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Home My WebLink AboutGr CY20032. WELL LOCATIN: Nearest Town: H4LLin5//: //N County 0-raliekivi IULt/ror Sec wyers rreruK RA. aS77) (Street Name, Numbers, /Comfnunity. Subdivision, Lot No., Zip Code) 3. OWNER:_J ei-t Come Address /n wet- Sa wyerS Creek /Rd'. PnAtlifrrst////e, A/c, a�s771 City or Town State Zip Code (a5?)- ti7ry—f?aU Area code- Phone number 4. DATE DRILLED /e—/`/-03 5. TOTAL DEPTH: /r.5- 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Est 7. STATIC WATER LEVEL Below Top of Casing: / 6- FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface* 'Top of casing terminated at/or below land surface requires a variance in accordance with 1SA NCAC 2C .0118. 9. YIELD (gpm): IS METHOD OF TEST i r 10. WATER ZONES (depth): 1��/() 11. DISINFECTION: Type if 7771 Amount O . !(P 12. CASING: Wall Thickness Depth Divmeter or Weight/Ft. Material From 0 To 20 Ft. (p ..F 5o)?;1.1 PVG From To Ft. From To Ft. 13. GROUT: Depth From () To 9.0 From To 14. SCREEN: Depth From To From To IS. SAND/GRAVEL PACK WELL CONSTRUCTION RECORD 282462 North Carolina - Department of Environment and Natural R spirces - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7�"CE'r> 14 ya e CERTIFICATION #r260 WELL CONTRACTOR COMPANY NAME 6-r0.116. W1 LtJr>I/ (.rt l/, y)(/ PHONE # f_ 1I7y-51.95 c-t STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use (Street or Rout No.) Material FL Ce enr Ft. Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degreeshninutes'seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description n LOCATION SKET Show direction and distance in m les from ar`I�asr — two State Roads or County Road . Include th 2mad-==J numbers and common road names. ,4'rorm .rrnTersecrion 9,8- e ncl 1 3 aka „9. W Uv 1-I mile 7/rY1 Method Pvmpr'ny Rlight on /000er 5a0-)yerS cre&k Ra Go, o-3 triNe Tyro l e47-6-0 0.) %owell or? Right. Diameter Slot Size Material Ft. in. in. Ft. in. in. Depth Size Material From To Ft. From To Ft. 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O' >1 e .Pery // O Jo-fit-a3 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE CO O 1 Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 274249 From From 16. REMARKS WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) J Ch FR y I-1 YD t= CERTIFICATION a aOS 0 IS If WELL CONTRACTOR COMPANY NAME /dt 4.1•Ndlr. W C.Q.Q. a)fttithM PHONE a STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT? (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use 2. WELL LOCATION: Nearest Towne CyL Vow eix it%L�J rl�` (Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code) 3. OWNER: 11\cz"r--C Address c"i.t')tit She-c-ern-1---) • (Street or Route No.) 12cLII to /2 4l Ik —CY) C �7 7 f County UWn� City or Town State Zip Code ()-474—xC4-3 Area code- Phone number 4. DATE DRILLED 5/aa//aoo 3 5. TOTAL DEPTH: a&'O' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Gil 7. STATIC WATER LEVEL Below Top of Casing: 2 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS ) FT. Above Land Surface' *Top of cuing terminated at/or below land surface requires a variance In accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): / /2 METHOD OF TEST i9 tiU 10. WATER ZONES (depth): %.'7 2 r I I. DISINFECTION: Type )4T/-1 12. CASING: Depth Diameter From O To 3 a Ft 4 79. From To Ft. From To Ft. 13. GROUT: Depth Material From C) To '?..,0 Ft. C.Crnwrt- From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft, in. 15. SAND/GRAVEL PACK: Depth Size To Ft. To Ft. Amount R).Y-9 Wall Thickness or Weight/Ft. Material numbers and common road mates. cD4tI PVC. acL= c ti,Qiyya-te>zeaLar�� • 'zI� / S Ltf (‘I �v„. 6,1�0 Method — 'Ol,Irc� �`2-fin ,� vc7i�Y,t- i�u-�cy�,rt7 ,un�tziu ,t, o.a., ip niiick en veto U // o " YYJzrn)to -±un. -c/. „ 174 Material Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description Slot Size Material in. in. LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road C', C7 CD rnz -4 0 1D #,(EREB CO&TI T �"�) lg. S/TRRCTIO1J ST ND� LPL T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER i Submit the original to e D 27699 1636.P 9) 73 G R G U ". ' 1,",;:'. ASIFFP/FL.F. f PEAS N � CONSTRUCTING THE WELL S j; o 0 DA E ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 3221, within 30 days. GW-1 REV. 07/2001 274250 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources ,,-'rDivision of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (pr int) 3 E F F) . R v MM T b C CERTIFICATION ADS. 0 WELL CONTRACTOR COMPANY NAME STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) Lt no 'r-h to at DkA,F_Gr''j' PRONE # (2SSr/- I. WELL Inc. (Check Applicable Box): Residential li?/ Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 2. WELL LOCATION: yC Nearest lTown: SoGETtin LLR.e County ilaitt� yLj-cicca (9,-Le-rock- .age% a 7_ (Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code) 3 OWNER:f. �%uv Address `%ageea 13n'vrte•�-„ (Street m Route No.) tatmanA City or Town State Zip Code (S2:8)-r{'74-ss27 o Area code- Phone number 4. DATE DRILLED 5,0,..C/20 0 3 5. TOTAL DEPTH: SOS 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El 7. STATIC WATER LEVEL Below Top of Casing: (c.O FT. (Uu "+" if Above Top of Casing) 8. TOP OF CASING 1S ) FT. Above Land Surface' 'Top of casing terminated at/or below land surface requires a variance In accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): 6 METHOD OF TEST ;A ^ti 10. WATER ZONES (depth): 4 95 1I. DISINFECTION: Type it%N Amount 0, to 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From O To I-3 Q Ft. G•?Lk <DR 2.t Pv oZ87o2- From To Ft. From To Ft. 13. GROUT: Depth Material From 0 To .2O Ft. LR/frwr1 From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Method mare gino Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPSOTopographic map (check box) DRILLING LOG Formation Description DEPTH From To j6 RFMARKS- ir-, I 1 L Fri;)� i I' )� 'xnritiPRCRv cE`rto hf rCONSTRUCTION ST,A t i, i Submit theoriginal to the GW-1 REV. 07/_OOl Z7649.1636 Phone (+1 ,_L919 733-3221, within 30 days. LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common mad names. tc .LLQ, g. a7,,e Qco-rat -� htirakw ay 4s N". a 5 >lo u y�� LL Eri7'dr-te.ccc t/zz/ c DAnr ,titol Lt7" CT-n._ yl aQQt R . O -n n.uor c� ttt. �c �) o Yr4CviW(.RZy 2�r LP- -Lo cL'l ytis a a AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER LM MIA 5/76/2.003 URE F PE SON CONSTRUCTING THE WELL DATE Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) (print)., EPP i=Rf /t ybC CERTIFICATION# -IOSU WELL CONTRACTOR COMPANY NAME )4 (1.awl m w sv- t T) tiatt;rn PHONE # a��lu79'g µ * STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 274245 1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION:_ ae p Nearest Town40;-�-C County A3hr✓r. rola (i+.tichlc e (Street Name. Num6efs, Community.nSubdivision, Lot No.. Zip Code) 3. OWNER: Lc..03L cJ .. -L- f c1-911As'n&aR Address Et..ft '64..ay/ e..to (Street oPRoute No.) ►Zr Q�tnuLU cut. '-n .c & 7 71 City or Town State Zip Code (K2.51)-4-79-6o72 Area code- Phone number 4. DATE DRILLED Si 9/.2o0 3 5. TOTAL DEPTH: aos' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 7. STATIC WATER LEVEL Below Top of Casing: / 0 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC 2C .0118. n 9. YIELD (gpm): I aMETHOD OF TEST i7't/L_, 10. WATER ZONES (depth): / 9 S I I. DISINFECTION: Type 7gri Amount t7.3s' I2. CASING: Wall Thickness Diameter or Weight/Ft. Material Ft. 6 %'F SOP a i ? V Ft. Ft. Material Method Ft. ei.ememk' 'PtVrryLira Depth From O To 60 From To From To 13. GROUT: Depth From 0 To 2,0 From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ftin. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. Crr- 1 G' iet sz_. -tQ /i-t: � cJ t"9LN.�uPJ' Ir;L2 cjo yr ,Lea; 6t-v tt.. Q tribe) CI.aic, t;T -I- ik-t- * c)2t k L'% -t n. ior rn 0 B- r J LI ' i-1-7699463.r I DOH j(EEW 4h,K I IFY 1 'L[ Cd)yST iJc'I1101v!ISTin ) P THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 5141�do3 TUR OF PERSON CONSTRUCTING THE WELL DATE IG Submit the original tol he D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 9) 73¢-322t, within 30 days. GW-1 REV. 07/2001 274248 L WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAMES (print) Q: EN F E RY l7Y I) E CERTIFICATION # oao SO WELL CONTRACTOR COMPANY NAME tom) tO.at{rrfl WQQQ tuQQUflL\J PHONE # ($Z) ti79-V4S 1/4 STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION:,1 � (� Nearest Town:IZ(/?/.-trn-1--L' t,Q.(i',C. County /1.414�rn L--�L a%i `-Yrtdt.0 mrCLVr., V1--C2-16) M. (Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER., .4-1 ` & . /O Q.Q.- `Z Address tZJ to. t' h.Osl.rCrO isr., r-'ttf • (Strut or Route No.) a-L4 R,/,Lnuc` ate `t1 . C-• f8) i l City or Town State Zip Code (2S)- Ij. 9- a3zz. Area code- Phone number 4. DATE DRILLED 5/ao/ago03 5. TOTAL DEPTH: a S 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface" *Top of casing terminated at/or below land surface requires a variance In accordance with 1SA NCAC 2C .0115. 9. YIELD (gpm): IS- METHOD OF TEST d9 LPL, 10. WATER ZONES (depth): / 4- S I I. DISINFECTION: Type NTH 12. CASING: Depth Diameter From 0 To TA- Ft. H P4 Amount 0, at - Wall Thickness or Weight/Ft. Material Sh& 21 ?YFC. From To Ft. From To Ft. I3. GROUT: Depth Material From 0 To 2-o Ft. CQryr-a:n1 From To FL 14. SCREEN: Depth From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. 16 RFMARKS• IDS E Ba CFRTIktI A" CONSTRUCTION STANDAR: GSSbfik"thtifMi$/id310W he Di SF/160046`Yd 0ii;r Ski.`/419) 731 Topographic/Land setting ❑Ridge OSlope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include0the rt%gd numbers and common road names. UW a C Q.6' f.11i .tM. R e tk-Ct_ 1 p Method 63marl, L7xn Diameter Slot Size Material in. in. Material rril P o''ftwrL 41.ce on 6- *-jat±o nijant ttAn..�*;�9 koriRos tat th\ VC -CULT %i i/rar-> LstT7� � lo mt.Qez4i:t «r,, / z THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER NA7YR FiLide .5keJa.e03 SIG E OF PERSON CONSTRUCTING THE WELL DATE. ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 3221, within 30 days. GW-1 REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAMEEQ(printt�)_S E 1- F E R if Phi I) P CERTIFICATION # 2.0 S WELL CONTRACTOR COMPANY NAME ri tie-PsLVTT' 1 Lit � IJ PHONE # r, 250 V79-%64-S4 STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS, (if applicable) (if applicable) 27 4 2 4'7 I. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: qq, Nearest Town: Rs.Lttmnnl LtU . County td L that . srtt.a-PAci. 7 / (Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code) 3. OWNER: 'rrru.�M Address 'F'E-L4, QS/now€--"4 (Street or Route No.) fRCA LONA,) ;.Lie Af . G . $ ?'2/ City or Town State Zip Code (R28)- 479- 8340 Area code- Phone number 4. DATE DRILLED 57) SJ Lcr c 3 5. TOTAL DEPTH: 14.0 S ' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 7. STATIC WATER LEVEL Below Top of Casing: 3 O FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface" *Top of casing terminated st/or below land surface requires a variance In accordance with 1SA NCAC 2C .OIIS. 9. YIELD (gpm): ) O METHOD OF TEST %14151, 10. WATER ZONES (depth): 3 7 S I I. DISINFECTION: Type Hr// Amount O. CS 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From O To 33 Ft. G. cat? aI 'AI`c From To Ft. From To Ft. 13. GROUT: Depth Material Method From 0 To 1-o Ft. &riiung- 61lac brig From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material To Ft. From From 16. REMARKS: To Ft. Submit the original t the I 27699-1636-Photte-N 19) 7 Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) ED PTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. �. caw_;Q-op-z.t4 zv vrr Rob-v2&o I L& Yr efv t t,r .Lc3 - �, y-, a tort� O/i_ tics, wt 3;0Yr� c nj-cid- c-n- s- �e,>LQ ,n.eQ , �,1 f f.cLt.w t w-vr1/4, kj f yr yy to 54 a JYLu-/Co. t1.uvr .. ilf crn S'�I .- 3 rEci. ytu--uxlV<-v�(f AA. at i Yr-c.E:.'ar t't''-t'z) ,L .tc •.X2�.t... LL}�6 x.vr.c IQ T o t'{ 7-a F—i, I/ 1 d fruba t r�,� p +at THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 5i/ ao3 SIGN',4TIIFIE OF PERSON CONSTRUCTING THE WELL DATE 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 3-3221, within 30 days. GW-1 REV. 07/2001 268430 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources vision of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) CS C-k157 -1 ca 1 � WELL CONTRACTOR COMPANY NAM to 15— l [�l U5CU k d1Y aPHONE # % 1 i STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) CERTIFICATION#4/✓/ �� I. WELL USE (Check Applicable Box): Residential Sd Municipal/Public 0 Industrial 0 Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOC Ne• stTown: County. (S Name umbers, C. mum'. , Subdi ision Lot No., Zip lie autumn e) Aril City o o`c,_ tare, reti • Area code- Phone number D3 �R Zip Code 4. DATE DRILLED 5. TOTAL DEP TH: 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (iIy 7. STATIC WATER LEVEL Below Top of Casing: ar) FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1 FT. Above Land Surface° *Top of casing terminated at/or below land surface requires a variance in accords e with ISA NCAC 2C .0118. ^ ` a 9. YIELD (gpm): M THOR OF TEST is-t-�1. 10. WATER ZONES (depth): � \fl 11. DISINFECTION: Type 12. CASING: Amount `` *re!,Wall Thickness From Dept( t Ft. (o/� W From To Ft. From To Ft. 13. GROUT: Deptl Mat ri9l From_ To W Ft.P From To Ft. 14. SCREEN: Depth Diameter Slot Size" Material From To Ft. From To Ft. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. in. in. in. in. Material 16. REMARKS: Topographi setting ❑Ridge ❑Slope alley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) PILLING LOG Forma DEPTH From To ` LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. kW 19 f (11 D�li'II1yt5�B SC��T�� T9NS TI il'1 ,• Sbbaft4he-anginal-tO.. hy4e-il�ivisi 27,-49 9 Phone NA (9101)'?-322 TOA WELL WAS CONSTRUC l F.D IN ACCORDANCE WITH I SA NCAC THAT A COJ'Y OF THIS RECORD HAS BEEN PROVIDED TO T A et_ ATURE OF PERSON CONSTRUCTING THE WELL DATE of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC , within 30 days. GW-I REV. 07/2001 1 C, WEI WELL I� L DINNER 03 268167 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality WELL CONTRACTOR (INDIVIDUAL) NAME (print)MS F F F tL )i" Y� (T7 / D E %SELL CONTRACTOR COMPANY NAME f�f 1hA� LU >L5A. .-/ Groundwater Section CERTIFICATION N 20 CO Of (gZS(1 oi''. 9= 0 Un STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQtRMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use 2. WELL LOCATION: n p�,, Nearest Town: Rc4L.tj lt.�LY -t County t4X+amt �Ylvtt� 13an-eQ CUrn�rnn�../rr..tri (Street Name, Numbers, Community. Subdtvisto . Lot No., Zip Code) 3. OWNERR Address S'Yl.a)&Ad. P. 2 (Street or Route Nu.) a$�ti7VY(J Lac -C 7 7 / City or Town State Zip Code G2x)- 47 9 -- S77 Q Area code- Phone number 4. DATE DRILLED /J2/J2Mb3 5. TOTAL DEPTH: 5°S' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tE 7. STATIC WATER LEVEL Below Top of Casing: So FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surfaces *Top of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): /9� METHOD OF TEST A Ati 10. WATER ZONES (depth): 4St I I . DISINFECTION: Type 1f T /{ 12. CASING: Depth Diameter From_ 0 To 37 FL 091 From To Ft. From To Ft. 13. GROUT: Depth From 0 To a O Amount 0.82_ Wall Thickness or Weight/Ft. Material cbRa1 PVL Material Ft. cl.P/Tr-t t,f From To _ Ft. 14. SCREEN: Depth Diameter Slot Size From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. o R.Ct�tAAJ/- (Tel l c ,1 1, at- Fes, ted2C, A.itv u -7t 129 NI, r Y).x.z a II te. Method -Pwy L Material tLtA/6-, I'u�jh1-/ GrYt— Sma,-u: &Da 9 zv-� � a rtu,4149, cLitAnsL « 7.1-1. t-P Cy\_e_ 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CUNSTR.UCTION.9TgNDARDS, AND THAT A COPYOFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 9d PERSON / aa3 � SI A E O PER3ON CONSTRUCTING THE WELL ATE ) Submit the original toali8 Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919733-3221, within 30 days. GW-I REV. 07/2001 2681r13 - 1 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) TE F F Hn� it 14 if DE CERTIFICATION # ,..0 SO WELL CONTRACTOR COMPANY NAME t ea 60 •ThZLCttjaC PHONE # VS) 179-84sil STATE WELL CONSTRUCTION PERMIT# ASSOCIATEhVQ PERMIT (if applicable) (if applicable) WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use 2. WELL LOCATION: a4 ttinJtLL , 53''a rr„rr /4 I Q Q cad)... County btueLhtvre. (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: F Address ` .. 434,o( II49 (Street or Route No.) `Zl aA-14A/ f.Ib ,-n . C ,a -77 / City or Town State Zip Code (2Z- y79' 3S$7 Area code- Phone number 4. DATE DRILLED //l S'f aaa 9 5. TOTAL DEPTH: / O ' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO g 7. STATIC WATER LEVEL Below Top of Casing: K A FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface* *Top of casing terminated at/or below land surface requires a variance in accordance with I5A NCAC 2C .0118. 9. YIELD (gpm): RC) METHOD OF TEST 4 -w 10. WATER ZONES (depth): / o O 11 DISINFECTION: Type fing Amount 0 . / g 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From O To 7S Ft. lurk cnR./ }pvc- Ft. Ft. From From To To 13. GROUT: Depth Material Method From 0 To , o Ft. Cepuilki pu V From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS: Topographic/Land setting DRidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the row numbers and common road names. 0 `o 4 z5)zr-e 4-„„a tie /J t�-ua / 13 E. a 1'3t- jt brL OA-'6 s J tecl wV ' ern-1- as-17- , LN , e y4,-cp- !Z` at,t ,r-o ,itt 4.t6 % J o 1*v""- , q.f_Q cry._ I DO HEREBY CERT11-11(i1'4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDMDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER Y � i/R�id.