He CY2003

283211
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James t^r Cam Jr- CERTIFICATION# 21 i$
WELL CONTRACTOR COMPANY NAME ('amps c WP11 R Primp Cn Tnr PHONE #7R) tl 1-7322
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
i_
I. WELL USE (Check Applicable Box): Residential 1hr Municipal/Public 0 Industrial 0 Agricultural d, o-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N•
Nearest Tom k
llkMAS AG . Cos .
(Street Name, Numhe'rs, Communniitty�j.Subditision, Lot No., Zip Code)
3. OWNER:a' I-Q. t`tilt �-l1.MA1% �• ,L4
Address P. l b-C-k \ 0 CC{�
si4JA4(Street or Rou� No.)
City or Tow State Zip Code
us)-�Ui 93,L
Area codo- Phone number
4. DATE DRILLED \ fl J IQ . U
5. TOTAL DEPTH: V,IS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO bt
7. STATIC WATER LEVEL Below Top of Casing: 'KO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): 0 METHOD OF TEST Air
10. WATER ZONES (depth): Ws:A ..u1M-
11. DISINFECTION: Type (" h 1 n r i n a
12. CASING:
Depth
From p To C7 f)
From To
From To
13. GROUT: Depth
From_a_____ To 2 0 Ft.
From To Ft.
Diameter
Ft. 6
Ft.
Ft.
Material
Neat Cement
1/4
Amount 0 A
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Hand
Slot Size Material
in.
in.
16. REMARKS:
County M m all,t A.r t-^-
_// Topographic/Land settin4
Midge ❑Slope ❑Valley t"JF14d
(check appropriate box)
Latitude/longitude of well 1ocatiOn
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Tope: <p
(check box)
DEPTH DRILLIV C1 T Ord
From To Kornatilion Description
0 U10 ,1
(p 0 g1,s /AAA.*
G)
0
J.00ATION SKETCH -c
Show direction and distance in miles from atast
two State Roads or County Roads. Include the road c
numbers and common road names.
V f
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1kD IN ACCORDANCE WITH 15A NCAC 2C, WFI I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
ATURE OPPERSON CONSTRUCTING THE WELL
11 -0{ -63
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29'3163
WELL CONSTRUCTION RE CORD
North Carolina - Department of Envirrnment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA -LE (print) Deectc-x IAS 0. QCJ
WELL CONTRACTOR COMPANY NAME C'' M S'�-U`Qe� 'a Sc.. uelt-0. P+ne PHONEY s. CofoS- Lccr
STATE WELL CONSTRUCTION PERMIT:- ASSOCIATED WQ PERMIT#
(if applicable) - (if applcable
CERTIFICATION #_at )'to
e=
I. WELL USE (Check Applicable Bo r): Residential RP Municipal/Public 0 Industrial 0 Agricul ural 0
Monitoring 0 Recovery ❑ Her t Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 91 tndQt' r Hill Ite County mend strso„
C'•..e1te` Y\', x
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: (Std.-twat. A ?t L Q,\•
Address PO P'ta < trli
(Street or Route No.)
Z•cccn'•n nC 2.89Cle
City or Town State Zip Code
(�)- r 7r1- 'Act ')`•j
Arca code- Phone number
4. DATE DRILLED t•'4.)-`�
5.-TOTAL DEPTH: a05
6. DOES WELL REPLACE EXISTIN G WELL? YES ❑ NO lig
7. STATIC WATER LEVEL Below 1 op of Casing: 'AC' FT.
(Ut : ••+" if Above Top of Casing)
S. TOP OF CASING IS t 'T. Above Land Surface*
*Top of casing terminated at/or below la surface requires a
variance in accordance with 15A NCAC C .0118.
9. YIELD (gpm): 15 METH( D OF TEST a•O
10. WATER ZONES (depth):
Topograph.c/Land setting
[]Ridge 4Alopa ❑Valey ❑Flat
(check appropriate t ix)
Latitude/longitude of wi 11 location
(degrees/minutes/sect ids)
Latitude. longitude source:I:CPS ]Topographic n ap
(check 1 on)
DEPTH E RILLING LCG
From To Forr Cation Descrif tic
',- \ 3t-\
(�y�t QDaeekb.
3y g (ieon.tl
11. DISINFECTION: Type ?.VvS
12, CASING:
Depth Diar eter
From i\ To 34 Ft. (a:, ,ta12i p1a..5t-:c
From To Ft.
From To Ft.
13. GROUT: Depth It/ rterial Method
From 0 To Q0 Ft. ('Pmert ?✓-.e4ed
o
CD
Tilt
J
nri
LOCATION SKETCH,,
Show di -ection and distance in rr iles frorblit kill
Amount
Wall Thickness two Stat: Roads or County Road . Include- he -.h4
or Weight/Ft. Material number; and common read name;,
From To Ft.
14. SCREEN: Depth Diame' tr Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz , Material
From To Ft.
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WE ,L WAS CONSTRUCTED IN ACCORDAN 3E WITH 15A NCAC 2C, ?JELL
CONSTRUCTION STANDARDS, AND TI AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WI ILL OWNER
t\ cLta,'c!t 71r%Crl.-CXL.,•.+9-2.03-
SIGNAT 1IROF PERSON CONSTRUCTING THE V "ELL
11.3 e3
DATE
Submit the original to the Division of 'Nater Quality, Groundwater Section, 1636 Mail Serviet Center - Raleigh, NC
27699-1636 Phone No. [phone], wihin 30 days. GW-1 REV. 07/2001

283159
From
From To Ft.
13. GROUT: Depth I aterial
From C To 2c Ft._ fie n^e At
From To Ft.
14. SCREEN: Depth Diame :r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz: Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirr nment and Natural Resources - QDiviQQsion of Water Quali
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D€CCtCx 1)1 y2CJ
WELL CONTRACTORCON1PANY NAME eNt. Saa QCO 'a .ont t'vt Pw"Q
STATE WELL CONSTRUCTION PERMIT= ASSOCIATED WQ PERMIT# -
(ifapplicable) s_ (if appllcable
momm
I. WELL USE (Check Applicable Bo t): Residential Municipal/Public ❑ Industrial 0 Agricul ural ❑
Monitoring ❑ Recovery ❑ HeaPump Water Injection 0 Other ❑ If Other, List Use
ty - Grour dwater Section
CERTI 7ICATION #=2t l'3b
PHONE 4 (et% Co 6S- ;LCz:'
2, WELL LOCATION:
Nearest Town: I-lo cis SF.efl. County )At+taaoa-..
2E)313 (-3ov<1e Ccari,x , \1/4ccses tiQe a874x
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3 OWNER: L'r-S1 `c'S
Address 353t3 (3e-vt\e C curt.
(Street or Route No.)
.kc iesage /QC a s7v:
City or Town State Zip Code
(tick- 4OS tic' -Os
Arca code- Phone number
4. DATE DRILLED 10.1c - c 3
5,-TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTII' G WELL? YES ❑ NO le
7. STATIC WATER LEVEL Below 7 op of Casing: (cU FT.
"+" if Above Top of Casing)
8. TOP OF CASING IS s .'T. Above Land Surface*
*Top of casing terminated at/or below la d surface requires a
variance in accordance with 15A NCAC C .0118.
9. YIELD (gpm): 2 METH( D OF TEST Ric
10. WATER ZONES (depth):
11. DISINFECTION: Type p: t�s
12. CASING:
Depth Diar eter
From -it To 71...' Ft. t.;=
To Ft.
Topo�ggr phic/Land setting
[]Ridge O:Slope ❑Va'ley ❑Flat
(check appropriate t )x)
Latitude/longitude of w4 11 location
III
(degrees/minutes/sect ids)
Latitude, longitude source:❑GPS7Topographic n :.p
(check I ox)
DE 'TH E RILLING LCG
From To Fort Cation Descried(
1-74: `tc-'i he an: re
O
U
c
0
o c
LOCATION SKEF2H
Amount 77 Show di 'ection and distance in rr files frorirrat 1easFr;
Wall Thickness two StatRoads or County Road Inclu W the o5:13
c
or WeightlFt. Material numbers and common read name I. o
o
-it 2I pIr_5:T:e_ O
Method
eou_ved
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE'.I,WAS CONSTRUCTED IN ACCORDAN 7.E WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TFAT A COPY OF THIS RECORD HAS BEET 4 PROVIDED TO THE WILL OWNER
10- c-ca
1-Jezti-e3+ l-Lt-e.
SIGNAT': IRE OF PERSON C STRUCTING THE V "ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, ) 636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], wi hin 30 days. GW-1 REV. 07/2001

W1;LL CONSTRUCTION RECORD
North Carolina - Department of Envin nment and Natural Resources - Division If Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA`4E (print) Oar C:e-x ?l.11-4p1 1!) 0,.. ya CO CERTI?ICATION 4_2• 13(c
WELL CONTRACTOR COMPANY NAME Q-"‘tde Sa SueSt V SGn li Qt 1e, P"'.t^ PHONE t (%'Z% Coco $- ;LOZt;
STATE WELL CONSTRUCTION PERMIT ASSOCIATED rV(l PERMIT# _
(if applicable) - (ifappl cable) 1
�� tom;
I. WELL USE (Check Applicable Bo O: Residential Er Municipal/Public ❑ Industrial 0 Agricul utlal 01
i
Monitoring ❑ Recovery ❑ Her t Pump Water Injection ❑ Other 0 If Other, List Use I
2. WELL LOCATION:
Nearest Town: 'f Cd'ae
C Cecv-.
County 112'+1de
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: C,T)a\e 4cec.e
Address I^3\ 5ttu1.1,. Reels Qn
(Street or Route No.)
.1c. c23'7 Ey
City or Town State Zip Code
( )-
Area code- Phone number
4, DATE DRILLED 1O*(o-03
5,-TOTAL DEPTH: 285
6, DOES WELL REPLACE EXISTID
7. STATIC WATER LEVEL Below 1
(Ut
S. TOP OF CASING IS 1
`Top of casing terminated actor below la'
variance in accordance with 15A NCAC
9. YIELD (gpm): 10 METH(
10. WATER ZONES (depth):
G WELL? YES 0 NO
op of Casing: AO FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST R•l
283153
• Topographic/Land settin
[]Ridge 54Slope ❑Va ley .Flat
(check appropriate t »j)
Latitude/longitude of will location
(degrees/minutes/sect n dj
Latitude. longitude source:❑GPS Topograp
(check t
DE'TH_ LRILLINGLOG
From To Forratie t Descrip tic
-4 % 5"
5Y .28b
11. DISINFECTION: Type f ,1\S
12. CASING:
Depth
From tl To 54
From To
From To
13. GROUT: Depth
From 0 To 2o
From To Ft.
14. SCREEN: Depth Diame er
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diaceter
Ft. (*TA
Ft.
Ft.
Amount S
Wall Thickness
or Weight/Ft. Material
312.1 ?lo.Z41G
N aterial
Ft. C,t...e.at
Method
ro...teek
Slot Size Material
in.
in.
Siz : Material
16. REMARKS:
Oyes t%wtaon
n,-
J
LOCATION SKETt.'H
Show di 'ection and distance in miles froijPat
two Stall Roads or County Road,. Include the v`oz
number: and common read name;. rr,-u
CD
w
V
C
I DO HEREBY CERTIFY THAT THIS WE .1 WAS CONSTRUCTED IN ACCORDAN ,E WITH 15A NCAC 2C, NELL
CONSTRUCTION STANDARDS, AND TI'AT A COPY OF THIS RECORD HAS BEET t PROVIDED TO THE WILL OWNER
SIGNAL IRE OF P SON CONSTRUCTING THE V "ELL
lO-(o-O3
DATE
Submit the original to the Division of Neter Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
27699-1636 Phone No. [phone], wihin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirc nment and Natural Resources - Division of Water Quality - Groundwater Section
CERTI TICATION #_� L3tra
PHONEY (gt (o4S- LC Z;r
WELL CONTRACTOR (INDIVIDUAL) NA`4E (print) IJeec c4. ?\ a.o&R ,Qa �QpJ
WELL CONTRACTOR COMPANY NAME '-v-ese SC-'avca d 5c.A LSe1Vel
STATE WELL CONSTRUCTION PERMIT,. ASSOCIATED WE/ PERMIT#
(if applicable) - (ifapphcable)
283152
1. WELL USE (Check Applicable Bo c): Residential Mt Municipal/Public ❑ Industrial 0 Agricul aral ❑ -
Monitoring ❑ Recovery 0 Her : Pump Water Injection 0 Other 0 If Other, List Use - 1•
2. WELL LOCATION:
Nearest Town: 'Af lue-n County i enicie
Pc,:aoe: cvex,e,
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: lOa\2 Res
Address lil so-k“, Reece ila
(Street or Route No.)
Ac<1er` IAC
asrrti
City or Town State Zip Code
('at,)- B9I•Y�O;o
Area code- Phone number
4. DATE DRILLED 1°-5 •(-)3
5. -TOTAL DEPTH: .265
6. DOES WELL REPLACE EXISTID
7. STATIC WATER LEVEL Below 7
(U,
8. TOP OF CASING IS 1
*Top of casing terminated at/or below lei
variance in accordance with 15A NCAC
9. YIELD (gpm): 10 METH(
10. WATER ZONES (depth):
G WELL? YES 0 NO CO
op of Casing: FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST R .iQ
Topographic/Land -eau rg
[]Ridge 9/Slop❑Va fey, ❑Flat
(check appropriate Ilya)
Latitude/longitude of wi II lothtion
(degrees/minutes/sectt'rdsj_
Latitude longitude source:❑GPS iI-flifographic ri a
(check I Orin
DEPTH RILLING
From To Forr
irk St
5% a2 f0.5
OVt,C 'Surd tc
(, na ni TQ..
0
0
n—,
CD
11. DISINFECTION: Type 1 .t\S
12. CASING:
Depth
From i \ To S1 Ft.
From To Ft.
From To Ft.
13. GROUT:. Depth IV atcrial
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diame sr Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz , Material
From To Ft.
From To Ft.
Amount V
Diar eter
Wall Thickness
or Weight/Ft.
L (2.me n♦
Material
LOCATION SKETI
Show di -ection and distance in rr
two Stat r Roads or County Road.
numbers and common read name
e.-
Method
pouced
16. REMARKS:
m es fro Wit lea des
Includprlhe
3.
I DO HEREBY CERTIFY THAT THIS WE'_LWAS CONSTRUCTED IN ACCORDAN'2E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI AT A COPY OF THIS RECORD HAS BEEII PROVIDED TO THE WELL OWNER
J,uvtivk EA. cp, ,pin,�Qn IbYi-O3
SIGNATIRE OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of bVater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], wi hin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirt nment and Natural Resources - QDivision
WELL CONTRACTOR (INDIVIDUAL) NA 1E (print) be.O:e-/t fl V1L4 yt ta. yev4
WELL CONTRACTOR COMPANY NAME C-N'tele. SZU vCtJ Q114•
STATE WELL CONSTRUCTION PERMIT,- ASSOCIATED WQ PERMIT#
(if applicable) illimmwmuma (if appl:cable)
1. WELL USE (Check Applicable Bo r): Residential V Municipal/Public 0 Industrial 0 Agricul:u
Monitoring ❑ Recovery ❑ Hee : Pump Water Injection 0 Other 0 If Other, List Use
(13 ' —0
If Water Quality - Grourdwater Section
CERTITICATION #_al i_%(c
PHONE # (2t CotoS- ;cz:
2. WELL LOCATION:
Nearest Town: I' 1e1C\.ee
County 7 +C{erytrl
(\4 A_
(Street Name, Numbers. Cogliminility, Subdi ision, Lot No., Zip Code)
3. OWNER: escwne 'a-$Cnp\
Address avi CPC4aC t- -"e
(Street or Route No.)
t`l c k-ie. nC
City or Town State
(SSs )- (n%M - 'i'k5U
Arca code- Phone number
4- DATE DRILLED I0-3'03
5,-TOTAL DEPTH: 303
6, DOES WELL REPLACE EXISTIP
7. STATIC WATER LEVEL Below 7
(U;
S. TOP OF CASING IS 1
*Top of casing terminated at/or below lal
variance in accordance with ISA NCAC
9, YIELD (gpm): J METH(
10. WATER ZONES (depth):
�S'loy
Zip Code
G WELL? YES 0 NO
op of Casing: 8o FT.
••+'• if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST 0 .q
Topogrp�hic/Land sifting
[]Ridge [dope ❑Va'Iy:!]Flat
(check appropriate t
Latitude/longitude ofwt.11 toca ion
(degrees/minutes/sec<
Latitudelongitude source:❑GPS
(check l o )
DEPTH L ILLING L
From To Fon ration Descr p tic
OVer %3'•nf_cipn
I0 k 305 r>r«n; k'L
II. DISINFECTION: Type P,tAJ
12, CASING:
Depth Diar eter
From *k To 103 FL to-;,
From To Ft.
From To Ft.
Amount 1.4)
Wall Thickness
or Weight/Ft. Material
It \ P\g5t,c
13, GROUT: Depth Ktterial
From (� To ao Ft. !_eme'nk
From To Ft.
14. SCREEN: Depth Diame er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz : Material
Method
ro-AV ert
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show di -ection and distance in miles frost leifilTer
two Stat: Roads or County Road.. Include he :nay
number: and common read name;.
O
G
z
1 DO HEREBY CERTIFY THAT THIS WE .CWAS CONSTRUCTED IN ACCORDAN 2E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T} AT A COPY OF THIS RECORD HAS BEE; PROVIDED TO THE WLLL OWNER
I£wtn.n-ek 1-t 2 h'L I0 3 - QZ
SIGNAT 1RE OF PERSON C STRUCTING THE V ELL DATE
Submit the original to the Division of Nater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], wi hin 30 days. GW-1 REV. 07/2001
a¢ i

283072
WELL CONSTRUCTION RECORD
mall Wliatert{iLuiItM .-diiutunlS..i num
RHNt11I8iR'. W�UtO[fa
fHN9aai K cL
Noelllli'+aal+ll.+mu- ;)cpartlnt nt of Erte•elra�tuntt:atill R4itftuuilitltr_vauur:ua•-`�
roll (IS UI VIUf ALIt"VOW 1W)mi
it"
•atl�9fali'It a_,R,n :�
9Ltl. iOS I R All OK C oat PAR\ R 01114 '�' ,V
.Ib'IF.tt}.ILCt1S]1 klCrlrl\i'F:Rnll'a_------ ---
ti dOrtica^Ie l
es. ,,%ciCn'ck'Applicable 13t,x1: R stcytkr'sl)II( IXtnp)FafPhblte0
L nexa_ 0 RCCdVCLY ❑ Heat Pump J'-
N+I i I LOC. ATION
2 _ fount3'
S+.hdhi.ion Lai Nn. Z' C+alcl.�-
V.
Jtu
1 - C.rk " Z-1 3l
_-/.'-j". Co4e
TOT .\L DEPTH:_? ----
REPLACE EXISTING WELL" YES 0 NO
to WATER ZONES tdcpth) �
aSSOCCK YMYs dl el lfirrO 7V
Industrial 0 .A_rsnakvfal 0
(Other, List—.—
Topographic/Land salting /
❑Valk �f at
❑ItWgc ❑Slop+: Y
Ich -t anpr+n,ui not
Latitudc+longuude of well lb t_'m
tNgrces'nict'CS Ia01410S
Latilud.:. longitude sours'
EP H
From To
6. UO(±S WELL - of Casing: �,�Q __FT- _.----------
-/. ll -\IIC WATER LEVEL Below Top.. If Mime Top Casing,
1 �.
q I (II' OF CASING IS FT Above Land Surface*
'Top st ct.ae terminated atior hcW$ rod sarlace requites aIL r -��
t'ariaiNe in accutdance whit Ian NCAC )< OF TEST ��' =�-�
Q. Ylkl_D tgprnl METHOD-----'�„__..
Show riircclion and di>ran;.: in males from .�-'`�Z.t Amount .____S two Stutz Roads ord County Roads. mil Ir, f iom !h•_ mad
11 CASING.
S ING. 'T 10'r T}'pe—} Wall Thickness
I'_. C'AS L'vG' „µetshLFt Materal numbers and common road navies.
Depth —
fro,,, _ To._-.- IFa-------_" —'---- --
r rt I 1 __ — _...—__- h1c ho.I
I1 + ItC t'f Uci„,, \lutcn .•-�, 'J f„ IFn g ' *251 i ` X TlC1
14 Si 'RI a Sy Moth
Ill II___— __ _ ii A>Pe
IT 01.1--- _ To_
To._" Slot s,, hla t.r.a;
Ummeu•+
Fro:" To__ in _ _.
15 'SAND ORAA'EL. PACK: S,, t Material
Ucp'th
l'CTEp IN ACCORDANCE WITH I `A �+-.4 C•
I
-- _ -- pATi
WELL WAS
CONSTR .. . .
L)C, Hi: i?I.I31 iEi:TIFI TH'
l i".tiiR v."�1-A� nRU5. AND'>• T A COP) Or THIS RECORD HAS BEEN PROVIDED t C) T
H
I tiIG\:1T l.RE UP PERSON C ONSTRLCTIhc, 7H6. \\ LLc.
JQuality, Ground} nter Section. 1*36 Mail Serbia Centel Raleigh. �ulxair the iginul to Ihr Utt 73'-it. at. H1 Rhin day+
'76Yy�lh7n 1'hun, N��. IYIYI ".. �.
Iturringt IU.kfa*IFrytatr
t AT UN St, lCl --.—
e)kbyd fed
t ai laa>t
O
W
CD
371.
Zr
LC
O
Ul
3C. WELLS c
E WELL OWNE1

283071
WELL CONSTRUCTION RECORD +� wm
or TIT %,awn(411010t e-Lantn,avanrr
ttmlil7'Mixwuilw ,.,•,„r ub- Ills 2aiwR1IRCCWNlat°�;
lconllB,G ❑aiu'.:+ml-.)CP'tUnc nl ul tlltinn�lttn �-_.
1Mi py .1. atl\CfC \c'I'UN (t%utvIU1'Ala \f�IH: INs�ot143
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4. DATE DIOLLED_/f .,-_ / .-- __
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a TOTAL DEPTH:_ 6 �_- .__
e. DOES WELL REPLACE EXISTING of Casing:
YES NO FT ----------_.-- -..
�. i %utC WATER LEVEL Below TopaAhoic Top ofCasms---___---
C C. Above Land Surface` -- _
at I OP OE CASING IS _ 1
'Top p1 casing terminated at/or h<b.s b*0 surtax re4alr<s ay �� ___ .
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CONS flit ION.. AND.\R DS. AND THAT A COPY Oh THIS RECORD HAS BEEN PRO\ I DED io 1 HELL O
E w v. I
1L)C;H:',KL.IF,CEialFS THAT IH IS WELL WAS CONSTRUCTED IN' CORDANCE WITH I5'\ 23- ��
THt'. \ELL DATi'
Sl 1TTRE OF PERSON CONSTRI CTIN
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l't hte I'Iwm11N','IYf4+ D1.3221 („(i/th o JO da♦s1t\, (, suundn u[¢r SClt10n, 1636 Mail Seri(r CG\\ - • Raleigh, N

282871
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and mantra) Resources - Division'n\ _o_f Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \\� `N" CERTIFICATION a a 7 7 /
wELLCONTRACTORCOMFANVNAMe_RF.UBEN CALDWELL DRILLING, INC. PHONE48 �254-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V efunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearestLn (L
Town: pFodz_ County \lest' a -Se.
p0 O 11 N ;-)AC L{+ A c o oT4) N AD
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
\(e12 2y Ge-tFrIJ
Address SS SAD
(Street or Route No.)
[- t_AT 2cr.le IOC_
City or Town slsjc aO Zip Code
(ems)- 1 \ 3
Area coda- Phone number
4. DATE DRILLED 10/ /3 I / b3
5. TOTAL DEPTH: R 10 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS/
Topographic/Land setting
D1�idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depea/mim,ta/secondr)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0 \l l iSp.) ee..r
G n.+: , t Lr W,1 re LoC iC
a- G rn
GJt_A t -
DEPTH
From / To /
5's `- d,60'
026c
a00'_
7. STATIC WATER LEVEL Below Top of Casing: \ O i FT.
(Uso `+` if Above Top of Cuing)
8. TOP OF CASING 1S .1— FT. Above Land Surface'
*Top of ening terminated Woe below land sancte requlree a
vadaoce In acardanee with ISA NCAC 2C .011a. 'n^/
9. YIELD (gpm)• a METHOD OF TEST YI G ` A i 2-'
10. WATER ZONES (depth): O ' a- G 1'
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From To b L Ft. (: ( 8
From To Ft.
From To FL
13. GROUT: Depth Material Method
From d To atti` Ft. CONtGn) Qo
From To Ft.
14. SCREEN: Depth Diameter Slot Sire . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
Sor bW2cirthVFt. fQ tcrid
Jam- J i
ITS
LOCATION SKETCFI''
Show direction and distance in miler`fro at least
two State Roads or County Roads. clure the road
numbers and common road names. 1'c
3t0Ao
41(410.
(LoA4
1,5
m
1V -
O
C-Il
W
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1ij3/6'3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc/Barker Well & Pump
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f 828) 697-7263
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
County Henderson
High Country Estates, Lot #8
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Kenneth E. Peck
Address 101 011ie Weaver Road
(Street or Route No.)
Weaverville NC
28787
City or Town State Zip Code
( 828 )_ 645-4516
Area code- Phone number
4. DATE DRILLED October 2, 2003
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 20
From To
By pump installer Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Concrete Poured
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Ft.
Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setti
®Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well to
(degrees/minutes/seconds) -
Latitude/longitude source:OGPSOTo zo
(check box)
DEPTH DRILLI G
From To Forrnatio 1 Descrip
282803
W
c
-c
O
c
O cm
C C��
c
LOCATIONSKETCH :EL41
0
Show direction and distance in miles from at jsast
two State Roads or County Roads. Include theroad r
numbers and common road names.
1,%wwin .4Iadt 'zct eci
Pat L',ia t 1/2XIc(. SOAP a-
44t a- Veit. LE cad (wet go /�xde
c o� c ru e a-xdfo
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 yCORD HAS BEEN PROVIDED TO THE
7" ��/
SIGNAT OF PERSON CONST TING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2010
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc/Barker Well & Pump
282801
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT('! r-
(ifapplicable) - ---
(if applicable) f__-J
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville County Henderson
Com Mountain Estates, Lot # 182
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Heriberto Patino
Address PO Box 709
(Street or Route No.)
East Flat Rock NC
City or Tovm State
( 828 )_ 697-0914
Area code- Phone number
4. DATE DRILLED October 7, 2003
28726
Zip Code
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 220 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting I
❑Ridge ID Slope ❑Valley ❑Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -I _.
Latitude/longitude source:0GPSOTopog4aphic mapi r-
(check box) j
DEPTH DRILLING LOG
From To Formation DesyxIptioE
CJ
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 29 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
W Ch
N
n
N E,
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.
SDR21 PVC Aimed A ,L&' toJQ (LEE
Q �/�+ (tit J(aDMd Ja '
dal 0-
a Of ft mt, fix- acuslarn _
oc-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To
From Ft.
From To Ft.
Method
Poured
Slot Size Material
in.
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O THIS RECO' : .HAS BEEN PR • VIDEO TO T . E WE L OWNER
c /U /0 O
SIG AT ' OF PERSON CONSTRUCT • THE WELL 1 • TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME Barker ConMtrudbn, Inc./Barker Well & Pump
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
282799
PHONE # [phone]
I . 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: Hendersonville
Kyles Creek Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County Henderson
3. OWNER: Brett Johnson
Address RR 2, Box 175-4 Kyles Creek Road
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( 828 )_ 272-9296
Area code- Phone number
4. DATE DRILLED October 20, 2003
5. TOTAL DEPTH: 630'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tKI
7. STATIC WATER LEVEL Below Top of Casing: 300 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 32 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0
To 20 Ft. Concrete
Topographic/Land setting,
®Ridge ❑Slope [Walley OFlat
(check appropriate box)
Latitude/longitude of well locat dnc:.
(degrees/minutes/seconds) -
Latitude/longitude source:OGPSOTop
(check box)
DEPTH DRILL
From To Formation Description
c
O
CO
O
0
•
0
rV r=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J,L.cm JLen_dttLon of eev tale- 64LE -
oj(aoc at JAct.c.t-eGt/i2cC.PAt •
L'Q.% Q mat ..ib Gt�D 9E/ ,ed.
td (-/o9D.
aAct AIM
Method
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
From To
From To
16. REMARKS:
Ft.
Ft.
Jz
dAtivx
Material 1 r)., bit � it nceuinctai 2.�"/9^"`^
at C_ . C /
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lC42. 4/14- -. Orli,e de-41.—D `0 ( Z i I b 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — -1 RRHVgh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION it 2010
WELL CONTRACTOR COMPANY NAME Barker Constmction, Inclearker Well & Ptznp
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
282798
PHONE it 1828) 697-7263
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
2852 Old Kanuga Road
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Lynn Huffman
Address 2852 Old Kanuga Road
(Street or Route No.)
Hendersonville NC 28739
City or Town State Zip Code
( 828 )- 693-6772
Area code- Phone number
4. DATE DRILLED October 22, 2003
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 60' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST Timed
10. WATER ZONES (depth):
From To
Topographic/Land setting:.
❑Ridge ®Slope ❑Valley j0
(check appropriate box) :..
Latitude/longitude of well locatio II
(degrees/minutes/seconds) I. rr.
Latitude/longitude source:OGPSCTop
rapalc ll
DEPTH DRILLII�I
Formation Description
O
CO
Cn
cn
r
u
M
c
11. DISINFECTION: Type By pump installer
12. CASING:
Depth
From 0 To 50 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. Concrete
Amount
Wall Thickness
Diameter or Weight/FL Material
61/8 SDR21 PVC
Method
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:
CD
LOCATION SKETCH N -"
N _
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road
numbers and common road names.
(Corn 1/4iiA2d.e.a0/uuLt- 2t
ado Oct KQvoiud,�� oQd .
^/Y','A^ nyQnn a--
otuyiL CJt1�1J teak
Ai: At OR fiztaInv mak&
1iz sa ` &-P
fdtiat-
Ifr,y .
CD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED'IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT�A C�� -/, 'GS� RD HAS BEEN PROVIDED TO THE WN�R
�GNATURE OF PERSON CONSTR
ING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Wed & Pump
282'797
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential m 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: Hendersonville
Webb Subdivision, Lot #1
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: United Covenant Mennonite Church
Address PO Box 948
(Street or Route No.)
Etowah NC
28729
City or Town State
( 828 )_ 890-1052
Area code- Phone number
4. DATE DRILLED October31, 2003
5. TOTAL DEPTH: 245'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below Land surface requires a
variance in accordance with ISA NCAC 2C .0111t
9. YIELD (gpm): 8 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 56 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, Concrete
Topographic/Land setting
[Ridge ❑Slope ❑Valley K1F)at
(check appropriate box)
Latitude/longitude of well location`s
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopogrftphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
O o
V
rn
CJ -c
=ice
mV
w Lim
LOCATION SKETCH rV a,
Show direction and distance in miles from at least=
two State Roads or County Roads. Include the road
Material numbers and common road names.
SDR21 PVC
item Lkand>2Lo ai t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Slot Size
in.
Method
Poured
From To FL
maisaijo @mum . J
taw Attbo(uath n.
Yam- #/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 hI) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD S BEEN PROVIDED TO THE L OWNER
S AT-612E OF PERSON
r47/ CONSTRUC/ /TING WELLDATE //G)
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
28279E
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary CERTIFICATION # 2008
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME Barker Constnxdion, Inc -Barker Well & Pump
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural r,
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use -- -
2. WELL LOCATION:
Nearest Town: Hendersonville
Byers Cove, Lot #2
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Gary King
Address 47 Union Hill Road
(Street or Route No.)
Hendersonville NC
28792
City or Town State Zip Code
( 828 )_ 685-8634
Area code- Phone number
4. DATE DRILLED October 27, 2003
5. TOTAL DEPTH: 430'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Igl
7. STATIC WATER LEVEL Below Top of Casing: 60' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope [Walley C3Flat
(check appropriate box)
Latitude/longitude of well locatio
(degrees/minutes/secords)i.c '-.j
Latitude/longitude source:OGPSOTu pographic map
(check box) j
DEPTH DRII4LING LO0.._
From To Formation Description
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth
From 0 To 205 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
Diameter or Weight/Ft. Material
6 Z .185 Steel
From To Ft.
14. SCREEN. Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Poured
n
ram) V
x
G
-0
W
N
LOCATION SKETCH 0
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Join J✓ JZcat /2-oitcUW is t S ¥
&u t. 076IQ a_ k" ex . any
/X _ /ed. 40/mooarentof end lav-
4
Slot Size Material / {76-t� and la (/,-,Q
in../i C& t • o`' `t
Material
%tzez2
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TFIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i<JCL Pi C
SIGNATURE OF PERSON CONSTRUCTING THE WELL
w 3+ _o'
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
282795
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary
WELL CONTRACTOR COMPANY NAME Backer Construction, Inc/Barker Well 8 Pump
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 2008
PHONE # f 828) 697-7263
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industria1 ❑ Agricultural C i
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use - -
2. WELL LOCATION:
Nearest Town: Hendersonville County Henderson
Peaceful View Estates, Lot #6
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jeffrey L. Harvey
Address 203 Lamb Mountain Road
(Street or Route No.)
Hendersonville NC
28792
City or Town State Zip Code
( 828 )_ 685-2291
Area code- Phone number
4. DATE DRILLED October 30, 2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terndnated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting-- ,
❑Ridge Slope ❑Valley DFI4 ®t
(check appropriate box)
Latitude/longitude of well locatioitl
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTo ographic nkp--- ) j
(check box)
DEPTH DRILL
From To Formation Description
0
C�
O
n
0
11. DISINFECTION: Type BY pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material '/ 1__ pO ��
From 0 To 63 Ft. 6 V8 SDR21 PVC titan e N ryi�.plf Z(k /FG �7L
From To Ft. /76 y��i . A , c%aa a
From To Ft. �J `f�'/ f, �f
Material Method C.C�G(. die0aa-✓'�"QW A) ""I€
Ft. Concrete
0
N
13. GROUT:
From 0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Depth
To 20
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Slot Size Material
in.
in.
Material
16. REMARKS:
LOCATION SKETCH —
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ti)
CLG�i e 4aGC!�'ic"��fU�
se/to ' /� ..Lc e'a7c_
4,ad . 4 rzuficia
�7�9( , Al ad thane)
/toZ - of (' eta' -(20 iiaC •
y/(twIa*/,
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 C2Nl7-n- lv, z (�/l�a,...., to 1- p i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 8 27 9 4
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kenneth McCrary
WELL CONTRACTOR COMPANY NAME Barker Construction, InciBarker Well 2, Pump
CERTIFICATION # 2008
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural £j
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
)t1•
2. WELL LOCATION:
Nearest Town: Hendersonville
Neely Drive, Lot#13
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: William Javarey
Address PO Box 435
(Street or Route No.)
Edneyville NC
28727
City or Town State Zip Code
( 828 )_ 685-1561
Area code- Phone number
4. DATE DRILLED October 31, 2003
5. TOTAL DEPTH: 180'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface regulres a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley Lil is
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) _
Latitude/longitude source:DGPSDToppgra ktic map
(check box) F
DEPTH DRILIJNG LOG _ )/
From To Formation By c,iption
w o
ern
n_
0
O rn
'D
. G
rn
•
N
11. DISINFECTION: Type BY pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 96 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. Concrete
From To Ft.
Material
PVC
Method
Poured
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
To
From
From
Ft.
Ft.
LOCATION SKETCH
N o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
J/to/7L e.-0Y4d.Gt2U/ZLGcta—
eca-oe, °laic_ CL A_ n 6
Sao" --fie .
',r:ca-, Ztd/ems
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
1« 04c C f� -- tl -0?
SIGNATURE OF PERSON CONSTRUCT G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

