount � e 2 fo
Wall Thickness two State Roads or County Roads. Include the rnaad z
or Weight/Ft. Material numbers and common road names.
Atk.1a, $Pitt 50a21
13. GROUT: Depth Material
From () To %.M Ft. CON ese1.0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
PeOAInty
Clay ven breek
Ects rvi ew, PC
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
SIPrNATURE OF PERSON CONSTRUCTING THE WELL
/4(o
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200I

298574
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Br, try bt) i f70 ff t) CERTIFICATION#aoas
WELL CONTRACTOR COMPANY NAME Ff u-so,/s u]e// prll li'„, ro PHONE WO 6S372VV?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential VMunicipaUPublic 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: FlartrVftttti County ( ALOIN be
Brash Cre.1( PalnUiew'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:. 1 nn ,h�e.vbe.r
Address'tS3 ClentQR (hcstaIn PIG •
(Street or Rout, No.)
Have Shoe 11C a��ya
City or Town State Zip Code
(`h28)- air)-77(n'1
Area code- Phone number
4. DATE DRILLED 59k)
5. TOTAL DEPTH: A S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (r3'
7. STATIC WATER LEVEL Below Top, of Casing: L SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
topographic/Land setting
ge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/1onngitude of well location
/V3S°3"),55/ / Wane 1V,/ys'
(d grees/minutex tends)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O — 76 r bin T
76 , 3eir' Granite
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TESTA/DWiy//2 j
10. WATER ZONES (depth):
11. DISINFECTION: Type *kJ/rrf
12. CASING:
Depth
From 0 To >6 ' Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To An Ft. Concrseic lau/Yn17
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.
O- c
J
m
� a
t
rJ
3 � i
LOCATION SKETCH
Amount tea Show direction and distance in miles from at leash �-P
Wall Thickness two State Roads or County Roads. Include the roa_
Diameter or Weight/Ft. Material numbers and common road names. — Z
6.aS 2/6./As Pvcfbadl
` ?ru5h CreeL
Fairview, IBC
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL "-" •- -
CONSTRUCTION STANDARQS, AND THAT A COPY of TI]JS-RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF P
RSON CONSTRUCTING THE WELL
A
D3
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

298572
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
I/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L&"bt , Q/� h'S
WELL CONTRACTOR COMPANY NAME „IC „A -Cry S On/S / R/C// a", j/ f Cn
STATE WELL CONSTRUCTION PERMIT# �� ASSOCIATEDWQ PERMIT#
(if applicable) (if applicable)
Groundwater Section
CERTIFICATION W20A8
PHONE W 8),b7,5 -find-7
1. WELL USE (Check Applicable Box): Residential III/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Nearest Town: /o %rt/r 9W County %i(ln CD°%6G
eHlr/Lf RI 4724/ ,lip.r/,v.l- /et Ale
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Fi4 kent' Co71s-IrUC71101.
Address 1U ('an+al( hur LA LCtYtQ
G.vcier� (Street rRouteNo.) J gcRi^,y
City or Town State Zip Code
(C62$)- 1n2-7- CIOG2-
Area code- Phone number
4. DATE DRILLED S/i�./o1
5. TOTAL DEPTH: 14 S /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Zte
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): . METHOD OF TEST
10. WATER ZONES (depth): /t6
11. DISINFECTION: Type J6/CtT
12. CASING:
Depth
From el To 7S Ft. c' 2(w,05 pia 5-n2.k(
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 02.0 Ft. 0nne-retc
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.
Topo�gr�a3ph c/Land setting
❑Ridge [(Elope ❑Valley ❑Flat
(check appropriate box)
LatitudeA3 ongitude of well location
S Ff/3lI
Zgs/orysz°7v,z43
(degrees/minute conds)
Latitude/longitude source: PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(mina Hi ,x P
7S -It^s
0 tJ
+ Cx
crrx
n
LOCATION SKETCH ;n
M
-
Amount /Sd a Show direction and distance in miles from at Iearse
Wall Thickness two State Roads or County Roads. Include the raxS
Diameter or Weight/Ft. Material numbers and common road names. — 2
EmeVa.ld Pad. d'f Tomna Ln.
Method
From To Ft.
16. REMARKS:
r0.XYvigW Inc
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THHIIISSRECORD HAS BEEN PROVIDED TO THE WELL OWNER
5 NATURE OF P RSON CONSTRUCTING THE WELL / ¢''ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
298566
)~. W& cj CERTIFICATION g3/4/0
WELL CONTRACTOR COMPANY NAME F.1 w So AI We Per/i hi PHONE (tele f%- 'skit
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L9" Municipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT/I�ON:/
Nearest Tow11*., /t% County ,z pp
LneOA l{
Sggsq B#.ifl... r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: kivrl s• X'Sei
Address g9Gc txocls�`iil,U (,(•rde
(Street or Route No.)
P�
1 QC agl I�
City' or o n State Zip Code
( -a41—(I)C{(oB
Area code- Phone number
4. DATE DRILLED 3` 2,4 ' 03
5. TOTAL DEPTH: 3 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L"J
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use "+"'if Above Top of Casing)
3. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated an'or below and surface requires a
variance in accordance with I5A NCAC 2C .0118. p
9. YIELD (gpm): 30 METHO OF TEST OOinaf
10. WATER ZONES (depth): 25.i, 3/0/ 335-
11. DISINFECTION: Type { ab Lets
12. CASING:
Agricultural 0
Topographic/Land setting
0Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
1V35' 33.342' WoIti° c/%. o'
(degrees/minureyseconds)
Latitude/longitude source: 2GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Tirt
(o5 C1iri racte
DEPTH
From To
(00-0
0
Gfn
L
3 *fr.
LOCATION SKETCH
Amount IC) OZ. Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weoi ht/Ft. Material numbers and common road names.
From 0 To /.0 Ft. G. aI.has PurGv7Plat
t
From To Ft.
From To F.
13. GROUT!::! Depth Material
From V To aQ FL caner-6e
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
Tvzired
?YCtdSI Circle
Cand I er, PC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIO STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-Una 3- Z6-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
Noah Carolina - Department of Environment and Natural Resourrcesy- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pprrint) Yr CA e / ik � 14(5 CERTIFICATION #J/Vo
WELL CONTRACTOR COMPANY NAME YGrCo f- n yellDj,/,r^S PHONE (I 41l-9
STATE WELL CONSTRUCTION PERMIT# O ASSOCIATED WQ PERMIT#
(it applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 17MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: // pp /
Ne9rest T n: C.+dltr County P'v^COM le
(Scree/Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / Qtor or
Address P G bt 18
F_n ka sueetor nc ate No.) 7 a$
City or Town Stare Zip Code
(gad)- (41110'-(aggb
Area code- Phone number
4. DATE DRILLED 1st" r3
5. TOTAL DEPTH: qC 0 s /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: VG FT.
(Use -1-"If Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface+
'Top of casing terminated ar/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118. pp
9. YIELD (gpm): ?O METHOD OF TEST alika of
I0. WATER ZONES (depth): t3 , NC)
Topo�gr�9Phic/Land setting
❑Ridge alSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well ocatio
P35°21% b2s' wonnf iron
(degreeslminute econds)
Latitude/longitude source: aoPS❑Topographic trap
(check box)
DRILLING LOG
Fognation Description
rani•te
DEPTH
From To
0-61
(03- Q35
298565
0
(r
Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road 0 '
Depth Diameter or Weight/Ft. Material numbers and common road names. From 0 To 63 Fa6.a5 9)G.!'S P VCSDRai
From To F.
From To Ft.
13. GROUT: Depth Material Method
From 6 To aG Fr. C.CYtr ref-Q. red
From To Ft.
I1. DISINFECTION: Type +ado IAmount 7 fen_
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Frain To Frin. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
-q t'rn
LOCATION SKETCH - cr-
Hwy• 151
Card l era fC
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
«2 -03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Wafer Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298564
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /.e. ,t s , sJc (c.'ge,j CERTIFICATION ,I2J VD
NAME WELL CONTRACTOR COMPANY re Q. Sa+$ k'tfr! �/ ti
./bet, PHONE re2n p) -,47
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDWQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:as-titer
714 /I .ed.
County /LAC amok,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: D.-c es N, moo,*
Address 414 T Ll Li
Vic.
n StrRoute No.)
C44/er V ^fl15
City or Town Star Zip Code
923)- Cod.?, -Roily
Area code- Phone flambe'
4. DATE DRILLED 4 "3-- CO
5. TOTAL DEPTH: 22S
6. DOES WELL REPLACE EXISTING WELL'S YES ❑ NO (9
7. STATIC WATER LEVEL Below Top of Casing: FT,
(Use "t"'if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surthce*
'Top or casing terminated at/or below land surface requires a
variance in accordance with li.A NCAC 2C .0118. p
9. YIELD (gpm): lv METH,QD OF TEST !7h..-;1f
10. WATER ZONES (depth): /e V
11. DISINFECTION: Type
12. CASING:
Depth
S
From 0 To
-1 Thiel-5
From To
From To
13. GROUT: Depth
From (7 To `�()
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
/ Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/lon y•irude of well location
AZr 23.4.3'won°«7gs
(degreestminuteps econds)
Latitude/longitude source: E(GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,p, •,.
DEPTH
From To
0- L5
(5 - 22_5 G-tr,,; fc
-cI a
LOCATION SKETCH ? tf,
Amount `T nt. Show direction and distance in miles from at least r!? c
Wall Thickness two State Roads or County Roads. Include the road 0 o
Diameter or Weight/Ft. Material numbers and common road names. i Z
Fri 'd5 a 1 I .1a5 PVLS,DR' J
Fr.
Ft.
Nlarerial r ,,
Fr (OY7rrr f-o
Fr.
:ctite‘d.N4erhod
Diameter Slot Size Material
Fr in. in.
Ft. in. in.
Ft.
Ft.
Size Material
Tv I !
Card ter, f1C
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
114;261 Lk off
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

ddl
Depth Diameter
From 0 To 7`/ Fr (p.aS
From To
From To
13. GROUT: Depth
From 0 To ao
From To Ft.
Fr.
Ft.
Material Method
Fr. Concreko epom 040
WELL CONSTRUCTION RECORD
298563
North Carolina - Department of Environment and 0.:
Naarural Resources -� Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Veti-r i ltd //�•'!c5 CERTIFICATION#/%
WELL CONTRACTOR COMPANY NAME Feri4Jonl a-e-// . /le,/ PHONE ItniGf'SV'f
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT#
(if applicable)
lit -applicable)
WELL USE (Check Applicable Box): Residential B- MunicipaVPublic 0 Industrial 0
Monitoring❑ Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /p�
Nearest Town: T`*�- tee County .L t co
Tv, SA, eir WW1
(Scree( Name, Numbers, Community, Subdivision, Loa No., Zip Code)
3. OWNER:
Address�7 flcY'r I Ci 1l
0(sh&l1)Q
(Street 11C, or ROUIC No.)
Cay ( ag)- 7.7(o-3��gfp
aSgc
Zip Code
Area coda- Phone number
4. DATE DRILLED '1"7- 03
5. TOTAL DEPTH: ...no
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (�
7. STATIC WATER LEVEL Below Top of Casing: .60 FT.
(Use "*'^if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
`Tap of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): Go METHOD OF TEST "BA"1. ''f
I . WATER ZONES (depth): 200'
Agricultural ❑
!! Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location ,
i
pp-oeir.sty 'i✓oa2 °33.3J-co
(degrees/ m inures�/ conds)
Latitude/longitude source: I$GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-7`/ d;N o .
7�1-265 entn k OTrirn
om
LOCATION SKETCH
11 DISINFECTION: Type '} ail I Pt.5 Amount ci 02- Show direction and distance in miles from in least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weighr/Ft. Material numbers and common road names.
acei25TVILDRaI
14. SCREEN: Depth Diameter
From To Ft in.
From To Fr in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Fr.
Slot Size Material
in.
in.
Material
Twig -brook- Hills
JuyefevI 11C
t' .
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC-2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`'fir, 'X z^ ..�- % 7— D 1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299623
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) nir f 42/4ie7
WELL CONTRACTOR COMPANY NAME Fet-Gt.i Son well lc,tl,rt( C6.
STATE WELL CONSTRUCTION PERMIT'S \J ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
CERTIFICATION i 3c?,,S'�p
PHONE @V 2I (o r,34v41
I. WELL USE (Check Applicable Box): Residential ErMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: L.-LrA✓o.'v;)le- County Ruacnfnb/e
Gs�a�Qc oP She9Anz r.tzncl.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /hod r ,e. t7C27c arm n,/
Address #/(o f(2ZG/mr// led .
,^t � (Street or Route No.)
/y�he!////C 4 C au7S-4/"
City or Town State Zip Code
(fa,- 799 -0/e
Area code- Phone number
4. DATE DRILLED A- / C' 0 3
5. TOTAL DEPTH: 30c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: .Ao 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): ,�'O METHOD OF TEST
10. WATER ZONES (depth): /?eoa9a
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 7 7
From To
From To
13. GROUT: Depth
From (J To LID
From To Ft.
ND N Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G /v TRAM Pvc
Ft.
Ft.
Material Method
Ft. en//Gretee .cr'eci
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 LA'v`alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35AVON*ova/as-5-5 w
(degrees/minu es/se onds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 30 7)%.-f
3/ 60 cA/!A Shsn-L
61 70
7/ ?9
3oS
)3Lu,e lrrea ✓lt
l3li.e 6rnys;Ve L
c
cs
Gm
—
N G
LOCATION SKETCH
Show direction and distance in miles from at least �.
two State Roads or County Roads. Include the road �:.
numbers and common road namesf
85fco, 5 ej .5bcr. d e.
/Jetuaev•//e
n C-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(,zJ 7-/f-o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 98 619
North Carolina - Department-a(Environment and Natural Resources - Division of Water Quality - Groundwater Section
1\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) georgn /C (&i•9C,i CERTIFICATION �� BelJ
\\L'LL CONTRACTOR COPANI' NAA' E ni.e i t4' ,Lai/AT PHONE p%frarr —PVT E
STATE 1Y ELL CONSTRUCTION PERMITP ASSOCIATED WQ PERMIT,/
c lf,cr G:.blcl /'. (ir:1pplicable)
WELL LSE (Chock Applicable Box): Residential ❑ Ivlunicipal/Public 0 Industrial ❑ Agricuhural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It Other, List Use
2. WELL LOCATIORN�•:w-
Near sLTolrn: �'�I &ks �/C County "CCncGhiG
. k 3 Co-t
lsnoct Nanm,:Num Cc(u, Community, Subdiv 'stun, Lot Nu., Zip Codc)
3 OWNER:
Address c € teles clue ?rt.
(Sircer ate Route Nu.l
Weauera'l�Q nc
all1r7
City or Town Suuc Zip Coda
A)- 7s-5-2
Area toac- Plonb number
4. DATE DRILLED '3 -3-03
5. TOT.AL DEPTH: Zf'i —
6. DOES WELL REPLACE EXISTING WELL? YES,❑ NO 0. /
7. STATIC WATER LEVEL Below Top or Casing• O FT.
/ (Use ".'"'ii.�bovc Tap ul CavnAy
S. TOP OF CASING IS FT. Above Land Surface"'
'Top or coitit turminatcd avor belaw IInd surface requires a
variance in accoroauee with 15A. :NCAC 2C Ants.
9. YIELD (gprn): S N(ETH)DD OF TEST lli'af 'WY
10. WATER ZONES (depth): /00 17i s0
DEPTH
From To
-Lf
Z-/- ZS
7S - prs
1I. DISINFECTION:TypeC/°ref.
12. CASINO:
Toprh
From 0 To Z5
From Po
From To
13. GROUT: Depth
From 0 To zi'!
From To
IJ. SCREEN: Deprh
From To
From To
15.SAND/GRAVELPACK:
Depth Size
From To Fr.
From To Fr.
Diameter
Fr. /v./2f
Ft.
Fr.
Amount // 4f'
Walt Thickness
or WeighrlFr. Material
SO.?z/ .Ott
Alarenal
Ft.COnc•L�it,
F r.
Diameter
FL in
Fr. in.
10. REMARKS:
_ [vlcmod
Slot Size Nhirerial
in.
in.
btarcrinl
�Topographic/Land sexing
04Ridge ❑Slope ❑Valley QFlar
(check Appropriate box)
Latitude/Iongirude of well location
(degrees; m inuicsrscconds)
Lariwdeilongirude source: l?CPS❑Topographic map
(check box)
DRILLING LOG
Formal Description
&..J'A•^....
LOCATION SKETCH •
Show direction and disrance in miles from at least tiol
two State Roads or County Roads. Include the road
numbers and common road names.
1es Cauc lam.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, ,AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• ie x% 9-3-0)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original co the Division of Warer Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone Nu. (919) 77J-3221, within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)Dt/V1 L W.ies CERTIFICATION if 7/4/10
WELL CONTRACTOR COMPANY NAME /abed ✓et/ Di.•//•q$ PHONE Pile (an- fz/em
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if. applicable)
298616
1. WELL USE (Check Applicable Box): Residential li NfunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / yy
Nearest Town: Crie, / County ,IheneMrl
r,/,., /.'nX /i•1/f t.f vo
(Street MOW.. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER• .VQVLII �0 El /dins)
Address 3"d-}.P1('1 k.. 5 -j' Treli 1
1. 2&VQ,rvilletor;flut(e o.) c
City or Town Slaw Zip Code
.Area code- Phone number,
4. DATE DRILLED �',-''s
5. TOTAL DEPTH: e `r!"
6. DOES WELL REPLACE EXISTING WELL? Y$ ❑ NO 19
7. STATIC WATER LEVEL Be[owTop ofCasing: yv FT.
( Use "+"'if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface"
*Top of casing terminated atfor below land surface requires a
variance in accordance with 15.A NCAC 2C .0118. p
9. YIELD (gpm): / f' NIET,J-IOD OF TEST P �+✓0. ^f
10. WATER ZONES (depth) //O J4 0
11. DISINFECTION: Type +Ca.1')1 e 5
12. CASING:
Depth iamerer
From 6 To tr Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Ft (oncref e faired
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 Fr.
From To - Fr
Amount 70z
Topo�grr phic/Land setting
❑Ridge L7Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/lon 'irude of well location
P 3,r' 0.30i' V ore 33.0i'
(degrees/min_ure�econds)
Latitude/longitude source: e(GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-Yf A., tF
3S-2yr tie
0
0
LOCATION SKETCH
Show direction and distance in miles from at lei
Wall Thickness two State Roads or County Roads. Include the r
or Weight/Ft. Material numbers and common road names.
e 1(o lay PVCSDRQ
Twcn 3v00k WIfr Lb±' a
Supi tev l7C
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
EttitN x / - 4/—r-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'ti R. bil/nri3 CERTIFICATION #7/tip
WELL CONTRACTOR COMPANY NAME "'ft+f"nl ✓Li, /�/////hs PHONE »}r2K GYI - C''/VF
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
288615
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tower Jac {.'ems County d»^,o„+ 4
AR -on er bei/f `a -' v 7?
(Scree: Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER Cr y(/it ✓
Address 3a r112,6rk 2;,-55 7r�,r: /
G(/C��er!'Ulletor12/ NC) a87P/
City or Town Stitt �N� Zip Code
pp9)- lvVS= 5P61a9/
Area code- Phone number
4. DATE DRILLED ci /C- 03
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+"'if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated auor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. p
9. YIELD (gym): 2- ME ]{0D�F TEST r!1 /Nr
�
0.4VATERZONES (depth): "
I. DISINFECTION: Type (/cache_
12. CASING:
Depth
From l5 To /t`�2 Fr
From To Fr
From To Ft.
13. GROUT: Depth Material Method
From e4 To 16 Fr ran eret ?att.-d
From To Fr.
14. SCREEN: Depth Diameter Slot Size Nfarerial
From To Fr. in. in.
From To Fr. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fr
i
Topographic/Land setting
Ridge ❑Slope ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
N 3f ° ig-, 3oz' idbre33.3/CC'
(degrees/mina siseconds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O—/oz ,a
I O L .. 50S ��..- •,,e
tJ
0 O
LOCATION SKETCH m
tn=
Amount /teiabs Show direction and distance in miles from at teams.? �"-
Wall Thickness two State Roads or County Roads. Include the roam "t
Diameter or Weight/Ft. Material numbers and common road names. 'D 2
b Xe d/le 1s5 PI454'e1 /
16. REMARKS:
/3-2°t /:,-I/S
-Su pile I, /Y -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TF}E WELL OWNER
ez, 1 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298610
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources --I Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) Abby �/ r P1 S CERTIFICATION # AOa
WELL CONTRACTOR COMPANY NAME f*C92LCdA/f Wee Lit//C� Co. PHONE al 4)-95/41
STATE WELL CONSTRUCTION PERMIT# • ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential fY 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: 13
`-
Nearest Town: BLac/( 440CM4b1p/County /3.r betinc».
S/cnd or n c.ti lad 2 ether ip..
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code;
3. OWNER: RGa-55 ):::;NFoF
Address 032.26 cendIjeta .,ea, %al
(Street or Route No.)
Z a.cl 12/42/. /7 C .18 ?//
Ciry or Town State Zip Code
(gdy- a43-/oa9
Area code- Phone number
4. DATE DRILLED g4-O7— a;
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL'S YES 0 NO IY
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TESTD/otOfeyne
10. WATER ZONES (depth): 70
pographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of� ell locati n
Njs° .a3.Ylrf/AJs Aida'
(degrees/m in u�sneconds)
Latitude/longitude source: VS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,bhit
Ac tie AY C.
DEPTH
From To
0 — Y7
vf— 31r'
11. DISINFECTION: Type *eb/C, /5
12. CASING:
Depth Diameter
From._&_ To ram_ Ft. LrdS
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From_Q__To _ FL concp4c �yn/,tf.
From To Fr.
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.
6
-r
N T
1
LOCATION SKETCH tV
Amount /V Show direction and distance in miles from at leasi
Wall Thickness two State Roads or County Roads. Include the romp
or Weight/Ft. Material numbers and common road names.
1/4tMs Pvc sbA;/
16. REMARKS:
nC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD ND THAT A COPHAS BEEN PROVIDED TO THE WELL OWNER
ERSON CONSTRUCTING THE WELL
G1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

298607
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource's, r-Divisio of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL-) NAME(print)1?0b� 1/ W r �d7/s CERTIFICATION #ZOZS
WELL CONTRACTOR COMPANY NAME Peg (130Ns (MQfl pull )4,9 `0, PHONE SAS) eV—`?r/f'9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/4
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: -/
Nearest Town: TCct'a4/Er Coun Fonct."rbe
(2S'/ ✓K�hce P'L.'5-rl-
(SVCCI Name, Numbers, Community, SubdIVision, Lot No., Zip Code)
3. OWNER: &?//:a,rn tea/Ac,r
Address Cain Sac-ste-e r.�d
(Street or Route No.)
C
City or Town State Zip Code
(t2J)- (P
Area code- Phone number
4. DATE DRILLED 7/Gi05
5. TOTAL DEPTH: Y S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EV
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+•• it 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 aoeordanrle with 15A NCAC 2C .0118.
9. YIELD (gpm): 2/2. METHOD OF TESTS /0t4),, /'
10. WATER ZONES (depth). /74
LOCATION SKETCH fi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topo is/Land setting
❑Ridge [slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitud�•e 99f well location •
jJ3S°V,i5? ' inzW' We
(degrees/rinutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(VA, -
DEPTH
From To
6 —.$
V - 1/6SG-,anittc c
n
n�
1 Crll
y in
tV ern
�G
r
3 �0
N
11. DISINFECTION: Type froi/t P'j
l2. CASING:
Depth
From 0 To .S Y
From To
From To
l3. GROUT: Depth
From 0 To 7.D Ft.
From To Fr.
Amount /S otY
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6,XS 7,4,145 pot Sp2AI
Fr.
Ft.
Material 2 Method
QOncrC1C 40/'/ny
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
66/ % se, eaQw:scse/2d
CaG,, 4/c r n C
l6. REMARKS:
t 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
SIG
(ot P
ATURE OF PERSON CONSTRUCTING THE WELL
DA
E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
O

�c To: NCDEt of Ennd Na Resour
r 7:me: 9:3634 PM
280448
WELL CON STR,
Entaronenenr, and Natural Resource
._ .0 (-.`SDI\ ID ' +'.) NAME (print) SCOTT
i,i.I. C'GN....0 OR COMPANY NAME CAROLINA \VEL'
`..LT , _.- :_. _ _CTIO N PERMIT#
30{e Rm i1esidentiai ❑ M.nic.]-.
-:eat Pump \Vater injection ❑ Order
C. n'y
M.
Slot Sir 2.Laerv.c_
ASCf)ASTRti 't ;,
COPS OF THIS nt. Crt
.0NA1T:ECF
of if 1 Qe-,ity, Grourdtcate' Sc
') 733-37a,"_, o:iihin 30 days.
i ti17
Quality Ground\.
CERTIFICATION
NC. PHONE # [phone]
S ;C I t TED WQ PERMIT 4
(if zppiicable )
Agiculru:ai �,. ..
Topozaphicianct sci1
Li Ridge ❑ Slow l
.,.3-l:ad&Lon2itude cfn-311 iecati,..
35 29.105. -
>•105'. r Cr'8 r -
be
300
e
LOB:.TOR S'{E
Cc
r. roar: n`a-:_
":nl SA \ CAC 2C. AiPl.I.
iDED TO THE WELL CY AEd.
Dsc
akigh, NC
C-

WELL CONSTRUCTION RECORD
- Department or Environment and Natural Resources - or Water Quality t Groundwater Seek()
%NEU ( ON I R O. I OR (I N \ IDUAI 2, ;ME (print) Label- Ill, CERTIFICATION 7(43
PRON VI) (413-91C3
\ ( A 1 It C OMP 0.‘ \ 13,-,F0_
01.ittelo
,1 "! c
‘S'101. 1 I ED Q PF.RVIITti
lit icaElei ( .1)3 »iicatil:)
28042,15
WI:- Li_ LSE il..ilieck.Vpplicable Beri: Residential W NIttnicipaliPriblic 0 Industrial 0 Aeritultural 0
Nlotittinine Rtivevery El Heat Primp Water Injection 0 Odinit Li )(Other, List Use
2 \V LILL LOC Firriv•
01-1n (. Lititv .1114..CC
ICt-1 21P Lfe Colic LitteeS_
N 14-- 000-400A Suhdols.cn Lo1 ‘11, C. ode:
OWN1R-12Air.if
to zo • Wilt" EsC
*LI 1
l'30 0 Zip Code
Topogniphic 'Land setting
0Ridge loot: EIValley DPhil
check :Or f0714EC box
LatillIdC1011g1R1d..!
2_22
Olegrces usocio; sec:00/1.s;
: Itudk IongitHe sottr..t: DGPSO ropocraphre map
The, bcs
OLP Hi L)RII LINU
Elton) To Formation L),!:c notion
A re...vslo- Phucc bunt.....jer
T. DA1 h DRILLHD
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO F.' r.
7. ST A i iC WATER LEVEL Below Top ofCasing: It) FT.
, Use Abmc Top o1•C4singi
S. 10P OE LI:\ SING IS 1 f Above [. 30:1 Surface"
'Top of casing termihatcd aror 0.CIOW oar surface requires a
Nai Lane,. in accordance '0 Ili 15 k 'CA( 2C .0118. r ,
9. 'MELD Timm): 30 METHOD OF TEST a i • Cc-A=1k_ _.. _. ____
WATER ZONES Blentril: ttsa
! ! DISINt ECTION. Type Tfte-h\ RA- Amount L.
2. CASINO: Wan Titcknc5s
Tkpir Dimircier or Weight Ft Maiet0
Ftdni_o___ ro 57 Ft.
. row To Irl
From 10 Ft
I T. CROUT Dept el Material Vlenied _
Ft
rots 1 To
1
Vkaict 1:11 2. 1'11 k i 1- N 11L.T,11: E)13111VICT Sior S'.1.0
F1010 1 0 Ft in ill
1 roin 1 o Ft In in
i 5 SANDaiRAVEL, PACIC..
Size 1)err ti N1aletial
.1- 1011 1
1 t,
[ I 01•1 .. .. . I ir 11.
I- t
L OCATION SKLTCII
Snow dm:Lillian and cii‘tonesi In milds t
o Stunt Roads m Court' Rords Incinde the road
s :Inc' common road
HE:it'd;31. (El
ONSI?W''
HAT THIS WELT WAS CONSTRUCTED IN Al CORDANCE 1111 I5A NC.AC 2(7, WELL
F.ANDs RDS. AND -1HAT A COPY OF THIS RECORD HAS BEEN PRO\ iDED -10 THE WELL. OWNER
CiNATURE OF PERSON CONSTRUCTING THE WELL. DATE
Submit toe or' ral tu the ()iv ision of 'Water Quality, Groundsv ater Section. I 636 Mail Service Center - Raieigh,
CW-I. REV. 0.7 .200 I
276i/9-16.10 1'
pm; No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
Nuu1h C":Irolm.l Oaparlrl;-nt of Environment and Natural R_sol tells - :iic ,son'. f Water Quality - Cn-oundAVater S cticc
tat] I. cos/ta_U IOK(IsV(\IU1111A.AVIF. (punt)
\L1 C ONI \( itlli(OUP \\, \.\91F:
1 r \l 1•. \\ P; I.I. ('i., \>I I l'C'17 U\ i"F: H)I I n;
sarinsterammitheliesmairiturrom
v bLl_ ESL Kilda!: AL ,I ca tvie Uov Reent- :lai leeefvin ucil.;a h•bllc ❑ Iuurt 1a! 0
:sIdntItasitt.t I' Kcco; .l . [7 Heat I a'np AVatter I Ic:rnn ❑ Other ❑ II Other. List U3r,
z'tiJ��1
280428
(172,
_A 5
ft;9.
vccv fie .
.; low• Jlnlc' rlp
- SSOC1 Yl -4, 11111'B.NVti7n`"�
ah',rl
0. .:,cl".halal C
E(I 0 aph1C L,1 llt V [(1' h
01<idge EdSlope ,JA vI1:y
tette.k.ettestivas bus;
:_al.tLd Iv tg,itatl _ U AAt a !octal:, n
stettcees int stsmti,..r
La 11\IC I. nritni outer' J I vL]T 0 Ethic
00:1, b ,.;
11 .l 11! IDRIL IN OCi
f=;uu To t ornlstion (ln.: npudh
-I U I E DkI1 I t D L U_- 0 �__ -- -_--
H �'S `
-
0 1 It S 'WELL REPL A.C.7E EXISTING N ELI.' 1 ES 0 NO ei
r s;; ,I IC WATER LEV EL Belo.. ltp ofCasin:li _ r;
1Ce no, (mr,E,
,, 1 UP r1'` C.\ i' ( IS _. ' t.
tt-tict11 cAsing r rn mated at ur below Tana surfacerolui a —
U11H1 )�1,11 -S] vFTHO )�Uv Ti:S I((��RC_I_. _S
a(.eh !rtlll yC_,u in.\rdl \ wirhl \\CAC'1c 0118
:UA 1' v 7i)L t (.nth)�
L(r(AIil)N sKEICli
DISINFECTION Type 1 fl%� Amount T Shott dtracinen and disttinec in miles; hl ai t I-e
12 CASING!.
1/21'a!: I .eldest, cast stars Roads or Count Roar.,. (n: l_; d the mad
CJ
Depth D.Snbtcr or At hCR 1 rlt hclaorta-non road ranms
v
I1net Tok1.-
I O P t 1 Depth fei NI. terra \ lc! ' ....
F1 1 1-1nt r' 4.I,b`L
1 1 To it --- --- -- ---
I:, t_ F I - A Darnl, ivinstc S o; 0 P1
!'term ro___-_ l'I _.----in In'
L 1 Ir IL;
". t 1.--____— III —.._.. 11).
15 S V'l11 GRVA1L PACK�
i; RE RI A R. k5'
taur td 1:13'r' CLRI 11
5',zt
1.
I
11;usridl
2/0
t9' Z3
as-r`'t&
yNke - t 1 c-t k\ 0 Pc
11-I:1d1 THIS AAEI( WAS C( .vfFICFI) IN -1_ L°RI11A(6 WITH 15A NCACICV.ELL
)ARD4, AND T}i.A f A COP T CII 1 H15 RECORD i1A E EN I 'KOA DID TORE 11'E. 11. OWNER
51C;
st1)FPLl. SON O ONS LI,Cr4'vl, I1t! I"y[i1 I:AII-
Submit the oril„ uu 1 to the Di1 {SOH of Water Q1r:11ity, Grounrly,ater Section, If,Jn Mail Scrvlce (cuter- Raleigh, vC
2;509.1(136II r Ni 019i711-3231,vl ithin 30 days. (PA -IREV .17:1%01

\•st LJR 1\
WELL CONSTRUCTION RECORD 280427
Nor 1 C 0; hod zl,arm)enl of Environment and Natural Reest uces - Div , on of Water Quality - t iroundwa'n 'section
VAt1I 1uV'lit Vl II1RtlAlilAI11141.I AAI,,II(L (print!_L _ _L CFRTIFICA'I t(1NV Z�Q3
ttEli (' to. /4t ( ,/It(0.IPvAV A.AvIl:L'3 6
' 1tei.�. , I. �..8�:- V��VMf°NO[F a V`� 1�Cr � ��
?I\1i',.hI I I, (1 l\r. I I: C C I IV\I' F, N\I I' I' 4 ASSOC II 11, I) V, Q PF-RNI IT/�
( I' ar; tcab1:1
'OItlldelael/o111rrasemz111a®ililrimi
VA -Li. 1. zt:. il. h-ck .vrplt..,L'Ic L10x;'. R _idcntiat Ct/Nlunicipal Public Ll Industrial L-J AL.ricnhural 0
C ll^.Ilnth [ 1 it ch. tochi, 7 H.cat Rump Wluir injection Cl UiPlel O II Other, I I,I lisc_.
_. Al k I irlC vT. N'y����/
'st 1 Ili QY,4LY SColllll)ci
-
2.1.411‘
syeutt c... a '5
in Ini r'odCI
lopog apliic-1 rnd setting
(1'idgc OSItiou ❑\ tk'y ❑Fl:u
ichrek - I
_atiiudc lul iinuic CIE lacacrr,
I)\\\i:R _. ..
1d ii �- M 9 ._. C..._ 1_3.7 Lpi1t L)IL Il ilE�inldc, I: c'L�( ISL, fupt I lu; Wrap
CSsak
•�` rI Cfc\
A&lj t.. DR !.LI CrICCi
IIa: Zip Cour I rot' Tu I I,t.rtl.r, Dr.: ipGym
Ai Jr- Pho mlhe i
_- TUT AL. DLPIH' t Qr---� --, I2,1
-- -----. f- --_
6. DOLS W ELL REPLACE EXISTING W EI_ I LS El NO i
Sf,\IIC WAFI:I21.1- VEL- Eielov. Top ofCasing.-_ Q__e T.
ILs= IAhplcf tnelrgt
-- --- - -
P. ICJ) Ot CASING IS _ 1 F T Alio:'c I_arch Surlace• —" --- ___ C..0
7 H ( easing to twinated altor below sand t surfat rniulres a
mitotic in 'e with 15\ \Cb\C2C .0118 a — .. — _- __ __.,
tlrl ), [gain ®_ vt THO)OF fisi 1�,1 [IIC I 1
?II A\ -1 I.I. /O'VL S ld(pd.)'. _�140 --r
-- - 1_9K Al ION a! 11_H, L__.-
'I )IHI Ni EC !I ) Th-he ��Q, y Amount T.— Sho rcuon 11ct inch: Ir _r. nIIi1n 11 ii.
17 C \SING' 'V L Th ckm s 1+vo Stara Roatl t Cou,.t Routh . (n;l iIEC I .
C)Ajiti (Dft.-Meter or AV _ - l I F- Ma ..I ntm t and cC 1o.A road I191-1C4_
-. I...1l. iJ I c._0„,,,-_-j Fr _..__. ' .Zts
I ho, i le h i iCI - Z'S
IJ-' hU f UPth Nl..hherI vlun
I t L'Sp.V,r{t_ �_L1.\[__ Z 5• c
I 1 I' ov.�tCsL110 O1 r o
I >(. RI. FN. Depth Diamttc S.or S.,ie Mal r..' p .,
I I' T,• It in an gT'
Qri�.� i L�S4-� —�i n 1
f , co in I --
.
1` SAND (IRA \IL I'\CK0 - EH
pcp'n S'.ze iAlalcndl —"ice
7' m
I t,nn I 3 rn
Fh.r:I R`_-____._ I .
1. = cn:
r-1.--,:
0
— --I
2
IDVrL ItLEV CtI1ll!'Y 1HAf fil;SWELL A1 AS CONSTRUCTED IN AC CY)It DANCE WITH 1^A NI, .Air WELL
:'list/ IRE( T '\ S' DAB :AND THA l A COP) Cir THIS Rk:CURD IiAS BEEN PROVIDED TU •IHE WELL OWNER
• Z•03
(.11. PERSON LONST RLC TIRO-1 H L: WELL D 'F.
Submit ItIe °rigim,+ 11. the Ditision u( ‘\ater Quaid), Gruundisater Section, 1636 Mail Ser,ice (.enter- Raleigh VC
:7699-16}n I'hunr N i.1919) 733.3221, within 30 days. (SW -I REV ) 200!

IN III 1 CI \ IR1( IOK i.IND!‘ WI Al I N. %ME (prtori___11.-AtVi ---.S
\.LI I (0\ r R 1.( 111R I: 011R \ 1‘ \ 1"1 ‘,11.
Sr 11, V,r1r31.30‘1111.: I 11V% PIRMI14 _ SSOC; I ED l% Q
I 1L ,( \IT5I.0 Resitiennai l'u5k fridis.Y[ritd LJ Ajiu.,Dikutai 11
IIVIITlr Pump ailer (1) ()1;•1:1 Li 11 L
11 434 \ IX/ 1/3 031111:3 4.14s)ka
• \ ShA)‘. %(ThZ6
N pp, "I 1.111" SI„Thenl, 0111 Lai .11.0 ) 0211,1
Topographic. Land selling
.„„,, -Ed Koign 0Slope C-2‘, PETI;JI
.0ilitucic,kTgi(utio or well Ic-c....qikii!t
OW:\ LH
S&):Si.),1%••• Littgb:“ seconc1,1
SOilictrt_JCIPSEIT:priop-,pitiC ;ii 11‘
eatY‘4
1 DA DRILL. FD 21,1):
OLP 71; Code I 'in 1 Li 1-0tinatiurl; "
•
(}
-
DrpFl111
i DOI'S 'A i:L I. 1<E1' PI AL'I'. [XIS TING \VEIL? YES 0 Ni.) Fr ------- - - 1
7 ',I- \ ; I( W.A..1 F.. R I. i: V EL 1-1“tov, Top 01Ta73ihg. LI FT
iLse", '11 *,i-v; Top of ( atgrig „-:
< 10P Cli C 2,,Si m , is t .I. Above Land Surfai*
WELL CONSTRUCTION RECORD
280428
N001, - Jcpartioc ot En. r(ninent and Natural Resources - :),('or or \\inter Qualitiy - Citouilioater Section
1,.fiTIF10.1A1 ON 0 raila,_3
ISJ 'cs t \ E 4 (4.134ZZ:a
l:w1l"1po; f t.a:sin
g
t:D11 rm,:itn
:PktaHt,d a__i_tflIur.ii.FfF.n
b.t1,I
lo...1D1n.St:.:i1MIoF,a).l,VAi,.d r.Cs2rurilrfAsecI,_e
requir,.eiksll_a
e
nee 1;1 Jctortaic 11th 15 NC A( 11 .111eri V_ic.Hi tloti
.4,
el ,
-,--.7YI-1 FI0)OFTESTQ, „)Vi6•
0i1/4S
___.-_-_-". _1
.(._5•c
:._ ,,
1.2_E-cm:r7__
-"-7
W.AII7(N10CAT10\,ECIi
--7C--( rr3t1 - z3t
1)NIN,b(1I( ): Tie0,AAmount s,, itiCIDLICkii,C: 1 11LN Titf.t
12 VaE 1111cnes i‘o 7112L,:-cisorCOuf:, Rrads nclu:12 rer
or V.ht Ft yaer 1 111111)CS 'nd cenn(. r0
i :Ct .i51 (-
:a al/A-
;,,: ,ti,),„,,,e, sio,,. Iser L
III In
1hi III
U. \\F(iR \VeIF'ACK.
33,
II•ze HI, !J i;.• I I „I
Ni
i DO itiiiti-.14•4 C 111 I IF t Iiii \ 1- j.„HiS \.\ EU WAS C. ONSTRa TED IN. AC COR D,A V 'E Willi 15 A NCAC 2C, WELL
1.11‘.r1?: ( . " iii i 4.4 N DARDS \ \ D-1 - A.T A COP 0!- THIS RLCORD ii,\ S t3EbN PROVIDED TO THE 41, EL . O,l(NER
4
(1- • 03
Rf: Phi<S0 LONS 1RL 1 till DATE
Sulinar the ongt ntl to the Division titer Quail'', Groundviater Sei lion. 1636 Mail Ser‘iie ( enter - Raleigh, NC:
2769'2 6 ttili,.w N(0919)-113 3:,,Z I. 30 \ :2001

WELL CONSTRUCTION RECORD
N
orth Carolina - Department of Environment and *r+ i Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (prtat) 1:5 i L I_11,
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL
'g0Li31
t-g 1
- Division of Water Quality - Groundwater Section
tsASN CERTIFICATION/ a77I
DRILLING, INC PHONEQ?(8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential &( Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 0-At‘) f U21Z county n;Cvn-.(3
ALG5E .r WARICE& ,ZOfID
(Street Name, Numben, Community, Subdivision, la No.. Zip Code)
3. OWNER:
Address
4.
5.
6.
to(Ke R.1 Rea.)QA LL
(� o . (So)C to I --I
(Street or Rows No.)
CArJC)Leg t3 C
ag-i, 5
City or Town Slate Zip Code
(n )- (,C,1- 3t419
Area coda Phone cumber
DATE DRILLED ° I' D 3
TOTAL DEPTH: q- I o
DOES WELL REPLACE EXISTING WELL? YES 0 NO 64'
7. STATIC WATER LEVEL Below Top of Casing: 2- O FT.
(Use `+' if Above Top of Canna)
8. TOP OF CASING 1S `� FT. Above Land Surface•
*Top of wain[ terralaated Woo below land surface require a
variance 1n accurdaan with ISA NCAC SC .011i.
9. YIELD (gpm): 5 o METHOD OF TEST KI 6 A 12
10. WATER ZONES (depth): 33 90 - '6 o Ger-•
DISINFECTION: Type Ikfl
12. CASING:
Depth D'u9eter
From a To o Fi. �'/Y
From To Ft.
From To Ft.
13. GROUT: Depth
From -S To a 0
Amount 1 ( 6
Wall Thickness
or Weight/Ft. Miderial
Sokol f c
M;;crisl
Ft. Etc,/ e,r3T
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in. -
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QFiat
(check sppn,priatc box)
Latitudc/longitude of well location
(derrecern ieutesh«mds)
Latitude/longitude source:❑GPS❑Topographic map
(chat box)
LL'P_TH DRILLING LOG
From / To / Formation Description
d - 1 S 04 ,z(&;)2Jed-)
'15= 3ao ' Gil-4N,T�wrtiTe 6t'c/L
301 O 5a GFn-.
-SctDe_ 4 io c, ayz,'1"CC
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.
5 o c
S� T Mwit CGn(41 a
Method
pe vre_ h 114
Slot Sire . Material
in.
in.
I7'
16. REMARKS:
I DO HERESY CERTIFY
—`CONSfRUCTIOW SAAND,
MAR
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRIT 15A NCAC 2C, WELL
"-'S, AND TI-,gt 1 A COPY OF THIS RECORD HAS BEEN PROVIDED TOT/ WELL OWNER
Y1 WELL OWNER
SIGNATURE O PERSON CONSTRUCT1NG THE WELL
-SubrItitiht,orWal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone .oE(919) 733-3221, within 30 days. G W-1 REV. 07/2001

280432
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'J) L l.. I E e- AS I-t CERTIFICATION E
WELL CONTRACTOR COMPANY NAME _ REUBEN CALDWELL DRILLING, INC. PHONEEI B )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ TERMITE
(if applicable) / (ifapplicable)
1. WELL USE (Check Applicable Doz): Residential -I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: WEAN) RJt(.t € County gv,ticzM�E
et A eono\ �C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: A a2.c4u ODin" on5,,S
Address 13 g M oN r c 1_� C 12. 0
(Street or Routs No.)
WeA\Jef-OttLE Nc a81&`7
City or Town State Zip Code
(83-8)- 1045-- 5615
Ana coda- Phone number /
4. DATE DRILLED of /I a10 3
5. TOTAL DEPTH: .3 1 o j9
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO l(-i
7. STATIC WATER LEVEL Below Top of Casing: $ C) FT.
Topographic/Land setting_
❑Ridge ❑Slope ❑Valley [BFlat
(Mack spprvp^•l• box)
Latitude/longitude of well location
(devua/rnimnes/sermds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From- 1rmr�t
To / Foaation Description
tiS0 046gAusLouP
Ko'— 3.qo e Gaft GRAto1T6
' Po'- 3a-a hTcf «ocIL-
3 Ao' ;!_a G pry-,
3a01- '310' Goo-IkTG
(Usa "s" if Above Top of Cuing)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
Top or cuing terminated aIor below land surface requires •
valance In accordance with ISA NCAC IC.011S.
9. YIELD (gpm): 0 METHOD OF TEST Q(e - q OIL?
10. WATER ZONES (depth): Sao' - a C) Q fT
11. DISINFECTION: Type
12. CASING:
Depth
mi Fro.To S 5
From To
From To
13. GROUT: Depth
From 4 To 3,0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
NTH ciolu
_.1.6_.REMAJ4)€S^_
Ft.
Ft.
Di ter
Ft. b
Ft.
FL
Material
Fi. CA; meNT
Amount t h..
Wall Thickness
or Weigh tFt. Material
S to—at
Ft.
Diameter
in.
in.
Size
Ft.
Ft.
Slot Size . Material
in.
in.
Matcnal
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road c:
numbers and common road names. o
O
n
a ,
z r.,
r3 — o .-c
-
/14c D
—
BETt.EB1cC-ERTIFy"VAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE watt 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
--I
Submit the origin'aLto the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No.4(9W
SIGNATURE OF PERSON CONSTRUCTING TITS WELL
733-3221, within 30 days. GW-1 REV. 07/2001

4. DATE DRILLED q/rl o 3
code Phone
2 O432
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Manual Resources - Div sion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3iL-t-1L n1ASN CERTIFICATION a l-(I
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC;. PHONE (1g 1254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
ASSOCIATED WQ PERMIT,
(ifapplicable)
I. WELL USE (Check Applicable Box): Residential LI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 51C/t_A ti i)
C3 C (L C e .
n
County '1'» ccrh(‘;C
iN C-L
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: . (v(�n/
Address 4 ik fya 2t� —
,/I ,, (Saxe or Route No.)
Ige aeRcv
City or Town State Zip Code
CIS"-71T
Area
number
5. TOTAL DEPTH: .- 3
Topographic/Land setting 7-
❑Ridge ❑Slope ❑Valley ciFlat
(chart appropriate boa)
Latilude/)ongitude of well location
fD,B (desreeahnie iestsocmda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO 0
7. STATIC WATER LEVEL Below Top of Casing: s3v FT.
(Use `+" if Above Top or Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated War below land aWare requtru •
vdanu I. accrdsory'wttb ISA NCAC 2C .0118. pp
9. YIELD (gpm): `f� METHOD OF TEST RAC A I (21
10. WATER ZONES (depth): A 3 - ' 4 (:0 M
DEPTH DRILLING LOG
Frgm / To / Fomrtion Description
1 — 5 "rx,it. „.(-193Lti
3c ' 4 / Gp,
3-3(2 '— 4 3,' C-,:17( C%2r1�, re
11. DISINFECTION: Typc 11/4I I i cl�` c Amount
12. CASING: Wall Thickness
Depth Di ter or Wcight/Ft. �°
From To 5) Ft. (7 Jr9g 31 f V
rial
From To Ft.
From To Ft.
13. GROUT• Depth
From .1 To 00 Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Material
u t:1,v -
n Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From Ft.
From Ft.
Depth
To
To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. a `"'
-
3/4 M
•
a tom`
o.=
mc.
to
m
G
us I - a*
1 Da HEREBY£ERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS* AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
. a)2 c 7 ( °
,SIGNATURE OF PERSON CO TRUCFING THE WELL DATE
Submit the original to the DI jslou of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733/3221, within 30 days. GW-I REV. 07/2001

STATE WELL CONSTRUCTION PERMITS
fif applicable)
298659
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesy-.D'i/vision of Water Quality - Groundwater Section ��77 ,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Y6n 1. to nE,f CERTIFICATION #?t' /q
WELL CONTRACTOR COMPANY NAME Ore 'f.t3D7s woe Pe iiin5 PHONE C%IYt 673 - 7W1
ASSOCIATED WQ PERMITS
(if applicable)
I. WELL USE (Check Applicable Box): Residential "Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Ne rest Town::CC) Ter County Awe) e.» IC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Alcove.. I-(_JG1t5
Address 6 to 1/0 s
(Sams or Route No.)
!f/tdcv %1 C. aZ8705/
Ciry or Town Stare Zip Code
faa )- aS. - a33 si
Axca code- Phone number"
4. DATE DRILLED '/'2,2'O3
5. TOTAL DEPTH: 20S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "t"'if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface"
Top of casing terminated atlor below hind surface requires a
variance in accordance with IiA NCAC 2C .0118. 7�
9. YIELD (gpm): 20 METHOD OF TEST Of°«'%0f ' A
10. WATER ZONES (depth): I>Da
7 Topographic/Land setting
6I1Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
Nbr°yl.y3S'were 3S,7O3'
(degrees/minutesiseconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
no 9—
DEPTH
From To
0 er
79 -' Z r'
11. DISINFECTION: Typer/e,€its Amount alert,.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 8r5 Ft. G 'Ai i!/C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To ,I n FLfotatete pate-ct
From To Ft.
19. 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.
0 CI
LOCATION SKETCH
Show direction and distance in miles from at leso
two State Roads or County Roads. Include the Ie`add
numbers and common road names. —o cc'0
ri
Z
refol✓14dsc.�/2.
cw'erz..
,
J_A rn
_ r•t
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
14c ,..� 22 - 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Norm Csro ina - Dcpalunencor Environment and Natural Resources - Division of Water Qualiry - Groundwater Section
CONTRACTOR'ELL CONT�CTOR (1ND.A I\1DUL) N.aAIE (pritir)A41 X bd. ;se,
CERTIFICATION B 7"1/442
14ELL CONTRaCTOR COMPANY N.AA1E Flit .r.7 t ester PHONE j-Zr r-- PY/ts
S'L.KI'E W ELL CONSTRUCTION PERh11Tri
iiL:orlie,blal
ASSOCIATED WQ PERM
t.I0 plicablel
WELL USE (Check Applicable Box), Residential (21<vi unicipal/Public ❑ Industrial 0 Agricuhural ❑ t`lonuormg 0 Recovery 0 Hear Pump Water Injection 0 Other 0 it' Other. List Use
2. WELL LOCATION:
Nearest Topye: e{/cel Counryf+'r'4c .k
Pe'%'- rfzhs e1(1034
[Barr Nanm, Nambcrs, Convnuniry, Sub1{ioion, Lor No., Zip Codc)
3. OWNER:.L7C.4,1/ • tLJe4L7
A dress Ro. 25ox 3'S7
(dote[ or Route No )
Ze, NC. 2275/8
up or e»Tn Slim Zip Code ) 4'83-9/59
.Alta LJac- Phone number
4. DATE DRILLED q '23 -03
y. TOTAL DEPTH: 2 Vr
Q. DOES WELL REPLACE EXISTING WELL') YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use ":' lr.lbove Top or Casing.)
8 TOP OF CASING IS 0 FT. Above Load Surface-
'1' p or as sin; rcrminsmd aVo r hcluw land surface requires a
vat iuuce in sccorcLi co with lid NC
AC lC .0118. y�
9. YIELD (gpm): 1tt METHOD OF TESTMrn-43
Id. WATER ZONES (depth): /O•e ///- r
Mr -
I. DISINFECTION: Type t6n'6 Amount 1 MS
12. CASING:
O Depth
From To CZ 'F
From To Fr
From To Fr.
13. GROUT: Depth tvlarerial
From'-_.. Tor Ft.�o.e. _
From To Ft,
14. SCREEN. Depth Diamc mr
From To Ft.
Wall Thickness
is serer or eihrlFt. Material
r. *at- .f /1�2 / �G
Slur Size
in. in.
From To Fr in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fr.
Mcrhod
deli .Or;•1J
Io. REMARKS:
Ma renal
299658
le
selling
0 <idge ❑Slope ❑Valley ❑Flan
(check appropriate box)
❑twit1 longitude of well to ation
ST Sr r/4 ' t-'a—n. d0. ?it
(degrecs:min uutesr�sc'onds)
Larimdeilongi[ude source: L7G PSDTopographic map
DEPTH (check box)
DRILLING LOG
From To Foz11ation Description
0 - 77
- Sz
Sk-sarsf--2 c
p V
r n a
- am
LOCATION SKETCH
Show direction and distance in miles from at lets)
two State Roads or County Roads. Include the rgfid ?t°
numbers and common road names. Arn
o
rn
J G
new gtuvci ESAvieS
LeCeSie121 /`c*C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• 1' W
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL �' DATE
- 03
DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 MAR Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days.
GW-I REV.07/2_001

STATE WELL CONSTRUCTION PEILMIT#
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (IND/1,1DUAL) NAME (print) •In• 0'1 F. W;;;LS CERTIFICATION N.7/r/`J
WELL COiNTIt4CTOR COMPANY NAME tC'p. °Jn S (.-e /� ��'�F PHONE O wn I- r-vrc
ASSOCIATED WQ PERMIT/it
(if applicable)
1. WELL USE (Check Applicable Box): Residential L9' MunicipaUPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: I(#CP y
5-112wfb C&eel, SA
County riff .ncw5 ,,r,
iSneei Name, Numbers, Community, Subdivision. Lot No., Zip Code)
/
3. OWNER:CAA/Ole5 re;&Nee
Address Tj.o 3°1. '%\t
(Street or Route No.)
�iCeJ� C
Ciry orT wn Stare
.Ares node- Phone number,
4. DATE DRILLED Got '27 - 03
a� t 4'
Zip Code
5.TOTALDEPTH: 2 I�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "r"'if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top or casing terminated arlor below land surface requires a
variance in accordance with ISA NCAC 2C .D118.
9. YIELD (gpm): e• METHOD OF TESTJID•-•'I/- "eS,
10, WATER ZONES (depth): 220
I I. DISINFECTION: Type ('ale: .nc
12. CASING: Wall Thickness Iwo State Roads or County Roads Include the road rn o
Topograjihic/Land setting
❑Ridge (Slope OValley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
,U3f° 3r, 226' Pore 4/s' OL2 •
(degrees/m in u teslyyeconds)
Latitudeilongitude source: lacPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D- /25 t
/lS-24.5—
i
0
an 'A
3 m
n
Ct:LOCATION SKETCH �
Amount Show direction and distance in miles from at 10.9t =•- C)
Dearly Diameter or Weight/Ft. Marerial numbers and common road names. 2 fir"
From From 0 To /2f FL '4 vJb,/.25 / ✓LS0e2/ nZ
To Fr.
From To Fr.
13. GROUT: Depth Marerial Method
From D To ZO Fr. (OvrclC w •-•ns
From To Fr.
1T. SCREEN: Depth Diameter Slot Size Marerial
Fran To Fr. in. in.
From To Fr. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Marerial
From To Fr.
From To Fr.
298657
16. REMARKS:
<ou1-/- lC(c-e-et /al
LerCCSTerr te(_,.
• 0
cr% a
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PifAa'6-L7-oJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
,J
Submit the original ro the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27099-163o ?hone No. [phone], within 30 days.
Gw-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carotina - Department of Environment and Natural Resources - Division of Water Quality -
\%ELL CONTRACTOR (INDIVIDUAL) NAME ( rinr) fie•mq
WELL CONTRACTOR COMPANY NAME terp,, sun" (/G/J 1%////•n.
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(ifaoplicable)
(if applicable)
298656
Groundwater Section
CERTIFICATION�# �?1�0
PHONE d1 /j Z.rr'- PsiCA
1. WELL USE (Check Applicable Box): Residential II/Municipal/Public ❑ Industrial 0 AgriculNral 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: we•ate ✓ • g t
ink p4. /) ii
County Ot.Hddsnsee
(SVect Name! Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OW'NER:J'jQR.h
Address LOO$ Ca_tti rJ tANG-r lad -
Knit or No.)Route
M r3p$
. ?895LJ
City or Town State 11 ''f� Zip Code
(Di?)- 775- I0103
.Area code- Phone number
-4. DATE DRILLED 7-7-0 3
topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check uppropriate box)
Latitude/ ongitude 9f well losarion
1y jr fo AN. D -N Katz 33. IYt
(degrees/minure� conds)
Laritudeilongitude source: ®tPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
!� - Fer,0.- J-
`'7
5. TOTAL DEPTH: 34 r /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use "+"'if,Above Top of Casing)
S. TOP OF CASING [S J FT. Above Land Surface*
'Tap or casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /3— METH? TEST ,176....�'
10. WATER ZONES (depth): / 75 5 - S
11. DISINFECTION Type Cf'J•-. n( Amount )'\+n6a
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To ¥$ Fr. A /ZS- 5PL 2L
From To Ft
From To Fr.
13. GROUT: Depth Murerial Merhod
From 0 To 20 Fr. Cor+Cien. PZ„e;,5
From To Fr.
14. SCREEN, Depth Diameter Slot Size Material
From To Fr. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fr.
16. REMARKS:
l✓c-
Nlu..ehy Wit
f eam er u l te-1
O o
c ^ram
LOCATION SKETCH r- cro
Show direction and distance in miles from at lei ;pl
two State Roads or County Roads. Include the Is41d (1).Z
numbers and common road names. tJ 2)
t11 6
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH !SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cel( / TO
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to [he Division of Water Quality, Groundwater Section, 1636 Mail Service Cenrer - Raleigh, NC
27699-163o Phone Nu. [phone], within 30 days. GW-I REV. 07/2001

County Ot-.,crtie
27699-163
o Phone No. [phone], within 30 days.
WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resources - Division of Warer Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME ((prinr) tteil �• .144111.5 CERTIFICATION Nr17y�! l
WELL CONTRACTOR COMPANYNA.NIE / r 7t 5,94J L"'e/ taeril•Hf PHONE Pe) Zf%'PVC
STATE WELL CONSTRUCTION PERMIT/I ASSOCIATED WQ PERMIT/I
(if aoolicablel (if applicable)
298655
1. WELL USE (Check Applicable Box): Residential CY Iv lunicipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �t
Near si Town: Apo i n
r"re it;Ice /4- 113
tSace� Name, Numbcre, Community, Subdivision, Lot No., Zip Code)
3. OWNER: it. if flied
Address `fin Er'ie J. I45
Arcot or Route No.)
AS/leu,tle /UC
City or Town State Zip Code
frrf5- a1lei
Aca code- Phone number
4. DATE DRILLED 7- /7-03
5. TOTAL DEPTH: G 4 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 5:17
7. STATIC WATER LEVEL Below Top of Casing: %S FT.
(Use "r"'if Above Top of Casing)
S. TOP OF CASING [S FT. Above Land Surface*
'Top of easing terminated auur below land surface requires a
variance in accordsn e with ISA NCAC 2C .U118.
9. YIELD (gpm)' M;THOD OF TEST d'Cats -
10. WATER ZONES (ddpth): J 7C-
II. DISINFECTION: Type
IL. CASINO:
Depth
From b To rG
From To
From To
13. GROUT: Depth
From b To )O Ft_
From To Fr.
I SCREEN: Depth
From To
From To
L5. SAND/GRAVEL PACK:
Depth
From To Fr.
From To Ft.
l6. RENIARKS:
Diameter
FL 4./2)--
Ft.
Material
it lteeA
Amount /2
Wall Thickness
or Weight/Fr. Material
51,2 / five. -
Method
r.#bf
Diameter Slot Size Material
Pc in. in.
Pi. in. in
Size Material
topographic/Land sexing
Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location /
N3i it Ws Wan J?,ors-
(degrees/minur�e" conds)
Latitude/longitude source: QGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
-SO
rr
O o
n
A L crt
--
0
LOCATION SKETCH N o
Show direction and distance in miles from at lent o
two State Roads or County Roads. Include the ra7d u,--
numbers and common road names. r C�
(n G
- a rc. fir; d9d-- i4;us
1
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
/-12-o3
SIGNATURE OF PERSON CONSTRUCTING -THE WELL DATE
Submit the original to the Division of Warer Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualiry - Groundwarer Section
\FELL CONTRACTOR (INDIl9DUAL) NANIE (print) 't cn 4 Wma
WELL CONTRACTOR COMPANY NAME 7.+/'swJ001l '.- /I
CERTIFICATION N 3/✓"
PHONE ri2J12J 7•- PEE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM1Tg
fir -applicable) - (if applicable)
L WELL USE (Check Applicable Box): Residential ❑ MunicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NewestTowmkloce) P-
Cc�� r
(Suter NameNmnoers, Community, Saar on. Lot No., Zip Code)
,N/
3. OWNER. `.44 /.•/ /#/..,,
County 06:4"Con%
Address -)).to B o 'F. 1 $ (y S-
• jit�rRoar¥c
AShwP•SSI4
Ciry or Town Sure Zip Code
g)- 6, g•aa9y.
.Area code- Phone number
4. DATE DRILLED I - IC," 03
5. TOTAL DEPTH: 3-or
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: C FT.
(Use "t"if .Above Top of Casing)
3. TOP OF CASING IS FT. Above Land Surface'
'Top of casing Terminated ar/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): / METHOD OF TEST efe•Car-4.
0. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth pianrerer
From Toha _ Ft. Cr•/er
From To Er.
From To Ft.
13. GROUT: Deprh
From b ToLo FL
Marerial
From To Fr.
I4. SCREEN: Depth Diameter Slor Size Marerial
From To Fr. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Marerial
From To Ft.
From To Fr.
Amount i1. kb
Wall Thickness
or Weight/Fr. Material
�ORL/ "mkt
Method p
16. REMARKS:
,Topographic/Land setting
01Ridge ❑Slope ❑Valley ❑Flan
(check appropriare box)
Laurude/lo�n britude of well locarion
?V J're 31, (IN 440)2.';n crr .
(degrees/minu�re�s/ conds)
Latirude/longitude source: QGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
LO— COS b-..y.rk
DEPTH
From To
0-4o
298654
r
t n-
- n
LOCATION SKETCH 71, sE"
Show direction and distance in miles from at I t '
two State Roads or Counry Roads. Include the ad '=+—
numbers and common road names. 3 �p
(.1) —
N,,
V•w -
cn G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH 15A NCAC2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7-1h47l v1.-tne4- '1-A-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone Nu. [phone], within 30 days.
GW-I REV. 07/2001

From To
From To
13. GROUT: Depth
From 0 To /7 Fr.
From To Fr.
WELL CONSTRUCTION RECORD
298653
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIFzip riot) J/%t-t /% V(i>'Li CERTIFICATION N1/y<%
%ELL CONTRACTOR COMPANY NAME tg/S4 loot) Well Al /,:'/
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMITN
(if eppllnblel (if applicable)
PHONE 62Y7 ark- )'jt
1. WELL USE (Check Applicable Box): Residential LT MunicipaUPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It' Other, List Use
2. WELL LOCATION:
Nearest Town' {/!✓."1,4 Nc Counry BvAL"rjC
QA Ceaaed. Wtax eeu'J/e
(Suet( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Sc.F.Ff W0.RNe-C
Address 3.1tS leak Crec.k ]ca
(StreWectmef0llet�pa10) a81
City or Town Site
et; 2)- (1) - fol5'
.Area code- Phone number
4. DATE DRILLED 7-4/-al
5. TOTAL DEPTH: 44/r
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ET
7. STATIC WATER LEVEL Below Top of Casing: t$O FT.
(Use "+"'ifAbove Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
'Tap or chain; terminated acor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST //Owrnq - .44
l0. WATER ZONES (depth): yoiJ',. 2021,y
I I. DISINFECTION: Type rbria,
(2. CASING:
Depth Diameter
From 0 To sr Fc, 6./2Jr
Ft.
Fc.
Material
`fl"t2 /(
Amount /G Arte
Wall Thickness
or Weighr/Ft. Material
5:4/2/ Az-t
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Fc. in. in.
15. SAND/GRAVEL PACK
Depth
From To Fc.
From To Fr.
16, REM A RKS:
Size Material
'Topographic/Land setting
Ridge ❑Slope ❑Valley.'. ❑Flat
(check appropriate box)
Larirude/longirude of well location
/J3, ° ya,t2S-' foal' it.,n'
(degrees/minutes/seconds)
Lacirudzilongicude source: I'OPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
©- r'S"
srs <NS'
v
v
LOCATION SKETCH N
Show direction and distance in miles from ar w
two State Roads or Counry Roads. Include the roall u,
numbers and common road names. N
rr ,
dr
Oy, Crett- Ed •
Lt-
Jecwerul•lIe-/ N•C-.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7-2/' 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Cencer - Raleigh, NC
27699.1630 Phone Nu. [phone], within 30 days. GW-I REV. 07/2001

WELL CONTRACTOR COMP ANY NAME Ater. rat)).
STATE WELL CONSTRUCTION PERMIT#
f it applicable) (if applicable)
North Carolina - Deparunenr of Environment and Naauural Resources - Division of Water Quality - Groundwater Section
R ELL CONTRACTOR (INDIVIDUAL) NAME (print) Ls/ t n /C Id -e f CERTIFICATION #
PHONE tan yr 2-i'—Qyg
1. WELL USE (Check Applicable Box): Residential el—Municipal/Public ❑ Industrial 0 Agriculrural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 It Other, List Use
2. WELL LOCATION:
Nearer Town: /01/LagionaV
Item //
County �r+^U^liL
(Street Nome, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C'r,y. (Co 6••Jon
.Address y / Ti,<c. ,tn, id (OH G
/1 (Soeer or Route No.)
` i'e-Y4 Aid e /rC 2 170 /
Clry or Town State Zip Code
$as)- Le ig5 -.57o 3
Area code- Phone number
4. DATE DRILLED 7- DJ
5. TOTAL DEPTH: 7o /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
7. STATIC WATER LEVEL Below Top of Casing: 76' FT.
(Use "t" 'if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance in accordant with 15A NCAC 2C .0118. �J
9. YIELD (gpm)' METHOD OF TEST /p/au/rI-J/7
10. WATER ZONES (depth): 4 4o
Topographic/Land sexing
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
N Lazio 4P-4 g13'I of location
ll1��ii��HH a �O• / 17.7'
(degreeslminure� cconds)
Lariwdeilongitude source: L•3OPS❑Topographic map
(check box)
DRILLING LOG
Forpiation Description
DEPTH
Fromr/ To
J /- 7t q
II. DISINFECTION: Typeltuo-/-.rt-
12. CASING:
Depth'From 0 To
From
From
13. GROUT:
From 0
WELL CONSTRUCTION RECORD
298652
Diame,y
Ft. C. /21
To Ft.
To Ft.
Depth Materia/l�
To 20 Ft. Cent .ft
From To Ft.
1.4 SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SANDiGRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amountzr 1C.6
Wall Thickness
or WeighrFt. Material
sower c
16. REMARKS:
D..//.;,f
Method
Afteici
Slot Size lvtaterial
in. in.
in. in.
Material
ASSOCIATED WQ PERMIT??
O
wA
bairn
n
e a
LOCATION SKETCH ) a o
Show direction and distance in miles from at leasto ro,
two State Roads or Counry Roads. Include the roai; c, r
N
numbers and common road names. �
F s4e /Cs, t sx Is
4/rr-J - P. c.
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v., T. -,,� 7_ z s_ 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-I REV. 07/2001

298651
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Warer Quality - Groundwater Section
w ELL CONTRACTOR (INDIVIDUAL) NAME (print)
w ELL CONTRACTOR COMPANY NAME f-'(If tit1M,/
��//�//// CERTIFICATION # / 0
AVI PHONE Farr en--Pie
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/4
(if applicable)
(if mpl iccb141
I. WELL USE tChecl: Applicable Box): Residential rrifunicipaI/Public ❑ Industrial 0 Agricultural 0
NWnitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: p
-G
Nearest Town: LN.V r�County /ti-isa&
Pie .rN 1' //
(Sweet Name, Numbers, Couniry, Subdivision, Lot No., Zip Code)
LI ccs-Ec—i "t or JN."C'. 2.814ig
Cry ur Town Scare Zip Code
4e81- fo.83— D-124
.Area code- Phone number
4. DATE DRILLED %/-a
5. TOTAL DEPTH: tit — /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO La'
7. STATIC WATER LEVEL Below Top of Casing: GO FT.
(Use 'w"I r Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top of easing terminated ador below land surface requires a
variance in aeeordzi re with I5A NCAC 2C .011d.
9. YIELD (gpm): (ID METHC)D OF TEST hy
10. WATER ZONES (depth): I r0 , 1,r
/Topographic/Land setting
Ridge ❑Slope ❑Valley !CEDE
(check appropriate box)
ati de/Ion'irudeof well locati n
Jr" J7,47rs'�erz.'WOa»
(degree/minute�st' conds)
Latitude/longitude source: LTGPS❑Topographic map
(check bux)
DEPTH DRILLING LOG
From To Fo ation Description
/4 • ' in)
3.OWNER: rgtal
.Address 54l h 1DOrc Ua Iec1 , h/ I
R J
l 1. DISINFECTION: Type C/.e
12, CASINO:
Depth Diameter
From 0 To /ZY Fr, 4•,Lr
From To Fr.
From To Ft,
13. GROUT: Depth
From 0 To 2.0 Ft.
From To Fr.
14. SCREEN: Depth Diamcrcr
From To Ft. in.
From To Fr, in.
15. SAND/GRAVELPACK:
Depth Size Morerial
From To Fr.
Amount `1 ,sbib
Wall Thickness
or Weight/Ft. Material
Marerial
Co te/G�
tvlcrhod
Slot Size Material
in,
in.
From To Ft.
l6. REMARKS:
O
Pe Grp*
LOCATION SKETCH N S_ 7
Show direction and disrance in miles from at leash v1_
two Stale Roads or County Roads. Include Lhe roattO ;C
numbers a and common road names. 3 p
/ IOOecS U4,lle-tn LC NC— s� 'a JJ
Lc,'c -Fe-r-t NC •
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7( zip
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-1 REV. 07/21)01

WELL CONSTRUCTION RECORD 298649
North Carotinu - Department of Environment and N�atural R�s �'1esources - Division of Water Quality- Groundwater Secrion
WELL CONTRACTOR (INDIVIDUAL) NAME (print) £... e1 CERTIFICATION tr2:1/0
\4 ELL CONTRsCTOR COMPANY NAME 4.Ts1001f 4-r_..../ env./ikr PHONE eels e%r— cet-
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERIv1IT$
i Y zoclizablcl (if applicoblel
1. WELL USE (Check Applicable Box): Residential CJ MunicipaUPublic 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:4�
Nearest Tow11:a" ✓: /4
Counry tn'ce ns(
iSaecr Name, Number), Communiry, Subdivision. Lot No., Zip Code)
3. OWNER: 5{-a-c e CL4
r r((\�
Address 3a,R rc rd
(lacer or Route No.)
ASAe✓ute_ N� . .:2fr8ocf
Ciry ar TON1n Sure Zip Code
(8;51- !e5£s- 0979
Area rode- Phone number
-. DATE DRILLED 8--r-D3
5. TOTAL DEPTH: J O7
6. DOES WELL REPLACE EXISTING WELL') YES ❑ NO (�
7. STATIC WATER LEVEL Below Top of Casing: WC FT.
(Use "*"lf Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface.
`Top at using ferminared arfor below land eurrace requires a
variance in accordant with 15A NCAC 2C .011S.
9. YIELD (gpm): a METHOD OF TESTA:L.%y- Z .
IQ WATER ZONES (depth): 430, 1/70
Agricultural 0
Topographic/L_a_n�d s�ening
❑Ridge ❑Slope reValley ❑Flat
(check appropriate box)
arinde/Ion •itu�qe of well location
Tf 44 si ✓circe sr. /oy •
(degrees/rhino eslseconds)
Latirudeilongitude source: Cif PSDTopographic map
(check box)
DEPTH DRILLINGLOC}
From To For,Lnation Description
O r/
11. DISINFECTION:Typeo/...ie
l2, CASING:
Depth
From o To re
From To
From To
13. GROUT: Depth
From d To /t Fr.
From To Fr.
I-. SCREEN: Depth Diameter
From To Ft. in.
From To Fr. in.
G. SAND/GRAVEL PACK:
Depth Size
From To Fr.
From To Fr.
Diameter
Fr/../Lr
Ft.
Ft.
Amount /1' %Li
Wall Thickness
or Weight/Ft. Material
.5)1L/
Material
(Q,tok
Method
Slot Size Material
in.
in.
Marerial
G..., h
LOCATION SKETCH
Show direction and distance in miles from at least
two Stare Roads or County Roads. Include the road
numbers and common road names,
Parvf sz SrnNck Rd.
0IJwe(U;JIB- t1'LL •
I . REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH LSA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11/141,1 114 %-<4- —p3
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Submir the original to the Division of Water Quality, Groundwater Secrion,
27699-163o Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC
GW-I REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualiry- Groundwater Section
%BELL CONTRACTOR ([NUIVIDUAL) NAME (print) 1/401 X. ('no CERTIFICATION Yi refs
\\ ELL CONTRACTOR COMPANY NAME Ft/NJonl tad/
STATE WELL. CONSTRUCTION PERMITS ASSOCLATED WQ PERMIT#
cif eo[I:.ablcl if applicable)
. WELL USE (Chock Appticable Box): Residential Q" IvfunicipaUPublic ❑ Indusaial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 Ir' Other. List Use
(Sneer or Retire No.)
/Oa1rvcsD/lie Mae axM 7.
Clry -Town State Zip Code
()- .07--6/75
.ilea todc- Phone number
4. DATE DRILLED r'/i-aJ
2. WELL LOCATI N: vv
Nearest Town' •Ct$ fee County.4.na+'6t
(onal nlesdokQB- L.r;rej71•9_,v
,saeer nw, Nun1ocr3, Community, Subdivision, Lot No., Zip Code)
•
3. OWNER: h'J.hc p.34C1kdA)
Address til3 V6 dd,'.v9
5. TOTAL DEPTH: 2 s'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "*"'if Above Top of Casing)
S. TOP OF CASING 13 FT. Above Land Surface'
'Tap or casing terminuted at/or below land surface requires a
variance in accordance with IiA NCAC 2C .0)1S. pp
9. YIELD (spin): /0 METHOD OF TEST/41 .nl- Ater
I0. WATER ZONES (depth): Z70 160
Deal" " PHONE : - igerc
DEPTH
From To
0-/or
/lo .3G5—
II, DISINFECTION: Type (/i..nt
12. CASING:
Depth Diameter
From 0 To //o Fr. L•/Lr
From To Fr.
From To Fr.
13. GROUT: Depth
From 0 To 2°
Amount ?iysa -
Walt Thickness
or WeighUFt. )renal
SSAWG
Marefiall
Fr. ipnG• .fi
From To Fr.
14. SCREEN. Depth Diameter SIot Sire Material
From To Fr, in. in.
From To Ft in. in.
15. SAND,GP.AVEL PACK:
Depth Size Marerial
From To Ft.
From To Fr
Mcrhod
lo- REMARKS:
298645
Topographic/Lana cuing
❑Ridge ❑Slope C7Valley ,.❑Flay
(check uppropriarc box)
Latitude/longitude of well location
Ab °3S.i(fr7'4✓orL
4i. 30.E
(degrees/minutes/seconds)
Larirudeilongitude source: 26PSOTopoigraphic map
(check box)
DRILLING LOG
Fotgation Description
St.,.l.#ec it
G s'fre
fa,
7
LOCATION SKETCH o'er
t--sr
Show direction and distance in miles from a[ kastN
two Stale Roads or County Roads. Include the road-o
numbers and common road names. ' tn?,
rn
to Meadow D2,
Letee.ile; N.0 .
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL ER
L-gtr SI V J
N OF PERSON CONSTRUCTING THE WELL DA_ATE
Submit the original to the Division of FVater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o 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 p�
WELL CONTRACTOR (INDIVIDUAL) NAM1IE (print) Bet 6jr- tat 1 4J'lf CERTIFICATION #2.0A
WELL CONTRACTOR COMPANY NANIE FL7dria.'5 [(/e// vj&IX., t . PHONE jelaill, fQ}-9*iy
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
228648
I. WELL USE (Check Applicable Box): Residential Cl Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FQU USrfW
f2//0647I/ to
(Street Name, Numbs/3, Community, Subdivision, Lot No., Zip Code)
County juACOm pC
3. OWNER: Do m+N e avv5./ LGsitSb
Address ? (#o JL 580
(Street or Route No.)
Fa/EN; ec.c., NC 22.1Y730
City or Town State Zip Code
02)- !ae18- 3o8a
Area code- Phone number
4. DATE DRILLED 7//2/13
5. TOTAL DEPTH: SOS' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: /7D FT.
(Use "+" if .Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
*Tap of casing terminated et/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST Q✓vW.2/4
10. WATER ZONES (depth): /20 - L YD
11. DISINFECTION: Type 11: We T Amount //o
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. M
From p To yf Ft.J , a$
From To Ft.
From To Fr.
13. GROUT: Depth
From 0 To zl)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
Ft. 0,4r/Gie
ttdopographic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude fwelllocation
N 3S°29r07y/wen°2G,$GL
(degrees'minutesh�e onds)
Latirude/longitude source: W8PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o fiy IWAY—
VV sOs its, 6.0n,Y�
O
O
a
CJ O ;i
-o r�
i e1+
01 'a
0
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
aterial numbers and common road names.
atyr/2s PVC seer/
Ft.
Diameter Slot Size Material
Fr. in. in.
Ft. in. in.
to idea Ugh. Ceece
Iflohacj•
rot lgyfew1l✓.0
Method
Size Material
Ft.
Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDEDTOTHE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TFIE WELL vATE
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. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL)NANIE (print) ,bt346y w t foZ4
WELL CONTRACTOR COMPANY NAME
298646
Groundwater Section
,,[[�� CERTIFICATION ti �z9
PcetusQn11 Ma ilvee//i.. f PHONE in
b33nYYf'ai'
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IY MunicipaUPublic 0 Industrial 0 AgriculturaI ❑
Monitoring Cl Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Calf s/Cad414
Wady Feat I/,
(Street Name, -Numbers, Cmnmuniry, Subdivision, Lot No., Zip Code)
3. OWNER: �0(1C.(-AJtranW -
Address In- ey was
enkA (Street or Route :No.) a�l7aS'
County AAraM IJC
City or Town State Zip Code
le (C% S% O,
Area code- Phone number
4. DATE DRILLED V(1/D3
5. TOTAL DEPTH: /'j`S /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�
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 with 15A NCAC 2C .011S.
9. YIELD (gpm): 6o METHOD OF TESTbfDw;wf/4
10. WATER ZONES (depth): /OD
Topographic/Land setting:
❑Ridge ❑Slope ley ❑Flat
(check appropriate box)
Latitude/longitude of well locasjon
A/3S °zr.0?y%/ vorz R4,5'6 y .
(degrees/minutes/seconds)
Latitude/longitude source: SG S❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n —?,Y nb -
tV — /TS [neat./Jfc
O
11. DISINFECTION: Type \Wit S Amount 071
12. CASING: Wall Thickness
0
m
IMF G
_l iJ
v
CIA
LOCATION SKETCH '/',,
Show direction and distance in miles from at least N i
two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material. • numbers and common road names.
From A To Z(/ FL 6(45 z/6,/AS Ott Sin/
From To Ft. s
From To Ft.
13. GROUT: Depth Material Method
From___t5 Tot j/ Et. ronca,elc QQO^,rth
From To Ft.
14. SCREEN• Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r~ N k4 , N.C-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG A RE OF4ERSON CONSTR� THE WELL �v DA/TE f
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298642
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalnResources - Division of Water uality - Groundwater Section �t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tJO b6y k)s Pd 5 CERTIFICATION #ROa(� 4
WELL CONTRACTOR COMPANYNAiv1E re /YUs cm. WP/( t/+//II4/ Co. PHONE RA 683 - ?fig?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: � Faint)/ Li" County 3QACO M be,
172/lu/'LK) Pantie*
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
3'OAn/ 471/ Qi,J
Address SO 5 -1 e 4{-
(Street or Route No.)
ztrvieL� h C.
Ciry or Town State
LN.
a8',3a
Zip Code
(%)- :4 ?S a. i .->.'
Area code- Phone number
4. DATE DRILLED $l�4
712,3
5. TOTAL DEPTH: 6 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (�
7. STATIC WATER LEVEL Below Top of Casing: ZO FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): 30 METHOD OF TEST 6(OC[W* /I;
10. WATER ZONES (depth): SVO
H. DISINFECTION: Type
12. CASING:
Seelth
Depth
From Q To 64
From To
From To
13. GROUT: Depth
From 0 To tb
From To
14. SCREEN: Depth
From To
From To
l5. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft. 4.25
Ft.
Ft.
Amount / 7 pa
Wall Thickness
or Weight/Ft. Material
A/4,J2.s ,ovc 5-n4Z/
Topograpkit/Land setting
El Ridge leglope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/'V35•257,714 A/arc?0.Sg/o
(degrees/min u conds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 —bi Dim
/lccK
bb - 605 (s',w47
Material
Ft. CD'1.cr
Ft.
Diameter
Ft. in,
Ft. in.
Ft.
Ft.
Size
Method
Slot Size Material
in.
in.
Material
6/ - bb
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
Pat; rlJ;et° Far"1-
a rLI; / .1\ C -
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
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

298637
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mof ;/O
M/
K Allz tl ( CERTIFICATION#3g
WELL CONTRACTOR COMPANY NA E /" nLaren l-fall Drill Ii et _C!T PHONE Filial th? -947
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if appl icable) (if applicable)
l
WELL USE (Check Applicable Box): Residential le Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water lnjection 0 Other If Other, List Use
WELL LOCATION:
Nearest Town: tutave(v1:) It County Bunco.
alri5:Jon Esind-cs
(Street Name, Numbers, Communniity,, LSubdivision, Lot No., Zip Code)
3. OWNER:'31 ) i y S+b W P>
Address 9 r3o 6 i e( 1-4•
(Stree or Route No.)
WEER Yefj v Ile- 1t4cs a3751
City or Town State Zip Code
( )- to 9 5" 4 `I 9 9
Area code- Phone number
4. DATE DRILLED 1- /S' - 0
5. TOTAL DEPTH: ads
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO H�
7. STATIC 'WATER LEVEL Below Top ofCasing: go 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): Q METHOD OF TEST R(19
10. WATER ZONES (depth): JEDO
I I. DISINFECTION: Type Sa {i
12. CASING:
Depth Diameter
From 0 To /05 • Ft. tiiY
From/b3 To//0 r Ft. b>7
From To Ft.
13. GROUT: Depth
From To Ft,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Material
Amount 3 OZ
Wall Thickness
or Weight/Ft. Material
fict at ?it
it r sfeM
Method
Slot Size
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: /4-` 5.19/1 Colt,
DEPTH
From
Topographic/Land sing
❑Ridge ❑Slope Verney ❑Flat
(check appropriate box)
Latitude/longitude of well !ocati n
3; / /S/ 0314 -era/3?/
q
(degrees/minutes/sec nds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
/00 ' ilaa:
A lyfYinv e
B kke, arrrvs l-e /
LOCATION SKETCH
Show direction and distance in miles from at least .q,
two State Roads or County Roads. Include the road ^i cn
numbers and common road names. t;i?
Cfi
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
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 j- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print) MQpk Mh^ CERTIFICATION it 3a 86
WELL CONTRACTOR COMPANY NAME Fer5a Solt (•✓e/I PHONE 61,29I 673-WVp
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
298636
I. WELL USE (Check Applicable Box): Residential EY-MunicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 5 LVi tie County8Lirtea
/7 ni7 (.)�c flc&iter
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address "1 r+ Cf.
i �e IG1 eZ[orNut�a No.) �!O ^Q 73
City or Town State
()- tip — t 173
Area code- Phone number
4. DATE DRILLED rI "
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO £ -
7. STATIC WATER LEVEL Below Top of Casing: (P t9 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 accords a with ISA NCAC 2C.0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): C5O OFLTEST
Code
11. DISINFECTION: Type hirip 11
12. CASING:
Depth Diameter
From 0 To teW Ft.lyi{
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To aD Ft.
Amount 511 p2.
Wall Thickness
or Weight/Ft. Material
51,Pa1 p✓C?
Material
Cantreke
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge OSlope 03falley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35� i/N / u
(degrees/minutesiseco ds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Q - /D
1i— ..?l
$ro,.+n chat 4,
Q///trr iha /e )
(�1r3 r -r t.�in.sty -She le
0
O O
r C%
LOCATION SKETCH
Show direction and distance in miles from at li;t
two State Roads or County Roads. Include the road
numbers and common road names. ari
tv r:,�
CO
Mit ei/IC
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THA A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298634
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((pprint) l ' 2 c k ,41fC [1 CERTIFICATION # ;a __
WELL CONTRACTOR COMPANY NAME 'C4 s+t S G.'1 W RAI tITI1 �i t'Kt CIC). PHONE 4I 4 693 '9QQ
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential P 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: Le. ee5kr
-Red fQk -N-intake,
County a nee,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:tot,_�q� W2,n�69FTe ell
Address S5 "repot. tad
(Street or ute No.)
J'44 r $ b,r-II 1 C_ 2•C 7S3
City or Town State Zip Code
(E )- [083 - 551
Area code- Phone number
4. DATE DRILLED % -.O ?
5. TOTAL DEPTH: 3/)C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I9--*/
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant with l5A NCAC 2C .0118.
9. YIELD (gpm): METHOD/ F TEST FZtc�
10. WATER ZONES (depth): Y%
11. DISINFECTION: Type /1'D /-( Amount 3e2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To % Ft. G -S' SI)R r1( pVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To .20 Ft. eer?rrek2, Bored
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
/Topographic/Land setting
L•iitdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35/ 39/4r e n) - o� 'onds) 9 w
(degrees/minutevse onds
Latitude/longitude source: E3CiPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
i r
Bre a Drk4. (53&e
�Iwc. Grv, 44/2
DEPTH
From To
m G
N".
N -tea
LOCATION SKETCH -o r cifa
Show direction and distance in miles from at least t
two State Roads or County Roads. Include the roadN i
numbers and common road names. at o
Leic.esf-e-r NC
I6.REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
7 dY-oS
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
d1

298633
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / 15C k .4JIPrl CERTIFICATION #3a /70
WELL CONTRACTOR COMPANY NAME /GCli San .s.di Dt-,!/inr', Cc PHONEPJ'-&`�t/9 s1 �-U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQJPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I - Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Leice jPtr County &Li (Inn,
teen herrar ?..d Lriciest e.r NC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:De ,Lj , els NTII1PM
Address r1 to C r !-N -towel° .9J •
(Streetor Route No.) a 1I O
21P-i CA nP rn NC s �1148
City or Town State Zip Code
(2QS)- Lo23 - 1451
Area code- Phone number
4. DATE DRILLED r% " r9 - n3
5. TAL a \ '
6. DOESOTWELLDEPTH:
REPLACEnEXISTING WELL? YES ,(7 NO @V
7. STATIC WATER LEVEL Below Top,of Casing: XL, FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (gpm): ''/O METHOD OF TEST R'r
10. WATER ZONES (depth): / /2 C ` 4- 20 `�
11. DISINFECTION: Type /'/Ti H
12. CASING:
Amount a OZ
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To ti FL (41'Y Pk at PvC-
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To aD Ft. CC?CfGit-
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Diameter
Ft. in.
Ft. in.
Method
P,oezc1
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
Topographic/Land setting
Ea -Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
:35 /Ya/Si t l� -c n! sr3/44q w
(degrees/minutes/seconds)
Latitude/longitude source: Ct1GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
69/ • )7 Y, f35hr.l!•
95' 39` 3)tat &rnn,4e
LOCATION SKETCH
Show direction and distance in miles from at leas€ rPl
cr
two State Roads or County Roads. Include the roaQ;W
numbers and common road names. Jt o
en hotoerN..
Lcc�si r, PrC.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7 - r-o 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (,////f�, i ,A` _J/J' CERTIFICATION #%D)$
WELL CONTRACTOR COMPANY NAME fc,,nl VSo Ss 1S W,1Irr[J CO. PHONE ten�`(}—ljfil
STATE WELL CONSTRUCTION PERMIT# V
(if applicable)
29$600'
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential L7 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water lnjection 0 Other 0 If Other, List Use
2. WELL LOCAT(ON: Nearest Town: CanclIer County lion cowl he
?h.nc-harf /et
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IC -re- Ca.. JY/eSscr
Address ,P m ee , opt 3e iS
(street or Route No.)
d/Gr it [ . 87/S
City or Town State Zip Code
reif)- ((4r5 - 699..3
Area code- Phone number
4. DATE DRILLED ez//.y' 3
5. TOTAL DEPTH: i
Topogra c/Land setting
❑Ridge UiSlope ❑Valley 0Flat
(check appropriate box)
Latitude/longituleyf well location ,
A/3s°33 SO6 /Won°V/, �3X
(degrees/ mutes�/s Dods)
Latitude/longitude source: 19GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o/r7`
DEPTH
From To
0 — b S'
by- Des
6. DOES WELL REPLACE EXISTING WELL YES 0 NO fry
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST fV0f-Drl/X//
10. WATER ZONES (depth): /0X - 7,>w
20
t 1. DISINFECTION: Type -i-,r6/Y 7r / Amount 6 t tS
l2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Frotn_0 To AV Ft. b A.S. afb.laS Pig s/)L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From p To 10 Ft. concrctc Pour, Al
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH 'o �c
Show direction and distance in miles from at leas'mr-
two State Roads or County Roads. Include the road �?,~
numbers and common road names. c..n o
aD
it i vreh a if '2-1
Ca- n nl /c( NCB
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY Of THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
wt 6/fE 2
SI NATURE OF PERSON CONSTRUCTING THE WELL DA EO 2
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
at-

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division (of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LL bb PGonI ft , s
WELL CONTRACTOR COMPANY NAME Nq✓✓ ',SANS )den Orin", Ce.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
298598
Groundwater Section q p'
CERTIFICATION/ DZ
PHONE Pleat 6R3'9S/Yq
1. WELL USE (Check Applicable Box): Residential C3-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
t
Nearest Town: t314Ck MMOMiatttt/ County $(/4C-OMbC
Dined Mtn j9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
,C
3. OWNER: 1' IQ,I'1ri, /an
Address CV. O, e SG / C
� (Street or Route No.)
/S t+.e*) //,!/C / S , C. .293
City or Town State Zip Code
(�L 9 )- jt S 3- 9 S/9d
Area code- Phone number
4. DATE DRILLED //O3
5. TOTAL DEPTH: 2 S ` /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ifs'
7. STATIC WATER LEVEL Below Top of Casing: 6 _FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118. "al
9. YIELD (gpm): A S METHODCOF TEST 1.3/01,, f7 3
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ailat
(check appropriate box)
Latitude/longinrd of well location
it" 3S°30 :Nb3 'dell'//,3-17
(degrees/ inutes/seconds)
Latitudeilongitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
0 — 76 t,'*l- Fad
IV<' .0j.ran/'j'C
c
0
am
c cl
Sr"
Nteern
10. WATER ZONES (depth): 2/12
LOCATION SKETCH
Amount Met. .1 Show direction and distance in miles from at least p
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
t),5 2/4,ld5 Pk 5oP91
11. DISINFECTION: Type NNjk15
l2. CASING:
Depth
From D To 7G Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From t2 To 'Lb Ft.
Material
CdncIt$C
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
ethod
Slot Size Material
in.
in.
t?
M
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF� ON CONSTRUCTING THE WELL / DA
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. OW -I REV. 07/2001

298597
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionyN
(of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i)A66 y ��)W r pm l t S CERTIFICATION 2
WELL CONTRACTOR COMPANY NAME FCr oso45 WCl/ pr/(ffn` Co. PHONE Ft )
STATE WELL CONSTRUCTION PERMIT# ✓ ASSOCIATED/WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential IH' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,t
Nearest Town: pf°c Ot)r1 R1 /Ai County 80 /t CAM YC
Ofd Port Ad, off- Hwy 9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R-ctrAt)raby
Address ;$53 O/d A / KW -
Street or Route No.)
8/cck mf» /ve . arr7//
City or Town State
Zip Code
(gas!)- erfedi - 040
Area code- Phone number
4. DATE DRILLED 4-7/2 //OS
5. TOTAL DEPTH:_agc '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (il"
7. STATIC WATER LEVEL Below Top of Casing: 2O 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): / S METHOD OF TEST glow,' g
10. WATER ZONES (depth): /7 $ 6 ,on
1 aS �p..t
I1. DISINFECTION: Type ittbfeif mount /402;
12. CASING: Wall Thickness
Topographic/Land setting,.
❑Ridge 105`lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitud of well location
N 3x°A/.gs6' wnga°L3.Y511
(degree minutes/set Dods)
Latitude/longitude source: 190PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
b;r7-
t00- avS' 6-tor,.1r
DEPTH
From To
0 -- /0/)
Depth
From 0 To we Ft
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2-0 Ft. CO4crcfC Pnbnr:.y
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
Diameter
.4S
or Weight/Ft. Material
Pk soiOld cart "hoar/ or/
Htou.
►tlack. Vovr-t-co:n, NG J
15
From To
SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STT"A/NDARDS, AND THAT 0 Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
i o
tJ O
:tit/
.rr)
LOCATION SKETCH 41
rr)
Show direction and distance in miles from at least 0
two State Roads or County Roads. Include the road 0
numbers and common road names.
9

298593
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � bb l -`� "1 f I S CERTIFICATION # a o a 2
WELL CONTRACTOR CONIPANY NAMEt-<rye co4S Oki/ .P27/..)t, (o PHONE 040,8 ° 1e;•9ir9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential B' MunicipalfPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: *She UW'I/c County
�lK rl)W Ser ih. Kwy
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Con
3. OWNER: e'-eN CansJeuej.dAJ Lrt
Address /4f MW frets w.
4V&cOnr /le
(Street or Route No.)
IA/ (Attnidie wC 737
City or Town State Zip Code
(l)z- "29 yvs 1
Area code- Phone number
4. DATE DRILLED 3//4/6
5. TOTAL DEPTH: 60S Pl
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Li3
7. STATIC WATER LEVEL Below Top of Casing: 380 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A ?CAC 2C .0118.
9. YIELD(gpm): 3D METHOL OF TEST 15,awi'I'
10. WATER ZONES (depth): 3 fs`O
Il
12. CASING:
DISINFECTION: Type
Depth Diameter
From a To Ft. G• -S
From To Ft.
From To Ft.
13. GROUT: Depth Material
From ,O To 20 Ft. r'ao,rreft
ographic/Land setting
stiRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
SS° 59.al N on°A9.7e2.J
(degrees/minJteJseconds)
de source:
�
Latitude/longitu
DEPTH
From To
0 —03 Ft
YS ��
GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
O-rarer' i C
r
3 r c,
la ac
—a cr
Amount /S s -a S Show direction and distance in miles from at leaF cop
Wall Thickness two State Roads or County Roads. Include the roQ n
or Weight/Ft. Material numbers and common road names. 0 —
3/6•/a, /�Irc5D22/ 0
From To Ft.
Method
Tho ra. C!
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
C /ram. »1 N xc evi C / ' 1
4:Ae e//e, NC
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF JI[IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTMG THE WELL " r BATE
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-t REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Depamnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/� V 11 'f� n CERTIFICATION #/�dstg
WELL CONTRACTOR CO c r !.J +.r PHONE #4251 6OR3'9�/9c%
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQPERMITS
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print),A 6h)( V� e �O
MPANY NAME F2r WS (dell r, JLt Pa
298591
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:A/fu✓Cr✓/W! County Buncombe
--Yu)/in/ l3raoX /fi i—arupHem
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) C 3. OWNER: 0.5P PIdIlIe,
Address 16F) till I Q. trl VQ
(Street or Route No.)
CI ret q TN �� tord.
City o own State Zip Code
(y23)-'F71-3092
Area code- Phone number
4. DATE DRILLED,_24.
_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
(degrees/minut
Latitude/longitude source:
DEPTH
From To
d - By
gy AS'S
Topo phic/Land setting'.
❑Ridge rigSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of w ll location
N 3s°V3, 396 Yw oyz°5, 3G/
econds)
GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
D.r1'
G ran, i fr
,
7. STATIC WATER LEVEL Below Top of Casing: S 0 FT. o
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface* r 0
"Top of casing terminated at/or below land surface requires a m
&01.
variance in accordance with I5A NCAC 2C .0118. G
9. YIELD (gpm): / S METHOD OF TEST 01 7(1111 o 2
10. WATER ZONES (depth)' 2 p.' //tf0 m' r3 Z v
aS�9{I„t /�0 ' LOCATION SKETCH N �_
1 I. DISINFECTION: Type fah )2_35 / Amount CIO-7 Show direction and distance in miles from at least 'a %
12. CASING: Wall Thickness two State Roads or County Roads. Include the road-2-
Depth Diameter or Weight/Ft. Material numbers and common road names. 3
From G To 'N Ft. to .a-GJ `d.l lo.I'? TVCSPY �k � }{ ��S `�
From To Ft. I uicn bra
FromTo FL .7--U�pl+ , WC
13. GROUT: Depth Material Method _I
From 0 To )._ Ft. C.C1jfFPfQ_ -poured
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material -
From To - Ft.
From To Ft. -
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
298587
North Carolina - Department of Environment and Natural Resources - Division/�of Water Quality - Groundwater Section, ^-t p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,� / !/!/ . //''/''J,ivS CERTIFICATION NN/At�
WELL CONTRACTOR COMPANY NAME Fgy3t - -J5 / we 11 TVS l/1 &J. PHONE #Arlin e05?J—!/Sty
STATE WELL CONSTRUCTION PERMIT/ J ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential e Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
QOM�>°
Nearest Town: /Y-et UtrNh'7//ra CountyAUPVC
Pnrjer< �1d�C /fa57' QAn/dr r Way Ad... (Street Name,
^ Numbers, om mry, Subdivision, Lot No., Zip Code)
3. OWNER: r freedom klfP es
Fj (Street or Route No.)
6Address Nei ) P I r IJ1A)3
0s112vCUR_ NC a86ob
City or Town State Zip Code
(8�8)- a2e) Gi)145
Area code- Phone number
4. DATE DRILLED V / c93
5. TOTAL DEPTH: eSt /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I�Z'
7. STATIC WATER LEVEL Below Top of Casing: /41/2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.4 NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OFTESTA W41 /R,
10. WATER ZONES (depth):
Topograp�hic/Land setting
❑Ridge I'1Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude f well location
At3S°//2/.775 /&� ea°3s,a3G'
(degrees/m'nites/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
O — a.0 INIPt
�v—(p/JS` Znr )e-c
11. DISINFECTION: Type +cab) Q+S Amount ) LI 02
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and common road names. 0
/^ �
From l / To a5 Ft. fJ . 9'5 •Ile 16 T VGsi$ ' O
From To Ft.
From To Ft.
l3. GROUT: Depth Material Method
From 0 To .20 Ft. Q7TV1Y PI- e
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
From To
Ft.
Ft.
se
0 o
3 re;
.4
r••
N c
LOCATION SKETCH 'o 0 m
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
0
�a\dtr hic /Fes+ ?order
I,upavexvdtle, NC
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL / / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone Nu. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2985806
North Carolina - Department of Environment and Naturaln,Resources - Divisionof
Water Quality - Groundwater Section
/� o
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Y"h' y W I A If!% / s CERTIFICATION # O� 0
WELL CONTRACTORCOMIPANY NAME r-rVVSOn/5 We// pe1J(IM CO, P HONE KW) 653-%Y/9
STATE WELL CONSTRUCTION PERMIT# V ASSOCIATED WQ PERMIT#
( ifapplicable) l (if applicable)
1. WELL USE (Check Applicable Box): Residential 5d Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town' /1,'Frester County %3U/tCOMbe
ee/7 a /4f 01# Pie) cy KIM /2.1.
(Streer'Tame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LA/e Soe..t .ejn
Address 77 614
(Street or (Thure No.)
Fiekclfsr n/.r ;r73a
City or Town State Zip Code
8q- Gee
Area code- Phone number
4. DATE DRILLED Z./ V 03
5. TOTAL DEPTH: / a$S' —/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I7d'
7. STATIC WATER LEVEL Below Top of Casing: 5.-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 0 METHOD OF TESTN01.0;AJ//1i9
10. WATER ZONES (depth): 9a r- Yy+"s
7 xpp
11. DISINFECTION: Type it 1P-ES Amount q p 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 ToS3 Ft. 6..25- B/41✓94 J✓CSh' /
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To as
Material Method
Ft. CenC/a/c ?ouied
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
pographic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/lon itu of well location
•9
N 331Y1- , agx'Ya.�$Q
(degreeAminutes/ onds)
Latitude/longitude source: PS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To / Formation Description
Q — S3 Diet-
S - 215-S' 6ran,'$e
p O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
(, a .'c aat.e /1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200I

4
5
6
298584
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ea.Sby1.1 Ql , P07-6- CERTIFICATION pA0)\�
ic WELL CONTRACTOR COMPANY NAME Feryt5 / Well Lvilh)-iG Co. PHONE OBE) f08- -/ 4z{q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential GY 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: Poi; nut' ecQ County /i)YV CD .i b c
Wright-5 (Dve 1 azd
(Street grate, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: eleve McCort
Address I OC1 W YCQhts (;QV2 'Road
(Street orttbute No.)
Fey rview NC a53 13G
City or Town State Zip Code
(` ? )- (D'3°O 115
Area code- Phone number
DATE DRILLED y//y/p3
TOTAL DEPTH: L( (Q FJ
DOES WELL REPLACE EXISTING WELL? YES 0 NO lev
Topogr is/Land setting;.
❑Ridge @Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude 99f well location
/V 3S°aq./OS /ur�gt°zy7vy
(degrees/_�`econds)
Latitude/longitude source: l9GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
D — 97
,b;rt
4 7 — '45 Grtyn.'fc
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): /0 METHOD OF TEST//ACJ.AJ / �;
10. WATER ZONES (depth): 37D t — (oien
II. DISINFECTION: Type +(Lb e'4S Amount 13 02
12. CASING: Wall Thickness
Depth
From 0 To CO Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To AG Ft.
From To
14. SCREEN: Depth
From To Ft.
Diameter or Weight/Ft. aterial
Ca•a.S a,Im.125
Material
cart trete
Ft.
Diameter Slot Size Material
n. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
T
N o_
N `r'
-.o
LOCATION SKETCH -O �p
Show direction and distance in miles from at least t='
two State Roads or County Roads. Include the roa4^? rn'O
O
aI 0 i
numbers and common road names.
(A) v isI-rtS
Tairrvie�
Cove Tic ad
,NC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INNCCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN THAT A COPY OF Tfjl` IS RECORDHAS BEEN PROVIDED TO THE WELL OWNER
SIG
RE OF PER
y//�v3
ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298583
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�d�{1 y "' WELL CONTRACTOR (INDIVIDUAL) NAME (print) . , /(S�CERTIFICATION iallar55.
WELL CONTRACTOR COMPANY NAME n9USONS tar If DP/YGA9 Co,# fla o. PHONE ) M ^Mt
STATE WELL CONSTRUCTION PERMIT('J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: i /tack rb(Jnilslk7 County punt nmhe
Alfa- 01ti Fart Rd. off NIoy 9
(Street Name, Numbers, Community, Subdivision, Lot'No., Zip Code)
3. OWNER: tilte t /C�,j1Qn, D 'Sow
Address aOld Yrn4 TIOG-d
(Street or Route No.)
Stack mr h. NC agli I
City r own
- 68(03 Smte Zip Code
Area code- Phone number
4. DATE DRILLED ¥i' /.€O3
5. TOTAL DEPTH: 36 S /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q"
7
STATIC WATER LEVEL Below Top of Casing: 64 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below and surface requires a
variance in accordance with I5.A NCAC 2C .0118.
9. YIELD (gpm): /5 METHOD OF TESTt/ntu.•n,/. ,,
l0. WATER ZONES (depth): b1S'Qr ^/z9
3zo )�yfr i
I1. DISINFECTION: Type +allVtr5 Amount 1(6CIL
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
a To (°co Ft. Le so,_
To Ft.
To Ft.
13. GROUT: Depth Material Method
From To •ac, Ft. urnrre+e pin-Finf
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From
From
From
pographic/Land setting.
tdge 0Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longi de of well location
it) 35'a/. CV ,.) eaa°/Yr3441'
(degreevminutes/yye�conds)
Latitude/longitude source: fAGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To / Formation Description
.'fl-- 3 63
3 �m
zt m
N4m
0
LOCATION SKETCH -o Ica
Show direction and distance in riles from at leas =
two State Roads or County Roads. Include the roar? 01--
numbers and common road names. O
o G
also old Fort 'PPaac1 off Tlwy.
t\Gc.k ro-vniarict NG
I5. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
[ DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYPYOOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Td ` 0. !
/103'
SIGNATURE OF PERSON CONSTRUCTING THE WELL D TE
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