°03 SIGN/. U F P RSON ONSTRUCTING THE WELL DATE Submit the original to the bivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 Phone No. (919).733-3221, within 30 days. GW-1 REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality WELL CONTRACTOR (INDIVIDUAL) NAME (print) 33'E FF r RY HY,�I ,etIJ E� WELL CONTRACTOR COMPANY NAME ♦-Jtia-4.rrr' Li I* 14 D rYt''i+{\ ASSOCIATED WQ PERMIT,/ (if applicable) STATE WELL CONSTRUCTION PERMITR (if applicable) 268165 - Groundwater Section CERTIFICATION N 0'S 0 PHONE N 6224479^g 4"SN' I. WELL USE (Check Applicable Box): Residential 6s1 Municipal/Public ❑ Industrial ❑ Agricultural 0 Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town: a, G77aL iz uc.w t2 ? (Street Name, Numbgrs, Community, Subdivision. Lot No , Zip Code) 3. OWNER: S fan Sin.a.rua2 Address 677a. Hvity al% County is &a-3. wr+v APS;ree1'r RouteNoJ /I-r_tC.7-w.p ag 7 6 City or Town State Zip Code (flS)-479-!2sl Area code- Phone number 4. DATE DRILLED I/ $ ao 03 5. TOTAL DEPTH: / 5 S� 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: 40 FT. (Use "✓' if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface* •Top of casing terminated at/or below land surface requires • variance in accordance with ISA NCAC SC .0118. 9. YIELD (gpm): t METHOD OF TEST A K-2• 10. WATER ZONES (depth): j / S II. DISINFECTION. Type 12. CASING: Depth Diameter From 0 To S 7 Ft. 4, tk4 From To Ft. From To Ft. 13. GROUT: Depth From O To zo From To 14. SCREEN: Depth Material Ft. 0e.Trtr,4 Ft. Topographic/Land setting DRidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude longitude of well location (degrees/mino:es/seconds) Latitude/longitude source:OGPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Amount O a.J 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. L SbR 2.1 "? C- ��C t4-t r cr QA/�7 fkiykuual N Method O l�Yt-1- ±,,,r,,rY . 2Li,L`/ Slot Size Material in. in. Diameter C.A From To Ft. in. From Tc Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. 16. REMARKS: Material -o CA, O W Cr, 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 -, �o //53/Aao3 ATUttE OF PERSON CONSTRUCTING THE WELL 15AT Submit the original mine Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No.Oil) h33-3221, within 30 days. GW-I REV. 07i2001 270701 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME ,�� (print)pJ FFF ERy ki 0 CERTIFICATION# a05 Id WELL CONTRACTOR COMPANY NAME /LGWxI'n 1. Atei Di w�-a..vnn PHONE # 6232) Ui79- Li3 S STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 2. WELL LOCATION: NearestI�Town: 1�1 JLe- L7cot 13 A en't-can �.. County /.Ya.Ynnnn (Street Name. Numbers, Community, Subdivision, Lot No-, Zip Code) 3. OWNER:rd-O'1J0-0-1-1 Address 7�Z %3tcr1I4 �A� � _p(Stree(Jr Route No.) //1TiVM_Ova Yl _C . ? 0 2 City or Town State Zip Code ( )- 4 )9- Gz3s Area code- Phone number 4. DATE DRILLED //0J2.1503 5. TOTAL DEPTH: 2 b S 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RJ 7. STATIC WATER LEVEL Below Top of Casing: 4o FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1 FT. Above Land Surface* *Tap of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): /a METHOD OF TEST >'+� ID. WATER ZONES (depth): I (S I I. DISINFECTION: Type HT)) 12. CASING: Depth Direter From_0 To 3- Ft. H/Li. From To Ft. From To Ft. 13. GROUT: Depth Maten I From O To 2 _ Ft. tritkunt . From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. Front To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. Amount 0•30 Wall Thickness or Weight/Ft. Material Sb/1 ?VC- Slot Size in. in. Topographic/Land setting DRidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) —= DEPTH DRILLINNitLOCr' From To Formation DaRriptiiin- fV J 0 fV— LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. . ccrAn& Ak= - at— '' r ,�.8 /�-�y)1�uc �- o� n. U . �*7 Method 5 y� /o A i'- b—� c ?'" rr�'ti'C� (j Material - • I - . tmAAN 2 Material 6itai 4-1,. AA. 440 �� ' 04,21 16. REMARKS: S 1.100j q B`4'),CEKTIF~.\-IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL f ToNSTRtt-T N 44 t RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER R/zV /1c / /0 / oO RSOR CON RUC TING Olri TING THE WELL DATE -Sabriiit the original1to tin Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC '27699-1636-Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 271634 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resourcesf- Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) (print) E F F F R5' ! 1 v DE CERTIFICATION M)OS t. WE Li. CONTRACTOR COMPANY NAME lif ACJnWT1 IX'Qn 3)/O-t PHONE a IS'ZS) 419-84S' STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS( (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential co Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town:RSA/14J.LQCQ County %,)Z'n. 9,OI p Pa. (Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code) 3. OWNER: bzeoC4aZ ep.e-L!1 Address a'-' , t�a�.Lnc Rn.c,-iti pm.Q, '(urea or Route No.) I � nnviUe Y�-C 38771 City or Town State Zip Code (' l)- 14?9.1 Zo3 Area code- Phone number 4. DATE DRILLED 3111 J ,ac to 3 5. TOTAL DEPTH: / O S 6 DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: 0 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1 FT. Above Land Surface* *Top of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC 2C .0118. , 9. YIELD (gpm): o METHOD OF TEST A A t- 10. WATER ZONES (depth): I OS I I. DISINFECTION: Type Ifrti Amount 0 i/ 9 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From C) To ?.O Ft. G'At S;7R2.1 ?vc From To Ft. From To Ft. 13. GROUT: Depth Method 'a.(.,From 0 To 'a.rf Tt-t/rr�74 Material Material mt' Ft.V-t', From To Ft. 14. SCREEN: Depth Diameter Slot Size From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. 16. REMARKS: Material Topographic/Land setting ❑Ridge OSlope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrces/minutes/seconds ) Latitude/longitude source:❑GPS❑Topographic map (cheek box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. LCA A j Rn n%n -Ra& Inw4' 10-4-t LI ay #1 43 Sductto d-e i O Y»r-LL-A', tLwr. U / ern N-rL& #28rl rr 3 440 Witco, too. f .Q* av Q�v7u,'fi tarnc'V` - �/cJ� &o p 7-.2 0: . tILn n,j6)44- em old Ya Jed.} c -[ an,AA tip. AA. I as rYu �� W (-CI err, .LLO ( e j f .> 1 DO+H$REBY CERTIFY CONSTRUCTION STANdt-11 , THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER e. /ciA 3/N/aon3 SIGN OF P RSO 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. (919) 731-3221, within 30 days. GW-1 REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources l - Division�of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME(print)TE r�) } ye %� 17 Y M E CERTIFICATION #,aOSD '/ WELL CONTRACTOR COMPANY NAME kJ �t•F^i'LiCVM Gi Q-U, 7 aLL-A�� r�( ��\ PHONE • ISS4HI Li 799- g 454 STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATE PERMIT*/ (if applicable) (if applicable) 271633 1. WELL USE (Check Applicable Box): Residential 12I Municipal/Public 0 Industrial ❑ Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCAT�IONi'Q��-Q Nearest Town:aaerery/ fl-tJ &lie County / i71)--744a `7 ndu<,rith. ruck. (Street Name. Numbers. Community, Subdivision, Lot No., Zip Code) 3. OWNER: .73 La. Wcatr&a Address 3LLL- CALti9 R 4 - (Stint or RXute No.) -7 /[aatA1QL'sQkt vri -C xs l'%/ City or Town State Zip Code Gin)- q79-L9“. Area code- Phone number 4. DATE DRILLED 3/6/0o 3 5. TOTAL DEPTH: O 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a 7. STATIC WATER LEVEL Below Top of Casing: / / O FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface` `Top of cuing terminated aVor below land surface requires ■ variance In accordance with ISA NCAC 2C .01 ts. 9. YIELD (gpm): o-l- METHOD OF TEST A 10. WATER ZONES (depth): q 9 l 11. DISINFECTION: Type /I TN Amount O. S9 12. CASING: Depth From CD To S5 From To Ft. From To Ft. 13. GROUT: Depth From O To d20 Ft. Cz Wall Thickness Diameter or Weight/Ft. Material FL._419- SORZI '?VC Mat 1 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. Topographic/Land setting [Ridge OSlope CValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees:minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DRILLING LOG Formation Description DEPTH From To Method do i ) W,v1Lcv/t._. yyta,- n/ A 4nU )1l 0 ynit , tn,'. M-, ./)AW- V -ttvvrv.lr. 20 %topuly a Slot Size Material in. in. From To Ft. LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. V JLCU-&L tt&mcr& 6)(k.4dfr cl) O hi)-5-?.L ccl1ks&&Si�,�y %ke I: v-; o puat4), t_@i-t C) C 16. REMARKS: I DO HEREBY CERTIFY 1 (JONS UCTION STANDARSA,. Ie r.rt al IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 3/40.ot3 hE O PERSON CONSTRUCTING THE WELL DA E Submit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919)733-3421, within 30 days. GW-1 REV. 07/2001 ode Phone mirky •1. OAF F DRILLED _ 5�—LC -0 3 h. DOI'S \\'1iI.1. REPLACE EXISTING WELL? YES El NO tie' 7. S I A IIC WATFR I,IEVEl, Below Top of Casing: /OG F1'. (Use" r"if Above Top of Caslogl a. Tr or OF CASING IS _ / VI'. Above Lnnd Stufacc• • 1 np or cad,q, tcnuIstmed DI/or below lent \1,rroce requires p :u l.u,rr In :Repotanrr alit IL\ NCAC t(' 0118. v Vlll.U(ppm):/, _- METHODOFTEST Ill WA! FIE TONES (depth): /L%) LYx GPI I I. I)ISINIII'.(`IION: Type 0 ithnawe Amount -L Cccblik I1. LASING: Wall Thickness Depth Diia/a'mcI�tt'rI or Wciglial. M^aterial It„m__-V__ 1it cis' .I't. 1n11'i_ 'bP I/ PvL fllnm TI, _ Pt. IIoI„ ---- Tr, _ Ft.—_...---- .. 13 (iltlmU! Depth Maielial Method Ilinll -. 01 a'.0 _ Ft. CI C4 J i Ali Orf� S 1QAtht i i ii (VI t'ii tJ- Depth Diameter 'Slot Size ✓ Malclia,((( I hell 'I a Id. in. Imo _-_--'lo.._. Ft. in. IS. S,\NI16;RAVI''I. I'N.K: I Size Material 1000 In Ft. f I0n11 10 II. Ilour-7O_lh (p.g_II. CH WELL CONSJ'RUC'1'IUN ItECURI) N„I Ih I :u olina - I )(p:u(mcid of Environment and Natural Resources - Division of Water Qualify - Groundwater Section // mill .Ir)'I(I\l-(oltIINIIV(iIIAI.)NAME (irInt)_ne, 1.(! ROSE CEIRTIFICA'tIONIr3Bb \\I -I I.I l)N I It \t-I Cm COURANT NAME RQ Set U L4, 1,RILLi - I'IIONE w (Gli)-343� SIMI. M I LI, ( OAS I ltl'l-1 ION FERMI ra ASSOC IA'I FII III) 1'ER N!! I II l 1-applicable( t if applic able) I WI I I(('heck Applicable Box): Residential ISYNIunicipal/Public ❑ Indnstiial ❑ Agricultural ❑ Mnuihniug O Recot cry ❑ Ilea( Pump \Valor Injection O Olhct ❑ If Oilier, list Use 2 whl1 l O('AIION/� ri,:neci lone__-!"`Qkk Az nA-C County f{A-- "1 I'd.• I Naina thud r,.. I',nuplm,IlY. Subtlivicion. Lot No.. Zip Clnlc) I. (1,\ NFit : �C Inn g14-11-kv Gem! Addles., (I3 .5 _HO /� i;l rrl or "° No) 1/v tiMm,�n` rA- 30o41 l ilv n, lovn Cal Zip Code 7!Q wzCiI j6 5. TnfAl,UBPTIF. YOQ D R y�n�[i.rn ., llll RI IIV 4TIt I il1,1 III/, i I'l R1S I PI IC I IIINS IANIft:{It1 ;la C AS 6 Ii q,�irt",i0iT'citCi 4(,rkli;ii,G Addle DI -Ishii' of \\' tier Quality, Groundwater Scctlon, Ihih Mall Servlee Cclllt'r - Raleigh, NC ht Ir,th I h� n T 1221, nilhin 11) days, " GR'-I REV. 1/7/2001 in. cp Show diteclion and tlislance In miles From east two Stale Roads or County Roads. Include ic ro@ numbcts and common road names. il'cgnlgrapIlic/Lank selling Ditlidgc OSlopc ❑Valley OFlal I check nyn np, ime broil I.aliludc/)ongilude of well localion Idepmes4nfnolcs! ccoolrl Latitude/longitude soul cc'.D(il'S(J I opographic map (check hnv) DCII fll DRILLING LOG Flom Tn Formation Description — /o0— SR^J/Y/ S'9lL. 273918 CJ o LOC:AI;cm $KE ICII I111S WFLI. \VAS EONS lltt)('l lit) IN ACCORDAN('E \VI III MA N('AC 2C, WELL IIAT A COPY OF'I I IIS ItECOI(W IAS BEEN PROVIDED ID I I Iti WELL OWNER �P 5-15—a3 INA'!URE OF I'ERSO CONS' RUC11NG l l IE \VF.I.1. DA'lli r 275881 2. WELL LOCATION: Nearest Town:Rty WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section O WELL CONTRACTOR (INDIVIDUAL) NAME (print)n/4 VD 6_, CERTIFICATION Mao S � e j RC' WELL CONTRACTOR COMPANY NAME Flrla-LTr. LV.Qtt 1 -l-Q PHONE # ( 1st y'%g-8 St STATE WELL CONSTRUCTION PERMIT# ASSOCIA ED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use Topographic/Land setting ❑Ridge OSlope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location "Litt County (Street quirk, Numbers. Community, Subdivision, Lot No.. Zip Code) 3. OWNER: J1.-1:0 `-L�cT,��'%il Address ,t.L A (1 Lbz1'v (Street or Route No.) rZo�-�twutiUC,7ItC aC?i7! City or Town State Zip Code (Rt&)-trig • Zz C Area code- Phone number 4. DATE DRILLED 6/ R 7I -a 0 d 3 5. TOTAL DEPTH: / 3 O 6. DOES WELL REPLACE EXISTING WELL? YES 0 NW RI 7. STATIC WATER LEVEL Below Top of Casing: 3 O FT. (Use"4' if Above Top of Casing) 8. TOP OF CASING IS i FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC 2C A118. 9. YIELD (gpm): a o METHOD OF TEST A'w 10. WATER ZONES (depth): % O 0 11. DISINFECTION: Type H / N 12. CASING: Depth Diameter From C To g 0 Ft. 6. /l)t From To Ft. From To Ft. Amount O. t 3 Wall Thickness or Weight/Ft. Material ta./S.S 5:bot 13. GROUT: Depth Material From 0 To a0 Ft. e-C'rrir- From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. 16. REMARKS: Method Slot Size Material in. in. Material (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation @trip -(`tort c W 1 Ql 6 LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. (�/a � CrA�r LLfr. O'r` S lLLc-n 'yt. LLL fit ,� cif Loa/ or_ i .�. c6 r" ' NCAC 2C WELLDO HEREBY CERTIFY TPIA!f THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA STRUCCTION STANDARDS,' AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 6,/ 7/9.003 -SIG A OF PRSON NS RUCTING THE WELL DATE S51jJitir Die origins?to the. Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27,,0404mone N4,.(9.19)1733-322 , within 30 days. GW-1 REV.07/2001 275880 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ` WELL CONTRACTOR (INDIVIDUAL) NAME (print) a.EF F ER t/ N � n 6 CERTIFICATION NaaZ r,0 t� ��_...y. WELL CONTRACTOR COMPANY NAME F-I�).dG�'tVn'ry W ��r't"'^^" "1 PHONE N €Z2) 479-Sj'$ ASSOCIATE' WQ PERMIT# (if applicable) STATE WELL CONSTRUCTION PERMIT% (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial O Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town: - County "J+tlan.et.rn 1f�2�tcv Ru.,yVc Dtv9..tz nts: (Slat Name. Numbers, Community. Subdivision, LEt No., Zip Code) 3. OWNER: T.'sJtCQ Address I P.fir, L., �tsi 0 (Street or Route No.) jZ&R. CnnaQ i 1tC1 C 7 ?�? 71 City or Town S Zip Code (2.31)- 5' 4 3 Area code- Phone number 4. DATE DRILLED G/E/tO 7 3 5. TOTAL DEPTH: 330 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13 7. STATIC WATER LEVEL Below Top of Casing: . )O FT. (Use -'+" if Above Top of Casing) 8. TOP OF CASING IS f FT. Above Land Surface` *Top of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC 2C .0118. • 9. YIELD (gpm): / METHOD OF TEST A 121, 10. WATER ZONES (depth): / 2.0 e II. DISINFECTION: Type /'TJ� 12. CASING: Depth Diameter From 0 To ;a.0 Ft. E. /9 From To Ft. From To Ft. 13. GROUT: Depth From To From To Material Amount O. Wall Thickness or Weight/Ft. Material v)Rxl f VC Ft. Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. Method Topographic/Land setting ❑Ridge OSlope OValley ❑Flat (check appropriate boa) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPSOTopographic map (check box) DEPTH DRILLING LOG From To Formation Description 0..) C_ —D Cr `� „layt a �4�m to-A,IAArN 'Awn_-7 on Rft :44.a�, r En SKETCH o Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. ra F3, e,o Thi4& ro NT\A. L¢o]i —tt-i%v ry TVs it Q= in. Slot Size Material r Ce�uA I3 `RcI`t 1(2y YT�O�y,", in. f/ LLY1. Yt. OhYl et-4L.E) I.O y�,JtQ-t'i`es Material 16. REMARKS: 0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL TRUCrIONSTANDARDS, ANL/ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGN OF PE SON C NSTRUCTING THE WELL DATE Su bmirthe original tathe ,.{Yivisioit of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27004641Phanc3!ko:(90i733-32211, within 30 days. GW-1 REV.07/2001 275879 WELL CONSTRUCTION RECORD North Carolina - Department of Environment andre Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME '(Print ]l,� `Je_ /' r F%1�^�_ �)_DI 1. E CERTIFICATION 0 STh WELL CONTRACTOR COMPANY NAME F\'v+-'T �"r*" t tt`' �(-U tiw\ PHONE 0 (52.�--L%79-13kin- STATE WELL CONSTRUCTION PERMIT**ASSOCIA D WQ PERMIT# (if applicable) (if applicable) 1. WELL USE (Check Applicable Box): Residential fin Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION n � � Nearest T��j}w�n� Liwink) iCounty�r�r u W Mtva (Street Name. Numedrs, Community, Subdivision, Lot No.. Zip Code) 3. OWNER: K%f 4 5.-) Address }44 4a}, (Street or Route No.) -Rm41--t4 ALL 71.c .) S''2 2 I City or Town State Zip Code (222).279_24o43 Area code- Phone number 4. DATE DRILLED 61 XSJaaa3 5. TOTAL DEPTH: 7 2'7 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: / O FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface* *Top of cuing terminated at/or below land sarface requires a variance In accordance with ISA NCAC 2C .0I IS. , 9. YIELD (gpm): 4S METHOD OF TEST rl t-"L, 10. WATER ZONES (depth): 5 y 7 I I. DISINFECTION: Type )}T/I 12. CASING: Depth I From 0 To Si /j.. Ft From To Ft From To Ft. 13. GROUT: Depth Material From 0 To o Ftat/Mant 14. Amount 0.9 g Wall Thickness Diameter or WeighUFt. Material d Ai sari 'PVC. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. From To Ft. Slot Size Material in. in. Method Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees:minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description 0 L c CJ) LOCATION SKETCH LT. r'' Show direction and distance in miles frotaat leans& two State Roads or County Roads. lnclue.the mad - numbers and common road names. cri # 1'1.3, o mL14--.n LW+/P- .1.1)GY,- /4.;/,4- W .