Cd CY2003

WELL CONSTRUCTION RECORD 2 8 3 4 2 9
North Carolina • Department of Environment and Natal on of Water Quality - Groundwater SecteA „/
WILL CONTRACTOR (INDIVIDUAL) NAME (print) I -/1�C, e— CERTIFICATION S
WELLCONTRACToa coMPANYNAMM1E PRICE WELL DRILLING, INC. PRONG I P2$ 327 0268
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ FEEIHTTO
Of wplicable)
(if applicable)
). WELL USE (Check Applicable Box): Residential W0' MuoicipafPublic ❑ Indushial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, Liu Use
2. WELLLOCATIOrIyy
N_, _ Tow`J•
l rum7
(km New. Num
3.OWNER• (
Address / Lon(
Cse —� r
_321t L1
4�S County
/.drat No.. IIp Code)
Gcn.p/Kld !Aar KA
i S LC a/Y,Cn 3 G /
Goy oe Them Stue e
M soda-Pboea 2
4. DATE DRILLED
/ .-7 "1 03
5. TOTAL DEPTH: ¶75�
6. DOES WEIL REPLACE EXISTING WELL? YES C( NO O
7. STATIC WATER LEVEL Below Top of Casing:
(Use's" if Above Top Caste
8. TOP OF CASING IS a PT. Above Land Surface*
flop of slog tealeatee die below land notice requires a
mime I. seontiamitit ISA NCAC 2C .011L
te VT_FLf (gpm): of METHOD OF TEST .4 t b /oW/i
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount_
12. CASING: Wall Thickness
at/Pt Mptcial
F TDo��O D Ft lv
Fr To Ft.
From To FL
13, GROUT•t►ADepth )aosial.
From Q.,To 20 Ft. // ---7
From To Ft
14. SCREEN: Depth Diamen Slat Sim Maul
From To
Frog_ To Ft in in.
1$. SAND/GRAVELPACK
Depth size Muerial
FroI_To Ft.
From To Ft.
EroCcda
•
Topographic/Land setting
Midge OSlope *alley Elliot
(check appngdtle box)
Latitude/longitude of well location
Nepeatmiskumbewedp
Latituddlongitude smacr.❑OPSOTopognphic map
(slick box)
DRILLING LOG
F°myvact,c aQ
DEPTH
£2
CO / d cc
ls'cU .3570 cop
30n 57C Roc
,6c
r-
Co
a
n
C)
LOCATION SKETCH
Show direction and distance in miles from at last Fr; _-
two State Roads or County Roads. Include the -road `;
numbers and common mad mmes.�G �C
1/ d�
lid 6ince ( /
1?„yrr / n -7'6 -eft/
? 204 e7/1
/Ji end C La-i/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAND ' . _ _ a - THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—7 o3
sF S r TIME 0 CONSTRUCTING THE WEIL DATE
Submit the al to • vision of Water Quality, Groundwater Section, Man Service Casa - Raleigh,
27695-1636 Thom Na (919) 7334221, within 30 days. GW-I REV. -.
Rdr/ dtt
✓r4-'am
a
Er
•
r: 7
m
r

281781
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l 1 itfi -U-55- all /� CERTIFICATION # J.2,3/
WELL CONTRACTOR COMPANY NAME e(/O2a-�L W.L�L zL wn"- - PHONE # (rt r�r� ¢+3,:-je.KS'
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (k/Municipal/Public 0 Industrial ❑ Agricultu
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County L az„..L.Lw-c.ge.
(Street Name, Community, Subdivision. Lot No., Zip Code)
OWNER:'+x- frCZrtvJ/
Address 96) ,;1.3 7Y\
(Street or Route )
', '71CC ii,30
City or Town State Zip Code
S428))-,S96-=?4D�
Area code- Phone number
4. DATE DRILLED /�/0— 4—D
f. TOTAL DEPTH: figc6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fIY
7. STATIC WATER LEVEL Below Top of Casing: SJ FT.
( (Use "+" if Above Top of Casing)
S. TOP OF CASING IS Fa- FT. Above Land Surface*
*Top of rasing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): 4/ METHOD OF TEST /2t2
10. WATER ZONES (depth): _ 4.25
I I. DISINFECTION: Type
12. CASING:
Depth
From-_-1 -7o /10
MT I -I
Ft.
From To Ft.
From To Ft.
Amount I'1 etar- i
Wall Thickness
Diameter or Weight/Ft. Material
13. GROUT: Depth Material'' Method /'
From 0 To ,-`,ZO a ,.._ /LL"W -
From To Ft. o
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.
16.REMARKS:
r,o
n
n-
Topoggraphic/Land sittbi
DRidge LNSlope ❑ValleFlata
(check appropriate bo. Pp. 11
Latitude/longitude of wel ,3loccii ion o
o —i a
(degrees/minutes/seca z
Latitude/longitude source:❑GPS❑ (degrees/minutes/sect
nic_man
(epee
DEPTH
From To
0 4 0
10/1 "f�sr
ktn. x)
DLILLING L
Formation Description
G�Ltf
/1-1*64co
"�
u
C
fV
'
r-
U1 -_r1
n
O mat
.
LOCATION SKETCH d1
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers . nd common road names.
.-ite-w
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
� S
//— aR— 03
SIGNATU E 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

FROM : MORETZ IJELL a PUMP
FAX NO. . 724 521722 Jul. 20 2003 07:3EFM Fa
276451
WELL CON STR.IC TICN RECORD
North Carolina - Depot -anent of Environment and Natural Resources - DI-, i;ion of Water Quality - Groundwater Section
CERTIFICATION # 2 7 F 6
?BONE a (704)4 6 2 -1 32 ;.
STATE WELL C.O'NSTRVal ON PERMITW_, _ ? 2>Cc!ATED WQ PERMIT#
wjantass(ifiz applicable) twinoteif licable)
1. WELL USE (Check Applicable Box): Residential u _c_aal Pub is in Industrial In Agricultural ❑
Monitoring 0 Recovery CI Heat Pump Water iajectie : Cr_:e; ED If Other, List Use
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ASHLEY T. .4ORETZ
WELL CONTRACTOR COMPANY NAME MORETZ tJELL }D&ILLING
„ WELL LCCA ="ION: �.,
r-;earI ow-//f reiirt t 1�.i /d County esPldlerl S10, A
(Street Name, 'N• burs. Community, Subdivisioq Lot No., Z12 Cods)
3. OWNER- 7/14gS✓ii11- /2wcs Por7`
Address sSL7 Siin c t✓ /;� A,
&i AP-, igab r RoujE Nc ff fff 2 :3 4-)
City or To r. StateZip Code
rea cde- ?tote 2512il2r
=. DATE D 'RIr T YD Z,/7 02
5. TOTAL DEPTH: Z .V
6. DOES WELL REPLACE EXISTING WELL? YES O NO LI
7. STATIC WATER LEVEL Below Top of Casing: r, Ft
(Use "+" if Above Ton or Cs ine)
TOP OF CASING IS / FT. Above Land Surfacce
'Top of casIn tcnn'.oatad et/or below land surface requires 2
vatienee ln.c,;:6a.:ce wit ISA NCAC 2C.011$.
9. YIELD (g m): „5 METHQD OF TEST
ATER ZONES (depth):
11. DISINFECTION: Type
12. CASING: //
rromA,To'_.✓d Ft. Dir
From._____-. To Ft
..rom To Ft.
GROUT: D:po- Material '..
F_om In d: To Z0 Ft. Cep r'%r: r.7
From t� To Ft. I
14. SCREEN: Depth Diameter Slot Size Ahatrri_;
i rotriT_ Kj'1'\> in. �i^r--,
;tom i T Ft. > in.
,ff' opo aphic/Land setting
E'_2dge OSlope OValley OFIat
(check appropria:c bat)
Latitude/lony ttide of well location
(de$tees/miout /sccoods)
Latiolde.Zongitcde source:OGPSOTopographic map
(check box)
DEPT5- DRILLING LOG
Fr.'ra To Fo m Lion Desse 1 tion
:t /'-ta/40l1 1Cs S iL
tut
1 7, '..^' Ars ' erx."i lie W �.
�-
CO
LOCATION SKETCH
gfil. —*no>r, r, .i,- Slaow direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Wei buS:. a?aic-ia; 'Yuri ers and common road names.
5DC, cZ;
15. SAND/GRAVEL PACK:
Depth
Frans_
Fro
16_ REMARKS:
O o
Gj
Size
Matatb1
_-1'` .'4FRERY C:'.;-2T,FY T-ga; -
CON TRUCTIOd: STANDAJt S,
c
S ON .TITRE OP
Submit the origin#; to the Divis on of Water Quality, Cruttnda -ate: Suction, 1636 Mail Service Center -Raleigh, NC
L"fi:G-1639-hotte-Ne: (939)/733-3 - I, within 30 days. GW-1 REV. 07/Z001
cm- I WAS CONSTRUCTED L UCC?u)ANCE Wall ISA NCAC 2C, WELL
THAT ' COPY OP HIS :R 'CORD HAS BEEN PROVIDED TO THE WELL OWNER
ON CONSTRUCTING' SHE WELL DATE
.>w