298582
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,Qet rtiy )tie / 0/ `145 CERTIFICATION #aoa rI p
WELL CONTRACTOR COMPANY NAME F (no/1E Well DP/�/l. n (b, PHONE AAA k23-YYYy
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town:PAC A' County Bo Atom be
Rosy Brant -A Farr, crAC S*N. F?h,✓ Enema
(Arn
e, me, Numbers, Community, Subdivision, Lot NZip Code)
ttdopographic/Land setting':
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/long= de of well location
/J 3S°3/. /0,1 ga'(a .30D
/Wo'
3. OWNER: i 44 S/1 �G-/' (deg 5/minutes/seconds)
Address ref 70l'-)P 7 r xi . Fo rrYl Y C 1, Latitude/longitude source: 19C�,PS❑Topographic map
11(..S��treet or Route No.) (check box)
tlosk` �LI • fIC g.6-7 I 1 DEPTH DRILLING LOG
,��..��gq>a-nlC'ity or Town �Srajt Zip Code From To Formation Description
(%- (0Y-I-i42&
4. DATE DRILLED e0 Q OiP �'
Area code- Phone number Qp 2' ,3 r G-+van El fe
i//8/
5. TOTAL DEPTH: 6 as r V
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO o
7. STATIC WATER LEVEL Below Top of Casing: /CO FT. 0 t
(Use"+" if Above Top of Casing) en
3. TOP OF CASING IS / FT. Above Land Surface* y' ee'
73 m
*Top of casing terminated anor below land surface requires a N O <
variance in accordance with I5A NCAC 2C .0118. --ern
9. YIELD(gpm): 4 METHOD( OFTESTL3/0u14/Ray tJ '4-.1°
10. WATER ZONES (depth): IiOB --- (oyyoM co
�rrn
LOCATION SKETCH a'' a
rn
11. DISINFECTION: Type 4ti1 €2t Amount I (0 o2 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the roag o
Depth Diameter or WeighdFt. M�atena numbers and common road names.
To i Ft. (°. r`�5 a((°.��7�Y1-�V Aai
From 6 q
From To Ft. �� .,
From To Ft. i" ICSU lbra.nch Far►Yi off 5 ,(
13. GROUT: Depth Material Metho J('y�' J,, far tit �„I
From 0 To 'G Ft. Where+e I - Lth. r c
From To Ft. 'a\ at
'V flc -rut co: IA , ' 'C
IA. SCREEN: Depth Diameter Slot Size Material la e Iv v
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:
[ DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,
,AAND THAT Al�COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL r4s/a3
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. OW-1 REV. 07/2001

282876
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Dniivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1J \: ;'gL CERTIFICATIONS tl1
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHONE4%8 )? 54-35B1
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS J C
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI :
Nearest Town: t? be N County ,, `' N t'
IJ Le ,vN (C o&F 9
(Street None, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ame5 1 EC
Address -o oisNftRC) O2-k.Vc
Ar> I� (S CRowa No.) 3rr0
City or Town State Zip Code
(6Q6)- 6 s 4 - 5-1 6
Area code- Phone number
4. DATE DRILLED l 0/1 b/o 3
5. TOTAL DEPTH: a q C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Id
7. STATIC WATER LEVEL Below Top of Casing: 6 o FT.
(Use"+' if Above Top of Cuing)
8. TOP OF CASING IS 4 FT. Above Land Surface'
*Top of cuing terminated at/or below Ind surface requires a
variance to accordant! with ISA NCAC 2C .0118.
9. YIELD (gpm): kt' METHOD OF TEST e--1 G " tt IiZ
10. WATER ZONES (depth): I h o 1 6 O m
— 3 Geren
11. DISINFECTION: Type }.I IN `inso Amount -j. I b
12. CASING: Wall Thickness
A Depth Diameter or Weight/Ft. Material
From . To 6a b'/$ 50t-dl y2r/c-
From To
From To
13. GROUT: Depth
From 1 To a v
Ft.
Ft.
Ft.
Material
Ft. C-6rne,NY
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check approprioe box)
Latitude/longitude of well location
(der eedmiautethrconds)
Latitude/longitude source:❑GPS❑Topograthic map �l
(chat box)
DEPTH
Flop i To
5 S
63'- q-D '
' o'— ibo '
thr,
I Ho' _ Ls
0-6 S I
abs ;CID
DRILLING LOCI
Forrm�aation Description
Je62-(HOC(-0 C6—
N0 )1"c:1-=C
G Prr
62A a.1 i Td (-J r(iyLK--
d e r,
GR-Ar-t i
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
o fLCt(A9_ 0
,
O
L ;.
2
c71
16. REMARKS:Air
( 01
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OPY OF THIS RE RDHASBEEN PROVIDED TO TUB WELLQQ j
i`
SIGNATURE OF PERSON CONSTRUCTING THE WELL /DATE
e c11
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mali 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 *kenl Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6 t t-`( i2
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITS
ifa Iicable (if applicable)
282875
- Di1V islon of Water Quality - Groundwater Section
^ is..) AS 1.1 CERTIFICATION 1/3C T
DRILLING, INC- PHONErrYi8 ?54-3581
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural'F)
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: .
+A
Nearest Town: t. &uCe.vj County U, -
Sf.tzH K,aet 5L.flLf II Soo
(Street Name, Numbers, Community, Subdivision, tot No., Zip Code)
ro
3. OWNER: L)Q `i 5
Address 2 Il Y . 1Air-ctr,
(Street w Route No.)
711 Ci-r-e../.e
City or Town Slate
(2S- r7 e 3 tel P
Area coda Phan number
4. DATE DRILLED /O � T / n 3
5. TOTAL DEPTH: ij ;A b / 4
Z
H r_
J Topographic/Land setfi6k
vt❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well 1oato I
(deyseahoimuahecoads)
Latitude/longitude source:❑GPS❑T
(check box)
DEPTH
From To
/ /©
//Q — l3-r)
/. i t') - / •- g
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
cgf
Zip Code
7. STATIC WATER LEVEL Below Top of Casing: 4- a FT.
(Use `+` if Above Top of Casing)
8. TOP OF CASING IS J r-Z FT. Above Land Surface'
•Top of caring termla•led at/or below Iaad unlace requtru •
variance In accordance lib ISA NCAC 2C .0111.
9. YIELD (gpm): w METHOD OF TEST Re �/
10. WATER ZONES (depth): 3, - o jA1Q,( V
11. DISINFECTION: Type Ah#-1-( 9c• 7,Amount / 'z p L
12. CASING: Wall Thickness
Depth _ Diameter or Weight/Ft. Material
m t / ? FroTo / 3 t5 Ft. 6 � I1 Z/ p Ur
From To Ft.
From To Ft.
13. GROUT: Depth Material ethod
From D To - 0 Ft. -n-•-
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Forrnatiop ascription
iP
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
BEEN PROVIDED TO THE WELL OWNER
r// L/o1rn�i /o�i /fl
SIGNATURE OF PERSON CONSTRUCT] HE WELL DATE`
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Ralefgh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources ^ - Division of Water Quality
ta
WELL CONTRACTOR (INDIVIDUAL) NAM! (prt) \ L. L \ (� taJ AS i4
WELL CONTRACTOR COMPANY NAM! REUBEN CALDWELL DRILLING, INC.
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) if applicable)
282874
- Groundwater Section
CERTIFICATION S al
PBONEY?(8 ?54-3581
1. WELL USE (Check Applicable Box): Residential L9" MunicipaVPublic 0 Industrial 0 c�
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:
Nearest Town: t S Work i_l-1/46 County
S
Ura Corn C
(Sweet Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
ST�da �r-'P t e
1� 2L L-LICo 5(
As (Suoct w Roula N .)
City or Town Stale Zip Code
(4 Q} ),5ra.-300:Q
Ara coda Phone number
4. DATE DRILLED f C/ram/o 3
5. TOTAL DEPTH: -I 70 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: b FT.
A wig -4.- if Above Top of Canna)
8. TOP OF CASING IS FT. Above Land Surface°
*Top of castoa termlaated at/or below land surface requires a
variance In accordance 'ph ISA NCAC IC.0113.
9. YIELD (gpm): s =l- METHOD OF TEST P-1 L A I ,92
10. WATER ZONES (depth): aSi0 < i (Tenn
11. DISINFECTION: Type
12. CASING:
th
From 1. To al Ft. bDity,eter
From To Ft. 7
From To Ft.
13. GROUT; Dcp' Material Method
From .;-1- To J Ft. (iMe700T PL.;:2eD
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 Sire Materiel
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft Material
S al pVc
// Topograpd setting
Midge OsloSIo ❑Valley ❑Flat
(clack rt.t boa)
Letitudcllongi de ofweil1t)Catibn
qc.
(degrenAnamteshecoodr)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DRILLING LOQ
FoyTnattion Descriptio
lb' - r3 briars
i CpM
J$0'--.t`loG1T
DEPTH
From i To
S — IC,
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
N
0cvr3c. L- rte. D
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T1I ' A COPY OF THISAKORD HAS BEEN PROVIDED TO THE
flaaku
SIGNATURE OF PERSON CONSTRUCTING THE WELL
1 a/ S / 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282873
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Manual Resources^ DiIVls!on of Water Quality - Groundwater Section
WELLCONTRACTOR (INDIVIDUAL) NAME (print) /II NACJ%
WELL CONTRACTOR COMPANY NAME._RE.UBEN CALDWELL DRILLING, INC. PHONE4(8 .?54-3581
STATE WELL. CONSTRUCTION PERMIT/
(if applicable)
CERTIFICATION Zl 11
ASSOCIATED WQ PERMrTf�,. ,I (if applicable)
I. WELL USE (Check Applicable Box): Residential IT. MunicipaVPublic 0 Industrial Q' Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:'-Q.eA_w.> County? c'-rmase_
4-o L\yy-)loot Q_ e a ,
(Street Name, Number, Community, Subdivision, Loa No_ Zip Code)
3. OWNER: ( -6 C Gno IN)
Address n `f / A2e D - Cut9 (e
(soon w Raw No.)
466tit\\t0 NC
Cityot Town Sine
(T)-1)- 68i4-fl-N'F3
Area coda Phone number
4. DATE DRILLED tat 3 l0 3
5. TOTAL DEPTH: 1 t 70
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111'
7. STATIC WATER LEVEL Below Top of Casing: 79 FT.
(Use -+- if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
'Top of cuing terminated sI/or below laid surface requires
variance In accordance with 15A NCAC IC .0111.
9. YIELD (gpm): 3 METHOD OF TEST Roc.
10. WATER ZONES (depth). CYo - / Aso _ / - 7d-o - /
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
'3-84?o3 PEPTH
Zip Code From To
- 30
p
So -
SS
570
eq o
Si' Si
95-6, - P 57:)
, ogr phic/Latltsettiag----
'dge ❑Slope ❑Valley ❑Flat
(check appropriate boa) ---
atitude/longitude of well !oc•tion.
N 35v 3% a45 W e5doaa_15-5
Latitude/longitude source: E3GPSDTopogrsphic map
(check boa)
DRILLING LOfi
Formation Description
11. DISINFECTION: Type ii'�kk. go 7,.. Amount f P 03 ,
12. CASING: Wall Thickness
Depth Dior Weight/Ft. Material
From,t l To 5 - Ft. (e .iV.V f / 2t'C
From To Ft.
From To FL
13. GROUT: Depth u�r a) M'c ' '
From O To RO Ft. t „^/
From To Ft.
14. SCREEN: Depth Diameter Slot Sire
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:
q.7'0 - / / 7 0
tit (t`1u.'sc j
R&_e3
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TINTS RECORD HAS BEEN PROVIDED TO THE WELL O'
SIGNATURE OF PERSO
CONSTRUCTING T�
0
CT
CO
!fie AA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282869
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and uahtnl Resources -Division of Water Quality - Groundwater Section
13 tic )1 A 5 k CERTIFICATION 12- 7 Z/
NeY
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHOi8 )254-3581
WELL CONTRACTOR (INDIVIDUAL) NAME. (print)
STATE WELL. CONSTRUCTION PERMIT/
ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential PJ Municipal/Public 0 Industrial 0 Agricultural 0`l
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I bUy�cFlrl�(
Nearest Town: NI- AtS Ivlt-L— County `b
31Ga- GA6ater,5 C(Lrel�
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
r"-tct
(Street or Routa No.)
LJeAJe,CU R,kc 1J
ag'7''7
et-i ..?, )
City or Town S Zip Code
uigt� ()- 2-0- 33i;
Arc coda Phone number
4. DATE DRILLED \O J&&. o3
5. TOTAL DEPTH: ? O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: G O FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface•
'Top of easing termlooted at/or below Iced sodate requires a
variance In accordion with ISA NCAC IC .011a. G
9. YIELD (gpm)• St METHOD OF TEST ram+ -
10. WATER ZONES (depth): I o -- 4- G Prn
3 9-(3_ - 4 6 G P I"
11. DISINFECTION: Type tATbt q D 4o Amount 1. lb
12. CASING:
Dcpth
FroTo 55 Diameter
FL (bt/X
m
From To Ft.
From To Ft.
13. GROUT; Depth Material
From a To a0 Ft. 0.6M€t
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcpth Size Material
From To Ft.
From To Ft.
Wall Thickness
Sor baal uFt. p Materiel
ebnrb
opographicfLand sett g`
dge ❑Slope ❑Valley _0 at
(cluck appropriate box) _1
Latitude/longitude of well lokatiott
tographic
(dupe Wtnimnea/se odds)
Latitude/longitude source:❑GPS❑T
(check box)
DRILOW i-ati
Fo lion DesPcription
Db t��Rp, )
�A P-e LC)
6AA/4 C Prv.
Gm & i-t'6W IJ 1 2e IZZ Uc_
t.Jr41 -re ) be/L-
4-e GPn^
W Ir I &s (Lcc1C 02A/ Ga,AN I[
r
DEPTH
From / To
55'- 15o
Igo'
150'3 3o
3 30 - 34-D
3 4T5
3 4-0 - 390
I
LOCATION SKFTCFI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cRee1C
5 t'( "3
16. REMARKS:
c
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTDI 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON THE WELL DATE
1o/a3/03
ai 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2008
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc.
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) hirable)
(ifapp
282802
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial E Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Asheville
Hwy. 74 across for Reynolds High School
County Buncombe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Vance Gibson
Address PO Box 15976
(Street or Route No.)
Asheville NC
City or Town State
( 828 )_ 298-1984
Area code- Phone number
4. DATE DRILLED October 1, 2003
5. TOTAL DEPTH: 530'
28813-0976
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FF.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 35 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By Pump installer Amount
12. CASING:
Depth Diameter
From 0 To 50 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20
Material
Ft. Concrete
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.
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Topographic/Land setting c-
DRidge InSlope EValley OPlac-
(check appropriate box)
Latitude/longitude of well location }--`
(degrees/minutes/seconds) L-)
Latitude/longitude source:OGPSOTopographi'
(check box)
DEPTH
From To
DRILLID) , r nr,
Formation Description o
O
m
_
om
0<
O
.{
x-o
- m�
y o
c.7 cn
N
ry c
-r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L/�^LnG/ c C24Jtacae- tact J 'O Gf/za"-
Method &kik Hi Ja .w Exit . ?Vichy.
914
a-
awetly act tOmar/Kai, Ay a Aila-,,biethv,
at /t /'L&I.te e1OX hieixot
Slot Size Material
in.
in.
Material
16. REMARKS:
iwad.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)C12/1•t�-nc -1-. crnt (7n/cc L o I1- / o 3
SIGNATURE OF PERSON CONSTRUCTING THE WELdj 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

282696
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME sprint) CERTIFICATION # 30'/ /
WELL CONTRACTORCOMPANY NAME / !� * 1 O (-Zrnp PHONE a.-p (.Kt YS - 3 / 7°
STATE WELL CONSTRUCTION PERMIT#_-_.._. J419si. _.:\SSOCIA"TED WQ PERMIT#—_.-
1if applicable) cif applicable(
I. WELL USE (Check Applicable Box): Residential Municipal Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Ike
2. WELL LOCATION ,
Nca st Fown Lf_ I C
,� irk,.►.lJ-
Sirua Nana. 'umbers,Cunut mite. Subditt: ii m. I.ot No.. hip Codes
3. OWNER: Cipt _ud /�P
Address 6' O Bc%. l7 i,J
IStsn of Route No.)
( )
State
75-1
:Area code- Phone number
4. DATE DRILLED ' -? 4 -C'J
5. TOTAL DEPTH: 5 1f 5 I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below lop of Casino: LoL5 ET.
(Use...- if Mime Top of Gassing,
8_ TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant • with ISA NC.AC 2C .0118.
9. YIELD (gpm): METHOD OF TEST of I'1P..S .
10_ WATER ZONES (depth): R;-i' - 1 alp t c pcA'1
Topographic/Land setting I
❑Ridgy CRlopc ❑valley EIFfi
he k opploprinte box
I.Mantle longitude of well loe.nute
Id c cr n,]nnl e<a,d.)
I.atiutdc. loneitud ;uurcct❑GPS❑I op ) i t liic neap
WhsA box)
DI-.1'TII ''//
Iio6 Y'
may' 5/T'
arc
DREAM(' In( i C__� :'
-_�HMV aSjolylTvsuip:io��— ---
I OC VI ION SKETCH
1 I. DISINFECTION: Type J7/ (� Amount sici slip,direction and distance in miles from al least tiir
12_ CASING. Wall Thickness itto Stale Rsad; or County Roads. Include the road
numbers and common road names.
Depth , ,, // Diameter
From 6 To /A 4- it. & II
From Fe It.
From To Ft.
13. ( iROIII: Depth
From U To 6) Pt.
CIL1-tivk Rol
From To Ft.
14. SCREEN'. Depth Diameter
From To Ft. In
From 'To Ft. in
15 SAND/GRAVEL PACK:
Depth Size
[rum To Et.
Ft.
lions 'To
16. RIiMARKS:
or Wci_In Pt. Material
PVC')
Minoru( Nlethad
Slot Sue
In.
in.
?sate via
Nlalcnal
O
W
O
G
O
p
O
I DU I IE12FBV (ER ll v MAT THIS WELL WAS CONS I RUCITD IN AC CORDAM. ACIII I I5.A NCAC 2C. WELI.
CONSTRUCTION STANDARDS, ND IIIAT A COPY OF T111S RECORD 11:AS I 12UA'IU6U ID THE AVI 1 . OWNER
`�U � /L'L 2.t" \_� -- / o - 3 / - a 3
SIGNATURE OF I'IiRSON CONS I RUC ZINC I111 AAI.I L DAIT:
Submit the original to the Division of Water Quality, Groundwater Section. 163o ,Mail Syr' ice ('enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07 2001

282507
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) Qr'g-7 .35) 4,cj CERTIFICATION1472/3'
WELL CONTRACTOR COMPANY NAME �(t�ic t ck%IL On C( ;Ai
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMITS
(if applicable) (if applicable)
PHONE 0r(Z7c
1. WELL USE (Check Applicable Box): Residential uKMunicipaUPublic 0 Industrial 0 Agricuituiral fl
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:a 4
Nearest Town: %P r"2- County /`ik.h,,*-+'-72LlL
fApvr<z'c i 4r-
(Street Name. Numbers, Community, Subbdd+i-vision, Lot No., rip Code)
i:66e4t
3. OWNER:
Address a co
n (Street or Rome No.)
F4 , JI;C.
g ?2
City or Town State Zip Code
f7 )- 4 2 - Q5
Area code- Phone number
4. DATE DRILLED q-?ec 3
5. TOTAL DEPTH: IOC
6. DOES WELL REPLACE EXISTING WELL? YES OKIO 0
7. STATIC WATER. LEVEL Below Top of Casing: 64 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing tnaiaated Wor below Ind surface requires a
variance In accordance with ISA NCAC 2C .011g.
9. YIELD (pen): GM zr-zr METHOD OF TEST
IO. WATER. ZONES (depth): t ti %7 Yco'
( ✓� 1 I. DISINFECTION: Type +-v e L Amount grie9 =;..
e 12_ CASING: Wall Thidmess
`�' Depth Diameter or Weight/Ft. Material
Ft. G' Yv S'O Pi
Ft 6VA /1G' P7t
Ft. &%{ f/RB iQz K.
Material Method
Ft. ;1
Ft. tip/ fie vi ai16(•
Topographic/Lan l setti
❑Ridge ['Slope alit*
(check appropriate bo
Latitude/longitude of wet
weareessiosemeconan
Latitude/longitude source:❑GPSF Tnpoerpht9
(check box)
DEPTH DRILLING LOG
From To Formation Description
0- zoo
:Zoo . . 4/c
29C ��C)
age, 74.5
From d' To 177
FronR'7 To Col
From%' b J To
13. GROUT: Depth
From To
From f' To .V.i
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft
Slot Size Material
in.
in.
Size Material
16. REMARKS:
,L ✓; N G1�/xil
ea •/_ k���
i
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers common road names.
?y
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A! D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
Cl it-)
NATURE
PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quaity, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
.282506
North Carolina -DcpanmentofEnvironment and Malmo' Resources
�-DiivisionofWater Quality -GroundwaterSection �y�
WELL CONTRACTOR (INDIVIDUAL) NAME (pelmet) 9.4*y Jv��1K/J,c CERTIFICATION .,2,
WELL CONTRACTOR COMPANY NAME TUSf % GEyr IIP�QQ JAtr.r6.13 PHONE 8 tS 2I91- y.Syg
STATE WELL. CONSTRUCTION PERMIT! ASSOCIATED WQ FERMITN
(if appiiablej C—)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public ° Industrial 0 Agricultural 0 'I
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(if applicable)
2. WELL LOCATION:
Nearest Town:.
ue County blot ___c
(Street Name, !embers, Community, Subdivision,
Let lib.. to Code)
3. OWNER: rotC 51 Qd
AddressBey /S77
tveAueed2le wc) lei9797
&►- 7F
CityoTowns- y4Staw sz Zip Code
Area code- Phone ameba
4. DATE DRILLED ? •± O
5 TOTAL
;opographic/Land setting
Madge °Slope °Valley
(check appoprire box)
Latitude/longitude of well
(d)
Latitude/longitude source:°OPS°Topograp�tic
(cheek box) .O
DEPTH »RILLINC G
From`To Fonpationlf'ription
!J%/fiDesc
DEPTH:
6 5
/4-5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Bid . 40
(Us7. STATIC WATER LEVEL Below Top of CasingCIO FT.
if Above Tee of Craig) -in5
8. TOP OF CASING IS / FT Above Land Surface* W
'Top K ming tenanted Mier bUsw Iasi aconite rgnires
valiance Inc aceardasee with ISA NCAC IC .attt
9. YIELD(gpm): /e METHOD OFTEST ili/C
M. WATER ZONES (depth): /2 prof r5-0
11. DISINFECTION: TypeeZaie//VW Amount OZ
12_ CASING: WalThidmees
or Weight/FL Zail
Depth
From, tY To
From Z To
From To
13. GROUT: Depth
From To Ft.
FrommToJ� FL14. SCREEN: DepthFrom To FLumFt uTo Ft.
15. SAND/GRAVEL PACK:Depth
From ToFL
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STAND
F
SI
•
Itstrissais
LOCATION SKETCH
direction and distance in miles from at least
two State Roads or County Roads. Include time road
numbers and common mad tonnes.
/
Material Method
•
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND TH THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a•
OC:C Wd L-AONCO
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cella- Raleigh, NC
27699-1636 Phone No. (919) 7333721, within 30 days. GW-I REV. 07/2001
c
0_

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat�p
WELL. CONTRACTOR (INDIVIDUAL) NAME (prat)
WELL CONIRACfOR COMPANY NAME 1041 GE-
STATE WELL CONSTRUCTION PERMIT./
(ifapplicable)
282505
al Resources - Division�of Water Quality - Groundwater Section
3d4i`e- CERTIFIC�ATyIIONs?/5tl�
v� CLL V r t(. t 1M1(4 PHONE i 1y17ZV'T�!e
ASSOCIATED WQIPERMrTe
(if applicable)
1. WELL USE (Check Applicable Box): Residential Lt vlunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION j� 1 �(J -��e
Nearest Town: 1" ,�,Ge,/�� County
te—
nr..v.t .vd4 i e 7Q
(Street Name. Numbers, Community, /Subdivissiion, Lot No., /Zip Code)
3. OWNER: Wtt .ce
Address .SZ IZ.aJeuwna4l b✓
(Street or Route No.)
rL.e-Icks,
City or Town State Zip Code
- tat)-@,(..C<
Area cote- Phase number
4. DATE DRILLED 9 Jb ' 03
5. TOTAL DEPTH: g a9
Topograp,hic/Land setting
❑Ridge &Slope 0Valley
(check appropriate box)
Latitude/longitude of well Ioa
(degrmdmimWdseconds)
Latitude/longitude source:OGPS❑Tapo
(check box)
DEPTH
From To
0- 90
90-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 5O FT.
(Use"+" if Above Top Of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of easing terndaated stlor below and state require a
variance In accordaate rdtb ISA NCAC 2C .Mlle.
9. YIELD (gpm): /5 METHOD OF TEST 4/.-
10. WATER ZONES (depth): l ,%prrt 62 370
1 I. DISINFECTION: TypeaDie .AJP. Amount Qo2C'73%
12. CASING: Wall Thielmess
Depth ea._ or Weight/R. Material
From To a) Ft. /Da (D � P
From 80 To Ft
From /06 To iCZ Ft. 194 1 t38 Q«,.
13. GROUT: Depth Material Method
From To FL
From © To M Ft
14. SCREEN: Depth Diadieter Slot Size
From To FL in. in.
From______ To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
itO
Formation
p
c map
L•
u escnptio
U's'
gam
is)Z4a.i,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C~
A
16. REMARKS:
I DO HEREBY CERTIFY THAT TH1
CONSTRUCTION STANDARDS,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WFI.I
THAT A COPY OF TH)S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGMA RE QF PERSiON 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

284372
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and uantral Resource -Division of Water)
Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) — 13 t 1 \ N k CERTIFICATION / 21'1-k'- -
wELLCONTRACTORCOMPANYNAME_REUBEN CALDWELL DRILLING, INC. PRONEqY8 1254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IY" Municipal/Public ❑ Industrial 0 Agricultural ❑ ..
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER:
2. WELL LOCATION: nn f
Nearest To A g-ij i count, iJv0(.4Ak
AJi3(4 r A2K Pd13245 Cli.�f;IC
(Streit Nam , Numbcn, Camnunity, Subdiblision, Lot No., Zip Cork)
Qu-cT'
iToWA
(839 )- �9 - 56G a
Arca Bodo- Phone number
4. DATE DRILLED ic2/at3/0nJ
5. TOTAL DEPTH: 4- -1 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fl
7. STATIC WATER LEVEL Below Top of Casing: 1 lob FT
4 (Use '+' if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface•
Top of castes termlaated at/or below had surface requires •
variance In accordance with ISA NCAC IC.0111.
9. YIELD (gpm): 3 � METHOD9F TEST t-tG ` A I a-
10. WATER ZONES (depth): A Ciie — 3b G t?i n
11. DISINFECTION: Type
12. CASING:
{{ Depth c/ Diameter
From 1 To 50 Ft. �/`�
From To Ft.
From To Ft.
13. GROUT; Depth
Frorn To a o Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Address c.I tog
(Sera C No. ^ `i 3q
rX0 I
City a own State Zip Code
Amount 1 1 b
Wall Thickness
or5Weight/Ft. t�at�rjal
Material Method
C e tAbla t 3/4/CLOP-at)
/Topographic/Land setting
Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatiojl
(detpetemimne✓.econde)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fro,_,Lm T9 Formation De scriplion
=3 GeN
53=
4 30 /45c
4-5:
4Sc'- 410
n
532
LOCATION SKETCH"
cr„
Show direction and distance in miles fro r t leait�
two State Roads or County Roads. Include the r;
rd
numbers and common road names. me
m
O u)'
m�
r,
(fit,
Jrn
G4ru) Aker s
Qnr�
T
C (LES iqC
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE waif ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CAP J'Y O��F REC()�D HAS BEEN PROVIDED T `�� WELL � `WiJ�t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2843'+'0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u+t.uaIResources -Division of Water Quality - Groundwater Section ,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ( S t Luke (‘..)ASH C.RTlFICATIONa a
WELL CONTRACTOR COMPANYNAME_RF.UBEN CALDWELL DRILLING, INC
WELL 1254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if appl icable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0/Municipal/Public 0 industrial 0 Agricultural Cf
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER:
Address
2. WELL LOCATION: /j
Nearest Town: WC=h�EtVILt_L County U',0wyn(%L,
34 ,-tools (L0A0
(Street Name, Numben, Community, Subdivision, I.a No., Zip Code)
\Rotor tE e-IfOOLE.
3e, Rten = a-0AD
(Sui( w Route No.)
1,EAJegAi LLt ,ac_
as -1 g -I
City or Town State Zip Code
( gee)- b 46 - s S1 3
Arta code- Phone number
4. DATE DRILLED
t a,,((l3.��0/03
5. TOTAL DEPTH: r30
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO t3
7. STATIC WATER LEVEL Below Top of Casing: % FT.
(Use'+' if Above Top of Casing)
8. TOP OF CASING IS -S FT. Above Land Surface•
*Top of cuing terminated sI/or below land surface require a
variants In accordance with ISA NCAC rC .0111. 9. YIELD (gpm): `). METHOD OF TEST i l
10. WATER ZONES (depth): 'a `allo ' — I C e tr
1 3'-1 e ' — . Gen-,
1. DISINFECTION: Type VA TIJ R b f Amount
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From -i To Il5 St)Rat PYC
From - To
From - To
D6itib.mcter
Ft.
Ft.
FL
13. GROUT; Depth Material Method
From To ao Ft. CCcnc— t o.g.. )
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 °Fiat
(t3cck appropriate boa)
Latitude/longitude of well loca'tioti'.
(depeeemimdu/seunds)
Latitude/longitude source:❑GPS❑Topgpaphic _.
(check boa)
PTH '_
DEDRILL11116 . we__n -_-
F1pm,_ 110 nFukTAtiod✓4eIJrtn
((ot- aac,' C;lCA t'T
aa0 t Gs'^
��e'— s4' r 2A. tTCT
'i' 0' f3/P .rx
34c ''— �- 30'
O CA c-fk9S!T€
crcE
r-m
>0
�c
JOCATION SKETCH p mz
Show direction and distance in miles (r at �ast
two State Roads or County Roads. Inc!i e thgoad
numbers and common road names.
Sm O
C2ir
try
J.]
i I -AT CiCee,ic
XiT
IJW( la/a3
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT PY OF THIS RECO HAS BEEN PROVIDED TO ` a V1�
SIGNATURE OF PERSON CONSTRUCTING THE WELL 1XATE /
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

284363
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and >Jahrnl Resources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (plat) i3 11-1.1 (_. NA S � CERTIFICATION / al 1
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC.
PHONE448 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential [3v-MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIQ N:
Nearest Town: 11 SNeVtt-i-k
Ccw4NI CcJL.
County !',✓N Co evG
it° r( ID
(Street Name, Numbers, Community, Subdivi,ion, Lot No., Zip Code)
3. OWNER � LL A v 4 S
Address 36'/a (3yd-T-ce (2-/ A2{c Ave
(Street or Route No.)
ASNEvPc- aflci.
City or Town State Zip Code
(AS')- 5S — 15S
Area code- Phone number
4. DATE DRILLED 1 a� I 1 / 01a
5. TOTAL DEPTH: b \ O ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 9-0 FT.
(Use "t" it Above Top of Cuing)
8. TOP OF CASING IS - - FT. Above Land Surface*
*Top of wing tenolaated at/or below Ind surface requires a
variance in acardenc with ISA NCAC 2C.011a. 2 .
9. YIELD (gpm): ace/ardency METH_QD Of TEST Rt( - A
10. WATER ZONES (depth): 12S 0 - 3/4 C>P,.-�
11. DISINFECTION: Type 1 h
12. CASING:
From �- To 1h3 `� FL
From To Ft.
From To Fi.
13. GROUT:. Depth
From i To ao Ft.
D.{epeter
Amount
Wall Thickness
or Weight/Ft. Material
Material
C.n\6tr
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Lend setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(deg xehulanmd,eamds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) L------- -.
DRILLING LOQ
Formation Description
C hZ13 v eZ-IJ(i 13
C, (t-/1 :v t T E Gam/
3/4 r2e
.--r4-rdfr
bG /
DEPTH
From " To i
30
30'-- ISo
Sc
$o'- 6to
cn
m
...F-
ri :Cr
LOCATION SKETCH c7I =-a
Show direction and distance in miles from itPleasg
two State Roads or County Roads. Include the road
numbers and common road names.
Cr:`/CV 114. —
I
01-6 C-0VNIy /{d:v\C? /Z(i
16. REMARKS:
I DC) HEREBY CERTIFY THAT 7113 WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ace, A c.-- I a% 1 g/o_s
SIGNATURE OF PERSON CONSTRUCTING THE WELL GATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283395
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) if��ryJ G, nL L CERTIFICATION i(�['pQ_2(�7ry
T WELL CONTRACTOR COMPANY NAMF, �� ¢y���! LLZ2iL ,/,{��p_ 2.H-Lt. PHONE St {car Ipr/_Q.Ty I�
STATE WELL CONSTRUCTION PERMIT# L%� ASSOCIATED WQ PERMIT# Iy/I7
il
(if applicable) (if applicable)
1- WELL USE (Check Applicable Box): Residential X! Municipal/Public ❑ Industrial ❑ Agricultural C
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town:
COuntyttrEnLC
(Street Name, Numbers, Comsonity, Subdivision, Lot No., Zip cwt.)
3- OWNER:P
Address 1/45
(Street or Route No.)
—1V•Ca 8 wr
City or Town Start Zip Cede
(
Area carte- Phone number /
4. DATE DRILLED //� 5/ 0.�
5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing:,. 3 D FL
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 3 _ FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance la accordance with ISA NCAC SC .0118. •
9. YIELD (gpm): S!O METHOD OF TEST nt
10. WATER ZONES (depth): l C t
Topographic/Land setting
❑Ridge Jx$lope DValley DFIat
(check appropriate box)
Latitude/longitude of well location
(degreezmunmesiseeunds;)
Latitude/longitude source:DGPS❑Topographic map
(Lisa box)
DEPTH DR17.LTN(31�(,)Ci
From To Formanioa.Desciiptiai
r—
f�l
r
LOCATION SKIT%
11. DISINFECTION: Type6aaa
Amounin miles I�----
-
t OL Show direction and distance -
12. CASING: Wall Thickness two State Roads or County Roads, include the road
Depth Diameter or Weight/Ft. Material numbers and common mad names.
From p ToS._ Rio j? ¥.Zl d r From To Fr
From --
From__--_. To_.—.___.. FL _ __ _...
13. GROUT: Depth Material Method ,
From-DTo_ _ Ft. �� LS1 rifes_
From To F
14. SCREEN: Depth Diameter Siot Size Material
From To Ft. in. in
�To . t. in. M.
15. SAND/GRAVELPACTC.
Depth Size Material
From GTh Ft.
Frorn _
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WE __
CONSTRUCTION STANDARD' ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ .2S o3__
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days- G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME tint)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
283392
aural Resources - Division of Water Quality - Groundwater Section
bA//i//C /JIL.L - CERTIFICATION pt�1177
/ASSOCIATED WQ PERMIT'S _� A
(if applicable)
PHONE #
1. WELL USE (Check Applicable Box): Residential X Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIOI-
Ne tr st Town:
CountyihL/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
,�pp (Street or Route No.)
rdGcr�c ACC • .29935
City or Town State
Zip Code
AreaA code -
DRILLED
EDnumer ///9 /D
4. DATE DRILLED
5. TOTAL DEPTH: _7 f> ,S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO rif
7. STATIC WATER LEVEL Below Top of Casing:, 3 � FT.
_ (Use ,*" if Above Top of ing)
8. TOP OF CASING IS 5 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): /0 METHOD OF TEST
10. WATER ZONES (depth): _42 4 .:la.%/) I
Topographic/Land setting
[Midge QXSlope [Walley ❑Flat
(check appropriate box;
Latitude/longitude of well location
(degrees/minutes/seweds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLFNG-Wra--
From To Formation Descriptidn--3
11. DISINFECTION: Type
12. CASING:
Vat -octet
From tO To JO Ft. _
From
From
To Ft.
To Ft.
Amount ZS •'"
Wall Thickness
or Weight/Ft. Material
*2/ pile_
13. GROUT: Depthn Material Method
From D To 91
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From�o Ft.
From / _lo Ft.
16. REMARKS.
r
-71
C::I• S CFI
Show direction and • stance in miles from at least
u
two State Roads or ounty Roads. include theioad
numbers and_ton road names. 5'W-�o o
v
/a0
2 OP
ur=
0
) DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL thD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TT�HEE WELL OWNER
SIGNATURE OF PERSON
CONS7RUCCINGTHTE 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. 07i2001

283391
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N�y�� Resources - Divisionisof Water Quality - Groundwater Section
r�n
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(print) oral
I C jiAt e_ ,, /J CERTIFICATION $7
WELL CONTRACTOR COMPANY NAMEJSc2.WGGLt.eL>?.L'p/ ( 4- JC�Yyr/ N?4! PHONE #r(ga14V7-oyks
N/ r
STATE WELL CONSTRUCTION PERMIT# ' ASSOCIATED WQ PERMrr# /Y//7
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tit 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
Near p4 Town: I.CleLas.t/ CountY_/hJs%t
(Street Name, Numbers,bs,Community, Subdivision, Lot No., Zip Code)
3. OWNER: C�2rwu-w
Address # /y i-s ni— Rd
(Street or ute No.)
tacLea 'y.c a f 797
City or Town State Zip Code
Area code- Phone number,
4. DATE DRILLED ��/.S7 D 3
5. TOTAL DEPTH: LZGS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jdr
7. STATIC WATER LEVEL Below Top of Casing: aZ FT.
(Use "+^ if Above Top of Casing)
8 TOP OF CASING IS / LC FT. Above Land Surface`
`Top of casing terminated at/or below Iand surface requires a
variance In accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): 0 ME HOD OF TEST
10. WATER ZONES (depth): 5- I % Yo
11. DISINFECTION: Type
12. CASING:
Depthu
From__Q To %1'
From To_ Ft.
From _ To Ft.
13. GROUT: Depth Material
From 0 To�Q
From To
14. SCREEN: Depth
From o_ —
From / To Fi. in.
15. SAND/GRAVEL PACK:
Depth Size
From �o Ft.
From / TTo Ft.
Amount /0 GI --
Wall Thickness
Diameter or Weight/Ft. Material
FL_.6 t +#a/
Topographic/Land setting
❑Ridge %Slope Malley ❑Flat
(check appropriair box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING-to,G R ----
Formation Description,
DEPTH
From To
Method
14 ii•C y
Ft.
Diameter
Ft. in.
16. REMARKS.
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles fro , at:least
two State Roads or County Roads. Innd tfie road
numbers and common road names. c'O
0
rtl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIj.AY)AACCOOPPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATGRE OF PERSON
ON CONSTRUCTING THE WELL DATE
ze/ tdrLo3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 clays. GW-1 REV. 07/2001

283387
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N rural Resources - Division of Water Quality - Groundwater Section
�/
CERTIFICATION tb X 7
PHONE # (&si✓L 1 Aff 0 n
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable)
(print)
(if applicable)
1. WELL USE (Check Applicable Box): Residential lit Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Near Town.
3. OWNER:
Address
(Street or RoutfNo.
CLr C ity or TOW!) State
.
Area code- Phone number
4. DATE DRILLED /42�// D 3
5. TOTAL DEPTH: 3 Q S
6. DOES WELL REPLACE EXISTING WELL? YES 30 NO CZ
7. STATIC WATER LEVEL Below Top of Casing: frit FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5" FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST
10. WATER ZONES (depth): 8o r JfS'
7;70
Zip Code
Topographic/Land setting
❑Ridge TaS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minims/seconds)
Latitudetlongitude source:❑GPS❑Topographic map
(check box)
pRILLING L6G— r
Formation De$cription ) C
11. DISINFECTION: Type/ * Amount /D
az-
12. CASING: Wall Thickness
Depth atneter or Weight/Ft. Material
From /0 To Depth.
Ft. «4 / 91/C.
From To Ft.
From To Ft.
13. GROUT: Depth nnMaterial ' ' 'Meetthod .
From 0 To 40 Ft. (�_yr1401-4 i ( +��
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Frotn__�To_ Ft. in. in.
I . SAND/GRAVEL PACK:
Depth Size Material
From Ft.
From 7'o Ft.
lb. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DEPTH
From To
LOC TION SKETCH
Show direction and distance in miles fro' at least
two State Roads or County Roads. Incl e the road
numbers and common road names. 1
a
CFI
tT
rT
cn
rrl
0
p.3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283386
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pilot)N! G,,Qf.(��L t- CERTIFICATION 02,2877
M WELL CONTRACTOR COMPANY NAE j m -c..r a)Lr /4.200'PHONE # (82,)— 4 9"7-41s-6
STATE WELL CONSTRUCTION PERMIT# / /f ASSOCIATED WQ RMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearesy7own: /2t County%ri.IiaP.ri
y.1 £'9d y
(Street Name, Nrs, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address /c/
City or Town State
_sider A.
(Street or Route No.)
Zip Code
Area code- Phone number
4. DATE DRILLED/4AI/6, 3
5. TOTAL DEPTH: re2 &5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111
7. STATIC WATER LEVEL Below Top of Casing: -3 -5- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /S FT. Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /S METHOD OF TEST�Gm/
10. WATER ZONES (depth): _14.2 DO '
11. DISINFECTION: Type Amount .9 n-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_/% To_Zz Ft. 4t-.2/
From_ To Ft.
From To Ft.
13. GROUT: Depth Material Method •
From D To oZ b Ft. (4mt?i� 1',`I'.iy`y`"ie
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From /To Ft in. in.
From / To Ft. in. in.
Material
Topographic/Land setting
[Midge i>itSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To
15. SAND/GRAVEL PACK:
th
To Ft.
To Ft.
From
From
16. REMARKS:
Size
Material
'DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in tni
two State Roads or County Roa
numbers and common mad
cn
cal
r-
1 DO [HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUC1 hD 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 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

283385
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources i Resources - Division of Water Quality - Groundwater Sectionr� /J
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) 1 /l f,AI # / t� AL Z.- CERTIFICATION Min?
WELL CONTRACTOR COMPANY NAh'U; ] 1 //]lY-' PHONE # (/. y9>H80
STATE WELL CONSTRUCTION PERMIT# 4 SOCIATED WQ PERMIT"
(if applicable)
, (if applicable)
I. WELL USE (Check Applicable Box): Residential X Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neartst _.wn
.lfl.GeOL�]i P.li County 8% t
(Street N r Numbers, Comtnunity, Subdivision, Lot No., Zip Code)
3. OWNER:727 Address
or Ro
r (Sgeet ijc. mp No.)NoCity 65.5 4' State S$ /
aen7
Zip Code
Area code- Phone num
4. DATE DRILLE /7 3
5. TOTAL DEPTH: 7.OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12
7. STATIC WATER LEVEL Below Top of Casing: 9.0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /...c FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance to accordance with ISA NCAC 2C .011S. •
9. YIELD (gpm): /O METHOD OF TESTrierne,
10. WATER ZONES (depth): a.Z2 0 I
l 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To/dQ Ft.lI- r.2/ 601/G
From
From____
From
13. GROUT:
From F>
From
14. SCREEN:
From Ft.
From r To Ft.
15. SAND/GRAVEL PACK:
To Ft. -
To Ft.
Tth Material
o. 2.0 Ft. (Sat945fr
To Ft.
Depth Diameter Slot Size Material
ir.. in.
in. in.
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/Minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Fonnatiop Description--- - 7
Method ..
■ l
Fromi oo From To Ft.
16.REMARKS:
1 DO HEREBY CERTIFY THAT THIS WFI I 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
Size Material
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles f um at least
two State Roads or County Roads. Include the road
numbers and common road names.
cc; .7.-7
O
3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283378
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources - Division of Water Quality - Groundwater Sections
L_ CERTIFICATION 4877
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMTT#
(if applicable)
4//*
tute.. 'tghregd d4RONE # UCI1-/ey
ASSOCIATED WQ PERMIT# Mb/
(if applicable)
I. WELL USE (Check Applicable Box): Residential III Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nest�o
CountyGOeclateltnieY/
,.2f7Vf
(Stint Name, Numbers, Communi
• n i
3. OWNER:_a4
Address gr.9
City or Town
State
Subdivision, Lot No., hip Code)
Zip Code
Topographic/Land setting
❑Ridge MSlope ❑Valley ❑Fiat
(check apprmriatc box)
Latitude/longitude of well location
(degrees/mimaes/seconds)
Latitude/longitude source:❑GPS❑Topogr phic map
(check box)
DEPTH PRILLINO LOG
From To Formatio, a-+• ••
Area code- Phone number,
4. DATE DRILLED /D//6/ D 3
5. TOTAL DEPTH: / fs
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO }R
7. STATIC WATER LEVEL Below Top of Casing: 25-- FT.
(Use "-t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): e.2 t METHOD OF TESTT�G...e!
10. WATER ZONES (depth): 4 0 1 ./49fj
11 DISINFECTION: Type(f'" ount ot--
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. iv' nal
To-30 Ft._4_4,_ #v--/ V'c
From %)
From To Ft.
From To Ft
13. GROUT: Depth M
From � To .Zb Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Ft. in. in.
From / To
, Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
From Io Ft.
From To Ft.
16. REMARKS:
CA
Show direction d distance in miles from at leas
two State Roads . r County Roads. Include the rod
numbers and co •• • on road names.
0
0
Fri
(Il
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE MO IN ACCORDANCE WITH 15A NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ZO
SIGNATURE OF PERSON CONSTRUCTING
WELL DATE
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

283369
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) Ixtoiv,vie. (Lint '"""� West
CERTINICAT{ONt(�4gJ._z
WELL CONTRACTOR COMPANY NAME fA.2JJ ii2a4 ryr- WL C PHONE
STATE WELL CONSTRUCTION PERMIT# gig_ASSOCIATED WQV PERMIT# I
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 111 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
County livehi .L,t
(Stint Name, Numbers, Comm , Subdivision, Lot No., Zip Code)
3. OWNER:
Address
t./� 711�f
ad ut ezp
City or Town State Zip Code
Vie- 93.2-4/n2.e
Area code- Phone number
4. DATE DRILLED /D/3//D 3
5. TOTAL DEPTH: 1 ..
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j
7. STATIC WATER LEVEL Below Top of Casing: 'S FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface'
'gap of casing terminated at/or below land surface requires
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): S METlHOD OF TEST
10. WATER ZONES (depth): �%J t Na./.0 I
11. DISINFECTION: Type Amoumt.�[� r=
12. CASING: �/ Wall Thickness
Diameter or Weight/Ft. biat
Depth al
From 10 _To_ O Ft. 4 #.1/ ®lG
From To Ft
From To Ft.
13. GROUT: Depth/t Material tad From D To 2 rl _ Ft._�i
From To Ft.
14. SCREEN: Depth Diameter
From_^ o_ Ft. in.
From_ To_ Ft. .
SAND/'RAVEL PACK:
Topographic/Land setting
[Midge IXSlope ❑Valley ❑Flat
(check appropriam box)
Latitude/longitude of well location
(depfees/minutes/sccoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formati
15.
Depth
From .7:-To
From__ T°- —
16. REMARKS:
in.
Slot Size Material
in
Size Material
FL
Ft.
LOCATION SKETCH
Show direction and distance in mile from at
two State Roads or County Roads. Inc
numbers and common . ad . • tes.
Uvd
m
roan
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Lo/3//03
SIGNA tir O PERSON CONSTR
CTING THE WELL "DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283273
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *Natural Resources -Division of Water Quality - Groundwater Section �r
WELL CONTRACTOR (INDIVIDUAL) NAME (print)g I L U e rJ CERTIrFrICATION a o�( 1'
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONEY8 '254-3581
STATE WELL CONSTRUCTION PERMIT/ ♦SSOCIATED WQ PERMIT/
(i f applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential i MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: &ALA 20SJ I LLe. County € yp) rv'(3 E
A-S CIi)21Sr% 1-A4JIa
(Street Name, Numbers, Community, Subdivision, LA No., Zip Code)
3. OWNER: \-6 koy,e (Le ) e v \--
Address 45 CN(.1STt \-Ae3I
(Strut cc Route No.)
aAtA)A20SJ)L-L%1n)( 3g1o9
te
x City orTown )- &al.S as 5(.0
Arca code- Phone number
4. DATE DRILLED
la`3/o3
5. TOTAL DEPTH: 9- 3 e ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IN
7. STATIC WATER LEVEL Below Top of Casing: If 0 FT.
(Usa "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated al/or below Ind surface requires a
variance is accordance with ISA NCAC IC Alts.
9. YIELD (gpm): 5 D METHOD OF TEST R (7 - A I ti
10. WATER ZONES (depth): a). 1 O / 56 G PanN 11. DISINFECTION: Type I f( go- /c Amount
Zip Code
Topographic/Land setting
Ridge 0Slope ❑Valley ❑Flat
(t:ex& appropriate box)
Latitude/longitude of well location
(depeu/m tmr us/seconds )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DE TIi DRILLfNG LOG
Frpm To / Fomiation Description
— 13 o4
b,2(S �-.5e
(2(LA .u'TEs/AL)pit r (2CC/C
So 2C, Prv'
4 3 — ato'
alo'
e9,{0 -bt '
12. CASING:
1
From To �T b Ft.
From To Ft.
From To Ft.
�e Wall Thickness
Dtatter k, '( r L2�t/F1. 'kf_pt�rial
D Y1 C
13. GROUT: A Depth Material Method
From To Au Ft. abwka,.3l Pv..2Ea
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 Materi❑
From To Ft.
From To Ft.
16. REMARKS:
3 t
c
)
rn
LOCATION SKETCH r11
Show direction and distance in miles from -tat leas`
two State Roads or County Roads. Includi-The road
numbers and common road names. r "'
u):7
L)Sin,(V
e (S
LAzOe
)14
�Fl 2NA ROSN) \LLT.,
4 frd
iJuITr,r.c4LC
l n,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ---�'.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC HAS BEEN PROVIDED TO THE WELL OWLfER
9-1 SIGNATURE OF PERSON CONSTRUCTING THE WELL D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleig
27699-1636 Phone No. [phone], within 30 days. GW-I REV.
C-
0
0

283274
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mantra, Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (plot) anode fiAgi* CERTIFICATION a-i1
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC.
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Dos): Residential D' MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: p /�
Nearest Town: WEAN( O.) l County Vvn; COMIJ>r
&LOOKt/tl.13 (3c7)TL `S
(Sweet Name, Numben, Community, Subdivision, tot No., Zip Code)
3. OWNER: G (LE
Address P- U . ci 14- 69
(Street or Routs No.)
C,06AfeP,JI\t_L✓ Nc as--1
City or Town Stale Zip Code
(secs)- 61-5-o1 o4
Asa cockPhone number
4. DATE DRILLED
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !N
7. STATIC WATER LEVEL Below Top of Casing: $O FT.
(Use'+' if Above Top of Casing)
8. TOP OF CASING IS -I' FT. Above Land Surface•
'Top of cuing terminated at/or below Ind 'urine requires a
variants to accordance fiqlth 13A NCAC IC.01 I1. n t ^
9. YIELD (gpm): 'F- METH D OF TEST K-t " 'C.-
10. WATER ZONES (depth):
I1/.1GAo 3
f %34•r 3 a
11. DISINFECTION: Type RTP r c Amount 3- I IC
12. CASING: Wall Thidmcss
Depth,
Fron To 9 ter or Weight/Ft.
D
From To
From To
13. GROUT: Depth Material Method
From.J To el Ft. CEritib.�T Pct):e D
Ft.
Ft.
Ft.
Material
Di me
(�`/c SJSFL9,1 Pf�
p crvl 1 zA
LOCATION SKETCI(
Show direction and distance in miles from aa�h�eas(
two State Roads or County Roads. nclude 7" road
numbers and common road names.
J- n
—4.:7K�1 ;'�
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:
PRONEQ2C8 )254-3581
Topographi setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude longitude of well location
(dtuw/mtoutnhecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING i.O0
Frop i To / For*Pation Descriptiomo
- 5 0Vet(06�2o
�rs " ("i +211 s.)i its tiJNfi r ,�ccit
1 3-o ' .-�
t2�P' 31n' , o NIrL c,�Nlre. g.L.0
+3 te_ o
Sip' - 3So U >J
w
IJ
n c'
(< -
•am
nR
r_ J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COnits RECORD HAS BEEN PROVIDED TO THE WELL O'
► i• c{/ 4\ r i/�
SIGNATURE OF PERSON CONSTRUCTING THE WELL IbATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV.
c
v
;-)
CD

3. OWNER:
Address
283275
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mahuall Resources-Divisionof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - 6 vi.lL)(j ,aAsa3.1 1CERTIFICATIONif y
'
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I3% Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other ❑ If Other, List Use
2. WELL LOCATI,ON:
Nearest Town: (51-AC< I71DuIIJ 1-A/oJCounty >JCam(ar
r o(ttt Pe, 2eA D
(Street Name, Number, Community, Subdivision, lot No., Zip Code)
(\(\IKts C7eD3Sac�
f. o �.oy/
(Street or Rowe No.)
eLAc-K MoO;JTAC. a sfl I I
City or Town State Zip Code
(VP21)- 6e) - -s, 55
Ares code- Phone number
4. DATE DRILLED 1' jai /0 3
5. TOTAL DEPTH: a) o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (7
7. STATIC WATER LEVEL Below Top of Casing: Flo FT.
also "s" if Above Top of Carina)
8. TOP OF CASING IS - FT. Above Land Surface*
•Top of cuing terminated at/or below lad surface requires a
variance In accordance with ISA NCAC 2C.01II.
9. YIELD (gpm): i 5 METHOD OF TEST RIG'" A It)
10. WATER ZONES (depth): / )0 — 15 G PM
11. DISINFECTION: Type
12. CASING:
1 DepLh
From 1 To 3-0
From To
From To
13. GROUT: Depth
From To as Ft.
S qb�
From To Ft.
Amount
IIa I
Wail Thickness
Dinnwr or Wri t/Ft. Material
FL D'/q' .1Ca cS 1ti6-.!
Ft.
Ft.
Material Method
CdrY1(3fyr et °Re b
14. SCREEN: Depth Diameter Slot Sim Material
From__To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Sim Material
16. REMARKS:
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley Mfelat
(check appccptieto box)
Latitude/longitude of well location
(deyeu/mioutea/secoads)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DRILLING LOG
Formation Description,
fo,4t e 40--tc.)L
DEPTH
Frojn / To i
a5
a5- i to
h1D'
ate.
c,)
0
ICI
-0
_1,_
LOCATION SKETCFI
Show direction and distance in miles from at iejst
two State Roads or County Roads. Include therroad 2
number and common road names. t c.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TIF1S RECOHAS BEEN PROVIDED TC OWtij;R,
SIGNATURE OF PE
ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Set -vie
27699-1636 Phone No. [phone], within 30 days.
GW}1 REV. 07/2001
Pr.il i9J fJ ^C

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u+hual Resources
WILL CONTRACTOR (INDIVIDUAL) NAME (prtat) lt^LI�
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL
283272
- Din)sion of Water Quality - Groundwater Section
`,,
1-1 ASJJT CERTIrF�ICATIONY al-1DRILLING, INC• PHONEY?(8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Wl'+A'XBRUI'—'S County Gu c_oryAC
6ANIc.STO aJ aoA.D
(Street Name, Numbers, Community, Subditirion„ Lot No, hp Code)
3. OWNER; - 7. / /t fk
Address 0 cy :0, 3C,
_ (Streets RoUeN.)
G(1Oci-cc , (.u9.1p. -111 (9 s 777
City or Town State Zip Code
(ss-;2SX)-' 776 9 7/ y
Area code- Phone number
4. DATE DRILLED n - 0 -3
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: bD FT.
if Above Top of Casing)
8. TOP OF CASING 1S _ 1 FT. Above Land Surface*
*Top of cuing Iarmlo•ted Mfor below laud surface requires •
variance In aewrdaA ea lib ISA NCAC IC.0111.
9. YIELD (gpm): 'i' 1�r3. METHOD QF TEST 6- Ai
10. WATER ZONES (depth): too — q-' V5. eon-`
11. DISINFECTION: Type T t4 q „ Amount
12. CASING: Wall Thickness
Det
Diameter or Wet t/Ft. Material
From Top 3 Ft. (-- b SQr*•l PVL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To 3-1 Ft. �EyY16�r QaLieD
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting_
❑Ridge ❑Slope ❑Valley Qf'lat
(deck appropriate box)
Latitude/longitude of well location
(depeeahninutes/vxonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING lAr
Fompition Description.,
SA/Uri cot-lats
414_GOf.
DEPTH
Frpm To
5K'— \So'
($0•
c
O
tTI -
i.LOCATION SKETCH _
Show direction and distance in miles from apjeascL14.
two State Roads or County Roads. Include I16 roast;
numbers and common road names.
U5 H/a3
Iz
n:
5-
6J/1rK-SYC NJ �L-D
(.�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A OP HAS R ORD AS BEEN PROVIDED TO THE WELL. O
ckfrit &-- ;
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
CSji
_
Lna
r-
1Z>
0
0
CG
•
TMT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

nl
JUN1 ?
292476
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural( Resources - Diivision of Water Quality - Groundwater Section^.-1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1J \ L-LI e ii A S I o CERTIFICATION N a 1 1
y
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC• PHONEpY%$ ?54-3581_
STATE WELL CONSTRUCTION PERMIT/ _ ASSOCIATLD WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public Cc Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other Dif Other, List Use ea (1-e i2 e a-K
2. WELL LOCATION:
Nearest Town: L 3 e f J g tJ 1 U C County Qit-'C-am%C
DuL,A Sf(-r3QS (OAO
(Street Name, Numben,
n, Cornuniry. Subdivision, Lot No., Zip Codc)
n
3. OWNER: 1) A A)`-/ W i t'Sa cJ
Address "\ r /E (Z t o r-. AVE •
(Street or Route No.)
t.)eAVegstL-Le_ ais-18
City or Town State Zip Code
(�a�y 64-5 - bc,1
Ara coda Phone number
4. DATE DRILLED 1 9./3 1 /D 3
5. TOTAL DEPTH: 4 S o
6. DOES WELL REPLACE EXISTING WELL? YES Q NO 0
7. STATIC WATER LEVEL Below Top of Casing: b 0 FT.
(Un-a' if Above Top of Cuing)
8. TOP OF CASING 1S -- FT. Above Land Surfaces
*Top of cuing termleated attor below Ind mint requlra •
variance In accordance with ISA NCAC 2C .0111
9. YIELD (gpm): at, METHOD OF TEST MG - Ai (L..
10. WATER ZONES (depth): •6h o ' — as e err.
11. DISINFECTION: Type
12. CASING:
Depth
From �- To a\ Ft.
From To Ft.
From To Ft.
13. GROUT; Depth
From 1 To ao
Amount
Wall Thickness
or Weight/Ft. Material
SO(aa1 QJc-
Material
Ft. C» me NYC
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 Sire Material
From To Ft.
From To Ft.
Method
route b
16. REMARKS:
Topographic/Lend setting —
❑Ridge ❑Slope ❑Valley l3tlat
(check appropriate box)
Latitude/longitude of well location
(depaet/mimttedsecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From 1 ToI / / Fo :tionDescrirlion
ITN gasc.i_
16'- 36o
35o'- 4 ?o •
r,
en
z �m
G) o c
LOCATION SKETCH
m
Show direction and distance in miles from atlast m o
two State Roads or County Roads. Include tlms z
e roa
numbers and common mad names. �G^
ta ~
ug
(1/
bOLA
S (aNcp 5
a M
MOPJi tC6)-1_0 PPD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT Ar��COPY
�OF THIS RECORD HAS BEEN PROVIDED TO THE WE 11L OWNER
31
SIGNATURE OF PERSON CONSTRUCTING THE WELL
4-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

'Oeur11.,b1 C 2 I Ura3 - Depart' la: nt ul Efl%tS eorntlmnil! Satttut�Jlltti1SrS+1reu
*lit Una aVI' 'ION (IN DI a'IDCALa O +lei lh++btt -!'
atL1. C'ON1 N%USON CONtPANN .lam., aisitattNicjMj,�ry
%t %Ir. P FI.I. RIN\I NI:C l'1ON 11.1011T11
1 it
WELL CONSTRUCTION RECORD
ImaimwatterVaiiivi.. ia1 1]},w/Ir$431.4Um
a7ptllllHdR:anAOMw Ii 'j1
I /Si et i
ASSOO YEre ittYmllcwp
t,` r::Ifirt
R I Naddrocipa!Ytlblir 0 Industry! ❑ Arftarlaural
as r ID Recovery
able tnrz n
V,,i,1e;,,,��.,,.u;,p._,Q' Re.ovcry 0 Heat Pump Water In3c:non!] Other 0 II'Other, List Usc_.----.. I _____
2. \VEIT LOCAr ON
tl!
INuc, N:nn:.>:',r^hel. (ommu'iip. SuhdiwelUn. LM No_ Zip Cuiel
I nil `c:K.. Lb bN-C-KuiL-.
�71 ur x,i�l • ' �• - ZipC„s.
A•ct ctn.- iNq'Aa Q�y
4. UAlE —�
DR1LLED__Ik -r--
TOTAL DEPTH'. . ---
- CE EXISTING WELL' YES 0 NO
Topogra c'Land setting
ORidge lope °Valtcy ❑Fiat
(check approoriale hot Latitude/longitude Sr+a4lt Iklu'auikm
Ide$teeS. nintees■Oanaar SditritL Wtllpl�
ert
Latiulde• longitude source: sP1r1° 1
i,d:it....
P_1 r tor;
OEPT
F rum To
6. DOES WELL. REM., Sf Al IC WATER LEVEL BeIOW Top of Casing: Q--FT.
---
7.
IL'at if allot Tap of Casm$i
x. 1013 OF C ASINC iS --- F I. Above Land Surface' --, -_
clop at eating Rrndnated at/or bcWI Itd aortace remakes a -
vtrlaa.t in accordance with ISA INC AC ZC.ltt TEST
tD 1 300 _METH D F
to. WATER ZONES Idcpthp.._
DIti1NFFCTION Tcpe�f—
_ Amount _—_.--
v. Y'IF.. Igptn'
I?. CASING- Wall
t rem SZ T, I't.....__-_
h rem...__. To—,— Fa__
To_—_.-- Pt . Method
Fr„ I,i ._.._
Depth M1tarer, '
Ma n --
Utainewl Jot..,2'.
IC 'SCR' Depth F1._... in. .._
TO to ---
Frum — -- In. in. _. ____
n, Ft - --
15. SAND GRAVE(.. PACK:
Uepfn
Fora"__ ___ I n__.
Size Material
292326
t
- Show
Shew Oroution and distance in mites from al leas'
two Stare Roads or Counp Roads. inched: the road
WalW 'Thickness
Disnua-r >r WclghtrF:. Madera' mi'nhels and cornrnon road names.
W�
(c
TDI.EGEOWEr
1,,1 JUN 2 2 2004
GROUNDWATER S`GTR)N
-_ 1(.97Ern1LTE• GROUNDWATER
;h NI -MARLS' _
S. AND THAT A COIL OF THIS KECOKD HAS BEEN PROVIDED TO THE WELL OWNER
DC' Kt. IkEll', ChitnIFY TH \T (HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A N(AC 2C. WELL CONSTR:1" ION S FAN
_ _ ,
sIc;NA11 E CIE PEILSON CONSTRUCTING THE WELL D1Ti rA�
i t
Submit the original to the 3-323n of Water Quality, Grounds. Section. in36 Mail Sayler Center' Raleigh. NC
27n`79�I61h 1'hunc Nu. I919)' 1t-J221, within JO days.

WELL CONSTRUCTION RECORD
North Caro;ina - Department of Environment and NaturalalxResources - Div ..on of Water Quality
\\f:l.l- COST RA('t'OK (INDIVIDUAL) NAME. (print)
t Cl.rf
w LL1. CON I R:\CTOR CO\IPANI' NANO.ili*Il (mil-
SI s'i I: \V Ft.I. (ONS I RI"I ION PERMIIP
ASSOCIATED Q PER\tITM
itC a>dic:)hlcl fir licable)
I WELL USE (Check Applicable Box): Residential ,MunicipalPublic 0 Industrial ❑ Agricultural 0
Monitoring D Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIC N. Topographic; Land setting
Neatest >\,n: tiles -Ski county i___co ,
292327
- Growldw)ter Secti n
CERIIF ICATIONw__yiQ,3
P11O1Ea (A.1(�__otr3
�- _ _-- ❑Ridge �9`lope ❑VaII' ❑Flat
C.-1e 7fr (check appropriate bor.)
15:rect Nmnu. Nl•ers. Cnn.munity, Subdivision, Lot No.. Zip Code) i Lalltudcdc,ngitude of well location
DEPTH
( AV 0:1-.,"n sties Zip cede Eton) To
.Area Cede- Phm-c num her
I. DA1 E DRILLED i 1-b-
5. TOTAL DEPTH: 2-45
6. DOES WELL REPLACE EXISTING WELL? YES NO £'I
7. STATIC WATER LEVEL Below Top ofCasing:
11 (Use if Above. Top of Casing;
8. TOP OE CASING IS 1_._ F f. Above Land Surface*
slop of casing terminated atior below land surface requires a
variance in accordance w 15A NC AC 2C MI It. /►
9. YIELD (gpml.__-7 METHHODOOFTEST 6.(,�r,lel Vs)))
U. WATER ZONES (depth):
OWNER'.eatiof .0Ii'e;US
1—C1e 6 Z_11_$4
�° Y
1 I. DISINFECTION. Type $ii\D 1- Amount Z--
12. CASING: Wall Thic:knrss
'y Depth lI lI Diameter or Weight.
From Cl._ itoy.FT _ ---_
From i _ To Ft
Front To Ft.
13 GROUT:: Lleptli pi Material' ,�(^_ Mcihocr
Fl on. 'fo ET yrpits.,1-e- tit _ _4ik`.i_.__
I-;. SC R. it EN Depth Dtamricr S:ot S:zc Matur.:d
Finite. To FI. in. In
Eton) 'To Ft in. in.
15. SANDICIRAVELPACK.:
Depth SJve Material
a
(degree=itu cmc aeconds 0
LatiWc✓longitude source:OCPSOTopogri !Tic nich
totter boa) yy�
DRII:LINCIi�OG2
Formation D(i ipti ^)
tD �m
-1C
AO
o i
cif
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
Mate-: l numbers and common road names.
rom_-__ To Ft.
From------------ Ici--�----- Et.
'L. REMARkS: _--
6.Qetr-td
oQit)f Qv
ji JUN 2 2 2004
GRflllp'1WATER SECTION
I DO HRE13Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ) 5A NCACA . r�}IL-� . REGIONAL OFFICE
L
CO\ST :CTIiO STANDARDS. T AN AT A COPY Or THIS RECORD HAS BEEN PRO\ IDED TTi HE \ LL tvNER
`� a 1 t 3-6_c .
SI(_1NATURF. OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to he DIN ision of Water Quality, Groundwater Section, 1436 plait Service Center - Raleigh, NC
27699-1 b36 I'honr No. (9 9) 7:13-3321, within 30 days.
GW-I REV. 07'2001

295279
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jer@T)ty H. Bowman CERTIFICATION # 28 0 9
WELL CONTRACTOR COMPANY NAME D Rnwman We1 1 nri 111 rig, Tnr PHONE 8 p78 252-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IR Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: eanc3l er County Buncombe
Hidden Meadows Subd. Milksick Cove
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Dwayne Roberson
Address P.O. Box 212
( tr afi�or Rout ona
P.O, Box
NC 28728
City or Town State
( )-
Area code Phone number
4. DATE DRILLED 8/77/01
5.TOTAL DEPTH: 780'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO GI
7. STATIC WATER LEVEL Below Top of Casing: 700 FT.
(Use "+" if Above Top of Cuing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST rotary air
10. WATER ZONES (depth): 400570' 700'
Latitude/longitude
1 1 DISINFECTION: Type
12. CASING:
Depth
From 0 To 55
Zip Code
tablet Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.51 /8 SCh-8.0 pvr
DEPTH
From To
Topographic/Land setting
28715❑Ridge 0Slope OValley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuteuseconds)
source:❑GPS❑Topographic map
(check box)
DRILLING LOQ
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
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ems, JJ.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
9%-J /t3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
17699-1636 Phone No. [phone], within 30 days. OW•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) Jeremy H. Bowman'
WELL CONTRACTOR COMPANY NAME D Anwman Well Drilling, Tnr
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
295276
CERTIFICATIONS 2 8 0 9
PHONE N Ji7A 252-7779
WELL USE (Check Applicable Box): Residential (x 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:
NearestTown: Weaverville County Buncombe
Snelson Road Weaverville 28787
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Madison Homes, W.C. Inc.
Address 5204 US 25/70
Marshall
(Street or Route No.)
NC 28753
City or Town State Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED R/ 1 9/ 0
5. TOTAL DEPTH: 120'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I%
7. STATIC WATER LEVEL Below Top of Casing: i0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 . 4 FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC IC.01I9.
9. YIELD(gpm): 40 METHOD OF TEST. rotary air
10. WATER ZONES (depth): 1 00' 1 70'
II. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40
FL.61 / 8 S ch__a0 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
gravity flow
Slot Size Material
in.
in.
From To Ft
J
-o
IV
From To Ft.
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
DTP^Q.1_ N. oz.�
v SIGNATURE OF PERSON CONSTRUCTING THE WELL
8/I7hi.
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. (9I9) 733.3221, within 30 days. GW-I REV. 07/2001

2952'; 5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jereply H. Bowman'. CERTIFICATION a 2809
WELL CONTRACTOR COMPANY NAME D Rnwma❑ Well Drill Inu, Tnr PHONE S/R?A 252-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (x Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: weavervi 1 1 e County Buncombe
grip"! cnn Pnad weaverville 28787
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Madison Homes, W.C., Inc.
Address 5204 US 25/70
(Street or Rowe No.)
Marshail NC
28753
City or Town State Zip Code
( Area code. Phone number
4. DATE DRILLED 8 / 1 8 / 03
5. TOTAL DEPTH: 1 1 5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IX
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 60 METHODOFTEST..rotary air
10. WATER ZONES (depth): 80' 1 1 0'
I I. DISINFECTION: Type tablet
12. CASING:
Depth
From_ To 40
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
Diameter
Ft.51 /8
Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
Sch_80 pvr
Material
Method
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG -_ .
From To Formation Description
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.
Ft. concrete gravity flow
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
N
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
17699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

295274
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATIONS/ 2809
WELL CONTRACTOR COMPANY NAME D BnwmAn We11 Dr1111nge Tnr' PHONE ,/p7A 757-7779
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Weaverville County Buncombe
Stockton Acres Subd. Lot #12 Robert Allman
(Scree: Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Jimmie Davis
24 Indian Camp Road
(Street or Route No.)
Weaverville NC 28787
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED R/12/03
5, TOTAL DEPTH: 700
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fX
7. STATIC WATER LEVEL Below Top of Casing: d0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of using terminated at/or below land surface requires a
vial -lance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 15 METHOD OFTEST '.rotary air
0. WATER ZONES (depth): 1 Fn t 2nn r
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
Rd. (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I,OG
From To Formation Description
11. DISINFECTION: Type
12. CASING:
Depth
From '0 To 95
From To
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter
From To Ft, in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
tablet Amount 6
Wall Thickness
Diameter or WeightFt. Material
FL51 /8 Sch_84 Mir
Ft.
Material Method
Slot Size Material
in,
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N ice,---- i)--/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
ci

2932T3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jereply H. Bowman ' CERTIFICATION N2809
WELL CONTRACTOR COMPANY NAME n nnwmAn wet 1 nri 11 ing Tnr PHONE N g28 2S7-7779
STATE WELL CONSTRUCTION PERMIT N ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ut 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: Weaverville CountyBuncombe
3 Meadow View Terrace, Weaverville
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Kealilan & Irene Clark
Address 3 Meadow View Terrace
(Street or Route No.)
Weave,rville NC 28787
City or Town State
( )-
Area code. Phone number
4. DATE DRILLED 8/06/03
5. TOTAL DEPTH: 270'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QT
7. STATIC WATER LEVEL Below Top of Casing: 70' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2CMtg.
9. YIELD(gpm): 40 METHODOFTEST.rotary air
0. WATER ZONES (depth): 770'
Topographic/Land setting
❑Ridge ❑Slope OValley 0Fiat
28787 (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPS0Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Zip Code
11. DISINFECTION: Type tablet
12. CASING:
Depth
From 0 To 110
From To Ft,
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount 6
Wall Thickness
Diameter or Weight/Ft. Materiel
FLf1 /8 Sc.}L8.0 PVC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material - Method
Ft. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in,
Ft. in. in.
Size Material
0
r
c_
v
r.2
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW•I REV. 07/2001

297566
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION#2809
WELL CONTRACTOR COMPANY NAME i) Bowman Well f)ri 11 ing, Tnr• PHONE # R78 752-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CX 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:Alexander County Buncombe
135 Jenkins Valley Road Alexander
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Francis Duckett
Address 2G1 IIookerc Gap Road
(Street or Route No.)
Leicester NC
City or Town State Zip Code
28748
Topographic/Lendsetting
287octRidge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED 9/75/03
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 1 00 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface•
•Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST :.rotary air
10. WATER ZONES (depth): 300'
II. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
or Weight/Ft. Material
Sch 80 vvr
Depth
From 0 To 35
From To
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
Diameter
Ft..61 /8
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the lord-
numbers and common road names.
From
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From To Ft.
From To Ft.
0
L
J
ti
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2975 6 4
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME I) RnWmAn Well Dr( 11 ing Tnr PHONEY AA 252-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lX Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Candler County Buncombe
5 Heddon Lane Candler 28715
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Walter Smith
Address P.O. Box 34
(Street or Route No.)
C'anril.ar NC' 28715
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9/ 0 9/ 0 4
5. TOTAL DEPTH: 1 20 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I8
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .01I5.
9. YIELD(gpm): 15 METHOD OFTEST:- rotary air
10. WATER ZONES (depth): 80 e 1 10'
Topographic/Land setting
ORidge ❑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 tablet
12. CASING:
Depth
From 0 To 38
From To
From To
I . GROUT: Depth
From 0 To 20
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
FIB /8 Sc15_2f Pvr
LOCATION SKETCI{
Show direction and distance in miles from at.least'--
two State Roads or County Roads. Include the road
numbers and common road names.
Ft.
Ft.
Material Method
Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in
in.
16. REMARKS:
0
L
c
0
rn
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION'",STANDARDS, AND COPY OF THIS RECORD HAS BEEN PROVIDED TO �E WELL/a� �OWNER
e�—
SIGNATURE OF PERSON CONSTRUCTING THE WELL /\DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
297563
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)JerHQljr H. Bowman CERTIFICATION 12809
WELL CONTRACTOR COMPANY NAME T) Rnwm to Well flri 11 ing Tnn PHONE, B28 2 5 2 — 7 7 7 9
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WO PERMIT,
or applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential a 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: Asheville County Buncombe
Fern Street Asheville 28803
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Peter Nordeen
Address 17 Fern Street
(Street or Route No.)
Act) eviIIP NC 28803
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 9 /03/03
5. TOTAL DEPTH: 5Rl'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO H
7. STATIC WATER LEVEL Below Top of Casing: 1 00 FT.
(Use'4" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
Top of cuing terminated at/or below land surface requlrea a
variance In accordance with ISA NCAC 2C.0111.
9. YIELD (gpm): 5 MF0T�I0D54�OT,EST'-rotary
Zip Code
1 I. DISINFECTION: Type tablet
12. CASING:
Depth
From '0 To 55
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.F1/8 SCh 80 pvr
From To Ft,
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth D
From To Ft,
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material Method
ameter Slot Size Material
in. in.
in. in.
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degree✓mi nutes/teconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOO
From To Formation Description
air
LOCATION SKETCH
Show direction and distance in miles front at leasi
two State Roads or County Roads. Include the road
numbers and common road names.
c
0
O
J
O
N
rn
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9 d3
SIGNATURE CONSTRUCTING THE WELL DATE
/e
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days, OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
298601
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Wt Pelts CERTIFICATION#o10d.8"
WELL CONTRACTOR (INDIVIDUAL) NAME (print) £ahby
WELL CONTRACTOR COMPANY NAME Ferci OSO4/s We// Dr,1///:y PHONE('SY) kQ3 - 94W
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 67 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:
be
Nearest Town: Caned ter County Bonci7m
law�r 67 2d17 4'/2-24 Rel
(Street Name, Numbers, Coyimunity, Subdivision, Lot No., Zip Code)
3. OWNER:Sew i /t)R �✓l�eueo ate. /
Address �O I/P C !a . /
(Street or Route No.)
t hG
City or Town State Zip
(- gyros-r/ad7
Area code- Phone number
4. DATE DRILLED /03
5. TOTAL DEPTH: 2OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2-0 FT.
(Use "t" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Tap of casing terminated actor below land surface requires a
variance in accorda)i c�e with ISA NCAC 2C .0118.
9. YIELD (gpm): 9G METHOD OF TESTA/Owt i//1r�
10. WATER ZONES (depth): JSI ,
/ 70
11. DISINFECTION: Type iab(tf5 Amount (� azr
12
CASING:
Depth
From 0 To 2(€, Ft.
From To Ft.
From To Ft.
Topographic/Lan setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitud ofwe)llocation
)5 Z4,7S7�/M t I/A.641
Q/I dersua 4'», GS (degree minutes�) conds)
Latirude/longitude source: Lt3'GPS❑Topographic map
(check box)
03iii9/y— DEPTH DRILLING LOG
Code From To Formation Description
0 -» b/rr
)4 - 20S ' (rnonr1$C
v"
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
(.2 S 2,14. ixs pvc spa?( �( / � FORA
lbw e,v
E,n hC-
13. GROUT: Depth Material
From 0 To 7,0 FL cnncrcit
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Pm rtiny
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 IS RD HAS BEEN PROVIDED TO THE WELL OWNER
SIONATURE OE PERSON CONSTRUCTING THE WELL A
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC
GW-1 REV.07/2001
LACE.
)
� Z

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Et Obey R/t. � /-. CERTIFICATIONtr
WELL CONTRACTOR COMPANY NAME Fe ydsoev's £Ue// Der/ y- Co" PHONE 1nnAS1 b s3 -43»
STATE WELL CONSTRUCTION PERMITK ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
298603
1. WELL USE (Check Applicable Box): Residential tr 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:blark MD •/Aid Counry ©Un Cask be
Pe rk Cat t/.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: /-X)WarC avLk, ✓'
Address 6 7 % 0/7442,1as 17R' •
(Street or Route No.)
/P11 esa.A/ i S•L' 9ybq
City or Town State Zip Code
( )- IgV- 93/9
Area code- Phone, number
4. DATE DRILLED 7/joie3
5. TOTAL DEPTH: 50
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gIV/
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated arfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ta METHOD OFTESTB/Owinf/1/O
10.WATER ZONES (depth): foe /
dpographic/Land setting
0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/Iongitude,f ell location •
N 3s ' ai.YYf'�weff '23. 7s'J'
(degrees/min [ev�• Dods)
Latitude/longitude source: L GPPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
D/n 1'
DEPTH
From To
e YR
YL- SOS
11. DISINFECTION: Type jnb/efr
12. CASING:
Depth Diameter
From 0 To4_Ft. di %
From To Fr.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2.0 Ft. COnu'4t Pa urriy
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.
ry
-0
LOCATION SKETCH N
Amount hZ Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road 1/40
or Weight/Ft. Material numbers and common road names.
2I I S PVC sn aj
l6. REh1ARKS:
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFTHISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SICATURE OF PERSON STRUCTMG THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

Depth
FIJIEy To Vet. Fc.
From To Fr.
From To Ft.
13. GROUT: Depth hlurenal
Froal__,Q__ To_alZ Fat_
From To Fr.
1;. SCREEN: Dcprn
Diameter
From TO Fr. in.
From To Fr
ul.
IS. SANDI3Rri\EL PnCK:
Dcpnl Size hiarer;al
From To Fr.
From To Fr.
298720
WELL. CONSTRUCTION RECORD
Norin Carolina - Ceps' -ahem r of Environment and rat Resources - Division of Water
\\ ELL CO.NTRAcTOr2 (INDIVIDUAL) N.ahLE (prier) /./}M
2 . 1.II,y� s
\\ tLL COIN rn..Cron CO:1IPANl' NA.ME )eract_Son, 1, D.r/ hp.
Qualiry - Oroundwarer Sec non
CERTIFICATION/J./IQ. r�
G • PHONE An
a5YE 04/4.,
3 rn1 L YELL CONSTRUCTION PERAIIT? ASSOCI.dTJD
LiL,rrl.r,c1r1 NlliRlyllTu
(irsnolie3Dle1
WELL LISE,.Cheek Apphoa6le Sox): ResidcnrialC 1,.1uriicipa UPublic ❑ lnduarrial ❑
Alonnming❑ Recovery 0 Hear Purnp \Y'aicr injection 0 Ocher❑ ]f Other. List Use
2. WELL LOCATION:
Ncaresr Town: e r: fa-
Aa-
Isa'ccI Nanm MIMI); n'. Camnrum ry, Subsiruion. Lot Dlo., Zip Codc)
Counry A't^•"*"+f!
'•..1 OWNER. hlj�artkci
A I.lr,ss g£pr,',vrc.
ISlrccr or'Rourc No4
(/YC a&7y(�
'ey or Toar: Suu Zip Cock:
&29,1- /QS3 - .59/4 •
rode- ellane nu In ocr
4. DATE DRILLED 0 - 1J"- Of
5. TOT.+.L DEPTH: 0 C-
o. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Lr--
7. ST+:rIC WATER LEVEL below Top of Casing: <'" FT
/
iU;e ^r ^i(,{buvc Top ur Cwm)
3- TOP OF CASING IS FT. Above Land Surface'
"'l'ap or es4n� mrmin, wa aVur below Jana surface requires a
ria clam:. in acute Ilcc wirti lid NC..0 ]C .011e,
9. YIELD (;pm). L '/<- METI- OD OF TEST Bintarg .K4'9
10. WATER ZONES (depth): 7r' ,27D J
II. DISINFECTION: TYPc C/ /7 JC
2, CASING:
Amount
Wall Thickness
or WtighUFn Alnrdri:Il
'e-ez, / ht.
Diameter
e. /2, -
INcrnorl
4-42.4. • nJ
Slot Sizc t?larcrial
in.
T _ in.
I . REM.-&rucS'.
griculrural ❑
Topographic/Land sec -ring,
❑Ridge QSlopc ❑Valley ❑Floc
(cheek. appropriate box)
Luritude/longitude of well locarion ,
N3r °3r. q74' wos-t°s�'.No
(degrees: m inurcvscconds)
Laliwdtilongitude source: IMPS ❑Topogr ophic map
(sbcd: bug)
DEPTH DRILLING TOO
From
�i To Fu rion Descriprion
/ i
.fir- G,y
eat- C/o r
LOCATION SKETCH r
Show d;reer;on and distance in miles from :Sr;as e0-, ,
two State Roads or Councy Roads. Include Ihgroaa7-i
numbers and common road names. 70 ern
IV c
IN)
3
tV
U7
01
DC HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDAR S, AND THAT A COPY OF THIS' RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 'I HE WELL DATE Z i — a 3
Submit Eric ori;ival ro aid Division of Water Quality, Groundwater Secriun, 1636 Mail Service Ccncer - Raleigh, NC
37699-103s Phone No. (9l9) 733.3221, leirllin 30 days.
CW-1 R.EV.07/2001

WELL. CONSTRUCTION RECORD
Nornl Car oluts - DcperOwenr of Enviromncnr and rat Resources - Division of Warcr Quality - Groundwater Seccion
r
15 ELL CO:Vl'Ri%POG\1NUI\9DU.a1)NAME (prim) 2J/t/✓ 1I N C5
-'7171� I CERTIFICATION rt�/�
Vl ELL cu:V'rR.kcTon COMP. -‘,NY NAME rPr-jric.SoNsr hew pf/ii/vq C5 • PHONE
SPATE 11. ELL CONSTRUCTION PERMIT,/ J ASSOCIATED WQ PERMIT,/
:crI.: bl-1 (if applicable)
r�� asp YYYl�
I. WELL USE LCheetc AppGaable Box): Residenrial B Nlur,ieipaVPnblie ❑ lnduarriul 0
Manhoring 0 Recovery ❑ Hear Pump Water lnjecrion 0 Other 0 If Ocher, Liar the
'_. ' LL LOCATION:
NearestTamE• W(-l'r v.lie COurity DD
sH Le 'It /l.</i ��ooK Di.
tiae.r Nanlc, Nua ben Ca n:numry, Subdivision, Lol No., Zip Cade)
'-3. OWNER. 7,21/1el &It
3dr„s 3(p i-vac,/y/✓
re_co /VC .2873a
O:n or To\111 9Clrc Zip Cods
Sf a/S-Gt/4,
Phone (lumber
4. DATEDULLED)r� '43-03
tsnc. urRo c a.)
i. TOTAL DEPTH 21r
298719
griculcural 0
iP`opographic/Land serving .
'idge ❑Slope ❑Valley ❑Flay
(cheek uppropriarc box)
arirude/Ion imde of well location
h-' Y%gib/ wor2'Sr 977'
(degrecs;minurcv�' conds)
Latitude/longitude source: IMPS❑Topographic map
ielmck box)
DEPTH DRILLING LOG
From To Formation Description
0- .2/! /]_�
-. 4 -Cr 7e✓/yI'nt
3c - 2zr d—.n-
d. DOES WELL REPLACE EXISTING WELL') YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: a O FT,
1 (Use :..':'it.Abovu Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface's
'fop o(c., in; rcrminama avur below land su rty et rag aires
valane<w a;aoruanca wirti lq,i N CAC 2C AI 1s. y
9. YIELD(°pm): (Ica 1):_ti -fpDOFTE.T 3kw11.K.3
Id. WATER _ONES (depth): O
I I. DISINFECTION: TypzC /022rivc, Amount
2. CASING:Wan Tiiclmes;
Depr��LL. Diameief or Weigho'F . Iv urerial
FrFromD ro F/zr= S/%ZL/ "nit
From To Fr.
From To Fc.
13. GROUT: Depth Nlarerial Method
From --,-a___ To ,t9 D Fate on -I
From To Fr.
I+. SCREEN: Depth P Diameter S'1o[ Size material
From To Fr in.
n.
From To Fr in. in.
15. S,AND,'OIL„VEL PACK:
Dupth Size marerial
From 1'o Fr.
From To Fr.
I O. REMARKS:
LOCATION SKETCH
Show clirecrion and distance in milts from arprst o
nvo State Roads or County Roads. Include rlaoailS
numbers and common road names. 3" oc
4 rn
H�
me
yr Z
rn�
r)rdiebroP1t
//Jedaew.'/lt_ C.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH LSA NCAC 2C, WELL
CONSTRU' ION,STAiND.ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OIVNER
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL
DATE
Sumir chc ori;inal to the Division of Waver Quality, Groundwater Section, 1636 Mail Service Center-Kalzigh, NC
l?099-163D Phone No. (919) 733.3E-1, within 30 days.
GW-1 REV. 07/2001
Cs

293 718
WELL CONSTRUCTION RECORD
Norm C;rolinu - Boparmrnr of Environment and N--::rul Rcsourccs - Division of Wafer Qualify - Groundwater Sterion \\ LLL CONTRtCCOR (IND119DU.aL) N.ANIE (princ)L!/i/✓ /7� /! j
/^ "�" r NC S CERTIFICATION \4 ELL CU,1.1'R .0 I'OR CUit1P.ANY N.u1-lE .er 1c50/✓ j hie // Z?r/r//Ov .
Sl'nl'L' WELL CON$1'RUCTION PER111Tg J,J f (J Jq PRONE i� aSlr''YY`%(�
ASSOCIATED WC {��1�1IT11
(ii-npplie2h1o)
1. WELL USE (Chcc); Applicable Box): Rcsidm,rial L7 ,Vlunieipa Up t5Iic ❑ IndDswial ❑
\Wniwrin2 0 Recovery 0 Heal Pump \Valcr lnjceriun 0 Other 0 If Orhzr, List USc
22. WELL LOCATION:
Nc_r-st Town: }up,'I/,e County �4.. &1, '(
04";',0: K )114 11-43¢u.4-vas&r.
I:ac_, Rim; N,mmcra, Cmn,nunlfy, SubQiruion. Loc No., Zip CoJc)
):-3 O\YNER: £d E/fir s
=.ouress l: e______ r I'o.j
- 1.S arc Rourc No.)
eau P •/i /'7 C at7
i,pyarT)„n jute Zip Coop
{C2iSi- Io45-Sire
r1 t:i itla-l3113e IIWl1Do
4. DrkTEDRILLED O-23-03
5. TOTAL DEPTH:22 r
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI
7 STATIC WATER LEVEL Below Top of Casing: 20 PT. -
(U;c ":'-ii .Abavc Top arCumns)
5. TOP OF CASINO IS ___L.__ FT. Above
^lb at.a,m, Land Sun'acc^ -
N rQ»... «a svor below land surface . rcq uiru , arianccm a:coraaa' with lii :NCAC 2C.U) IS.
9. YIELD (;pm): _�_ hlE HOD O ;TEST r 9
lO. WATEPI ZONES (depth):
I I. DISINFECTION: Type WQ ,'
!-'. C SNu: -- Amount d3
Wslil Thickness
Depth Diameter or Weight/Fr. &Lreriak
Proin_AL To_L Fr ,e4I S
FCn,n to %�i12 / �bL
Fr.
Finny_To
13. GROUT: Dcprh
From.___Q_ liter Fr. C'ON-- &,-
From lJ fr.
I-ic. SCREEN. Dc rh
p Diamc[tr Sim Slzc blamrial
From ro F.
FN1'o lll Ill. IR
Ff. in.
I5. S;.N0/0P VELPACK: 11'.
Desch Size Material
From To Fr.
From To Fr.
Io. REMARKS:
Ft.
ndatcnal
Agricultural I]
Topogra io/Land serting
DRidge PlSlope DValley 0Flac
(check uppropriaft box)
Lurirude/longinlde of wet] location
At" Lin : 2SL iynrr `r �G%-O v
(dcgrcGs; min�ulc�sr roods)
Luliwdwlongirude source: t7GPSOTopographic map
(check: bus)
DRILL IN- LOCI_
Fo ation Descriprioo
DEPTH
From To
0 S/r
5=22�
•
a _I
Thi
LOCATION SKETCH N Sm
Show direction and dis lance in mitts born act .o
ai[m0
nvo SEno Roads or Counry Roads. Include 4 watt' rrrl
numbers and common road names, r"'
%J/IV Brae.4 /1rvs
Mcnotl 4/e-wver✓.'//ems /1.c.
OH�rir
U1
al
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CON"TRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CUNSTRUCTM01 HE WELL
DATE
Suomi[ the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Cenrcr- Raleigh, NO
27699.1630 Phone No. [phone], within 30 days.
OW -I REV. 07/2001
i

298714
WELL CONSTRUCTION RECORD
Noah umlina • Dcparin ni of EnvironmcnI 4ntl rill Resources - Division of Warcr Quality
r )
w ELL CO.VT I.iCI'OR (lNU119UUA1) N.+AIE (prim) �• G(II NG S
\:tLL CONrltl CIO le COItI PAN Ns,1IE iC rQ6s.scWj UJC �/ arzi � Co
YYn VIA 1F ELL CONSTRUCTION YEFAnT3 JJ ASSOCIATED WQ PT'I21v11T11
(ii.inplit.btc1
- Oro❑ndwatcr Scion 2 '/T
CERTIFICATION 3/b
• PHONG .RaxS aSZ LV4.
I. WELL LISE Lt heck AppLoablc Box): Residcmial Ll hlunicipgVPublic ❑ Indu serial ❑ Agriculnaral ❑
VLmGlonng 0 tccol-cry 0 Hear Pump W.ucr lnjccrion ❑ Other ❑ if Other. List Usd
2. 'A ELL LOCATION. ��/
Nc rcdr Town: £eo - T••'� County 4-1..4•t4
C-c.ff LX % 5,4 • /4 .Pl.
ISucc, N.on.. �Nwnocn, Community, Subaivnion, LOIN.) , Zip Cauc)
-3. 0\YC NER /' 1 io,
..J.7 rcca %O L1Nn F�K.
IS aCCC Ll Rout; No.)
Asheu.lk_ /P)C
CO) err Tarn Swtc
.=_es tear Phanc Il MDT'
D E DRILLED %D `H :'T-o3
FOT.A.L DEPTH: so r
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121"---
7_ STATIC\V.ATER LEVEL Bclow Top of Casing: Ya FT.
i we "r"it .lbovc Tap of C441n0
S. TOP OF CASING IS 1 FT. Above Land Surface'
-14p of.as,n; rarmmoraa aver bcluw lung Dur(a[C rcouirts a
Topographic/Land setting
❑Ridge OSIope ❑Valley ❑Flan
(check uppropria[c box)
L}}['rude/longitude of well location
�y sd.r7s 4,clee' . r'
(dcgrecslm inuresnccour D)
Lstiludulongirude source: BGPS❑Topographic map
DEPTH DRILLING LOCr
From To Formation Description
4 / - ro G SA c
< Y" /r
&C l05�
O
eu:a,ao o, eccoro a� �wiar 15A. NCAC 7C.1)1'16.
9. YIELD (_pm): METHOD OFTEST %Wirq •'•s
10. WATER ZONES (depth): Jit), 2S0 J
10
To
Dcplh
'Co a 0
'Po
Dcprh
From 'ro
Li. S.>.NaORAVELPACK:
Dcpih
From To
From To
I L D1SLNNFECTION: Type(' fP lop ).vim, Amount /V /sis
12. C SFNO: Will Thickness
0➢cp[h i`Jmcr,-r or WeighrFt. Ndarerial
From To C b F r. . /2 r 5;42 /
From
Fmin Fr.
13. GROUT: Marcnal
From_.) FL C0/Y Retie.
From Fr,
I;. SCREEN: Diameter Slor Si2c Material
From FE. in. in.
Fr. in. in.
to REM AELKS:
..oG
Zip Cudc
/j (Vie Mod
er
]',Le Material
Fr.
Fr.
LOCATION SKETCH
Show direction and distance in miles from at leas[
two Stele Roads or County Roads. Include toe road N
numbers and common road names. ••
C.11
&,1;1 C, ld . 'Mg roetkik/
Laic e Ste /✓
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STAiND.ARDS .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
' -..x
SIGNATURE OF PERSON CONSTRUCTINO THE WELL DATE
— /1 - 03
Sun toil me oriinal co the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-103o Pliunc No. i919) 733-33:1, within 30 days.
GW-I REV. 07/2001
01
C
0
-rn
o<
grn
;%o
H
Fria
zrn
NS_
rn ?
c-I
G
z

298713
1. WATER ZONES (dcpLh):
DISINFECTION: Ty pc
C SrNO:
Depth
1J—toga/
From To
From To
GROUT: Dcpol
Froln_-_Q_ ro ,
From ro
SCREEN: Dcpnt
Fmul To
From Td
SAND;ORAVEL PACK
Dcpnl
i rani To
From To
PAENLil j:
FL
Fr.
Nlarcnal
Fc —ega'�
Fr.
WELL CONSTRUCTION RECORD
Norm C4roti1u - Dcparunenrof Environmcnr and cal Resources - Division of Water Quality
1\ELL CO:NTIL iCTOta (INDIVIDUAL) N.A LL' (print) 1Z //}/, �. %%j✓cS
\LU L CC,�r�L.CtoR CO.\IP.ANV r i\le ferja..Sow[s h_rre,, pl�f/ Co .
51'n1'L' 1 y CLL CONSTRUCT/ON PERLITe cJ
ASSOCIATED WQ PTil2A ilTn
- Groundwater Scerion ,/T
CERITFIC.{.T1oN 3/T0
PHONE' 4ga8i asflatlet,
(if .tpplicable)
WELL USE LChcac Applicable Box); Reiidcnrial Municipal/Public ❑ Induarrial 0 Agricultural ❑
LoM1 torin‘L 0 Recovery 0 Heat Pump Water lnycccion 0 Ocher ❑ It Other. List Use
22- WELL LOCATIQN:
Nearest Tov.n G`ce5 k- County i'ttne4.-24
kcr . 5ec. ' Te. • /
»:--i h.,mq Num Dc ri Community, Su bdl vbion, Loi (`to. Zip Coda)
0`,1 itER. D0�/Qy� Be? r/ferr
.:Less It f crcrro» DR
ashev,///.nerraehute e Aego‘
'e) or TuN,I Scan; Zip Cada
frC - &Se
Ato iodc- I'hullc pulnbcr
D=.'T'E DRILLED /1 - � 0-35. TOTAL. DEPTH(u: o r
o. DOES 11 ELL REPLACE EXISTING WELL? YES 0 NO 6"
7. STATIC WATER LEVEL Below Top of Casing: /c/v FT.
( Use • T'" irAbove Top otCising)
�. TOP OF CASINO 13 / FT. Above Land Surfaces
'Tap or cam); fml➢In L o acot bclulr land iurfacc rcquiros a
rariaur, n, aucorooIi tin, itA NCAC 3C .tti Li.
9. YIELD \ pm): J METHOD OF TEST BA) L 4ij •g.q
Midge
setting
L-N.Idge ❑Slope OVallcy ❑Flat
(check appropriate box)
Latitude/Ioll'1Rlde of well location N.? ° 37. *c/✓v,Fz °
(degrees; m inures/sc: ands)
Lutirudcilongitude source: OCHOTopographic map
tchceic box)
DEPTH DRILLING LOCI -
From From To Fo mtttion DescriP. non
`-l3ry p
/JC- /ul SIC!I
/Vl - Coy 6rsn.' {[
Amount /Q /ell
Wall Thicl:ncso
Dian -met or WeighriFr. Mareriul
Fr. 2r S,D,j1/ /144-
Macho
Diameter Slol Size Material
Ft. in. In.
FL ;n.
Fr.
Et.
SL=e Material
LOCATION SKETCH
Show direction and distance in miles from ac leasr
(WO State Roads or County Roads. Include the road
numbers and common road names.
So KM %at, rk e-K
o0 e� (An d 0.."7?a
te/1/
ed
HEREBY CERTIFY TH.ATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
-STRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
mil /0 /v p.I
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL
DATE
It the original to the Division of Water Quality, Groundwater Section, 1636 Moil Service Center - Raleigh, NC
).lo.io Phone No. [phone], wi rh(It 7d days.
CW-1 P.EV.07/2001
-o
_,z
N
C./1
0i

WELL CONSTRUCTION RECORD
Norm Carolina - Dcparwlcnr of Environment and ]y•i rot Resources - Division of Water Qualiry - Oroundwarcr Sccrion
.0�� %
11 ELL CO.TRACVOa illYEI\9DU.AL) NAl{E (prier) 12,1 s-N/ //,�,, . wT / (VC 5 CERTIFle.8T10N»3146
w ELL iiLMIRE&ll Oa COMPANY NA -Me rerjtc,So»s L'kji Z r."i/r/vv c , PHONI a�lasd YZ{�
Sl'er6 WELL CONSTRUCTION PERMIT» J ASSOCIATED WQ PP�I27v1ITO
(i P.iPplic_,blcl
1. N ELL USE (Lanett App6aabla Box)'. Rcsidcnrial Cal lvlur,ioipaliPublic ❑ Industrial ❑ Aydoulnrral Q
\1.zniLonng 0 Recovery ❑ Hea[ Purnp \V:ucr lnjccrion 0 Other ❑ It Other, List Use
1. (1 ELL LOC.ATIIIN:
/12/)„ 4'. �`
Nesre3L Town: C,Cr)Act - CouULy A T e":+-4(
:N uamcrs. winammry, Subsr siio[onn, Lor NE., Zip Coat)
OWNER Zeude S -Sr)
.=.sorts Te9 S te /3G
/ Lauer or Roue: No.)
C Pr se eSAtte /Ye. eP$ 7v2
c., 4..Town Swlc Zip Cues
O81• A7SI-/joy
r1G Akk- 1'I12RG Ilunloor
4. DA:1'E DRILLED /d -1--0)
i. TOTAL DEPTH 3 o r
298712
��TopographiciLand sening
Midge ❑Slops OValky ❑Flat
(check appropriarc box)
ytirude/lo lginrde of well loc�rion
(72. Z vJ ({1on S/.� Eq7
(degrdnrminu lcvcconas)
Lalirude)longirude source: B1PSOTopographic map
(cr¢ic box)
DRILLING LOCI
Formaci n Description
sent/ CJ..ac
DEPTH
From To
o-a�
S�3
�5-- 3or fat
o. DOES WELL REPLACE EXISTING WELL') YES ❑ NO L�
7. STATIC WATER LEVEL BelowTop ofCasing: JD FT.
tune •'r •lr Above Top arCasng)
3. TOP OF CASING IS / FT. Above Land Surfeee's
* Ibp of c.�my ¢nnm arts 4Vor bcluw Lod su rrsoc reg uiras u
rsriau:c m a::o Naucc with li.t NCAC 2C.UI Ns. D
9. YIELD lgpml: ,V METHOD OF TEST BbW2rq .?.9
10. WATER ZONES (depth): 07r" - 742)-C, J
11. DISINFECTION: T e I
yP-� OP4v�,
1'_. CASING:
Depth Diameter
From D To rYil Ft. `„12S-
Fmrn to F.
From To Fc.
13. UROUT: Depth
From._ 0 To a 0
From To
to. SCREEN. Dcoch
From To
From To
Amount a K42
Walt Thickness
or WeightiFt. Ntircriul
1/el PPVC
Ivtarcrrtl
F. CONCP.Gfe
Ft
Mcmod
011
Diameter Slot Size blurcrial
Ft. in. in.
Fr. in. in.
t.i, S-.ND,ORAVELP:ACi:
Depth
Fruiri Te
From To
I o REMARKS:
.Size RI:Rerla!
F t.
F r.
O
a
LOCATION SKETCH -
Show direction and distance in miles from ai least
Iwo Stare Roads or County Roads. Include the road
numbors and common road names.
Leif e5Ier Nr.
I DC) HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suumilt rtld original co the Division of 1Yarer Qualiry, GroundwaEer Section, 1636 Mail Service Cenier- Raleigh, NC
27699-1o3o Phone No. (9191 733.3221, within 30 days.
GW-I REV. 07/2001
N
fs
Q%