-L $, c1-a L o rra,et,i, Ovi. Cy At� bpj-, tact( ctre 'fit h- fl2/Ld& r% -Lc_ 16. REMARKS: 11 ~1 DOHEREBY. CERTIFY IHAT "! THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 1pNSTRt7CTIONSTANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SLR- It 4)2-572003 DATE /1 4 OF PF?RSON CONSTRUCTING THE WELL Submit theoriginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC f 27 9 k k l rriu (9,1A)753-322j1,within 30days. GW-1 REV.07/2001 275629 WELL CONSTRUCTION RECORD North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) NEIL CRAFT CERIIFICATION # 3114 WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # (828)-453-0662 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: ROBBINSONVILLE County GRAHAM ANDERSON CREEK RD. (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: JIMMY MCCLENNEY Address ANDERSON CREEK RD. (Street or Route No.) ROBBINSONVILLE NC City or Town State Zip Code (770) — 468-3677 Area Code Phone number 4. DATE DRILLED 06/24/03 5. TOTAL DEPTH: 245 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 7. STATIC WATER LEVEL Below Top of Casing: 60 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1-1/2 FT. Above Land Surface* *Top of casing terminated at/or below land surface requires a variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): 6 METHOD OF TEST ARD 10. WATER ZONES (depth): 11. DISINFECTION: Type CHLORYTE Amount 6 12. CASING: Wall Thickness Depth Diameter or Weight/Ft Material From 0 To 60 Ft. 6-1/4" SDR21 PVC From To Ft. From To Ft. 13. GROUT: Depth Material Method From 0 To 20 Ft. QUIKRETE POURED From To Ft. 14.SCREEN: Depth Diameter Slot Size Material From _ To Ft. in. in. From _ To _ Ft. _ in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To _ Ft. From To Ft. 16. REMARKS: yII` •rvv 2769Sub c ,;rr, l sion Topographic/Land setting ❑ Ridge ❑ Slope 0 Valley 0 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 HWY. #19 S. FROM BRYSON CITY. RT. ON HWY. #129N. APPROX. 6 MILES, LEFT ON ANDERSON CREEK RD. CABIN AT DEAD END. 0 w L r c0 cn S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL \ID THAT PON AUCOOP�Y%OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERt CONSTRUCTING LL OF DATE f Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC 1, within 30 days. GW-1 REV. 07/2001 WELL CUNS'I'I(UC7'IUN IU COiW 274785 Dui Ili Cnlolinn - Dcpatlulclit of Envllonrlrelll and lint Ilenourcca - Division of Water Quality -CEo i,dnkr 5 a iou �`�0-� Irrl �r,t /'nt CGS w ct.L CON I RAC; 0a tIrmivinunL) NAME it ) ruaNe a VI Sri- 2�iC11 `j/j•lie/ weu (J+ rt IN ELL ct7n nlncnnl COMPANY Nnnle_____---- n55uuni Eliwrl rennuu S r A I yt Eli. CONS HOOT I nIN PERM! Ia-- itnrdWI) itn ikahic itabic I. Will- USE (Check Applicnllic Ilan): Itcsidcnlinl 11I Milldicipal/I'ulllic LI Iuduslrial LI Agricultural LI lOollilrn iug U Recovely LI I Ie:d fungi Wale! Injection CI Oilier LI If Other, L151 the 2. WELL LUCAI ID b�,;,5,,,1/e_ _County G/-A:0-r. Ncnlcsi l own: ` -- � - �y,.� � R kS\ _OnVg-,:''I ?� �� --_-- Ily. Subdivielorl, Lid No., lilt Code) iehttl Nernq Numbtn, G�.•.._. 1. UWNI.it 4/ cr_#i/0%Je2- Add'cs \1-C`'\_r {__L4-.1-ldy`ICZ>�- Pled cr flout (In.) �� j cf ''lO` _0�------- City m loan Slnle Zlp Code Lit__ ) _ - Air.calt I-bntninnbet �� . .t. DA II1 Dllll I EllG- 6�_ 5..101 AI. Dlil' Ill: /55" _--------- 6. DUES Mil. It1'iLACp. ExisIIIJU WEIL/ YES/ LI No 1l }- 7. S IM IC WA! ER I,EVIIL Helot,L / iii0 F oir evies:„_/Q.,_p1 B. I O1' or CASINO IS / ----_ I.. I. Above I.nnd Sul like' • Irr ide.m,e Irl,„ Ir,.lr' .ver brin.. 1.1111 .l •rt ,firth to • n ulmre In sund.itt. nlllr I5A NCAC 7C ala n. YIPII(rp111)!_I=°..._h111IHUD UtIFS 1_.At/ r -- 111. WA! tilt 7.UNP5 (drpllr): o�------_____ .hl T7{ Anunnd`f �� — II. NISINI"r.0 Ill)bb.1).pr_\\,all "Ildckucv 12. CASINO Uimuclrr of I e. Wright/H. h/ CI _Cani - I irpal I or i i. D 'I a V 7 fiirlit 1 It El -- - 1'rrnt 'fo._ 11. (iltc)U it Dcitili flaw _a__i,_2-0 now__ _ _ Io LI._. 1,1. SCiI l.pl1• Drydl' I Jimnclef le, fl. in. him,� _— -- -- I rl_. -_ 11 .-in. I lalll______. -- 15. SAND/URAVIIL PACK: Sire Drplh lit I`I._— - In —_ II fowl How ff_G.25_ 1-1 . -- hialin' h cihtld !�'�fr ehi c Il n� Slot Sire hlnicltal ill. -__- I 1 NrRPi Y CEP. 111A L 11SIIlUCJIONSIALIOAII1), hiniei!nl 'fopuinnphic/Lmnl r..elling Ultidge i-ISlape I )Volley Uflnl (check nrtnr1llntr Irnt) Lalhudeilongitude of well local ion N.,s'..2 /22.2" Cti swsr. C' Lnlilu�:^r!r,ngiludc soince:OUl'SCI I npoglnpllic Iii (check !tn.; hI� UL oats LIIl(J Flout "Io ruination Pesoiplion Do Win,te- 1 V( ATI(1iJ_5KIli 01 Show direction anti distance III mile, limn nl lencl Iwl Sinle hoods or Couul)/ Itonds. Include the toad uui!bets anti common rand ,antes. /4, S r" yt v CI-rig/my? c rn Jy4 WEI I. WAS CIJIIS I Rl1U11 U IN ACCORDANCE WIIII I5A IICAC 2C, wfI,l. NA l • CUP? UP 11115 ILEC0RD IIAS LIEEN I'IIOVIDED 10 711E WELL OWNER SICK lUll11UPI'ERSONCONS1iWF_ 1NO1IILWELL AIIi GROU +D,SAT R SECTION D ASH "L', F G;r'N L OFFICE nit of \Voter ljuntlly, Groundwater Section, 1636 hall Service Center - Raleigh, NC OW-1 itnielREVi,IlLU7/201 176aa.1616 Fiume No. (919) 733-3111, it11111 t 311 days. WELL CONSTRUCTION RECORD Null. I .onoliml - DernI neat of Environment and Natural Iicsointcs - Divisionsi(7of Water Quality - Groundwater Section wl'll.1('NI um- Ion (INDIVIDUAL) NAME( (print) TA ,MtO•• _gOS• E CF.RT IFICArION 131 g�1 1vl'I I. I IINI rt:\C TOR COfIPANV NAME n^cP15 j/ a - QII-Li C6- I'IIONE 0 J'/2i) YN2-3113i :i SI.1II'.w lit. ('ONS 1111'("IION I'GIIh11 TM j ASSOCIA'I En WI) I'rptIiiM (if nj'plicablc I (if applicable) 274438 I WI 1.LOSE (*heck Applicable (lux): Residential l Municipal/Public ❑ Industrial ❑ Agricultural 0 hllmiloliug CI Recoler)' ❑ Ilea( Pump Water Injection C7 Other ❑ If Oilier, List Use i VV1'1.1.1.(I('IAIION: b /� Nc;ncs' Tolmn: POUt3IaSVILL_ Courtly 1 G.wwbbetS ._C" ac C Yob I'anT! N:nm, Nnnihcls. I' onnnunily, Subdivision, Iol No-. Zip ('total Nflt: €J5iE l,). (ktef ,\d,hcss - tics G 4bb Pete RL (Snarl m Rooc Nn 1 f�c,l,6tv,l(e'�[JNC a%771 1 Oily or i'_ 7C1 — `i l 03 Zip Code ;iv i Dole I'h'me nnobrr I. DA 1 P. D12II.LEl) _"-/6 -03 S_ 6. I)OPS \\'ELT. REPLACE (EXISTING WELI,7 YES ❑ NI) ti 7. SIAIIC\\'AIERLEVEL Below Top of .using: O= Tcs!.M,1 ((lse"4"If Above lop of Casing) R. l OP l )1- ( -ASIN(i IS I I''F. Above Land Surl"ace' • 1;.p ,,f radnp WI minion! •I)or below bowl snrrnre rellulres e can knee In nrrorilaoce nlili ISA N('AC 2C AI IR. 0. \' IF1.D (ppm): __Do___ METHOD OF TEST A QC - In \VA I Ell ZONES (depth): e2Csce II) r Al, I) El'F I I: 70 ' II. IISINIE('1lON:"l ype Cli-rame_ 12 CASING: ucplli Diameter (//�w�) I'nnn \�" To yo II. fn*A I'win "rn It. 1 loin 'to It. Amount i_CLI) Wall Thickness or Wcighl/fl. M:ucl ial tbf2 2-I r_vc. 11. (iitl)ll I': Depth Atolclinl Method Rom()_ 'to 0•• II. C-eMe-' g►t✓/W I -II'ul . -Io 1'-IC,) Et. rtarn NHS .4277V1 I F S(- RPIiIJ: Depth Dianietcr Slol Sin MNe,d,l I nos 'III H. 1nnnn ... _._ In _.. .._. E1. 15. SANIV(iRAVI'.I. PAIR: in. u. in. I)cptll Size Material I Tom lu I'I. bail to It. 16. RrhiAR KS i = 9 All\ 1,r) -0IIrt`t'll:I'i �1_(_'Ia!-I cl rl)NS11t11CIION SIAN' tiS fop('gfaphic/I-an( cllitlg Li itiipe ['Slope alley OElal I rheck nly'mpl Tale bur l Latitude/longiludc of well location ldo preewhn hoot s'srcunds) Latitude/lougilude soul cent I1'S❑ Topographic loop (check how) PEPIN Olt ILLINULOCI Hem" - 'I o / Formation Description C_N pic,- 'fc� DLO r Ca72nn'tTC LUC'A'IIUN SKETCI I �� Show llilcclion and dislance in miles IiolnRlcas4 o two State hoods or County (toads. Includcae roaadd numbers and miniu mn road names. C) CO G 1 yo IIIS WELL WAS CONSTR(J('I EI) IN ACCORDANCE WI III ISA Nt'AC 2C. WELL AN TAT A COPY OUP IUICORD 11 S BEEN I'I20VIDEI) T(J TI RE WELI.OWNER •tUltti OF I'IiitSD l'ONS lit ll tne--• _5-/6-C3 l INO 111E. \VEI.I. DATE Snt)iI!Illtlo Ioi in,al In Y, (e Dirl sine nr y\rater Quality,(;1 muffin ater Section,1636 Mnil Seri lee ('rider- Raleigh, N(' 216'E). 1(116 T1uww-Nrcl4Et'iTT.tt3221. 1litllin 311 days. (iW-I REV, 117/2001 r WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q (print) JEFFERY i- D E CERTIFICATION # AO SO Ca WELL CONTRACTOR COMPANY NAME A 't'n IA) at -bAitr .Z j PHONE # 82S14 99 - S4S I/ STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 272678 I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: q t Nearest Town: ,.Lunn-11 2.. County k1ne-emir-^ s 4 s' 79, L L en)RrO. (Street Name. Numbers, Comma itv, Subdivision, Lot No.. Zip Code) 3. OWNER: Kettilinnik pm.uiu� Address SY S BLit. eM1A , Rf3 (Street or Route, o.) i4Lo 71,G, 2W)7! City or Town State Zip Code (407)- 29 i-t W/ Area code- Phone number 4. DATE DRILLED 1 1/30/1o03 5. TOTAL DEPTH: I 2,0 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 21 7. STATIC WATER LEVEL Below Top of Casing: 3 5 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 1SA NCAC 2C .0118. ,p 9. YIELD (gpm): ' O METHOD OF TEST r l A-'1-, 10. WATER ZONES (depth): 9 S I I. DISINFECTION: Type it77/4 12. CASING: 13. 14. 15. SAND/GRAVEL PACK: Diameter From From To From To GROUT: Depth From C) To 'A0 From SCREEN: From From To Amount O./ 7 Wall Thickness Depth or Weight/Ft. M�a^terial 0 To 3 7 Ft. E 4 Si)R a/ 't V L Ft. Ft. Material Ft. Czrniff0' To Ft. Depth Diameter Slot Size To Ft. in. i Ft. in. in. Method Topographic/Land setting ❑Ridge OSlope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/secarids) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH c.2 Show direction and distance in miles frongt lease r, two State Roads or County Roads. Includeahe r ; n numbers and common road names. 1 ^_ �� G� tJl Do 2 t&ttc sjLrr e$ . 6�" V�� o to.-:2-e._. i.�,P)Qt 1101 * 8// IV. at , Jm-teN tAa- ..ru Pl- trrj 2 o Material c o n. (� Ynt-t�� On ki>.,jrg ciiLt,�n.�,. Depth Size Material From To Ft. From To Ft. 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIRECORD HAS BEEN PROVIDED TO THE WELL OWNER Submit the original to 27099-1636( Phone No. (9 E ION OH ICE JdATTE 03 SIGN PERS CON TRU ING THE WELL vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC i-3221, within 30 days. GW-1 REV. 07/2001 272676 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources / CO Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME � (print) SEFF1= R Y /7 fD E CERTIFICATION II ae Q WELL CONTRACTOR COMPANY NAME asol ,„ Idi _b'LLL*at PHONE a P3"1211479-St/Sq. STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: l) Nearest Town: aii 1.L .. County ns l 6x1 �vx• (Street hiaine. Numbers,.Community, Subdivision, Lot No., Zip Code) 3. OWNER: (4fltcLt.tl r� y,' nt Address r (Street or Route No.) R.014 .tG4J;..111 11.0 2S ? 7 / City or Town Slate Zip Code 64)-y79-S4S Area code- Phone number 4. DATE DRILLED `f/'" 5. TOTAL DEPTH: 3 3 0 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 7. STATIC WATER LEVEL Below Top of Casing: / yo FT. (Use "+^ if Above Top of Casing) 8. TOP OF CASING IS I FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance in accordance with ISA NCAC SC .allg. 9. YIELD (gpm): 6 METHOD OF TEST i .vl 10. WATER ZONES (depth): / 9 0 1 I. DISINFECTION: Type 12. CASING: Depth From 0 To :).0 From To From To 13. GROUT: Depth From n To ao HT)) Diameter Ft. 4. %y Ft. Ft. Mate al Ft.Ce rv.t.'rt Amount O, 3it Wall Thickness or Weight/Ft. Material soRxi PVC From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft in. in. _ From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To. Ft. From To Ft. Method 6".7t2vrt3 16. REMARKS: Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude sotuce:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description O O o G.i LOCATION SKETCH 3 x� Show direction and distance in miles frog° t lea c^r two State Roads or County Roads. Includelthe numbers and common road names. 'rn e`� us'^Ar` Qtr', ; Ro-4 nto taht Ntyj.k.t,uUn ,2.9 N. ` "6� y1 atj y % o 'Z". 4 II Raj lw�1 AKe r a__. 1.1,a Lid ,O e V Ct/ti . Weir IlDO HERSY CERT)FMT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL LUNSiROLT1ON-STAND4Rt1DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER L--$pbirtit the original -lb the c r.37699-1636 Phone N0..[919) � c', /ic 9,) jao o3 SIG NNi OF PURSON CONSTRUCTING THE WELL DATE ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 3-3221, within 30 days. GW-1 REV. 07/2001 14. SCREEN: Depth From To From To WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resource`s'- Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) J EUF-k Rif 17YDC CERTIFICATION# AO 50• r� weLLCONTRACTORCOMPANY NAME td/S'rTt Wa- ,J�_' ,gyp'+�;�PHONE # IRTQ)�'?9'-` c%'TT STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 272675 I. WELL USE (Check Applicable Box): Residential 6d Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 2. WELL LOCATION: :I /� Nearest Town: 7R04.4L iwslaL-. County "loccieuver, 3 0 70 Tc77racCt Rd (Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code) 3. OWNER:PL+p O-JU2 Address 0 70 rase—cn Rd , , (Street or Route No.) �c+:fiCS+-nn-a; �ELi 72 •G 2 3'7 7 City or Town State Zip Code (S -S)-979.937ss Area code- Phone number 4. DATE DRILLED LH/la°03 5. TOTAL DEPTH: / SS' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El 7. STATIC WATER LEVEL Below Top of Casing: a0 FT. (Use "+' if Above Top of Casing) 8. TOP OF CASING 1S / FT. Above Land Surface* 'Top of casing terminated at/or below land surface requires a variance In accordance with ISA NCAC 2C .0115. 9. YIELD (gpm): 3 0 METHeOD OF TEST Ain, 10. WATER ZONES (depth): / 35 I I. DISINFECTION: Type 7 Y/i Amount 0, �• 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From 0 To 3 s Ft. 6'4 Sbft a7 'p 1 t;, From To Ft. From To Ft. 13. GROUT: Depth Material From 0 To .2 0 Ft.CC4n-tr7 P wire Method '\ From To Ft. Diameter Slot Size Material Ft. in. in, Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material To Ft. To Ft. From From 16. REMARKS: rI f [I DOIEIt$BV CE,RTI Y 7i�6 1 CUNSTRUETION Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minul&secorsds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at leas two State Roads or County Roads. Includegge ro numbers and common road nines. S a t e.1>1 � 1-0 it a9 N' " b A toe / cn -Liu. ,i it• 0 t G z Li U IMIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL AND k' TH//))Ak(T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER id/ 2-003 Li/ �% SIGT E OF PERSON CONSTRUCTING THE WELL DAI£ i 1---SObxtitthe orie' nal tuihe DiYision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone Nb.! (419) 73i-3221, within 30 days. OW -1 REV. 07/2001 WELL CONSTRUCTION RECORD 272674 North Carolina - Department of Environment and Natural Resources - IDiivision of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAMEErr(printp) -3� E F F E. ^g^ Y A Y b r" CERTIFICATION ti 7.0 5 '0 �y WELL CONTRACTOR COMPANY NAME M,14 orrn LL3a-kat bILLLW': 1 PHONE # (S1S1�y' % y-g J STATE WELL CONSTRUCTION PERMIT# ASSOCIAT D WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town:R04wnvn-II al .. roU Yrw•s-CRi c!. (Sired( Name. Numbers, Community,u'Subdivision, Lot No., Zip Code) 3. OWNER: Rd:IL + ickinvp,.cvt_ Address sa-kct to n'-t- R d . County life Yte/rn (Street or Route No.) - 0-444:rw-U eQ.Ct YI .0 City or Town State Zip Cade (7'76)- 5 99 - S 3 g 9 Area code- Phone number 4. DATE DRILLED 13.//4`003 5. TOTAL DEPTH: <L 3O 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2 7. STATIC WATER LEVEL Below Top of Casing: / / 0 FT. (Use'»" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surfaces 'Top of cuing terminated at/or below land surface requires a variance In accordance with ISA NCAC 2C .011S. 9. YIELD (gpm): :20 METHOD OF TEST A AIL. 10. WATER ZONES (depth): 3).0 t II. DISINFECTION: Type 117'E Amount O.SS 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From O To E t]- Ft. SBR 2I PVC From To Ft. From To Ft. 13. GROUT: Depth Material From O To 20 Ft. Lan'rwm From To FL 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material Method From To Ft. From To Ft. 1 DO HEREBY CCRTI CONSTRUCTION STI J Topographic/Land setting ❑Ridge OSlope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include: ro numbers and common road names. o ]�,2 Q e ri Cn.. £.e nri CZ_t .dya /2,9N. W'> -titer nr' aitiC yeti lomJQ.M- rn .' -%t7 rer N1, et4 lunge nt9Q. c( j� rrti eels n. Or rid-jCL }'��+i,,-t•Ri�y.2yv cpEttr� ,11. Caa I�/d )Tr�r�-pr�t -co TAArYrt AL C/ (!amaw 9_44 CHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNAT RL� FPERSON cO RUCTING THE WELL DA E 0O3 Su Knit the -original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 24499-l634 Purina 'J. (9l) 733-3221, within 30 days. GW-I REV. 07/2001 WELL CONSTRUCTION RECORD 272673 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME ((pint)) J' Err a:K 41 d4'I)6 CERTIFICATION #ZO So WELL CONTRACTOR COMPANY NAME iNtav trn W DA:dc-n STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use 3. OWNER: Address '/'Z 6 t} d% S n<:wdvi.ut zl. (Street Route No.) —gAiltrn..da a '?7 C. 7/ City or Town State Zip Code ($ 3) F 76- 47109 Area code- Phone number 4. DATE DRILLED }t /?Vacs 3 5. TOTAL DEPTH: 7 /vO' 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C� 7. STATIC WATER LEVEL Below Top of Casing: 4 2 FT. (Use ••+" if Above Top of Casing) 8. TOP OF CASING IS I FT. Above Land Surface' *Top of casing terminated at/or below land sedate requires a variance In accordance with l5A NCAC 2C .0118. 9. YIELD (gpm): .)S METHOD OF TEST A ,:tL 10. WATER ZONES (depth): 7 /�`' 2. WELL LOCATION: 0, NearestTown:RC (Lett County 1Arm Rci. ;zS77/ (Streee. Numbers, Community, Subdivision, Lot No., Zip Code) rt , 'TIQ-et-4,at I I. DISINFECTION: Type TH 12. CASING: Depth Diameter From To 20 Ft. 6 From To Ft. From To Ft. 13. GROUT: Depth From o To ao Ft. Amount 0,124/ Wall Thickness or Weight/Ft. Material co 'PVC From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Method /7currr�un+y 1 9n�w8c �P rid, r)o / mat, -La, cr. 13 Le Sinw�nxi Ad . Oar. r.� /Licgr* "& cGviAik Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description 716--.REMARItS`_ C-r�„, yONSUy tCRC ION STAN Su 6u4lt�I� t �L�XlS°'I� p O -a- LOCATION SKETCH 3 � Show direction and distance in miles frog lead^'[ two State Roads or County Roads. Includthe ro numbers and common road names. • m �.CGr.�ak xYt�lC/1� t-'ram 1 tan, to- 171-6-0-4,y manta., �. 3 % trvidn, ni.* an, Sm.e-cot%Il PHONE # 15>et1479 - Slf HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER EOF RSO CONSTRUCTING THE WELL D ao TE n .on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 221, within 30 days. GW-I REV. 07/2001 273154 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME E,.t(pdnt)3 EF FE"R9 14 YbE CERTIFICATION M.