284504
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC/BARKER WELL & PUMP
PHONE # (828)
697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
CORVIS ROAD OFF OF KAY ROAD
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LLOYD A. MULLINAX
Address 6463 LONGLAKE DRIVE
(Street or Route No.)
PORT ORANGE FL 32128-7188
City or Town State
( 828 )_ 693-5374
Area code- Phone number
4. DATE DRILLED DECEMBER 1, 2003
Zip Code
5. TOTAL DEPTH: 455
6. DOES WELL REPLACE EXISTING WELL? YES D NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .8118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope DValley ®Flat
(check appropriate box)
Latitude/longitude of well location c
4- o
(degrees/minutes/seconds) Cow
Latitude/longitude source:DGPSDTopogr*is n
(check box)
DEPTH DRILLINCPPOGec
From To Formation Descriptioji
w m 55
1.10 =-I
WNW
0
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 Ft. 61/8 SOR212 PVC
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
t,.J,t orx. uAd ti—nc u tale --it/
13. GROUT: Depth Material Method z25/ C �
From 0 To 20 Ft. CONCRETE POURED 9 —12
e f_ 5 do � -"4
From To Ft. Gf-><- O axd fah_
a /� /� 01
14. SCREEN: Depth Diarrrter Slot Size Material /�/ Q/J(d ,f, (�fX.�. Q.- /u.
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
cil vic ,ta-e .ild.e /ea d. ,Z 67
("Laud cVnt # /s ficca 4 k aQ
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
CiUnAA..41 heft Ciliaf./ 11, -
SIGNATURE OF PERSON CONSTRUCTING THE WELY DATE
Submit the original to the Division of Water Quallty, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

284503
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL & PUMP pop # [phone]
STATE WELL CONSTRUCTION PEIIMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
POTTERY TERRACE, LOT #5
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROLAND JULIEN
Address PO BOX 568
(Street or Route No.)
HENDERSONVILLE NC 28793
City or Town State Zip Code
( 828 )_ 692-7299
Area code- Phone number
4. DATE DRILLED DECEMBER 8,2003
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES O NO 131
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑FIat
(check appropriate box)
Latitude/longitude of well location.
(degrees/minutes/seconds)
Latitude/longitude source:IJGPSOTopograph_ic-map
(check box)
DEPTH DRILLINGI'ILOG
From To Formation DesL. iption-- --
O
O
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
From 0
Depth
To 155
From To
From To
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Diameter or Weight/Et. Material
Ft. 61/8 SDR21 PVC
Ft.
Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
POURED
Slot Size Material
in.
in.
LOCATION SKETCH N n
Show direction and distance in miles from at least i
two State Roads or County Roads. Include the road
numbers and common road names.
L4xan JLnentu LL_ to o 64-ECLt.
jab_ a_ Met o2. ifana Road . "lab
ltc g,kt C7 cl4it4C9 ,f1U2do i&oad..�o iv
J1 critc14 Q/xd etc t cwwit h
461.zit 14ad. o'aka , Otit
&dui dace_ dz.ituaihtp-,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRG� DATE �/ ' V ` OJ
Submit the original to the Division of Water Quallty, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

284501
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # [phone]. ---
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
JETER MOUNTAIN TERRACE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEWIS & MEGHAN CHAVEZ
Address 51 IVES FARM LAND
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )- 698-0612
Arm code- Phone number
4. DATE DRILLED DECEMBER 11, 2003
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 6 METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
Topographic/Land setting
❑Ridge ElSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sou rce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descripti@g
r
cr
V
v
1
W
N
WWI
11. DISINFECTION Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
D [h Diameter or Weight/Ft. Material. n O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
ep
From 0 To 5o Ft. 61/8 SDR21 PVC . AA.,..,.. ailmcittiatadit" zt
Qd• ` An aGx-
��a .4
Ad at tit 649_,14.14., VitaltimoC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth
From To
From
Diameter
Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Ft. CONCRETE
Method
POURED
Size Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL QWNER
DATE
SIGNATURE OF PERSON
CONSTRUCTING
UTHE WELL Li
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REV Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pant) RICHARD MCCRARY CERTIFICATION,' 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC/BARKER WELL B PUMP PHONEit(826) 697-7263
STATE WELL CONSTRUCTION PERMIT,' 1871 ASSOCIATED WQ PERMED/
(if applicable) (if applicable)
284499
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
SUGARLOAF MOUNTAIN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TED H. FREEMAN
Address 2105 SUGARLOAF MOUNTAIN ROAD
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )_ 685-3428
Area code- Phone number
4. DATE DRILLED DECEMBER 17, 2003
5. TOTAL DEPTH: 345
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 48 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, CONCRETE
From To Ft.
14. SCREEN. Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Slot Size ma�cua� v• - -T / /
Topographic/Land setting
®Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopdgraphic map- (check box)
DEPTH DRILLINGTUG - ---
From To Formation Description
O
o -
A
N
r.)
G
LOCATION SKETCH
Show direction and distance in miles from at least --
two State Roads or County Roads. Include the road
numbers and common road names.
Son d%stu.t.e-Cc-
yr to cI,ziarn %1607
Method civ_A.4t (/9_ t
AZD
POURED any X -
/�t/f� ��v;�y �{ ,y
in.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC WELL
CONSTRUCTION STANDARDS,AANNDD�THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T WEL» OWNER
�i nee G
_f SIGNATURE O ON CONSTRUCTING THE WELL DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

284498
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2010
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL & PUMP PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public ❑ Industrial O Agricultural 0
Monitoring O Recovery O Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
DAVEY BRANCH ROAD OFF OF NORTH MILLS RIVER ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SIDNEY WHITAKER
Address RT. 1, BOX 186-C
(Street or Route No.)
HORSE SHOE NC 28742-9754
City or Town State Zip Code
( 828 )_ 890-3679
Area code- Phone number
4. DATE DRILLED DECEMBER 19, 2003
5. TOTAL DEPTH: 145'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ®Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopo$raphic map
(check box)
DEPTH DRILLING -LOG
From To Formation Description
O
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
From 0
From / _ C j
From yySS��t/� ��,n �/��j �,�p �s ',p,,':-,,
13 From 0 Ft. CONCRETE �(i- • &t,o g2cd ppu./�C��(/G-.
GROUT: Material
From To Ft. t/(�j '7 �/ r7CG� /Cl.C• 26
14. SCREEN: Depth Diameter Slot Size Material '_ /Z -e. - ttt
From To Ft. in. in. /
From To Ft. in. in. j/T�,
15. SAND/GRAVEL PACK: �"`"
Depth Size Material
From To Ft.
or Weight/Ft. Material
SDR21 PVC
L
IV
err
cr'
-o
�. - m
rn
<
m
▪ m�
N) —t
LOCATION SKETCH z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Depth Diameter
To 26 Ft. 61/8
To Ft.
To Ft.
Depth
To 20
From To Ft.
Method
POURED
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL7{.pWAS CONSTRUCTED IN ORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDT T A COPY OF THIS RD HAS BEEN PROVIDED TO T fE WEOWNEROWNER
f
SIGNATURE OF PE ON CONSTRUCTING THE WELL
�y/ a
D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
O10
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION #
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
284497
1. WELL USE (Check Applicable Box): Residential ri MunicipaVPublic ❑ Industrial 0 Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
BEAR ROCK MOUNTAIN ESTATES LOT #32, SECTION 1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES FRADY
Address 206 CRAB CREEK ROAD
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
( 828 )_ 674-6111
Area code- Phone number
4. DATE DRILLED DECEMBER 31, 2003
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING:
Depth
From 0 To 20
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
To Ft.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
Method
POURED
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box) Latitude/longitude of well location
(degrees/minutes/seconds) Latitude/longitude source:0GPSOTopogrijphic map ,
(check box) __,,,__._.
DEPTH DRILLING LOG -
From To Formation Description
From
14. SCREEN.
15
Material
Ft. CONCRETE
Depth Size Material
From To Ft.
From To Ft.
V
�9
-1
3 cp
CA3 m-
LOCATION SKETCH N 2
Show direction and distance in miles fronr3r leas[
two State Roads or County Roads. Include the road
numbers and common road names.
JLarxJ7JlKd Anniutft -C.z-
Onto a
io art Latta. in,
Jilt •
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS CORD HAS BEEN PROVIDED TO THE LL OWNER
/77/Zer-7 , �C- 2i iZ 3/ 76,3
SIGNATURE OF PERSON CONS CTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # ( 828) 697 7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ZI Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
TALMADGE LANE OFF OF FLYNN BRANCH ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID & APRIL FREEMAN
Address 202 COVE VIEW LANE
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )_ 692-6006
Area code- Phone number
4. DATE DRILLED DECEMBER 29, 2003
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location..
(degrees/minutes/seconds)
Latitude/longitude source:oGPSoTopogiraphic map.
(check box) v__.___._.. .._
DEPTH DRILLING LOG
From To Formation Description
o z
.r• n
c-,
N o<
n
N -4
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth
From 0 To 81 Ft.
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20
Amount
Wall Thickness
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method ,yam n' ,
POURED 7lad 4 Q 4 A -le ter/J i.
in.
Slot Size Material Jxced Q a 4/(.(ly.C(.T °to
attenc-
in. �� f ,1(,�. L. it enter Ca-
Attic •
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
LL
CONSTRUCTION STANDARDS, D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W!LL O ERc.,
E
to l
284496
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.
lh-arxabi
ut a,toc d e c (Ed. a/Z-01 , a_
,,Lf 1gCte ltitz %d. 40 J tj"Z
/2
SIGNAT1. OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
DAT

284495
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP pHONE # (828).69L72S3....._. -:.-
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) --
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic 0 Industrial 0 Agricultural El
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
ANN MOUNTAIN ESTATES
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lcd No., Zip Code)
3. OWNER: GAYLE MCHAFFIE
Address 10 COOPER STREET
(Street or Route No.)
TRAVELERS REST SC 29690
City or Town State Zip Code
( 864 )- 325-0195
Area code- Phone number
4. DATE DRILLED DECEMBER 29, 2003
5. TOTAL DEPTH: 1005
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 500 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: DGPS0Topographic map
(check box) I- ...... ..... . .
DEPTH DRILLING LOGO
From To Formation DeskiptieE
F o
I1. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 48 Ft. 61/8 SOR21
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CONCRETE POURED
N Zc
c
:-c
m
W
N
rri
--1
G
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common'/road names. ,1- " ' c
PVC Jan- bil ut Afjl7NLU.e.I Pe.. ,e-a.a.e_ Z✓ S
1/4/Acecdo.• dcam-A rc—
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
To Ft.
To Ft.
From
From
Material
16. REMARKS:
9%io 441 / -
c Q;t
I DO IHEREBY 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� CC :z 1 ial:1iI03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283399
WELL CONSTRUCTION RECORD
North Carolina - De artment of Environment and/l9 tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)I// 0 de/ e U ALL- CERTIFICATION 'tam
q
WELL CONTRACTOR COMPANY NAME`�2 uA.f fJ /ASS ED RMTT# PHONE
/ 7 e �W
STATE WELL CONSTRUCTION PERMIT# ry/i�
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Q Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LO,/
Nearest own:
wn:County.,b'
(Street Name, N4mbers, Community, Subdivision, Lot No., Zip Cade)
3. OWNER:ji
Address 7Df.3 i Q.
tteet outc No.) �t .t
K /i Net . " (%7
City,Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ///.3 /D 3
5. TOTAL DEPTH:_ 25/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,l
7. STATIC WATER LEVEL Below Top of Casing: /0 Ff.
t (Use "+" if Above Top of Casing)
S. TOP OF CASING IS 7.5 FT. Above Land Surface*
'Top of casing terminated at/or below Land surface requires s
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Q METHOD OF TEST�,y.n L_
10. WATER ZONES (depth): _s,„.29 0
Topographic/7 Ard setting
❑Ridge ❑Slope ❑Valley 71Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRTLLING LOG
From To Formation Descriptions-__ _--
11. DISINFECTION: Type Amount /AS ez-
12. CASING: Wall Thickness
Depth }Diameter or Weight/Ft. Material numbers and common roa
From D To �.y _ Ft. (i "19_ .kx'.Z/ PVC_
From To FL__
From To Ft
13
14
15
GROUT: Depth Matc__
From E% To _O Ft._l,�t �-,�tJ
From To Ft.
SCREEN: Depth Diameter
From �o Ft.
Ft.
Slot Size
in.
To
in. in.
SAND/GRAVEL PACK:
Deeth Size Material
From fo Ft.
From �To Ft.
16. REMARKS:
Method
Material
1
LOCATION SKETCH
Show direction and distance in miles i� —_fro at i� cta1{e�ect _
two State Roads or County Roads. Include t'ae, road
names.
0
0
0
rn
2)
LD
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED 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 CONS ' UCTING THE WELL
foot/
/ /„Nr
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

283398
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Secti�on� �j�
WELL CON r1tACfOR (INDIVIDUAL) NAMEE(print) D�4p ) G .�L I.- ,, CERTIFICATION #p21I
WELL CONTRACTOR COMPANY NAME .0 ,i4e.4 ri.4 it,,�� `F( a1 PHONE # t iY 1, v4-aka
STATE WELL CONSTRUCTION PERMIUt " U
(if applicable)
ASSOCIATED WO PERMIT# # 77p Z
(if applicable)
1. WELL USE (Check Applicable Box): Residential NI Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Neares
County
(Street Name, tubers, Cppatununity, Subdivision, Lot Non., Zip Code)
3. OWNERvi�RX�.lt 5t1dd�tc11)!�
Address
own State Zip Code
fit D6S7
AtPhone ///
4. DATE
DRILLEDED /,/Y� o 3
5. TOTAL DEPTH: .Z 7 s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER LEVEL Below Top of Casing: 95 FT.
(Use "+" if Above Tap of Casing)
8. TOP OF CASING IS A s 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): 02 D METHOD OF TESTrei ne
10. WATER ZONES (depth): 232LSZ 2.
11. DISINFECTION: Type— Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. b terial
From/ _ Tory Ft. G 4-e #-.Z /
From To Ft_.
From To Ft.
13. GROUT: Depth Material
From 0 To e2 O Ft. / setter
From To Ft.
7 OL
Method •
14. SCREEN: Depth Diameter Slot Size Material
From To — Ft. in.
From Co Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From �To Ft.
From _/ To FL
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Plat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secant)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRTI�I-IhT(L —
From To Formation Description
Show direction and distance
two State Roads or County
numbers and common road
miles from at least
ads. Include the road
es.
Ul
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDTEify"]- 1 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o ,:, s fie/Q i
SIGNATf)RE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM (print)/� G� �L/l� H/1L"L�
WELL CONTRACTOR COMPANY NAME ea4-1- 4.. ca�ai
STATE WELL CONSTRUCTION PERMIT# 4/in, ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
283393
Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 43277
. PHONE # f,d figle2Wel
# 778 G
1. WELL USE (Check Applicable Box): Residential 41 Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection ❑ Other O If Other, List Use
aSK
2. WELL LOCATIO '. J/
'ea t9Town: (�/ G%��untyJ�'
,(.P „19 79 L.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 1.35( or
VC, .c 8'763
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED ///. a / D 3
5. TOTAL DEPTH: V S
6. DOES WELL REPLACE EXISTING WELL? YES O NO X
7. STATIC WATER LEVEL Below Top of Casing: /J O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS . ..S FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordan�` with ISA NCAC 2C .0118.•
9. YIELD (gpm): 7 M� THOD OF TEST1 nt/
10. WATER ZONES (depth): /Na d r ., re
11. DISINFECTION: Type
12. CASING:
Depth ��77 Diameter
From 0 _ To_f� Ft. % re
From To Ft.
From To
13. GROUT: Depth
From 0 To yea fl
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
th
From To
From To
16.REMARKS:
Amount /d it'
Wall Thickness
or Weight/Ft. aerial
r? /
Ft.
Material
Ft ea rLaW
Ft_
etbod r
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
Show direction and distance
two State Roads or Conn
numbers and commo
Topographic/Land setting
ORidge XSlope OValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH
From To
Formation D
LOCATION SKETCH
es from at least
oads. Include the road
ad names.
pRILLINq LOG r-
ription ���
�t G v0 G��
0
c,>
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
///3/0
0 2/ eat
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283380
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�(J�I O 4" 4/G) ,,SRRnL L_ CERTIFICATION Y77
WELL CONTRACTOR COMPANY NAME.Pae.. 1� 4.1.2-1L _(4.2CAV'{LY?wGG.yr. PHONE # ( �—A v -,vs-a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential al Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Neaj�st Town;�0
3.
(Street N
unty N�2sril_tfrt...
e, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER: r.I U__
Address .3od 0 i ..0411 el
n (Strec�f.inc No.)
Zip Code
City or Town State
Area code- Phone number
4. DATE DRILLED /B///S//O 3
5. TOTAL DEPTH: 12�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Lit
7. STATIC WATER LEVEL Below Top of Casing: /D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.5 FT. Above Land Surface*
*Top of casing terminated at/or below laud surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): p MEJOOD OF ��L%..o
10. WATER ZONES (depth): VP
11. DISINFECTION: Type,, S
12. CASING: (/
From d
From
From
13. GROUT:
From 0
From
14. SCREEN:
From
From / To
15. SAND/GRAVEL PACK:
th Size Material
From To Ft.
From To Ft.
16. REMARKS:
Depth Diameter
To_02_ Ft
To Ft
To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Method •
J4
Diameter Slot Size Material
/To Ft. in. in.
Ft. in. in.
Depth 02 1) Ft %4W
To Ft.
Depth
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IZFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DRII 1 (NO 1.0G
Formation Description —'
DEPTH
From To
Show direction and distance
two State Roads or County
numbers and common ro
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
.. /oiY/a 3
AT
SIGNATURE OF PERSON CONSTRUCTING THE WELL /E
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295278
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jereply H. Bowman' CERTIFICATION # 2809
WELL CONTRACTOR COMPANY NAME D Anwnlan We ) nri 1,11ng, Tnr PHONE e' R2R 2S9-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
inapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Edneyville County Henderson
Turkey Walk Lane Lot #1 Edneyville 287
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �h82 Pine
Address Ff
(Street or Route No.)
West,,Palm Beach
City or Town State
Lane
Florida
Zip Code
( )-
Area code. Phone number
4. DATE DRILLED 8/25/03
5. TOTAL DEPTH: 740'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO I%
7. STATIC WATER LEVEL Below Top of Casing: 900 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surfaces
'Top of cuing terminated aUor below lend surface requires a
variance In accordance with ISA NCAC IC .0I15.
9. YIELD(gpm): 1 METHOD OFTEST'- rotary air
10. WATER ZONES (depth): 600'
83417 DEPTH
Topographic/Land setting
27 ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
From To Formation Description
1 1. DISINFECTION: Type
12. CASINO:
Depth
From 0 To 36
From To Ft.
From To Ft.
13, GROUT: Depth
From 0 To 20 Ft.
tablet Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
Ft.61/8 Srh RQ Pvr
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
Material Method
concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Ft.
Ft.
Slot Size Material
in.
in.
Material
I Z :ZI 1!d 01 NIT h0
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
SIGNAATURE OF PERSON CONSTRUCTING THE WELL
g1 /03
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

295277
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION$ 2809
wELL CONTRACTOR COMPANY NAME D Rnwmi'n We11 Dri11 inrgr Tnr• PHONE # f17A 757-7779
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Ix Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Edneyville County Henderson
759 Hudgins Rd. Edneyville 28727
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER. Paula Frenkel
Address 759 Hudgins Road
(Street or Route No.)
Edneyville NC 28727
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 8 / 71 / 0 i
5. TOTAL DEPTH: 78,0'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (X
7. STATIC WATER LEVEL Below Top of Casing: 200FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.01I8.
9. YIELD (gpm): 2 METHOD OF TEST -rotary air
10. WATER ZONES (depth): 600' 770' 780'
Topographic/Land setting
❑Ridge ❑Slope OValley :Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LQG
From To Formation Description
II. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 40 Ft.51 /8 Srh An
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
PVf
gravity flow
From To Ft.
From _ To Ft.
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
riuse.N . l sums
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center• Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
297565
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION#2809
WELL CONTRACTOR COMPANY NAME ID RnwmAn Wp11 Dri 11 i nt7 Tnr PHONE f fi28 757-7779
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) -
(if applicable)
1. WELL USE (Check Applicable Box): Residential CZ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HendersonvillECounty Henderson
47 Forest Edge Drive Hendersonville 2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Jane Wallace
Address 47 Forest Edge Drive
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9/74/01
5. TOTAL DEPTH: 1 80'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0111.
9. YIELD (gpm): 1 0 METHOD OF TEST'. rotary air
10. WATER ZONES (depth): 1 60'
Topographic/Lend setting
8792 ❑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
I1. DISINFECTION: Type tablet Amount 6
12
CASING:
Depth
From 0 To 40
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft.F1 /8
Ft,
Wall Thickness
or Weight/Ft. Material
Sch RO Pvr
N
LOCATION SKETCH
Show direction and distance in miles from at'least
two State Roads or County Roads. Include th6 road -----
numbers and common road names.
Material Method
Ft. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in,
Size Material
Ft.
Ft.
0
J
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 t D 1N ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
✓-- SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
14. SCREEN:
From
13. GROUT:
From 0
WELL CONSTRUCTION RECORD
298602
North Carolina - Department of Environment and Natural /Resources �-,/gDivision of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Pobe,y lit/ ! P\0 P CERTIFICATION p,�%ao
WELL CONTRACTOR COMPANY NAME Y er(V r4rVV s /OC// {..vtrr�/14r CO,..PHONE y€Y16R3 -VYY9
STATE WELL CONSTRUCTION PERMIT# ✓ ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13/ Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / /
Nearest Town:He/te' t&504'//C County /rTCc tp'SOa✓
IV/n(/irty M 5 cZy es/tries
(Street Narne, Numbers, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: KM/ p1-9fric(a ('dn/f6A) Actrt^
Address /4/O tat nizt tC,rest 4.
(Street or Rohde 136.)
11,andersanid:/4c- n t AY79/
City or Town State Zip Code
)- 6946 ` MG
Area code- Phone number
4. DATE DRILLED 7/aY7O
5. TOTAL DEPTH AVS
6.
7. STATIC WATER LEVEL Below Top of Casing: 2.0 FT.
(Use "1-" if .Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below laud surface requires a
variance in accordance with 15A NCAC IC .0118.
9. YIELD (gpm): 30 METHOD OF TEST 1Thw/tolfALA
10. WATER ZONES (depth): /7S
11. DISINFECTION: Type 1t4lc13
12. CASING:
Depth Diameter
From 0 To 66 Ft. 4, XS
From To Ft.
From To Ft.
Depth
To 2D
From To
Depth
To
Topographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of ell location
N3S° a 3,YV3' Auel2 DA3,7Yy'
(degrees/min tes�ty conds)
Latitude/longitude source: 2OPS❑Topographic trap
(check box)
DRILLING LOG
Formation Description
Di n 1
6.r1/474i (Ic
DEPTH
From To
0 — 66
Amount 7o2S
Wall Thickness
or Weight/Ft. Material
ar6.ras 1 -. S 4
Material
Ft. t e'Lne 1 <
Ft.
Diameter
Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Method
Slot Size Material
in.
in.
I6. REMARKS:
0
F o
D
t ▪ O
m
N p
LOCATION SKETCH ern
Show direction and distance in miles from at leaf
two State Roads or County Roads. Include the wail
numbers and common road names. sta
�ind,`N
W &-27ae,S
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A Y of THIS RECORD HAS BEEN PROVIDE TO HE WELL OITINER
t
/SIG ATU
OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
2--

WELL CONSTRUCTION RECORD 2 9 8 6 4 3
North Carolina - Department of Environment and Natural Resources - Divisionsgff Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((print) mety e, ///NZ5 CERTIFICATION # W23
WELL CONTRACTOR CONIPANY NAME / t , now,%ttf d/PIt��AO a, PHONE cn)GYT -frr
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HOPSC S%LDt. County Kfil hrl0(A/
itakOsv / Wg c Lo'
(Street Name, Numbers, Community, Sadivision. Lot No., Zip Code)
3. OWNER: /61c4Qnp_
Address a 3 11m4.pite'rte. (e
(Snee( or Route No.)
ld-orsboc_ he a�9L
City or Twn State Zip Code
(')-8)- S631-104-32
Area code- Phone number
4. DATE DRILLED 4/%.�/Q 9
5. TOTAL DEPTH: (plfS -/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO LY
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( ET. Above Land Surface*
*Top or casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): f METHOD OF TEST5/DtO tA4/ %
10. WATER ZONES (depth): 590
Topogrphic/Land setting''
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N 3S°z4.7/8A,on°2p,511/'
(degrees/d(inutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- YY Q/,o7`
(>ranrt�c
en- 4as
11. DISINFECTION: Type fahittS
12. CASING.
Depth
From_ To VL Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Diameter
6 As
Amount 19 in
Wall Thickness
or Weight/Ft. Material
2t4,/as puc sat?/
Material Method
Ft. Contrefi VA/.9
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.
�itleoN g;cd5c- Lot'
Morshoe 11 C.
From To Ft. -
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDA$DS, AND THAT A COPY OF HIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
• d2- ,3
SIGNATURE OF PERSONCONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section,
27699-1636 Phone No. [phone], within 30 days.
1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

298599
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/A- Divis n�off Water Quality - Groundwater Section /� p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �%n y ([I/ . ,r //% CERTIFICATION #;AZ D
WELL CONTRACTOR COMPANY NAME �<Nf UiOA/ / Wel/ Dr//, 3S+ e e PHONE ftWAYI G$3 --7fl7
STATE WELL CONSTRUCTION PERMIT # _ v ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential VMunicipal/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: CIA erth
old Plug, CAA' R/A
(Street Name, Numbers, Community, Subdivision, Loto�No., Zip Code)
3. OWNER: �v5P fti Rya A/ 4/ f
Address S7 Old gear Crrel 4"
(Street or Route No.)
Rend e`sorlAti,I/e iu C .a879
City or Town State Zip Code
VS)- fife T-7%/
Area code- Phone number
4. DATE DRILLED 62/2.7 3
5. TOTAL DEPTH: .ZD
6. DOES WELL REPLACE EXISTING WELL? YES C•3 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if .Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfacer
*Top of casing terminated ar/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 2\19 METHOD OF TEST!/oW/rn//9
10. WATER ZONES (depth): $D r I7(1
11. DISINFECTION: Type
12. CASING:
Depth
From Q To 6 y
From To
From
13. GROUT: Depth
From a To AD
Counry r/C,iff rrsgj✓
xra/cam
To
Diameter
Ft. (o, )..3
Fr
Ft.
Material
Ft. PAAcreir
Amount
Topographic/Land setting;
❑Ridge ❑Slope ❑Valley QPIat
(check appropriate box)
Latitude/longitude gf well location
N3S°d.3 rfi3l'/Lccora°11.3.as
(degrees/m(((nutes/• onds)
Latitude/longitude source: rPOPSOTopographic map
(check box)
DEPTH
From To
fr Y- 2.051
DRILLING LOG
Formation Description
(! a /, Ye
O
rn
ts
co
F1 A-
f,a
tt.?
S
LOCATION SKETCH y
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
26, /d5 PVC SDR7./
From To Ft.
14. SCREEN: Depth Diameter Slot S
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
5
02$
Method
Pour/
ze Material
in.
in.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPXOF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
0r1 DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298596
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division-o of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I/? V `C9 t P!///3 CERTIFICATION i %027
WELL CONTRACTOR COMPANY NAME PY.nfulStIot .3 ///USCG( AMc/I%, CO. PHONE $ SI fat) -V VIYf
STATE WELL CONSTRUCTION PERMIT# ✓✓ __ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential L9' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Fizteyrl/HC County f-i'cnJtrSDA>
eg4pr.S Of /sty/5 e*-rcr ti< f.mt. rx
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: D1.'G.rhn �&e../ /9 • EUGt 3
Address [CT L/'tlma_ C-r^o°a RA_
(Sneer or Route No.)
feJ-cMe/ NC RE73a-
City or Town State Zip Code
(P8)- (tag- Ygem w-
Area code- Phone number
4. DATE DRILLED 7/Y//�3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ire'''.
7. STATIC WATER LEVEL Below Top of Casing: /A FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated anor below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OFTESTQf°Wt 7'€ j
10. WATER ZONES (depth): 2✓/%
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Lan etting'
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude well location
4» '° 24r bd/Ar won L/dfO°s
(degrees/mi tea/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description/
0 —/76' /VAlySQi✓O
/71 -34,S /niwef f e 9
0 D
5. TOTAL DEPTH: 3 S
11. DISINFECTION: Type '-a /d/e 1i.7 Amount /ho a
12. CASING: Wall Thickness
Depth iameter or Weight/Ft. Material
From 0 To /7G Ft.� .18 sue/
From To
From To
13. GROUT: Depth Material Method
From 0 To 20 FL CDA&t'tdC At9ryri,
From To Fr. _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Fr.
Ft.
Ft.
16. REIv1ARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
IGNATURE 0
PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.

298590
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division �ofyWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,0be y Ill/ tf Path' �s CoCERTIFICATION tNlii i
WELL CONTRACTOR COMPANY NAME vs�'5 Weil Vrtlll nq W. PHONEP (pB3-Qy1-1q
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PEt IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (IX Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: //
Nearest Town: 14 eY,1�i2Y5tritvl1(2 County /kniQt!'S/M.
FYI/76 f Ai'in/ fc Gil 74
(Street Name,, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: firl)C2 !a' Yeene CO1S47-(1-c'1707`,
Address 50) TQ.her St- rPPf
(Street or Route No.)
Ct5h2 u Q. 'Arc 22024
City or Town State Zip Code
S )- I'M - %52.1
Area code- Phone number
4. DATE DRILLED 37a'ls/D 3
5. TOTAL DEPTH: 3o C —/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L7
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if .Above Top of Casing)
8. TOP OF CASING IS E2 FT. Above Land Surface*
/f'opographic/Land setting,.
Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of I1 location
° P °3Y. rely'
(degrees/minut s�//' ands)
Latitude/longitude source: D-GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n - ao t5,rt
p0 -3oSc-na4.),}4F
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST/YeLOK.ey Z/9
10. WATER ZONES (depth): a30 ff — /SiIpa, -
11. DISINFECTION: Type +minI ets
l2. CASING:
Depth Diameter
From 0 To G6 Ft. (A 3.6
From To Ft.
From To Ft.
13. GROUT: Depth Material
From elTo 9-0 Ft. C TY,r2Le
Amount q AZ
Wall Thickness
0
LOCATION SKETCH -fl r^o
Show direction and distance in miles from at leash „
tnz
two State Roads or County Roads. Include the roes AtO
or Weight/Ft. Material numbers and common road names. O
alto .195 INCSpR21 0
P1 C Lle -Pointe Lot 1479
I -tend erstsnvi 11 e , NC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft.
From To Ft.
Method
7avred
Slot Size Material
in.
in.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANrD-,A�RDS,,AND THAT A COPY OFIISS,R�,�pRD HAS BEEN PROVIDED TO THE WELL OWNER
/l//J/, GNATURE OF PERSON CONSTRUCTING THE WELL 0- DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water�Quality - Groundwater Section �,y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �t�hV �/. J Q / / j CERTIFICATION #./.o2
WELL CONTRACTOR COMPANY NAME Ay1u-C /LJ / ear if DAV ri(!it J re PHONE MT) LrT) -fiery
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ/PERMIT('
(if applicable) (ifapplicablel
298589
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: cif n1P )[S07»V i' l k County/L/emJerrSefr1/
Zs y /Zee Pinny/r lirtv Zed
(Street Name, Numbers, Community, Su rvuion, Ldt No., Zip Code)
3. OWNER: fri , (l0L•c j. A2/e anger
Address i3L/ /-2J.r 29, fed
(Street or Route No.)
Jetvrider&mo;11e AJC, 9,R1 A3
City or Town State Zip Code
(428) ',74-1-t6)-r
Area code- Phone number
4. DATE DRILLED.,) /a4./03
TOTAL DEPTH: / S
Topographic/Land tting
❑Ridge ❑Slope uncalley 0Flat
1.4s— (check appropriate box)
Latitude/longitude of II location
it/ 35°�3,3xgr' VOV°35,2,64
(degrees/minut slse nds)
Latitude/longitude source: LECiPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
hilrfr
Grnnr `Ac
DEPTH
From To ,
p _ )The
SY - /s s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L7
7. STATIC WATER LEVEL Below Top of'Casing: // FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118. J�
9. YIELD (gpm): /D/) METHOD OF TEST W r /
10. WATER ZONES (depth): 9S - /O09/#'
I I. DISINFECTION: Type -tatt Pt S
12. CASING:
Depth Diameter
From () To g9 Ft. (.0 2P)
From To Ft.
From To Ft.
13. GROUT: Depth
From O To can
O
�m
on
isa cn
LOCATION SKETCH -o re; 0
Amount (n 07 Show direction and distance in miles from at least i U,y
two State Roads or CountyRoads. Include the road P
Wall Thickness C;? n
or Weight/Ft. Material numbers and common road names. Op S.2liea PVC
SPRa)u I .` �L i /7,.:n n SUIp(i(VIS
Lo+ #5
Material
FL cQllcrebe
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.
Method
'prnn—Pd
Slot Size Material
in.
in.
Re, dexsunvilia / NC
From To Ft. -
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL;
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
20)
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionioof Water Quality - Groundwater Section o
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �+ ]Q r(S CERTIFICATION N ao as
WELL CONTRACTORCOMPANY NAME frryu so/Vs Nil/ ,�/t////A4 ca PHONE flee) is ros
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"(
(if applicable)
(if applicable)
298588
I. WELL USE (Check Applicable Box): Residential D Municipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: p
Nearest Town: ly/A-SO County
Snt th sob CM'tI/64A Cqk
(Street Name, Numbers, Commu try, Subdivision, Lot No., Zip Code)
3. OWNER: (Skrg� gAen SYc pp
.Address ` G Tji(, 0l3 (.01
(Street or Rowe No.)
H ertrlersonut Lit N a� 7 a3
rMJrtsem/
City or Town State Zip Code
1(CM)- t°G3—yi35
Area code- Phone number
4. DATE DRILLED ,3//l /o)
5. TOTAL DEPTH: S9/ S ft
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I/
7. STATIC WATER LEVEL Below Top of Casing: '/O FT.
Topographic/Land setting
❑Ridge 21Srlope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location r
N 'SS°/A.3Yy,/Wota°a7. os $
(degrees/ musy/teeconds)
Latitude/longitude source: L13iiPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To r Formation Description
c — 4Y, D/�t
6 v - SYs GsaAlte
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0115.
9. YIELD (gpm): 6 METHOD OF TEST5fiwi /L)
10. WATER ZONES (depth): 8 Ff
Z.pn LOCATION SKETCH
11. DISINFECTION: Type 4-able-is mount /Ai Q2.5. Sbow direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads er County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To (OLi Ft. to,ra5 aLto_LO5PVC,GID1 t)
From To Ft.
From To Ft.
Depth Material Method
ToQ.0 Ft. CC/)-10Ve-fe Wired
To
Depth Diameter Slot Size Material
in.
in.
13. GROUT:
From 6
From Ft.
14. SCREEN:
From To Ft. in.
Ft. in.
From To
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Sv-hjob Creek/Gad Crvek nctzc1
5%edo NC
l6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,7AM
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
298585
North Carolina - Department of Environment and Nat ral Resources�-� 9Divisio of W ter Quality - Groundwater Section 9� p
\YELL CONTRACTOR (INDIVIDUAL) NAME
(print)�y W r t�a CERTIFICATION #L0ZO
WELL CONTRACTOR COMPANY NAME FerQI/5(jy1'5 We') Tn. Ili n9 Co. PHONE c�dd$1443 '9449
STATE WELL CONSTRUCTION PERMIT# ,JJ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 17Y Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Town: '1,c1,O County %�Y,�tatrrsak✓
41
(Street Name, Numbers, Comm_unii y, Subdivision, Lot No., Zip Code)
3. OWNER: HOYYIP 07 n-ierlca.
Address Soto &6hey! Il€ f wty.
(Street or Route No.) J
Hendergahvdse NC d -ic
City or Town State Zip Code
ifl- (Ogle 411 H
Area code- Phone number
4. DATE DRILLED y- 9-03 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l3
7. STATIC WATER LEVEL Below Top of Casing: ZO FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST�]g,'_"_
10. WATER ZONES (depth): /20 — (Aim,
5. TOTAL DEPTH: SDS'
11. DISINFECTION: Type tab I eks Amount IN Q2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 6 To L'ISS FL tt.96 'allo.125 -yWe nn!
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To aC) Ft. Caine4C-pcarred
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.
pographic/Land setting''
idge 0Slope :Walley ❑Flat
(check appropriate box)
Latitude/longitude o well location
N_45 irf.s36,' O'inz°ac' ass'
(degrees/tn.
Latitude/longitude source: L9'GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From �/S-- To Formation Description
p — elr' pint
vs— SOVr eizngnrfe
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. ••
Mt. Clive{ (load
Tuxedo , NC,
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AA COPYY00 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q3
S NATURE OF RSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
O
O