275437
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/,Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L trtep_LL-/ CSL55 e // /� CERTIFICATION # .1.3 /
9:1 WELL CONTRACTOR COMPANY NAME Lade L..1A-e LJ+'- _ . PHONE # (R.ni &i 31,1 - 3Ic 'g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ei Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:WIE_ i; J
NeOLLE
arest
�nT,',o.',w'�'n'':�'r''"-��'/L�L_�d%y County(J.r.t,
(Street Name, NLmbers,'6bmmunit lSubdi vision, Lot No., Zip Cod
3. OWNER: -mg-teSdhisii.t
Address _..L23 `L asc
(Street or Route No.)
7 Q-Yn2�-w 710 )86g'7
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED .S- 020 - 03
5. TOTAL DEPTH: 7 e .5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IP'
7. STATIC WATER LEVEL Below Top of Casing: _7. FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS it-5- FT. Above Land Surface*
*Top of cesima terminated at/or below land surface requires a
variance in accordance wirk IS.' NCAC 2C .0118.
9. YIELD (gpm): �` METHOD OF TEST Rw
10. WATER ZONES (depth):
11
12
13
DISINFECTION: Type-4 Z
CASING:
Depth �/ Diameter
From Q. To 7f2_ Ft.
From To Ft.
From • To Ft.
GROUT: Depth MaterialO
From� Too�' Q Ft.
From To Ft.
Amount n2
Wall Thickness
or Weight/Ft. Material
Pvc'
Method
14. SCREEN: Depth Diameter Slot Size
From_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
To
From
I;6. •REMARKSI:
I DO HEREBY k ' Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTIO ;Sr • DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ft.
Ft.
Size
Material
Topographic/Land setting
Etkidge ❑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
9ic ' 7os'
L
_
LOCATION SKETCH
Show direction and distance in miles frorn3t. least-
-two State Roads or County Roads. Include e roec%
numbers and common road names.
i'
V
IV
L
IL AL,IC'
original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GVV-1 REV. 07/2001
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
270533
WELL CONTRACTOR: Dewey Wright Well Pump Cc., Inc.
WELL CONTRACTOR CERTIFICATION #: 2797
030019 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential I VI Municipal Industrial
Recovery I I Heat Pump Water Injection Other
Agricultural0 Monitoring
If Other, List Use
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: GRAnuTF FALI s County: f'Ai MW l L_
PRI V ATF r2k;) ?FF G`UT�-{Erb V°.LuE�Ct ELF OGF HWY
(Hoed Name an um ers, communi y, or iston and o o.l
3. OWNER
Address
101-IN 1-1 MQflPE II
0000
A
1
LFNnI R
City or Town
1 A/nl LOCO
state
Nr
4. DATE DRILLED 2/1AI7D03
5. TOTAL DEPTH 2-P5
6. CUTTINGS COLLECTED YES I 1 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 5n FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth)•3 nom69-7n 27 corn 260-261
9 corn
12. CHLORINATION: Type HTH
2q 5
Zip Code
DRILLING LOG
From To
DEPTH
Formation Description
0 51 DIRT/0.'-14LFJ GRAIL
-Al 6g flPANITF
60 70 SRANITF
70 260 GRAN1ITE/Gll4RT7
2R0 261 GRWNDTr
26.1 285 GRANITE
13. CASING:
0 com
Amount 47
Y
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 5Q Ft 61/p 1Z,0 PVC
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From D To 2n Ft Cpmpnt Gra'A1v Flow
From To Ft
15. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From To
1fl ,
REIMARICS•
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
La Roads, or other map reference points)
NAP\
Diameter Slot Size Material ,fir
in in \<\��
in in.
in in
Ft
Ft
I DO HEREBY CERTIFY THA9T!
CONSTRUCTIONrSTANDA D
2
FOR OFFICE USE ONLY
Quad No: ... _.. ..
Serial No.
Size Material
.fit?
oix
fV
rs� 18t1
. 1 prCX • iA F-1'
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PRR IDED TO THE WELL OWNER.
G NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274887
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 1ti81
030132 STATE WELL CONSTRUCTION PERMIT#. bteve Hefty
y
1. WELL USE (Check Applicable Box): Residential 71 Municipal 0 Industrial Agricultural U Monitoring El
Recovery I I Heat Pump Water Injection Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County: CALDWELL
MOONBEAM LANE OFF HWY 90 OFF HWY 18 OFF HWY
(Road Name and Numbers, Community, or Subdivision and Lot No.(
3. OWNER MARC F. GUERRA
Address 28 MEANDERING WAY ,
GRANI) ElvAl t ute No.) NIL 28b30
DRILLING LOG DEPTH
From To Formation Description
0 '2 DIRT
72 94 GRANT FE
City or Town
4. DATE DRILLED
5. TOTAL DEPTH 14,,
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES L_ NO
8. STATIC WATER LEVEL Below Top of Casing: U FT
(Use "+" if Above Top of Casing)
State Zip Code
4/ 3/ 2003
II
9. TOP OF CASING IS 1 FT Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01103 Air
9
10. YIELD ( pm)' METHOD %F TEE ST •
11. WATER ZONES (depth): 1 opm 4__ aUi ppm 13U-133 r(.-.7
3
N p9-
94 9e SHALE
yn 130 (.3 ANI I E
130 133 SHAL E
133 145 GIZANi
CO
U ppm U ppin
12. CHLORINATION: Type H H Amount 1b
13. CASING
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 7e C .1 rro 35.,, PVC
From To Ft
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERT FY-
CONSTRUCTION S cT
FOR OFFICE USE ONLY
JLY
Quad No:
Serial No.
If additional space is needed use back 9f_{ormo
CO
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
to
r�Y.f� \L
7\V p(1\
/co-.
A I ItittWEtt-WAS-CONSTRUJ TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OFilIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(
J /0 _off
SIGNATURE OF PERSON CONSTRUCTING T2WELL DATE
GRDUNDLVAThlISgCVIt Did. ro Div sion of Water Quality, Groundwater Section within 30 days cw-1 REV. 12/99
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
268002
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
021017 STATE WELL CONSTRUCTION PERMIT* Leslie Reece
1. WELL USE (Check Applicable Box): Residential Lx Municipal ❑ Industrial
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County rA.I f 'vVFI I
STONE MTN CHURCH RD OFF STONE MTN RD OFF BU
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ROBERT WOODRING
Address % ANNA CRISP 7197 STONE MTN CHURCH I ANF
I ENOIR (Street or Route No.) NC 78845
City or Town State Zip Code
4. DATE DRILLED 1/1/2003
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
Rise "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth)' 1 ppm 91-92 4 ppm 211-212
0 ppm 0 ppm
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
D 63
63 91
91 P2
92 211
211 21?
212 245
DEPTH
Formation Description
DIRT
GRANITE
SHALE
GRANITE
QUARTZ
GRANITE
X
12. CHLORINATION: Type HTH
13. CASING:
Depth Diameter
From 0 To 66 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
From
From
Amount 43
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
0 To 20 Ft Cement Gravity Flow
To Ft
15. SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft -
From
From
17. REMARKS: ll
I DO HEREBY CERTIF ,, yIHAT-THIS.WELL WAS CON RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPt PI THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
II
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) �(,`i
Ctt
FOR OFFICE USE 0
Quad No:
MLYL
-I—ea /-3i-63
SIGNATJRE OF RSON CONSTRUCTING THE WELL DATE
Submit origin4l to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
272324
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687
020866 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential I Id Municipal
Recovery 0 Heat Pump Water Injection 0 Other
Il
Industrial Agricultural! Monitoring
If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ! FNOIP County: rd' rltA/FI I
POt INnh!VG MII I Rr7 OFF DY GAP OFF I ONG RIDG
1Road ame and Numbers, Community, or
Subdivision and Lot No.)
3. OWNER MITCHFI I K RAY'MOW";
Address 25nri WRr1NnING OAK DR
�
t or Route No.l
CHAP) ONO
City or Town State
9P,'7n
Zip ode
4. DATE DRILLED 3/27/2003
5. TOTAL DEPTH dOn
6. CUTTINGS COLLECTED YES I I NO IA
7. DOES WELL REPLACE EXISTING WELL? YES 0
NO
xl
8. STATIC WATER LEVEL Below Top of Casing' 100 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 2 METHOD OF TEST Aar
11. WATER ZONES (depth) 2 opm 190-194 0 gpm
0 PGm 0 gpm
12. CHLORINATION: Type HTH
13. CASING:
Depth Diameter
From ^_ To 35 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Amount 60
Wall Thickness
or Weight/Ft. Material
350 PVC
Method
Cement Gravity Flow
DRILLING LOG
From To
n ^n
DEPTH
Formation Description
DIRT
='n 1C+n GRANITP
tan
194
1a4 OIIA,RT%
4nn C-,RANtTF
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)
OfiAtip
L O
e
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS'I DO 1,F ( THIS �/ p� try
CONSTRUCTIY ON R 7A HP(ADS A,NIID TH,4TA C Y
FOR OFFICE USI1O LY
Quad No.
J
444
:TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Lev-°;
ect
Subm
1 dal
NATURE OF PERSON CONSTRUCTING THE WELL DATE
:o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
gA
Serial No.
GHCil Jiho.J
2SHEViL:..1- G;:GJCI uL Ih-, ICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030040
272302
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it 2681
STATE WELL CONSTRUCTION PERMIT#. Steve Petty
1. WELL USE (Check Applicable Box): Residential A Municipal
Recovery Heat Pump Water Injection Other
I
Industrial 0 Agricultural n Monitoring
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
NearestTown• LENOIR County' CALDWELL
PRIVATE DR. OFF MARIAN DR. OFF CHARLIE TRIPLE] I
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DAVID J. WILLIAMS
Address 1444 0 HENNESEY LANE ,
I I
DRILLING LOG DEPTH
From To Formation Description
0 90 DIRT
LENOIR (street orRoute No.) NC 28645 90 240 GRANITE
City or Town State Zip Code 240 242 SHALE
4. DATE DRILLED 2/21/2003 242 460 GRANITE
5. TOTAL DEPTH 505 460 462 SHALE
6. CUTTINGS COLLECTED YES I NO I %1 462 505 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011gg
10. YIELD (gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depth)' 1 qpm 240-242 1 qpm 460-462
0 qpm 0 gprn
X
12. CHLORINATION: Type HITH
13. CASING:
Depth Diameter
0
From U To 9U t_� Ft. i/o
From To Ft
From To Ft
14. GROUT:
Amount 97 If additional space is needed use back of form
Wall Thickness
or Weight/Ft.
3JU
Depth Material
From 0 To 20 Ft Cement Gravity Flow `
From To Ft
Material
PVI,
15. SCREEN:
Method
t
Depth Diameter Slot Size Material \'
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS
I DO HERE
CONSTRU
Size
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
l r K1 iet+
r�
G(4
ode
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL •
DS, AND THAT►',Co "Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE k1SE'.ONLY
Quad No'
Serial No.
IGNATURE OF PERSON CONSTRUCTING THE WEL}% DATE
I to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
bccPl-

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
272293
WELL CONSTRUCTION RECORD
030044
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2681
STATE WELL CONSTRUCTION PERMIT#' Steve Petty
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal I I Industrial fl Agricultural 0 Monitoring
Other If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County' CALDWELL
PVT. DR. OFF I -WY 321
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER
Address
ROBERT VONNEGET
% MFN AI RE CONSTR. , 421 RIVER RD. # 1
DRILLING LOG DEPTH
From To Formation Description
0 80 DIRT
BANNERItnof Route Nal NC 28804 60 93 GRANITE
City or Town State Zip Code 93 94 SHALE
4. DATE DRILLED 2/20/2003 94 187 GRANITE
5. TOTAL DEPTH 205 187 189 SHALE
6. CUTTINGS COLLECTED YES n NO >` 189 205 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use `+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' METHOD OF TEST Air
11. WATER ZONES (depth)'` gprn93 94
qpm
XI
5 qpm 187-18u
0 ppm
12. CHLORINATION: Type HTH Amount 38 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State .
From O To u' Ft u 110 : 3y' ITV C. Roads, or other map reference points)
From To Ft (.�,� i 1\e\
From To Ft t'
14. GROUT:
Depth
From 0 To 20 Ft Cement
From To Ft
Material
Method
Gravity Flow
15. SCREEN: 3 _
Depth Diameter Slot Size Material O.
From To Ft in in / Vf, r(
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMAR
I DO HE
CONST
FOR OFFI
Quad No:
Serial No.
Size
Material
N STANDARDS, AND TH
ONLY
GROUNG'A'f:"F
ASHEVILLEE AEC C
200
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCT! G THE WELL DATE
Ruamit or ginat to Division of Water Quality, Groundwater Section within 30 days
SECTION
AL OFFICE
GW-1 REV. 12/99
a

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
2'722.75
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2797
030082 STATE WELL CONSTRUCTION PERMIT#: Jerry Wilson
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
I
Municipal 0 Industrial FT Agricultural I I Monitoring
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: DEEP GAP County CALDWELL
KENDALLTOWN RD. OFF DARBY RD OFF ELK CREEK R
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ANNDORA DULA/RICKY DULA
Address % RICKY DULA , 6839 KENDALLTOWN RD.
FERGUSf§N° or Route No.) NC 28624 72 90 GRANITE
city or Town scare Zip code 80 91 GRANITE
DRILLING LOG DEPTH
From To Formation Description
0 72 DIRT SHALE GRANITE
4. DATE DRILLED 2/27/2003 91 268 GRANITE
5. TOTAL DEPTH 285 268 269 GRANITE
6. CUTTINGS COLLECTED YES ILI NO I S 269 285 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES O NO rI
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm)• METHOD OF TEST Air
11. WATER ZONES (depth):1 ppm g0-01 2 ppm 268 269
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 46
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
83 Ft 6 1/4 .188 GALV
Ft
Ft
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND
Material
From
From
17. REMA
I DO H REB CERTIFY TH L W . CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS RUC ANDARDSFATsINTHAT COPY F THIS RECORD HAS BEEN OVIDED TO THE WELL OWNER.
Ari'E` i A-2- <dU�
S���RE OF PERSON THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
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 poi�s)
s^L' 1 a —I
6•A
r
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
272274
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2797
030045 STATE WELL CONSTRUCTION PERMIT# Jerry Wilson
1. WELL USE (Check Applicable Box): Residential A Municipal Industrial El Agricultural I I Monitoring
Recovery L I Heat Pump Water Injection Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County: CAL DWELL
3. OWNER
Address
MOTHERS WAY LANE HUFFMAN RD OFF ABINGTON RD
(Road Name and Numbers, Community, or Subdivision and Lot No.)
JASON C. HARMON
4916 CALICO RD. ,
I I
DRILLING LOG DEPTH
From To Formation Description
0 150 DIRT LIMESTONE
LENOIR (Street orRoute "o.l NC 28645 150 380 GRANITE
City or Town State Tip Code 360 381 GRANITE
4. DATE DRILLED 2/21/2003 381 390 GRANITE
5. TOTAL DEPTH 405 390 391 GRANITE QUARTZ
6. CUTTINGS COLLECTED YES 0 NO X 391 405 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I I NO 0
8. STATIC WATER LEVEL Below Top of Casing 125 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 2 METHOD OF TEST Par
11. WATER ZONES (depth)• 1.5 ppm 360-361 .5 ppm 390-321
0 ppm 0 ppm
12. CHLORINATION: Type i-TH Amount 56 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 1" Ft U i14_ . Ann GI\L.'Vr
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
f:Derkfh i, S-1ze 1^1
T8 Ft Lni1
To Ft.
From
From
I
17. REMA
I DO H
CONS
Sr
REB CERTIFY THAT THIS WE
RUC
Material
ASFir„
!N ar■ f
FOR OFFICE US
Quad No:
Serial No.
0IIOIN
FEICE
LW
AT
LOCATION SKETCH
(Show direction and distance from at least two State
`•( Roads, or other map reference points)
Cr
tc, C-)
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEENFROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 9 1(7 9 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] Ow
3. OWNER
Address
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2797
030052 STATE WELL CONSTRUCTION PERMIT#. Jerry Wilson
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
I)I
I I
2. WELL LOCATION: (Show sketch of the location below)
Municipal I I Industrial Ei
Agricultural El Monitoring
Other El If Other, List Use'
Nearest Town: LENOIR County: CAL DWELL
THAT WAY OFF BROOKSHIRE RD. OFF ABINGTON RD 0
I Road Name and Numbers, Community, or Subdivision and Lot No.)
CLYDE F. GILBERT
1233 THAT WAY ,
LENOIR (Street or Route No.)
NC 28645
City or Town State
4. DATE DRILLED 2/26/2003
5. TOTAL DEPTH 345
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT
(Use "+" if Above Top of Casing)
IN
Zip Code
I XI
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C 011$
Air
10. YIELD (gpm)• ` METHOD OF TE 0
11. WATER ZONES (depth)' qpm 310-11
3
U qpm 0 ppm
12. CHLORINATION: Type Hffl Amount 57
pprn
DRILLING LOG
From
0
185
310
311
To
135
310
311
345
I
DEPTH
Formation Description
CLAY SHALE SAND GR1
GRANITE QUARTZ
GRANITE
GRANITE
13. CASING:
Depth
From 0 To
From To Ft
From To Ft
14. GROUT:
Wall Thickness
Diameter or Weight/Ft.
190 Ft 6 114 .188
Material
G.ALV
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SANT
I(
From L
From; r To Ft
17. REMAuuRKSI`
I DO HEREBY C.FRTIFY THAT THISLL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIiOKSTANO,Aft SS,i I$D THA- A COPY OF THIS RECORD HAS B PROVIDED TO THE WELL OWNER.
ASHEV!'LL r h i !CINA_ OFFICE
1F-7, 0(40lly
[
SS i
To Ft
Material
If additional space is needed use back of form
V
LOCATION
(Show direction and distanc
Roads, or other map
N. NAQan
SKETCH
e from at least two State
reference points)
Vlan
�j �YOO-I� '-
FOR OFFICE USE ONLY
, NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 6 8 0 16
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.2tl81
020307 STATE WELL CONSTRUCTION PERMIT#• Maus reify
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
xI
Municipal
Other
Industrial Agricultural Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County: CALDWELL
PRIVATE DR. OFF PACK HILL RD. OFF OLD JOHNS RIV
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DIANN W. CRAG
Address P.O. BOX 2250 ,
BLOWING2ROCA°nte No NC 28805
Ow or Town State
4. DATE DRILLED 1/16/2003
5. TOTAL DEPTH 145
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
Use "+" if Above Top of Casing)
x
Zip Code
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm)' 1 METHOD OF TEST Air
11. WATER ZONES (depth)•3 gpm 70-71 7 qpm 130-132
DRILLING LOG DEPTH
From 0 To Formation Description
35 DIRT
35 70 GRANITE
70 71 SFIALE
71 130 GRANITE
130 132 SHALE
132 145 GRANITE
I N
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 27
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two =fate
From 0 To 40 Ft 6 1/6 .350 PVC LejU.tf Roads, or other map reference poin
From To Ft N.7
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size
From To Ft in
From To Ft. in
From To Ft in
16. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft
Ft
1M)
17. REMARKS: gI DO HEREBY CrY THAT THIS WELL W
i'
CONSTRUCTIC(?JIS NDA DS, AND THAT A OS
A
in
in.
in
PO-C,I u'r
rn
CO c:;
_
Material
FOR OFFICE USE ONLY
a al
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIG NATURE OF PERSON CONSTRUCTING THE WELL
Submit:o iginal o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
DATE
vd
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater 2gtiO op 0 0 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] U
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Vv`nght Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2818
030012 Steve Pnce
STATE WELL CONSTRUCTION PERMIT#:
xl
II
1. WELL USE (Check Applicable Box): Residential Municipal Industrial
Recovery I I Heat Pump Water Injection I I Other I
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR
II
Agricultural I I Monitoring
If Other, List Use:
County: CALD`hELL
HEADWATERS OFF BOLICK RD. OFF BLACKBERRY RD
(Road Name and Numbers, Community, or Subdivisior and Lot No.)
3. OWNER THOMAS MCNAMARA
Address P.O. BOX 527 ,
BLOW N&ROCPOp1e "°.) NC 28605
City or Town State Zip Code
4. DATE DRILLED 1/16/2003
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
200
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
I
I XI
DRILLING LOG DEPTH
From To Formation Description
0 160 DIRT
160 260 GRANITE
260 261 GRANITE
261 330 GRANITE
330 331 QUARTZ
331 360 GRANITE
360 361 QUARTZ
361 465 GRANITE
485 466 QUARTZ
9. TOP OF CASING IS 1 FT Above Land Surface* 466 505 GRANITE
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01143 Air10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):5'ppm260-261 .5 qpm 330-331
.5 PPM360-361 .5 gpm 465-466
12. CHLORINATION: Type FITH Amount 64
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 170 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS. ; 1 ----_ i
IDOHEREBY EVIP THAT THISWELLWA9ICC
CONSTRUCT ON STANDARDS, AND THAT A CD
Sent/ Mier:Sa. /-?/—Of
(Show direction and distance from at least two State
Roads, or other map reference points) VjA/U
HCOC1 wait LS
v
Cr
r4
,lark brrij
L
FOR OFFICE USE ONLY
Quad No:
WO)
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL �C�
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SI ,;NATURE OF PERSON CONSTRUCTING THE WELL DATE
Subm1r eriginal to Division of Water Quality, Groundwater Section within 30 days
GW.1 REV. 12/99
L,nF
Serial No.
r