WELL CONSTRUCTION RECORD
Nm'nl Csrotina - Dcparullenr-oi Environmcnt anti ral Resources - Divisionof Warer Qualiry -
11ELL CD:Y l'I.iCPOR (INDIVIDUAL) N.iMli (grin[) �/rf Ne 4
\L1 LL CONrlt-i:'rUR COMP .ANl' NtU Tt�/'j�LSowj Gk// 5 2)hilt
l tl r. W LLL COIYba RUCTION PERMIT*
ASSOCIATCD We PTP.lUyilTu
(if pplicuble)
298"'11
Groundwater $ecrion
CCRTIF!C..4�Tr1ON 3/Tv
PHONC y t) a5jyr S n&
I. `AiEti. USE 1Chccic Applicable Box): Residential lE pluniaipaL/Public ❑ Indue[rial 0 Agricultural ❑
htonlwrin; ❑ Reeo'sry 0 Hear Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LUCATIyy1:
N;'aresl Tonn'. the view CDunry Aw^td-n4<
69/4. 13. s1 C /4e to/l}
,Socc� N.un c, Number, Co,n'nun:ry, Suboivuion, Lr No., Zip Coat)
OWNER. /7/4y l/ub6
..dacess iJS9 /%?C -h qt
(Sat:1Lr It Dinc No.;
/s Av, We 1-7e nos
'e)-or Tmrn SWrc Zip Cudc '
53ki- •=39s— eesi 3
. a O:Odd Pllurm llunlOcr
4.DATE DRILLDD —7-05
5. TOTAL DEPTH: 20 f—
a. DOES WELL REPLACE EXISTING WELL'! YES ❑ NO a'
7. STATIC VV' TER LEVEL Below Top of Casing: 20 FT
(U;e''.'ii. bone Top orC>singl
�'. TOP OF C=SLNC IS FT. .Above Land Surthee^
"17p A['or bclulr )and surryce rcquir<s n
ear1411a=m,;aurae ,<IrinISn NCAC 2C .blla. 9. YIELD t,pini: 7 METI-!OD OF TEST B.hfdli, •(�pp
,'
0-WATER ZONES Idcpthl: /20 ' 140 ✓ .9
F1''0111 0
From To Ft.
From To Fr.
i3. GROUT' Ooplh M ittenal
Frill 0 To a o Fr. CONCEef:e
From To Ft.
I-i. SCREEN: Depth Dismcrcr Slot Sizc Min -octal
From To Ft. in.
In.
From
'Po F! in. in.
L5.SAND/GRAVEL PACK:
D:pm She Ylarcrial
From To Fr.
From To Fr
I. DISINFECr10N:TypeC/ogr;ve, Arounl 7 ids
13 _SFNG Wall Thickness
Dianrer or Weighr/Fr. a.arerial
Er. 6, /L r 51,1 z ju
. 4crhod
Io. REh1ARJc3
Depth
To /D L
Topor�ap ghic/Land setting
❑Ridge 0-Slope ❑Valley ❑Flat
(check appropriate box)
ride/long'IRcati
lde of well loon
5) 24, 1' WOtti*LN.727'
(degrees m i n u [e]JCC onds)
Latitude/longitude source: 130PS❑Topographic trap
(i h cic beai
DRILLING TOO
Show directionar L,a,t
two State Roads or County Roads. Include the rcnri
numbers and common road names.
k/Yo as o Fr"-5 s h Cr
fV
cn
C71
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH liA NCAC 2C WELL
COiNSTP111CTION STANDARDS, AND THAT ,A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%l -T✓.�,-r.-t 0 3
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL
DATE
Suunric (Re original ro the Division of Water Quality, Groundwater Section, 1636 Nlail Service Canter- Raleigh, NC
'-7699-163o ?ileac No. (9I9) 733.3:31, within 30 days,
GW-I REV. 07/'_'00I
DEPTH
Frorn To Formation Description
--s'7
97— /de s ii
/O2 - 2 o r G /y
ys :CT
LOCATION SKETCHT
and distance in milts 70
m0
ern
cnz
rnu
0

slnl6 IYLLl CON01 IiUCT ION YLRhilTe
WELL CONSTRUCTION RECORD
Nona Laroliii - Dcparmanr of Env ironmcnr :Ind yurut Resources - Division of Water Qualiry -
I,J[ r %� %
6 GLL CONTIL.CTO1. i1Ndn9ouwL) N.anlL (prior) /L/AN/ WING S
tr LLL CO3vriz.Croa CUMP.AN1' NAME fcr 1 .So/✓s L(lej/ DP/'��/%yq Lp •
��JJ .:SSOC1.&TEL WQ PR:11I1TH
(ir cuplici blei
298710
Groundwarcr Section
CERTIFICATION 11.3/
PHONE Baas a57-2i`t&
I. WELL LISE LChecic Appl
40niiacina 0 I:czovcry ❑ Hca[ Pump 1L alcr 1n)ccnon ❑ Other 0 1f Other. List Use
7. 11EL.L LOCATION_
IVcarcI1 Tenn'_ bC,-i ✓/ea./ C.
toyer, /2"., r < et". fa
ISa r: N.:m c, :Ylun c:rs Cam,n unny, SubJiriiioa,
' 3. OWNER. njA-er Ple.‘b
e> x ark
on," or Rout; No.)
AS-h.et/7/('r hC
1p JrTOn it S1mc Zip Codo
42s'l- ;)9s- l0 VG 3
ci :eac-hhull. pum Dor
DATEDRILLEn /O -G-OJ
5. TOTAL DEPTH Z1-c'
oun[y 14 "", 1c
Zvi Cw
Lot NO., Zip coact
2d
gco5
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO ari
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
1 iUse"r"'irAbovc Tap ui Ca,uig)
:i. TOP OF CASING IS FT. Above Land Surface'
"r4p or :.vn� Icrlllhli(aa n'ur below land surreet requires
rar:ancc In a:c orr:n.c 1141t: led NCAC 2C .011a.
9. YIELD METHOD OF TEST Bp7Li/r •��t
16. \V.ATER ZONES tdeput): /ko:. L7a • Za-a' 9
II. DISINFECTION: TypeC/ORrp.c, Alnuunt // -41.r
12. C. SFNQ.- Will Thickness
rl Dcp[n Diameter Or LVcighr/Fr. P,p1L4rrial
Fruni To J/r/ F[. £./2r 5,0/012/ /VL
From To Fr.
Froa1 '1'o Pc.
IS. G OLI-F: Ocprh Miliaria!
Froln 0 'I'o_ FL. GONCpG1e
From Tu Fr.
1-i SCREEN: Dcpgt Diameter Slor Sizc relurcrial
Front 'Po Fr. in.
Fruln n.
�l'� Ft in. in.
I5. S.<.NDcQRuVEL PACK:
From
From
Id. REP:LARRKS
Depth
'o
To
Fr.
Fr.
Stair Material
IcrhoU
able Box): Rcsldcncial ErNiunicipIUPublic 0 Induv¢iol ❑ Agriculnlrnl ❑
Topographic/Lanj,serzing
❑Ridge ❑Slope alley ❑Flat
(chezk:,ppropriarc box)
1(irude/looginlde �r well loearipyt
j J,r° c35', r7 L'On' 2 Y
,,7e,
(dcgr“s%m Inuresiscc°ads)
Laumdci longitude source: ❑GPSOTopographic map
(.heck bus,\)
DRILLING LOC}
Fontration Description
DEPTH
From To
0 — /05
/ OS - /A/ 54-
//N - zrs- G ii
V
LV
LOCATION SKETCH fV
Show direction and distance in miles from ac kasr -p
nvo State Roads or County Roads. Include the road
numbers and common road names, fV
crt
fin/oils o P 3)*(At 4el? e e-et ai
ra'd• Gu /V.0
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT .A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-7l 7✓. /o - t - 03
SIGNATURE OF PERSON CONSTRUCTINQ THE WELL
DATE
Suumir ncc ori;inal ro the Division of Warer Qualiry, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27099-163o Finnic No. 1919) 733.3221, trirhin 30 days,
GW-I REV. 07/200I
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O
t7O
Sr"
c r'
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o-c
KP1
-4o
rn�
zc
<nz
m o
c-�
O

WELL CONSTRUCTION RECORD
Norm Carolina - Dcpermunror Enviromncnr and ratN,,J�(,Rcsourccs - Divis)ion
/of Warcr Quality - Groundwater Section Q //� \\ELL CO:NTIL.CI'OI.(tND I\9DU.,L)N.AME (prior) Ljt/fiN , ITL L VeS CCI2TIFICAT1QN H..%IT�
' it U7/'/hiyj Cc .
cLLCo,vrR.cronconte..nvNAnlE PI'QLeSp/✓S PHONE dflSaS�f'YYI�
.i'Liriz WL'LL COINSTRUCTION FERM%Ts ccJ� ASSOCIATED WQ pt1tg1Tn
,d:if-I :ink!
(if' anpltetirlft)
293709
I. WELL LGE rChccic Applicable Box): Residential IE Municipal/Public ❑ Induarrial ❑ A.g
\1o114oring 0 Rzcovcry 0 Hear Pump Warcr l(.1jcedon 0 Ocher 0 If Other, Lis[ Use
2. V, ELL LOCATION.
Nears( Ta,\n: s4 /e ✓; //*
at./ ,e1---m..e/ -en'
3acm N.,mc, ,V,,m ocrs, Cam,n umry, Subai vision, Wr NO
County ""e1 S<
Zip Code)
OWNER: r L er
es
to ac.tcrR derg No.)
hC ..agiso3
-el_ Jr To„n S is Zap Cudc
gag*
,a7?- roes;
.;,ea muc- Irllune humour
4. DATE DRILLED
5. TOTAL DEPTH: /.tlr
2 — 03
S. DOES WELL REPLACE EXISTING WELL? YES 0 NO l�
7. STATIC WATER LEVEL Below Top of Casing: 2 o FT.
(Lite •':'-ir.nbave Tap or Casing)
S. TOP OF CASING 13 / FT. Above Land Surface'
•'lbp fir.n,m, tcrnunarca Lur below land surrace requires u
varia,lac III acua raancc with lie :NCAC 2C .Ilt'le.
9. YIELD l;pmj: le 0 METHOD OF TEST B%41t/yqq .1i
10. WATER ZONES (depth): J .9
cultural 0
TopographiciLand seeing
❑Ridge ❑Slope 9Valley ❑FIat
(check „ppruprium bJ%)
,1„(titude/longitude of well location
1 J
5 3) S7rl I'p f''f�•S3/
(degrees; minuicie seconds)
am/le/longitude source: EIGPS❑Tupographie map
Icheck bun)
DEPTH
From To
0-3/
5/- �G
DRILLfNG LOG
Forgiatiio Description
- I�5� G fl
11. DISINFECTION: Type?/oaLtivc,
12. CASING:
Dcpm Diem<r.r
From 0 To 3 '4. Fr. 4. /2 f
From to Ft.
From To Fr.
13. GROUT. Daph Maccrial do ManeO
FC0111.__0_ TO a FL. CCAre "ea.-, t
From To FL
I+. SCREEN: Dcpm Diamecer Sim Size Material
From To Fcin. in.
From To 1n.
15. SAND/GRAVEL PACK
Dc pro
From To Fr.
Fron, To Fr.
Amount 7 k
Wall Thie&ncss
or Weight/Fr. hiorcrial
5D.f'Z/ /r/C
to/4cwaod ied.Scan()
Js/h n 5' .
C
O
16. REMARKS.
Ft in.
Size ixdarerlat
c
LOCATION SKETCH �- Z„\
Show direction and distance in miles from ac Wadi .*ri
two State Roads or County Roads. Include the -road mo
numbers and common road names. zp
DO HEREBY CERTIFY TIiAT THIS WELL WAS CONSTRUCTED M 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 CONSTRUCTMG THE WELL DATE
Suomi( the original ro the Division of Water Quality, Groundwater Section, 1636 Mail Service Cenrcr - Raleigh, NC
77699-1o3o Phone No. [phone], rrirtlin 30 days.
GW- 1 REV. 07/2001

WELL CONSTRUCTION RECORD
Nona Caro boa - Dcparunenrof Env iromncnr and rut Resources - Division of Water Quali
r � /�
uEueo:�irlCror,(inulwou.;r)N.;n1E (p,-iar) jZ/A�N/ �. [_{,Ji�PS
i+LLL CO.NTI`_•.C`rOR COn1PANY Nc-lGCA4IE f PTQSoNs L! k// 7)Pi'/ILi, Cs
ST'APE WELL CJNSTR.IICTtON PER.n IITp ASSOCIATED WQ Pfllunri,,
f ii:inGlinblc)
,,YELL USE tChccC Applicable Box): Residential Er< urricipo UPublic ❑ Induyrrial ❑
M0naorul3 0 Recovery ❑ Hear Pump Water lnjcctlon 0 Other 0 It Other. List Ilse
2. WELL LOCATIyDJ�I: y
Nearest Town- ✓• r// ' Cotij y 4C.Oild[
/5 oat rlook Rd AShey , //e
,Bata N.imc, rLnnocrs, Cmnmuoi y, Suba i wsion, Lai No., 21p Cadc)
•.,3. OWNER. ulv nt ek c7h;//Ips
0i'cS ,/5 OOerloox Arco-
r> atat tit Rourc Na.)
As b e u, /le p E 40 80 3
C'iq.-'Tonal Stara Zip Case
wag 1- a9 ?- 03G 9
?.;ca sac- Pnorie aumoer
4. D:ATE DRILLED l7'- Z^7-o3
. TOT.;L DEPTH: /rr
O. DOES WELL REPLACE EXISTING WELL? YES.4 [] NO Lr
7. STATIC WATER LEVEL Below Top of Casing: �/!/ FT.
/ (Use `."l( .ioi va Top ue Casmg)
S. TOP OF CASING IS FT. Above Land Surface'
'Top or:aom; mrmurarca avor below land eureaee rcQuires a
variance,n a:e m-uaL:ewitl, 13A NCAC 2C .0116. 9. YIELD (,pm): /3 METHiQD OF TEST 3kw41qq •X...'
td. WATER ZONES (depth): %./D J
I I. DISINFECTION. TypeathR, _, Amount t, `a/'
l4. CASING. Wall Thickness
Dcprn ianurer or Weight/Fr. b11arc ial
h'ran,�_ To 5-0 El. . 2)- 54eZ/ />
From i'o F.
From To Fr.
13. GROUT: Depth Nlarcnal Mcmod
From 0 To aO Fr. CeArePeie.
A+^/ of
From To Ft.
lo. SCREEN: Depot Diamcrvr Slor Sizc 1114rcrial
From To Fr. in. in.
Fmm To Fr.
in. ut,
Li. SAND/GRAVEL PACK:
Dcprn S zc Nlarocial
Front To Fr.
From To Fr.
Jo. ILEM.ARJCS:
298707
ry - Groundwater Section
CERTIFICATION /3RI P
• PHONE age as - (�j L(.
Agriculnlral 0
Topographic/Landd.serving
ORidge ❑Slope L7'(2alley ,OFlac
(cpeck oppropriare box)
Lori dofLp ngin d of well�locarion
�193� JO.IZJ �}WarL 3/.5l/
(degrceslminule' cconas)
LanrwdelIonglNde source: an PSOTopographie map
(c lled: Dux)
DEPTH DRILLING LOCI
From To Formation Description
!�- yr v. m—I"
So - lef�
O
O
0 E.c
ry sm
LOCATION SICETCH = c3
Show direction and distance in miles from aeascro
two State Roads or County Roads. Include rlyg cog 3
numbers and common road names. n
A
U7
Q1 E
9L'er Look ,ed_
45/r V,Jfe /Y C.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l3A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT 1, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2C- 0.1
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Suomic chc original to ate Division of 1Yarer Quality, Groundwater Section, 1636 Mail Service Cancer- Raleigh, NC
GW-I REV. 07/200I
17699.1o3o Phone No. [phone], wirnin 30 days.

alnl C \r LLL CONSTRUCTION PEKAitTA
WELL CONSTRUCTION RECORD
Norm Csrolinu - Dcparunanr of Environ ncnr and rat Resources - Division of Water Quality - Groundwater Section
\V ELL CONIIt.CTOR (INDI\'1DU.al) NAAIE (print) Lje(A'/✓ L fI K!C S CERTIFICATION A/4° \l ELL CU:Nt'It1C'rt)li COMPANY N.1S'IE fe i"'Q�(.S �/✓�i /lei DP/ /I',y4 C5 . pHONF 18,31..%25, elZ fee
J ASSOCIATED WQ FEERIyAATv
ti t ': oplicsblcl
I. \4ELL LISE \CbccE Applicable Box): Residential CE' NlurlieipoUPublic 0 Industrial 0 Agricultural 0
loanoriny 0 Rcco.ery ❑ Hest Pump Water lnjcerion 0 Ocher Q If Other, Lisr Use
2. KELL LOCATION:
Courtly 0141.2A, /(
Nc.rcttTown:
Cs se (J.-C
r3o-cn �.m'm, wont ors, Canmun, ry, Subdiruiml, Lot No., Zip Cadc)
rr,vNER Nal &ordo.' Sir.
ASaress ip�sf/tfoN t..-
H/ 1?ncct cr Route Na.)) �1
Lnderso ,-/Ia. e .fl7/,
C:ry ar Town Swre
Material
Fr. 60NC2Gfe.
From To Fr.
IA. SCREEN: Depth Diamcier Slor Si2c Mamrial
From To FL in
In.
From To Fr in. in.
15. S--NDATR=,VELP.ACK.
Depth Six. Mamr,ol
From To Fr.
From To F1
Zip Curie
"241- to 7W 863 9
.wc:i ieJc- Phan: punlbcr
;. DATE DRILLED �i IL -O?
5. TOTAL DEPTH • WO- /
DOES WELL REPLACE EXISTING WELL? VES 0 NO I3
7. ST-.TIC WATER LEVEL Below Top of Casing: g0 FT
(Lire "r "11' Abavc Top or Casing)
S. TOP OF C=.SIN'G IS FT. Above Land Surface"'
rap or<%+.o6 rcrmm.:q sour below hind surisce requires u
r: ri.nc; m ac.ara.uyic witl, li'. :NCAC .0 .0116.
9. YIELD (spin): 647 METHOD OF TEST $bfalt/Irci *gall
1.0. 11 .-1TER ZONES (deptn): l35"' 330 3 S-Q J
y�Topographie/Land setting
Ridge ❑Slope ❑Valley._. ❑Flat
(check appropriate box).
Latitude/long mde of well location
is' 3LT7�'Noirt' � r'
S r21
(degrees minute� --++cconds)
Lath-tide/longitude source: C'FGPS❑Topographic map
(chccl: box)
DRILL 1NG LOG
Formation Description
air -
6 7 - 72. 5 gey
DEPTH
From To
0-47
298706
'/2 - 9b)_
I. DISINFECTION: Ty fpcC' OjL.Nc, ,Amount /V fcft
12. C*SING: Wall Thickness
Depth
From To Fr.
From To Fr.
From To Fr.
13. GROUT: Depth A hlcmoit
Front_ p To a
Diameter or WelghCFr. Morelia]
I c. REM.Aft;S.
r%t
0
O
4.
2- aN
�s m
�T7 Ccr
N 0<
>0
LOCATION SICETCH -0 rri�
3 —a
Show direction and disrance in miles front leasxez
nvo Stale Roads or County Roads. Include lc rier
numbers and common road names, rn o
z
G �v7i9J, N< .
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH 15A NCAC 2C, WELL
COi1S'CRUCTION STAND.AI.DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
£g;% -Y 4.' Q-26-03
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Sunmic CRC ori;inal CO rbe Division at Water Quality, Oro undwacer Section, 1636 Mail Service Cenrer - Raleigh, NO
:7699-io_3o Phone No. [phone], wirh(u 30 days.
OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
Norm Carolina - Department of Environment and Na(ural Resources - Division of Water Quality
\\ELL CONTI.AcT3a iINU11TDU.AL) NAME /(2riuq f+ r•5e1 ,(, U%"c
\42LL CUNT Ka CTUR COb1PnNY N.AKIE / ir. n Co'? S We (/ gill ;,-
SloorL 4YELL CO:NSTIUCTLON PERn11T»
ASSOCIATED WQ PERIr1IT/I
(if auplie' ble)
298705
Oroundwarer Section
CERTIFICATION » S��rt7
PHONE' AYr- n Zr/--et
I. WELL USE \Cheat Applicable Box): Residential I�MunicipaUPublic 0 Indusrrial 0 Agricultural ❑ btoniroring 0 Recovery 0 Hear Pump Water lnjcerion 0 Other 0 If Other, List Use
2. WELL LOC.ATI9N:
Nc_resi Town: Zeite 5'h"-
/'le,<,.i
,iac.� Na;ne, :Numbers, ia,nmuniry Subdiruion, Lot No., Zip Code)
3, OWNER: MCS• ck �f.' h/`
=-setae 117 Ma /f,;v 7r !2a
/ ' tSnca. or Route No.)
to esiee' x c - a8792
i:p or Toyrn Slott Zip Codc
`�ca&I- • 025 9//4
.v c; iOdc- Pltun: au:ubel.
4. DATE DRILLED 4/'- 2k/-03
Camay �`'^e✓tea SC
5. TOT.u.L DEPTH: )Q $'
6. DOES WELL REPLACE EXISTING WELL YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: '10 FT.
time ".' 'Ir,.Abeve Top ur Cavng)
S. TOP OF CASING IS FT. Above Land Surface'
'Top or :aan; iermmorco auur bclufr land surr(ct requires u
var,anca in aceor93ucc with I>.A NC AC 2C ANIS. D
9. YIELD (spin): METHOD OF TESTl�y, -i
I0. WATER ZONES (depth): //D' Ms'
-/%f
I I. DISINFECTION. Type Ck'.%re
12. C.=.SFNG:
opographiclLandscning
edge ❑Stope ❑Valley ❑Flat
(cheek appropriate box)
Taritu4lk" Srf- d ; Df wellcation
f 'i�orL sfz o/d
(degreesmninuicslcconds)
Lalitudeilongitude source: O 'PSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
�`� Sled -oc
''t - Or
Amount / 4)
Wall Thickness
0DomDiameter or Weighl7Fr. Material
From To 54 Ft. 6✓2r G
Fro,n Po Fr a /
From To Fr.
13. GROUT. Depth Material
blcthod
From D To Fr o 23 Fr. liat'Cj'C
From /�
/Pwe.7/%
I4. SCREEN: Dcprh Diameter Slot Sizc Mureria]
From To Ft. in. W.
From To Fr. in.
I5. SAND/GRAVEL PACKW.
:
Dcpm Size. Material
From To Pc.
From To Fr.
16. REMARKS:
v
Z
tV
LOCATION SKETCH
Show direction and disrance in miles from at left 3
[WO State Roads or County Roads. Include the trid
numbers and common road names.
Ili marftN/31e.ed.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED
t7'ULtM OWNER
TO THE WELL 0
SIGNATURE OF PERSON CONSTRUCTING- THE WELL
DATE
Sun ma the original ro the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2,7699.163o Mac No. [phone], within 30 days.
GW-1 REV. 07/200I

298704
WELL CONSTR.-LTC/ION RECORD
Norm Csrolina - Deparunenr or Enviromnent and Natural Resources (/1�-' Division of Wafer Qualioy - Groundwater Section
H �-' �nil CERTIFICATION ftJ/V°
\\ ELL CONT1otCTOR CO:NIP.AN1' tLNI Ale'. Ton J''G// �I•72:7 PHon 2 rjerr-/ i
a1'nriz WELL CO:NSTRUCTLON PERbIITA I ASSOCIATED WQ PtRM1TU
(ir appl icoble)
\\ELL CO.NTI:Ls:von (1ND179DU,a1) NAME (prior)
ili.: r.;a.:oble)
I. WELL USE .Check Applicable Box): Residential IS Municipal/Public ❑ Induoaial ❑ Agricultural Q
:Moilitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It Other, List Use
2. WELL LOC.ATIOfN: /T
Neater[ Town: ACi CaJidi•.- County, /�'^u•+fc-
IVC/14 r.<n /lc Ce.'e r
UD-eei Nm1e, Numocrs, Commumry, Subdisuion, Lot No., Zip Codc)
3•OWNER: GIndte 4t'irrvixp%D
aro_s QS- etth .*ueN
t Scr cr ar Roucc No.)
.vsFe. lrc .�,t7Se
':� ar Town Sate Zip Codc
( Q)-(r3—tea
AAP iUdc- Phune OutuDA'
4. DATE DRILLED L% - T2 -03
5. TOTAL DEPTH: 1 YI'
o. DOES WELL REPLACE EXISTING WELL') YES 0 NO b
7. STATIC WATER LEVEL Below Top of Casing: 4"O FT.
(Use "+"'i1 .Above Top of Cumng)
S. TOP OF CASING IS / FT. Above Land Sur atx^
rap or coon, [cr mrnated a our bcluw land su rraee requires a
various.: W sseorna;mc with 15a. NCAC 7C.0116.
9. YIELD (gpm): SHOD OF TEST envoy ,l,
10. WATER ZONES (depth): 5�
Topographic/Land sorting
❑Ridge ❑Slope ❑Valley Mist
(cheek appropriate boa)
Latirudc/ton rinide of well location
3'°3r 4324't/osz°S//,Poi'
(degrcesrm inwcsncconds)
Laliwdeilongicude source: OGPSOTopographic map
(dieel: box)
DEPTH DRILLING LOG
From To Fo motion Description
0•77 ,1j:�
37- VC s4//titer
1 - Orr end*
I I. DISINFECTION: Type a-e'AG
t'_2. CASFNt3:
Dcprh Diamc f
From 0 To G/2 Fc.L./l+
From Fo Fr.
From To Fr.
13. GROUT: Depth Mareriol method
From 0 To 2d Fr. COnvnliY Airh9j
From To F.
14. SCREEN: Detach Diamcmr Slor Sizc Nlurcrial
FUOLII To Fr. in. in.
From To Ft. in. in.
I5. SANOr31ZAVEL PACK:
Depth Size Marcelo'
From To Fr.
From To Fr.
Amount % 4SI
Wall Thickness
or Weight/Fr. b'rqvial
5j)l1zl (/C
In. REM.ARJCS:
c
0
3 "a
b' p^t
▪ cm
Nori
N ern
LOCATION SKETCH -p mo
Show direction and distance in miles from at lit o
�T
two Scare Roads or County Roads. Include the Wad rn
numbers and common road names. U7
c G
q4 t1Jkf,' /✓ ile& /aci.
1 DO HEREBY CERTIFY THATTHIS 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
14QA,4 7_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. i9191 733-3221, within 30 days. OW-1 REV. 07/2001

008 702
WELL CONSTRUCTION RECORD
North Carolina - Department o(Environmenr and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRaCTOl2 (INDIVIDUAL) NAME
// (prior) leiv'cn
WELL CONTRACTOR COMPANY NAME NC- f-' 50.-t
CERTIFICATION K 'f if VD
PHONE Rwel ,F- EVC4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITIt
if applicable) (it -applicable)
t. WELL USE (Check Applicable Box): Residential lJ NlunicipaUPublic 0 Industrial 0 Agricultural 0
Monimring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: A, - ✓ e.✓ County Rr-.neV(r'v'%
Ole/ : b Rd: F.ar' r ✓.'er J
(Soecr Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER: iC kt L 1C.
Address ,-2 g O d R, t 2d
(Sneer or Route No.7
City Jr Town Sate
(ig;F)- (o AR- S(oo
.Area erne- Phone number
4. DATE DRILLED - 03
S. TOT.AL DEPTH: S—Ur
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1:i"-
?. STATIC WATER LEVEL Below Top of Casing: & n FT.
/ (Use +"'ir Above Top of Casing)
3, TOP OF CASING IS / FT. Above Land Surface'
'Top of eating terminated Dior below land surface requires a
vn riance in aced rdanee with I5A NCAC 2C .U118.
9. YIELD (gpm): % METHOD OF TESTI/d ' —'
l O. WATER ZONES (depth): 70 /
1 1. DISINFECTION: Type ('l7 r. n L
12. CASING:
Depth
From 0 To Go
From To
From To
13. GROUT: Depth
From 0 To 10 Fr.
From To
I4. SCREEN: Depth Diameter
From To Fr, in.
From To Ft, in.
15. SAND/GRAN EL PACK:
Depth Size Marerial
From To Ft.
Zip Code
Amount /S' }e6r
Wall Thickness
Diameter or Weight/Ft. Material
Fr. !i 9► /A✓C
Fr.
Fr.
Material .4"lerhod
Li-,c-cam °✓.aI
Ft.
Slot Size Material
in.
in.
From To Fr.
topographic/Land sexing
dge ❑Slope ❑Valley ,: ❑Flat
(check appropriarc box)
Larirud Aon'irude of well location
NsraZ Zr.
° 32.34e Lie) Dr2 r
(degrees/minure�• econds)
Larirudeilongirude source: O"GPS❑Topographic snap
(check box)
DEPTH DRILLING LOCI
From
m GTo Fo¢rra- 01* Description
0
(0 - So s' G rc., . if(
� O
N
3 7m
LOCATION SKETCH N ��
Show direction and distance in miles from &lkust-j
two State Roads or County Roads. Include Ile roa
numbers and common road names.
pj8:s O/d- gofer
/ Uf` t.ai »- C,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Z2.. o —2E, 03
SIONATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o 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 Qualiry
\A ELL CONTRACTOR (INDIVIDUAL) NANIE (print)
w ELL CONTRACTOR COMPANY NAME F j4••$ r3 li(_'I 0,;I'tnj
298701
Groundwater Section
CERTIFICATION/4- 4°
PHONE tin 2fl- -44141.
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
if aoplicablcl (if applicable)
\VELL USE (Check Applicable Box): Residential LJ MunicipoUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearg j Tovm: /fie. i 14 ✓ Counry
r o • fBort. .0. 35 4 -Nish.
r3uccr Nonni, Nuinbcrs, Community, Subdivisian, Lot No., Zip Codc)
3.OWNER: 11 Lou_g tI,-,oz.e
Address . •O. $o l!- a35 �1
(Suez[ or Route No.)
Fa;ru1-1c- CC 73a
Cry or Town Sm[e Zip Code
(IC2)-
Afea Coco- Phone number
4. DATE DRILLED 6-2.cl-03
5. TOTAL DEPTH: Jo 5
topographic/Land setting
.Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
1�Ccr32 as-.'vosiit. In'
(degrees/minutec�scconds)
Latirudeilongitude source: L'1GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
H
DEPTH
From To
a-44
4c-.303
a. DOES WELL REPLACE EXISTING WELL? YE''S// ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: '-[') FT. OL---
(Use 'N-"'if .Above Top of Casing) A
S. TOP OF CASING IS / FT. Above Land Surface.
"Top of casing iermina red a vor below land surface requires a
rarianec in accordun•e with 13A NCAC 2C .0118.
9. YIELD (gpm): 'y METHOD OF TEST/L✓ref - L!'S
I0. WATER ZONES (depth): ("°r %/)'
I I. DISINFECTION: Typer4t t Amount
12. CASINO: Wall Thickness
Dcprh Diameter or Weight/Fr. Material
From 0 To 46 Fr. L %d t✓G
From To Fr.
From To Fr.
13. GROUT: Depth Material
From 0 To 20 Ft. C..91-.LIC
From To Ft.
(4. SCREEN: Depth Diameter Slor Size Material
From To Fr in, in.
From To Fr. in. in
I5. SAND/GRAVEL PACK:
Dcp[h Size Material
From To Fr.
From To Ft.
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two Scare Roads or County Roads. Include the road
numbers and common road names.
ylesb;+S (Inc,Fel .
F-c,;rJ;e-w �<
k•
Fq(ck/twMr.
Id. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL -
CONSTRUCT [ON SSTT..AND.ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r Z✓alto_ o - 2v- O-7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No, [phone], \virhin 30 dap. GW-I REV. 07/2001
N
N
0
N
CTI
171

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME/ (print) £t4 ik W•sit'5
WELL CONTRACTOR COMPANY NAME /"may, 10•.f We SI .4' /I"f
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
('1 uppllcable) (if aPolieablel
298604
- Groundwarer Section
CERTIFICATION K f/VD
PHONE IOy7l'I ZI J" %frf
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: p
Nearest Town: j+g e' V%'/IL County at^ico,�d(
M« GY
(Sacct Name, Numbers,, Commuuniry, Subdivision, Lot No., Zip Code)
3. OWNER: --)Co 7L d✓/+['t.
Address
zewtit
SR•ure No.)
I -eve-, �./joeet or ( Nrc,
City or Town State
612(2_)- 09 -47ss
7y-7?7
Zip Code
.Area code- Phone number
4. DATE DRILLED (o-(v' US
S. TOTAL DEPTH: 30}'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l3
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "*"'if. Above Top of Casing)
S. TOP OF CASING IS f FT. Above Land Surface*
-Top of casing terminated odor below land surface requires a
variance in accordance with liA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST,&... ,-•f
10. WATER ZONES (depth): 151.7
I I. DISINFECTION: Type (6.. e
12. CASING:
Depth Diameter
From To F.,r Fr. G'A/
From To Ft.
Amount 7 /cSr
Wall Thickness
or Weight/Ft. , larerial
P1Z31 tie
From To Fr.
13. GROUT: Depth Material Method
From I) To 1a
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 Fr.
From To Fr.
f(/T4R:Yt1 i3/Anc4.
weatit (0. le Y! .
Topographic/Land,._,Csetting
❑Ridge Eope ❑Valley ❑$lat
(check appropriate box)
Latirude/longitude of well location ,
p rd L13. Utd " uoyZPZY J7Z
(degrees/minutes/seconds)
Latimde/longitude source: 63GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To don Description
O - �> Fo r'.
(,f- 2O56.-41,'kJ-
0
A cm
N o<
LOCATION SKETCH
yo
Show direction and distance in miles from at Cas$'r xo
two State Roads or County Roads. Include the,&ad u,
numbers and common road names. •• m�
V1 ti
Ql 0
2
to. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNEROWNER
Seto !, h,14,4u.4 (n6y -�DJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

293693
From To Ft
From To Fr
)3, GROUT: Doprh
Frain O To 20 Fr.
From To Pc.
WELL CONSTRUCTION RECORD
Nrrn Caroline - Depenmenr of Environment and N rural Resources - Division of Warcr Quality
\\ ELL CONTRACTOR (1NDI\'IDU.AL) NARIE (print) r'4.1 1e�q CS
\\,L L isCONTRACTORCUb1P.ANY Nn.1lE IC/pa IOwr Lvei/ De,/MI/
STi CE NY ELL CONSTRUCTION PER2 tlT» ASSOCIATED WQ PtiU 11Ta
anplicabltl
- Groundwater Section
CERTIFICATION N
PHONE fr'i Z%r` f'vr
I. WELL USE tChocir Applicable Box): Residential n-...-clurricipaUPublic ❑ Industrial 0 Agricuirmal []
Wniiarin❑ Recovery 0 Heat Pump Water Injeedon 0 Other 0 If Other, List Use
2. \\ELL LOCATE:
:
N eon-esr Town: • / County 4"nr�'sh-
e di 1 � i. M,Aen. We.
lS0 oL N.inr., ,N,„nbcn, Community, Subdivision, Lor No., Zip Code)
._, 3 OWNER. 7r/foni ahe, -s
Adaress 2A /30X 0.50
(Saari or Rourc iNo.)
flare U.. C. Jer C a&73d
OILY or Toorn Stare Zip Cade
tf(361, G Ii±" /a7/
v'e'i ;oat- Phone pumocr
4. DATE DRILLED S'/b -01
5. TOTAL DEPTH: ZS-.
o. DOES WELL REPLACE EXISTING WELL') YES 0 NO ET--
7 . STATIC WATER LEVEL Below Top of Casing: 4FT.
(Uie "r"'ir above Top or Casing)
S. TOP OF CASINO IS FT. Above Land Surface -
'tap arcaa it tcrmina rca a pur below land surface require' a
vari>ueo in sCcornzucc wirfr 15A NCAC 2C.0) I8. J
9. YIELD (gpm): ZO METHOD OF TEST 4.411-4•7
10. WATER ZONES (depth): /%% , 60pin e
11. DISINFECTION: Type %/i-en6 Amount
f2. C-.SINO:
Wall Thielcnesa'
Dcprh Diamerer or Wei ht/Ft. Material
From 0 To 7) FL G•itr' s ,) j ,v✓c
Material
CDPICAtt
&lc rhod
14 SCREEN'. Depth Diameter Slot S'izc Marcrial
From 'fo Fr in. in
From To Ff. in. in,
15. SAND/GRAVEL PACK:
Dcpih Size Material
From To Pc.
From To Fr
to. REMARKS.
Topographic/Land serving
❑Ridge ❑Slope ❑Valley DFlar
(cheek uppropriare box)
arir�de/longitude of well locarion
3r!.4rr4/on?3k72a
(degreesrmin uIenceonds)
Larirude/longitude source: ❑GPS❑Topographic map
lcllcc}c box)
DEPTH DRILLING LOCI
From To Formation Descriprion
D - 7J ,pry i"
/t- 2o3'
LOCATION SKETCH
Och
5_
F
Show dm irection and disrance in miles froa asr ��.r
two Scare Roads or County Roads. Include LVwa:C r.tc
numbers and common road names, N o
N - m
i0
1
u, X
r"
rn�
r7
ti
O
Odd 8•1 l gwt-
--o
N
c,71
rn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAiNDARDS, .AND HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a; z . q-i6-c93
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suomic ehe original co the Division of Warer Quality, Groundwater Section,
27699-163o Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC
OW -I REV.07/2001

WELL CONSTRUCTION RECORD
Norm Carolina - Depsrunencor Enviromnenc and Natural Resources - Division of Water Qualiry - Groundwater Section
11 ELL CO:NTIZACTOR (INDIVIDUAL) NAME (prior) J-1c1 .t Ld..., CERTIFICATION ti T/V.)
tt 6LL CONTRACTOR COMPANY NA,'v1E FYyu /on" A1/tif PHONE ,rtrr G�"r—ram
SYn IL beELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERM1TIl
Ir.arl.:.,blci lirspplicablal
298692
WELL USE L0htalr Applicable Hox): Residential LT NiunicipaliPublic 0 Industrial ❑ Agricultural 0
blonirorin$ 0 Recovery 0 Hear Pump Water lnjection 0 Other 0 If Other, Lis[ Use
2. WELL LOCATIjOVDp
Nca1-i.sLTown: /7S✓ it'//C County- 4—eon4
-
Se. t_sr t e ' e. ar//L
tSa'ccr N.:mc, :Numbcn, Camawn:ry, Subdivision, (.oi No., Zip Coda)
...3. OWNER. lio/tes
stir ;, o1U
t)aCH ur R0ELc No.)
o./enders,,yz,lie n,'
Cay Totrn State
L(87-ve/741
At Nat- Phone hum bar
4. DATE DRILLED f/-/5'-Di
5. TOTAL DEPTH: 245—
ok79/
Zip Coo°
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: sAD FT.
( Lisa "T"'ir Abava Top of Casing)
S TOP OF CASING IS / FT. Above Land Surlacd'^
R'1'op or cmloi rarmla tea uvur below land surge CC rcq aires a
varmnee in accords with ISA NCAC 3C.U1 IS,
9 YIELD (gprn): 250 METHOD OF TEST AVI•f- .d11
in WATER ZONES (depth): 40, 2 v1—
I I. DISINFECTION: Type C/n/.L Amount 9- he
1'_'. CASINO: Wall Thickness
Depm Diameter or Weight/Fr. h1.arcrial
From 0 To S'i Fr./edit
From To Fr
FIOLD To Fr.
13. GROUT: Depth Marcni
From 0 To Zd Fr. e C.nlemoa
SJ% / ?✓G on V e o Zd .
lh 6ea;/le'r'
From To Ft.
14. SCREEN: Depth Diamcrcr Slot Site Marcrial
From To Fr in, in.
Frain To Fr in. in.
15. SAND/GRAVEL PACK:
Dcprh Size Marcrial
From To Ft.
From To Fr.
I . REMARKS.
Topographic/Land sluing
❑Ridge 13S`lope ❑Valley 4FIac
(check nppropriarc box)
L Dude/longiwcee of weep location
�13 po plots if, S'fr'
(degreesuninutcy seconds)
Latitude/longitude source: IT GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0-,TJ 4;ef-
n— n- FMr ibcJC
LOCATION SKETCH
Show direction and distance in miles from acrkssr ---
c
two Staid Roads or County Roads. Include lli�ioado
numbers and common road names, -p
N3
CII
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lithelAS-' 11r ~ 9- /J COJ
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Submit the original ro the Division of FVarer Quality, Groundwater Section, 1636 Mail Service Cencer - Raleigh, NC
27699-163o Phone No. (919) 7)3-3221, Will -till 30 days.
GW- I REV. 07/?DUI
ono
rn
m70
O

WELL CONSTRUCTION RECORD
Norm Carolina - Deparunenraf Environment and
\\ ELL C05,131iCTOI: (INDIVIDUAL) NAME (print)
\4 ELL DOWN rl'aa CTOIt coal PAN N.AMC FVf'a f°91
Natural Resources - Division of Water Quali
1445-01
42// 40.-!
298691
cy - Groundwater Section
CERTIFICATION N 31(4%
PHONE ai2A2-r1'YS/S'C
5VtTC \YELL CONSTRUCTION PERAIITH ASSOCIATED WQ MINIM{
(ii:Ipplicable)
f it ,r-rJ c_blcl
WELL USE \Chccic Applicable Dux): Rea idenrial CT 1,iunicipaVPublic 0
Monitoring 0 Recovery 0 Hest Pump W'alcr lnjecrion 0 Other Q I
3. WELL LOCATION,
Nearest Town Ci!p i its Counry �Wc,nlC
350 lek.rik- NI (e.- #s/-Por-
k 3,1-c.:e name, Nwnocn, Oammuniry, Subdivision, Lai No., Zip Code)
3. OWNER: Toaiv; e goYd.
A.14ress 3356 /7.e w /.e,- cafti .',tu
rSaccr or Route Na.)
Lc,'ees/er /✓C tha7yd'
Or or Tana lute
(f2K)-Jsk3-Ux°
Alca QUO: -Phone numbsr
4. DATE DRILLED q - /7-03
j. TOT.AL DEPTH: .ro
Zip Code
O. DOES WELL REPLACE EXISTING WELL') YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /be FT.
1 (Use `r"'i(. bove Top of Caring)
3. TOP OF CASING IS FT. .Above Land Surface"
Top termm area aver bcluw land au race rcguirer u
variance w acco raiqv leial !SA NCAC 2C .0116.
9. YIELD (gpm): / /Z METHOD OF 'Af
to. WATER ZONES (depth): ✓'
11. DISINFECTION: Type Ch-•'t
12. CASING:
Deem Diameter
From 0 To VP Fr. L-/LI-
Fmm co Ft.
From To F.
13. GROUT: Dcprb
From 0 '1'0 20 Fr.
Amount A Asi
Wall Thickness
or Weight/Ft. Material
SAW 2/ Pvc
MarerialJ,/
From To Fr.
14. SCREEN: Depth Diameter
From To Ft. in.
From Ti Fr. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft
I . REMARKS:
Method
,,•49 4 f
Slot Size Material
in.
in.
Material
Industrial ❑ AgricuLrural ❑
Other, List Use
Topograp is/Land seeing
DRidge LdSlope ❑Valley ❑Flat
(check appropriate bo)
Larioade[I-on6 5 of well lococion
A/3r �b1° /%S.2 44
(degrees/m inutcvsseondS)
Latirudeilongirude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(T -c/s ��%%:14c/t
' STh Y 6-b., Pc,
DEPTH
0 m y3To
0
O
r n
--S T
0n
?r^i
LOCATION SKETCH N cat
Show direction and distance in miles from IIN'east5G
two Stale Roads or Counry Roads. Include !diproag"--
numbers and common road names.
t,)=
;Co Aew Le-� eS eer cg
LY. c e_s ter ».- c
I DO HEREBY CERTIFY THAT THIS \YELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C,-WELL
CONSTP ICTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
g- /L-o 3
SIGNATURE OF PERSON CONSTRUCTMO THE WELL DATE
Submit the original ro rllc Division of Warer Qualiry, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
Norrn Cerai na - Depalvnenrof Env iromnem and N<rural Resources - Division of Wa[cr Quality
tt �n 4f
-t /
SPATE WELL CONSTRUCTION PERMIT,# ASS'OC[ATeD WQ PERMITU
(iiannlieablel
MILL CONTRACTOR (INDI\9DU.,L) NAME (prtnp 4703/401
WELL CONTRACTOR COMPANY NAME /LG1...)04j
'299689
- Groundwater Secrion
CERTIFICAT1ON a c311940
PHONE eflM' art-- 4f-s'ri
I. WELL USE t0hcck Applicable Box): Reaidcnrial H' Municipal/Public 0 Induarrial 0 Agricultural ❑
NWnitonng 0 Recovery ❑ Hem Pump \\'arcr [njccrion 0 Other 0 If'Other. List Use
2. \hELL LOC.ATI;.1V �7
c
Ne cjl�own: }or'kr o-Fi Counry.ZnD.yii
!IS) 1- a l rle rz.47/e
raaun tome, :Vomiters, Co,nm unary, SubOineion, Lot No., Zip Codc)
3. OWNER.VSC.K S4/7c/'d
ASdecis
/' [Street or Rout: No.)
&L v r 'fie /✓C
,pot To:,,, 3cu:
.41. kS- b-AG,"
aR707
Zip Cade
.Ages coat- Phone purnocr c�
4. DATE DRILLED 6- $ - 03
5. TGT.A.L DEPTH: ro
O. DOES WELL REPLACE E\[STING WELL? Y.E.3' 0 NO 13"
7. STATIC WATER LEVEL Below Top of Casing: ft FT.
(Use "r 'ir Above Top orCosmg)
3. TOP OF CASING IS FT. Above Land Surfaeal'
"Tap oroonn; rrmmatea auor below land su rfaee requires u
variance in acmrbzucc with li.A NCA.0 2C Al IS, /�
9. YIELD (gpm): 1/t (`METHOD OF TEST o'•-*'f — 4
Ira. WATER ZONES (dttaih): '3 So r
t 1. DISINFECTION: Type riorAZ Amount /a--''eit7
12. CASING. Wall Thickness
Depth plamerer or W ighriFt. Ivlarerial
From 0 To Zo Fr. L • /zC SDrc�l/ pile
Frain To FL.
From To Fr.
13. GROUTq' Depth Martria pp rvlcthod
From l/ To}O F. Con( "t�L /h.r.1
From To Fr.
14. SCREEN: Depth Diameter Slor Size tvlarerial
From To Ft. in. in.
Fmin To Fr. in. In.
l5. SAND/GRAVEL PACK:
Dcprh Size Riotous)
From To Fr.
From To Fr.
16. REMARKS:
Topographic/Land sexing
❑Ridge ❑Slope J> CIley ❑Flat
(check appropriate box)
Lutiwde/longirud of welllocarioo
AI,IS°4L. 4,T6 !./ore ,22. 4'. '
(degrecs'minurtar woods)
Larirudeilongitude source: I PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
G..,. tie
- ,tor
DEPTH
From To
-T
-20
� 0
9-2
LOCATION SKETCH
cm
Show direction and distance in miles from alriaast cc
two State Roads or County Roads. Include Lliuroarfi>- o
numbers and common road names, "v rn
o' L /9-- '
Aft a "An //G
1V
CM
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
tr
SIGNATURE OF PERSON CONSTRUCTINO THE WELL DATE 03
Submit me original [o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1o3o Phone No. L919) 733J::1, within 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Depanmen of Environment and N.yrural Resources - Division
ll J,t/•..t3
298685
of Water Qualiry - Groundwater Secrion
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) 0ten
W ILL CONTRACTOR COMPANY N.ah1E `€'11/4l”'-15 well `t- 45
SKATE WELL CONSTRUCTION PERMIT#
Cif scplizlblel (if applicable)
CERTIFICATION N ��yo
PHONE j2? Zf?. 1V%
ASSOCIATED WQ PERMIT#
I. WELL USE (Check .Applicable Box): Residencial ❑ Municipal/Public 0 Industrial 0 Agricultural 0
NWniwring❑ Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neares( To\wr. 2e., „kr
Creek
(Srcci hams, 7'Nwnbcn, amnuniry, Subdivist n, Los No., Zip Code)
3. OWNER:(refit c.5ctin/ �4jptstC r,rrL
Address .30 Bnjr/ ` n4� -L� ncc fed
n(Sireec or Route N
Counry fx.r.ers , fc
City es Town $ale Zip Code
(W1). aS'- /535
A'ea Iwo- Phone number
4. DATE DRILLED 7-/?-03
5. TOTAL DEPTH: Cm'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO c<
7. STATIC WATER LEVEL Below Top of Casing: <30 FT.
(Use "*"'if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface'
"Top or casing terminated aUur below land surface requires a
variance in aceordauce with IS .:NCAC 2C .0118.
9. YIELD (gpm): Jv MEHOD OF TEST /jale
IU. WATER ZONES (depth): �d ,
II. DISINFECTION: Type ('!i)-.>,C Amount /e3et65.
12. CASING. Wall Thickness
Depth Diameter or WeighrlF. Material
From 0 To Sr" Fr,/./2.r fan? / ,A-'c
From To Fr.
From To Fr.
13. GROUT: Depth tvlarerial Method
From 0 To Zo Fr. ro...co,o/C ,./-3..,-.6F
From To Fr.
14. SCREEN: Depth Diameter Sim Size Marerial
From To Fr. in. in,
From To Ftin. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
Topographic/Lan) seeing
❑Ridge OSlope QValley : ❑Flat
(check appropriate box)
Latirude/longiru4 of well location
,U,yr° 37-iva L ota°3 4.oz
(degrees/m inures/ 'econds)
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
It
DEPTH
From To
o - sr
Fr - L 's
r7
u
LOCATION SKETCH -c c
y
Show clirecrion and distance in miles from leas,,-".t
two State Roads or Counry Roads. IncludelVe rog
numbers and common road names, yo
rn
za
rig
m
to =
-
Ql
2
vix, et call 46/
Old' eocen 6r.r H 'n--
3
From To Ft.
la. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION.jSTANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tar) Ft, �3 — / — Of
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cencer - Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-1 REV, 07/200I

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
fir ELL CONTRACTOR (INDIVIDUAL) NAME(print) dr'"‘ 1< LEL end- CERTIFICATION #
WELL CONTRACTOR COMPANY NAME '` '---S•^5wiJ /vtf/ At' II, +J PHONE 07bl
STATE WELL CONSTRUCTION PERNIITei ASSOCIATED WQ PERMIT#
i ii upplicablel (if applicable)
298684
1. WELL USE (Check Applicable Box): Residential Il 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 Towm i' //c
County /mac-', '•'•e SC
(Soect Name, Numbers, Community, Subdivision, Lot No., Zip Code) 1
3. OWNER: Ponies r'9'Ynr2- .[. /CT/Rni u2_ 1ati)
Address Solo /r shel>./sse- l—It.,r�
(Sneer or Route No.)
PC-nt frS OIV 0;1I12_ n 3-1701
Ciry or Town Sue Zip Cade
fS) teg1 - yU7tf
Area ode- Phone number
4. DATE DRILLED Gar
5. TOTAL DEPTH: /S'C
Topogr9hic/Land setting
❑Ridge °Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/I9ngirude of well location
�)?3» LAC Oro '4'ort'11•/3L
(degreesim inu re,v�i+econds)
Latitude/longitude source: E'7GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F rmar Description
O.1D
z° - /VC
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑ -
7. STATIC WATER LEVEL Below Top of Casing: 3o FT.
(Use "t" if.Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface"
'Top or casing terminated ar/or below land surface requires a
variance in accordance with IAA NCAC 2C .011S.
9. YIELD (gpm): 30 METHOD OF TEST /��o-- of -/LS
to. WATER ZONES (depth): /h'r
11. DISINFECTION: Type
12, CASING:
(to,: ^C
Depth Diameter
From 0 To 2 O Fr. (. A
From To Ft.
From To Ft.
13. GROUT: Depth Marerial Method
From 0 To 2c Ft. (a itte I( lD ar:Al
From To Fr.
14. SCREEN: Depth Diameter Slor Size Marerial
From To Ft. in. in.
From To Fr, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fr.
Amount (o fc6r
Wall Thickness
or Weight/FL Marerial
1DZ. af /'dc
16. REMARKS:
C t x/.'
0
O
Maw
0
`tea
LOCATION SKETCH
im
N �m
0
rn
Show direction and distance in miles from a[iccs[
two State Roads or County Roads. Include dlyWoad,`�,-, 55
numbers and common road names. CJ1
Qn O
z
j egNhr-
fei uervi'i/ei ACC.
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRIjfTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone Nu. [phone], within 30 days. GW-1 REV. 07/2001

298682
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (1NDR9NAM
E (print) Ike K- Ia1XS
WELL CONTRACTOR CONIPANY NAME to )'U'-',t i ✓C:/ •• (-1-
Groundwater Section
CERTIFICATION NJ/c/0
PHONE yi•Z") G% P.gr/`rr5
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CrMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Torwa: t✓C-It'✓•fit
dtt
County br+^ce.-”fe
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. llal24,k Cpa.lt'ts
Address 4so m .-%/ C "%G-det ?et
(Seeer or Route No.)
FYI Ar s t/i h C
A2954/
Cory or Town State Zip Code
(P2)-
Arrea code- Phone number
4. DATE DRILLED _F'20 '03
5. TOTAL DEPTH: I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eft
7. STATIC WATER LEVEL Below Top of Casing: I/9 FT.
( Use "tif Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
^Top or casing terminated odor below land surface requires a
variance in accordance with ISA NCAC 2C .011d.
9. YIELD (gpm): 20 METHOD OF TEST 481'•":"1 _
ID. WATER ZONES (depth): 300
I1. DISINFECTION: Type (Ie -.1e- Amount /2 te6.
12. CASING: Wall Thickness
Depth Diameter or WcighUFt. Material
From a To it FL (_-)DK T t �L
To F.
To Ft.
13. Materiat Method
C oncrr,'� Method
From To Ft.
14, SCREEN: Deprh Diameter Slot Size Material
From To Ft. in, in.
From To M. in. in.
From
From
GROUT: Depth
From 0 To 20 Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Size Material
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge Ca 'Slope ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
Hi)" a“c -. ' iron ° as . 90'
(degreeslminumcseconds)
Latitudeilongitude source: C9'GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1Y � -
ir-
zip
2ziCm
N rfl
LOCATION SKETCH - -10
Show direction and distance in miles from a[ast r~*t \o
two State Roads or County Roads. Include the roaQ,,
numbers and common road names. N m�
(11 --
o
R, aka Brock
.euvcrv: g-11C- •
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C; WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
✓ -1,1A- --
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1630 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
298681
North Carolina - Department of Environment and Natural Resources - Division of Water Qualiry - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i&.b, . Wne5 CERTIFICATION ff2
WELL CONTRACTOR COMPANY NAME F/5,.54'15- j..r/% !%'/I'5 PHONE Oral ht'f- 5'4/4"F
STATE WELL CONSTRUCTION PERMIT/1 ASSOCIATED WQ PERMED/
iir applicablcl (irapplicablel
1. WELL USE (Chock Applicable Box): Residential El MunicipatiPublic 0 Industrial 0 .Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �7
Nearest To )n: dvwi—v. /le Counry Ogaoc +,6 SC
0,k' Cr, F./
(Sncct Numc, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3 OWNER. U, r,`���� &r.5d-c'u4.. brJ
Address //? )f//rr roue 42r4
(Sweet or Roue No.)
iveaue ethIle.- 0C aSS710
City or Town Soe Zip Code
(V )- 4,5-a-9el/q
Area code- Phone number
4. DATE DRILLED C-/iv - 03
5. TOTAL DEPTH: .S kr /
6. DOES WELL REPLACE EXISTING WELL" YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 3-9 FT.
Topogryphic/Land setting
❑Ridge it Slope ❑Valley ❑];.tat
(check appropriate box)
Latitude/longitude of well location
/Jis'O go. Ur ' •rof-L21-271r•
(degreesiminute ' •econds)
Latitude/longitude source: EPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
CJ-/70
/70 - )kr G f<
7 (Use "v"li Abave Top of Casing)
3 TOP OF CASING IS ) FT. Above Land Surface'ra
--
'Top of casing terminated aUor below land surface requires a
variance in 'Accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OFTESTI/O w,AS - %'f -�rrei
l0. WATER ZONES (depth): ?6O, JW C e�
11. DISINFECTION: Type C/o -,:se Amount /f AA5.
[2. CASING: Wall Thickness
Depth Diameter or Weight/Fr Material
From 0 To /70 Fr. L v"v Sfl a-i /✓C-
From To Fr.
From To Ft.
13. GROUT: Depth Mareriat Method
From b To ,(0 Fr. (O,creit /371-fcnr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Fr. in. in.
From To Ft. in. in.
15.SAND/ORAVELPACK
:
Depth Size Ma erial
From To Fr.
From To Ft.
t6. REMARKS:
LOCATION SKETCH IV o c
N r'
Show direction and distance in miles from at least >t0
two State Roads or County Roads. Include thegad 'o
numbers and common road names.
e -.tic.
Lim et UL-✓11 //L
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original ro the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-I REV. 07/2001

299680
WELL CONSTRUCTION RECORD
North Carolina - Depalvnenr of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/�•
\4 ELL CONTRACTOR (INDIVIDUAL) NAME Istria()��i'1 CERTIFICATION N10
Istria() terj., f°-1) L'v1%/ PHONE Pr) Cr.l'3,6a/y5
WELL CONTRACTOR COMPANY N.VYIE
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential E"MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LOCATION:
NeawstTown: bte-tery ile
/kktn7n J/llS
Counry .g^[ntie
(Scree' Numa, Numbers, Cmninuniry, Subdivision. Lot No., Zip Code)
3. OWNER: Cixs .1 tg:dine C0 .s4
Address 7-to ?A Adm//wes) -Dr.
(Street or Route Na)-
RSI�r„yia 7e A8f(os
Cory or Town
State Zip Coda
gag - . a9 - 400 d
Area code- Phone number I
-L DATE DRILLED 5- 2/ - O
5. TOTAL DEPTH: MO 3
6. DOES WELL REPLACE EXISTING WELL? YES` p NO
7. STATIC WATER LEVEL Below Top of Casing: SW FT.
(Use "It" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
•Top or casing terminated a'or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ' METH2D OF TEST A/'y -.i
10. WATER ZONES (depth): I7
11. DISINFECTION: Type C/Or.•n ( Amount /
12. CASING: Wall Thickness
Depth Direcer or Weight/Fr. Mateal
From D To jr-Fr. 1,.4/ SDr?I I ri
From To Fr.
From To Fr.
13. GROUT: Depth Material , Method
From O To 20 Fr. A ni'e i( O�"int
From To Ft.
Mines
I-t. SCREEN: Depth Diameter Slor Size Material
Frain To Fr in. in.
From To Fr, in. in.
l5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
"'Topographic/Land setting
El Ridge ❑Slope ❑Valley ❑F.lar
(check appropriate box)
Latitude/longitude of well locae n
w'3s '/1, 7,r7 tioobz°IJ; /bv
(degrees/m in erns) seconds)
Laritudeilonginide source: GFPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
D
DEPTH
From To
p-s-r
s—r- c/os" -n • /e
O_
Cm
cn
Z_n
N o^
LOCATION SKETCH o
Show direction and distance in miles from at least
ri
qq
two State Roads or County Roads. Include the ro-a arco*h
numbers and common road names. N ��
(1ct# (t1 N /4:11 S
C.
(JA4u.t
6. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y✓,; r- Z 7 - 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original IC the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-1 REV: 07/2001

298679
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N,a(,r.}rral Resources - Division of Water Quality - Groundwater Section
WELL CONTItaCTOR (IND1Y1DUAL) NAME•// (�prior) 6c'kti rG• �•de5 CERTIFICATION #��VC)
ee tcOn5 (4•ei7 Qi: /�i •9f' PHONE Iv<%} 6J7-ft/Llel
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
iir apph.ablcl (ifapplicable)
1. WELL USE (Check Applicable Box): Residential l+1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Leiceiler
P.r f��- Cu, /Se"e
(Sneer Name, Numbers,Community, Subdivision, Ler No., Zip Code)
3. OWNER: a . //141L/BR
County ,Gr "ecti/t
Address g3-o Pi-i e4 Pine I) Riff(S� oya or Route N )
/a.r1'/) (Atsk#/) /V C
Ciy or Town Sine
Area code- Phone number
4. DATE DRILLED S "2.11103
.ZSiS-3
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tat
(check appropriate box)
Latitude/ ongimde of well location
N1r° z, U.' IJofl° 0/1,,A,2'
(degreesiminutey seconds)
Latitude/longitude source: laiGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/ - 30S - /c
5. TOTAL DEPTH: 3°f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q�
7. STATIC WATER LEVEL Below Top of Casing: Q ' FT.
(Use "-PTV Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
-Tap of casing terminated aror below land surface requires a
variance in acaordanye with IiA NCAC 2C A118. d
9. YIELD (gpm): 2 /L METHOD OF TEST/'4O"^f - S
10. WATER ZONES (depth): 10 Y
LOCATION SKETCH
Show direction and distance in miles from at least —0
two State Roads or County Roads. Include the road
I I. DISINFECTION: Type Cie , int Amount / / hi -
12. CASING: Wall Thickness
Depth Diameter or Weight/FL. Ma terial
/ From 0 To -- Ft. w'/N SAP.( ✓C
From To F.
From To Ft.
13. GROUT: Depth Material Method
From D To 20 Fr. amcer-f'- /'c....--qy
From To Ft.
14. SCREEN' Depth Diameter Sior Size Material
From To Fr. in in.
From To Fr. in. in.
13. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Fr.
0
0
C�
c�
N 0 C
tv �o
rn0
r!r
z
numbers and common road namesr9 rnF
74 r c. ' L°'-
(e •C esta(• /✓C.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANp THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11,e1A4 S-Zb--o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
cri
-..1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources ``-//Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6r'4•'1 y ut:ref
WELL CONTRACTOR COMPANY NAME Ff., feed il-see i/•-..//•f;
293678
Groundwater Section
CERTIFICATION IfS/y4•\
PHONE ptkan Cti 9c'y7
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (S Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LOCATION:
Nearest To%q: //2 mile'✓•//e County AfinceY1.4r
g✓p.t v: t✓ YL .
(Svccr Name, Numbers, Community, Subdivision, Lor No., Zip Code)
3. OWNER: -DeN N; s R rc. N Ar
Address *04 If Oy.
(Sneer or Route No.)
1/?.4 Ul./e/ a //e e7e a s/78.7
City or Town Scare Zip Code
fag)- lr9S •.V/3
.uroa code- Phone number
4. DATE DRILLED 4 -3 ` p )
5. TOTAL DEPTH: 4/65-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SfO FT.
(Use "+"if Above Top of Casing)
S. TOP OF CASINO IS / FT. Above Land Surface"
"Top or casing terminated at/or below land surface requires a
varinnce in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): / V METHOD OF TESTA— if C5
10. WATER ZONES (depth): e-//"
I I . DISINFECTION: Type (' )o,. re
12. CASING:
Depth
From 0 To IV
From To
From To
13. GROUT: Depth
From 0 To 10
From To
14. SCREEN: Depth Diameter
Froan To Fr. in,
From To Ft. in.
Amount 147 /Las .
Wall Thickness
Diamerer or Weight/Ft. Material
Fr.
Ft.
Fr.
Material Method
Ft. CONC, eh
Fr.
Slot Size Marerial
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Fr.
16. REMARKS:
Topo�g�raphic/Land setting
❑Ridge CSSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Nat NL, ib e 4/04-z ° fr...if 7-
(degrees/minutes/seconds)
Laritudeilongitude source: L"3CGPS❑Topographic map
(check box)
DRILLING LOG
ForCrtation Description
!� t
DEPTH
From To
rJ-re-
Yr- SIGs
O o
rn
c�
c
LOCATION SKETCH
Show direction and distance in miles from at leas) em
two State Roads or County Roads. Include the rd9 >o
numbers and common road names. rn
o mo
3 ern
m�
c4
O
N
(J• '1
J
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 CONSTRUCTING THE WELL
('-3.o-
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2986,3
North Carolina - Department of Environment and Natural Resources - Divisionivnof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 407,47 k /7"�l zb t CERTIFICATION #
/ WELL CONTRACTOR COMPANY NAME "e CI t. Son ) 21/ 1 r J I J� (.(, PHONE rnd-n '3'L ? �p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ LSERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricul ral 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use it\-,
2. WELL LOCATION:
Nearest Town: act( nerds vine
,BQ rda'4) ri.7/c "°' `l
(Street Name, Numbers, Communist)( Subdivision, Lot No., Zip Code)
3. OWNER: 134rnerLvs , )Je Aire 'DT/
Address ?O./$e[ /2(�
(Street or Route No.)
/3Qr/iirrdsv,%/c /) C
County t.tnee,"ri
ak7a 9
City or Town State Zip Code
((&- 4a&---
?a:ea code- Phone number
4. DATE DRILLED 9-a3-o3
5. TOTAL DEPTH: Q/O '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E9-
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /00 METHOD OF TEST
10. WATER ZONES (depth): 7J40 r 0?/0
11
12. CASING:
DISINFECTION: Type
Depth
From 0 To ?
From To
From To
13. GROUT: Depth
From 0 To .le)
From To
/-/DJ/ Amount ? oz
Ft.
Ft.
Ft.
Wall Thickness
Diameter or Weight/Ft. Material
0 ( / b'rI Sftel
Material
FL nm/Krek
Ft.
14. SCREEN: Depth Diameter
From To Ft, in.
From To Ft. in.
l5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Methpd
,reCI
Slot Size Material
in.
in.
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley IOF-Fat
(check appropriate box)
Latitude/lo
3S/Ve .77 gitude of well location
N-09.E/aG/sw 7
(degrees/minures/seednds)
Latitude/longitude source: 00PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
5einr1 -1 6e. „el
&r,a n.4-e
DEPTH
From To
0 /0
/f /
N pG
LOCATION SKETCH to yto
Show direction and distance in miles from at least° rtp
two State Roads or County Roads. Include the roams ?-
numbers and common road names. r9
G
aids tf i /l e. Hum (
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
t41a/ 12/L— 9-a3- 6j
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298663
WELL CONSTRUCTION RECORD
Noah Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 3/�D
WELL CONTRACTOR (INDIVIDUAL) NAME (print) &'u X �,s• "�nO CERTIFICATION ft /V 0
WELL CONTRACTOR COMPANY NAME ricra•'IS Wtfl D-. J/''y PHONE } i PI -IV '
STATE WELL CONSTRUCTION PERMIT# t/ ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CS- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: {...A
Cei,'//Aram /nee
(Scree( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: f I c.c.een. et,
Address h rrr.$) e/eeS er i'fwU
(Street or Route No.) J
fps tielidw !vC
Cry or Town Stare Zip Code
c1c3k A 35 -00 Vs
Area code- nude number
4. DATE DRILLED 1-' I - 03
5. TOTAL DEPTH: I DS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use "+"if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): ?O 1vIETHOD OF TEST/"•0,•'f -.O;
10. WATER ZONES (depth): %T
II
12. CASING.
DISINFECTION: Type
County ,8,•se."Ael
firh+
Depth
From 0 To Gi Fr.
From To Ft.
From To Ft.
13. GROUT: Depth
From t9 To , D FL
Digmeter
6 /v
From To Fr.
14. SCREEN: Depth Diameter
From To Fr. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fc.
Amount /cZ
Wall Thickness
or Weight/Ft. Ma erial
Nlarerial Method
&mereit ?OW' to i
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope OValley Flat
(check appropriaie box)
Latitude/longitude of well location
NJf° P.Syt' wotz ct% Z/7
(degreevminure conds)
Latitude/longitude source: firtGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
AY
DEPTH
From To
O - 1.6
p o
� v n
LOCATION SKETCH N �m
Show direction and distance in miles from at Mist .7:io
two State Roads or County Roads. Include the -road 'o
numbers and common road names. S N
N
o
bj;/,00J,t%/pe
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
f— f -- ©J

298668
WELL CONSTRUCTION RECORD
North Carolina - Dcpartincnt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) •' �^ k" 11�' ),„5. CERTIFICATION #.TitiO
WELL CONTRACTOR COMPANY NAME lee-, w S°•' J Alt // dt , I/eij PHONE f2,1 4.13 - 1-`/'1 i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a---Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nesest Town: 7";•%✓•01!
County /_6_...,.,/ c
(Street Name,, Numbers, Community, Subdivision, Lot No., Zip Code)
T 3. OWNER: (""Cr4tdrx, ,r`�CNn36h)
Address 40 it/tct/ eaC e,fe Hwy
(Sete( or Route No.)
tieua7/e iVer alto
City or Town State Zip Code
(tiro )- 4-5-6-a6re)
Area code- Phone number
4. DATE DRILLED C_ J5�- 03
5. TOTAL DEPTH: 10 S-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO «
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+"'if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated a°or below land surface requires a
variance in accords99c with ISA NCAC 2C .0118.
9. YIELD (gpm): 10° METHOD OF TESTJ�D•-*.A) - �•5
10. WATER ZONES (depth): ) re'
Amount 7 f6
Topographic/Land setting,.
❑Ridge 11381ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of wet ocation ,
%17t-031. 404'. //-'OY2 Z/. (7O
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0- /02
/D2- Z°s
I I. DISINFECTION: Typef/or '.re
12. CASING:
Depth
From b To /D Z. Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From O To 1° Ft. Cu.,cr/it
From To Fr.
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.
Diarmerer
G hr
Wall Thickness
or Weight/Ft. Material
jZ1pC/.rertan
(J Fa,PtJ,-ew/1 C.
Method
16. REMARKS:
r:
O
t n�
't
C"a
=m
LOCATION SKETCH N
Show direction and distance in miles from at least ?A—
two State Roads or County Roads. Include the rad vo rpn
numbers and common road names. N
•
� U
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION
!lSTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
414
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) te.<'t
WELL CONTRACTOR COMPANY NAME F') w000f I✓LIi
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
f Wr15
298667
CERTIFICATION''It3/�)
PHONE PO
A") s _CLA/5
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential GY 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: 7
Nearest Town: A,- vi %tal-i County/"ra'/t
88No4/v 2d );r✓a•e&
(Street Name, Numbers, Community, Subdivision, L'on``No., Zip Code)
3, OWNER: ANrlr(SON k-A•mati IAM% S
Address h10 Caret', Kef.
(Street or Route No.)
a51 e ch 2/e /✓ C
a88O/a
Ciry or Town State Zip Code
00ii)- fls-- VGG3
Area code- Phone number
4. DATE DRILLED iV"/u'0i
5 TOTAL DEPTH: SG5
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO e
7. STATIC WATER LEVEL Below Top of Casing: NV FT.
` (Use "+"if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ( METHOD OF TEST I/>.-, - /Z/
10. WATER ZONES (depth): YSo' u75'
I . DISINFECTION: Type Cce.Ae
12. CASING:
Depth Diameter
From t' To re" Ft. 6 %t./
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 _ To 20 FL [v;Ac:e /4 /0---,5
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Fr. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount (Q 02
Wall Thickness
or Weight/Ft. Material
f't'L
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge E3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r.) 3y °iI.2av'tforz°�3. g�7
(degrees/minutes/seconds)
Latitude/longitude source: Led'FiPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
S -
C-..,,'le
0
LOCATION SKETCH N
Show direction and distance in miles from at leen
two State Roads or County Roads. Include the Ad
numbers and common road names. N
cJI
gbRd
F .rule,.- N. C •
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1/ S- I4-Oct
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299666
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section M[
'/0
Y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ( "F^ X, •Li �CERTIFICATION�#3/
WELL CONTRACTOR COM
PANY NAME ' I-4WS I1.L// v''r/J., ,r
PHONE l�tY1 eft "5V4'Y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential EI Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 WELL LOCATI
Nearest Town: iI✓V1Cr✓ County co *i of
(vac., ln, %A'}/0.c 7i4 Aisi/vs',dal
(Sued( Name, NumherrCammunity, Subdivision, Lot No., Zip Code)
3. OWNER: l4u)tJ Dar tt
Address /9 £b s.4.0 4NL
(Street or Route No.)
«ti,•e.,ti ,rc
2873a
Ciry or Town State Zip Code
(Oa)- (147— 4a98
Area code- Phone number
4. DATE DRILLED ( • ) Z - 0 3
5. TOTAL DEPTH: S' O S
6. DOES WELL REPLACE EXISTING WELL? YES Ig/NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated aUor below land surface requires a
variance in accordan a with 15A NCAC 2C .0118.
9. YIELD (gpm): G METHOD OF TEST /0•-0 - it5
10. WATER ZONES (depth): 200
11. DISINFECTION: Type Ch. int
12. CASING:
Depth/ Diameter
From 0 To VO Ft. %
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
Amount JP
Wall Thickness
or Weight/Ft. Material
/YG
Material
�0•, tre /G
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Frorn To Ft.
Method
Slot Size Material
in.
in.
Material
Topogrr hic/Land setting
❑Ridge ClSlope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well J,ocation
N)s ° 3/. f-or'Wof 2w.rr'
(degrees/minute econds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0- 4o Rif
60 _ s os
0
LOCATION SKETCH
Show direction and distance in miles from at least "
two State Roads or County Roads. Include the roatj
numbers and common road names.
Tay/o/1 RA-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TR
1-4
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.[phone], within 30 days. GW-1 REV. 07/2001
2

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL.) NAME(print) se!. eo ,d el
WELL CONTRACTOR COMPANY NAME o %rr
298661
Groundwater Section
CERTIFICATION # "NO
PHONE I1t211 et,- TV` 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM1T#
(if applicable) (if applicable)
l WELL USE (Check Applicable Box): Residential by Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest
`Town:
AA ree.1 / > �1Co_unty
Atte 44,reJ /ra t ede2
(Street Name, Numbers. Community, Subdivision, Lor No., Zip Code)
3. OWNER: e,110(51ic_ Strrdkle•
Address fool 4/ea miter' Xel
(Scree( or Route No.)
Ned, Ne/4r _A'( --
City or Town State Zip Code
9ir1A)- !a-8 3— cx.r
.Area code- Phone number
4. DATE DRILLED u- Z O)
5. TOTAL DEPTH: 34 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO H
7. STATIC WATER LEVEL Below Top of Casing: `v FT.
(Use "r"'if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top or casing germinated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): G M METHOD OF TEST/41 - /et
10. WATER ZONES (depth): /YS, 2 7S 3 '
WO /
11. DISINFECTION: Type doe /A,
12. CASING:
Depth Diameter
From 0 To �i FL 4 Yw
From To Fr.
From To Ft.
Amount Vitt. .
Wall Thickness
or Weight/Ft. Material
PdC
13. GROUT: Deprh Nlarerial
From 0 Toao F[. (49ncftfc
From To Fr.
Method
poAt
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Deprh Size Material
From To Fr.
From To - Ft.
Topographic/Land setting
'Ridge ❑Slope ❑Valley ,GFlat
(check appropriate box)
Latitude/longitude of well location ' fi3f ,�Y.,S"YO stew' 7N
(degreesiminuteikeconds)
Latirude/longitude source: L(GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 fr nir
r 0..z
LOCATION SKETCH ^rn
Show direction and distance in miles from at ast Sr'
two State Roads or County Roads. Include tiler -lad a
numbers and common road names..--
"L6 o rcl
N n
Fcr / r �•
/ G*tC CS i C11
-I 0
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
714-2441 % ,"fh 05
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to he 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

Zip Code
4/- 777
Area codc- Phone number' /
4. DATE DRILLED 'Y -24- 02
5. TOTAL DEPTH: ,dos
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ES/
7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAFIE (print) fir '41 K.utd.,(5 CERTIFICATION N4J1VO
t3. I4.5 Udell eat PHONE 4.0k) li ft- nevi
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(i r applicable)
I. WELL USE (Check Applicable Box): Residential 13' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use _..
2. WELL LOCATION: Topographic/Land setting
Nearest Town: C.4+.11t' County 47,4ti001th Midge ❑Slope 0Valley ❑Flat
Dir ,51iini Dd. (check appropriate box)
(Sued Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of hell location
J.
/� N35'2t.23G WOS2 W.Els"
yiI U. !r(� �''rl��r�K/V�/`$7�N1 Flame(degreeslminute econds)
O Bex ¥f D Latitude/longitude source: GPS❑Topographic map
(Street or Route No.) (check box)
rieiChrn N c a b 73 a
City or Town State
3. O\VNER:
Address
STATIC WATER LEVEL Below Top of Casing: VO FT.
(Use "+"'if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
-Top or casing terminated actor below land surface requires a
variance in accordance with I5A NCAC 2C .0118. D
9. YIELD (gpm): NjETHOD OF TESTS °✓14f — Meg
10. WATER ZONES (depth): 751
298660
DEPTH DRILLING LOG
From To Formation Description
0 • 10.3 Drt
C3-SOS k
11. DISINFECTION: Type Ue2:.ar s. Amount ,Taz. .
12. CASING: Walt Thickness
Depth Diameter or WeighUFt. Material
From 0 To 43 Fr. 61/4 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 61 To 21O Ft eon P54 red
From To Ft.
I4. SCREEN• Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
P
^rri
n
LOCATION SKETCHCD yr�
Show direction and distance in miles from at le� yr^
two State Roads or CountyRoads. Include the Pond ?tp
numbers and common road names. �.rn
M-A
7r• Spaiw.cl
•6 Jffts.g1S/�JJ
Ca-ncJie-g fie'
get
rJl
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TP THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001
O

279296
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources - Diivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) CERTIFICATION"'
WELL CONTRACTOR COMPANY NAME_
RF.UBEN CALDWELL DRILLING, INC. ruontri8 ?54-3581
STATE WELL CONSTRUCTION FERMITJ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use &'& W4erk--•
2. WELL LOCATION:t
Nearest Town:4-4 Aces OA Q y - County ---42
I0117)A) Pub
(Street Nurse, Number, Ceinmuniry, Subdivision, lad No.. Zip Code)
3. OWNER -IL P-Lewea 'LOW 3
Address 14 I(.9 t..4 Rat b
A-54I (Sve<(a Rowe No.)
e0t e 2C0tre.
City or Town State Zip Code
(1.4t} 111 -
Arca coda- Phone number
4. DATE DRILLED 1 2 to-35. TOTAL DEPTH: foe
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M-
7. STATIC WATER LEVEL Below Top of Casing: it
(the "r' if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface•
*Top of cuing terminated aIor below lad surface teyulras •
variance In accordance whit 13A NCAC IC .0111. ^ ( -
9. YIELD (gpm): "t D METHOD OF TEST K
10. WATER ZONES (depth): (Qt7 "" l m Crr4rt_
11. DISINFECTION: Type
12. CASING:
Depth Di or cl at. M nal numbers and common road names.
Froth f " . 3 To 66 FL t o2� �
From To Ft.
From To Ft.
13. GROAT: Depth
�— �f teri `n t 1
From To o Ft. /'may
From To Ft.
54 ISC�t
o t
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ElPlat
(check Appropriate box)
Latitude/longitude of well location
r(35°- 31,
(devannninui&sccooee)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DRILLRJG LOG
Formation Description
DEPTH
From o
0- O
Fw-4
w, Gam
1
LOCATION SKETCH
t: 3s - f-� Sh d' l' nd distance in miles fronita)le
ow tree on a
Wall Thickness two State Roads or County Roads. Includ
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in. = in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WfT)I 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL OWNER ; ;,
SIGNATU F PERSON CONSTRUCTING THE WELL ATE ; ;-
-1
in
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC I
27699-1636 Phone No. [phone], within 30 drys. GW-1 REV. 07/2001
c rope
=2"
orp
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CO
0
2
3

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
/N,p/Iu¢, al Resources Division of Water Quality - Groundwater Section
�7
WELL. CONTRACTOR (INDIVIDUAL) NAM (print) OW
(� D //X � `C, ,D9/y� /. L CERTIFICATION 1��OQ / 7p-1
WELL CONTRACTOR COMPANY NAME ,t7�%LG'.GZe-tLdPo L4i4 1!{ PHONE a en 49 -eTirD
STATE WELL CONSTRUCTION PERMrru 49' .4 AOC1ATED WQ PERMITS!
(if applicable) (if applicable)
/Y/Ai
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑�.__—_
Monitoring ❑ Recovery* Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATITown:/ OBI:
N Sons�i/�4,.." ��� 'l g%�
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER:
Address
jetitgVr
City or Town State
(_F
({Nro) e2% l/b
Zip Code
Area rode- Phone number
4. DATE DRILLED S1/yfr/.S/D 3
0,4
EXISTING WELL
Below Top o
FT.
r below land
A NCAC 2C.01
V
Diameter
Ft Q Ft V
5. TOTAL DEPTH: '%
6. DOES WELL REPLACE ? YES 0 NO 12
7. STATIC WATER LEVEL f Casing:[ Z/o. S FT.
if Above Top of Casing)
8. TOP OF CASING IS 2 Above Land Surface'
'Top of casing terminated atlo surface requires a
variance In accordance with 15 18.
9. YIELD (gpm): / FTESI1 aco
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount /k
12. CASING: Wall Thickness
FroTD o e2 17 or Weight/FL M�Jerial
From To / /}�
From To Ft
13. GROUT: Depth
From_0To haYi Ft
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
16. REMARKS:
a de.
Topographic/Land setting
['Ridge ❑Slope Malley ❑Floc
(check appropriate boa)
Latitude/longitude of well location ".
(de& minu28/seconds)
Latitude/longitude sotace:❑GPS❑Topographic map
(check box)
DEPTH DR LLTING_IOG
From To Formation Desc
a.r
n
rTt
V
LOCATION SKETCH
279495
Show direction and distance in miles froffit le
two State Roads or County Roads. Inclu4thhe
numbers and common ro , names. 4--
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4//x//5J/t 3
SIGNATURE OF PERSON CONSTRUCTING THE WFI 1 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 278954
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section n0 9
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATIONS
WELL CONTRACTOR COMPANY NAME n Rnuman Wel 1 lira 111 ng, Tnr. PHONE 8 fi%'R 752-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED AYQ D) applicable)
PERMITS
(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: Buncombe
Nearest Town: Weaverville County
2 put end nonce Drive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Bruce Budnev
Address 7 Ruffed Grouse Drive
(Street or Route No.)
Weaverville NC 28787
City or Town State Zip Code
( )-
Area code Phone number / 21 0 3
4. DATE DRILLED
5. TOTAL DEPTH: 1 85
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Di
7. STATIC WATER LEVEL Below Top of Casing: 20 e FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of casing terminated at/or below land surface require, a
variance In accordance with ISA NCAC 2C .0118,
9. YIELD (gpm): 11 METHOD OF TEST -rotary
10. WATER ZONES (depth): 60'
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 Tom Ft.b1 /8 Sr'h 80 PVC`
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
To
To
From
From
Material Method
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
air
Q'—'Z f>t
— VL
ri
Show direction and distance in miles from= leastoFn
two State Roads or County Roads. include e roag
numbers and common road names
LOCATION SKETCH
Cal z
T
m
w
ry
ll
I D0 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
�'-�y �. J �0,— �� 11 1 D3'
p SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceen1tteerl RHVgh, C01
27699-1636 Phone No. [phone], within 30 days.
16. REMARKS:

WELL CONSTRUCTION RECORD
278953
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prhst) Jeremy H. Bowman ' CERTIFICATION 2809
WELL CONTRACTOR COMPANY NAME D RnWman Wel 1 fri 11 ing, Tnr PHONE $ R28 252-7779
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I$ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Weavervill e County Buncombe
Anna Glenn Lane Lot 1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Paul Roberts
Address 570 Forest Street
(Street or Route No.)
Mars Hill NC 28754
City or Town State Zip Code
)-
Arca code Phone number
4. DATE DRILLED 7/18/03
5. TOTAL DEPTH: 200'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 60 pp,
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top or casing terminated aUor below land surface requires a
variance In accordance with ISA NCAC IC .011g. aA ;CI'S"
9. YIELD(gpm): 12 METHOD OFTEIST_rotary air Ca c
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
• (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
n
10 WATER ZONES (deth): 140 r 160 r 180'
p
11. DISINFECTION: Type
12. CASING:
tablet Amount 6
Depth
From 0 To 45
From To
From To
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
Ft.61 /8 Srh 8() Pvr
Ft.
Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WC
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JU. Y% Y — -7ii4 /e3
eta#1 - SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
LOCATION SKETCH "` -
Show direction and distance in miles fror4 leaop
two State Roads or County Roads. Inductee ro>acR
numbers and common road names.
Material Method
Ftconcrete gravitv flow
IV
c)

WELL CONSTRUCTION RECORD 278958
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION N2809
WELL CONTRACTOR COMPANY NAME D
STATE WELL CONSTRUCTION PERMIT%
(if applicable)
Rnwman
Well nrilling Tnr PHONE %fi78 757-7779
ASSOCIATED WQ PERMIT%
(if applicable)
I. WELL USE (Check Applicable Box): Residential 1$ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Candler County Buncombe
71 Fincher Lane
3. OWNER:
Address 71 Fincher Lane
(Street or Route No.)
Candler NC 28715
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Karen Wilde
City or Town State
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
( )-
Area code- Phone number
4. DATE DRILLED 7/29/0'3
5. TOTAL DEPTH: 480'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Cuing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9 YIELD(gpm): 100+ METHOD OFTEST:- rotary air
10. WATER ZONES (depth): 480'
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30 FL51 /8 Srh RO PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity f1
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.
0
O 0
ITS
ITS
om
-an
zm
LOCATION SKETCH — nc
Show direction and distance in miles from*t le i-.
two State Roads or County Roads. IncluRgthe ro s
numbers and common road names. IV m
ow
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
7 .4.44, _ 7/XT/s3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 278 955
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman ' CERTIFICATION S 2809
WELL CONTRACTOR COMPANY NAME fl Rnwman Wpll llrilling, Tnr PHONE I 1:178 9S7-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CZ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Lc.ic aster
County Rnnrnmhe
3 Peil valley flrive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Phylis Wilson
4
5
6
7
Address 3 Reil Valley Drive
(Street or Route No.)
Leicester NC 28748
City or Town State Zip Code
( )-
Area code- Phone number
DATE DRILLED 7/23/03
TOTAL DEPTH: 500'
DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
STATIC WATER LEVEL Below Top of Casing: 1 00 FT.
(Use "+" if Above Top of Cuing)
8 TOP OF CASING IS 1 ' 4 FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .01!8.
9. YIELD(gpm): 9 METHODOFTEST:.rotary air
10. WATER ZONES (depth):400' , 440', 500'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1 I. DISINFECTION: Type tablet Amount 6
12. CHASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From()_ To 110 Ft.b1 /8 Sch_a.0 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16.REMARKS:
C
O p
rrnn o
rrn
zrn
LOCATION SKETCH — S-m
yo
Show direction and distance in miles frotitat legt-.
two State Roads or County Roads. IncludThe r33W.
zz
numbers and common road names. N ma
=e
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
1J. Y'azr:
C SIGNATURE OF PERSON CONSTRUCTING THE WELL
7%r3%s3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) Richard McCrary CERTIFICATION M 2010
WELL CONTRACTOR COMPANY NAME Barker Con ruction, InCJBarker Well & Pump PHONE TTtte 1037 7463
STATE WELL CONSTRUCTION PERMrr'k 1871 ASSOCIATED WQ PER11HTg 1 ��
(if applicable) (if applicable) '11-`
281173
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial 0 Agriculfu 4i
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Asheville
Gravely Branch Road
County Buncombe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Teal Leming
Address 193 McKinney Point Road
(Street or Route No.)
Etowah - NC " 28729
City or Town State Zip Code
( 828 )_ 329-5705
Area code- Phone number
4. DATE DRILLED October 30, 2003
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 5 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Lanc j ng
[Ridge ❑Slope ❑V*149 HiFlat
(check appropriate bo
Latitude/longitude of wilt.' cation
J' r
(degrees/minutes/seconds) ��j ?
Latitude/longitude source:❑GPS❑ToPo`}nc.map
(clecc box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 170 Et. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
c
O
W
t�
rn
t-0
Cr) -
c
—o
00
LOCATION SKETCH
Show direction and distance in miles from leas€G
two State Roads or County Roads. Include the roarl:
numbers and common road names.
...iutrpjXPl-C'&ffile_dN/tee-
etui
`4Qt1. So afrp ttSvinu,r y- 07 or;I v
dam_ o c C)Qxe. a team.
d
6440q el-)
Slot Size Material ,�" x�,
in- cuaLt. �(nt Plv 0/t--IV-•
in l a Leiri«t_ Aft4 p .
Method
Poured
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 IIAS,PEEN PROVIDED TO THE WELL OWNER
SIGN /tTIRE OF PERSON CONSTRUCTINWELL 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 Envin nment and Natural Resourcess- Division If Water Quality - Grour dwater Section
e-
WELL CONTRACTOR (INDIVIDUAL) NA 4E (print) Derte:K �"`uQ'e 1)a"yaCERTI9CATION'�=�ct_3�
WELL CONTRACTOR COMPANY NAME Q_ a SaJt.e•CO d SC) e�B. Pane PHONE I on,
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
281109
l if applicable) - (ifa i le) e���
1. WELL USE (Check Applicable Bo :): Residential 1 Municipal/Public ❑ Industrial ❑❑ Agricul
Monitoring ❑ Recovery 0 Hez: Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:4 eo_t.t \le. County (2).,,wc+r+:bc
F/r+T GR
(Street Name. Numbers, Community. Subdi ision. Lot No_. hp Code)
3. OWNER:
Address
4
5. TOTAL DEPTH: Lc 5
6. DOES WELL REPLACE EXISTII• G WELL? YES 0 NO El
7. STATIC WATER LEVEL Below 7 op of Casing: Era FT.
(U: "+" if Above Top of Casing)
8. TOP OF CASING IS t 'T. Above Land Surface*
*Top of casing terminated at/or below Ia' d surface requires a
variance in accordance with 15A NCAC C.0118.
9. YIELD (gpm): 2 METH( D OF TEST &.
10. WATER ZONES (depth): d
5}eve. a
an, r 2cr. t v tee
at'7 54
Zip Code
(Street or Route No.)
City or Town State
Area code- Phone number
DATE DRILLED ‘"-"• it3
11. DISINFECTION: Type I-."ts _ _ Amount Y'
12. CASING: Wall Thickness
Depth Diar eter or WeightiFt. Material
From k \ To C'l Z Ft. -gi e is ic;a:�
From To Ft.
From To Ft_
I3. GROUT: Depth K aterial Method
l: Ft.'.'...t n n er w..�P
From �. 7 o
From _ To Ft.
14. SCREEN: Depth Diane' :r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz : Material
From To Ft.
From To Ft.
Topographic/Land
Midge [Slops ❑Va
(check appropriate t
Latitude/longitude of w
:sal r=.-iti_I
�i_
aet}ilhg
DFlat
l Jpination
qTi4 cif
s ographis n
1330
RILLIN
(degrees/minutes/see
Latitude. longitude source:DGP
(check
DEPTH
From To
\ q3
q3 low S
F
LOCATION SKET'H
Show di ection and distance in re Iles from at least
two Stat : Roads or County Road. Inciude the : oa
numbers and common read name;.
0
0
0
rn
0
0
CD
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WE _L WAS CONSTRUCTED IN ACCORDAN ;E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND Tl AT A COPY OF THIS RECORD HAS BEE PROVIDED TO THE W1 :LL OWNER
SIGNAT IRE O ERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, :635 Mail Service Center RREVgh, NC
27699-1636 Phone No. [phone], wi. hin 30 days.

281105
WI at CONSTRUCTION RECORD
North Carolina
Department f Elwinnment and Natural Resources - Division )f Water Quality - Grout dwater Section
CERTI rICATION #_'' °° :3&C
PHONE '-.CZ;'_
- o
n
a.c.c9\ tu. yc.
WELL CONTRACTOR (INDIVIUUAL)NA 1E (print) Oecr;evt
C>>sde jaJJ�QCo a S&nlaVVel, p.sr
,V ELL CONTRACTOR COMPANY NAME
ASSOCIATED NO PERMIT#
SLATE WELL CONScable) ON PERMIT: (ifa I.cable
(if applicable_)
1. WELL USE (Check Applicable Bo t): Residential B—Municipal/Public O Industrial ❑ Agric
Monitoring O Recovery O Hea Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: 4lCo-\t 4\a County 4-,.-3Co*`��0�
(Street Name, Numbers, Community. Subdi ision, Lot No., Zip Code)
3. OWNER:
Address
4a. eineti Y\a;.Javr_\
(Street or Route Nvr4
City or Town State
Area code- Phone number
4. DATE DRILLED 10-E- c'
5.-TOTAL DEPTH: 3O5
6. DOES WELL REPLACE EXISTIT
7. STATIC WATER LEVEL Below 7
(Us
8 TOP OF CASING IS
*Top of casing terminated at/or below la;
variance in accordance with 15A NCAC
9. YIELD (gpm): METH(
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
7
Zip Codc
Topograph:.c/Lan
[Midge E+6lop, ❑V
(check appropriate
Latitude/longitude of
(degrees/minutes/sec
Latitude, longitude sourcc:OGP
(check
DEPTH_
From To
tk
73
G WELL? YES 0 NO
op of Casing: vo FT.
^+" if Above Top of Casing)
T. Above Land Surface*
d surface requires a
C .0118.
DOFTEST
d
Depth,, Dian eter
From r) To 2 Ft. �' �c
From To Ft.
From To Ft.
13. GROUT: Depth
From O To 20 Ft.
K rterial
Amount `d
Wall Thickness
or Weight/Et. Material
Method
From To Ft.
14. SCREEN: Depth Dia=:r
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz:
From To Ft._
From To Ft.
Slot Size Material
in.
in.
Material
Forr Cation Descrir tic
O`.1- a- ac.,
acS 6r>d,. re_
LOCATION SKET )H
Show di -cation and distance in rr :les from at least
two Stat; Roads or Cour.ty Road:. Include the vela
numbers and common read name ;.
vz
rt
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE".L WAS CONSTRUCTED IN ACCORDAN ICE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TEAT A COPY OF THIS RECORD HAS BEET 1 PROVIDED TC THE WI-.LL OWNER
(o- xB C3
S!G
SIGNk'fI IRE OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert Raleigh,
C
27699-1636 Phone No. [phone], wit hin 30 days.

WELL CONSTRUCTION RE CORD
North Carolina - Department of Envirc nment and Natural Resources - Division )f Water Quality - Grourdwater Section
WELL CONTRACTOR (INDIVIDUAL) NA 4E (print) Dee -CM "Au6(-9a ,t)a,N - CERTIFICATION #Zt'31•0
\Srir-1*1QCD b �6:�tat' d Q�n PHONE a S- ;c LT_
WELL CONTRACTOR COMPANY NAME arc O Q
ASSOCIATED.WQ PERMIT#
STATE WELL CONSTRUCTION PERMITr linsus(ifmmonnam (if appl'cable) ' 7t�
applicable) �1m�
1 ❑
281106
1. WELL USE (Check Applicable Bo ): Residential CST Municipal/Public 0 Industrial ❑ Agricul'ur
Monitoring 0 Recovery ❑ Heel Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:vv^ "r� � --County 12).(.0.3<Tnt"vbet
�)C NC ).). \ t2x�—
(Street Name. Numbers, Community. Subdi ision, Lot No_. Zip Code)
3. OWNER: Sar,�e` N>.s-a.,c
Address es 4-- \ ^ (Street or Route
City or Town State Zip Code
Area code- Phone number
DATE DRILLED to aH-c'S
4
5.'TOTAL DEPTH: aP�
6. DOES WELL REPLACE EXISTID G WELL? YES 0 NO M
7. STATIC WATER LEVEL Below] op of Casing: ___FT.
(Us ; "4" if Above Top of Casing)
8. TOP OF CASING IS t i T . Above Land Surface*
*Top of casing terminated atlor below la; d surface requires a
variance in accordance with ISA NCAC C .0118.
9. YIELD (gpm): METH( D OF TESTdo_—
10. WATER ZONES (depth):
Topographic/Land se
[Midge 1261op: ❑Va"le
(check appropriate tax)
Latitude/longitude of aaa 11
(degrees/minutes/sea id
Latitude. longitude source:❑GPS 3
(check 1 o
DE'TH E.R
From To Forr ra
74 may^ L�.tda•
I I. DISINFECTION: Type
12. CASING:
From_* 1
From
From
13. GROUT:
From 0
From To Ft._.
14. SCREEN: Depth Diame, tr
From To Ft._ in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz
From To Ft._
From To Ft._ —'
Depth
To 1v
To
To
Depth
To 20
?,
(\
Dian eter
Ft b �v--
Ft.
Ft._
N. sterial
Ft. (ne^}
_ Amount _1�--
Wall Thickness
or Weight'Ft. Material
11.
Method
�vcaCe�
Slot Size - Material
in.
in.
Material
LOCATION SKET11H
Show di -ection and distance in rr':les from at least
two Stat ; Roads or Cour ty Road.. Inelude the roe
number: and common read name;.
O ES
co
O n_,
ern-)
O - -r
71,
r=
t,n .72
U)
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE'. L WAS CONSTRUCTED IN ACCORDAN:E WITH I5A NCAC 2C, ;TELL
CONSTRUCTION STANDARDS, AND TE AT A COPY OF THIS RECORD HAS BEEI1 PROVIDED TOT H� 5 V 3 OWNER
_= G
SIGNA'it! IRE OF PERSON CONSTRUCTING THE V ELL DATE
ei
Submit the original to the Division of Nater Quality, Groundwater Section, 1636 Mail Service Ceentteer; �V gh, C01
27699-1636 Phone No. [phone], wit hin 30 days.