WELL CONSTRUCTION RECORD
299579
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IMY b)W I Pet7.7 CERTIFICATION #20 a 3
WELL CONTRACTOR COMPANY NAME 1 .e r`9 USD N/y 44e // DPIY/I�4 CO PHONE $fl) BR 3 -9 9y7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 03 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: F nCrVr r /f County Hen de^s.o '
i4ro kola . /.0AMIn f /Wye
(Street Name, Numbers. Community,(division, Lot No., Zip Code)
3. OWNER: crre m Hai e
Address ' J e d Teti
(Street or Route No.)
f /dPrs
ri V2
41o.rrjP rwnvi I 1p NC �a
QCiry or Town State
(50- i120g:�7'?i3�Jr'J
Zip Code
Area code- Phone number
4. DATE DRILLED /G�//
5. TOTAL DEPTH: [ ISM
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CV
7. STATIC WATER LEVEL Below Top of Casing: /10 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
pographic/Land setting
tdge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
/V ISba3. ARAI°re, &cc('
(degree minutes/s conds)
Latitude/longitude source: MCIPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
tie — vsr
6-"es ni f2
O
`Top of casing terminated at/or below land surface requires a r.2 7G
a--
variance in accordance with I5A NCAC 2C.0118. rn0
9. YIELD (gpm): /0 METHOD OF TEST i r` -�O ^"'
10. WATER ZONES (depth): 5 16t ,
LOCATION SKETCH
Show direction and distance in miles from at least 0 ?;
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
To M&D Ft. (p,96 2i0.125 TYCW79)
To Ft.
Depth Material Method s
To Ft.
dnesv1.11e, NC
1 I. DISINFECTION: Type +Gill €tt Amount )Ll (32.
12. CASING:
From
From
From
13. GROUT:
From 0
From
14. SCREEN: Depth From
From
To 'a0 Ft. (O71fle�.2 epaurei
To Ft.
eptr Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Material
)eo/Q. old. iiriot o&rf "Pilidede
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 '
SIGNATU
OF PERSON CONSTRUCTING THE WELL / DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. OWNER: 1�:-?S tv C[r^tpaHr/J
Address bfrQ [,iCIW ICk Sctilra.ve C.'E
(Street or Route No.)
kind etrsfnlllc -vle f
City or Town State Zip Code
6121) Q-5O`by
Area code- Phone number
4. DATE DRILLED % S/303
5. TOTAL DEPTH: 5 S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
298571
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) AO & 6 - 4_ t YO1 CERTIFICATION # z si
WELL CONTRACTOR COMPANY NAME Fr fy' S O n tS L(%e// r/�rvt/bin CaI PHONE¢gtSI/IS�3'YYYp
STATE WELL CONSTRUCTION PERMIT# ./ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ek"Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: D 1 �J opographic/Land setting
Nearest Town: iv, red County/ t/ fn#ftSc5 /ge ❑Slope ❑Valley ❑Flat
On /' eo/r Mil is sr tifie Srn', r. tip/ , I�,(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Sdnnifgs*C Latgude/longitude of well location
/U3S (,/Or'/lvos DES',/9S'
(degrees/(ninutes/ onds)
Latitude/longitude source: '' PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Net-
- S'HS' ranr'/ r o
7. STATIC WATER LEVEL Below Top of Casing: 4,0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST NDWw i, /Z?
10. WATER ZONES (depth): 30r7
LOCATION SKETCH
1L DISINFECTION: Type fah/Y7
Amount /4if zs
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (t To 10 Ft. 6,AS alb./,t5 iL SDR /
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q To V) Ft. ('Onrrcl'r loor,101y
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.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Gat Cote H%II /€uij nt'-t-I- BrdF
Tt,xedo, NC
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER ._ .
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

3. OWNER: 6 rN (laye5
Address Il'>1-C. CkIrldWIC-- r1vLinae Ct
(Street or ?tame No.) a2 739 l�endlzrsfrnvi)ltz /fC
Ciry or Town State Zip Code
(SA)-Sagr50 14
Area code- Phone number
4. DATE DRILLED n//`1/Aj
5. TOTAL DEPTH: Sys' /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C8'
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'
9
10. WATER ZONES (depth).j/Q
*Top of casing terminated at/or below land surface requires a
variance in accordance with (5A NCAC 2C .0118. YIELD (gpm): '3 METHOD OF TEST/3/Cu) r r y/4,i�
11. DISINFECTION: Type idtge f Amount /Mess
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To S?. Ft. 661.LS 2/6./,2S QvC,SOQZ/
From To Ft.
From To Ft.
GROUT: Depth Material Method
From 6 To AO Ft. CBrucrefc Qpfq/ i,
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
13
14
15
2.98570
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naatural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �l (print)I,/C961/ (�� /, ,t)/Q CERTIFICATION flr,Z
WELL CONTRACTOR COMPANY NAME F- yaca.YS// a/c/� /iN%'//'y 6. PHONE fen)k R'3 '9Y99
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential r Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: 'Fit .t•rd0 County Hen i/etrs)w ORidge ❑Slope ❑Valley ❑Flat
Q»-' (We / // ,eiF #f /q/{[ S'Jrn.cr, `Ic .QJ (check appropriate box)
(Street Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)50n,4, 144,8ge Nis°/b,o b°Latimde/Lon itude of well location
/uoff) °ar,a /3'
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 — Ra ` /7,ilf
v
�O 2!
N.r'
y+o
LOCATION 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.
r T
cfa
Oak Cola hill /S1 nmi4 f�'ti1p
Tuteda, flC
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
SI
NATURE OF PERSON CONSTRUCTING THE WELL
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298569
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural"_�/Resources - Divisionionof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) AOYJh y W r f th CERTIFICATION # p
WELL CONTRACTOR COMPANY NAME Fey ()SOK/ Wc// i�ePtini COr PHONE 67$l7 — 9ft?
STATE WELL CONSTRUCTION PERMIT# ✓ ASSOCIATED WQ PERMIT#
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: H{n(,IY/YDnmm. County hi[nit'tION/
C'aM//,va Crf"c% one 13rooks/'/c camp id,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Frnnlii( 1-/ Bc✓I_SAN
Address 3S Care//NI} C/inc/e
(Street or Route No.) /h �nt Cam/ ds'rsa#ai;/e- •1 C NO/4j
City or Town State Zip Code
(in)- 77R— S/9R
Area code- Phone number /
4. DATE DRILLED b(/4/Pb
5. TOTAL DEPTH: 3 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO cV
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 0
9. YIELD (gpm): a METHOD OF TEST 13 totd,ity /9 .O Cnr"
10. WATER ZONES (depth): 200 to
,zt LOCATION SKETCH c;? 111
nt
11. DISINFECTION: Type -tiu b (c 1-5 Amount /Q d25 Show direction and distance in miles from at least 0 o
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
2/b.Ik5 CDR of PK
Topographic/Lan 1ng
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
L e/longitude of ell loc�tion
• r6ar c,�dsa as,ysr
(degrees/mi tes/secc s)
tude source: C9fei'S❑Topographic map
(check box)
DRILLING LOG
Formation Description
btri-
/rnanr %G
titu
Latitude/long
DEPTH
From To s„
o — 7y
7S'— 3VS"
Depth Diameter
From 0 To 7? Ft. (o, AS
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Xb Ft. Con( rcY(.. Poorly
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.
•
d/k yfoaASrie (At/
0 ii2/vg1'e/SOYUrA41
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 TOTHE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL / IYATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/200I

298568
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (paint) 13oed y �/�C r vQ / / S CERTIFICATION # 2QA
WELL CONTRACTOR COMPANY NAME l�f�JSO& WC/1 ON/4 foll Ce• PHONE fan 613 -9rri'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ui' 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: Elf ndf/'.50(00We County Kehdei'tprfi
O/D 1'rftcy Place,
Name Numbers ommuni ,
Subdivision,
(Street. ry, Lot No., Zip Code)
3. OWNER: w 4/,1d'p "— br�enda B ur
7p n //
Address i4q,44 /v/4_ ./.
(Sft et or Route o.)
,CJ.zdeen 17 e A270 v
City or Town State Zip Code
g2x )- 6 9 7- 0.55
Area code- Phone number
4. DATE DRILLED (�//7 3
tdopographic/Land setting
tge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longituudepf well location e.
Nis°aysilor iuosa° R3,56/
(degrees/ inuteslseconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
ai 1-
6.rrrn, rice
DEPTH
From To ,
0- 50
SO - sos
5. TOTAL DEPTH: SOV 0 P
6. DOES WELL REPLACE EYIST[NG WELL? YES 0 NO rim
7. STATIC WATER LEVEL Below Top of Casing: (e0 FT. e m
(Use "+" if Above Top of Casing)
A o=
8. TOP OF CASING IS / FT. Above Land Surface* ' -gin
ot'casing terminated at/or below land surface requires a �--
variance in accordance with 15A NCAC 2C.011S.
9. YIELD(gpm): 3 METHOD OF TESTPidtdiy7Zk
10. WATER ZONES (depth): i>o'
11. DISINFECTION: Type 14b/t?5 Amount /.3 Dzs
l2. CASING: Wall Thickness
Diameter or Weight/Ft. Material
&,as alb.las Puc s&U/
OIa �/Yt e5 �IAC'L
ye,ydersorou,fie_ , I1 C .
Depth
From 0 To SD Ft
From To Ft
From To Ft
LOCATION SKETCH
13. GROUT: Depth Material Method
, From To 20 Ft. can cre fc Pouf - fry
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
l5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
v f^G
• 70 r't
- cP�
0
Show direction and distance in miles from at least %
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, DELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEtL OWNER
r Q� WO)
S1F,NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
298567
f�
-+! Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Oak by vt) t Pl7
WELL CONTRACTOR COMPANY NAME F4rr U.SQN S Wilt Dri'fi y CA,
STATE WELL CONSTRUCTION PERMIT# J ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION #aon
PHONE WRAY) 6E3 ?VrPt
1. WELL USE (Check Applicable Box): Residential I9" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Coin tyo/ //t County Hrvtdtrrp,✓
140 et •cf,5 .01 Si ..4 ' / Aaad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Vq(ar%G IVIC/i{nz/tG
Address 49er / / i-/erS Rd
(Street or Route No.)
J/endeeson1.47/c !) C a13793
City or Town State Zip Code
(tl)- 49 .2/7/
Area code- Phone number
4. DATE DRILLED t4 03 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�'
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. pp
9. YIELD (gpm): /2 METHOD OF TEST56Wr y/ p _
10. WATER ZONES (depth): 3I23 r
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lac
(check appropriate box)
Latitude/longitude of well location
`1C 35°3.3,/Ia/[U0t-°74,24SSr
(degrees/min cands)
Latitude/longitude source: PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o - 7U` Dirt"
- Leos rrrAn,'Jtc
5. TOTAL DEPTH: S r
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 90
-I�n fflr
From To
From To
13. GROUT: Depth
From_ To ao Ft.
From To
14. SCREEN' Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft. / a.S
Ft.
Ft.
p CDt
C n
J n
rJ yC
rn
�o
Amount //o; s Show direction and distance in miles from at leas[
LOCATION SKETCH
Wall Thickness two State Roads or County Roads. Include the read rr)
or Weight/Ft. Material numbers and common road names. Q --1
441 s.LS PVC SD2t1/ — i
(JQ si, 3 get l Pd .
Method
Pooivty l end e C .
Material
Con rr C%C
Ft.
Diameter
Ft. in
Ft. in.
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL -_.. _
CONSTRUCTION STANDARDS, AND TH T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
ATURE OF PERSON CONSTRUCTING THE WELL
3
ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298613
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res'ources'- Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL.)NAME (print) r3j1bby IV r POS
• /
WELL CONTRACTOR COMPANY NAME FLry0Si.ry W S e// D/VW .t,• 11i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED/WQ PERMIT#
(if applicable) Iif applicable)
I. WELL USE (Check Applicable Boxy Residential /Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Oat- eauG CCountyHen le#100061
M
/i/.Di hdet Kd ia<endenoi/l/e-
(Strect Name, Numbers, Camnuniry, Subdivision, Lot No., Zip Code)
3.OWNER: //110ot.v Balm
Address 93 GUmedw:.Vd J'o..
(Street or Route No.)
$p rranh...9 ,vc Z9�oa
Gry or Town State Zip Code
( )- Sks — ota V3
Area code- Phone number
4. DATE DRILLED 'D7/3Q3
5. TOTAL DEPTH: _ S /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
*Tap of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpmj: 30 METHOD OFTESTf3%W/4y/i4
10. WATER ZONES (depth): //Q
11 DISINFECTION: Type 1-4610Amount r a'
12. CASING:
Depth Diameter
From 0 Tom_ Ft. 4. a,$
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_ To 20 Ft. tencrC'/. Pearti f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
l5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
r f'lt f sYw(
Groundwater Section QQ
CERTIFICATION # 3.03-1
PHONE Bag) 013144r
Topographic/Land etting ,:
ORidge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of ell location
/V 3 S ° �7. pll/wepa °/L . fl2. '
(degrees/min
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH
From To
0- �s
DRILLING LOG
Formation Description
o„ t $,44.041
C7 O
c ci;o
se n
rn
S n
J -6G
ma
O
no
try
n
G
Z
LOCATION SKETCH
Show direction and distance in miles from at least td
two State Roads or County Roads. Include the road
numbers and common road names. .D
)1{oU.%/t /(4
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
DATE 11
SIGNXtURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298612
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 9b y W f PQ7`TS
Fc9r,spn i Wc// I) ,r/Gwy re
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(ifapplicablel
Groundwater Section
CERTIFICATION 82028
PHONE ALM r7'YYY9
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 II'Other, List Use
2. WELL LOCATION:
Nearest Town: (Iowa h
CVaris Rea//
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3.OWNER: Ponnit &ry,
Address /7.3 C.Ocaw- Ciro trs-• /
County Nt/lit/`SDAri
(Street or Route No.)
AA•enders'Orly die ne arr�9a
City or Town State Zip Code
(K116- t 242 - Sa 0 9
Area code- Phone number
4. DATE DRILLED 4/17Q?
5. TOTAL DEPTH: .3ni
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ire, FT.
(Use "*" if AAbove Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): /0 METHOD OF TESTDIows / /,;
10. WATER ZONES (depth): LOD /!!
11. DISINFECTION: Type 1-arl?lLlr
12. CASING:
Depth
From Q To /Of
From Tn
From To
1.3. GROUT: Depth Material Method
From 0 To ).O Ft. CaAcreic evn,nf
From To Fr.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Diameter
Ft. 6, LS
Ft.
Ft.
opographic/Land setting
idge ❑Slope ❑Valley ❑Flay
(check appropriate box)
Latitude/longirud of well location ,
A/ss°Ta J' /100/L.52. 4 A,
(degrees/ mutestfreconds)
Latitude/longitude source: tPOPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
jet ,.T
Crwn»C
DEPTH
From To
e — to/
ios ^ 30.S
LOCATION SKETCH
Amount Show direction and distance in miles from at lea.
Wall Thickness two State Roads or County Roads. Include the rdte
or Weight/Ft. Material numbers and common road names. t�
W4./us PVC MDIUI gel Ad -
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size Material
FL
Ft.
pia
nC
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY Oj; THJS, EE20RD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699.1630 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298611
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Section �r
WELL CONTRACTOR (INDIVIDUAL) NANI(EE (print) 1106 I/��9 W / j%/s CoCERTIFICAQTI'ONN'#, Ofl
WELL CONTRACTOR COMPANY NAME PCy (ASOrt/ S / t/r.i4// j)A////.9 C. PHONE ✓I IDU3-Pyty
STATE WELL CONSTRUCTION PERMIT# Cl ASSOCIATED WQ PERMIT#
(ifapplicablel (it -applicable)
I.
2,
WELL USE (Check Applicable Box): Residential Cif/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town:Edne O///C County Pim/ Y/`SD/t/
p'/O , voi idatj
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 440i4/nllvu
Address //7S %t !Otis led
(Street or Route No.)
Ciry or Town State
2tfl9
Zip Code
b )- G BS•789ci
Area code- Phone number
A. DATE DRILLED $/7 /Q3
5. TOTAL DEPTH: 0S
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
Topogra Land setting.
❑Ridge lope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of ell location r
N zraxt7$1,osz°,700.72
(degreeilmi tests nds)
Latitude/longitude source: L'3GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/3 G bile%
A ` vos 40antitc
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if .Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing germinated arlor below land surface requires a
variance in accordancewith 15A NCAC 2C .0118.
9. YIELD (gpm): 22l1 METHOD OF TEST(lMoytes;
10. WATER ZONES (depth): !bQ
11. DISINFECTION: Type
12. CASING:
Depth
Front_pL— To no
From To
From To
13. GROUT: Depth
From_6 To pJ
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Ft.
Diameter
`.as
16. REh1ARKS:
0
LOCATION SKETCH
Amount /2 p1i Show direction and distance in miles from at leash
two State Roads or County Roads. Include the fog, `n.
Wall Thickness
or Weight/Ft. Material numbers and common road names.0
..-1
/GgfxS en 30R21 s i
T, lot MIA/ Rd
gLndcant 3,r7<e-
Material
Ft. CO4 e PC it t
Ft.
Method
Qev�
Diameter Slot Size Material
Ftin. in.
Ftin. in.
Size Material
Ft.
F t.
nc
N �o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
TU Ua ON CONSTRUCTING
TURF O PERSSTRUCTING THE WELL
ATE ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298609
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division. of..,�W�ater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 oLh 7 W ( PB (y/ J CERTIFICATION # X%a.$
WELL CONTRACTOR COMPANY NAME F-c, U Sorts ki./9// DOI/h"t , (1. PHONE IS(rj$) B$S ^ YYYT
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if :wokeable) (if appticablel
I. WELL USE (Check Applicable Box): Residential ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
,Y 440 b
Nearest Totni:f dnt�/ Ur /�C County tit i'NO
Mrai/,ujs OA Le✓ni Crt•ek eat- *Ye
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER:-Cii¢e/ ,r4ane
Address /59 Phj in as 5-rea Rai
(Street or Route No.)
AVestch.f ne 8 73
Ciry or Town State Zip Code
(WI- 421- 99e a
Area code- Phone number
4. DATE DRILLED 7/rob
5. TOTAL DEPTH: 5 Si6
7
Depth Diameter
D Tom Ft. to
To Fr.
To Fr.
13. GROUT: Depth Material
From n To 2J Ft. eonCre( t
DOES WELL REPLACE EXISTING WELL? YES 0 NO P
STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use''+" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 13A NCAC 2C .8118.
9. YIELD (gpm): / S METHOD OF TEST GWew y/16
,91
10. WATER ZONES (depth): 200
Topogra 'c/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude f well location
as /V Zs°aa.swega'.a/.os•
(degrees/ inuteSe€conds)
Latitude/longitude source: fGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Iit i-!SOWS
r,-nanzif e
DEPTH
From To
r0 - 4 A
Oa -vs
11. DISINFECTION: Type 'i-ccWe 1S Amount /0 A?
12. CASING: Wall Thickness
or WeightFc. Material
From T(b./as PVC sbAX(
From
From
From To Ft.
Method
Party
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:
O
0
t
O
^
V. cm
2
LOCATION SKETCH 3 co%
Show direction and distance in miles from at least r ��
two State Roads or County Roads. Include the road 01 G
numbers and common road names. vfl z.
�ew/5 C_re °� c1ot1
l�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARS, AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�vGd / ��
SIG ATURE OF PER ON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298608
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources /-,rD/ivision of Water Quality - Groundwater Section �9
WELL CONTRACTOR (INDIVIDUAL) NAME (print) en bbyt /V t pO1j CERTIFICATION SiAOA6
,f - rq
WELL CONTRACONTRACTOROR COMPANY NAME )�[ r9 USN/ S at/L�� P/4`I//Yt� co, PHONE j42S (.21
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ/PERMIT#
fit. applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ii Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:j/,IhCt/Wi /IC County��tyyyy'f 4i`fdh/
Apphe4' AA Gda�ri oaf n 2 ie, €.n)t SA
(Street Name, Numbers, Community, Subdivision. Lot No., Zip ode)
3OWNER: ram/[ II)) t FOrtcsr
.
Address ?? .2.ci % : / 2)/2
(Street or Route No.)
/lendersm je,,,bet /I 287F�
Ciry or Town State Zip Code
YAK)- 3.5(r
Area code- Phone number
4. DATE DRILLED 773/43
5. TOTAL DEPTH: r%D$ — /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: 5 0 FT.
(Use `+" if .Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST/i/erA.ny/L9
10. WATER ZONES (depth): / l%'
11. DISINFECTION: Type 1'461t tS
12. CASING:
Depth Diameter
From_ To 410 Ft. b,d5
From To Fr.
From To Fr.
13. GROUT: Depth
From6 Tot_ Ft.
topographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N i5°zs,O)2l/hoire / Sib 79
(degrees/mi utes�h onds)
Latitude/longitude source: MG`PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
atiNt
lrrentte
DEPTH
From To
6 - YO
yo - h0S
Amount /1 ptS
Wall Thickness
or Weight/Ft. Material
2/G,IX5 PVC 5bt.I
Material
Cone rCte
From To Ft.
I4. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
pay nr n>
Slot Size Material
in.
in.
Materiat
cn
2%
N7 Or
G
trG
'IC. al 5
Show direction and distance in miles from at least � n�
two State Roads or County Roads. Include the road
numbers and common road names. .D y
/ k OJ ,2 !°
6, do e.eta fie-`iC
LOCATION SKETCH
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
IGNATURE OF PERSON CONSTRUCTING THE WELL D E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298606
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) O06/ W r Pe✓lt CERTIFICATION p410.1g WELL CONTRACTOR COMPANY NANIE fr/va0 Sd2S WG./ Dnr6/ y CO. PHONE OY2$ FS.3—�%YY/p
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED
ASSOCIATED/WQ PERMIT#
(ifappiicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
?. WELL LOCATION: //
Nearest Town: �o�ne.yll/%/r County ktek rn97v✓
/aws b rv)w go{ Wl•A Fkr-K
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: YaMCs ¶ ce
Address 700 Sltot-hon /Lear!
(Street or Route No.)
f/mot lace /1 C 28s73 /
City or Town State Zip Code
(tali -la 4t), eleb
Area code- Phone number
4. DATE DRILLED /21,43
5. TOTAL DEPTH: S05 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FdZ
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 arior below land surface requires a
variance in accordance with l5A NCAC 2C .0118. /
9. YIELD (gpm): l METHOD OFTEST,(/DWr%t�1495
10. WATER ZONES (depth): id 11. DISINFECTION: Type "ke"t %S
12. CASING:
Topographic/Lands ding
❑Ridge ❑Slope H'v`alley ❑Flat
(check appropriate box)
Lat,(to /longiudr/ o ell lscation
3S-2./.9DJ /a; 2p,/Y7
(degrees/rn nutes/seconds)
Latitude/longitude source: 13?'IfS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o -- 70 ^ t /senD
a/'an r e•
-7o - sas`-
Depth Diameter
From 0 To 70 Ft (p AS
From To Ft.
From To Ft.
0
0
-r m
LOCATION SKETCH NZ
Amount (S 02 Show direction and distance in miles from at least C"? �a
Walt Thickness two State Roads or County Roads. Include the road 01
or Weight/Ft. Material numbers and common road names. %D 2
aj'.l,Is Pvc sAA2/
13. GROUT: Depth Material
From 0 To 10 FL (0l1(Pcie
From To Ft.
l4. SCREEN: Depth Diameter
From To Ft. in,
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
r
pv,my7
Slot Size Material
in.
in.
From To Ft.
From To Ft.
(t m b 'In`
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSTRUCTING THE WELL
z
/
Dr
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298605
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - / Division f Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME (print)? 4b,,� //✓ , 7 ,�7f CERTIFICATION p 7`Ura?`O
WELL CONTRACTOR COMIPANYN.ANIE 'Fcy as 'us- We// Priallyi C. PHONE an ba3-yY`
STATE WELL CONSTRUCTION PERMIT# ✓ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential /Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: &IA e yV'WC County PLoneerardW
yr zr,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /ChI'/5 " fipnir/ 8/SAo p
Address /i�{ 7 T/If -t- 111
(Street 6r Route No.)
il`endvi-son/4/a- - /2 r 9.871 2
City or Town State Zip Code
(kJ8)- A72 -Ce2/9
Area code- Phone number
A. DATE DRILLED 7/203
- TOTAL DEPTH N�S
5. A : /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO !fd"
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 or casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): V METHOD OF TEST/i/aW/17/25
10. WATER ZONES (depth): 7D r
Topogr is/Land setting
❑Ridge Slope ❑Valley ❑Flat
t (check appropriate box)
Latittude/longitude f well potation
N3.S 36rSb IS't @ ra
(degrees/ inure seconds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DI% 1
DEPTH
From To
- SY
Sy— Yes n,nr`rc
11. DISINFECTION: Type t} /el7
12. CASING:
Depth
From 0 To Fr
From To Fr
From To Ft
Diameter
Amount //023
Wall Thickness
or Weight/Ft. Material
24(e.0S Pre- $2RAt)
13. GROUT: Depth Material Method
From 0 To 2M Ft. CoACnc1C poUNlny
From To Ft.
IA. SCREEN; Depth Diameter
From To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
N ern
t� �0
S Ac
LOCATION SKETCH rn
rn
Show direction and distance in miles from at least` nn
two State Roads or County Roads. Include the ro5
numbers and common road names.
/z64--,ed
pea obc r 5 6N ?id( e--4 C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT//A C/O/P//Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�S1GNA URE OF PERSON CONSTRUCTING THE WELL / ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
Carolina Department of Environment and Natural Resources - Division of Water Quality -
North arc ma - �� f�Y /FA AMC -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) nO I7/ �J / /
WELL
WELL CONTRACTOR COMPANY NANIE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if upplicablc) (if applicable)
Ft yrrsv bac// prfalljnf co
298604
Groundwater Section
CERTIFICATION # 2.-/225
PHONE 01,16 4,13'9VY9
E. WELL USE (Check Applicable Box): Residential 13" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 'Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Town:�/ rnit/`Se+/✓t/ft County �'L✓l4CAnit ✓
"fiat Lit/ — Le Y -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
co
3. OWNER: t/tI i///s
Address / a 9 £s't/f e LmWt
(Street or Route No.)
/r le-lSes+/ffat- i) C
City or Town Stare Zip Code
gat)- G 9.1-- J6
Topo is/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location r
N3S° a,�,YYBsA e'a3t7YY
(degrees/min a econds)
Latitude/longitude source: PS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Area code- Phone number
4. DATE DRILLED 77flA 3
5. TOTAL DEPTH: y0 S /
6 DOES WELL REPLACE EXISTING WELL'? YES 0 NO 197
7. STATIC WATER LEVEL Below Top of Casing: AO FT.
(Use "1-" if Above Top of Casing)
S. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5.A NCAC 2C .0118.
9. YIELD (;,rpm): 3 METHOD OF TESTI no$177//9
10. WATER ZONES (depth): /6Q '
11. DISINFECTION: Type
12. CASING:
Depth
From.-__0_ To %l
From To
From To
13. GROUT: Depth
From_ To -).D
From To
14. SCREEN: Depth
4.0.4/t )tY
Diameter
Ft. bras
Ft.
Ft.
Amount / Sd t
Wall Thickness
or Weight/Ft. Material
7rf,fe PJc saki
Material
Ft. (j).tcreYc
FL
Diameter
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DEPTH
From To
p - ']b
7&- vas
D. nt
&.ra.ai7c
L
V
3
r- orn
s0
N -4�
�r1 r'O
LOCATION SKETCH n
Show direction and distance in miles from at least e11 2
two State Roads or County Roads. Include the road`fl
numbers and common road names,
- As fig
Method p-en deco r//fie fn G
fD Jrf'i,
Slot Size Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTITHE WELL
NG DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center) REV Raleigh,
NC
C01
27699-1636 Phone No. (9 19) 733-3221, within 30 days.

9 c
gym_:„, ..
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- AFr/// Ito///i '777
WELL CONTRACTOR CERTIFICATION #: 7/9 6'
STATE WELL CONSTRUCTION PERMIT#: /�
1. WELL USE (clack Applicable Box): Residential 1:1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Piecovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Shower ( the location below)
NearestTowrc ��� County.
;!(I5
(Road Name andilumbers. CommuNty. or7btfivis' n an tot No.)
3. OWNER Lc ry, GC�'�
Address
(Street or Route No.)
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH qOS'
6. CUTTINGS COLLECTED YES Q NOE
7. DOES WELL REPLACE EXISTING WELL? YES I�I NO[
8. STATIC WATER LEVEL. Below Top of Casing: o FT.
(Use 'a' II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface
Top of cuing terminated atior below land surface requires a variance in accor-
dance with 1SA NCAC 2C . 16
10. YIELD (gpm): 5 METHOD OF TEST o"� ✓
11. WATER ZONES (depth).
DEPTH
F
, r{
oc
12. CHLORINATION: Type
13. CASING:
11
N
0
Amount If additional space is needed use back of brat
Wall Thickness Ma
From 0
Depth
� y Ft DI % Jr origMra S�FP
From To Ft.
From To Ft.
14. GROUT:
Depth C Mate M, r{ r r
From To Z FL ��� �(de-
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. In. _ in.
From To FL In. _ In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads. or other r reference points)
�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
C S TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.-

WELL CONSTRUCTION RECORD
North Carolina - Depalen nt of tnvironma N eal D, View Quality WaLcormeAcrot W'DWIDUAL NAME .-L/ j" � j
WELL CONTRACTOR COMPANY NAI4E /l2.rr: (1
WEsT/ WELL coffly :rla. rnzirri / dt\ ASSOCIATED WQ rl�ealse
clef applicable)
•
Resources _ f - Groundwater Section
4- HAW % ut °C r CrannCAnONw 3 (5c
t.�.&d1 d- %atl r,P moos d f P h f 1-1 - 4q-5 o
Cc33p
Blameable)
1. WELL USE (Check Applicable Boa): Reuel rota aVFablic 17 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pomp Water ligation 0 Other 0 If Other, Lis Use
2. WELL I.00ATI0N- Topogtaphic/Land setting
Nearest Town et�eKonki/tP comity konot< n ° ge)Mope °Valley °Flat
(cheek apaoaiaeebon)
Latitude/lometode of well location
(Stag Name, Nambo; (am , SIBdivisioa, Jai No.. Dp Cads)
3. OWNER' Kt1 Yk (fit iC r t'/
Address r4) ja..tcsan Ret
(Sweet relate No.)
DvCode
Awned. l'banseeea , , „, 2
4. DATE DRILLED 1-1
5. TOTAL DEPTH' 455
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E9-
7. STATIC WATERLEVELBtelowTop ofCesiug: tbO' t:r.
Ni e' `t" irAbovorep of Cutup)
S. TOP OF CASING IS t FT. Above Land Surfaces
Kw of auks to rethaoed ati rbdow lead swim runs a
ration le acards= wi615A ?CAC IC .0113. it �b w,
9. YIELD (gpmr 3 METHOD OF TEST
10. WATER ZONES (depth):
(
Latkudellemgitadc somce:°GPs0Topogtephic map
aseek bo)
Frain 3T5o
3S 3
35t efk
02. ttb
9fk yss
Ll. DISINFECTION:Iy'pe UTl♦ Amount
12. CASING: per, , Wall ThicknessFrom (q To `'tV Ft. Di S IJ &(
From—__ To Ft
From To Ft Ural) V Cl
13. GROUT: Depth. Maned
Ftom__o_To z o jrt S iniblea e�i?�
Frond_ To Ft.
14. SCREEN: Depth Diameter Slot SLID Matetial
From.......... To Ft,.ILL ia.
Flom To Ft.T_in. in
15. SAND/GRAVEL PACK
Depth Size Mewl
From To FL
From To Ft.
16. REMARKS:
DRILLING LOG
fJorton
Description
(Lott
rt-
Roc IC
µnkike /r
LOCATION SKETCH
Show direction and distance in males from at least
two State Roads or County Roads. Include tbe toad
numbers and common road names.
.r,--6l
64P
0
cn
I IX) HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC ARD2C, WELL
CORM IOt3 Si (NDS, AND THAT A COPY OF 7Hi5 RECORD HAS BEEN PROVIDED to na oat OWNER
q (3
SIGNATURE OF PERSON CONSTRUCTING ME WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Midi Service Caner -Raleigh, NC
27699-1636 Pawn Ne.[phone], within 30 days. GW-1 REV. 07I2001
tr, Ann
it

l-,
is l�
North Carolina • DepanmantOf EmLorvnsM and Natural Resources • Division or Water Duality . Groundwater Section
•
1636 Mali Service Canter. Raleigh, N.C. 27699•1636-Phone [phone]
cfr rfw
WELL CONSTRUCTION RECORD W� CONTRACTOR: CERTIFICATION I: 3 PC&
STATE WELL CONSTRUCTION PERMIT#: tx R.
1. WELL Heat U$ (C$ubleS 4 Rn1 O O M*I a Other, CI Agricultural C7 Monitoring 0
' Flowery
ter
'. 2 '-.WELL LOCAnt :. (Show sketdl of C» location Wow) fie ()duco,,
Nearest
msito�y` u r
'C°Wy
'>rfC C4'rFFs (Yr-
. _ DRIWNG LOG DEPTH
pima SomeY,tSuo7Onandtot s! Description
$, OWNER 4t kkard U f !orr ((P "'Tuts! ' . From To r
1'J'P C� I alp
Andress. `'0 8�Am*Ql� �y a We r cte-
' �/ Pie 2)O
City arum Store Zip Cods
4,. DATE RRlU.ED t`" y-O 3
S.,- Tam. gam tS
6.' CUTTINGS COLLECTED YES 0 . wry'
7. _ DOES WELL REPLACE EXISTING WELL? YES 0 NNTO�'
6. STATIC WATER LEVEL Below Top of Casing:
(use W V tan TIP a case)
9." TOP OF CASING IS FT. Above Land *
Top ofcooing WarknudW ubelowpadsurfammgWna
a mimes In sccow
danceMmISANCAC2GM1i"METHOpOFTEST ��r(31tlt✓
,.10. YIELD (gpm): tc
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
4771
Amount
WalThic4aua
O Depd'1 C ....,� o low .
From To FL l"' r? 2I
Front-11- . ToL FL--�
1 From To FL
!4 CAROL
DePth •:'Malarial
From: - To io FL Skitere-
`From` To FL
15. SCREEN: <,
(tatit
t.k,ra( roe 9-
if additional space is needed two bad<or fan
CATEN SN FT _.
(Show direction and distance Iran at Nast hag Stab
Roads. or Ohm map reference pow)
method/
M: 1lGP tb°e-
Diameter Slot Size • Malarial
To•
Ft • In. ._.-1n.
From
From: .:To Ft. in:. In.
From --To FL In __ In.
::15. SIWQIGRAYEL PACK.
Oapth
From':_.,. To h1
Material
17. REMARKS: '
I DO HEREBY CERTIFY THATTHIS WELLWAS CONSTRUCTED IN ACCORDANCE WITH I5A #CAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL WEL
474 g/t/3
- FOR4 1 f 11 wag OFFICE USE ONLY 1 --i SIGNATURE OF Dpr V T e WEU.
1 SuawodginatNad**elWwDuality. orowdwatrSWIM Within 30days /29t
.�--- 'fWt Mt Sad t