� 0 SO WELL CONTRACTOR COMPANY NAME td4.41t rn '(.ZJ �.c..c. .� PHONE N cos 74-SkjSL,- STATE WELL CONSTRUCTION PERMIT# ASSOCIATEWWQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential Cgl Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: q p Nearest Town: c County t6A.01u04n I07 lino n, ' R4, (Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: kr. bit.- Address j 0714w atilt]. C'/1 Wk. r a-a;t treet or Route No.) lg-17/ City or Town State Zip Codc (ZS)- Li7R-813X. Area code- Phone number 4. DATE DRILLED 9/ijac,0 3 5. TOTAL DEPTH: 7 SS 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IR 7. STATIC WATER LEVEL Below Top of Casing: 60 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS ) FT. Above Land Surface' 'Top of casing terminated at/or below land surface requires a variance In accordance with ISA NCAC 2C .0115. 9. YIELD (gpm): ao METHOD OF TEST A 10. WATER ZONES (depth): 9 S , I I. DISINFECTION: Type ETN 12. CASING: Depth Diameter From C) To l';L. Ft. t 9 l From To Ft. From To Ft. 13. GROUT: Depth Material t�.C"/ From 0 To a o Ft. ruvrj— Amount O.) 7 Wall Thickness or Weight/Ft. Material SDKx1 j?VC From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS: Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH O Show direction and distance in miles fromtaDleasF two State Roads or County Roads. Includge roR numbers and common road names. / - c c n-I ,CL -6)O:v.op_Ct .C-2 4.-„,-.nFig}yla.'(i3. .. to-i2 _Air itliar') c) W. U Q Method wilt+ (91)- ott cola /da;r t f?t"")"'^r3 50 7Y o nt,UR-0) -as)vr, etAS.4f' t .x,. m (-went- -rnet-4.40 m. Cmatk 7Let. z, }/r a ►rwitc -t. v+., Ay-. 5. 1Y1 (A' a t en- -Ymrl L) ctt itAA-- . bII [ :, I DO HEREf1Y CERTIFY\T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL )--CON3TRUCTIONSTA7e) DS, AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER `711 SIGNATI.i>,E QF EE CONSTRUCTING THE WELL ATE 03 Cubmit-the origigal-Hrthe Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 17699-1.636 Sine No..1%19) 733-3221, within 30 days. GW-1 REV. 07/2001 NB168 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME Q�(print)�)TEF%KRy icy D� CERTIFICATION */ QO S'0 WELL CONTRACTOR COMPANY NAME (r1.t1tnai/'JYrt /t'_-1)/14. u—.ss PHONE It9,23)4179- STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED .(wil PERMIT*, (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ® Municipal./Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use 2. WELL LOCATION: o Nearest Town:: County . AtL'" ScAwNxw c�z�h LPva-l.fr-cr7 (Street Nam Numbers. Community, Subdivision, Lot No., Zip Code) 3. OWNER: r?CJOMA /r7444.-fln� Address (Street �o6J11/y Cry or Route N IRO- a n�/ al4 iL C a e 7 I/ City or Town State Zip Code (g>,S)- 83S-7333 Area code- Phone number 4. DATE DRILLED // x,gla,00 3 5. TOTAL DEPTH: a 5; 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E 7. STATIC WATER LEVEL Below Top of Casing: 1/O FT (Use "-r" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): .5 METHOD OF TEST i Att., 10. WATER ZONES (depth): t Li 11. DISINFECTION: Type JJ 12. CASING: Depth Diameter From I To 47 Ft. 61/4/ From To Ft. From To Ft. 13. GROUT: Depth Material From C) To at Ft. eomu rr-sf Amount O . y-,i Wall Thickness or Weight/Ft. Material ChgaI'PVC From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To From To 16. REMARKS: Ft. Method Slot Size Material in. in. Material Ft. Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/Ion itud well location (degrees/ nutes/seconds) Latitude/longitude source:g1GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. _ L/`��rwiv,� / -tet) -- H �J�ta u # i 13. �v l a tia;6_o2, %c/1(J" zrnut'n�{j•5R 2240 o Yr Jtx. fry -• ltl. 1 h /9 c t-✓t^ 11.1-•" c t5�cu.' t4a Cat2rh, acv-d-pn-64 ALLm ar, ? 2 cam+-• co G 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 ��18��ao3 SI AT AT ' E OF �ERSON 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. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 , � Ci isi Aber rr 14 rNI - lire « 3S, lie., IaA fE NMI,Ep 5 Z___ 1. �'---- 5. IUTAL PEI'1IC_3..7_ (. DUES WILLREM .ACE EXISI INU WEI.13 YES U MU Lk' 7. SIAlIC WAFER LEVEL Rclow 1It rcrr .1[ .t,_t".5 i_ __ET. t IS / t f I. Above I.nod StuInce' P. 'I le OF CASINO _ I r - • Irp rl none Irn,d i,.trd drnr Ir.lon IumA ni.t.n rrq nine. , On, to In utmdurrf viIIII ISA rICAI. IC:.PI IA o. 1ILI II (Ilan)' lU- -_ h1l I I IUU IJELES I __ IE.WAILitZONES (drpllly7lr- -- Show dilccllon and dislnncc In multi Il wQ.Dl I +cl N yT�_ Annnud � c✓ Iwo 51n1c 'lunch Coonly Rltnds. Indvta(bc Iomf 11. UISJ P71"ECIIUN; I)Irr_ R'nll Iblrt nose 12. CASINO: I rrplh Ulmnctrl or Wrip,I'211. hlniclinl umbels nud common tond ❑n11IC9. _ I'loll'la VS-- I. 1-3 - E2 t /-✓'-' I1. fL____ RC1I o_ _- fl.- Method I I W___ Inlc inl 11. U U P.DWI!) .4- 2ffw-c- flow _ _ Il ow_ . _ I lr- _ - 11 llinulclrl Slot Sire hlntelinl II _in Ilom__to_- II_ ill. __ ln. floor— --- to__ --- IS. SAND/URAV111, PACK: hlldcllnl Urplll Slle floor_ Ile_ IL_.___ I.o I i._- -•-f.. a flow r- w—4-674,10n r I A`/IiLI. 1 n HAS 1VIIGiI t I1IllswpiI,1VASCUpIS11010EliitiACC.(11(UAIICI,WIIIII5AIICAC2C 1 _,1, •-�yila III'Itf IttiICI I5I M1,. � BEEN I'1lUVIUL'i)'10 I ilE WC,LI, U �(-''�' CUNSIItUCl1UN51AN��1�195,ANI1�IIlAfACUI'YUI"IIIISIIL'i,Vit..... 5,�25'�03 ,� � SIUNAiUIIE UI' VEIL UN CUNSIIUJCIIIlU 1IIE WELL L i Y I,r f,ua tt I�Iclelon o111'nlrr (unit!), Crnundwnler Section, 1636 pall Service Center - IlnteiRll, NC r fJW-I IlL'V. 07f2001 ;cdllno.i6:Eali P 4 _ _.:...____ ____— - 0 9�1J111, rvllhln 311 dny9. 17C,no.1(161'TinnelVo.lvl i 276103 ll'ELL CUNSTRUC'I LUN JU Uiji ccoud nlct5Al arion Neill; Clnoliun - Ucpnllnlenl of Euvbolrlllcul mid N �ulnl Itesy�l�� ivlsluu of 14nlcr ()wilily - UtouuJ W nlcr 5••dwu rhrl zl-z if7 is ELL crinlunc!lilt llN lrl r'IIHIAI,)NAnI F. In 1 PIIUN F. a IS��C✓ -- svE.l,l. Cllf+i iii, i': "° CUn1EAN )' NAME A�iUCiAi P.ii :aj i�Eiinil IN $rA IF. ��ELLIIOI-IIUN 1'Elti.ii i: - iln rrlicnblc 'In • dinrblc k I. fluidly,' USEg(C Itrc vet rlicnbte Iles): Itcsidrulinl 1:-1-hiuutdpal/I'nd lic L) Itrdusllini i_S Anlicuhul.;! f I -- W himriloting U lircovcly LI Ilc:d Pump 1Vnlcr hlJcdiolt U Ulhcr CI If Oilier, List Use 'fopUlnnpllidLmnl rrllitip 2. W WELL LUCA I IU J: (y /„�q Ultldgn 1-ISlnpr LlVnllry Ul lnl CUUIII)' Idvck nppmRllelf hrr,) 7%cv r fa 4Czt f _ __ ... _------- Lnllluddluogilud � f well lucnliunC 47/ _ -Ilv, Subdivision, Ltd No., 71p Omit)'C ' /a •' : i -2 , Iclrtel Nerve. Nmnb[n,::.•......Fdivielo . /I%�5 'c1 i _.. -------. . (drprrrJnJ nntr Jr-^^dQ 1. U1t'III'.II' t0a/L___C, 6•� ---___ _ „-- �. I,ly� LnliludclLmnilude suulcc: I'L[f!knl !lI opogtaphic nrgl AJdlcSs �/n tJL=Llc4_0111e!-_IIII)lllll.l.lr_1(;L�JII ^Irrrl PI Rnllif 17n1 l� )lillll �L�rSinie1p \ -`.— I`luul .10 f`olnlalion Ucsuiptlun ��:- ]Ip code - ±___ t G/n:re- L- LOCAl.lui1 SYJJclI 276096 WELL CUNS 1'ItUC'fJUN itEl:vA:.J '. anual Ilcnuecn - Division of Wnlct ()wilily - Urouudvrnlcr Secltun iJonhCmulina- nr;.allluruoiii +•oa"''d mod Mu f y 1c CErrlirlCnitori:23a8" (cu,r, CON I RACI Olt (INtI YN,IAI) N Am r, (r, ud) I'I\\ O ( \-�4Y1 ---- beerIIUNP,ELL"i�-��)�1� t'CONI RAn Olt COnlrAH a•NAM F. l ((1(11 r 1rvl'll O(il((1 - ASSOCIAlrnavgrennnu ---- StAIF.wII.I.COtJSI tilCi ION rrllnlllr---- iIn I likable olissesso it n?,Iinlldc W PLI, FiSIi. (Check Applicable hers): Itesidrodal Muuiclpal/Public CI Indusliial U Aglicullulnl U Mooilel lug U Recuvely LI I Ic:n Puna, Writer Infection U Oilier U If Wier, List tine 'I °pog'nphidl,uld 'yelling Ultidge light!, ClVnllry UFI:I (clerk elgnrgllnIr tin nll'till c1Iugtltied( e of (veil lucaliun I (ii.ar r r✓minnir✓r-c,ndq I,nliiud c'Inliviiude snurco:U(. Jr5IJI opoglaphic ill gl (rhea l.)•; WWI LLWC) IJA) F011iralipll Ncsuiplion 2. Nf.l. LUCAIIU J: N5, �� County tr+ra1--- NrnlIst1ownt_ CS (sure' fluor. Nunibo •. C� ^: """nv. Snhlw vielvn, Ld 110., lip Code) �r^-Cv2 r �r r' ( rye {— AIIdICSn ISIrci itoilte II') p 1�4C(Q�Q _ lir Code Cil)m [Pun Slnle ( ) A r. cr.lr rhnne mamba 1. PAr( ottit t nit u v Id�°3 _ (.. DUES WELL Ill'I'LACE p.XI SritJU 1VEI.l.1 YESU NU 7. SIAIICWATERLEVEL Below Toof Caning: (the If ITT nlCC al A. "DI' uF CASINO I. 1 ! 1' I. Above I. nod Suitnce• C • t l` rl r•d•4 irnnlndrd .Ira, I�.in^ np, Inc r nprlm . .nln„r lit Nur;dune ..Ili ItA NCAC 7C.alla. U.1 !PI n (ri")ie ntcruuu Or Rs r_� Ih.WAIEll 1u1Jh.S(drplh):— ----- ,r,l �� II. CIS FL:I _ l)I'e With lldAnoint ckucss 12. CASINO:Depth ['inflicter or Wright/FL pMrleu lnl how_ Ina �-�— Ho ur In Flom -- In__—_1"L------. -____ Mnlclinl Method 11. (iliuU Devil. (Q 11 � 4 flan, Tel .26 F1. 1oc_ble Fnn— In.-.— --. -- 14, SCREEN: nrplil ninnmlct Slid Sire Mnluinl Itom Ir,— - --_hi In To_ ____ II._iulu.. 15. SANn1CIItAVR1, I'ACIC: Silt binlnlnl Perth r„m II,— I'l. __ __ Fiche Fo_-- I1.-- -" ___ -- ))11111 1'ww I10 5 )ci 1,UCATIQNS.YI I S' Show tllrectinlr awl (Balance 111 Iltllen Ii rrl I leas] Iwo Stale Runds or County Ronda. lucludc- he toatl._ uumbcls nod common fond names. r— otfrift I,:;I�{41-tUErl'-Y-L=1it117-6-111I �will, WAS C'UN,.11(t ICI LU(IJACCUItl)AI1CPW111115ANCA,2C, f i coils I RUC! IUN SIANUAI'1�`�,IANU'IIIAI A COPY OF 'MIS RECORD HAS BEEN PROVIDED IU 111L' WELL OWNER raj/ _ 0 U.NG is U � 1 tomwiIy-uF'riltSUiJCUNSIitUCtltiUI1in WELL UA r, rr GPI P1 OW -I IILIV.0112U01 , hall ltldl{pot,14 .44911” 1i).t nldrlan o111'nlrr ()wilily, Urouilthsnter Section, 1636 Mill Se'vice Ceder - Ilalelgll, tit_ h� 0 111-3111, 1rhalw 311 tins. limn. 6161'hont Nn. (91. ) ) WELL CONSTRUCTION RECORD 2 7 6 612 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) ',.i_,rne S(-I�. W�\SO Y WELL CONTRACTOR COMPANY NAME vidlar IQ1 It �f',1I•in� STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable` if alicable a 1. WELL USE (Check Applicable Box): Residential it�'Municipal/Public D Industrial ❑ Agricultural 0 Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use CERTIFICATION # o2Y () 4 PHONE # e;s2cvAcf-2�7 2. WELL LOCATION`` Nearest Town:gnh�, Dn 2.V , C- County(' ra\rinvvt MrnAnir.4i✓1 CA (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER:.i)P\r-P_�C,eCA l-anQ C/o OCIG//a )/Sias. 21 Address PO C f4 l (Street or Route No.) ^ an 1Cl City or Town State Zip Code ( )- Area code- Phone number 4. DATE DRILLED r1- b`Z - E�3 5. TOTAL DEPTH: foS 6. DOES WELL REPLACE EXISTING WELL? YES E NO 0 7. STATIC WATER LEVEL Below Top of Casing: 15n' FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1 FT. Above Land Surface* *Top of casing terminated at/or below land surface requires a variance in accordance with I5A NCAC 2C .0118. 9. YIELD (gpm): co METHOD OF TEST IQ 10. WATER ZONES (depth): II. DISINFECTION: TypeVnAn pcIIA < Amount It" 12. CASING: Wall Thickness Depth or Weight/Ft. Material From fL To (PO( Sc)CLl FDVL From To From 13. GROUT: From F7 From 14. SCREEN: From To From To 15. SAND/GRAVEL PACK: Depth Size From To Ft. FrOc^Tro -Ft. 16. REMARKS: Diameter Ft./o,as Ft. To Ft. TopograPhic/Land setting DRidge DSlope OValley ❑Flat (check appropriate box) Latitude/longitude of well location 4/3S:2/: S7 c✓83I 46:4(o (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DRILLING LOG Formation Description DEPTH From To f: - c r 1 -%5 t Depth Material Method To a(9 Ft. yet,- r�Vt. ft'sScad-P To Ft. Depth Diameter Slot Size Material Ft. in. in. Ft. in. in. Material 6rG4/7, f P LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Incite the _road numbers and common road names. ,. 7 G) It Sc lwnl c` CI i W9fer ,edl air> 1i I DO HEREBY CERTIFY THAT THIS W.ELI. WAS CONSTRUCT hD IN ACCORDANCE WITH 15A NO ^ C 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THr? WELL OWNER / SIGNATUFIE OF PERSON CONSTRUCTING THE WELL DATE '7- o�-os en d Cc in d. Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 276485 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources WELL CONTRACTOR(INDIVIDUAL) NAME (print)1- Te Altosry WELL CONTRACTOR COMPANY NAME 6 rail O. 17,1 weal STATE WELL CONSTRUCTION PERMIT# (if applicable) - Division of Water Quality - Groundwater Section Hyde CERTIFICATION I r-.O5C (hi/fine PHONE # (gIsdy79—£s446-4.1 ASSOCIATED WQ PERMIT# (if applicable) I. WELL USE (Check Applicable Box): Residential I'ib Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION Nearest Town: R�ihSV,CIO County6s-Pa.h0.YY1 /o1AJFr an An Creek Rd, (Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code) 3. OWNER: Pe Ter Pus %iA Address 7Nd Akio -or -PS Cn vP Rot. (Street or Route No.) Da_nick El 3300H City or Town State Zip Code (cai)- Li 7g _ 69i0 Area code- Phone number 4. DATE DRILLED 7-3 O3 5. TOTAL DEPTH: N 30 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO al 7. STATIC WATER LEVEL Below Top of Casing: W2 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS % FT. Above Land Surfaces •Top of casing terminated at/or below land surface requires • variance In accordance with ISA NCAC 2C .011g. 9. YIELD (gpm): �d METHOD OF TEST CL I r 10. WATER ZONES (depth): 3C-t I I I. DISINFECTION: Type f'>t T 14 Amount n. Lei 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From To 112) Ft. rs SOr.21 PVG From To Ft. From To Ft. 13. GROUT: Depth Material Method From D To 2O Ft. CPmen7 pumpins From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS: Topographic/Land setting ❑Ridge ❑Slope 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 u ('n C_ -r, 717. C-a) r\l LOCATION SKETCH — Show direction and distance in miles from at least` two State Roads or County Roads. Include the road numbers and common road names. 'r'M r,,lrridr/A Po5 r oPt6/ CC Torn R,Oh T on v9c' 5m;IPS 7vrnRtjhTori lower Pevlt r Cret k R�� :off m/'/es %ern 1e�T oe )Ake V;roW p� Go 0.1 mats Tor lePT 7.0 house Well on 19.1 I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER d [� P-Pd r ♦// 1-10 e SIGNATURE OF PERSON CONSTRUCTING THE WELL 7-3-03 DATE.._ _... Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. ;OW -I REV. 07/2001 Depth H From From To Ft. From To Ft. 13. GROUT: Depth From_t To 20 Ft. WELL CONSTRUCTION RECORD 2 7 g 6 5 2 North Carolina - Department of Environment and Natuel jtesources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) aP e r1/7 yj t? CERTIFICATION*/ aO.St7 WELL CONTRACTOR COMPANY NAME 6. ra hoar) G /r ll i-k r r 11 i h a/ PHONE N f fr2i d/7 9- 5'Ljs y STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT*/ (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential ISI Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use 2. WELL LOCATION: NeaestTown: n Obbrl75V;/1e County 6.rechAIn re. n/CS CrPAk /P is- 77/ (Street Name, Numbers. Community, Subdivision, Lot No., Zip Cede) 3. OWNER: a e Cv.Y v , v' Address rAnks r'.A Pra/( I (Street or Route No.) R4bb,'nsv; //P ,LLC. 2.277/ City or Town State Zip Code (qn)- q77 — 3/97 Area code- Phone number 4. DATE DRILLED "S"'-/9- 03 5. TOTAL DEPTH: 2 i-O 6. DOES WELL REPLACE EXISTING WELL? YES ❑ f1O la 7. STATIC WATER LEVEL Below Top of Casing: IFT. (Use "f" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface* *Top of cuing terminated at/or below lead sur6ce requires • variance In accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): 16 METHOD OF TEST 0. rr r 10. WATER ZONES (depth): Rd Z6s 11. DISINFECTION: Type %i T fi Amount n,rr7 12. CASING: Wall Thickness Diameter or Weight/Ft. Material O To lc Ft. (e I SS/ STe,( Material CPmPn7 From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth From To From To Ft. Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (dogrees/minutests econds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. Prom Red jrrghT a7 Po gdiis %nnn Q/ Method RicghT on 129.-5 G-o �I Isles Pumf?,Tic TO nee— {19hT 6-v !'7, eiTornN Slot Size Material in. in. Size Material Ft. 16. REMARKS: %efrPT on ant-,'rporT Rd 00 EA) mje Torn on Pro-rtl(s Gree 3.1 codes 'Tura lePTr bm-o l;m,'/e Well Os? le�T he17.dei—A 5C' I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THII,�S/'RREECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNATURE F ERSON CONSTRUCTING THE WELL Submit the original to the Division of Water Quality, Grou 27699-1636 Phone No. (919) 733-3221, within 30 days. 3 DATE rl erE5ec(�yy n,[630M40Segicr V er - Raleigh, NC -1 REV. 07/2001 0 GROUNDWATER SECTION 273650 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Re Natural sources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) 01e*7 e ry WELL CONTRACTOR COMPANY NAME STATE WELL CONSTRUCTION PERMIT* (if applicable) Al 4e Graham taiol/ dr,It, ASSOCIATED WQ PERMIT* (if applicable) CERTIFICATION a QO PHONE * (sxi v79- s' 6-414 WELL USE (Check Applicable Box): Residential 0 Municipal/Public ® Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION Nearest Town: ins 1<;Be County C-tek,ha, kw School /levse Rd, 22771 (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: STOoach (/o.IIF P,i"e netr Address 5c1,,»1 hie vas e, RA (Street or Route No.) RObbtin SVW/ Ala2.ti'771 City or Town State Zip Code (Qfl-)- Y 7/ - R 2 yo Area code- Phone number 4. DATE DRILLED K 't 6 3 5. TOTAL DEPTH: /O 6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0 7. STATIC WATER LEVEL Below Top of Casing: 36 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface° *Top of casing terminated at/or below Ind surface require a variance In accordance with ISA NCAC 2C .01I& 9. YIELD (gpm): 66 METHOD OF TEST O.l'r 10. WATER ZONES (depth): 7tC II. DISINFECTION: Type I/Ty 12. CASING: Depth Diameter From O To `!P Ft. 6 From To Ft. From To Ft. 13. GROUT: Depth From n To YW Ft. Material Cement Amount 0,/3 Wall Thickness or Weight/Ft. Material 1S+f/ 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. Topographic/Land setting ❑Ridge OSlope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. t, -Fran almenel Post of " //urn co R,'owr on p`lSs N, 0-o 7• p' i,` , . Tara Method /Do+,7I°s%j /6i-FT on STeoac''h RA. Go 1� Mr%s Turn to/Ion Se el use T Slot Size Material in. in, Rok• e-o a.! miles Tar; 6-o . o.l indes to e// o rr / 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNATURE OF ERSON CONSSTRUCTING THE WELT cr Submit the original to the Division of Water Quality, G 27699-I636 Phone No. (919) 733-3221, within 30 days. WUYet"S'ectMn 4 4- DATE enter - Raleigh, NC GW-I REV. 07/2001 GROUNDWATER SECTION ASHEVILLE REGIONAL OFFICE WELL CONSTRUCTION RECORD 273649 North Carolina - Department of Environment and Naattu�rah /$resources - Divisi n of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) I 7? Pi r>/ k((yy�c)e CERTIFICATION #aA 5d WELL CONTRACTOR COMPANY NAME ter r0.lR'a m La a if CTrrl/'cn; PHONE # JQ`Ai'17t STATE WELL CONSTRUCTION PERMIT# 0� (if applicable) ASSOCIATED WQ PERMITS (if applicable) I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public Industrial ❑ Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use 2. WELL LOCATION Nearest Town: D,ht /15 Vt /i!d County Grevita S(„bpA) {reuse Rd.9.4Z7I (Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: S7scocs Veali., enter Address Se4n�/ A ✓S C /R(Str, ROnbi NS ViL/Leer oA e, No.) 25777/ City or Town State Zip Code (4 'MO- y77 - N7/b Area code- Phone number 4. DATE DRILLED R—;;-/—en 5. TOTAL DEPTH: 35Wi 6. DOES WELL REPLACE EXISTING WELL? YES gia NO ❑ 7. STATIC WATER LEVEL Below Top of Casing: 0.0 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS I FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance to accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): 17 METHOD OF TEST C,/ e 10. WATER ZONES (depth): 36 n I I. DISINFECTION: Type /i T N 12. CASING: Depth Diameter From_—_ To 13 3 Ft. 6)4 From To Ft. From To 13. GROUT: Depth From 4 To 133 Ft. Material Ft. re me n i From To Ft. Amount o .4,14 Wall Thickness or Weight/Ft. Material <Tee 1 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft, From To Ft. Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the red numbers and common road names. co .� Ptvrn at!r,onj PosT oil e rgrn I? $ Oh c0 7, 7ni; ,s rn Method P�m p� 'e'e o n 5'Tecoah %)j Miles Torn lePT oris' 01-11ovse Rd, lr-O, a) ; /es 1 '6' T We/lon/e-FT ' ,— 0 Slot Size Material in. in. Material 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNATURE O PE SOre CONSTR/-6J OCTING THE WELL DATE Submit the original to the Division of Water Quality, Ground 27699-1636 Phone No. (919) 733-3221, within 30 days. do I6 4I OCT21 GROUNDWATER SECTION Raleigh, NC REV. 07/2001 277792 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natu I Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME(print) 1» ram/ -1)4 E1 CERTIFICATION M 2oSO WELL CONTRACTOR COMPANY NAME CY ro.koaI ideII at Na STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS (if applicable) (if applicable) PHONE S i926141741-514J t-i I. WELL USE (Check Applicable Box): Residential Ill Municipal/Public 0 Industrial ❑ Agricultural 0 Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 2. WELL LOCATION Nearest Town: Robb11 i41/P CountyGta{totirt 14P�i a.Tnah RA • .2 771 (Street Name. Numbers, Community, Subdivision, Lot No., Zip Cede) 3. OWNER: }rieu-shdil Co tnpbe%l Address l4i6".04.Tdah fjel lYo b:nsv:lir (Street or Route No.) Rdbbl'n f Via a 11.14 l* 77/ City or Town StateZip Code (Cat)- y79- 63.k Area code- Phone number 4. DATE DRILLED t -£' 4i3 5. TOTAL DEPTH: td o,S 6. DOES WELL REPLACE EXISTING WELL? YES ❑1JO f$ 7. STATIC WATER LEVEL Below Top of Casing: 6 b FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): '.� METHOD OF TEST Gi r 10. WATER ZONES (depth): 36%Q I I. DISINFECTION: Type NTH 12. CASING: Depth Diameter From_d_To Sf 9 FL (e From To Ft. From To Ft. 13. GROUT: Depth Fromm To, _ Ft. From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SA.ND/GR4VELPACK: Depth Size Material From To Ft. From To Ft. Amount Q.(p1 Wall Thickness or Weight/Ft. Material 5Ar 2.I Put - Material Method Cemen-r pumPi* Slot Size Material in. in. 16. REMARKS: Topographic/Land setting ❑Ridge ❑Slope Malley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/setonds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. -Prom l00peyes Torn R h'En 1a91V 6o oil 1-7;/es ?o Red l; T Tern %1tgh7 on °AST plain Sitreeern6-o.0.1 mats Torn le,ET on 11erPIAW�,�,; STreeT 6.0T,o,/ Ihr"les I Ifnajvskn fl4 6-0,02 R11 vrn 'eh' on 5n610 b;rci Ra Ga. 1 miles Tr rn l e-k on aToc-i Rd 1r4, 1.6 Yn; l es Trn lekr Ott /6'6 STrpeTG-e 76 over I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER OL0-1 -Pcor �I Ifrok Q SIGNATURE OWPERSON/CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Se 27699-1636 Phone No. (919) 733-3221, within 30 days. enter 1!_RaleIgh, NC i; , G I REV-07/2801 — U ji 277791 WELL CONSTRUCTION RECORD North Carolina - Dep;rtmer t of Environment and Natuzallld Resource�s)- Division of Water Quality - Groundwater Sectiono_ GRGIVF14, Sprapl,t')i gR(IN DIVIIDUAL) NAME /(print) 3etf O r y YFjV j» CERTIFICATION a 0S o pCr �tvbr=r�rntcM'dk r oire'OMPANY NAME &ralsu s tt/®1r dri It; 11G2 PHONE #Jr]-f�4/79-$JH SAt STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERM ITN (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential )41 Municipal/Public 0 Industrial ❑ Agricultural 0 Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATI Nearest Town: t;cab V , rt a County (Y1/1✓t UJ GZEx, r Q6771 (Street Name, Numbers. Community, Subdivision, Lot No., Zip Code) 3. OWNER: l 6.,new..r Crt,(/ sp Address OTeoll la, Me()btnsVi11e (Street or Route No.) Ro�b�nsut'El# Mc-. 2277/ City or Town State Zip Code ( )- Area code- Phone number 4. DATE DRILLED V-to-63 5. TOTAL DEPTH: 9 65- 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 121 7. STATIC WATER LEVEL Below Top of Casing: L o FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS r FT. Above Land Surface" *Top of casing terminated at/or below Ind surface requires • varlaace hi accordance with ISA NCAC IC MIL 9. YIELD (gpm): St METHOD OF TEST 10. WATER ZONES (depth): /1/.5-- I I. DISINFECTION: Type 12. CASING: C�ir Depth From 0 To 72 From To From To Diameter FL In /1 Ft. Ft. Amount el& Wall Thickness or Weight/Ft. - aterial SD, -al VG 13. GROUT: Depth Material From__ To 2 0 Ft.S.ri th e n T From To 14. SCREEN: Depth From To Ft. From To Ft. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. Ft. Diameter in. in. Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. 11 /2.9 6-0 d.� !mhos is Rea, �t ilk' orn orn pump;4j Rlgkson e0.5TMa;n a a miles C!L � tarn ieAran Norib Mama•f Tarn Right 6nTo unaF3s%�4d 6.0 en b,al pI;/es Turn ?e3 ptj7o �lawb'rt RA a-6 r.3 , 1PS 7vrryf� an 4Toe Method Slot Size Material in. in. Material -From PoPeye' Torn Re ga" R�I60 I inH C Turn le4 on «Toa)t lick 6-o 6.6 m'Ie Turn !e Ton 16. REMARKS: Oder 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 �-tio—n3 DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-I REV. 07/2001 WELL CONSTRUCTION RECORD c9aae-L c- /eZz A 277442 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / CERTIFICATION'# �rS �,6 WELL CONTRACTOR (INDIVIDUAL) NAME(print) / WELL CONTRACTOR COMPANY NAME /1 ,M l .I en-e- STATE WELL CONSTRUCTION PERMIT# (if applicable) % z • lace PHONE # ._5 -SS 1] ASSOCIATED WQ PERMIT# (if applicable) 1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural 0 Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 2. WELL Town! 6jvr: ;,j /✓� l J Nest Town! o �1,0-(f{J!X� County ��",l�' We -Lb- 1 (Street Name, Numbers, Communi Subdivision, Lot No., Zip Code) 3. OWNER: Addres ( /7 (Street or Route Dlo.) 7/ 1 City or Town State t Zip Code 7. STATIC WATER LEVEL Below Top of Casing: 62 L' FT.A/-3/ _ / (Use"+" if Above Top of Casing) CPo _ / O 4 8. TOP OF CASING IS / Z-- FT. Above Land Surface* �/)pp .• *Top of casing terminated at/or bolos land surface requires a /- 0, 4- — 3.3e) variance in accordance )with IS.A NCAC 2C .0118. 53/J ^ 33437 9. YIELD (gpm): if METHOD OF TEST iL _ 3, j / , s' — ', D 10. WATER ZONES (depth): 11. DISINFECTION: Type_- Amount r7-R 12. CASING: Wall Thickness Depth Z? Diam ter or Weight/Ft. To � T Ft �o SP2-Z Topographic/Land setting ❑Ridge slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description Area code- Phone number , 4. DATE DRILLED /: 3 //�' Y 5. TOTAL DEPTH: (r 0 0 6. DOES WELL REPLACE EXISTING WELL? YES NO 0 —97 99 /o y /DV— /8J /3d—/3/ From From To Ft. From To Ft. 13. GROUT:Depth MaterialMethod From V To 02 O FL_ From To Ft. LOCATION SKETCH yShow direction and distance in miles from at least i two State Roads or County Roads. Include the road C7 ,i LK_ numbersQ d�� road names. 14. SCREEN: From From Depth Diameter To Ft. in. To Ft. in. Slot Size Material in. in. 15.SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS: lit- ✓ G -zt 9 O Co C I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL x: r--, :- CONSTRUCTION STANDARDS, AND THAT A COPY 0 IS ,CORD HAS BEEN PROVIDED TO THE WELL OUTER" SIGNATURE OF PER NCO TJC`5ING THE WELL - one CA o Submit the original to the Division of Water Quality, Grounc 27699-1636 Phone No. (919) 733-3221, within 30 days. 3tr Section, 1633faiFSeFvTcN{egtr -Raleigh, NC Gi -1 REV. 07/2001 WELL CONSTRUCTION RECORD 2 7 4 2 4 6 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAMEEQ (print) SC PP E R U HMG. C CERTIFICATION #10 )Ao Sri WELL CONTRACTOR COMPANY NAME /c O.-ncvr-n ta)„t_QQ �/t-c-C,(,t��) PHONE # e2'd) 479-H4/'S4L STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential M Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: q., Nearest Town:'Rd-%.Pj.1•;w�t,�-. t-(L2 County M/la `id ,L4 ` ncw.1124 - LS7'?/ (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNERD&M. P&,) AddrcsZ'j'-'%t Sett--U4L&cr Kdt/541/tl/al% (Si o , •i) -C oute No.) ag7 i City or Town State Zip Code tQzS)- -39510 Area code- Phone number 4. DATE DRILLED 5//tfi• co3 5. TOTAL DEPTH: / WO ' 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO al 7. STATIC WATER LEVEL Below Top of Casing: 3 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING 1S / FT. Above Land Surface* *Top of casing terminated at/or below land surface requires a variance In accordance with 1SA NCAC 2C .0118. 9. YIELD (gpm): 2 S METHOD OF TEST 10. WATER ZONES (depth): 1 '7 7 A I I. DISINFECTION: Type Hr/I 12. CASING: Depth From 0 To ;7-0 Ft. From To Ft. From To Ft. 13. GROUT: Depth From fl To 0 Ft. Material CC --me. Amount O, 3P., Wall Thickness Diameter or Weight/Ft. Material ✓ % cot? 'XI PVC From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. Slot Size Material in. in. Material Topographic/Land setting ❑Ridge OSlope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road rates. t `.wuy * lz9N. », 3 4/0 ,4./.1 en -rne,aa.ci 13.umtik.+i.d.-aL*3• 5 Method ttaA/l, . - Cm S-rt,..-,4,•�w,cQ 40 Tnt.Lk/y PA „) ants£ t`" brm, 11)-j- en, 5mcu� E n cQ, rO a `-faun, ' 0 6�-i Nryal ctL c ST`cu'ttnel d 7 /ui. [ s}{+0ec, rvteA ''�'��1'iJl'�L -CG pV&Q, C\w-.,,11)�{�i -iJ , r-,*.•r.i,{ __ ry 10 itrrL .CC N—, ) P dry 61 kids/ 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER • sj S AE OF PERSON CONSTRUCTING THE WELL DATE/�oo3 Submit the original to the pivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 7J3-3221, within 30 days. GW-1 REV. 07/2001 WELL CONSTRUCTION RECORD 2 8 0 0 9 8 North Carolina - Department or Environment and Natural •per,./,,`urea - Division'/of Water Quality - Groundwater Section 'YELL CONTRACTOR (INDIVIDUALINAME (print) c/c�' r Y-GUp / A:tYyrA 9 CERTIFICATION a 2 o5) WELL CONTRACTOR COMPANY NAME GYG )1Lv nn f✓e-/I Girl)/Jla 1c PHONE w Pisa'I79-5'yij4"/ STATE WELL CONSFRUCTINN PERMIT,/ ASSOCIATED W12 PERMITS Of applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection D Other 0 if Other, List Use 2. WELL LOCATION: Nearest Town: Robin n s v, ll,N County 6reithah'1 U V/ Rd Q 77! (Street Name. Numbers. Community. Subdivision, tot No.. Zip Code) 3. OWNER: rar Io$ O P Address U G-o. N /)t ,- (Siren w Rowe No.) J?obb/nc voile N,C r2 77/ Cny or Town State Zip Code 0,1v)- '179- 6l'/3 Area code- Pion number 4. DATE DRILLED Ci `,2C--O3 5. TOTAL DEPTH: LID 5� 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: 3g" FT. (Use "t' if Above Top of Casing) 8. TOP OF CASING IS I FT. Above Land Surfaces `Top Mashie terminated etfor below land surface requires entente in accordance with ISA NCAC IC .01113. 9. YIELD (gpm): 2 METHOD OF TEST 6., r 10. WATER ZONES (depth); 36 7 I1. DISINFECTION. Type I/TH 12. CASING: Depth D-iamcter From_(,___ To .33 Ft__ From To Ft. From To Ft 13. GROUT: Depth From h To 96 Amount p.(e6 Wall Thickness or weight/ft. Material ,S D r :2! PVC - Material Ft tC nme n 7 From To Ft. 14. SCREEN: Depth Diameter SIN Sine From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft From To Ft. Topographic/Land setting ORidge OSlopc OValley DAM (check nppmptiaie box) Latitude/longitude or well location (depeevmimncsneronds) Latitude/longitude source:DOPSOTopo -_--1 (check box) a DEPTH 1 —I._�� r. From To Formation D scriplion' LOCATION SKETCH - --- Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. et)Fni RPA I,811TCCU PonryPS / rrl /e o n / 29 W. 6-0 /..3 M t7e Method Aonipt T'rn /PPT on Massey (3rrh .nc Material Rd, G-O 3.a mt lyds oinr tcehT Oy I Snv t,o 20 / d Rot. 6- 4p-i, i L'S To en Ito T an z u GUI+ ratj, G o 0,6 "mitIt's Torn %1,61h(rn G To etr57 Or, ve on j�,c9h' /on lei 16 REMARKS' O m I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL .0 —+ CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEiW JN.�-;`&ry Al P 9-9.5-03 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 cD d WELL CONSTRUCTION RECORD 2 $ 0 0 97 North Carolina - Department of Environment and Natural�'rces - Division of WaterQuality- Groundwater Section WELL CONTRACTOR (I,NDIYIDUAL)NAME(perol 4)-F /may /` yl�/ P CERTIFICATION /eg0SQ WELL CONTRACTOR COMPANY NAME re..Ch 6../17 /e/e// Ae11 h!) PRONE t( f&24 4/79 STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: / Nearest Town: /)nn%Ih,i re;u, l/N County C-rnhckj f it ll ✓17(�Y (rr.p $ -k . afr77) (Street Nemc. Numbers. Caodtunity. Subdivision, Lot No.. Zip Code) 3. OWNER: IRO V 10-7+// J'DY1 Address 1r.!ch S G41fA Robb II 45 It.'I/r (/p$tten or Route No.) R.iink' 12Sv" e elf 2C77/ City or Town Stet Zip Code (`Y30-2)- 773- Area rode- Phone number 4. DATE DRILLED 9.- 2 3 - 0 3 5, TOTAL DEPTH: / 1(.O 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®' 7. STATIC WATER LEVEL Below Top of Casing: 60 FT. (Use `r' if Above Top or Casing) S. TOP OF CASING IS / FT. Above Land Surface* `Tap err cube terminated sOor below lend surface requires a variance in accordance wlta ISA NCAC 2C .0113. 9. YIELD (gpm): 3 0 METHOD OF TEST G r r 10. WATER ZONES (depth): / O I1. DISINFECTION. Type 12. CASING: Depth From C) To /07 From To Front_-_ To 11. GROUT: Depth From 6 To O Ft. FL _ Material Ft. Gornan7 fir Amount o.zi Wall Thickness Diamrtcr or Weight/FL Material rt. 6 y SOR:21 PVC From To Ft. 14. SCREEN: Depth Diameter From To Ft in. From To Ft. in 15. SAND/GRAVEL PACK: Depth From To Ft. From To FI. Size Slot Size in. in. Topographic/Land setting ❑Ridge ❑Slope Malley ❑Flat (check appropriate box) Latitude/longitude of well location (de9ccslmnnlnshecads) Latitude/longitude souree.00PSOTopogmphic map (check box) DEPTH FRILLING LOG From To Formation Description hr Ei Method owNr PunFi'nY R 1iT o'� �runTer Gu/o R , 6-0n Material 0 ,(p m, ifs / U{'I rl /11p' p LOCATION SKETCH I� Show direction and distance in miles from arieasr--- ` two State Roads or County Roads. Include the road numbers and common road names. rDr) G ma PcT oe orat) AT on ?& iU. 6.-6 '9 In de jars Material 16 REMARKS.. i 0 h Rook 6-0. O: Th r ISS m P-P7- on 13ri s COUP moo, 5 mice! JG /err ue// on 164Tpr 3 ono NY C� r4 ti G I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL c.) CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNATURE OF PE //A e ?-023 -03 iONCONSTRUCTING THEWELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 072001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources -%,,Division of Water Quality - Groundwater Section /� WELL CONTRACTOR (INDIVIDUAL) NAME (print) /��AI,v&4( I tf7A/Q r CERTIFICATION' #0/ g7 WELL CONTRACTOR COMPANY NAME AAA @Teela e fro Wc!iI Pr/C4 PHONE # 'b'Ss0 STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 1. WELL USE (Check Applicable Box): Residential y� Municipal/Public ❑ Industrial ❑ Agricultural IDMonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use 2. WELL LOCATI. Nearest Town:' �0 rr i ' lie County .5=kee .Bpi,ri�4rit,1UIne, N (Street Name, Numbers, Comm nity, Sof/division, Lot No., Zip Code) 3. OWNER:Eas4'r4T3a4 4L�llevokee ni Address Ian its t nqe'-rni-fyts*l"t:.ch4tro Doh (Street or RoutNNo.)C. �7�A ccc?t-Lo7C. CI .0.n�kee 4. DATE DRILLED 5. TOTAL DEPTH: (! OTh C 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 29 7. STATIC WATER LEVEL Below Top of Casing: . FT. (Use '4" if Above Top o Casing) 8. TOP OF CASING IS I /uZ FT. Above Land Surface" •Top of casing terminated at/or below land surface requires a variance in accordance rith ISA NCAC 2C.01 Is. n . 9. YIELD(gpm): METHOD OF TEST 10. WATER ZONES (depth): (30 City or Town State) Zip Code (Si)- q Ci % — PEe / Ls Area code- Phone number iSiU3- �1Flryl . Topographic/Land setting '�'a ❑Ridge Slope ❑Valley ❑Flat ..O / 7I (check appropriate box) Latitude/longitude of well location / 11. DISINFECTION: Type 14 j — Amount i- Show direction and distance in miles fro 12. CASING: Depth Diameter From 3 To /05iFt. From To Ft. From To Ft. (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description U- 4'CI 4c7 I- - KOy /S0,4)-330 3.30 — 33/.� 33)S' —NSA LOCATION SKETCH O leas Wall Thickness two State Roads or County Roads. Inclut�a'Yhe rta., or WeighUFt. Material numbers and common road names. s/7Ez/ ,e) fv �� 13. GROUT: Depth Material From 0 To �.,2d Ft. ( -a-2 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. lethod From To Ft. 16. REMARKS: I Sri ^pr-kyeS,m � N tn' I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER CONSTRUCTING THE WELL DATE -r� -- Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, ILIC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 .y WELL CONSTRUCTION RECORD 279525 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION p 3295 WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE a (828) 837-8008 STATE WELL CONSTRUCTION PERMIT!! ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 1. WELL USE (Check Applicable Box): Residential ® Municipal/Public O Industrial 0 Agricultural 0 Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town: ROBBINSVILLE County GRAHAM YELLOW CREEK - UPPER COVE (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: CARROLL ARNOLD Address 682 UPPER COVE RD (Street or Route No.) ROBBINSVILLE, NC 28771 City or Town State Zip Code ( 828 )_ 479-1566 Area code- Phone number 4. DATE DRILLED 09-19-2003 5. TOTAL DEPTH: 605' 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El 7. STATIC WATER LEVEL Below Top of Casing: 30 FT. (use "F" if Above Top of Cnsing) 8. TOP OF CASING IS 1 FT. Above Land Surface *Tap of casing terminated aUor below land surface requires a variance In accordance with 15A NCAC 2C A11g. 9. YIELD (gpm): 4 METHOD OF TEST AIR 10. WATER ZONES (depth): 180' II. DISINFECTION: Type CHLORINE Amount 100 PPM 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. From 0 To 72 Ft. 6 1/4" .188 From To Ft. From To Ft. Material STEEL 13. GROUT: Depth Material Method From 0 To 20 Ft. CEMENT GRAVITY From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Topographic/Land setting KIRidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location 3524.097N/8347.904W (dcgrees/minutes/seconds) Latitude/longitude source: IGPSOTopographtu map_._-, (check box) i DEPTH DRILLINVY LOG k.` From To Formation DCstTipltbif--'-' 0' TO 20' BOULDERS & SAND 20' TO 30' BOULDERS 30' TO 72' SAND & GRANITE 72' TO 605' GRANITE SLATE CO C en l_ 7+) CC' N CC' — nm -'TO LOCATION SKETCH 0 rn Show direction and distance in miles from aast -no two Slate Roads or County Roads. Include troati�)K numbers and common road names. r AD o QI tie2 1� 12D C9` / / v ur 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT j COPY OF TJ,[IS RECIIAS BEEN PROVIDED '10 THE WELL OWNER 71-0 - Y.-Xi-0 3 SIGN '.URE OF CONSXRUCT'ING TILE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-I REV. 07/2001 WELL CONSTRUCTION RECORD 2 7 9 218 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section it (i<l WELL CONTRACTOR(INDIVIDUAL)NAME (print CERTIFICATION #aU PHONE # WELL CONTRACTOR COMPANY NAME jf \\P C t .`1oi\ r; \\: /t� SSOCIATED WQ PERMIT# (if applicable) STATE WELL CONSTRUCTION PERMIT# (if applicable) 1. WELL USE (Check Applicable Box): Residential ET—Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Neared Town: Rp\t* County inct'ti,Xavvu In);\) ,Shexc\\\ (Street Name, �Numbers, Community, Subdivision, Lot No., Zip Code) tJ 3. OWNER: nt,' DY\Q k,C)(11\s Address t7y l,)lll ‘4/7e1r511 rie, (Street or Route No.) 2� l l 1hOtxr\svt\\e cc- Code City or Town StateZip Area code- Phone number 4. DATE DRILLED °6- 1 a -n Z 5. TOTAL DEPTH: 1 OS' 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [U 7. STATIC WATER LEVEL Below Top of Casing: nth FT• (Use "+" if Above Top of Casing) 8. TOP OF CASING IS I FT. Above Land Surface* *Top of casing terminated at/or below land surface requires a varianceaccordance Dwith ISA NCAC 2C .0118. METHOD OF TESTA, P 9. YIELDELD(gpm): 10. WATER ZONES (depth): 11. DISINFECTION: Type\ e.\\f'-s Amount 1 12. CASING: Thickness Depth Diameter or Weight/Ft. Material From ToSt_. Ft. (r,025 2/ /O✓t Ft. Ft. Material Ft. Qn(A-lavi ti Ft. Diameter Slot Size Material Ft. in. in. Ft. in. in. Size Material Topographic/Land setting ❑Ridge ❑Slope OV-alley ❑Flat (check appropriate box) Latitude/longitude of well y I location (degree) .:^•,test axunm) Latitude/longitude source:❑GFSLiTupob.anhic map (check box) DRILLING LOG Formatipyn Description /?nn /APR DEPTH. From To 0 - �fD From To From To 13. GROUT: Depth From_f> To 1O From To 14. SCREEN: Depth From _ To From To 15. SAND/GRAVEL PACK: Depth From To From To Ft Ft. reMethod LOCATION SKETCH e Show direction and distance in miles tan atrltastla., --- two State Roads or County Roads. IncMe tl mad numbers and common road names. 'u Zm o< +J s_n a m0 a =m cn = rf U CA) --4 .C o Z 'v)t113Aerri/( a R abb,�f)1 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER I. SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE Submit the originalGroundwater to the Division of atei Quality', y' Groundwater Section, 1636 Mail Service Center -Raleigh, NC GW-1 REV. 07/2001 27699-1636 Phone No. (919) 733-3221, within 30 days. WELL CONSTRUCTION RECORD 2 7 9 ; 16 North Carolina - Department of Environment and Natural Resources -\\Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print;30.1Sn`\ CERTIFICATION # v2y Oct WELL CONTRACTOR COMPANY NAME m a\Pr t.J01t PHONE # (3a kl ii37- zqc STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 1. WELL USE (Check Applicable Box): Residential @"Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town:Rebkn<J;\\ (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER:/4Qt/q /�c r/'e Address l 4 2 1\1 IDlVi n1 l Cif CountyCJrn 4C vv( (Street or Route No.) �` 4Rob' `Nei'y Q 2- -1 City or Town State Zip Code Area code- Phone number 4. DATE DRILLED C - I S - t7 5. TOTAL DEPTH: IBIS' 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fa' 7. STATIC WATER LEVEL Below Top of Casing: r?')FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface' *Top of casing terminated at/or below land surface requires a variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): (D METHOD OF TEST41‘,0 10. WATER ZONES (depth): 11. DISINFECTION: Type,4H1 PLl/P is Amount A 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From/_ To. 1I Ft.7a ?i ,Sbs11 pr.. From To Ft. From To Ft. 13. GROUT: Depth Material Method From f) To aD' Ft. flm-Hem r✓ ,nreSS'rr Ft./ Slot Size Material in. in. From To 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Topographic/Land setting ❑Ridge ❑Slope Galley ❑Flat (check appropriate box) Latitudeflongitudc dwell locaUca rJ 3V'I(o sib41 W 83"H/56 (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DRILLING LOG Formatipn DescriptiLo�nry go 0A/PC5 s�.S; l T 0/0,,P,,✓ erect DEPTH From To O - IS LOCATION SKETCH Show direction and distance in miles frpm a two State Roads or County Roads. Inclpde thetw��e_,..- _ numbers and common road names. Iw o .reki rn c', { r -0 esn 1 I Em J HO S 77a I m <n m= CO (ci y G z Z a c,11 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 7:4-rT4t.(C2A -'- S -d3 SIGNA I UtW OF PERSON CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 ivio1; Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-I 11EV. 07/2001 WELL CONSTRUCTION RECORD 281263 North Carolina - Department or Environment and N�aWn Rcaomccs-D)ivission of Water Quality - Groundwater Section tvELL CONTRACTOR (INDIVIDUAL) NAME &/'A+nti I �I� P.P Y'/ gr-1 a CERTIFICATTOH .DSD WELL. CONTRACTOR COMPANY NAME GrG�i Awi Cir: II/11PRONE fRTtil 1-179-C/545-( STATE WELL CONSTRUCTION PERMITS ASSdf1ATED IVQ PERMITS (tfapplicable) (iftpplitabie) I. WELL USE (Check Applicable Box): Residential f MunicipaUPublic O Industrial ❑ Agricultural CI Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other II IFOtber, List Use 2. WELL LOCATRINr' Nearest Town: rtit ns v, l County G h6 so-W) Lops-7- flu 4,Jn RcA• (Street None Numbers, Community. S thdwi.sie. tut Na. Zip Code) 3. OWNER: FV.Q) on /cooper Address �.Jp?,t li+ etet ny 55 (Street a Rum No.) (�611nit N51/,liA R)C. %77I City or Town Sate Zip Code H7i-ca.10 Am code- Phalle number 4. DATE DRILLED II-/D - 0 -3 5. TOTAL DEPTH- I7n') 6_ DOES WELL REPLACE EXISTING WELL? YES 0 NO la 7. STATIC WATER LEVEL Below Top of Casing: 3 3 FT. (the "a'tf Above nap area* 8. TOP OF CASING IS I FT. Above Land 5trrfwx' Map at flan terari..tcd attar bd.w taad sunhat eegshes a Vanntce In arcertonee with ISA NCAC r6 Alea. 9. YIELD (gpm): 3 o METHOD OF TEST CamY 10. WATER ZONES (depth): qt II. DISINFECTION..Type 12. CASING: Depth From (S To 3 SC From To From To_ 13. GROUT; Dept Mumricl From__ To 'oj C) Ft. (.PfrlPro- From To Ft. i4. SCREEN: Depth Diameter From To Ft. _in. From To Ft. in. IS. SAND/GRAVEL PACK Depth Siu Maerial From To Ft. From_To Ft. Tlf Amount 0•17 Watt Thickness Diameter or Weight/Ft. Material FL/n-i"I 5'DRG,1 PVC FLFL Topographif/Land setting ORidge OS)ope OVafey OF a (dndk appmptaa test ,_ Latitude/longitude of well location,:-_-;, oram m*/um megedr) Lalituddinngitude sourca:OOPSOTopo Nittahw) From11 To Formation D 01 It t rt y N_, tJ Cn F O LOCATION SKETCH. Show direction and distance in miles from at least two State Roads or County Roads. Include the mad taunts.numbers and common mad taunts. �rvr-) got. 14h` TPopyesYrnlerT on a9 Go 1-3 m: /es ivrn ✓e T AvMadan r ' Slot Site Material x� art /n0-f55e, F3vo,rach Rc ' 1GO 31 .6 d .a 1�,'1 e! dl ✓Urn l��'qqJ1 I �oi� Sbtou/�i,i" Rtit in. �r jn,'Io6 (Urns ,)D)70 5G17/e&irak GU ,1 01tiela %a)rn /et' T o;i es-r /301E,10 Ro G6 ✓. fli /96 tide/ ) o n R1002 16 REMARKS: I OD HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER k e Il"l-d3 SIGNATURE OF FiRSON CONatRUCDNG THE WELL DATE Submit the original to the Division of Water Quality. Groundwater Section, 1636 Meg Sate Raleigh, NC 2T699-1636 Phone No. (919) 733-3221, within 30 days G W-1 REV. 07/2001 WELL CONSTRUCTION RECORD 281262 North Carolina - Department of Envinammen and Natural WELL CONTRACTOR (INDIVIDUAL) NAME (WW1 J gaf f e r /y a tit .G -,q WELT. CO.WTRACTOR COMPANY NAME Cr ra.kD-Pal b-,IP/ M( Irht 11i Y)O vHONEij Sri �ir/-��1 STATE Iva/. CONSTRUCTION PERITS ASSOCIATED WQ`PECRMrn (ifapplicable) (if avp itahle) I. WELL USE (Check Applicable Box): Residential El Municipal/Public CI Industrial ❑ Agricultural a Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use 2. WELL LOCATN: Nearest Town: � � n it n s t'p l /P Courtly i-ci uLJ IS'fen irl{t'r /vr1ranr%I I'€L (Street NuK mambos, Community. Sennett tot Ni.. tip Code) - Division of, Water Quality - Groundwater Section CEriTt:ICATION a TopographiClLand setting ['Ridge OSlope OValley 0 (drrca appoptiae tear3 Lati(udrllongitude of melt foam 3. OWNER: Cut''ri s ! -ecvgier tdr .cth i ) Address ,5'Tnlj4 l7r lira n'Xc% laliwdeTnngitude source: DOPS0Topo .hie map (stun a aoam Nit) (abet boa) {� PAA6,Inc vii/ NC. Z£f77/ DEPTtj 'RILLINGLOG Coy m Town _gnu Zip Cede From To Formation Description tzv- y/az' 799 0 Area code. norm number r p ^t om 4. DATE DRILLED / -7 - 0 3 O `; S. TOTAL DEPTH- 972 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Intl 7. STATIC WATER LEVEL Below Top of Casing: __ ___Fr. (Use go-if/non Top of jai) S. TOP OF CASING IS / FT. Above Land Surftn c' Kap of caring tcrminnttd stlor adva tad surface regains a vrttcnce In ttcamanct Ma t3A:CAC 7C.0l ia. 9. YIELD (gpm): METHOD OF TEST 0. i r W. WATER ZONES (depth): ra s.i I I. DISINFECTION_ Type Fit TH. Amount O. N 5' 12. CASINO: Wall Thickness Depth or WeiglWFt. Material From (1 To Ng sspr.. 1 PUG From To From______ TO IS. GROUT: Depth From_ To a0 From To 14. SCREEN: Depth From To Dior atcr FL G� Ft. FL Mauaial Ft. (emery - Ft. Diameter Ft. From To Ft. IS. SAND/GRAVEL PACIC: Depth Siae From To Ft. Frerr__To El- 16 REMARKS: in. in. p Method Slot Sim Material in. -^ IR Material Clt `- rcnr 0 �y LOCATION SKETCH. Show direction and distance in miles from at bast two State Roads or County Roads. Include the road numbers and common road mums. ire rn R t?C� 1 bc/)i T 4T P pe yes / u r n L e 129N GO /.3 y.1;1?s Turn Ie T oN ivlas (ranch RA, 6-o 3.ar rides Torn an d $no u6t rck Rd.Go 0,IC M lrs Tvr✓t e S'e.nrl1 td-eia1l RA r�- 0 .J mi Les T(/ le-7 an wesT r3v alrot Gee a./ m- Tor R0r'i 67"rn-i'0)4T /3rca.inck Rd.. CuGo,3m;le laic CW1 fei_ I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2G WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS y�RECORD HAS BEEN PROVIDED TO THE/WELL OWNER SIGNATURE OF OEI(SON /CONSCTING THE WELL ( DATE O Submit the original to the Division of Water Quality. Groundwater Section. t636 Mall Service Center- Raleigh. NC 27659-163o Fount No. (90) 733-3221. Within 30 days G W-1 REV, 07/2001 WELL CONSTRUCTION RECORD 281261 North Carolina - Department of Environment and Natural LT— brew - Divisionl�of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (pint)</BTIery /niyri(U cttimrtcAnnxa Qi3,l-U �y WF.L!. CONTRACTOR COMPANY NAME lrH0.h 0./✓) l.J�!% c�y, �rrnO PHONE a MIS) l 7%'S(z6{ STATE WELL CONSTRUCTION PERMITd AREOCIATED wQ PERMrri (If applicable) (ifapplicable) I. WELL USE (Check Applicable Box): Residential p. Municipal/Public ❑ Industrial 0 Agricultural O Monitoring ° Recovery O Heat Pump Water Injection 0 Other ° If Other. List Use 2. WELL LOCATI N:�t Nearest Town: ntV7i✓15 //,l% ugly GIr0.17C0Yl J %p,° skPe Nir. (Street Nrmr, Numbers. CanmunitSextet' # co -Lot N47W Cod:.) 3. OWNER: l,i l- r S he? I TL Address /4l✓ell fl s/ eo Pg PP (Strut w Route Ito.) RAif,�<,l; //ti Ahr. ? �r77/ City or Tam State ZipCodc (2.). 4179-i-)!U Arta code. Phone number 4. DATE DRILLED //- to- d 3 5. TOTAL DEPTH- S'A6- 6. DOES WELL REPLACE EXISTING WELL? YES O NO 6i 7. STATIC WATER LEVEL Below Top of Casing: i/h Fr. (Use `r` if Atom Itp ofCWna) S. TOP OF CASING IS / FT. Above Land Surface• `Tap orcmdq terminated mks Wow taad surface rumbas • vaetarree in aecarusoct with ISA UCAC TC .oi ia. 9. YIELD (gpm): METH°&''1FJEST G—, r (0. WATER ZONES (depth): � �J II, DISINFECTION. Type I-f ! N 12. CASING: Depth Diameter From_() To 6 D FLJp le/ From To Ft. From To FL (3. GROUT: Oepth Moroni From n To an Ft. CPMPN From To Ft. 14. SCREEN: Depth Diameter Slot Size From To _ Ft. ; . _ in. From To Ft. in. _ ire 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To FI- Amount O. i 2 S Wall Thickness or Weight/Ft. itrial amr2t i-'VC, Topographic/Land setting °Ridge °Slope OVailey Of lat Work appmpriue her) Latitude/longitude of welt location (degresrmm) Latitude/longitude suurce.00PS°Topographic (cheek So.) From To Formation Descripl Method PUmp no C J n cn LOCATION SKETCH. _a Show direction and disean= in miles from at (easy ni r two State Roads or County Roads. Include the to� co w numbers end common road namf7es h t r tin Froh7 airnooA Po5T U?F ° a.`6 I le.7 P-rdes Toro R,,A7-or /0toer T skee ee 801, GO /.9 /)'i, /e Torn Material /-#T Go. oa, m,7e % �; n /e » T Go. 0-I jn,'/e Lie/! OP /e-T 16 REMARKS. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND TN HAT A COPY OF THIS RECORD HAS BEEN PROV IDED TO THE WELL OWNER r) 1-1-E-L" y Rs// At p //- 6 - el -3 SIGNA7URE0 PE CONSTRUCTING THE WELL DATE Submit the original to tot Division of Watt; Quality, Groundwater Section, lea Mon Sender Center- Raleigh, NC nag 9-1 d36 Phone No. (9193 733-8221, within 30 days G W-1 REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department or Environment and Naturesj'Resources - Divisionof Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1)P Teel r y hiyA P CERTIFICATION a .aCCSO WELL CONTRACTOR COMPANY NAME 0ra.6el Ill LJi 11 telrr l/,in0 STATE WELL CONSTRUCTION FERMITP ASSOCIATED WO PERMITS (if applicable) (if applicable) 282468 PHONEY (SH,Si) 47`!-Sf�f s(-( I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0 Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use 2. WELL LOCATIQN: NearestTg9wn: lithr in 6 t/C7/61 County Gret/ta.rn fv)d&de franc;/, 2977/ (Street Num. Numbers Cotomuoity, Subdivision, Lot No.. Zip Code) 3. OWNER- /7 /e2/1I r y /41' 11/6k, yr Address hi PcICCoi.J hrahch (Street or Ruoe Nu.) Rdlib /In5Vide° N.G, 877/ Coy or Teem Stair Zip Code (n-d-�195s -a�r7N Area code- Prone number 4. DATE DRILLED /O - / — 0 3 5. TOTAL DEPTH: /0.5— O. DOES WELL REPLACE EXISTING WELL? YES 0 NO IN 7. STATIC WATER LEVEL Below Top of Casin2 410 FT. {Use "+•` if Above Top of Casing) S. TOP OF CASING IS I FT. Above Land Surface* `Top of mite terminated atter below land sort ee requires a variance in atmrdaate With ISA NCAC 2C.UI /B. 9. YIELD(gpm): 2)I5 METHOD,DFTEST Gl-tK 10. WATER ZONES (depth): l I. DISINFECTION. Type HTA/ Amount 0. U. CASING: Depth From n To 79 Wall Thickness thunder or Weight/Ft Material PI. /n ,SOR2) PVC From To Ft. From To FL I3. GROUT: Depth From O To Qo Ft. From To Ft. Topographic/Land setting ❑Ridge ['Slope OValley ❑Flat (check oppmptiate bog) Latitude/longitude of well location (degrecsvmimnts/scconds) Latitude/longitudc source. 7OPS0Topographic map (check box) DEPTH From To LOCA Show direction and distance in two State Roads or County Roads. Include the road numbers and common road names.E'<� //' `j! Turn iOY✓1 �OPEirPS R6� /C /efr on /7N. 6 /6 / /yl,%� Materiel Method ,,.� n (/„ l T o n �j�f eo. C,l o (ti) b f et nG r' (emenT »�mA; c) /Ur/7 37/ I � nj //1 kTl��' Material /r CT . (T o /' 3 fti, /C� S /Lt r!7 /Lc I . SCREEN: Depth Diameter Slot Size From To Ft. in. in. From Tn Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To FL From To Ft. 16 REM ARKSi on R1,hr b I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL L CONSTRUCTION STANDARDS, ANDTHATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER tT Lc ricn Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC rt 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-I REV. 07/2811X1 H 0-2-P- er �{ysF /69`/-63 SIGNATURE OF 1 EERSON CONSTRUCTING THE WELL DATE las 0 - to G 2 WELL CONSTRUCTION RECORD 282466 North Carolina - Department of Environment and NaWn •p/ nources - Division of Water Quality - Groundwater SectionWELL CONTRACTOR (INDIVIDUAL) NAME (print) Jec 77p>, / r 1viy)e CERTIFICATION a/.C.