281103
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirenment and Natural Resources - DivisQion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DQCCSC.1t ?.O,rJt \A. ,.Q ct„ya CA CERTIFICATION #-Zt.(Sto
\VELL CONTRACTOR COMPANY NAME
eNike- Seatleseca ' 5Onuti.a Pan c PHONE # (t (moS cz,_
STATE WELL CONSTRUCTION PERMIT:- ASSOCIATED WQ PERMIT#
(if applicable) - (ifa 1 ltable
WELL USE (Check Applicable Bo:): Residential E nicipal/Public Industrial 0 Agricul ur [`,[]r - r
MuEl .- L
Monitoring 0 Recovery 0 Hea : Pump Water Injection 0 Other 0 If Other, List Use
1.1-o
2. WELL LOCATION:
Nearest Town: 1/Sen lak.:c.'\��'
aerey•t Creec
(Street Name. Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: ( �� 'f%n�e=3u.\d
tto^ tee
Address ?0 emu" ai31:1.
(Street or Route No.)
02 CVNIrtcv:l\C tVC
City or Town State Zip Code
(P tP')- (058-)64(c
Area code- Phone number
4. DATE DRILLED 10• aj- 03
5. -TOTAL DEPTH: 1SS
County e
Topo�g��r�a�ph:,c/Land se
[]Ridge GNSlope ❑Va le:
(check appropriate t )x)
Latitude/longitude of well
:Ern
(degrees/minutes/secndpi..-
Latitude, longitude source:❑GPS 7 opV, ra hie n nn
(check lox
DE?TH DR LING
From To Formation escrlfttc
-ii
30,
pvec
a9 I9.5 Gca�:l2
6. DOES WELL REPLACE EXISTII' G WELL? YES 0 NO I
7. STATIC WATER LEVEL Below ] op of Casing: d tO FT.
(Ur ; "+" if Above Top of Casing)
8. TOP OF CASING IS 1 1T. Above Land Surface*
•Top of casing terminated at/or below lai d surface requires a
variance in accordance with 15A NCAC C .0118.
9. YIELD (gpm): to METH< D OF TEST R
10. WATER ZONES (depth):
11. DISINFECTION: Type r,WS
12. CASING:
Depth
From 4-1 To Z9 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From J To DC Ft.
From To Ft.
Diar eter
Amount B
Wall Thickness
or Weight/Ft. Material
K aterial Method
Cement Pouced
14. SCREEN: Dcpth Dime' er
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz, Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
LOCATION SKETCH
Show di -ection and distance in miles from at least
two Stat, Roads or County Roads . Include the roa i
number: and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE..L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIAT A COPY OF THIS RECORD HAS BEEI I PROVIDED TO THE WILL OWNER
10.30-03
144111 -8 „tS
SIGNATI IRE OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Vater Quality, Groundwater Section, 1636 Mail Service Ceenter' RREVgh, NC
27699-1636 Phone No. [phone], wh hin 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirc nment and Natural Resources - Division of Water Quality
b
WELL CONTRACTOR (INDIVIDUAL) NAME (print) eeC'CM IA 9e Q$�",Q pa
WELL CONTRACTOR COMPANY NAME C\4& SavaIVCa c9 'SC.�tat'% pKee
STATE WELT. CONSTRUCTION PERMIT,' O ASSOCIATED WQ PERDIIT#
281099
- Groundwater Section
CERTIFICATION # 'It_ -t_tLc
PHONE # (era cocas- +0Zt
(if applicable) (ifa 1 cableoommime
1. WELL USE (Check Applicable Bo c): Residential d Municipal/Public ❑ Industrial ❑ AgricuLurallfl 1Ii 1 rj=i7
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
i
2. WELL LOCATION:
Nearest Town: ea..a\¢c County Q.+-4,cor.be
3 04`c Street aer1tS
(Street Name. Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: W¢ \ Warce-es
Address 3 Ca.' btceek
(Street or Route No.)
ea d\ec fie 28'145
City or Town State Zip Code
.5 b5
Area code- Phone number
4. DATE DRILLED It- tti-o.;
5. -TOTAL DEPTH: StaS
6. DOES WELL REPLACE EXISTIE
7. STATIC WATER LEVEL Below 1
(U:
8. TOP OF CASING IS 1
*Top of casing terminated at/or below lap
variance in accordance with 15A NCAC '
9. YIELD (gpm): 1 METH<
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
G WELL? YES 0 NO I '
op of Casing: ioV FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .011S.
D OF TEST R•c
Topographic/Land settlim&
Midge 121Slope DVa'leyl Qlat
(check appropriate t ix)
Latitude/longitude of wtII Ikcatign
(degrees/minutes/sect n
Latitude, longitude source:DGPS]'opographiC---
(check t-ox `,_
DE'TH DRILL
From To Forrlation Descriptic
t_ fog
Ovec
(on 514s innf%. to
Q''5
Depth
From t% To tag
From To
From To
13. GROUT: Depth
From 0 To 20 Ft.
Dian eter
Ft. lacy
Ft.
Ft.
From To Ft.
M iterial
Amount (n
Wall Thickness
or Weight/Ft. Material
scat 1•:c
14. SCREEN: Depth Dimne::r
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
�r�v.ced
Slot Size Material
in.
in.
Siz Material
16. REMARKS:
LOCATION SKETCH
Show di-ection and distance in miles from at least
two Stat t Roads or County Road:. Include the toe
numbers and common read name[.
0
r�
rn
c-)
O
•
i
r
J
r
Etc
re-
E .
-rn
cn I:
rt
0
G
I DO HEREBY CERTIFY THAT THIS WE '•L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rr' 1 -
/7 R-f7SSII'GNATI IRE PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of -Vater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV.07/2001

DeTo pth
0
To
Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
282870
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tdantnl Resources_- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior)
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PBONEY8 )?54-3581
STATE WELL CONSTRUCTION PERMITI
(if applicable)
CERTIFICATION / L 71 1
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use :T_.C'%€€e
2. WELL LOCATION: n
Nearest To/wJ ce-C% t ., County /12tr.-taro-t
Shen Name, Numbers, Community, Subdivision, In No., Zip Code)
3. OWNER:r/{fi&Z ' 1/47a,-722-.;e )
Address 9.5 /1/:; :d/�f't,,//id R,� ietaig
cl �l r21 -) 7.�
City or Town Slate Zip Code
his- �ss�
Area code- Phone Dumber,
4. DATE DRILLED /&/ h/D;3
5. TOTAL DEPTH: 6 S o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Be
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use 'r' if Above Top of Casing)
8. TOP OF CASING IS // FT. Above Land Surface•
•Top of cuing termtnted aVor below Ind.edge. requires a
varlanea 1a accordsaca with ISA NCAC 3C.011a.
9. YIELD (gpm): METHOD OF TEST te t t, it
10. WATER ZONES (depth): 40 • 1 G f
11. DISINFECTION: Type (�Tt{ °Io Amount
12. CASING: Wall 'Thickness
Depth Diameter or Weight/Ft. Material
From * / To he2 Ft of f /*j'rr j% z /
From To Ft.
From______ To Ft.
13. GROUT:
From a
Ft.
Material Method
C,e/ne , QoOtt..e0
From Ft.
14. SCREEN: Diameter
Ft. in.
Ft. in.
Size
From Ft.
Slot Size , Material
in.
in.
Material
Topographic/Land setting �
❑Ridge ❑Slope [Walley LAiaat
(cried sp;eoprtu- Mx)
Latitude/longitude of well location
(degraa/m imu&secood0
Latitude/longitude source:❑GPS❑Topographic map
(check box)
emIii DRILLING LOG
Frgm �' ` � Forrna_tjyn D a e_\
11 J V rri�lS i t i
S4 d '_ 65o
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From Ft.
16. REMARKS: US eLl
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 CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

282863
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -^ Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . rJ/ Noce CLRPI TICATION• 271(
WELL CONTRACTOR COMPANY NAMe_REUBEN CALDWELL DRILLING, INC. PHONt4?j8 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) {if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic 0 Industrial 0 Agricultural O-
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use Y'
2. WELL LOCATION:
Nearest Town: unry�t
(Strat�Name Nu, Cornmuniry, Subdivision, No., Zip Code)
3. OWNER: Bit-4Ue7B7 1-cf/ / 6 6 CjpknlS
Address 331 G At(t'1ttrW -AC>
AsUeVI(kE o 4,)Rouc.. .)
Lag a 3
City w Town State Zip Code
73 7_/
Ara code- Phone number
4. DATE DRILLED /D//510 3
5. TOTAL DEPTH: fit
6. DOES WELL REPLACE EXISTING WELL? YES NO Eil
7. STATIC WATER LEVEL Below Top of Casing: OFT.
(Use "+' if Above Top of Cuing)
8. TOP OF CASING IS I FT. Above Land Surface•
'Top of cuing terminated at/or below land surface requiem a
variance In accordance wltb ISA NCAC IC.011/.
9. YIELD (gpm): % V METHOD QF TEST R C - 111 i1'
10. WATER ZONES (depth): A 3 0 / ' 3 �/3- GP,fl
11. DISINFECTION: Type 4 rto 7
12. CASING:
t / Depth Diune(ef
From To S'A Ft. G
From To Ft.
From To Fi.
13. GROUT: Depth
From A To 2-0 Ft.
Muerial
Amount
Wall Thickness
or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
•
Slot Siu . Material
in.
in.
Depth Sire Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ^✓;}Flat
(shack appropriate box)
Latitude/longitude of well location
(depeealroimi )
Latitude/longitude source: S❑Topographic map
(check box)
DRILLING LOG
Formation De criptio
DEPTH
From To
t9 — r®
bo- a30' G(2# 1 1-7-6-
3 o ' ,3 GPM
rci 1Rj ki Chrt 1'j'15+
LOCATIO KETCH'
Show direction and distance-inits-from-ai-bast-.. E
two State Roads or County Roads. Include the ro
numbers and common road n. es.
From To Ft.
From To Ft.
16. REMARKS:
Gv,y,l1-fr
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY�RECQ(tD 1{!1S BEEN PROVIDED TO THE WE OWNER
YY�I(N�fYL to as 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL LATE
LA,-) try_
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ccoter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *Manual Resource_ - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ¢ck CERTIFICATION 1 'L1 1
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PRONEY(8 54-3581
STATE WELL CONSTRUCTION PERMIT/
ASSOCIATED WQ PERMITS
(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 ❑ Other 0 If -Other, list Use
2. WELL LOCATION:
Nearest Town: C- A 4%) County 6..J,4 r, �e
L-c-c fl- '1 .0 J tei,J ab-rAT€S
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J \,...% /00rJ C'
Address lB Gt-AI:Z Fo2it g2vAD
(Street or , )
CAN 7 LB 12_1, C- No. 9-C> i s
City or Town State Zip Code
(2g)- ,b6 — aa4�
Ara coda- Phone number 4. DATE DRILLED t \ /I 1 /c 3
5. TOTAL DEPTH: "5 i o
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO i
7. STATIC WATER LEVEL Below Top of Casing: b o FT.
(Use -+- if Above Top of Carina)
8. TOP OF CASING 1S ,-- FT. Above Land Surface•
*Top of casing terminated alter below lead surface requires a
variance In accordance with 15A NCAC IC.0111.
9. YIELD(gpm): �-I� METHOD OF TEST CIG - Ai a---'
10. WATER ZONES (depth): k (6C i .- c3/I- OP'^Th
4 Sn / - 1.34 G P rem
11. DISINFECTION: Type A 1 ` 9101e Amount 1 tb
12. CASING: Wall Thickness
Depth Diarrter or Weight/Ft. Material
m Fro1 To 14 5 Ft. b 8 soma) L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From , To 9--0 Ft. C e in e ' ec ,ZC l�
From To Ft.
14. SCREEN: Depth Diameter Slot Sim . Material
From To Ft. in. in.
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land ttin g
❑Ridge ❑Slope C3Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeahnim1teshecood )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forrution Description
F fcg.3u2oGJ
6 a r3 ('t3
3/4 C, r'/"\
GiA:.> cam`
3/4 G ? ^"
Lis
DEPTH
From , To
14-o
121-o- Igo'
45C '
hlwE
Show direction and •'slant
two State Roads or • • unty
numbers and commo. ....
S"E? ' D" F qC -.-.-ICE
3
281700
A
lJLe/Vjr
/Mr) C) -
PT
C-2
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a/o 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
I
D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

2 8172 4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources`\ Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) II(\` * kIN. CLRTIrFLICATIONN AT7/
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PBONEY8 '254-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT/
I. WELL USE (Check Applicable Box): Residential E(Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: At-E/A tu COL ( County guN
F s-t 1ST N i ` Red A t•
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
f.sh t o=ti
3. OWNER: 5--fE\jbra l Aa.t.,.)e) e .() (30
Address `loo F V-AN T (LoA 0
(Street or Route No.)
AL-C/ArJ13e2- rac as7C 1
City or Town Stale 4 ,,tt Zip Code
(82g)- A-J- C94-1-
Area code- Phone number
4. DATE DRILLED l 1 / 19 / 63
5. TOTAL DEPTH: 5 ,30
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C5
7. STATIC WATER LEVEL Below Top of Casing: 1 0' FT
(Use -a' if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface•
*Top of cuing terminated atfor below land terrace requires a
variance le accordance with ISA NCAC rC.01U•
9. YIELD (gpm): 5 METHOD O.F TEST J�.t (s Ait
10. WATER ZONES (depth): I )( c ' 9/4- V iPrV\
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley BFlat
(check appropriate box)
Latitudellongitude of well location
(deyw/m imneahecoods )
Latitude/longitude source:❑GPS❑Topographic map
(cock boa)
DEMI DRILLING LOG
From / To / Fonyation Description
e *�2(3 u�Of N
1 - l0 5
ICS' .- ISO'
\ c,�'
V-6 / t' c
5c•a'
i
Cc'
1 �o o ' -- 4 t/Cj- G PM
11. DISINFECTION: Type (ih T H 90 v Amount l (p
12. CASING: Wall Thickness
Depth Diameter or Wetet t/Ft. Material
From To (ID Ft. ('4, SSZ. 2 PV C-
From To Ft.
From To
Ft.
13. GROUT: , Depth Material Method
From L - To c10 Ft. C-6 MQN 1 ec ug..eb
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:
—ara GlAwtrc-
S /4i- C.r',-v-\
L;.-ANt-CZ) WhI(if_. ;cG/e-
4 ✓4_ GPM
3(2..A.) - CDSLA
%
LOCATION SKETCFI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
W
o
ni
n
�'J(��C-t� QD
FL101 flit-L (LAD
u.5 m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE Wifll ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO T'% WE`" Ot
\a0� 1I/ 90 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DA
-o
cr
W
d5:6o
0M
v:
c
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Midi Service Center- Ralelg -j¢C
27699-1636 Phone No. [phone], within 30 days. GW-I REV.
1

281725
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *Neural Resources - Di_vision of Water Quality - Groundwater Section
WILL CONTACTOR (INDIVIDUAL) NAME (prim) \ \\ �c 5
RCERTIFICATION I`X'1 1 1
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHONEY?($ c54-3581
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERM ITI
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
3. OWNER:
Address 51 S 3 R e A.'I QR0 R rv\ ;Lb it O
2. WELL LOCATION: Q
Nearest Town: W CA f e(2-.1/4) t LLC County n c M (✓
OLD E z 2 C=o -c, (Lab
(Street Name, Number, Community, Subdivision, Los No., Lp Code)
MA,Ly (our .)R-Ar3
(Street or Route No.)
AK lOc-
2j iib
City or Town State
(&a)- aa3-\q44
Zip Code
Asn coda- Phone number
4. DATE DRILLED 1 l �3 O 3
5. TOTAL DEPTH: '3 i 0 ' J
6. DOES WELL REPLACE EXISTING WELL? YES El NO i
7. STATIC WATER LEVEL Below Top of Casing: G c F'.
(Use `t' if Above Top of Casing)
8. TOP OF CASING IS -' FT. Above Land Surface*
•Top of culog terminated •Uor below lead surface requires a
variance is a<cerdeace pleb I SA NCAC 2C.011 a.
9. YIELD (gpm): 1 S METHOD OF TEST e---C.,- A) 2'
10. WATER ZONES (depth): a 3 o r_ t 5 G P r>^
11. DISINFECTION: Type I -ITN C1Dy/0 Amount - Ik
12. CASING: Wall Thickness
Depth Dig/ ter or WcighL'Ft. Material
From To O Ft. 6 i(s 50e3) pv C.,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From .j, To ao Ft. f-CM6Air �17
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 Sire Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tat
(thack appropriate box)
Latitude/longitude of well location
(depreealmiouLe heconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forrtfstigp Aescription
D -e (3valee'N
(-4-1 LTa (LoCtC—,
DEPTH
From / To i
- ss
- a 30'
or30 '
a30'- 310'
t5 Gvr^
G un..A Nt t e , U
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. include the road
numbers and common road names.
0).-D z,I,LaR t (LD
UQ1To A- 6 °A�
�f— J
-21-11
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI711 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF THIS CORD HAS BEEN PROVIDED TO T WE OWNER t.
90.0.. w / II 4- D3
r,
SIGNATURE OF PERSON CONSTRUCTING THE WELL J
cn
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mill Service Center - RaIefgb,.14
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV.0112031 U'nl
m
Innl
S?
[,rn
Dtsv
ry
r
<< �J

281603
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourccees7- Divi
ission of Water Quality - Groundwater Section 1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :ij// ✓l//4 d% CERTIFICATION! ��
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONE4i8 C254-3581
STATE WELL CONSTRUCTION PERMIT/
ASSOCIATED WQ PERMIT/
(If applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
4et
(Surat Name, Number. Commutiry, Subdivision, Lot No., Zip Code)
ile
3. OWNER:5f-cast 47C ______ \ `
/opographic/Land setting
01112.idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Address ),11 ".� (d<Veeahnwne/secoade)
3
57- Latitude/longitude source:❑GPS❑Topographic map
(Surat or Rowe No.) (check box)
es� a Srz.i3
City or Town State Zip Code
(God `321 2100
Arta coda ?bona number
4. DATE DRJLLED 1 `/ 17 1D 3
5. TOTAL DEPTH: /O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Cuing: 8(, FT.
if (Uae"a- it Above Top of Cuing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of cuing lermlaated sttor below had surface requlru •
variance In accordance f with ISA NCAC IC.01111.
9. YIELD (gpm): / z_ METHOD OF TEST / (v
10. WATER ZONES (depth): I l n c C I S C, P r"'
11. DISINFECTION: Type hLrx/ Amount 24 O2
12. CASING: Wall Thickness
or WcighVFt. Material
Li c
Depth Diameter
From f1 To t-I- Ft. 1,-Ri
From To Ft.
From To Ft.
13. GROUT: Depth Materiak
From t) To -02 Ft. ,,
From To Ft.
NIcthod
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Maleri•I
From To Ft.
From To Ft.
16. REMARKS:
pP.PTH
Frpm , T 3 /
4r3 '— Ho'
1 1"
k1o'— -ltO"
DRILLINfi LOCI
Form lion Description
o J& hLLn>3
SLAT1C CDeAr.5ttCwitre i
VtI�I G )
Show direction and di. tan 'n%tS t'orR (dskl`)N
two State Roads or ndcthetSued.
ICE
numbers and common road names.
r rt'1(T,
%20 •
I DO HEREBY CERTIFY THATT1iIS WELL WAS CONSTRUCTED IN ACCORDANCE wrri1 15A NCAC 2C, WEIL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF THIS RECORD IlAS BEEN PROVIDED TO Ti WELL OWNER
11 1?1b3
D TE
SIGNATURE OF PERSO1PcONS VOTING TIIE WELL.
Submit the original to the Division of Water Quality, Groundwder Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
281883
North Carolina- Department of Environment and Natural Resources - Di
otl OrWaer Qualily - (iroundW,ucr Section
\NELL (ONTRAC OR (INDIVIDUAL) NAA E (print)RDh11L.tJh ltuntl(N /Sig3),7b
WEIl( ()NIRA(TORCO MRAN\ NA\lEbrctnc pra . ,le11 Pk rep, S�. elONE k S�
P/y-D—raC---- \11o( IA Ital\\O IrIIt\Ir1a ----. - _
S'rATF;AA'k;LL CONSTRUCTION 4:12VII'Iq __. lit applicable)
(il applicable)
I. WELL. USE (Cheek Applicable Box): Residential Municipal Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Ileat Pump ARater Injection 0 Other ❑ It -Other. List (Se
2 W'IJ [. LO( A -(ION'
Near cs foram:
s tyq h 4-'s epic Trr�
el Aline. Ndnlhco. ( ommunuv- luhdn i-,,,m. I art Ko. . hip( ...ILI
3. OWNER: /-�{�-�• cic-.,ram ��.
Address _._� 0 01— (S Lautud:I.orsuude,ouree.❑(iPS❑ Iopogrphic in.q)
lore boy
iSuvcto It nua Noi � ) DRILI_IN(i FUG
✓�lQ,f f. t/VCR aa7�'1. DE lrIli
1n� - Penn Iu )°final n Dcurgmon
n smic /q,t.,Jr 1
4. D'AI L DRILLED / / - / '7
Topographic Land selling
❑Ridge ❑Slope ❑)'alleyfritijiar
Ie6ccl..irp„pn.I;c hay
.n nude I,m,,uudc of well location
5. IOIAI. DLI'III: .57psci __-.. -- -- - - - --- t—_ —,
6. DOES WELL REPLACE EXISTING WELL' YES ❑ NO' C-
7. SI AII( WA'FI-R LEVEL Below Top of((using: _to CD El. ,.., ---
itk r.-Abne Icu.mul
u,
8. TOP 01- CASING 1S _I I I Abuse Land Surlaee _--
- �G
*Top of casing terminated at/or below land sup lace requires a .. _
cnmm�i m accordance nn}�h Ip,\ N(-A(' 2( 111 I%. �1 - — - - t _ I�
9. IILLDIgpm): .�i[J METHODOL 1E-Sl 21-4rs - ------ I ; + -.
W. WA II It /ONI-.S (depth( 5ij5 r - -3D 4pYYN
i
LOC.AI II)N SKLICV�i n r
I I-4T ---- [�a Short dlrcawu.wd di>I.mu. m nnlg3 lml i:n Ilrj't
II. CAHN(r. IIUN, fvac lmouut -+�� - I"0 S1.u. Road or ( °aril\ Road,- i* e (hei ld
i Wall l I n4.nca
12. ('\SING. --
nunlhcro und common road nunles. cam''
Depth Dimauer or AA Laub( I-t. Alatirl.ilm
17on1 f lb % / FL /n 7(
From To Ft.
From To
13. GROUP Ucpth Material Alaho(I
Peon( 0 To _e2,0_ Ft.
[rum Tu [L
14. SCRI-F.N: Depth Dmmcter Slol SIR: Aluterral
[ruin lo Ft. In- in.
From To Ft. in in.
15. SAND (,RAVEL PACK:
Depth Nile AlaIenal
1•1)I111 lu Pt.
1loin to I=t.
16- REMARKS:
u-
I I)O I ILRI-:ISI ( 1 ICIIFP l 11AI I I ID) W I.LI. AV AS l ONSIILL( I I.I) IN :A( CORD AN( P AA Ill) I>A A( \( 2(.. AAI.1.1.
( ON") I R)LI ON STANDARDS AND DIA I A COPA OF IIIIS RI CORI) II AN B1 1 N 1'ROA-IDI-.I) II) l lll. ARILL OWN( -.IL
_-/1-P t 4 e- --- — //-36 - 6.3
SI(iNAlt RI= OI- 1'[. ILSON ( ON'. IRI (I IN() I III Wll 1. D,AI I`:
Submit the original to the Division of AA ater Qualify. Groundwater Section. 1631, Mail Senice (enter - Raleigh. N(
27699-1636 !'hone No. [phone]. vyithin 31) d.13s. (iAA -I RI- \ - 0' 2001

281698
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and uamnl Resources - Divviijsion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IJ \ \` S • \ CERTIFICATION N 2% -7I
WELL CONTRACTOR COMPANY NAME _RF.UBEN CALDWELL DRILLING, INC • PH0NEYp?J8 �254-3581
STATE WELL CONSTRUCTION PERMIT/ - ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublicc Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Wit Other, List Use -fru Ci-r; n t
2. WELL LOCATION:l-
Nearest/Town: ,C Al A1A- . County '
Uk-ILA >1 «% fiTe,(Li ALS sic r47
(Street Name- Numben, Community, Sebdivid :-., Lot No., Zip Cod.)
3. OWNER: () U L Oletu K NA -CAA .pit S
Address t7 - o . `S a7 S 4-'1
-[iJ�-7j, - (SUM R orar3o.)
City or Town State
Zip Code
(3f)- a55- �f
Area coda- Phone number /
4. DATE DRILLED P/ 12. 6 -3
5. TOTAL DEPTH: g I o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ei
7. STATIC WATER LEVEL Below Top of Casing: 4- C' FT.
(the `.- if Above Top of Gina)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing lerrotaated attor below Ind surface requires a
variance In accordance with 15A NCAC IC.0111.
9. YIELD (gpm): R.3 METHOD OF TEST R t (s - A t %L-
10. WATER ZONES (depth): j (o O / _ . 5 C
11. DISINFECTION: Typeki-k
12. CASING:
Depthm Diaeter
From 1 To 144 FL b 14-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To m Ft. Ceram,- (Jo .... et. c c
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
.l X2/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QPfet
(check appropriate box)
Latitude/longitude of well location
(degreethninuin/asoode)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o V21.4-.6e i
DEPTH
From To r
- 3ci
ko
hc' -- ato'
W t4l7a uLoc1.
a5 G2rm
Lut-i C:,r4� 6RAiJ,T6 &42tr
Show direction and di tancegtaimliesfrbmatleast- r1-E
two State Roads or Cob tyRb TncUude the road
numbers and common road names.
/u ens
rt<e„ Cr:
JE wq 3
�WM
US -'
tD
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WI77I 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY RECORD HAS BEEN PROVIDED TO HE WELL. OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

281820
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Njural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) (2 i9.t/,f//c 84 L /J CERTIFICATION #r2$ 77
WELL CONTRACTOR COMPANY NAME i o f/�-rJa.h 1IiLL� (�� 7�1?T_ PHONE # G S�9' 07SY�
STATE WELL CONSTRUCTION PERMIT# MAO' ASSOCIATED W PERMIT# 41/41
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Near T wn: County y
yv771/ a2sT�7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a34 �- TOP_
Address „3 O/ Attu yaie 9'�/
�n /� (Street or Route No.)
VI/71Y ,V.r. =ZR 77.5�
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 7"./ l) 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,0(
7. STATIC WATER LEVEL Below Top of Casing: It FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ./..S FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in acoordau wl SA NCAC 2C .0118.
9. YIELD (gpm): TH9D OF TEST/...-eszt
10. WATER ZONES (depth): tD
11. DISINFECTION: Typed Rr^ Amount Wileat-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ® To --SD Ft. b ? 46.2 / FUC.
From To Ft.
From To Ft.
13. GROUT: Depth Material
5. TOTAL DEPTH: /
Fromm To l
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. SAND/ RAVEL PACK:
Material
Depth Size
From o Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley KF1at
(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 Descrip...
-AC
LOCATION SKETCH
Show direction and distance in miles from e4 least
two State Roads or County Roads. Include the road
numbers and common road names.
r-n
0
Lad et L
7,0
rl
cn s
rya
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEI t WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7/e2/aS
SIGNATURE OF PERSON CONSTRUCTING THE WFI f 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

281819
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WETS. CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY N
Resources - Division of Water Quality - Groundwater Section CERTIFICATION et N 7/ry
s.). e (Algid 4424]4-u o P
STATE WELL CONSTRUCTION PERMIT# WQ PERMIT#
(if applicable) (if applicable)
HONE
# Wt01L7!'Vy
1. WELL USE (Check Applicable Box): Residential liL Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATI
Nearo Town County
Ltd
(Street Name, hers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /y6
Address
r+l.eGP.ut (Street o.
- 02 8 ? y
City or Town State tip Code
(pin- 442
Area code- Phone wm 4. DATE DRILLED W./ /ii 3
5. TOTAL DEPTH: v2. //I_T
6. DOES WELL REPLACE EXISTING WELL? YES O NO IZl
7. STATIC WATER LEVEL Below Top of Casing: /1, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 S FT. Above Land Surface"
flop of casing terminated attar below land surface requires a
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): d t) TROD OF TEST-72.nL.
10. WATER ZONES (depth): !)
11. DISINFECTION: Typefa
12. CASING:
�}ameter
From 0 TDota30 Ft TIT
From To Ft.
From To Ft
13. GROUT: Depth
Fromm To e2C\ Ft
From To Ft.
Amount /p DZ.
Wall Thickness
or Weight/Ft. terial
is -a/ rt)c
LD.r r�t�w
i
14. SCREEN: Depth Diameter Slot Size Material
From _ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
FromFt.
From ✓✓ To Ft.
16. REMARKS:
Topographic/Land setting
ORidge OSlope Walley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/mirages/seconds)
Latitude/longitude sotrce:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1-1
LIMTT
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads.
numbers ancommon road names.
# 7/
cn
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
23 ee 9/i/3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001-
c

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qiality - Groundwater Section
L_
QQ CERTIFICATION ik.2 77
M WELL CONTRACTOR COMPANY NAE)CLr tio... .e f�L4Ll�W 4.rGG�Y. HONE # (822)— V9 OyErl1
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
281811
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential )k' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Neare
(StreetN
3. OWNE
Cotmty/Q.amer s.ni j�
arc, a5?76
e, Ntunbers, Community, Subdivision, Lot No., Zip Code)
J n
Address *59 FF ii& irI
tteet or Route No.)
e.r. .28 roJ
( ity
4 Town y States-9 Code
Area code- Phone lumber/2
4. DATE DRILLED .2.2� D 3
5. TOTAL DEPTH: 3 as' '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO WI
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 S FT Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 0 METHOD OF TEST ante
10. WATER ZONES (depth): / /f1 .2 /,. S i
11. DISINFECTION: Type,zQe�,�tg:
12. CASING: ((//''
Depth
From 0 To saz
From, To
From To
13. GROUT: Depth
From D To of D
From To
14. SCREEN: Depth
From
From / To
15. SAND/GRAVEL PACK:
��th
From / fo
From To
16. REMARKS:
Amount / 4 °z'
Wall Thickness
Diameter or Weight/Ft. Material
®vim
Ft.
Ft.
Topographic/Land setting
($Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forman gnS)esrriptioo
t: =_ ;C i
Material �M.Oil,/
ethodd.
Ft. C firl1- I L'14l
Ft.
Diameter Slot Size Material
o Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
LOCATION SKETCH m �{
Show direction and distance in miles om at lea3`_
two State Roads or County Roads. In e e nua --
numbers and common road n.
t,2
Iv ran 5444114
0 o
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS 1 RUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�tl tc: agage9 9/4 63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

281807
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM�I.) (print) O7 0 A/A/ / G . BI41b L CERTIFICATION Uro� 77
WELL CONTRACTOR COMPANY NAMEXXA/ t42 a_ IIYL���", Zrr PRONE # (cg4 6W-orb-a
STATE WELL CONSTRUCTION PERMIT# AIL/.�% ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
4/
I. WELL USE (Check Applicable Box): Residential Dr Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1f Other, List Use
2. WELL LOCATIO : • 7
Nearest Town: County �1uwo�P-
(Street ayea e, Numbers, Community, Subdivision, Lot ,.z Code)
3. OWNER:E de_.
Address ..c..r.3
ae.4:01. cz4 &r1
trees or Route No.)
/. P A/ • C• a t 7o 9
City or Town State Zip Code
Area code- Phone mmtbet / o 3
4. DATE DRILLED
5. TOTAL DEPTH: .3 a -
6. DOES WELL REPLACE EXISTING WELL? YES/�❑ NO
7 ,i
7. STATIC WATER LEVEL Below Top of Casing: t t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 yr 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): METH OF TEST /.. Mini
10. WATER ZONES (depth): b7 �.� t
11. DISINFECTION: Type riga
12. CASING:
Depth Djam
From a To %/8 Ft
From To Ft.
From To Ft
13. GROUT: Depth
From_Q_ To_cat Ft
From To Ft.
14. SCREEN:
From
From
a Material
Amount .401 4z-
Wall Thickness
or Weight/Ft. a
th Diameter
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
th
To Ft.
From
Fro
Size
Slot Size Material
in.
in.
Material
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation a •••••
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Inclu
numbers and common road names.
WALL
0
0
cA
0
Cr,
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 CONSTRUCTING THE WELL
90 /0 3
ATE
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
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
281804
tural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #547??
PHONE # ( Kl 02-ewira
ciJ€ttP t4itai z&c
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: n A /
Nearest Town: o Co ty ,r�
swr
(Street N e, Nvra�rb�crs,/C�ommunnity, Subdivision, Lot No., Tap Code)
3. GG�Ltlt/
OWNER:2Z7 taca.u)
Address L?9717 cLGte.J 4:2
(Street or% Dote No.) • a b97/
City or Town State tip Code
(`j
Area code- Phone number/9/
4. DATE DRILLED J
5. TOTAL DEPTH: j g.S
6. ELAE XINWL? ES ❑ NO I$
7. STATICDOESWWATERL LEVEL CEBelowSTITopG oELf CasingY: i�'J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 S FT. Above Land Surface"
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):REPLMETHOD OF TEST-rat/0'
10. WATER ZONES (depth): We $ '
11. DISINFECTION: Type
12. CASING:
Depth
From O To L.7.0 Ft
From To Ft.
From_ To Ft.
Amount /D S
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material
From 0 To Ft /e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Ft.
From / To
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
Fro To Ft.
Method
(,e] eT2
in. in.
Ft. in. in.
16. REMARKS:
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatio
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads. Inc u
numbers and common road names.
e e roa
wa4L-
0
1 DO HEREBY CERTIFY THAT THIS WEI.1 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 CONSTRUCTING THE WELL
SiP3
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

WIC :.L CONSTRUCTION RECORD
North Carolina - Department of Envie( n nent and Natural Resources - Division : Water Quality -- Grour (-water Section t Sb
.ce- ao.rJh G..ye. CERTI .CATION i!-
WELL CONTRACTOR (INDIVIDUAL) NA d `% (prior) , a,pl.% Gt�rc < -
cz`
t'Sca.0 .Ti 50.�0.Z.1 P:wne PHONE `a
WELL CONTRACTOR COMPANY NAME _ —\ `� O1YQC
ASSOCIATED It Q PERMIT#
STATE WELL CONSTRUCTION PERMIT, _ aole
(if applicable) •i ® (if appPc lble) a Ott■ I II
1. WELL USE (Check Applicable Bo Residential PI Municipal/Public 0 Industrial 0 Agricuht ral 0
Monitoring 0 Recovery 0 Hea:"limp Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Co--RdVer __County ('u.tCc'"`be
n'te aGo-a ,3-$1 ltj
as �Ci�'S !n:
(Street Name, Numbers, Community, Subdi i on, Lot No., Zip Code)
3. OWNER: L'ne-c\Qs T. Arc'.ee
Address 9.5 Rc,5 t-Vr» asc.-4.
(Street or Route No.)
ec.suNe.r nc._ asnlis
City or Town State Zip Code
(S2SS)_ (ele- fi859 ._
Area code- Phone number
4. DATE DRILLED io- S- 03
5 TOTAL DEPTH: .(15
283162
Topographic/Land sating
❑Ridge li$lope ❑Va ey ❑Flat
(check appropriate t : t)
Latitude/longitude of wr1 location
(degrees/miouteSlsecc ds)
Latitude, I mgitude source.❑GPS'..ITopographie n )
(check 1 t x)
DE?FH EIJLLINGLOG
From To Forr-. ttion Descriliic
ti 53
Sa 5
6 DOES WELL REPLACE EXISTID (i WELL? YES 0 NO.
SI
7. STATIC WATER LEVEL Below 1 i p of Casing: HO FT.
(Us: '+' if Above Top of Casing)
S. TOP OF CASING IS 1 1' -. Above Land Surface*
*Top of casing terminated atlor below lac surface requires a
variance in accordance with 15A NCAC'. `.: .01I8- �`�
9. YIELD (gpm): '7 METH(' ) OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type 1 ;VYS . _ Amount 8
12. CASING: Wall Thickness
Depth Dian .ter or Weight/Ft. Material
From 41 To 53 Ft. -A
7k 2t ifGS 4'•t
From To Ft.
From To Ft.
M terial Method
13. GROUT: DepthFes.tik
From c To �O Ft._�'.t ngnF
From To Ft.
14. SCREEN: Depth Diamet r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth S1Z
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE
CONSTRUCTION STANDARDS, AND TT
SIGNATI
tC' r�vrdc,.
kt
CJ
r-i
LOCATION SKET'. Id ^'
c
L�'
Show di action and distance in n-,les froWat Iers ;
two Stat Roads or County Road:. InciudH the 2a
numbers and common road name
.L WAS CONSTRUCTED IN ACCORDAN' IE WITH 15A NCAC 2C, VELL
AT A COPY OF THIS RECORD HAS BEEI !PROVIDED TC THE WI LL OWNER
1L-"1\ o
DATE
RE OF'PERSON CONSTRUCTING THE V ELL
Submit the original to the Division of Vater Quality, Groundwater Section, ) 635 Mail Servic( Center • REVigb, NC
27699-1636 Phone No. [phone], wit Sin 30 days.

2. WELL LOCATION: v.eccmbfl
Nearest Town: Cc-�a'.0 c _ County tb
Ns \P S'ttQe.N er-ra.,ec acll\s
(Street Name. Numbers, Community, Subdivisi in, Lot No., Zip Code)
3. OWNER: 'Re'vva.
Address 5a\ ec\Nee_ tote r
(Street or Koine No.)
QSIvev:11‘e nc
City or Town State
(128)- as'& - Ern \
Area code- Phone number
4. DATE DRILLED 1.0
5. TOTAL DEPTH: 5C5
6. DOES WELL REPLACE EXISTING
7. STATIC WATER LEVEL -Below Ton
(Use
8. TOP OF CASING IS i FT
`Top of casing terminated at/or below land
variance in accordance with ISA NCAC 2C
9. YIELD (gpm): I METHOE
10. WATER ZONES (depth):
t 1. DISINFECTION: Type S1it1S
12. CASING:
oi
Zip Code
WELL? YES ❑ NO
WEI.L CONSTRUCTION REC ORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground. eater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Deee'cK l-\Q4'tti °NZ CERTIFI:ATION# 24i'0
WELL CONTRACTOR COMPANY NAME Q t41,4 Squirt D
a n Flea\ t' .n one PHONE # ; _(o�$- 'c Lt
ASSOCIATED W.2 PERMIT#
STATE WELL CONSTRUCTION PERMIT'S_ " _ (if applict bl�
(if aPPlicablcusunie)
�a
1. WELL USE (Check Applicable Box): Residential IS Municipal/Public ❑ ndustrial ❑ Agricola'.. al ❑
Monitoring ❑ Recovery ❑ Heat F imp Water Injection ❑ Other ❑ If 0 her, List Use
Topographictand se tting
❑I.idge &Slope ❑Valli y ❑Flat
(check appropriate bo,
L Itiwde/longitude of well location
(degrees/minates/secon( s)
Latitude/Ic ngitude source:❑GPS❑ ropographic ma
(check bo: )
DEP' H DRILLING LOG
From To Forme tion Description
} \ 'o '711
ci u., 5c: z
of Casing: taILFT.
if Above Top of Casing)
Above Land Surface`
.orface requires a
.0I 18.
OF TEST R:
Depth Diamet :r
From t I. To 7 L' Ft. (e'
From To Ft.
From To Ft.
13 GROUT: Depth Mat rial
From O To___ZO Ft. Ce. ;al4.
Amount t7
Wall Thickness
or Weight/Ft. Material
it21
Method
Po v,c'e-a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. n. in.
From To Ft. n. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. —
From To Ft. —
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WEL WAS CONSTRUCTED IN ACCORDANC F. WITH 15A NCAC 2C, %ELL
CONSTRUCTION STANDARDS, AND THE T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE 1 OWNER
10-3\ c3 —
pv t FSecd>n
Gc an: t ecp
211
0
3 1,1
LOCATION SKETC I Ca ooC
Show dire tin and distance in mil fronuat
two State loads or Counts Roads. Includge re
numbers a ad common road names
1a 1LZ.>t.e<J' 74a05A �. DATE
SIGNATUi.E �' PERSON CONSTRUCTING THE Wl iLi.
Submit the original to the Division of N ater Quality, Groundwater Section, It 36 Mail Service Ceentteer' , EVgh, C
27699-1636 Phone No. [phone], with In 30 days.

283158
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirc nment and Natural Resources -Division 1f Water Quality - Grourdwater Section
WELL CONTRACTOR (INDIVIDUAL) NA 4E (print) CHflC.k
P:C'1-\.ilAA Qn'QCA CERTIFICATION l.%ko
WELL CONTRACTOR COMPANY NAME Q_ ed
k S‘l�eco a woa n tJe�v9 ;A" q PHONE it art dos- dos -:LC
STATE WELL CONSTRUCTION PERMIT' v ASSOCIATED WQ PERMIT#
(if applicable) - (ifapplcable
e�
L WELL USE (Check Applicable Bo c): Residential A Municipal/Public ❑ Industrial ❑ Agricul.ural ❑
Monitoring ❑ Recovery ❑ HeE : Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: A ev.\\e County fiaLLr,Ccni '
rJ2‘.4\_Q\cma'res )Aia A 251t14S
(Street Name. Numbers, Community, Subdi ii on, Lot No., Zip Code)
3. OWNER:
4.
5.-TOTAL DEPTH: t'\(ob
6. DOES WELL REPLACE EXISTI %
7. STATIC WATER LEVEL Below 1
(Us
8. TOP OF CASING IS \
*Top of casing terminated at/or below tar
variance in accordance with 15A NCAC
9. YIELD (gpm): a METH(
10. WATER ZONES (depth):
'MCCe.c So v
Address 5 TCecCSo l,rtve
(Street or Route No.)
LP,crasrec
.� �City or Town State
(& - (n%`,,-(Ass
Area codc- Phone number
DATE DRILLED 10-\7 -03
a8'7 M K
Zip Code
G WELL? YES ❑ NO
op of Casing: c\O FT.
"+" if Above Top of Casing)
T. Above Land Surface*
d surface requires a
.0 .0118.
'D OF TEST Al
Topographic/Land setting
[]Ridge r'Slope ❑Va'ley ❑Flat
(check appropriate t tx)
Latitude/longitude of wt 11 location
i•
(degrees/minutes/sea ids)
Latitude longitude source:❑GPS 7Topographi.; n ap
(check fox)
DE'TT E RILLING LCG
From To Formation Descriptic -
\ \\_s2vec (? cdc.,
ll2 4W6 (,-ccn)be—
11. DISINFECTION: Type ? "
12. CASING:
Depth Diar eter
From -1'\ To 1%"1- Ft. Cait
From To Ft.
From To Ft.
13. GROUT: Depth K aerial
From 0 To -10 Ft. Ciar,pn4
Amount `C0
Wall Thickness
or Weight/Ft.
1\
CO
0
-c E n
0
cmr'E
Show di ection and distance in rr-les from at 1Esk`-
two Stat Roads or County Road.. Inch thew
Material number; and common read name c.
Method
:cam....1/40813a
From To Ft.
14. SCREEN: Depth Diame er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz: Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
1 DO HEREBY CERTIFY THAT THIS WE .L WAS CONSTRUCTED IN ACCORDAN :E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND Tl- AT A COPY OF THIS RECORD HAS BEE] 1 PROVIDED TO THE WELL OWNER
\0-1rl �3
t yhr i.e3t "7lQJ'i t\
SIGNAT JRE OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri REVgh, NC 1
27699-1636 Phone No. [phone], wi' hin 30 days.

2830
WELL CONSTRUCTION RECORD Satinet
ar.ollUKatler(Qltaitit)}•-iuiuuntllv&tt>r .A
"'--1r--- 1w
miasma m o...�.1
-I. 0 AT T L. D-J 5,20a „/—
TOTAL DLP'TH._� -- ES --
n DOES WELL REPLACE EXISTING Casing, b'^O_ FT. _ -__ —___
CK-' 7. 'i-ATIC WATER LEVELLEVELBelow TW+_of Casing, Uvavc Top o rcnntng,
1i
)s 1 OP OF CASING IS _.1--- FT. Above Land Surface'
laud carfare requires a
•'1'vp of <asrag lrrminaled ai o. 2C .15118. V,y f —C—_ _-_ --
-below a t �r
vvinacr In accordance wri 15,M ET HOD or TEST bI' fiL.�r t1 �--
u YIELD(twin)'..
[V. \CA TER ZONES (depth). -_ --- --_.
I�ECTii)N Type_ 1p , Amount—_,�c.-----
Diameter or We,ghVrt. Slater.11 nnln
D,ptn --- I
1 f DISIN. — wall Thickness
'0nmIciSi'S. asat•mu - zlcpartmenl 01 Enviivan®tltnttmtlL'!flatwuill44.t�aw» - �3
\Mit.LiUn�.4 at�C l'Ux ;I•UIPIUCA4 y,@ItH: ltlraot) .. u
%Ua. ( l/\ 114 \ crept ( omr,\n1' %.:�Apes'�-ir��mt Ir.']'i_
.1 YI F. N. Eli. c&i sInt CI Ilr it:xMfff.__- -..-'-'.._ —.
Sc 11 tlte.,Ck ,Applicable BOX i', ResS1/40I 41411 MtiliPtipal: PublIC 0 Industrial 0 Apacuhural 0
UQtct 0 II -Other, list :'Sc
-------
- --liian 0
soHeat pump \i•slu And(•-
t-a::msfe� R�«'''=r>' 0 tviandsetting .
Topogra g]Fta-:
2
lc t.!t LCIi; AiI lo,e 0\ellry
iiyy � �. fOwn _ ❑R,dEc f
LS4 �. aki-p ,Town Icho.k �rP'vn.tm h
r �� �'- .� Latitude/longitude longnudr ai vcsl.r, lybt:;alp'fft
r< oavna icy. Sul+Cn afore Lot Na . GP C,rki
15t.. Care.:.._t .:
eRt •s. noon 'S ftarW61
t\P4ipgnij uonapl�
Lati ado longitude sourer ' �MGNN<
mil, gfri
• eon) To H<.masiva, es rl'�t...�
-.---..---- J'. - _ 1
0
l tRi NLR'.-.0
d
vu.0 `> n I z•��
t>,uat .r lt. yN•
1 ) ATIU'� yEl'Cl
Sttow di r:ati on and dist an,.o m inda,.;from
athc`r>t
two State Roads or Coup) Roads.
bad
et s and cornmon road names
q z3
tic lc� c ve '
March A1cii,,ta
ttoui lo__..
Ma n't' .j-1C�1
CO 6
t ur Du nel:t S r; S 7 VL; C)
15 :SAND GRAY EI. PACK. Stzr Material
Vcp'.it
o (n
-
IN ACC we L OWNER
CONS11 )'i t CEis1A\1'H.\T? HIS WELL A COPN 01- THIS REAS CONSTRECTEDYCORD HAS1iBLEN PRO\t!DED I ) 1RE EU.O
+:'.y)N�rA,�»Trc Z3'_0__Th
— O— DATi
---PbRSON — — --
- -- � 5K��ATPRE h c.uNST
.Rci;nnu rHl:. weuL
tNC
Subndt 1hv on� ual to the Die isiun of Water Quality, Gru und(c Section.titer In36 Mail Scrvicr Center
Ra_e h'Raleigh. NC
22T0 J-14- Ilion: Ni. t9191^ 13•322t. within 30 day sG ,

Le�C- r z From TO
')\lb 11KIL1 pD LI_j-,-"�-'--
EXISTING WELT' 'I ES 0 NO
test ...,r•tos c Tap of Casing
/ _—
n DOES WELL REPLACE g:.-%_Q--il. —_
-, �: At IC W.ITER LEVEL Below Top
of
- Above Land Surface'
f
.-us,aetermna xc.otea
t)1' O CASING IS �— requires i
1 tad stem' bcW Ind sdrbct S _ -
s&duosr in wvurd- wu• 15A OF TESTGei � • �' 1� 231_ — _— -_
��_ M11ElHO
%:uI' ilii 'l ::lr n:dtil - i)cpartmenl of Enrcralltntt,eidl lG0tuu11itu�luuvnsi -
(iDtl
)Idl.
\,Pen,iin.%AU Mit:IN0IsILWAl*VOW Iw L
fkiNtibil
e\ll 1. <'ON1R\t-1lIN <f)\IPAn\'N•�'
+1 VI NFtl.;;la-ICI ION (P-____--.. _
•
sisU MundceiaalPublicD industrial a_:^annanMunl0i
\y-'„ II-uns: Rc. iscis blC Boat Rot\V J (Jthei ❑ II' Other. List 1.'se__ ---
.• ,��utnlm_• O✓' 7tt.eo<e1>� 0 Heat Pump Water In coon 0
Y Topogra hie and setting
WI l LOi; ,\fl< Nam' p �'yt//''�` 1� ❑R1Jpe lop. ❑\ Valley UlEls
1.� _ �1. __ 11 - ch :k apPm. 'albait I
\ .n l it..n - _ I1/ __-.. of ikDti.1_3)illi
.i rN� S.r`_ V - Latitude/longitude --�
(1. ]Non:. V.Y\]i 'kL:5 l'oa1m J', )'. SubdN lsi Jn. Lot M,. LY• Cm1t'i -.
1,1
rL:cnes npr-r<s UI• r w Clapp
1 t>\ v�� � i alinrdd h,ngitude sours I -n
Zip coat
a. L
c Tr)T \L DEPTH'.-__ ----- --
to \\AT bR ZONES
(d\p +drvan,,mm
niQY_ .Amount � --
!I DISINt'ECl'lilti T �----
I2. CASING'
WELL CONS'CRUCTION RECORD Si¢uun
rmui[ u%let9r (Qilsitt� .. Ulitau1,i�.`enter
Inn91H!
Pv.de.'1
283056
v \ ILLD to;. I thk
•.1�•.. trnm x: Ica>i
--�-- Show ate R adany. !nei & the r°ad
two Jute Roads or C'oun;) Road...
ype. namcs-
Diantet 1 or Weiglrt'i4 Mater::I nwnbei s and ernranOP road -
Depth i —_.-� -
Wall Thickness
Lion)f o 1 _ 111---'-- - ---.
I rom To_ _ lit
r
yke:en
I7. GROC f Ucp'h (1SI
..;\. zc
Diemen', �-
.KLF4. Ueplh Ummc_-.. MatdriLl
in. ..
15 :SANI) (IRA \ E1. PACK'. \1alerial
veil! Size-.. _.._
won__ ...._I a-_.'_
O
Ca)
0
O
cn
r
L 0
r
KI.\I.\Lt.S' _ -- �.- �\, VI ITH I»\C.AC '_i, wrt.i
OP) ST THIS ED IN ACCORDANCE
HAS BEEN PRO ITH 1 D 1 L l HF WELL OWNER
I[)CIHt.Rl1f,CRia IF'i TRH:\TS. FAih WELLWAS
Ai 1fl ST HIS RECORD DASD CE 2I _EI°�
DAT
� __ - yl ;�ATi,ItR Oh PERSON l:UN57Kl(?IOci THI: WELL
e
Q
1hni
Ph,,ic NiI t19191 9'33221. Iwii1 1n 30 da,v 5ity, G
ruundl. uter Section. In36 Mail Service CGS- i RF eigh.7NC�C

1 DO It F.K P.l3i ltrt
C U"•iTli'.
Il SI'Kt !'' Ucpii,
WELL CONSTRUCTION RECORD
i �ii 'Sautlum
hmmil V1C;819r Q)t 2r.. iiiiuvndlvmtm�
'k a:tntcm of Em.irm®tunn;nrlilylwtuull Wualuula+%y-'� Q)fig8trt'attuala:m 1413
ciliSt
uVNSAar.l K(I\UICW WEALS sail Orison _ ��l INK Iti�1
,Si t I. • `Y_R IV!it lA"l\`
►t.t l.(UNIq\("f 11HC01tPnwY>VOW . �gg(1CCl YY3Ci'xQP
.41'4h r,Yll C41\S1 Pt CPION PF:KnII C*..._---
_. .__- __...__.
an• a i 1 r':
ai ril ,.'. Utinitipal Public a Industrial 0 Antiatittu l p -
ear i Si. i RC %ciy cubk ling Y R P°Mar 0 I I- Other, List C Si.: _ -
T
+`n,,m__ �, Kc..,t�cry 0 Heat Pump Water In caion 0
Topog(phic-1 and settings
❑RIdgc Slope ❑\airy Ui+lm
+c M.A appr. n ++ibox, I
,ittaau T I1 I
Latitude/longitude oixst+ I
Idcgras mimes /1, -.\ •tupl• I -,�
❑crsti lrie..si ,
I_:uiiud-Inngi;ude soucc' ..isdaawo, --_____
xyL' an)t1uJ ,S 7;
' �l1 __-
From la hh.ttraai iWMi i1.
2 vet-LI LCtt:.'l TiOIS
_.\A e
Coup
\-^n:, \ .h. i (1 r1 `+u .i:). Suhd+ c:Of. Lot No . hip C,n1
t if\l"NEK VIn ! ___
LerceN
-'- �nu< ZiP Co.ie
28305'7
4. D:.T L t)KILLFD__1 `- I b _5. _ -
TOT.\C. DEPTH .___.. 0Sci-
- - aa
o DOGS WELL REPLACE EXISTING ELL')Casing: YES
O O E _- -
't. St At IC WATER LEVEL BeIOW Top
., r Cno,e Top ofCaiing: _..—_-_
i Cu -•
l Fl. Above Land Surface. _--
H I OP Or CASING ;S SA C ____—
*Top _
l..p o. ...dome ar lydance n Nor below larC I surface moires h -_-
.'arl.r)(tI aaoreanc(1rl_NI FTHOUaF TEST g h . • b�. -_..-
YIELD IgpmP - _'_ (� ._ -- '-
Z�b
(p WATER ZONES
(depth )t and dis an+; m nnlca irvan r.l lea>i
�r� nmoum __-----
?1 DI51Nf'cCTtil'` Type ^name,
1'_. CASING
Wall Thickness
Diameter ar W'cnghUh:. \later+:1
n Depth
on,__a__Tn_20 It —`
To_-----'taAla:,•ri
— !.^,c;hoa
Frori_.__
Diauu,ci
15 SAM) l;14,AA El. PACK- yzc
M3 erial
Show utcR on .'.
two ll'1t^. Reads Jr [Coin) Roaes. IPc ud: the rnad
6limbet s end common. mac:
/(
5 J n'y
hk.rch a-e c +
W
O
{
_. --- an. _yam-,-
nilc
_ ._ -- ,, ern
SIANBEEN \'IDED 10 i HE WELL O\\` R o
\T IRIS W'ELI. WAS CO' TRI.'ICTED IN ACCORDANCE WITH --
STANDA S. AN THAT A COPI' Uh PHIS RECORD HAS DC E (1 0 il.‘ i_i -a 3—'--
--''- 5WN:1Tl:RE UM PERSON CUNSTNL( 71K:i THE )‘[Li.
er Quality,Ground"ater Section. In36 Mail Serlice CGWiI KF\igh'SC.:01
Submit the hint aal to the flit 3221. n of
tithin 30 da s'+
,; �97.11 tiN Mtn: Nu. IYL4)7..-.

283067
O.nncif"Q,at,Ras- iicp.annent of Enaultmennittmttll`i to
+wctuenn.ealuroa(INUI%IueMLa'%tUk._ wi+tu_-tt tiiii
tutcno�rtatattr�'`_%�_ L__
Industrial ❑ Aizn utmnl Pit'
Topogr i I
\c' . t LUi:Ai1(i•\ L p .\pi ❑Ridge Slope O\all+y .'�]Flai
--p' Y u. _ Count) ij Icha arp'.:n n 1, 1
T n J3 it `i �� ` • i'��V� . Z.� a '{ n'fi.l taLSO- t
•LL�-__ _---_.Iut't nun✓
WELL CONSTRUCTION RECORD
.mailVll'ssi Onfitit3
u at
Intta»aw hr__.t (..i . •)
wilt I.O:111 (TOHC Ox-10Nr NAVIO'.. - ,AssO[tsttowerlt tv`
+1'1R Nil
S;-,(. pr�-�k •\ppficublc Box t. Rest 7:7nnx4°al"Pub Tobin:
as Heat Pump Water Injeruon 0 (Jthcr 0 I i Other. List Use
.r
�',:,�..a•,u.nm Cl Rc�. very C7
'�•l and setting
L� �utl`i{K -- I ttudc%longnu '° !
;,p IIIUJ:IV11 L;llllde •JLL(:e
1\\ N1 R \ T. - - L .rsH Post_ .
i",L [ Coat
I;r..�: Stott Zip •• -__
-- 'L;LHd I'' liM1J I. LP.DI
ZS 1 t 14,.rrrcniwu tlrTuns 1 +�" '"' -
DEPTH
Eton) To
1 L DRILI EU IQ-T5. OTAL EXISTING WELL
YES
i)A - 5 )
i) .\L DEPTH:__ --- .) •ES 0 NO H
h DOES WELL REPLACE EXIS ' of Casing: _ S0'0 —FT. —
T. Sf.\ I IC WATER LEVEL Below Top
t"
I Ute d♦b+c Top of Cu,nP
S 1NG IS .
-- Ff. Above Land Surface'
% I OP OF CASING — ilia senses etYaM*'A a
vari*'+C. i. agurd nnsaaY}a 15.A - CAC 3C .01111. G� j • .a-.
Q.
"IF`Uptepr'Sraae:t4 METHOD OF TEST
Y ATE tZONE .___.__ __ _
cl WATER ZONES (depth).._------"—""—_
t l�_ Amount _—_----
1 CASING. TICIN Type Wall Thickness
C. CASING. Diameter :1r Wc•,ght'Ft Mater ai
Depth ``LL
——'UN�
Lacit ItI1
Show eir:‘tion and dlstafl in mileO) a+c`a t d
two Sure Roads of C'otun) Road!:.
! •.c
numhelS and common road names.
CD
I 1 _
NIcthotr
LOWLY I;'f uep'I' c z 1
(-o Irn —i• J C�
Laedi ear
D,athetct Stir Matcr;u:
c,ANI) i,R \V L PACK'_ S c Material "O
L1ep'.11 — —. C/1
1LX Kt 121:11%
AN
1.
\T (HIS WELL WAS CO\ST RI(IEU I`AP+' OF THIS R`✓CURD HAS DC.E'r p13OVIDED 101 H WELL OWNER
COROANCE WITH 35A N' AC 2C. V.ELL
S AN THAT A COQ
C
-� _ - D,,T i
—�— SINATC.RE OF PERSON LONSTRL(:TING 7H1:. \HELL. '.
Submit the nrigiu:tl to the Dn islon of Water Qualitp' Graunds liter Section. Ih36 Mail Service Centel Raleigh. NC
2709• 161h Pluto; Nu.(dlvl 7 t3 3;2 i. v.1111111 SO dace GAA-t RE\ 07:2u01

283068
,!ii it 4
vvt c'iu aMY._.nae nba L.l
'Otto �qQ>_ MET _j FTEST_ -- —
LSO d
. � Roads or Count\ oaa,. • ' .. .
wall TLghtt s Twilit/el s and common road D�.amct;r Dr Wr. cht'F:, \luter;a
Depth
Match
Mc!hua
e S�-Ql.ra_ _
.__.----- 61aiet.ii•:
Dlsalcrc., she. yzr
e�. WATER
WELL CONSTRUCTION RECORDuom
at oil\lkatet((kbalii- _iirirnttnlllwfeutr ,al ,
wtutnr:ua%un 44
w
4„350Ctt Y)'JEr Vie M tiesty
• -!
I— q o3
Nc:::.J L)kl,.c:mmn_I , . IL
1. Oil E DRILLED__ --
.i TOTAL DEP'TH'_.
h DOES WELL REPLACE EXISTING ofC'Lstr,YES., NO
FT" — -----
LEVELBelowTop 5—W —
7. ii \"IiC WATER icaa--`,1Ahu,cTop ofCikunr: _
—__ FT. Above Land Surface' __.__.--
X I Or OF CASING term i5 ncir below land surtax* requires
• •'tVV et rY"Fe terminated a 1t. fit. 2C .Otte. ._.—.�._
ZUNiiS (dipih).._J-- {— '_ Show clraction and dislan�:: in miles iroln ah�z{,�.
R scrod
.Amount two Stir_
DISINFECTION Type 511�1'+u-- adnamc,
1'_. CASING
Nt(4119i,t RI•u.Irw- i)epainienl t' EtlonxousnrnuanL tastuai11t4wwlcua;- LID
x �cvrA"yytY_�
\watt. ub%iltlt. 11)H;IN VI%1U1'ALJ%t 'I4.1)t+i1
V tti. (t)%1 R \rink C 0\wAr1 Vat
inpOlL
.i)i h\\ E t 1. CU\ 1 H1. C I'I 0\ ,•tweets .. r—
ea i.= at heck
OW.o.,1°i.• 1 ay/ 1tlCl+suul 0 etaJiural Ci
1 11 LOA 1 Relle(.TPRN111 N1011)Cip31'p4b11L ❑
)Ihcr ❑ IrOther. List'; . _ -- sc___ -.. Ir__
Topogra 'l-andsetting1
Applcdc
-
Heat PumpPump\\'atel Injcaion 0 I.
Av L. t LOi, A
1 — �� K•`i 11). Suhd,\1•'00. LOI i t.. ZIT, C0,16
di .:,, _i'1 a-
—hp Co -le
❑Ridge lope OValicy 01;la.`!
!check appr:,orum hoe _ II
Lalitudellongiluik yf •Ae It01'aati )It
I
,a.u< :, snprc)farmai w. IcruMpmuipl•
Lutitud: longitude sour:r: ,L}gyY'.tiTtv,�74
,y FL Ntit; I `—
it) s. iFie.t�'
DEI'r
Fr'-m To
KCr:"r Uclvl,
I.; tii: RI F.N nep'h
IS .,AND OR-ACH- PACK: 5••7e Material
Uapol
C'U"•tiTlt:' N ;TA
z3
0
CO
0
c�
F
WAS U'HLI. AJ CU\JTHL(TEp IN ACC WITH 15A • -o, v e.LL
DO Rhin IFS VI S, AHD THA'TACOf'1 OF It.IJ RtC'UKD HAS BE'4PRU\li)IHF WELL OWNER
IDED'l0
`'-3-0
CD
tit
Ppp Iy' DATi
`—._--- i HI- \\LLL. ___.
JI('R ti AT01tt C } Pt1LSUN CANST{t1-T 11
i:'
Water
Submit the original co the Dit21. of
in 30 wsity, L,
ruund)suter Section. Ih36 Mtil Service Cotter Raleigh..NC.'Ui
iision
±7694-IhMI'bun; N�1. 49191"
.12

WELL CONSTRUCTION RECORD
'O,;uncik ..;nu\.irks - Department of En. uottoro ntnaltil'fka(urlil i tmottoa:b - lQt
1/ y[vf`Yi111
V Lit ('U% 1R idi ON( U1TPA'%% % •$[ _f*'i�IQLm,*1•j�,,1._
+r�t3/44.013
t \\ Y: 1.{. CU\51 Rl C Ilr)\ 1'4001110 —.. __.._.—.
T SC ,t 9u-r:k App il:ablc Box r RespecneA41
?..,.. , adrf El Reis), tap 0
Heat Pump Water Injc
�vT•t,; ^ ; ,�y(LL'� iitrW- V 1--�`%—Fown) U
Z,+II„A
l}V NLI
✓
28305'4
orris elKauart{Qirsiiit..(Cliseamt YMtrrSm.noth
awitotamtnauukto. As .0,
1HKiltt .
7— Industrial 0 .kpicathalral
7)gcrtit( aOWeL C 1 List Lse.____
coon 0 ()Wet ❑ .I Other,
Topogra lac/L Ladd setts g :
❑Ridge ope ❑1 alley il�lat
Y �`LI fY.L zi50s3 tchc:[ �npr:,n lal lr r. i31
:ataudeilongitud. od iste'lcr�yb:
so. J�3
r r:n _ au hip (\Nit
J. DAL E DRIL.L.ED_. �1-2-�3
d TOT .el. UtPTH:_ --_-- —.
DOGS WELL REPLACE EXISTING ELL) YBS NO
---------'
v. s i 1 T IC WATER. LEVEL Below Top g. -- -----t T —
t Il.'x'•' d Abw lop of Cumg, __._.__
CASINGIS 1.--_ t-f. Above Land Surfatce'
clop of .in us; t.dancerwi Nvor SC Ind furlaee reY+k°! --- _- _ -
vviaY.a'in accordance with RA ETHAC K.Orto V
1Z Ni ET HOD OF TEST
--_-.�r s nu:,to
1_a(,tuJ.r longitude suur c. LSu�lll..
L'rvm
To th.nmsi
I
ttLMe: IT16t vC! 1
r(1 WATER ZONE. l cp _ __ --- —
Show usat�on and dislan in r\•�Icy from nAl
i� Amount 'Thickness
(\\o State. Roads or Coun') Roads. !IteIt d., th•. r:-ad
!I UISINttCT!i)h T)'pe�— Wah'ILirknras
Depth if__ Diameter or Wc:ght.H. Mater,:i
v YHILO tgpml .-
4 (depth): .�_Z5
12. it sr
)
a ,.•,unbe,s and common road names,
row __ To iFa------ -- --- 1 l(
Shoot '
T
St itt t EN Depth Dtametet s:et S.,,tCI
In. __
FrO(11 TO „ in
15 'SANI) Oj A\ Et. PACK.-. Stic Material
Dap'h
REMARKS, —
((J..STlt:'Cll�'<<l �ItDS.AN'DTHATACOP) 01'FHIS RECORD HAS BEEN PItOI I DED 11)1HE WELL OWLS It
DO Hi141;13'i et in IF) THAT THIS WELL WAS CO STRL'(TED I\ ACC ORDANCE WITH 15A SC AC 22C, WELL
Ili 0�
S I:;]:1T l.Rt U1' PtRSUN (OnSTKC('TIKv 7HI.DATi
er ua{ity, Ground"titer Section. In36 Mail Sercicr CGeel l Raleigh.'M.
Su bunt Ih('Iton ual to the .i3.1221. ision Iwitl within 30 day\.
^6a9.1 Uttr !'hap; Nu. IYt4r7

282902
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and * Arural Resources-DiivisioRn of Water Quality - Groundwater Section
WELL CONTRACTORoNDIYIDUAL) NAME (pent) E311\ N45% CERTIFICATION% a 7 7
WELL CONTRACTOR COMPANY NAMERL.CUBEN CALDWELL DRILLING, INC.
PHONEQ8 _
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
3. OWNER:
Address
1. WELL USE Check Applicable Box): Residential ( PP ) MunicipaVPublic 0 Industrial 0 Agricultural ❑ '
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �
Nearest Town: CO AJ l2,Q tLLL County 'i7..+cn3Cenne
(Street Name, Numben, Community, Subdivision, La No., Zip Code)
j f`r 11,,:14t YT � p
tS I LJ rJ 1 o c_ 144 A P a L SCnAD
(Street or ROW/ No.)
LCL*Af2i-‘i1t_tx'r (1t--
iry or Town State Zip Code
(V- b4-5 4" 5-1
4. DATE DRILLED 10 /a-(/
5. TOTAL DEPTH: a 1 e '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1B•/
7. STATIC WATER LEVEL Below Top ofCasing: 4 FT.
(use "+' it Above Top of Cann')
y
8. TOP OF CASING 1S FT. Above Land Surface•
•Top of rung termleated at/or babes Ind surface requires •
varlsoee In accordaate win 15A NCAC SC.0111. nn p n
9. YIELD (gpm): `i METHOD OF TEST 6`t ta r4I 1L
10. WATER ZONES (depth): / b 0 " —7 Lin"
Ara coda Phone number
11. DISINFECTION: Type N71I c1 C to Amount 5f4 �).
Wall Thickness
Enter SobtteiRht/FL prat
From To Ft. �j�� ,�Il (�
12. CASING:
DcP
From i To 'd EL
From To Ft.
13. GROUT- Depth Material n Method
From - To 9.0 Ft. Lk'rRfptJ'(- rOdtaP
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Material
Topographic./Land setting >-
❑Ridge ❑Slope ❑Valley
(deck appropriate box)
Latitude/longitude ofwell location
(degrees/minutes/seconds)urcP� "--
Letitude/longitude source:❑GPS❑Topogn
pEPTU
From 1 To S /
(bow
I ollen
(check box)
DRILLING LOG
Formation Description
o ‘/QY-t3U(1 -N)
5-g LO O
0 (Zt.trJ t-rtr,tei41rK 2oCic
(C,En—,
C ("ANtTe, E,ay
LOCATION SKETCH
Show direction and distance in miles from at least.
two State Roads or County Roads. Include e road
numbers and common road names. W r'
/oP
nktiLikitz
AV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WE
CONSTRUCTION STANDARDS, AND THAT rOPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
SQ_Lt 0,y4 L ei b 3
SIGNATURE OF PERSON CONSTRUCTING THE C.L D 7E�� /
6 CZ. -
) J1
to
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-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) �e tc2 Ck t4. •Sa..44 QrA CERTIFICATION # a-y31O
WELL CONTRACTOR COMPANY NAME Ill* SC1191tt S:n Fiat lld +..? ♦n¢. PHONE # ($f29 a55- 2G S*i
TAT SE WELL CONSTRUCTION PERMIT# 0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Bo::): Residential 6d Municipal/Public O Industrial O Agricultural O
Monitoring 0 Recovery 0 Hee: Pump Water Injection ❑ Other O If Other, LisLUse
WELL LOCATION:
Nearest Town: era ncornIne County Ashev:4e
04fr'trs i' V QK tOrSQnt
(Street Name, Numbers. Community. Subdi'ision, Lot No., Zip Code)
3. OWNER: tw14 11uoa1.eS
Address -H.:40,f a Moor..,,
(Street or Route No.)
144ae op;tn�3 he— a8141
City or Town State Zip Code
Rd
1,
2.
(1)- (oz2- 3bsv
Area code- Phone number
4. DATE DRILLED "5-53
5. -TOTAL DEPTH: 3.5
6. DOES WELL REPLACEEXI,STING WELL? YES 0 NO 3C1
7. STATIC WATER LEVEL Below Top of Casing: CID FT.
(Us't `+" if Above Top of Casing)
8. TOP OF CASING IS i IT. Above Land Surface*
`Top of casing terminated at/or below lar d surface requires a
variance in accordanceLs.f�with ISA NCAC :C .0118.
L
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
O'P
pographic/Land setting
rekidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudc of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic rrap
(check box)
DEPTH DRILLING LOG
From To Formation Description
� \ lab b' Q* +?gear.
lac0 32,5 b-ra a%e
274602
O
C_ c
LOCATION SKETCH Jr- 1,1
_
11. DISINFECTION: Type 1:1IS Amount Sy Show direction and distance in miles frornl2ODleasty-.=
12. CASING: Wall Thickness two State Roads or County Roads. Include t�e roZS o
numbers and common road names. 3
r — or W cighUFt. Material _
From it To la(O FL L— it t•2I III c...ht:C
From To Ft.
From To Ft. _
13. GROUT: Depth Mrtcrial Method
From 0 To aL'' Ft. Ce+nent c+cam _
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.
Depth Diameter
16. REMARKS:
Ge
c-n
CO
-r.i I(130 BERBB'IItBERTIF
n t' , CON5tR114IT1 N S�f�A
IhJ
h----
T THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THi A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
eAr
-,)I Weed
�LE
SIGNATURE OF RSON CONSTRUCTING THE HELL DATE
Submit the original to the
t___ i
g A716p9-1636 Phone No. (919) 7
3-2s- 03
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. G W - I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAr1E (print) LSti rtCKbl. maw 4=r'C CERTIFICATION# a`t 3to
WELL CONTRACTOR COMPANY N.ANiE Q Sa41'1QCS San NGJI Uoi*+1p AAC- PHONE #(Sf29 a SS 'Zp(IS
STATE w'ELL CONSTRUCTION PERMITl d ASSOCIATED WQ PERMIT#
(if applicable) (if ap�+licable
L WELL USE (Check Applicable Bc::): Residential 6d Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heil: Pump Water Injection O Other ❑ If Other, ListUse
efq_.
2. WELL LOCATION• /�
Nearest Town: AShcJo. \la County lJv,taci.[nD<-
La.uCence rid
(Street Name. Numbers, Community, Subdk ision, Lot No.. Zip Code)
3. OWNER: i)C" (3:cc%' c:Q A
Address as L+'cC I,F:tkA !.o-nC
(Street or Route No.)
Fleic er AL a.7,'0.
City or Town iatee Zip Code
( $a-
274599
Tdpogr�Phic/Land setting
DRidge fJSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m i notes/seconds)
Latitude/longitude source:OGPSOTopographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Descript on
99 p•e< Z et.lr..
Area code- Phone number
4. DATE DRILLED b-ato- C-3 - aft Lip (.*Pc"-n1".e
5.'TOTAL DEPTH: 'ia*&
6. DOES WELL REPLACEEXISTING WELL? YES O NO FI
7. STATIC WATER LEVEL Below 7op of Casing: 3n FT.
(U:c"+" if Above Top of Casing)
8. TOP OF CASING IS i ET. Above Land Surface'
*Top of casing terminated at/or below le r.d surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1 METHCD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type 1:11S Amount
12. CASING: Wall Thickness
Depth Dia:retcr or Weight/Ft. Material
From "'i 1 To 9,21 Ft. J. CL . a i Plc,a'f;S
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To ab Ft. C..`_rnent Tcv.c
From_ To Ft
14. SCREEN: Depth Diamet:r Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Si: e Material
From To Ft.
From To Ft.
16. REMARKS:
�01
•
Hft EE
aT C
togs
Submit the original to he D
( 271i99483,,6EJHIC>rEc.NQ1f(919) 73
AS IL` - CaiOL,L itrICE
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Include the rcad=
Lt mc-+
�w
ro..:o
cn ---4i
W o
z
S- L
/\
C"1
W
r-'
numbers and common road names.
f
T
(Pty.°
THIS WFLL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
S, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5- aca- 03
SIGN
IRE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
i-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Kimura] Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) U 1 LL \ E NA S 4 CERTIFICATION 1 I
WELLCONTRACIOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PHONEEi%8 )254-3581
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
274550
1. WELL USE (Check Applicable Box): Residential Cl/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T, wn:U)6A4ep_Vt)..,�''
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ bt)60-- qvt t_Oe 12-S
Address ao`t 0nJ3Le/ OP -A vE.
(Street or Route No.)
NS 14, ilk LLt N e- a� 5 o
County Zup)cor\�E
City or Town State Zip Code
(03)- aqb-c+a-
4. DATE DRILLED 4/0- 4-/(9
Aran code- Phone number
0 3
5. TOTAL DEPTH: act()
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !H
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
{{ (Ure"+" if Above Top of Casing)
8. TOP OF CASING IS 4- FT. Above Land Surface'
`Top of cuing terminated at/or below land surface requlru •
variance In accordance with ISA NCAC 2C.0111.
9. YIELD (gpm): 5 METHOD Of TEST QaG
10. WATER ZONES (depth): kg D - 5 G PGThr1
11. DISINFECTION: Type N r f4 9 b i 7
12. CASING:
Depth,Diameter
From .1- To 39 Ft. 6 't S
From To Ft.
From To
13. GROUT: Depth
From 1 To °
Amount =1- Co,
Wall Thickness
or Weight/Ft. Material
56 1 Pic -
Ft.
Material
Ft. C- Mt3ry'C
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Method
Po Liekb
Slot Size Material
in.
in.
From
From
i "11
CONSTRUCTION STAND
L 1
27699-1636 Thune No: (91119 33
Topographic/L.and setting
Ridge ❑Slope ❑Valley 0Flat
(chock appropriate box)
Latit'9e/longitude of !well Location
/y-ir ftido'jy&&'
(depoalmiau )
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o4t3(L/g,)2peJ
'( LAN)ire/wr4re(&ciC
vPM
dQA E
DEPTH
From i To
4
5it- '- t40'
tot 0
Rio `- 3-40,
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.
Cr
AND�ltJG
VI Iv-
`n
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT ACOP'YOFTH�IS RECOHAS BEEN PROVIDED TO T WE OWNER
1 qa 0 3
N
C 1,1
tnz
0
S GNATURE OF PERSON CONSTRUCTING THE WELL
on of Water Quality, Groundwater Section, 1636 Mill Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)—/
WELL USE (Check Applicable Box): Residential YX Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge OiSlope ❑Valley ❑Flat
�V IO` (check appropriate box)
�I m�- Li/longitude of well location
(Street Name. Numbc s, Co unity, Subdivision, Lot No., Zip Code) atitude
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING ING LOG
Formation Description
2. WELL LOCATION:
Nearest Town:
2-L -€0 3
Su mit the original to the Di
276 4 Phi= No.,.(919) 73 -3221,
AS
C C�:.ir ''t;ilUfd
272785
3. OWNER:
Address
City or Town State
Arca code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: Z
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: _-----
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface* —_
*Top of casing terminated atfor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. Ls Mlw
9. YIELD (gpm): -M MHO OF TES
220
10. WATER ZONES (depth):?
ASSOCIATED WQ PERMIT
(if applicable)
11. DISINFECTION: Type
12. CASING:
Depth
From_y.t__To Ft.
From To Ft.
From To Ft
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To Ft..
To Ft.
From.
From
16, REMARKS:
Diameter
Amount
Wall Thickness
or Weight/Ft. Material
Material Method
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ftin. in.
Size Material
- Groundwater Secji031
CERTIFICATION
��0� (gal
PHONE # ti*!!Jst ta""*
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.
Ati�natcdR-Y`):1•
tO
THAT THIS WELL
WAS
O
NSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
tgM4srRUCrlgN sTANDAHATACOOFTHSRECORDHASBEENPROVIDEDTOTHEWELLOWNER
3 - ZS-O
ISI �UREOFPERSON CONSTRUCTING THE WELL
DATE
j Li
n of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, Raleigh, C01
within 30 days.
N3
0

272784
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division r Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r7
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable) ,�
1. WELL USE (Check Applicable Box): Residential u/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT1
Nearest Town: e )
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address Lr.G '`'"C'
(Street or Rout e.)
City or Town State
(--)'
Ama code- Phone number r
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO ZI'
7. STATIC WATER LEVEL Below Top of Casing: A.12_FT• �—
(Use"+" if Above Top of Casing) —_
8. TOP OF CASING IS - FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a --_
variance in accordance with ISA NCAC 2C .0118. t yrtAl*
9. YIELD (gpm): IS METHOD OFTEST�.1+ h�
10. WATER ZONES (depth):
Topographic/Land setting
ORidge QSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
Ep PTH DRILtING LOG
From To Formation Description
11. DISINFECTION: Type3a-
12. CASING:
Depth
From_a__ To� FL
To Ft.,
To_
13. Depth
To__
To
Depth
To
To
From
From
GROUT:
From
From
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
To
To
From
From
16. REMARKS:
Zip Code
ASSOCIATED WQ PERMIT
(if applicable)
Amount
Wall Thickness
Diameter or WcighUFt. Material
Ft.
Ft.CQJ:
/—� Mateer�rii�a,l��
1*L L
Ft.
Diameter
Ft. in.
in.
Ft.
Ft.
Ft.
Method
Slot Size Material
in.
in.
SizeMaterial
Er, HEREBY CERTIFY THAT
TAN(SARD
r4-
L.
i ttt�
Sutunlike-.aT$i al to the Division
276A9kL4$ Finite No.(9J➢IQa3-3221,
�' a OFHCE
- Groundwater SecUtipa3
1
CERTIFICATION #y /
PHONE # 1521a
�t •2Ls6L
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. include the road
numbers and common road names.
g
o
Carte Ciec'L ' T
lD -zn
_c
a m,
0
_ -m
— - cnz
rn,a
N —.
G
z
JELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'f . Z./ • d
tTURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REVgh, NC 1
within 30 days.

Ca:). j-e8-d.e��
272783
WELL CONSTRUCTION RECORD
d Natural Reso ces - Division o Water Qua 't - Groundwater Secti403j
North Carolina - Department of Environment
an� yya , ' Y_ {)�'►�_ CERTIFICATION #� �j�t�
WELL CONTRACTOR (INDIVIDUAL) NAME (,p�rt�nt)yLbyY� e fr K• PHONE Si �7,, � Z�
WELL CON'I'IL\CFOR COMPANY NAMEH9 L c. ttSt " "et ��, L
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
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
Topographic/Land setting
'L Count be ❑Ridge ❑Slope ❑Valley-ICHirt
y (check appropriate box)
etNC7vtli location
2. WELLLOCATIO
S. OWNER:
Address
(Street Name, Numbers, Community, Subdivision, Lot No., Zip )
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Nearest Town:
-lA {x
-rot � Code •a'�r'(7t1 Lahtude/I gItudeofwell
J cL. f,iLA- ew•�r..
s (Street or Route No.)
Z��a/`}-
�
Lit / e e t f&`( _Al Zi Code
City or Town Stale P
(_)-
Area code- Phone number
4. DATE DRILLED 3 211—o3
5. TOTAL DEPTH: I4 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i7'
7. STATIC WATER LEVEL Below Top of Casing: (DO 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 accordant with IS
9. YIELD (gpm):
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount ?
12. CASING: Wall Thickness
/� Depth Diameter or Weight/Ft. Material
From_SL_ To 5 Ft.
From To Ft.
From To Ft.
l3. GROUT: Depth .0--VAX--
From Method
From To FL
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Size Material
Depth
From To Ft.
From To Ft.
DEPTH
Frotn To
A NCAC 2C.OI1S. •1�thlh
MF,( CJ ODi ' TESTC0.1
.
LOCATION TCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 p0 HERE Y,CERTIF "1 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�i'-. CONSTRUCTION STA t ' IF. S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
r") ♦ �: :'!'1�1 . DATE
J L.. / h' r ; SIGNATURE OF PERSON CONSTRUCTING THE WELL
L Submit the original t t the ivision of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RREVgh, C
01
r 7fi b fl:yh9 .,. 919) p3-3221, within 30 days.
ASHEVIL E F LI f'.AL t. HHCE
A
0
o
n—

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division o Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\YELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if appl icable)
WELL USE (Check Applicable Box): Residential Er--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
ASSOCIATED WQ PERMIT
(if applicable)
Nearest Town: lr I \ County
2. WELL LOCATIO
V7 T is �,✓e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .eo
Address
(Street or Rowe No.) Z�
(�?i+vea✓-u-Lr— rtic_
City or Town
(_)-
Arco code- Phone number .�
4. DATE DRILLED _
5. TOTAL DEPTH: l-j-Q
6. DOES WELL REPLACE EXISTING WELL? YES O NO CY
7. STATIC WATER LEVEL Below Top of Casing: __S¢Q—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. r (yaf 1A1
9. YIELD (gpm): 4. METHOD OF TEST
10. WATER ZONES (depth): 2,Z5
I . DISINFECTION: Type Amount 7
12. CASING: Wall Thickness
/� Deptlel Diameter or Weight/Ft. Material
From-y1_- To� FL From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.�1a
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
State
Zip Code
Topoggrahic/Land setting
❑Ridge 4d51ope OValiey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
Slot Size Material
_ in,
in.
Size Material
272782
- Groundwater Sectionw3t
CERTIFICATION #t
PHONE # faltliffltiza
n �� 605,
LOCATI_ OSKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3 x^
as- pie b
t�a y
3 am
16. REMARKS:
I DO HEREBY. IFY-THATiNt3 WEtt'_ CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRIUE11I tNSTANDARD,S, AND THAIrri6, PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
��,...i DATE 11
SIGNATURE OF PERSON CONSTRUCTING THE WELL
NC
Submit the original to the Division of Water uality, Groundwater Section, 1636 Mail ScrviceCenter- Raleigh,
27699-1436 PhogaNa: (919).733-3221,within 30 ays. GWr1 REV. 07/2001

272781
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To____
From To
16. REMARKS:
1 DO H
CONS
Submit the
27699-I636
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division 2 Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V
WELL CONTRACTOR COMPANY NAME
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMIT# (if applicabie)
(if applicable) /
I. WELL USE (Check Applicable Box): Residential f3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hcat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQ `yTopographic/Land setting
Q 1!� C nt I�Q, Midge ❑Slope ❑Valley ❑Flat
Nearest Town:.h�V _ (! / e (check appropriate box)
�Z-J d Lot No.. ZipCode) l \Z$1$� Latitude/longitude of well location
(Street Name. Number ununily, Subdivisi n,
3. OWNER: - ti•
Address
City or Town Stale
Arca code- Phone number . i O
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GY
7. STATIC WATER LEVEL Below Top of Casing: —.FT• _
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface*
'Top of casing terminated attor below land surface requires a
variance in accords ce with ISA NCAC ZC .0118. t �yr �t
•
9. YIELD (gpm): METHOD OF TESTCy .S a M
- Groundwater Seej}oaci3
1
CERTIFICATION fl li1424021
Ap.� y
PHONE t a �l �1`n"�
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
From
10. WATER ZONES (depth): =.
11. DISINFECTION: Type .S .
12. CASING:
Depth
Fromn _To Ft.
From To Ft..
Ft.
Zip Code
Amount
Wall Thickness
Diameter or Wcight/Ft. Material
Material
Ft.S
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft.
Method
\
Slot Size Material
_ in,
in.
SIGNATU�LE 1
I
riginai to the Division oflWate
rlrytS-No, (949)J33-322I, within
Material
To
LOCATION H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�a-Z? 0
lt
_ c
—$,( co V (et3 a ao
rnz
mz
IV ai
F G
S CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F PERSON CONSTRUCTING THE WELL
DATE
Quality, Groundwater Section, 1636 Mail Service Center' RREVgeih, NC
GW-07 2001
days.
c_
0

WELL CONSTRUCTION RECORD
71
so
North Carolina - Department of Environment and
ur
/
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTR,ACTOR COMIPANY NAME
STATE WELL CONSTRUCTION PERM rut
I.
d t' 1 0/ Municipal/Public 0 Industrial 0 Agricultural 0
272780
(if a llicable)
WELL USE (Check Applicable Box): Rest en la
hloniloring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
ASSOCIATED WQ PERMIT
(if applicable)
Nearest
WEI.LOCATIQN 1 11County�L]l�
Nearest Town: \
d
(Street Name. Numbers. Coni
3. OWNER.
Address--Q -
Sveut or is No..lr ^
jaa
/�.� �isait
\e /V lr p�uJ
City or Town State
e
(r—o Area code- Phone
4. DATE DRILLED 7 f a
5. TOTAL DEPTH:--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FT. Q'
7. STATIC WATER LEVEL Below Top of Casing:--
(Use "-" if Above Top of Casing)
B. TOP OF CASING IS
FT. Above Land Surface'
•Top of casing Terminated nUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
METF%OD OF TES
9. YIELD (gpm): —��- Zf-�
10. WATER ZONES (depth): ------
unity. Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge 2S lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latimdc/longitude source OGPSOTopographic map
(check box)
hQ'PTH nRILDIN_G LGG
From To Fomlation Description
11. CIS
Show direction an
Amount ��- two State Roads or County Roads. Include the road
CASING:
ION: Typed-,iJ,- Wall Thickness
12. CASING: Diameter or Weight/Ft. Material numbers and common road names.
h �.
Groundwater Sec t
all /
CERTIFICATION
�I'� � _
PHONE 8 rylJv-"/%'4y
L
From_a_. To111__ Ft.
From_ To Ft.
From To Ft.
13. GROUT Depth
From To Ft.
From___ —To ------FL___'_---- Material
Diameter Slut Size 14. SCREEN: Depth in.
Ft. _in. --
From_— To Ft. in. in. _
From__ -Fo_—
15. SAND/GRAVEL PACK: Size Material
Depth
To Ft.__._.--
Fro:n_ -.—.- Ft.
Front____To
Mate Method
i nCA�,T)pSKETCH
d distance inmiles from at least
i-) 1-.),_0 Cd L vi--
Ni.; _m
a en pcenr
— cnr
sv
nN
N -+
• G
Z
16. REMARKS:
p THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
•y
CONSTRUCTION STANDA�DSM.AN, C. ` J.
��✓✓ rr�� DATE
YI. ATURE OF PERSON CONSTRUCTING THE WELL
I .
Submit the original to the II: v# n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2 699-1636 Phone No. (919) 7p3-322t, within 30 days. GW.1 REV07!2001
HiCE

272779
2. WELL LOCATIION:"'
Nearest Town: `
tSia3'
�y---
(Street Nome. Numbers. Community, Su?i
3. OWNER: ea cc. e F--
Address A t-• /.4 K
(Street or t ute No.) �� qael
r_w �,�C Xc /
Zip Code
City or Town State
(—)-��—
Area code- Phone number - r
,t DATE DRILLED ].tr
t_c)yC
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C'
7. STATIC WATER LEVEL Below tTop
se of
if Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surface'
*Top of variance c ns,ng accordat to withed t/orIS below
2C .0118. requires a� ( em66
9. YIELD (gpm): _L.. METH OF TEST +� `�
10. WATER ZONES (depth):�
Amount 7
11. DISINFECTION: Type Wall Thickness
12. CASING: — Diameter or Weight/Ft. Material
From_
CD___ Depth
t—To CIS Ft.
From To__ Ft.
From To Ft.
Depth 13. F Material
GROUT: p Ft.
FroTo
From To Ft. Material
Diameter Slot Sizc
14. SCREEN: Depth Ft. in. in.
From To
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
To
To
ASSOCIATED WQ PERMIT
(if applicable)
From
From
16. REMARKS:
Ft.
Ft.
NtFRO StAND 'it 14
SI
t li
ubmithe original to the Divisi$n
699-106. Pilnnc7N1.,(919} 733,3E}l,
Method
hkesy
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division o.Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print) •+
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(ifa licable)
WELL USE (Check Applicable
Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery
0 Heat Pump Water Injection 0 Other 0 IC Other, List Use
Topographic/Land setting
OFlat
�o.unty =L�•Cp ❑Ridge HSlope ❑Valley
Groundwater Section
CERTIFICATION IO#tL
jQS li
� %..
PHONE # sleet
L • ZLrS
(check appropriate box)
n, Lot No., Zip Code) Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLS LOG
From To Formation Description
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
i 4
Kof on.
we1k, l_ i V.. dim
t o<
rn�
�rn
rnz
rn�
O
,= L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�, M AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G
RE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REVgh, C01
wilMin 30 days.

i1
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
SLATE WELL CONSTRUCTION PERMIT#
(if a licable) . WELL USE (Check Applicable Box): Residential E / Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
DRidge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING OG
From To Formation Description
272778
WELL CONSTRUCTION RECORD
Water Qua
WELL LOCATION:
Nearest Town:
(Street Narnc. umbers. Community. Subdivision, Lot No
3. OWNER:
Address
City or Town State
Area code- Phone number at ' `
4. DATE DRILLED 1
5. TOTAL DEPTH: ' 'r
6. DOES WELL REPLACE EXISTING WELL? YES ONO Fes'
7. STATIC WATER LEVEL Below Top of Casing: _S=---------
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surface*
`Tap of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. T��I
Mk,TH�OD OF TES
9. YIELD (gpm):
10. WATER ZONES (depth):
Amount �._._--
1 1. DISINFECTION: Type —' Wall Thickness
12. CASING:
Depth Diameter or WcighUFt. Material
To .
From Ft
From_Ft
_—To To Ft.
ASSOCIATED WQ PERMIT
(if applicable)
Groundwater Sectiota0 3 t
CERTIFICATION
�#71► , ,
PHONE #
From
13. GROUT: Depth
From To
From To-
14. SCREEN: Depth
Froln To
From To
15. SAND/GRAVEL PACK: Size
Depth
From To Ft.,_
From To Ft._
Zip Code
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
Mat oria Method
slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�3 s
\NA. Q&i kite
©\A \h(CeS` 1
0 _%'u yO
ma
N --
i G
16. REMARKS
IN
RDANCE WITH 15A NCAC 2C, WELL
C ONTRU.HEREBY G[ ((T4p THAT TAND THATAS CO Y OF THIS REECORD HOAS BEEN PROVIDED TO THE WELL OWNER
GONSTkueN . sh,Ai�ls'
L Submit the original
Grin '3�7.69 1fk16CRboneNo
AS'r Isf. C)1:71_ UH ICE
[�JTZ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REVgh, C01
[phone], within 30 days.

WELL CONSTRUCTION RECORD
at*,
North Carolina - Department of Environment and Natural Reso ces - Division? Water Qua t - Groundwater Sect
ion
CERTIFICATION N3�fy�jp�T.�'7�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �� s PHONE #CA �"l-L",
WELL CON-1'RACI'OR COMPANY NAME � �.� � �
ASSOCIATED WQ PERMIT'
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
( if applicable) —/
1. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I f Other, List Use
2. WELL LOCATI
Nearest Town.
(Street Name. Numbers, Community, Subdivision,. of No., Zip Code)
3: OWNER:
Address ti
City or Town
(Street or Route No.)
1
State
(—)-
Area code- Phone number
4. DATE DRILLED
5 TOTAL DEPTH:
O
Zip Code
Topograyhie/Land setting
O ❑Ridge Mope ❑Valley 0Flat
(check appropriate box)
ti fl3▪ ' 1 Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YENO (7'
FT.
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. I��*
9. YIELD (gpm): _ METHOD OF TEST.I I O11��br
10. WATER ZONES (depth): \ a
II. DISINFECTION: Type
12. CASING:
From
Depth n,
To G 1 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
:I pc! HEREt3y CEIt7`Ih
rpc!
T10N sT
Diameter
Amount
Wall Thickness
or Weight/Ft. Material
Material Method
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft
Ft.
272776
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
IR"z3
F't4+ C-rce SC-
•
tAetect 'di C'IGzm
--Fj`CaWK Q V4 r
O
w
`Ftt S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e `
$j; NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the orig'nal to theiDivis on of Water Quality, Groundwater Section, 1636 Mail Service Cennnterf REVgh, C01
27699-1 36 I'hon :No. (711J'733-3221, within 30 days.

North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (ICOMPANY NA(print) '�� me_
tl�,
WELL CONI'I2AC1'OR COMPANY NAME ,' 1 V )
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential fiY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL L LOCATI
WELL CONSTRUCTION RECORD 27 2 t7 7 5
Water Qua�iy - Groundwater Sectlop „Ur+31
CERTIFICATION tr7 ten
ME (prm[
• PHONE # t7s �•�""3
ASSOCIATED WQ PERM iTtr
o 1t -2126
(if applicable)
t _ v �c V Count Qti�
:_ ?�'%
�l5 2SuKNearest Town
�1f►cA
tic (Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
1-c tire s or Rnu - No.)
4e )P
City or Town State
( )-
Area code- Phone number �` �y
4. DATE DRILLED 1 0
r
5. TOTAL DEPTH: .30 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑OT. NO Ea'
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ` FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
Topographic/Land setting
❑Ridge ❑Slope DValley pflat
(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
Zip Code
variance in accordance with ISA NCAC 2C.o1IS. t
9. YIELD (gpm): Z.CP MET4OD OF TES Ta.1 r 1Rsituh
D
10. WATER ZONES (depth): Z.
11. DISINFECTION: Type-41b1C4
12. CASING: Diameter
Depth
From O To `t.
From To Ft.
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
Amount Z
Wall Thickness
or Weight/Ft. Material
Ft.
Material Method
FLCO,�t( )OMY
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
nnY HFUt J3Y____—.pUtFJ Y Tn AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
OYt1STItII C ON $Tq 1D , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IV
se
Submit the original to t
L27L911636 Phone Na
SIGNA
RE OF PERSON CONSTRUCTING THE WELL DATE
e Di ision of Water Quality, Groundwater Section, 1636 Mail Service Cee'nW-r -I RREV. 07 2001
eigh, NC
) 733 3221, within 30 days.
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272 596
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater ry Section
�Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Aennetth .4leeriCERTIFICATION C220_1}
WELL CONTRACTOR COMPANY NAME
KerlArel/Ond R(rxp PHONE #2.01 )6 /'7Z4-
3
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PER.\IIT#
(if applicable) _ (if applicable)
1. WELL USE (Check Applicable Box): Residential tr Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQN:
she vine CountyEe.( inybe
Nearest Town:
(Street NCommunity, Subdivision, Lot No., Zip Code)
3. OWNER: EfC/l\l Wes
Address ?O ROX lyZO
(Street or Route No.)
Tisgah- Forest /\1c
tyo Town State
lam)- 466- 75 to cf
28768
Zip Code
Area code- Phone number
4. DATE DRILLED -2 -03
5. TOTAL DEPTH: 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: IQ r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ' 3P FT. Above Land Surface*
*Lop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
n
9. YIELD (gpm): if O METHOD OF TEST T %1led
10. WATER ZONES (depth):
-ay pump in,.Sf1k11er
11. DISINFECTION: Type
12. CASING:
Depth Dian'eter
From 0 To 50 Ft. (01/2
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
La'ii: do/!ongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
Fri
LOCATION SKETCH
W
m�
CI
•-•-t
0
z
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
Tit— on 1200 Wiggi lS P.OL ^ jQ Tf1Io rr).
end©fWIQo,IHs, 1/L•�, Ito in. Pass
+2;riraaµ>atj Ba&/sf ChAir4-i .2
J on
R.; yew Rol C''o Vim. 4D encL- of-tLhe.
eaveme4 around_ Cemetere . C?ros..s
Rs -tracks oLn-d T/L -go 1/z m . on
new gravel road— steel bride- one
Zane. -T•/L . Small k.ouse &Look
3©x�d-o.
S_w_22,) Jdcc_ Goo( Enka_ 'Plant 90 5$om.oK14-23
13. GROUT: Depth �n7 Material
From 0 To o?O Ft. (1 Or1Crete-
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:
Method,
rtP
Slot Size Materiai
in.
in.
Material
BY CERTIFY THAT
:TI V STPNDAIYr5s r+,N
,!II II
SuU„4rt AI ti oryd`±i*�1-augft�r�4cDiision
1`di°+ro''1-TWQ Uri '322221
VELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/� (y"L.AIt
4TURE OF PERSON CONSTRUCTING TH WELL DATE
of Water Quality, Ground itillter Scction, 1636 Mail Scrvice Center - Raleigh, NC
Nithin 30 days. GW-I REV. 07/2001

2-, /
Zip Code
�ji (- 25?-I ( 7 /
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (plot) �,!I� c'
WELL CONTRACTOR COMPANY NAME_
RF.USEN CALDWELL DRILLING, INC.
273173
- Groundwater Section
CERTIFICATION N Sn 7 -
PHONECR8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. 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
2. WELL LOCATIO
N )re t Tgwn:
County I /lL9uc
(Street Name, Nu bets, Canmunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address /,
(Strat a, R5No.)
City or Town Stare
d Afcode- Phone number
4. DATE DRILLED �i<-/—o 7 4- 3 5. TOTAL DEPTH: 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: K0 FT.
(Use "4.- if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface
*Top of cuing termlu.ted at/or below land surface require a
variance In Recordenffe vela ISA NCAC 2C .0118.
9. YIELD (gpm): /5 METHO,p�OFTEST
10. WATER ZONES (depth): /( nit/ /%i 'J
11. DISINFECTION: Type
12. CASING:
Depth
From '/' ( To /D 5
From To
From To
13. GROUT: Depth
From 10 To 2C�
From To Ft
i /it Amount qi & .
Wall Thickness
�"'�ter or Weight/Ft. M terial
Ft. h'� 4��'2/ /'TIC
Ft.
Ft.
Material
Ft. �i
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)
DEP
TH DRILLING LOG
From To Formation �Descyiption
70
0o
7r7
Meth
Per
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To F
From
16. RE Jr.MARIIKS:
I I �)I WO HEREBEI CERTIFY 111
THIS WELL WAS CO STRUCTED IN CCORDANCE WITH l5A NCAC 2C, WELL
CONS IRUL I ION h I ANg.))' S, AND THAT,',(�C OF TH CN/•1HAS BEEN PROVIDED TO TUB WELL OWNER
Sire Material
LOCATION SKETCH o ;';
Show direction and distance in miles fromjit,`easf_,
two State Roads or County Roads. Include,
numbers and common road names.
ern
a
N a
z
t.
To Ft.
p�
SIGNA
OF P ON CONSTRUCTING THE WELL DATE
` (3ttbmtt theartgIa tt?-the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
„; 27(j89+1'63619(rope N6,'1,9A9) 733-3221, within 30 days. GW-1 REV. 07/2001

273094
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu al Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEE(print) ] r do�,--t, "'LC r!_ CERTIFICATIONO# 364 /
WELL CONTRACTOR COMPANY NANIE �-YC en2-/ Ba 2 Jo., /el )J -� i4 me Jtic .PHONE # (ryay 4,��-�319d
,Y/ STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 131- 1unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Tawn:
County Si f vntCrn er
�sl r-tt�� L'Ire/At-r �,.;
(Street Name, Numbers,AC mmunity, Subdivision, Lot No., Zip Code)
3. OWNER:
G
Address % D,j d�E </�� %'�-, Re
/s r (Street yyr Route No,)
F Ur j/I x/e 2&2(p
City or Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED 3 - ) o -- 3
5. TOTAL DEPTH: 1/06
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f
7. STATIC WATER LEVEL Below Top of Casing: .50 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 (pm): 1 o METHOD OF TEST rS •
10. WATER ZONES (depth): 2 Si S ' - S p t„
85' pm
1l. DISINFECTION: Type %--i-T/-/ An�unt /o %
Wall Thickness
12. CASING:
From a
Depth
To 9 it Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material ,_t.
From 0 To ,-2 D Ft. (v ,tv c,u—1
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.
Diameter or WeightiFt. Material
le rr
i 1/ ('
ethod
topographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees. minute /seconds)
Latitudedon_itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To I Formation Description
95i1/05' /-4
i
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
t-4
,16• -REMARKS:
i-'tr9 DO)H RE&Y CC12TIFY
EICTIION STA.N
pMI THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS 1 N PROVIDED TO THE WELL OWNER
{_Submit the original to_ lie Dt
9-1636 Phone No. (919) 73:
ASn i
SIGNATURE OF PERSON CONSTRUCTING T
y—Se)-L
ELL DATE
vision of Water Quality, Groundwater Section, 163o Mail Set", ice Center- Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
O
O
.
C_ 73
371
` -▪ s
ter
rn
to
rna
n
G
z

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): `�i METHOD OF TEST cZ k r
10. WATER ZONES (depth): SOS ' - S p m
Topographic/Land setting
DRidge ❑Slope OValley Flat
(check appropriate box)
Latitude/longitude of well location
Wccrcc>minutcsiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
Sk' 'foS'
11. DISINFECTION: Type 1-4 T \-I Amount Lo'1
12. CASING:
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ii - I -
5. TOTAL DEPTH: tl-DS ,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO F_
7. STATIC WATER LEVEL Below Top of Casing: 'i-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS
WELL CONSTRUCTION RECORD
: North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
CERTIFICATION r 1
WELL CONTRACTOR COMPANY NAME` Yrf e n 13: a>. \ta p PHONE # (62t !., 4 d - 3 k "1 C
STATE WELL CONSTRUCTION PERMIT# 14- b a. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IfOther, List Use
2. WELL LOCATIO ..
Neat Town: County U i ��'i L
bcowtvc 11-'Yrt �DCS{I
(Street Name, Numbers, Community, Subdivision, dot No.. Zip Code)
3. OWNER:e,t //_V t et 'rein \) .-k
Address .1 1 l Lo C a'. I I r 4-o-,- Q)
�(-1.' t pr Route Na.) o
h�xll�_' tit, �J C� a t3 � '� '�
City or Town State
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To .Sire Ft. Lo 't
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To .D Ft. (' Q.w.n ..•}
From To Ft.
14, SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
b,'n L3e.1h
Material
PUC-.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
Ft.
Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THI
CONSTRUCTION STANpgttDS, A
/�t
-/,t.? v0
273074
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L. ti V
L WAS CONSTRUCTED IN
iTHtAT A COPY OF THIS RECO
•
SIG ATUItE OF PERSON CONSTRUC
Did
Submit the original to the Dlvisio of WOK (r2R81 Y (Gi'otinjh r{b'r Sre ion, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
A
DANCE WITH I5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
y-3o-n
f+C WELL DATE
GW-1 REV. 07/2001
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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) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STA I F. WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FAIRVIEW
SMITH KNOLES RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TERRY DUFFY
Address SMITH KNOLES RD.
(Street or Route No.)
FAIRVIEW NC
City or Town State Zip Code
(828) — 625-1997
Area Code Phone number
4. DATE DRILLED 04/17/03
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
County BUNC
11. DISINFECTION: Type CHLORYTE Amount 16.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR.21 PVC
From _ To _ Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From To _ Ft. _ in. in.
From _ To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
16. REMARKS:
Size Material
Ft.
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A.W FROM LAKE LURE. TAKE
HWY. #74 T BAT CAVE. APPROX. 8 MILES. LEFT
ON SMITH KNOLES RD. 1ST PAVED DR. ON RT.
PAST OLD CHICKEN HOUSE. 1/10 MILE ON RT.
O
ca
3
IV
w
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PR
CONSTRUCTING THE WELL 1 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-1-12EEi:OW2Q9}
P� hEG ./VL CH10E

WELL CONSTRUCTION RECORD
North Carolina - Department of Envir tnment and Natural Resources - Division of Water Quality - Groundwater Sectior
WELL CONTRACTOR (INDIVIDUAL) NA ME (print) lit trICV- 4. Sawy4rh CERTIFICATION Y. a43to
WELL CONTRACTOR COMPANY ty't}&NTF ` Sctta>re635. a n s-at 11dP;ti ♦AC. PHONE #(Sera a-Ige Ir
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
imis(—t
if applicable) (ifapplicable)
1. WELL USE (Check Applicable Br 0: Residential 4a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Hea: Pump Water Injection 0 Other 0 If Other, List/Use
2. WELL LOCATION:
Nearest Town: 0e.0.verV:Ite County Quh:..e.mb¢
f eenns Ctere.0 1(1-< +.:; c.. h. i7:2
(Street Name. Numbers. Community. Subd L-tt No.. Zip Code)
3. OWNER: 4dR 14nderac�n_ C3;,;Idett
Address po Co X 135d
(Street or Route No.)
t.&aver v:Ile
City or Town State Zip Code
(2)- (Oslo" oVota
Area code- Phone number
4. DATE DRILLED Co-b-o3
5. -TOTAL DEPTH: 306
6. DOES WELL REPLACE_EX(STING WELL? YES ❑ NO LtI
276000
Topographic/Land setting
❑Ridge Si1Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitud^/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Descripl on
Kv1 Glt4f i3 efa in
cS'i
3c5 Sr Co": e
7. STATIC WATER LEVEL Below' -op of Casing: 10, FT.
(U tit "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below Is rd surface requires a
variance in accordance with ISA NCAC 2C .0118. q
9. YIELD (gpm): 2e METHCD OF TEST %.
10. WATER ZONES (depth):
11. DISINFECTION: Type VI Amount
Wall Thickness
Dia; reter or Weight/Ft. Material
tt $t II 131 eCyl e
Ft.
Ft.
12. CASING:
Depth
From ir1 To Wi
From To
From To
13. GROUT: Depth
14
D I aerial
From 0 To at) Ft. C.'_fntnt
From To Ft.
SCREEN: Depth Diamcr:r
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Si:
From To Ft.
From To Ft.
16.REMARKS:
Method
�aUca.d
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show c irection and distance in miles from at lea it
two Stz to Roads or County Roads. Include then 'ail
numbet s and common road names. W
r-
r/ TS
1.1 DP HEREiY GPRTIFY
CONST .t1QI�-8AP1; ��)1
')', I� �i� %lLaxLf �o (0 5-o3
i II
tit
SuitDltthe .oripin:a 7ts-ihe Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
t/9699-1636 Yltotye lVv 101'9) 733t-3221, wSthin 30 days. GW-I REV. 07/2001
THIS WI LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND T -1AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RRa
SIGNAL LIRE OF PE ON CONSTRUCTING THE WELL DATE

W ELL CONSTRUCTION RECORD 276080
North Carolina - Department of Enviranment and Natural Resources - Division of Water Quality - Groundwater Sectior
WELL CONTRACTOR (INDIVIDUAL)NAME (print) ltt tr: Clot Ti. 1GWy¢F"S CERTIFICATION# a436
WELL CONTRACTOR COMPANY h;AME el* SQa» tr Cp Saw N♦• 11 dS101: �j9 rAC'. PHONE # (gLcm a-Z(eSY
STATE WELL CONSTRUCTION PERMIT E ASSOCIATED WQ PERMIT#
(t
if applicable) (if ap4cable)
1. WELL USE (Check Applicable Bc ;:): Residential 6d Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 He. Pump Water Injection 0 Other 0 If Other, ListUse
2. WELL LOCATION:
Nearest Town: c:Ni cv;1\t County --k%wncc.tvtj,,,
Ooze C ceeIe r
(Street Name. Numbers. Community. Subd •ision,lot No.. Zip Code)
3. OWNER: 'Penal ^R•,de: sc•� Q.+:1de.+•.�
Address Pc (sex' a13$
(Street or Route No.)
WCc..\tecv:t\e V1C-
City or Town State Zip Code
(gets)-- ( 54- Darla
Area code- Phone number
4. DATE DRILLED (p• Y' O
5. -TOTAL DEPTH: 33:i
6- DOES WELL REPLACE EXISTING WELL? YES 0 NO 7P
7. STATIC WATER LEVEL Below Top of Casing: inOFT.
- (U "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below Ir r d surface requires a
variance in accordance with 15A NCAC ;C .0118.
9. YIELD (gpm): 10 METHt)D OF TEST R' 5
10. WATER ZONES (depth):
Tdpographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
■IS
(degrees/minutes/se:ends)
Latitud-:/longitude source:❑GPS❑Topographic nap
(cheer. box)
DEPTH DRILLING LOG
From To Formation Description
SsS otec 3etZan
_325 3%.5 {r ee.e.1
11. DISINFECTION: Type 'a3S Amount g
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From *1 To S5 Ft.___L2T -L— it .2i ines4-:t
From To Ft. _
From To Ft.
13. GROUT: Depth h tAerial Method
From 0 To ac5 Ft. C tnient CUCa.ci
From To Ft.
14. SCREEN: Depth Diamc for Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Si: e Material
From To Ft.
From To Ft.
16. REMARKS:
I H} I 11- 1 fib HERESY C£RTIE
1 CONSTRUCTIA
STAi
I1'
ICJ
LOCATION SKETCH
Show c irection and distance in miles from at lea;t
two State Roads or County Roads. Inclale then ad
numbers and common road nacres.
a
0
Cfl
- THIS WI'a WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND T -IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/a only
SIGNATURE OF PERSV CONSTRUCTING THE WELL
io- H•03
DATE
Sutemitthe originhLtothe D vision of `Hater Quality, Groundwater Section, 1636 Mail Seniee Center -Raleigh, NC
27699-1636rPftnne_Isli4419}73. -3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION REC ORD
le orth Carolina - Department of Envirenn:ent and Natural Resources - Division of Water Quality - Groundwater Sectior
s 'EI.L CONTRACTOR (INDIVIDUAL) NA ME (print) (e_tr'cK H. 10.3.441e.d'A CERTIFICATION Y. a43L
.,.? sne- PHONE# (rtn ass -24sir
�
x'ELL CO\"r R.\CIOR COMPANY pFAhTE ��" Sore/GSA a'S'n sae 11 r
IV'
0
5 FATE WELL CO' STRUCTION PERMIT 4 ASSOCIATED W PERMIT:
(if apTlicable) _ manusisin (if app1ic 51e) lams
lel
I. WELL USE (Check Applicable Br::): Residential 6Q Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heil Pimp Water Injection 0 Other 0 If C ther, List/Use
2 WELL, LOCATION:.
Nearest Town. gt5ile J: \fi r' County 0 t
v 2.,- C cvt e ( ccx -Se*.
(Street Name. Nu.nbers, Community. Subd',ision, Lot No., Zip Code)
3 OWNER: pAtci ('cc-r .ct< els:1S"t ra. c+:a va
Address Pt) ;3Ciir jn2P
(Street or Route No.)
ilic-c_i< AAty\ .vr` Q87 It
Zip Code
City or To*;n State
So-S)- Lcc-C: `01433
Arca code- Phone number
4 DATE DRILLED 5- a7-03---
5 -TOTAL DEPTH: 105 __-
6 DOES WELL REPLACE_EXISTIIiG WELL? YES ❑ NO ig
7 STATIC WATER LEVEL Below "-op of Casing: /fit FT.
(U >"t " if Above Top of Casing)
8 TOP OF CASING IS i ET. Above Land Surface'
*Top of casing terminated at/or below lard surface requires a
variance in accog dance with ISA NCAC :C .01I8.
9 YIELD (gpm). 4 METHCD OF TEST
IC WATER ZON'I S (depth):
276085
Tipographic/L�an�dd setting
❑I:idge DSlope I.ailey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/sesends)
Latitude:/Ir ngitude source:❑GPS❑Topographic nap
(check box)
DEPT DRILLING LOG
From To Fomnation Descript on
5
11 DISINFECTION: Type ill
12 CASING:
Depth
From % To `15
From To
From To
13 GROUT: Depth
From 0 To a0
From
14 SCREEN:
From
From
Amount %
Wall Thickness
Dia: retc r or Weight/Ft. Material
Ft.�e:L # ig�:e
Ft.
Ft.
h I de "ial
Ft. C talent
To Ft.
Depth Diamct,r Slot Size Material
To Ft. it.. in.
To Ft. it.. in.
Method,
01I.r o.q
15 SAND/GRAVGLPACK:
Depth Si: e Material
From To Ft.
From To Ft.
16 REMARKS:
�— 1,C0ii Ef�EBY'Cfk_d(T
., C�tatSTR>;tGF-}0id-Sf
LOCATION SKETCH
Show cire :tion and distance in miles from at lea ;t
two Stzte Toads or County Roads. Include theFi al
numbe; s aid common road names. n
S
0
rT
AT THIS WI.LL WAS CONSTRUCTED IN ACCORDANCI WITH I5A NCAC 2C, WELL
DS, AND T:+AT A COPY OF THIS RECORD HAS BELN ::"ROVIDED TO THE WELL OWNER
5 2.7"ca
SIGNAT UR:i OP PERSON CONSTRUCTING THE WE LL DATE
i ^StrarnttI ,,.(�>P,n to [h t Division of SNater Quality, Groundwater Section, 16: 6 Mail Service Center - Raleigh, NC
t x7��%99,�b p�iorti¢ tug{[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 Sectior
WELL CONTRACTOR (INDIVIDUAL) NA ME(print) e' tic 14. :coda V.*,
WELL CONTRACTOR COMPANY 4AME 011ie is S• n N tlldo:r�? +4C•
STATE WELL CONSTRUCTION PERMIT = 0 ASSOCIATED li'Q PERMITS
(if apius plicable) 1 (if appEcable)
I. WELL USE (Check Applicable By :): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Hot: Pump Water Injection 0 Other ❑ l f Other, List/Use
276083
CERTIFICATIONS a 36
PHONES (SfL9 a5S-7Sc Sk;
2. WELL LOCATION:
Nearest Town: ASN,ev:1\e County lgunco•x't b.N
Sac 0t.a”A0`'i
(Street Name. Numbers. Community. Subd ' ision, Lot No.. Zip Code)
3. OWNER: Crac A.C\%Ws
Address 620 11161X e Rand
(Street or Route No.)
dokev. lie vte ,2xBoLi
City or Town State Zip Code
(2215)- R52- 1ct 30
Area code- Phone number
4. DATE DRILLED (pJ (� 101
5. `TOTAL DEPTH: aG 'j
6. DOES WELL REPLACE..EXLSTIIJG WELL? YES ❑ NO 1P
7. STATIC WATER LEVEL Below'. -op of Casing: SO FT.
(U .: "+" if Above Top of Casing)
8. TOP OF CASING IS i I'T. Above Land Surface`
*Top of casing terminated actor below Is r d surface requires a
variance in accordance with 15A NCAC :C .0118.
9. YIELD(gpm): i•0 METH4;lt)OFTEST a;rz
10. WATER ZONES (depth): d
11 DISINFECTION: Type 3:11% Amount `6
12. CASING: Wall Thickness
Depth Dia-retcr or Weight/Ft. Material
From -:1 To 83 Ft.___t2:L M .21 Tees}:S
From To Ft.
From To Et.
13. GROUT: Depth h I Aerial Method
From 0 To ao Ft. C-'=mitnit our esa
From To Ft.
14. SCREEN: Depth Diarm t r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Si: e Material
From To Ft.
From To Ft.
16. REMARKS:
!rLD(hHE,EEt¢)i AUK
.•!CONSTI4JCT101'*T
Tdpographic/Land setting
❑Ridge iSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
SIN
(degrees/minutes/se:ends)
Latitud :/longitude source: ❑GPS❑Topographic rr ap
(check box)
DEPTH DRILLING LOG
From To Formation Descriptl. on
\ 83 c>1tec 3 ecdfn
0. to5 (r rasa,e
LOCATION SKETCH
Show c irection and distance in miles from at lea st
two Ste to Roads or County Roads. Inch than ad
numbers and common road names.
L lAT THIS WILL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rtRDS, AND T:IAT A COPY OF THIS RECORD HAS BEAN PROVIDED TO THE WELL OWNER
I 21
I.J I SIGNA1 URE OF PBR SON CONSTRUCTING THE R'ELL
Submit the originap to the Division of `Hater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699 1636Pfu r NO. [phone], w thin 30 days. GW-1 REV. 07/2001
KIS
tnI(nI0
DATE