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) grlvowl i.'/rass rir o.a,J
WELL CONTRACTOR COMPANY NAME .yyn E.pq re
CERTIFICATION # 4I94,
na.bair.( t�r.+.�.rjr PHONE # sj'Otter
STATE WELL CONSTRUCTION PERMIT# fa2.2 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: y.�,,, ., e,County a - -cvd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .0-4 r.we.n.escevv
Address —=2/ 4 .a.,vr,.re• ,.-,..
(Street or Route No.)
City or Town State Zip Code
(WA)- %94/ ,yj"/
Area code- Phone number
4. DATE DRILLED /i- 7— p
5. TOTAL DEPTH: see) - !6S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Gd
pographic/Land setting
Elalkidge ❑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
.r.-i?T
-- 2 C G.Q�vcrr_
7. STATIC WATER LEVEL Below Top of Casing: a;, z, 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 . /o,,,/it/ —1
I0. WATER ZONES (depth): i o O r; _ / 6 n
-- O .`r i G .v....s �f=.
11. DISINFECTION: Type
12. CASING:
Depth
From n To 2 6 FL
From To Ft.
From To Ft.
13. GROUT: Depth
From___CZ Tom Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
6 9v- orkere-,2 e-e,7
M terial
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
O
t7
N
LOCATION SKETCH
Show direction and distance in miles from leasta
two State Roads or County Roads. Include the road
numbers and common road names.
G i?al/3 c
C
e i2r
0Q�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN AT A COP HIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

e•(1)
"r NOM Goer a: O.pwf fl a EtMaownan and Natural Rasarats • Division of Water Quality • Groundwater Section
lb3B Matt Sala Canter• Raleigh, N.C.27Se0-163ei'Umw (918J 733 1 •
'WELL CONSTRUCTION RECORD viELLCONTRACTOR: 7-7-7A-A'AC" �-C "
WELL CONTRACTOR CERTIFICATION e: ? > `-/
STATE WELL CONSTRUCTION PERb1ITd: / a a
1:: WELL USE(grakAppikalsim Residential Er -Municipal Industrial❑ Agricultural CI Mordlodng�
Aecavary 0 Heat Pump water Injection ❑ Other ❑ If Other, list Use:
*WELL t crag O t(Shwaaietch oldie location below)
::NaawatTwrc LinwRA•/ pang i're) .7
-';p�fstamssad IN bah, /or.Sut o an and tNo4
OWNER /7a i�3A�%--+�59-1.a0 - -
/ laGaator i1�iNO
7`,�l1l/
r/�. ts' 5-220/4- /t/ K. or Tows ttiats apt
DATE DRILLED .� °'
.:.5.:"TOTALDEPTH
, /�/ r'
6.- cutntas OOU.ECTED YES 0 : NOD
7... DOES WELL REPLACE EXISTING WES? YES ❑ NOU"
- a STATIC WATER LEVEL Saba Top d1 Cadep: z o FT.
-"9,-TOP OF CASING Is .. FT. Above Land Surface*
: 4latens
lasted colas swam
Y /laSa
� /^�
dwaWmISANWW2C.011a J
1a-Yi8D Om " r_ METHOD OF TEST
11.WATER ZONES (depth): 1-)-o ynAcT
DAtUNG LOG
Ram To
DEPTH
Formates Desaiplien
d7.S/2T- f/4G/ e_
/n s - /2 % r,e,54-.0
12. CHUORINATION: Type
1S. CASING:
- Waltddaws
pis w
To " FL
To o R �reF�r
FL
1 DO HEREBY -CERTIFY THATTNIS WELL WAS
CONSTRUCTION STANDARDS. A D THAT A COPT OF
Mods
Method
0
d *Mond space is needed use be* aform
,.q rY a-,9.0 Ct.
IFOR OFFICE USE ONLY, - -
Oaa Nee
sMetfa
LOCATION SKETCH
(Slow trrecian and distance lam atMast two State
Roads, or other snap Sara pokiest
1 1 91 r?
SIGNATURE OF SONCONSTRUCTING THE Va. POE
Sulanaa*uI10Mon dwWrOuY G uds=SatanMAhkt30days GM RIM ism
ACCORDANOEWITH15A MCC
`-
PROVIDED TWINE WELL OMER.
cvru P

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . t?,.-7/i,✓ '�./,as.SCE n�✓
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
-w <r-C
CERTIFICATION 3''/t/
("'•^N PHONE # W..1s�
ASSOCIATED WQ PERMIT/4
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Jana ra.v-
County .41.c.n/n.=f 00..n/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: „en Ad J-,Q n cy
Address
(Street or Route No.)
N0t3/ aet , G
City or Town State Zip Code
(2"1-* Q1/45-- Q/ZO
Area code- Phone number
4. DATE DRILLED . o _ 3 0 -- o
5. TOTAL DEPTH: in"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E
7. STATIC WATER LEVEL Below Top of Casing: 2-b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. ��//
9. YIELD(gpm): '?0 - METHOD OFTESTfysYy..&thj/,t/
10. WATER ZONES (depth): ♦ a n - iVELC -
I I. DISINFECTION: Type
12. CASING:
3 %isz
Depth Diameter
From 0 To "n) Ft. 6 %i
From To Ft.
From To Ft.
13. GROUT: Depth Material
From p To 2 O Ft. ,-�>a6t,r7J_F
From To Ft.
14. SCREEN: Depth
From To
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
Diameter
Ft. in.
opographic/Land setting
tdge ❑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
— s S Nor27-
- IO GASvzr7>�'
Slot Size
in.
in.
Material
VE7 — 4P'S G.er3 77.4=
O
tV
0
LOCATION SKETCH LTI
Show direction and distance in miles from at least .,
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, »9 THATT,C9PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of WateraQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (p/rri'nt//5,M/ZS GL /4"..914- ''fr "IvCERTIFICATION #.7cYJ/
WELL CONTRACTOR COMPANY NAME Vt unifi, ,(! % [•`LcCf / PHONE # 458) 3 ITYYSo
STATE WELL CONSTRUCTION PERMIT/4 / 2 ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION : //
Nearest Town:9/6 -1.4e2,aounty
(Street Name, Numbers, Community, Subdivision, LotoNo., Zip Code)
3. OWNER' Sri 4,--- ree-tnr�Ci•!/L (degrees/minutes/seconds)
Address itf 541.5 pin Ain , Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�ciliakGLS 4tid 'QC, DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
5. TOTAL DEPTH -I.? ' �O—r7 3 '�� l7c7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: re, FT. q
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J� FT. Above Land Surface*
*Top of rasing terminated atfor below land surface requires a
variance in accordance with I5A NCAC 2C .0119.
9. YIELD (gpm): 9 METHOD OF TEST Cie--✓
10. WATER ZONES (depth): _/ 70
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To G Ft. (4--4" -., / %9,,1,1
From To Ft.
From To Ft.
13. GROUT: y Depth Material Method
From CI To i 7 Ft. 511l4.-7el fouee0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
.97C7 •- 9-r4
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.
ec3 'tZ . — ice
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, A5NDD�THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
?? ,v --ay
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of' Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -j lA *'v ,W fr,rrc raM-) CERTIFICATION # ?l yy
WELL CONTRACTOR COMPANY NAME
Syr -C- ' Zf e lit/. el 7 c'n-l/.> PHONE # b? y 4*S t;
STATE WELL CONSTRUCTION PERMIT# 4,2 2 ASSOCIATED WQ PERMIT#
(if applicable) — (if applicable)
1. WELL USE (Check Applicable Box): Residential 12 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: Wen, ircrv,.z yn- County/ Vflc'�X�7itl
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)X 3. OWNER: i ' /
�LLriA 'F_.7STi /;aa n��ir{.c`'S' '.i (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
J<;zT
Address So 0 c,-,„,r.s.CT
nh c s,Tj(Street or Route,No.)
rSTV
City or Town State Zip Code
( -)- Cc— ?O3C
Area code- Phone number
4. DATE DRILLED ;1/?/0 2�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ,� o o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST iT/?,otvft/
10. WATER ZONES (depth): Fyn — eScx]
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.
2 990,2_
pographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
0 — 0
�c> rc7
7? Z-7
Ye)— S//
5i7— -Zf5
I1. DISINFECTION: Type
12. CASING:
Depth
From 0 To S'7 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To '2d Ft
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
Amount
Wall Thickness
Diameter or Weight/Ft. Material
%V /edc
rial Method
n/4'rri n7C �>a vii
16. REMARKS:
Ft.
Ft.
Slot Size Material
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT
SIGNATURE OF PER
1
Arnt. i e
✓fit
TRUCTED ACCORDANCE WITH I SA NCAC 2C, WELL
-HA BEEN PROVIDED TO THE WELL OWNER
O
1 —
---I
rN
O
/mow' tin _J>
ON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r':74#0.' NXf/Jf[/YJ/✓
CERTIFICATION */ ?./
WELL CONTRACTOR COMPANY NAME 2, e ri rOi! 'i,417, PHONE 'C�kS'��
STATE WELL CONSTRUCTION PERMIT# /27 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:.9 j7-ccc : rt,,Ce County ,•;j; :>a3y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7...4rzizt?/ /--'�•c/>�n
Address .2 s - . r,A //'C/
(Street or Route No.)
cyeAr# °/itr Alt C>
City or Town State
(c:2<)-
Area code- Phone number
4. DATE DRILLED /- 2 — O
Zip Code
5. TOTAL DEPTH: 2-05—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lEr
7. STATIC WATER LEVEL Below Top of Casing: 300 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): I METHOD OF TEST rx,+.�tn>A/
10. WATER ZONES (depth): ., nn -- --ae/�T
11. DISINFECTION: Type
12. CASING:
Depth
Fromm To 2 n Ft.
From To Ft.
From Ft.
To
13. GROUT: Depth Material
From 0 To .^so Ft._ ilras=�,ic'
Amount
Wall Thickness
Diameter or Weight/Ft. Material
C %jr jtv.fAl
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
>rrzx tV t L.t_ e
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
graphic/Land setting
idge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1� — ne, r??/
t- .20
0
---1
N
LOCATION SKETCH 0
Show direction and distance in miles from at! least-
two State Roads or County Road sr�Include heroad
,
numbers and common road names.
�ie tgil.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT
SIG
AT
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THISRD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION/ 2809
WELL CONTRACTOR COMPANY NAME IDRE1wrAT1 well Drill.' ng Tnr PHONE 82A 757-7779
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
276010
1. WELL USE (Check Applicable Box): Residential DI 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: Saluda County Henderson
W.G. Eargle Subdivision Lot #9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Terry and Susan
Address 4775 Apt. Blvd. e
(Street or Route No.)
North.Charleston,
City or Town State
Trelford
Apt. ES
SC 29418
hip Code
( )-
Area code- Phone number
4. DATE DRILLED 3/03/03
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
5. TOTAL DEPTH: 740'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top at casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC SC .0118.
9. YIELD (gpm): 1 5 METHOD OF TEST'. rotary air
ID. WATERZONES(depth): 140'
200'
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 43 Ft.S1 /8 Sch 80 pvr
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft,
Size Material
c
0
16. REMARKS:
1 PC HER FRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CQNSTRUcrI00 STAND4DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Y II
I Submit the original to the D
' 9-1434-P 4-,...ne-„"'-. (S 19) 73
GRC ll'ill ^.AlliP SECTION
ASHE HLLE J/+.I. (JFFCE
3/c?It3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
ee

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
276006
WELL CONTRACTOR (INDIVIDUAL)NAME (print) Jeremy H. Bowman_' - CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME n Rnwman Well nr1111ng Tnr PHONE Y fi2A 252-7779
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ($ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:Hand rcnnvi 1 1 eCounty Henderson
Brad fora Terrace Lot #10
(Street Naine, Numbers, Community, Subdivision, tot No., Zip Code)
3.OWNER: Michael Williamson
Hen
Address 37 Bittersweet Drive
(Street or Route No,)
City or Town
( )-
Area code- Phone number
State
Zip Code
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sourcc:OGPSOTopographic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
4. DATE DRILLED 4/14/03
5. TOTAL DEPTH: 210'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fa
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .011S.
9. YIELD(gpm): y METHOD OFTEST `.rotary air
10. WATER ZONES (depth)
120' 200'
I I. DISINFECTION: Type tablet
12. CASING:
Depth
From 0 To 80
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
Amount 6
Wall Thickness
Diameter or Weight/Ft, Material
Ft..61 /8 Srh 80 PVC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the Foad
numbers and common road names.
L -
c
Material Method
concrete gravity flow
From To FL
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
CO
ens
m
n
0
16. REMARKS:
1 D0 HE (Fa trs T THIS WELL WAS CONSTRUCI ED IN ACCORDANCE WITH I SA NCAC 2C, WELL
' cON$712RUCT1t N yS,TA S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I� �� I, , � GNATURE OF PERSON CONSTRUCTING THE WELL
u
Submit the original t the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
11514d616.2.a - 19) 733-3221, within 30 days, GW-I REV. 07/2001
r UL. ION
ASH ,r1>.i_ , r, _ -.;:FL OFLiCE
l a4 /6 3
DATE

275973
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and manual Resoj(yes - Divisi_on of Water Quality - Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NAME (print) 'J}LL-t tJPSN CERTIFICATION a—I1/
WELL CONTRACTOR COMPANY NAME _
REUBEN CALDWELL DRILLING, INC. PHONE4i8 }254-358
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) / (if applicable)
I. WELL USE (Check Applicable Box): Residential QY Municipal/Public 0 Industrial 0 ultura 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I lher. List Use L v4ai l aite
2. WELLLOCATIQJ4 _�
Nearest Town: 'Y ! ,�t unty "-Ite��4'(__
/i2„zlv r GLa/j AP — �lrLe te2 j) ,
(Street Name, Nuummbeh, Community, Subdivision, lot N r Zip Code)
3. OWNER: /) 0 T , 5 2_ L)- L.-
Address J 5u.l.t i e
-I /zietrecto pisNo.) L�e7� �
�'Y�Cit or Town Stet.i Zip Code
(MS -(MS- &u C y%
Arcoda Phone number
DATE DRILLEDIK
A
Topographic/Land setting/
❑ Ridge ❑Slope 0Valley Flat
(check app.-opine box)
La3itude/longitude of well location
/V3' 7, 4bs 1.0o P,-34 ycv
(deveea/m tmnn/serc ads)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DEPTH DRILLING LOG
From To Formation Description
4. 3�G_3
5. TOTAL DEPTH. +3 O
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: Cs D FT.
4(Use `4.' if Above Top of Casing)
8. TOP OF CASING IS / K FT. Above Land Surface*
*Top of casing lermlosled at/ar balow land surface requires a
variance lea acwrdsoc wnh ISA NCAC IC.01 U.
o.S--
U.�- 3.o
310 S B'e,
3 to
YIELD 9. (gpm ): � METHOD OF TEST j 9 543 0
10. WATER ZONES (depth): ao 5 — pre(
�/�� 3Yor
' ^ 3 G?r
11. DISINFECTION: TypeN /�.l,OT Amount \. I b_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From-.- / To , - Ft. iti _r „
From To Ft.
From To Et.
13. GROUT: Depth
Material Method
Ffom_!a—.To a Ft. Cemar)T Qo Jain0
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.
1r ON ONS AND .
Ii ' 1,
�/
,4 C' 5 /1 `.
c'c(- i o/
s!QuLe Rw h L,)/T.a
3c7d>
sa `kfifi
(i3.eeiei 3 pent
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the pond .
numbers and common road names. JQ e�rl�
r
IS WELL WAS CONSTR 1 CTED IN ACCORDAN E WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECO1\HAS BEEN PROVIDED TO THE WELL, OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
03
SiBuuiiilt:fh'6 ordgln*I tenhe DIv
A$760-Ib16ilkheine Nitlk94Y24 733-
!Ion of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
i221,within 30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
27620.1
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
County HENDERSON
CLIFF TERRACE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LOYD G. KELLY
Address 171 CLIFF TERRACE
(Street or Route No.)
LAUREL PARK NC 28739
City or Town State Zip Code
( 828 )_ 696-9168
Area code- Phone number
4. DATE DRILLED 06/21/2003
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 500' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
I I . DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth
From 0 To 48
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6% SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, CONCRETE
Method
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:
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description r,
O rt
(.J
L —
O
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.
J,LOnt JIJM aszAko at u U°
h. alkenua gad- Aa c
tiicikwa kt. at Rd.b-uiwQ.c»- W arnR-
abuv ,A Calif ae ut.a c-c.. as
QNet 1An.
t--vonct¢-rrr-cin rn
il"'� CDNSTR(JCTION STAIN4
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI
DS, AND THAT A COP OF THIS RECOB.D HAS BEEN P'
SIGNATURE OF PERSON CONSTRU
G THE WELL
SA NCAC 2c.f WELL
IDED TO TH %VELL O
�, 27
DATE
ER
o' 3
Submit the original to thei Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
..._ 27699-1636Phane No (919)1733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
of Water Quahr,
North Carolina - Department of Environment and
wELI CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COPIPA.NY NAME CTIrc C\ �IV9 NC
STATE WELL CONSTRUCTION PERMITW
(if aophcablc)
WELL USE (Check Applicable Box): Residential LaY MunicipaUPublic 0 Industrial ❑ Agnculbural C
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other. List Esc
\WELL. LOCATION
�.l 11--
Near e t Town--.k)pgf fe.Al t:` K.. County \km&tSon
_ Qat.t» 0lew
Berea Name, Numbers, Community, Subdivision,, Lot No., Zip Code)
! c-4-- rn TrC.t1'1d-ram
Address to be.
(Seca or Route No
E& i u;►L. Nc
City or Town State
(0Z5- 3a3S
A:u code- Phonc numbcr J Art Q�
DATE DRILLED
TOTAL- DEPTH. TO h
DOES WELL REPLACE EXISTING WELL? YES 0 NO a" ---
STATIC
WATER LEVEL Below Top of Casing. 2 0 FT.
(Use"�" If Above Top of Casing)
S TOP OF CASING IS l FP. Above Land Surface'
'Top of cuing ter.nln.ted .tior below I.nd surface rcqulres a
Wo 44
Zip Code
Topographic .and setting
❑Ridge R' fope ❑Valley ❑Flat
(check e pprap net: box
Latitude'lo gitude of well locatior.
35`a5'5a N f ova al `R.w
(degreessninu:c&'secondfl
Latitude longitude source • C"vP SCTopogra,rh•,
(^cck hoz)
PRIL:,INQ :.00
Formation Descry)?
gQQ t
v.rlance In accordance with I5A NCAC 2C .0118.
9 YIELD (gpm). z METHOD OF TEST /Irkk
0 WATER ZONES (depth) / e5
DISINFEL I ION. Type /I %// Amount
_ CAS fNG. Wall Thickness
Dcptn Diameter or Weight/Ft. Malcnal
Frurn / _To- `/�_ Ft irk- 27,G ��7P/—
rulu ti2 To Lz FL 21.1
To
;ROOT Depth. Material Method
r,l 0 lo_L Ft. • ,tkath� M%*sit Po�Z
From. To Ft.
$ SCREEN: Depth Diameter Slot Size Material
�_ To�O Et in. in.
F rein
rent To
Ft m. In
SAN3:GRAVEL PACK Malena'.
Depth Size
.•oni_--To— Ft.
To — Ft
1DEPTI;
From To
d -
- aO
� O - h 5
Ss SOS
in _
_
LOCATION SKETCH
Show direction and distance in miles front a'. !east
two State Roads or County Roadsinclude the czar'
numbers and common road names
O
p
03
'Thud CREE;:, /?[�
O
CO
C
r
O
CFI
tiilBfi C }TH?.T THIS WELL WAS CONSTRUC.I LD IN ACCORDANCE WITH 15A ',CAC ZC'
WELL
.0 0 •ISiy(f; AROS, AN HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \OLL[. OWNEP
71
Submit the o❑bmit the o gina) to the Division of Water Quality, Groundwater Section, 1636, Mail Service Center - Raleigh. NC
-'-} eu:s ne No. (919' 33-3221, within 30 day s.
Division
Natural Resources - Div
\\ s goL
P mP
OCIATED WQ PERMITS
(if applicable)
27613,3
Groundwater Scccon
CERTIFICATION
r/
_ L-c-S 3
SIGNATURE OF PERSON CONSTRU CifNG THE W'ELt-
DATE

276132
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources �- Division"of Water Quality - Groundwater Secnon
WELL CONTRACTOR (INDIVIDUAL) NAME (print) $Ryirc2!� Sin ft'�'1 CERTIFICATION._`" 0 "
WELL CONTRACTOR COMPANY NAME C-IVIM' el RIMY r \M/ II S CkATO D Cn ,, PHONE a (nil C/ 43- 12 CC
ff
STATE WELL CONSTRUCTION PERMITI ASSOCIATED WQ PERMIT" /Y L 9 37
(if applicable) (if applicable) _
I. WELL USE (Check Applicable Box): Residential 0' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL tsLOCATION: ,,
Nearest Town: ee•Ipafvann.die County Orerderaan
►� GkssrCfste_k.
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3 OWNER:- LaudLn,4 I -Son
Address . fb \'Jox Srl 5
1 (Street or e. Route No.) OW7 ay
City or Town State. Zip Code
_ a ua
Arca code- Phone number
4 DATE DRILLED L •'/3 -U �f
5 TOTAL DEPTH: 2 4 5-
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO W—
STATIC WATER LEVEL Below Top of Casing: '119 FT.
(Use' t • if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface•
•Top of cuing terminated at/or below land surface requires s
variance in accordance with ISA NCAC 1C .0118. A
9 YIELD (gpm): '3 METHOD OF TEST ?//Z
10 WATER ZONES (depth): /i. r
DISINFELI ION -Type tiT>` Amount
12 CASING: Wall Thickness
Depth Dian4ter or Weight/Ft. rPit-
From,.{aerial
From To `10 FL L 2 Z (
440 To L 0 Ft. Z 1/ 2 /. / Pdc-
From To Ft.
13 GROUT: Depth Material Method
From 0 To 2 0 Ft..SAkro"fY" Xi5f- 7C47/Z o°
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From • To Ft. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
Topographic/Land setting
❑R dge ❑Slope ❑Valley at
(check appropriate box)
Latitude/Iongitude of well location
rip 19'141/ 0S2°,H'Oita}
(de grew m i n u tes/s ccon d s)
Latitude/longitude source:3S0Topographlc map
(check box)
pRILL[NG LOG
Formatiop Description
DEPTH
From To
C% " / 0
/0 - h/0
y 0 - i D S.�ct� SYvde
60 - A45 RA -ate
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roa•• County Roads. Include the4oac
numbers and on road names. Cr*�
i .r- c--
C-:13
r—
h
O
CrI
�•fO w/>/ice
•ti E KEgEB* C THAT THIS WELL WAS CONSTRUI, I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r sTil, ARDS. AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L -73 -03
L...,TU NARE OF PERSON CONSTRUCTING THE WELL DATE
i�
Subtnit the original o the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' Raleigh, NC
---.7776994tiCti ;ho'ne No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
276131
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR rWDMDUAL) NAME (print) /Jn2y/kYlr Sen; h CERTIFICATION. - Tt
WELL CONTRACTOR COMPANY NAME GI TILT n nal+r \Nv 11 't PIArn 2 (n
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT«
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential lir-MunicipaUPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
?. WELL LOCATION:
Nearest Town: 1iQrapr3onoiIlc
Diana County I� r9er5oh
(Surct Name, Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: 1'jrler 1' QrS
Address VOL4T_rso ReL pn be L 51a'l
(Street or Route No.)
17 1/II1R— N4 c ff193
City or Town State
(8ag)- 1o93-4rV
. Zip Code
Area codo- Phone number `
4. DATE DRILLED C -
/
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES Br -NO ❑
STATIC WATER LEVEL Below Top of Casing: A 0 FT.
(use "+" if Above Top of Cuing)
8. TOP OF CASING IS i FT. Above Land Surface'
•Top of wine terminated .tor below land surface requires a
variance In accordance with 15A NCAC IC .0118.
9. YIELD (gpm): 30 METHOD OF TEST
10. WATER ZONES (depth): /2. f
11 DISINFECTION: Type
12. CASING:
From /
From
From
4in_
It TN
Depth Diamter
To 7tg Ft
hi To eg Ft.
To Ft.
Amount
Wall Thickness
or Weight/Ft. ?QC-
13 GROUT: Depth Material Method
From C2 To 2 0 Ft. Seitkr3tffe, fit 4:-/i)otf,
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
To Ft.
To Ft.
From
From
16. REMARKS:
,c0NSTFiU I
PHONE ,/ inn I/ rf 3 - 1200
4.11 733 g
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [(at
(check appropriate box)
Latitude/longitu e of well location
YN4 pq(`2 92'c'
(degrtcs/mioutes/seconds)
Latitude/longitude source:G3dPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
d - 5 ea)
5"- GL9
Gv fY5
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include t3Tc road
O
numbers and common road names.
I. LI
Submit the orlil glnalt theDivision of Water QualityGroundwater Section, 1636 Mall Service Center Raleigh, NC
27699-1636 Phbne N
•
aw�.z Rd;
_
�II
i
swot/
rtrw
O
CI
FY THAT THIS WELL WAS CONSTRUL I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAx A COPY/SF SF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
;YcYps,�Cn+r.�GJZJJ C '/7-03
9 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
o
GW-1 REV 071200:
(919) 73}J221, within 30 days.

r•y
I
WELL CONSTRUCTION RECORD
276129
Water Quality - Groundwater Sccnon
ASSOCIATED WC) PERMITM �---'
STATE WELL North Carolina - Department of Environment and Natural s cS - Division of
g
hv rJ �l CERTIFICATION
WELL CONTRACTOR COMPANY
NAME) G1 (prior) / PL.m (n PHONE a j7i�.�-ili 4�_ )Z Op
WELL CONTRACTOR COMPANY G7r4-tf1 R111Yr AN'P II \ P P
L CONSTRUCTION PERM TTa if applicable)
(if applicable)
I WELL USE (Check Applicable Box): Residential Q"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery Cl Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATION: ' \-
Nearest Town: flni net A0 t 0 County tC-mere.,
mcm',lln. Dr;1
(Svccl Name, N
umbers. Community, Subdivision, Lot No.. lip Code)
3 OWNER: c 0-`1/4 TO_ArLSer
Address Il,`D
(Svcct or Rou e No.)
Ft,Ti cry-. fL
Ciry or Town State
I I/d)- tiist,o— aCcrs7I
Anus code- Phone number
4. DATE DRILLED '%' 7- 03
5 TOTAL DEPTH: 42_6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C
7 STATIC WATER LEVEL Below Top of acing:: /CFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of cuto6 terminated .Uor below land surface requiru a
varlsnce In accordance with 15A NCAC 2C .0116.
9. YIELD (gpm): 10 METHOD OF TEST Mt/Z
10 WATER ZONES (depth): 1/ 00
Zip Code
11 DISINFECTION. Type /I/ N
12 CASING.
Depth Diameter
From e To 90 FL L Y
From 6t0 To t0 Ft. 6 fr
From To Ft.
13. GROUT: Depth Material Method
From_ To_ -D Ft.5.1ARak A:r2r/oacfZ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK SizeMa;cri al
Depth
From To Ft.
From To FL
Amount
Wall Thickness
or WeighVFt. Material
27;e _P
2 /. { / ✓C
I6. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTtQN STANDARDS, AND THAT A C
Topographic/Land setting
CA'I:idge ❑Slope ❑Valley ❑Flat
(check appropnate Dos)
Latit�dc/1ongitude of well Ipcation
�x✓o4z°eY 37lin
(d e grew/ ni ou ids coon ds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
nett I fNG LGG
Formation Description
pEPTH
From — To
0 — ;5—
J,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
v`AU 7 he4 pito,
0
0
ONSTRUL 1 bD M ACCORDANCE WITH I5A NCAC 2C, WELL a II j
Y OF IS RECORD HAS BEEN PROVIDED TO THE. WELL OWNER
IGNATURE OF PERSON CONSTRUCT ING THE WELL DATE
Subrnat thSL7nloal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center' REV NC
(
27699-1636 Phoge No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR (INDTWDUAL) NAME (print) /3is
WELL CONTRACTOR COMPANY NAME C-It--9 RN4r ANY Pump (C
STATE WELL CONSTRUCTION PERMIT# 7 :),-1 d ASSOCIATED WQ PER111Trr
(if applicable) (if applicable,
276121
Groundwater Section
CERTIFICATION 075.2'
PHONE # (y27) y - 1 J/
I. WELL USE (Check Applicable Box). Residential Cfi Municipal/Public ❑ Industrial ❑ .Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town. `jaa ,r:\L1
c
'crr:_ C-r ti
t;Scree:cc. Name, Numb n, Communiry, Subdivision, Lot No., Zip Code)
County 1 \zrccoc y
3 OWNER- 1��'cA-131rar
C
Address
(Street or Route No.)
)i I I x
City or Town State
(ji*- 3C-10- `79.%a
�5l iR
Zip Code
Area code- Phone number _
4 DATE DRILLED 2 -(25 — C 3
5 TOTAL DEPTH. ) 6 5
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑"
STATIC WATER LEVEL Below Top of Casing'. / CO FT.
(Use "t" if Above Top of Casing)
S TOP OF CASING IS / FT. Above Land Surface•
•Top of using terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9 YIELD (gpm). /> METHOD OF_TEST f4,/Z
10 WATER ZONES (depth). 2,`/`5
. DISINFECTION. Type /irit Amount
12. CASING: Wall Thickncss
Depth Dtarr�eter or Weigh9Ft.
From 7 To 4'7 Ft C it 2 Z ‘
Frorn 4J. '7 To Si7 Ft. / �47 .z /, C
From To Ft
:3 GROUT. Depth Material
From / To : C Ft- S/{4R1-3/1i=
From To Ft.
14 SCREEN: Depth Diameter Slot Size
From, To Ft. in. in.
From To Ft. In. in.
'x SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16 REDIARKS.
De Ht E X
?Nsl'RUCTIO
1""
Submit the oriinal
e No.
Topographic/Land setting
❑Ridge ❑Stope ❑Valley Flat
(check appropnetc boa)
Latio.:de:longitude of well location
3i Ji y/E7oa'2 ll'j0't.)
(de greevmi Quasi se onds)
Latitudeaongimde source: tPS❑Topographic mac
,check box)
DRILL[NQ LOG
Formation Description
(7h=/r/! .Pc c,k Sf $£,.)(71
DEPTH
From To
C C' Q// L'
cc - 2e'S
LOCATION SKETCH
Show direction and distance in miles fry ate"�s:
two State Roads or County Roads. InoINOe thE4oac
numbggrs and common road names a"'- -
f� 67
Y THAT THIS WELL WAS ONSTRU(,I LD IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND . AND THAT A C Y OF RECORD HAS BEEN PROVIDED TO TEE Iy"ELL OWNER
SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
[phone], within 30 days.
GW' -I P.EV 07.3206..