� E 6: WELL CONTRACTOR COMPANY NAMrc&hcLw, L✓ell Ck I^r ll i,r r) PHONEY f 4/]9-Y45-77i STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITY Of applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATEry,(�/�y��%� Nearest Town: / IL'r Jell hs (Zilie County( rcJicihn Tnbbcl.rcn bro.nc. h .5j77 (Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code) 3. OWNER: l7et.n .57wh Address 7nhact 0 Eirr.,rh RIB. /� (Street or Ruuie No.) /CA%binsv'/led N.G. .26;77I City or Toiw Stoic Zip Code 6sy)- e/3— 4 In O Area code- Phone number 4. DATE DRILLED /Ll —7—c3 5. TOTAL DEPTH: 94;n 6. DOES WELL REPLACE EXISTING WELL? YES ❑/ N'0 12( 7- STATIC WATER LEVEL Below Top of Casing' 66 Fr. (us, nr ifAbave Top of Casing) S. TOP OF CASING IS L FT. Above Land Surface* `Top or easing terminated auer below land sorlace requires a variance in accordance with ISA NCAC 2C.011a. 9. YIELD (gpm): O n METHOD OF TEST 6 r 10. WATER ZONES (depth): a II. DISINFECTION. Type f-{%/( 12. CASING: Depth From 6 To 7Q From To From_ _ To 13. GROUT: Depth From rl To ®20 From To Ft. 14. SCREEN; Depth Diameter Sled Size From To Ft in. in. From To FL in in. IS. SANDJGRAVEL PACK: Depth Size Material Amount 0_4'0 Wall Thickness Diameter or Weight/FL Material .SArai »Ur Ft. Ft Material Method Ft. Ceme,n7 wmp; ny From To FL Material Topographic/Land setting [Midge ❑Slope ❑Valley ❑Eiat (check appropriate box) Latitude/longitude of well location (degeevmimnrs/socont) La tituddlongitudc source.DGPSCITopographic map (check box) DEPTH DRILLING LOG From To Forma i- LOCA Show direction and distance in mi two State Roads or County Roads. numbers and common road names, -- rem CJliraSri /a57 0- Peicc TurfsfJ�149/ /ets 72'r'/1 /e cin fl N Go 3,7m on %abcccc branch Rd, 6-o 0.9, Milt( 7-vrn /g76=o, 6,1 j(i We'll on 1/1T From To Ft 16 REM ARKS' i DC) HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER -I; C -c C / i rye! F SIGNATURE OF PEN CONSTRUCTING THE WELL DATE p D Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 ('hone No. (919) 733-3221, within 30 days. GW-) REV. 07/2001 282465 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Qf`sources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) 06) /16-ry hiydle CERTIFICATION# .2O:Sc WELL CONTRACTOR COMPANY NAME GYClhe.k YYt °JO /I dNi'IIt'k10 PHONE it Inli) 979-sr -jb411 STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential lT 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: JRok14 ,1H5tv,'/iE' County Ci-l'0.116l37 C-117hNnv Thrc.pr/t /ir� 2i177( (Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede) 3. OWNER: She/W. ins S44orns Address C'J17h6/hy 13rncch Rel (Street or Route No.) R01371'h5 friNi 1 N.r 2 s;777 City or Town State (2Y)- 979— S b e "3 Arca code- Phone number 4. DATE DRILLED 10— 9— 63 5. TOTAL DEPTH: /n n C Zip Code 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: y,.30 FT. (Use "+•' if Above Top of Casing) 8. TOP OF CASING IS % FT. Above Land Surface* *Top of casing terminated st/or below land surface requires a variance In accordance with I5A NCAC 2C .0118. 9. YIELD (gpm): -4[ METHOD OF_ TEST C).. t Y 10. WATER ZONES (depth): / 7s I I. DISINFECTION: Type l'l % /I Amount 0,31 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From 0 To 3.2. FL G 4j 5Di' .i VC. From To Ft. From To Ft. 13. GROUT: Depth Material Method From 6 To 2.0 Ft. Cerndn7 Aim %oI PIP'?" From To Ft. 14. SCREEN: Depth Diameter Slot Size From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH From To TION S Show direction and distant two State Roads or County Roads. Include the road numbers and common road names. r t rorn Red i,'ihTct.,ofJeY?S % vrn R ,i h T e n OM 5 6-0 1-/.7 rn 1e>T oif} anT/Aany l3r«Nch ormation EMI Eki BEI Material Rat 6-0 /.6 m ties 7 vrn Righ i 6-6 U.a 'm/'/PS %D well roil leT co o Tax 16. REMARKS: m 2J I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL 0 CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER Tre4erme SIG NATURE OF PERSON CONSTRUCTING THE WELL DATE /6 •-7--03 Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-322 I, within 30 days. G W-1 REV. 07/2001 G WELL CONSTRUCTION RECORD 282464 North Carolina - Department of Environment and NaturalResources- Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) J ✓ , / ci r y Hy ok e CERTIFICATION # Q.0 5 U WELL CONTRACTOR COMPANY NAME ir'r a an'' Well rkr ; l(_ ______PHONE # Pas) '-179— 51t(6 cl STATE WELL CONSTRUCTION PERM/TO ASSOCIATED WQ PERMIT# (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential HI Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town: R01710ir7S V/ /{A County rail cx ni Beach Creek Q { a 77/ (Street Name, Numbers, Community, Subdisiston, Lot No., Zip Code) 3. OWNER %nynnqy 14N124..rd Address /3Pacln ereeK Rck .1rx�/ (Street or Route No.) 11alOklin/.5 Ville) ALca 0. 77/ City or Town State Zip Code (f2)-1127_v`t/C Area code- Phone number 4. DATE DRILLED in —/(7-- 6 -3 5. TOTAL DEPTH: ao ' 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: 'C FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1 FT. Above Land Surface" *Top of casing terminated at/or below land surface requires a variance in accordance ith 15A NCAC 2C .0118. 9. YIELD (gpm): METHOD OF TEST r 10. WATER ZONES (depth): Pi 1 I. DISINFECTION: Type if T H Amount O- a 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From 0 To -5 s Ft. 6 y Sin2.7 PVC From To Ft. From To Ft. 13. GROUT: Depth Material r� Method From 0 To 9.0 Ft. (emer, j Pvm p, )19 From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS: Topographic/Land setting ORidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description . Z, r— C_ LOCATION SKETCH Show direction and distance in mile Tron at ler��_�7 two State Roads or County Roads. Include the — numbers and common road names. 1-7"0/71 Red ),rhrczT �&Pej1E'5 G=� 11/3 E 3.ym,les Tot-n RQ n 3e-4Lch Cre&IC RcX Go l•I ni,'les i z,r Ie4T G-c) o..1 in/ 1e e) 1/le II ola /e4T 0 rn c� C, 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 �e-hPer y Hyde SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE /U-/O- o� Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 1 WELL CONSTRUCTION RECORD 282463 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print)i�..)e'Pe r Y //yde CERTIFICATION # a a Co WELL CONTRACTOR COMPANY NAME (T ro-k o, Vs'1 to NI) �V' 1111 iv PHONE o f2-Q) Li 7l'fHS4-I STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/ (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential G3 Municipal/Public ❑ Industrial 0 Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATIpOIN: 1 Nearest Town, Alb in.Sv,/I.' Countyri1-oWahi %a/,t»et- Se&Wy/e'r5 G'reseek RA / (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: 6r71P Rd Address it) (AA' Sc.1.).-/yer5 Creeic PA (Street or Route No.) Rnkb,';�S l.r l/N ALL 2877/ City or Town State Zip Code (sa - L-/79 3 "' 7.5 Area code- Phone number 4. DATE DRILLED /0 —i 3 — 63 5. TOTAL DEPTH: a S(0 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ei 7. STATIC WATER LEVEL Below Top of Casing: Ft) FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS f FT. Above Land Surface" 'Top of casing terminated at/or below land surface requires a variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): 7 METHOD OF TEST 6,1 r 10. WATER ZONES (depth): 406 II. DISINFECTION: Type N T H 12. CASING: Depth Diameter From 0 To £-l3 FL /c Y From To Ft. From To Ft. 13. GROUT: Depth From 0 To a0 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 DescrfpG-an-) .- LO 'ATION SKETC i d ) ) Show direction and distance in mile two State Roads or County Roads. Include the road numbers and common road names. SFcT,Ion a�'c�nc\ P-13 Taff€. a U 6'o 11 Mde* Turn fir:z9hTof) /elder Saw yerS creek RG` C-0, Slot Size Material in. in. C5.8 m,'!e irrrn ;e Gv, 6,{ !a Welton ie Y Size Material O From Ft. 0 0 From Ft. ,C 16. REMARKS: rn 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 — Amount 0-• Wall Thickness or Weight/Ft. Material SArJ-i PVc Material Method Ft. CePie nT rti MID; 1g From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15,SAND/GRAVEL PACK: Depth To To r�F4'ery Hyde SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE 10-/3-6 3 0 to Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 c 53. rrl rf72 rn u C) 282461 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural ,p•`/�.�`,`,'urces - Division'of ater Quality - Groundwater Section^t WELL CONTRACTOR (LNDIVIDUAL) NAME (print) rjy�eaTPttrr Y Kyoto CERTIFICATION e K nl6-d WELL CONTRACTOR COMPANY NAME; 6TYC-LVI c. m I.I (-'l i Arc P.470 PHONE Y �°�L/7it— S,^1-154f STATE WELL CONSTRUCTION PERMITl ASSOCIATED WQ PERMITS (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Recovery ° Heat Pump Water Injection 0 Other 0 If Other, Ltst Use 2. WELL LOCATI N: Nearest Town: et {t; A' n I /W County (: fre's �rritt Eri 57" li t t rkI9 77 / (Street Narnc. Numbers, Community. Subdivision, Liu No.. Zip Code) 3. OWNER: ONO,P1 S7a y Address to sr 13114 (Siren or Route No.) R4h1 i,',1/ /V. G City or Towo State Zip cot (7A7)- 476" —$ t� 5/77/ Area code- Pion number 4. DATE DRILLED 16- /S - o 3 5. TOTAL DEPTH: / j 0 6. DOES WELL REPLACE EXISTING WELL? YES C) NO tli 7. STATIC WATER LEVEL Below Top of Casing: G () FT. (use "e' aAba,t Top of Casings S. TOP OF CASING IS / FT. Above Land Surface' 'Tap al easi&g terminated attar belong land surface requires a tnrtance in accordance Rita ISA NCAC IC El Ie. 9. YIELD (gpm): '7 li METHOD OF TEST ().-i V 10. WATER ZONES (depth): /20 11. DISINFECTION. Type 12. CASING: Depth From__ To Li From To From To I3. GROUT: Depth From (\ To aU Ft. From To Ft. 14. SCREEN: Depth Diameter From To Ft. in, From To Ft, in. 15. SAND/GRAVEL PACK: Depth Size From To Ft From To FL it 7-14 Amount 0.:2) Wall Thickness Diameter or Weight/Ft, Material Pt ( 035f 5Trel Ft. Ft. Material Method n O el pi' hc2 Slot Sin Material in. in. Material Topographic/Land setting °Ridge °Slope ❑Valley OFIat (check appropriate box) Latitude/longitude of well location (drpecsfmirutrs/secartds) Latitude/longitude sourcc:DOPSOTopographic map (check box) DEPTH Rll LIP. G LOG From To Formation Description Cr_ IN 1, m _ LOCATION SKETCH Show direction and distance in miles fro —.r-ai-ieest two State Roads or County Roads. Include the road ntmbers and common road names. R h CI {7 ac7 It, row) Pofeys �rn 616, L-1,3 r1,'1(es 72,1q rn ,g47 on (�ee5/ ✓AACLlt 62o, l,a }lily. 7Urn lEbr on oil/'Fs creek RaI 6L0. o.S W c N to d1; ),J bl o u s e O W 16 REMARKS: a O I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL 1 CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER �to-7EPer v /Joao In (s-a3mitt SIGNATURE O PERSON CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mnil Service Center- Raleigh, NCO 27699-1636 Phone No. (919) 733-322/, within 30 days. GW-I REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural'Resources�- Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print)�+d{eaf1'"'E'r y MyAe CERTIFICATION # Rt -CO lT WELL CONTRACTOR COMPANY NAME rah {vl (,Jr// r&Ntl(11,10 PHONE # (224y 79-Sri/SY STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQtPPERMIT# (if applicable) (if applicable) 282460 I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring ❑ Recovery 0 Heal Pump Water Injection ❑ Other 0 If Other, List Use 2. WELL LOCATION: R Nearest Town: i h1'105 Vi HP County G.r4ic)✓I Cinri'5t eat eaIv" Q -77/ (Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER' di) Address Roil i'nc nil/F (Street or Route No.) Rnklo/In4w;//, 11/-C 9.877/ City or Town State Zip Code (fray)- '179 2317 Area code- Phone number 4. DATE DRILLED (_{) —/7-0 3 5. TOTAL DEPTH: tn.t 6. DOES WELL REPLACE EXISTING WELL? YES O NO @ 7. STATIC WATER LEVEL Below Top of Casing: L/40 FT. (Use "+" if Above Top of Casing) S. TOP OF CASING IS / FT. Above Land Surface* 'Top of casing terminated at/or below land surface requires a variance In accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): qq--- METHOD OF TESTe-Uv r 10. WATER ZONES (Depth): 3YJ 11. DISINFECTION: Type /f T 12. CASING: Depth Diameter From C To SC Ft. Oct From To Ft. From To Ft. 13. GROUT: Depth Material From !+ To 2,0 Ft. Cepip n T From To Ft. 14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in. Froth To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material To To Amount f.ln2 Wall Thickness or Weight/Ft. Material 5faai pvc From From 16. REMARKS: Ft. Ft. Method PO inialiv Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:OGPSOTopographic map (check box) DEPTH DRILLING LOG From To Formalio LOCATION SKETCH Show direction and distance in miles f two State Roads or County Roads Inc n umbers and common road names. om a least rem Rr. l'9hT(LTPOPey% /L!-o le47 cn 07 roes /corn /647 6/1 chris%'fU co(/P /U 6-0 /4 PT GVe// CM /(' 1 O CO CD O { 01 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 c 0 rn nri _ m =„ O — — Ce--tery y4e /0-/7-c1.3 tO 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-I636 Phone No. (919) 733-3221, within 30 days. GW-I REV. 07/2001 282459 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) *de .PPer y /r'yG1P CERTIFICATION k Q co WELL CONTRACTORCOMPANV NAME - ro,ham u-'e)) art 9I,tr PHONE # (Sr2sJ 479-846-4 STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable) (if applicable) 1. WELL USE (Check Applicable Box): Residential Ig Municipal/Public 0 Industrial 0 Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use 2. WELL LOCATI(y}�(�N: Nearest Town: I\(1VLb)/25v,'//P County�ttGraha Wl p CI%lS CV6',4( RA a1�77/ (Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: %36b 5E'/l&yeS Address v/!/es CF&&K /2d (Street or Route'No.) Rnbh,'ns v/)/e' JU as'771 City or Town State Zip Code (770)- `176 f96UI Area code- Phone number 4. DATE DRILLED /0-23-03 5. TOTAL DEPTH: `,CGS 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El 7. STATIC WATER LEVEL Below Top of Casing: 670 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS I FT. Above Land Surface* *fop of casing terminated at/or below land surface requires a variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): 30 METHOD OF TEST Gs.i r 10. WATER ZONES (depth): I '-{.S II. DISINFECTION: Type 12. CASING: Depth From U To Jam/ From To From To 13. GROUT: Depth From 6 To Qb From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth From To Amount O 9-6 Wall Thickness Diameter or Weight/Ft. Ft. rL y Ft. Ft. From To 16. REMARKS: Ft. Size Material Ft. Material Ft. (emenT Material %Teri Method Pump1 g Topographic/Land setting ❑Ridge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:OGPS❑Topographic map (check box) DEPTH DRI From To Formation Description l LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. /pyn Reck l,ghT Ur PO Peye 2 i'n 1r- 1 on IA? N 6:6 4/,3 /n//es Turn R107 on Ea.s T ,61j7cdlo GO I • . y)-1,'/es %v0f Je4T on allies Creek Uo, G, 5 />)i/f LC-1 Slot Size Material h in. ///!/1 /r�T 6-6)•0,a%YIt00 �E'5.4?i T in. O.) !7'l, /eS /6 hevse, tA/ co40 /e 0 C rn a I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL in CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER c� N1—Yc r y N yc JD-23-63 SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 282458 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR(INDIVIDUAL)NAME (print) tieery /"tyete CERTIFICATION 0 Q-0JJ WELL CONTRACTOR COMPANY NAME Gro-li&01 Wf I air, ((t no PHONEft fS2y)H%y-5lr-/S'{ STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMITM (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential El 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: RdFih;'h5v:fie County G-ra.hc.Y✓1 <i ///es Chf'f'(: a-77/ (Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: dP f rid AGin 5 Address !S///6'S Cr6C/C Rrk t7 (Street or Route No.) I AI-,12).h 4 u,'l/P /l/G QS'7 n City or Town State Zip Code (. )-ti79- v/3 Area code- Phone number 4. DATE DRILLED /h- 2,.ci-()3 5. TOTAL DEPTH: 336 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EA 7. STATIC WATER LEVEL Below Top of Casing: / 2.0 FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surfaces *Top of casing terminated at/or below lend surface requires a variance In accordance with ISA NCAC 2C .011S. 9. YIELD (gpm): 3o METHOD OF TEST G)`+ r 10. WATER ZONES (depth): a/o I I. DISINFECTION: Type /4 T li 12. CASING: Depth Diameter From Cx To /a.s Ft. (c From To Ft. From To Ft. 13. GROUT: Depth From O To C From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Amount 0.3 7 Wall Thickness or Weight/Ft. Material SAY 9.i fVc. Material Method Ft. CemQnT Puripint, Slot Size in. in. 16. REMARKS: Material Topographic/Land setting ORidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formatio LOCATION SKETCH Show direction and distance in miles two State Roads or County Roads. Inc numbers and common road names. i^1 Reck. ,'h`reAT RR- yes %arn le*r on 1a9iu,C-0 11,3 rv,/es /o•-'Or 0 l4.5-1 /t3v-P-Palo Go •Q M 16,s /L,cr le,#T gI(,e's C r&Nl< RA Go 0.3 inat-Soj ur,1 Ri)'yhr Go o.a ni/1rS c( I Uv C c ;, I1'h� 1 al a - x �= rn O I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL lD CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNATURE FPE SON CONSTRUCI NG THE WELL /oDA E�� 3 Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-I REV. 07/2001 G WELL CONSTRUCTION RECORD North Carolina - Department of Environment and NaturalatS- fl/Resources - WELL CONTRACTOR (INDIVIDUAL) NAME (print) e tee r V WELL CONTRACTOR COMPANY NAME G Ye-k1 o. ri W e / / STATE WELL CONSTRUCTION PERMITS (if applicable) 282457 Divisionof Water Quality - Groundwater Section HyA P CERTIFICATION Mail Sv Arr ll tang PHONE ♦ (t2S Lf79-sf, L/ ASSOCIATED WQ PERMITS (if applicable) I. WELL USE (Check Applicable Box): Residential CS' Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use 2. WELL LOCATION:I Nearest Town: RON6i h$ V; /l County Cr0.�0.1,v) hi LONE, Ynskree Ca �877/ (Street Name, Almbers, Commune. Subdivision, Lot No., Zip Cede) A 3. OWNER:e 6-c r%tnA Address /r11t 6 r 77,,SkPe &e (Street or Route No.) Rl 1in5 v lip N.!: i 77/ City or Town State Zip Code (crag)- /17y-3<,o7 Area code- Phone number 4. DATE DRILLED f()-- 2 7-03 5. TOTAL DEPTH: 2 6-6- 6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO B 7. STATIC WATER LEVEL Below Top of Casing: WO FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface' *Top of casing terminated at/or below land surface requires • variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): I a. METHOD OF TEST 10. WATER ZONES (depth): Topographic/Land setting DRidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formatio Description-_ I I. DISINFECTION: Type if 7 -J Amount 0.. 