Candler'
City or Town State
Area code- Phone number
4. DATE DRILLED 4/30/01
5. TOTAL DEPTH: 2701
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO iS
7. STATIC WATER LEVEL Below Top of Casing: 20FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 .4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 1C .01t ,
9. YIELD(gpm): 30 METHOD OF TEST rotary air
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeregly H. Bowman' CERTIFICATION 2809
WELL CONTRACTOR COMPANY NAME D Rnwmnn Wel 1 lira 111 ngr Ter PHONE # fi 28 797-7779
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
276009
1. WELL USE (Check Applicable Box): Residential CZ 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: Candler County a,, Rbe
110 Chnrt 'Maadnw Tlri va
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Richard and Robin Miller
Address 110 Short Meadow Drive
(Street or Route No,)
NC 28715
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sourcc:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
10 WATER ZONES (depth): 2 2 0 '
II. DISINF'ECTION:Type tablet
12, CASING:
Depth
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
From p roil Ft.61/8 Srh R-0 PVC'
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles fr@ID at list
two State Roads or County Roads. Incltti the:road
numbers and common road names.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LJ ,,()NCI 12(JC.1.I, N T
U7 U 11
,1
Submit the original o thf
27699-1636 Phone No (919)
%wr-an+a-r---
SIGNATURE OF PERSON CONSTRUCTING THE WELL
4 / 3r /!
DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001
M
1FR ELOiION
E h GFrl'DE

n I ; r'
1
I1 1� Ji
IIlIi
U� 'Submit the original trb`tfie
1 27699-1636 Phone No. I(919)
r SECIIGN
ASHE L Hi r riJgh\-1_ OFFICE
1J
WELL CONSTRUCTION RECORD 276008
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman . . CERTIFICATION 12809
WELL CONTRACTOR COMPANY NAME D Rnwman Wel 1 Tlri 11 ing, Tnr
PHONE # R7F1 752-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential EX 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: Leirpstr=r County Buncombe
Soloman Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: W.J. Smith
Address 259 Dix Creek Road #1
(Street or Route No,)
LeicRStpr NC 7R748
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 4/77/01
5. TOTAL DEPTH 160'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST': rotary air
10. WATER ZONES (depth): 120' 160'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitudc source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LQQ
From . To Formation Description
11. DISINFECTION: Type tablet
12, CASING:
Depth Diameter
From_a___ To 47 Ft.61/8
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
Amount 6
Wall Thickness
or Weight/Ft. Material
Srh an PVC.
Material
Method
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ft, concrete gravity flow
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slvt Size Material
in.
in.
From To Ft.
From To Ft.
0
W
c
e.0
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
74; nt.A.nAD._—_— 4/ 21 / 63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
i33-3221, within 30 days. GW-I REV. 07/2001
N

276005
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeregly H. Bowman ' - CERTIFICATION S 2809
wELL CONTRACTOR COMPANY NAME D. Rnwman We11 tlri 111ng Tnr• PHONE Y 87A 752-7779
STATE WELL CONSTRUCTION PERMITS • ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ($ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:Weavervi 1 1 e County Buncombe
Double Brook Drive Lot #5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Melinda Splain
Address 128 Bambud Tree Lane
(Street or Route No,)
Fsnrncvi,.11 a
NC' 7R714
City or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED 4/02/03
5. TOTAL DEPTH' 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 290 r FT.
(Use "+" if Above Top orCasing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .0t1S.
9. YIELD(gpm): 60 METHOD OF TEST`.•rotary air
10. WATER ZONES (depth): 1 80' 260'
300'
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 107 Ft.61 /8 Sr'h RO Pvf'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Ft in. in.
Ft. in. in.
From To
From To
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:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
L
c
r—
IV
rn
Lour:
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`fla z /5 3
ti SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LGB0 P 5ECTION
ASHEVILLE R C „L OFFICE
it
SIlibfiirthe origins
27699-1636 Phone N. (919
Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001
r

276004
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin) Jeremy H. Bowman' - CERTIFICATION 92809
wELLCONTRACTOR COMPANY NAME D Rncaman We11 nri 11 inge Tnr PHONE S R2A 252-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL. USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Weavery i11P County Buncombe
88 Double Brook Drive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Andy & Stephanie Carter
Address 88 Double Brook Drive
(Street or Route No.)
WPavPrVi11P NC 28787
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 4/01/03
5 TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I%
7. STATIC WATER LEVEL Below Top of Casing: $0Q FT.
(Use "a" it Above Top of Casinj)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .el ia,
9. YIELD(gpm): 30 METHOD OF TEST rotary air
10. WATER ZONES (depth): 1 00 r 1 40 r
II. DISINFECTION: Type tablet
12. CASING:
Depth Diameter
From 0 To 62 Ft.b1/8 Srh AO Pvr
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
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.
concrete gravity flow
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Efi bmit the original
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC.
27699-1616 Phone Nb. [phone], within 30 days. OW -I REV. 07/2001
N
GROUNDWATER SECTION
ASHEVILLE REC'iOINAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)'NAME (pilot) Jeremy H. Bowman ' - CERTIFICATION Y2809
WELL CONTRACTOR COMPANY NAMED Acumen We11 1ir1111 nqe Tnr• PHONEYfi2i1 757-7]]9
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
276003
1. WELL USE (Check Applicable Box): Residential CZ 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: Candler
21 Green Knoll Drive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Matt Borum
County Buncombe
Address 21 Green Knoll Road
(Street or Route No.)
Candler. NC 28715
City or Town State
( )-
Area code Phone number
4. DATE DRILLED S/7n/03
5. TOTAL DEPTH: Ogg'
6. DOES WELL REPLACE EXISTING WELL? YES O NO IX
7. STATIC WATER LEVEL Below Top of Casing: 1 p0 FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .01111.
9. YIELD(gpm): 5 METHOD OFTEST '=rotary air
10,WATER ZONES (depth): 300 360' 100'
Zip Code
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 90 Ft.b1/8 SCh-80 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN; Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
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 sourec:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
R. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft, in. in.
Ft. in. in.
Size
Material
0
CO
0
c-t
0
16. REMARKS:
ID() HFPFB) CFRTIF,..��3=FATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
R I� LopILTR JC" I NIT ✓i tDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S 120 I E j
Submit the original o the
21699— . (919)
GROUNL tr•LEi `HCTION
ASHEVILLE RECICtIIIL OJFICE
1A/✓1't-Piv�-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
t33.3221, within 30 days. GW•I REV. 07/2001
H

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' - CERTIFICATION S 2809
w ELL CONTRACTOR COMPANY NAME n Rnwman Wel 1 nri 111 ng, Tnr PHONES fi78 757-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
276002.
I. WELL USE (Check Applicable Box): Residential EX 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: Lairester County Buncombe
276 nix Creek Road #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Harold Hawkins
Address 276 Dix Creek Road #2
(Street or Route No.)
Lcicoster Nr
City or Town State Zip Code
28748
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitudc source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( )-
Area code. Phone number
4. DATE DRILLED S/16/03
5. TOTAL DEPTH: ppoo t
6. DOES WELL REPLXCE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OFTEST ':rotary air
10. WATER ZONES (depth): 270 e
II. DISINFECTION: Type tablet
12. CASING:
Depth Diameter
From O. To 17R Ft..61/8 S
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. concrete
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in in.
From To Ft. in. in.
Amount 6
Wall Thickness
or Weight/Ft. Material
rh RO PVC
LOCATION SKETCH
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
gravity flow
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
Ft.
Ft.
0
CO
c_
16. REMARKS:
T THIS WELL WAS CONSTRUC 1 hD IN ACCORDANCE WITH I SA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3/1u03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original t the lvision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
c(Ij(gN(919) 7 3-3221, within 30 days. GW-1 REV. 07/2001
C R 1 OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section —1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ L..L. 6 - 13-7.44 S4.1 CERTIFICATION # al t•
WELL CONTRACTOR COMPANY NAME ReSIRI `\ Cc�‘OA\ tJr',\VT\r3'inf • PHONE # (Z22)254-35 S /
275974
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential We-Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: k\a1a J LL-_( County Q.p DrnQer-
s-c PTsc CS3,, rcRet5 (L tt o c (tzt-t-'i;
(Strcct Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER:.1tt PA-e
Address 44- C7frJLLAra A nc 201�
(Street or Route No.)
ASKM ..[u t e3 ti C
dt{`6o4-
City or Town State Zip Codc
(14 j- 2,) _ q 41
4. DATE DRILLED 6/aVo 3rca code- Phone number A
5. TOTAL DEPTH: 4 3o '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 14
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF T.ST 4.16
10. WATER ZONES (depth): i%
11. DISINFECTION: Type
12. CASING:
From
From
From
13. GROUT
From
14
From
SCREEN:
From
From
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/]ongitude of well location
N3ri yu u)n4•,L`55.7—
(degrecs/minutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From�n1 e Tio /
- 7
li/- 4;c
AIL
0
Depth I?i ter
To a` a- FL (D
To Ft.
Amount Q
Wall Thickness
or Weight/Ft. Mat ��rial
Soil
To Ft.
Depth Material //1I Method
CC��
T 6' To a� Ft. C_.0,..,-e 00 0 (le CD
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Formation Description
O 1Ie2(l1/4>{1-04, r"
O
CO
L
LOCATION SKETCH e—
Show direction and distance in miles from at-teast==,..
two State Roads or County Roads. Include Ii road's
numbers . d common road names.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS ND THAT t},COPY OF THIS R ORD HAS BEEN PROVIDED TO MI E L[.•• OWNER
�E
1
ISubmifthe -original to th L:
7699-1636 Phone No. (919 733-3
r
GNATURE OF PERSON CONSTRUCTING WELL
DA
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
A
iScc06t.)—
Cs;CT!CDTTITIEP SECTION
q ' L OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (i"' (b A ), CERTIFICATION # t3\11 1
WELL CONTRACTOR COMPANY NAME RPSOCx". C ON).Wle\\ \-$.\\VC c;t 'TO C • PRONE # C3;231254 -.359 j
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: W CA ✓61\tl l `LC County 6 u,Jc o
RJ'YM ) 1LiL-LS Sv601JtS)or'
(Strcct Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PO
. S . C` A IAddress %- deo y
(Street or outs No.)
i.QU {✓fI e- AT C r;s737
City or Town State Zip Codc
(Sfl)- -\Tho— nt4
Arca code- Phonc number
4. DATE DRILLED "1/\ / O 3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO )/
7. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS - FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance pith ISA NCAC 2C .0118.
9. YIELD (gpm): a t%a METHOD OF TEST CA G A 1
10. WATER ZONES (depth): 1 b0 ' ' i G Q M -
LOCATION SKETCH
Show direction and distance in miles from 0:least(/''
two State Roads or County Roads. Include le road
ocr
numbers and common road names. .r
276199
Topo�grg�phic/Land setting
❑Ridge LU51ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N3 ` / - 696 1E08 .D.35 /3/
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
oN160-60243 E r--)
(, MN rt. E
GPn-'
DEPTII
From iToy /
a
11 $
Ss 5/-- 16 o
160
Iba'
.5Go:
3601- -'low
C; P.A .3 I T•E
11la GP Tr
G2,nNlad—
C
5. TOTAL DEPTH: 4 \ o
3 bo' — 11/a GP nr\
11. DISINFECTION: Type VA— 4 q 07c Amount .' (p •
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From .i To Q D Ft. 6I!$ Sbp.al P,IC'
From To Ft.
From To Ft.
13. GROUT: Depth Material p Method
From i To a-0 FL e-fi Me",O-i t' C VgCb
From To Ft.
14. SCREEN: Depth
From To
From To
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
erP
H J
us cc-3.3
16. REMARKS:
IDQI yEREB�}" crIATIPy
..,' Hai
L
I.
�yht{ttF
e Di'
{1p) 733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THI; WELL OWNER
aio3
SIGNATURE OF PERSON CONSTRUC LING THE WELL
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and U+htnl Rpesources
01cLle`
CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (prim)
WELL CONTRACTOR COMPANY NAME REUBEN
276198
Divisi'o+n of Water Quality - Groundwater Section
ASI, CERTIFICATION all 1
DRILLING, INC.
PHONEVf8 )254-3581
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: NSI-46‘%tt-Le, County gyAi MQ6
1-AWSzetJ 1.At3L SST iko)SQ ot. (L(Gt-4 l
(Stsew Name, Numbers,,/Community, Subdivision, Lot No., Zip Code)
3. OWNER: Fe' 1`) l— P LC LYJ
Address u
a.)SCrt 1 qtJ
(Street or Roule No.)
QS1-34t1.-cC NC-
ssxoV
(xa% j. o Town9,54- Sine bKyCo
Zip Code
Aria coda- Phone number1
4. DATE DRILLED (� / /0 3
5. TOTAL DEPTH: '3'j0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NC)
7. STATIC WATER LEVEL Below Top of Casing: lQi^ FT.
(Use -a' it Above Top of Cuing)
8. TOP OF CASING IS S. FT. Above Land Surface•
*Top of ruin termlo•ted sVor below Iced surface requlrup•
q • �7 variance In accordance with ISA NCAC IC .011a. 2I�LG ' l it-
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth): 3 i 0 /,- ao' Gp v-•
11. DISINFECTION: Type AT I♦ ci o`/
12. CASING:
Depth, i ter
From �- To s Ft.
1/8
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From i To ao Ft. C-67nkst3T PeOat; b
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 Siu Material
From To Ft.
From To - Ft.
L.a ices-reit- FL.) i
16. REMARKS:
Amount ± Ilo
Wall Thickness
or Wet t/Ft. M rial
SO4 l Pee'
TopographicfLand setting yr
❑Ridge ❑Slope ❑Valley HFlat
(check appropriate box)
Lalitudcflongitude of well location
N35'3t.7 la u)o8'i` 6 7-57
(deneahn imnesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEMI I DRILLING LOG
Frgm To / Formation Description
1 6a Jee-(svy-.A t,
@o`- 0290 CAA,/
00141Te Ito c.Ic
-210' a-c C,P/`Tc)
2ID= 330 - WNLie GE.ttc)
aqo - '31D
a
LOCATION SKETCH o _
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road `
numbers and common road names.
1/4
-�� I DO HEREBY CERTIFY,
L.! I CONS I KUCfIONSfANR
am,
j L.
i1
1_0t.45C»%) LfuJe;
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A CO Y OF'INI� C� HAS BEEN PROVIDED TO ���W��WNER
ILL SIGNATURE OF PERSON CONSTRUCTING THE THE WELL
he D'vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3221, within 3 0 days. GW-I REV. 07/2001

276197
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
&L-L\e N ASH
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME RP sib? ti\
&QQ\\ \�c�\"3�Snr_•
CERTIFICATION # 3171
PHONE # (t2$1.254 -.35 j /
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential tit MunicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery �❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:N LeJ/-,A `'�L'J n %opographic/Land setting
Nearest Town: - s'Cidr`� County '-.�cefx�`'- p{.dge ❑Slope ❑Valley ❑Flat
IL I .nC 1 €4,0 tiL 0 A b . to LeZA tJ Obs2- c_eir 01 (check appropriate box)
(Street Name Numbers, Community, Subdivision, t No., Zip Code) Latitude/longitude of well location
/ was 'go. y lb tale 'V139 7(v-1
3. OWNER: ihtl L, K/ Mait tJ C 0 y ote ( Crest. (degrees/minutes/seconds)
Address 3'1ci C ,., / o e ( �fsS i(rs V Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
)-t',iLeS-r&' C_
City or Town State
(ga5)- 1bs-E13c;
Zip Code
Arca codc- Phone number
4. DATE DRILLED 19/a 3/c.3
5. TOTAL DEPTH: S 3 o -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I1
7. STATIC WATER LEVEL Below Top of Casing: s3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS -- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): of c. METHOD2F TEST it V tL 2-
10. WATER ZONES (depth): LID - i G ern
10' - ICI CI) PO^
11. DISINFECTION: Type ftTN c107 Amount I I b .
12. CASING: Wall Thickness
Depth Diamftcr or Wei ht/Ft. Material
From To �3 FL b'(b Sii'r9-1 1110
From To Ft.
From To Ft.
13. GROUT: Depth Material Metho4,
From d- C-
To a0 Ft. evlbtLit FOJ:-L 3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DEPTH
From / To /
1 I
i0$ .7L)o
(check box)
DRILLING LOG
Formation Description , ,J
(Wet6ut&o) S*�nti6I'oCf—
C tit / WeliTe��c-L
L$+l ITe 6Zccti'/ 3 E/&Ci itC
19 C' P :12
0
C
LOCATION SKETCII a --
Show direction and distance in miles from aT- ast
two State Roads or County Roads. Include t eroaiIII
numbers and common road names. c'
o —
c
J
a
J
(IL94A/JDeiz--
Ow
16. REMARKS:
•
i 030 HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
40NSTRt3C17oN S'I AN1YAADS, AND THAT A COPY OF THIS F( -CORD HAS BEEN PROVIDED TO THE WELL OWNER
i!I �� \ o'er
"SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
S ubrgitthe vft to 1Qeivisio
27,6944636-P1;opq"e (919)i733-322
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION: •
(Street Namc, Numbers, Community, Subdkision, Lot No., Zip Codc)
3. OWNER: L.'J/I.—rc C.�;r3Stt.-2c i i Eit—>
Address / 3'l0k Y�tE C(L •. 6
(Street or Route No.)
LE) c-r N C.
276196
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(print) \\ I L-U\ e f.t\.St- CERTIFICATION #
WELL CONTRACTOR COMPANY NAME R2Ube-n esavvC\\ �'cti\�\�J �x1 PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential E MunicipatPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Nearest Town: 1 /, .�c Z_- County L3uN�-0,Ar tS E
City or Town State Zip Codc
(s(�g)-
Arca code- Phonc number -
4. DATE DRILLED b/0-4/C �3
5. TOTAL DEPTH: 3 1 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (b m FT.
(Use'•+" if Above Top of Casing)
8. TOP OF CASING IS � FT Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): Ia. METHOD OF TEST I t G — I it'
10. WATER ZONES (depth): 2b0 - t o G M--
Topographic/Lan setting
DRidge DSlope alley ❑Flat
(check appropriate box)
Latrtude/longitude tell location
3,`7' 0.33� JoB� 3�f.7�
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTI I
Frgm,, To
ti15
I&S—ab0 '
�bo-
-ajoL - 3 i o
n/ f v
11. DISINFECTION: Type tLT l{ CCOYc
12. CASING:
Depth
From 1 To IaD Ft.
From To Ft.
From To Ft.
13. GROUT:
From i.
Amount . t b
Wall Thickness
Diameter or Weight/Ft. Material
t
Depth Material , Method
To AC' Ft. (r &Mcty \ iC.'-t D
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
DRILLING LOG
Formation Description
C'n i:-2D i S�Wi �Zt
0.}.J4 s•-) t-nr- 1 W t1 i re /tt ct
(� 2r f' C': jZ t ,.j t i
CO
L
LOCATION SKETCH
Show direction and distance in miles from ataeast = �'
two State Roads or County Roads. Include tlta road`- ,�
numbers and common road names. r'
c`
r—
CG/IANfDCJZ Ito
�iAtis A2,0(x)
M
�} M
0
2
{ 9
REMAR.KS:','! f -"`,
i• StHEREBY CERTIFY THAT' THI$ WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NSTRUCTION STANDARDS, A D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
_ _ _I SIGVATURE OF PERSON CONSTRUCTING THE WELL DATE
o c i11
Suhuiit the ririgina1'to tire-flivisiWi of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

276195
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ma tura! Resouurces-�D%Lvlsion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3 f 1 r' ! ''yVV . CERTIFICATION a gl 1 i
WILL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLING, INC. ??HONKER-3?54-3581
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: " e
Nearest Town: �P ""'
Sr -
County CIAAA^eav*CI-tr
(Street Name, Numbers, Community, Subdivision, Lm No.. Zip Code)
3. OWNER: I�tC'iutQ �^
Address 70 fl • Cauca—
(Sued or Row. No.)
VLDPhee-Au\\\c We- 2.47fs7
City or Town State Zip Code
Area coda Phone number
4. DATE DRILLED ID/ai / 0
5. TOTAL DEPTH: 9-5 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use's' if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
*Top of cuing terminated at/or below had name requires a
variance In accordance with 1SA NCAC 2C .01I1.
9. YIELD (gpm): a-O METHOD OF TEST ICI
10. WATER ZONES (depth): tor) — ' Zo G F"
I I. DISINFECTION: Type AU 'le% Amount
12. CASING:
Depth Diameter
From 4- To 3 D Ft. /_ VI
From To Ft.
From To Ft.
13. GROUT: Depth
From To ao Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: t.OUe-hawa�L 1--
Wall Thickness
or Weight/Ft.
b0£31
Ib-
Material
P°
Material Method
(N,JP-6Q
Slot Size Material
in.
in.
Topographic/Land setting z
❑Ridge ❑Slope ❑Valley QFlat
(check appropriate box)
Latitude/longitude pf well location
Nei) '1, C5/ ult-)241°.-3l 1- 1
(dcyea/mim tn/wcoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
F00V4:11i,opDoscri SuW/
Ci 5 .-. 0-0 o �/ ,oLT W rl tTcc aocIL
Lo o Gt244Utz'
DEPTH
From To
5
"2eo--c 5O
w
LOCATION SKETCH
Show direction and distance in miles from atlypst ,„';.:
two State Roads or County Roads. Include ttroad. --
numbers and common road names. r-
j l HEREBY. CERTIFY THA,,rr++.7L4 WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
i �" NSTRUCrION-STANDA)ID$ YJ D THAT A COPY O 1111S RECOIU1HAS BEEN PROVIDED TO THE WE OWNER
Hsi
DATE
ATURE OF PERSON CONSTRUCTING THE WELL
U9
4TJ�
rJgnattpse>iI SU(1mlthe 0�Ivlsl2o
2769f636PHonefrf91F3-32
of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
, within 30days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural RRources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f�� \ LS t�l—\ e. e, ASld CERTIFICATION# CR11 t
WELL CONTRACTOR COMPANY NAME ?cSn •C-Aspc-�\li)'(1\\m3Tnc • PHONE # (S.29)254-.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2f'6$94
1. WELL USE (Check Applicable Box): Residential [1f Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: We A4131/-n11t 11s
?t. SA tar G1^-zW41( 4
(Street Name, Numbers, Community, Subdivision,
3. OWNER: (AA -CV( Go) vim
Address COO 5it(ty,4.or-
1 _ ((Stmc[ utc No.)
ci "oe O: L (!
�Sity or Town State Zip Code
VA)- Cot 5— l h v (o
County pbx-)(•)Co,rv'AP-
dot No., Zip Code)
Arca code- Phone number 3
4. DATE DRILLED b / I bib
5. TOTAL DEPTH: S'{-o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
7. STATIC WATER LEVEL Below Top of Casing: (DO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 9 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. nn
9. YIELD (gpm): ".3o METHOD OF TEST fLIG
10. WATER ZONES (depth): V.00 / — 1 G P M
�,' 6)01- aei Gen"11. DISINFECTION: Type ki 1 tt q D /t Amount _ i , b
12. CASING: Wall Thickness
Depth Diameter or WeighliFt. tgr'al
From To -(o Ft. (t 1% S 1 1,
From To Ft
From To Ft
13. GROUT:
From =j
Depth Material
To D-° Ft. e rNtatat
From To Ft.
Method
vJ,_)fl
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
(check appropriate box)
Latitude/longitud of well location
A.(3.5‘)IP, I "Jo8)1`l7'S(e7
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fro / To / Form tion Description
b 5 0 ed�
6.5 /.� 2o✓' GLL9 /idITe Wt((-re /c/C
aQo'
aoo'-5 to
610 /- 5¢0
at
I G1'm
G(2A,3,Te (,vrr4rr
aq c� yr
C
(Lac 1L
LOCATION SKETCH 7
Show direction and distance in miles from aast
two State Roads or County Roads. Include t roar
numbers and common road names.
r
I
r,
f
1
16. REMARKS:
)--Lc/ct Cn v e; o D
37
1 DU H>:RbBY CERTIFY( THAT IS WELL WAS CONSTRUCTED TN ACCORDANCE WITH I5A NCAC 2C, WELL
1 CO)`1ES,, 5TRUCT1bN STANDA N THAT A COPY OF TIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER/
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
L
ubmit the original to th4 Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001
:-,F30. Ptfox'c,rVP::

276193
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mantra' Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtat) S(ttYJA5 k -' CERTIFICATION Z 1
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC PHoNE4i8 - 81
ce
C
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: •
Nearest Town: We earl /!.�. County
�V I fl t 4 st e rife ,(tar else
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Nu
3. OWNER: t \OA, e /L
Address / i3 / tn.
X�
(Street or o.)
/-/ of /lc 3
City or Town Stale Zip Code
)- 77q —2-4' 7 e
EJ
Ana code. Phone number
4. DATE DRILLED .7/4 1, /63
5. TOTAL DEPTH: 3 `60
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topographic/Land setting
❑Ridge ❑Slope ❑Valleyat
(check appropriate box)
Latitude/longitude of well location
/1/4( 35f15, fo 3 i (JAR `i3 ac3
(deyea/mtnute /seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From To Formation Description
!aS
0
f/ -n - /So
7. STATIC WATER LEVEL Below Top of Casing: r, d FT. /�V 'Cr
( if Above Top of Cuing)
8. TOP OF CASING IS 1U,e'+ FT. Above Land Surface*
'Top of cuing terminated at/or below lead surface requlru a
variance In accordance with ISA NCAC 2C .0111. p •
9. YIELD (gpm): 10 METHOD QF TEST fk '
10. WATER ZONES (depth): I 0 I
1113. G 9 m
350' slit). Grp..
1 I. DISINFECTION: Type NThk 9 c 40 Amount 4- J P
12. CASING: Wall Thickness
Depth Dian)etcr or Weight/Ft. Material
From 1/ To 3o Fi. 6 ,4r >. f Rae'
From To Ft.
From To Ft.
13. GROUT: DepthMaterial / J Method
From p To h�J�v FL (`�P192 /kel�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Materiel
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
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.
II myt
HER'EEY'CEI*TIFY THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
STRUCTION STANDARD THAT A COPY OF THIS RECORD }L y$ BEEN PROVIDED TO THE WELL OWNER
•
I SIGNATURE OF PERSON Ct'�NSTRUCi')SJG HE WELL
Subitil-t,the ,orient Oahe Divislog of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
2769141636 PhbniiNl (419j503322jJ within 30 days. GW-I REV. 07/2001

3. OWNER: Lorv-• E,E/Lt-kst
Address SS \ O t-LEV' a 126 _vi 01-15
(Street or Rowe No.)
ASV1cJt xt rJ 3 Imo
City or Town Slate Zip Code
(US )- 514— 5155
(o/5/O 3
5. TOTAL DEPTH: 3) O ' 1-14n)0 DU G
Area cods Phone number
4. DATE DRILLED
6. DOES WELL REPLACE EXISTING WELL? YES E1440 0
7. STATIC WATER LEVEL Below Top of Casing: cL o FT.
(Use's' if Above Top of Casino)
8. TOP OF CASING 1S - FT. Above Land Surface*
•Top of analog terminated at/or below lad surface requires •
variants In accordancs with ISA NCAC 2C .011a. 9. YIELD (gpm): (o METHOD OF TEST e-1V ' Ai R-
10. WATER ZONES (depth): t oo - — t' U e in,
a.ao ' — 5 ee
11. DISINFECTION: Type htTM TO'/r, Amount ± t b -
12. CASING:
Depth,
From -L To 0 c Ft.
From To Ft.
From To Ft.
13. GROUT: Depth MaterialMethod
From To `I" Ft Qt6t�3
vI i PD,,(L-e0
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
Di ter or Weight/Ft. Material
6 sekaL pvc,
276192
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and U•hrnl Resources -Division of Water Quality - Groundwater Section
OrhSi-t CERTIFICATION Y a -ill
DRILLING, INC.
WILL CONTRACTOR (INDIVIDUAL) NAME (print) e I -L.%e
WELL CONTRACTOR COMPANY NAML_REUBEN CALDWELL
PHONL4%8 ?54-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ reRMrrS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential GY MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, L st Use
2. WELL LOCATION: Topographic/Land setting,,, -
Nearest Towp: LJeAJt04V _LGCounty flucuconntaG/ ,( ❑Ridge ❑Slope ❑Valley IHFIat
FIouSe- 6-iov' C&`cr`rtcL F-vl� 2EEK CNttlert 4 A)Q l-�,tr_op+i,e 6c (rLai appropriate box)
(Street Name, Nurnberg,Community, Subdivirion, Id No., Zip Code) 'ilea Zice)- tQ. Latitude/longitude54, �of well location
zte a8—(K7 /:/��'`lil% 5iSU8a4-13 55e
(degroad ntmnu)seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forn)ation Description
v J S-AuRoe,$)
DEPTH
From e To
Pr-
yr
LOCATION SKETCH O n
Show direction and distance in miles from tft?rcast,
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
'..� DOHU1CYlONERTYFILRE'1
tiOtSE l
I;LiS
`(1S WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A C Y OF THIS REC RD HAS BEEN PROVIDED TO THE WELL 0
pis,
GNATURE OF PERSON CONSTRUCTING THE WELL
DA
SubmitlhenrI Inalto thi Dlvlf
27B4011e36h?i e/4o:i HF
i$E33-3'
on of Water Quality, Groundwater Section, 1636 Mill Service Center- Raleigh, NC
21, within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divi ion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1J\4)- tt 6 OAS 4A CERTIFICATION # $C11
WELL CONTRACTOR COMPANY NAME _k)\le r. csAu Z`t1n c . PRONE # P.2025`F- 3 Sf /
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
276161
1. WELL USE (Check Applicable Box): Residential IH Mtmicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Ileat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: FA t r-t-v/ County
;j-g coi>vdT/ Ac(Le,S '+��•
(Strcct Name, Number , Community, Subdivision, Lot No., Zip Code)
3. OWNER: (R/'
Address '9 L3 i No.)
a.p� f.CiLE,S(StreetAI(�'�1Cor R3 .
C_ a `t3o
City or Town Statc Zip Code
(23S )- (0aR •-• (Q .
Arca code- Phone number b7/I 0 / o
4. DATE DRILLED ��� Due)5. TOTAL DEPTH: bit) '
6. DOES WELL REPLACE EXISTING WELL? YES h/ NO 0
7. STATIC WATER LEVEL Below Top of Casing: to 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. �7
9. YIELD (gpm): a- METHOD OF TEST 1`t
10. WATER ZONES (depth): a40' — Genn
'I 4 3o' — I Gerr
11. DISINFECTION: Type FIT( cut) Amount
12. CASING: Wall Thickness
Depth b' " Der or WlhVFi.
From To Ft. 4:Wg
From To Ft.
From To Ft.
13. GROUT:, Depth Material Method
From 1 To a0 Ft. MOOT I-p Jte0
Ivl�en�al
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.
@v,J cArnQt
Topographic/Land settin
DRidge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude o well. location -
0(35tit S1l�o :�° yap
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
DEPTH
From / To / Formation Description
— 55 i„/ezr(zoE N
5 S'- L40C2-4 rJt Tir
4- o '
0- 430'
43e'
d-Tn'— (7o'
G Prr\
C, itiq c,
er-
Ca 11-11 NP T E
LOCATION SKETCH
Show direction and distance in miles from avast
two State Roads or County Roads. Include the -road
numbers and co , on road names.
d 2g
w H i rA PE (L kD
(-1
16. REMARKS: �a11-
160 4ER sY' EKTIF? THAT 11HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
N-ST-ANDARDS, AND THAT A PY OF THIS RF,�ORD HAS BEEN PROVIDED TO THE ELL OWNER
et/ 1`W�,JV
Submit the origliwal tn.-ltle Div
AS`1-1 9E` 4 RY: �t)i94P)733-
IGNATURE OF PERSON CONSTRUCTING THE WELL
6i 03
ATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

2'76160
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na�}1ucaa1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME'1/4c' (print) C LL-Lit.; a A 5+4 CERTIFICATION # `'`� 1
WELL CONTRACTOR COMPANY NAME RQob Cr. 0.\t1yJ2-\\*S;1-Cs \Ire.)TY1 C • PHONE # (Ra l:254-'35E/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O Municipal/Public industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other If Other, List Use 0.-101,12-4•4% A.S i4
2. WELL LOCATION:O
Nearest Town: 1711,TMoft-t: 6(-EST County traTy tucorr 3(
AL.) r95 n}L-LMEIW Fee-e,
(Street Namc, N umnnnbers, Conkmunity, Subdivision, Lot No., Zip Code)
3. OWNER: t'jpyglZ 5v%lCe Good t�
Address /53D Pl-tets-eivt7. )ir -Ca.
(Street or Ry tc No.)
ge-th (lP
City or Town State Zip Codc
(f$1)- "TiCt' C�.GCS
G
g ro3
Arca codc- Phonc number •
4. DATE DRILLED 5/a l / 0 3
5. TOTAL DEPTH: 3 1 O '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Y.
7. STATIC WATER LEVEL Below Top of Casing: 4-c, FT.
(Use ••+•• if Above Top of Casing)
8. TOP OF CASING 1S .-1- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. n ! �1
9. YIELD (gpm): 35 METHOD OF TEST 1'-
10. WATER ZONES (depth): C 0 — 3 5 er''-•
11. DISINFECTION: Type 4Th4 q o-/o Amount I I b •
12. CASING: Wall Thickness
Depth Diarm�et r •
or Weight/Ft. Material
To .i.D Ft. 6 t( SOiLd-1 NO
To Ft.
From 1
From
From To Ft.
13. GROUT: Depth Material Av1ethod
From S To 61-0 Ft. `O e rA C3t ti cjiat' D
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valleys
(check appropriate box)
Latitude/lon nude o well location
#3 e o 30. $0 wJo gS ".-3 /. �3g
(degrces/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
i Formation Description
10 o v e12-602,081,2
to `- 6o'
cI C ' fat! t-rrs ace /siz4�1 i
DEPTI I
Frgm / To
=to' '35' er's
etc - 31 o Kee-47& ft,^DITC
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
co
c_
r—
r=
/jw/ //rt.Uifs.S✓raVri-.t.C"--I ::
O
W
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARFS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I O 361A1,-
Submit the original to h1`
27699-1636 Phone No.I19) 7
7E+. SECTION
ASHEVILI E ' , OFFICE
SIGNATURE OF PERSON CONSTR
THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
E
pJ
C- 9019y C)NW7

276109
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quaiito
WELL CONTRACTOR (INDIVIDUAL) NAME (print) BRy,e. Ir SAP, ;IL Li
WELL CONTRACEOR COMPANY NAME CIr'P C n one r 3/hk ll 'S Porn p rC
WQ PERMIT"
STATE wF.LL CONSTRUCTION PERMITN ASSOCIATED(if applicable)
(if applicable)
WELL USE (Check Applicable Box)'. Residential VIMunicipaL(Public ❑ Industrial id AgHeulmri 7--
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Usc
ock-Iy„ kr-
Ciry or Town State . Zip Code
.35a)- Ong- a3�3
Arta code- Phone numbcrr
4 DATE DRILLED :8 3
TOTAL DEPTH: 'jor
c DOES WELL REPLACE EXISTING WELL? YES IS -NO 0
STATIC WATER LEVEL Below Top ofCasing: 200 FT.
(Usc if Above Top of Casing)
S TOP OF CASING IS / FT. Above Land Surface'
Top of cuing terminated .Uor below land surface requires .
variance In accordance with 15A NCAC 2C .0118.
U YIELD (gpm): L METHOD OF TEST
WELL LOCATION:
Nearest Town :, G_e1r4 n County'�`'^1e R
1*CU ` IC1kL11
Stare: Name, N'umbcn, Community, Subdivision, Lot No., Zip Code)
)V.'NEB .—m w
C r t
\ ss 'aL Ianclf bikes rQ5
(Stroci or Route No
L 119
CATER ZONES (depth): 3 Z6J
DISINFECTION. Type
_ LASING:
Depth Dian ter
Fwm _L To AO Ft. r
To Ft.
o Ft
OUT Depth Material Method
From. 0 To 2.0 Ft. 51-kR[i/+ "tali 7}PoaQ
Front To Ft
4 SCREEN' Depth Diameter Slot Sizc Material
From To
Ft in in.
To Ft. in. in.
sAtslYGRAA'EL PACK'
Depth S:zc Materia)
Amount
Wall Thickness
or Weight/FL Material
tee $terl
- Grounaxeter Secusr.
CERTIFICATIONS -
PHONE
Topographic/[.and setti g
Galt dge ❑Slope ❑Valley -F!at
',check appropnaic box)
Latitudelongirdde of we; location
iL
(dcg,-ccs'n, mutes soconds)
Lat tudelon gltude source C3CiPS0Toc ograsht huts
check bcxl
DRII : LOC G
Formation Dernpsm.
if TIf
To Ft.
To Ft
PEPTH
From To
— '1 or- _S2[Ttla
LOCATION SKETCH s
Show direction and distance in miles frotit.ai ie:
two State Roads or Counn Roads. IncludS _1..„
numbers and convnon road names
7't
fRiLM ARKS.
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL I ED IN ACCORDANCE WITH ISA NCAC 2C. vA'ELL
(,TtiNSTr.d 1.07.f.64N.v ARDS A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL `�`R
4101 T
SIGNATURE OF PERSON CONSTRUCTING THE WELT.
DATE
Submit the orig t the Division of Water Quality, Groundwater Section, 1636 Nall Sersrce Center - 1ta::eigh_ yr
17699-1036 Phort e No, 919) 737-3121, within 30 days.
717
'ASHcA'"_LE Fr6i
EON
CE

276512
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeregty H. Bowman" . CERTIFICATIONS 2809
\YELL CONTRACTOR COMPANY NAME D Rnwrnnn Wel 1 i)ri 111 r7rge Tnr PHONE S R78 757=1779
STATE \YELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (ifappticable)
WELL USE (Check Applicable Box): Residential 4Y 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: Leicester County Buncombe
Newfound Road 28748
(Stree( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
•
3. OWNER: Ted Plemmons . (degrees/minutes/seconds)
Address 88 Blazing Star Drive Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
Lai nester NC 28748 DEPTH DRILLING LOG
Cry or Town State Zip Code From . To - Formation Description
( )-
Area code Phone number
4. DATE DRILLED 6/25/03
5. TOTAL DEPTH: 260'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C
9. YIELD (gpm): 30 METHOD OF TEST`. rotary air
10. WATER ZONES (depth): 200' e "'BO'
LOCATION SKETCH
11. DISINFECTION: Type tablet Amount 6 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the i0ad
Depth Diameter or Weight/Ft. Material numbers and common road names. o
r�
From 0 To 90 Ft.51 /8 Srh 80 PVC
From To Ft.-LD -
From To Ft. t
I1. GROUT: Depth Material Method -�
From 0 To 20 Ft. concrete gravity flow = � From To FL
14. SCREEN: Depth Diameter Slot Size Material O c-"'
From To Ft. in.in. r
From To Ft. in, in. 0
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
ILREBY CERI(FY—THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIQN STA BARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to
f 27699-t63e Phane-No. (9
SIGNATURE OF PERSON CONSTRUCTING THE WELL
(9/-5/03
DATE
he Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
9) 733.3221, within 30 days. GW-I REV. 07/2001
tv

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman ' - CERTIFICATION42809
WELL CONTRACTOR COMPANY NAME I) Rnwman We1 1 nri 111 ng Tnn PHONE # fi 7A 757-7779
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) - (if applicable)
276.511
WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:Lei cester County Buncombe
Newfound Road 28748
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Ted Plemmons
Address 88 Blazing Star Drive
L eicester(Strcct or Route
R>'c
28748
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED A/74/03
5. TOTAL DEPTH: 360'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ j40
7. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface+
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST.: rotary air
10. WATER ZONES (depth): 280'
300', 360'
I1. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
' (degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From . To Formation Description
Depth Diameter
From 0 To 83
From To Ft,
From To Ft.
or Weight/Ft. Material
Sr•h 30 PVC
13. GROUT: Depth Material
From 0 To 20 Ft. concrete
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To in,
in.
Method
gravity flow
Ft. in.
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the -Road
• numbers and common road names. w
r
16. REMARKS:
rr—TDiJ.FfEAEBTCERTTFY,,'I(HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I i � CONSTRUCTIONS' ANOARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to t
L__
37699tI6`33 PIt9r✓r:No. (91
r(trc
,n,
SIGNATURE OF PERSON CONSTRUCTING THE WELL
i2-4/163
DATE
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman . • CERTIFICATION F 2809
WELL CONTRACTOR COMPANY NAME n Rnwmnn wpl l Dri 11 ing Tnn PHONE s 87A 757-7779
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WQ PERMITH
(if applicable) (if applicable) .
276509
I. WELL USE (Check Applicable Box): Residential CZ Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: weavprvi 1 1 e County Buncombe
147 Longs Chapel Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Nat & Shirley Hyatt
Address 147 Lons Chapel Road
(Street or Route No.)
Wravervil l p NC 7R787
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 6/11/03
5. TOTAL DEPTH: 260'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Di
7. STATIC WATER LEVEL Below Top of Casing: 60 F'('
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 . 4 FT. Above Land Surface'
*Top of casing terminated at/or below land su r(a ce requires a
variance In accordance with ISA NCAC 2C .01I1.
9. YIELD (gpm): 120
METHOD OFTEST':rotary air
10. WATER ZONES (ept ):
180', 240'
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
' (degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From . To Formation Description
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft.F1 /8 Srh 80 PVC'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
• numbers and common road names.
0
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
O
0
r,
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
Submit the oii&a
27699-1636 Ilene N
, eivYle Ul ti ih3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
. [phone], within 30 days. GW-I REV. 07/2001
!,S'r U b,FG, LIF!iGl:

27.6 510
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION S 2809
WELL CONTRACTOR COMPANY NAME 11 FirawmA n WP11 i)ri 11 inge Tnr' PHONE # [phone]
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. W ELL USE (Check Applicable Box): Residential CZ 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:Weavervi 1 1 p County e
Ridge. Brook Estates Lot Ai1F, 28787
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Russell & Kim Schroeder
Address 35 Snowy Cove Lane
(Street or Route No.)
Black Mountain rJr 28711
City or Town State Zip Code
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
( Area code Phone number
4. DATE DRILLED 6/23/03
5.TOTAL DEPTH: 260'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO at
7. STATIC WATER LEVEL Below Top of Casing: 60' FT,
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST'L'rotary air
10. WATER ZONES (depth): 200'
gqq rr '
DISINFECTION: Type tablet 2 Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft.61 /8 Sch 80 Pvr
From To Ft.
From To Ft,
13. GROUT: Depth Matcrial Method
From 0 To 20 Ft. concrete gravity flow
• From To Ft.
4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n
0-)
'375
16. REMARKS:
-. I DO HER CERTIFY-.T-ITI AT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
1 i�i&I CONSTRUCTION ST4NRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'
/c3
7)N), 11. ;7nzrxaLP mn . l z 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original' to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27679rm3'6PIran,<:Nv. [phone], within 30 days. GW-1 REV. 07/2001
M

276506
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman'
v. ELL CONTRACTOR COMPANY NAME D
CERTIFICATION Y 2 8 0 9
Rnwman Well Drilling, Tnr PHONE S/828 757-7779
STATE 1YELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS(
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:I-pi rester County Buncombe
33 Ponrs Man's Hollow 28748
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: Jerry Justus
Address 27 Poor Man's Hollow
(Street or Route_No.)
Leicester NCN
28748
City or Town State
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
( )-
Arca code• Phone number
4 DATE DRILLED 6/02/03
5. TOTAL DEPTH: 140'
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ca
7 STATIC WATER LEVEL Below Top of Casing: 101 FT.
(Use "+" if Above Top of Cuing)
S. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top or casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9 YIELD (gpm): 50 METHOD OFTEST .rotary air
:0. WATER ZONES (depth): 1 40 I
.I. DISINFECTION: Type tablet Amount 6
,'
CASING:
Depth Diameter
From 0 To 36 FLF1/8
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
Srh 80 PVf
13. GROUT: Depth Material
From 0 To 20 Ft. concrete
LOCATION SKETCH o
Show direction and distance in miles fronjt leasn
two State Roads or County Roads. Includee road.
numbers and common road names. "t
Method
gravity flow
From To Ft.
i di SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I S. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ic. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE -
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
2'699-1636 Phone No. (919) 733-322I, 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) CrA/21 CERTIFICATIIO)N toe/ .CO
M�
WELL CONTRACTOR COM
PANY NAME Th-5'FIc' A/f L-L DIZt.LLI tt-A PHONE #(9 7241-9Sy9 STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential CY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: it Ji UI L4:- "C County
R , &zah & nk
5(J/t/Ct'fI (,-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4/0 /Q. /9/U 0t d
Topoggraa is/Land setting
DRidge Ii!'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address /? 2 elifit/L 154'e'CL+ dx!FLC Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)
Zip Code
)- '— get/E
Area code- Phone number al
4. DATE DRILLED 7'/0 3,
5. TOTAL DEPTH: (')
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ilk'
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
it (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 .OIl8. �, N
9. YIELD (gpm): 30 METHOD OF TEST
10. WATER ZONES (depth): 30 fen uti ZSO
1. DISINFECTION: Type C�(OIL,!� e Amount R 02
fet
City or Town State
12. CASING: Wall Thickness
Depth Diamett�e%j or Weieht/Ft. Material
From To ii`/ Ft. 6 %4 d c re
From To in Ft. i Pt •e-
From /2¢ To /3 / Ft. 627Y eR Q,/✓
Material Method
13. GROUT: Depth
From To
From 0 To
14. SCREEN: Depth
Ft.
From To
Ft. /';//rQ/
Diameter Slot Size
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To
16. REMARKS:
Ft.
DEPTH
From To
(check box)
DRILLING LOG
Formation Description
0 - /Zc" ---Tirca,vlai ,61/2/
/25- 2 Y
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.
it (Lk
o
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
att
S ATUI/E OrERSON CONSTRUiCTING THE WELL r�;\ DATE
Submit the original to the Division of Water Quality, Grotj� rater Section, 1636 Mail Se4icje enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. i I LiGW-I REV. 07/2001
...I L I
I
I

278293
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ^�A2y JbSI1/ee • CERTIFICATION
##o1J5
WELL CON TRACTOR COMPANY NAME -IDS&€ &iatOAndit,s4
W PHONE # ( ) 729 1r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L4••41unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION -
Nearest Town: LAW"
IQ ttn tPoiaur
(Street Name, Numberrs, Community, Subdivision,dLot No., Zip Code)
arXi 3. OWNER: t" ((� feleeeziek.
Address an upiLP%r.e.4 Rd.
/ L (Street orC No.)
(FZCity or Town S 47—SOS°, Zip Code
Area code- Phone number
4. DATE DRILLED 71 it O 3
5. TOTAL DEPTH: .,7 SS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I3-
7. STATIC WATER LEVEL Below Top ofCasing: .?O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST /9/%1
10. WATER ZONES ( epth): 02
�� ////%6!m 2 0O'
11. DISINFECTION: Type 09244c/ Amount it _L
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From To Ft.
From_0_ Tom Ft. / C' sea
FromTom Ft. �7
13. GROUT: Depth Material AldilL
.. From To Ft.
From 0 To ZQ Ft. 1yr
14. SCREEN: Depth Dia�r((eter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Material
pummel
County_ Ssee.GC e
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nameso
IJ
O !
5
1 DO HEREBY CERTIFY THAT THIS W L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RLf$ING TILE WELL „ rDA`fj.
e
SIG ATURE O P S ON CONST
Submit the original to the Division of Water Quality, Ground
27699-1636 Phone No. [phone], within 30 days.
Raleigh, NC
REV. 07/2001

278354
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ra1 Resources - Division of Water Quality - Groundwater SectionWELL CONTRACTOR (INDIVIDUAL) NAM (print)J�L� , ,.4/ /G J&A9A L.-CERTIFICATION O
WELL CONTRACTOR COMPANY NAME An) v.. s -Qdu Z Luta tk • .. s�� PHON/F,�f# Pal L VR D WO
STATE WELL CONSTRUCTION PERMIT# AVM _ASSOCIATED WQ PERMIT# 4Y.4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Pt Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest
(Street Name, Numbers, Community,
3. OWNER -I. —I-- / 1AA
Countydz
Subdivision, Lot No., Zip Code)
Address . T/ 3 _w �yrfAges Or ild
(Street or Route No.)
/Y.C. .2S4Y3
City or Town State� Zip Code
o -y ?V
Area code- Phone number
4. DATE DRILLED 53D/ .63
5. TOTAL DEPTH: t�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Air
7. STATIC WATER LEVEL Below Top of Casing: VP FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 'C FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance to accordant with 1SA NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TES{�.Gsri
10. WATER ZONES (depth): /D12
11. DISINFECTION: Type Amount OL
12. CASING: Wall Thickness
Fro m�Depth
, G � ter o Weight/Ft. terial
To
itnal
FromTo Y From To
13. GROUT: Depth
Ft.
Ft.
Ft.
Material
From_ Tom Ft. /o..,u.azi
From To Ft.
14. SCREEN: Depth Diameter
in.
From To Ft. in.
Fromo Ft.
15. SAND/GRAVEL PACK:
From Ft.
From To Ft.
Method.
�,,,LLMeyod��'
Slot Size Material
in.
in.
Size Material
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
S
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads.
numbers and common road names.
z=
m
mz
c�
cn 'o
om at least
elude the road
I DO HEREBY CERTIFY THAT THIS WEI r WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
671-114
SIGNATURE OF PERSON
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
Section, 1636 Mail Servic
3o b 3
- Raleigh, NC
1 REV. 07/2001
FON

780
WELL CONSTRUCTION RECORD `- '� r
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME rant ,,Q /�/T—
WELLCONTRACTORCOMPANYNAME A%i- - Z1X
STATE WELL CONSTRUCTION PERMITS,
(if applicable)
Resources - Division of Water Quality - Groundwater Section
CERTIFICATIONOS, t1L D 7ram
.� .r .c(t' PHJONE JI (ia G U9-IO yd S
H 1cSOCIATED WQ PERMrru !v/iQ
(if applicable)
1. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearer( Town:
NJN4,24i
(Street Name, Numbers, Comm
3. OWNER: 2/ c&
Address jp
(Street or Route No.)
-gatf
cOSt ,l n.
vision, Lot No., Tip Code)
4V,1
2r7YR'
City or Town State Zip Code
Am code- Phone number
4. DATE DRILLED S/JD In 3
5. TOTAL DEPTH: / S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pir
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in 0. WATER ZONES accord a with 1SA NCAC 2C .0118.
THOD O TEST
1 (depth): ep ) ///o
YIELD
9. (gpm): : [OD l 5'
SIGNATURE OF PERSON COt Utmwgt THE
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
11. DISINFECTION: Type
12. CASING:
epth Diameter
FromTDo taD Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
Frorn To T% Ft.
From To Ft
14. SCREEN: Depth
Diameter
Fro o Ft in.
Fro To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From Ts�_ Ft.
Fro o Ft.
Topographic/Land setting
❑Ridge PliSlope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Amount
Wall Thickness
or Weight/Ftrial
V rC
Slot Size Material
in.
in.
16. REMARKS:
Show direction and distant
two State Roads or County
numbers and common ro
Lase
-r
N
7.0
m miles fro at least
oads. Luck yShe kgtcl
names.
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
dial/ �r,2a/z.3
er Section, 1636 Mail
DATE
enter - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and I n ra1 Resources - Division of Water Quality - Grotmdwater Section 7 WELL CONTRACTOR (INDIVIDUAL) NAM (min CERTIFICATION
4/4//e ./1�L CERTIFIC/A.T,IIOON�a&7
WELL CONTRACTOR COMPANY NAME ,o,r.tle r.t., 1. Ll4� ,fd�_ PHONE lit &, (Il W-oS/€U
STATE WELL CONSTRUCTION PERMIT# /t//4 ASSOCIATED WQ ERMIT# /y/Hj
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential W. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO.p.
Nearest T� Corn
/4-.•
(Street Name, Numbers, Community, Subdivision., Lot No, Zip Code)
3. OWNER: ' . rrsw y %?-.L.c /S _
Address i5" 3 / .�S.tltie� j.G[i�e.9� V.Qa
(Street or Rome No.)
Gtieaulu 24€4 y, e ,
City or Town State Zip Code
Arta code- Phone number
4. DATE DRILLED vr7/57�3
5. TOTAL DEPTH: /ea-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R
7. STATIC WATER LEVEL Below Top of Casing: it' 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /...5"." FT. Above Land Surface*
'Top of using terminated at/or below land surface requires a
variance in aemrdancs with ISA NCAC 2C .0118.
9. YIELD (gpm): to 0 METHOD OF TEST—raw'
EST—ra r'
10. WATER ZONES (depth): / 5/h
arsy
11. DISINFECTION: Type j2#e
12. CASING:
Depth
From To /D 0 Ft.
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To t.20 Ft.
From To
14. SCREEN: Depth
Fro oFt. in
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To
From Ft.
�To Ft.
iatneter
Amount Ste- OL
Wall Thickness /
or Weight/Ft n,,v^ial
t#v�/
MateP1T7tal �(
Ft.
Method
Lab/ /Sty
Slot Size Material
in.
in.
16. REMARKS-
Diameter
Topographic/Land setting
iltRidge 0Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
n? ma
LOCATION SKETCH tv —'
Show direction and distance in miles from at leg
two State Roads or County Roads. Include the road
numbers and common mad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND3HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CON ATE
Submit the original to the Division of Water Quality, Gro
27699-1636 Phone No. [phone], within 30 days.
ter Section, 1636 Mail Se
er - Raleigh, NC
W-1 REV. 07/2001

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH.N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 8it.jCtM_ al'E7'��
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
(p} STATE WELL CONSTRUCTION .(74 e) .2-
DRILLER REGISTRATION NUMBER O. PERMIT NUMBER:
1. WELL LOCATION: (Show etch of th I cation below)
NeargTown: County:/O,YL.(' J
( Depth DRILLING LOG
(Road, Co unity or ubdivision and t, t No.)
2. OWNER %1 AUL) (^y
ADDRESS / 9 e{ ` M M.
CaaCaI tr8Qt fute No,),: W 7 18
City or Town / State „ Zip Code
3. DATE DRILLED 7-a/ i-63 USE OF WELL hi -4414 Lrdi AL
4. TOTAL DEPTH 3LOS 1 CUTTINGS COLLECTED [1]Yes VI -No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes lfi1{{No
6. STATIC WATER LEVEL: aG FT ❑ above TOP OF CASING,
TOP OF CASING IS / FT ABOVVE elow LAND SURFACE.
7. YIELD (gpm): /00 r METHODTOF TEST r11 nTS
8. WATER ZONES (depth): a t1 6 I 6 U 3 pcn
9. CHLORINATION: Type iltT71 Amount q 1 44, I+
10. CASING:
Wall Thickness
Depth /y Diameter or Weight/Ft. Material
From e�i To 7J Ft ZZ " P tic!
From To Ft
From To Ft.
11. GROUT: �ho
Depth ( Material )) Me /
d
From � To -20 Ft. i7t.P 1�Art7
From To FL
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
From To Formation Description
i 73
73 ' 3DS'
If additional space is needed use back of form,
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
c
b
W
CI)rn c^'
-n c
1 of
CO >m
>o
a m�
m
nz
o m7d
N
LROiU:e[,`:".'F.:;ER, SECTION
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS B EN P DED TO THE WELL OWNE�1,
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

City or Town /State
3. DATE DRILLED / -3I -t3 USE OF WELL
4. TOTAL DEPTH / a S r CUTTINGS COLLECTED ❑ Yes
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes .No
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
WELL. CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER c2 N / g
27 8 5 8 9FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
1c14.41
(Road, ComfrtyLr>4)ty, or Subdiviaton and Lot No.)
2. OWNER Nj_V9�y�- 1� �'-�
ADDRESS ca(5 42 ,LS- 1-4
(Street or R to No.) 71 1 1 1
I�] r i��i.yt '(1(�'
Zip Code
6. STATIC WATER LEVEL: 1 p FT 0 above TOP OF CASING,
below
TOP OF CASING IS FT A OVE LAND SURFACE.
7. YIELD (gpm): l Ob METHOD OF TEST a 1v'rs
8. WATER ZONES (depth): I ED5 ) - i o 6 cep M
9. CHLORINATION:
10. CASING:
Type HTla Amount lb `%11444
Wall Thickness
Depth Diameter or Weight/Ft. terial LOCATION SKETCH
From 0 To Ft 40
!! (Show direction and distance from at least two State Roads,
From To Ft or other map reference points)
c
From To Ft 0 pGO
n
11. GROUT: tTi cn9
Depth ,L Material Method -p _cm
w1n /1
From 0 To �lr Ft. l D,11L4 .>t ,1�) aD 0'<
>0
rn
A From To Ft. y'
rn
S =frr
12. SCREEN: O mz
Diameter Slot Size Material T.SIy
N c�
Ft. in. in. Z
County:
Depth
awn
DRILLING LOG
From To Formation Description
6 &D'h�t�
se) t_t
Depth
From To
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
If additional space is needed use back of form.
S': ILv1L1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEE PR \0...V5)ED;IV WELL OWNER.
SIGNATURE OF CONTRACTOR OR AGENT
WELL CONSTRUCTION
DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
Rob,r1 LC/c 6 h
DRILLER REGISTRATION NUMBER
aye 8
278
FOR OFFICE USE ONLY
$No. Serial No.
Lat Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION .�.
iv0
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
NearesClTown: , Chon ,M_
(Road. Community, or Subdivision and Lot No.)
(Street or Route No.)
a�� 2� ,) /c! C 2 g 7 / 6City or Town State Zip Codeo
3. DATE DRILLED 1-3/-b3 USE OF WELL po_Aic1rsr-1 it,e
4. TOTAL DEPTH '/OS' CUTTINGS COLLECTED Ell Yes gNo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes ViNo
2. OWNER
ADDRESS
County: CZa
Depth DRILLING LOG
From To Formation Description
6 a/ '
a/'VIS' �aa(
6. STATIC WATER LEVEL:
TOP OF CASING IS
7. YIELD (02m): a
8. WATER ZONES (depth):
9. CHLORINATION: Type
10. CASING:
From
From
From
11. GROUT:
FT. ❑ above TOP OF CASING,
below
FT ABOVE LAND SURFACE.
METHOD OF TEST r S
30.5 — alp+^eN
/-f rig Amount '% ! + 61+5
Depth To a
To
To
Wall Thickness
Diameter or Weight/Ft. Material
Ft /r
Ft
Ft.
Depth4 Material
From 0 To 4�t C U Ft. ( n' D.N � }�i
From To Ft.
12. SCREEN:
Depth
From To Ft. in. in.
From To Ft. in, in.
From To Ft in. in.
13. GRAVEL PACK:
P V C,
Method
Diameter Slot Size Material
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
a
O
C/1
IN)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 20 WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEE PROVI E TO THE WELL OWNER. f �\ G, j
SIGNATURE OF CONTRACTOR OR AGENT 7"" DATE C
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy•to well owner.

277872
a uNEJf.IA ER sEC 'ON
Na )Lr tfl[GIDpi:i •u. •• • ironmcntand *1• rural Resources^Division of Water Quality - GroundwaterSectionWELL CONTRACTOR (INDIVIDUAL) NAME (pr1.1) �!r , r- �. �'!J CERTIFICATION / . o7 /
WELCONTRACTOR COMPANY NAME_RF.UHEN CALDWELL DRILLING, INC;. L PHONEYRjnn 8 54-3581
STATE WELL CONSTRUCTION PERMIT/
(If applicable)
LL CONSTRUCTION RECORD
ASSOCIATED WQ PERMIT/
(irapplieable)
1. WELL USE (Check Applicable Dox): Residential Q MunielpaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Neste
County/L4.7
(Street Name, Nuben, Community, Su•bdiriuoti la No., Zip Code)
3. OWNER:
Address) 1/
�/ � _ j •(Strat u Rr No.)
City or Town State
Zip Code
(DS7- 257-/0 7
Ana code- Mono ownber
4. DATE DRILLED �ft-/-0 7
5. TOTAL DEPTH: 1,L. ? O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1:1"-
7. STATIC WATER LEVEL Below Top of Casing: ?S O FT.
if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface°
•Top or cuing termlo•4d •Vor below Ind surface require. •
vadanc. 1n accordant a with I5A NCAC IC.O1II. ,� 1
9. YIELD (gpm): /,' METHOD OF TEST
10. WATER ZONES (depth): /S rpl'l /4'n
11. DISINFECTION: Type (' % l Amount cc oA .
12. CASING: Wall Thickness
Depth Dtatr� ter or Weight/Ft.
From")' ( To to? FL 6 r
From To Ft.
From To FL
13. GROUT: Dcpth Materiel,
From To 20 Ft.C.
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcpth Size Material
From To Ft.
From To Ft.
16. REMARKS:
PMellor)
cw..0
I DO HEREBY CERTIFY THAT 7I113 WELL WAS CO
CONSTRUCTION STANDARDS, AND THAT,A)C
SIGNATU
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(lack appropriate box)
Latitude/longitudeLatitude/longitude of well location
(eepeeahotoutn/uceadt)
Latitude/longitude sourcce PSOTopognphic map
(check box)
DRILLING LOQ
Fo rma d o ry D e s c,(ip L i o n
DEMI
From To
qo ) OQ
m4/J y''n
o r
•
LOCATION SKETCH
Show direction and distance in miles from " '
two State Roads or County Roads. include
numbers and co on road names.
•���yyC(� e,f
017,4
CCORDANCE WITH 1SA NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSTRUCTING TIE WELL
— l (/
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

277871
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *1+hual,(gesourees -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM! (pent) IIFFVsn. L. L,\r, KT A' SA CERTIFICATION a.-il-/
I
WILL CONTRACTOR COMPANY NAM!_ REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMTTm
(i f applicable) (if applicable)
1. WELL USE (Check Applicable Dos): Residential 0/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI ? Topographic/Land setting
Nearest Town: 17-4-1U-D County e om- [ dge ❑Slope ❑Valley ❑Flat
Oct U L.� L C (--o2.�S-T (chock appropriate box)
(Street Name Number Community. Subdisisiot ink No., Zip Cock) Latitudellongitudt of well location
3. OWNER: '- 6:-s,`. . �-tn.-Lc- ((depeealmie ndsecmds)
Address \ 4-40 E9 ANS ioP. .LC AD
Latitude/longitude source:®GPS❑Topographic map
Suot Rowe No.) (check box)
yy it-R-et c onto 440a4
City or Town SI Zip Code
(L2Ib)- '3c18 - -11 t
Arta coda- Phone number
4. DATE DRILLED '1/ 1 `//o 3
5. TOTAL DEPTH: '1 c f'.
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2t O FT.
(Usei if Above Top of Caoins)
8. TOP OF CASING 1S — FT. Above Land Surface'
•Top of culag termtauttd odor below Ind surface require a
vat -loon In accordance IIh 1SA NCAC 1C .011a. 112..11.1
1 tO 4� I IL
9. YIELD (gpm): 1 1/2- METHO� OF TEST •L
10. WATER ZONES (depth): h 0 t (`Z C, P
DEPTH DRILLING LOG
From To / - Formation Description-
1 -- 33 c/�r;!�?Od>✓
3s'- 5'
5 ..
ciQ-O (� - V ern ,
547vo l ILry C 211 tt l
11. DISINFECTION: Type 14-1- Ft t(0V0 Amount b)- b
12. CASING: Wall Thickness
Depth Diameter _ °01/eight/Ft. Material
From"i"� To I3 FL 4 / 'off Z( gvc
From To FI.
From To Ft.
13. GROUT: Depth Material From_ To Zv FL /"l�i�'�'� �'-�"'e
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 Et.
From To Ft.
Y
16. REMARKS:
LOCATION SKETCH 5
Show direction and distance in miles from at -least
two State Roads or County Roads. Include the road -._:
numbers and common road names.
C v C
C=�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THApI4 COPY OF THIS ORD HAS BEEN PROVIDED TO T {E WELL OWNER
SIGNATURE PERSON CONSTRUCTING THE WELL i-=�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, N
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2
Z5)
Rj,_

277870
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /\_ \ tLL1e &3AS-Li CERTIFICATION it a-11(
;I
WELL CONTRACTOR COMPANY NAME T1e..utFs'�. W�(Ytw�^`�� �r'.\\NYv ' PHONE # ($28)Y4"352
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Cvi Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nearest Town: ," Sind✓i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ICP %iESc9.)e (X
Address es L p n)C e (Lo F D
AIL(Street or Route No.)
OgN C— a—l7D+
County 4,14€41,vk
City or
Town
oi— Slate _/ Zip Code
oe }�
Area code- Phonc number
4. DATE DRILLED 7 /o7o3
5. TOTAL DEPTH: Q S
6. DOES WELL REPLACE EXISTING WELL? YES CiNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 1 o O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordao with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST el
10. WATER ZONES (depth): 0 0 — a G t Y\
1 I. DISINFECTION: Type
12. CASING:
Depth
From/ To 2 (P Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 7) To Zia Ft.
�V Shd ('(.0 /u Amount - nor
Wall Thickness
Diametcy or Weight/Ft. Material
Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. J.-0AG S W c ri IS
From To Ft. t (2 rA
16. REMARKS:
ethodi
Slot Size Material
in.
in.
Topographic/Land setting
[Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N' ; 7 3%5 lrloSa`34.017
(degrees/minuteils conds)
Latitude/longitude source:1 S❑Topographic map
(check box)
DRILLING LOG
Formati r n Description
�t C
DEPTH
From To
0 — 20
7 — 14.OP
L�/Dl9 — /©
wrllrt gfiCk
RCD
K00 - Q 5D
c)
LOCATION SKETCH
Show direction and distance in miles from a[geast _ 7
two State Roads or County Roads. Include tI4 road_..-_
numbers and common road names. c,
c0
LA&ct,
CvAb
m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT CO THIS RECORD HAS BEEN PROVIDED TO THE WELL QWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
i-J

2. WELL LOCATION: _
Nearest Town:l /4 laae/ t e LL) County ��r .vCs•ra e_
75G r /.s 14-6P'/ eA4 co ite
(Strcct Name, N umbe Community, Subdivision, Lot No., Zip Codc)
3. OWNER`1�,16.3 /f'o4/rPA-/
Address
(Street or Route No.
«2-.) . 7 3 v
City or Town State ZZp Code
(,3,2 )- /v - % - 2, 3 '/
Area code- Phonc number
4. DATE DRILLED % / of/O 3
5. TOTAL DEPTH: 3/0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 7 Y FT.
(Use "+" if Abovc Top or Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /2- METHOD OF TEST ,r
10. WATER ZONES (depth): R. b if / 7 771171
11. DISINFECTION: Type ITN r/, r✓ Amount % 191
12. CASING: Wall Thickness
Depth Di etc'. or Weight/Ft. Material
From To /%/ Ft. 2/NC-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 7-7) Ft. (s>µ�'
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:
277869
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -v, //7 M h
WELL CONTRACTOR COMPANY NAME t)2." .n CA5L Q\\ V t`A\t 1ln •Sil_•
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION #
PHONE # (3110,25ht
1. WELL USE (Check Applicable Box): Residential C" Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge BSOpe ❑Valley ❑Flat
)//114rve_ (check appropriate box)
Latitude/longitude of well location
/7_55 °5/ /10� X ° S.ot 43 / 7j•-
(degrees/m inuterconds)
Latitude/longitude source:❑fGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTI I
From To
/oc
/00 - 2 »; g
24.''
2& E — 3/0
�s T
/ Z 6-P ]vti
C.t i.ru •
w
LOCATION SKETCHc.
Show direction and distance in miles from at tast
two State Roads or County Roads. Include th'' oad:
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUIOOF PERSON CO THE WELL
D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
i

2756g
LL CONSTRUCTION RECORD
*rantnl Resource;.1- Division of WaterQualityGroundwater Section
North((LaA1dFi61P!A�.(�� Envt nmcntand -
N iIL E R lnhat� � �°
CERTIFICATION / 2-7 7 /
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PNONE4 8 •254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable)
AL)NAME (prim!) refit �// 6���(
(i f applicable)
1. WELL USE (Check Applicable Box): Residential Irfwfunicipal/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: JvnLeee ' County
(Street Name, Number, Community, Subdivision, lot No., Zip Code)
3. OWNER: ti.w 721a4-11.-Fp
Address 6-2- ,&(
Atri;etierStreet or Rout. Noj
City w Town Stare Zip Code
( v� -k '?/
Area code- Phone number
4. DATE DRILLED ei / z /G3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: b D FT.
(Us. -r if Above Top or Cuing)
8. TOP OF CASING IS 1- FT. Above Land Surface'
Top or cuing terminated at/or below Ind surface repulree •
variance In mundane' with ISA NCAC 2C .0I1a.
9. YIELD (gpm): la METHOD OF TEST (LA& I (L
10. WATER ZONES (depth): Q-Ro ' - tea_ e eon
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(theck appecpriste box)
Latitude/longitude of yell locationn r
(devealroimues�l.eoadt)
Latitude/longitude source:MPS❑Topographic map
(check box)
QRILLING LOG
Formation Description
to 4 b g...G a>-A0co
(, c, rc
W i TY a-oc IG.
a GPM
Lorkye Qocry G((4,r), c C-
DEPTH
From To
.C `- 3'
3c
4Vo'- 4'c '
I I. DISINFECTION: Type 1-tT k ci0 `l Amount 1. fib _
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From .i- To�Ft. ��/Sf 5MRaI e/C..
From To Ft.
From To FL
13. GROUT' Depth Material Method
From 1- To a-o Ft. GE MBta Po 0--6
From 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:
t
LOCATION SKETCH o7
Show direction and distance in miles from ableast;..--
two State Roads or County Roads. Include ilk road
numbers and common road names.
;3
�� Su HILL QD
a�
fscs
.1
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
ed(t GTilEW-7
SIGNATURE OF PERSO ONSTR CTING THE t (L A
Submit the original to the Division of Water Quallty, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

277865
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mahrnl Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) 131 LLIC. NAS N CERTIFICATION $ 42.11
WELL CONTRACTOR COMPANY NAME_ REUBEN CALDWELL DRILLING, INC. PHONE4*3 )254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential @" Municipat/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: J ty p Ja.
Nearest Town: A t 2 t C tJ S tc inn
13
(Street Name, Numbers, Community, Subdivision, I.ol No., Zip Code)
3. OWNER: 6DN,vr1
Address 5 9A21C 5TA& WA1
w
(Street orr)� Route No.)
FAIRJt€.as�(3i)
City or Town Stale Zip Code
('4) )- (, ajS I 10 to
Ares code- Phone number c/
4. DATE DRILLED 7 3.46103
5. TOTAL DEPTH: •fie\ o '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top o(Casing: bo FT.
(use-4.- if Above Top of Casing)
8. TOP OF CASING IS �- FT. Above Land Surface•
•Top of colas terminated at/or below Ind surface requires a
variance la accordant wtlh ISA NCAC 2C .0111.
9. YIELD (gpm): METHOD OF TEST fLtO A t 2-
10. WATER ZONES (depth): 7 40 ' — ' h (2 'n--‘
11. DISINFECTION: Type FArA-ok chi, Amount i/7-
lb
12. CASING: Wal)ThicknW
Depth Diugeter or Weight/Ft. MgrSriil
From 1 To t0t7 Ft. L Y S(La\ iJ
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To 3`' Ft. QQ tidu @CU(LUlf
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft.
From To Ft.
Topographic/Land setting /
[Midge ❑Slope ❑Valley 0Flat
(aback appropriate box)
well fl'35`-2yo°fy WO8 oc0i ativ8 %
Negro Wrn tau tes/seconds )
Latitude/longitude source:0thS❑Topographic map
(check box)
DEPTH DRILLING LOG
From / To i Formation Description
o It-nJ.J
- 9s
c1C - Ql- '
.4- c
7,40'- a`io
LOCATION SKETCH
Show direction and distance in miles from afIeast
two State Roads or County Roads. Include thoroad='
numbers and common road names. 2
0 o
DA'rY- SiAI:
jl =Y
tieL0— y1,-,.Sit CILL-tk
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrrn ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A,(OPY OF THIS ORD HAS BEEN PROVIDED TO T WE OWNED
cr: o
53--cl c ;Lao
w
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE _ n J
zJ
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC cr s
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2601 ' ocn
I7

WELL CONSTRUCTION RECORD
27';' 9 81
N n•il ( an,Gna Department of Environment and Natural Rcso ca{ - Division Wa r Qua t - Groundwater Seth, I}j�k�/
�I�a'�7Vial* ?tun .11111threnta
et Asst.
. `,. i I• CERTIFICATION /7,ij6;..tit
et.t. (ON 18.\C'f Ok IINDI\IDL'At.7 NAME
ASSOCIATED WQ PERMIT _._
Sr CIF st bt t.1 rplica lei WN PYRMITa t if �,licable)- _ - - —-
1 it u�phcable)
'A'GLL 'LSE (Chock Applicable Box): Residential V./Municipal/Public 0 Industrial 0 Agricultural 0
N;.rnironng 0 Recovery 0 Heat Pump water Injection 0 Other 0 If Other, List Use -.----
U E..l. CI \ !'k tt" TOk COMPANY 9 AME
2 WELL. LOCATION:` ,/
Nearest Town'...:CticeSSICe County
915 f(. �uYT�tr1C („e(S4.S
.5rrea acme. Nunioen. Corunun y. S bdiviaiun, lot No Zip Code!
See.,:e.; ?,e)
_ . State
l
l ry ur , uw n SlZip Code
Zvic_-.
tiros curie- Phone uu,nMT Ids V-7
Apr, 7r
t DATEDRILLED__,
' COT AL DEPTH:—2.-UP 5' —
6. DOES WELL REPLACE EXISTING WELL? YES 4F NO GY
7. STA ITC WATER LEVEL Below Top of Casing: -_�Q.
T.
tUa ..." if Knave Toper casing)
8 TOP OF CASING I5 ___ . FT. Above Lard Surface°
'Top of casing .ennioamd Ivor bebsa lead sursece npacrta > s __
var in nee in accordance a r•Y�ICa ISA NCAC 2C .011E. ^ _ t e `_. ":C -__
9. \ IELD lgprL .__ I___ METHOD a'. TES IIII --
lr) WATER ZONES (depth). _.._ eat:% _------^. -----_._ -, ; AT! )— ^,yiItiETCii
4
Topographic Land setting
7Ridge IQ31ope OValley ❑Flat
tchetk aapropeale neat
Latitude/longitude of well location
p>tptevminoiev seconds:
Latiiudell nyitude source ❑GPSOTopoyraph,c map
rceesi box)
p£PTH yli.' L.OG
From To Formation Description
_ Amount ,I�l11 Show dneclion iurd distance in miles !`rain et least
C1S CASING.
fUN. Typq -s"" two Slate Roads or County Roads. Include the read
[2. CASING: Wall a ht'esz
/�-� Japr u` Diameter or WeighVFt. Material numbers and common road comes_
Fron•,fl To 1. Ft - .. -_
From _ To____._..,_ Ft _ --
From_ _ To_Ft._.__
Method
I) GROUT Depth MaterialIs
���
Fr _ o__
From(
---....-' fo.�._ --, Ft..__.
T Ft Stijl
.M. kE.ENDepth Diameter Sic( S. cc Malcnol ...
a. .
Et _.__.___�in to __-__.
Froth-.____. To .__----- in __..
From. __To ___ Ft._----:n - -----
'5 SAND/GRAVEL PACK: S Material
Depth
Prom_.___ To Ft. ___
�_- _..--
From_.. `To_.-._. Ft
46 RCMARKS. __-----.
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED i ACCORDANCE
COR BEEN PROV IY U THE WEE L
OWNER
CONS'FRU' ON STA A'DS. D THAT A COPY GE THIS RECORD
_
SICNATLRE OF PERSON C'ORS'IRUC.TINC THE WELL DATE
Snout theoriginalto the Division o Water f W t Quality. Groundwater Section. 1636 Mall Service Center - Rattier, NC
r'R i
29699-l0l6 Phone No. 19191 733 3221, within YO days. D)
-�l
GRDUN6WATER SECTION
ASHEVILLE REGIONAL OFFICE

WEL1L l'Q TRUCTI Ni REC4RID
No-th C uruhna - Department of Environment and Natural Resouf
W ELL CONIR AC 1OK i 1NDINIDL'a L) NAME
(grin)
llfa.I. CON IR ACC OR C. OM AN\ NASIE
latile-
S t' ATE U t 1.1. CONSTRUCTION PERMIT* _______________—
(it\
nntcaglei
ces • Division
fli
27 ,F 979
Groundwater Salim.*a
CERTIFICATION elF call
dRwaM.1Nelti 1�a
PHONE a m,� s
__irks,
Associn TEV wQ TERMIT
it aoPiicsbiei--
W al�r Qua
V ELL USE iCheck Appttcable Box), Residential Cr MunicipaliPublie 0 industrial D Agricultural G v
Monhoring 0 R.ecovery 0 Heat Pump W aier Inj.rodon 0 Other 0 If Other, List Use
Topegrephi;.tLa' d setting
°Ridge °Slope ON/alley tat
tense' orreernae bo.
—
�, Latitude -longitude c!' well location
rdeffeei.in. i...erin Cendai�
L r,ttludr-rl6ngr.ude tour�e.00PSOTopoyr rk. mu!+
ltteci. bcii
FnrmabJn iescrlpunn
L LOCAL
Ne rest Town-� County
I� vie
SrrrAi N, nr.Nuorbbeern. CCommunity. Subc,v,s on. 1.or "i0 Zr
Nse akn 1 7 j.�
hr e'wle
t n. ur T<,.,n Slate P
Nun c eft- Phony nuio r
TOTAL DEPTH._$ 5._-----
6 DOES WELL REPLACE EXISTING WELL" YES 0 cO C'
STATIC WATER LEVEL Below Top ol'Casing _�._
t� T.
iUa " if AtwvC Tc.p of Cooing)--_.__�.__.--.
S 'o ('P OF CASING IS ._ _1_---- FT Above Land Surface" -- --—.�--,_.
'Top of tYSlna itr mt0etta YUct b.10 load :orlon r"g9itef a
viraacc In accordtntt nrtb 15A NCAC SC .a11a.
METHOD OP ThST� _
I v; :\'fFp ZONES (depth). __1�.b _.—._�_--------- �`
y i
.,_,�•'���� Y Amount two State Roads or County Roads. IudLdc the road
! DISNFEC'.tON. T'yacLi. '— Wall Thickness
t2. CA;ii`ai cumber; and common ra;ti names.
L7cprh Dixnleicr or WcigtVFt. Mlatenal
LA I E. UkILt.1:D__
._... -�(- -- Showd rci'lit"1 era? distance in md, •rQ
�T_d
From To
From._a__, T o_S—L Ft —_—__
From _.�_ To_.___— Ft .._.__ _---
!vlatenat Mettive
Fieo;'i (i6Yl_ Ucptn
_ Te_.___._._ F'i___ _.-------._— ------
Disinter Sic: 'S ec
,d. Si. RE i:N: Ucpth to _
Metenal
To Ft .....__in __...__.._._
Fro m.�____. --_ .
I5. SANO/GRAVEL PACK.. material
(kF:h.
Sits
h rum
From.___— _To _._--..- E..----_.__
I b R I. NI ARK S.__._____—_.—_----------___._.------ _--- ____.___---_._ WELL
L
CE
100 F; r...'MATTHIS WELL WAS CONSTRUCTED1N A.CCOS8AN, W IT PROVIDED Ti>THE , WLO�'✓N'tR
CONS"
— --
15 . rt1 :n least
772
0
ERL.31 CER. .. _
R•.UC"CfON S f. Duerr AND THAT A COPY OF THIS RECORD A• -- --_1- �� 0.3
- "-'
/ SIGNAILIRE OF PCT
PERSON CONSTRUING THE WELL DATE
Suurnit the ariy,inat to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center' Raleigh, iC
Z7640-106 Phone Nn. 0014 713.37.21, Hithin 30 days
GROLINNATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
w'ELL CONTRACTOR (INDIVIDUAL) NAME (print)
VVELI, CONTRACTOR COMPANY NAME
SLATE %Vi".t.t. CONSTRLCl'ION PERMI'rk _
Of applicable)
ces - Division o Wat r Qua
ASSOCIATED WQ PERMIT
(if applicable)
2T7992
- Groundwater Sec! b.s
CERTIFICATION elf
PHONE 0 4
7
as fi•1b6L
I. FELL USE (Check Applicable Box): Residential VMunicipaVPublic 0 Industrial 0 Agricultural 0
Moniioring ❑ 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
2. WELL LOCATION'.
Nearest Town: Q t �s_`_"(------_ County n {
I Street Name. Numbers. Community, Subdivision, Lot No., Zip Code)
1 Y_ (degtecsiminwesisecunds)
3. OWNER: - .J __� Latitude/longitude source:❑GPS❑Topographic map
Address - (check bus)
f ISSeetlr Rome "Cal l pEPTH DRILLING QQ
City
-ity or • To. n State Zip Code From To Formation Description
C
4
5.
6
7
Area code- Phone numbs ) �` e3
DATE DRILLED--� —t---
TOTAL DEPTH:
DOES W'ELL REPLACE EXISTING WELL' YES 0 NO 0
STATIC WATER LEVEL Below Top of Casing: F .
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS _ ___ FT. Above Land Surface"
'Top of casing terminated atfor below land surface requires a �1
variance In accordance with ISA INC AC 2C.0118.
Q YIELD (gpm): METHOD OF TES
10. WATER ZONES (depth);
1 1. DISINFECTION: TypeS Amount i -
12. CASING:
nreT1` n� N C— KETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
DepthDiameter or Weighti Ft. Material numbers and common road names.
�e�Y �Ye e � ��r
From
From— To--:L. Ft. _—_. K
To_ Ft.
T Ft
From
13 GROUT:
From
From
Material Method � v
Depth
10
co
To Ft
1 CAN.-- tl� �)
To Ft. —
14. SCREEN: Depth
From To
From To_
IS. SAND/GRAVEL PACK.
Depth
From —_To-
From_ _To
Diameter
_ Ft._ in.
Ft. in.
Size
Slot Size Material
in.
in.
Ft, —
Ft._.—
Material
r.�
:S
0
16. REMARKS: _
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCT ON STANDAitD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L�/1_ DATE V
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the origina to the Division or Water Quality, Groundwater Section, 1636 Mai
27699-I636 Phone Na. (9t9) 733-3221, within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

2 i'7991
Submit the original to the Division of Water Quality, Groundwater Section, 1636 M
27099.1616 Phone No. (9I9) 733-3221 • within 30 days.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division o Wat r Qua
WELL COVER %CIOR (I N DIRIDEAL) NAME
� (pprlf
riint)�
WELL CON'I'R:vC'fOR COMPANY NAME VI t•Ci
ASSOCIATED WQ PERMITSTATE \\FLI. CONSTRUCTION PERMIT# (if applicable)
(if applicable)
- Groundwater Sege_
Woes
CERTIFICATION M7� �.�,� ��.,a=
P HONE N 15Is 1_tt
't1tBL
1. WELL USE (Check Applicable Box): Residential
icipalOtublic 0 ❑ If Industrial 0se Agricultural 0
Monitoring 0 Recovery 0 Heat Pump
2. WELL LOCATION:- a ` Topogra hiC/Land setting
j� �J�ll '� ❑Ride laSlope ❑Valley OF'lat
Nearest 'Town: -e1Ce� i County¢Z h
r< n 1 .Li 1(�, .3 1 P 1(t f�GS'`( (check appropriate best
(Street
Latitude/longitude of well location
IStrca Name. ne. Numbers, Comm,yfuy. Sabdwtimn, Lot No_ Zip Cale')
(degrecs/nu nwes'seconds )
Latitudelongitude source:OGPSOTopographic map
(cheek box)
pEPTH 0 It 1 ING LOG
From To Formation Description
In
3. OWNER:
Address
Sweet or Rnt- Not
Le c 25'k\
Cane or Toren State Zip Code
oo
Area code. Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS j FT. Above Land Surface* —_
*Top of casing terminated actor below land surface requires a //�� y��h
variance In accordance alb is MET CO.0118.
Q�j ST'� .1 s Coves 1`�-�-
9. YIELD(BPrn)�-z' y- (4�, �1-�6�
ID. WATER ZONES (depth). _—
I I. DISINFECTION: Type
12. CASING:
jitEIFA,CA."—tount y
Wall Thickness
//��
DepthDiameter or Weight/Ft. Material
From__0_- To_s yL Ft. — ---
From.__._ To Ft
From To _
13. GROUT: Depth
From To FL
From To_—_.—_ Ft.___— _
Slot Size Material
Diameter
11. SCREEN' Depth� in.
To� Ft in. _ in.
From
From . _
To_.—__. Fr in. in.
15 SAND/GRAVEL PACK: Size Material
Depth
From.—_—._Te Ft —
From To _ Ft.
I ()CATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Ft
smart Method Sc'‘ ' 12_'J7
0
C.)
6-2
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%' lc� _ DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
viiiCtiger hta ig 1
San;Nl� (WATER SECTIONfF
A

'ON. TRTREC RD 2 7 7 9 3 9
North C arolina - Ucparirrlcnt of Environment and Natural Russ cea •Division • Qua t - Groundwaier Seca nog
1 ... I. Vs�
1vH'-LCp\'1'R'\C'1(?R fINDIl IUUALI NAME (prior) S CERTIFICATION ak a PHONE la��'a�� ��ra .,a
w �w�uauN eLYl�b• �.L ��`_
1 RR
D. FL 1. CON-rR ^tCrolt CO\1P AN\NAME
STATE \t EI.1. CONS RLCTION PERMIT*—._—_._-
tii a?llu::olel r.,
WELL. USE i Chcck Applicable Box). Residential,f.+/ Municipal/Public 0 Industrial C Agricultural C
M anon/nog 0 Recovery C Heat Pump Water Injection 0 Other 0 lcOther, List Use
opographic'Laad Bening
age °Slope °Valley °Flat
tdMek arp roe,,aa: SAY!
Latitude/longitude of well location
tonakea ,ufev/1e:or.ael
La:ItaCCilongitUde source.D PSO epograp Ills map
(cree
Formation Description
2 WELL. LOC?tZN:
Nearest T' own �sli- County bt£l - )
zi Nearest
.L—.
,$rtcu n.uno. N. -iCommunity. 5ubdDivun. Lae No Z.p Codt)
OWNER'.LC
%bldiiF3
_ASSOCIATED FERMI"(
1;1 , licablr)
tIO::etn a' °utti Nu.l
$tata ZrP C'at
nj or Tu�xn
Front To
\r.a ;ode- "ono ti.snter� . Z< C,
s IOASEDRtLLED. __
< rOTAL DEPTH _ tro ..------- --
5 DOES WELL REPLACE EXISTING WELL' YES C NO GA'
". S'fwTIC W'ATERLEVEL i`i<SDw Topsao _.._FT
Disc '4"41AhVtTor ofCasing)
3 It OP Of CASING IS ___.1.____ FT. Above land Surface• _
•Tay io casing Su niiaaied boor Brio. lad iodate require e - -_ --_-- _--
vanaatt In aecor'dance lrtta IS NCAC :C .6I la. , 4 s..�.
9 YIE D tgpnti: _IC3 .-__ METHOD OF TES a'��^• �iaL'•i{L .__...._.—_.._..
10 W,AT'ER. ZONES ideplh) � --._.—.__..--_..- ---'--'-- :52SAT.L4.\.S.1SET.S.i+
Y ,.. nt _ Show direction and disunce In vole; trues at Teas!
i. CriSSINF E'CT ION. T' t - two Slate Roads or County Roads. Include 'l I aced
!2. CASING: Wall Wcghness
Diameter or WcighVFt, Material number( anut common rand naives.
From ._Tu .2,, _Ft.------ -- . y ,�_ r I I�.I
crt,.P, 1'Q—'—'i._ _ _--_ Sudsier) ice. �GJ�
GROUT .r. F cgiessisits. �; S S
\
To �..._._. _ i r
:ti �,h,c�Coti
--ll i ,
t [Mincer Slut :site IMmcnd =
II SCR EtEN.
in
hrult,__.. Tu.----' F'r—'--'n ___ in. Eli
-
Flvrr__-____tQ--._—F'-- in --'-- ----
15. SAND;GRAv EL PAT:Xi
Depdt Stu Matertal
From_..__._ _To. —_. Ft.
It, RLM ARKS. —_-- ________________ -- -- .------ .r
I DO HEftL3\' r, ERVY THAT THIS WELL NVAS CONSTRUCTED IN ACCORDANCE WITH 15A NC AC 2C, WELL
.2 N STAN ARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROV'DED TO THE WELL OWNER
C
oN�rR4 I - 0 3
Zt S DATE
SIGNATURE of PERSON CONSTRUCTING THE WELL
•1 :
y omir tna original to the Division of Water Quality, Groundwater Section. l636 ,Nall Service CatGV,- • RaieI* ifl- C .') ill
u
27894 •I41M1 Phone Ion. 1919y733J:21. is iahin 30 days.
O i-,

North Carolina - Department of Environment and Natural Reso
WELL CONTR:AC-IDR (INDIVIDUAL) NAME (print)
L_a.r
277988
WELL CONSTRUCTION RECORD
ces - Division�o( Wataer Qua`it - Groundwater Seelig
fainCERTIFICATION 0 fain
\\ELI. CON'i'NACTOR COMPANY NAME awa► II 111 PHONE # n :9gn.3
SLATE Witt. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT at L
(if applicable)
1 if applicable)
W ELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCAT ON: •
Nearest Town:
I _ Coun
11l211- A 0CC1 �'c�tYUtQ
(Street Name. Numbers. Coommmunity,,, Subdivision, Lot No.. Zip Code)
3. OWNER: (Yy� I'e�` )-1-a 8--{-----
Address 111o`i- �i `iV(C`� �' 'I 1��1
• (Street or Rou No.l
{ q/YY1'Cu-) �'
City or Ton State Zip Code
Arca code- Phone number zu_
DATE. I DRILLED_
5. TOTAL DEPTH: LL1-
6. DOES WELL REPLACE EXISTING WELL? YES O. NO a
7. STATIC WATER LEVEL Below Top of Casing: (PV FT.
(Use if Above Top of Casing)
8 TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated anor below land surface requires • s
variance inaccordance with ISANCAC ZC .017 S. /� 1Lt
o YIELD (gpm)' 1 Z METHOD OF TES1C0.I
j"OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley CFlat
tcheck appropriate boa)
Latitude/longitude of well location
(degrecshnintueshecondst
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH 2RILLING LOG
Front To Formation Description
10. WATER ZONES (depth): I Cssi L LG
1 L DISINFECTION. Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material r
From 0 To (Z''-( Ft. �,R' J t�
From To Ft i` \~G f U rGYI4 I� (,,
From DTe Ft.! ��ld CZ__ �l44 1
13 GROUT: Depth Material Method V �
From To Ft.
From To Et.
Diameter Slot Size Material
13. SCREEN: Depth
From To Ft. in
FromTo Ft. at
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
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
k' »�
•
�� SIGNAI'L'RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail
27699-I636 Phone No. [phone]. within 30 days.
fI
I �1�a �I/ B
OCT 2 7
:TON
c1CF

2 779S7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso c ` - Division or Water Qua 't - Groundwater Secit �.k
CERTIFICATION IC , ,
WELL CONTRACTOR i OMP'IDt'AL) NAME (prior) ItC y� �'�la �'�
,/�L`,y�^`. yam/ �O ��• 11� PHONE 1
WELl. C(I\'1'R:x ACTOR COMPANI'.VAME� sa ASSOCIATED WQ PERMIT L
(if applicable)
Sf %rE 1s VIA. CO\STRLCTION PERMITk
t iranplicable)
I. WELL USE (Check Applicable Box): Residential CT Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: Topographic/Land setting
e C ounty^,)t (��'tl `� ❑Ridge ❑Slope ❑Valley Flat
Nearest kL. Town: M\-d zV11 /J tcheck appropriate box)
l r L. i . Nu 1-� O 0 Latitude/longitude of well location
!Streit) Nome. Numbe . Community. Subdivision. Lot No., Zip Ccdcj
Leg`- A ` 0 G GU11 (degreeshninwesrseconde)
1. OWNER_ __Ol. . �-iO -tom- ' 1 1/4 Latitude/longitude source:❑GPS❑Topograpvc map
Addre55 �L -- (check box)
QIsrccta Rn No.) Z ��' DEPTH DRIL IL is L(N
�� \ �'� From To Formation Description
City or Town State Zip Code
Area code- Phone number 7 - Z�? - ---- —
4. DATE DRILLED C --
5. TOTAL DEPTH: -3ie 5 r
6. DOES WELL REPLACE EXISTING WELL', YES �0)NO Q'
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING !S ____ FT. Above Land Surface`
'Top of casing Urniinuted ar/or below land surface requires a ---- -_
variance In accordance with 15A NCAC 2C.01 i8. Lsaa.atA
9. YIELD(gpm): METHOD OFTES
T��i� -- —
10. W ATER ZONES (depth): I.1< — and
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o -'
I I. DISINFECTION: Type Amount —._ --
12. CASING: Wall Thickness
Depth i Diameter or WeightFt. Material
From_S1-
/-� _ To 1..r _ Ft.--_— ,�I From__ To Ft.—. —
13. GROUT: Depth — 00 V �d
From__ To Ft. —
Material Method I�G�
From _ To Ft 1�Y �
From To Ft.__ — -
14. SCREEN: Depth
Diameter Slot Size Material
From._To
Ft in. m
From to--- Ft. in --- in.
1S. SAND/GRAVEL PACK: Depth Size Material
From. T0_____-- Ft --. _
From _ To___ Ft. _
16. REMARKS.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONJ U- ON STAND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T�WE LGWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mai
27699-1636 Phone No. [phone], within 30 days.
OCT 27 CJ3
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CON TR11Crk9N RE
North C arulu!a Department of Eno Iromnent and
s� Natural Reset ce - D.t tiro Wit r Qua
u ELL. COVt* sC l OR t 1NDlti IDEAL) Nair (Pr!anµl�.1
Uri. t. CON rk v tTOn C.OMRANN NAME
ASSOCIATED be PERMIT
S ATE la F.l.t. CONSTRICTION ION P£8M[Ta��_..—.------ (ifa icable)
lit ;.�.hl'aiaei .,. � .-....
2. WELL LOCAT ON:
r.eareslTown ! Count
/
iln'CI r..rtie. Numbers. Coal unity. SubEiviaun, la No Zip Cwfr)
3 OWNER'._ i--�.1. _5-------
Add!c :t . t?L. 1 ssia__ . 1 ?
lsasa Rautc No
t ny ct Tu., 1. Srzte hip Cafe
i t-
yua :, n!e• Prow n.nnter
au L_-3
I DA"fE DRiLt.ED._�Z.�
1
277986
t - Groundwater Sect 1,
CbRTtr'CATION �Ir9'�a�/��=.ay �{,
PHONE a ".11i -iZet ei.sjuiSt.
WELL USE tChccl. Applicable Box:I: Residential 0/Municipal/Pohl': 0 Industrial C Agricultural 0
Munuonng 0 Recovery 0 Heat Pump Water Injection 0 Other 0 Ii Other, List Un___._____-.---_----
Topographic/Land setting
DRidge °Slope °Valley Whit
tcht.k apNopisis box)
Lat tuderlongitude or well location
taenmr metes/seconds
mr ee�rp /seconds!
L:I i:ude;longitudr, souree:DGPSDTc`P0yraph,c map
(chick box)
pgl! N �QSi
Fornail on Description
uL'.i
From To
5. rCiTAL D'cPTH:----i-__---_
f; DOES WELL REPLACE EXISTING WELL" YES 0 NO Cfr f�.�„____
7. S T q FIC WATER LEVEL Below Top of Casing. __
Wre ..+., it Anew Tep or Ca+rna) �_�._._.
CASINGIS �_�� FT. Above Lars! Surface' —___-,
o "([TOF Sg ----- --
• Top of cat!wa lcoulee u2 war below i.Ad soAaee eagseres s
vorieaee In accerdince wHk 15A NCAC 2C .07 It e•-. r ale --
u. YIELD igpm) _LZD _ METF OD Of TES -.
�.. ON :S rile thl. ___--_--
lf? AA,ERZO F p ..y r)N S1SiZ`Mi.l
.,��`��{�at�--A—///'tint --- Show direction and distance III miles from at least
12 CIS CASING:
iION. Type—asa+r.-..�"'--- two State Roads or County Roads. Include the read
12 CASING: W'atWinghness
Diameter or WetghVF+. Material numbers and cor:trtlon road names.
Depth
1��sr�Yc�SYI I1�Lc&�
Ft
From_ _. 70 Z� Ft--- .. _______
From To_.---` Ft — ___ From_._.__ To_.._—_ t.
!vlatcnal Metl:na
GROUT: Depth /�_ - �,, _ cv u From__ To_ Tn__ 1�1
From Tc FL_'__— ____.._.—_
a SCR ..:EN Depth Diameter SW( Sue
Minimal
_ Ft...__IA !n _______.
Fre m___-___ 1 �_..___ -
rt. in
I SANDIGRA`%EL PACK' Site Maranet
Depth
r. rum___..__ _To._----ft.--'----
Ih ALN1 ARKS .._—___.____-_—_—_.—_..-- _'--_------ WELI.
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V) riEPEJi <ER'Tipy THAT THIS WEE.:- WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2
t'OiNb �
�� SIGNATURE OF PERSON CONSTRUCTING THE WELT.
Submit int original to the E'isrlsion of Water Quality, Groundwater Section. 1636 M 11
17009.Irs.rA Phunc No. r999) 733-3221, wtthln 30 dams. Ir
"rR UC'( ON STAN ROS. AND THAT A COP[ 1 -
1 (� - DATE
fV
O
r.c.
C:
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 277522
North Carolina - Department of Environment and
-Natural
rResources - Division of Water Quality - Groundwater Section . / Q
WELL CONTRACTOR (INDIVIDUAL) NAMJ (print) 1--t0D 1 Al ,1LA R /1, CERTIFICATION # o! 4 / U
WELL CONTRACTOR COMPANY NAME P Gnt''//.6 aS- �I /IPXi 4f Rt, .Az PHONE # 8 : 31 70
STATE WELLCONSTRUCTION PERMIT# /%C1 . - ASSOCIATED WQ PERMIT#
(if applicable) Or applicable)
WELL USE (Check Applicable Box): Residential l Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATI p q
Nearest Tpwn: /� [/p 7,
/ 5-7
(Street Name, Numbers
�J
OWNER: [ ./
Address /�o J�Y.togi �,U'LLajaii
,,{St/t/eet or Route N
/14 LPrJi4J . Vd, ,Ig'776
Count4/47.001 e 1-
mmunity, Subdivision, Let No., Zip Codc)
City or Town Stde Zip Code
-'' Area code- Phone number 4.. DATE DRILLED 4_/9 -Z
5:'TOTAL DEPTH: /
6.'DOES WELL REPLACE EXISTING WELL? YES ❑ NO Id
7. STATIC WATER LEVEL Below Top of Casing: a© 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): (o C2 METHOD OF TEST c2)n r5
10. WATER ZONES (depth): le; S 2 -'land pm
11: DISINFECTION: Type_.��-� Amount 2c/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mat riall
From LC To 9, W Ft. (e 7/
..-.From To Ft.
From To - Ft.
13. `GROUT: Depth Material i Method
From (f) To c O Ft. C0./-.tie-t 4!-6
721
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
From
To Ft.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Format'o t Description
DEPTH
From To /
-ni -)
C..)
7.
LOCATION SKETCH —
Show direction and distance in miles from at least
two State Roads or County Roads. Include the -toad
numbers and common road names. —'
O
O cr.
16. REMARKS:
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`l,1) 7 .0J?7-3/-43
SIGNATURE OF PERSON CPE P €L-6
Submit the original to the Division of Water Quality, Grotadyaier-Sochion, t4444-ai1Sef cti {tenter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. � : IGW-I REV. 07/2001
DATE