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sect'( 6 8 0 O 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 21086
030009 Leslie Reece
STATE WELL CONSTRUCTION PERMITS':
1. WELL USE (Check Applicable Box): Residential I XI Municipal Industrial Agricultural I I Monitoring
Recovery I Heat Pump Water Injection I Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
I CRInIP rAl n\A(CI I
Nearest Town: L""'-" County: "^"'°°"`
PRIVATE DR. OFF ROBY MARTIN RD. OFF HWY 321
(Road Name and 'lumbers, Community, or Subdivision and Lot No.)
3. OWNER R. GENE NORMAN
Address 2880 ROBY MARTIN RD.
LENOIR (street or Route No -1 NC 28845 94 11 B GRANITE
DRILLING LOG DEPTH
From To Formation Description
0 94 DIRT
City or Town state Zip code 118 119 SHALE
4. DATE DRILLED 1/13/2003 119 173 GRANITE
5. TOTAL DEPTH 205 173 174 SHALE
6. CUTTINGS COLLECTED YES I I NO I XI 174 205 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: Q0 FT
(Use "+" if Above Top of Casing)
I XI
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm): METHOD OF TEST Air
11, WATER ZONES (depth):2 ppm 118-119 8 ppm 173-114
0 ppm 0 ppm
12. CHLORINATION: Type F-ITH Amount 35 If additional space is needed use back of form
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 96 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS: (i •:'\
I DO HEREBY RTIIFY THAT THIS WELL WAS c $IfRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION 'STANDARDS, AND THAT A copy' F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
t W� �NS.R�
FOR OFFICE USE�NLV / - ; i- 03
SIG ATURE ERSON CONSTRUCTING THE WELL DATE
Submit inal t Division f Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
A
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Q
I eC
pvml
gobt5 tjkr,th•a1n ki
0
W
Quad No:
or
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030002
270548
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
STATE WELL CONSTRUCTION PERMIT#: Steve Petty
1. WELL USE (Check Applicable Box): Residential I XI Municipal 0 Industrial 0 Agricultural 0 Monitoring n
Recovery 0 Heat Pump Water Injection 0 Other I I If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENnIR County. CA.I ITIWFi I
PRIVATE DR OFF HINDS DR OFF RI(7HLAND RD OFF H
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG
3. OWNER MID ATLANMC CUSTOM PI riRS From
Address P 0 BOX 3702 0
MOORFR`ahi rrt pr Route No.)
City or Town 11�F- State
4. DATE DRILLED 7/1'D/7nnz
NC 7 11 ,
Zip Code
DEPTH
To Formation Description
60 DIRT
fin an C�RANI i
on Q, S)-4AI E
Q1 2An GPAN)T
5. TOTAL DEPTH anfi zdn Rd', .,uA) F/01 IARl7
6. CUTTINGS COLLECTED YES ❑ NO =.27 anR GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I I NO I xI
8. STATIC WATER LEVEL Below Top of Casing: 311 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 1.5 METHOD OF TEST Air
11. WATER ZONES (depth)'1 gpm90-91 .5 Pm 240-342
0 qpm 0 ppm
12. CHLORINATION: Type HTH Amount 74
13. CASING:
From
From
From
n
Depth Diameter
To 65 Ft. 6 1/3
14. GROUT:
From
From
15. SCREEN:
To Ft
To Ft
Ii
Wall Thickness
or Weight/Ft. Material
350 PVC
010
Depth Material Method
0 To 20 Ft `:cement Gravity Flow
To Ft
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter Slot Size Material
Ft. in in.
Ft in in
Ft. in. in
Size Material
Ft
,R —%
2OO
17. REMARKS:
I DO HEREBY CERTI=Y
CONSTRUCTION STA
FOR OFFICE USE ONL'
Quad No:
Serial No
r 1 r,
r
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)
391
-THISWELLWASCON31R CTED IN ACCORDANCE WITH iSA CAC 2C, WELL
RDS, AND THAT A COPY Ofi IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
��7 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subntft oTig'Ih fTo Divithon of Water Quality, Groundwater Section within 30 days
f';c 1 ;jfF GW-1 REV. 12/99
C'