3 ff 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. Material From C) To 73 Ft ___ snp.zl PVC Ft. Ft. 13. Material Ft. Ce/nPYIT From To From To GROUT: Depth From Ct Tor 0 From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. LOCATION SKETCH I r— Show direction and distance in miles f m a ieastLi.:- two State Roads or County Roads. Inclu a the road numbers and common road names. tram .7nTer5&cT.oin as-,-,4 /1-/3 %acite 9.& N 6-6 0.6 /n,ks 'Tern Method ('vr»p;yb�j Rl hr on /get/e)' Tuskrevgec-& Rd\ Slot Size Material in. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. 16. REMARKS: 6-0 ni/le,s -n 16, i Go 0.1 m/les 0Jel/on le7ET 0 O CO O a 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 OWNIgit 6-" ry /*/yote 10 7-0 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. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR INDIVIDUAL NAME (print) o CN �I Y '>l /Tyc /� (INDIVIDUAL) (P ) l f CERTIFICATION N 9-o6-0 Grc&kam Well rkr/'lInv PHONE N(n4`t79-$-iSH STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERM ITN (if applicable) (if applicable) I. WELL USE (Check Applicable Box): Residential 1SE Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use WELL CONTRACTOR COMPANY NAME 282456 2. WELL LOCATION: Nearest Town: Rot-J2 r,5 v; //e County Gt-ck. ai'( 7vs/1 ue PA. (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 3. OWNER: l-A-r UPI /3reicksiNtre Address Le IJ Pk LS%C NNtg& R (Street or Route No.) (dr, ,'f45u,'11e N.c ASr77/ City or Town State Zip Code (4 9 iL/.- 3 7/3 Area code- Phone number 4. DATE DRILLED /o -30 -o3 5. TOTAL DEPTH: Quo 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111 7. STATIC WATER LEVEL Below Top of Casing: ;.6"- FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / FT. Above Land Surface` *Top of casing terminated at/or below land surface requires variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): q METHOD OF TEST Cr-. r 10. WATER ZONES (depth): Ss 11. DISINFECTION: Type 12. CASING: jf rH Depth Diameter From C7 To Ft. (ck From To Ft. From Ft. 13. GROUT: From o To Depth To 2.6 From To 14. SCREEN: Depth From To From To 15. SAND/GRAVEL PACK: Depth From To Ft. From To Ft. FL CtmenT Ft. Diameter Slot Size Ft. in. in. Ft. in. in. Amount O Wall Thickness or Weight/Ft. Material 5n'ral Pre, Topographic/Land setting ❑Ridge OSlope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRIL IN From To Formation D LOCATION SKETCH Show direction and distance in miles fr two State Roads or County Roads. Include the road numbers and common road names. --;reyr) '2hTer5ec j,o i 02'Jctin4(. )-IF! Ta/Ye A )V Go a .6, ni /'/�s scription fr ) C LT. V ti. Till Material Methodpi)'c Ron let✓t'!6'5k d€ZP• leewe( l�vrntt�ht r 6-0 - m ,'l e s Tr„n /6-4 T G-c) Material /miles /0 (Li el/on R- hT 16. REMARKS: Size Material 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 d o --4�e: y l-�.y,I P /6 ;3O.- 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. (919) 733-3221, within 30 days. GW-1 REV. 07/2001 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and N ural Resources - Division of Water Quality - Groundwatar Section ��y �Q�Ge CERTIFICATIONIf903 WELL CONTRACTOR (INDIVIDUAL) NAME (print) J j i 1 i r�J{ PHONE (d� 7 yy 7 ASSOCIATED WQ PERMIT® (if applicable) WELL CONTRACTOR COMPANY NAME STATE WELL CONSTRUCTION PERMITS, (if applicable) 282394 I. WELL USE (Check Applicable Box): Residential 9 Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCAT1Oth, �irc �ya>n Nearest Town: t D • its County Duffs Ceteh (Street Name, Numben, Community, Subdivisieu, Lot No., Zip Code) 3. OWNER: 1E.w•;S 5orjli h- CYo Marian 411 I Address C1til N-A est,. CPV Vo eu PIT) (Street or Route No.) 40)vcooyv\\( IJC lati City or Town State ( )' Area code- Phone number 4. DATE DRILLED /O - 0 3 - 0 3 5. TOTAL DEPTH: .2 6 0 6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO LI-- Zip Code 7. STATIC WATER LEVEL Below Top of Casing: '21 D FT. , (Use "+" if Above Top of Casing) 8. TOP OF CASING IS / 2- FT. Above Land Surface` *Top of casing terminated et/or below land surface requires a variance In accordance with I5A NCAC 2C .0118. 9. YIELD (gpm): % METHOD OF TEST /51 Y 10. WATER ZONES (depth): s- 11. DISINFECTION: Type //T/l Amount `Yr-`/% 12. CASING: Wall Thickness Depth Diameter or Weight/Ft. STMate Material t From C To (Sri Ft. From To Ft. From To Ft. 13. GROUT: Depth From-P.— To_X From 'To .17i 14. SCREEN: Depth Diameter Slot Size Material From— To Ft. in. in. From To Ft. in. in. 15. SAND/GRAVEL PACK: Depth Size Material ��%/``Material Ft. /"oi?YAW.) From To Ft. From To Ft. Topographic/Land setting DRidge ❑Slope ❑Valley ❑Flat (check appropriate box) Latitude/longitude of well locati n, ,vas° Ws/Y./ " wo83°5/352 (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DIULLING LOG From To Formation Dc:cription 4 — 674 c•z- _/pro /` o- 02CO (jrtrrn.4 Msjhod retswe O { r •1 rc) LOCATION SKETCH Show direction and distance in miles frdtd at least two State Roads or County Roads. Incldlt theroad numbers and common road names. 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARD,�S,AAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER SIGNATURE OF I'ERSON CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, �Vgh, C01 27609-1636 Phone No. (919) 733-3221, within 30 days. WELL CONSTRUCTION RECORD 284017 North Carolina . Department of Environment and Naturrall�rocress - Division ,qtf Wafer Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME ((�print) /I J9 1 Pry/ 411/ j(A P CEtertai ATION ad.SU wE.L1. CONTRACTOR COMPANY NAME 6; PA Y1 Llh1 /✓frl// Ar-7/i/i!7_G/ PHONE a fgaal c/7Y-irySH STATE WELL CONSTRUCTION PERMITS AeSOCh1TED IVQ PEYRMU (if applicable) (if applicable) I. WELL USE (Cheek Applicable Box): Residenlial Municipal/Public CI Industrial a Agricultural O Monitoring 0 Recovery 0 Heat Pump Water Injection U Other() IF Other, List Use 2. WELLLOCATION• NggrestTown: R oink; h �' Vt/(//' County 6--1 rc 10.4; 1 rc.n k Cr e€o Rrct.A ,ZSs 77/ (St/mutant. Numbers, pmmmniy. Subdwniat lee No-. Cat) 3. OWNER: ,,lQ' C K Pr„ N /6L/3J Address t n1/4.11 A ("tee is- IX c. cLr, (S.. Ruing Nu) ��bh�ns� lle 1VC �Sr77/ Coy or Town State Zip Code (galz]-Li7V-a1cle/ Area coat. Panne number 4. DATE DRILLED id. - / 7 - r2 3 5. TOTAL DEPTH- .3 3r) 6. DOES WELL REPLACE EXISTING WELL? YES O NO 7. STATIC WATER LEVEL Below Top of Casing: (use ne-ifAbn Top of Cuba) 8. TOP OF CASING 1S / FT. Above Lend Surfaces *Top of ad•e term4.ted sUor loam bed surface ftglrlrte • mime In arcero.nee with IJA NCAC zC .elaa. 9. YIELD (gpm): �a METHOD OF TEST *1 IO. WATER ZONES (depth): .Sf7 I I. DISINFECTION- Type %/ T N 12. CASINO: Depth Diameter From (l To Sr 3 FL G 19 Frum To Ft. From To FL 13. GROUT; Depth Fromm To Q(i Ft. From To 14. SCREEN: Depth From To From To 15. SAND/CRAVEI. PACK: Amount (,.SI Wan Thickness or Weight/FL hnr21 Material Cc-n1 &ITT Ft. Diameter Ft. ;n. Fi. in Slot Size in. in- TopographidLand setting ORidge ()Slope OValley OFlat (check(dnappropriue tam) Latitude/longitude of welt location tdeg estrmrertatatacrds) Latitude/longitude souret:OOPSCITopographic map (check her) AtPTt1 DRILLING LOG From To Formation Description Material LOCATION SKETCH Show direction and distance in miles from at ?easl— wo State Roads or County Roads. Include the toad numbers and conm road pig -I- in Pe- 11 TaT �ij'ey S i7,r� /I R l,9/1To t2 /A9 S c-0 /,m � PMMod I h C `- rJGrT flOCcG� lT 0 /.7 t h i/t C T/, /161,A ( it_%_ // c n c) 0 2 Material %('r/.2 6 /1 /pc:Li)i I S Cr. Pet' Rc« _ .6 Depth Size Melerial From To Ft. From To Ft t6 REMAt1KS- I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED (N ACCORDANCE WITH I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER Jam! &ry HyA& /7-63 SIGNATURE OF PERSON CDNSiROCT1NO THE WELL DATE -' Submit the original to the Division of Water Quality. Groundwater Section, 1636 Mail ServtetCenter - Raleigh, NIP ZT699-1636 Panne No. (9 t9) 733.3224 within 30 days OW -I REV. 07R401 WELL CONSTRUCTION RECORD North Carolina - Department of Environment and Natural Resources - Driiviisio of Water Quality - Groundwater Sectionil 'YELL. CONTRACTOR (INDIVIDUAL) NAME (print) ``�/CU er')/ / Yale CERTIFICATION f9 ,rr C� w F: LI. CONTRACTOR COMPANY NAME Cr-I"'cc./7 es- tUe/l (71,j'I l4r/h(y PHONE N (cas1'l79-f9661- STATE WELL CONSTRUCTION PE RAI ITN SSOCIATED WQ PERMIT# (if applicable) (if applicable) 284016 I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural ❑ Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use 2. WELL LOCATION: Nearest Town: R1ti6rt7CY','// (, County-rcthcl/4 CIO SIdec'T ldc.Qer emr, (Street Name, Numbers, Coatmunity. Subdivision, Lot No., Zip Code) !1 3. OWNER: elly GLMJ re Li5 Address rlrk 6t✓eer£Jc76r- Rc��ct (Streets Route No.) /Qo-21); )t 51.•;//r^ hk- as-77 / Cny or Tam Siam Zip Cale (t.7S-)-Y7Q - &/O�� Arei code- Mine number 4. DATE DRILLED ! 2 —,2c. :3 5. TOTAL DEPTH: a FtG 6. DOES WELL REPLACE EXISTING WELL? YES 0 N0 El 7. STATIC WATER LEVEL Below Top of Casing: a FT. (Use "+- if Above rep of Casing) S. TOP OF CASING IS / FT. Above Land Surfaces Kop of easing terminated aUor below lead surface requires • variance in accordance with ISA NCAC 2C .911c. 9. YIELD (gpm): 0 METHOD OF TEST a- r 10. WATER ZONES (depth): C 11. DISINFECTION- Type H Tft 12. CASING: Depth Diameter From C', To_-.G FL (r From To Ft. Amount (t. 5-'0 Wall Thickness or Weight/Ft. Material <Dral AVc From To Ft. 13. GROUT: Depth Material From () To_a(„Ft. ( c')f7E%t7 % From _ To Ft. 14. SCREEN: Depth Diameter Slot Size From To Ft. in. From To Ft. in IS. SAND/GRAVEL PACK: Depth Size Material From To Ft. Topographic/Land setting ORidge OSiope OValley OFIat (check appropriate box) Latitude/longitude of well location tdegreesrminu nrseeonds) Latitude/longitude suurce.00PSOTopographic map (check boa) DEPTH DRILLING LOG From To Formation Description O 0 co_ = A pt't =0 LOCATION SKETCH Show direction and distance in miles From at least two State Roads or County Roads. Include the road numbers and common road names. N,.c poPeyes �o STr«, hT //(04Yh Rej IighT Tc )473 tic /a%p)r/c-s pint i /e rn /� t h! on c lc( .$1L;ee7-4« jf r in. in - Molest £ &c rO 0-Q /u e/ CI) err From To Fl 16 REMARKS- 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED (N ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER 7—4-Er� /VA I C7j SIGNATURE OF PERS N CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Gruundwnter Section, 1636 Mail Service Center- Raleigh, NC 27699-1636 Phone No. (919) 733-3221, within 30 days. GW-1 REV. 072067 WELL CONSTRUCTION RECORD North Carolina • Do.pertment arEnvrirzinmentand Natur a Resources • Dii,iision of Water Q'_ I '• Gro� iarvate• Sectizin YELL CO;NTRACT'0,R(DDIv';OL'AL)NAME (prir„) Jzr,es fi. Brown CERTIFICATION = 2045 293855 WELL COnTR,ACTOR CON PANYN.I:lEHedaaD Brothers Well Drilling, Inc PHONE 62Sl 369-9591 STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIIT4 (If aonhca51e) aoolic.ble).. WELL USE (Check Applicable Box): Residential MunicipaliPubit: G Industrial ❑ .ura, G Monitoring G 'Rezo;ery.❑ Heat Pump Water I ;ccticn G Other G If Other., List Use 2. WELL LOCATI Niarosi Town'- ` b/1a.) (5,:ceei Name, N. i, ocrs, Cola OWNER -.dc uss Count' <LaS.en.liico, Lot No., Zip Code) tfr opd.r Pcdi, O /J Cod. Ar:n rode. Pie num'c:r 4, DATE DRILLED 4' d6'03 5. TOTAL DEPTH 5 DOES WELL REPLACE EXISTING WELLS YES 0 NO G 7. STATIC WATER LEVEL BelowwTop of CasineFT, (es: ,; ,, if Abc:e —cc of Cas 6g E. TOP OF CASING IS 2 FT Alcove Land Surfa:e* 'Top of casinis t;rmina:ed at'or below Sand surface requires a variance In accordance it h IS.A NCAC SC ,01IS. S. YIELD (;pm), METHOD OF TEST blow IC. WATER ZONES (dep.h): 'Topographic'Land setting CRid; CSloot CVa'le: ❑F..L-t (C:1eck oprrcQhole SCQ Latit d.'lon "i:uda of v location ey. S;a... L G:'t ^__ nL r' .., sz ze CGPS - aoh(t rap `b ) DEPTH DRILLINI LOG Cam Forma Deiett`_`tYY—.._. /�� clay `& seho Pq t Goo' crane • DISINFECTION: Type H T H 12, CASiNG: Depth Di .meter From 0 Tc iJ� Ft. ` FSr To From To IS. GROUT: Depth From 0 To 20 From To Amount ' 15 oz Wall Thickness or WeicH. Ft. Material dig 'ateP Maieriai Method Fl. 1:L11ite & c.etct:L pumped Ft, • I 4 SCREEN: Depth Diameter Slot Size Material From - ' To • ct. ir. in. From To Ft. in. I5. SAND/GRAVEL PACK: Depth To To From -From Sze Ft. YI LOCATION SKETCH Sho direction and distance in miles nom a: least two State Roads or County Roads, Include the road numbers and common road names, 0 r —c CO O 3 C) W CO 16, REMARKS` I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL CONSTRUCTION STANDARD_, AND, AT A COPY OF THIS, ��,�� RECORD �HAS� BEEN PROVIDED TO THE WELL OWNER r� )? 0'4 SIGNATURE 7' PERSON CONSTRUCTING THE WELL DATE Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC 27699-1636 P1mnc No, (919) 733-3221, within 30 days. • Gfti •I REV. 0712001 c o` n sr, rrs oc :PD —+G r-aC r-1 cn rnzu 0 WELL CONSTRUCTION RECORD North Caro:ilia- Dc_a Im_ d o-. E rl:on.-e,nd and Natural ResourC'a • Division of Water QV°' � Crour G,ate• Section })ELL CO TR,AC1'OR (I)DIv IDUAW lNAh1E (prirll' Jeres E. Brawn CERTIFICATIOIN # 2045 WELLCO;N'rR,(CTOR COMPANY NAat EHedden Brothers Well Drilling, Inc PHONE ) 369-9591 STATE WELL CONSTRUCTION PER.HITe AcSOCIATED AYQ PERMIT: (if applicable) - (iiaonlieable) WELL USE (Check Applicable Box): Residential L Municipal/Public 0 Industrial ❑ Agricultural ❑ Monitorin_- 0 Recovery 0 Heat Pump Water Injection C Other 0 If Other, Lis' Use 2. WELL LOCATIO ': Nea s t h Nam:, e, Numbs s Co ^Ch: ntv� nuui / 9uSavis o:, L No. Zip Code) O'WNEFs / odd uss O '' I.Y. i 2S Zip Cod: (z$ (48X - I30(0 Are. coda- P,:cm:e numer 4. D.ATEDRILLED �1-.3-03 5 TOTAL DEPTH: 5 (00 ' 6. DOES WELL REPLACE EXISTING WELL? YES NO C' 7. ,STATIC WATER LEVEL Below To:e Casing. FT. (L''se ". .. Ace Top of Cas'H;� S. TO? OF CASINO IS 2 FT. Above Land Surface' •Tcp of Basin; tarminated at'cr below land surface requires a variance In accords n with ISA NCAC 2C MI IS, 9 VI=` D (:pm): METHOD OF T S�T blow 10. WATER ZONES (depth): O 7 293849 T000g hie/La d setting CRd� nS Cb CFlat /19 (o ria too) CI- taja La.citudeilongiiuda of well location Ci:, orTc'.=n 5i-r• I I. DISINFECTION: Type 12.CASINO: Depth/� Djarne From 0 To-99 Ft. (s". From To /Oa Ft. (i" From To Ft, 0. GROUT: : Depth tNta!eria:. From 0 To 20 Ft, i. cute&�iei From To Ft. 14. SCREEN: Depth D:a From To Ft. From To Ft. 15. SAND/GRAVEL PACK: Depth Size From To Ft. From To Ft. H T H Lotituda'r n_itude so-; e:0GI S I c 3r4b! i msc.. (chck .,x) DEPTH DL(NGLLOG Fo _ D-,cr.-lion clay & san in I/4C cranit_ LOCATION SKETCH Amount 16 oz Show diredtion and distance in milts from aI least Wall Thickness two State Roads or County Roads. Include the road or ‘.'eight/Ft, Material numbers and common road names, afrp Metnoe.. pumped Slot Size ,Material H. i n. in Material -a Ca) CO m Id. REMARKS: I DC HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH. 15 A NCAC CC, WELL CONSTRUCTION S, AND THAT A COPYTHIS RECORD HAS BEEN PROVIDED TOME WELL O'1,1ER SIGNATURE OF PERSON CONSTRUCTINGTHE WELL Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mal Se 27699-1536 Phone No. (919) 733-3221, within 30 days; /-ya-63 DATE ice Center • Rag sigh, NC O •I REV. 07;2001 WELL CONSTRUCTION RECORD 2 7 8 6 51 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) fe P'Per y Ye a CERTIFICATION .�O R WELL CONTRACTOR COMPANY NAME GroJ- »t &nl UY/l/in (I PHONE # jgailt7q"FS 41151/ STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT. (if applicable) (if applicable) WELL USE (Check Applicable Box): Residential I& Municipal/Public ❑ Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use 2. WELL LOCATION:' Nearest Town: ROW/ in C V; //# County (r-Yd 1, (A. )n SSlal / Bacon RA 2877/ (Street Waffle. Numbers. Community. Subdivision, Lot No., Zip Code) 3. OWNER: /ill //,'cks Address Si0.v BAcon na (Street or Route 2c.771 1 No.) ToM,r'nSv;Ile Mc City or Town State Zip Code (ca.)-k79- 41344 Arca code- Phone number 4. DATE DRILLED 2- )Y - 0 3 5. TOTAL DEPTH: s-0 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IN 7. STATIC WATER LEVEL Below Top of Casing: Co FT. (Use "+" if Above Top of Casing) 8. TOP OF CASING IS 1 FT. Above Land Surfaces *Top of easing terminated at/or below land surface requires • variance In accordance with ISA NCAC 2C .011S. 9. YIELD (gpm): /0 METO�DvOF TEST O.r r 10. WATER ZONES (depth): I I. DISINFECTION: Type f { T W 12. CASING: Depth Diameter From 0 To /d2 Ft. 4 ire - From To Ft. From To Ft. 13. GROUT: Depth From 0 To 'sib Ft. Amount 0.39 Wall Thickness or Weight/Ft. Material steal Rut Material (e menT From To Ft. 14. SCREEN: Depth Diameter From To Ft. in. From To Ft. in. 15. SAND/GRAVEL PACK: Depth Size Material From To Ft. From To Ft. Slot Size in. in. Method anti Material Topographic/Land setting ❑Ridge ❑Slope OValley ❑Flat (check appropriate box) Latitude/longitude of well location (degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map (check box) DEPTH DRILLING LOG From To Formation Description LOCATION SKETCH Show direction and distance in miles from at least two State Roads or County Roads. Include the road numbers and common road names. W o -From Popeye5 Go 723 /y Ern Go /,s flit'/es 7"crn /e4T ro,y l3acon 0-4 0.3 Ir)i/es ioW)i l T aT 36l .510,y 1.30_con R Grim o.1 pi 1 es To house rcl 11005 8 16. REMARKS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER je4-}er./ 11yde SIGNATURE OF PERSON CONSTRUCTING THE WELL Submit the original to the Division of Water Quality, Grou 27699-1636 Phone No. (919) 733-3221, within 30 days. if-/y.-03 DATE GROUNDWATER SECTION r - Raleigh, NC -1 REV. 07/2001 y G