277521
WELL CONSTRUCTION RECORD
NorthCarolina- Department of Environment and Natural Resources - Divisionfof Water Quality - Groundwater Section
• WELL CONTRACTOR (INDIVIDUAL) NAME (print) A7n [, r n( I (\i)e./) (� CERTIFIC��AATIO/N#.24 Y
WELL CONTRACTOR COMPANY NAME re.e-v-1 e Ern - Imo Iu ct Pit rv}O,�n&. PHONE # 1, . to `f"d - 3/ 7 L
STATE WELL CONSTRUCTION PERMIT# / 9 t ..2 ASSOCIATED WQ PERMIT#
- j (if applicable) (if applicable)
WELL' USE (Check Applicable Box): Residential.. Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
'WELL' LOCATIO,
I�ear t Tow :
en) CP a �c
Name, Numbers, Community, Subdivision, Lo
Topographic/Land setting
eft County /JLt./✓ eryzi(i ❑Ridge ❑Slope DValley Flat
/ (check appropriate box)
p Code) Latitude/longitude of well location
City or Town State Jr) Zip Codc
( ' )
Area code- Phone number r
4 ,DATE DRILLED / c, - D -3
5." TOTAL DEPTH: to D 1
6.,DOES WELL REPLACE EXISTING WELL? YES ❑ NO"L
7., STATIC WATER LEVEL Below Top of Casing: /Q FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): % METHOD OF TEST a h r S
10, WATER ZONES (depth):
n_ /
(St et or Route No.) d 7 g
//vv - 71Pin
lG
11. DISINFECTION: Type El Yi4
12. CASING:
Depth _
From 4) To 53 Ft.
From_ To Ft.
From To Ft.
13. GROUT: Depth
From 0 To crIt Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
Diameter
to
Amount /D 8
Wall Thickness
or Weight/Ft. Material
PVC
Material Method
ant.u--7� / n P
Slot Size Material
in.
in.
Size Material
From ` To Ft.
From To Ft.
( degrees minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
Frog To t For mJion Description
(( Q�<v {
5 5t (n t,� r .t
0
LOCATION SKETCH —
Show direction and distance in miles from alTeast�_
two State Roads or County Roads. include thtoroast;
numbers and common road names.
0
0 F.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITFI I5A NCAC 2C, WELL
CONSTRUCTIONS A DARDS, AND THAT A COPY OF THIS RECO AS BEEN PROVIDED TO THE WELL OWNER
Anat.- 7 TIN / - SIGNATURE OF PERSON CONSTR G THE WELL DATE
t
�ls aljer Section 163o Mail Scrvicej Ce gir- Raleigh, NC
—t� C } -I REV. 07/2001
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 277518
orth Carolina - Department of Environment and Natural Resources/' -. Divisionjof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/'� (print) K D F5I )t) )�JE� ') CERTIFICATION # 2 y(�/
WELL CONTRACTOR COMPANY NAME(2EFAIK ..Wr05 • ViJe 11 -d t"u-rn0�)lL PHONE # (22W G4Id --3 / ' '
STATE WELL CONSTRUCTION PERMIT# / 40 -- ASSOCIATED WQ PERMIT#/
• (if applicable) (if applicable)
1.WELLUSE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
`-Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IrOther, List Use
2. WELL 1.00AT
Nearest Town:
(Street Nat
3. OWNER:
Address
County
Numb Community, Subdivisioi i No., Zip Code
S,y (tr eto oule No.)C. 5 �d I/
CC�t� ����i Town State Zip Code
Area codc- Phone number /���
4. DATE DRILLED /-
5. TOTAL DEPTH: / 8.5- )
6."DOES WELL REPLACE EXISTING WELL? YES 0 NO Yl-
7:.STATIC WATER LEVEL Below Top of Casing: I 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): ? h METHOD OF TEST �•� l 1 r S
1Q. WATER ZONES (depth): /Z5 !j ) - 6/3 vi ni
11. DISINFECTION: Type HT 14 Amount 3 /
`12 .. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 2 1 Ft. (o it PVC
Y From . To Ft.
From To Ft.
13.' GROUT: Depth Material Method
From L� To �l% Ft. l'�e ft177-1
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 �F'I
(check appropriate box)
Latitude/longitude of well location
(degrees. minuiesiseconds )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Format'? Description
0
c
D F'
LOCATION SKETCH w
Show direction and distance in miles from mast ct
two State Roads or County Roads. Include tt©road-,
numbers and common road names. `
16. -REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS RECOfD-HA$BEEN PROVIDED TO THE WELL OWNER
7,3/, 6 3
SIGNATURE OF PERSON CONSTRUCTING THE W'EJ-L,_.____.___i DATE
Submit the original to the Division of Water Quality,
27699-1636 Phone No. (919) 733-322I, within 30 days.
d [eY`$eetion' 16ii M(_"I 'fr tit{ Center - Raleigh, NC
1, GW-I REV.07/200I

}\(3 J (' 171. 3oS
vJ ( D.°'"7 35f
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
277386
North Carolina - Department of Environment and s`1•tunl Resourcn_zDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtot) r1
WELL CONTRACTOR COMPANY NAME_RF.USEN CALDWELL PHONEER8 1254 - 3561
STATE WELL CONSTRUCTION PERM R/ ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
CERTIFICATION I
DRILLING, INC.
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9N:
Near Torn
CUM rft.
unty
01
(Stidsl Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address �i cO ) ul-t-f-
r
(Street Routs No.),
Lt oat,LieC a-- g
City or Town State Zip Codc
(raj- ( ^ as 9'-2-
Am code- Phone number
4. DATE DRILLED -7 'LI- I o 2
5. TOTAL DEPTH: . CO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: of fie
(wits -+- if Above Top of Cuing)
8. TOP OF CASING IS / taFT. Above Land Surface•
*Top of cuing termisated at/or below land sorfets requires a
variants In sceardans Ith 15A NCAC 2C.0111.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): // Y$ 0 3 7j4.i1
11. DISINFECTION: Type F1-'t' 1-S, 6,7Amount 1 "1.2,.o3
12. CASING: Wall Thickness
Diameitej or�v�y/ciggh✓Ft. M nm
al numbers and common road names.
Ft
YY ,
Ft
.
767
Depth
Frorr -/ To
From To
From To
13. GROUT: Depth „Material
Front42_ To..22 Ft. 7. gz.it
From To Ft.
14. SCREEN: Depth Diameter Slot Size .
From To Ft. in. in.
in.
Material
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(chock appropriate box)
Latitude/Ionaitude of well location
/350 ef7. ta5 NI08(2°,37-3 5 f
(deprrahnimttalsecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOC'L
From To Formatii n Dgscript.°
to 2o'
S "(Co
to -8 °
)-R O
FT. ygc -.39D
-ILf fl-tw,..t r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
�Q c
I DO IIERE&YCEP,IIFV;B1 T TNIS WELL -WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUaPIONSTANDARDS, AND THAT A COPY OF T111S RECORD NAS UEEN PROVIDED TO THE WELL OWNER
7 h--t- H 0 3
SIGNA1Ui4� OF PERSON CONSTRUCTING TILE WELL DATE
'LJJ
Submlt the original to the Division o Wat .r Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 PhoneNo (9191733-322 thin 30 days. GW-1 REV. 07/2001
r t iION
Pil'_ L: 'AI URCE

277533
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAMtn(print)
N'>LI. CONTRACTOR COMPANY NAME ALP It F'' / /� L2 .OJ.i %tl tV/
STATE WELL CONSTRUCTION PERMIT# / Y'O.,G ASSOCIATED WQ PERMIT#
(if applicable)
al Resources - Division of Water Quality - Groundwater Section
r'
t
CERTIFICATIONHa' l-M Q?)
l "1
(if applicable)
WELLUSE (Check Applicable Box): Residential ID' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest
3. OWNER:
Address
0,m
County &L.i/ (VFW fit
Community, Subdivision, Lot No., Zip Codc)
h(St ectgr Route No.)
,37027
City or Town State' Zip Code
(` )-
' Area code- Phone number
4:-DATE DRILLED 7 - - 0 3
TOTAL DEPTH: / SS
:6;-•"DOES WELL REPLACE EXISTING WELL? YES ❑ NO Br
7.'STATIC WATER LEVEL Below Top of Casing: 4o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST 0(I e._
10. WATER ZONES (depth): / 415- /S q p r»
II.''DISINFECTION: Type /-/7"/4 Amount 'S
12 CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ,e) To /.;1 Ft. 6' /' PVG
,From To Ft.
,!• From To Ft.
3:: GROUT: Depth fiterial Method
From 0 To ao Ft. t o.Ynk.wJ it , p
From To Ft.
14.,SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
..`(From To Ft. in. in.
15.'SAND/GRAVEL PACK:
Depth Size Material
From • To Ft.
From To Ft.
Topographic/Land settip
❑Ridge ❑Slope ❑Valleyla
(check appropriate box)
Latitude/longitude of well location
(degrees. minuets/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D /a0 Zc5.r�
..}}
/� as—h/�.iz t,,
0
LOCATION SKETCH
Show direction and distance in miles from a lst rr,
two State Roads or County Roads. Include tl road
numbers and common road names. —
0
v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDgRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSC
Submit the original to the Division of Water Quality
27699-1636 Phone No. [phone], within 30 days.
C
NrnNtcTRII TING THE WEIL
E,-.1 it it i
�, ....,�
h 1�
avrar Sbrt in 'That i �ice Center - Raleigh, NC
GW-1 REV.07/2001
/7- 3/ O3
DATE
L
C=3

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `r``i`'e1A , (( CERTIFICATIONS 2
WELL CONTRACTOR COMPANY NAME j\Ptlilet\ \ r�aloy.la\\ \wrrq SY1 C •
STATE WELL CONSTRUCTION PERMITS /0 3"1 ASSOCIATED WQ PERMITS
(if applicable) / (if applicable)
279688
PHONES (A.7$).L54-357? /
1. WELL USE (Check Applicable Box): Residential I]' MunicipaUPublic D Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: yy
Nearest Town1a tijdls. County /,f>` be -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,4/4 C15 (�
Address 31 t. /146-el6ye0,' 4441n
Street or Route,
nJNo2- 753
City or Town 5letc Zip Code
(Q1)- 7 7 7 - c (3R
Area code- Phone number
4. DATE DRILLED/ .5,
5. TOTAL DEPTH: f /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 15 ' -� r j
7. STATIC WATER LEVEL Below Top of Casing: /'f FT.
1 (Use"+" if Above Top of Casing) �� i
8. TOP OF CASING IS / FT. Above Land Surface" / S
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): W METHOD OF TFST irt6--:
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
,3s'5.s97tfi1onassys
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
ormatii n Dg criptio
11. DISINFECTION: Type mil'. Amount
12. CASING: Walt Thickness
Depth Diameter or WeishuFt.
From'To-�1 Ft.-- t�' 5 f
From-( To Ft. /
From To Ft.
13. GROUT: Depth Material _
From 6j To Z9t Ft. {:.ea/ciL'l
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size ' Material
From To Ft.
Slot Size
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
teriai numbers and common road names.
Material
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL f'.-- _ ,
CONSTRUCTIO STANDARDS, AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWVER
ATE I
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Ralei t
g¢:1YGl
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. K(20b1
1

279687
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *rani ra,I Resources -^D. i+ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (riot) i�1--1 C'� � CERTIrF1ICATION0 all(
WELL CONTRACTOR COMPANY NAME_RUSEN CALDWE L BILLING, INC. PH0NE1148 >254-3561
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IB' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
3. OWNER:
2. WELL LOCATION: To hic/Isnd setting
Nearest Town: UiCA•1612N 1 Ll-G County gki4Cc/vka� ❑Ridge❑Slope ❑VaIIey
Flat
to 14- Twrr1 32-ot44-s ¶v(2431JIS)C (check appropriate box)
(Street Name, Numben, Community, Subdivision, Lot No., Zip Codes) ` Latitude/longitude o well IRCation
ien�,— C oLC Cor�STf—)cY c.3 (de,ern,m,teaseeonm)
Address abi F� -c c9'r,EK- CRocct4 Z.oAb Latitude/longitude source:❑GPS❑Topographicmap
(check box)
DRILLING LOG
Formation Descrip ' n
O / gbe
r, GPm r.� HI re' /&c.i<
6QAracrE w{J ire ace)
3 Gern
(Street or Route No.)
W6�fo-R-Vtk_k_s SIC__
set `t
City or Town State Zip Code
'T 11 — b 4R `j
Ara coda Phone number
4. DATE DRILLED 7/3 1 0 3
5. TOTAL DEPTH: ?� D /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ¢"
7. STATIC WATER LEVEL Below Top of Casing: a FT.
(Use '+' if Above Top or Casing)
8. TOP OF CASING IS FT. Above Land Surface•
'Top of culag terminated Mier below Ind surface require •
variance In accords acs wltIt ISA NCAC 2C.01111.
9. YIELD (gpm): METHOD OF TEST 9-1(� - A ‘12-
10. WATER ZONES (depth): \ `6 0 r -• 3 G en,
-3ao ' -- 3 C, P n"
11. DISINFECTION: Type F1 a Y Amount
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Ma}erial
From L. To ‘ 0.,._,
�FL, hit SbCa Qv/ C,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From , To a-0 Ft. Le(rV30 ` r0J9.-U 0
From To Ft.
14. SCREEN: Depth Diameter Slot Site . Material
From To Ft. in in.
From To Ft. in. r in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
It/�35' y5. ctr23 Gf o8(3, . 3. %I if
DEPTH
From Tio0o
Joel- ISo'
It
\Ro' - 3a-or
390'
"53O `35c '
LOCATION SKETCH o
Show direction and distance in miles fromCt? leasyt,
two State Roads or County Roads. Include ! to nips%
numbers and common road names. a �'
TWtt; 14-oo(S 3
3/4
COB,- L
Fci;14
US ktur] 0/a3
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD I(AS BEEN PROVIDED TO TI WE
SIGNATURE OF PERSON CONSTRUCTING THE WELL /DATE/
I +3i
Submit the original to the Division of Wafer Quality, Groundwater Section, 1636 Mall Service Center- Rat17Ijh, *e -
27699-1636 Phone No. [phone], within 30 days. GW-I RE'('. 07/2001 f '

279514
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na . Resources - Division of Water Quality - Groundwater Section �7
CERTIFICATION #rgD 27
WELL CONTRACTOR COMPANY NAME [Aka, 7�«{..„.PHO///YNE u (P.TSiS-D(FJYL
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED W PERMIT# /Y
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM_ (print)
1. WELL USE (Check Applicable Box): Residential J Municipal/Public ❑ Industrial 0 Agricultural 0 ;
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION � � �� �p
Nearkst To 9i: /e� CountyL�/.11
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: %%fif deer
Address /f t? /� ene.t �? Q(
L ` ( Route No.�J q �f�Cr. �J yG 'tG
City or Town Stater' Zip Code
Area code- Phone comber
4. DATE DRILLED Geo2 %Q 3
5. TOTAL DEPTH: CS
"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ja
7. STATIC WATER LEVEL Below Top of Casing: /8 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7LS FT. Above Land Surface"
`Top of cuing terminated at/or below land surface requires a
variance In aemrdaa£e with 15A NCAC 2C .0I18. •
9. YIELD (gpm)• n METHOD OF TEST —rave -co
10. WATER ZONES (depth): /1-2_5—
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Inc
numbers and common road names.
Topographic/Land setting
❑Ridge ;Slope ❑Valley DFIat
(check appropriate box)
Latitude/longitude of well location
(degreeslmimues/secondt)
Latitude/longitude source:❑GPS❑Tops$gaphic map
(check box) '
DEPTH PRILLI4NG LOG `•..::
From To Formation Description
N
11. DISINFECTION: Type
12. CASING:
Depth atneter
Front To Ft -'
From To FL
From To Ft.
13. GROUT: Depth
Frott> �_ Ta2Ti Ft
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From Ft.
From � To Ft.
Amount / L, AL
Wall Thickness . d? to nut&
or Weight/Ft /C y
Sat' r
Meth
""_c
Ft
Diameter Slot Size Material
Ft. in. in.
Ft. in. in
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELT WAS CONSTRUC1 h1) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(ll ia4
SIGNATURE OF PERSON CONSTRUCTING THE WFJ T
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 279ti 03.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H.
\YELL CONTRACTOR COMPANY NAME n Tinsman
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 2609
Wel 1 T1ri 11 i nrge Tnr PHONE # g7A 75?-7779
ASSOCIATED WQ PERMIT#
Bowman -
(if applicable)
WELL USE (Check Applicable Box): Residential CiC Municipal/Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: rand l er County Buncombe
Hidden Meadows Subdivision; Milksick
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dwayne Roberson
Address P.O. Box 212
(Street or Route No.)
Enka „ N('
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 4/29/03
5.TOTAL DEPTH: 7801
6. DOES WELL REPLACE EXISTING WELL? YES 0 p0 (H
7. STATIC WATER LEVEL Below Top of Casing: 1 00 FT,
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C,0I18.
9. YIELD(gpm): 18 METHODOFTESTErotary air
10. WATER ZONES (depth): 400' 520'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
Cove Rd . (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(chock box)
DEPTH DRILLING LOG
From To Formation Description
28728
II. DISINFECTION: Type tablet Amount
6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 94 Ft.81 /8 Sr'h-_RD
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. concrete
From To Ft.
Material
PVC'
C-3 o
R1 Om
—O zm
oc
10
yG
'O
Dc
enz
N
+71
LOCATION SKETCH 2
Show direction and distance in miles fromebleasE
two State Roads or County Roads. Include the road
numbers and common road names.
Method
gravity flow
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.
IV
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED 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 CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NCi
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 074001

270839
1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) 4etip ',PIN. V\ . .1a(\ JPC S CERTIFICATION It Q4 3(:
WELL CONTRACTOR CO\IPAN7' NAME CV* a6s.s. at.c 5 R JGs wr\\ casavn\a inc. PHONE # (`,+{r220 (ob5-aOaa
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WO PERMIT#
(if applicable) , (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heal 1'ump Water Injection 0 Other 0 IfOther, List Use
WELL LOCATION:
Nearest Town: Co.t awc
:5
Co}I{uy (3\r e.unnbe
as -Ifs
(Street Nmne, Numbers, CBmmun ity, Subdivision, Lot No., Zip Code)
3. OWNER: Reatar E. -bVtt ors
Address as <)L ,a6\ykn t'M ' Q
(Street or ute No.)
Cvnalec (\e
dBi15
City or Town State Zip Code
( 88a)- ‘ et,- \87(e
Area code- Phone number
4. DATE DRILLED a- S
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JR
7. STATIC WATER LEVEL Below Top of Casing: (05 FT
(Use "+" ifAbove Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
"'Fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): L\ METHOD OF TEST 1t,
10. WATER ZONES (depth): U
LOCATION SKETCH t\>
Show direction and distance in miles from at least =
two State Roads or County Roads. Include theraad
numbers and common road names. o-
Topographic/Land setting
❑Ridge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
+1 4S
4B
r-�
I I. DISINFECTION. Type f''vvs
12. CASING:
Depth
From Tk To 48 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ao Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Pt. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Amount "3
Wall Thickness
Diameter or Weight/Ft. Material
Material
Cement
From To
Method
Slot Size Material
in,
in.
Material
Ft.
tall"
16. REMARKS:
i,D HE1 tI3YCERTIFY TH T�T4
- CONSTRUCTION STANDARDIp
,i WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
ATUR
OF PERSON CONSTRUCTING THE WELL
DATE
0
Su3mit the original to the Divisio of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (91*L733-T))tIk within 30 days. GW-1 REV. 07/2001

271894
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and }datum)-
tural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'J IL IA I, to ASy.I CERTIFICATION All I
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. rxot(e4B ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lt7/ MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
/eJf�l�iNearest wfu4_ � ICA)t(C.
(Street Name, Number, Community, Subdiviei
3. OWNER: NtJ (V\o2(L) S
r c-on(3C
Address 14 ag e� )-0 Fort, k o
(Street or Route No.)
FA1e4)EW fv C.
2$%3 D
City or
Town ,( Zip Code
(sag)- a735
— �t
Ana code- Phone number
4. DATE DRILLED al - / 8 3
5. TOTAL DEPTH: `; 10
6. DOES WELL REPLACE EXISTING WELL? YES NO ill
7. STATIC WATER LEVEL Below Top of Casing: D FT.
(Una `I.' if Above Top of Cat ins)
8. TOP OF CASING 1S A FT. Above Land Surface•
*Top of cuing tarmlaated at/or below laud surface requlrea •
variance to accordance with 1SA NCAC 2C.01111. i
9. YIELD (gpm): IS METHOD OF TEST K
10. WATER ZONES (depth): �� o — { S G err
11. DISINFECTION: Type hI I N R %D Amount a c' Q 5
12. CASING: Wall Thickness
Dep / Diameter or Wei t t/Ft. Material
From y To O I.)FL OD S U. a 1 Q �( C
From To Ft.
From To Ft.
13. GROUT: Depth
From To -0
From To Ft.
Material
Ft. Cmn%v �T
Method
14. SCREEN: Depth Diameter Slot Site Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
Lot No., Zip Code) AB 73et
Topographic/Land setting
NJ Ridge 0Slope ❑Valley ❑Flat
(check •pntooriste box)
Latitude/longitude of well location
A 3,5°33 `);48)NIog2,° 9,0,40V
(depecehni uteshecoods)
Latitude longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From 1 /ITo / Formation Description
— C, 4 tqv-dug J(L(ptrra
64-1- a(.) 0 G kAe (-re
,a_k b IS GenN
9.60^— 'Sloe Gg-daN,1-ram
r_.
ry
LOCATIONSKETC11
rn�
Show direction and distance in miles f onnt st E-2,
two State Roads or County Roads. Includc.T6xbad o
numbers and common road names. C?Z
v S
rt DO1TEREBY CERTJPY TFlN1{
CONSTRUCTION STANDAR155
L
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS IUfORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
03
A 1 bniit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
-- 47699-1636 Phone No. (919) 73323221, within 30 days. G W-I REV. 07/2001

271886
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and "ttural Resources - Diviisi_on of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Eed/C Ps A CERTIFICATION a a -/ r y \'
WELL CONTRACTOR COMPANYNAME RF.UHEN CALDWELL DRILLING, INC. PBONE448 )254-3581
STATE WELL CONSTRUCTION PERM ITT ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I,7" MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATIO,1 n
Nearest Town: �IRV 1 E I County k� /OC°j `ia�
3.5 Dt'V15 L1r36) EA+RvICL)) Pc:- agiso
(Street Name, Numbetr/,, Community, Subdivision, Lot No., Tip Code)
DA 3.OWNER: , o`FrrAr
Address 9-6 DA-415 1--4 r )
(Street or Route No.)
- & R'J e it) t C-
a-g t D
City or Town State Zip Code
(Sass )- bag-0 4-q
Area code- Phone number
4. DATE DRILLED St/o3
5. TOTAL DEPTH: a5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use'+' if Above Top of Casing)
8. TOP OF CASING IS 3— FT. Above Land Surface'
*Top of cuing terminated at/or below lead endue requires a
variants In aeeordenes Itb ISA NCAC 2C.011S.
9. YIELD(gpm): METHOD OF TEST RIG
10. WATER ZONES (depth): \ 0 — ' n C-,
II. DISINFECTION: Type EAT 90 T' Amount L CO
12. CASING: Wall Thickness
Depth / Diameter or Wet t/Ft. Material
From To 1 a'C FL C Gt R I to L
From To Ft.
Front To Ft.
13. GROUT: AA Depth / Material
From 1 To a Ft. C‘' n e,O
Mcthod
poJicD
From To Ft.
14. SCREEN: Dcpth 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.
i6.1 ARKS:
1 DO HEREBY CERTIFY THATTHI� 'WeLL WAS CONSTRUCTED IN ACCORDANCE WriiI 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANII THA3' A COPY OF THI RECORD HAS BEEN PROVIDED TO THE Vl1;IL OWNER
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(aback appropriate box)
Latitude/longitude of well location
r(3sal9ra Toga,°4�0(9
(degrecdminuta/secmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PTH DEDRILLING LOG
From , To / Fo,���,�,y,/dDesc
ription-,
a c. J t7 uY-(aucjo�jN
la3 �4o c-,a/+aL-c6( wN1-rc crc
Nevi •
`io - 0— o G2n�i-7e
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.
7
Z
u (PeR
Dtt
0
CO '
47-
O
CO
c�
€a_us c2EE�
���Q o, a) o 3
SIGI'
. _. Submit the odglnai to the Division of Water Qudity, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322P within 30 days. GW-1 REV. 07/2001
ATURE OF PERSON CONSTRUCTING THE WELL ' DJ(TE

1
271885
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcees/- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(�(print)\3'i(''� r1\AS (-' CERTIFICATION #.2177
WELL CONTRACTOR COMPANY NAME Ile-V`TY�YCS�.\\ dW\ 2 L1)T2k �s`{�tT --MC _PRONE # (2vaf),254-353 J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER.MIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential la/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT[
Nearest Town: Ati County
3
(Street Name, Numbers, Community, S
City Town State
3- or5— 9, -�/
Arca codc- Phone number_ // //
4. DATE DRILLED 7 — T-- 6 3
5. TOTAL DEPTH: 3 .5-t)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In according with ISA NCAC 2C .0118.
9. YIELD (gpm): 1,0 METHOBI OF TEST
10. WATER ZONES (depth): 2 u /t( — /2/ r
(gm- ,)f( — 3�-5 11. DISINFECTION: Type 6ETE1 Amount /6 e,_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From +/ To Ft. (":4- S/ '-2-/ /YC
From To Ft.
From To Ft.
13. GROUT: Depth
From 9 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
1 16: REM*RI4S:-_._
'1 DOLIER£BY-CERT1FYTflr\)-
CONSTRUCTION STANDARD
I
Zip Code
Material
(Grnvui
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeiiongitude of well location
Nos '.3 5. 3(7 go s2:79 8'47
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTII DRILLING LOG
From To , Formatio» Decpription
v-' 7t0
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads 1br County Roads. Include the road
numbers and common road names.
— 0
L-- Submit the original to the Di
27699-1636 Phone No. (919) 73 -
S WELL WAS CONSTRUE 1 ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AN AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU
— �3
OF PERSON CONSTRUE 11NG THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

2718S3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -^Diivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (petal) g%t--�-lC rJ AS tj CERTIFICATION a d-ii1
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL DRILLING, INC. PRONEYi8354-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (ifapplieable)
1. WELL USE (Check Applicable Box): Residential 0// Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION:
Nearest Town: i.JSM 111-shLLC County g•JNCremBE
rofLD RoAD
(Sired Name, Numben, Community, Subdivision, Los Na., Zip Code)
3. OWNER: (3ti'T C 0 4-- E.
Address //
oext.reet or z.u..t4-` ), 27i %
$City or Tpwn Si Zip Code
} b R
4. DATE DRILLED 3/0,4-/ n3
5. TOTAL DEPTH: of 3 0 � /
6. DOES WELL REPLACE EXISTING WELL? YES NO 117
7. STATIC WATER LEVEL Below Top of Casing: ka FT.
(Uw "a' It Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing termlasted aUor bslow Ind sedges requires a
vas -hoes In accordsaeo with ISA NCAC IC.011 O. ,fn� 11nn
9. YIELD (gpm): o o METHOD OF TEST CAG f, i, e_
10. WATER ZONES (depth): '.1 o — a:o CG P M
Topographic/Land setting
❑Ridge ❑Slope ❑Valley VIM
(clerk appropriate box)
Latitudefongitude.ofwell location i
t) 35°46. coG I (,J o5101° 35.8z1
(deDeu reimnra/ oads)
Latitude/longitude source:SfPS❑Topographic map
(check box)
DEEM DRILLING r.00j
Prim _ T oo7 Fomtatio Description
�7— is �' 1' IYe-
)I b ` I To W. lie oGC-
Lo G Pry
110
Nit - 15D
tg - 0,3D
(83 G0
Area coda- Phone number
11. DISINFECTION: Type 4114 9C`7
12. CASING:
From 1 To rl
From To
From To
Amount 4,z CupS
I%t+!�e Wall Thickness
FL �q%q-�r Sr Weight/Ft. t,�pg
�V(
Ft. 1
Ft.
13. GROUT: DepdI,
From S- To A 0 Ft.
From To Ft.
Material
�W(P)JT
Method
Po0D
14. SCREEN: Depth Diameter Slot Size Material
Frolic__To Ft. in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
r--- ,..,MARKS:
' CONSTRUlipagECTION STAND
' i SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
w
N
�.i
2a�
LOCATION SKETCH
Show direction and distance in miles from at least -
two State Roads or County Roads. Include '9 road
numbers and common road names. y _
Q
J a
J
\o P'.a ft- (C0
Y
MILS
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRN ISA NCAC 2C, WELL
, AND/THAT A COPY OF CORD HAS BEEN PROVIDED TO THE WELL OWNER
))1"5/19 3
-0
(Submit the original to the Dllrt'slon of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
Ac 27699-1636 Phone No. (919) 73}-3221, within 30 days. GW-1 REV. 07/2001

271882
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u•hvaI tesources - Pivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prigs) ✓t Li_ 1 C. 1J A S f4 CERTIFICATION all
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONE48 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f2J MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: w6A�el(L0l1--lxE. County EJ.tac`r--lC ❑Ridge ❑Slope ❑Valley fJFlat
C- 1. A P-K S C(1 A Pe L try' l . (check appropriate box)
(Street Name, Numben, Community, Subdivision, La No., Zip Code) Latitude/longitude ofrell location
J`oN.�sn J A.)35°4-4-a6-t 1 cJ 0ga° 34.CS`l
3. OWNER: 06 (6 sates)
Address 56 Ct_n 2(CS C 4K L GI c Latitude/longitude source: GPS❑Topographic map
(Street or Route No.) (check box)
t J6 AJe1LV! LLG NC_ 35S 1 B i DEPTH DRILLING I.G(i
_City or Town State ZipCodc From ,, To i FommationDescrijion
(3')- h45-F0-9 1 A - 110 oJe26y20ero
Arta code- Phone cumber 1 I0 ' — 1 Z 5 ' G ON rrE W N t — Z /2-0C IC
4. DATE DRILLED '1/a//° 3 \a5 r I G Pr`-.
5. TOTAL DEPTH: 170 ' d 10.S - I35' 4 �1 re. tic�rL
6. DOES WELL REPLACE EXISTING WELL/ YES ❑ NO 35 1 (0 ' G ILy C (an ra Cr E
7. STATIC WATER LEVEL Below Top of Casing: 7.-0 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 1. FT. Above Land Surface*
*Top of cuing terminated at or belaw lead surface requires a
valance to accordance with ISA NCAC 2C-0111. n t
9. YIELD(gpm): \S METHOD OF TEST f G A i
10. WATER ZONES (depth): 1 2C5 / ' VS c>P r '
'I LOCATION SKETCH
11. DISINFECTION: Type N7 ll cl 0 VG Amount 1 CU V Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di ter or Weight/Ft. Material numbers and common road names. azi _;
From
_a__To H'S Ft. Y " 5D(a1 P (C— -
From To Ft.
From To Ft.
13. GROUT- Depth Material n Method
m j
FroTo a° Ft. C0ivVet-)i r 0v Rai
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. P
From To Ft.
16. REMARKS:
&Lb rv•-AP-S
I LL
7i;0
0
L i DO HEREBY CERTIFY
rCONSTRUC ff6)TSTANf
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A CO FTHIS RECORD HAS BEEN PROVIDED TO THE WELL O'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L'Sribmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
pc 27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

271805
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
- STATE WELL CONSTRUCTION PERMIT#
(if applicable)
_Brada.da T BrLL!_L CERTIFICATION# 3t'4 /
fine evxr R. • LI> 11 v- iu-nvp.PHONE # 420
/yto
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential CB' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: C_A.4414.1 tx County a Los
SriuA4 morftft 13 ra-w c-1... ta4 .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topograyhic/Land setting
❑Ridge MSlope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
3. OWNER: m 14 r * I G. 1 ' t c... n t n Lh- (degree. minutes/seconds)
Address 3 %'La S fllnrar+... Sr . la . Latitude/longitude source:OGPSOTopographic map
(Street or Route
�No (ehcck box)
LA 1 l)�� -.) -a 157 /S DRILLING LOG
City or Town State Zip Code Formation Description
( )- gii' clay
Area codc- Phone number 9 41 ' 41D, 4 '
4. DATE DRILLED 3- 1 - 0 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er/
7. STATIC WATER LEVEL Below Top of Casing: 1 b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm):. 30 METHOD OF TEST 1-,r5 •
-10. WATER ZONES (depth): 90' - Lo 9 Q rvv
445' - 24 r
ew
• 11. DISINFECTION: Type h1 T I-1 Amount I Q.4.44,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From f To Sit Ft. /U it P✓(a_
From To -Ft.
'. From To FL
•13. GROUT: Depth Material Method
From fD To )O Ft. ('n_.vva -1- -F-n P
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
-15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
ie
0
0
16. REMARKS:
1 D41ihREBYSURTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST - JS, AND THAT A COPY OF THIS RECOR�YfTiiS.@EEN PROVIDED TO TIIE WELL OWNER
e
�\77r �.�)) 3-3/- 3
G[/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
IISubmit the original to the 'vision of Water Quality, Groundwater Section, 163u Mail Sen ice Center -Raleigh, NC
L. _..27699-1636 Phone No. (9 9) 7 3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONIIR:\CTOR(INDIVIDU.AL)NAMME ((print) (fry SUS '/ 6 g CERTIFICATIONy�#V5 0
WELL CONTRCTORCOMPANY NAME 3us7tLam' / PHONE ( )80P-72%-7SVrS,i
271741
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential G Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Usc
2. WELL LOCATION:
Nearest Town: )=/1 r)C.0) 2-✓'
County &IOpt. Ii'G
(Street Name Numbers, Conununn/iit'ty. Subdivision. Lot No.. Zip Code)
3. OWNER: P. 6 /V EN
Address 4 (y' ieµ)cm.4.K-e 2, A,U-C.
(Street or Route No.)
�Ai/-fl;Cw Ave
7 CJ
(�r,_ ) ry or,Townc cS) es_ Zip Code
Area code- Phone number 0.
4. DATE DRILLED gi—I E— 0 3
S TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES m NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /Cx.' ' 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 requtres a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): t/2. METHOD OF TEST -C"
10. WATER ZONES (depth): ,z rjeit, e 7Oc
11. DISINFECTION: Typed Lor'r/e'e Amount f',GZ ' 7j>-
12. CASING: Wall Thickness /"
Depth Diameter or Weight/Ft. Material
From To Ft. /�
From v To E?' Ft. C.:: IC/ O plle-
From To �%+q Ft. C' (/ % e x 4 I
I . GROUT Depth Material Method
From To Ft.
From C) To 2 z Ft. t l pe i #'tlOre (1
I4. SCREEN: Depth
From To Ft.
From To
5, SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Diameter Slot Size Material
in. in.
Ft. in. in.
From To Ft.
16. REMARKS:
DG'FiEl @ 1311I IT! 14Y "1
] I r Ir'QN�`CR L( O.Nr TA` TLI
4.. Submit the original to the Di'
27699-1636 Phone No. (919) 733
Topographic/Land setting
3f2ge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ninutes:seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7C,5 &Rth'-•.t
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.
5 02r1'l (si ;.'
()laid Ic n
OLD Puri.gl
THIS WELL WAS CONSTRUCTED ]N ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LA
IGNATUIRE OF RSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
1221, within 30 days. GW-1 REV. 07/2001
7
11-sbieL.t_

2717,10
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)( VJ///'LJ /� Cl1s,';e CERTIFICATION#M%SG
WELL CONTRACTORCOMPANY NAME Si)St/CC We Le., n,ItL;K't�' PHONE # f )74-o5-41
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Ad' btunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: c" if /C fol.' County624/60p
7ularaa Vlru: fl lj
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: SU/U C10,+/5'//t ''bait/
Address P. 0 /3 C.Y
(Street or Route No.)
(/}r/zL'iCe..✓ i'Jt
city or Town State Zip Code
a
()- 62E1-2/Qz
Area code- Phone number
4. DATE DRILLED .,� �%� O
5. TOTAL DEPTH: 705"" —' (P0- 5 C;S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO llr
gel;
setting
E3Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi nules'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
•
0— 8r) 0,.2/lgc:r`/;
7. STATIC WATER LEVEL Below Top of Casing: i✓O' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST 4fre
10. WATER ZONES (depth): .c2/.,vt Cy Sow
II. DISINFECTION. Type L/O,A•Afe Amount eV" C 73J,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From Cl To r%4 Ft. 4
From 85 Toe 7.__ Ft.
13. GROUT: Depth Material
From To Ft.
From (.'l To z"'Z Ft. eve
14. SCREEN:
From
From To
15. SAND/GRAVEL PACK:
C/o pee
Depth Diameter
To Ft. in.
Ft. in.
From
From
Depth Size
To
To
Ft.
Ft.
Method
`C)1I ii
Slot Size Material
in.
in.
Material
16. REMARKS
r-- I D �h�-I EB,' C'L�I2TLF?Y
l , r COL' T VICTION-STAPH
(7AO/I .,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road,
numbers a d common road names. o :
4rIcce
Gam%/-✓,LticJ
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 5A NCAC 2C, WELL
AND TI-T A COPY OF THIS,RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON CONSTRUCTING THE WELL
DATE
L_. Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
• 27699-1636 Phone No.(91.9) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
forth Carolina -.Department of Environment and Natural Resources- Division`of Water Quality - Groundwater Section
ELL CONTRACTOR (INDIVIDUAL) NAME (print) 1-?0 % t rn LJN..16 LIB CERTIFICATION k .2 `I/ ?
-
.,':: IL CONTRACTOR COMPANY NAMEGr a eav , R rL`s - L,� L ^(-- f tA.xv,? t J! we. PHONE # 04 L 54l - 3I 7 r'
% �0 T ASSOCIATED WQ PERMIT#
-' (if a:plicable) (if applicable)
WELL USE (Check Applicable Box): Residential 131---Municipal/Public 0 ❑ Agricultural 0
Industrial
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
`
Nearest Town: ra.r f1.r,t_t Gl ri County5,ti
•
(Street Name, Numbers, Community, Subdivision,` Lot No., Zip Code)
i. OWNER: �7h-cw.-� ) 3V1 -r,-14,--
Address 1 S 0-P rt.. Ce-1 L O-tr- iE A.
11 (-Street or Route No.)
/�,aao t)1 Ylc. 3%730
City or Town State Zip Code
Area code- Phone number
I. DATE DRILLED s - 03
5. " TOTAL DEPTH: 5 I.5'
o.,DOES WELL REPLACE EXISTING WELL? YES 0 NO
'.''STATIC WATER LEVEL Below Top of Casing: LED FT.
(Use"+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
;r4Top of casing terminated aVor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
') .XIELD (gpm): 3, 5 METHOD OF TEST rS
WATERZONES(depth): LIPS- - -a@rrn
549 - ) . cop
1 .DISINFECTION: Type i--I T I-1 Amount Q a
-:'.. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
promn To I :, Ft I p V ('
-From' To Ft.
From To Ft.
GROUT: Depth Material Method
'From G - To • 2O Ft. Ca-_ -e --1--e
from To Ft.
1 ,SCREEN:,, .' Depth - Diameter Slot Size Material
Ft. in. in.
;from ' To Ft. in. in.
?. ISAND/GRAVEL PACK:
., ` Depth Size Material
.From To Ft.
,from To
271193,E
'.CTE.WELL CONSTRUCTION PERMIT#
"From ` To Ft.
I6.i MARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 13Plat
(check appropriate box)
Latitude/longitude of well location
(degrecsminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatiop Description
0 Iaa• k
❑D • S45'.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road_
numbers and common road names. 0
0
r
0
REq',, CSRT I`Y1fl
i.priaTRUCIY STANDAR
•
{ WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD I-L & SEEN PROVIDED TO THE WELL OWNER
P_P—t;
NATURE OF PERSON CONSTRUCTING THE WELL
3 -3/- 6>3
nbptit the original tethe, ivision of Water Quality, Groundwater Section, 1636 Mail Set ice Center - Raleigh, NC
2,7691-I636 Phone No. (919),7;3-3221, within 30 days.
DATE
GW- I REV. 07/200 1
rn
r

272380
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divi_si_on (Water lQuality - Groundwater Sectionr
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i"�lj f� CERTIFICATION/ All
`1
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DR IL IN , INC. PHONEY(I%8 '254-3581
STATE WELL CONSTRUCTION PERMIT/ /. % / ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential gr.-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO Q
Nearest Town: I/i[fI Countyj4APkfl r-
pp
/9 Q3 — t 77r (-Van'
(Street Name. Numbers,ommunity, Subdivision.,tut No., Zip Code)
3. OWNER:
Address
(Street or Route No.) v�
C - O �j7d? D
city or Town Sy� Zip Code
(K�- Le497- ?fig 5
Area coda Phan number
4. DATE DRILLED .7 —)- 5 --
5. TOTAL DEPTH: 3 /0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: l3 0 FT.
(the "a' if Above Top of Cuing)
8. TOP OF CASING IS ( FT. Above Land Surfaces
Top of easing terminated at/or below land surface requlru •
valance In accordance with 13A NCAC IC .0113.
9. YIELD (gpm): 7 METHOD OF TEST
10. WATER ZONES (depth): ,A UKY— 20r
e?' - -2-85
l 1. DISINFECTION: Type ff%Ff Amount -.4 07,,
12. CASING: Wall Thickness
Depth Di) ter or Weight/Ft. aterial
From +I' To /S7' FL 6 "(4Sf%I2• 2 / (ice
From To Ft.
From To Ft.
13. GROUT: Depth M•tcriel a h;,d
Fromi_ To?..I Ft �i,-nit
�('ru-t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
/Topographic/L.and setting
(Ridge 0Slope ❑Va!!ey ❑Flat
(check appropriate box)
Latitude/longitude of well location
IV15S°,31 — 53.2R W xa° qy. /V'
(degreeandnutarsecoods)
Latitude/longitude source:❑GPS❑Topogr is map
(check box) W 7
DEFTH DRILLING-LQG -
From To Formatio,p De option
r1 /9
/35' /-5'
/ jC/ S£'
S ' ? //1t
From To
Ft.
J ()CATION SKETCH
Show direction and distance in miles from at least two State Roads or County Roads. Include thrread `."
numbers and common road names. w —,
16. REMARKS:
Y
fni
'$ubmit the original to the
JI/A09-1 /.l6 Phone No. (9.L9L
GYG,"",;)'NATER EECTIGN
UFHLE
IS WELL W CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C. WELL
THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 S V
.SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I -DM on of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
733-3 21,within 30 days. GW-1 REV. 07/2001

272372
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionisof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM((FF��jj (prfut)6t) Er/(/ / e 1.. ,l,n/1� L'' ooLpD ,, /� CERTIFICATION #n77
L
WELL CONTRACTOR COMPANY NAME SCmute Lowish 221.c.i PHONE II (col L S14ayro
STATE WELL CONSTRUCTION PERMITS 4//i' ASSOCIATED WQYYPERMITIt Agri
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 13, 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 . B./ &at L(!d �� a/
e2$9/J
( e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: act, GU LF
Address Erg faatee. /ta-a ell at
(StJett or Rome No.)
7:44r,� Ade r • .2 IT -5"
City or Town State
Area code- number
4. DATE DRILLED �/nZ S/ O 3
5. TOTAL DEPTH- yO S`
6. DOES WELL REPLACE EXISTING WELL? YES NO lsa
7. STATIC WATER LEVEL Below Top of Casing: /
Mac "+" if Above Top of Casing)
8. TOP OF CASING IS / .S FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): 'S METHOD OF TESTT.Gtet/
10.WATER ZONES (depth):- 5— ' 3Q6"m
Topographic/Land setting
❑Ridge ❑Slope XOValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Zip Code
11. DISINFECTION: Type(20..S.44‘ Amount / 7 OZ-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
0
FromTo So Ft. G..2j gt .1 / Pa c
From To Ft
From_ To Ft
13. GROUT: Depth Material Method .
Front 0 To t2 0 Ft. ettent S -uif ri'uy
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 o Ft.
Fro To Ft.
16. REMARKS:
(deg as/mimos /secmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and di . ce in miles from at least
two State Roads or Co ty Roads. Include the road
numbers . common • . names.
1
LSN
MA7
Submit the original to the
G R O d161 416 flaiiieNo. (919)
ASHEl4LLE REGIONAL OFHCE
T THIS WELL WAS CONSTRU(, mt» IN ACCORDANCE WITH 15A NCAC 2C, WELL
�S, AND THAT A. COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFr 1 OWNER
� :1 o3alf 3/0 'f o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

272370
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grotmdwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(print)
�// (8Q��v/g/i //,���/t//%//LL //�� CERTIFICATION #,u 7?
WELL CONTRACTOR COMPANY NAME..t%r .t1/2Ltcheek W Ina/W.1IKtc�/ LGrc! PHONE re (IulhL y90 yin)
STATE WELL CONSTRUCf1ON PERMITS, WQ PERMIT# N//S%
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO,
Nearest Town: Coqunty43...P.ae tk1
Its/ d o 891/P
(Street Nam Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER G¢Naei
Address /DD .UOin�4/
�1Retor teNo.)
N. C.
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3/1G/o 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO ts,
7. STATIC WATER LEVEL Below Top of Casing: L / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1, X FT. Above Land Surface'
'Top of wing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .9I18.
9. YIELD (gpm): /, METHOD OF TEST12L .
10. WATER ZONES (depth): /D 5 r
11. DISINFECTION: Type cui.s
12. CASING: v
Depth Diameter
From0 To ff Ft. %a
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To .JC) Ft.
From To Ft.
eMatenal
arse.
Amount
Wall Thickness
or Weight/Ft Material
.**II 6) c
ter
Method ,
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.
REMARKS:.S — -
n___IksiEB1L'CFIRd1 of - T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUC ITON 1r� Ii' a S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI T OWNER
Topographic/Land setting
[Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesrminuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
D_EP DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at east
two State Roads or County Roads. Includ e road
numbers and common road names.
e sce
d
to 0 iiblhitxl)pro-gipa(1
ASLFG R'���� S
&9- S £22'" 3 70 3
( SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
_ 2i3.n99-1G1&Phone,iNo. (91 ) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEQ(prt�nt),epC) 4/A/ / G T34L.L CERTIFICATION#oil%7
WELL CONTRACTOR COMPANY NAME .2c- 01..t e1LC /e u(Gli w
UPHONE # (r G N/' O1/trd
STATE WELL CONSTRUCTION PERMIT# .U/.� ASSOCIATED WQ PERhIIT# HA?
applicable) (if applicable)
272364
1. WELL USE (Check Applicable Box): Residential E) Municipal/Public ❑ Industrial CI Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County ii
e/Qt , ca2S7A.C—
(Streei4lerne, N(/��ben. Cammwity. Subdivision, lot No., Tip Code)
3. OWNER: LOGY/
Address a2 /. t 224ta44r / -4*! u .
nn � /�J�o (SuVet or Rc4c No.)
(�ir/XiL2K ,(/.G. e f%/ .--
City or Town State Zip Code
(=-)
Area code- Phone number
4. DATE DRILLED ,3 /D .3-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D?
7. STATIC WATER LEVEL Below Top of Casing: 'YS FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
'Top of wing terminated atlor below land surface requires ■
variance in accordan witb 1SA NCAC 2C .0118. T
9. YIELD (gpm): Q_ METHOD OF TEST /.Gnio
10. WATER ZONES (depth): VS ' .2 of
Topographic/Land setting
❑Ridge ❑Slope ❑Valley MElat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type
12. CASING:
From 0Two �7/4
From To
From To
13. GROUT: Depth
From 0 To ta2-n
From To
14. SCREEN: Depth
Fro To
From / To
15. SAND/GRAVEL PACK:
Depth
To
To/
m
Fro
From
Diameter
Ft. 4
Ft.
Amount
Wall Tbiclmess
or Weight/Ft rial
ems/ r.
�oZ
Ft.
Material Method
Ft Carry)/ LY%tty
Ft
Diameter Slot Size Material
Ft. in. in.
Ft in. in.
Size Material
Ft.
Ft.
-/
LOCATION SKETCH ci -
Show direction and distance in miles frari at least,
two State Roads or County Roads. Include the road
numbers and co'... on road names.
THAT THIS WETI WAS CONSTRULtbt)1N ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
-3//io.3
DA
G R 0 U N E9 4. itipal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASH- \'!LLE2 9'1 61.11
roolaNo. (n19)733-3221,within 30days. 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) Jeremy H. Bowman' CERTIFICATION #2 8 0 9
WELL CONTRACTOR COMPANY NAME D Amman Wel 1 Dri 111 nut Tnr PHONE N R2R 257-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
272189
I. WELL USE (Check Applicable Box): Residential ($ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest TownAsheville County Buncnmhe
960 New Leicester Hwy. 28806
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER :Michelle Whitc
Address 960 New Lcircatcr IIwy .
(Street or Route o.
Asheville NC 28806
City or Town State
)-
Area code. Phone number
4. DATE DRILLED 2 / 20/ 0 3
5.TOTAL DEPTH: 760r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Tap of casing terminated aUor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 12 METkIODOFTFST:rotary air
10. WATER ZONES (depth): 1 40 e 240
Zip Code
II. DISINFECTION: Type tablet
12. CASING:
Depth Diameter
From 0 To 100 Ft..61 /8
From To Ft.
From To Ft.
13. GROUT. Depth
From 0 To 20
From To
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
Srh an min
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
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
Ft. concrete gravity flow
Ft.
C)
16.REMARKS:
gNSTRMTIhN STAND
11 MAY - 72C13
T
Submit the original to rile Div
(irigO§L 16.16 PifdrfiEB311 l9) 733-
1 NL OFFICE
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
slon of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
)221, within 30 days. GW-1 REV. 07/2001

:'':_186
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman CERTIFICATION 2809
PHONE Y R7A 7 5 7 - 7 7 7 9
WELL CONTRACTOR COMPANY NAME D
STATE WELL CONSTRUCTION PERMITY
(if applicable)
Rnwman Well Tlri l l i ng•
Tnr•
ASSOCIATED WQ PERMITY
(if applicable)
I. WELL USE (Check Applicable Box): Residential CX Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Te-vn: Weavervi 1 1 p
Riche Brook ates-
County Rnnrnmhp
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Russell & Kim Schroeder
Address 35 Snowy Cove Lane
(Street or Route No.)
R1 ack Mt-n Nr 78711
City or Town State Zip Code
( )-
Arca code- Phone number
4 DATE DRILLED 1/22/03
5. TOTAL DEPTH: 200
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO IX
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9 YIELD (gpm): 30 METHOD OF TEST rotary
ID. WATER ZONES (depth): 30', 1 20 s r 1 00 s
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 Ft.h1 /8 ScH RO PVC__
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From
14. SCREEN:
From
From
To
Depth
To
To
Topographic/Land setting
ORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH PRILLINO LOG
From To Formation Description
air
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
concrete gravity flow
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From
16. REMARKS:
To Ft,
E U`7DO IEICEE' C, AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
� ) CONSTRUCTION ST'AN(j S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-` J MAY - 7 [`' SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Epp(samistfgt pglBpllal to thl Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
ASHEVII2'ciirALIt14'!{thoWFh (9191733-3221, within 30 days. GW•1 REV. 07/2001
14,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME D RnWman Well llri 11 inrf, Tnr PHONE Y 137A 759-7779
STATE WELL CONSTRUCTION PERMIT
(if applicable)
272185
ASSOCIATED WQ PERMITH
(if applicable)
WELL USE (Check Applicable Box): Residential CB Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: T,Pi rastar County Rnnr nmhe
178 Newfound Road 28748
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Roy & Geneva McDowell
Address P.O. Box 244
(Street or Route No.)
Leicester NC
28748
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 120/03
5. TOTAL DEPTH: 29U
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 20FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
va rlance In accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 100* METHOD OF TEST%rotary air
10. WATER ZONES (depth): 1 50'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
❑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
220'
11. DISINFECTION: Type tablet
12. CASING:
Depth Diameter
From 0 To 40 Ft..81 /8
From To Ft.
From To Ft.
13 GROUT: Depth Material Method
From 0 To 20 FL
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 6
Wall Thickness
or Weight/Ft. Material
Srh 8n PVr
16 REMARKS:
MAY - 7 20+,
concrete gravl y flow
0
Cy)
-a
r0
cn
0
v
Submit t inal
GROUNDN7 )-5MT1�� No
ASHEVILLE REGIONAL 0
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Ilu IC_
DATE
o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
919) 733-3221, within 30 days. OW -I REV. 07/2001

272182
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jerepty H. Bowman ' CERTIFICATION 2809
WELL CONTRACTOR COMPANY NAME D Rnwman well Dri 111ng Tnr• PHONE # R7R 757-7779
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I$ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Fairview County
Rudicil Drive Fairview
Buncombe
28730
(Sirect Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3OWNER: Renae Ingram
Address Budici1 Drive
(Street or Route No.)
Fairview NC 28730
City or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED 1 /08/03
5. TOTAL DEPTH: 500'
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO CI
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC ZC .0118.
9. YIELD (gpm): 3 METHOD OF TEST'. rotary air
10. WATER ZONES (depth): '160'
4RQ'
11. DISINFECTION: Type tablet Amount 6
12. CASING:
From 0
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
Depth Diameter or WeighUFt. Material
To G5 FI.Fi1 /8 Sc R0 Pvr
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
0
Ca
U1
0
16.REMARKS:
LJ� 70� TfCOt"Tit
i 1, ,e"xl
Lli
•
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
WS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/1,
i/srt-,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the originaljto th Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
i ,. 27699 1634TboneMNo. (919)1733-3221, within 30 days. GW-I REV. 07/2001
r
--

272170
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Ma tura)Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) 'J V L L.1 ( ) A S Pt CERTIFICATION N all
WELL CONTRACTOR COMPANY NAME_RF.USEN CALDWELL DRILLING, INC. PHONE4%8 5 4 - 3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 19-/ MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: V-A(F-J1e(...) County &NCoMO(
,vxti= \Nc�Aimp -T24111_ S0.. F`+1(2._65i,4.)
(Street Name, Numben, Community, Subdivision, Lot No., Zip &de)
3. OWNER: n d t) C el n.-•E
Address 3 (o I,t) S rcF(l STE (2_
(Streetor Route No.)
n�a�vt.'.- •$•)�
i.t` •
ag 3
City or Town State Zip Code
( �)- a 54-'\Gf''
Area code- Phone number
4. DATE DRILLED A /I 0/0 3
5. TOTAL DEPTH: 6 to
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121/
7. STATIC WATER LEVEL Below Top of Casing: (70 FT.
(Use "+' if Above Top of Cuing)
8. TOP OF CASING IS 3- FT. Above Land Surface•
*Top of cuing terminated alior below land surface requlru a
variance to ■emrdance with 15A NCAC 2C .011S.
9. YIELD (gpm): 3 l/.- METHOD OF TEST UG - 1
10. WATER ZONES (depth): S o ' - 3/4 G PM
�50 — as/4 GPM
11. DISINFECTION: Type I'11' ct 0t 7> Amount C 'P3
12. CASING: Wall Thickness
Depth 5 Diupetcr SD,pl t/Ft. Material
FromTo 3 Ft. b 5 fC !�
V
From To Ft.
From To Ft.
13. GROUT: 4 Depth Material Method
From To a Ft. ec T ( LNC
opographic/L.and setting
idge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcpees/mhiu seconds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
o is a-/S v (lb E nD
V4- & P,ry,
a 3/4 GPM
(LANtTL
DEPTH
From / T3oo
3o '- "ol
d5D'
a60 ' - 55DcScSo
.5-5D - (io'
LOCATION SKETCH
Show direction and distance in miles from atlleeast ,`
two State Roads or County Roads. Include the -road '.
numbers and common road names.
,$
cJ�
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in in.
From To Ft. in. in. t.'1
15. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft.
From To Ft.
3M Q�
l-o5e 14t«
c1)
ra)
16. REMARKS:
1E1tEBkt[tEST11 ' T�1jT TP.0S WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
-S A1NDTHAT A COPY OF RECORD HAS BEEN PROVIDED TO THE WE OWNER
M1
.5MNATURE OF PERSON CONSTRUCTING THE WELL /DA
Submjttbe-orlgfnalr4e-Ihe-Dlvlslo a of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phonerflp, �(9F9) �/33-322 , within 30 days. GW-1 REV. 07/2001

272169
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *satool fR�esources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prier) '-"l^LLE 6J ASI4 CERTIFICATION ail
WELLCONTRAQORCOMPANYNAME_REUBEN CALDWELL DRILLING, INC. yr�t�g 54-3581
THONEY
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(ifapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I1d-/ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Nearest Town: Al �Ni1 b („� County ()bun) CorriQC
lit SAARe' r3 /C.D_(Ade Neese
(Street Name, Numben, Community, Subdivision, tot No., Zip Code)
3. OWNER: C t"c L PI\\.-rCt-ke h).,
Address 1/4-3 5i:A62-oto R
(Street or oc Route No.)
?A &i e (.J § a8 `r 3 o
City or Town [ate Zip Code
(33Y, )- b Q- ) 34 a
4/4/b,'
5. TOTAL DEPTH: —1 e
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4; FT.
(Use's if Above Top of Casing)
8. TOP OF CASING IS ---I- FT. Above Land Surfaces
•Top ofesales termlasted at/or below had seam requires a
variance le Records:1p wltb 1SA NCAC 2C .011t.
9. YIELD (gpm)• METHOD OF TEST 62i V -- At SZ-
10. WATER ZONES (depth): E D 5 G ePr\
11. DISINFECTION: Type 1i IR clo`2
12. CASING:
Area code- Phone number
4. DATE DRILLED
AA Depth Di ter
From 1 To 6 3 Fi. C'/S
From To Ft.
From To Ft.
13. GROUT; Depth Material Method
From To �0 Ft. Cc3 tv\,N c P° .i2ty b
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 3 cues
Wall Thickness
or Weight/Ft. Material
Sett s.\ 9'f
5
Subndtthe original t&tie-Division lof Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
2.369941636 Phone No IN1„Hil/E123.1„w1thl n 30 days. GW-1 REV. 07/2001
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitudeofwell location
N 36° 3aail5'I (3 05o' A-_6(4
(dcDeuhniwln .r.vwl,)
Latitude/longitude source:) 6PS❑Topographic map
(check box)
L1:P_TH DRILLTNO LOCI
Fr m , To / Formation Description
- 53 v 26t;aPJ
._Cs-'0
\GOM
Gcvo - 110' aN.) rc
CO
J ()CATION SKETCI{
Show direction and distance in miles from atleasL -
two State Roads or County Roads. Include the road
numbers and common road names. -,
a
r4
Ctinie C_eet<
1 rr-‘
16 RFMAltkS-
t, j v. r ..
Yk�' RTIPY 'l4_4Tt7JT1! WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
'tSTRUCTION STANDARDS ANBT T AnClO�PY OF IS RECORD HAS BEEN PROVIDED TO THE WE`f OWNER
H1 ,J, , Ck-� 1c ClAIV 4h / D 3
TURE OF PERSON CONSTRULTINO THE WELL A

272168
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and U+hurl Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (riot) I J ILL A S eJ CERTIFICATION / a-7 -I /
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. PHONER?(B •?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable)
(i f applicable)
1. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 13-If Other, List Use CHu(Lc-ft
2. WELL LOCATION:
Nearest Town: 15 ARNAPBS VILLE Cunty eu.tom@E
1639 QA2tJMRDSV1LLLa:, 14LO/ (�A�ARQSJILtg11.1c
(Street Nurse, Number, Community. Subdivi ton, LAX No., Zip Code)
3. OWNER: QAe AYZbSVILLE (3APTtST CNu(cf(
Address Ibb3R /3A21UA9- SJIL.LE Nw/
BAMA)AR.ASJiL(L.E �I Route 709
City or Town State Zip Code
(V34)- SAL- . 3�r✓4
Area coda- Phone number
4. DATE DRILLED 3/Q5 /0 3
5. TOTAL DEPTH: L5O'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑'
7. STATIC WATER LEVEL Below Top ofCasing: ¢O FT.
(Use `t' if Above Top of Cuing)
8. TOP OF CASING 1S FT. Above Land Surface*
*Top of cuing Iennlested slier below land surface requires a
variance In accordance with ISA NCAC 2C .01 U.
9. YIELD (gpm): oZ O METHOD OF TEST 1 .sG A 12
Topographic/L.and setting,
❑Ridge ❑Slope ❑Valley /Flat
(check appropriate box)
Latitude/longitude of well location
N 3 5' q-E - (, a 1 ) taJ o fie a 1 .355/
(depeeahninu °Ods)
Lai itude/longitudesource: G(F7 PS❑Topographic map
(check box)
DEPTH DRILLING 1.0Q
Frprn To�4 / Formation Description
_
77 o Je24,4.oen�
k.4-/— Ito' (II-AeJt-r6
I it) r ado G Pr,
110 / - 150' C5 ni tit-
10. WATER ZONES (depth): 1 to - a n G Pry
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type N-N R 0 70
12. CASING:
Depth
From 1 To 69 FL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To c9-0 Ft. Cernbk ' flea -Et
Diameter
Amount 1- Cu P
Wall Thickness
or Wei t/Ft. Material
.• IS C SteeL-
From To Ft
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Site Material
From To Ft
From To Ft.
16. REMARKS:
r-
FihRE�f1' CERTIFY}klAi TH.�l IT
WELL WAS CONSTRUCTED IN ACCORDANCE wan I5A NCAC 2C. WELL
STRUCTION STANDARDS; AT D THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL 9WNER
I 01N3/al /o3
$i i JATURE OF PERSON CONSTRUCTING THE WELL DATE /
i
SubrncifWeitingiiiiitinTihc DI 1sIon of Water Quality, Groundwater Section, 1636 Mali Service Center- Raleigh, NC
_276924636 Phone Nd:'(9191933-3221, within 30 days. GW-I REV. 07/2001
LIJ /C o
!S A 2-ARDSJ Ii_
C i+,}P.c“
-J
L_!

272167
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources-Divisionof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JI 1^L.tC Q3AS44 CERTIFICATION• all
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. ?HONKERS )254 -3581
STATE WELL CONSTRUCTION PERMIT• ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Nl MunicipaVPublic 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: �RNARb&./ L.LE count, &)A )Co61e
14yr iC 11- JGA 2 CQEC;• OSTA j e
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER. GY\14R-CNRj.,SOoJ
Address
4,444aftreet or Routs
�No.) e g a 3
City or Town State
Zip Code
(erg)_ �ssx-0
Arcs coda Phone number
4. DATE DRILLED 3 /ao/b 5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I9
7. STATIC WATER LEVEL Below Top of Cuing: by ET.
A (Use '+' if Above Top of Casing)
8. TOP OF CASING IS 1- FT. Above Land Surface'
'Top of casing terminated aUer bebw lend surface requires a
variance In accordantff wise ISA NCAC 2C.011s. pp
9. YIELD (gpm): �F" METHOD OF TEST 1`tG - A I A
10. WATER ZONES (depth): 1 q 0 LI-. 6 Pr,
11H'o`a
5. TOTAL DEPTH: 330
11. DISINFECTION: Type
12. CASING:
jTopographic/Land setting
Ridge 0Slope ❑Valley ❑Flat
(check app+oprisle box)
Latitude/longitude of well location /
t4 3S°45.9g4,ei We00.A810(7
« (degrahn inr t&seconds )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frpm , To , Formation Descriptign
.
1 05 O viet26.,40.8 -)
V06 /- t0! c ct 4/ G(--etoIle
ISO /- tio' wI4'Te AC-
19 0 r 4- G P r✓,
cxnITta /,Loc4-
2-to'- "5 30' GrZAV GZANi-1.
140 ' - 2- o
Depth ter
From To I t O Ft. "
From To Ft.
From To Ft.
13. GROUT:1 Depth Material ()Method
Front_.1 To as 0 Ft. C-tcrienYC V o 0(LED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
Sor
OIi(bt/Ft.
LOCATION SKETCH o
w
C o P 5 Show direction and distance in miles from at -least
two State Roads or County Roads. include thud-
numbers and common road names. —
Sa, 6(Lac v1LLE N1'37
f�i ial
VV <i
16 REMARKS•
iL] t..�
Il'O HERE
NSTRUCTION STAND
rics
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
TT A COPY OF THRECORD HAS BEEN PROVIDED TO HE VIpLL OWNER
A ,6_, ok / ` 3 bl i O 3
SI ATURE OF PERSON CONSTRUCTING THE WELL r I1'ATE
Sdb t the origlit tlfo Ylk Olvisl n of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
274994636 Phont)!In':
1,within 30 days. GW-1 REV. 07/2001

272166
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Uahtnl Resources -^Diivision of Water Quality - Groundwater Section
%
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ✓ LL. ErJ CiRT1FrICATIONY �1 I
F.
WELL CONTRACTOR COMPANY NAME _RUBEN CALDWELL DRILLING, INC. PRONErY%8 )254-3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(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:
Nearest Town: IhA(ZS f4 L L count, Q ✓ C,o r'•(5E
FAINT t41 iZoAo
(Street Neon, Numbers, Crvtununity, Subdivision, Lax No., Zip Code)
3. OWNER: Sc cri S
Address 35 a o6p MAPz.S NI LL N W `/
WurkjeltvlLL tnrliciri.t.) ass (`Li
„City or Town State
rug) v4s — 33o-7
Arta coda Phone number
4. DATE DRILLED 3/a7/o 3
Zip Code
5. TOTAL DEPTH: 3 3 0 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CT
7. STATIC WATER LEVEL Below Top of Casing: Go FT.
(Use "r' if Above Top of Cat ins)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated Wor below land marten requires •
variance In atcordane. with 15A NCAC IC .0111.
9. YIELD (gpm): 3 /4 METHOD OFTEST (LIG ry i
10. WATER ZONES (depth): 2- 2 o / \ %Z ' 0 PM
3 c o 3.V4 GPM
11. DISINFECTION: Type
12. CASING:
Dep
th I
From To ) UC
From To
From To
13. GROUT: Depth
From To a v
-TN 907.2. Amount?
Wall Thickness
Diacter or Weight/Ft. Material
Ft.
Ft
Ft.
� � i( s toZa k Q✓ 5
Material Method
Ft. CGMZNT Pe otej
From To Ft.
14. SCREEN: Depth
From To Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter Slot Size Material
in. in.
in. in.
Topographic/Lan setting
❑Ridge ❑Slope ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcpenrminu )
sourer. Gt�7' PS❑To
Latitude/longitudepographic map
(check box)
DRILLING LOG
For)rtation Description
BBC( �R-pC. rJ
G��tr t {In (Zoc(L
iI Gror
1Te/63NITedaocC
ono )t/4 G?rr-
DEPTH
Frpm ,. To i
155
S5'- ciao
`moo
a-ao "- 3 o o
-3 so -
cJ
w
LOCATION SKFTCH ^�
Show direction and distance in miles from at tt�st
two State Roads or County Roads. Include the roadnumbers and common road names.
3
4
1Q)iBffit>REHYtERT)FY l t4A's
�S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'CONSTRUCTION STANDAR rAt ---
a-v-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to t'MgD{vlslo¢ of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone tin= (Ys r) r33-32211, within 30 days. G W-1 REV. 07/2001

273796
WELL CONSTRUCTION RECORD 4ly
North Carolina - Department of Environment and Matrtnl Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 11/ N%�'//GG// CERTIFICATION/ 2-77/
WELL CONTRACTOR COMPANY NAME_RF.UEEi�CALDWELL^DRILLING, INC PHONE£i7j8 •?54-3581
STATE WELL CONSTRUCTION PERMITS
ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Boa): Residential Cr-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:C4•W94C#t County t1 AJCact Topographic/Land and setting
❑Ridge ❑Slope ❑Valley ❑Flat
-7orti-Ie (L MAT . QODa ' + IS ( (Seri appropriate boa)
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3S63/. /57 WW689,654A.9o8/
3. OWNER: S/ A4, Li It' V Al tr- (deyeum,inuces/secoads)
Address 7aR ADwrd getAe, 'P8L4 en Latitude/longitude source:❑GPS❑Topographicmap
(Street or Roue No.)
e�i e2 0.X' at 7 lc DEng (check
LOG
��pCityorTown State zip Code From To Formation Description(�
G - VS-. -. ZZe/ t) - 5r /• cin.1 /9a (Nam
Mt. code- Ph/misnumber number fy�• � -
4. DATE DRILLED 2f�. TJ 0-3 �� +rY.",�,.,, d� e
5. TOTAL DEPTH: 6a D4 c w 6. DOES ELL REPLACEEXISTING WELL? YES ❑)I O �
7. STATIC WATER LEVEL Below Top of Casing: Y-] FT. 1/o r. s4,a
(Use `s' if Above Top of Casing)
8. TOP OF CASING IS /• .a!• FT. Above Land Surface• 3� - Yee.�'
'Top of cellos (molested odor below laud surface requires • i
variance In accordance with ISA NCAC 2C.011 I. p
9. YIELD (gpm): METHOD OF TEST I` ! tr.
10. WATER ZONE (depth): 26,5 - 2. 0-44-'
34.0 - 2-6-1244
11. DISINFECTION: Type tf 55f' fO70Amount /9 )
12. CASING: Wall Thickness r
Depth Diameter or Weight/Ft.eterial
From# t'-C To %D I Ft. 4 - Ij- 2J (ITC
From To Ft.
From To Ft.
13. GROUT: Depth Material brand
Fromt_ To. % Ft. AYG4_ lJt.4c /
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
From
16. REMARKS:
To Ft.
To Ft.
/d
o t,
LOCATION SKETCH `y
Show direction and distance in miles from ai ast ^ �'
two State Roads or County Roads. Include tpe roa D
numbers • • ommon road names. '.0_ m
---1
w4,4 m
N rn z
m�
ti
CT
JUL it.C3
T.?
IS WELL WAS CONSTRUCTED IN ACCORDANCE wan 1SA NCAC 2C, WELL
IJD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'"!13NATU1 PERSO CN ONSTRUCTINO THE WELL
DATE
Sum t�ttgTjg11nt1Otl�Ivisloo of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27609-t 36 Phone No;(910)17; 3-322 I, within 30 days.
GW-1 REV. 07/2001

273795
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NA twatResources - Division of Water Quality - Groundwater Section
R WELL CONTACTOR(INDIVIDUAL) NAME (print) L5!/(/ 11-brf5 CERTIrFtICATION/ ��7/
WELL CONTRACTOR COMPANY NAME _
REUBEN CALDWELL DRILLING, INC. PHONEY8 I254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C7 Municipa(/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N rest Town: 2A--77 County nr/^''(' eat lc
LCl
(Street None, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:Cres4(77 /(Wei
Address 7 c l-nonce 4
(Street or Route No.)
n'DLc Air
/)4
2-g7/-5"
City or Town State Zip Code
( sq- (005— a 2-SL7
Area code- Phone number
4. DATE DRILLED 5t//s1(/fi
5. TOTAL DEPTH:300
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 37
A (Use `s' if Above Top of Cuing)
8. TOP OF CASING IS % FT. Above Land Surface•
*Top of casing terminated at/or below had surface require a
variance In accordance with ISA NCAC 2C .0111.
9. YIELD (gpm):30o METHOD OF TEST
10. WATER ZONES (depth): T v -
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
,4 35.3/.f&411ogVe72.y.zs
(dents/minutes/sanods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
Formation Description
CrttcG-c%rr,.l'i 'L.d-
r4 X) ft.. , Jac
/O (2 466 ,! /"S.o.4,1-e.l C -
rn
From
`2 -
To
7O
7
9 /` -
/or_
2-Vo,
FT. Li0
11. DISINFECTION: Type // 229
12. CASING: O
Depth
From f / To /6 FL
From To Ft.
From To Ft.
13. GROUT: Depth
From D To £ - Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Material
70
.3 00
,
0
0
—c
LOCATION SKETCH N3 o
Amount /1 774 fo c Show direction and distance in miles from at least y\
Wall Thickness
two State Roads or County Roads. Include thg,ad'Mc
or Weight/Ft. tend numbers and common road names. cn
?�Z/ C/�� �v,// N
/ / ON G
z'
/
From
From
Depth
To Ft.
To Ft.
16. REM • RRS•
' EIMBI�
NSTRUCTION STANDARD
n
SI
Subkrdhernrtg1nall(Eli a DIvlsto
270,94636YIWemKii SJS(9tij1 S-322
P rnio
Metho�
Slot Size Material
in.
in.
Size Material
-2-3
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A"- ,g / A 3
ATUREOF PERSON CONSTRUCTING THE WELL DATE
of Water Quality,.Groundwater Section, 1636 Mall Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

274227
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and >Jntural Resources -Division of Water Quality- Groundwater Section �1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , U) LA._ (' t'J A S J4 CERTIFICATION a X 1 1 )
WELL CONTRACTOR COMPANY NAME _REUBEN CALDWELL DRILLING, INC. rHONER?(8 '754-3581
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
2. WELL LOCATI N:
Nearest Tow/`n:____ Co ty
ntat(Street N , Numbers, Comm , Subdivision, Lot No., Zip Code)
3. OWNER -IT -;a a tit ?D - U €4 dl)A't'r(% ettatu
Address di W r AF9ro7 -
Street of Route No.)
Ahnt(,e �e a?Co3
City or Town State Zip Code
(Pzc)- 0-,4/C/
And coda Phone number
4. DATE DRILLED Slag 0 -3
5. TOTAL DEPTH: ADO
6. DOES WELL REPLACE EXISTING WELL? YES1NO L)
7. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use "a" if Above Top of Cuins)
f
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated at/ar below land surface requlru a
variaaee la ■ceardaace Itb 13A NCAC 3C.dl IS.
9. YIELD (gpm): 1 ita METHOD OF TEST Rt € —
10. WATER ZONES (depth): 33 0 — elt°/f
t I. DISINFECTION: Type (41 i4 ' 01( Amount 1 1 % ••
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. aterial
From * 1 To 2X FL l° t -P9-1 \JG
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To—: ` Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Topographic/Land setting
❑Ridge ❑Slope ❑Valley m1'iat
(check appeopttue box)
Latitude/longitude of well location
N 35°3,,.-3ta (a) 3ao
(deveeahnimttu1/.c nA.)
Latitude/longitude source:WeiPS❑Topographic reap
(check box)
DEMI DRILLING LOG
Frqm / To / Formation Description
5 0 / e rt-6-42- ?e r"
I -- 330
33n/
30 SSE,'
G ILA •J (TW cot-kt e
14 G C' e
G2Aa'TtLa-- (
',
LOCATION SKETCH rc:1)�
Show direction and distance in miles from it[.ieas
two State Roads or County Roads. Include the ro
numbers and common road name
6iiehtva, Me
ti
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
aesA
\pft-(i/r c e
:0
30.`144-
ocj
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
(D THAT A PY OF THIS REC RD HAS BEEN PROVIDED TOC F}E�WEu.I¢�OWNER
SIGNATURE OF PERSON CONSTRU
Submit the bdglnaiYe 1,h�ii��Dlv1sian of Water Quality, groundwater Section, 1636 Mall Service Center - Raleigh, NC
.27699-1636 Phone NNu.4tix}-4+'I-v7l, within 30 days. GW-1 REV. 07/2001
NO THE WELL . DA

3. OWNER:
Address
274222
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �``\\ yL1--t la NAS 1, CERTIFICATION # all
WELL CONTRACTOR COMPANY NAME IIu Nne r tILr)s, krITQC ' PRONE # JS23)254- 352/
STATE WELL CONSTRUCTION PERMITPERMIT'SASSOCIA—TED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearpt Town: V. AI(4\1)6 W County gut')CDMQE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
0ArS cQEt2 i I—
ectS li n.r3>r (Z- ►-floe
(Street or Route No.)
AS Rgtil
aggas
ity or Town State Zip Code
8a )- aa(ct - --i a-7 D
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Fl
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 caning terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a5 METHOD OF TEST 9'16 A 1R-
10. WATER ZONES (depth):
Wo/03
Topographic/Land setting
❑Ridge ❑Slope ❑Valley GIFlat
(chock appropriate box)
,� /Latitude/longitude of wt11 location
/V35a 3/ .5OZ kJX,2 °,,? /r,05G,
(degrees/minutes/it-conch)
Latitude/longitude source:L PS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr s T,p / Fo�i ation Description l\
- 9-° o J4:7RC6u0192? NJ
11. DISINFECTION: Type NT{ 90 Amount V 1/2. I h
12. CASING: Wall Thickness
DepthA 5 Qiarr)et r or Wei l t/Ft. Metal
From To `Y Ft. �bj // Y(C�
From To Ft.
From To Ft.
13. GROUT' Depth Material Method
From To at Ft. C 18f461JT f ov2(jb
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:
CD
LOCATION SKETCH I o
Show direction and distance in miles from at leas'f_t
two State Roads or County Roads. Includae road-
adnam
SS. m
•
Nrsa
o
numbers and commo
P l to Nt'AtS
Ccf�
I) 'FDO` ?EREB`f CERTI
CONSTRUCTION STA
II
T'H�A��"t``THIS WELL WAS CONSTRUCTED INp�A�CCORDANCE WITH 15A NCAC 2C, WELL
ARr6, AND THAT A �I;Y OF THIS RE 9p.D HAS BEEN PROVIDED TO THE )YELL 0
L ¢,
SIGNATURE OF PERSON CONSTRUCTING T}-IE WELL 'DATE
Subttlltt1le;afieijjjaq the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27690-1616Phone` o.11419) 733-3221, within 30 days. • GW-1 REV. 07/2001

274220
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and idatural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION N
WELL CONTRACTOR COMPANY NAME _
REUBEN CALDWELL DRILLING, INC. PHONE448 ?54-3581
STATE WELL CONSTRUCTION PERM ITO ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name, Numbers, om.:.uniry, Subd' ti , Lot No., Zip Code)
3. OWNER.
Addre
City TeStale Zip Code
( )-flGl'a 27 -2333
Area coda Phone number
4. DATE DRILLED
5. TOTAL DEPTH: -3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tErt
7. STATIC WATER LEVEL Below Top of Casing: ro FT.
(the"+- if Above Top of Cuing)
8. TOP OF CASING IS ( FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. r
9. YIELD(gpm): ( METIJ-O��FTEST i
10. WATER ZONES (depth): � b 9'Cr
11. DISINFECTION: Type (97f
12. CASING:
Depth
From 4- / To 4F5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material titcth°i�
From 0 To 2 FL �> �ivlfN
From To Ft.
Amount ri
Wall Thickness
Diameter or Weight/Ft. Material
6 %; 5Q/1. 2/ l v C
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Sire Material
in.
in.
16. REMARKS:
11,
pO�lEIE9ct)_aSTi[rY`7
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(chock appropriate box)
Latitude/longitudeLatitude/longitude pf well location
115.5. 38'.g1 g Wo$Xe38.aao
(depxa/m iou tea/secoods )
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation pescrjption
DEPTH
From To
0 ;7
3 7 CF 9
CA)
1 E5
LOCATION SKETCH car !gn
Show direction and distance in miles from leash; :1,
two State Roads or County Roads. Include -fife rop'X.
n{Iimbers and common road names.
W n
N_
0
Lieg
LL WAS CON (ICTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
THAT A 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
�t
-f-
CubmIt S Ito th9 Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
G i'��✓f7644 i'B3#'I)ti` af(919)I733-3221, within 30 days. GW-1 REV. 07/2001
ASHL LL' , —_-

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Rfesources - D
ivi
sion of W ter Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME I(print)/D P / /v/ LC/ CERTIFICATION */ .Jy/
%3 (c�zIA ` s&2t h yk - 3 / 9 �'
rvs . U/a7D /t(` PRove w
/14.2
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
Of applicable)
274170
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
(Street Name, N
County iJic-ruv-tr--C.u.--
bers, Community, Subdiv ion L , p(No., Zip Codc)
3. OWNER: L.XA - e fr J /a,t2r.43.J
Address /7nD f"t'Set p. Nil ,
(alma or Route Na)--/ (7
a-ntn en /Vi' ,?k7LC
City or Town Slate Zip Codc
Area code- Phone number
4. DATE DRILLED 1/ - 3 — .03
Topographic/Land setting
DRidge ❑Slope ❑Valley ItFIat
(check appropriate box)
Latitude/longitude of well location
(degrees. 1ina es seconds)
Latitude/Ion_itud• s urce:❑GPS❑Topographic neap
(check box)
DEPTH DRILLING LOG
From To�� Formation f�escription
"YY
5. TOTAL DEPTH: ADD ' ,,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GIEL
7. STATIC WATER LEVEL Below Top of Casing: Z:sD 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): / 20 METHOD OF TEST S '
10. WATER ZONES (depth): .jG/D ` _ / 9/) q r'T'l
11. DISINFECTION: Type /—/-/ /4 Amount Lip.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
. From r To li // Ft. & " {3 V G
From To Ft.
From To Ft.
13. GROUT: Depth /i Material Method
From n To O FL t tty, s -71
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.
0
w
C
c_
0
t cc
rn �rT.
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
Nto
ln=
cA m:::
at II ,st 0
tht ad
16. REMARKS:
r HEntir
�QNS,TRU TIbIN S'i'AN
Submit the original to the 1
r216994636 Ph6MWNb (919) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
h e t t< YceD .S 3/ -- 0 3
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL
DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
274169
.- North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION#-7T///B
%� o D
WELL CONTRACTOR COMPANY NAME (l'/'P 2Jz!', �re $ . L�/j�L. +/ invil HO• # Ott 4iZP �'3/
ASSOCIATED WQ PERMIT#
(if applicable)
' STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/4/6-2
1. WELL USE (Check Applicable Box): Residential Ca Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If'Other, List Use
2. WELL LOCATIO
NeareAtt Town: County
(Street Name, Numbers, Community, Subdivision, Lo No., Zip Code)
3. OWNER: (7/)1!(,(/ Jq, �/✓�l�t
Address 4141 Fd+d[ T iirx
(Street r Route Na)
City or Town State / Zip Code
(—)-
Area code- Phone number `�
4. DATE DRILLED 7 " ' 6,3
5. TOTAL DEPTH: g 1p
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 4,0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): 4p D METHOD OF TEST c�1 ( h /J
10. WATER ZONES (depth): .3 45_ ' - Got Jp M
11. 'DISINFECTION: Type /—/77/ Amount Alp
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From et [o
From
From
13. GROUT:
From 0
From
14. SCREEN:
Depth
To toC Ft.
To Ft.
To Ft.
Depth
To ..2e Ft
To
Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material�11
0.-eta
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
PvC.
Method
Size Material
Topographic/Land setting
❑Ridge 0Slope ❑Valley AFIat
(check appropriate box)
Latitude/longitude of well location
(degree:. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To / Format'.,Description
61
69 ' ,3Le
O
CO
Z
LOCATION SKETCH -'o
Show direction and distance in miles from at It
two State Roads or County Roads. Include the toad
numbers and common road names.
16. REMARKS:
etT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE 14 ELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TTri LL
DATE
3� 3
Submit the original t99 the 11ivision of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
7699-1636 Phone No.1(919) 7.t3-3221, within 30 days. GW-I REV. 07/2001
c

YeehL /J
STATE WELL CONSTRUCTION PERMIT# /AU 2
(if applicable)
WELL CONSTRUCTION RECORD 274168
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section,/ p
/ / CERTIFICATION
/#.!,/%y/p
YOS . Gci2.I �' carry) PHONE # (81 I 7,/I)
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAMEt
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATIO}j : Nearest Town: C ,gli-LcUl et. County /8./ ale %&L/3 C-
Peck ✓VL IPA
(Street Name, Numbers, Community, Subdivision,
,�Lot
JJNo.. Zip Code)
3. OWNER: 6 r//-tt a An- Luu/2.EtJK.J a.
Address / LO C,.--U 171— /-'letZ Ci—
y (Street or Rowe No.)
[ e Ca,tgnes cal II t Ale -2V /7210
City or To n State Zip Code
Area code- Phone number j/
• 4. DATE DRILLED T 4 a
5. TOTAL DEPTH: / AS
• 6, DOES WELL REPLACE EXISTING WELL? YES 0 NO Li
7. STATIC WATER LEVEL Below Top of Casing: «2' FT.
(Use "+" if Above Top of Casing)
- 8. TOP OF CASING IS FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118. I Q�
9. YIELD (gpm): as METHOD OF TEST cQ N r
10. WATER ZONES (depth): /G)5- ` - t7 l'J�
/ / 11. DISINFECTION: Type 71-] Amount 00.21
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley t4Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forni�artio Description
i% / L
' /.2 5-'
C
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 4/% Ft. 6 '" P L/L,
From To Ft.
From To Ft.
.13, GROUT' Depth
From © To .VO Ft.
From To Ft.
aterial
Li'v J
Method�et�
4�1
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From To Ft.
c_
O
c
1 0<
LOCATION SKETCH
Show direction and distance in miles from at leash
two State Roads or County Roads. include the rd€
numbers and common road names.
16. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
SnU(TT[p;N STAF�{jj�f. �S, AND THAT A COPY OF THIS RECORD 1{A���J,/ PROVIDED TO THE WELL OWNER
EG
Submit the original t4 he
27699-1636 Phone No. (I) 9) 7
SIGNATURE OF PERSON CONSTRUCTING THER ELL
DATE
ivision of Water Quality, Groundwater Section, 163o Mail Sen ice Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina = Department of Environment and Natural Resources - Divisi9n of Water Quality
WELL, CONTRACTOR (INDIVIDUAL) NAME (print)_____
WELL CONTRACTOR COMPANY NAME (Sri'tht.
STATE WELL CONSTRUCTION PERMIT/4 / V2OZ
(if applicable)
274162
- Groundwater Section # CERTIFICATION ..2 40 / '
PHONE #
0211.jg-3/7P
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATIN: , Nearest Town: / P esl 2 r County iteti kirt m it
I4rrnr.'11 s/.w ,.Thr-
(Strcet Name, Numbers, Community, SubdiviJon, Lot No., Zip Codc)
3. OWNER: 8tPJa
Address %g7 'S,,,2CA (_n✓e_elAtel 2.4
( mci or Route No. )
> 'City or Town State Zip Code
`Area code- Phone number
4, `DATE DRILLED .S - .2 —0,3
5: TOTAL DEPTH: 3
6.=;DOES WELL REPLACE EXISTING WELL? YES 0 NO
7.: STATIC WATER LEVEL Below Top of Casing: 7o FT.
(Use "-i" if Above Top of Casing)
8:'(TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance In accordance pith ISA NCAC 2C .0118.
9. YIELD (gpm): -5" t/ z METHOD OF TEST i � %a rS
O. WATER ZONES (depth): o3DS r- S 1 R p rr)
Topographic/Land setting
❑Ridge OSlope ❑Valley ij�Llat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/lonitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To , Forma ioR Description
601
hrt..-vu
11,.DISINFECTION: Type /t,17-7-/ Amount 171,3
I2,' CASING: Wall Thickness
-Depth Diameter or Weight/Ft. Material
• From D To In 2 FT 6 " Eve.
From To Ft
From To Ft.
GROUT: ? • DepthMaterial ,J. M thod
From To �% Ft N>e.F - zr
From - To Ft.
SCREEN: Depth Diameter Slot Size Material
From, " To Ft. in. in.
.`FromTo Ft in.
15.: SAND/GRAVEL PACK:
Depth
From` To
From To
16.' REMARKS:
Size
Ft.
Ft.
in.
Material
LOCATION SKETCH
0
Show direction and distance in miles from at`I st C
two State Roads or County Roads. Include tt�oade7-7
numbers and common road names. C
w
0
l N,
1E'RE$Y&ERtTJF
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S A D THAT A COPY OF THIS RECORD HAS BE$N..EROVIDED TO THE WELL OWNER
AJ
SIGNATURE OF PERSON CONSTRUCTING THE WETC DATE
the 1 ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
• ASFfE?RQO@SFtF CPAP95,i•::0919)
33-3221, within 30 days. GW-I REV. 07/2001
r-,
rri
r

2'74160
WELL CONSTRUCTION RECORD
Oh eget*ga ,.Department of Environment and Natural Resources - Di ision of Water Quality - Groundwater Section
CQ;VTRACTOR (INDIVIDUAL) NAME (print) Tl D �/ N L! CERTIFICATION #.� '1/ 2
YELE CONTACTOR COMPANY NAME l Yre_P-Y)P rC1.Ylt'
STATE WELLCONSTRUCTIONPERMIT#
(tf applicable)
/4'D.'L
k/
PHONE # 6,/t/ Tk-3/7d
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
'-Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Usc
'2. WELL LOCATION: ,
: Nearest Town: Lei Ct S ;tit County A./ A nen-0 IL,
7 In aa-�-a-h o-, `77 r .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3 OWNER: ex) n 1 s Gopc�iyyrr<.�_
Address (' C) a v R Qs-EaLk c �t o-r-
(Street or Route No.) /� )
R'7 Lnl/er5 Loop ,/ A•SAF 1/lint
City or Town State Zip Codc 1
Area code, Phone number J
DATE DRILLED _S - / a - 0 3
5,`-TOTAL DEPTH: '7C.)5' •
..DOES WELL REPLACE EXISTING WELL? YES 0 NO 14..
7., STATIC WATER LEVEL Below Top of Casing: (013 FT.
' (Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in nceordancf pith I5A NCAC 2C .0118.
9 YIELD, (gpm): METHOD OF TEST a ArS
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(((check appropriate box)
Latitude/longitude of well location
(degrees: minutes/seconds)
Latitude/longitude
lie.. DEPTH
From To
D
source:❑GPS❑Topographic map
(check box)
DRILLING LOG
/ Forma o Description
7.05 /
Q. WATER ZONES (depth): (n $.t — 'i q p rn
I1-DISINFECTION: Type
12. I I.- DI SING:
Depth
;From .1 ` To 59
From To
From To
13.. GROUT: Depth
From To
'Frool - - To
1j ,;:SCRgEN; Depth
2,Frpm To
From To
;' 15, SAND/GRAVEL:PACK:
Depth Size
From ' To Ft.
From To Ft.
Ft.
Ft.
Ft.
77-1 Amount 1 D C'1
Wall Thickness
Diameter or Weight/Ft. Material
aterial Method
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
LOCATION SKETCH c
Show direction and distance in miles from attst o
two State Roads or County Roads. include thg road 92;
numbers and common road names.
rn
v
w
0
16. REMARKS:
t--
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ccri A CFI N �,jjAt)IDA , AND THAT A COPY OF THIS RECORD H C-n>= N PROVIDED TO THE WELL OWNER
K, /1�a l,i v1 N X. j -5 / o 3
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to th `CJiv lion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
12769?-I630 Phone No. (919 733-3221, within 30 days. GW-I REV. 07/2001

274139
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM��[s (pri�nt�) I�L / s . ) //1O�.,yn ,p y�//� CERTIFICATION #.2O 77
WELL CONTRACTOR COMPANY NAMEy/Lte.e./-0t? �r'' G La T'C,Z ' """" PHONE (1 (MS( .6 99 t70u
STATE WELL CONSTRUCTION PERMIT# H ASSOCIATED WQ PERMIT# y//T
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
N Town:
t
County
f 741r
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address /Y(A0
(Street or Route No.)
o� Vic . t,2r7f?
City or Town State Zip Code
( Area code- Phone number , /
4. DATE DRILLED 7/a.2 /0.3
5. TOTAL DEPTH: ) O .�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ai
7. STATIC WATER LEVEL Below Top of Casing: ,L- F'I'.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I C FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance 1n accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /D MET1WD 1EST /
10. WATER ZONES (depth): //
Topographic/Land setting
❑Ridge IfI Slope ❑Valley ❑F1at
(check appropriate box)
Latitude/longitude of well location
(degredminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chat box)
DRILLING LOG
Formation Description
DE
From To
0
11. DISINFECTION: Type y�%p.�/.� 5 Amount /0 4- 6G-' Show direction and distance in
12. CASING: l/ Wall Thickness /// two State Roads or County Ro
Depor Weight/Ft Material numbers and common road
From 0 To gZ Ft. 1921/C-
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To..22_ Ft Sfle %
From To Ft.
14. SCREEN: Depth Diameter
Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
Slot Size Material
in.
in.
Size Material
From o Ft.
T
From To Ft.
16. REMARKS:
.1 I ���/lC
tJb §Ti nONISr
—di.f—
I
•
s.
3 rn
m
c-,
s fro }t ler t
Include ther3ad
/F/dd ys%
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORDHASBEEN PROVIDED TO THE WET T OWNER
% 8-1 #j r;
SIGNATURE OF PERSON CONSTRUCTING THE WELL ��TE
Submit the origin to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
R 0 /7699$636111ioii®No. (919 733-3221, within 30 days. GW-I REV. 07/2001
ASH D'Il1E Pr G'A I OFFICE

275763
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and � Natural Reso ces1- Division o(Watpr Q` - Groundwater Selmer,
‘SELL CON'1'RAC'rOR(INDIVIDUAL) NAMa/E� (print)/�/`�K ��•� J` I�L,j�J^�,�(_jl ,Wv CERTIFIC�A�TI�ON�A3�,�f►,Qq�
WELL CONT It A CT OR COMPANY NAME A I%Ale_ 1,Z1tMlt(�� 111 PHONE or 7`7-eaza
ASSOCIATED WQ PERMIT
Sf:CI'E WELL CONSTRUCTION PERMIT,._. (if applicable)
1 i(upplicablel
I. WELL USE (Check Applicable Box): Residential l7 —/ Municipal/Puolic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATI N:
N rest Town: � Q( aC,�(-� Y� Count
9reta Nut Numbers. Community. Subdivision, Lot No.. Zip Code)
(dcgrees/minwes'seconds)
3. OWNER: Latitude/longitude source:❑GPSOTopographic map
Address- (check box)
u1eNo.) . -D 2dr1 ci- DEPTH jbRILLINGLOG
City or Town
Area code- Phone number
4. DATE DRILLED
5.TOTAL DEPTH:
ti. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: e Lc FT.
(Use "ie" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface"
'Top of casing terminated as/or below land surface requires a
variance In accordance with ISA NCAC SC .011S. y�two
9. YIELD (gpm): f 00 METHOD OF TES
From To Formation Description
10 WATER ZONES (depth): ZZ f
H. DISINFECTION: Type-4 (71+t Amount_ Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To _ Ft.
From_____ To Ft.
From To Ft.
Material
13. GROUT: Depth /F �4 Method
^ xMetheth
From To Ft uj� V
From To _ Ft.
14. SCREEN: Depth Diameter
From To Ft, in.
From To _ Ft. in.
15. SAND/GRAVEL PACK: Size Material
Ft.
From.__.To .� Ft.
Slot Size Material
in.
in.
From
State
Zrp Code
Depth
To
/Topographic/Land setting
0 (/Gf�[t'idge ❑Slope ❑Valley ❑Flat
T o (check appropriate box)
Latitude/longitude of well location
CI. ATION SKETCH
0
Show direction and distance in miles from at IThist
two State Roads or County Roads. Include the road
numbers and common road names.
g
16. REMARKS:
1 CIO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED CINN ACCORDANCE WIT1 PROVIDED NCAC ZC, WELL
WELL
OWNER TO THE
CONSTR ' .ION ST` • a R"S, A 0 THAT A COPY OF THIS
Sr -
SIGNATURE OF PERSON CONSTRUCTING THE WELL
I Submit the or' yn Ito the I YAat n of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
DATE
jy 0712001
IL l4fr699.1636 Phone No.(�1�) 73 if1, within 30 days. - .
JII
L

£ v &yi trskf'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ce' i DivisionoL Waigt Qua
MEI. I, CO\TR%CI OR (INDIVIDUAL) NAME (print)
YY4,(1'
%VEI.I. CONTRACTOR COMPANY NAME
STATE WEI.l- CONSTRUCTION PERMIT#
I i f applicable)
_ASSOCIATED WQ PERMITM
(if applicablelfilli
Groundwater Sectio�%
CERTIFICATION
yft
PHONE .''g
ta it
I. WEL L USE (Check Applicable Box): Residential Cg' Municipal/Public 0 Industrial 0 .Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use__
2. WEI.i- LOCATION: ✓
Nearest Town: &le Count
IOC /1ct -- - �
(Siren( Name. Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWN ER. (K-'I
Address✓°. �( 'i-•---1,4
(5ircet of Routs No.l L�47O Lip
City or Town Stain Zip Code
Area code- Phone number, --
4. DATE DRILLED LP ` 3 -0 Z
5. TOTAL DEPTH: 3z-'5
6, DOES WELL REPLACE EXISTING WELL? YES ONO ,cC
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC IC.0118. j'j s i� yt
METHOD OF TES 1i-Y�al-'�hY9r
1 D. WATER ZONES (depth): /0
11 DISINFECTION: Type Amount __I- _
Topogr phic/Land setting
L��,r`/ ❑Ridge lope ❑Valley ❑Flat
`f (check appropriate box)
Latitude/longitude. of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
il (check bo
DEPTH ILRII LING LOG
From To Formation Description
_ 0 _
CO ci
___-. 0
9. YIELD (gprn):—�'�--h
12. CASING. Wall Thickness
Dept lameter or retie)
/� To p' WcighuFt Ma
Froln_y1—_
Ft
From To Ft,
From To _ Ft.
13. Depth
To Ft
GROUTS coM��ate/r�ia_ 11 44 `1�Method
From '�^�'a" _ LLY
From_ To Ft.,.
14. SCREEN: Depth Diameter Slot Size Material
Ft. in. in.
From To —
From
_ To Ft. in. in.
15. SAND/GRAVEL- PACK: Material
Depth Size
From _To _ Ft.______
From To Ft. .— —
16. REMAKES _
1 DO HEREBY CERTIFY- i3
CONSTRI}@TIDN STANDARD
f
1
OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 ri
5qt &3
wee
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
St
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
\ r--
Stibind the orig uai to,Ihe-Di4isbid of Water Quality, Groundwater Section, 1636 Mail Service Centter'Raleigh, C
11-21�ti)9-16} Phone Nn. (Y1Y) 73 2jli within 30 days.
it
11
L
L
AL QF.HCE

275761
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division o Wat r Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
writ. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERM ITN
i 1 applicable) /
I. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. T h' /Land setting
ASSOCIATED WQ PERMIT
(if applicable)
Groundwater Sectttior31
CERTIFICATIONN at..
PHONE gg'-s `a
_s± Jives
W Nearest
LOCATION:. + g p°gr Slope Nearest Town: �A -.,r/ - Count ❑Ride Sloe ❑Valley ❑Flat
S 65k I PV IY, L� r rr O LCI e �n ere- (check appropriate box)
1 tCbd Subdivision,
Lot No.. ZipCode))J-' 7TZ�-,J Latitude/longitude of well location
(Street frame. Numbers. Community, Subdivision,
3. OWNERlets(
Address /'I
tmv or Raue o.) Z� rf45
�e_IC��ec /�� y-(�
City or Town Stale Zip Code
e
(--)
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH'._ -5075
6. DOES WELL REPLACE EXISTING WELL? YES NO F(3'
7. STATIC WATER LEVEL Below Top of Casing:
(Use'•+" if Above Top of Casing)
8. TOP OF CASING IS _-_�__ __ FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118.
9. YIELD (gpn0: L .. METHOD OF TES
10 WATER ZONES (depth): �i
II. DISINFECTION: Type AmountWall Thickness
12. CHASING:
or Wcighat. Material
Depth Diameter
From CD _Tot Ft.
From_ To Ft.
Frou . To
13. GROUT: Depth
From To
From To_.—.
14. SCREEN: Depth
From To
From T°
15. SAND/GRAVEL PACK:
Depth Size
From To Ft. _
From__ To__._ Ft.
Ft. Ft
Material
Fi.
Diameter
Ft. in.
Ft.. in.
tdegrecshninutes/seconds)
Latitude/longitude source:❑G PS❑Topographic map
(check box)
QEPTH DRILLING LOG
From To Formation Description
Method
Slot Size Material
in.
in.
Material
—J r-
N
ICtN SKETCH w
Show direction and distance in miles from almleast 2
two State Roads or County Roads. Include the road
numbers and common road names.
t#(aft} 0,5
\BO,ti
3-6
16. REMARKS: —
NCAC 2C,
I DO HEREBY CERTIFY T iAT THIS WELL WAS CONSTRUACCORDANCE
BEEN WITH
IT IDATO THE WELL
WELL
OWNER
CONSTRuiION STANEtA DS.AND THAT A COPY OF THIS RECORD
SIGNATURE
RE OF PERSON CONSTRUCTING THE WELL DATE
e original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cent r RalRE. NC
4.un i12:.-Alu_-(1141 733-3221 wItilin 30 days.
/2001
•1
H
L.

li • . P.
275756
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reset ces Divisio(Wate r Qua 't -Groundwater Sect�3/
yam, el ��
r( )'W CERTIFICATION 014 0, ,
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ArOt PHONE . trm.{.sh Z-Sze-eeitL3
tits, L
w Et.I. CONTRACTOR COMPANY NAME
SIAT E sv HA. CONSTRUCTION PERMIT. • ASSOCIATED WQ PERMITIl�
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential h]'/ MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 !f Other, List Use
2, WELL LOCATION:
,Neea`r s>T own: �.
County
(Strvet Name. Numbers. Community. Subdivision, Lot No., Zip Code)
O W.
a
3. OWNER : w • ♦ _ (dagreesyminiaes!seoonds)
e tatiPide/longitude source:❑OP S❑Topographic map
Address �� (check bus)
{,, • IS:reet rRokNo.) 2.��h�y PEPTH DRILLING_I&Q
P'^�I I li " — ( From To Formation Description
Topographic/Land setting
❑Ridge Slope ❑Valley 0Flat
(check appropriate box)
atitude/longitude of well location
City ur Ton State Zip Code
Area code- Phone number -Z -
4. DATE DRILLED
I
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O'
7. STATIC WATER LEVEL Below Top of Casing: Cn 0 FT.
1 (Use "r" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated atror blow' land surface requires a
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): _ 1 5 METHOD OF TES
10.WATER ZONES (depth): 'CO) 351
I1. DISINFECTION. Type b1t 4
12. CASING:
Depth Diameter
From CI To 2-3 Ft.
From To FL
T�'ys(. ('�va
Amount �_
Wall Thickness
or Weight/Et. Material
From To Ft.
13. GROUT: Depth Material _
From To Ft.(yi"�j�,
From To Et.
14. SCREEN: Depth Diameter
From. _____ To_ Ft. in
From . To __ Ft. in
15. SAND/GRAVEL PACK:
Depth
From _To
From To
Method
QV.
Slot Size Material
in.
in.
Size Material
Ft.
_
Ft.
15 REMARKS: __-
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDA
CD
CO
C
t
Itcr
_� me
LOCATION SKETCH __
Show direction and distance in miles fromlyyleasrFE
two State Roads or County Roads. Include& road
numbers and common road names. el -5,e
CV 1t-Cit.d
(<..) Bw1( 'y &tb-a•
f, �S�
Y�l� •
THIS WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL DATE
ei
_, he on tl to the Divisto of`Vrrater Quality, Groundwater Section, 1636 Mall Service Ceenter, RRaEIV gh, NC
279#.,FG�6 Phuna No. (919) 733 32 Is with n 30 days.

275754
North Carolina - Department of Environment and Natural Reso
WELL COS I'RAC'TOR (INDIVIDUAL) NAME (print)
w'EI.I. CON'I'RAC'FOR COMPANY NAME
S'f ATE w'EL.t. CONSTRUCTION PERMIT$
1 if applicable)
WELL CONSTRUCTION RECORD
ces - Division o Water Qua t - Groundwater Selo
�31
CERTIFICATION N7 ��1�
PHONE N laidiegetta
ASSOCIATED MI) PERMIT
(if applicable)
n d • Z�1{.p
WELL USE (Cheek Applicable Box): Residential lD" Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
.SttvoN: me. umbe Community. Subdivision, Lot No., Zip Coda)
1. OWNER: J�/�-{�rp�.,jut`d bl13.d
Address PO ROD ( IIO2.•
s (Street or Route No.)
City or'fmcn
( )-
Area code- Phone number Q
4. DATE DRILLED C4Z " —
f
5. TOTAL DEPTH: Z4 —
6. DOES WELL REPLACE EXISTING WELL? YESi O NO 0"
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
• o of casing terminates atfor below land surface requires a
variance In accordance with
Topogrwhic/Land setting
❑Ridge ($Slope ❑Valley ❑Flat
•eY (check appropriate box)
219 i 5 Latitude/longitude of well location
(degrershninemarsecunds I
Latitude/longitude sourec.OGPSOTopographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
late
County
Zip Code
P 'hIS\NCAC2C011a r /� •
9. YIELD (gpm): (kg METHOD OF TEST i • COW 4
N.
10. WATER ZONES (depth): 'gi5 r 7-3 5
1I. DISINFECTION: Type "ib1U� Amount T.
12. CASING: Wall Thickness
Depth s(-� Diameter or WeightiFt. Material
From CD _ To "C.=- Ft.
From To Ft.
From _.__ To_._ FL — —
!i. GROUT: Depth /�M aterial Method
Frorn_ To _ Ft 2flS{"�j� cif) 't
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From--- ToFt. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
'r'rom
To Ft
From _To Ft.
11C.�
16. REMARKS:
Size Material
W
r
LOCATION SKETCH 1�5 cn._
Show direction and distance in miles from arteast
two State Roads or County Roads. Include t roads
numbers and common road names.
i9- z3
�r�15I
Qv-C4(.6 0( eit Il..
vlllq.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S<i&s
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
d {-igllral rq:ihe Division of. y;tartir Quality, Groundwater Section,.i636 Mail Service
Center
Raleigh,
g.N C
pp;..,hen 019)17334224;w t i! 0 days. EV�iOI
I/
G
L.