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274916
WELL CONSTRUCTION RECORD
030202
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc
WELL CONTRACTOR CERTIFICATION #• 2!N1
STATE WELL CONSTRUCTION PERMIT#• Albert Matz
1. WELL USE (Check Applicable Box): Residential
Recovery fl Heat Pump Water Injection
Municipal I I Industrial n Agricultural I I Monitoring
Other 0 If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County CALDWELL
RIVERVIEW DR. OFF BUFFALO COVE RD OFr CALDWE
Ifload Name and Numbers, Community, or Subdivision and Lot No.)
_ DRILLING LOG DEPTH
3. OWNER i OMfIY WINKLER From To Formation Description
Address 1703 RIVERVIEW DR. , 0 109 DIRT MUD
LENOIR (Street or Route No.) NC 28845 108 640 GRANITE
City or Town state
4. DATE DRILLED 5/5/2003
5. TOTAL DEPTH 640
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO El
8. STATIC WATER LEVEL Below Top of Casing: 3D FT.
(Use "+" if Above Top of Casing)
I ki
Zip Code
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C0118_
10. YIELD (gpm): • 3 MrFTHOD pFFT SSTT' .Air
11. WATER ZONES (depth):•" gpmL.FiaarvN n gpm
U Own U gpm
12. CHLORINATION: Type HIH Amount 121
13. CASING
Wall Thickness
Depth Diameter or Weioht/Ft. Material
Q .anq o n�ro ?`cart• PVC
From To Ft
From To Ft
From To Ft
14. GROUT:
t_,
w
rn;
If additional space is needed use back otforrp L t
LOCATION SKETCH c
(Show direction and distance from at least two State
Roads, or other map retence points)
Q;vor
\op --
Depth Material Method �rA .P 3--I
From 0 To 20 Ft Cement Gravity Flow J� te
From To Ft
15. SCREEN: - T
— J
Depth Diameter Slot Size Material �'
From To Ft in in i y �l
From To Ft in in 'n1/�So�Q,q Ca
From To Ft in in 68 is
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMA
I DO HE
CONST
CkRIUI9YA� TF�I,� LI
'0id`3TtkWB
FOR OFI
Quad No
E l E ONLY
Subm
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
YJ'" 4'
C _>il/o _?
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
GROUNDWATER SECTION
Serial No fl.Sla : E n�yrr
IONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274897
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2081
C30179 STATE WELL CONSTRUCTION PERMIT*5teve retry
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
Municipal Industrial Agricultural Monitoring El
Other 1 1 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County: CALDWELL
JOHN RIVER RD OFF HVVY 90 OFF ANTHONY CREEK RD
(Road Name and Numbers, Community, or Subdivision and Lot No.(
3. OWNER TOM THUSS
Address Ic CLAY GENTRY , P.O. BOX 888
GRANITE~/ALt5OteNo.) NC 28830 70 93 GRANITE
City or Town State
4. DATE DRILLED 4l25t2003
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES NO ElIl��ll
7. DOES WELL REPLACE EXISTING WELL? YES tl NO
8. STATIC WATER LEVEL Below Top of Casing' FT.
(Use "+" if Above Top of Casing)
Zip Code 93 9-4 SHALE
Al
94 178 GRANITE
178 179 SHALE
179 205 GRANITE
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011,
10. YIELD (gpm): �` METHOD OF. T ST Air11. WATER ZONES (depth)' 2 Mr".1U porn 1 r l-1 ru
12. CHLORINATION: Type Amount `a
13. CASING
u Clorn u corn
NTH
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 78 Ft 5 1/3 350PVC
From To Ft
From To Ft.
14. GROUT:
Depth
From 0 To 20 Ft
From To Ft
15. SCREEN:
Material Method
Cement Gra•T-,ty Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS'
Size Material
I DO HEREBY Ct)tf 1A' THAT -THIS WELL WAS;CQ
CONSTRUCTIOIJ fADAR S;A1'1UTPtATACO
NI II
FOR OFFICE US
NillY
DRILLING LOG DEPTH
From To Formation Description
0 70 DIRT
W
L
3
If additional space is needed use back 94jormcn
W
LOCATION SKETCH ca o
In
(Show direction and distance from at least two State
T
%fit
Roads, or other map reference points)
,.SonA Kin(+(o\obced
E —I,4
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
= THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ATURE OF PERSON CONSTRICTING THE WELL DATE
Submit original t¢'Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274890
WELL CONSTRUCTION RECORD WELL CONTRACTOR Dewey Might Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION it.
030147 STATE WELL CONSTRUCTION PERMIT#• `teve Petty
WELL USE (Check Applicable Box): Residential
Recovery FT Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR
FALCON CREST OFF HVVY 321
(Road Name and Numbers, Community, or Subdivision and Lot No.)
Municipal
Other
I I
Industrial El Agricultural FT Monitoring
If Other, List Use.
3. OWNER BEN GRIFFN REALTY
Address dLLV
AVE.
COEGE AM
County' ref ,^WELL
DRILLING LOG DEPTH
From To Formation Description
0 _5 DIRT
LEN i R (Street or Route No.)
NL 28845
35 92 GRPJ-I! IE
City or Town
State Zip Code
92 g3 SHAL
4. DATE DRILLED 4/9/2003 J3 1 i U GKANI I t
I I
5. TOTAL DEPTH 225
6. CUTTINGS COLLECTED YES I NO
7. DOES WELL REPLACE EXISTING WELL? YES II NO
8. STATIC WATER LEVEL Below Top of Casing: uu FT
(Use "+" if Above Top of Casing)
1f2
110 GrtANI I E
210 211 SHALL
211
10 LHANI it
u
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.014
10. YIELD (gpm): ETHOD T Air11. WATER ZONES (depth): l;IpmQg_TJ + 'I ppm
z ppm 4 to-4'l'I U Barn
35
12. CHLORINATION: Type H.h Amount
If additional space is needed use bagkyf form_:
Ca)—
13. CASING: LOCATION SKETCH ° ET
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
43 811E .350 PVC
From - To Ft Roads, or other map reference points) „ o
From To Ft fj� W
From To Ft 17�%'
14. GROUT: O
Depth Material Method u O
From 0 To Dn Ft Cana, Grant y Flan
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS: rTh - l r, t
I DO HEREBY C I}tlI� THAT1HIS WF`I I WACCp NN
CONSTRUCTIO ISi4INDARDS, AND THAT A COOP
nil1I
FOR OFFICE USE
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2,1
2,' Rod
-/o-o3
Quad No'
Serial No
S GN
_ nal to
GRCUNL••NATER SECTION
%'.E-VIILLE REGIONAL OFFICE
TURF OF PERSON CONSTRUCTING THE WELL DATE
livision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
o es
h
t —• ,. '
Cr:
U ciPm
WELL CONSTRUCTION RECORD
274883
WELL CONTRACTOR Dewey Wright Well Pump Co., inc.
WELL CONTRACTOR CERTIFICATION #: ltiy 1
030069 STATE WELL CONSTRUCTION PERMIT#• Steve Hay
1. WELL USE (Check Applicable Box): Residential I X Municipal Industrial Agricultural E Monitoring
Recovery I I Heat Pump Water Injection I I Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County: CALOWELL
3. OWNER
Address
JOHNS RIVER RD. OFFMW' 90 OFF SETZER CREEK OF
I Rcad Name and Numbers, Community, or Subdivision and Lot No.)
RICHARD S. SIMPSON
P.O.BOX 13
I I
DRILLING LOG DEPTH
From To Formation Description
0 60 DIRT
COLLET 8rtil° °te No.) NC 28811
80 90 GRANITE
City or Town State
4. DATE DRILLED 4/24/2003
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES I NO
I .1
Zip Code
7. DOES WELL REPLACE EXISTING WELL? YES LJ NO
I AI
8. STATIC WATER LEVEL Below Top of Casing: au FT
(Use "+" if Above Top of Casing)
90 91 SHALE
91 194 GRANITE
194 195 SHALE
195 205 GRANITE
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 4 METHOD OF TEST Air11. WATER ZONES (depth):
3 nprn 90-91 1 cipm 194-195
u ClPrn
12. CHLORINATION: Type HIH Amount "t:
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
n RR C' .}/G 7,5C our—
` From - To "Ft. .-
From To Ft
From To Ft
14. GROUT:
If additional space is needed use back`t form J_2
r_..)
LOCATION SKETCH to o
(Show direction and distance from at least two State
p( Roads, or other map reference points)
Depth Material Method
From C To 2" Ft Cement Gram.; Flow ti
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
Size
Material
From To Ft
17. REMARKS: i
I DO HEREBY C1 '
CONSTRUCTIO i SI
Irl
tzer Cra e_K
t—Z.2—�i�
THAIt THIS WELLWASC' : RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ABSS—*ND-TIIATACo'YoFTHIS RECORD
HAS BEEN PROVIDED TO THE WELL OWNER.
f
FOR OFFICE US •
Quad No:
•TUBE OF PERSON CONSTRUCTING THE WELL DATE
Submit onyinal to Division of Water Quality, Groundwater Section within 30 days
_ f GW-1 REV. 12/99
c.ROUr [i `:ATER SECTION
Ai='-F19L' E REr ; •:4L OFFICE
qD
03
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 7 4 8 7 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030092
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it268/
STATE WELL CONSTRUCTION PERMIT#• St1ye Reece
1. WELL USE (Check Applicable Box): Residential I )1 Municipal I I Industrial n Agricultural El Monitoring
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use•
I I
2, WELL LOCATION: (Show sketch of the location below)
LENOIR CnLDyvRt I
Nearest Town: County.
SANDY GAF RD. Orr Hi NES BRANCH RD OFb RICHLAN
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER MICHAEL E. MALYSZKO
Address 9806 PENNISLILA DR. ,
TERRELLstreet or Rome No.) NC 28682
DRILLING LOG DEPTH
From To Formation Description
0 31_1 DIRT
30 38 GRANITE
ity or Town
tate Zip Code
4. DATE DRILLED 3/28/2003
5. TOTAL DEPTH 160
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
r•
38 40 SHALE
40 140 GR N Tt
140 144 OLIARTZ
144 160 GRANITE
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 t5
10. YIELD (gpm):METHOD
; (-
ETHOD QF TEIST fvrjll qpm 14U-14d
11. WATER ZONES (depth) `
u 4iprri U ppm
12. CHLORINATION: Type HTH Amount �G If additional space is needed use bagl,pf form--:
13. CASING:
Wall Thickness
n Depth Dia t or ht/Ft.
From To "Ft �'� 'jV('19
From To Ft
From To Ft
14. GROUT:
N�a\erel
Depth Material Method
From 0 To 20 Ft cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
17. REMARKS:
Ft
Ft
I DO HEREBY C :iI $Y Trt-IAfj"THFII$ W pLL yW4� C_
CONSTRUCTIO V 51 NSA tt§§DS,'RNETHAT A-C
FOR OFFICE USE Nt�Y
final t2
Quad No.
Submit on
CO
LOCATION SKETCH c o
(Show direction and distance from at least two State
Roads, or other map reference points)
Hineg�
Cal, 7 y
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BOEN PROVIDED TO THE WELL OWNER.
.)-(L
T
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274874
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION St.26it7
030124 STATE WELL CONSTRUCTION PERMITS,.Ste.e Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
Municipal 0 Industrial 0 Agricultural Monitoring
Other If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County' CA.LDWELL
HEADWATERS RD. OFF BOLICK RD OFF BLACKBERRY
1 Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER EDWARD C. LEDFORD
Address P.O. BOX 2581 ,
bi_U MINerlrtgtpL! ute
DRILLING LOG DEPTH
From To Formation Description
0 75 DIRT
288Oo
10 Ib17 L*,ANllt
City or Town
State Zip Code
4. DATE DRILLED 4:'312003
5. TOTAL DEPTH 4110
6. CUTTINGS COLLECTED YES I NO El
7. DOES WELL REPLACE EXISTING WELL? YES tl NO 71.
8. STATIC WATER LEVEL Below Top of Casing: U FT
(Use "+" if Above Top of Casing)
160 163 QUAR
10'd 400 GkANl It
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011(]
10. YIELD (gpm)' METHOD OF TEgT Air
11. WATER ZONES (depth) fan 150-1 E' U porn
U ppm a pprn
o
12. CHLORINATION: Type HIH Amount b0
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft
From 0 To 80 Ft 6 1/8 .350
From To Ft
From To Ft
14. GROUT:
Depth
From To Ft
From To Ft
15. SCREEN:
Material
PVC
Material Method
CEmert 6ra4t. '
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Size Material
17. REMARKS: �1
I DO HEREBY CE
CONSTRUCTIO
FOR OFFICE USO—DNLY
If additional space is needed use back ottorm
ra
CO es
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
4 Srgdo^1it
Y4HAT THIS 1IV' EL'L WJAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, ANU I HA I A 9 P !OF THIS RECORD HAS BE N PROVIDED TO THE WELL OWNER.
C _te,�e - (� //-63
Quad No
Serial No.
SIGJATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit o iginal to Division of Water Quality, Groundwater Section within 30 days
CROON WATER SECTION
GW-1 REV. 12/99
ASHE1'ILI. RECIC.P:Al OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
000163
274873
Dewey Wright We!I Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #•
2bd(
STATE WELL CONSTRUCTION PERMIT ,'teve Keece
PERMIT*
1. WELL USE (Check Applicable Box): Residential kj Municipal 0 Industrial I I Agricultural Monitoring El
Recovery
Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town BLOWING ROCK County' CGi DWEL l
RACQUET CREEK RD. OFF ANTHONY CREEK RD OFF J
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TERRY WINSL0W
Address 464 PRESNELL RD ,
BANNER(Etg(or Route No.)
NC 28604
DRILLING LOG
From To
0 35
35
DEPTH
Formation Description
DIRT
4 i GRANT E
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO 7. DOES WELL REPLACE EXISTING WELL? YES 0 r-
NO I ''I
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
3I3.1/200s
ISO
Zip Code
I
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): .0 METHOD 01 TEST Air11. WATER ZONES (depth)2 -43
41 43 cHn,LE
43
140 GRANITE
140
an + SHALE
id3 18UU GKANI It
n
Co
L
Iipm 140-1A3
0- cGni
11 ppm
12. CHLORINATION: Type rl
13. CASING
Amount
<&6
Wall Thickness
Depth Diameter or Weight/Ft. Material
From C To 40Ft 6174 1BE `nl
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 2�- Ft Cement Gra(nty Flow
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS.
I DO HEREBY 0
CONSTRUCTIO
Diameter Slot Size Material
Ft. in in
Ftin in
Ft in in
Size
Ft
Ft
Material
YLTHAT6THI$ VijELL W)
41\TDARDS AND THAT X q
FOR OFFICE US Y
Quad No•
Submit o iginal
If additional space is needed use baCf forth;;
L�
i
�s
N) r`-1
LOCATION SKETCH w
(Show direction and distance from at le7gf twotate
Roads, or other map reference points)
,jokr1 2de(/4fbbc&, •
rr
W
Ract.a Cr, PL,
E-2�
a
Q
a
L
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING THE WELL DATE
o'Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12,/99
CROON
Serial No. ASPEVILL
WATER SECTION
RE ?ZONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
030099
274858
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #.
2tibb
STATE WELL CONSTRUCTION PERMIT# Leslie Kee
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
II
Municipal El Industrial 0 Agricultural
Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• LENOIR County: CALD YELL
BEARTRACK LN. OFF AUSTIN VALLEY DR. OrF ROSY MARTIFI
3. OWNER
Address
(Road Name and Numbers, Community, or Subdivision and Lot No.)
STEVE KAJSER
595 DPJ•1A'S RIDGE DR. ,
Monitoring
DRILLING LOG
From
0
To
75
DEPTH
Formation Description
nIRT
ROS'VvELTIreet or Route No.) GA.
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES Il NO
8. STATIC WATER LEVEL Below Top of Casing: 'C9 FT.
(Use "+" if Above Top of Casing)
4/115/2003
905
30075
Zip Code
9. TOP OF CASING IS
*Top of casing terminated at/or below
dance with 15A NCAC 2C.011ts
10. YIELD (gpm):
11. WATER ZONES (depth):'
p
1 FT Above Land Surface*
land surface requires a variance in accor-
HOD Of TEST Air
gpm 43-144 o.db f!prn
Gpr11 U ilpfri
EiTrl
12. CHLORINATION: Type Amount
13. CASING
Depth
n
From To
From To
From To
14. GROUT:
75 243 GRANITE
243 244 QUARTZ
244 701 GRANITE
701
702
SHALE
702 805 GRANITE
O
C
C
/111_1112
—r1
If additional space is needed use back orm 0
Wall Thickness
Diameter or Wei ht/Ft. Material
L l c .114 ^89g GAL?/
Ft. Roads, or other map reference points)
Ft goo/'; o)-- 32 I
Ft
Depth Material Method
From 0 To 20 Ft 'Cement Gravity Flow
From To Ft
15. SCREEN:
From
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REM
I DO
CONS
Diameter Slot Size
Ft in
Ft in
Ft in
Ft
Ft
CERTIFY THAT THIS WE
FOR O'FICE 1.1SE ONLY
Quad N
GROUNOWATFR S
ASHEVILLE REGIONP
ECTION Sub
L OFFICE
Size
Material
in
in
in
Material
.vtM v1},)
LOCATION SKETCH
I
DC•
ION.STANDARDS, AND 1 S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C_ WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF
ginal to -Division of
ON CONSTRUCTING THE WELL DATE
er Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
•. fl;,
W
—1 ar
(Show direction and distance from at least two Stare
C-
Serial No

274575
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [MINE Tf CERTIFICATION#2343
WELL CONTRACTOR COMPANY NAME HTCWFY WFTI. I1 TTI TN; (1I PRONE # 1328) 324-0015
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential h ( 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: I FNOIR County ('.4T FL?FT T .
619 HIETICOD RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 4598 TERRACE VUJ/� ER
(Street or Route No.)
MU MAI\a' FL 32129
City or Town State Zip Code
(386 } 763-3346
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 465
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
"Top of casing terminated at/or below land surface requires a
variance in accordance pith ISA NCAC 2C .0118.
9. YIELD (gpm): O' METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
WLLI TAM & 1 NA El EHI4
11. DISINFECTION: Type FIIFI TABS Amount 94
12. CASING:
Depth
From_ To 185
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
Wall Thickness
Diameter or Weight/Ft. Material
Ft. CAW L,IFrT
Ft.
Ft.
Material
Ft. GROUT'
Ft.
Method
ILURID
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
C
LOCATION SKETCH
CO
C �- n
Show direction and distance in miles from aNLast r^
two State Roads or County Roads. Include tby,roa4�
numbers and common road names.
`o
- N�
G
^, JI DO HEREBY CERTIFY I
_--_. I ,. CONSTRUC5IO4'STgID
I
JL
Submit the original to the D
GQ).RhoQgjy4919) 73
ASHEVILLE REGIOPU'L OFFICE
THIS WELL WAS CONSTRUC1ED
3, AND THAT A COPY OF TH
ear
SIGNATURE OF PERSON CONSTI WWCTING THE WELL
CCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
05-28-03
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

272604
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE TONG CERTIFICATION# 714-i
WELL CONTRACTOR COMPANY NAME HICKORY WELL DRILLING CD. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential$K Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: T ENOTR County CALDWELL
4742 GRADY PT ACE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
DRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: HORTON HOMES OF MORGANTON/SHAUNLIPFORD (degrees/minutesfseconds)
Address ' 1 9 CARBON CITY RD. Latitude/longitude source:QGPS❑Topographic map
(Street or Route No.) (check box)
MORGANTON, NC 28655 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(._82.8)- 438-0771
Area code- Phone number
4. DATE DRILLED 04-17-03
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated attor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type HTH TABS Amount 46
12. CASING: Wall Thickness
Depth Diarup,er or Weight/Ft. Material
From 0 To 140 FL 6-4 GALV. STEEL
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. GROUT POURED
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
Diameter Slot Size Material
in. in.
in. in.
Size Material
From To Ft.
From To Ft.
16. REMARKS.
CONSTRUCTION ST
BY t 'RTt i
THIS WELL WAS CONSTRU
5, AND THAT A COPY OF
era
SIGNATURE OF PERSON CON
C
Ss
14
LOCATION SKETCH
Show direction and distance in miles from al ieasto
two State Roads or County Roads. Include the roaW
numbers and common road names.
ca
z
2
IN ACCORDANCE WITH 15A NCAC 2C, WELL
ORD HAS BEEN PROVIDED TO THE WELL OWNER
dT1NG THE WELL
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASHaylf*¢ >�5'g'p °hht a *ldtho) 71 L3221, within 30 days. GW-1 REV. 07/2001
GF60.1btb(t'tErotititiidDlto the