276120
WELL CONSTRUCTION RECORD
North Carolina - Depatmtent of Environment and Natural Resources��- Division of Water Qual:1 - :rroundwater Sectio
WELL CONTRACTOR (INDIVIDUAL) NAME(p rant) ��/s.3/ZytL1iL( �z»'��1 CERTIFICATION -
07571
WELL. CONTRACTOR COMPANY NAME C-7r"9 e Ii,ve \NV II S P,rr10
STATE WELL CONSTRUCTION PERMIT# L;C? 50 ASSOCIATED WQ PERMIT#
(if applicable)
(It/applicable)
PNoNe # (Y29) C
4 1 Cer
. WELL USE (Check Applicable Box): Residential er-MunicipaUPublic 0 Industrial 0 Agriculturai ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town. t.40r-icP (SCD"tV1��
County CC -Or-
riv RL;I
,Strvcl Name, Ik4amben, Communlry, Subdivision, Lot No., Zip Code)
3 owNER. %cv,tocVr n
Address \ 5 C-det �c. Reci
(Street or Route No.)
�City or Town State
%y)' (p 3- 1 L L,
Arca code- Phone number
4 DATE DRILLED R - L
5 TOTAL DEPTH / z 5
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
- STATIC WATER LEVEL Below Top of Casing: Lib PT.
(use "*" if Above Top of Cuing;
S TO}' OF CASING IS / FT. Above Land Surface'
•Top or casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): 2. Cf METHOD OF TEST /;,./5
10 WATER ZONES (depth): / K' O
ag-71a
Zip Code
63
DISINFECTION: Type // TN
I] CASING.
15
Depth
From 0 To 51 Ft.
Frorn `/ 2, To Ft.
From To Ft.
GROUT: Depth
From Ci To T.0 FL
Amount
Wall Thickness
Diameter or Weight/Ft. Material
(/ 2 7 L P"'(--
G
Topographic/Land setting
❑Ridge 05llope ❑Valley ❑Flat
(check appropnatt box)
Latitude/longitude of well location
39-`..x1 o--Yhs JSIrR3 35?4)
tdcgccyminu;es/sccand.sJ
Latitudedongitude source EIGPS ❑Topograpb:e map
cheek bexi
DEPTH pRILLING I.OG
From To Formation Descnpuoe
C%- YD.R�
yC - 517 Si} .,e1 `ifc .a
> 6/</rr-/9T
Matcnal Method
5 k/zk-t/- lf. yVAL9c
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK.
Depth Size
From To Ft.
From To Ft.
'.o REMARKS-
Siot Size
in.
in.
M atonal
Material
LOCATION SKETCH w b
Show direction and distance in miles frota-4.at !ners:-
two State Roads or Couno Roads. IncluS the
numbers and cornmon roar names. —
t7S
ri Do HERt(}Y C�k11
'Mot:SIRIICTIO11hX..
711
lI
Submit the or ginal
27699 1.636_211one No
Y THAT THIS WELL WAS CONSTRU(3. I ED IN ACCORDANCE WITH 15A NCAC:C, WELL
v'DARDS, AND THAT A COPY f THIS CORD HAS BEEN PROVIDED TO DRE WELL ON'NE P
7-6
SIcSATURE OF PERSON CONSTRUCTING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
[phone], within 30 days. OW -I REV _001r
cn:

276119
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6IZ y/34l-t%f- SS.14 r 01
WELL CONTRACTOR COMPANY NAME C-, rt-e n RIV-P r \/`.* 1I \ PLA M P
STATE WELL CONSTRUCTION PERMIT" pk'tvJ ASSOCIATEDapplicable)
) PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: LC4,20'r.�G '. County 1'�Iccb f1J� -
M ss e_A-0 r Ica IkJ.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
4 C� YAP- N <'-ttivb'C'FL'.
V'pr.
(Street or Route No.)
\� t7 \ e_ ass-ICa
City or Town State . Zip Code
��yy--C
Arca code- Phone number
4. DATE DRILLED 2 " ;it -62 3
5 TOTAL DEPTH: 1 b'3-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a-
7. STATIC WATER LEVEL Below Top of Casing: L L/ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of cning terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9 YIELD (gpm): 7 METHOD OF TEST 42Z'
10. WATER ZONES (depth): 2 cc
11. DISINFECTION: Type
12. CASING:
Depth
From / To / Z
From 4.2 To 'IL
From To
13. GROUT: Depth
From [i To 2
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
/f %/i Amount
of Water Quality - Groundwater Section
��77
CERTIFICATION l 6.7
Cn PHONE p 0,71) (), ] -12019.,
Topographic/Land setting
❑Ridge Bflope ❑Valley ❑Flat
(check appropriate box)
Latittvde/lpngitu e of well location
36' /5- 2,L4i &S2°2z'41
(degrees/minutes/seconds)
Latitude/longitude source:BGPS❑Topographic map
(check box)
DEPTH pRILLINO LOG
From To Formation Description
2'C
va— �C
y`G - b u^
V -qL
is - ifrS
Wall Thickness
Diameter or Weight/Ft. Material
Ft. G7 27.0 /'✓
Ft. L s t . Z. Pc'C C-
FI.
Material Method
Ft. S rtk-ate /✓t; y W76; ✓l t
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size
Material
CR d tv/r-tr_
5N.-Staid,er
6"7247,7 t,_
LOCATION SKETCH o
Show direction and distance in miles frtST1?at Icast
two State Roads or County Roads. I cl the Toad
numbers and common road names.
19-
J
0
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
£ONSTitU£TI©Al-ST-ANDARD AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUL ZING THE WELL DATE
M i
I
Submit the orl'I to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No [phone], within 30 days. GW-1 REV. 07/2001
L
•
CI;
RCE

276118
. WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- - Division of Water Quaint, - Groundwater Section r7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) <S)Z Vd1-.1-� / JM 11 h CERTIFICATION
WELL CONTRACTOR COMPANY NAME C, m4,f f3 RIDe r 115 Pun rr)P rn PHONE a fIZP)(r`f t= /'/
STATE WELL CONSTRUCTION PERMITN 11-sa
(if applicable) (if applicable)
ASSOCIATED WQ PERMITS
WELL USE (Check Applicable Box): Residential 0 MunicipaUPublic E Industrial ❑ Agricultural E
,Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION;
Nearest Town. __,-Sotl+.�cto..
vrAown l
County kie-rx\efX?-s
,Seca Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER.
t001 t , C lASJP
\ddress clicArnx.
(Street or Route No.)
(A73
City or Town State Zip Code
'14) -S`J°j
Arca code- Phone number
4 DATE DRILLED "3 - y - rJ 3
5 TOTAL DEPTH: tf L
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO ET'
STATIC WATER LEVEL Below Top of Casing: ZC FT.
(Use "✓' it Above Top or Casing)
S. TOP OF CASING IS / FT. Above Land Surface'
•Top of cning terminated at/or below land surface require a
variance In accordance with ISA NCAC 2C.0118.
9 YIELD (gpm): } METHOD OF TEST '4, R
t0 WATER ZONES (depth): 9#
'. I DISINFECTION. Type /1 %f/ Amount
12. CASING:
Depth
From To Can
From Go To /
Frorn To
. 3 GROUT Depth
From L To -� C
From
':4 SCREEN:
From To
From To
5 SAND/GRAVEL PACK
Depth
From To
From To
Wall Thickness
Diameter or \Veight/Ft. Material
Ft C 27 L /9••
Ft. L $ 21.Z f
Ft.
Material Method
Ft. S r{)=trr M,ikssl- t;l
To Ft.
Depth Diameter Slot Size Material
Ft. in. in
Ft in in.
RY:MARKS
Ft.
Ft.
Size Material
Topographic/Land setting
❑Ridge ape ❑Valley ❑Fla'
check appropriate boa.
Latitude -longitude of well location
324, 42.S3c) ) c.:
(de greelmi nutes/secondsj
Lati tude/longttuce source.[3GPS❑Topogra?h:c ma_
(check box)
DEPTH DRILLING : OG
From To Formation De.cnpnc.
U gyp, !"Z�d �7�
1/6-1• /vZ' .5,w i )zt
/ric / V : S // lioe A
OCATION SKETCH
Show direction and distance in miles fo n at leas:
two State Roads or County Roads.:nc(Ce th-great.
numbers and common road names.
O
rn
Cr
L 'f-nNSTR4CT[piN
II
L_
Submit the orig nal to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, Ns_
27699-1636 Phon No. ((.19) 733-3221, within 30 days.
GROUNDIAIATER SECTION
P,SEIPAILL- ISECillpljAL OFFICE
' THAT THIS WELL WAS CONSTRULI ED IN ACCORDANCE WITH 15A NCAC ZC, WELL
"DARDS, ANI➢-JRHAT A&OPY OF THIS RECORD HAS BEEN PROVIDED TO THE `.CELL 0\'\NER
mcGU
7a/i
SIGNATURE OF PERSON CONSTRUL ING THE WELL DATE

27611e7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
,Yb i
/y.,�t S CERTIFICATION.
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lr,J fzy2t'`�� `-'�%���
WELL CONTRACTOR COMPANY NAME G, 7 1-1)Nlpr Wo l‘ S Pt,.m pHONE N
p Cn
ASSOCIATED W Q PERMIT/I
STATE WELL CONSTRUCTION PERMITH (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest Town: DF Z I A)() t [ County
I r,ulri A)4K Cc0e ect•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER: S i 61L.. 7. µc FT1 ITT --
Address 'C) T3d y g25
(Street or Route No.) .G z?7 9�
(�ENDEKSoN t (Tel E
City or Town State . Zip Code
Arc. code- Phone number
4. DATE DRILLED 3 - z ,T - 0 3
5. TOTAL DEPTH: / 1,'3
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
i!tfl0
7. STATIC WATER LEVEL Below Top of Casing: /0 ' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
"Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC IC .0118.
9. YIELD (gpm): '2 0 METHOD OF TEST /'}i 1Z
10. WATER ZONES (depth): O
11. DISINFECTION: Type /ini Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From / To ''O Ft Z 17, C
From 1/0 To Go Ft. At,6 P✓C-
From To Ft.
13. GROUT: Depth
From 0 To 2 O Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Material
Material
Pv'c�
Method
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
16. REMARKS:
Size
Material
Topographic/Land setting
[Midge ❑Slope Lalley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3i° Ali' o°N ofl° 371001A,
(degrtes/minuteiscconds)
Latitude/longitude source:36PS0Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
a— 30 !JrKt-
30 — So Gip;A Rack
6-12 -/ R C (ER Avr'i-,-
w
LOCATION SKETCH
Show direction and distance in miles fra?at least'
two State Roads or County Roads. IncluTe the'ro:d
numbers and common road names
e✓
2 So
4,
Coo , R.
I DO REV EER
n1 nCONS UCfION sir
u
Submit the orlginial to
1-77699'1636-Phooe-No. (9
IFHAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH ISA NCAC 2C, WELL
/ ) ARDS, AND THAT A CCWY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-03
I' IG � OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mali Service Ceectter' Raleigh,
NC
9) 733-3221, within 30 days.

276114
WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resources -'Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDI DUAL) NAME ip rtnt) rfizr4Ji% f gym irf k CERTIFICATION a - 0 '
WELL CONTRACTOR COMPANY NAME CIT.() -0 IN Il1Vp r \%IQ l\ S P mp (ri PHONE u (YZF) (r43-i2DC
STATE WELL CONSTRUCTION PERrJ MITli I L1O ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
i. WELL USE (Check Applicable Box): Residential B—MunicipaUPub1ic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:________________ County ,Wvir
Gl, OtRel.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER. 3 C C4 to x--
Address 0.. So lo`S
1 (Street or Route No.)
City or Town State Zip Code
(Y b)- fib— '2,19(D
Area code- Phone number
4. DATE DRILLED '7` — —O. 3
5. TOTAL DEPTH: 3Or
6 DOES WELL REPLACE EXISTFNG WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top or Casing)
8 TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated eUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118. st
9. YIELD (gpm): 9 METHOD OF TEST AIR-
10. WATER ZONES (depth): 2. L `
1 I. DISINFECTION: Type YIN
12. CASING:
Depth
From / To / t7
From /O To 3 0
From To
13. GROUT: Depth
From 0 To . P
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diameter
Ft. G
Ft. 6, ZI,Z pvt_
Ft.
Material
Ft. 61NARi ti5.
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Amount
Wall Thickness
or Weight/Ft. Material
22 Z Pa'G
Topographic/Land setting
❑Ridge ❑Slope Dey ❑Flat
(check appropriate box)
Latitude/longitude of well location
36-v13' 9RI✓062°AS'33iJ
(d e greesim i n u tes'scw n ds )
Latitude/longitude source: 0 'PS❑Topographic map
(check box)
AEPTH DRILLING LOG
From To Formation Description
0 — 2a ,o/iir
.20
LOCATION SKETCH
Show direction and distance in miles from at leasr_
two State Roads or County Roads. Include road
numbers and common road names. .�
Method
111,Y u /lizo/L
16.REMARKS.
Size Material
Material
O/d •zy s
N
V
cl
o� 'i)r
cn G 2
r_
041
BY LER'Ii rl.-
CONSiTRUCTION STD 1
T THIS WELL WAS CONSTRUL IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4/-1 —03
SIGNA l URE OF PERSON CONSTRUL I ING THE WELL DATE
Submit the original co the ivision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1_636. Phone Nr9J919) 33-3221, within 30 days. GW-1 REV. 07/2001

Diameter
From ( Ft. _ Y
From GO To 90 Ft. G fr
From To Ft.
GROUT. Depth Material
From 0 To 2 0 Ft. $it4'REtic
1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of/Water Quality - Groundwater Section
q it `7" CERTIFICATION a_J
WELL CONTRACTOR (INDIVIDUAL) NAME (prt nt) � � ie 4 � _ I�
wELL CONTRACTOR COMPANYNAME CiERN-4 4u
4.fn R�AN115 �lP (n
PHONE a..-'--
__ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMITN IeaXY-
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential C3i--MunicipaUPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: W J 1a
, Ili c,rn ?kn4-
(Street Name, Number', Community, Subdivision, Lot No.. Zip Code)
OWNER. Yani\no.+ nNand:, /Th.
Address ea9)ln Srn, ++$ a 'Dr
•
` (Street or Route No.)
-AA mrvsef U11%r 5C. r".)94Fi5
City or Town State . Zip Code
Area code- Phone number
:. DATE DRILLED , - 5' - -
TOTAL DEPTH: 3 pis
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C3�
STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS l FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires s
variance In accordance with ISA NCAC 2C .0I18.
9 YIELD (gpm): L O METHOD OF TEST Af &
I0 WATER ZONES (depth): J 9 5�
County IVnrAQXfl or+
DISINFECT ON: Type it %H Amount
CASING: Wall Thickness
or Weight/Ft. Matenai
Z7 C Pv2
Depth
To 6 0
Methoda
%N. Y5f% i
From To Ft.
14 SCREEN'. Depth Diameter Slot Size Matenal
From To Ftin. is
From To Ft. in. In.
:5 SAND/GRAVEL �
pithth y
Size Materialr.
From To Ft. �-' n
From To Ft.
Topographic/Land setting
❑Ridge R3rope ❑Valley DFlat
(check appropriate box)
Latitude longitude of well location
;'IZ. 12 t23i✓ U6'2° i L'
(degre 'minutcs'scconde)
Latitude/longitude source:BCPS❑Topographic map
(check box)
DRILL NG LOG
Formation Description
__70i/Z t
ys, 9wCi S"ra-7
W, n.klr fr
pEPTH
From To
U - `✓s7
`jD - G5-
GS 5 r
c
O
LOCATION SKETCH
Show direction and distance in miles from atleasc- . 2
two State Roads or County Roads. Include -Mt road:-.o
numbers and common road names.
0
(II
.6. REMARKS".
I D HF,e,EBY CFRTIFY THAT THIS WELL WAS CONSTRUL1ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
- � CONSTRUCTION STA(o, y-�DS, AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEE WELL OWNER
1� 9 4 Leta :i Yf yXZ �7TILU CTigjj— " �} G'_7 — -- _.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1 l l
J L
Submit the origlnallte-til Division of Water Quality, Groundwater Section, 1636 Mail Borneo Ceenttteeri Raleigh, z00'.
27699 1636 Phone Nal [phone], within 30 days.

276112
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
73i V t Sm! CERTIFICATION w y
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�/ d-k� p -'
WELL CONTRACTOR COMPANY NAME �� yl - I C
r Ip U S PV.fnO C(J PHONE
CONSTRUCTION PERDt ITX WQ PERht[TX if a plicablc)
(if a livable
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
Topographic/Land setting
❑Ridge RSlope ❑Valley ❑Fla:
(check appropnue box)
ell
Latitude/longitude o(degrees/minutes/seconds)location
3.5'` zl' 3�-N e62
/b'�/2t✓
(degrees/minutes/seconds)
Latitude/longitude source:L iPSOTopographtc map
X
r ASSOCIATED 2 3 7
STATE WELL
2 WELL LOCATION: Hy,�Z�r:,150n/
Nearest Town: 1•lt w'� �r County
0- lin„� hlJ
(Street Name, N'umben, Community, Subdivision, Lot No., Zip Code)
3 OWNER. �-
Address
Zip Code
Arcs coda Phone number
4 DATE DRILLED /it /Z " G 3
5 TOTAL DEPTH: L 12 5
b. DOES WELL REPLACE EXISTING WELL? YES EYNO ❑
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 cning terminated stor below land surface requires'
variance In accordance with ISA NCAC IC .0118.
9 YIELD (gpm): L— METHOD OF TEST /9I)2
10. WATER ZONES (depth):
11 DISINFELIION: Type %i%f
,2 CASING:
Depth
From_ To �0 F
From_j_0____ To 30 F
From To
13 GROUT. Depth
From_1L_ Tom_
From To
14. SCREEN: Dcpth
Frorn To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
6. REMARKS
lij
NC
t ..cV hq '20G'.
Submit the original So the Division °vilhint30 Quality, t}, Groundwater Section, 1636 Mail Service Center - Raleigh,
.._� 7. ..P-p ,yy (919) j73 -3221, Y
Amount
Wall Thickness
Diameter or Weight/Ft. Matcnal
CH .22P"L
t. L err Zr. L Pdc-
Ft.
Material
Ft. S'aknr tr
Ft.
Diameter Slot Size
Ft _In. in.
FL_ —in. in.
Size
Ft.
Ft.
Material
pEPTI4,,
From To
u - o
20 co'
Formation Description
'OCATICH 5 _._,
Show direction and distance in miles from-e'.-least
two State Roads or County Roads. Includethe road-1-'
numbers and common road narnes
Method
Al, y aif-POuR
Material
O
U7
tare
<ow
G '/3
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY � F THIS
IS RECORD HAS BEEN PROVIDED TO THE WELL 01.1 NER
ATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD 27611.1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%I �M lit CERTIFICATION._
WELL CONTRACTOR (INDIVIDUAL) NAME (print)� R y.�P.� N N7Y1� �O
P
WELL CONTRACTOR COMPANY NAME C-1 rs t tl alup r \M ze 11 ASSOCIATED WQ ERMIT% PHONE39�1
STATE WELL CONSTRUCTION PERMIT% (if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential E ' 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: ia�PNbOfslLUt County 4srdErSor.
�•,
rrao
(Street Name, Numbcn, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C)ra.Aes
Address
(Street or oute No.) \i19 eai
� N.Y.Nc.
City or Town State . Zip Code
Lam- (02S —9d5Uo
Area coda- Phone number
4. DATE DRILLED LI „- ��r"9; d3
5. TOTAL DEPTH: O fY 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 7, 00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
*Top or casing terminated at/or below land surface requires a
variance In accordant, with I5A NCAC 2C .0118.
9. YIELD (gpm): l2 METHOD OF TEST
10. WATER ZONES (depth): %DO
11. DISINFECTION: Type
12. CASING:
lb tit
H7ww
Depth
From To Al O Ft.
From '9 0 To go F.
From To Ft.
13. GROUT: Depth
From 9 To 2 O Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount
Wall Thickness
Diarnctcr orWeight/Ft. Material
6
J^ a2t.G P/G
Topographie/Land setting
❑Ridge ❑Slope ❑Va11ey effect
(check appropriate box)
Latitude/lpngitude of well location
33 DZf SZK/ 4V2 t7'2aeti
(degrees/minutes/seconds)
Latitude/longitude source:E G S❑Topographic map
(chock box)
DEPTH DRILLING LOG
From To Fotion Description
a - Sv
ro— 'io
7o - G64
LOCATION SKETCH co;,.
Show direction and distance in miles frQltl at leasi
two State Roads or County Roads. Inclddu� thes64d
numbers and common road names. F-. `'
_Material Method
bA4R611R= %t1 7`PoLr2,
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
I DOREBY CERTIFY THAT THIS
P
'CONSTRUCTIOIITS'%A.NDAR�S• AND
' L. i yi 1
Submit the origlail to the Division of Water Quallty, Groundwater Section, 1636 Mali Service Ceenµteer' RRHVgh 2001
h, NC
27699-1636 Phgne No [phone], within 30 days.
Slot Size Material
in.
in.
Material
L WAS CONSTRUL.IED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COP % OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y-z9 03
DATE
SIGNATURE
OF PERSON CONSTRUCTING THE WELL

276110
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources ��-rrDivision of Water Quality Groundwater
Section
Aft J/�li CN
\vELL CONT RA CTOR (INDIVIDUAL) NAME (Print) ��/Zy CERTIFICATION
°
_y�I � II � PLArr D c _ J l
WELL CONTRACTOR CO�MIPANY NAME CI rQPn R --— (�(f} ,/�f.! -
ASSOCIATED WQ PERMITa
STATE WELL CONSTRUCTION PERhtITa if applicable)
(if applicable)
WELL USE (Check Applicable Box)'. Residential C( Municipal/Public ❑ Industrial ❑ Agnc'-Itural r--
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
TopogTaphic.T_ac:d semng
WE LOCATION tY l{ Valle.d'
(/a J d ((F Coun '•' ❑Ridge ❑Slope ❑
V Ca CC)t TO�q^ �f..—C.- Ichec'k appropnetc boz
�`
_ >; iztatude.9ongln:de of w II !ocPtio
lt
$�. < Name, Num�n. Corn rnumtY, Subdl�i lion. Lot Na.. D Code ) 3 i i3 z ./ O p ` - E53.
cg .T. csnut sa
son'u
(�,., Lat mdc".oast oe sou:cc °SC.s a
S rcei or Route o
CitypEPTu TJ RIL ttif'
jifallORSDitiediti. ,,VC '2i739 T Forma
Desc n;ticr.
ZipcPm3 5 al i Y"
or Town sate ode 0 — _
0 —
Arcs codo- Phone number n V
—
0 - rG__ 5,_ /i f/7cv�C
-1 iOt'EDRILLED 5 —.S 1 c7. 3 g0 L05. .�f"�'' F`�
TOTAL DEPTH. / �5 —
i :DOES WELL REPLACE EXISTING WELL? YES ❑ NO
---
STiATIC WATER LEVEL Below Top of RasCasing:
Top oZf g O FT.
ve
)
s FOP OF CASING IS / ET. Above Land Surfacc'
•Top of cuing terminated .Vor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
c YIELD (gpm)- ( METHOD OF TEST r R.
a WATER ZONES (depth', 2 L5
i4 ri Am
ount Show direction and distance in roller inn
:71SINFECd-10,1 Type— - ss two State Roads or Counn Roads :nS.
:\S!1G Wail ei hU 1.
- � to tametcr or AVei$ht/FI. Material numbers and comrnnn road na .,� C
tii Trp_LC, F 2.Ze Pic w.
60 To /C F1 ! ,:LAX__
�� �'
rot:: --To
Matcria; Method
Font Depth , r9—Povi
Froii,�_ �io�._i2 R. SA-k'Ra l� M
From To Ft
SCREEN. Depth Diameter Slot Size Material
From_ _
To Ft in. In
'ro:r.
io Ft m In
_ ' .\ti D-GR,\ E!. P.AC..'C. ytatma'.
Dcpth Slzc
From To Ft.
From To Ft. ------
RE \'. ARK S
r tr:prnr t TEAT THIS WELL WAS NUU
STRED IN ACCORDANCE. WITH SIfH <, NcA2C. E: ..
•' ^'r Y OF TRf RECORD HAS BEEN IRO\ DE.D TO - StiTI 1'E
IGti ATURE OF PERSON CONSTRUCTING THE V.
Submit the on Ut the Division ofter Quality, Groundwater Section. 1636 }t a�i Seale
_^699-1 tiJ6 rho[ c No 1919"33-3221,days.
IOIN
rI OE
r - Raleigh. 'r

Jd, Submit the oriel.
27699-1636 Phorie No.
000 t r ` - , T ION
ASHEVILLE
�F
276.i08
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION • S
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME C—tro-e n
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
Bnyssit sm;tb
Rt�er \IJe 11 5 PLArr1P (n
PHONE a r9741 0%,
ASSOCIATED WQ PERMIT
(if applicable)
WELL USE (Check Applicable Box): Residential le Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION' ,,
Nearest Town: ‘\ertper sonV s \le_ County tAt_tuatr-Nnn
"Thtdt e %load.
(Street Name, NumWrs, Community. Subdivision, Lot No.. Zip Code)
3 OWNER: 11 onsn. f-iill h.t%
Address in°1 [..z rn.,ac• Ilis LA
(Strecl or Route No.)
)A Ile- l-Jc a4rlg2
City or Town State Zip Code
S)- o'"!a— 51aa
Ares code- Phone number
4 DATE DRILLED 5 0 - 03
5. TOTAL DEPTH: /4
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E'
7 STATIC WATER LEVEL Below Top of Casing: 2. 0 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated odor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9 YIELD(gpm): 30 METHOD OFTEST fila.
10- WATER ZONES (depth):
Topagraphic/Land setting
❑Ridge OSellope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longltyde of well location
35°2/e23N Os ttzw
(degrees'ni nut&acconds)
Latitudeilongitude source:DOPSIITopographic map
(check box)
DEPTH PRIL1,ING LOG
Formation Description
From To
C9 -- 10
/ o — 10
Yv -60
LO %0
11. DISINFECTION: Type H7W
Depth Diameter
12. CASING:
Amount
Wall Thickness
or Weight/Ft. Material
From j To f L Ft. L 27 L Pate —
From 5'4 To 44 Ft. 4 jb L P✓L
From To Ft.
13. GROUT: Depth Material
From D
To 2 O Ft. $ HMVtshe
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:
RY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONBTRU'CT'IDNISARDS, AND THAT A COPY - THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2/-03
f"1
� I 1 SIGNA OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Senice Ceen„er, Raleigh, N07/2001
C919) 733-3221, within 30 days.
Method
1t y
Slot Size
in.
in.
Material
Material
LOCATION SKETCH CD
Show direction and distance in miles ft-of-PA lea":
two State Roads or County Roads. Includc'the road-
numbers and common roar i
names.
C
a
i
RId9E Pei

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of WaterQua.t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3L. --
WELL CONTRACTOR COMPANY NAME C-Irf.0 n R.1114 r ANY II S Pt7
STATE WELL CONSTRUCTION PERM ITN
(if apolicablcl
WELL USE (Check Applicable Box): Residential MunicipaUPublic D Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
27610;'
Groundwater Section,
CERTIFICATION --1
PHONE #
OCIATED WQ PERMIT a '-4%-7
(If applicab1el
WELL LOCATION -
Nearest Town: ZS County
Ogratnon
3. L J^ .
Strvc: 4arne, Numbers, Community. Subdivision, Lot No-, Zip Code)
7 OWNER. .5n.a f 1 cAudaliCirn-
Address P.c. 1m63'70
(Sheet or Route No.)
•
City or Town State
b'v 351�
Ary cwo- Phone number
4 DATE DRILLED i -2,7 - r" 3
TOTAL DEPTH: G O7
a7R 1190
Zip Code
Topographic,T and setting
BCge 0Slope ❑Valley
check approbra:e box.
Latitude longitude ofwelllocatr_r.
3 3fJ.2,3N 4,6/- "fly
tdegrecs mtnutes/accondsj
Latitudelongitude source 0GPS❑Topogrephlc -:
.chock box)
pEFTF( pK[t t rN :
From To Formation Descnc':".
zo
iR✓' - ce:- J
(A 7..,t,_ . 113
DOES WELL REPLACE EXISTING WELL? YES 0 NO -------
STATIC WATER LEVEL Below lTTo +o fCasin : 7`t--' FT- -
p ae Top of Casing;
n_)2 OF CASING IS / FT. Above Land Surface'
iop of cuing terminated aUor below land surface requires a
v arlan cc In accordance with 15A NCAC 2C.0118. - --.
YIELD (pm): hii METHOD OF TEST 4r1z. —
:,. A4'ATER ZONES (depth): 2 J %n - .w
tin 5-5)- kOCATION SKETCH
1 \SIN.0, /7 jiy Amount Show direction. and distance in miles from at leas:
).SNG. ION . Type Wall Thickness two State Road or Counts Roads Inelu 'tie =-a
.
LT,am<ter or W'ei7,hvTt. Material numbers and common rozs n'afne 1 � --
Depth EF
Fr,Ini_ / To ), . Ft. / ti 22, C /'N�Z-
u 25' To 7.5' Ft. G st 2/.L /'✓C-
of _ To Ft.
'IL'T Depth
Material Method
p eZ
:ram:- C� To ) Cr/ FL Dr4�<Li'� !"lr,A� c"t -'"\
F;�❑, To Ft
I4 SCREEN: Depth Diameter Slot Size Maternal
Front
To Ftin. in:.
Front To Ftin. in.
SAND'GR.AVEL PACK. Material
Size
To Ft.
:Um To_ Ft.
REMARKS.
CJ
Submit the orig nal t
27699-1636 Phon No.
ITT
ci Hirt
/f Ivy 2 9
THAT THIS WELL WAS CONSTRUCTED IN ACCORD A`iC` V1' T H :5A' C CI C, AV"
lL
ARDS, AND THAT A PY OS RECORD HAS BEEN PROVIDED TOTHEL As AVT CN6r
/Z 4Cc fra / ____5 2�j_...
✓ SIGNATURE OF PERSON CONSTRUCTING THE WELi-
E ATE
the Division of Water Quality, Groundwater Section, 1636 Mail Senlce Center - Raleigh. NC
19) 733-3221, within 30 days.
0
Sib; t
(c_

276106
WELL CONSTRUCTION RECORD
:.:alma - Depanmert of Environment and Natural Resources - Divls,on of V. ate E - -
r 5rn, fL_1
ttl..l. �_�i�THnC rOR (I?Dlq'IDLALI'�nD1E �rioQ �'"] J%<�w
o
. t r ILe.CI Oft COM? AN S NAME C7 t-)tP Riv4 v1'���•c
s.1E tt F: LL CONSTRUCTION PER'IITa _ ASSOCIATED WQ PEk,atr: a ft —
±lot _-
IC 8DJ'. r:ab:'
SE Check Applicabic Box, Residential Ce?'. !.A nicipa'_TUb - _.-
g El iSecoccn E Heat Pump Vs,'a.er Injection ❑ Other rl '. Ot-ti.e: .-.
-OCATIOti r
ca:cs. \T�u1t"�, 1\e.S% nO I Ik County
c: e:ac. Nu:nS<n, Co ',mu.airs. Subd:c^sia1, Lol No., Zip Code)
l\c\% C 30rcs
Sac v Rnble So
FI'v•bl\e Ns.— tc`l39 P Ft-
ft
S.a:: L:, Cc e 1 r n
n.
704)8 Li / c. i zZ t
b93 15 --
1� �' ��,1�tL, y p2,r
I, I .D__, -z 5 ('3_ lie "14s L'•gyr-,..,b'5
E f /' 5-- —
.:> AA 1 PS? ..A C r_ XISf NG WELLS YES r. So IC
TER _5\Fl_ 3e'.ot. Top of Casing. `74C2 _FT
Lsc .' if ASovc Tun of Cuma:
CAS NC-.,. [S / Above Land Surface
al ca1'.ay tut:Si a:HI ...or below land surface rcqulre• c
ca n accordance .a(h ISA SCAC 2H.0118.
..,an.-) gpn /,Z METHOD OF TEST /1,/ L
iL ZONES i dcplhl /DO
Ippo `2,pn C. is sett
:es,0.o.ndS
ATi(' S?;ETCL
Sho. d ect s _ e
Trl'_ A ' yPc—�� Amount
Iwo State R�r...._
Wa!: �hielcness CJ
Nliiier.s,I ti/c .
kt_C2. .. -L4? 21_ct_. _V
I If
LiI J'
1 _.... "he or In'
-o'r,-, s is Prue So
ti18:ma1 Mctnuc Cr1,`)�i L,iEGjN sr
D.a:neter S.o: S1zc Ntateea.
rIttd
f frtz - .<1k - -
THIS SVEL, WAS CONSTRUCTED tN ACCORDANCE .t -
ARDS, .AS'D THAT A COV1jO'y�F THIS
ICI RECORD'.AS BESS 5 Zy
,
_JAE CS
s.
lcat,e
u tha Division of Water Quality, Groundt.eler Section, ivo .l a.. cn•
919 "33J:'I, "[thin 30 days.
A b5 Li -' fE ,TION
Or:?CE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin() Jerelhy H. Bowman - CERTIFICATION N2809
WELL CONTRACTOR COMPANY NAME n Rnwrnan We1 1 Dr111 inrge Tnr• PHONE # 137R 752-7779
STATE WELL CONSTRUCTION PERMITS
(if applicable)
276508
ASSOCIATED WQ PERMITS
Of applicable)
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 LOCATION:
Nearest Town: Frandersnnvi 1 1 bounty Henderson
Crntnty View Subd. Lot #18
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Everett A. Bennett
Address 1206 Charlotte Hwy.
(Street or Route No.)
F'a1 rVi rw NC
City or Town State
( )"
Area code Phone number 6/09/03
4, DATE DRILLED
5. TOTAL DEPTH 1 00
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fa
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface"
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 50 METHOD OF TEST ::rotary air
10. WATER ZONES (depth): 1 00'
28730
Zip Code
11. DISINFECTION: Type tablet
12. CASING:
Depth
From (1 To 65
From To
From To
13. GROUT: Depth
From 0 To 20 Ft,
14.
Diameter
Ft.b1 /8 Sri" 80
Ft,
Ft.
Material
concrete
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 6
Wall Thickness
or Weight/Ft. Material
PVC
Topographic/Land setting
❑Ridge 0Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
' (degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Method
gravity flow
Slot Size Material
in
in,
From To Ft.
From To Ft.
16. REMARKS:
_ L O-HEREBT`..CERIITIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIQN SI ANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0 9 /b
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
I li � ...27699-i636?Pone NodOW-1 REV.07/2001 [phone], within 30 days.
Submit the originad,to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2010
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard D. McCrary
2'76206
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Well and Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Lot #4 - Pottery Terrace
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Eugene Oehler
Address 129 Leibestraum Drive
(Street or Route No.)
Horse Shoe NC
28742
City or Town State Zip Code
( 828 )_ 891-1731
Area code- Phone number
4. DATE DRILLED 06/16/03
5. TOTAL DEPTH: 365'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ['Slope ❑Valley fa Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type By pump installer
12. CASING:
Depth
From 0 To 68
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
To
Diameter
Ft. 61/8
Ft.
Ft.
Material
Ft. Concrete
Amount
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Ft.
Diameter
Ft. in.
Ft. in.
Size
From Ft.
From To Ft.
Slot Size
in.
in.
Method
Poured
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.
ti.Acvx .lJR/id-0/1ur3l a s
woad eiaitt a teat e.NRu fr.e rys,
tad. o.1A a- _. Ja e_
A Ata n )
O 4 agekta-r-t- 4Jd i'! /lO z,si.c.
Material Ad le ,lid IL ..t.c Phase_/l
(2 j-a t taen- d Z/d i,��ta.t-.e-
Material
16. REMARKS:
IDO HEREBY CERTIFt. T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ID S, AND THAT A COPY DOFF THIS RECORD HAS BEEN PROVIDED TO TH/E/ WELL OWNER
it SIGNATURE OF PERSON CONSTRUCTING r WELL DATE
Submit the original's the Ellivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
.,27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

276208
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalResources - Division of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME2(print) Knennethth7l (Crary I ,/J CERTIFICATION # CW0
WELL CONTRACTOR COMPANY NAME B rk'tt l.0h Sf•/Rii. ter /We '-4np PHONE #F2 Lb49-7263
STATE WELL CONSTRUCTION PERMIT# 12 1 1 ASSOCIATED WQ PERMIT#
(if a..licable) (if a licable)
1. WELL USE (Check Applicable Box): Residential tS'Municipal./Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N: II
Nearest Town: elirier_SonV(IJe' County Her7C/PYSoi
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Alat IrPn1I r4I'ni
Address ' n Pmx 45
(Street or Route No.)
laRork
k tar.227. /
City or Town State Zip Code
(2ark94- D 5(a 3
Area code- Phone number
4. DATE DRILLED 6-6 -Q3
5. TOTAL DEPTH: 120 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Gi'
7. STATIC WATER LEVEL Below Top of Casing: 0 F'f.
? (Use "+" if Above Top of Casing)
S. TOP OF CASING IS I- FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (epm)• - METHOD OF TESTMS___
10. WATER ZONES (depth):
By pump Instedsvr
1 L DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dia% eter or Weieht/Ft. Material
-
From 0 'l o ' 5 Ft. R
'sDrzzl Pic
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. 0.Onanci-e Poi, reo(
From To Ft.
Topogr hic/Land setting
DRidge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes!seconds)
Latirudc!loneitude source:❑GPSQTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
in.
From To Ft. in.
15. SAND/GRAVEL PACK
From
From
LOCATION SKETCHShow direction and distance in miles frotrat least,_
two State Roads or County Roads. Incluahthe road
numbers and common road names. r
Tamt..1,1ekL.der-5onviUe Fate Kcu�t�(1/L%a-
Qooct -fro Crab Creek Zoo4 . 10.Le
0. left on .3tatan --oad -f--P
seems grid dri u e j l ,
(opposite of sK NIA4(Ley Pri-) tx.f
J IVe . Go I>°ft Iv -Fort
barn and- kome uP
Depth Size Material �,�,
To Ft. kr) �,o(,t11
se �L.G•
To Ft.
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVID TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WE DATE
Submit the origina to h Division of Water Quality, Groundwater Section, 1636 Dlail Service Center - Raleigh, NC
Un(:L$IitA7.-l1;bc44twu pH . (919
A HEVILLE i- •L. OFFICE
( 733-3221, within 30 days. GW-I REV. 07i2001

276203
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
y��
WELL CONTRACTOR (INDIVIDUAL) NAME (print) X('nne th ,t/fe erary CERTIFICATION #M.VL/
WELL CONTRACTOR COMPANY NAMEj (2rKer We nnol Pump PHONE # pP)6854.r4/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tW Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ID Other ❑ If Other, List Use
2. WELL LOCATION: I
N arest Tow i County EPgdeysnr n
hndo4 kaid o F 621. tear Moat Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER,
Address
R
(Street or Route Nov
/JpndercntviIle NC 2A79Z
City or Town St to Zip Code
(8 i)- 068/
Area code- Phone number
4. DATE DRILLED (O-cl4-03
5. TOTAL DEPTH: 0730'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO to
7. STATIC WATER LEVEL Below Top of Casing: a0' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1.53 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): 15 METHOD OF TEST Timed
med
to. WATER. ZONES (depth):
3y Pump installer
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (i To a 9 Ft._____ cf>me 2 1 PVC -
From To Ft.
From To _ Ft.
13. GROUT: Depth�1 ,,Material
From �_ To r��t,(l/�t Ft. U1)1CMK.
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
Method
enured
Material
From To Ft.
From To Ft.
16.REMARIS:
Topographic/Land setting
Rif idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
U
c
C
r—
Q
LOCATION SKETCH L.-- i
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From Mendersomil)e -take 64 East.
Turn ;eft on Fri-utlarid kvad• Go to
3 watt inMi Its Gap - (.3-0 5tra.i�ht or)
Ctear Cree.t-Rct rro about 3 miles.
Take tz left on Rhodes -goad. Go
+D end of pavement and Continue
ico vo ain . dross Ouer efeeK
then of Kill +a Property On r31'tt.
1 DO HEREBY CEKT1EYIHAt 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
144 c_G /V5)03
SIGNATURE OF PERSON CONSTRUCTING TH VELL DATE
_.
Submit the original to the D`arision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
27699-1636J'trimc No..[phone], within 30 days.