275753
10. WATER ZONES (depth): (9 1ST © 0
- Z
II. DISINFECTION. Type b 144 Amount Show d
12. CASING' Wall Thickness
North Carolina • Department of Environment and Natural Reso
WELL CONTRACTOR ( INDIVIDUAL) NAME (print)
1VF,Lt. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
I. WELL USE (Check Applicable Box): Residential 13' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL CONSTRUCTION RECORD
ces - Division o Water Qua t Groundwater Seelig _
eli�. CERTIFICATION Nai•en
PHONE S lititiegetitta
ASSOCIATED WQ PERMIT
(if applicable)
2, WEI,L LOCATI N: •
Nearest Town: Q-) L��_�Y County
tal4Cr N .L-IC
t Street Name. Numbers,Community. Subdivision, Lo No.. Zip Code)
Address •
'c L\-.&k-
o nx 43__
OWNER:
3.
4C Cy eor"w NU.1 7:53,
rf c1
City or Town State Zip Code
( )-
Area cede- Phone number, 30 - 0 3
4. DATE DRILLED LQ
5" TOTAL DEPTH: 5 O-
6. DOES WELL REPLACE EXISTING WELL? YES pl NO
7 STATIC WATER LEVEL Below Top of Casing: 1-4-C ) FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surfaces
*Top of casing terminated alor below land surface requires • _ c
variance In aceordary^/r�g'ith ISA NCAC IC.9I iS. f
•
9. YIELD (gpm): l METHOD OF TEST .1 a C�V1�� �
r
cn
j.00ATION SKETCH 1?
rection and distance in miles from ausast 2
two State Roads or County Roads. Include tADteacS
Denali, Cal • Diameter or Weight/Ft. Material numbers and common toad names.
To `Y1 Ft fief }�e����-eh`�
Topographic/Land setting
I�wCA>�zt,p4 idge ❑Slope ❑Valley Viet
(check appropriate box)
Latitude/longitude of well location
(degreeshninuies/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTh DRILLING LOG
From To Fonnation Description
c
J
From 1�,�T ( '
From To _ Ft. /'y Q��Q�� e�Y We��.t
From _ To_ Ft. ...--_ Ej1
13. GRUT: Depth n Marena� Method c CL\ CQX ��1 AM , /� L,l , n
From To _Ft. l� �LL� ti J\ L-�Q.�l X�-1�1
FromToH.
-- 1I SS }r(r.9,
14. SCREEN: Depth Diameter Slot Size Material 70 e( �b
From io_—. Ft. in. in. ��j���J
From_. To Ft. in. in. 1
15. SAND/GRAVEL PACK:
Depth Size Material
From To _ Ft.__
Rom To Ft.
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRU
CTION STA
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL DATE
{ l
trthe on Fnai t e Dry eibd uok Water Quality, Groundwater Section, 1636 Mail Service Center - RRaleighh, NC01
1636 Phone No. (919) 733-�P� IJ ithin,.'30 days.
LL

275745
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMF+(print)
WELL CONTRACTOR COMPANY NANIE I�',YP.PPi4J& /did5
'STATE WELL CONSTRUCTION PERMIT# / 7 O z
(ifapplicable)
1.» WELGUSE(Check Applicable Box): Residential JRL Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
CERTIFICATION Na77/6
.+PHONE # 022 /ijf-3i n
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATI
Neares,$ Town:
County
(Street Name, Nu bers, Community, Subdivision, Lot No.. Zip Code)
3.OWNER:
Addr
Ci
Arca code- Phone number
'4, DATE DRILLED .f- 'l& --0a
5 TOTAL DEPTH: 7 !AS '
6.,DOES WELL REPLACE EXISTING WELL? YES 0 NO le,
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 ISA NCAC 2C .0118. 9, YIELD (gpm): 1' t METHOD OF TEST a Ars •
): WATER ZONES (depth): it .26—' p rn
�1 le�S'
11. DISINFECTION: Type Fri T Amount 11
12. CASING:
//er
itz� Routes C on 73 Y
Town State/ Zip Code
Wall Thickness
Depth Diameter or Weight/Ft. Ma trial
From °!� - To la Ft. /o yr i v
From • To Ft.
From To Ft.
13. GROUT: Depth Material Method
From d To D f . Ft. PAIN-e4t2 '--/I'T
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From' To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
la
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatigppescription
-ye/
7. ' 7,15- '?Aa I /�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road.names.
0
w
L
r—
J
ry
CO
rn
" 16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON TR1NTIONSTA D DS, ANDTH7&T,,}. COPY OF THIS RECORD SS BEEN PROVIDED TO THE WELL OWNER
r
se)AjteAti ' _
SIGNATUREOF PERSON CONSTRUCTING TIIE WELL DATE
- gd -6 8
Subnllt the original to the Division of Wat*r Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NC
769911636 ?hone No. [phone], within 10 days. GW-I REV. 07/2001

From To Ft.
From To Ft,
13. GROUT: Depth
From O To ')—O Ft.
From To Ft.
14. SCREEN: Depth
27 602
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and 'manual Resources - Div`isi-onn of Water Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pr110 13 t / ( t( /V • CERTIFICATION N A 77 /
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC• PH0NEY?(8 )254-3581
STATE WELL CONSTRUCTION PERMITN - ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
_/
1. WELL USE (Check Applicable Box): Residential V MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name, Number, Cominuniiy, ubdivi,ion, La No., Zip Code)
3. OWNER:
dd_ress `Lt3 (041J
(Street or Route No.)
City T wn Sisk � Zip Code
(82g)-Lc53-23.5e„
Acode- Phone numbe
4. DATE DRILLEDra �� d3
5. TOTAL DEPTH: (p
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO "&
7. STATIC WATER LEVEL Below Top of Casing: 2O FT.
(Use `a' if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA ,CAC IC.01 U.
9. YIELD (gpm): 3 t 0 METHOD OF TEST /1 l L.
10. WATER ZONES (depth): / 30 — ' 1 '/-Z G eon
AA``��c' 7o — 4— c�PM
l 1. DISINFECTION: Type /'t l e-1 a eib�pAmount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. aterial
Frorn t(• To Lb J Ft. (a 14 -( [rrl
Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Material
Depth
From To
From To
16. REMARKS:
Size
Ft.
Ft.
..Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
4/35e3j-'Sa3 tJolidtq L3/5
(depa+hnimnegyre'',,A,)
Latitude/longitude source:OGPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From To F tion ton
t0 3— 13o
30
I3n 7 o
2-7v — 3I o
co 14 mire —
I th (( l�
tuy41-res /LeciL G246,)1re-
4 tjP •.-
00-Aati6
0)
LOCATION SKETCH C ''
Show direction and distance in miles from etlea{t-
two State Roads or County Roads. )ncludeee road:
numbers and common road name
/ A
Ot--r LC1 c s L 441
•5�6
HERE_.— •i
1'DO HEREBY CERTIFY THATlili
CON
STRUCTION STANDARDS a.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1TIAT A CO OF THIS RECORD IASBEENPROVIDEDTOTHEWELLQWNER
0,12✓\ 12-8-/ oTh
ISIGNkTURE OF PERSON CONSTRUCTING THE WELL DATE/
i J ,
Submit the original to the-entr Ian of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Metrual Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (prt.t) (7%1—L-Ii
WELL CONTRACTOR COMPANY NAME_RRUBEN CALDWELL
275601
Division of Water Quality- Groundwater Section
r3AS h& CERTIFICATION Y —I 1
DRILLING, INC
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (i f applicable)
• PHONEYi8 '754-3581
1. WELL USE (Check Applicable Box): Residential Ed/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ac d ks ft 1 LL County 3 ('Or -AC
S HI eat 1,0 2D Le 1 CQS-fe L, C'a rr'vn
(Street Name, Numben, Community. Subdivision, Lot No., Zip Code)
3. OWNER: 3 A r-•US ageAS rv--A c7
Address 516 ni (r Jl o ✓C D 40
Zip Code
ci(acg)- -1tib— O`1 c
(Street or Rowe No.)
leICAS-tea— 13(;
City or Town Stale
Area coda- Plane number
4. DATE DRILLED V 3 0 3
5. TOTAL DEPTH: . O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1Y
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS -a FT. Above Land Surface*
•Top of cuing terminated et/or below had surface require/ a
variance In accordance with ISA NCAC IC.01111. 9. YIELD (gpm): 1 0-- METHOD OF TEST gA G-- A 1
10. WATERZONES(depth): t 30 - 5 .GQr^
Aoo` -1 CGPrrn
11. DISINFECTION: Type l4r14 Wee. Amount .l I b
12. CASING: Wall Thickness
, Depth Diameter or 110 Ft. 6 'At 5ok-ainvFl. f VMaC-a
From
From To Ft.
From To Ft.
13. GROUT: Dcpth Material Method
From .1 To ago Ft. CBMEtOT eo v2C.D
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To Ft.
J 6.EM
1; LAATIEREBY CERTIFY THAT T11
C1ONS RUCTION STANDARDS,
I
t ,1,fr S ;i�
slubmIt th'e C at4Vater Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
/Topographic/fand setting
Ridge ❑Slope ❑Valley ❑Flat
(check appopriatc box)
Latitude/longitude of well location
fi 5' 1.5/8 �Dgl.°.y1.7/5
(deveatmtmnrsltcconds)
Latitude/longitude source:Q6PS0Topographic map
(check box)
DEPTH DRILLING LOQ
From / To - Formption Description
9, - 105 OJea—G.la-dL°''
1 C S - 130 ' Lod Ire 2oc)L. Caa.4&
) 5o' 5 Gerr!
13v '- Doc' cvr(ITe acct, csIc4JtrC
P-C O' '1 C.,ew-v--
7co'- aorc - c,ett GR-A,4I1-E
c.3
J OCATION SKETCH
Show direction and distance in miles from et lea4=r
two State Roads or County Roads. 1ncludege roa_d:_
numbers and common road names.
-a
N
W
1,0
PA, Fe aJC
LL WAS CONSTRUCTED TN ACCORDANCE WITH I SA NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
WELL OWNER
Q1c 'Aa4 `,d303
OF PERSON CONSTRUCTING THE WELL A

275600
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and '1•n,nl Resources -- Division of
�ff
ff�W�ate�r Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1947 /v» ' F.CERTIF�ICATION/
WELL CONTRACTOR COMPANY NAME_RLIBEN CALDWELL DRILLING, INC- PHONE[phone]
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 13-- 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:3Q.0AM)) l Itt. e
La. f .34o , o Fa <
County gU ries mE"e=
(Street Name, Number, Cenununity, Subdivision, Lot No.. Zip Code)
3. OWNER: lain 5600 iC.
Address A b L&L..9T 6-.1/41uQ j,/
(Street or Route No.)
� etwetu)/JP NC 0Z. P 71 7
City or Town State Zip Code
(42fl- (o}4 r3O (
Area coda Phone number
4. DATE DRILLED r �'i-3 (u 3
5. TOTAL DEPTH: 3 i o'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: a( io FT.
/ (Use `+' if Above Top of Casing)
8. TOP OF CASING 1S ( FT. Above Land Surface*
*Top of rules termlosted at/or below lead surface requires s
variance In accordant with 15A NCAC IC.011 a.
9. YIELD (gpm): tb METHOD OF TEST
10. WATER ZONES (depth):
JOCATION SKETCH
Show direction and distance in miles from at
/P 1 (,
DEPTH
From To
D - 3t
"D - /00 r
/OO'- /,S3.
/33- Aid) .
?_roc
Arlo -3Th
11. DISINFECTION: Type Prit . q s
12. CASING:
y� Depth Diarnff r
From�r To_On)._ FL /e, Vcf
From To Ft.
From To Ft.
13. GROUT: Depth
Frorr__O___ To to Ft.
Amount 1 b
Wall Thickness
or Weight/Ft. �j�,aterial
*2/ Y'�<_
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
Depth Sizc
To Ft.
To Ft.
16. REM_A
�, 1 DO HER�'HV C>?d''n�aurl
CbI STRUCTION STANDARDS,
Material
Material
Topographic/Land setting
HRidge ❑Slope ❑Valley ❑Flat
(sleek appropriate box)
Latitude/longitude of� well location
/T3`) `qG, �10711%X i i3 3i 3
(deueeahnthui laeemds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forrgption Description
r-*
two State Roads or County Roads. Include therksad cn`
numbers and common mad names. cri--
1
UWct*-
t�t .
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH$ WELL OWNER
SIGN
TURE OF PERSON CONSTRUCTING THE WELL
tacket O( ((,P
0
'Y\ k a 3 /D3
DATE
SubmTf , e osielltatlSrah'tagf5lon . f Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699=1636tPhaii Cato 3-`334t;ivIthIn 30 days. GW-1 REV. 07/2001

Fra.,. SCOtt ZI To:
Date: 6/11/2003 Time: 11:07:18 PM
275001
WELL CONSTRUCTION RECORD
rth Cart: -sn - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WE LI, CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT
CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC PHONE I4 ONE R(704) Q PERMIT #
-7277
STATE WELL CONSTRUCTION PERMIT # (if applicable)
applicable) = _
1 WELL LSEheck Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agicultural ❑ Ngnnirc _
Recover Heat Pump Water Injection D Other ❑ If Other. i.ist Use.
County BUNCOMBE
,:I:S 1 N;C.L \TAI\COVE RD
,,: <a `tsar:::au'b cr. Community. Subdivision, Lot No_ Zip Code)
t O\\GFR STEVE CIIANIBERS
d.P.SS PUB 60
DoI:S WH,'.l<EPI.ACL RXIS'IIN(i WELL?
_._., igt 14: 5'94 Being,Top ofCasing-
28-10
Zip Code
YES ❑ NO ID
20 I' f
(Us<"*" If Above Top of Cazing)
o:: Of 0..0 SG IS 7 ET Above Land Surface
eagee mquva a vwvu<m
.t AC 2CvttE
Topographic%Land setting
❑ Ridge ❑ Slope ❑ Vauzy Fl:a
L_atitude'Lonanmde of well location
35.29.343; P2.18254
(deaccltnlnatcr scconcl l
Latimdelongitude source: ❑ GPS ❑ Topourapiue ::.tic
DEPTH DRILLING LC::
From To Formation DospRi ..:::
0 10 C1ac
10
140 Consolidated Rost.
CIO ,,al, prETHOD OF TEST ARDM
I icR22 NES :depth. 120 135
J15h1_'I N-TYPE HYPOCHLORITE Amount 4 0a LOCATION SKETCH
Wall Thickness Show direction and distance in miles from at least
Del t; Diameter or Weight/Ft. Material two State Roark or County Roads Include the re
26 Ft 6 114 " SDR 21 PVC numbers and common road manes. CO 0
O
L
C
tr..O
e0 Ft. GRAVEL MIX GRAvrrV
t-c
Diameter Slot Size ➢lalerinl A m"
3
Ft. in. in. Ern -
CO
C
6 0 —z
Drvli Size Material lD .-.
To Ft.
Material Method
.FY THAT THIS WELLWAS CONSTRICTED IN A000R2A:CF VA'LTH 15.P. NCAC 2C, WEL.1,
AADARDS, AND THAT A COPY OF' THIS RECORD HAS BEEN PROVIDED TO THE WELL OW NEE
L � 510'03
SIGNATURE OF PERSON CONSTRUCTING TIE WELL Date
ion of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
-3221, within 30 days.
GW.t REV. ,.- }.,:1 1
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 274807
North Carolina - Department of Environment and Natural Reso ces - Division o
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
MEWL CONTRACT OK COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
Iif applicable)
I WELL USE (Chcck Applicable Box): Residential tt� Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge BSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m i n mes'seconds)
Latitude/longitude source:❑GPS❑Topographlc map
(cheek box)
DRILL_iNG LOC—'
Formation Description
WELL LOCATI ,. r
Nearest Town: 1 Q� >/Co tin
Cvb
(Street Name. Numbers, Community, Subdivision, Lot No., LIP Cade)
3. OWNER:_(_J2
Address
Watr
Qua
ASSOCIATED WO PERM!
(if applicable)
(-1-
Area code- Phone number ��,,..��._�• / i(_�t.p3
d, DATE DRILLED D
5. TOTAL DEPTH:_ 3 ._ _ —
6. DOES WELL REPLACE EXISTING WELL? YES 0 O FQ
7. STATIC WATER LEVEL Below
Use" of Above Top of Casing)
8, TOP OF CASING IS
FT. Above Land Surfaces
variance in accords/cc p Ih ISA NCAC 2C 18,
9. YIELD (gpm): _L.e- V ME Hai)? TEAS
10. WATER ZONES (depth):
•Tup of casing terminated at/or below land surface requires a
1 I. DISINFECTION: Type
12. CASING. Depth Diameter
From To Ft._._
From To Ft.
From— To Ft. it Method
13. GROUT: Depth /1 Material j " From_ . To FL
From To Ft.�--
Diameter Slot Size Material
!4. SCREEN: Depth in.
FromTo Ft._ in.
Ft. in. in. _
FromTo —
15. SAND/GRAVEL PACK: Size Material
Depth
From To Ft.
From _To_ Ft.
Amount
Wall Thickness
or Weight/Ft. Material
pEPTH
From To
Groundwater Seclio,.
CERTIFICATIONS
PHONES �.S.Ldi--inb
les
L.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names.
W
fl cam! -ate
n( IL`1-C I�
0 (aov&be Cave=
16. REMARKS: _-----
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
rra cp_NSTRUQTI N AR , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TH WELL OWNER
`% �'.Z xs / DATE L
,z
rn
0
Submit the%rigl
27699.1636 Phone NNo. (9
SIGNATURE OF PERSON CONSTRUCTING THE WELL
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh,
NC
9) 733.3221, within 30 days.

274806
From
From_
13. GROUT:
From
From
WELLCONSTRUCTION RECORD
North Carolina - Department of Environment and
1' NyaturalR��,�esorycce, - Division
WELL CONTRACTOR (INDIVIDUAL) NAME (print)FA6j
WELL CON'i'RAC'rOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS/
(if applicable)
Water Q`Lity
bik
ASSOCIATED WQ PERMIT
(if applicable)
- Groundwater Sec0ou
CERTIFICATION ..�U�7'�(3 fl 3
PHONES/ 11L.41R-IOy-'� a
J • ta
Z,Ct'S.
1. WELL USE (Check Applicable Box): Residential d Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use____----
Topogra hie/Land setting
❑Ridge EdSlope ❑Valley ❑Flat
Q zS'71/
2. WELL LOCATIO
Nearest Town:
bve
minty
(Street Name. Numbers, Community, Sub.ivisiun, Lot No., Zip Code)
3. OWNER:
Address
City or Town State
(Street or Rute No) ZCR$•'
f/iVy11rQ VC 1
L.
Zip Code
(—)'
Area code- Phone number , t _ ��+ 3
4. DATE DRILLED l.�
5. TOTAL DEPTH: LD b
6. DOES WELL REPLACE EXISTING WELL? YE 0 O F0'
7. STATIC WATER LEVEL
,Below
T.
(OTop ofCasing:
Above gTop of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variancetoaccorda`ih cy'Wi5MEtC 2C .0118.
9. YIELDIELD(gpm): d
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From
Q_ To 2-0
To
To
Depth
To
To
Depth
To
14. SCREEN:
From
From
15. SAND/GRAVEL PACK
Depth
From Tn—
From To
16.REMARKS:
RDANCE
ESTYTHAT S, AND THAT A COPY OF THIS RECORD HNSTRUCTED IN AAS BEEN PROVIDED TO THE WELL OWNER
1 1-/: IRCl11} N STA , 3- 1- 63
1 L �i� li l � DATE
i !�'+ i i SIG! ATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Center' REV eigh, NC
733-3221, within 30 days.
To
Ft.
FL.
Ft.
HQD OF TES'
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Material Method
Ftassx.e ecit
Ft.
Diameter
Ft. in.
Ft. n.
Ft.
Ft.
Slot Size Material
_ in.
in.
Size Material
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. r= o
r1ai- at}c• Ex if°
C ICI �� CY 1-- .
-_
t3sf h Ra � e 5
E
ca
Submit the original unit
27699-1616 Phone Nr. (919
5f
-

WELL CONSTRUCTION RECORD
Notth Carolina - Department of Environment and Natural Reso ces - Division o. Wat-r Qua
DELI. CONTRACTOR (INDIVIDUAL) NAME (print)
\\FAL CON'1'R,\CrOR COMPANY NAME
ASSOCIATED WQ PERMI
ST,V i'E WELL fap heable) ON PERMITN (ifa lieable
t ifa lieable)
I . WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use2. ___,------'
WELL LOCATION: ' • Topographic/Land setting
SC,2 4 5-' Count %Nee YVI. DRidge WSlope ❑Valley ❑Fiat
Neared Town: < ) Ces (check appropriate hoz)
.0
uD I S 12.1 Latitude/longitude of well location
(Street Nne„ umbers. Comrnunity. Subdwision, Lot No.. Zip Cod-COel
3. OWNER'_ 'r �p
Address---_. 0
r 'vucome Ni)LI`-Y to R
.eices
City or Town Sine
Ztp Code
Arca code Phone. number
4. DATE DRILLED_ r
.5. TOTAL DEPTH:._.,-�5
6. DOES WELL REPLACE EXISTING WELL? YE ❑NO Q
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
�
S. TOP OF CASING IS —
FT. Above Land Surface'
'Top of caring terminated et/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. Ten _ _ ^ a a, a1
9. YIELD (gpm): METHODIQF TES
10. WATER ZONES (depth): 1f
274805
Groundwater Sege
i
CERTIFICATION SEttaO
PHONE It t>pL.
(degreeshmnutes/seconds)
Latitudeilongitude source:❑GPS❑Topographic map
(check box 1
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type_]l
12. CASING: Depth_d Diameter
h/�
Fromy__ To Ft. _
From To Ft.
From To F
13. GROUT'.
From_
From
14. SCREEN:
From
From_
15 SANDiGRAVEL PACK
Depth
To______
To
From
From
l6. REMARKS:
Depth
To__
To
Depth
To
To
1 DO HEREBY CERTIFY THA"
CONSTRUCTION STANDAR
r-') ,' l
bmit the origin? II IIto t
27699.1636 Phone Nhl (o1
J
IUN
L OFFICE
ET
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cortunon road names.
Amount
Wall Thickness
or Weight/Ft. Material cc
Y
�7 tA'�..Se 9 `Lei • cz
Ft CThatirtat t i !!e-Ls.)
Material Method
Diameter Slot Sizc
Ft.in.
—._-- ..
Ft. in. in. _
Size
Ft.�_
Ft.
Material
c
0
r THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-
D Z
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center; REVgh, C
733-3221, within 30 days.

274804
ASSOCIATED WQ PERMIT
(if applicable) _
Arca code- Phone number
4. DATE DRILLED .'3--
5. TOTAL DEPTH. Zi0'S�
0. DOES WELL REPLACE EXISTING WELL? BYES_S 0 O Fes'
7. STATIC WATER LEVEL Below Top of Casing:
lop or rasing)
T.
(Use" P
8. TOP OF CASING IS
FT. Above Land Surface"
'Top or ctit c terminated IS below land .0118, requires a
variance in accordance with 15A NC AC 2C .0118.
igedsecaltd
9. YIELD (gpm): MIE4O DOF TES
0 WATER ZONES (depth) i art-O
DISINFECTION: Type Amount
- Groundwater Sects
CERTIFICATION #l.a,iar 12,
PHONE # ttIOt-ta t-fl
t OCATION SKETCH
Show direction and distance in miles from at least
1 I. Wall Thickness two State Roads or County Roads. Include etthe rc �d
I2. CASING, numbers and common road names. CO
Depth Diameter or WcighVFt. Material
QZ_Ft To Ft.
} f� (n3 r.
a
From To - `// �/' y�[
From____ __ Ft. N. 'j Lt 0 'IMF L'( �' I,{ �� c� ,.
From To Ft Mate Method
csY I�Q s 1 I _ e
13. GROUT: Depth }.�.� ! r ".,' � rt
From__ __
L r 1L��-
From_-- T°— Ft. .---- --' rn:.%
Diaineter Slot Sizc Material IC
14. SCREEN: Depth in. il-'�- .� o
f0 Fr._—ia z
From_ in.
From____
To_— Ft. in. .Y_
15 SAND/GRAVEL PACK'. Size Material
Depth
Front_ To________ Ft.
From__ _T To_ Ft._
Ft._
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL coN'rR:\Cron COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
1 if applicable) _.
I. WELL USE (Check Applicable Box): Residential Q/ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
___.----
Topograp�hie/Land setting
❑Ridge ope ❑Valley ❑Flat
WELL LOCATION:,
Nearest Town. I 4 -': _ County
10 �(1� Rey�� arc 2,I C
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: A^'—w‹(
Address
+ Street or Route o.)
Clay or Town State
Zcfl
Zip Code
r�,1
Z 6GJ `4 (check appropriate box)
Latitudellongitude of well locatton
(degrees/tontines/seconds)
Latitude/longitude source:❑CPS❑Topographic map
(check box)
pni DRILLIN 'LOG
From To Formation Description
16. REMARKS: WELL
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C,
CONSTRUC N ST�AA((�� DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO OWNER
/"�DATE
SIGNATURE of PERSON CONSTRUCTINGELL
e Division of Water Quality, Groundwater Section, 1636 Mail Service Cen�r RRaleigh, NC
001
733-3221, within 30 days.
Submit th(origin
27699.1636 Phone;
GROU"r.'ESSSATER SE,.iIGN
ASHE VILLE PL
OFFICE

Notth Carolina - Department of Environment and Natural Reso
\t'ELI. CON tr,\CTOR (INDIVIDUAL) NAME (print)
CON I RAC TOR COMPANY NAM
krE xx'EI.I. CONSTRUCTION PERMITS
if ap Ilicablel
WELL CONSTRUCTION RECORD
ces - Division o - W at- r Qua t - Groundwater Sectkop,3
_ASSOCIATED WQ PERMIT
(if applicable)
274802
CERTIFICATIONkT�
PHONE S�T4 `�+
ev a
i WELL USE (Check Applicable Box): Residential Si Municipal./Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: .
Neat Town:T.
21413
(Street ame. Numb s, Community, Subdivision, Zip Code) Z
KQI
3. OWNER:_
Address
.re/jyj'yl eei oorr Rode N�q(.
vr Slate
till}'OfTown S`SWI
(r_)
Area code- Phone number
4. DATE DRILLED
TOTAL DEPTH'��
Topoggrphie/Land setting
❑Ridge fsSlope ❑Valley OFlat
"� y (check appropriate box)
'7 y- U Latitude/longitude of well location
Idegrccs/m inums/scconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
b.
6. DOES WELL REPLACE EXISTING WELL? YES NO L�
7, STATIC WATER LEVEL Below
wUTop ef asingopofCasing)
8. TOP OF CASING IS ___t_-- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a , u .,
variance In accordance with ISA NCAC 2C .at I8. •
TVY,
9. YIELD (gpm): —..�Q—METH F 20 —
I0. WATER ZONES (depth): — kQCATION S1E.TCH
Amount Z Show direction and distance in miles from at least
1 I. DISINFECTION: Type --Th• k ss two State Roads or County Roads. Include the road
12. CASING: Material
//�� Depth
FronLO _ To
From To__
From_._. To Ft. —
13. GROUT: Depth
Matcrial Method
From _ To _ Ft.
From_-- To Ft.
—
14. SCREEN: Depth Diameter Slot Sizc Material
From To --
From To----
15. SAND/GRAVEL PACK
Depth
From__ To
FromTo ---
Wailis ne . , numbers and cortmton road names.
Diameter or Weight/Ft.C173
'(&Qou^
tkl5
16. REMARKS.
I DO HEREBY CER'
CONSTRUC
n ml e ongit
27699-I 636 Phone
GROUNDWATER SECTION
AS'HEVILLE REGIONAL OFFICE
Et. in. in.
Ft _in. in.
Size Material
Ft.
Ft. —
ye
CD
W
v
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J1 DATE V 7J�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GW-1 REV. 07/2001
733-3221, within 30 days.
L.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality -Groundwater Section
CERTIFICATION
2/Ja
WELL CONTRACTOR (INDIVIDUAL)NAME (prL—�"
PHONE
WELL CONTRACTOR COMPANY NAME ••.� ASSOCIATED WQ PERMIT*
(if applicable)
STATE WELL CONSTRUCTION PERMIT*
(ifa icable) p Agricultural 1. W ELL USE (Check Applicable Box): Residential 5 -_M nici al/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use___--�
274799
2. WELL LOCATION: `
Nearest Town: E' � it
(Street Name. Numbers, Corn
3. OWNER:
Address
County .5 6'7 'kti-�.
✓P
State Zip Code Co /
City or Town (
Area code- Ptw.,e Dumper
G /4
4. DATE DRILLED i/11 R-
Z L,
5. TOTAL---
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO-4��
7. STATIC WATER LEVEL Below
Use" of Ab Casing: ve Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA *CAC 2C .0118.
9. YIELD (gpm): ? METHOD OF TES n /,-- Z
10. WATER ZONES (depth):
Topograz_hiciLand setting
ORidge BefOpe OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrces/minutestseconds) hie map
Latitude longitude source:O(checkbox)P ogra P
DEPTH DRILL NG LOG
From
To Formation Description
•
11. DISINFECTION: Type
12. CASING:
Depth
From T
From___0—T
From a —To
13. GROUT: Depth
From To
From__S`L—To •
14. SCREEN: Depth
From To_
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
16. REMARKS:
r TOY CrER�
I' Inc st U 9K$
11.
Wall Thickness
Diameter or Weight/Ft Material
o
0
Ft
Ft..2 l 1r _Q,
Material
Ft. (�
Ft.
Ft
Ft..
To Ft.
HATT'1
ARD , AN
Method
Diameter Slot Size Material
in. in.
in. in.
Size
Material
ID OI SKETCH
Amount i+'G. r J Show direction and distance to
two State Roads or County Roads. Include the road
numbers and common road) names.
/./t.Y2Giet�aji=cp
r_
C ;
z c
O
l`
Tam rir.
miles from at least
% 1cAe;�. ' .d
• LL WAS CONSTRUCTED IN ACCORD • . WITH I5A NCAC 2C, WELL
THAT A COPY OF a,•�=aa AS BEEN PROVIDED TO THE WELL OWNER
UOF P •+�•'t>;
Submit the original to he Division of Water Quality,
27699-1636 PIUMe No. (9 9) 733-3221, within 30 days.
CTING THE WELL DATE
ndwater Section, 1636 Mail Service Ceerntr' eigh, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �
WELL CONTRACTOR (INDIVIDUAL) NAME (print) g 1 3 d S41(� CERTIFICATION # v / 5)
PHONE # 7%�y'Zt
WELL CONTRACTOR COMPANY NAME
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
7aSi- )Gc
(if applicable)
1. WELL USE (Check Applicable Box): Residential t' MunicipaliPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: •
Nearest Town: FrO.C, (Yt1JJ-/ County (1)f/L-044.)'e-
FSr )A.es �OIJ'-AtPXr, n,AP; L;P`>*,
(Street Name, N pmbeg�/Community, Subdivision, Lot No. Zip Code)
3. OWNER: inn)() t..) SCIA/0-e _rive
Address &/O Lc(_'¢ i,(
274798
Topograp and setting
❑Ridge Mfope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
City or Town sate Zip Code From To Formation Description
2 6le-3i&e >
Area code- Phone number ("/ — 4c ,/sue"�h
:
4. DATE DRILLED %7 it] el' ,',1 C., n-3 4e
5. TOTAL DEPTH: 5-0,5"---/ &O- 50� j ",i''
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Iii
7. STATIC WATER LEVEL Below Top of Casing: '90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Z. METHOD OF TEST %}/X
10. WATER ZONES (depth): 29rni L^' 4zt.,
(Street or Route No.)
k c/a N C- 2 S792-
11. DISINFECTION: Type d Lacirve
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft. }�
From To &7 Ft. Gy/47 did ! V6
From C7 To� (/ Ft. £o/Y a%8e i!L'
13. GROUT: Depth Material
From To Ft. /
From 0 To 54/ Ft. -2/
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
LOCATION SKETCH
Amount crzcv 25- Show direction and distance in miles froilat leasi
two State Roads or County Roads. Include the road,
C
numbers and common road names. A,
rn --
Method
From
From
16. REMARKS:
.1 b6HEftt6B1@ CttT1Li
CONS I KUL I ION STANEI
ponf l
n`r
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AN TJIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNASrt RE OIIPE(SoON CONSTRUCTING THE WELL DATE
fl5k l(e
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 73313221, within 30 days. GW-I REV. 07/2001

r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesr'- Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) &fl J rag ps'rec CC
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Svsr ia; U Df%L,C A-5
274794
- Groundwater Section
CERTIFICATION #
PHONE N2,))) 2, 15?"8
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): ResidentialO' Municipal!Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:- -
Nearest Town: 1r- County BU /UC:l-
r/)Y7/)v/P {')'t •t C-.1
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
3.OWNER: Ltit.eLAI,•'C,i
Address / ciTr; l02.G,Y2. elitt /2e7
F(Street or Route No.)
City or Town State Zip Code
( )- 6 R'7— 76 5—e,
Area code- Phone number
4. DATE DRILLED 5--Z6 -.03
5. TOTAL DEPTH: 2 7 5 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top of Casing: /r°' 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): /2 METHOD OF TEST 4 /'2-
I0. WATER ZONES (depth): / 2 fr., 4t1 2 00
11. DISINFECTION: Type 1 to itit✓e Amount 2C2P7»Z.
12. CASING: Wall Thickness
Depth Diame,teFr or Weight/Ft. Matena
From 0 To /0Sr Ft. C. %y 4/C /1d'
From/b4/ To /39 Ft. 6 VT f/a 111 C
From / fl To / 46 Ft. l 6'S G Vy 6 it/t/
13. GROUT: Depth Material Method
From To Ft.
From CC To 2fl FL ,7el
14. SCREEN: Depth Dian(eter 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:
ijDCFHEREBy CERI1-
!ONSTRHCT,10111'ST_.. inia
tJ
Submit the original tolthe D
27699-1636 PhoueNa T9'19) 73
Foiled
0
Topogra OandV setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
p- >So
4100— ZOO
7LO- 72i-
pirf6 /rri/c.
/LUde--
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 -_
ca
Piner
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
'AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUR OF P RSON CONSTRUCTING THE WELL DATE
'.vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C.7I5�•%I 07$ CERTIFICATION # 2%SZ
9VSFk t PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED Q PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
274793
�zy-� 771/-45�9
I. WELL USE (Check Applicable Box): Residential 13- unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town: F,4County eux-eSrn / t'.
wer"t'z Phzst. &id g.k / d
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER: Ail -a / X
Address 1 3 Id aLtst� teM. -t-
? nn (Street or Route No.)
R)t 2,87G2.
ettpCity or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 2 v'
5. TOTAL DEPTH: >vS
TopograPh-ic/Land setting
❑Ridge Ll8)ope ❑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
— .5,4 4/2
�g — I5/- &t/2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D
7. STATIC WATER LEVEL Below Top of Casing: 20 FT. /0i3'-' //n C
O5
(Use "♦" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atfor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST ///
10. WATER ZONES (depth): 40t71-'.i 1 10U
11. DISINFECTION: Type(.Lau;-2
12. CASING:
From
Depth
To
From b To /ci'
From ez4-, To G R
13. GROUT: Depth
From To
Diameter
Ft
Ft.
Ft
Ft.
Material
Amount bOZe7.? .
Wall Thickness
or Weight/Ft. Material
From CJ To ZZ., Ft. Z £/
14. SCREEN: Depth Diame(er
From To Ft. in.
From To Ft. in.
Method
Slot Size
in.
in.
Material
hrpal lCcc%.
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.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. A"A
From s�
16. REMARKS:
To Ft.
O
c
Sr7sL;ft-'
THAT THI WELL WAS CONSTRUCTED IN ACCORDANCE , TH I5A NCAC 2C, WELL
DARDS, ppl» THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Mty
ATURE F PERSON CONSTRUCTING THE WELL DATE
G Rii l!T<d J 14lbikt the t 'nal o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASi' r'./L, 2109-I630intone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 217 4789
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 94 _LT� {{u�3 c.C. ".-L CERTIFICATION # 2/�
WELL CONTRACTOR COMPANY NAME
t'Scc, 1. .-sw-PHONE it�(�Nj4?7044- Sys
a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 4Y Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIONl:
Nearest Town: /Q Sj u .LLt County LINGO 7K Irk
21 g -0Q4i
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: .StJN Cc hl1^ l;C-4(14.4
Address r, C. oc)c SIS
(Street or Route No.) (2 a?
P .24trw �1c
City or Town State Zip Code
? )- 62 ,-2)t,Z-
Area code- Phone number
4. DATE DRILLED %J�/t'7
5. TOTAL DEPTH: -7O Sr 60 - %y
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO &�
7. STATIC WATER LEVEL Below Top of Casing: /co FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): g- METHOD OF TESTS'/A
10. WATER ZONES (depth): 2 9 pin a..y
Topograpyic/Land setting
❑Ridge Wgiope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
8 *-4
6to Sit
LOCATION SKETCH
11. DISINFECTION: TypeCLOn, N t Amount b c d. e 741E Show direction and distance in miles from at least^
12. CASING: Wall Thickness two State Roads or County Roads. Include the roa`
Depth
From To
From O To &S
From 67 To 6,7
13. GROUT: Depth
From To
From (0 To-2 2
14. SCREEN: Depth
To Ft. in.
To Ft. in.
VEL PACK:
c 0
Ft.
Diameter or Weight/Ft. Material numbers and common road names. W
Ft. 6.y
FL
Material
Ft.
Ft. A'S{
From
From
15. SAND/GRA
Diameter
90 Pre-
.IBS 4,4/1/
Method
pa ma
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
(1tt Et BM-`CEICTIE TkAT
STRUCTION STANDARDI
N
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G
RSOXt CONSTRUCTING THE WELL
DATE
Su bliaa the pUaglin p-f�dfa, ,i maven of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
7744:f636(Ph41ie Nit. (919)1733-322
, within 30 days. GW-1 REV. 07/2001

274621
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # a.'i310
PHONE # (Sera a55-ZSaSS
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Utt r: CK t{. Sos4V¢1%"i,
WELL CONTRACTOR COMPANY NAME el St:oa>.�¢re t 5 c n Nt 11131 TMt� Tie.
STATE WELL CONSTRUCTION PERMIT 6 c ASSOCIATED WQ PERMIT#
(if applicable) -. (ifa licable
I. WELL USE (Check Applicable Be:): Residential Sd Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Hen: Pump Water Injection ❑ , Other ❑ If Other, ListUse
2. WELL LOCATION4' O
Nearest Town: t/S�teu 1 )( e
�e.44ctnez as
County aktsC'arrAr
(Street Name. Numbers, Community, Subdk' isi on, Lot No_ Zip Code)
3. OWNER: born ( tvch V:eld
Address CCl-f.'e td SAL.AQ
(Street or Route No.) ��� 30!
rleeke.c NC d
City or Town State Zip Code
(Ras)- co - gta
Area code- Phone number
4. DATE DRILLED 5"ati-03
5. TOTAL DEPTH: 35
6. DOES WELL REPLACEEXISTIT•G WELL? YES ❑ NO Lil
7. STATIC WATER LEVEL Below -Top of Casing: yP FT.
(U :o "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC ZC .0118.
9. YIELD (gpm): It) METHOD OF TEST i<IQ
10. WATER ZONES (depth): Q
11. DISINFECTION: Type :TIS Amount 4
i2. CASING: Wall Thickness
Depth Diarreter or Weight/Ft. Material
From i 1, To 102 Ft_iri'cI— 44.2i Ale.si•:i
From_ To Ft. 1
From _ To Ft.
13. GROUT: Depth Nrterial
From 0 To ab Ft. C;71 nest
From To Ft.
14. SCREEN: Dcpth Diamet:r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Method
your ask_
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Si;c Material
Ft.
Ft.
Tdpographic/Land setting
❑RidgeiSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
■I
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Descript on
4-1, 1GZ OatQC 3ecacs,
10 2 3e CrCo....:
0
0
r
C
LOCATION SKETCH N Et: I111
Show direction and distance in miles froid,rat Ie�
two State Roads or County Roads. Incluagthe— re -erg;
rr,
m.=
numbers and commo`n, road names.
J`C
i
;•
1 DO HEREBY eERtIFit-Tt-1
CONS I RUC] ION SI ANUA;
ii
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C. WELL
D • ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
54 03
S@tdRi11C IVAPgiarx#RR16Ee Div'
Ait614/fdd36;Ptilifa'/Riox`01733-
48es-
IGNA] UR F 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tet r:CK '!�. �G..4 jQr5 CERTIFICATION >< `oi l3lo
WELL CONTRACTOR COMPANY 21ANtE @ 41 i 4c- PHONE # ('IN9 a 55- 24,n
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(ifapplicable) (ifapplicable) pis
274617
1. WELL USE (Check Applicable Bcs): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hen: Pump Water Injection 0 Other O If Other; ListUse
2. WELL LOCATION:
Nearest Town:_ As de e,
Piverytc, 1'GCX
(Street Name, N mbers. Community, Subd.'ision, Lot No., Zip Code)
3. OWNER: t: a-t1, i ac te--.(
Address l"`1 d :+.a Ke^IceA4
(Street or Route No.)
ilratn RC
City or Town State
osaa )- tc i S'fl
Area code- Phone number
4 DATE DRILLED 3i1a 1c3 p
5. -TOTAL DEPTH: I0,5
6. DOES WELL REPLACE_EXI,STING WELL? YES ❑ NO En
7. STATIC WATER LEVEL Below ' op of Casing: tiCo FT.
(U.' "*' if Above Top of Casing)
8. TOP OF CASING 1S i [T. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): z METHOD OF TEST etI
10. WATER ZONES (depth): 4
County i3vv.Ca+.,iaQ
• at:vt
atIolk
Zip Code
I1. DISINFECTION: Type
12. CASING:
Depth Dia;retcr
From -Irk To 'itc Ft._Se__1
From To Ft.
From To Ft.
13 GROUT: Depth NI iterial Method
From 0 To a0 Ft. C'_ =Ment ca.c
From To Ft.
14. SCREEN: Dcpth Diatnet tr
From To Ft. in.
Amount 5
Wall Thickness
or Weight/Ft. Material
# r2i Ale.;tii:e
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
I DO HEREBY GE.Rt'FYrTH
inbmit theMriginalto. Divis
;7699 1636 Phone No. 1733-3
Tclpographic/Land setting
Ea 'Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
■Its
(degrees/minutes/seconds)
Latiiude/longitude source:OGPSOTopographic nap
(check box)
DEPTH DRILLING LOC'
From To Formation Descripton
1-ita y Cr Coo-01.Q
CJ
C_
c
L 0--t
x
LOCATION SKETCH 1
Show direction and distance in miles fromW1cazEZ
two State Roads or County Roads. Includeatke rcg^
numbers and common road names.
r1
ri
C I 4
C
Wg3
Ue°")s ca.
4-
t1wy Ielf
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3iaiel3
NATVE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
v.

2. WELL LOCATION: -
Nearest Town: {\:141-Thse F.z-etn County a'^b4
VG.0 wy ?�cce_ j2assc3
(Street Namc. Numbers Community, SubdA, lion. Lot Na. Zip Code)
3. OWNER: JEAN (heore WSS
Address _ fl e v ` La"4 _. ' S T P O n'e
(Street o Route No.)
aikey: tlt AC. -. ali503
City or Town State Zip Code
6274- 5979
Area code- Phone number 4. DATE DRILLED 1" ar-' -
5.'TOTAL DEPTH:
6. DOES WELL REPLACE EXJSTIN'7 WELL? YES �oNO_
7. STATIC WATER LEVEL Below -Tip of Casing:
(Us: "+" if Above Top of Casing)
8. TOP OF CASING IS ! I r. Above Land Surface*
*Top or casing terminated at/or below lar 1 surface requires a
variance in accordance with 15A NCAC :':.OI I8.
9. YIELD (gpm): 20 METH() ) OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Tye l3 S Amount I
P 12. CASING: Wall Thickness
Depth Dia:citer or WeichdFt. Material
From 'ij Tc SO Ft. (eft - L Fte,a*4C
From To Ft.
Ft.
DI- teriai
Ft. l'...: "went
art
Ft.
Diamct r Slot Size Material
in. in
in. in.
From To
13. GROUT- DepthMethodaue
From O To a�
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
FromTo
16. REMARKS:
STR CTION(,STAND
{_Submit the original-�a�
( 67,4036iP "pT,N nv'9) 73
Ac- OFFICE
Ft.
Ft.
Sic Material
Ft._
Ft. _
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviror ment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) iNsttr:Clc)-i '<Ccw+gdQ*"1 CERTIFICATION F a. to
(lyejg 4n+.1VQft 4i-:, uC y: Lt`-nt Tie.
WELL CONTRACTOR COMPANY (�10-tE ._�
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT4. (if appl-cable)
(if applicable) - lineramins
274616
PHONE #(YZ9 66- 2C.Frr
1. WELL USE (Check Applicable Bc:: c Residential Gd Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Hen: Pump Water Injection 0 Other ❑ if Other, List,Use
Topogaphic/Land setting
[]Ridge IMSlope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degtees/minutes/seceads)
Latitude/longitude source:❑GPS❑Topographic 1 -ap
(check box)
DRILLING LOG
To Formation Descript. >o
5E7 one< Sec&.n
DF?TH
From
}
So tlin5
E C0.nFet
0
W
L
C
e
0
1 C c
LOCATION SKETCH
Show di -ection and distance in miles from at lea
two State Roads or County Roads. Include y'err
numbers and common road names. _ on=
CFI —!T
.c G
THIS WF:.L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND Ti? 4T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
G_
GNAT t RE OF PERSON CONSTRUCTING THE WELL
ision of Vater Quality, Groundwater Section, 1636 Mail Service Ceenteri RaRle gh, NC
3221, wit tin 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Envire
%vELL CONTRACTOR (INDIVIDUAL) NA'
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITt
(if applicable)
274615
mnent and Natural Resources - Division of Water Quality - Groundwater Section
1t (print) liv t r t cH N. K aw11-1S CERTIFICATION 1 a i MP
Ck '5ca. _Sei i 1 E Ctt t,^T7 ilc. PHONE : firL9 a55- 7_G88
ASSOCIATED WQ PERMIT#
Of applicable)
ss
1 MI
1- WELL USE (Check Applicable Be::): Residential W Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Her. ; Pump Water Injection ❑ Other ❑ I Other, List.Use
2. WELL LOCATION:
Nearest Town: ?v., lernao r e Pe> e'i County f'lY. rice m h Q
(Street Name. Numbers. Community. Subd,Lion, Lot No., Zip Code)
3. OWNER: C- t - a ?'wr t t
Address Av4.
(Street or Route No.)
ASlner iie tic o1s80
City or Town State Zip Code
(528)- of io
Area code- Phone number
4. DATE DRILLED 4-aa• 03
5. TOTAL DEPTH: 5,25
6_ DOES WELL REPLACEEXISTIf Ct WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: S'T.
(Ut "+" if Above Top of Casing)
8. TOP OF CASING IS i Above Land Surface'
"Top of casing terminated at/or below lard surface requires a
variance in accordance with 15A NCAC it .0I18.
9. YIELD (gpm): S METHGD OF TEST IQ :11.
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From ''' To -J5
From To
From To
S
Diameter
Ft. ( -t
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft, Material
.2I pi�.�}:c
13. GROUT: Depth N11:Mal
From 0 To af3 Ft el, t',WA*
From To Ft
14. SCREEN: Depth Diameti- Slot Size Material
From To Ft. -_ in. in.
From To Ft. in. in.
Method"i
15. SANDiGRAVEL PACK:
Depth Sirs- Material
From To Ft.
From To Ft.
16. REMARKS: —
Topographic/Land setting
ERidge EiSlope ❑Vailey ['Flat
(check appropriate box)
Latitude/longitude of well location
(decrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic 'rap
(check box)
DEPTH DRILLING LOC
From To Formation Descriptioa
}i 75 01611. '-6 @Seen
—15 5a 5_ G- Can:, e_
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
iociC 1Cll
ia
19,p0(iHEREB5rCad T IFaClHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
rOF THIS RECORD HAS BEEN PROVIDED TO THF, WELL OWNER
r—G9��5'IBUC+10`� ETA V1�rKDS, ANDTHAT A COPY
,a.
SIGNATURE F PERSON CONSTRUCTING THE 'JtELL DATE
L. Submitthe
! r 2769,9-16e6I
r1
/nal to th
to No.(919
Division of'-iater Quality, Groundwater Section. 1636 Mail Service Center -Raleigh, NC
.
733-3221, within 30 days. GW-I REV07/2001
c

274613
WLLL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAP'SE (print) t4tr: CK14. tirLw Art-, CERTIFICATION # a-436
WELL CONTRACTOR COMPANY tAMt 11"i4 SaWVQf4 S-_��C_.I %3?tr'�'15 *de- PHONE # (SfZ.9 a 56- Jy58
STATE WELL CONSTRUCTION PERMITA ASSOCIATED WQ PERMIT#
(if applicable) - (if applicableinii
)
1. WELL USE (Check Applicable Box): Residential $ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Hea. Pump Water Injection 0 Other ❑ If Other, List,Use
2. WELL LOCATION:
Nearest Town: i JecNle+Vt\�e..._ County vaCtw e
}l cAr a rnh* ('ranch ac.ack
(Street Name, Numbers. Community. Subdi•. ision. Lot No.. Zip Code)
3. OWNER: Andyy, iiAAQryan 5u1tier,
Address Ver M11/29,a a'ltm
(Street or Route No.)
lr3 Won Vtit Q CC
a$,s,
City or Town State Zip Code
(Sas)- (051 o$tob
Area code- Phone number
4. DATE DRILLED L- +-a3
5. TOTAL DEPTH: 2(0-5
6. DOES WELL REPLACE.EXSSTIN(5 WELL? IcES 0 NO NI
7. STATIC WATER LEVEL Below Top of Casing:/0 _FT.
(Use "+" if Above Top of(
8. TOP OF CASING IS i Ff. Above Land Surface*
'Top of casing terminated at/or below lar•I surface requires a
variance in accordance with 15A NCAC 24: .0118.
9. YIELD (gpm): i a METHO-D OF TEST ate.
10. WATER ZONES (depth):
II. DISINFECTION: Type ?CHS
12. CASING:
Depth Dian' -:ter
From '41 To Me _ Ft. (fit:
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a Ft.
From To Ft.
Amount 8
Wall Thickness
or Weight/Ft. Material
M :tcrial
C'.e.wien*
14. SCREEN: Dcpth Diamet r
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
_126 t}
Slot Size Material
in.
in.
Material
pographic/Land setting
Ridge ❑Slope ❑Va'ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic rrap
(check tox)
DEPTH DRILLING LOG
From To Formation Descriptioa
4- 40 o7es e aLrk
Rio ata5 (,-f0.n21e
O --
fa
f c
ac �a
LOCATION SKETCH I
Show direction and distance in miles fromn'aPleast r=.
two State Roads or County Roads. lncludoe romi
numbers and common road names. DC
rn=
f- 1
c
(�rj� DQ'KEIR'EB CBI TI{�
I f COt`1"#iROCTIONtSTAND
,HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEti PROVIDED TO THE WELL OWNER
y-3-a3
SIGNATL THE N ELL DATE
LSubmit the original to t�te Di ision of VaterPE ON CONQuality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
106911,1636 PlioiieN&C( I9) 733 3221, wit lin 30 days. GW-I REV. 07/2001
C`HiCE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION: W-I3io
PHONE # aSS-JS i�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'jilt e r:CK li. 'Saw yQ ti,
WELL CONTRACTOR COMPANY NAME eihtk SOU'Q QCS Q C _, l) -2nc-
STATE WELL CONSTRUCTION PERMITL ASSOCIATED WQ PERMIT#
(if applicable) (ifapplcable)
1. WELL USE (Check Applicable Bo:;): Residential RI Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Hea: Pump Water Injection 0 Other 0 If Other, List/Use
274610
2. WELL LOCATION:
Nearest Town: 117151.evtt le. County &ur.tavn Q
Prow1_yuhM Ccndltr I\C 9fl15
(Street Name, Num ers. Community, Subdis ision, Lot No., Zip Code)
3. OWNER: (Z.\\
Address
C caa\QC
-T Y.c Yn ��� n
r7 19ro-a r Lynth
City or Town
(a' )- We,
Area code- Phone number
4. DATE DRILLED 5• a\-o?y
5. -TOTAL DEPTH: \l05
6. DOES WELL REPLACE.EXISTING WELL? YES ❑ NO IC
7. STATIC WATER LEVEL Below Top of Casing: '*0 FT.
(Use: "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC:C .0118.
9. YIELD (gpm): 1OO METHCD OF TEST KA
10. WATER ZONES (depth): C
(Street or Route to.)
Rd
State Zip Code
• saCIa
Tdpographic/Land setting
DRidge ❑Slope f Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Description
4- -](a ova( '3ecdcn
71
11.05 4('a.e.1%e
11. DISINFECTION: Type :11S Amount 16
12. CASING: Wall Thickness
Depth Dian eta or Weight/Ft. Material
From :\ To -"](.o Ft. (n`rl -14 2I jiwgi.c
From To Ft.
From To Ft.
13. GROUT: Depth M atrial Method'
From 0 To av Ft. C' mfiemt ymAc sk_
From To FL
14. SCREEN: Depth Dining( sr
From To Pt. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sid(
From To Ft.
From To Ft.
16 RI=MARI:C
1-89-14ERBBa'-C
I CONSTRUCTION STAN
Slot Size Material
in.
in.
Material
c
O
LOCATION SKETCH
Z E.
1 ct-
Show direction and distance in miles froth QIeas ;
two State Roads or County Roads. Includeje ro c
numbers and common road names.
Cn--
CJ1
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5•a\-ea
SIGNATURE 0
ERSON CONSTRUCTING THE FELL DATE
Submit the with-614u the F vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Pheme-Na. (919}-73 -3221, within 30 days. GW-t REV. 07/2001

274609
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAPIE,, (print) t tt ct CK I4 1c.wyQ.c-t CERTIFICATION am3to
WELL CONTRACTOR COMPANY N4NTE R ',SQ «• S• n NC flddrip T Ac• PHONE # (SZ9 a 55- 245Y
STATE WELL CONSTRUCTION PERMITt ASSOCIATEDJJWQ PERMIT#
(if applicable) (ifa icable
L WELL. USE (Check Applicable Boz): Residential 6Q Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Hea: Pump Water Injection 0 Other 0 If Other, List/Use
2. WELL LOCATION:
Nearest Town: Can A\¢c County eau ^--nbo-
Ca, AXV-C
(Street Name. Numbers. Commuifity. Subdivision, Lot No., Zip Code)
3. OWNER: \e j::cl 7-IL) e:•i
Address \R\(;) e),�.nt PIo.eS
(Street Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED y-
5. -TOTAL DEPTH: Se;
6. DOES WELL REPLACE.EXISTING WELL? YES 0 NO TO
7. STATIC WATER LEVEL Below Top of Casing: / DC FT.
(Us- "+" if Above Top of Casing)
8. TOP OF CASING IS 1 IT. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): %z METHGD OF TEST R.:
10. WATER ZONES (depth): d
11. DISINFECTION: Type 1:i%S .Amountt5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ii To cd\ Ft.___6ThL 443i rkes4.:C
From To Ft. 1
From To Ft.
13. GROUT: Depth M aerial Method
From 0 To ad Ft. C'-q_+nentt ilc'v.co.gl
From To Ft.
SCREEN: Depth Diamet nr Slot Size Material
I
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft. in. in.
Ft. in. in.
Sic( - Material
Ft.
Ft.
16. REMARKS:
ILDOIHEREBY LER I IF,Y 1
TRLT TIN strAtomflr AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4'tb -c,3
Ldpographic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:EIGPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Description
Sit creel' t e.e&.cr
R1 G-mane.
w
L
r
Chi
1 0
LOCATION SKETCH >,
Show direction and distance in miles from1easC'.c-
two State Roads or County Roads. Include -the roaAL'
numbers and common road names. c-,Cfl
G
L1
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IGNATURE OF PER
N'CONSTRUCTING THE WELL DATE
Submit the original to t e Dhision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
g2(99-1636.Rhonet01�J )733-1i221,within 30days. GW-I REV.07/2001

26S000
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mantra! Resourcy_zDivision of Water Quality- Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) J)yk-tt Nt>si4 CERTIFICATION 91 1(
WILL CONTRACTOR COMPANY NAME_ CALDWELL DRILLING, INC. 4�8 �254-3581
Atone
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Bog): 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: Q
Nearest Town:5pfkr. LAta0A County " Uri ccfr,ge
ALPINe rA2ADa ,.-)S $SThfc 1 iATTui Cemc-AfZ/ RD
(Street Nune, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
5co-C s. Csre1!<LI\
Address c S \ fl Q. CR-A l t_ '``t244
(Street or Rowe No.) 1
WeAJE(WIL,_l, No- a-gl81
City or Town Stale Zip Codc
(8 )- GaS - “Gaci
Am coda Phone number /
4. DATE DRILLED a/2-o 0
5. TOTAL DEPTH: S t O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: fo O FT.
(Use 'a' if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface•
'Top of cuing terminsted st/or below land surface requires a
variance In accordsn a with ISA NCAC 2C .011s.
9. YIELD (gpm): METHOD 9F TE T SIG - A (fL
10. WATER ZONES (depth): 120 4-. G Pm
1 I. DISINFECTION: Type \4 1
12. CASING:
Depth
From To S S , FL
From To Ft.
From To Ft.
13. GROUT: e Depth /
From 1 To ao Ft.
Amount a a eto
Wall Thickness
Diameter or Weight/Ft. 1.Iq Cal
b" weal (V
Material nn Mc
CES(fa
v u(fa
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To •
Ft.
Ft.
r M. REMARKS:''
ilfI
po HEREBY CERTIFY THAT TFI
CONSTRUCTION STANDAROS, µ
si
Slot Sire Material
in.
in.
Material
Topographic/Land setting
kilgRidge ❑Slope 0Va1Iey ❑Flat
(=-=Y =pp.-o rise; box)
Latitude/longitude of well location
(degren/m ioutea/aecaods)
Latitude/longitude source:❑GPS❑Topographic map
(chat box)
DEPTH DRILLING LOG
From, To . Formation Descriptio
- So bV JR-o61)
laoG(-A TE
\ZoGe
3io' G 8-A1.3 C
LOCATION SKETCH
-Tsa r; o
Show direction and distance in miles from atsist cnx
two State Roads or County Roads.' e the- r,
numbers and common road names. '% p ,�
,(
5(n,t'A 9tt'1 5
e 574 tF
a
v
0S "70
WELL WAS CONSTRUCTED M ACCORDANCE WITH 1SA NCAC 2C, WELL
THAT A COPY OF THIS REC,QRD HAS BEEN PROVIDED TO TL♦E WELL WNER
Cis. vv 11iV a�� l a. C, 3
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Ln
S sbmitthe original to tha Dlvlslen of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
tThI9-I636-noneNo.Z9-19)733-3221,within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Jeremy H. Bowman CERTIPICATIONY 2809
WELL CONTRACTOR COMPANY NAME n Bnwman Wel 1 11r111ing Tnr PHONE Yf17A 757-7779
STATE WELL CONSTRUCTION PERMIT Y ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
278952
I. WELL USE (Check Applicable Box): Residential lx Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Swannanna
10 Long Branrh Road
County
Bnnromhe
(Scree( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Charles Roberts
Address 10 Long Branch Road
(Street or Route No.)
Swannanna NC
City or Town State
( )-
Area code Phone numb,/ 1 7 / 0 3
4. DATE DRILLED
5.TOTAL DEPTH: 355'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 3C .0118.
9 YIELD (gpm). 200 METHOD OF TEST '..rotary air
10. WATER ZONES (depth): 355'
78771
I I. DISINFECTION: Type
12. CASING:
Depth
From 0 To 30
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
hip Code
tablet Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.61/8 Sch g0 pvr
Ft,
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
O
W
C
0
cs
`rt
_
LOCATION SKETCH — te<
Show direction and distance in miles frouadt leeAi-.
two State Roads or County Roads. Includithe r130
numbers and cor anon road names. fV �z
Material Method
R. concrete gravity flow
Ft,
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
co) z
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
Ctr
/ Zf. 7.MW�-- 7/17 /b.3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
•

282698
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ,, //
WELT. CONTRACTOR (INDIVIDUAL) NAME (print) _ Yp Q.w�--_--LJ YL.i_('.(.iJ-.• CERTIFICATION 3t-)7/
WELL CONTRACTOR COMPANY NAME g e e_e_FI'C+ ),.]ros. 1i 72_I 1 ^F I wne-p PDONE # (O�tp �o Y g - 3 / 7G
STArE%VEI.L CONSTRUCTION PERMIT# /7"2 ASSOC I:\IED \NO PERM Ilk
(if applicable) lif applicable)
1. WELL USE (Check Applicable Box): Residential IW'Municipal Public ❑ Industrial ❑ ;Agricultural ❑
Monitoring; ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other. List Lsc
2. WELL LOCAII :
Nearest Town: i-ilar7ri.�Q.t nnet County 1.-i YlC C rm I> 'L
Su_rv\
(st'cct Name. Numbers. Community,)rtfri i>i,r. 1.ol.N�
3. OWNER:
Add IronI
(bloom or Route bit_
lfi
Stan: hip (-o,l:
Area code- Phone number
4. DATE DRILLED 10- IS 0 a
5. TOTAL DEPIIL. ca
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO R'
7. STATIC' WATER LEVEL Below lbp of Casing:
(Use -0' if:Ahove flop ot(a.iiic
8. "iOP OF CASING IS 1 El'. Above Land Surface*
*Tod of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2(' .I1118.
9. YIELD (gpm): 30 METHOD OPTIiSI. . r5
In. WATER ZONES (depth): aDS ' — 30 ooPry ----
LOC:V 11UN SKETCI1
11. DISINFECTION: Type_ :4 T-14 Amount 3 G}-I —s . Shorr direction and distance in miles from tit least
12. CASING: Well Thickness t110 State Roads or County Roads. Include the road
Depth Diameter or AVaight. It Alatcridl numbers and common road names.
From___ ri TogqFt. II
From To Ft. O
W
Topu_la)hic!Landsetting; 1
❑Ridge L'1Slopc ❑Valley grim,'
h 'k Jolooptw bust
1autude longitude of ucll locatyrm
rlc.sminra.: amd-,r .,-.
i
Latitude Ion_it ode sr ouce:❑GPS❑Topo4raphi�nido
IcisLk hos) l
UI-.PIII I)RILL+ LO(i L—__
From fo I 1 n i, 1on 1
_0 S_Li:
gLi aaC
From TO
13. (GROUT: Depth //�� �M�atcri'�al Method
From 0 'T0 a Et. t_/t_�"- _ ) 4 3'
From To Pt.
14. SCREEN: Depth Diameter Slot Sim Metcrtel
From To Ft. in in.
From 'It) It. in. _ - is
15. SAND : GRAVPi1, PACK:
Depth Size Material
Prom_ To Ft.
From 'Ft) Pt
16. RL,MARKS:
I DO IIhRL13V (FRTIFY TIIATTIIIS v,T11. AA AS CONS11211CTWIN A( CORDANCIi VVI TII I5_A N(:AC 2(. AA Lt.I.
CONSTRUCTION S FANDAI,2D$, AND TIIAT A CUI'1' 1)1 HITS RECOIL') I IAS BI N PRt)A'IDI.D TO 1HIE V 1.1 I, OWNLI<
/ -3
SIONA'IURP.-OI PERSON ( ONS 1R1,( IIN(i I AA1.11_ Dvt'lI
Submit the original to the Division of Water Quality, Groundwater Section, I o3u \Tail Se0 ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07 2001

298698
WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R ELL CONTRACTOR (INDIVIDUAL) NAME ((print) rir•z^ *1 ll�>Ics CCRTIFICATION #.7Ay`'r
w ELL CONTRACTOR COMPANY NAME fe-f-. //v elf PHONE 8.It1 In" iv"S(
SPATE WELL CONSTRUCTION PERMIT#
ii f ap pfc_blc)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE \Cheri: Applicable Box): Residential Et"---clunicipaUPublic 0 Indusaial 0 Agricultural 0
Mandarin; 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town �-5--pen-7sn✓.+'r County �^c-'n�(
Zee Pec'e /0"et- r
tSseer N:ne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER B EA -di Press /y
Address /c is' G O/rl Nw„7p-J
St.1 (Soon ar Route No.)
,3a hno rt o0. r C - aQ77€
City ar Town Score Zip Cods
fl%)- 97q. 930 0
.k,es dock- Phone number
4. DATE DRILLED 6 ' /s' -o
5. TOTAL DEPTH: 25-5
6. DOES WELL REPLACE EXISTING WELL') YES 0 NO Er.
7. STATIC WATER LEVEL Below Top of Casing: S 0 FT.
(Use''''' rAbove Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface.
`Top or ea,in; rerminared oVur below land unlace requires a
variance in accordsii- with I5A NCAC 2C .0118.
9. YIELD(gprrt)- / METHOD OFTESTa .�f,e
IQ. WATER ZONES (depth): /70" .2 %d r
II. DISINFECTION: Type C/a ,-.c Amount k /t5/
IL. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To in Fr 6 %i s✓L
From To Fr.
From To Ft.
13. GROUT: Depth Material Method
From 6' To 1° Fr CanveAA /°o—e.n/
From To F.
14. SCREEN: Depth Diameter Slot Size Material
From To Fi in. in.
From To Fr in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fr.
Topographic/Land selling
❑Ridge laSTope ❑Valley DFIdt
(check appropriate box)
Latitude/longitude of well location
Nis° 37, oo7 wvbz 2/.4"3'
(degrees/minutes�) conds)
Lariwdeilongitude source: UEOPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D - /02
C•-cn• tie
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L�2 e tie to)0/1'LCGhI-
S Vi^r wr'ocxr Nr
•
IV
al
V1
Id. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
ems, -• -U / s- © 3
SIGNATURE OF PERSON CONSTRUCTMG THE WELL DATE
Submit the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-1 REV. 07/200I

2. WELL LOCATION:
Nearest Tovwv 3-'-:^1Nn+✓S County ^e"'>ir
4e ,ve„eJenef
ISceer Nome. Numbers, Caaaommuniry, Subdivision, Lor No., Zip code)
3. OWNER: Eccc.hr.t ?resstt+.I
Address /a s & /d N� 25
(SPter or ROWEL NY)
SLIAIvstfrobA- f1 c 0877W
Ciry or Town Scare . Zip Code
g
r7k1- 7,79- 730a
Area code- Phone number
p. DAATE DRILLED 6-/s--O3
5. TOTAL DEPTH: Zyr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EY
7. STATIC WATER LEVEL Below Top of Casing: J`o FT.
Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
.Tcp or. asin; terminated oUor below land surface requires a
verianee in vccerdunyeto with ESA NC AC ?C .Ol I9.Y/
10 WATERZONES(depth): (Tto fi/Pn
II. DISINFECTION: Type G/i.. ,•C Amount r Id".
12. CASING:
Depth
From O To /Cr Ft
From To Ft.
From To Fr.
13, GROUT: Depth
From 0 To2 Fr.
From To Ft.
Diameter
Wall Thickness
or Weight/Ft.
Marerial
Martha; Method (CAL a. le
14. SCREEN. Depth Diameter Slor Size Marerial
From To Fc. in. in.
From To Fr in. in.
15. SAND/GRAVEL PACK:
Depth Size Marerial
To
To
From F.
From FL
WELL CONSTRUCTION RECORD 298698
North Carolina • Department of Environment and Naturalat%Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (prior) fit. C.', /e: [A/. n Ct CERTIFICATION H-7/(0
L-f Ef4,15 4tii 4 i/. _, PHONE (tor l- a-':
ASSOCIATED WQ PERMITS
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERhI1T#
ii:pplicsblei
1. WELL USE (Cheek Applicable Box): Residential 'Ivlunicipal/Public 0 Industrial 0 Agricultural 0
lonimring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting LI ❑Ridge S ope ❑Valley ❑Flat
(check uppropr are box)
Latitude/longitude of well location
U 75-° 37.0/4' WoaL° 21, /72
(degrees/minutest'y'econds)
Latitudeilongirude source: 0-GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - pc c
/0 c - 2fir
YIELD
9
. (gPm ): METHOD OF TE STS1° I9f-,r-y
Gri'.- /c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
$ f,0ONn4N6A-, /V' C.
3
N
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDA? DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Secrion, 1636 Nlail Service Center - Raleigh,.NC
27099-163o Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Iv; •;Y. (_ - 03

298688
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(��prinr) leis" i`. -.- CERTIFICATION H l c/o
M}}
WELL CONTRACTOR COMPANY NA E I" er.ron$ Y✓L" .Fig••//r�lf PHONE tlS2I1 01-f4' t
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITN
lifapplicabte) (if applicable)
L WELL USE (Check Applicable Box): Residential Er MunicipaVPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Ocher, List Use
2. WELL LOCATION:
Nearest Town: 5k/cM rah S
ft'ladk,)., hey ei 2d c5u.Artmnenaa-
(SRcct Name/Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: (Fj-.LVK
Address
(Street or Rour9No.)
be t'' e n c
Ciry or Town Sure
k�k 1- .19 F- 4vr 7
County N •tnesroiC
A 57,cs
Zip Code
.Area code- Phone number
.4 DATE DRILLED PI'D3
5. TOTAL DEPTH: C%67
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO te/
7. STATIC WATER LEVEL Below Top of Casing: C/J FT
(Use "*"'if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of easing terminated atror below land surface requires a
variance in accordaneq with I9.A NC.AC 2C .0118.
9. YIELD (gpm): G METHOD OF TEST/o-v't -f
10. WATER ZONES (depth): 37, y ! C7
I I. DISINFECTION: Type C'h/o 2 . o Amount 4 Pe. n
12. CASING: Wall Thickness
Depth Diameter or Weight/Fr. kc-lateriol
From (7 To yZ- Ft. /.Ai SDg- -i -
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To ao Ft. tone rte-e fbar.red
From To Fr.
13. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Deprh Size Material
From To Ft.
From To Fr.
Slor Size Material
in.
in.
. Topographic/Land setting
121Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Laritade/longirude of well location
N35 3,r, ynn woaz"z/.sis'
(degreesiminute- seconds)
Laritudeilongitude source: E7 GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D t/2
e/2- i/r,7
,D.-t
0
d
0
? -,
rm
LOCATION SKETCH v s
Show direction and distance in mites from ardeasrmci---,
two State Roads or County Roads. Include Ae roa3Pr�.1
numbers and common road names.
II G`` wG n n OJ, o cc."
rV
1V
C-fl
J
NZ
m70
c-1
--t
0
z
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
x 2-1. r- 1-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (9l9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 298672
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 71?0/rk. 4//trt CERTIFICATION #,3,25
WELL CONTRACTOR COMPANY NAME F rq /., son a-✓v1/ Dr ��c, Cu PHONEW 1443-75.9r(
STATE WELL CONSTRUCTION PERMIT# I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ErvMunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 5✓*Pan 0 County/3 rntoenfjt,
a7 m,•ny4l; S la Ne. 5eAngastufrne
(Street Name, Nu�mbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7 „_^f,n»rd f a.ne
(Street or Route No.)
5/dgn ttarnc&.• hC a S'72
City or Town State Zip Code
(n)- a99. 77//
Area code- Phone number
4. DATE DRILLED 1 -2 3 -03
5. TOTAL DEPTH: aGC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C9'
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST it'L
10. WATER ZONES (depth): Mir
11. DISINFECTION: Type f/ Tff Amount sniS ez- ,
l2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To S a , Ft. L 7Y 5-P4 2 f '7t/G
From To Ft.
From To Ft.
13. GROUT: Depth Material // 7� Method
From 0 To :7 Cs) Ft. %crnc,-Sc" Boy-0/1
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 f6$lope ❑Valley ❑FIat
(check appropriate box)
Latitude/longitude of well ocation
35/33—PCAL1 —67 ,C//Yz...,
(degrees/minutes/seconds)
Latitudeilongitude source: f]PVS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T Fo tion De cription
0 '�z egy
SG Shgle
0
O
F 00
pm
in
N r,
O �`
rnc
2 A �:Zo
Show direction and distance in miles from at least N �,
two State Roads or County Roads. Include the road
numbers and common road names.
LOCATION SKETCH
a7 M:mtd;
Set, an? 4 4.4-0._ n c,
l6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IJ0 �bY W t Polls CERTIFICATION# aoaa
WELL CONTRACTORCOMPANY NAME re a0,04/ r We /1J/I t^f1/A/ CO . PHONE RA 683 - 9yi'9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential L4VMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Stu°Ahtnd0. County QVne°rtdt
I49QMI: a le) wet /Z4.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (qf pn't'h HeSte,
Address 11fl. 3et.y
(Street or Route No.)
mo hi-Frcd— C
City or Town State
Ste)- /Qh9-b2
Area code- Phone number
DATE DRILLED R/7.4703
TOTAL DEPTH: HOr
A
5
6
7
azs7
Zip Code
DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ia'
STATIC WATER LEVEL Below Top of Casing: VO FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .o118.
9. YIELD (gpm): 20 METHOD OF TEST 8/°W �/A+4
10. WATER ZONES (depth): 340
298639
Topogra ie/Land setting
❑Ridge IESTope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N °39y s'/Eybya.°'
(degr es/minute,srsecoedsconds)
Latitude/longitude source: I 'GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
1) fin7`'
DEPTH
From To
0 " 3/
4i - S�Ds c t4
11. DISINFECTION: Type
12. CASING:
Depth
From0 To N6
fable is
Diameter
Ft. 6.JS
Amount //p 7
Wall Thickness
or Weight/Ft. Material
.'VL./JS PO< sDQ a/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From f) To_LQ_ Ft. CgAc r tt C
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
10J/YA°
Slot Size Material
in.
in.
Size Material
numbers and common road names.
LOCATION SKETCH
Show direction and distance in miles from at toes
two State Roads or County Roads. Include the Ad
N
Cva.1/1rr 7 LoN rn
5 W4h n0.Nb? vn C
v
- �A
ccrh
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
itc SIGNATRE OF PERSON CONSTRUCTING THE WELL R/DAB/W
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

298576
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural[[ Resources - Division of�t Water Quality - Groundwater Section ,,,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e46b V W , J /s CERTIFICATION # IW.t$$
WELL CONTRACTOR COMPANY NAME F<M iJ t Ilk /(si P iI Dhl,lIilt° CO. PHONE Stan 3-9YY9
STATE WELL CONSTRUCTION PERMIT# ✓ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential I[Y Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: 5 W,i5l a n r County Our COM be
p Ate filth iniq Ail SO b
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6-PCJ/ fjv h
Address /77 W/ioiratjirrt -out
(Street or Route No.)
Soar] nnInoa no ' 77c
City or Town State Zip Code
(Ss�)- 115 4'7? -J
4
5
6
7
pographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longlttu of well location
N3S°34/ s7a ."2Z,/37
(degree minutes�/aneands)
Latitude/longitude source: MOPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formatilon Description
p — h/3 0/4
Y3 - yOs' Gran/txc
TOTAL DEPTH: °/DSr
DOES WELL REPLACE EXISTING WELL? YES 0 NO 027
STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): /S. METHOD OF TESTB/BL4/9.../19
10. WATER ZONES (depth): 52
LOCATION SKETCH
11. DISINFECTION: Type to Wit' Amount // p25 Show direction and distance in miles from at least 0
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 93 Ft.J.29 2/b,/LS RVL-SbtU/
From To Ft.
From To Ft.
13. GROUT: Material Method
From 0 Conrhir Pow.",
Area code- Phone number
DATE DRILLED ..3./A/O3
Depth
Toao Ft.
From To Ft.
l4. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
O
attune R70o77tQL*.
ad an rtariGG f n C
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CCAPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lr
r 1/ 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
O

271829
WELL CONSTRUCTION RECORD
..: aril Carolina -.Department of Environment an ral/Resources-.Divisi/Qn /Qf Water Quality - Groundwater Section
1'.LI. 4QNTRACTOR (INDIVIDUAL) NAM (print)/°�6 i N /z �1� Z / CERTIFICATION�7# o%4i78
. r.LLCONTRACTOR COMPANY NAME k7Vp,e.ML'/AOA r'hOS iw�t-I) `4- T[f.ilrA \..4:- PHONE # f�i.2IRG4B '3/ 7�
l'AT$ WELL CQNSTRUCTION PERMITS/ 1440 2 ASSOCIATED WQ PERMITS
(if applicable) Of applicable)
:. WIrLL USE (Check Applicable Box): Residential 3.---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other q If Other, List Use
WELL LOCATION:
Nearest Town: f ks 1u v . 1) e.
r v o.-w. 1_ in
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County3µ.Y1Go/n b C
OWNER:Srtfer rem.. ( B50.S•� - Cr jod
Address 4.3 1 9 1 o r s,34 'Mr . J
(Street or Route No.)
1 \aq.DA; r Va I I ql Nr a 8 7-6
Ci own Statd ' Zip Code
Area code- Phone number
DATE DRILLED a - ) 7
TOTAL DEPTH: 4OS
DOES WELL REPLACE EXISTING WELL? YES ❑ NO L7
STATIC WATER LEVEL Below Top of Casing: a D FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS 1 FT. Above Land Surface*
'Top of eosin terminated at/or below land surface requires a
variance In accordance J ith 15A NCAC 2C .0118.
YIELD (gpm): / -- METHOD OF TES cQ k r s
WATER ZONES (depth): _ 305 ' - //2., Dr_
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Q 1'at
(check appropriate box)
Latitude/longitude of well location
(degrees minutcs/scconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Format on Description
O 3$ r_PAI,AA
3S 9nS' Crra,wh
DISINFECTION: Type F-I -r I Amount ) Lo 2,
CASING:
Depth
From AO To 35 Ft.
From - To Ft.
From To Ft.
GROUT: - Depth Material 1 Method
Fromm To a O Ft. l^ aX„_u...e I e p
From - 'To Ft.
ICREEN; Depth Diameter Slot Size Material
i'rptp " To - Ft. in. in.
i-rp(p'' To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter
L
Wall Thickness
or Weight/Ft. Material
Pyc.
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
G.)
0
r•
0
i REMARKS:
ii
dL,ni! he original to the Divisioojt of %%
; 9-Ib36--Phone No. (919)7333221,with
Y,'ERTIFY'I.THAT THIS
TlhN STANDARDS, ANI$,W
,TIw
SIGNAL R
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E OF PERSON CONSTRUCTING THE WELL
-3 -.3 - D 3
DATE
ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
n 30 days. GW- I REV. 07/200 1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1'�c cr:Ck i4. ia:wattq CERTIFICATION # &M36
WELL CONTRACTOR COMPANY NAME eye 54iarc �GT f—se dOYMD ne.
STATE WELL CONSTRUCTION PERMITe 0 ASSOCIATED WQ PERDIIT#
(if applicable) - (if appl :cable)
1. WELL USE (Check Applicable Bo':): Residential 5d Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery O Hea: Pump Water Injection O Other ❑ If Other, ListUse
274606
PHONE # CC/LC/ a56 .75.S*Y
2. WELL LOCATION:
Nearest Town: ASAc_d:1.�
County Qv.YacOMtpe
Tt�y low �a—
(Street Name. Numbers, Community, Subditision, Lot No.. Zip Code)
3. OWNER: -Two-. Ovacbo\*
Address NC 1 t %r Cn Zr vie
(Street or Route No.)
T00.'.CV)AW nC
aEl'3o
City or Town State Zip Code
(ta)- a1 S' 8e 61
Area code- Phone number
4. DATE DRILLED 3-aln'o3
5. -TOTAL DEPTH: SAS
6. DOES WELL REPLACE_EXI,STING WELL? YES O NO 81
7. STATIC WATER LEVEL Below Top of Casing: %L FT.
(Us:'•+" if Above Top of Casing)
8. TOP OF CASING IS 1 IT. Above Land Surface*
*Top of casing terminated at/or below lar d surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): $ METHCD OF TEST Rt q
] 0. WATER ZONES (depth):
Tdpographic/Land setting
DRidge QSrpe ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic nap
(check box)
DEPTH DRILLING LOG
From To Formation Description
1a9 olt( . ec4 ;.i
N.a9 31-k5
11. DISINFECTION: Type ill S
12. CASING:
Depth Dianeter
From '41 To 1O9 FL Cdtl
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a Ft.
From To Ft.
M aerial
Amount —1
Wall Thickness
or Weight/Ft. Material
44,ti
14. SCREEN: Depth Diamet tr
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
our 4.4
Slot Size Material
in.
in.
Material
LOCATION SKETCH
6
C.J
c
C
cI77- -
c.
Show direction and distance in miles from at IeaiSt
two State Roads or County Roads. IncluVlhe r;
numbers and common road names.
m=
16.REMARKS:
1.DOLIERIEBY/CEBT174 AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
,/ r--CoNSTRUETI©N s1#tIIDA DS, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• i ii
..J/ SIGNATURE t PERSON CONSTRUCTING THE WELL DATE
Submit the originailto th@ Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No; (919 733-3221, within 30 days. GW-1 REV. 07/2001

274605
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)'1i�ttr: ck ld, iawytr3 CERTIFICATION # a-y 3tO
WELL CONTRACTOR COtMPANYtti.AME CL t& $CCWVQct t `Scn satfi114t .+r'1? Tate• PHONE # ISfL� a55-Zfo&�Y
STATE WELL CONSTRUCTION PERMITt s 00 ASSOCIATED WQ PERMIT#
(if applicable) (if a..l_cable)
I. WELL. USE (Check Applicable B¢:): Residential QJ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Hea: Pump Water Injection 0 Other ❑ If Other, LisLUse
2. WELL LOCATION: (�
Nearest Town: 4SheA\I \\e County tJtrrJCOrtbr
Taesot Raad
(Street Name, Numbers. Community. Subdi'ision, Lot No., Zip Code)
3. OWNER: Torn 0vQC\Na%t
Address 1R ASlstcn lc:ve.
(Street or Route No.)
Va'•[V;QW Nc._ �1'd'73o
City or Town State Zip Code
(51a- 216,ins%
Area code- Phone number
4. DATE DRILLED 3•alo'p3
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE_EXISTING WELL? YES 0 NO WI
7 STATIC WATER LEVEL Below Top of Casing: 6.0 FT
(Us•:'•+" if Above Top of Casing)
8. TOP OF CASING IS 1 IT. Above Land Surface*
*'fop of casing terminated at/or below lard surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): ao METHCD OF TEST T::
10. WATER ZONES (depth):
I1. DISINFECTION: Type
12. CASING:
dpographic/Land setting
1311tidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic rrap
(check box)
DEPTH DRILLING LOG
From To Formation Description
-79 °Net 3ecdnn
�g 305
G ran: e
Depth
From '41 To —let
From To
From To
Dian eter
Ft. (o 1
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth M aerial
From 0 To kC' Ft. & Lmeat
From To Ft.
14. SCREEN: Depth Diameer
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sizr Material
From To Ft.
From To Ft.
Method
oat a.t(
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH L
Show direction and distance in miles froma""Lleasc ..
two State Roads or County Roads. Include t e roa3
:—
numbers and common road names. ;r-:;
01
W
r..
m:
,I D2 II cRTII:YrILLAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ii:CONSTRLJC11/16111S/FANIPItq S, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l Submit the original to the D
1 r27f:99rt636-Phinte o 419) 73
3aloca
SIGNATURE OFUPERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

274603
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `J@T o7 CK t{. SQW less CERTIFICATION am 3(C
WELL CONTRACTORCOMPANY t ANIE el+ S 3' .Q(K Q' S' �d.ill7e7+. to 44c• PHONE # (QZ9 ass Z4It
SLATE WELL CONSTRUCTION PERMITS V ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
I. WELL USE (Check Applicable Bo:;): Residential 6i! Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Hea' Pump Water Injection 0 Other ❑ If Other, ListUse
2. WELL LOCATION
Nearest Town: rr.jNc11•At•
JA h1 Saco KU
(Street Name. te3mbers. Community. Subdi( ision, Lot No_ Zip Code)
3. OWNER: Z"n Ld..t...•4
County (3v.wCOnbe,
Address Po C x At 31.
(Street or Route No-)
wtc.eo Yctlt ne o2 1 7
City or Town State Zip Code
( 2S)- a3a• a4as
Area code- Phone number
4. DATE DRILLED 4-15 o3
5. TOTAL DEPTH: 3 5
6. DOES WELL REPLACE.EXISTING WELL? YES 0 NO 741
7. STATIC WATER LEVEL Below Top of Casing: • D FT
(Usu "+" if Above Top of Casing)
8. TOP OF CASING IS ( I T. Above Land Surface*
*Top of casing terminated atfor below lard surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): $ METHGD OF TEST R•�
10. WATER ZONES (depth):
11. DISINFECTION: Type 1:1i 5 Amount '1
12. CASING: Wall Thickness
Depth Dianetcr or Weight/Ft. Material
From 'Ri To i GS Ft. (c'cL— .21 le,sty
To Ft. 1
To Ft.
Depth M. aerial
To aL Ft. C+Lment
From
From
13. GROUT:
From 0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. _in.
15. SAND/GRAVEL PACK:
Depth Sizr Material
Method
QA
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Tdpogra /Land setting
[-Midge Tope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic crap
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1'TO IDS Oaf isetacn
to.5 To 3ti5 (r(��I�e
L "-
C ,
r
LOCATION SKETCH t ain
Show direction and distance in miles froifl leaW;
two State Roads or County Roads. lncludeAthe rQ'a., '
numbers and common road names.
= N 27
in :Li
C!1
0 o
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HONTRn,T UI(N ST)ANpA I^�I ND TCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I
I 4i 5•os
GNATI.JRE OF aeojthitNSTRUCTING THE WELL DATE
i
ubmit the original to th Ulvi ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
7699-1636 Phone No. (919 733-3 21, within 30 days. GW-I REV. 07/2001

WELL CONTRACTOR (INDIVIDUAL) NAME (print) Deer:::.x "TN mod'\ Jj QQS
281107
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 3�131;
PHONE
HELL CONTRACTOR COMPANY NAME
Cede r J�Zca ci }�. Uex. -A 9 &I e
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERIMIT#
(if applicable)
I_ WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ AgricuhpMaE
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
\VELI. LOCATION:
Nearest Town: fl-.kele
7-1v:A
a?t�{ V3\iPtz, Ysr-i
(street Name, Nun1OCIS. Conn uldty, Subdivi>lon. Lot No.. Zip Code)
3. OWNER:
Address
v:LA "Jl•Ufy
-d
13 4sc�ns. 5
(Street or Route No
-S to lle Yl c
Coy or Town Stale
(ij )- ;,icJ�J' 7(nt3=A
Area code- Phone number
4. DATE DRILLED l0' a3-03
5. TOTAL DEPTH: y9fn -fk
County A•ur C Ske
(if applicable)
Topographic/Lan tthTg
DRidge E3SIope ❑V fieF ❑Flat
(check appropriate �ri
Latitude/longitude of\ i l ation
(degrees/minutes/se,
Latitude/longitude source:❑GP
(check box)
DEPTH DRILLING LOG
From To Formation Description
tk
1-to
4c yc5
6. DOES WELL REPLACE EXISTING WELL? YESj ❑�� NO r&
7. STATIC WATER LEVEL Below Top of Casing: %o FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS f FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): '1 METHOD OF TEST'
10. WATER ZONES (depth):
I1. DISINFECTION:Tvpe_:1J:> Amount �+
12. CASING: Wall Thickness
Depth Diameter or \Vcight/Ft. Material
1-rota it To 'AC FL iat, 'W'-7.3 13,4ec
From To Et.
From fo Ft.
13. GROUT: Depth
From 0 To ?C Ft.
Material
Ce eY\-
Niethod
Ia•Ace a
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 FI.
16. REMARKS:
OY Z e
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the mar)
numbers and common road names
0
0
I'l
0
O
77
co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC. 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD IlAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURENY PEN CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 281102
North Carolina - Department of Envirc nment and Natural Resources - Division(siof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Decc:e-x \On 9N 4]111."iQC3 CERTIFICATION #_Zrt3L
WELL CONTRACTOR COMPANY NAME Q-NN'Ite. Sa`31-y‘Ca 50'+s 0e1Ve* Pi"-e PHONE 4 (WI CAI S, 2.cz
STATE WELL CONSTRUCTION PERMIT,' ASSOCIATED WQ PERMIT# _
(if applicable) - (ifa (cable)
r
1. WELL USE (Check Applicable Bo 0: Residential Y� %iunicipal/Public ❑ Industrial 0 Agricubur
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: �}
Nearest Town: 1 S�LPJ�\fie County Bu...4corN\eve
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: bctiostic (ZoenaQ s
Address ?:3U Wv°ce 'pine
(Street or Route No.)
F\e�e\.xc nc aerna
City or Town State
(2)- (0E4- 9s\e
Arca code- Phone number
4. DATE DRILLED t\-VC 03
5. -TOTAL DEPTH: aa5
Zip Code
Topographic/Land s
[]Ridge 1lope ❑Vail
(check appropriate ba
Latitude/longitude of wit
(degrees/minutes/seal
Latitude longitude source:❑GPS''
(check L
DE'TH E.
From To Fore
__ 5o
aas
6. DOES WELL REPLACE EXISTII• G WELL? YES 0 NO '
7. STATIC WATER LEVEL Below.] op of Casing: G D FT.
(Us : "+" if Above Top of Casing)
8. TOP OF CASING IS ' 1'T. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC .0 .0118.
9. YIELD (gpm): .i METHOD OF TEST R')
10. WATER ZONES (depth):
O-vLV j�vcdor
G Cain: j'Q.
1l. DISINFECTION: Type ?'.N0
12. CASING:
Depth Diameter
From 41 To bQ Ft. (a te
From To Ft.
From To Ft.
13, GROUT: Depth
From 0 To ao Ft.
Amount 4
Wall Thickness
or Weight/Ft. Material
mat ptesr:r
M iterial
0 e rntni
From To Ft.
14. SCREEN: Depth Diane :r
From To Ft. in.
From To Ft. in.
Method
roused
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Siz Material
From To Ft.
From To Ft.
Show di
two Stat
numbers
LOCATION SKETCH
ection and distance in miles from at leist
Roads or Courty Road:. Include the roa I
and common road names..
0
ca
0
rn
0
0
a
J
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDAN.:E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TE AT A COPY OF THIS RECORD HAS BEEP PROVIDED TO THE WILL OWNER
1\- t\-03
SIGNATUR OF P RSON CONSTRUCTING THE VELL DATE
Submit the original to the Division of'Hater Quality, Groundwater Section, 1636 Mail Service Ceenter1 RREVgh, NC
27699-1636 Phone No. [phone], wit hin 30 days.
o

WELL CONSTRUCTION RECORD 281101
North Carolina - Department of Environment and Natural Resources - DivisiQion o£ Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA`IE (print) IJeee1Ck IA sQ,.QOegQCA CERTIFICAATION#- s_ 131.0
WELL CONTRACTOR COMPANY NAME QM Sa'J 4CD d SG+etaV t p" \ PHONE # Sot CloS `c L�
STATE WELL CONSTRUCTION PERMIT;ASSOCIATED WQ PERMIT#milmsinisimmon_
(ifapplicable) (ifappi cable)
mosam
1. WELL USE (Check Applicable Bo Q: Residential B—Municipal/Public 0 Industrial ❑ AgricuL'u
Monitoring 0 Recovery 0 Hea t Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIOJN:
Nearest Town: th5I'eor( \\e County Q,,..NcoMbe
/Jo/Is O & / r r G$
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER
Address
Fd o.c RCVen4
33. LJ•n to n4 t c:ve
(Street or Route No.)
Fletctiec A1C a87aa
City or Town State Zip Code
(ttae)- Lair:, 4. 9ei6
Area code- Phone number
4. DATE DRILLED \ t' le -o3
5. -TOTAL DEPTH: L\10 5 C60 k I (05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CW
7. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Ur. "+" if Above Top of Casing)
8. TOP OF CASING IS \ IT. Above Land Surface*
*Top of casing terminated at/or below la, d surface requires a
variance in accordance with 15A NCAC C .0118.
9. YIELD (gpm): 3 METHCD OF TEST 2:1._
10. WATER ZONES (depth):
Topograph`c/Land setting
[IRidge dillope ❑Va Iiiy {Flat
(check appropriate t t , .,
Latitude/longitude of we III I cat on
(degrees/Minutes/sea nolsj`.
Latitude longitude source:❑GPS❑Tr*o�)iob.AL raphv; n a
(check 1 0 1 ?
DE )TH D LLING L b- _
From To Forrta
+1 ao
I . DISINFECTION: Type F:110
12. CASING:
DepthFrom }\ To
From To
From To
13. GROUT: Depth
From 0 To ao Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
avec %sncao
Co oan:te
LOCATION SKETCH
Amount I b) Show di .ection and distance in rr les from at leist
Wall Thickness two Stat; Roads or County Roads Include the roa
Diar eter or Weight/Ft. Material number: and common road name;.
Ft. ioi{ ?L a\
Ft.
Ft.
M aerial Method
Camenf por+cu.cit
Ft.
Diame :r
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Siz Material
16. REMARKS:
0
0
m
0
0
1 DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TF AT A COPY OF THIS RECORD HAS BEET I PROVIDED TO THE WILL OWNER
D P \l- I0-03
SIGNATI1RE OF ERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of \'ater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], wii hin 30 days.
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirc nment and Natural Resources - Division af Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA 4E (print) DecC.e-k
WELL CONTRACTOR COMPANY NAME C'' M Sa1-.1 2Ca ti SG�,L ttv0t 9»-
vl ASSOCIATED WO PERMIT#
(ifappl cable)
STATE WELL CONSTRUCTION PERMIT
(ifapplicable)-�
WELL USE (Check Applicable Bo t): Residential Municipal/Public 0 Industrial 0 Agricul'ural ❑
Monitoring 0 Recovery 0 Het 1 Pump Water Injection 0 Other 0 If Other, List Use
281098
CERTI7ICATION#.2 `3o
PHONE : art Cofc S-
2. WELL LOCATION: //
Nearest Town: nif-le0 r1e
Pas k�FL. A
County ak.t-t Cc rAbp
(Street Name. Numbers, Community. Subdi ision. Lot No.. Zip Code)
3. OWNER: 0o4--‘ 3'-.cct,`<'•ei'v
Address i-:5 Citt. .4•'t_'d tong
(Street or Route No.)
1:19.?-4heC itC 2,t237
Zip Code
City or Town State
( )- (O.RE- 33 t
Area code- Phone number
4. DATE DRILLED t\-t7-03
5.-TOTAL DEPTH: -�45
6. DOES WELL REPLACE EXISTIN G WELL? YES 0 NO EW
7. STATIC WATER LEVEL Below 1 op of Casing: r 7D FT.
(Us ; ••+" if Above Top of Casing)
8. TOP OF CASING IS t 1.T. Above Land Surface*
"Top of casing terminated at/or below tat d surface requires a
variance in accordance with I5A NCAC C .0118.=�
9. YIELD (gpm): 15 METER OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type INC, Amount 8
12. CASING: Wall Thickness
Depth Diar .eter or Weight/Ft.
From T t To -3 Ft Lc. -y iftn'R 1
From To Ft._
From To Ft.
13. GROUT: Depth M tterial Method
From 0 To Qo Ft. Ce.ne-mot :ro.,cie c,
Topographic/Land setting
URidge C3SIop. OVa ley ❑Flat
(check appropnate t rx)
Latitude/longitude of wt: 11 location
rs
(degrees/minutes/seccids)
Latitude longitude source:OGPS :Topographic n .p
(check t ox)
DE'TH EKILLING LOG
From To Formation Descriptic
5T
LOCATION SKETCH c
Show di tenon and distance in rr lekfrOtiv at leist
two Stat; Roads or Courty Road: Ipc.ndp the roa
Material number: and common read name;. -i -1:
?tc St:C
From To Ft.
14. SCREEN: Depth Diame tr Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Siz
From To Ft.
From To Ft.
n
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TE AT A COPY OF THIS RECORD HAS BEET 1 PROVIDED TG THE WILL OWNER
SIGNATI IRE'OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Vater Quality, Groundwater Section, 1636 Mail Service Ceenterl RbVigh, C
27699-1636 Phone No. [phone], wit hin 30 days.
truii

WELL CONSTRUCTION RECORD
North Carolina - Department of Envin nment and Natural Resources - ppDivision )f Water Quality - Grour dwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Derc:CM ?\ 1h ., (L iQCJ CERT17ICATION#_at i_3 c
WELL CONTRACTOR COMPANY NAME Q.-\ Sia."-- rn 'd ZS€ tJ('Ye‘ PPHONE # (Petal (oto S. "Cr
STATE WELL CONSTRUCTION PERMIT;- ASSOCIATED WQ PERMIT#
(if applicable) e_. (ifapplcable
��
I. WELL USE (Check Applicable Bo c): Residential N Municipal/Public ❑ Industrial O Agricul u ❑ '
Monitoring ❑ Recovery 0 Her t Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ti54-t¢.v,\\e County 4LC-o,,2bt
&A? CCQrt`A {�GC,.d.
(Street Name. Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: t=cX 1-tecnoV
Address cm.? Cctetc (iud0
(Street or Route No.)
fAS —4 \\e YKC
City or Town State Zip Code
(pa )- '768' 797a
Area code- Phone number
4. DATE DRILLED 10- 3-0:
5. -TOTAL DEPTH: ` ca 5
6. DOES WELL REPLACE EXISTII' G WELL? YES 0 NO El
7. STATIC WATER LEVEL Below 7 op of Casing: (20 FT.
(Us : "+" if Above Top of Casing)
8. TOP OF CASING IS \ I T. Above Land Surface*
*Top of casing terminated at/or below Iavd surface requires a
variance in accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): 1 METHOD OF TEST R;c
10. WATER ZONES (depth): d'
11. DISINFECTION: Type ? \\s Amount (o
12. CASING: Wall Thickness
or Weight/Ft. Material number: and common rc ad name;.
tit 21 p1Gr}r:c
Depth Diar .eter
From '4\ To '7,1 Ft. (.0-;-L
From To Ft.
From To Ft.
13. GROUT: Depth M aerial Method
From 0 To 'ao Ft. Leone. v1.4 .poured
From To Ft.
14. SCREEN:
From
283151
Depth Diame er Slot Size Material
To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Siz, Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land sating
[]Ridge wSlope OVa7
(check appropriate t ix
Latitude/longitude of wt II
y, ;OFlat
1p9at on
(degrees/minutes/sect n s}
Latitude longitude source:OGPS 7 -opotraphr: n ap
(check I o )T
DE-'TH E R LLING L
From To Forr is
bve r
')2 485 (a,ran.te
r-1
0
c,'
LOCATION SKET':H r_-�
Show di -ection and distance in n- les from& least)
re
two Siat: Roads or County Road:. Include0ro e e-
-a
J
c
I DO HEREBY CERTIFY THAT THIS WE'.L WAS CONSTRUCTED IN ACCORDAN :E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TFAT A COPY OF THIS RECORD HAS BEET I PROVIDED TO THE WI.'.LL OWNER
10-3 -0 3
SIGNAT JRE OF P
SON CONSTRUCTING THE V'ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center- Raleigh, NC
27699-1636 Phone No. [phone], wi: hin 30 days. GW-1 REV. 07/2001

298635
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalt/Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r'IQ: k A'IZ.h CERTIFICATION #3a R/e
WELL CONTRACTORCOiMIPANV NAME —le ry r, CO W0.j! Mr:11 u- CO. PHONE(Ug?M /,q? -9 f%Y2
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water lnjection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: "hev:II r County t?mtato
r (Za Th.s k cu tl( e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Scott f 2.5/v(nr) HNrl
Address "Rya,''' Rd �j/ ) 5 Old ✓effe
(Street or Route o.)
{}shi-es);lk. n c a88o9
City or Town State Zip Code
(fa- Q51f - 4 3 3L
Area code- Phone number
4. DATE DRILLED '7 -u25 -o3
5. TOTAL DEPTH: }`t%f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top,ofCasing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /S METHOD OF TEST •k<"
10. WATER ZONES (depth): 3L C
11. DISINFECTION: Type //D/i
12. CASING:
From (�
From
Amount 1{%a7 .
Wall Thickness
Depth Diameter or Weight/Ft. Material
To / (/ Ft. b SD$ at
To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ,9O Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Material
Cogefelter
� r go(
{]o ( Z
Diameter Slot Size Material
Ft. in. in.
Ft. n. in.
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
geidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
iS/SOYA — 04'0/3v-42 /La
(degrees/minutes/second)
Latitude/longitude source: QQPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 /so ID,r
r3a.>n shoe
t�ilt.w Gfan c (t
IC/ /r/
/G3 Y+'C
O o
▪ i
i o
LOCATION SKETCH to A°
Show direction and distance in miles from at least.-0
two State Roads or County Roads. Include the road< u
numbers and common road names. �? tP3a
(1� G
Proc-r
pi-1,ex ; II n C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-t REV. 07/2001

298664
WELL CONSTRUCTION RECORD
Norm CeroGna - Departmentor Enviromncnc and
,Surat Resources - Division of Water Quality - Groundwater Section
\V ELL CONTRACTOR (1NDt19DUAL) NAME (print) yx.I 14A/ / 7
\\ELL CONTRACTJR COh1PAN1 NAat6 �G�GCSONS hiev p%/ 1/a�
S IC WELL CONSTRUCTION PERsMITo
,Ir _or l._.bla
�i
• id s /✓G_S CERTIFICATION 4.176
• PHONE gat a5Y 7W&
ASSOCIATED WQ PURJVIIT1l
(i f Applicable)
I. WELL USE VChcctc Applicable Box): Residential 19 NiunicipaVPublic ❑ Indusrrial 0 Agricultural 0
:xtoniwring 0 Recovery 0 Heat Pump Watcr Injcerion 0 Other 0 It Other, List Use
2. WELL LOCATIOF.Ij:
Nearest Town: 0 7Ctn
391 5' n'
tSacar Nonr., Nwnocre, Cmnmuniry, Sub nsion, Lot No., Zip Cods)
OIVNER..45kJ1iv--,a�ty B ;Icle.11S�
-..tires e7�f 1 �lln,1R 13pi ANr 6 •KNnnc
� tSaccr ar Roarc NO.)
,�1WANNANnn NC)
C1ry Or Taws SuLc Zip Cads
1n2)- ag9 LI 79
vca coac- Phone oumocr
4. D..CE DRILLED /D - 3 - 03
J. TOT.*.L DEPTH: )O C /
O. DOES WELL REPLACE EXISTING WELL'? YES El NO El
Count). 44P4cv111C
7. STATIC.. WATER LEVEL Below Top of Casing: yJ FT.
(Usa`-P 5r .{bore Tap orCasing)
S. TOP OF CASING IS / FT. Above Land Surface's
"lbp or casing rrmti -a a aUor below land fu rrsce rctiwires
varisa:c w ace araanec watt I5A NCAC 2C .01 is. —
9. YIELD (gprn): r METHOp OF TEST Bb(31//Yyy •g•r
10. WATERZONES (dept). 131 L(p�' J 9
Topographic/Land setting
❑Ridge EFSlope ❑Valley ❑Flat
(check uppropriaro box)
p,tirade/tongiwde of well loea[ion
3r}r/, ql7' Llorz° 24-4b-z'
Wearers/Fa in tics/seconds)
Lariwdeilongitude source: EF PS❑Topogrophic map
(eheclr box)
DEPTH DRILLING LOG
From To Formation Description
/2/ - JLG Sr 5.4,•7e
/2Z- 2or
6 �.'/r
I. DISINFECTION: Tyner? /❑(live.
12. CASINO:
0D,p[h Diarncrcr
From To /26 Fr. 4./Zr-
From To Fr.
From To Fr.
Amount, /141(
Wall Thickness
or Weight/Ft. Nigeria'
faC
13. GROUT: Depth Marcrial p Method
From D To a0 Ft. CO/Yesede /ot.,•es)
From To Fr.
I-4. SCREEN: Dcprh Diameter Slor Size 'Material
From To Ft. in. in.
From To Fr. in. in.
15. SANDr3RAVEL PACK:
Depth Size Material
From To
Front
Ft.
To Fr.
0
OO
flr
rm
9 G
tJ O G
LOCATION SKETCH
MG
Show direction and distance in miles from 01 least (WO Scare Roads or Counry Roads. Include the roads-? 2 '
numbers and common road names. LA
a Time 73
R
Id. REtIARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED [N ACCORDANCE WITH 15A NCAC 2C, WELL -
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
71 ID-3-of
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Sun mit the original CO the Division of Water Quality, Groundwater Section, 1636 Mail Service Cenrer - Raleigh, NC
GW-I REV.07/2001
17699.1oie Phone No. [phone], Wirt in 30 days.