WELL CONSTRUCTION RECORD
North Carolina - Depariment of Environment and Natural Resources - Division"of. Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3'e rDm2 W, eraLi.62 CERTIFICATION# 3637
ELL CON'IRAcroit COMPANY NAME Yadkin Well Company Inc. PHONE # (33{-468-4440
SFATE \VELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
270937,1 04;
ev
I. 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: I en4 J- County/
(Street Name. Numbers, Cbrnmunity, Subdivision, Lot No., Zip Code)
3. OWNER: V lJ+.t /22sort_
Address 3/'? /O`//n4Uj i r
( treet or Route No.) r/
L ',. in- 10 ✓' P-tc a 8 G 9 4-
City or Town State Zip Code
( )-7s9- yirr
Arca code- Phone number /
5. TOTAL DEPTH: 3 g• / en, — /D a ' G/'et.f C G.ty. rH-rS . /6_ ,1 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D
7. STATIC WATER LEVEL Below Top of Casing: /00 t FT.
DATE DRILLED �
Topographic/Land setting3
❑Ridge pSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(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): t#C7 METHOD OF TEST air pump
10. WATER ZONES (depth): (3tz.5 `.a°GAM) / 301906pp1)
I I. DISINFECTION: Type
12. CASING:
From 4
From
From
i 3. GROUT: Depth Material "-�/ Methelqd
From C7 To a I Ft. S4rrd¢ e<gstaT .,.,�d-
From To Ft. r-ic
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.
HTH Amount I //q Cups
Depth Diameter
To 5° Ft. e, I?.-S
To Ft.
To Ft.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To
—
Formation D cripti on
/�
-7i.' feroc. n Ho: A c �i.--.n"r� c.
O`
Soil osac (4 s
Ro G�cn.'i .c /�ti✓d
/t
'c
Bit Ser. # Size off
21sh1-Iso 4.o•I�
LOCATION SKETCH
Show direction and distance in miles from at least -
Wall Thickness two State Roads or County Roads. Include th9oad;.-;
or Weight/Ft. Material numbers and common road names.
77.
From To Ft.
16. REMARKS:
Material
et6Yt(
I DO HERE CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D_ SAND THAT A COOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c —4 -C-- ?-11-03
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
j II /
' Su Milih the�btrgiaGOBo theiDi ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (911 733-3 21, within 30 days. GW-1 REV. 07/2001
path Site Visiked.r3-� By VQ Permit Yes/No
//4

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030270
276933
WELL CONTRACTOR flowery Wr ght Wall Pump Co Inc
WELL CONTRACTOR CERTIFICATION it 2681
STATE WELL CONSTRUCTION PERMIT# Rtpve petty
1. WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection
IMunicipal I I Industrial In Agricultural I I Monitoring I I
Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOkQ County CALDWELL
cRAIDAW Qf€rk+MmgWQH,vQErEMPkW. 'ND RD OFF
3. OWNER RUSSE I r,a TANNER
Address 103 FAIRgeeP{nIQ cca
y Or l o
4. DATE DRILLED BIIO/700R
5. TOTAL DEPTH 9115
6. CUTTINGS COLLECTED YES I I NO Lid
7. DOES WELL REPLACE EXISTING WELL? YES I I NO I. xi
8. STATIC WATER LEVEL Below Top of Casing: "10 FT
(Use 'W' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST AIR
DRILLING LOG
From To
DEPTH
Formation Description
0 25 DIRT
/5 120 GRANITE
120 122 S' AI E
192 180 GRANITE
180 182 5HALP
182 2f15 _rPANITp
11. WATER ZONES (depth)• nnm 1211_122 If) npm 1P,f1-1R9
f1 nnm 0 nnrn
12. CHLORINATION: Type HTH Amount :in
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From a To __ID Ft 6 ire 1.50 P1"C
From To Ft
From To Ft
14. GROUT:
From
From
15. SCREEN
Depth Material Method
I1 To 2n Ft Cement Gravity Flow
To Ft
Depth Diameter Slot Size
From To Ft. in in
From To Ft in. in.
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
Material
Size Material
17. REMARKS- r "l r,
I DO HEREBY CERTIFY THpj_TH $ WELL-WA$CONSTRUCT DII I
CONSTRUCTION STANDARDS; AND THAT A COPY OF THE RE!r.
FOR OFFICE USE ONLY I
Quad No
If additional space is needed use bac=6f form
LOCATION SKETCH r `2
(Show direction and distance from at leaast2twotate
Roads, or other map reference points)
ACCORDANCE WITH 15A NCAC 2C, WELL
ORD HAS BEEN PROVIDED TO THE WELL OWNER.
�-/7 -03
Serial No
SIGNATURE OF F
066mif original toDivision of V
ERSON CONSTRUCTING THE WECL DATE
Vater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
276923
WELL CONTRACTOR. (Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2681
030264 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
I>d
Municipal fl Industrial E
Other If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 1 PMOIR County CAI f)WFI I
Co' kip-rreyll �F it OFF H Qf1 OFp sPT7FP CREEK
woad ame and urn ers, ommunity, or )vision and t o.i
3. OWNER fa4APIQN L HQt ISTON
Address PO BOY 00
veet'or Route No.)
rniI slinIF N
City or Town State
4. DATE DRILLED 9/Q/711rn
5. TOTAL DEPTH 675
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 3f1 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm) 2 METHOD OF TEST Air
11. WATER ZONES (depth)' 1 qpm 230-232 1 ppm 510-511
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 98
�2p ode
AgriculturalI I Monitoring
DRILLING LOG
From
DEPTH
To Formation Description
0 180 JTIPT
Ian "10 fPAMITF
'J'9D 737 SHAI F
o?? Sin GP4NITF
Sin 911 SHAI F
911 979 f;PANITF
13. CASING:
11a
I xl
Wall Thickness
Depth Diameter or Weight/Ft. Material
From ft To 1R.Ft fi 1RR 7,9f1 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 2f1 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD.
FOR OFFICE USE ONLY
Quad No'
Size Material
C,J
L
1fs
—
113
If additional space is needed use baglkyf form:H
r
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Q 2,3:u> 1
IvJ
W
ELL WAS CONSTRUCTEt7 N�AbCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS ♦2EPORD HAS BEEN PROVIDED TO THE WELL OWNER.
II l
il.
I SIGNATURE qF PER
GSt 1aPtit'driglraat to;Diviision of Wet
�qo
%-/7_03
ON CONSTRUCTING THE WELL DATE
r Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES FI NO I XI
8. STATIC WATER LEVEL Below Top of Casing: 111 FT
(Use'." if Above Top of Casing)
CASING
9 op TOP casing OF terminated att//or below land surface requires Land riiance Surface*
with 15A NCAC 2C.0116
10. YIELD (gpm)• 2 METHOD OF TEST Air
11. WATER ZONES (depth): 5 nom RR-99 1 5 aorn 703-71I4
n nom 0 oom
12. CHLORINATION: Type HTH Amount 44
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 5RFt R VP 35n PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 2n Ft CemRnt Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030290 STATE WELL CONSTRUCTION PERMIT#: Lpslie Reece
1. WELL USE (Check Applicable Box): Residential I ,.xJ' Municipal 0 Industrial Agricultural n Monitoring
Recovery 0 Heat Pump Water Injection l I Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LrnIOlp County: CALDWEI L
k(1�TRFI I HII I RC(-1 (1FF 7Gl^K FQR ply (1FF NEWAY CI
oa Name and Num ers, ommunity. or ub i iswn and of o
3. OWNER H4R(1I F) W HFI TOM
Address 1217 (1OTTRFI I HII I Pr)
I FNOI R (Street or Route No.) '
City or Town State NIr
4. DATE DRILLED 6/1W2M3
5. TOTAL DEPTH 775
DRILLING LOG
From To
n Sd
DEPTH
Formation Description
DIRT
5d RR GR4NITP
RR RP C21 JART7
Ra 7nS GRANITF
7n'z ?na Oh lART7
To
17. REMARKS' I I Li1j j
I DO HEREBY CERTIF if THIS WELL WAS CONSThU
CONSTRUCTION STrNii) DS, AND THAT A COPY OFIT
IA
276891
WELL CONTRACTOR' Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
FOR OFFICE USE ON
I I
GRANITF
Ct
I
Ca
_r
tN
ta 1
If additional space is needed use back cc{.forrrr -
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RFyCORD HAS BEEN PROVIDED TO THE WELL OWNER.
7-1S-D 3
Quad No:
Serial No
S)
SubmilbngibettoDivis
OFRSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 781 01
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]_
WELL CONSTRUCTION RECORD
030322
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
STATE WELL CONSTRUCTION PERMIT#• Steve Pefty
WELL USE (Check Applicable Box): Residential Lad Municipal 0 Industrial n Agricultural Monitoring El
Recovery 0 Heat Pump Water Injection I I Other 0 If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RI OWING ROCK County. ('Al f1WFl I
OFF HFADWATFRS RD nFROI tn< �2f)OPP HWY 321
I Road Name and Numbers, Community, or Subdivision and t o.
3. OWNER CHRIS MANNING
Address
% RIG SKY CONST PO PDX 308d
ity or own State Zip ode
4. DATE DRILLED 7/11/2003
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing 20 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depth)• 1 ppm 115-116 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 78
4
DRILLING LOG DEPTH
From To Formation Description
(1 R5 DIRT
35 115 GRANITE
115 118 SIHAI E
116 405 GRANITE
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 4(1 Ft II 1/R 35(1 PVC Roads, or other map reference pointsl._ -,A
From To Ft ( 31 o _ \ nc
From To Ft 1/ Y
14. GROUT:
Depth Material Method
From - 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS• - iSMa`pp05Q-'
Lr
° CM
//
orb' A
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
ge-
SIGNATURE OF PERSON CONSTRUCTING THE WEL DATE
Submit original to Division of Water Quality, Groundwater Section ithin 30 days
- O
Quad No
Serial No
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030308
278106
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2878
STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential I )d Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town I FNOIR County. f AI fWFI I
nl fl Name andS'. RIVER RfYty o j-1 FF HthN OD
(Road and umbers, Community, or ubdrvision and of 1
3. OWNER KFI IYR SPENCER I CONNIE SPENCER
Address PO ROX 27Q2
I FNOI R (Street or Route No.) NC' 7q(jQFi
City or Town State Lip Z;ode
4. DATE DRILLED 7/1/7f1n4
5. TOTAL DEPTH 4f1F
6. CUTTINGS COLLECTED YES P1 NO
7. DOES WELL REPLACE EXISTING WELL? YES ri NO
8. STATIC WATER LEVEL Below Top of Casing: 1n FT
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 2 METHOD OF TEST Air
11. WATER ZONES (depth): .50 ppm215-216 .50 ppm 265-266
1 ppm 280-281 0 ppm
12. CHLORINATION: Type HTH Amount 58
Agricultural0 Monitoring 0
DRILLING LOG
From To
O in
DEPTH
Formation Description
flIRT
10 71.5 GRANITE
215 211:1 GRANITE
716 7RF GRANITE
7fi5 768 _GPANITF
2198 28n , GPANITF
7Rn ?Al _ SPANITF
13. CASING:
I)4
xl
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21Ft 81/4 188 GALV v:
From To Ft UPC
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement GravityFlow
From To Ft CEMENT GRAVITY Fl OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If additional spat a is nee(ded Nkeibaah of $ tr
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
se-tz. 0 ¢,2K o
C- C)
17. REMARKS' )
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC S C 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 original to Division of Water Quality, Groundwater Section within 30 days
OW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
f
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
291U�
WELL CONSTRUCTION RECORD
030338
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2878
STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential
Recovery fl Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I ENOIR
OFF RICHI AND RD OFF HWY R71
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DANNY R STARNFS / Al MA RTARNER
Address 8283 RICHLAND RD
LENOIR (Street or Route No.)
City or Town State
NC
4. DATE DRILLED 7/23/2003
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES NO Trd
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use '4' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 10 METHOD OF TEST Air
11. WATER ZONES (depth): ppm 210-211 4 gpm 250-251
5 ppm 290-291 0 ppm
12. CHLORINATION: Type HTH Amount 58
7R645
Zip ode
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 124 Ft 8 1/4 188 GAI V
From To Ft
From To Ft
14. GROUT:
Municipal D Industrial Agricultural El Monitoring D
Other 0 If Other, List Use
I
County. CAI DWFI
DRILLING LOG
From To
fl 11A
DEPTH
Formation Description
DIRT
1111 Tin GRANITE
210 211 GRANITE
211 250 GRANITE
250 251 QUARTZ
251 290 GRANITE
790 291 QUARTZ
291 305 GRANITE
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY FLOW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, 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 original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
If additional space s n { ckinafThgi
SHEViLRLC D UbhlLh
LOCATION SKETCHLE
(Show direction and distance from at least two State
Roads, or other map reference points)=
0
fD
FOR OFFICE USE ONLY
Quad No
Serial No. --

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
273109
WELL CONSTRUCTION RECORD
030305
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2878
STATE WELL CONSTRUCTION PERMIT/S. Steve Price
1. WELL USE (Check Applicable Box): Residential X Municipal 0 Industrial
Recovery Heat Pump Water Injection 0 Other E If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• I FNOIR County CAI flWFl I
Ilf1NAHl1F PI Af F CFF I AYTfWN Rn OFF HWY 968 OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER POPFRT A RPIf /! HFRYI RFIII
Address 7771 flONAHIIP PI A(Street or Ploute CE
City or TOWFNOIR n State NC
4. DATE DRILLED 7/21/70n3
5. TOTAL DEPTH 4n5
6. CUTTINGS COLLECTED YES fl NO
7. DOES WELL REPLACE EXISTING WELL? YES I —I NO IT
8. STATIC WATER LEVEL Below Top of Casing: 7n FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 3 METHOD OF TEST Air
11. WATER ZONES (depth)• .5 ppm 130-131 .5 ppm 170-171
2 ppm 380-382 0 ppm
7ZipCode
12. CHLORINATION: Type HTH
Amount 78
I I
Agricultural E Monitoring 0
DRILLING LOG DEPTH
From To Formation Description
fl 77 IIIRT
79 13f1 GRANITE
1sn 131 Ol1ART7
1Z1 17n GRANITE
17(1 171 011ART7
171 3Rn GRANITE
RRn 3R7 Ol1ART7
3R7 4n5 GRANITE
rA-
If additional space
r
J L'
is nee
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 78 Ft 8/4 188 GALV Roads, or other map reference points)
From To Ft ,no'/
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO 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 original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
4
O-�yy
w
G7
tV
17.
0 ¶2
fN
CJ1
Riw2r51cAc Qd
bonethug, FL.
FOR OFFICE USE ONLY
Quad No
G - D /
Z
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
278925
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2878
030368 STATE WELL CONSTRUCTION PERMIT#' Steve Price
C1
1. WELL USE (Check Applicable Box): Residential I X1 Municipal n Industrial I I Agricultural I I Ing
Recovery I I Heat Pump Water Injection Other CI If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County: CALDWFLL
HWY 00 OFF ANTHONY CR OFF JOHNS RIVER/GI OBE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER DAVID G FLINT
Address PO BOX 100
(`RANIT�rgilS`uteNo.) Nf'
ode
City or Town State Zip ode
4. DATE DRILLED 8/26/2003
5. TOTAL DEPTH 775
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO En
IA
8. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 1 METHOD OF TEST Air
11. WATER ZONES (depth):1 gpm 170-171 0 gpm
0 am 0 op
12. CHLORINATION: Type HTH Amount 43
DRILLING LOG D'l PTA
From To Formatio Description
n 7n DIRT ROC
70 17n GRANITE ��--
17n 171 QUARTZ
171 725 GRANITE
o
W
IF v
r-r r "'
Cm
�<
— re -Fro
If additional space is needed use bacISf foi:11;r,
tV C)c'1
13. CASING: LOCATION SKETCH — —i
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at leas two-2tate
From 0 To 26 Ft 6 1/4 .186 GALV �� Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO 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 �u 9 -t/ c2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
GW-1 REV. 12/99
Serial No