WELL CONSTRUCTION RECORD
276204
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard D. McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Well and Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIF#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
North Clear Creek Road
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Roy W. Glaspy
Address 2905 N. Clear Creek Road
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( 828 )_ 685-2154
Area code- Phone number
4. DATE DRILLED 06/18/03
5. TOTAL DEPTH: 165'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO kJ
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use '4" if Above Top of Casing)
S. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 51 Ft, 61/8 SDR21 PVc
From To Ft.
From To Ft.
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
13. GROUT: Depth Material Method
From 0 To 20 Ft. Concrete Poured
L
r—
rn _-
nri;C
m.
numbers and common road names. o 2
cunt jlmcltt_Lon."•IZPW atCS d / eaet
-to 3itttti�ganaQQ�^R, ood• Ola1a a
JA./..t U-�a/,,((%Lt 4aL LUt�-t.;Q-,,(,/RA.t ,,(n _ .4'O
a/c_ Jktipttf oln ln_ p£1 j#. ,NA Jr Sind-
Ft.
14. SCREEN: Depth Diameter Slot Size Material . CEL A- CW-A-. r`'oa(- east Cd2l.tX1-
From To Ft. in. in. Lit
r ,
From To Ft. in. in. ea_ fif-
15
From To
SAND/GRAVEL PACK
Depth
To
To
From
From
Ft.
Ft.
Size Material
LOCATION SKETCH . .
Show direction and distance in miles from at least
two State Roads or County Roads. Include the wad
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
--CONSTRUCTINN TANt ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL OWNER
SIGNATURE OF PERSON CONSTRUCTING T LL DATE
Submit the original fb the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636.Phone No. (919) 73t3-3221, within 30 days. GW- I REV. 07/2001

276202
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL 8 PUMP PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
BLYTHEWOOD DRIVE
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DOTTIE PARKER
Address 115 BLYTHEWOOD DRIVE
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )_ 697-3934
Area code- Phone number
4. DATE DRILLED 06/27/2003
5. TOTAL DEPTH: 330'
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST TIMED
10. WATER ZONES (depth):
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 113 Ft. 6%
Amount
Wall Thickness
or Weight/Ft. Material
.185 STEEL
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley K1Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LQ6, ---
•
From To Formation DescriErwin °
Ln
r—
m
Method
POURED
Slot Size Material
in.
in.
Material
0
.r-
G
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
„hoot ,1/.2nCLe t.a or.� • :W 442.e. ',ui .
&P Eat* i-o ,ilowia Ld ,dap toad . (�,uvx
Q d p 10 nay ea , c9tivtn&
b� il,D cc�> e�eu�l/v
-to - U r �`Gi
16. REMARKS:
I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONSTANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS
DATE
M c C G 1-Z 1/43?
—' SIGNATURE OF PERSON CONSTRUCTING THLr WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

278353
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na 1 Resources - Division of Water Quality - Groundwater Sectionl/7
WELL CONTRACTOR (INDIVIDUAL) NAM (print)'Q,/L CERTIFICATION i��%S7/ �j
WELL CONTRACTOR COMPANY NAM I,UGL/ ' - , fPHONE / 62 1 r. - D�O d
STATE WELL CONSTRUCTION PERMIT# ivIn ASSOCIATED Wt! rERM1T# # // 7/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Jt" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection❑ Other 0 If Other, List Use
Nearest Town:: County
❑Ri
2. WELL LOCA/ ,Il Topographic/Land setting
dge ❑Slope ❑Valley ',Flat
I,u e2 S 79 (check appropriate box)
(Street Name, N
�um
jbers, Community, Subdivision,
Lot No., rap Code) Latitude/longitude of well location
3. OWNER:///rG ./--0-tip"(degreWmimnes/seconds)
Address /374, in 0(/ entie,P ene Latitude/longitude source:❑GPS❑Topographic map
adie (sweet or Route No.) (check box)
Ne • 1899z DEPTHFRILLING LOG
City or Town State Zip Code From To Formation Description
&fp- %910—Y94/
Area code- Phone number
4. DATE DRILLED 3/� 9/0 3
5. TOTAL DEPTH: .2 /5S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jls1
7. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS S FT. Above Land Surfaces
'Top of easing terminated at/or below land surface requires a
variance in accordan with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST LGrni
10. WATER ZONES (depth): /9/7 t
11. DISINFECTION: Typeoa Amount 9 I Z- Show direction and distance in
12. CASING: Wall Thickness two State Roads or County Ro
Do ta�n Ft to ter or � , Pi#�%fitdual numbers and common road
From 0 T
From To Ft.
From To Ft.
13. GROUT: Too n�M4ate_rial L lvlythod •
From To � 7� Ft t/"��[ e.�>/ '.`]"�!
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From To Ft in. in.
15. S /GRAVEL PACK:
Size Material
c
O
rn
c _
From o Ft.
Fro To Ft.
16. REMARKS:
O -cr:
T
r'1
m
US Tr-
0
c-�
O1 0
es from at least
lnclude the road
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 WEI 1 OWNER
•
a9/0 3
SIGNATURE OF PERSON CCiNrS U,f�17Nd THE VJEL¢ — ATE
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
-G❑ Cr.PIIfN
'enter - Raleigh, NC
GW-1 REV. 07/2001

278352
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM
}�i(, (mint) ppp 4L - CERTIFICATION tr2S%%
WELL CONTRACTOR COMPANY NAMECL 42.4 �f/.Q.Y.�� r -ernp C PHO; E� (�iil 4 D S(�D
STATE WELL CONSTRUCTION PERMITS N �/ _ASSOCIATED WQ PLR�Mr1Yf i 7
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential$. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO �p �%
Nearest Town: .s-Let�Ldpruldf.County_E derefi efe.
mite 4Ali c -27797
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JYit i..le j4/le yPi Address 19 r, �.ep 2fleinA121 t'.
(Street or Route No.)
1�e44 •• i2.a 4CC. ,2 74"Z -
5: 790 - 4475,1 T� Cade
City Slate
Area code- Phone number
4. DATE DRILLED 3%2 S1D 3
5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X
7. STATIC WATER. LEVEL Below Top of Casing: th FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 S FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance la aceordaaytwith 15A NCAC 2C .0118.
9. YIELD (gpm): -L 0 METHOD OF TEST te..�o
10. WATER. ZONES (depth): / 09 // S t
11. DISINFECTION: Type? Amount
12. CASING: V Wall Thi
Depth Diameter or Weigh
Front/2_To %d Ft. Ljr #r.�1/
From To Ft J
From To Ft.
13. GROUT: Depth Material
From To tit) Ft Canze�4'
From To Ft.
14. SCREEN: Depth Diameter Slot Size
Fro o Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth
From____To Ft.
Fromo Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitudellongitude of well location
(degrem/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
A
Or --Show direction and di
ckness two State Roads or Co
Material numbers and common
Method ,
Material
in.
in.
Size Material
-Z
3 �c
e in miles frm at lgt} '
ty Roads. Inclye thtr-tji 1 /
ad names. Q1 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON
Submit the original to the Division of Water Quality, Gr ' 11 2ter Section, 1636 Mail Seri"
27699-1636 Phone No. [phone], within 30 days.
g/63
ATE
enter - Raleigh, NC
GW-1 REV. 07/2001
HO'S
# g93
GROU,NE',NATER SECTION

WELL CONSTRUCTION RECORD
North C urolina - Department of Environment and Natural RcaO ces • Division • W r Qua
wkl_L COY!'RAC! OR (ISDM1!DUAL) NAME (print)
\SEtI.CON ;RACTOR COMP ANT NAME • a
ASSOCIATED wQ PERMIT
SDYfE tcF Ls. CONSTRUCTION PERMIT'S- Iif applicable)
of appiicable)
U. USE IChcck Applicable Box): Residential
lion it Pat iblr 0 1f Industrial Use Agncultural O
nilonng 0 Recovery 0 Heat Pump ]
277978
Cc
PHONE a �ti a
L
Groundwater Selina
N•.
2. WELL LOCATION:
Nearest Town
Street Name. N
3 OWNER:
A ddressp i�
L eeJl a itsg " 7. 1 D
-'"' , ea, R �7 �\..rr Zip Code
c ny or To State P
C _ Count ■ ' Ciekt401k.
Community. Sabdiv
un, Lot No Zip Cadet
-A to
4rea :rde- Phone Dumber - _O
i DATE DRILLED_ 5. TOTAL DEPTH•S
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO �"
7. STA. rIC WATER LEVEL Below Top o(Casing:�ofr_t__
(One'
8 TOP OF CASING IS � FT. Above Land Surface•
• fop ur easing terminated atror bete* lend surface requires •
cringe In aecordence r tb ISA NCAC SC .01 in.
9 YIELD( prrO:TV ZMETHOD OFTT .a-. �
Topographic/Land seising
=Ridge @Slope =Valley =Flat
,cheek appropriate best
Latitude/longitude of well location
toagrec✓in mnlc 1Heconda t
Lauu,de%longitude source:COPS0Topoeraphfc n:an
u n¢L boa,H D pEPTRu t wC LOG
From To Formation Descnptlon
g t�
TER ZONES (depth): _Z-S+' ) ZS---
I I. DISINFECTION. TypeAmount
12 C.ASING. Wall Thickness
Depth h �� �� Diameter or Weight/Ft. Material
From . 1oJlS. =Ft
From To Ft -----
From_._. To
3 GROUT: Depth
FromTo
From __._ To
14 SCREEN: Depth
From_—_—.- To Et
To___, Ft in
From -
IS SAND'GRAVEL. PACK.
D.•9th Silt
From_ To__. Ft.From .�
Es
16 REMARKS. _—_--_—
i DO HEREBY C ERTIF
CONS i RUC)'ION
Ft.
Maternal'k;e Ft �'
Ft.
Diameter
Method
Slot Stet Masenal
inin.
Maand
p ATION_SKU_CR
Show direction and distance in mites (ruin tit least
two State Roads or Count) Rods. Include the road
numbers and common r ad na,Qtes.
tam (O W1
Cs)
:J
r)
c1
N
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
DATE
SIGNATURE UF PERSON CONSTRUCTING THE WELL
C
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mall Service Center-1
Raeigh, N 0O1
276994616 Phone No. [phone]. within 30 dal
V,'1 j L.
j^3
IL Y.o L,
"'�R SECTION

WELL CONSTRUCTION RECORD
2'77998
North Carolina -Department of Environment and Natural Reso ces - Division o Wet r Qua t Groundwater Setts
i
]�� t� 1 �t� CERTIFICATION 07 I$fl7
WELL CO\'{'RAC"I'OR(INDIYIpL'A L) NAME (Drint)IerO■ /����•�' 1
WELL CO]1'R:V C'TOR COMPANY NAVE i tie 1� ib+i.�1tI1•Drictii� PHONE /I IY s1t �� Lass L
ASSOCIATED WQ PERMIT
STATE wEL {, faplicabtC9'ION PERMITM (if applicable)
tii applicable)
I. WELL USE tChcck Applicable Box): Residential Iii MunicipaltPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towt • Countv`xfloi4OK.
Suer Name. Numbers. Coromun ity. Subdivision. Lox No.. Zip Code)
3. OWNess U\L1IJ�1,,� N,�tllY�w.
Add�ss 7 � tS tSrtrct w Roust;No.)
tPEP1`CCOh(ti )SI From
City or Tot, n I State Zip Code
Topogra Ic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate bax)
Latitude/longitude of well location
Latitude"!
(degrees/nmuteslsecunds)
ongitude source:OGPSOTopograpitic map
(check box)
DRILLING LOG
Formation Description
TN
To
Vea cede- Phone 'winner Q
'1
4. DATE DRILLED_I - 3
5. TOTAL DEPTH:_ (AZS t6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: _
(Use'v" if Above Top or Casing)
8. TOP OF CASING IS ` FT. Above Land Surface'
*Top of (using terminated atIor below land surface requires a
variance In accard�af ce with ISA NCAC 2C .0118.
9. YIELD (gpm): 1Ld3%�' METHOD OF TESiCOi.1 a `•h�
10. WATER ZONES Idepth): _A/Q,�Iaaj
11. DISINFECTION. Type '«
Q To CO 2_ Ft.
12. CASING:
Depth
From
From To__ Ft..
From _ To Ft.
13. GROUT: Depth
From To Ft.
From __ To___ Ft. ____
11. SCREEN'" Depth Diameter Slot Size .Material
Ft in. in.
From. ___.'Co_ -
c To Ft in. in.
From__
15. SAND/GRAV'EL PACK: Material
Depth Size
_ Ft. From To — Front_ _ To Ft.
Diameter
Amount. tr --
Wall Thickness
or Weight/Ft. Material
Ltitk 2-5
CAb
_ h,tnteda I f Method
/.7R:��1� uY
1OCATION 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
rV
01
0
N
I REM IRKS: ___
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRL1 'DARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C.r� _,17 -am I C
SIGNAT CHOF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division or Water Quality, Groundwater Section, 1636 Mail Se
27699.1636 Phone No. [phone]. within 30 days.
cf�eitier al h fl
_ `#� 0702003
r) 7
GROUNOIVhJER SECTION
Ar" FVILLF Prn'nNAl_ OFFIrE

WELL CONSTRUCTION RECORD 2 7 7 9 9 7
North Catoline - Department of Environment ands Natural]�Rcsoufces - Division o(Watir Qua 't - Groundwater SecUPLaa
UAL NAME (dnt).s A I ALIT /Wf a1
ilkWELL CONIRAC1OR(INDI%tP ) �,/� p y/� 46
\\'ELL. CON'I'R.\C I -OR COMIPANY NAME A i V.`a %Sv+kd1a
ASSOCIATED WQ P
S'r:A'rF \4'.1. CONSI'RhCT10N PERMITS
CERTIFICATION alai.
PHONE xgtt11. Id PERMIT
L if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ga' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WEI-L. LOCATION:
Nearest To n: 4 I k
County
1StmJ Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_I euDh
Addiess
(Street or Row:No,)
5�lu�d )4
Ca/ or Tc' n State Zip Code
1 _/-
Area code- Phone number
4, DATE DRILLED �' la: 3
5. TOTAL DEPTH: 410
6. DOES WELL REPLACE EXISTING WELL? YES [J NO U'
7. STATIC WATER LEVEL Below Top of Casing: t�.�
(Use "s" 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 .0119,
irsit9. YIELD (gpm): 17 METHOD OF TES
10. WATER ZONES (depth): IC f)
11. DISINFECTION: Type -iib it%- Amount Z
12. CASING: Wall Thickness
Diameter Material
Depth D' or Weight/Ft.
From 0 To Ito Ft.
From To Ft.
From To FL -----
13. GROUT: Depth Material -(— Method
From__ To Ft. /6`:.Zt )QU (
From To_ Ft.
14. SCR EEN:` Depth Diameter Slat Size Material
From,__-_--- To _ Ft. _ in. in.
From _To Ft. in. in.
15. S.AND/GRAVEL PACK' Material
Depth Size
ilia -
Topographic/Land setting
2idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
istast
(degrees/inmates/seconds)
Latitude/longitude source:0GPS0Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Ft om._To Et.
From To Ft.
L,QCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. Cp c-
a
- Z�y
ed•
N
Gieev,vtk1e to
l�is.coLe.4
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT ION DARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_�efnL �t — DATE
• V
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 days,
G OLNESN'k;?EB SECTION
ASH:I : F Ri3EIO7JAL OFFICE

y l f
itii� tilt WI I,• 'ti PHONE a � iLtr eta
'.NIT
2 WELL LOCATION_ f: I ,, , 1 `
NeareM Town:J- JQC c f'�'� ` County ilk-e � `CL
Ld Q�'R
YL)ti Il kV \v\ \
—
i Snivel Name. Numbers, Community, Su 'vision. Luc Na.. Zip Colic)
3. OWNER:
Address rTh
lSuect or Ro No.
City or Toon score
Area code- Phone mmnber�
4 DATE DRILLED - i -(3 3
5 TOTAL DEPTH. �C S
6. DOES WELL REPLACE EXISTING WELL? YES �❑1 NO Q'
7. STATIC WATER LEVEL Below Top of Casing: (10 FT.
(Use "*" if Above Top of Casing)
3. TOP OF CASING IS 1 FT. Above Land Surface'
•'Fop of casing terminated atfor below land surface requires a y,
variance Ing accordance with IS METHOD OF TEST! a C.V11 "
q. YIELD (gpm): _ ��
10. WATER ZONES {depth): _ LS 0
Zip Code
277990
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resoices Division
}jo•{Wn` a rQuuaYa�M11(ry - Groundwater er SeSectionylt CERTIFICATION II
ELL CONTRACTOR (INDIVIDUAL) (prInOLISYilt
V. ELI. CONTR:\CTOR COMPANY NAME
sr tFE w VIA,CONSTRICTION P ERMITN ASSOCIATED WQ PER
(if applicable) (if applicable)
I WELL USE (Check Applicable Box): Residential Ad Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topogrp�pPhie/Land setting
:Ridge QSlope :Valley :Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrecs/mimnes/seconds)
Latitude/longitude source:OGPSOTopograpttic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
I i. DISINFECTION. Type b 1L4 Amount Z Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
12. CASING: numbers and common road names.
Depth Diameter or Weight/Ft. Material .
')Y Ft. �1O Q`i�j �`� r`v
From 0 To 1C
From To Ft.
From To Ft. ---- I `-‘ Y' R'
i3. GROUT: Depth Material Method CZ
-_ ToA ---- Ft.s ��Y —At( t ll - C��
From _ "ro Ft. --
14 SCREEN Death Diameter Slot Size Material
From To. _ Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK: Malarial
Size
From__ --To _ Ft.
From To Ft.
v
O
N
CO :ft
c.
I6. REMARKS. __
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
C'ONSTRUCZ)ON ST DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROV!DED TO THE WELL OWNER
ill�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Ser
27699-1636 Phone No. [phone], within 30 days.
Ira SECTION
OFFME

277205
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Nemeth McCrary CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME Barker Construction, IncJBarker Well & Pump
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El 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: Hendersonville
Pinnacle View, Lot #18
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bobby Morgan
Address PO Box 1031
(Street or Route No.)
Horse Shoe NC
28742
City or Town State Zip Code
( 828 )- 692-1925
Area code- Phone number
4. DATE DRILLED July 29, 2003
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID
7. STATIC WATER LEVEL Below Top of Casing: 30' ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diarneter or Weight/Ft. Material
From 0 To 89 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20
Material
Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Poured �7
Material „mum . cZ V
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ®Slope OValley ❑Flat
(checc appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
W
0 rn
W
LOCATION SKETCH ry o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
, j
-pQ K OCLCL y
,EJa add a ttWz Qatitte-)
at
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 THEWELLOWNER
- / 3 1 )
SIGNATURE OF PERSON CONSAtICTING TH@@ WELL D TE
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
dwater Section, 1636 Mail Se ice Center - Raleigh, NC
GW-1 REV. 07/2001
GROUND'.
FR SECTION

277201
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME
Barker Construction, Inc./Barker Well & Pump PHONE # f 828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: Hendersonville
Summit Landing, Lot #25
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Rosemary Miller
Address 205 Rhodes Road
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( 828 )_ 885-7262
Area code- Phone number
4. DATE DRILLED July 23, 2003
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 181
7. STATIC WATER LEVEL Below Top of Casing: 30' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
61/8 SDR21 PVC
3-uc.t. at bmxtorx
GuwL o to a gat a-
f O)c 2Z5 r a -Re_ "a- nt'
SCREEN: Depth Diameter Slot Size Material Clan') Q eat"—
. - QQa4 > 0 Q�
From To Ft. in. in WAAXr
From To FL in. in. J(,c. l " !tit ad 'Ci-/4 .
15. SAND/GRAVEL PACK: -
Depth Size Material Ate , _ AL 4-25
From To Ft. ll-1 Q'
From To Ft. r
Depth
From 0 To 36 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14.
Topographic/Land setting
®Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Q
w
7
— n
0
LOCATION SKETCH r'')
Show direction and distance in miles from at east
two State Roads or County Roads. Include the road
numbers and common road names.
J*ij! 4Cuic(pt ontrift A a ELSZ5
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS, AND, T A COPY OF T ORD HAS EEN PROV 1D TO THE LL O'
R�c�,
SIGNATU7zi (cif:
RE OF PERSOI'
Submit the original to the Division of Water Quallty, broi ndwater Section,1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. --- - - GW-1 REV. 07/2001
L
GROUNSIATER SECTION
AS-AAr_dJ/i ':.rICE

WELL CONSTRUCTION RECORD 2772 0 0
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Well & Pump
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMTT#
(ff 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: Hendersonville
County Henderson
North Milis River Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Fredrick Turner
Address 1727 North Milis River Road
(Street or Route No.)
Horse Shoe NC
28742
City or Town Slate
( 828 )_ 891-8750
Area code- Phone number
4. DATE DRILLED July 24, 2003
5. TOTAL DEPTH: 385'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FL
From 0 To 62 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
Material
PVC
Topographic/Land setting
❑Ridge ElSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
)
a
ca
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.
�}WfIL jzJpaidzL4oru,if_l.a_talc- J .
2-20 /191.iLt 4Lrrf P ggioth .'';tG�s-a-
Method o-..to its-1 7 n j� k'CG<F'<' jp '
"Jo ) 213 Yam an'.Qd_,tt.unc. tit
a Ells-e/` 7Ttc._Leg lani7CD1-
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.
N
'wad OIL vitt Q_GLcht Of lb Lattlit,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS j CORD HAS BE r '
4
r
t
TH 15A NCAC 2C, WELL
OVIDED TO T •� E WEI<-L ONE
LJ o
SIG URE OF PERSON CONSTRU
Submit the original to the Division of Water Qu
27699-1636 Phone No. [phone], within 30 da
�I.
G THE WELL
DATE
1Gj'auni4waSer Section, 106;11a�P1 ervice Center - Raleigh, NC
GW-1 REV. 07/2001
11
`DV.!.'H SE'CI DN
G
nsuFViLLE hEGiCi2a'_ Ur HOE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER WELL AND PUMP
277196
Groundwater Section
CERTIFICATION # 2008
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
TWIN BROOKS - LOTS 39 8 40
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CONNIE RUBLE
Address 126 GARLAND ROAD
(Sheet or Route No.)
FLETCHER NC 28732
City or Town State Zip Code
( 828 )- 776-1777
Area code- Phone number
4. DATE DRILLED 07-10-2003
5. TOTAL DEPTH: 755'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 350 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
[Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter
From 0 To 86 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth
To 20 Ft.
Material
CONCRETE
W
G7 c
UI
LOCATION SKETCH
Show direction and distance in miles from a1Reast :, "'
two State Roads or County Roads. Include Nroad=
or Weight/Ft. Material numbers and common road names. tut:
SDR21 PVC �itOgL ,f�(,¢ Q,GGO/LCCc.-C.e,C. ta.Lt.
c 15 WoA tft . jai_ Q ,tt�% itt o -
d 'iGoad wick
7 U tact . (JGi CL- n—
o eats -. ffw-ie.424_01_ , 02A- c-
D k `5iz t,i n¢a`dC
. a A.b_ G-tide- ,Loa4 . J,tf r" aR-
k3t t -eat �t t./
c�, -vw (73 w dLa.ta
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
POURED
Slot Size
in.
in.
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
'/►►I03
SIGNATURE OF PERSON CONSTRUCTING Tilt WELL DATE
Submit the original to the Division of Water Quality, proviadwatOrnSefition0636 Mail *ridI Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. ,--- ---------�', GW-1 REV. 07/2001
I
"L 9
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION yi/ip.7 y
PHONE #4astLW- °ma
W3-3
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMITS
(if applicable)
(print
pf
ASSOCIATED WQ PERhIIT#
(if applicable)
274133
I. WELL USE (Check Applicable Box): Residential IR 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 To D OO untycz<
nii�
(Street ame,Numbers,Community. y, Subdivision Lot No., TA Code)
3. OWNERT V7 '
Address
(Street or Rome No.)
City or Town
Area code- Phone comber
4. DATE DRILLED y/3/d 3
State
Zip Code
5. TOTAL DEPTH: e2 a.T
6. DOES WELL REPLACE EXISTING WELL, YES 0 NO M
7. STATIC WATER LEVEL Below Top of Casing. Y— . FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance wnb 1SA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OFTESTTCsrto
10. WATER ZONES (depth): %D r /10/
11. DISINFECTION: Type Amount az'
12. CASING: Wall Thickness
Depth/ or Weight/Ft Material
From_12_ To tos Ft60,2j file
From To Ft.
From_ To Ft
13. GROUT: Depth Material Method •
From 0 To .2 D Ft (rtnn
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sourer❑GPS❑Topographic map
(check box)
PULLING LOG
Formation Description
PERTH
From To
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From 7 To Ft.
16. REMARKS:
IDO.HEREBY CERTIFY
r
.--CONSTRUCTION.
Show direction and
two State Roads
numbers and co
4
W
CI
stance in miles from at least
County Roads. Include the road
on road names.
es
t>o
y/3Ti0 3
SIGNATURE OF •' •^ • N CONSPRUCFING THE WELL DA
Submittheoriginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.'[phone], within 30 days. GW-1 REV. 07/2001
O.w•
,shisy
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY O�1 RECORD HAS BEEN PROVIDED TO THE WFT t OWNER
l/

WELL CONSTRUCTION RECORD
279729
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME
Barker Construction, Inc/Barker Well 8 Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 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: Hendersonville
Willow Knolls, Lot #4
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Richard Nu
Address 21 Deer Run
(Street or Route No.)
Hendersonville NC 28739
City or Town State Zip Code
( 828 )_ 697-7149
Area code- Phone number
4. DATE DRILLED September 24, 2003
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ElSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(click box)
DEPTH DRILING LOG
From To Formation' Descripti
rJ
r_ I
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 31 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in stiles from at least
two State Roads or County Roads. Include the road
numbers,{and common road names.
d7/tci2 ///?Ay�i�P2 tail._ 6y'C(f.
Jab. a. on. er..Lmac c wi&
',toad and-o Qnd. - it .it)
bit" axJJicb2Dn .
'/z Maw ta-1 - au_.
Is/
blio LJta) Xn. iW • 48
o -i c:m
1 0,
CIa
Do
ri
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RE 1 RD HAS BEEN PROVIDED TO THE L r WWI*
IGNATURE OF PERSON CONST
TING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RaVgh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc/Barker Well 8. Pump pmmNE # [phone]
STATE WELL CONSTRUCTION PERMITS 1872 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town: Hendersonville
County Henderson
Oleta Road
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dennis D. Jones
Address 224 Gull Avenue
(Street or Route No.)
East Flat Rock NC
28726
City or Town State Zip Code
( 828 )_ 697-7589
Area code- Phone number
4. DATE DRILLED September 25, 2003
5. TOTAL DEPTH: 245
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OF TEST Timed
10. WATER ZONES (depth):
279727
Topographic/Land setting
❑Ridge 0Slope ❑Valley Erie
(check appropriate box)
Latitude/longitude of well location
(degrees/mvnutes/soconds)
Latitude/longitude source:OGPSOTopographir +nap
(check box) t— — '1
DEPTH DRILLING LOG r---
From To Formation Descripiion -- —
I _
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From 0 To 61 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Concrete 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:
Inn
0
irtri
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 can xtuZW ka.11t
J01/1 d ea [ o)(� Mcid. JUAN- -
6� a nee road . ILOLi'. 2
C &ad . o 3hato4
ht a, (lam
h.t
) klGz1
uAYf_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RFCORD HAS EEN PROVIDED TO THE
C
2
76
SIGNpIJRE OF PERSON CONSTRUCTING THI}YE'CL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
- G
z
R

279721
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME Barker Construction, IncJBarker Weil & Pump
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential in Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Freeman Creek Road
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: RaY & AMC Sharpe
Address 506 Moss Creek Drive
(Street or Route No.)
Cayce SC 29033
City or Town State Zip Code
( 803 )_ 794-8513
Area code- Phone number
4. DATE DRILLED Septemer 9, 2003
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES O NO 131
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2% METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
ORidge ❑Slope ®Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG -
From To Formation Description
In
11. DISINFECTION: Type BY pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 31 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
LOCATION SKETCH
Show direction and distance in miles from at two State State Roads or County Roads. Include the road
Material numbers and common road names." "' �/
PVC d-/L,flfl -o_mcctian r c..c.t?L 2 k�[.R-
IV
hJ
Method
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:
9pQ - ..
Jai_ a-/ at at_ au/at
Vexed, Atua-Ale ele:Lne-
iieejKRlC Cal. —2 . lutfri�
4.ee.infl&
c'
0<
m
4
mCD
yr. A
n
--1
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS 1 .E1(PROVIDED TO THE yfELL O'
GNATIIRE OF PERSON CONS
TING THE WELL /DATE
G)
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR COMPANY NAME
Barker Construction, Inc/Barker Well & Pump PHONE # [phone]
STATE WIT CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
279720
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public O Industrial O Agricultural O
Monitoring O Recovery O Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Kanuga Forest - Lot #23
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Michael Witt
Address 54 JP Huggins Drive Foxwood Subdivision
(Street or Route No.)
Hendersonville NC 28791-8511
City or Town State Zip Code
( 828 )_ 674-8131
Area code- Phone number
4. DATE DRILLED September 11, 2003
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST Timed
10. WATER ZONES (depth):
County Henderson
Topographic/Land setting
®Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14. SCREEN- Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATIONSKETCH 7- 2:
n
Show direction and distance in miles from at least � -- l
two State Roads or County Roads. Include road_
numbers and common road names.
SDR21 PVC nJ xJ/ tale- &
Method t �TChad- 6/4W FJ-rl 2 ��, O411117 1� 2 •
Poured ette - 'eC.(.GR . R t /I tip t
Material Cv�A. Jelaa ,& r.(.L.tUrn-
16. REMARKS:
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AC 2
CONSTRUCTION STANK S, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED O THEDAT
SIGbiATURE OF PERSON
STRUCTING THE WELL
WELL
/EISLOWNER
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REVgh 2001
27699-1636 Phone No. [phone], within 30 days.
c-'
_rn
=tom
rnco
20m
rn
ma
Cr