From
From
Fmm_
13. GROUT:
0 Deism
To iSig Fr
Fr
To Fr.
Depth
Froin__Q_ lb__ae2._ Fr.
From To Ft,
SCREEN: Dcprh
FrOnl
From Ts
15. SAND,QRAVEL PACK
Depth
To_
�rl
From
Fran
1o. REMARKS,
Fr
Pc
•
298708
WELL CONSTRUCTION RCCORD
Norm C;COIiJ - Deparunenr of Enviromnenc and '''rat Resources - Division of bracer Quality - Groundwater Seccion
\\ ELL CO:.TIt{CrOR t1N Dt\1 OU.a1) N.af{L (prior) ill L I, fVG 5 CI.RTIFIC.4TcoN
UL l'H
gr, �
_ 3f
MLCON .CIOR COMPANY N.+N-IE LB%i5!S //%P
LCSOW[/ (IPI�//�;WI C6, PHON2®4g142.5 YZL
1YLLL CONSTRUCTION PEFN119'a JJ ASSOC(n'1'2D WQ PTi121rILTn
„i..:.r Il .:,rick
(i P.ipplic�Ula1
I. WELL USE \:'Bock Applablc Box): Residential ❑�iunicipal(Ptiblic 0 Industrial ❑ A
4c„litacin3 Reeo\ery 0 Hear Purnp \Valet lnfcerfon ❑ Other 0 If Other, List USa Snculru cal 0
'-- A\ ELL LOC.ATI�N
N;ar`cii Town: 2/✓fnn '7pi County �'ca-+tc
P I//r' v l��C
Y Qr A/✓NSn OO .
ISacct N.mic, :Yam oc rs. Community, Suboi vision, Lot No., Zip Cooc)
OIYNER
Aosres
Strccr ar Roam No.)
v•'ann gnak !YG
Ce)-„r 10‘111 Swle
gasi 449- 35V3
=�c aouc- Phone au rnocr
4. D.ATEDRILLED /U-/- Oj
TOTAL DEPTH: 3 05`
.f&778
Zip Duos
Topographic/Land serving
ORidge ❑Slope ❑Valleyar
(cheek oppropriare box)
Latitude/Ion'iwde of well location
"3s ' $ r. /e/c h,arz " 217 VYl
(ocgrecs;minuccs�,s onos)
Latitude/longitude source: 2 PSOTopographicmep
tchcclt boa)
DEPTH DRILLING LOG
From To Formation Description
0— /ST
/eve - /c4iJ Slc ,c/S/� rC
a' r G
o. DOES WELL REPLACE EXISTING WELL? YES LY NO ❑
7. STATIC WATER LEVEL Below Top of Casing: (. 0 _FT.
/
(Use "T" i( .Above Top of C.ing)
3. TOP OF CASINO IS FT. Above Land Sur ace+
lap of eesuh renetnama a ((ar bclulr i n4 surface rcy wires
r armor- m a.eoraznee wire 15A NCAC 2C .0116.
9. YIELD will). ZJ METI-JOD OF TEST tithrf q •��r
J. WATER _ONES (dcpol): `/Q 220 9 .�
76 /
DISINFECTION: TypeC nc_ Amount // yc55
12 CAS MG:
Wall Thickness
Diameter or WeighrFc. Material
t ,/zr Soezi f'✓c
Material
CCifleM
Diameter
in,
in.
Fr.
Fr.
Size
hilt lion
Slot Size Ntaruial
in.
id.
Material
O
s
LOCATION SKETCH
Show direction and distance in miles from au Iq gc
two Stare Roads or County Roads. Include the t,d
numbers and common road names.
FOL/S eic, (, V C /ed.
SLuan/r4A0at, /vc,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t 5 A NCAC 2C, WELL
CONSTRUCTION ST.aipDAROS, .A4D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL I J _ 1 r 0:3
DATE
Submit [he ori;ival co the Division of Water Quality, Groundwater Section, t636 Mail Service Center- Raleigh, NC
:7d99.103o Phone No. (9l9) 733-3221, within 30 days.
GW-I REV.07/_'001
tV
al
C
O
0rn ;tea
H�
rno
�rn
cnz
rn ,
c�
O

284371
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and uanual Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) iJ t.. Lt t% (3 AS(.( CERTIrFtICATION/ c3--I1
CALDWELL DRILLING, INC. PRONEY8 ?54-3581
WELL CONTRACTOR COMPANY NAME_
REUB EN
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential GY MunicipaVPublic 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: AN)./s A4° r1 County
Ar) e IZ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cock)
JtN> n I OrJ
\ oS C- 2t S--1A,J e U IC
(Street or Route No.)
& AN&A&.)afi n) o— d-Sl1 cbc
City or Town State Zip Code
(6),6)- a`lS - �3 �
Ana coda- Photo number
4. DATE DRILLED t a- 1 C 3
5. TOTAL DEPTH: ? ?, O 1443; 6 Q U b
6. DOES WELL REPLACE EXISTING WELL? YES IW NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' if Above Top of Cuing)
8. TOP OF CASING IS - FT. Above Land Surface•
Top of easing Terminated sl/or below land surface requires a
vas -knee In accordance with ISA NCAC 2C.011S.
9. YIELD (gpm): 5 J METHOD Of TEST '2-(V " A r 2'
10. WATER ZONES (depth): 1! b `5 t V P
3. OWNER:
Address
Topographic/Land setting
❑Ridge °Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(devon/mi=tcsfuconds) .._..,_.
Latitude/longitude source:❑GPS❑Topog$aphic ma
(check box)
DRILLING r oq
Formation Description
DEPTH
From, To
i — 58 e v s�isU2l�ca�
J'6 " - 1 1 D ( PI tJ iT0J n at TUCK.
Ito
I1h / "- "3-
11. DISINFECTION: Type I-1Th1 ctD`"/
12. CASING: Wall Thickness
..4 Depth D�ter or Weight/Ft. Material
From To 03 FL 61 b SAe-aI Qvc_-
From To Ft.
From To Ft
13. GROUT? Depth Material Method
From To as) Ft. C (nbt- r j-9c u,2C' 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount Va f b
Sa G p1,"
it-t y 6 fL.rl NI
c-
L
See
Cit
z„"
UI
LOCATION SKETCH ^ m
Show direction and distance in miles fromileasf'i
two State Roads or County Roads. Include t(,}(a rola
numbers and common road names.
Fi.c _eye:' Cs, ✓ e
O
Va
US 70
czt
U �.
/OS
CK (LI ST '-
c - e
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE LL WNER
3.. 0 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL De(TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Malt Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman'
WELL CONTRACTOR COMPANY NAME fl Rncumnn We11 flril l 1 ng Tnr
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
278949
- Groundwater Section
CERTIFICATION */ 2 8 0 9
PHONE t B.2A 757-7779
1. WELL USE (Check Applicable Box): Residential Elt Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Swannanoa County Buncombe
Jim's Branch Road, 28778
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: ,Tonathan Pu.1sifer
Address 717 ,Tim'q Rranrh Road
Swannanoa (Street or Route No.) NC 28778
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 7/08/03
5.TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of casing terminated ar/or below land surface requires a
variance In accordance with 15A NCAC 2C .011 S.
9 YIELD (gpm): 1 0 METHOD OF TEST'.. rotary
10. WATER ZONES (depth): 120 , 1 60 . 200'
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
air
11. DISINFECTION: Type tablet
Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 95 Ft.51 /8
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Ft. '
From To Ft.
Scb Rfl Pvf
16 REMARKS'.
CO
N
4T1
—O
— co
LOCATION SKETCH
Show direction and distance in miles froat IF v
two State Roads or County Roads. Incltir the ma
numbers and common road names
concrete gravity flow
..
T
m
co
N,
0
6-711
Inntl
C
EMI
—31
I D0 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
fr 7/69 /63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW•1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
273497
d�7�t�t"r�wra�� Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM �el°t)4 """ /V I G %I L. CERTIFICATION
WELL CONTRACTOR COMPANY NAME4
STATE WELL CONSTRUCTION PERMTf# _ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
A C/ PHONENN riff 4:: YYb
Ag
I. WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town• County iektineenete
/I 3 71len4, ,r .c,..., ueber ird „2 S2 77Q
(Street Name. Numbers, Community, Subdivision, Lot
/No., Tip Code)
3. OWNER. Q ode ya
Address e. Ga.J4 Ord
(St;ezeet or Route No.)
Abe, � f 77f
City or Town State tip Code
Area coda Phone number
4. DATE DRILLED SI�/ 4 / D 3
5. TOTAL DEPTH. (i S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 04
7. STATIC WATER LEVEL Below Top of Casing: actFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS . S FT. Above Land Surface'
'Top of casing terminated at/or below hand surface requira a
variance hi accordance with ISA NCAC 2C .0118. . •
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES depth): /0 0 r
11. DISINFECTION: Type �jLi. E` Amount /9 j1 Oz
12. CASING: U Wall Tbiclmess
D//// or WeiP t/Ft. Material
From0To�70 Ft� ".2/ QI�C
From__ To Ft
From To Ft.
13. GROUT: Depth Material
From Q To_ 0 Ft
From
14. SCREEN:
To
Depth
Fro To
FromTo
15. SAND/GRAVEL PACK
Depth
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Fromm�GTo Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope i)Valley ❑Flat.
(check appropriate box)
Latitude/longitude of well location
1 TV
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographit-maps--
(cheek box) +`.:—.__-s
DRILLING LOG_ -
Formation Description
DEPTH
From To
LOCATION SKETCH z ='
Show direction and distance in miles fromait leas,
two State Roads or County Roads. Include4he
numbers and common road names.
CO
1»"
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
R%19/ o 3
SIGNATURE OF PERSON CONSTRU G THE WELL ATE
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 mantra' Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3 j i L+) E
WELL CONTRACTOR COMPANY NAME RF.UHEN CALDWELL
271884
^- Division of Water Quality - Groundwater Section
IQ AS I,1 CERTIFICATION 0 °'1 Y
DRILLING, INC-PRQNEY48 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential EV Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: SLAJ A4.)& 1 )° A County (3v v co'n-g
-Nc) PcUjL cogN6P. AP -NE SwAr-�NAn)�ft
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: C- L.t_o a A
Address act FcL) C3tt38tS Oat Je
(Sueet or Route No.)
'wANr)AtOOA
City or Town Sure Zip Code
Area coda Phone number 3/`� S 1 3
4. DATE DRILLED
5. TOTAL DEPTH: a t O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Art FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS - FT. Above Land Surface*
*Top of cuing terminated at/or below lead surface requires a A variance In accordance with ISA NCAC 1C .0110. (L1C�' AI�
9. YIELD (gpm): a o METHOD OF TEST
10. WATER ZONES (depth): 1 6 0 / - 'ao G Prr\
11. DISINFECTION: Type P i N 1D`7 Amount
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft.
From 1 To `6,a Ft. (i-»i 50(23.1
From To Ft.
From To Ft.
13. GROUT: Depth
From i To a t: Ft.
From To Ft.
Diameter Slot Size Material Lp
Ft. in. in. A
Ft. in. in. "�-
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Co Q
Material
plc_
Material Method
C-riA6 3T eocR-eD
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS,1I
I DOHEREBY CERTIFY THA,TIkHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS` AND THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THB WE OWNER
Topographic/Land setting
❑Ridge ❑Slope ❑Valley is?Flat
(chat appropriate box)
Latitude/longitude of well location
tf35.35. Zr fF.5d3
(deptts/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOC
Formation Description
o kleitBo2Dct3
ZnGa,c fG GAP/
L I1(r� (sect.
a-o G err,
C-yPNiTG -�% 7, tot -I I
R-Arvtts - Lail/
Frgmm,To /
11 '"
-11" / 1 5 0
ISo- i1o'
Ito'- 140
Vie '-" d-io
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
tri
tin
&triori CoU 7
w
rn
SIGNATURE OF PERSON CONSTRUCTING THE WELL / DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print)
pp�� �/J // CERTIFICATION it2 77
WELL CONTRACTOR COMPANY NAME .eL9. /Zw.LN (,,A)i(/ ✓ 7./.I,.,� Le PHONE # ft.V) , 0 y U
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
y/ig
ASSOCIATED WQ PERMIT#
(if applicable)
269874
1. WELL USE (Check Applicable Box): Residential JR Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest To
Coun
d c.2977
(Street Name, Numbers, Communi% Subdivisi. , Lot No., Zip Code)
3. OWNER;,%
Address A7 7
(Street or Route No.) �r �/ r/
i%IIMHtaN.A r, ram! 9 / /
City or Town State Zip Code
( T)
Areacode- Phone number
4. DATE DRILLED 7
7(CJ! l
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la
7. STATIC WATER LEVEL Below Top of Casing: e7 I FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ./ S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires •
variance in accordant with 1SA NCAC 2C .0I18.
9. YIELD (gpm): METHOD OF TEST? i-ram
10. WATER ZONES (depth):-300F
11. DISINFECTION: Type %^-
12. CASING:
Depth Diameter
From
From
From
13. GRO
From
From
0
/
Amount c. o Z_
Wall Thickness
or Weight/Ft. Material
Ft.7D T th2L1
To Ft. /
To Ft.
UT:
Q To rj 1) Ft. Conte
St
To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depdy. Size Material
ethod
From
From
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION STAND
1)J 1
Submit the original tojhe Di
` 27699.1636Phone rip e:019) 733
A� `'ISLE ,i-CiF!CE
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑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 Formation Description
LOCATION SKETCH
Show direction and distance in miles from toast -:
two State Roads or County Roads. Include groat
numbers and common road names.
CO
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//g/ n 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001
Depth platen

North Carolina - Department of Environment ands Natural Reso
WELT. CONTRACTOIt (INDIVIDUAL) NAMEf(priori/A ■
\VELi, ct/NTR:\CTOIR COMPANY NAMEfl 1%lC. '
S I'.YfE WELL CONSTRUCTION PERMIT#
(it applicable) — /
I. WELL U0/Municipal/Public
(Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
2. WELL LOCATION.
WELL CONSTRUCTION RECORD
Wat-rQua't-GroundwaterSec(o3
CERTIFICCATIIOON#7 ISA,
19,,
PHONE #
.a_e L
ASSOCIATED WQ PERMIT
(if appl icable)
ces - Division o
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topoggraphie/Land setting
❑Ridge [.l3lope ❑Valley ❑Flat
z $463
i Sven Name. Nun.beis, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address ' Oki" K_&
(Sin:n 9r Route No Z� �O
JAG
City or ?own State ) Zip Code
(check appropriate box)
Latitude/longitude of well location
275760
(degrees6mnutes'seconds)
Latitude/longitude source:❑GPS❑Topograp hie map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
T(•fji.I a Co vat' .A
10. WATER ZONES (depth): .3�P
Arca code- Phone number _ Q
4, DATE DRILLED Vf7t 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO FT.
7. STATIC WATER LEVEL Below Top of Casing: FT.
t Use "+" if Above Top of Casing)
8. TOP OF CASING IS __�_. FT. Above Land Surface"
*Top of casing terminated atlor below land surface requires a
variance In accordaopc�s'ith ISA NCAC 2C .0118.
9. YIELD (gpm): IYC.J METHOD OF TES
I I. DISINFECTION: Type i.4 Amount _1,,
12. CASING: Wall Thickness
Depth, Diameter or Weight/Ft. Material
From O__ To CP Li It.
From To Ft.
From _ To_ Et.
13. GROUT. Depth
From To
From----. To
14. SCREEN: Depth
Froth_ To Ft. in
From_._ To_ FL in
15. SAND/GRAVELPACK.
Depth Size
From To Ft.
From To Ft.
Material
Ft.
Ft.�_.
Diameter
Method
tip \Ls(
Slot Size Material
in.
in.
Material
0
J
LOCATION SKETCH
Show direction and distance in miles from aptgast
two State Roads or County Roads. Include tlroad
numbers and common road names. m o
-71
( (-lb Y C
I�
roYes-L-E
16. REMARKS: --
I DO HEREBY CERTIFY MAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
WITH I SA NCAC THE 2C,
WELL
OWNE
DED TO WELLR
CONSTRUCTION STANflRDS, POND THAT A COPY OF THIS RECORD HAS BEEN
16
'tom
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'SJ mmit iffe origitfal-twttre-fhtistbtl of Water Quality, Groundwater Section, 1636 Mail Service cenGter, RRaaleigh, N 7/2001
2Vb99-1636 Phone No. (919) 733; #2}I within 30 days.
i
I.
t

267541
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS 2140
REUBEN CALDWELL DRILLING, INC.
WELL CONTRACTOR COMPANY NAME PHONE448 c54-3581
STATE WELL CONSTRUCTION PERMITS_ 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I!}' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:/
Nearest Town:J LciA l t✓ County )3'^+++tovVece
(CF .7 1L C�.y ��1� Atr sec Nice'ryu't
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
4 3. OWNER:4(c) Q/ /10C- j NA'`)
1• 0- Address 2(L7 boric /(.l,INJ ✓✓LhhSa_
(Street or Route No.)
hiARQtiIrg gri.
City or Town Stale
(7ro)- fits- get,p-9
Area code.- Phone number
4. DATE DRILLED 7//fiD3
5. TOTAL DEPTH: if 7Q
340e>b2-
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: t f SO FT,
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC IC .011S. q
9. YIELD (gpm): 4 METHOD OF TEST 1f"lira
10. WATER ZONES (depth): (o $O '
11. DISINFECTION: Typef4. r
12. CASING:
Depth Diameter
From 1S( To 3 I Ft. ie
From To Ft.
From To Ft.
Amount /4 c
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material *Wail
1-10'/(
From 0 To Ft. eet17e. �r , fell
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From__To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
16. REMARKS: i
I i'r'I i' in .(tt - : lono
nerftgtaoeMDOPR 21,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ['Flat
(check a,Wepriate box)
Latitude/longitude of well location
(degreeehninutes/secoods)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DRILLING LOG
Formation Descriptipn
DEM FromTo
/L — yD
20 - 3/
•
La5�9 —0,0
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
. t MS �aAzaa cws<re-
.L WAS CONST UC lD IN ACCORDANCE WITH 1SA NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
Ave_
r
LP-
RE OF P ON CONSTRUCTING THE
WELL % DA/947E
c
Pt5ke0 ((l e
Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
!thin 30 days. GW-1 REV. 07/2001
Thal L
hC ,In

267118
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anceINahual Resource(.-JDivisio�n of Water Quality - Groundwater Section -7
WELL CONTRACTOR (INDIVIDUAL) NAME_(prlatt,t) RFT/ c1) 1P ff \ "�f I_I lw U /' CERTIFICATION 0 J5.3 /
WELL CONTRACTOR COMPANY NAME �Lt be Iv Cm Jri WCI( 1 YnI(tN 1 I--_tL PRONE / 0l 1d55L :358
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑r Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
9. YIELD (gpm): 2,S METHOI9 OF TEST O7Pi C:
10. WATER ZONES (depth): j a-
2. WELL LOCATION:
Nearest Town: We h'a tv t U •c County (3 d e eoat_yQ
.ti-iEt' a/ fit° ill -Vela 5To Ct`
(Strati Name. Numbers, Community, Su vusot, Lnt No., Zip Code)
3. OWNER: f a6-eiC (34ouJ4 r t?®
Address - -7 "ale .2.- A--,• /l e
(Street or Route No.)
!vC a.r9Of-
City or Town state � 7 Tip Code
(rAC)- 274-
Q
Area coda Phone number
4. DATE DRILLED y Jalo3
5. TOTAL DEPTH: (((l 2. to
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IV
7. STATIC WATER LEVEL Below Top of Casing: 2-i I FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
`Top of wing terminated atior below load surface minims ■
variance In accordance with 15A NCAC 2C .0111.
11. DISINFECTION: Type H•Ttr !D tltnount 1 m 2•-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft el
From'YI To 49. Ft. (a V-F * 2-( Pe
From To Ft
From To Ft
13. GROUT: Depth Material h'tgthod(,
From 0 To 2--v Ft. Coke sr Mt ken
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deveu/m;mmes/romods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
GAGA
20 - 1s .
! 2
!d L..- 2 !c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
u 1\e-
u
T THIS WEI f WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
�— CONSTRUCTION S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1��4B(•c( Jf 3 Ie3--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
P l
St the orlgj{p(1 to t e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
----17599T6I6-PtioneFo. [phone], wltbin 30 days. GW-1 REV. 07/2001

267176
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Re�sJou�rjc/ess -
Division/}of Water Quality - Groundwater Section
/�
WELL CONTRACTOR (INDIVIDUAL) NAME (print)kJChOri.Ate r,}�-. Y CERTIFICATION # O1
WELL CONTRACTOR COMPANY NAME3aorQK�er Welt and Iy�J(,A. (.[Y_Jji
STATE WELL CONSTRUCTION PERk11TN I i7 / / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential BY Municipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:1,(-
Nearest Town:A.41 .v,,.,� t tie. County
lCi itq Rrn4
(Streetblaje, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER Dan I I urior ind
Address C P ?j 7 RJCranch road
4shevi Ile(Streetortile No.) c2noLf
City or Town State Zip Code
IR?R )- 2332 -2030
Area code- Phone number
4. DATE DRILLED Ifni.i —2--03
5. TOTAL DEPTH' /
6.
7. STATIC WATER LEVEL Below Top of Casing: 110 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 33 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST 1 I mPci
10. WATER ZONES (depth):
PHONE # '&31011263
Agricultural ❑
� /_Topographic/Land setting
U1'Rtdge DSlope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ ong:tudd sourcc:❑GPS❑Toperwhic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
DOES WELL REPLACE EXISTING WELL? YES 0 NO V
3y instal(P/
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth is eter or Weight/Ft. Materialt
From To �� Ft. in . fQ21 �C_YiWW
From To
Ft.
From To Ft.
13. GROUT: Depth �,9t Materialn/�
From To 20 Ft. CJf1221t
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
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. )q Z3� �ol f k+rCC.
Crorn-Ashevi III {a
vJea ervi Re- from 1G1z3 +-ate nat.
Creek e)cit . T/L on eicit one an
Gross 41orne. C,=ocLfproy tut �t{
G-o B/ID nc.ile. T1R on upper Flab
CnneLVd . G-o 72. Hite -I ,dC h 2aa4
(ems. irtte s+Qte)T/L orit'dr�J2o&ce.
6.0 3 ncil.es.wive is Out tife I,
b4ore @olorud tees. —
Method
Irrd
From To Ft.
From To Ft.
16. REMARKS:
Submit the original o th
G R'E176994836 Fli9 iiu 1No. (919)
PiSt1E/ILLE REi:'i( 7+L (1FHLE
Material
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL — EA)
y
THAT A COEW OF/tHlS 12Es'ORD HAS BEEN P VIDEO TO THE WELL 0191111
V
DATE /
IGNATURE OF PERSON CONSTRUCT\
Division of Water Quality, Groundwater Section, 1636 Mail Sera ice Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Larry Wells/Mike Lusk CERTIFICATION(' 2603,260 2-
WELL CONTRACTOR COMPANY NAME Appalachian Well -Drilling PHONE # [phone]
SSTATE WELL CONSTRUCTION PERMIT# ASSOCIATED WI) PERMIT# Z-D - Cc - �
(if applicable) (if applicable)
267846
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Weaverville
144 Forge Crk. Lane, Weaverville , 28787
County Buncombe
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Cole)
3. OWNER: Kathy Parrish
Address 144 Forge Crk. Lane
Weaverville
(Street or Route No.)
N.C. 28787
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1-21-03
5. TOTAL DEPTH: 665•
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 40 FT,
(Use ")," ii Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST Gallon Container
10. WATERZONES (depth): 60,100,500
II. DISINFECTION: 'Type Tablet Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Et.
From To Et.
From To Ft.
13. CiROUI: Depth Material Method
From To Ft. Concrete Pour
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To H. in. in.
From To H. in. in.
15. SAND/GRAVEL-PACK:
Depth. Size Material
From To FI.
From To FI.
Topographic/Land selling
DRidge DSlope ❑Valley I51Flat
(check appropriate box)
Latitude/longitude of well location
(dcgmc.'m in led/seconds)
Latitude/longitude souree:OCiPSEI'I'opographic map
(check box)
D_EPT_II DRILLING LOG
From To Formation Description
LOCATION SKETCI I
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
trk_\ci
1;,) c.KAR, `K, CEiv
.Q
16. REMARKS:
I DO I1EREF3Y CERTIFY- 1AT TI11S WELT. WAS CONSTRUCTED IN ACCORDANCE WITFI 15A NCAC 2C, WELL
CONSTRUCTION ST ND���N� IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL ON -'Tr
( V
- —_
�-'—SILFIAlT71tra0E-j'LRSON CONSTRUCTING TIIE WELL DATL?
Submit
ryL original __ the it tsioD of Wla�er Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, \C'
27699 I*K36'Phnne No. [phone], wither 313,4lays. GW-I REV. 07/2001
c

WELL CONSTRUCTION RECORD 2 67 8 47
Water Qualty - Groundwater Scotia
North Carolina - Department of Environment and Natural R sou(cces - Division p
WELL CONTRACTOR (INDIVIDUAL)NAME (prInOLwdy \\!IAA••'' _�_e,N•^/Ttt�c.� e
WELL CONTRACTOR COMPANY NAME At >r+,31ttC
STATE WELL CONSTRUCTION PERMIT'S
(i f applicable) 1. WELL USE (Check Applicable Box): Residential l— /Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: slier
Nearest Town: t1Ce-Coon
(Street Name, Numbers. Community. Subdivision, Lot o.. Zip Code
3. OWNER:
Address ,Ly�
e "" (��brY�eet or Route of Z� ! o%
2iec. X
State Zip Code
City or Town
(—)-
Area code- Phone number O _
4. DATE DRILLED I' (13
5. TOTAL DEPTH: Z. L 'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G'
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accorda_nc{th ISA NCAC 2C .0118.
9. YIELD (gpm): 7- V METHOfj OF TEST0.1 a tir'h
ASSOCIATED WQ PERMIT
(if applicable)
U0 CERTIFICATION #tLt +—
PRONE t 1Tt O p:,r1ZL3
Topographic/Land setting y�
❑Ridge ❑Slope ❑Valley fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
Frain To Formation Description
10. WATER ZONES (depth): Z
I . DISINFECTION: Type —Cilbtd Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_..O _ To 63 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth /�1�M��aterial s�[�
From To Ft.
]..fl+t+-�-'s�►
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
1�_ATIDN 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 _
-N Co
T
e b26 a•ic E;
Method
n°�ks a IC
Material k�O, ,V11 ¥ ( 0
aY
.V
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT •N STANDAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEWELL OWNER
rt
Sub�Yin�1i the original to the Division[ f f
27 4-1 36 Phone No. [phone]; Wk►1n 30 days.
E OF PERSON CONSTRUCTING THE WELL DATE
ter Quality, Groundwater Section, 1636 Mail Service Ceenter' REVgh, NC
ri:J
0

Area code- Phone number ��
4. DATE DRILLED /
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 110 'i]'
7. STATIC WATER LEVEL Below Top of Casing: CO P
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
Top o casi
ng in
terminated at/or below land surface requires a
variance In accordance yt ISA NCAC 2C.0115. s
C/ METHO TEST�1
10. WATER ZONES (depth): 1�
11. DISINFECTION: Type -4bI d Amount Z
12. CASING: Wall Thickness
or Weight/Ft. Material
/�
Depth Diameter
From_,a_ Toi14_-- Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To_.
16. REMARKS:
1 DO HEREBY CERT FY
CONSTRUCTEa STA
3Supmit the origi
27699-1636 Phone
T
ARD
Size Material
Ft.
Ft.
Method
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Divisionio
yl
Water Qua
1115' Kt.%t�1S
WELL CONTRACTOR (INDIVIDUAL) NAME (print)LIMM _ ` ♦ .��s � N �.� A
WELT- CONTRACTOR COMPANY NAME Appall tte
sTATE WELL CONSTRUCTION PERMITS,
(if applicable)
ASSOCIATED WQ PERMIT
(if applicable)
267848
't - Groundwater Seciteo3�
lk CERTIFICATION Aisl�anis 7�
PHONE S, Bale 9 01n3
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: tcsft ( Count
•
zo 4 ca ,tdCTrY LctCC6M'( 2:VT4
(Street Nam , Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Lc Ce
'Ireet or Route
City or Town State
er
-SS 1 I-%
Zip Code
Topographic/Land setting
❑Ridge BSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6
Groats
rah
9. YIELD (gpm): �a--� ej
LOCATION H
Show direction and distance in miles from at least c
two State Roads or County Roads. Include tibBroad
numbers and common road names.
rn
)f4) 4 L03
ea.ve5eird
a 1
t
- ' GO rr•.�
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL —3 OWNER
1- 1 L --
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center ' RREVgh, 4C001
9) 733-3221, within 30 days.
ASEAii -'1S vL�
i
IHGE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso cesf- Division'�p Water Qua t
WELL CO\TItACI'OR (INDIVIDUAL) NAME (print)kbY1 `•lo- Lab
Appal �bvtlnletle ►Cli
WELL CON"I'R:\CI'OR COMPANY NA\lE�`
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMIT# (if a�licable)
(if applicable) 1. WELL USE (Check Applicable Box): Residential H/ Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: .
Nearest Town:
(Street Name. Numbers. �{
3. OWNERT K1,t1`p CY*4- Address t•1(ylL_Y+l.\ l)
yr V
Pt Sig .
City or Town
Area code- Phone number _ �y
4. DATE DRILLED � I r
5. TOTAL DEPTH: 2-*'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C-
7. STATIC WATER LEVEL
�Below CDC FT.
lTop of Casing:e op of Casing)
8. TOP OF CASING IS __.�.__— FT. Above Land Surface*
on, Lot No., Zip Code)
7513
267851
- Groundwater Sec
��w3
CERTIFICATION#3yf_
PHONE # tT '` to
'ZLf�vv.
Topogr�phie/Land setting
❑Ridge LdSlope ❑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
(Street Route No.)
State
Zip Code
`Top of casing terminated at/or below land surface requires a ((AC 2C .0118. `' yy���
variance in accordance with IS METHOD OF TESTC.1 a G Vt4b h
•
9. YIELD (gpm): � �
10. WATER ZONES (depth): 2..15-
11. DISINFECTION: Type 1Ib144
12. CASING:
DeptDiameter
Diameter
From Q To_1 Ft.
From To Ft.
Amount L.
Wall Thickness
or Weight/Ft. Material
From To Ft.
13. GROUT: Depth Material
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
jP��r— I DO HERhI#Y
HCONSTR -,
LI L
- Submit the original tc the
IT 27699':r636 Phone-Nur ( 19) 7
Ao�l' �rr
Mcthod
Slot Size Material
in.
in.
Material
LOCATION H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
v.ttei u3
350
O
fV
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)- I3�
•
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' �VgO NC
3-3221, within 30 days.

13. GROUT: Depth
From To
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. CD
15. SAND/GRAVEL PACK: v
Depth Size Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naatuurral/R,cces1- Division ap Water Qua t
WELL CONTRACTOR (INDIVIDUAL) NAME
�� (ppr�rin��t)Lwb. t Reso
`f 6- + L`.�.
WELL CONTRACTOR COMPANY NAME Appal' a.0 't��`n. 1.1i
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMIT,'(if applicable)
(if applicable) I. WELL USE (Check Applicable Box): Residential LC/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
(Str19
et Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: sejLtiC�4
Address x_4. Yao C `C
/ Ciee*kvrRok�f) zsl b
Cary or Town State
/r,1 Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED / r / A 0
e TOTAL DEPTH' tC6
267352
-Groundwater Sec#do( 0003
CERTIFICATION 7;J ,iin
PHONE W'i67% Op;J1?,•3
u at 3Ls5L
`n Topographic/Land setting
SEC ❑Ridge BSrpe ❑Valley ❑Flat
' p' (check appropriate box)
Z161 1o Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 91`1O Z3'
7. STATIC WATER LEVEL Below Top of Casing: $0
(Use "+" i f Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordanc��w�itt t1 ISA NCAC 2C .0118.
9. YIELD (gpm): _L,Z.. METHO F TES
10. WATER ZONES (depth): (15
11. DISINFECTION: Type �b%*$ Amount Z
N
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To.�2?S Ft.
DEPTH
From To
i
.G 4btWJ1i
From To Ft.
From To Ft.
Ft.CDM I
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbcrs and common road names.
From To Ft.
From To Ft.
604346 73".
atj I=`4 - GAY— TO?' `C( `6 4 c I ( 5
Method
--e641 cat
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
;.CONS i I,�ULWO�NSTANDfkRRDD ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
II
DATE
GNATURE OF PERSON CONSTRUCTING THE WELL
Submit the origin
`s a Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
27699-1636 Phone o. (9 ) 733-3221, within 30 days.

267853
WELL CONSTRUCTION RECORD
North Carolina - Department of' Environment and Natural Reso `VI�
ces - Division Water Qu`a�'tt - Groundwater SecZo03
yli-
-' --�1 1'J�CERTIFICATION to, to, !
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential rat Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
ASSOCIATED WQ PERMIT
(if applicable)
PHONE # t711 s e 1tz"3
L
2. WELL LOCATION: •
i County
Nearest Town: L Lei
; c-
3�l ���� w.IpC q
(Street Name, Numbers. Co tmunity, Subdivision, Lot No., Zip Code) Z 1
3. OWNER: Pi� ,�� t�4 t3L.�h .(�t
Address 1 r �'= l eaU4 • "t"' P.
Lt.(Street or Rnute No.) "seat) Lc
City or Town State Zip Code
( )-
Arca code- Phone number p,
4. DATE DRILLED I " —1 0 3
5. TOTAL DEPTH: t
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO 0'
7. STATIC WATER LEVEL Below tTop se of Casing: of Casing)
FT
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a (r ^w `'
variance in aceordan with IS METHOD OFCAC 2C eTESTM.I . Lc 41T� ▪ Th
9. YIELD (gpm): ��
Topographic/Land setting
0Ridge ❑Slope ❑Valley i t
`,r(check appropriate box)
t'8 Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑CPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
10. WATER ZONES (depth): 4''Q01 T 0
11. DISINFECTION: Type,"bId Amount Z
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Dept
From 0 To t, L FL
From To Ft.
From To Ft.
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
P Material� Methodxi*-
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roadl
numbers and common road names.▪ cn
0
N
-IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rn
r
SIGNAT RE OF PERSON CONSTRUCTING THE WELL DATE
L,_ Cnhntifibe_urigi, to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl Raleigh,
C
01
br<t $ b 9 16't6 PhuiQ+Wo. [phone], within 30 days.
ASELV:LLL :MICE

267854
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and � Naturalys/Reso ces - Division k) Water
�Qua
l�•tt - Groundwater Sec 2.o%
CTOR(INDIVIDUAL)NAME (print)IbkYt tI1 - vv . CERTIFICATION#74ilz.
WELL
CONTRA 15i l%� .�'a
,/� p tt%C 1Z /0.4. 1�' �W PHONE # u Z
8) ELL CONTRACTOR COMPANY NAh1E r4 t�1
STATE WELL CONSTRUCTION PERMIT#
Of applicable) /
1. WELL USE (Check Applicable Box): Residential f2 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ 110ther, List Use
2. WELL LOCATE
NearestIcown.
A+lylLi ty`�
• W.C.VAC $. V l(fe
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code'
3. OWNER:
Address
(Street or Route No.)
NC
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED i' U 03
5 TOTAL DEPTH: Zilie
ASSOCIATED WQ PERIDIIT
(if applicable)
'It")
Topographic/Land setting
❑Ridge &Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
varianceIELDg accordance s ith IS METHOD OFNCAC 2C aTESTO.I s CDV.&4 J �n
9. YIELD (gpm):
10. WATER ZONES (depth): Z k=0 ZS
11
12. CASING:
From To Ft.
DISINFECTION: Type b1'LA.
Depth fey Diameter
From O To (-1--0 Ft.
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
16.REMARKS:
Material
Ft.
Amount
Z
Wall Thickness
or Weight/Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
Method
t�QVLY
Diameter Slot Size Material
FL in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Z3
e ld leskeS c 3 iAIli
t1
P►\C Q(C
r,
C7 cnc
ry -
LSubmit the q/gin il to he Di
7699-1-4 -rn[rre-N4,, 9) 73
:; JrNCE
ASHEVIL E G ..
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

267855
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Diviy)404.
siii/O�fl��p Water Q`ua'ty1'tty - Groundwater Sectiop o3
� yy t e ` b � CERTIFICATION #� 1$A7 )
R'ELI.COS'rii,\C'1'OR(INDI VIDUAL)NAD,,I//E��(�prinQ 0..oY1C:J�'l , �• '—�.yp..���1y
%YELL. CONTRACTOR COMPANY NAME Fi i ZlQ Zi11t:YYL1�• 111%W PHONE # en
' ` ASSOCIATED WQ PERb11T vast.
STATE. WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable) — /
1. WELL USE (Check Applicable Box): Residential f1d' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: • r
Nearest Town:�e) e..S'F"��l County �
t13 yell', u/ �Y�.d•Le1 « v zg
(StreetValise. Numbers. Con nunity. Subdivision, Lot No., Zip Code)
3. 0WNER:1�i� `2Y
Address (Q Ill Z.6
N )
'"� �trcet or Rout• o. ����(�
.ice&rµx NCB `t D
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ` -
a3
5. TOTAL DEPTH:
-. DOES WELL REPLACE EXISTING WELL? YES 0 NO GI.'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS , FT. Above Land Surface*
*Top of casing terminated at/or below land surface requirres-a_
9. YIELD (gpm): t-�' METHOD Yoh
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
variance in accordance ith 15A NCAC 2C .0118.
t�� OF TES 1r h4
10. WATER ZONES (depth} I &-01 Z41
11. DISINFECTION: Type -rib Id Amount Z
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth Diameter
FrontQ To 1 (Z Ft.
From To Ft. Y...i��Qv1e,-\
From To Ft. �1�i
1
3. GROUT: Depth Material Method �0p �� �d •
From To FL�''J p� .--`i—]-Q ]��_ 1--1.t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roa4
I6. REMARKS:
numbers and common road names.
rei 1 eXatLolcC Rd
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the origil al to e Di
t- 7769V 1636 Phone Ni), (919) 733
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' Raleigh,
EV gO N 00l
3221, within 30 days.

North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if a licable)
I. WELL USE (Check Applicable Box): Residential ater Injection ic Municipal/POtublic If Other,Listtrial O e Agricultural O
Monitoring O Recovery O Heat Pump
Topogra is/Land setting
❑Ridge lope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING OG
Formation Description
W ELL LOCATION:
Nearest Town:4L
City or Town
Area codde- Phone number � ` l'
4, DATE DRILLED V
5. TOTAL DEPTH: Zs
-- �—
6. DOES WELL REPLACE EXISTING WELL? YES O NO a-
7. STATIC WATER LEVEL Below Top of Casing: AFT. _-_._.------
(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 aecorda a w- h ISA NCAC 2C AI IS. ICSyr w b
' HOD OF TES
10. WATER ZONES (depth): SPCI
WELL CONSTRUCTION RECORD
Water Quat}o20
�ity - Groundwater Sec3/
CERTIFICATION ��t(1.4Oa—
PHONE #
•Z�
4-ei Count
y -
(Street Name. Numbers, Community, Subdivision, Ls
,t No., Zip Codc)
p
3. OWNER: �. ,nsagttn�k
Address
O
ASSOCIATED wQ PERMIT
(if applicable)
1
From
To
(Sq •et or Route N
State Zip Codc
9. YIELD (gpm). MET
11. DISINFECTION: Type 1a,
12. CASING:
Depth
From To—t---7,�l Ft
To Ft.
Ft
13M aterial��p
Ft.S
Amount
Wall Thickness
Diameter or Weight/Ft. Material
From,
From
GROUT:
From
From_
14. SCREEN:
From
To
Depth
To
To
Depth
To_
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
BY GERTIFa
'CONSTRUCTE0 A !
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft
Method
Slot Size Material
in.
in.
Material
267856
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names. co
-Tt
in
}{ EA) 63
1)3}St to \J 0<
0
tV
.G"
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
f. ND Tl1,AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
� ER
Submit the original tojhe Di
i._ 27699•i 636 Phone No. 0191 733
fG�>c.2r DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ision of Water Quality, Groundwater Section, 1636 Mail Service Ceentteer, REVgh, C01
3221, within 30 days.
c.,

268550
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NAurall Resources�-_Di�ion of Water Quality - Groundwater Section
y�O
WELL CONTRACTOR (INDIVIDUAL) NAME
,,(prinnt)) �El `ll., u /I lh. 7AYIt /lar CERTIFICATION
�#ow�l02 g
WELL CONTRACTOR COMPANY NAME 1 OYK(�e Well Oil)! Yli/YF9 PHONE a IALDlb7r%1L0.7
STATE WELL CONSTRUCTION PERMIT# I U 1 I ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential iv-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI N:: _��,,
Ne restTown{..: heWIIe. County&flc[Unb6
4kn,
(Street N e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
7(n.gk Al puntalh, AIL' 22111
City or Town State Zip Code
(R28)-6 0929
rz D�by a.
Street or Rou[N7o
Topogr hic/Land setting
❑Ridge VSlope ❑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
Area code- Phone number
4. DATE DRILLED 2— 03
5. TOTAL DEPTH: 50'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 27.
7. STATIC WATER LEVEL Below Top of Casing: aQ FT.
2y (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordan a ith ISA NCAC 2C .0118. —i..-.
9. YIELD (gpm): METHOD OF TEST 1(med
10. WATER ZONES (depth):
7 untI •�,er LOCATION SKETCH
II. DISINFECTION: Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di eter or Weight/Ft. Material numbers and common road names. j 6"T
From 0 To J` �J Ft. ('J )�� U%R2! g9V& Front �encterSt)fUl ne. fake
From To Ft. Ea ± -t D 30± @aye..TLlyn lee.
From To Ft. �I ( ie.
13. GROUT: Depth Mate al Method Q�d aQ t �Cl m /
To o2J Ft. ill lereke. ftUIL°C7(-TarnC f�� # n/� C
From 'n pI,(A,t{,/• t_;l7lTllll.��
From DeTo Ft. _��^ of
14. SCREEN: Depth Diameter Slut Sir Material n�lYYf C. o
From To Ft. in. in. f
ant
From To Ft. in. in. ofQI�(9X( TTTYYY/_ A}
15. SAND/GRAVEL PACK: ff ni pri�QW /S on "YI2G i __.
Depth Size Material lI�,I, 'n �I tics;
From To Ft. �YV� I tJ
From To Ft.r� down hill.
"'
16. REMARKS:
Y t E 141 IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
et. e • ) • ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�t.H.PRSN, tC t f 3 03
S GNATURE OF PERSON CONSTSTItL'C.TINt THE WELL DATE
tialDuut..utt�eft n Dili • on of Water Quality, Groundwater Section, 1636 Nlail Service Center -Raleigh, NC
�����pp[©© 'rJ�(�l��I{r1Rqd' ,,,„,e. )033-32l,within 30days. GW-I REV.07/20U1

(54181- 6r SF5- u M e f
Area code- Phone number
4. DATE DRILLED i2 s-1 0
5. TOTAL DEPTH: S'JD
6. DOES WELL REPLACE EXISTING WELL? YEW NQ IF
7. STATIC WATER LEVEL Below Top of Casing:) 6 FT.
(Use"1." if Above Top of Casing) !r13Io_S
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of cuing terminated at/or below laud surface requires a
variance le accorda$ee with ISA NCAC IC .0113.
9. YIELD (gpm): c' o M THOD OF TEST 7-/
10. WATER ZONES (depth): Y 0
11. DISINFECTION: Type /43rbt
12. CASING:
Depth G�
From'/L-( To (Il Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To 2 t Fi.
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 to tSa ,
Wall Thickness
r or Weight/Ft. Material
PAP,
reiitefir
Material Meth
Slot Size Material
in.
in.
16. REMARK
268515
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL.) NAME (print) REUBEN CALDWELL CERTIpFICATION# 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY2f8 ,254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential */ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: •
Nearest Town:WQ M1elN (l) t. County Bo N e e Wt2Q,_
ghe,&tfne-l! UNtOrl PA API t.. NALO
(Street Name, Numbers, Community, Subdivision,�Lot No., Zip Code)
C' 3. OWNER: Me9 �/#t nn (degrees/minutes/seconds)Address ?.3 P O L . sta., a.r oaf. RAC . Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
WQsWtail( f/e uc '-t?e7 DEPTH DRILLING LOG
City or Town State zip Code From To Formatipn DS.ceription
O - 'gO
Qel' 90
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
LOCATION SKETCH
Show direction and distance in miles from at least c
two State Roads or County Roads. Include t)igroaa
numbers and common road names. to
Material
1S WELL WAS CONSTRUCTED M ACCO
E WITH 1SA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS B EN PROVIDED TO THE WELL OWNER
GNATIIRE OF PERSON CONSTR CITNG THE WELL DATE
/SubmIt thgoriginal to th4 Div( Ion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
A24Zyjj��''S+E'636 Pkohe:NO: (90.9) 733-3' 21, within 30 days. GW-1 REV. 07/2001
�1'iLLC Pr

WELL CONSTRUCTION RECORD
Ac.pf Environment and Natural Resou
rces - Division of Water Quality
268147
- Groundwater Section
(INDIVIDUAL) NAM/E++ (print) D fri )J Ul fES E II CERTIFICATION # a 3//$
COMPANY NAME e7Y2.P.14e- Eros 12s f) ffjute,P,.[rc.e •PHONE # flail L. 8 —3/7b
tytat
aRtICTIQN PERMIT# I ND
lioableY.>.
ASSOCIATED WQ PERMIT#
(if applicable)
§Pt'pe9lf 4pphcable Box): Residential Li/Municipal/Public 0 Industrial ❑ Agricultural 0
rm s+RgGovery 0 , Heat Pump Water Injection O Other 0 If Other, List Use
lJ rn�
An() . Topographic/Land setting
❑Ridge ❑Slope ❑Valley Wiat
, (check appropriate box)
Latitude/longitude of well location
P1• County Brine Atli"
St tlNatn„Nugtpers, Community', Subdivision, Lot No., Zip Code)
d
IV e •
e or Route No.)
U{;�It .NL 2 $$OCD
Qr;fown .1. State Zip Code
1ne ntti4Pr D 3
41-A J
?,i TH 1 a.< '
FI B ItEPJ4CE EXISTING WELL? YES ❑ NO IV
Tgg,j.EVEL'$elow Top of Casing: 4b FT.
I (Use "+" if Above Top of Casing)
. QA ijQr IS • FT. Above Land Surface*
91thfEpiRg Ffr011oYliktior »;low land surface requires a
�IRMI;alag tgith!jSyA NCAC 2C .0118.
.METHOD OF TEST ee.1h)'S
NES (depth) ' 1 DS i — o cJQm
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D '73 ' //laa'-1 oc u
'73t /25' err,.
ECTION Type F4-Yi-1
G a -
Amount % 1 n
Wall Thickness
Diameter or Weight/Ft. Material
Ln u PVC,
aterial
:Ft.=
Ft,}
Diameter Slot Size Material
'' Ft. ' in. in.
in.
Method
kop
Vk?'PpCK '
Qepss; Size
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
w
rr
w
w
O
RTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS r - x PROVIDED TO THE WELL OWNER
I 3/ ---
d3
IGNATURE OF PERSON CONSTRU, TING THE WELLTE
I (uVISdgRof Water Quality, Groundwater Section, 1636 Mail Service t r - Raleigh, NC
0r .within 30 days.
-I REV. 07/2001
.'

Material
/Dvc,
Method
Slot Size
in.
in.
Material
Material
2681,40
WELL CONSTRUCTION RECORD
ent Rf Environment and Natural Resources - Division of Water Quality - Groundwater Section
tr/g
([N�1tYWYAL) NAME (print) J-)t CERTIFICATION #
PJS$ MPA BYNAME ��/'Pete //%// LS. //JJ_/L cI /t/y)w JAL'• PHONE # (jam0!��E' 3/r/D
+i$T$PC 9N PERMIT /7(1; ASSOCIATED WQ PERMIT#
dap plieable}- (if applicable)
:US (Qhep,c Applicable Box): Residential CCU Municipal/Public ❑ Industrial 0 Agricultural ❑
Agcovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
QATION: •
)? —• ?ems coytttyR rcmth
I X
W(42 /, te,c .(
p($!(y bJ;Ntp, Numbers, Community, Subdivision, Lot No., Zip Code)
CIWp(EK �l /(I rn t�(it)? /
I#£as: /15" k,,Jer1ci kyle;
(Suva orRoute No.) /
U r. �43 AlC_ g t c
Town State - Zip Code
[lope number :
IILED . _3 v 3
1,4REPLAGEEXISTING WELL? YES 0 NO 127
4TER LEVEL Below Top of Casing: I b FT.
(Use "t" if Above Top of Casing)
/LNG 1S 1 FT. Above Land Surface*
f f(0144 [e6Ptlnated at/or Below land surface requires a
lC/ecpMyt o w th ISA NCAC 2C .0118.
r, ( ,SA " � METHOD OF TEST rs
QNES (depth); 1 ).-$. — I CO � I
TIQN1Type 1--! l 1-i Amount o
Wall Thickness
Depth i Diameter or Weight/Ft.
To tti)'Et; •
Pppth,vt'; x " Material
pr;. Ft cD-,.,c
Uepthw Diameter
,To;o';...�_Ft. in..
YIKPPAcK
F Depth t ;` Size To
p" Ft,
Topographic/Land sett ing�
❑Ridge 0Slope ❑Valley CrTFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSIDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/D/) 1 ('Gn_Ai
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
rn
co
-10
0
0
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS 13 . PROVIDED TO THE WELL OWNER
-3/ 03
SIGNATURE OF P:RSON CONSTRUCTING THE EL•1 DATE
STAR of Water Q itt Groundwater Section, 16.(i NIj•' Service Center- Raleigh, NC
*3410within 30 d4h. 1 GW-1 REV. 07/2001

269100
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pr�tat�)va t)�A//Af/r �/F/� A/yyLL. /n� CERTIFICATION ti R77
WELL CONTRACTOR COMPANY NAME i[lew.Lacatt 4IR.LLI�P iit ILK. PHONE # Illaill /s9- 0 02)
STATE WELL CONSTRUCTION PERMIT# # .# ASSOCIATED WQ PERMIT# 1//.ri
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
Ease. c T .2 r74'ic
(Street Name, Numb&, Commw,ity, Subdivision, Lot No., Tip Code)
3. OWNER.:
Address:•/HcA ad���.
(Street or Route No.)
A/.0. o289S/S'
City or Town State tip Code
Ann code- Phone cumber
4. DATE DRILLED ►2./2 to /O 3
5. TOTAL DEPTH: .2 O .S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11
7. STATIC WATER LEVEL Below Top of Casing:. T r FT.
(Use "9' if Above Top of Casing)
8. TOP OF CASING IS / .`J FT. Above Land Surface*
`Top of casing terminated actor below land surface requires
variance hi aceardana with 1SA NCAC 2C .0118. •
9. YIELD (gpm): e 0 METHOD OF TEST- esu,e
10. WATER ZONES (depth): /9s t
11. DISINFECTION: Type UU{ GC Amount 7 OZ-
12. CASING: Wall Thickness
Depth ameter or Weight/Ft.pal
From /2 To .hits Di
Jr" #.2/ tfC
From To Ft
From To Ft.
13. GROUT: Deptht Ma Ldl� From 0: To o.a Ft. �. t�+n it
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro Ft. Ft. in. in.
From / To FL in. in.
15. SAND/GRAVEL PACK
Depth Size Material/
From o Ft.
Fro To Ft.
Th1
1 DO HEREB-VCEW'FIF IAt THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT
�CONSTRUCTION STANbARCIS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFT T OWNER
L MAR 2 2 03 � py #tL' 13 4,LO .2/.26/ o 3
Topographic/Land setting
❑Ridge ®S1ope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inc!"d
numbers and common road names.
r/y
'`J
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733 3221, within 30 days. GW-1 REV. 07/2001

269397
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N trill Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) Ln• CERTIFICATION ihr 1 / 7
WELL CONTRACTOR COMPANY NAME 2e .s4GOI LIJIa� YJ..y 2/e+ PHONE #i 2B'i9DfRA
STATE WELL CONSTRUCTION PERMTT# ag ASSOCIATED WQ PERMITS(
(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 LOCATIO
Nearest To wfl• CountYteedekerstert
rt — QTd a177Y
(Street Name, Numbers, Community,�Subdivision, tot No., Zip Code)
3. OWNER:444-9 1/J»2
Address#.2,S lrs -e. S
n (Street or Route No.)
/�• e .
City or Town State
e2R772?
Zip Code
Area code- Phone number
4. DATE DRILLED 2J 3 J D 3
5. TOTAL DEPTH: .2 SAS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j$
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordancet with 15A NCAC 2C .0118.
9. YIELD (gpm): /, p METHOD OF TEST leaf da
10. WATER ZONES (depth):ct.7R� 5 '
11. DISINFECTION: Type.
12. CASING: 1/,i�w
Depth
From 0 To /671 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth From 0 To Material ` M ethod .
tat) Ft. CnrYlpp<�i 'r 1�1�i tar`L�i
14. SCREEN: Depth Diameter Material
From -To Ft. in
From ` To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKSS5 L' 2 e---fat /f-44- .11 J,,....0 U
Diameter
y
Amount 7
Wall Thickness
or Weight/Ft Material
##.2 / File'_
Slot Size
From To Ft.
:11 i�, I
f CONSTRUCTION ST
Submit the original to the
27699-1636 Ybone No. (i to) 7
Material
OZ—
Topographic/Land setting
❑Ridge R1Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrvWmimms/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Show direc
two State
numbers
OCATION SKETCH o 11
n and distance in miles fray' at least
ads or County Roads. Incli4 the road
common road names.
fi/ct) �t
O
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�C74-4/..1 , /6a/o
SIGNATURE OF PERSON CONSTRULi1NG THE WELL ATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

Zip Code
variance In accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): 7 METHOD OF TEST GIA-1
10. WATER ZONES (depth): / 60 - Z 61t7.G[
Sri
11. DISINFECTION: Type /L Amount
12. CASING:
Depth
From _ To C3
From To Ft.
From To Ft.
ethod
13. GROUT: Depth M isre— `�
From Q To�L Fi.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
Ft. L i)Uf__-
269671
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mutual Resources- D jvision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) se/ 444-54 CERTIFICATION N 4nq� 7 7 /
WELL CONTRACTOR COMPANY NAME_RF.UBEN CALDWELL DRILLING, INC. PHoneQ48 I254-3581
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1.
WELL USE (Check Applicable Box): Residential I3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIIN:
Nearest To
C-r
(Street Name
3. OWNER: �. /\•
Address ai0 or• /4 4Y sib
Coun
(4/
vision. Lot No., Zip C
(Smet or Rowe No.)
deC ee..n?2 Wt.
Cityr )"7��_ Stale
S
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Hl fat
(check appropriate box)
Latitude/longitude of well location
Al .35' 38 -5? ei W r)Paa yd ti5/9
(degrealmiwteshecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOtz
Formation Description
FroDWTH
Area code- Phone number /§ 2- Ri'.
4. DATE DRILLED Z� it '3 . 8r. `- ? a,
5. TOTAL DEPTH: 7O ' 3 2 ---5'3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LY _ /Ay
7. STATIC WATER LEVEL Below Top of Casing: 9/asFT.
(Use" - if Above Top oaCtng) /80 Z-1r'n
8. TOP OF CASING IS / FT. Above Land Surface•
`Top of casing terminated at/or below land surface requires a
a -ten .-p,7o
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft- in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS, -------
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
17
O
w
I DOHEREBY CERTIFY THA AT
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS,' AT A COPY OF THIS RECORDCHAS BEEN PROVIDED TO TICE LL OWNER
L STTRUC r wt / 4/03
SIGNATURE OF PERSON Cfl THE t D TE
e
$ubmlt the original to the Division of Water Quality, Groundwater Section, 1636 Mal) Service Center- Raleigh, NC
27699-1.636Phone No. [phone],within 30 days. GW-1 REV. 07/2001

From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To Ft
From / T,o/ D Ft.
16. REMARKS: /Y 0 II () m i )
i l I I } [ I DOHEREBYC i2... 'IJ� T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 CONSTRUCTION ST S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and /Nv�Resources - Division of Water Quality - Groundwater Section
/J
WELL. //
CONTRACTOR (INDIVIDUAL) NAME (print) ( 11/1/G II NI.-Le� CERTIFICATION nrYn 7/
WELL CONTRACTOR COMPANY NAME£ L U � a f"t "—"HONE ite,4 U9 . zip
STATE WELL CONSTRUCTION PERMIT/0WAf ASSOCIATED WQ PE IT# /
(if applicable) (if applicable)
269875
1. WELL USE (Check Applicable Box): Residential Di Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest
County/
���c a SPQfly
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
•
3. OWNER:
Address
(Street or Route No.)
4/ C,
City or Town State
41/ 1
Area code- Phone number
4. DATE DRILLED ///,3 d 3
5. TOTAL DEPTH: AA-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A.
7. STATIC WATER LEVEL Below Top of Casing: /Ss FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / , j FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): 3 b METHOD OF TESTI:Zeit
10. WATER ZONES (depth): /9 t1
a PRO y
Zip Code
11. DISINFECTION: Type r�� a"1 -
12. CASING: V
Diameter
tlt
From�_�-co Ft t
From To Ft.
From To Ft.
13. GROUT: Depth
From_12__To o70 Ft.
Ft.
Slot Size Material L,cTC.Pset Chiviey
in.
in.
Amount r, DZ
Wall Thickness
or Weight/Ft. Material
Material
Me od r
Topographic/Land setting
❑Ridge ❑Slope fi1Valley ❑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
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include thgoad
ci
numbers and common road names.
Me!,
6
T
I
I
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636Phone 14u.919)733-3221,within 30days. _ GW-1 REV. 07/2001
0
f9 ��
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N rural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) O /✓N / G I/t%nL L_ /J CERTIFICATION l 7� s7rj
/ /
WELL CONTRACTOR COMPANY NAME-i e J��i)rr t J(Ji CMG/' as iA 1r_J.�G�PHONE # lit -Vic b y9 U yr.)
STATE WELL CONSTRUCTION PERMIT# 4 /1 ASSOCIATED WQ PERMIT# W1/47
(if applicable) (if applicable)
269872
1. WELL USE (Check Applicable Box): Residential S. Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA 7pN::_
test Town-4.t te- /NTA/ County!/ N i1,44- Y,cf,�o
v wryJ 4i-Lfl wry ,2 g 7//
(Street Nat6,((NN�umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:ct(. D I.
"'` ((((v////
Address o% 97 7
(Street or 1)u. No.)
64
!mN c. 0277//
City or Town State Zip Code
(S )- 029l-oSo S
Area code- Phone number /
4. DATE DRILLED /9/1) 3
5. TOTAL DEPTH: G (a S '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO N
7. STATIC WATER LEVEL Below Top of Casing: /o b6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /-s FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires ■
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ® METHOD OF TESTA Ij'Y—NA! e
10. WATER ZONES (depth):
11. DISINFECTION: Type/7RV f1 A L r Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 Tosr2 Ft.2 / P v C
From To Ft.
From To Ft.
13. GROUT: Depth Material
From p To c,20 Ft temo..�
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 f / To Ft.
16. REMARKS:
I:DO.HEREBY CERTAIFY
CONSTRUCTION
S I N ,
si
Topographic/Land setting
ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH „Note t3 a 98
o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
074. vl-t; /3c2P //9/n 3
GNATURE 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

270523
23
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naesources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,(,,S `1_1-• Id F' «A S \A CERTIFICATION 0 a 11
WELL CONTRACTOR COMPANY NAMEVOOtT1 Cr.W.U-Y�N\-\)CtS\t`hA —Slit 1 L-• PRONE a (�1254-35$/
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED WQ PERMIT#
(if applicable) /' (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 11 / l
Nearest Town: 1\SAE'1 i L-L t County �\j'Lei'-`Qt'
IS SroLi_sc oQ. , AS(uaV, LC.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i kg_ !J o °o-)
SNtLS:, otLIJt.
(Street or Route No.)
City or Town I State
Address \$
• aoCO
Zip Code
(PO- (,R3 — 133-1
Area codc- Phone number /
4. DATE DRILLED 3(/ 1/ 0 3
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley 'Flat
(check appropriate box)
Latitude/longitude of well location
,i 35° 31.154' Lw 08v-3a•916
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From / To / Fottt»tion Description
i. 00 - 10 & I LA rJ \"1`t
�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L(//
7. STATIC WATER LEVEL Below Top of Casing: 4 c FT.
(Use "+" if Above TopI of Casing)
8. TOP OF CASING 1S FT. Above Land Surface*
*Top of casing terminated at/or blow land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a O METHOD OF TEST a-t V )ft.
10. WATER ZONES (depth): Qh 0 r 'to G Pry
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.
5. TOTAL DEPTH: 3 i J
11. DISINFECTION: Type h'viA 90` -0 Amount 1Y2- Cuej
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From
From
From
13. GROUT: Depth N/A Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Depth ,3/Ip
To
To
To
Ft.
Ft.
Ft.
16. REMARKS: eyISTItL'
0
fV
I/erJ U(�
wQt c..Le0 Ouch (L Ran, 2®c— 310
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-: CQNSTaUCTION STAS, AND THAT A COPY OF THIS RECgORD HAS BEEN PROVIDED TO THE,WEL
P1 '' 2 I2c
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit ^ original to
27699-1636 Phone No. 019) 743-3221, within 30 days. GW-1 REV. 07/2001
OWNER
3/`3/03
DA
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
CI)

CERTIFICATION # Q o
WELL CONTRACTOR COMPANY NAMEC-rfeJ A, c B°
{t... Le-)Q.....t 'd f I.1,-in ' 9---,PHONE # (f{.Yd L' - '2 3 1-7 C TR WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
' (if applicable) (if applicable)
270634
WELL CONSTRUCTION RECORD
Ngrth Carolina - Department of Environment and Natural Resources - Division of Wate' Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
1Li02
OWNER: Le C �I S ke 12
Address 1 'l I n .�f131 L e,?- P.-k •
Ai C v2 �ri/5�
Zip Code
[StreeIlit or Route NO
City or Town Static
( )-
"Area code- Phone number
A DATE DRILLED - I c't - �' h
5 :TOTAL DEPTH: lr C' c '
b:-'DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cd'
STATIC WATER LEVEL Below Top of Casing: (i-D FT.
(Use "t" if Above Top of Casing)
STOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
;YIELD (gpm): ) METHOD OF TEST cQ r5
:WATER ZONES (depth): QD ' - 1 rsp •
11:'DISINFECTION: Type F-1 Y -I-1 Amount / in) :%S
Wall Thickness
Depth Diameter or Weight/Ft. Material
To )D3 Ft. Ln"
'From To Ft.
:{,From To Ft.
..GROUT: Depth Material Method
From f> To , C' Ft. C'-+�--,r.�-,. 1 I e } s
::From To Ft.
14...SCREEN: Depth Diameter Material
'., From To Ft. in.
...From ' To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
j2, CASING:
From L7
1, 'WELL USE (Check Applicable Box): Residential 0' Municipal/Public 0 Industrial 0 Agricultural ❑
'Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATI N:
Nearest oven: %Z-VA P a county
rv- k%TC_;;-� -�C
No
Name, Numbers] Community, Subdivision, Lot
(Street ., Zip Code)
PUC-
Slot Size
in.
in.
From To Ft.
From To Ft.
1(.:'REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley tFlat
(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
I L' 3 ' Ln t:
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
CO
o-1
370.
-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
,tom
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centel]
21699-1636 Phone No. [phone], within 30 days. GW-1
Raleigh, NC
CV. 07/2001
(nut
rn

271255
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *tsntnl Reso�urces - Diivision of Water Quality - Groundwater Section
(INDIVIDUAL)j
WELL CONTRACTOR (INDI
VIDUAL) NAME (print) F�ttel ugh CERTIFICATION L7!I
RF.UBEN CALDWELL DRILLING, INC. PHONEY 7f8 54-3581
WELL CONTRACTOR COMPANY NAME_
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PaRMIZ/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er---Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
4.1 2. WELL LOCATION
n Nearest To "d
�7(Srnxkl7int, Numben, Commwu=y, Su(divieigyjl.
14 3. OWNER: V''t` �
Address y.W5Lfi�.ra✓t-/pet
s:
No., Zip Code)
9(Street or Rqu. No.)
"AZ)./ vrly- /1
City or Town State Zip Code
eta 44g- 2sgf
Asa coda Phone Dumber, // /D 3
C 4. DATE DRILLED �7/ .'
N.5. TOTAL DEPTH: 7 3 D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: i Q
(Use `+- if Above Top of Latina)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of ening Iermlosted ateor below lead surface requires a
varlaocc is accord n a wltb ISA NCAC 2C.OIIS.
9. YIELD (gpm): i M HOD OF TESTA t.. aiLA.1.41
10. WATER ZONES epth): l f� — "A% 9/VS
11. DISINFECTION: Type
12. CASING:
Depth
From To FL
From To Ft.
From To FL
13. GROUT: Death
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From To - Ft.
Material
Amount '2.L
Wall Thickness
or Wcight/Ft. Material
16. R,EMARiCS:
'rDO HEREBY CERTIFY"1
CONSTRUCTION STAND
Topographic./Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check approprisse box)
Latitude/longitude of well location
(degroeehninutes/secoads)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From To Formation Description
� - 3 96
31364*
❑
FT. 3ffse —
730 - /ID Alea.e
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road es
era,
Mc :hod
Slot Sire Material
in.
in.
4
..IS WELL WAS CONSTRUCTED IN ACCORDANCE WRH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
ut
0
astz
road-
°NATURE KSON CONS ' U r NG THE WELL DATE
Submit the original to (hs Dlvle Ion of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
--27699-1636 Phone No. (919) 79r3221, within 30 days. GW-1 REV. 07/2001

3. OWNER:
Address
271017
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and M.tew 1 Resources -Division of Water Quality - Groundwater Section
ILL CONTRACTOR(INDIVIDUAL) NAME tut) �L_t—lam N)I S(.1 CERTIFICATION ;-I� I
W(pr
WELL CONTRACTOR COMPANY NAME_ CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL. CONSTRUCTION PERM ff/ ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: tlR✓ )EFRVtLLE count, go )<-0/A6e
L IC1zN rc0 . �.�eA✓e.R�Jt�_�c.
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
(Lo(De (2- (gat)
1.onaG Prat
_LL/ANDe(
(Street or Routs No.)
Z NL
City or Town State ri Zip Code
06)- (79- 'aG-(
Area code- Phone number � /
4. DATE DRILLED •4O/b 3
5. TOTAL DEPTH: a3o ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I9
7. STATIC WATER LEVEL Below Top of Casing: Ar° ET.
(Use `a' it Above Top or Canna)
8. TOP OF CASING IS -1 FT. Above Land Surface•
*Top of cuing terminated attar below land surface requires a
variance In accordance with ISA NCAC 2C .011a.
9. YIELD (gpm): 3 O METHOD 9F TEST ZG - fl
10. WATER ZONES (depth): ICI 0 - 3o G e M
a`67o
11. DISINFECTION: Type
12. CASING:
Depth
From J- To a 5
From To
From To
D. GROUT- Depth
From To a o
gT t0.0 Amount
Wall Thickness
IJ��?ry�ter or Weiight/Ft. Material
Ft. Cc)%h" 5Is c/L P (
Ft.
Ft.
Material Method
FL ///� Q e Ole f0 I o LI (Le b
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{ REM
1 Db HEREBY CERTIFY THAT THIS WEI1
CONSTRUCTION STANDARDS, AND TI{
Slot Sire Material
in.
in.
Material
SIGNA
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Mist
(check appropriela box)
ntude/longitude of well location
je 35' 4d c, 0/.7cWei Lk° 55.a?g7
(dep ea/roimtta/secoods)
Latitude longitude source:OGPS❑Topographic map
(cluck box)
DRILLING LOD
Formation Description
J 61?-6020es0
(g t{ I re a-0 c(t
MILL
Fr .lao
49o-I;o
(so ats
c, iT`-r ?t�
et D
10 - a30
.g o— CDer»-
G.CA
LOCATION SKETCI{
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO T WE OWNER
Q CLA. 1 3 II 3
OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
276994636 Phone No. (919) 733-322I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (prlat) 31 LL-\
WELL CONTRACTOR COMPANY NAME_REUHEN CALDWELL
STATE WELL CONSTRUCTION PERMIT.
(if applicable) (if applicable)
271016
^- Dui ision of Water Quality - Groundwater Section
tJASN CERTIFICATION # alit
DRILLING, INC.
PHONEY 4?8 54-3581
ASSOCIATED WQ PERMIT.
1. WELL USE (Check Applicable Box): Residential I/ MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n
Nearest Town: bitrA'feR\1 1 L.Ll✓ County 2,) UcoingE Topographic/Land setting
i44 €LAcicc3 ita_)/ )n n) 0-0) W CAl is 1 kit- .) IOC, ORidge (check
pomp❑nobbo) tat
(Street Name, Number, C unity, Subdivision, Lot No., Zip Code) )
cl-8Yb' Latitude/longitudeofwell location
3.OWNER: CiiAfi-EsS SEvic.c (systestrY N3s•/fa, eft,' o4a°�7.�5z
Address 14 ct (L_ACK iabRt2 / t c- t.) ,{2-a Latitude/longitude a OGPSOTopographic map
(Street or Route No.) / (
i.JEA f �12d) LL6 I.) L v2p-
� `Y O � (check box)
DEPTH
CiyorTown State Z;p Code FrDRILLING LOG
(Sic‘ ��S 103qa 14oo - ¢To/ Fo/{rmationDescription
Arca coda- Ilona number �r`TN `"`
4. DATE DRILLED 3/ I /03
5. TOTAL DEPTH: �i-GI /
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 1
7. STATIC WATER LEVEL Below Top of Casing: (00 ET.
(Use "+" if Above Top or Casing)
8. TOP OF CASING IS FT. Above Land Surfacee
*Top of casing termineled at/or below lead surface requires a
variance in accordance with ISA NCAC 2C.01IB.
9. YIELD (gpm)• at) MET OD OF TEST /21(r (\ 1(6
10. WATER ZONES (depth): th So -- Zd C7On'm
1l. DISINFECTION: Type Amount
12. CASING: Will Thickness
Depth Diameter or Weight/Ft. Material
From To FL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMIkRjCS:. �3?C 6- JEb
1 r L �U
DO HERLBY CERTIFY THAT THIS WEL n,W,
CONSTRI CTIDN STANDARDS, AND THAT A
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or Co ty Roads. Include the road
numbers and con t n ad names.
CAAIVc�
DEOet3rt Ertory, \ 40 � — 4'1 /
0
IV
01
CONSTRUCTED TN ACCORDANCE WIT11 I5A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit t$e origlnat tothe Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 P'tione No. (919) /33.32I1, wlthtn .s0 days. GW-1 REV. 07/2001

271015
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and rdahtral Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6, L-L.i C dJ A S. id CERTIFICATION % a -'I -f I
WELL CONTRACTOR COMPANY NAME_ PHONE
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable)
(if applicable)
REUBEN CALDWELL DRILLING, INC. 4i8 954-3581
1. WELL USE (Check Applicable Box): Residential ® MunicipaiPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: �J Nearest Town: Lk;l,(t/BR\!1LL.G- County QJrJCcv-YJ/�
r7-
Le-r kk a6 (j?.ocjww
(Street Name, Numbers,n()ammunity, Subdivision, Lot No., Zip Code)
3. OWNER: I ✓ l A 21c CitQ Sort
Address 1Yi Lek ✓!Lett._. C42GE.IC CJL .
(Street or Route No.)
AE-,i N C,
CityorTown State
Area codo- Phone number
4. DATE DRILLED
Zip Code
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO �]
7. STATIC WATER LEVEL Below Top of Casing: 4 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 o METHOD OF TEST 9--AG- A 12
10. WATER ZONES (depth):
3 6 o ' — 3o CG p
11. DISINFECTION: Type)J
12. CASING:
Topographic/Land setting j
❑Ridge ❑Slope ❑Valley lat
(cheek appcopriue box)
Latitude/longitude of well logation
/✓ 35u get 875 j Opt 2•• 35 aj3.5'
(degree✓minutes/woods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
oV6RthvROghi
G v2A rJ ,Ter
DEPTH
From7— To
q 5
ctsi_ 3b-0
�6 cz
360'- 4.I0'
Depth
From 1 To i00 Ft.
ii)
- ctt`22 Amount c,oPS
Wall Thickness
Diameter or Wet t/Ft. Material
(c,/B SD6 2VC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Li, To a- 0 Ft. CQMO Pt'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
I5. SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft.
From
From
16. REM
1 DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRL CTION STANDARDS, AND THA,"F
SIGNATURE OF P
3 o G Pam-
(
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names. o
t-t
kw iq/�3 tJ
ONSTRUC 1 E+D IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RE� ORD HAS BEEN PROVIDED TO THE WEL,L OWNER
RSON CONSTRUCTING THE WELL DA
0
Submit thleoriginal to the Division of WaterQnality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and *mantra! Resour_ce_s -Division of Water Quality
WELL CONTRACTOR ONDIVIDUAL) NAME (petal)
WILL CONTRACTOR COMPANY NAMe_ REUBEN CALDWELL DRILLING, INC.
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
271014
- Groundwater Section
CERTIFICATION $ Z 71.
PHONEQ3B )54-3582
I. WELL USE (Check Applicable Boa): Residential L1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
NeaTyst Town
County
CVO'
oset Name, NuuummbbenCommuniy, Subdivision, Lot No., Zip Code)
3. OWNER:010 / �!/j e
Address 1v0 L3,-24
(Street or Rouse No.)
e-1 uuT- —0 %/) L , , t 7 fl
t$ j
Ci-Lyor ?.,rTown Swe /7 Zip Code
Area code- Phone Dumber
4. DATE DRILLED
IQ/oa
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: / 0/ FT,
(Use "a" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
Top of cuing terminted at/or below load surface requtru a
variance In accordance wltb ISA NCAC IC.01111.
9. YIELD (gpm): t METHOD OF TEST&LL Sal
10. WATER ZONES (depth): / .ZO Kt •
/3
11. DISINFECTION: Type
12. CASING:
From+ / To �oar 70 Ft. l0
From To Ft.
From To Ft.
13. GROUT: Depth/J /�Msleerial��
From 0 To dC 0 Ft. Cc-yrN
Amount
Wall Thickness
tAl
or Weight/Ft. M rid
From To
Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sire
From To Ft.
From To - Ft.
16. REIyfARK$
I E-
1 DO ElI BY STIFYHAT THIS WE
CON UCTION STANDARDS, AND TIP s,
f it
Method
Slot Size Material
in.
in.
Material
SIGNA
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(ruck appropriate box)
_Latitude/longitude of well location
35`go.nnq' tJv82.3I.,GY'
(&vTu/miout&soconde)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
o- t�0
7°
70 - l,.e
/moo- .4?o
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road.
numbers and common road names.
. a1
Cbtie
R
cn
Sie
It
CONSTRUCTED IN ACCORDANCE WRH 1SA NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Aeor
7
p o
PC•' c' ST THE WELL BATE
Submit the odglnal to the Division of Wale
27699-1636 Phone.No. [phone],.wllhin 3
Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tyrant I Resources
WELL CONTRACTOR (INDIVIDUAL) NAM IL(prim))\ L.♦.-( t
WELL CONTRACTOR COMPANY NAME RF.USEN CALDWELL
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
271013
- Division of Water Quality- Groundwater Section -f
IQ A 6 t� CERTIFICATION 11al1
DRILLING, INC. PRone48 54-3581
ASSOCIATED WQ PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential 17 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATJQN: � /
Nearest Town: A 112V 16-l.J County 03)`�A'CA r'ngg
6a4 oF-"kGM�s r.o ie c/Lta (.
(Stet Name. Number, Community. Subdivision, Lot No., Zip Code)
3.OWNER: VI1,3Cer-)T 1_vc_A
Address \� ILE1Ste42 (LQ
4n (Street or Rowe No.)
SNe:fle (VC -
/City ages
(ga%or Taiown 6 $4- b Zip Code
g Ana code- ?bone number
4. DATE DRILLED 3/ I'V ° 3
5. TOTAL DEPTH: -1 (0
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL BelowTop of Casing: 315 FL
(Use "+' If Above Top of Cuing)
8. TOP OF CASING IS , FT. Above Land Surface'
*Top of ening terminated sVor below had larfsce requires a
variance In accordance with ISA NCAC 2C.011E. nn �7
9. YIELD (gpm): D METHOD OF TEST 't'l3J al(2--
10. WATER ZONES (depth): a/A '
•
11. DISINFECTION: Type 11-TN f(
12. CASING:
Depth Di ter
From �- To 6 3 Ft. lit 4
From To Ft.
From To Ft.
13. GROUT: Depth
From , To ao Ft. C
From To Ft.
0 Amount ,2 cuf
Wall Thickness
or Weight/Ft. n Material
5bt
Material
e mE3 fit
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16 f-REMARK$t
Slot Sire
in.
in.
Method
Material
/ 1opographic/Landsetting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
IJ 3S° 39.SclV w oUo 9-4.56a
(degrealmimaeJrxoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From , To ,, Formation Descripti n
`a? /- S o ' Act &Mr-'tr
3So - 4-6o r cot -lure /LoLiC_
ou '— -1'10c3LIAC4 G24N1—c
J.00ATION SKETCI1
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road--;
numbers and common road names. `�
'9-i 1 w
7r^D
LLD
SiNOITtr)
rV
u s -14
0
rn
1 DO HEREBY CERTIFY THAT THISi11
CONSTRUCTION STANDARDS, AND
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF IS RECORD HAS BEEN PROVIDED TO Tfi)? WELL OWNER
3/17/03
SIGNATURE OF PERSON CONSTRU NG THE WELL
DA
1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699=1636 Phone No. (9I9) 733-3221, with n 30 days. GW-I REV. 07/2001

From
From
From
13. GROUT: Depth
From 1 To a
3. OWNER:
271012
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6 1 L L\ G IC AS H CERTIFICATION #
WELL CONTRACTOR COMPANY NAME te1\1D# �r. ` aAktJeAV Ct\ r\c- Iry C • PHONE ft (822i.2- -1- 35-8
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W>7 PERMIT!
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ili Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 2.
Nearest Town: ALE An) County '"/"CoM�'Jt,
55 EDA)A R-CAA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
PeGG1 1-(\es— 1L
G tJ ti: n = S
Address `% n o�(LT (LO AD
/((Street or Routc No.)
ryLE/a(AN) t; (J L ag10
City or Tow5Slate Zip Code
b
(8� )- Tole
- iSS
Arca code- Phonc number
4. DATE DRILLED i3,4 /6 3
5. TOTAL DEPTH: 1-3 d
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ1
7. STATIC WATER LEVEL Below Top of Casing: (mac 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 accordanef ith 15A NCAC 2C .0118.
9. YIELD (gpm): 1 �4- METHOD OF TEST V -A I (L
10. WATER ZONES (depth):
11. DISINFECTION: Type U 1 ° „ Amount 31
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. ht/Ft. Material
To 10 Ft. I' Suet
1
11 610
To Ft.
To Ft.
Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. �t I
Topographic/Land setting_
❑Ridge ❑Slope ❑Valley GFIat
(check appropriate box)
Latitude/longitude of well location
/(3S11gM•9/5 tIosa°.34 7g
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTII DRILLING LOG
Frof i T / Formation Descriptio
0 J c2(2) (4DE
‘7'ai 'w
Material Method
ry
Slot Size Material
in.
in. Pn
+6. REMf4RICS:._._
'.1FDO HEREBY CERTIFY
CONSTRUCTION STAND
i
S
LOCATION SKETCII
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Q
IS WELL WAS CONSTRUL ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
j.I)ID AT A CQPY5 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• -r
tV
-'.1—1,) Y ✓/z I — — — v 3
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
- 27699-I636 Phone No. (9.19);2aa-1 21, within 30 days.
GW-1 REV. 07/2001
0
4k
cr,

270922
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL.) NAME (print) LARRY WELLS/MIKE LUSK
CERTIFICATION # 2603
WELL CONTRACTOR COMPANYNAn1E APPALACHIAN WELL -DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PEILMIT# ASSOCIATED WQ PERMI I'#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LEICESTER County BUNCOMBE
392 DIX CREEK RD. #2 , LEICESTER 28748
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: MARGARET FRANKLIN (degrees/minutec/secon(s)
Address 392 DIX CREEK RD. #2 Latitude/longitude source: DGPSDTopographic map
(Street or Route No.) (check box)
LEICESTER, N.C. 28748 DEPTH D121LLING LOG
City or Town State Zip Code From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED 2-18-03
5. TOTAL DEPTH: 146'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST GAL.CONT.
10. WATER ZONES (depth): 100
LOCATION SKETCH
11. DISINFECTION: Type TABLET Amount 2 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. p
From '1'o FL +' COFrom To FL 3CO
js
From To Ft. l0
13. GROUT: Depth Material Method NL tl iWv d •'�_
From Too Ft. CONCRETE POUR
Ft.DcK tcfc d,l
14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. 0
From To Ft. in. in. x-
15. SAND/GRAVEL PACK: c.J
Depth Size Material
From 'I'o Ft.
From To Ft. '
16. REMARKS:
1 DO HEREBY CERTIFY IS WELL WAS CONSTRUCTED IN ACCORDANC?'VITH I5A NCAC 2C, WELL
CONSTRUCTION ST •� ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the on • final to
27699-1636 Phone No. (9
SIGNATURE, OF PERSON CONSTRUCTING THE WELL DATE.
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
270921
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDR'IDUAL) NAM1IE (print) LARRY WELLS/MIKE LUSK
WELL CONTRACTOR COMPANY NAME APPALACHIAN WELL -DRILLING
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION M 2603
PHONE a [phone]
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public O Industrial 0
Monitoring ❑ Recovery 0 heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: ASHEVILLE County BUNCOMBE
LOT 49 AVERY PARK,ASHEVILLE. 28801
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PATRICK BRANNON
Address 134 BILTMORE AVE., SUITE 2
(Street or Route No.)
ASHEVILLE N.C. 28801
City. or Town State Zip Code
( )-
Arca code- Phone number
4. DATE DRILLED 2-19-03
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACF. EXISTING WELL? YES E NO CFI
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FI'. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011 S.
9. YIELD (gpm): 9 METHOD OF TEST GAL . CONT.
10. WATER ZONES (depth): 125
11. DISINFECTION: Type TABLET Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 98 FL.
From To Ft.
From To Et.
13. GROUP: Depth Material Method
From To F CONCRE
From To
Agricultural 0
Topographic/Land setting
DRidge ZSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0GPSO'1'opographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cotillion road names.
! - Z. (..0
>'l z�60 0
co
[. TE POUR g I{ ' ' (�°j- _--
Ft. I'� 1 o J -
14. SCREEN: Depth Diameter Slot Size Material R0
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material CD
From To Ft.
From 7'o Ft.
co
16. REMARKS:
1 DO HEREBY CERTIFY THAT WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTINNI STANDA S, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the D v
27699-1636 Phone No. (919) 73fi-.
2-Zo-03
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-I REV. 07/2001
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso Dgrees- Division to
WELLCONTRACTOR(INDIVIDUAL) NAME,//�� (print) tie y + �tt�
WELL CONTRACTOR COMPANY NAME A�1 �,�^�`"• �j
STATE WELL CONSTRUCTION PERMIT# ppp���+++
(if applicable)
I. WELL USE (Check Applicable Box): Residential i"Municipal/Public 0 Industrial 0 Agricultural 0
ASSOCIATED WQ PERMIT
(if applicable)
270919
Water Qua - Groundwater Bede_+..
CERTIFICATION #7
�(ti �. 1
PHONE # IY It' /et PGt
es *vie_
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:ti * yq d(� 15 _ d.Couii
(Street Name, Numbers.
.CCommunitljS j iivision,, Lot
No., Zip Code)
3. OWNER: lv ig t. ( Y`` Ile ts� s
Address 1.T, twUl 1 .Lz!'C ocs
idGeet or Rnule
City or Town IC State /'l Zip Code
( )-
Area code- Phone number
4. DATE DRILLED Z`Z-1'00J
5. TOTAL DEPTH: tt0 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
7. STATIC WATER LEVEL Below Top of Casing: CD0 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. y�
�
fl1eXB
Topographic/Land setting
[dodge ❑Slope (Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
YIELD (gpm): 1Z-- METHOD OF TES Y��
10. WATER ZONES (depth). ZOO, L
11. DISINFECTION. Type tb1t4 Amount Z
12. CASING: Wall Thickness
Depth �e1 Diameter or Weight/Ft. Material
From O To 1 4U Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
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.
14tAL\C,3
-Palk 1 e'Y dgstct
'Ca
o
w
16. REMARKS:
I DO+4EREBY, CFRTI)_y, Tl AT TH S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'CONILETRUOI ANDARD , D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL DATE
1
Sujrmit the original to the Division
27699-1636 Phone No. (919) 73$-3221,
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

iSubmit the original to the Div!
'27699-1636 Phone No.(91;9) 733-3
WELL CONSTRUCTION RECORD 270915
North Carolina - Department of Environment and
s� Naturalyyaa���Resov1/2ces-tDivisiioon'ro)pr�Watte(r Qua
WELL CO:NTRAC"I'OR(INDIVIDUAL)NAME
��(���pprrll(((nt)�����yltaaaaa t kiii �»% (�iItiLL t'
IVELI. CONTRACTOR COMPANY NAME A itte ttsn. 4.ei •iJY 11 i�
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
't - Groundwater Section
CERTIFICATION,/ .Z,.
PHONE H 1tt th Zv
is s1 •vas
I. WELL USE (Check Applicable Box): Residential L7 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nea cst Town: . ¥ ti Count
r.f •41-. A CXoYit clr Z�
(Street Name. Numbers. Commun_ity,_Subdivision,
.Lot No.. Zip Code)
3. OWNER: Cti�F�,L( Y'y��Y
Address(� y" .�E(si(tetdp 'M.c V.X
il, 0 V �.3`Y ct or Route Ne..0 T ait'
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3- Z- O 3
5. TOTAL DEPTH: Zr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
7. STATIC WATER LEVEL Below Top of Casing: 7JE) 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 accordaneg with ISA NCAC 2C .0118.
9. YIELD (gpm): 140 METHOD OF TEST
10. WATER ZONES (depth): tS 0
--tt
11. DISINFECTION: Type rJ1t:.`t Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weighl/Ft. Material
From 0 To 4a Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.
From To Fl.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topo}gr�aphic/Land setting
❑Ridge f7Siope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
V; l e %rl
cis.) OV.. - ,44 DAC ILd t•
Method
�p�LY
16. REMARKS:
ZKd o sk. or-)
t DO HEREBY CERTIFY TItA' THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTION STANDA)i aifeji ND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�! I IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
;ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 7 0 914
North Carolina - Department of Environment ands Natural Reso cces\-`Division Water QualI- Groundwater Sec( 403
\YELL CONTRACTOR (INDIVIDUAL) NAME,//(print) lrenriu ysa�la- bl"(t . CERTIFICCATION#_/oA22,
\YELL CONTRACTOR COMPANY NAME A��%%e C1OL Y7tI�s 111TTT..JJJYYYZ tttjAILI
PHONE # lark Wier" n3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT et a •Zi tsL
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: •
Nea st Town: Asti C� `.�' ILY County r�I et abV
Cps 3 ks ht{ LS - 4 e i LL ci ttl
(Street Name. Numbers, Commuun�ntity, Subdivision, Lot No., Zip Code)
•
3. OWNER tV\VO\L AC,k
Address 1 t 1 AtP &a .J
Lctr ac ec`'Roulc NqJ ^4.<6
City or Town State NC Zip Code
( )-
Area code- Phone number t ` O
4. DATE DRILLED J 1
5. TOTAL DEPTH: 2--45 "
6. DOES WELL REPLACE EXISTING WELLS YES ❑ NO 0"
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1, FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
Topographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance in accordance with I5A NCAC 2C .0118. ��ii- �- t /1
9. YIELD (gpm): METH? OF
TES
s re vah
10. WATER ZONES (depth):
11. DISINFECTION: Type —di 1lltir Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From____^/� _ To 1 Z y Ft.
From To Ft.
From To Ft.
13. GROUT: Depth �1�Material
From To Ft. _.gy,i��
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
From
From
16. REMARKS:
To
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
)40 \v3
k.wtLj Lev--\
I PO HEREBY CERTIF`f
CONSTRUCT STAI;1
1
Method
Slot Size Material
in.
in.
Size Material
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-,C..Q 3 - 11— P3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.(919173 -3221, within 30 days. GW-I REV. 07/2001

270913
2. WELL LOCATION: , , p�p
Nearest Town: LC / C-<SA-C\- County ttC6wW't
I I Z QP vAv-, 6.4 A—s \\I P
(Street Name. Numbers,,CCommuunnity, Subdivision, Lot No., Zip Code)
•
3. OWNER: Cam! CY1\ \Alm
Address / Z Z {eY.v\C1V.*
Q,( Street or 2pu s .)
(CS Z S94- t�
City or Town State
(`l/ Statete �,
( )-
Area code- Phone number
4. DATE DRILLED �J- \ •O
5. TOTAL DEPTH: ZC7
Zip Code
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso nces -``Division rop)(�Water Qua�Ktt - Groundwater Sec( �3
WELL CONTRACTOR (INDIVIDUAL) NAME,/(print)RAtur�tl,� C1 Ia- Y1 �at•�6•� CERTIFICATION CP 1107 j,
WELL CONTRACTOR COMPANY NAMEA ttie, 1bw'Wetl ‘Iivcc PHONE # Itaalr, L st Z73
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# L
(i f applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Y Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minules/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q-
7. STATIC WATER LEVEL Below Top of Casing: c- 19 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS , FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Z-S METHOD OF ESTcI.� r vat, Kul
10. WATERZONES(depth): to0I hbC
11. DISINFECTION: Type -rif ? 1 .4 Amount Z.
Wall Thickness
12. CASING:
Depth Diameter
From 0 To 3� Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material �(_ Method
From To FLCQ�A�'''c
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
or Wcight/Ft. Material numbers and common road names.
From
From
16. REMARKS:
__ LDO-klEREBY
E CONSTRUCTION S.
C:J1i
FRAuf c93
(1,_U\�S.LIi
CZ
-
CO
ry
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ROS, ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
ra
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service CeCanWri REV�07 2001
27699-1636 Phone Nu. (919 733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and � NaturalyReso ces -` Division ao Water Qua t - Groundwater SectkiiO3
WELL CONTRACTOR (INDIVIDUAL) NAME (�pd(nOy1V0Yt y` 11a �1 i-Li4b i CERTIFICATION #7.�li 07 1
WELL CON'1'RACFOR COMPANY NAME ri tta`-t,"� \di Cif-`� PHONE # 1117-1 Oe' Z?3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT •^— Z.
(if applicable) —/ (if applicable)
1. WELL USE (Check Applicable Box): Residential UX Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: r
3'
Nearest Town: f�`c/ el<34-CY County
3 l-,,`t`k1\�
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Code) Z�I /'c�
3. OWNER: 1-,-5 ` � '�— �Y -e
Address .�� �3' V i 1 \\C . t -d `j.g
Lei e�
(S reel or
Y Route No. _ Z$
City or Town State Zip Code
( Area code- Phone number `
4. DATE DRILLED VJ
5. TOTAL DEPTH: \ C 0 5 (
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
270912
Topographic/Land setting�
❑Ridge ❑Slope ❑Valley LNPIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
•
variance in accords ce w th ISA NCAC 2C .0118.
9. YIELD (gpm): \ CO METHOD OF TEST7} .1. OVa�4I
TE
10. WATER ZONES (depth): \ CO I
11. DISINFECTION: Type —Ca b1424 Amount Z
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From CD To If-) Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.�
From To Ft.
14. SCREEN; Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles frotn at least
two State Roads or County Roads. Include the road
numbers and common road names.
�r C� CR
Method '� &I — ?—Q
pv1•r C Q
Material -
Material
16. REMARKS:
{, DO -HEREBY CERTIFY
AN THAT THIS WELL WAACCONSTRUCTED OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
COJJy�T'RUCTI(TANDA. ) �_ `_
TT`�
URE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001
j
Submit the original to the Divistdn
2769.9-1636 Phone No. [phone]

270874
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an4atural Resource/,)Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) A(' u h ,aff \ "'14Lit w F Li-__, CERTIFICATION 0 /-5-3
WELL CONTRACTOR COMPANY NAME �LLi3eN ( a' /c Wel! t YlI1tf`t _i_ ,tJC PHONE a 0.116 ,,5'f -35S /
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERM1Tt
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential &" Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:.
County
Name, webers, Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
%ea#
City or Town Stine Zip code
(tom- kz5
Route
Arca coda- Phone num l 4-34. DATE DRILLE ali
5. TOTAL DEPTH: 5 /'D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: Ay FT.
(Use'+' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below laud surface requires a
variance In accordance Mlh ISA NCAC 2C .011S.
9. YIELD (gpm): i ;4 METHOD OF TEST Cf ( /r
10. WATER ZONES (depth): / f /o
11. DISINFECTION: Type le/ f O
12. CASING:
Depth
Fromt/ ToLs4Ft.
From To Ft.
From To FL
13. GROUT: Depth
From m Tom Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
O— /mdo
/7../o
l
tn. —
/CO-5-/n
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depealmimwa/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING I.(N{
From To dalesea
Formation
dsc`es(
e
k A4tnt
0
LOCATION SKETCH
Amount /i_ 1/ 03 Show direction and distance in mileturor rat:least
Wall Thickness V.
two State Roads or County Roads. Includethe road
orµr t/Ft. Material numbers and common road names. co
II
0
w
m
cU
Mini=) .. 4sX/
rk ..16, REMARKS-- -�
%I DOHEREBYCERTIFY
.CONSTRUCTION STANDARD
IrJ
SI
S WEI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI I
AID THAT A COPY OF RECORDTHIS
'��A
HAS BEEN PROVIDED TO THE WELL OWNER
s`rR j
211ATURE OF PE ON CONUCTING THE WELL TE
Submit the original to the-Divisk n of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

270850
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ws ELL CONTRACTOR (INDIVIDUAL) NAME(print)!ij1>O;yas$� � ��1���_ ...^�Ql)NN CERTIFICATION# 24�(c
\VrI.I, CONTRACTOR COMPANY NANIE US� -\64:6 o Acr LaCN.X PHONE # (VS) (CC(c' S a�P?Z
s ATE 'V ELL CONST'RLCTION PERMIT# UU ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
I. WELL USE (Check Applicable Boa): Residential qI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2,
WELL LOCATION: p
Nearest Town: /J4W U County
.5o hh Foe rrx RocLa Lind
(Street Name, Numbers. Community, Subdimsion, Lot No., Zip Code)
3. OWNER: ' 'Q,, 1'1'ICtnJ'n-n
Address 'd as Q Dios -,-A rIAAA'
(Street or Rock No-)
nc as?-7,?‘
CtiLy or 1 own Stale Zip Code
(52%)- a3S 874ci
Are. code- Phone number
4. DATE DRILLED 3110 1e.3
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LB
7. STATIC WATER LEVEL Below Top of Casing: 41 FT.
(Use '4" it -Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): aO METHOD OF TEST
F" S
10. WATER ZONES (depth):
Topographic/Land setting
DRidge [ $lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m 1nu to s/sec and s)
Latitude/longitude source:❑GPS❑Topographic map
(check bux).
DEPTH DRILLING LOG
From To Formation Description
1 To
9c
tic / 0 ,305
I I. DISINFECTION: Type V __ Amount `1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From --/ To 9u Ft. (‘ -$21 •0RSis-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To .`CZ) Ft. Ca r7e.-) . bk,4
From To FL
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
nv;(7 e)ed,DvJ
r-.
GJ
LOCATION SKETCH 07)
Show direction and distance in miles from at least_
two State Roads or County Roads. Includalhe rga4-
numbers and common road names. n
IV
w cr,
16. REMARKS:
1 0O,HEREBY -CERTIFY THATMH'
CONSTRUCTION STANDAIiD, A
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.31(c1o3
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to tbBipivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
( 276 9-1636 Phone NII. (919) 74432. within 30 days. GW-L REV. 07/2001

270849
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\STI,I. CONTRACTOR (INDIVIDUAL) NAME (prnlint) to.-a]v.�`s� 1\_a CERTIFICATION#
w'EL1,CON'I RACFOR COMPANY NAME V.
S4 f 2)..1.—NA-g"-in Q49 a!'�r y�rPHONE # (g29 (c65 o'eDZ
I ATE WELL CONSTRUCTION PER.IIT# CUUUI IJ ASSOCIATED WQPER\IIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Con &e c County A..e+e ✓,„b\'
rn:\Ae Zt'Ve as/
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: 5h;e1w '✓I,crc: 4.4iaci
Address 0 cep. \Icy 0,n..p
(Street or Ptak No.)
Candlkr -rat
g,1-5
City or Itt n Slane
( gas)- aH3- 03c
Area code- Phone number
4. DATE DRILLED 3
5. TOTAL DEPTH: SC
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DJ
7. STATIC WATER LEVEL Below Top of Casing: 3 3 7 FT.
(Use •'+•• if Above Top of Casing)
8. TOP OF CASING IS { FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
rs
9. YIELD (gpm): METHOD OF TEST 4v cJ
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge PtSSlope ❑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
-f- l in €i O\; e Ct' \ ilr) ovlO
51"tn Sos
11. DISINFECTION: Type P `_Us_
12. CASING:
Depth Diamctcr
From -r / To 61 Ft. (,
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To (D
Amount
Wall Thickness
or Weight:Ft. Material
ems{
Material Ft. CP r'r7Pv.3'1F
From To Pt.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16_REMARKS:
Method
nks
Slot Size Material
in.
in.
Material
c-)
Ca)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include:Lk road--
numbers and common road names.
-
I)DNI,HEREBY.CERTIFY THAI
CONSTRUCTION STANDARD'
S WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C. \VELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Sulkmit the original to ther'.Divisio
2109. 1636EPhoncNo. t9J20-fi-M1t,i
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001

2. WELL LOCATION:
Nearest Town: Fa.,:ev'ei.1 County Zw,c_Qe"ttiR
15 t.Q..S&\ 3i x,K Ov:Vt CO-:“ V:ems n13G
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: leg. 2 V Cram..a c-r'r
S Lo_.ac i' Lieeo,c tor: vid
Address
(Street or Route No.)
ai '13o
City or Town Stale Zip Code
(Wes- Cogs e.7oq
Area code- Phone number
4. DATE DRILLED 3110 1 c 3
5. TOTAL DEPTH: ag
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: tO _FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): WO METHOD OF TEST 19--.2,S
10. WATER ZONES (depth):
I I. DISINFECTION: Type 9 k`S Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From -r / To qi FL l v 49&l -,�(n5.1.7.'C-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From t) To AD Ft. CP:'ne.J.1v- cn`'4_-ri—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
— 1-6_, REMARKS
I
I DO HEREBY CERTIFY
CONSTRUCTION STA
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WEI.I. CONTRACTOR COMPANY NAME Araiga
270846
Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #
'$ %r (,valt PHONE # (its GC 5 '::'(t,Q2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED NVQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
DRidge ❑Slope $I Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
IN
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic r. ap
(check box)
DRILLING LOG
Formation Descriptir
DEPTH
From To
S (?‘IP% C4r,1.avJ
SI T-o a93
w
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include tht ro uC
numbers and common road names.
ru
0)
pv.pa:ea
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3i Iblo3
Jam4ATTURE OF UREOF
SIGNPERSON CONSTRUCTING THE WELL DATE
Subrtiit the origiuitft)trhJ"ivision of Water Quality, Groundwater Section, 1636 Mail Service Ceentert �V gh, NC
27699-1636 Phone No. [phone], within 30 days.

27084 /1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- DivisionI�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM�^En1 {(prr�jint)) VSln]u.Q@( 1a6..A cth L1 CERTIFICATION# 242ta
WELL CONTRACTOR COMPANY NAME AQA-kr4Z1.%ctn Wb%.%a I v,r�VVVVVV PHONE # (Rai 6C 5 -Cx.QQ2
SLATE WELL CONSTRUCTION PERMIT# . ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential I& Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O if Other, List Use
WELL LOCATION:
044,,,rc.M,V_r.
Nearest Town: County (3r+vcx-vot-k`
s31 en ab0& a88ob
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: Tk -Fcm.azt,
Address 53 Mk Car+.&--4 «`�4
Q (Street or Route No_)
CwLv-t.4Q. xc
City or Town State
(Sas)- auz 1aa
Zip Code
Area code- Phone number
4. DATE DRILLED 2ila 1O3
5. TOTAL DEPTH: 4a5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 14
7. STATIC WATER LEVEL Below Top of Casing: 31G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .3 METHOD OF TEST +�
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope AValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1-1 q`1 C) c Ceeedon
v vas (.5(cnn;1e
11. DISINFECTION: Type Q.1/21S
12. CASING:
Depth Diameter
From 1-1 To R4 Ft. (ok,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a° Ft. C-¢rvt en,\ .va twed
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. S.AND/GRAVEL PACK:
Depth Size Material
Amount 1
Wall Thickness
or Weight/Ft. Material
\
From To Ft.
From To Ft.
16. REMARKS:
W
LOCATION SKETCH
Show direction and distance in miles fronnyt leash_'
two State Roads or County Roads. Includetheroad 71
numbers and common road names. __ � -
O r 77
fV
CO Er-
) killEREBy CERTIFY T7-1A'
CONSTRUCTION STANDARQ
•
Submit the original to the
27699-1636 Phone No. (919)713-322
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
alldlo?�
ATURR'OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I, within 30 days. GW-t REV. 07/2001

WELL CONSTRUCTION RECORD
270843
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) OQ'r'ts iJQ-'Ne+ 6CU-11QCj CERTIFICATION # c43t,
MEL.l. CONTRACTOR COMPANY NAME L\raOQ tJ.aQCS h -� Lit\\ ae �,.. o 7..rc- PHONE # ( 2 fc-5'aez2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery D. Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Os),cii%ut County NAnccm)0(a ❑Ridge E<Slope ❑Valley ❑Flat
3o' Q. nNfltb C o-uQ Rix- a 42,Eae3 (check appropriate box)
(Street Nana, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3 OWNER: MN*: L Pnref ta. aAQtek (degrees/minutes/seconds)
Address 303 e.nAQtb Con floo4 Latitude/longitude source:OGPSOTopoeraphic map
(Street or Route No.) (cheek box)
AeWev: y e A1)$e3 DEPTH DRILLING LOCI
City or Town State Zip Code From To Formation Description
(Rad)- 2.14•31bo td Cs Vet 13Qrdso
Area code- Phone number
4. DATE DRILLED 1 • 3- 03
5. TOTAL DEPTH: lc
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 19
7. STATIC WATER LEVEL Below Top of Casing: (G40 FT.
(Use `+" iFAbove Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST es:q
10. WATER ZONES (depth): Q
75 7rS yr en;}
CJ
LOCATION SKETCH I) --
I I. DISINFECTION: Type ?ANAmount '1 Show direction and distance in miles from a'{ieast;_I_
12. CASING: Wall Thickness two State Roads or County Roads. Include the mxi
Depth Diameter or WeighuFt. Material numbers and common road names.
From * 1 To 75 Ft. le, �e:a , 4.t Fla9
From To Ft. N
0) —
From To Ft. era
13. GROUT: Depth Material Method
From 0 To atFt. ecsen4ni -pc)ave i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
•r- �TT�6F1 EBYC2PIFYTHP
CNsT.12,UC.g1ON. STANDARI
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
JD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�j Ate. v 1-3-03
NATURE I: prizsoN CONSTRUCTING THE WELL DATE
Submit the original to the divisio of Water Quality, Groundwater Section, 1636 i\lail Service Center- Raleigh, NC
27'69911-616 Phnnc No (919) 733-322 , within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
270842
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V30.-eeiC tC -ktQtrwe. t'S CERTIFICATION # 2143(o
WELL CONTRACTOR COMPANY NAME C1L ,Q &1Ua $r't .�on t`leA-ecluMP .kne PHONE # (oZ$l to405-;2022
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL. USE (Check Applicable Box): Residential 18 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 3\aebc 'Mtn County Q :.nc“•"l be.
e . vnt K;&e,
(Street Name, Numbers. Comm nity, Subdivision, Lot No., Zip Code)
3. OWNER: l,ac-t-,-7 Ch,` (3cccx'S
Address g2_>kn Lick 7-4
(Street or Route No.)
(NC QK Mtn, nC_
City or Town State
(gas)- P-30 ()aka
Area code- Phone number
4. DATE DRILLED a- a-tk- 03
Ra
Zip Code
5. TOTAL DEPTH: `i(o5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4Sb FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST 12: c
10. WATER ZONES (depth): Q
11. DISINFECTION: Type Q;,\S Amount -7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t' \ To -71 Ft. (o t#z\
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a0 Ft. Ce.nan+ Po,.„c..a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL, PACK:
Depth Size Material
To Ft.
To Ft.
Topographic/Land setting
❑Ridge ItlISIope ❑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 Fomtation Description
i-\ '0 77
O-JQC Poe(dan
7/ to 51:o.) Gvo*n:te. C
On
LOCATION SKETCH
tr-
Show direction and distance in miles from aj.J3ast
two State Roads or County Roads. Include tltirkoacE
numbers and common road names. `
p145 t:C
From
From
16. REMARKS:
I p(?HEREBY CERTIFY THA
I CONSTRUCTION STANDARI)�
1
Submit the original to the -Divisio of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919):73.-32
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG i URE OF PERSON CONSTRUCTING THE WELL
DATE
4103
within 30 days. GW-1 REV. 07/2001

270841
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTIL\Cl'OR (INDIVIDUAL) NANIE (print) V\Qrt_pisCJ(Q `iA,y . >��t� CERTIFICATION # 0-4.jlp
WELL CONTRACTOR CON1PANY NAME 'kV Y AI 10 CR,1( a��In../� PHONE # 0(251 G65 'aea2
SLATE WELL CONS'IRCCTION PERMIT# ASSOCIATED WQ PER.MIT*/
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential Q Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CanaleC County (3_,neornb0
is 74 acc:5 0.'.d e RAQanaiter ✓IC 37i5
(Street Name, Numbers, ComiMunity, Subdivision, Lot No., Zip Code)
3. OWNER: Ecneot ek,rk
Address 7v; 71arc; ;N R;dr. Q Ccd
(Street or Route No.)
candle ,- VIC ag i t 5
City or Town State Zip Code
(n{)- 665 t9-1 (o -
Area code- Phone number
4. DATE DRILLED 3/ 18 io3
5. TOTAL DEPTH: 80,5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: /5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Vo0 METHOD OF TEST Rr'
O. WATER ZONES (depth):
Topographic/Land setting
❑Ridge WiSlope BValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
+ 1 % tl g 3 / e A'J
83'T"n 30S irrc y-Jt-4e
q
r.
1 I. DISINFECTION: Type D ' k4S Amount Io
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From -/- / To 83 Ft.___/,., u_]_ \ Ogsla
From To Ft. _ l
To Ft.
Depth Material Method
To .:(D Ft. ea r e..31— p ()LAS
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
From
13. GROUT:
From t)
Size Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from aTieast,p=
21
two State Roads or County Roads. Include' rest{
numbers and common road names.
0) 6-7
I p0 HERERY CERTIFY-TH
CONSTRUCTION STANDA
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
311%103
NATUIL OF PERSON CONSTRUCTING THE WELL DATE
Sjubmit the original to the-Divisi I n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No.(9t9y703-32 I, within 30 days. GW-I REV. 07/2001