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
[ 2- WELL CONTRACTOR (INDIVIDUAL) NAME (print) / e/ I./ -RU- SS t//
WELL CONTRACTOR COMPANY NAME /
mussell /4JPl1 7irr 11
CERTIFICATION # oPa.3/
PHONE # f0 la JS.2-3/O £9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential lirMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Street Nuntt, Numbers, Community, Subdiivvision, Lot NM4Zip Code)
3. OWNER: k'1
Address /523—R %7)eth—f 1u%2P-n t�t�l
(Street or Route No.)
2. WELL LOCATION: •
Nearest Town: County
71a agL5,3R
City or Town State Zip Code
S.-4- 7 Q 6r 1 z/ /S
Area code- Phone number m /
4. DATE DRILLED r} -' /4 — C
5. TOTAL DEPTH: S S e
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1le7
7. STATIC WATER LEVEL Below Top of Casing: 6— FT.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / i- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .01I8.
9. YIELD (gpm): / O METHOD OF TEST accizi
10. WATER ZONES (depth): LA ?$
11 . DISINFECTION: Type T Fl
12. CASING:
Depth Diameter
From_ To_ 3 to Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (0 To ,i D FL /C✓y.aQ-u..P
From To Ft.
Amount / C wpI
Wall Thickness
or Weight/Ft. NI terial
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
277901
Topographic/Land setting
❑Ridge ❑Slope RValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C 3la Glt'a 1
31c' a 3s
Method
O A�u�l ta4'
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name . ,,,J �,
{
•
\_4a
J
0
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
S(1GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Il
Submit the original to the Division of WaterQuality, Groundwater Section, 1636 Mail Service Center Raleigh, NC I
i(
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001'

WELL CONSTRUCTION RECORD
277410
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a I7 d e Ru...55 t i l CERTIFICATION # pp
WELL CONTRACTORCOMPANY NAME I-.55 ell (A1 el Dr Ill itsI.MC PHONE # (R(RRip�.�-3&8g
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERT\IIT#
(if applicable)
1
WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: � p
Nearest Town: ,etn tA) County latitamil.(..„
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Li�j;�?J�- - �— L �%
Address p S/o l 0 Ri u.r f:- efrito • KGL
(Street or Route No.)
r1�%,�Avu (II C olXtiS-S
City or Town State Zip Code
(942)- 7 7 ®-a 8KD
Area code- Phone number
4. DATE DRILLED d] - - Q 3
5. TOTAL DEPTH: R 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Wt"
7. STATIC WATER LEVEL Below Top of Casing: Ai b' FT.
l (Use"+" if Above Top of Casing)
8. TOP OF CASING IS 1 2. FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance wick 15A NCAC 2C .0118.
9. YIELD (gpm): 3 D METHOD OF TEST aM )
10. WATER ZONES (depth): g 5'
11
2
DISINFECTION: Type
CASING:
From 0
From To
From To
13. GROUT: Depth �.
From I) To 02 Q Ft. ""
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
PVC
/4 T k Amount t/3 air)
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 4 C Ft.
Ft.
Ft.
Material Method
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topograpphic/Land setting
DRidge Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
v w�
45 ' RS'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers . r common road names
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
Cp &r44_40ic
SIGNATURE OF PERSOI
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
L
1-,31- 03
STRU IINIG;TI ic. 11‘1.ELE[ , � \II DATE
I �'
hdwater Section, 1636 Mail Seattce Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalnnResources - Division of Water Quality - Groundwater Section s
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (- I yd-e__ R.., 5 e. 4/ CERTIFICATION # .�r„73 /
MM WELL CONTRACTOR COMPANY NAME IA_ 5 �
5 e I I tdd e_I VI # 1 I I t ry ` PIr PHONE (/toca 22 - e?
STATE WELL CONSTRUCTION PERMIT/4ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
277407
1. WELL USE (Check Applicable Box): Residential IbYMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town: r�
`a--vmisi,t_
(Street Name, umb s, Community, Sr division, Lot No., Zip Code)
3. OWNER:
Address
�i�ri�rL�U m0a
/'F 1 G1 /.41.-ICX22/ CwI�
(Street or Route No.) (,
Yl.�.t2 TI r, G �%<J
City or Town State Zip Code
( )- .72-0 p-k-O->tiR—
Area code- Phone number
4. DATE DRILLED '7 - / ee - D 3
5. TOTAL DEPTFI: 62. 2 r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ITV
7. STATIC WATER LEVEL Below Top of Casing: CIO FT.
I (Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with t5A NCAC 2C .0118.
9. YIELD (gpm): Lb METHOD OF TEST a -
10. WATER ZONES (depth): .4 caS r
I1. DISINFECTION: Type
12. CASING:
1+TH
Depth ` Diameter
4 From D To l Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To .),0 Ft. Op Zia.
From To Ft. 9
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 3/4 &cp.
Wall Thickness
or Weight/Ft. Material
Pva
Method
16. REMARKS:
//�� Topograan}�hic/Land setting
County (? uJLici-ei❑Ridge fJSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
n V/ rLd
Li
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and co mom road names.
G' D o
co
Sal
U
Cr)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-/e-03
0 SIGNATURE bF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality Grbinndrratn Section, 1636A an Se vice Center -Raleigh, NC
JGW-I REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.
GROURIT:":TATE9 SFC51riN

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e I zi RIL53 et I CERTIFICATION tt '="1-'aS/ p
WELL CONTRACTOR COMPANY NAME LASS e-L( (i et t Dhi))' h5,,L, NC PHONE #IIy�AoW f&3a- be??
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
277406
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential CWY Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION.
Nearest Town: en.e.Lrn)
°' �'
(Street N r N nbers, Comm u y, Subdivision, Lot No., Zip Code)
Countyj.LGJ,t.A.r»-t
Topographic/Land setting
❑Ridge DSlope ❑Valleyt
(check appropriate box)
Latitude/longitude of well location
3. OWNER: •Z'/,P�..&_-1 6-. sC. (degrees/minutes/seconds)
Latitude/longitude source:DGPSCDTopographic map
(check box)
DRILLING LOG
Formatio Description
Address 4 Cei-u-Q.t1LiL- 1t -,ry &/L4'.t/
(Street or Route No.)
City or own State
h a
Zip Code
Area code- Phone number
4. DATE DRILLED `/ - /(o - 6 3
5. TOTAL DEPTH: «? 6)-.5 t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO kr.
7. STATIC WATER LEVEL Below Top of Casing: fp D FT.
i (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): (0___ METHOD OF TEST Lam)
I0. WATER ZONES (depth): _3 6S z
DEPTH
From To r
o /a41
4,24 .3 eoS
11. DISINFECTION: Type I-)- T H Amount / 3 C.r.yo
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To /a4- Ft. IPUL'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To �0 Ft. GYLL2wf e—
From To Ft. Q/
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles fromm.'at IekSt
two State Roads or County Roads. lncluc he maat,
numbers and common road names. 0
�atczte�. 1Jg
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
Li SIGNATUREF PERSON CCITDSI[7RUCTINb TFPE WEEE
Submit the original to the Division of Water Quality, C oprMlvater Section, 1636 Mail S rvi
27699-1636 Phone No. [phone], within 30 days. -J L
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001
cECTI0N
J_ OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh,N.C. 27626-0578-Phone [phone]
270866
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #• AA 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the,location below) Nearest Town:, pP�'�9-ri'✓ _ County:
u SAL �h.e i-l: rn
(Road, Comm pity, or Subdivisio and Lot No.)
3. OWNER 7/4./1.24.rv��2rt
ADDRESS /2 3 3 s/I�GLi tp�Ct.yCX�
(Street or Route No.)
ity or Town State Zip Code
4. DATE DRILLED I— /- U 3
5. TOTAL DEPTH 30_� '
6. CUTTINGS COLLECTED YES n NORR
7. DOES WELL REPLACE EXISTING WELL? YES NOr
8. STATIC WATER LEVEL Below Top of Casing: / D p FT.
) (use "+" if Above Top of Casing)
9. TOP OF CASING IS / .2 FT. Above Land Surface'
* Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): S t METHOD OF TEST &&J
11. WATER ZONES (depth): .3o.c z
DEPTH DRILLING LOG
From To Formation Description
0 4'2 G�cit
37' ,3L.7 ' laic
12. CHLORINATION: Type 1 / r f
13. CASING:
Depth
From 0 To —
From To
From To
14. GROUT:
Ft
Ft
Ft
CD
co
n1
Cr'
Amount / G-r-P% If additional space is needed use back o
m en
—
LOCATION SKETCH Iv —
Wall Thickness
--Ic�
Diameter or Weight/Ft. Ma(Show (Show direction and distance from at least two State
Roads, or otFpr map reference points)
Depth Material Method
From CD To .10 Ft r cL fLd)-uitL.Q
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFfY THAT THI$ WELL WAS COOST
CONSTRUCTION STAjNOARDS, AND THAT A CaPI'-13g
114.1241
733
—7 /
CD o
W
rn
ww
0
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/-03
SIGi4 RE OF CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

WELL CONSTRUCTION RECORD
North Carolina - Depar(ment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3-Cr'ti/we fT CERTIFICATION N. 303j�
vVEL.L CONTRACTOR COMPANY NAME Yadkin Well Cailpany Inc. PHONE # (33k-468-4440
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential
Monitoring ❑ Recovery ❑ Heat Pump Water
2. WELL LOCATION:
Nearest Town:
oe County
74 0a 1 Pliny r kr�,
Name, Ne, Numbers, Commumt Subdivisnh, Lot No., Zip
3. OWNER:
Address
270942
"Munlctpaal/Public ❑ Industrial ❑ Agricultural ❑
njection ❑ Other ❑ If Other, List Use
tet.4.64,c es
Code)
e /36 v l.sf l et rw rr-r l
e/lbw S� s' 14+ r
(Street or Route No.) LJ
aoova.cr -klf
City or Town State Zip Code
( )- VI-1'996 w�2r "5"7—lpcloa
Area code- P one number e.
4. DATE DRILLED OV3/ Di
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO,
7. STATIC WATER LEVEL Below Top of Casing: _ . , FT.
(Use "+" it 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
WATER
SO M(T_ , St64"(a5c TEST air OP9�
mp
10. WATER ZONES (depth): �j,y i�
aga'
II. DISINFECTION: Type �1
12. CASING:
From 0
From
From
Depth iameter
To Ka. Ft. �.aS
To Ft.
To Ft.
Topographic/Lnd setting r 6O/
❑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 Des iption
Soil :N kb, A
1 35
33' G-t,, I-fav
— a�a'
It /f
Bit Ser, i{ Size off
599 811.. Sisvv
LOCATION SKETCH
Amount / CUPS 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,
'15' ba/adoo2ca
13. GROUT: Depth Materi I Methoii
From 0 To Ft. LI/erer< jY«e/C
From To Ft. POu.rtcc
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
Slot Size Material
in.
in.
From
'MARKS:
I DO HMIRBY.�R
CONSTRUCT
Size
Material
/Uol&W5pt% 1
/t
(7).
rpig tr./
I y�;wG CC„de,
op
41 ! cQr.' 'e
=QS
v h
Wltd< irrek -t-t
THAT'" I WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AR , T D THAT A fPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL WNER
- ^ SI MATURE 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
ti��

269376
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: GRANITE FALLS County CALDWELL
LIBERTY RD.
(Street Name, Numbers, Community, Subdivision, Lot No
3. OWNER: ROBERT WILSON
Address 5532 LIBERTY RD.
(Street or Route No.)
GRANITE FALLS NC 28630
City or Town State Zip Code
(828) - 728-7360
Area Code Phone number
4. DATE DRILLED 02/03/03
5. TOTAL DEPTH: 67
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 47 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): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 67 Ft.
From _ To _ Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
Zip Code)
CHLORYTE Amount 9:2
Wall Thickness
Diameter or Weight/Ft. Material
24" CEMENT
Material
CEMENT
Method
POURED
14.SCREEN: Depth Diameter Slot Size
From To Ft. in. _
From _ To _ Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From 47 To 67 Ft. 78M
From _ To _ Ft.
16. REMARKS:
Material
GRAVEL
Material
Topographic/Land setting
❑ Ridge ❑ Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORD COLLEGE GO NORTH
ON MALCOLM BLVD. STRAIGHT ON CONNELY
SPRINGS RD. WHEN YOU CROSS INTO
CALDWELL COUNTY. AFTER CROSSING
CATAWBA RIVER TAKE 1ST RIGHT ON DRY
POND RD. GO APPROX. 1-1/2 MILE. RIGHT ON
LIBERTY RD. BRICK HOUSE APPROX. 3/4 MILE
ON LEFT.
m
ci
0
c
Ti
1DOHEREBYC$RT3
(QNSTUCTION S Fe
Submit the original to;the Div
27699-1636.Phone No.(9I9 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
4 PER NSTRUCTING THE WELL DATE
c1
TURF FP
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