279719
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 0 2010a C McCrary WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard828 697-7263
WELL CONTRACTOR COMPANY NAME Barker Construction, Inc./Barker Well 8 Pump PHONE # )
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I . WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Evening Shade Lane
(Street Name, Numbers, Commtmity, Subdivision, Lot No., Zip Code)
3. OWNER: Robin Adriance
Address PO Box 1213
County Henderson
(Street or Route No.)
Hendersonville NC 28793
City or Town State Zip Code
( 828 )- 698-0819
Area code- Phone number
4. DATE DRILLED September 5, 2003
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 180-200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer
Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 7O Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Concrete 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:
Topographic/Land setting
®Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude Source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
IT
LOCATION SKETCH LS—
Show direction and distance in miles from atm least
two State Roads or County Roads. Include the road
numbers and common road names.
Mwrk 1.a,zd w.new- ee
64 E d a atJ
goad wind .40 tit Mid
4act gve.
4IC uvrt aZItGd2x-k`'el „�'."_
e et
� o
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS REC"
O
SIGNATURE OF PERSO,
G' cL.e-& goad
CCORDANCE WITH 15A NCAC 2C, WEL
HAS BEEN PROVIDED TO THE 6R
Cl J`
ONSTRUCTING THE WELL /DAT
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — REV.-1 Rh, C
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kennett McCrary CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME
Barker Construction, Inc./Barker Well & Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERM1T#
(if applicable)
(if applicable)
279718
1. WELL USE (Check Applicable Box): Residential ElMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Newman Estates, Lot #5
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: W.L. Barnwell
Address 2606 !Canoga Road
(Street or Route No.)
Hendersonville NC
28739
City or Town State Zip Code
( 828 )_ 693-4671
Area code- Phone number
4. DATE DRILLED September 5, 2003
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Timed
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation -amp
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft.
From 0 To 74 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Concrete
From To Ft.
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
Material
PVC
0
0
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Inclu
numbers and common road names.
SDR21
,^1 ,,ff //
�T/(A/x � V-Qjtd L WK "« a
a /oazi ; t c2xaG-
97Q -6-x.)
dcit ck;cd
Vada then
Diameter
Slot Size
in. in.
in. is
Size
From To Ft.
From To Ft.
16. REMARKS:
Material
Material
4
-o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
i.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)neam, 1 l 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0
7d
ill: en
cc?
U-u
J.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwaterror Section
N #ion
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Kennett McCrary
WELL CONTRACTOR COMPANY NAME
Batter Constmction, 'nu/Barker Weil Si Pump PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
2. WELL LOCATION:
Nearest Town: Hendersonville
Byers Cove, Lot #1
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®Flat
(cbedc appropriate box)
Latitude/longitude of well location
County Henderson
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: Gary King
Address 1120 N. Ridge Road
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( 828 )- 685-7118
Area code- Phone number
4. DATE DRILLED September 3, 2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 30' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1'/a METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 207 Ft. 6% 165 steel TA IcE A ktGNT oN GiLLtAµ MOUNTI"/r"
D. Go ISO YARDS TD piLOr AkoU rritim
(E
P
From To Ft. r'�a
14. SCREEN: Depth Diameter Slot Size Material (.f) T q I on) THE CORJJE� as
c�
From To Ft. in. in. ---1
C
From To FL in. in. W =r't -
I5. SAND/GRAVEL PACK: m o
Depth Size Material �m
From To Ft. - (-9 rt �cr>=
From To Ft. - r'
i O
(deguees/minutes/secoodc)
Latitude/longitude sotrce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation
N
0
O
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Concrete Poured
279717
i Lan.
LOCATION SKETCH Jrn r I
Show direction and distance in miles frog at least '-- - — - -
two State Roads or County Roads. Inclucie-thrrnutY"-"
numbers and common road names.
FROM HENDERSON'JIUF TAKE 64EA-S"✓
'Rpf}D On) THE RIGHT. GO 1 MILE.
,f LEFT ON 6YERs COVE LOAD .
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 E OWNER
I tt Y'ifenrev? � 10
3
SIGNATURE OF PERSON CONSTRUCTING IE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentteerl R leigh, C
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Richard McCrary CERTIFICATION # 2010
WELL CONTRACTOR (INDIVIDUAL) NAME (punt) 828 697-7263
WELL cONTRACTOR COMPANY NAME Barker Construction, leeiBarker Well & Pump PRONE # (828)
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
2. WELL LOCATION:
Nearest Town: Hendersonville
Mielke Family Subdivision - Lot #3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Meadow Tarves
Address Rt. 2, Box 170 E
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( 828 )_ 685-7002
Area code- Phone number
4. DATE DRILLED September 2, 2003
5. TOTAL DEPTH: 145'
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 40' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance hi accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST Timed
10. WATER ZONES (depth):
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
®Ridge ['Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
County Henderson
279716
(degrees/minutes/seconds) --- '��
Latitude/longitude source:OGPSI•JTo,ographic riD
(check box)
D...�
DEPTH DRIL �T G
rn
From To Foratio ptto�
11. DISINFECTION: Type By Pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 33 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To
Slot Size
Ft. in. in.
Material
PVC
Method
Poured s G Road , Co A�`c•
Ter �r
Material 7
3 nei les +he -bp of ric t .
1ereav or_sled aero4,a i(;A
horse. a,vnt ovt.tha ief-
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.
�rom »i endersonUi lie -Lalle
Tale a lea nvn Fruitland Igraa.,
Go -bp end . -raga A lair 9m
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To FL
From To Ft.
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
OF THIS RECORD HAS BEEN PROVIDED TO THE WNER
'' 6 el 33
SI AiATURE OF PE PERSON CONSTRUCTING LL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenterl REV eigh, NC 1
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalnResources - Division of Water Quality - Groundwater Section J�`
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (1.4 t , 3.U.$4- l C CERTIFICATION # ei ei
WELL CONTRACTOR COMPANY NAME troc4( c£ try ELL D rit(t 1'C1 PHONE # (er)a) 724'_ 4'' Sub
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential [17MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /'_ II
Nearest Town: flelcyvi County (V�'M56yi46
52/ Aka:A/1 G✓ty> 2.E
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4 N$j �UtS n
Address SL I r4 G LA.I Ara 6- 'sty,f c.c4
(Street or Route No.)
)A_1 e
City or Town late Zip Code
€C..?
Area code- Phone number
4. DATE DRILLED 9-7 4/ —C.) J
5. TOTAL DEPTH: 7 '2- c
6. DOES WELL REPLACE EXISTING WELL? YES GYRO 0
7. STATIC WATER LEVEL Below Top of Casing: Po 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
9. YIELD (gpm): 15 METHOD OF TEST /4 /2
10. WATER ZONES (depth): .7 C-fe, iv, N 700
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat'
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) .
Latitude/longitude source:❑GPS❑Topogra Mc map r-`:_n_
(check box) b,.
DEPTH D I LI -- _---_
From To Formation Description
etc- /00 Sy( /neat
loO- zlr 0 ,CAW. 74-z_
I I. DISINFECTION: Typee 4. /,... /'C Amount$?02 C'73 i
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Material
From U To .7/ FL qe PUS
From 5 / To 1'3 Ft. lv t` . /0Q, Al ncif
From To Ft.
Depth
To FL
FL ly12tl
14. SCREEN: Depttr Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
I3. GROUT:
From
From 0 To
Method
/'iJ41 /'DII
From
From
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
Material
280166
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and coinmon road names.
µ IK4
—1
0
CFI
IS WE L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND TH•TACOPY OFTHIS RE!jayIHA '••+itr%ROVIDEDTOTHE WELL OWNER
SI UR
OF PERSON
NST
NG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CERTIFICATION H 2O10
WELL CONTRACTOR COMPANY NAME
Barker Construction, Inc/Barker Well & Pump PRONE a (828) 69T-7263
STATE WELL CONSTRUCTION PERMITS 1871 ASSOCIATED WQ PERMIT/ (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Mills Gap Road - E. Evans Avenue
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Fred R. & Suzanne C. Dorsey
Address PO Box 429
(Street or Route No.)
Edneyville NC 28727
City or Town State Zip Code
( 828 )_ 685-3226
Area code- Phone number
4. DATE DRILLED September 28, 2003
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST Timed
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0
County Henderson
To 20 Ft. Concrete
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16, REMARKS:
Ft.
By pump installer Amount
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/8 SDR21 PVC
280320
Topographic/Land setting
❑Ridge ❑Slope ❑Valley KIFjat,�',
(check appropriate box)
Latitude/longitude of well locatiohr
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopogttiphicnlap.
(check box)
DEPTH DRILLING LOG
From To Formation Description
W
O
c-
--4
w
O
rl
nz
LOCATION SKETCH W <c,
Show direction and distance in miles from athast —i
two State Roads or County Roads. Include tifProa
numbers and common road names.
Jtont_ 4anckvw l aC- f 6k7tt
/O d zukt. w7 t cL l oOJ/. c .URAZ AL -et
Method ix- t7 Dpa clat )&Oad , ,(,G(/ 30O 4aadi
Poured `' / L ^ ,,,��1,
O0./ - � Q. YX_}�- a- 6.OchunwiC»
. !!// ,u a,t d D act M<
Slot Size Material
in.
in.
Size Material
Ft.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F HIS RECORD HAS BEEN PROVIDED TO THE WEL OWNER
S 'NATURE OF PERSON CONSTRU G THE WELL D E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl SV Raleigh,hNC
27699-1636 Phone No. [phone], within 30 days.

279515
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources - Division of Water Quality - Groundwater Section
h
WELL CONTRACTOR (INDIVIDUAL) NAM (print) C �.,/,g CERTIFICATION #e /
WELL CONTRACTOR COMPANY NAME. .//Ai JA- v. i -, P �i-,i PRONE - vat Gril.ofka
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WZRMTT# 717
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial CI Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. ATIO
Neare Town: mic41
yc-
(Street Name, Numbers, Conunuoity, Subdivision, Lot No., Zip Code)
3. OWNER(
Address /�i Z
// (Street or RouE'No.)
// rr n ct oro y C.
f'/Zc¢1f at .
,?899t—
(fr} City �/n % &— �p .� % / Zip Code
Sta
Area code- Phone number
4. DATE DRILLED G/l©yo
5. TOTAL DEPTH: s D.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO SI
7. STATIC WATER LEVEL Below Top of Casing: /f Fr.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ./S FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance witb 1SA NCAC 2C .0118.
9. YIELD (gpm): /Q METs tt OF EST T.I.Js/i
10. WATER ZONES (depth): i
3
11. DISINFECTION: Type
12. CASING: V
From
0
Amount eL
Wall Thickness
Depth Diameter orWeight/Ft Material
To �� FC __j pdc
From To Ft.
From To Ft.
13. GROUT: Depth, Material
Frort�_ ToFt. Cnma�+''
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: y
Depth Size Material
From
From
16. REMARKS:
Ft.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope J$Valley ❑Flat
(check appropriate box)
Latitude/longitude of well Iocatibn
(degrees/tam/seconds)
Latitude/longitude source:❑GPS❑Topographie-map
(check box)
pRH.LIT4G LOG
Formation Description
PEPTH
From To
LOCATION SKETCH
Show direction and distance in Dilles from at leato
two State Roads or County Roads. Incluc)he
numbers and common road names.
--cc".Ll,/
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.48
SIGNATURE ON CONSTRUCTING THE WELL
DATEDATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environrlent and Natural Resources - Division of Water Quality - Groundwater Section 16
WELL CONTRACTOR (INDIVIDUAL) NAME (print) °tee It $ Y\Q4tt2ta.2 .QC CERTIFICATION#__._
WELL CONTRACTOR COMPANY NAME_ .X., it%R '1 ZS Jon tiler\ - etamt Coe PHONE # (o fo5 f�o2Z
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT/4 " son(if applictblc)
(if applicable)
L WELL USE (Check Applicable Box) Residential IS Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat 1 ump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge I/Slope ❑Valley ❑Flat
(check appropriate box)
L atitude/longitude of well location
2. WELL LOCATION: ?lend¢cSe
Nearest Town: HeC''Q`5hC . _County
Bartle. C.<eew (200-4
(Street Name. Numbers. Community, Subdivisvn, Lot No.. Zip Code)
3. OWNER: to\ x.� T�ca.t\
Address 90 (3c'n 10 `'ito
(Street or Route No.) ag�y �.
14JC'Se51hct .11C
City or Town State Zip Code
(g2sy. tc9l- 72"? Area code- Phone number t$
4. DATE DRILLED
5. TOTAL DEPTH: aU 5 .
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
111
7. STATIC WATER LEVEL -Below Toy Cbov
(Do FT.
(Use' F"
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 .2118. q
9. YIELD (gpm): l 7—METHODOF TEST R; 8•
10. WATER ZONES (depth):
11. DISINFECTION: Type 4a Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
To Ft.
From t \
From
From
13. GROUT:
From 0
From
14. SCREEN:
From
From To
15. SAND/GRAVEL PACK
Depth
From To
FromTo
To
Depth
To 20
To
Depth
To
Ft.
Mat rial
Ft. CQ4, fi .
Ft. _
Diameter
Ft. Tl
Ft. a.
Size
Ft.
Ft._
Slot Size
in.
in.
Material
Material
?\45 t=C
279289
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic mrp
(check box)
DEP":H DRILLING LOG
From To Formation Description
y\ ro Z05
Method
Po ?a
Material
ove.' CiecdDn
Gcon: a e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers rnd common road names.
0
CO
cD
A
cnz
ca
rn2
ti
cn G
16. REMARKS:
i'
I DO HEREBY CERTIFY THAT THIS WELI WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER..I
Nue�+
SIGNATUI E OF trWKSON CONSTRUCTING THE WfiLL DATE
•
Submit the original to the Division of water Quality, Groundwater Section, 1636 Mail Service Ceenter' REV gal Odl- _
27699-1636 Phone No. [phone], with n 30 days.

279504
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirormtent and/N�torah/Resources - Division of Water Quality - Groundwater Section Ir
WELL CONTRACTOR (INDIVIDUAL) NAM (print) // pr ' n CERTIFICATION 119239 /
WELL CONTRACTOR COMPANY NAME I % � (Al a IJGL PH�O7NE'l y 's 9J aria
ASSOCIATED WQ PERMIT# # /, /y
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
2//4Y
(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
witylbS
.7p79a
(StreetKlame, Numbers, Amity, Subdivision, Lot No, Zip Code)
•
3. OWNER:
Address #:`'. 44.-41 /ZL e-4.)
f% � 4,/,Cr tva479�
City or Town State Zip Code
L^)
Area coda Phone number /
4. DATE DRILLED f ►24 / D 3
5. TOTAL DEPTH: 7.2 J'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ,22
7. STATIC WATER LEVEL Below Top of Casing:
(Use if Abovt Top of Casing)
8. TOP OF CASING 1S I S FT. Above Land Surface'
'Top of easing terminated at/or below land surface requirn a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 9 / METHOD OF TEST / 4na'
10. WATER ZONES (depth): 3 0 i
11. DISINFECTION: Type
12. CASING:
Diameter
From 0 To Depth,.3 O FL
From To Ft.
From To Ft.
13. GROUT: Depth
From /7 Tor 2?t Ft.
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. ID.
Fro To Ft in. in.
15. SAND/GRAVEL PACK: r
Depth Size Material
/To
To
Amount . S
Wall Thickness
or Weight/FL Material
iC
ethod
Topographic/Land setting
❑Ridge ❑S1ope ❑Valley *Flat
(check appropriate box)
Latitude/longitude of well location
(degreemimaes/sewads)
Latitude/longitude source:❑GPS❑Topographic map
(chat box)
pRILLING LOG
Formation Description
rial
CP.r�ttt
FromFt.
From Ft.
16. REMARKS:
s-o-frtyo.
DEPTH
From To
LOCATION SKETCH
Show direction and distance in mi from at least
two State Roads or County Ro • . Incthe road
numbers and common road
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 WFI 1 OWNFK'
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
n
r
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 0"
c0
cn
001 •

279493
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
(if applicable)
(print) %% N V/ C JL J L CERTIFICATION 4697
WPHONEI (KMLy9 »V82
ASSOCIATED WQ PERMIT# ' / G a
/
(if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest Tplyn;
(Street Name, Numbers,
3. OWNER:
Address
County /
lA . Tt79�
unity, Subdidd�o, Lot No., rip Code)
.tZC. ,2P797
City or rows State tip Code
(K ,zva-6VV9
Area code- Phone number
4. DATE DRILLED V..20aA�0 3
5. TOTAL DEPTH: 5.ZJ
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ..
7. STATIC WATER LEVEL Below Top of Casing: s i" FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface'
'Top of casing terminated atfor below land surface requires a
variance in accordance th 15A NCAC 2C .0118. •
9. YIELD (gpm): y METHOD OF ,ST�.LrncJ
10. WATER. ZONES (depth): / (D
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth
or Weight/Ft. Material
From 0 To O Ft. #.1/ Odr
From To Ft.
From To Ft.
13.
GROUT: Depth �MMaaterial
From Tom Ft. (s>te.-r�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft in. in.
Fro To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
Fro Ft.
Ft.
From / To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 00Slope OValley OFlat,
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) !
Latitude/longitude source:OGPS❑Topogtap
(cheek box)
DEPTH DRILLA:6 LOG_
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles fro
two State Roads or County Roads. Includ
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cnz i ed./ k'�..2O/D —3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279434 _
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section��s
CERTIFICATION Srf U 77
WELL CONTRACTOR (INDIVIDUAL) NAM (taint) Ste PHONE p (� •'�9 o�i8d
WELL. CONTRACTOR COMPANY NAME Gt:.l
STATE WELL CONSTRUCTION PERMIT: /1 / H' ASSOCIATED WQ mbar* 7(-5-
(if applicable) (f applicable)
I. WELL USE (Check Applicable Box): Residential- Municipal/Public 0 Industrial Cl Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
Town:2. WELL LOCATIO
. �yf �fd�/.Co t)
-.3 ; o257792—
(Street Nome, N
3. OWNER:
Address ._. / 0�r
(Street or
Commtmiry, Subdivision, La No., zee Code)
fLat�t.J tit
„�,�(yry t> Code
akin oT�J- it SLD'L- Zip
Area code- Phone rmmber,
4. DATE DRILLED Kit/ I e 3
5. TOTAL DEPTH: ..2 D.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t�
7. STATIC WATER LEVEL Below Top of Casing: Ff.
(Uae +' if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /D OD OFTESTt ni ,
10. WATER ZONES (depth): / A5
11. DISINFECTION: Type yt
attri
12. CASING: U
Depth, O
From b To 0 Ft
Amount fJ.J at
Wall Thickness
or Weight/Ft
From_ __ To Ft.
From_ To Ft.
13. GROUT: Depth ��ii ,,,, Material
From_ To.JPFt �Ys1a.4
From To Ft.
14. SCREEN: Depth Diameter
Fro To Ft in.
Fro To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Fro o Ft.
From�To Ft.
Topographic/Land setting
❑Ridge ❑Slope IliVailey ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degreeemmutes/seconds)
Latitude/longitude source:❑GPS❑Topogfapliicmap-
(check box) -- ---
DfU LING LOG 1`=
Formation Description
Slot Size Material
in.
in.
16. REMARKS:
DEPTH
From To
tV Y',T�i
LOCATION SKETCH t7
Show direction and distance in miles fromfa9 leag
two State Roads or County Roads. Include the r5d
numbers an • common road names.
4 331
O C�
v
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
R//3jo3
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMA (print) �'.-10. rh e€ ld • LA M. p �T` CERTIFICATION�r/Ip' (3 9-� -r
WELL CONTRACTOR COMPANY NAME Cam/IS We It * (�zt m p 1 D•r1171C PHONE p JdAdl 45.3-73�^
STATE WELL CONSTRUCTION PERMITS
ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
279286
1. WELL USE (Check Applicable Box): Residential 1V1/ Municipal/Public 0 Industrial 0 Agricultural c4
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : �J
Nearest Town: r E County /lerl eY9ott*
Peace 1 e (.4) L&i-te-
(Sueet Name, Numbers, Community, Subdivisionn, Lot No., Zip Code)
3. OWNER: L l l i att 5f (A.i--0YCI
Address —7-702c 3024
r.I ( trcet or Route No.)
-CI ReyViIle /V C cl.S%29
City or Town Sure Zip Code
( Area code- Phone number D 34. DATE DRILLED 7 —��
5. TOTAL DEPTH: 40
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4c
(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 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST GL Y
10. WATER ZONES (depth): 3 %a
11. DISINFECTION: Type 6.-lt 1 D r i Yle
12. CASING:
Depth
From 0 To
From To
From To
13. GROUT' Depth Material Methpd
Amount 1 c=ap
Wall Thickness
Ft.
D2i79eter 6or DRWeight/Ft. C
LoY4 gl
Ft.
Ft.
From 0 To -20 Ft YIeat Cl nerut kc&r
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth , Size Material
From To Ft.''‘'•
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
c
O
4.1
rn
Topographic/L setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box) -:
Latitude/longitude of well location'
(degrees/minutes/seconds) ,
Latitude/longitude source:❑GPS❑Top graphic iap
(check box) j tn
DEPTH pRILLING 1.00
From }' 1T-o Formation Description
0 l✓ ri1(t 1oaw+
Lk) 4lo5 (bn4D da art Yoc
O
zm
Cn
LOCATION SKETCH mo
Show direction and distance in miles front C leash ri
two State Roads or County Roads. Includdelle ro.
numbers and common road names.
0) o
I DO HEREBY CERTIFY THAT THIS WFI T WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
it-ine d hi ql a DJ
SI fATURE OF PERSON CONSTRU IN'G!➢HE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
•

2i91;3 7
WELL CONSTRUC['ION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WEAL CONTRACTOR (IJD PWIVVAL) NAME (Flap ,?et.te FZ . /✓T Dios/ era", CERTIFICATION# Rover
WELL CONTRACTOR COMPANY NAME %29L'Jl f// Q'V.C_/ / f/1 VM PRONE a (ro fa S'ri✓I-S///o
STATE flL.t. CONSTRUCTION PERMIT# Jag ASSOCIATED WQ PFBMITM
ofapolicable) / iifaoalirahle)
1. WELL USE (Check Applicable Boa): Resudeadialbd hltmicipaVPablic ❑ Imlustrial Q
Monitoring CI Recovery O Heat Pump Water Injection O Other C If Other, List
2. WELL LOCATION:
Nearest Town:Smey //END
6' y 4/4e.a. Dr.
(Street Name, Number , Oannami4, Subdivisiao, Lot No., Zip Cade)
3. OWNER* %7,9i7/
Address i z ,z2.2n/6 /?mess set G /(/
(Street ramie Na)
HPva/Pa.v6roe,
aty ar Town state Hp Cole
(t.111-Y /97- O7O?
Ana aode-ream ntobrr
4, PATE DRILLED z o
5. TOTAL DEPTTi• /
6. DOES WELL REPLACE EXISTING WELL? YES CI NO C1
7. STATIC WATER LEVEL Below Top of Casiwg'
(User if Above Top of Casiog)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top orates armh aNd aoorbeow had sarhae ngaM a
mina h accordance with I5A NCAC 2C ,011E
9. YIELD (gpm): 172- METHOD OF TEST S4 ,2 6t,4/4"
10. WATER ZONES (depth): / o o — o a ec-f
Agricultural El
opograpbic/Ltad setting
CISlope Walley OFlat
Mrackapproprle*bw
Latitude/longitude of well location.
arc map
Mime WO
DEPTH »RILLING LOG
From To Formation Description
el 5-5 r,.Cz/z•t
ss— 66 /'r/�r.,✓7T�"
11. PISINFECBON:Iype Amoucit
12. CASING: Wall Thickness
Depth Diameter or Widen/Ft Man al
FroD�_To GC FL / %e tor'-2/ pc'C
From— To Ft.
From
13. GROUT: Depth Material
Rom 0 To ,2.0 Ft ch1F/iL%f,
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material
From_ To Ft. in. in.
From To Ft�_jn
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
To Ft.
Method
/rev/2
is
16. REMARKS:
L OCATION SKETCH
Show direction and distance in males Bona at least
two Stara Roads or County Roads. include the road
numbers and common road names.
(/1/-Z21-9,9-i5,0(
I DO HEREBY CERTIFY THAT L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARP8 &:D AT ARAS BEEN PROVIDED TO THE OWNER
OF PERSON CONSTRUCTING THE WELL
0
CAI
ten
ten
g
Submit the original to the Division of Water Quality, Groundwater Section,16.36 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
c
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WELL CONSTRUCTION RECORD 279134
North Carolina - Department of Environment and Na)ural Res9✓jces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /tY„t.4 f z r 14 e ( CERTIFICATION # ✓) 5 4
WELL CONTRACTOR COMPANY NAME Mere-1' I I weI I r-K-p PHONE # (zY) c fr 7') -q' s
STATE WELL CONSTRUCTION PERMIT# ( 2.k ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IF Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:H erson✓r�le County L/ir/V�
-- I<yIC3 creep (5 0{A. ;c e)
(Street Name, Numbers, Community, Subdivision, Lot
No., Zip Code) II
3. OWNER: ereN�J� . PoveNel ..JC Lei I V LC f er
Address 6/4 N• (9reer�wpca� ,r€51—tr
(Street or Rowe No.)
(t4C. •
City or ofn',,;S3Zip Code
(S'LY)- '
Area code- Phone number
4. DATE DRILLED ''I L-E) 3
5. TOTAL DEPTH: 114 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: -/'O0 FT.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118. 9. YIELD (gpm): 'RI METHOD OF TEST Jr0-N[. `",
10. WATER ZONES (depth):
pographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING nn
To orn-ation Desy�riptio
From
n
d5_
gs ?0 2e,/e
I L DISINFECTION: Type. 14 f (E
12. CASING:
Depth
From 0 To rS O Ft.
From To Ft.
From To Ft.
13. GROUT:
From 3
Diameter
Ca'/4
Depth Material
To I_o Ft. Lek--f
Amount
Wall Thickness
or Weight/Ft. Material
50Rz( Jvc
LOCATION SKETCH
Show direction and distance in miles from alest
two State Roads 01 County Roads. Include the road
numbers and common road names.
D
Methook
pr t e-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
y Material
O
W
rn
— a
01
O
al
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANW RIIS, AND�TjH T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SYGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
279046
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Richard McCrary CER'nFICATION R 2010
WELL CONTRACTOR COMPANY NAME
Barker Construction, Inc/Barker Well 8 Pump PHONE', [phone]
STATE WELL CONSTRUCTION PERMIT'', 1871 ASSOCIATED WQ PERMIT',
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IE0 MunicipaUPublic 0 Industrial O Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Hendersonville
Evening Shade Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Robin Adriance
Address PO Box 1213
(Street or Route No.)
Hendersonville NC 28793
City or Town State Zip Code
( 828 )_ 696-0619
Area code- Phone number
4. DATE DRILLED August 26, 2003
5. TOTAL DEPTH: 605.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ea
7. STATIC WATER LEVEL Below Top of Casing: 40' IT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 1 METHOD OF TEST Timed
10. WATER ZONES (depth):
County Henderson
11. DISINFECTION: Type By pump installer Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft. 6 VB SDR21 PVC ,/ ,p�
From To Ft. yi a 110 t2 flit a Jn,.1 ^wf-Qa'xa ,tazc -
From To Ft. and o ,io £ Cott Mile l
13. GROUT: Depth Material Method VCQg ZLD 'Led
c ica. zet 71d.
From 0 To 20 Ft. Concrete Poured �/ lXx /�y� iC.
From To Ft. tJab__
�, a J. �%e /f Q� �, Lein /Zvcm h-
14. SCREEN:romDepth Diameter Slot Size Material -/ -� a'xt' 2 9- �_
From To Ft. in. in. J/ sy a' ��
From To Ft. in. in ki nc
15. SAND/GRAVEL PACK: '
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
®Ridge 13 Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
c-^
0
Gl•
r*1 rr'
m
➢o
�
LOCATION SKETCH 3 o
Show direction and distance in miles fromaleasi o
two State Roads or County Roads. Includ Lh4�e ro
numbers and common road names.
Zs Li
JLorx alai( (,[.oitJJ?k z'aie, *F-
0477d--•
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STAND AND THAT A C§OP P oyrllls)ECORD HAS BEEN PROVIDED TO TI%9I WNER
SIGNATURE OF PERSON CONS TWYCTING THE WELL DATE
- Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NCB ui L-_t.,.,_.
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/1)01 S, l

WELL CONSTRUCTION RECORD
North Caro',ucl - i)epanmunt of Environment and Natural`alResuurces - Div
ts1:I.L(-(1AlRAt I OR(I]DIS IDEAL) N,U�IE. '(pr"int�) J��.e_LY.)r� �(.i
1t ELL CI)NI It \(-1Olt ('OMP\ \ •.\\IE I 1 "a`l "'-'-�^
SI y11 \IF:I.i CO\sIREC I IIf\ P1: R\Ilia ASSOC I-\TED\ OPERSIIT0 ____„_ _._._
280421
on o! W'aler Quality - Groundwater Section
(, -_- CERTIFICATION B_ Q3
A_V PRONE a fgib_S4_fb/- 25-
It of applicable)
i. \ALL1, ESE trih k Applicable Box): Residential Alums pal Public 0 Industrial 0 A.iricultural 0
Alma t I ii'C 1 I Recocel c ❑ Heat I'uml Water Injection 0 Oilier ❑ II Other, List Esc
]. WELL. LOG � Topographic/Land setting
NealvTown ounty
�y, '',\1��P'rORidgc lope ❑Valley OHM
Lick5_ at!. _\r{ 'Mli,p Z.47I nQ 1Z' ch .A an;r:l,.ial Lox)
Latitude to Ignude of 'ell location
-.N llcVclhi r$. Chia TaPj1 �"tiL6t:Ivi9011. Lot tin.Lip CudC1
K i I, r 14, c I z to I
v�d Illy i1
r. 'lo,s;. S Zip Code
I-
\ , ,1:- F..,.Low her
U \1L DRILL ED__.
5 TOTA1. DEPTH: ��----"-
h. DOES WELL REPLACE EXISTING WELD? YES
7 STA IlC WATER LEVEL Below Top o1 Casing. u - _FT.
ruse . irAbo'c oD..ast•tgi
S. T01' 0b CASING IS .�_ _ FT. Aborc Land Surfaces
I 1 sf casing terminated avor below laid surface requires a
er a rcc in accord:W: with i' \'\C\C 2C0118.
1) ppnll'. _ S METHOD OF TEST('; � E �CiVAeL— - -�-�- -- - -
o.)AATERZONES (dcpthl. -1.1d
(decrees 1,1,n tie, secoialci
l ti 11ida,longitl dc. 0111,.0CI1'SCJTopl ittha map
Khcck hoc
D RitttNf;-i:Q:i.._.
Formaiion Des- ripsIion
L)EP1H
ant To
.1 DISINFECTION. ECTION. Type
13. CASING:
Deed Dram:ter
From 0 To , EL
Front
LOLTAI ION SKE 1C1 ..
Amount -- Shaw dRectidE and distance in mil;. can at ,231
Wall Thickness Rt o Stare Roads or County Road_- Include the road
or V, ,U 11Ft \I ntera ntunbets and cora-non road names
Et _.
limit To Ft - -- -- --
l DLO) Mrieria atedied
EIe, i (, Fl
11 SCR Depth Dianutev Slot Size INlatcn:i
I For'L------ Il:'------ FIin' ---- in_
FIJI1) To Fl in. -- 11) — _-----'
15 SAND-GRA`-'EL PAC K:
De(u, S'oe Vlute,ial
t'Weil _--_. l t,_ FI.
(Li Ft. _-_-------
Elul;, -- ---- ------
t,J 6sc\ c
cjAN, ` 9 1 IC ``)
,r'. REMARKS.
I DO HEREBY ( Eh11F' .t HIS WEIIWAS CONSTRUCTED IN ACCORDANCE WILE( 15A CAC 2C, WELL
(t) SI 12c'CTI(N .ANDARDS. NO THAT A COPY OF THIS RECORD HAS L3EFN PROVIDED) TO THE WEL OWN
ER
- DA"f
Sr'lilt. . OE PERSON CONSTRUCTING, )HE WELT_
Submit origiial to the DIY isi(rn of Waler Quality. Ground' Ater Section, 1636 Mail Seri
2764)9-1(60 Nome Nu. [phone], within 30 days.
Center - Raleigh, NC
(1W'-I Kb". 07 2001
0
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rtittiS
N�
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O

1-c To NC Dept of Env. and Na Resour
6,i9,20c3 Time: 7.37:52 PM p-2Gs2 7
STATES
WELLCONSTRlC;if;
rth Ce I nu i-)c?- tmint of Environment, and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOIT G_AVU
P FI,1, CON FRACTOR COMPANY NAME CAROLIN A WEi.I, `>
�SI CfJ7 WIN I. CONSTRUCTION PERMIT ;I
USE ,t ..,le Bed): Residential Q Municipal
,J
RECORD 27©S�V
r -1T 0:Water Quality - Groundwater Section
CERTIFICATION # 2584
,d3S�VC. PROSE ft [phone]
ASSOCIATED WQ PERMIT #
(if applicable)
t A&iculraral ❑ - ---
an Pomp Wino: injection ❑ :'.cr '�: I .,..
'Copowapnic%Lana settlr:o
[! Ridge ❑ Slope ri
r:tnde Long tude of well location
3527236 / 82.13) _53
(de,ees:minute:- sec on.1-.
e.ioir ilude source: © GPS ❑ Topapa:pluc map
30 Cla
County H.ND RSON
Zip Code)
I2e0 _:-,AC:' 2VVOOD DR.
_.. ...HDUN U.LP,
IL
State
YES 0 SO
50
of Casing',
It i == OF TEST ARDM
120
580 Consonante..
HVPOCHLORITF Amount Ic
Wall r'dcknesf
D:r_:.e:e' or Weight t. Nnitwist
61.i" SDR21 PVC
lwtet'in
C IsOCEL M1X GILL.
c:
,_amctr Sloe 16ze aFemvo;
Sie
.lREDS, AND THA.
\VAS CONS R --.•
-.A COPY OSTHIS
LOCATION SKETCEI
traction distance in miles Hoc 1.
. iciat RottOR or County Roads. include rn,
:,' common road names.
15,nN .ALI 2C w'LLL
ndit QED TO THE 43lEI -0 -.
10'9 03
CO
O
SIGNATIT E OF PL_'.003: CO3ISTIL
8 oloni. .:._ twig .rr. vision of Water Quality, Grounthtaior Recelo,e,
- ita . 0. 0 733-3721 within 30 days.
vice center - Raleigh, NC
CD
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(1NDIVIDUAL) NAME (print) Jam Aa ut-
C=1nr, Jr
280859
CERTIFICATION k 7 1 3 P,
WELL CONTRACTOR COMPANY NAME Camp' q WP11 R Ptt.mp C.ri Tnr PHONE #$2R) 45'1-T322
STATE WELL CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOIt
Nearest own: NI f V h"
CA County li U(J'I--Y,(nA.(l'n
(Street Name, Numbers, Community, Subdi
3.OWNER: d)
Address \go
� � I(Suttt or Route No.) yv 5a2
sion, Lot No., Zip Code)
City or Town State Zip Code
x ( Area code- Phone number
4. DATE DRILLED 9 L4. <) 3
5. TOTAL DEPTH: ,"0-S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 01,
7. STATIC WATER LEVEL Below Top of Casing: SC FT.
(Use'*" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of caring terminated at/or below land surface requires a
rariance in accord ace with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 u METHOD OF TEST Ai
10. WATER ZONES (depth): i xQ
11. DISINFECTION: Type rh 1 nr i n a
12. CASING:
Depth Diameter
From_a____ To .� 0 Ft. 6 1/ 4
From To Ft.
From To Ft.
13. GROUT: Depth
From p To 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. S.AND/GRAVEL PACK:
Depth Size
Amount \ (-i,t.tP
Wall Thiclmess
or Weight/Ft. Material
c9F21 PVC
Material Method
Neat Cement Hand
From To
From To
16. REMARKS:
Ft.
Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat.
(check appropriate box)
Latitude/longitudeofwelllocation
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) -... -
mall pRILLTNG LOG
From T o Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and ommon road names.
c0
I DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER�y< �, 1p= la o�
SIGNATURE OF PER59N CONSTRUCTING THE WELL �� DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0
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0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY CERTIFICATION k 2010
281180
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL &PUMP PHONE k f 828) 697-7263
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIrk
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential i Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
PINE VIEW DRIVE OFF OF BANNER FARM ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SCOTT AND LISA FRAZIER
Address PO BOX 791
(Street ar Route No.)
HORSE SHOE NC 28742
City or Town State Zip Code
( 828 )_ 890-1064
Area code- Phone number
4. DATE DRILLED NOVEMBER 26, 2003
5. TOTAL DEPTH: 340.
6. DOES WELL REPLACE EXISTING WELL? YES O NO EC
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ®Slope ❑Valley 3Fla
(check appropriate box) rr
Latitude/longitude of well location)
(degrees/minutes/seconds)n" [rTh1
Latitude/longitude source:OGPSOTopIt»aphic
(check box)J.
DEPTH - DRILLING LOC
From To Formation Description
O 1
(Jo
11. DISINFECTION: Type BY PUMP INSTALLER
Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 48 Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From
14. SCREEN.
From
From
To Ft.
Depth Diameter Slot Size
To Ft. in. in.
To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
rn
c-)
co
--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.
�Jtoirt LAIT e mate- - teat'
64, Lt(;d .Hatt N.4kkt.
ht tit L3aavn.u> adcvtnfd• 4
abxd-f k a Vitt oh,
32k
V
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD S BEEN PROVIDED TO THE WELL
/lam
SI ATURE OF P ON CONSTRUCT THE WELL DATE ,/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

281179
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INCJBARKER WELL & PUMP
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (826)
697-7263
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE County HENDERSON
LANCASTER DRIVE OFF OF NORTH CLEAR CREEK ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES BAILEY
Address 54 DOROTHY JANE LANE
(Street or Route No.)
HENDERSONVILLE NC 28792 '
City or Town State Zip Code
( 828 )_ 290-8505
Area code- Phone number
4. DATE DRILLED NOVEMBER 17, 2003
5. TOTAL DEPTH: 255'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ea
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 12 - METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) f
DEPTH
From To
DRILLING LOG
Formation DescriptioiT
a r
W
co
01
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 61 Ft. 61/8 SDR21
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Ft.
Ft.
Material
PVC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
�A/// at ill o tdeft—
Method tdiath a4o woad • "_�wL ` a
POURED �C-Gt
jt O)c 7&Q it(�:lXntak_a
Slot Size Material t411 .W 7t�,G(/A1:uJ.+c.L�, h.z^^a U2 , / ///%
in.
Material flat.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE L DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
OE