279700
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturaln�Resourcesrce- Division/of Water Quality - Groundwater Section
i.-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l VQ t ' \ t tsse I/ CERTIFICATION # 02a3 I
^LL55�11 te)e-t 113r, I I ; NS 4-Nc PHONE # 633. 6,36',S2
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lEY Municipal/Public 0 Industrial 0 Agricultural LJn ^ r_ E---'t
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use CNi
2. WELL LOCATIr'N&(N
�P) emu/ County
Numb>5u55
Nearest Town:
(Street Name,ommunity,
vision, Lot No., Zip Code)
7. OWNER: 7\GLef�«v 1geelli
Address / 2 D .t.$) ' r2 t, 8
Zip Code
(8 8)- 75 '- D9Dlc
City or Town State
Area code- Phone number
4. DATE DRILLED Li- I9- 03
5. TOTAL DEPTH: 01,o2S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lie"
7. STATIC WATER LEVEL Below Top of Casing: SI') 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): .-20 METHOD OF TEST Ct-
10. WATER ZONES (depth): ,,2 02.5 '
1 I. DISINFECTION: Type }-F%(-'t
12. CASING:
Depth
From D To 9 ¥ Ft.
From To Ft.
From To Ft.
GROUT: Depth
From 0 To Ft.
13
14
15
Diameter
Material
)/Ld&-c
Amount -V3 (;Ala/
Wall Thickness
or Weight/Ft. Material
Pi'c
From To Ft.
Method
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK: '
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topograpphie/Land settirk>�
❑Ridge QSlope ❑Valley 'Tln
(check appropriate box) !
Latitude/longitude of well locitigri:
0
_'i 0
(degrees/minutes/seconds) -
Latitude/longitude source:❑GPS❑Topbritc map
(check box) 11
DRILL NG LOG
Forman n
DEPTH
From To
O 94L dist
Q'f ' ol 25' b y-c-K
LOCATION SKETCH
Show direction and distance in miles frointti least
two State Roads or County Roads. Ic71udegte road
numbers and c mon road narrles. W 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, \VELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT RE OF PERSON CONSTRUCTING THE WELL DATE
CS -a
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

279698
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0_I fie 1L S se I I CERTIFICATION # cc23
/
/ PHONE # g1
WELL CONTRACTOR COMPANY NAME<I/6 Se'iI Gt)e-tI Dr; IIl ns _LNG
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential lP Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: County
71
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S /-/� YYt a4r-4,3
Address PD Rv,GSD3
(Street or Route No.)
-770 09f7bYs
City or Town State Zip Code
( )- 7s7— 93a 7
Area code- Phone number
4. DATE DRILLED ^ /a- 03
5. TOTAL DEPTH: ,,,244.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ad.
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 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): rD METHOD OF TEST act,
10. WATER ZONES (depth): 44 5-
11. DISINFECTION: Type /-Pri-I Amount 3A/ v p
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C To IDQ Ft. P VOA.
From To Ft.
From To Ft.
13. GROUT: Depth Material, Method
From D To cZ0___Ft. pt3c4.et1L-
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
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting -
❑Ridge I3Slope :Walley OF at
(check appropriate box)
Latitude/longitude of well locatio__,,,
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr
(check box)
DRILLTN
ForJrtati,on De
DEPTH
From To
its-ck
J CD
t
fV
Q
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers a a common rind names
(6 r-eK
O
G)
t/)
m
-a
0
D
cam_
rn
mac,
e
Cr']
a-
Da
rn
m�
cn;
toco
C)s
—1
ti
O
l5 u3
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
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
q- /'7-03
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] 280250
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION it. 2878
010318 STATE WELL CONSTRUCTION PERMIT#• Steve Price
WELL USE (Check Applicable Box): Residential XI Municipal E Industrial E
Recovery E Heat Pump Water Injection I Other 0 If Other, List Use: - r.-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: L EMOIR County: a-- nwFtt
l�i 7Na%Q areun, erg, RwctyR,FRbpD OFfi0WN RIOR RD OF
3. OWNER MANNING W PUFTTE
DRILLING LOG
From
Address d Rf11 FRLJITVA�Fte o. #N18F
treet or ou
RAKFRR IRI rl CA 94�11t8de
City or Town State p o
4. DATE DRILLED 0/limns
5. TOTAL DEPTH 2f19
6. CUTTINGS COLLECTED YES D NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing 7n FT.
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011E
10. YIELD (gpm): 12 METHOD OF TEST Air
11. WATER ZONES (depth): 1.00 nom 120-121
10.00 apm 190-191
12. CHLORINATION: Type HTH
13. CASING:
From
From
From
Depth
0 To
To
To
14. GROUT:
RS Ft
Ft
Ft
Diameter
R 1 /R
1
I XI
Agricultural E Monitoring
To
58
DEPTH
Formation Description
DI PT
FB 120 RRANITP
120 121 GRANITE
121 1d5 f+RANITF
1d5 1d8 GRANITE
1dR 1Q0 GRANITE
1An 1A1 GRANITE
11:11 7f16 GRANITE
1.00aom 145-146
0.00gpm
Amount 39
If additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
or Weight/Ft. Material (Show direction and distance from at least two State
ZFO PVCq� Roads, or other map reference points)
Depth Material Method
From D To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft in in
From To Ftin in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
Do
COI ticua(
how
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
0
o`
1,
04tf.l
c
.,SP/Y///)-
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

290834
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE IOC CERTIFICATION N 2343
WELL CONTRACTOR COMPANY NAME H(O<O Y WELL a CD. PHONE #
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
Irma
1. WELL USE (Check Applicable Box): ResidentialEt Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1 ENJI
1120 I tC a1ERRIIL RD.
(Street Name. Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOSEW & DELLEUR
Address ]j.20 10 S ERRHT, RD.
[mart
IIIJIR I28645
City or Town State Zip Code
678 )- 73-103
Area code- Phone number 07-28-03
4. DATE DRILLED
5. TOTAL DEPTH: 545
6. DOES WELL REPLACE EXISTING WELL? YES ExNO ❑
7. STATIC WATER LEVEL Below Top of Casing: IM FT
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011&
9. YIELD (gpm): 20 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
County NATTKE.
11. DISINFECTION: Type RBI TARS
12. CASING:
Depth
From To 0 61
From To
From_ To
13. GROUT: Depth
Fromm To 20
Ft 6reter
Ft.
Ft.
Material
Ft Mali
Amount 93
Wall Thickness
or Weight/Ft Material
CAW. STEEL
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
PCURFT)
calatailaatal
Topographic/Land setting ;
❑Ridge ❑Slope Malley ❑Flat
(cheek appropriate box) Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTII DRILLING LOG
From To Formation Descrjption
Slot Size Material
iL
in.
16. REMARKS:
C
0
E.
ry
C7
3-3
tr —_
3
LOCATION SKETCH tv rCR a:
Show direction and distance in miles fromat teal
two State Roads or County Roads. Includdihe road
numbers and common road names.
C977A-4L �y
ywy, 18
S
'
at
�.�els)' o/, iJEi-6
—a
0
6
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRU
CONSTRUCTION STANDARDS, AND T A COPY OF -
oey
re -
SIGNATURE OF PERSON
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
07-28-03
&ING THE WFII 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
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE
HICKORY WELL
.
WELL CONTRACTOR COMPANY NAME
Resources - Division of Water Quality - Gro
280841
tmdwater Section
IOC CERTIFICATIION # 224.3
M1]J TN3 CO. PHONE it(828 324-0035
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialResidential& 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: IFNI)IR County C UI F'II,
526 M)LEEPRY ST.
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER: JEAN RSLaHURST/RICK HEERICK
Address 526 MIIEEFFY ST.
(Street or Route No)
LFN)IR, NC 28645
City or Town State Zip Cade
( 828)- 759-7123
Area code- Phone number
4. DATE DRILLED 09-26-03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ER
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST BY MR IESI
10. WATER ZONES (depth):
11. DISINFECTION: Type ME TAffi Amount 54
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_0___To 41 FL t WC PLASTIC J From_ To Ft. IV
Wff 0
From To Ft. S'iyjy\ 044G `'
13. GROUT: Depth Material MethodMet �. t`'i '
0 To 20 FL Graff
iiI✓i��/G F
1
Topographic/Land settiipg
DRidge ['Slope ['Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:13GPS0Topngraphic map
(check box) ;
DEPTH DRILLING LOG
From To Formation Description - -
0
C-
t7
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:
la m t
N
fV mom,
Iii-
LOCATION $KETCH -. h
Show direction and distance in miles front mast a;
two State Roads or County Roads. Include the roa
numbers and common road names.
724ytcf--5vI/-2
Gieva//Z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS, AND THAT A (WY OF THISir
ORDANCE WITH l5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCW THE WELL DATE
09-29-Qi
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

Itj Ig l3 T.;n W t. I i
J
I. APR 2 7 2004
r � �,sN
WELL CON `TRITICN`N ,2LORD
2815070�o1
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
atu
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `)'I q e— 1'2t � CERTIFICATION It D.4If
WELL CONTRACTOR COMPANY NAME Yadkin Well Company Inc.
PHONE # f 33)6-468-4440
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) • (( (if applicable)
eI. WELL USE (Check Applicable Box): Residential rMt�cipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Uwe Nearest Town: Levi i V' County Co �y w e //
y/ar 4Y " IQ�
(Street Name, NutlAfhbers, Community, Subdivision,ubLot No., Zip Code)
3. OWNER: -P%oA y %%'>'rf71-LK
Address s23s y4a- F,rr- /21
(Street or Rout No.)
0 tole- he
City or Town State Zip Code
tt2i4- 7 sq — q 0 4140
Area code- Phone number
4. DATE DRILLED/0 -�Y-67
5. TOTAL DEPTH: 16 R.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO,Ifi"
7. STATIC WATER LEVEL Below Top of Casing: yO 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): CI METHOD OF TEST air
10. WATER ZONES (depth): I / i
11. DISINFECTION: Type HTH
12. CASING:
From i- I To , 15 Ft. S .!
From To Ft
From To Ft
13. GROUT: Depth i
h Ft. f0
From 6 To
From To Ft. #'
14. SCREEN: Depth Diameter Slot Size
Ft. in. in.
Ft. in. in.
pump
Topographic/Land setting
❑Ridge j$Slope ❑Valley ❑Flat
(check appropriate box) /1 �'
Latitude/longitude of + I�c n V�
ept of EHNR
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑TAR'aOIi9 n2004
(check '),
ikealNO LOG i :
o Foprlwtion Description '1.•f7q
Sot • -: i ��'' i ice
DEPTH
From
e
jN27
�Isl
Bit ser. # Size off -
.�L�a7 (-I-/9 Co 001 r-)
LOCATION SKETCH o c-+_
Amount ( i Show direction and distance in miles fronrel leaa_Ea�
/� two State Roads or County Roads. Include�ie roadT:
Wall Thickness �--__
Depth iameter or Weight/Ft. Material numbers and common road names.
�./zS OK PVC --
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Material
G�
Size Material ut/aY �1 is .
Ft. "-La rn.30 `,lark
Ft. i�w. f"
awe
to
(
;v
I DO HEREBY CERTIFY T
CONSTRUCTION ST
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
RDS, AND THA AC PY ' F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
..2C/-6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . GW-I REV. 07/2001

I::APR 2 7 2304 wi
L
WELL C014STI '% i3fi'jOE ! D
North Carolina
Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section IJ
CERTIFICATION # ,i
PHONE # [phone]
-
t -'� i^�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3C(r1 V"
WELL CONTRACTOR COMPANY NAME Yadkin Well Company Inc.
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. L USE (Ch k Applicable Box)' Residential ❑ Municipal/Public ❑ Industrial ❑ Agri g`ltur llL
(if applicable)
4111
281490 II�Ia4)
WEL ec
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other [IrOther, List Use
2. WELL LOCATION:
Nearest Town: r Cr�ank County /Q'diy/u, se,
r
4.(Street Name, Numbers, Community,A
Subdivision, Lot No.. Zip Code)
3. OWNER:theta- pfaI � y"' Oqtd el' A/ te/ (degrees/minutes/seconds) Address ���� Latitude/longitude source:❑GPS❑T al$,MpP .ijE,I..Iy
'� A;' �'h �� (check box)
(Street orRteN- DEPTH • DRl if;_9c'11 Office
12SH wn State From To Formation Description
City or Town Zip Code 00 Soil
a0 - 390
Area code- Phone num er !
4. DATE DRILLED ii I /3%U 3
5. TOTAL DEPTH: Sao
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N0
7. STATIC WATER LEVEL Below Top Top
Casing:
FT.
(Use "+" if Above 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 Nth ISA NCAC 2C .0118.
9. YIELD (gpm): 312 METHOD OF TEST air pump
10. WATER ZONES (depth): :Po
os>4
11. DISINFECTION: Type HTH
12. CASING:
Depth Diameter
From +I To_�_ FL
From To Ft.
From To Ft.
Material pMethod
1}. GROUT: Depth 6AN oureci
From__fZ._ To�7 Ft. i`a f
From To Ft. LrrrAcni'
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 EEN PROVIDED TO THE WELL
Topographic/Landsettin., EIV D
❑Ridge *Slope OValley F
(check appropriate bti v. De 3_ of E H N R
Latitude/longitude of we I ocation
R 23 2004
Lr
n 1
Bit ser. # Size offro
2IS(o I- /17 S•9(o5
LOCATION SKETCH
•-0 r' ,
Amount t .yg Show direction and distance in miles from at+least c
Wall Thickness two State Roads or County Roads. Include theoroado-
or Weight/Ft. Material numbers and common road names. is o
SDRal PAC- (ri-0,4mA `i
OWNER
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H ( r3 0
3
CaATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' RREVgh, C01
27699-1636 Phone No. [phone], within 30 days. h jA
f fe

281779
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a- IyG th-i 5 al/ CERTIFICATION���# c.2asi �/
WELL CONTRACTOR COMPANY NAME U55P (I (d eII 4)r. ( PHONE # L2��-_rr�.3.:.1- 3Fp SO
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# 1
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Cd- Municipal/Public ❑ Industrial ❑ Agricultdral ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:A-TiA144.1 County
h b dAt-i, 7rkf"
(Street Name, Numbe/s, Community, Subdivision. Lot No., Zip Code)
(jaa IDLE_
?. OWNER:( 6d.rls. J1 �/.l�rti Address .575-.34
(Street or Route
et No.) r ' p 41
6--
City or Town State Zip Code
(R 8)-'7 5-5 AA-5 8
Area code- Phone number
4. DATE DRILLED / D ;.2 A -. n 3
5. TOTAL DEPTH: 545 '
6. DOES WELL REPLACE EXISTING WELL? YES VX tv'O ❑
7. STATIC WATER LEVEL Below Top of Casing: )00 FT
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS L3 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): _ 4 METHOD OF TEST Grid
10. WATER ZONES (depth): ..7 4f-S
I I. DISINFECTION: Typek-frf Amount 137�
From In To _�C Ft.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Pvc
•
From To Ft.
From To Ft.
13. GROUT: Depth Material
From C To ,QO Ft. L -,
From To Ft. //JJ
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
Topographic/Land s
€idge ❑Slope OVall
(check appropriate bo
Latitude/longitude of wel
(degrees; minutes/seco
Latitude/longitude source.❑GPS
DEPTH
From To
o as`
„,2s' T4 6 '
(check b
DRILLING LOG
Forrmli�"lionn Description
"")
try
O
G
Show direction and distance in miles from at least
two State Roads or County Roads. Include the ma
numbers and common road names.
16. REMARKS:
LOCATION SKETCH c17
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SWNATURE OF PERSON CONSTRUCTING THE WELL
/l-/-D3
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

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
283043
WELL CONTRACTOR: Dewey Wright Well Pump Co Inc
WELL CONTRACTOR CERTIFICATION it: 21378
030547 STATE WELL CONSTRUCTION PERMIT* Steve Price
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
Municipal Industrial I i Agricultural ❑ Monitoring El
Other F If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest TjoWw�n:... . �.�jy County. rh,. D LL
IRoad N rresand ffbers.Lomm�nity, or Subdivision and Lot No.)
3. OWNER KFI I Y n RI ANKFNSHIP
Address PO BOX 11
R�
Ki
t
t or Route No.)
City or Town State
4. DATE DRILLED 1Cll27/2005
5. TOTAL DEPTH 705
NC 92681
I
Zip Code
DRILLING LOG
From To
0 PA
DEPTH
Formation Description
nlRT
Rd 150 GRANITE
150 151 011ART7
151 1R5 GRANITE
1R5 1R7 Q11AR17
6. CUTTINGS COLLECTED YES NO 1R7 705
7. DOES WELL REPLACE EXISTING WELL? YES NO I XI
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 6 METHOD OF TEST Air
11. WATER ZONES (depth): 1 00 aom 150-151 5.00aom 185-167
O,(10 nnm 0 00aam
12. CHLORINATION: Type HTH Amount 30
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 13QFt 81/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
GRANITE
If additional space is needed use bail( .f form
LOCATION SKETCH:;;
CS; ow direction and distance from a leas two eas
Pje
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY FLOW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in. in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft
Size Material
_J
Roads, or other map reference po&rtol
Aril a
Xma
0
C/1
t0
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No•
p
-6� t124�� // -/v - o3
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
283038
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• 2878
030497 STATE WELL CONSTRUCTION PERMIT# Steve Price
1. WELL USE (Check Applicable Box): Residential I Municipal Industrial Agricultural n !Monitoring V --
F
Recovery Heat Pump Water Injection Other I I If Other, List Use: 1 -
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County.Cplp1,
a LO6 Rsfe�FF ElyS r 1d CsU FA 21
3. OWNER C DAIVID RUDISIU
4.
5.
6.
7.
8.
Address 571d NC' HWY 127 SOUTH .
(Street or Route No.)
City or. HICKORY state NC
DATE DRILLED 1f1/7f /7ll4
TOTAL DEPTH A05
CUTTINGS COLLECTED YES
NO LK,
DOES WELL REPLACE EXISTING WELL? YES I I NO
STATIC WATER LEVEL Below Top of Casing 1pt1 FT.
Use "+" if Above Top of Casing/
221p Code
xl
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 20.0118
10. YIELD (gpm)• 4 METHOD OF TEST Air
11. WATER ZONES (depth). 0.50 aom 230-231 0.50aom 340-341
n Ff1 aom 3711-371 2 50aom 390-397
12. CHLORINATION: Type HTH Amount 84
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To R.5 Ft R 1/R 30 PVC f 7
From To Ft 1
From To Ft
DRILLING LOG
From To
0 79
DEPTH
Formation Description
DIRT
79 230 GRANITE
210 231
241 3en
3n0 3n1
341 370
I
J)I IART7
fRANITF I
fll IAPT7
GRANIIF
�70 371 _fl11ARTZ
371 3g0 _ PANITF
'Rp11 4Q2 _S111ART7
4a2 Af15 _GRANITE
)
If additional space is needed use back of form
14. GROUT:
From
From
15. SCREEN:
Depth Material
0 To 20 Ft Cement
To Ft CEMENT
Method
Gravity Flow
GRAVITY Fl OW
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) c
3a.I
Ct1
�3
FOR OFFICE USE ONLY
(Fr'.
-
2
C
U,1
Quad No'
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
283039
WELL CONSTRUCTION RECORD
030549
WELL CONTRACTOR. Davey Wright Well Pump Co Inc
WELL CONTRACTOR CERTIFICATION #• 7R7R
STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
2. WELL LOCATION
Nearest Town:
d
ity or
(Show sketch of the location below)
LENOI R
c-n nl rocrlr nrr onov r.ano
36d Nu a .CTfrdr,iGhM. drSGbtYi�isthfS�Fx
4. DATE DRILLED ann7/, nnz
5.
6.
7.
8.
State
Municipal I I Industrial n
Other 111 If Other, List Use
County. CALDWELL
de
TOTAL DEPTH 405 �J
CUTTINGS COLLECTED YES NO I ?4
DOES WELL REPLACE EXISTING WELL? YES I NO I yl
STATIC WATER LEVEL Below Top of Casing g0 FT.
(Use "+" if Above Top of Casings
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 1 METHOD OF TEST Air
11. WATER ZONES (depth): n 50 nnm 73f1-731 n 5nnnm SPf1 3A1
fl.fln anm n nflpnm
12. CHLORINATION: Type HTH Amount 74
13. CASING:
From
From
From
Depth
n To
To
To
14. GROUT:
From
From
15. SCREEN:
From
From
From
Diameter
BnFt R Ir6
Ft
Ft.
Wall Thickness
or Weight/Ft. Material
3'S0 PVC
Depth Material
n To 7f1 Ft. Cement
To Ft. C'PMFNT
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
From To
From To
Agricultural Monitors g17J,_1
3
DRILLING LOG PEP1H
From To Formation Dgscription
0 85 DIRT
85 230 GRANITE j u c l
238 231
231 300
300 301
301 406
9U R-T;b
I (,
GRANITE I
QUARTZ
CRANITE
If additional space
s needed use back of form
Method
.Gravity Flaw
C-1PAVITY FLOW
Diameter Slot Size Material •m)
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Ft in in
Ft in in
Ft. in in
Ft
Ft
Size Material
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No
Serial No
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
283040
WELL CONSTRUCTION RECORD WELL CONTRACTOR' flewey Wri0ht Well Pump Cn Inc
WELL CONTRACTOR CERTIFICATION #' 7R7R
030562 STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential I Municipal I I Industrial I I Agricultural Monitoring
Recovery 0 Heat Pump Water Injection Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENOIR County CALDWELL
YYFFnE,/cci LIoP d. 268-err YA
OWNER HAROLD G. WOODWARD
Address % BOYD WeQgpyl/rr p 1415 DOUGLAS� LANE
city orTcNOIR state NC 2$rpp4bFBe
4. DATE DRILLED 10/28/2003
5. TOTAL DEPTH 105
6. CUTTINGS COLLECTED YES I I NO x
7. DOES WELL REPLACE EXISTING WELL? YES I I NO I ,XI
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST Air
11. WATER ZONES (depthQll,nn Qnm 1Rn-1R3 n nn OOm
n nn nom n nns[nm
12. CHLORINATION: Type HTH Amount 30
3.
13. CASING: LOCATION SKETCH
DRILLING LOG DEPTH
From To Formation Description
0 60 DIRT, SAND
80 130 GRANITE
130 133 GRANITE
133 165 GRANITE
_r
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To A Ft. B 1/8 250 PVC Roads, or other map reference points) ��
From CL
If additional space is needed use ba,'ck:of torm________J .
1'
(' -7 1
To Ft
14. GROUT:
Depth Material Method
From n To 2n Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY Fl OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
i.
Lad{kin
--- .3. 3 c;t1,
a(c81
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
//—/0—o-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No -
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030540
283042
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION* 2878
STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential n Municipal ❑ Industrial n
Recovery Heat Pump Water Injection I I Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LENnLR
X
I xI
Agricultural ❑ Monitoring ❑
180
DRILLING LOG
From To
0 5
DEPTH
Formation Description
ni PT
55 1FQ GRANITE
1 Fr1 1F1 n11ART7
1F1 9711 RRANITF
970 971 r]IJART7
771 7RR (RANITF
3. OWNER MICHAEI A CARRIKER
Address
107 6AEI Fw Rn
tree[treet orate No.)
LFNOI
City or Town State
NC
4. DATE DRILLED 10/71/70ffl
5. TOTAL DEPTH R05
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 1(10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth). 1.00 qpm 150-151 1.000pm 270-271
3.00 apm 288-289 0.00opm
12. CHLORINATION: Type HTH Amount 43
2Tp`tode
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From f1 To R9 Ft R 1/8 3F11 PVC
From To Ft
From To Ft
14. GROUT:
7RR 2RR OI IART7�
7R9 R05 GRANITF
If additional space is needed use bac
0
m
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft. CEMENT GRAVITY Fl OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
LOCATION SKETCH
(Show direction and distance from at le.tat twe Ct.to
Roads, or other map reference points)
I�
tq
W
0
rv..
' nrL
17. REMARKS' .5
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-a_'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
FOR OFFICE USE ONLY
Quad No'
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030543
2989"9
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2878
STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential E Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I FNOIR
oad Name and Numbe
3. OWNER LARRY D DAY
Address 1508 YADKIN LANE
LENOIR t trees or Route o.l
City or Town State
NC
4. DATE DRILLED 11/4/2003
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES 7 NO n
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" it Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1.5 METHOD OF TEST Air
11. WATER ZONES (depth) 0.50 ppm 230-231 0.50ppm 320-321
0.50 gm 393-394 0.0Oppm
12. CHLORINATION: Type HTH Amount 78
ion and Lot No.)
?ZipC ae
13. CASING:
From
From
From
Depth
0 To
To
To
14. GROUT:
30 Ft
Ft
Ft
Diameter
6 1/8
IA
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material
From 0 To 20 Ft Cement
From To Ft CEMENT
15. SCREEN:
From
From
From
Depth
To
To
To
PRILLING LOG
From To
0 24
DEPTH
Formation Description
DIRT
?4 230 GRANITE
230 231 QUARTZ
231 320 GRANITE
320 321 QUARTZ
321 393 GRANITE
393 384 QUARTZ
384 405 GRANITE°
t9
u
c•c
1 0c
If additional space is needed use bacf fof
Method
Gravity Flow
GRAVITY FLOW
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
`—i
O_
(Show direction and distance from at least two State
Roads, or other map reference points)
its
rV
LOCATION SKETCH
R
a
1
17. REMARKS' 3- fc;, LA.
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"eirtei 3- 11-0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No'
Serial No
GW-1 REV. 12/99

9.SAND/GRAVEL PACK:
Depth
From To
From To
From To
10. DRILLING LOG
From To
0 1;5
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2
S73
1. WELL CONTRACTOR:
STEVE PRIr.E
Well Contractor (Individual Name)
DES;=`- 'WRIGI-;T WELL & PUMP CO., INC
Well Contractor Company Name
STREET ADDRESS p 0 BOX 30'c:
EOONE NC 23607
City or Town State
( 928 )- 2134-2851
Zip Code
Area code - Phone number
2.WELL INFORMATION:
SITE WELL ID #(ir applicenie)
STATE WELL PERMIT #(it appiicabiel
DWO or OTHER PERMIT #(r applicable)
WELL USE (Check Applicable Box): Residential
DATE DRILLED 11; i i.'2 0r!
Water Supply la
❑ PMZI
'CAL 'WELL
TIME COMPLETED AM
3. WELL LOCATION:
CITY: L ENC4 R COUNTY
YADK?".; LANE OFF CHARLIE TRIPLETT RD. OFF q
(Street Name, Numbers, Community, Subdivision, Lot
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat 0 Ridge 0 Other
No., Parcel, Zip Code)
(check appropriate box)
LATITUDE 3
May be in degrees,
minutes, seconds or
ina decimal format
LONGITUDE
Latitude/longitude source: ❑ GPS ❑ Topographic
(location of well must be shown on a USGS
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEJOSEPH L. DOLL
map
topo map and
STREET ADDRESSQ BOX 127
PATTER= _yr t NC: :'8661
City or Town State Zip
(i 28) )- 758-9143
Code
YES ❑ N0>U
FT.
Area code - Phone number
5. WELL DETAILS:
5
a. TOTAL DEPTH: 125
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below Top of Casing: RO
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS FT. Above
Land Surface*
surface may require
.0118
fi;r
' Top of casing terminated at/or below land
a variance in accordance with 15A NCAC 2C
e. YIELD (gpm): 5 METHOD OF TEST
030 539
f. DISINFECTION: Type )411-4 Amount 70
g. WATER ZONES (depth):
From 220-??1 To From , --:3+ To
From 413-417 To From To
From To From To
6.CASING: Thickness/
Depth Diameter Weight Material
From n To 1f:4n Ft. fs 4/7 `RR R/+l V
From To Ft.
From To Ft.
7.GROUT: Depth Material Method
From 0 To Ft.1 orr, r` art -pit,. Fir)..
From To Ft.
From To Ft.Clrment ?•„'iPJ Pocti
8.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Yt. in. in.
From To Ft._-IECEiI.V E D
175 220
Ft. Size MAR 2 ` 1/rd
Ft.
FtAahaville Regional Office
Aquifer Protection
Formation Description
DiRT
GRANITE
220 221 QUARTZ
121 R3
330 3,1
331 415
GRANTEE
QUARTZ
GRANITE
415 d1? QUARTZ
.417 425 GRANITE
11. REMARKS:
1 GPM 22D-221 _ 1 GEM 33O-: 'i -
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.
i t i G' La
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
STEkE PRICE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05