281177
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION k 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC/BARKER WELL & PUMP pgONE # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I . WELL USE (Check Applicable Box): Residential Ea Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
MARK FREEMAN ROAD
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PATRICK COOPER
Address 272 H ST. PAUL ROAD
(Street or Route No.)
HENDERSONVILLE NC 28792
City or Town State Zip Code
( 828 )_ 712-5766
Area code- Phone number
4. DATE DRILLED NOVEMBER 10, 2003
5. TOTAL DEPTH: 730
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:EGPSDTopographic map
(check box) ....
DEPTH DRILLING LOG
From To Formation Description
_
�) k=`
CO
m
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth Diameter
From 0 To 41 Ft. 61/8
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Amount
Wall Thickness
or Weight/FL Material
SDR21 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
in.
in.
W u._
LOCATION SKETCH N o
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
j..koo/'n J/n-n-e� � -
y //t(/
Method noy &eait
JLw �,Q L1Wcn
rt
POURED 4t .t^,'A koad • r) of
L Q. Jt.Lentom Leoa4 a'7ucL c+ w
. � 10 opt- &
Material
Material n „ -.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROV ED TO THE WEf OWNER
14
SIGNATURE OF PERSON CONSTRUC ING THE L DATES
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center P4101gh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 .07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL&PUMP PROM,? # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
if licable if ,licabl
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
BRADLEY ROAD
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK BISSONETTE
Address 102 PEBBLE CREEK DRIVE
(Street or Route No.)
ASHEVILLE NC 28803
City or Town State Zip Code
( 828 )- 274-1957
Area code- Phone number
4. DATE DRILLED NOVEMBER 12, 2003
5. TOTAL DEPTH: 355
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ea
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST TIMED
10. WATER ZONES (depth):
County HENDERSON
281176
Topographic/Land settin
[Ridge ®Slope DValley
(check appropriate box)
Latitude/longitude of well to
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTop
(check box)
DEPTH DRIL
From To Formatio
Int
Inn]
a
m
G LOG
c map
c-
0
W
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft. 6 1/8 SDR21 PVC j/ ^� J/��Al_„ , e n , i
thj
From To Ft. ID � /UA�.�
From To Ft. • / 9 I - JGt-Ak- a_
13. GROUT: Depth Material Method q Aleut941
, n L
From 0 To 20 R. CONCRETE POURED „ -t p „, , Pc , t✓ R.L Q. 1LCY
From To Ft. q GL[MJU n
14. SCREEN: Depth Diameter Slot Size Material at l- atil(EdWit A L
From To Ft. in. in. 1Q _
From To Ft. in. in. i-�n-k-- oll cL YX F QQ OX "
15. SAND/GRAVEL PACK: n ,1 ,.
Depth Size Material[.A_,.
From To Ft. _ �f
From To Ft.
rn
t Jc:
ni-
LOCATION SKETCH
r-
16.REMARKS:
Cf1
N o
Show direction and distance in miles from at least_
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDE T) TO THE WELL OWNER
L-emnvuXt,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2010
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICHARD MCCRARY
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC.BARKER WELL & PUMP
2811'75
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricul
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
FREEMAN CREEK ROAD
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHAD & REBECCA HEATHERLY
Address 196 FREEMAN CREEK ROAD
(Street or Route No.)
ZIRCONIA NC 28790
City or Town State Zip Code
( 828 )_ 696-3933
Area code- Phone number
4. DATE DRILLED NOVEMBER 7, 2003
5. TOTAL DEPTH: Ro-owe°a"Oe4e°°ta'°Ia15'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID
7. STATIC WATER LEVEL Below Top of Casing: 240' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1,33 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a .
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land
DRidge ®Slope DVa1
(check appropriate
Latitude/longitude of we
(degrees/minutes/
Latitude/longitude source:LIGPS
(check
DEPTH D
From To Formation Description
o c
CJ
Fri
0
11. DISINFECTION: Type BY PUMP INSTALLER Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To unkown Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
Ft.
Method
POURED �����'��`�"��Q�
Slot Size Material Andawl
_ /! eat)irL M. L1�..peRrnafi') aw
in. d 1 T C!)V(t (j /St" itiAte.
,t.ee.t ( ,Qa ¢t cheat)
Material
From To Ft.
LOCATION SKETCH to
F
Show direction and distance in miles from at leas`
two State Roads or County Roads. Include the road
numbers and common road names.
Jton,4.1.and¢wfl at jc&e
IXgq54Lawak ,rbo 4t oci3O. gl,0,
a
Ltd fgoad 0/nd-
16. REMARKS: We re-enterd this well (which was drilled by someone) else and drilled an additional 315' making total depth 965'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REESORD HAS BEEN PROVIDED TO THE L OWNER
• IGGNAfURE OI�RSON CONS G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 8117 4
North Carolina - Department of Environment and Natural Resources - Division of Water Qulity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KENNETH MCCRARY CERTIFICATION # 2008
WELL CONTRACTOR COMPANY NAME BARKER CONSTRUCTION, INC./BARKER WELL & PUMP PHOn, # [phone]
STATE WELL CONSTRUCTION PERMIT# 1871 ASSOCIATED WQ PERMED
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ell Municipal/Public ❑ Industrial ❑ Agricultyt$f7
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
INDIAN RIDGE
County HENDERSON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RANDY M. KNIGHT
Address 320 CAVINS ROAD
(Street or Route No.)
WOODRUFF SC
City or Town State Zip Code
( 828 )_ 2435640
Area code- Phone number
4. DATE DRILLED NOVEMBER 14, 2003
5. TOTAL DEPTH: 280
6. DOES WELL REPLACE EXISTING WELL? YES O NO gi
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST TIMED
10. WATER ZONES (depth):
Topographic/Land
DRidge ®Slope ❑Val OFlat
(checc appropriate box)
Latitude/longitude of we#l(fy`ption
(degrees/mimaes/s�
Latitude/longitude source:OGPSI.Ttopogra
(check box)
DEPTH F$RTI r NCH
i
From To Formation Description
11. DISINFECTION: Type BY PUMP INSTALLER
12. CASING:
Depth
From 0 To 46 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CONCRETE
Amount
Wall Thicltness
Diameter or Weight/Ft Material
61/8 SDR21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
CO _=r-
LOCATION SKETCH w.
Show direction and distance in miles fromatileasf
two State Roads or County Roads. Includd'the row
numbers and common road names.
t,J,wm �/ end of tt ixzQ tali.- b 4 Wks-.
Method Jtam., bn Etv l fi P[(n 7C adQ�,,,p
POURED �t.trV2 Q24t 6-n Ph nQ/j/lltt oltQLtl�- lewd •
Slot Size Material 'J�,�f""�' a( 4� /J� pt x��12fw"''" ,&VAL ,^, ^A^tA eb
in.
e4a . . lCGIJ(L_ Q. Q Le cold
01nd.icvl . r lame.. e
Size Material ,6g_ A „ „YLd ui l ip _ lag -
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ter:
SIGNATURE OF PERSON CONSTRUCTING THE WEL!(/ DATE
\TIb
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

281108
North Carolina - Department of Envin
WELL CONTRACTOR (INDIVIDUAL) NA
WELL CONTRACTOR COM PANY NAME
STATE WELL CONSTRUCTION PERMIT;
(if applicable)
WELL CONSTRUCTION RECORD
nment and Natural Resources
s - aDivision ')f Water Quality - Grout dwater Section
4E (print) DeCC`X =e-0.-vy CERT'rICATION#_ 1.'_3tc
Q2-iske Sxav-ese e t.aece. Pant PRONE # as'c Cu65-:_cz:_
ASSOCIATED WQ PERMIT#
(if appl cab'
to
1. WELL USE (Check Applicable Bo c): Residential S Municipal/Public 0 Industrial 0
Monitoring ❑ Recovery 0 Hea: Pump Water Injection 0 .Other ❑ If Other, List Use
Topoggraayhi
[]Ridge (+}Slop;
(check ap
Latitude/longitt
2. WELL LOCATION:
Nearest Town: Ne Nekersu,aaZ4t Q County
�\J Clro CR RS-
(Street Name. Numbers, Community, Subdi ision, Lot No.. Zip Code)
3. OWNER: i "-.. °° " 'It._ccQY\
Address Pc a 'mo t
(Street or Route No.)
}IeNcio rsc
City or Town State
(C:1;2)- r i 4-1`1-3
Arca code- Phone number
4. DATE DRILLED tt 2)-03
5.-TOTAL DEPTH: 3-05
6. DOES WELL REPLACE EXISTth
7. STATIC WATER LEVEL Below 1
(U.
8. TOP OF CASING IS \
*Top of casing terminated at/or below la.
variance in accordance with 15A NCAC
9. YIELD (gpm): 15 METH(
10. WATER ZONES (depth):
d T4c
Zip Code
G WELL? YES 0 NO
op of Casing: +-i(-1 FT.
, "+" if Above Top of Casing)
-T. Above Land Surface*
d surface requires a
C .0118.
DOFTEST 1.:y
I1. DISINFECTION: Type t--»> Amount
12. CASING:
Depth Diar cter
From 4\ To 331•t Ft. to
From To Ft.
From_ _ To Ft.
N n'tcrial Method
ToTopthT - Ft Le ^v?'^t
Wall Thickness
or Weight/Ft. Material
11-2
13. GROUT:
From i✓
From To Ft.
14. SCREEN: Depth Diame'sr
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Stz
From To Ft.
From To_. Ft._
16.REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE
CONSTRUCTION STANDARDS, AND TF
Slot Size Material
_ in.
in.
Material
n
Nr
ul ural ❑
d setting J
a -ley OFLF_-
ettx)
�cm WI 11 location
C rn
-'o
(degrees/m notes/
Latitudelongitude sourct tIGPS 7
(check 1 ox
DEPTH_
From To
jt\
3‘1 Ob
ecc id
(id
Forr ration Descrir tic
O vim:
(z{r_n ,tee_
LOCATION SKEF;H
Show di -ection and distance in rr files from at least
two Stat : Roads or County Road . Include the -roa
number: ar.d common read name e.
c
�L WAS CONSTRUCTED IN ACCORDAN ,E WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEET 4 PROVIDED TO THE WELL OWNER
SIGNAT It E OF PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Hater Quality, Groundwater Section, ; 635 Mail Service Ceenteri RE�igh, C01
27699-1636 Phone No. [phone], wi hin 30 days.

281806
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
Resources - Division of Water Quality - Groundwater Section r�
(print) // 1 / i £ : 1—CERTIFICATION nag 7,7
PRONE # ( /. vyt d fsZ
/y/# ASSOCIATED WQ PERMIT# 7422g
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public in Industrial CI Agricultural 0
Monitoring El Recovery 0 Heat Pump Water Section 0 Other 0 If Other, List Use
2. WELL LOCATION: n ep
Nearest Town: -PHIwG/, tmty_45 .d l> G
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERh ny
y)Address
l2ers
Ev (Street qr mute No.) tz 79 t
City or Town State Zip Code
tt )- .2 y2 - 7S .7r
Area code- Phone number /
4. DATE DRILLED Z /1/D 3
5. TOTAL DEPTH: !9 Q
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: //fl FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5- FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requira a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ."2 METHODnOF TEST — Tam o
10. WATER ZONES (depth): �ea� D ` 3/Z>
11. DISINFECTION: Type
12. CASING:
From— To Depth 2-D Ft.
From To Ft
From To Ft.
13. GROUT: Depth Materi
From & To -I Ca Ft
Amount /4f
Wall Thickness
jameter or Weight/Ft
From To
14. SCREEN: Depth Diameter
From o Ft. in.
From To Ft. in.
15. SAND GRAVEL PACK:
tb Size Material
From To Ft.
Ft
Slot Size Material
in.
in.
OZ, Show direction and distance
two State Roads or County
Material numbers and common road
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 1RS1ope ❑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
,,,
OCATION S 'CH
miles fr m a leastV„ ))
ads Incl a *h- r^a
S.
TrI u
rn
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT T
CONSTRUCTION STANDARDS, ANg.T,I-IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CIGNA GF PERSON CONSTRUCTING THE WFT T
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

268548
WELL CONSTRUCTION RECORD
North Carolina Department of Environment andNatural Resources - Division of Water Quality - Groundwater Section
L Yiiry CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Ker3ne hMel
WELL CONTRACTOR COMPANY NAME ) I I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
PHONE #
1. WELL USE (Check Applicable Box): Residential lia Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest Town: �dQrsp n)(IIe_ county
iiesdericll
�I ernon Creek FS1-m es of #
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: of
Address Q ernpn4- Trive-
(Street or Route No.) 281.3
fnk Rc)ck, CSC
iry (r 3- 176te 5 Zip Code
a
Area code- Phone number
4. DATE DRILLED i — Z2-03
5. TOTAL DEPTH: 705 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lid
7. STATIC WATER LEVEL Below Top of Casing: V 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l' 3a FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a I
variance in accordance th 15A NCAC 2C .0118. TEST
�.r vv..�s.-1
9. YIELD (gpm): I l7Z METHOD OF
10,gATER ZONES (depth):
Topogra c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source.OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
y PW%P inSk lber
l 1. DISINFECTION: Type
12. CASING:
Depth
From To r(
From To Ft.
From To Ft.
13. GROUT:/-�
From tJ
Amount
Wall Thickness
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Ft. Qi P) r `.or W i1VFt -Mat0j Material numbers and common road names.
LO
Front IMendersonr Ile-La-Ke Vito Bards
5oJuda.7ate a righk Ot gc5oticth,
Method -b the Green E2'i a r 'Qoa.d x i t'- 3.�.
eou-Mdt ExiL )e-FE bogorx OFOA /&, ,
Slot Size Material Greeri[R wad- ct4 4J2
in. Ota�ko . keI� On 01d Z.5. 14►'sit
in. left off lt- Ol Iva toad. %&Ga -
3 jt.r hti les -fo 1ern.on &ea
ors the ►eF&. Lod G o2the t,
Material
Ft. n ii
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Size
Material
Depth
To 20
16. REMARKS:
G :l,, f1419gtirf6 o the D
ASHR765G1f69611dite tiliE.l(Sfl9 73
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
t2sYNAft,—,-4 At c," C t ! Zvt .??
SIGNATURE OF PERSON CONSTRUCTIN . HE WELL. DAT .
ivision of Water QuaTtty, Groundwater Section, 163e 6lail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

268549
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atuural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) chard �//�l CERTIFICATION1Ifni
WELL CONTRACTOR COMPANY NAME.r eer/ yl%E/tGGL[ftI PHONE pAYA)47 - l LGZ7
STATE WELL CONSTRUCTION PERMIT# l� LL—
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential V- Municipal; Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use__
2. WELL LOCAT N:
Nea,5 st Town Coun
'1Sr /ter riddq� oar/
(Street Name, Numbers, Co unity, Subdivision, Lot No., Zip Code)
3. OWNER:
•0•13oX
Address {� '��jj �X
(Street pr Route N
deadetioir
et"a4-
Sea Zip Code
Area code- Phone number
4. DATE DRILLED l' .Z 2 ')3
5. TOTAL DEPTH: 2115
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing. .0 FT.
(Use "+" if Above Top of Casieg)
8. TOP OF CASING IS f • 'e3 ET. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord-iiyyce with 15A NCAC 2C .0118.
9. YIELD (gpm): on METHOD OF TEST —riffled
10. WATER ZONES (depth):
y pump instQU''ec _
11. DISINFECTION: Type
12. CASING:
Amount
Wall Thickness
Depth/ Diameter or Weight/Ft. Steel
From 0 / OW Ft. 6'At 8 ee l
From To Ft.
From To Ft.
13. GROUT: Depth Materiall A Method
From 0 To 90 Ft. 1,0.% eOLL-
From _ To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
-- SDOTHEREBN-('ERTiFYTHA
,..)�L-5Ob1STRUC 10\I;STANt3AR?
1 I vst
o
}.1 DPP,—
Submit the original to
GfiOL vD6H
ASHEVILLE REGIGiI
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
atitude/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.
/ors Nendenonvi tie 4are.
Wow. as ,6111ter Bo
03
'Road- Turn Jere on_
rrdge Zoad. La- is oa
the- teft side of licontesceasLu]
-0; -
./aeeka s ica-I •
N cn_
r,t.
— —+
a
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ! 5A NCAC 2C, WELL
AND T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE r PER,r ' CONSTRLICTINGTHE WELL D iE
vision of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

268547
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITN
(if applicable)
Division of Water Quality - Groundwater Section
CERTIFICATION
#8,2
16.69.1163
PHONE
ASSOCIATED WQ PERb11TN
(if applicable)
1. WELL USE (Check Applicable Box): Residential Fir--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT N:
N rest To e PTsonYillt2, county enderson
l/11/f /1 crest - Loot t 2-9
Numbers, Community, Subdivision, Lot No., Zip Code)
(Street N
3. OWNER:A/Che! bi%rr
Address ♦ arnon rive_
a (Sytreet or ppum No.) A n irn
`)'ry°i Tow4—gi3i
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fd'
7. STATIC WATER LEVEL Below Top of Casing: ��FT.
a (Use "+" if Above Top of rasing)
8. TOP OF CASING IS i • d3 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordanci with I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST —rind
10. ATER ZONES (depth):
i PWJW ifistaller
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth D(a ter or Weight/Ft. _Material
From 0 To /d FL t�l/ PVC)
Zip Code
- 5-03
From To Ft.
From To Ft.
13. GROU/�[) Deptth Material1,,�� Met od
From s/ Tor a Ft.C�)lwad-E. Poura
From. To Ft.---
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
La
DEPTH
From To
Topogr hic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
ddlongitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
lrrorn pendersonag. turn_ rrq{
of of ehuref_.54ree-t- r
r c out . Co 5. tArxri s
F-01Y-St. Wil4'
4/le Ate
iV err,
cn r,
rs
G
z
pnact
ll�
toe 4 z
*h&. let.
THIS WELL WAS CO4ONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THPsT AA C PYOF' IS RECORD HAS BEEN PROVIDED TO THE WE OWNERAf
L , SIGNA - ` OF PERSON CON
NG THE WELLDATE
L - (Saknut the ftriginal t i the t ivision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
,1c;7699-1636 PhoneNo. 919) 3-3221, within 30 days. GW-1 REV. 07/2001

267953
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment And Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS CERTIFICATION # 2785
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: HENDERSONVILLE
BLACKWELL DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: VINCE GILL
Address BLACKWELL DR.
(Street or Route No.)
HENDERSONVILLE NC 28739
City or Town State Zip Code
(828) - 817-0442
Area Code Phone number
4. DATE DRILLED 01/10/03
5. TOTAL DEPTH: 225
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 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): 60 METHOD OF TEST ARD
10. WATER ZONES (depth):
County HEND
1 I. DISINFECTION: Type CHLORYTE Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From _ To _ Ft.
I4.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. _ in. _ in.
From _ To _ Ft. _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. ?
From
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64 E. FROM HENDERSONVILLE. CROSS
1-26 & RT. ON SUGARLOAF RD. APPROX. 6 MILES,
LEFT ON RIDGE RD. LEFT ON BLACKWELL DR.
1/4 MILE ON LEFT.
To Ft.
16. REMARKS:
c
0
n_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
rC NSTTRRUCTION-STANDARDSf ltND THAT A COPY OF THISRECORDHAS BEEN PROVIDED TO THE WELL OWNER
l �1"-Par
r ij i- �J/��/2�1�— GT-e _ /- / 0 -4
// �IG$A7 RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the D isiod of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27649-1636 Phone No. (919} 33-31221, within 30 days. GW-1 REV. 07/2001
1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print(hard Ate&' dry CERTIFICATION #?). d/ I1n
WELL CONTRACTOR CONIPANY NAmilo Ke WdLQmdittrap )641-7263
STATE WELL CONSTRUCTION PEIMIT# 1811 ASSOCIATED WQ PERbIIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Z IvIunicipal/i ,i tic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: �ende�a
t�erest Town: County rf
�C(maga_ Foret st-
(Street Naltk, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ir{Zard Fr S
Address 4- Marlon nVe
(Street or Route N )
ende nnville, a87a�
e. )ry orT ! $late Zip Code
Area code- Phone number
4. DATE DRILLED 8-U
5. TOTAL DEPTH: o1051
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E.
7. STATIC WATER LEVEL Below Top of Casing: _IA FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l • 5r FT. Above Land Surface•
*Top of casing terminated at/or below land surface requires a
variance in accorda e with 15A NCAC 2C .0118. �, _'
9. YIELD (gpm): �SSL_ METHOD OF TES'fsirl2r
10. WATER ZONES (depth):
23zf pump installer
DI INFECTION: Type
I I Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Et. GO saliz i _eve'
Depth
From° To 5
/
From To
From To
13. GROUT: Depth
From 0 To a0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
„ Material
Ft. COrl ore1r
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
16. REMARKS:
MAR - 3 2003
ubmit the original to tht Di
PHONE
268551
4,/;
ridge
setting
tdge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
�etit ide/icagitud, sourze:❑GPSDTopographic 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.
Front Aleitclersonvi'J rfoie on�
street wiLL
woad. G-o M`W5a-
For 5. 4- J Items .
htn intro KQ�1u9Ct geS"; `7)
cC 4-
iI
rt
rat
0
G
1S WELL WAS CONSTRUC1E IN ACCORDANCE WITH I5ANCAC 2C, WELL
ND 7 T A COPY OFZISORD BEEN PROVIDED TO THE \"ELL OWNER
}y- — ATE
GNA LIRE OF ['ERSON C'UNSTRCCI)NG THE ' -i..!-
'on of Water Quality, Groundwater Section 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and/I��atural Resourcess-- Division of Water Quality - Groundwater Sections 7�
WELL CONTRACTOR (INDIVIDUAL) NAME
(print))'flt)4YN%L' 13A%L 2. n �j CERTIFICATION
`#-2/l/[!�G
WELL CONTRACTOR COMPANY NAME ��J-2tJ.n , 1 L1 /( ),..P/4L(44 f 7,6< PHONE # fSF-2A (t y7- 67 p tj
STATE WELL CONSTRUCTION PERMIT# /1//i>7 ASSOCIATED WQ PPERMIT# 7 y7
(if applicable) (if applicable)
269395
1. WELL USE (Check Applicable Box): Residential NI Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: n
dNe�ares�t Townlie4sAtemil>29
J% County' �
(Street Name, Numbers, Community, Subdivision, wt No., Zip Code)
3. OWNER:
Address
9,)
0'
(Street or Route No.)
caw
- ° v%- 7 "13 Zip Code
Area code- Phone number
4. DATE DRILLED . �// ,/ A, -5
5. TOTAL DEPTH: - 3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eli
7. STATIC WATER LEVEL Below Top of Casing: Vj FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .5" FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF ESf72nto
10. WATER ZONES (depth): 7
11. DISINFECTION: Type___________/_f_9,_— Amount a_
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. aterial
From 0To Ft. fn L t,2 , l% (
From To Ft. 7
From To Ft.
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH 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.
13. GROUT: Depth daterial Method •
From Q To /S Ft. wri.5,+`4 ( m y
From To Ft.
14. SCREEN: Depth Diameter
Fro To Ft in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
fr
L MAR
HAT 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
9
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE
Suhmit the prig' 1 to t e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GF r 17699-166 Ph1iiirib(o (91 ) 733-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAMEeriot)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
269393
Resources - Division of Water Quality - Groundwater Section /�
�/p c .(�L // CERTIFICATION gag ./
�/1.iA%/P U%4/An ' alter, NNersoNE # wfrAyytolin
4//17 ASSOCIATED WQ PE # S / 3 S'y
(if applicable)
1. WELL USE (Check Applicable Box): Residential Pi Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town;
(Street Nam-�
Nam; Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:/J /� Address / r7 /
// (SUegt or Route No.)
��ytd& __ _1i z ,y C e2Sj%97
City or Town State Zip Code
( ay- at./ 7
Area code- Phone number /
4. DATE DRILLED &/lo/D -3
5. TOTAL DEPTH: /9..S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: /..5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 4- FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface requires a
variance In accordant Mth ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METTIIIOD OF TEST /4Grrtf
10. WATER ZONES (depth): /0/0'
ty ite:..tSK
f792_
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type901,g- Amount to ° Z Show direction and di
12. CASING: Wall Thiclmess two State Roads or Co
or Weight/Ft. terial numbers and common
/
Depth A._ Diameter
From_ To I /) Ft. lot
From To Ft.
From To Ft.
13. GROUT: Depth Material
o
From 0 To 7O Ft. &Ansa
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
Method ,
afittie
From —To Ft.
From / To Ft.
16. REMARKS:
12E ]'
) �i S UL I
1
Submit the original to thDi
27699-1636 Phonee No..{919) 733-ILL
N SKET
ce in miles from at least
ty Roads. Include the road
ad names.
to
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

C
269389
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DEAN SHEHAN CERTIFICATION # 2160
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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:
Nearest Town: GERTON
COBBLESTONE DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BUDDY DYER
Address COBBLESTONE DR.
(Street or Route No.)
GERTON NC 28735
City or Town State Zip Code
(864) — 325-1950
Area Code Phone number
4. DATE DRILLED 02/19/03
5. TOTAL DEPTH: 805
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: T
12. CASING:
Depth
From 0 To 60
County HEND
e CHLORYTE Amount 22.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
14.SCREEN: Depth Diameter Slot Size Material
From _ To _ Ft. in. _ in.
From _ To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
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. 74 W. FROM BAT CAVE. GO APPROX. 2.2
MILES. RIGHT ON MIDDLEFORK RD. STRAIGHT
ON TOM FALLS RD. STRAIGHT ON HIGH FALLS
RD. RIGHT ON ELMCREST. GO APPROX. 50' AND
TAKE 1ST LEFT. GO APPROX. 200' AND TAKE 1ST
RIGHT. LOG CABIN AT CUL-DE-SAC.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S'I'RUCTION ,ST is S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•IGNA OF PERSON CONSTRUCTING WELL DATE
Submit the original to]the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
L.f769't2636 PhoneN.p. [phone], within 30 days. GW-1 REV. 07/2001

2. WELL LOCAT'IIIO,,N,,�:,,, f 1 (de�Sl7n
N arest Town:�rueIS0 Ville_ County IIF
ll A1tinfainFpad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J YYI Ceraltl t MO.
ed.
Address 101'54 t OII_A nit if if
(Street or Route No.)
zir '.nnia, , NG
City or Town tag 5, Zip Code
Area code- Phone number 2) 03
4. DATE DRILL •, T(r5 z
a87R0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Pr-
7. STATIC WATER LEVEL Below Top of Casing: 010 ' FT.
2 (Use "+" if Abave Top of Casing)
8. TOP OF CASING IS i • 73 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requirrs a
variance in accordane with IS` NCAC 2C OF8T
YIELD m:
9 YI (gp ) ESTTifted
10. WATER ZONES (depth):
Sy pump iYLs'tiLLe/
(.DISINFECTION: Type
12. CASING: WallThickness
Depth pm[ietcr 1
T _Ft (0/
WELL CONSTRUCTION RECORD 2 6 9 3 a5
North Carolina - Department of Environment and Natural Resources - Division of Water Quality CERTIFICATION Groundwater
Section
onto
Aladin
WELL CONTRACTOR COMPANY
(INDIVIDUAL) NAME (pY t) r W �''l nd pimp
1 m p PHONE N e ,
WELL CONTRACTOR COMPANY NAME /iQ.C�d, K \W,/
3
PERMITN
STATE WELL CONSTRUL?fON PERMITN I 1 r'r I ASSOCIATED WQ (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential lirMunicipalfPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
ns
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
L_atit❑de/Ior.gitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Front 0
From
From
13. GROUT:
From 0
From
Amount
Wei ht/F Lake To Ft. Sauf %( 4t7 Lake Su_rn/XfL
To Ft.
v
-Cr
LOCATION H
Show direction and distance in miles from east~_
two State Roads or County Roads. Include the roaxrt
numbers and common road names.
l
rn
r.
or [. fit__
SDR I Front �en_dersonviLle. take gloact
Depth Material Method
To X Ft.eOYtere{e Poured
To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. 15. SAND/GRAVEL PACK: Material
Size
From To Ft.
From To Ft.
16. REMARKS:
Oft the I e4E• iro 11/2_ vxi Les
OR Be.11 J1rl.ouracc(n Toad +t) a -
red brick touse-oKihe- ri9h+
after IZ.ocL' (; .
1
r 1 — t;; P
I�' ii r 1 DO I+IERE`'BY'�AE
i .,. - —CONSTRUCTION
i
16.' I`
c Suunt tthe original to
Pc 27699-1636 Phuttic'
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND TH..T A PRY OF IS RECORD H. BEEN PROVIDED TO THE WELL OWNER
v
ERUCTING THE WELL. DATE
SIGN. TUBE OF PERSON C.
he Division of Water Quritty, Groundwater Section, 1636 Mail Service Ceen`ter' Raleigh,
NC
9) 733-3221, within 30 days.

269354
WELL CONSTRUCTION RECORD
I ResourcesDivision of Water Quality - Groundwater Section
North Carolina - Department of Environment and Natural
- nO yo
(,,^,d,./ M q y CERTIFICATION q 1
TRACTOR([`iDIVIDUAL)NAME (print)�.IQ.!(LL[U /I`e Nr
'WELL
COY
WELL CONTRACTOR COMPANY NAME r}ler • WPM 0fyld Fume PHONE II
ASSOCIATED WQ PERMITS/
STATE CONSTRUCTIONWELL cable PER.\1ITp /I (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential CN' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: 1( ��
Nearest Town•�Ppne SOrrat lle County
a5 6ol,fh
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:n:511) -Oit// YIP /U1x
Address I avid]t ftA hl- Cof
(Street or Route NoJ/t��
50SkFIa-fRcCK C 2Fs+++(
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED a -l-3-0;
5. TOTAL DEPTH: 5`10
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ili-
7. STATIC WATER LEVEL Below Top ' ifAbo Above
pQ
FT.
I dJ (Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
•Top of casing terminated at/or below land surface requirre-ss a
9. (-- EST -rimed
ii'Jed
10. WATER ZONES (depth):
By purr ins -toiler
EC ION: Type
(i_Z123•
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lacnide/longitudc source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
variance in accorda ce with 15A NCAC 2C .0118.
YIELD m): j 5 METHOD OF T
II. DISINF
12. CASING:
From 0
From
From
13. GROU Depth
From 0 To olp
o Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Depth DIagteter
To Ft.�
To Ft.
To Ft.
Amount
Wall Thickness
or Weight/Ft. 1 terial
V
spez1 e_C,
0
c)
,,,
71
W r^.:3
LOCATION KETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
U
Ff oock• eri_ders-onUide- •LaJc�
0,5 s(_th.-touJard tircat1C,L.
Material Methn V Z I ©n J )e' I ,E , I
i1)v1.°felt PInuYtP k pass
�h ne-rk LUIII bit woad
Slot Size Material
in.
in.
Material
16. REMARKS:
l r, CONSTRCICTION
•
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. 4919) 733-3221, within 30 days.
(,uith. _Sake Q.cro_s3 t cLCL
2•erc4 Q.!iet, on_
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COJ Y OFT HIS RECORD HAS BEEN PROVIDED TO yr` /WEL' OWNER
IGNATURE OF PERSON CONSTRU I�C; THE WELL. DAT
rater Section, 1636 Mail Service Center
W-1 REV. 07/2001

269353
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAhIE (print) ldJtard Ate Crary CERTIFICATION # PHONE q RA 69 �-7763
WO
WELL CONTRACTOR COMPANY NAME 7a g t.a�dII Qn
•
STATE WELL CONSTRUCTION PE RM ITN I S7/ ASSOCIATED WQ PER.MIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential QV-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:}i@rldersorNille_CountyOJP denOn
Fairway 1Trive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:P (life -rod A( S_S
Address - 0 i - n r `Ron Gl
(Street or Route No.)
Nero Prg irNiIle N 2S 191
City or Town Stgie Zip Code
62/2.)- ✓l'!'1-rlrl OZ
Area code- Phone number�t O
4. DATE DRILLED of -t�
5. TOTAL DEPTH: 50S'
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 21-
/Topographic/Land setting
[ytctdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latir;:d_ ion:;ltude'source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7. STATIC WATER LEVEL Below Top of Casing: t+0 FT.
(Use "*" i f Above Top of Cuing)
8. TOP OF CASING IS I •.%3 FT. Above Land Surfaces -"
*Top of casing terminated at/or below land surface requires a
variance in accordae with ISA NCAC 2C .0118.
9. YIELD (gpm): s2lL— METHOD OF TEST Timed
—
10. WATER ZONES (depth):
Sy pump i rtsta.U�
1 1. DI INFECT ON: Type
12. CASING:
Depth Quat
(p Fie
From 0 To_B_ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From0 To a0 Ft.t.Qne.refe"
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK.
Depth
From To
From To
Amount
Wall Thickness
or Weight/Ft.
SD221
16. REMARKS:
�? !IA -Atli
L.._ submit the oriyijal to
G '- '2/699=1636.'t'tioitl No. (9
ASHE\ f. f'.. i.^..F
Ft.
Ft.
Ntaterial
PVC
co
0
LOCATIONCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
froa- ){e .e( oriville. 90 out
(willow )Road . brt-e ha(f mile -
Method �nss -I-he. Volley bill Flue
eoured
Size Material
tQK4._ a_ right brt+v Fairway
--- Drive . Pa.5s 2kh Fojrwa3
in. �
Material /'..l�uI_ C I V 13-tfl ri and_ go -Fa n ayt
in. house OVL e kf Prop -eft]
is -b+h - rip+ofthis kaus�
H R'YgR
VST Udf]ON SVA
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND TFIAT A COPY OF THIS ' CORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONST TING THE WELL
i
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center
e Vrl REVgh, NC 001
9) 733-3221, within 30 days.
//if z /0
DATE

269352
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ry�y��QQ
0 7
WELL CONTRACTOR (INDIVIDUAL)NA�SQ(E (print) KennethPHONE q 6 fU Ce a ry CERTIFICATION # C21-72b3
WELL CONTRACTOR COMPANY NAMEBorp er Wei( OM d �!L4v1
16 { 1 __ _ASSOCIATED WQ PERNIITI
(if applicable
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential I.Er--Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: f - _�0�
Nearest Town: iiniderSOn'i Ile County
Old C1pnr (reek RO2d
(Street Name, Numbers, Community, eeSu�"bdivision, Lot No., Zip Code)
nE
3. OWNER: ebA. /Rorq avn)
Address I I 1 ,1WPS(de `Drive°
(Street or Route No.)
ElandermrNNT11e, Nit 28139
City or TownState Zip Code
�)- 9��O h 6
Area code- Phone numberCJ
4. DATE DRILLED 67-, d
5. TOTAL DEPTH: oQ /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33- FT. Above Land Surface`
•Top or casing terminated atiur below land surface
requires_
varianceIn accordance with li•
9. YIED (gpm): � l�.METHOD OF TEST
Vnroci
10. WATER ZONES (depth):
y purW ; u:Later__
SIr1FEC fON: Type
1l. DI Amount
l2. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 100 FL (o (lg 6D(221 PVC
From
From
13. GROUT:
From 0
From
14. SCREEN:
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
11. -
ISO-HERE$Y�£E
'�CONSTRUCTION STAN
Ii
Ji
t ' Submit the origiil,al to
G;-'—' -3 644=i6361'hone Nn.
Size
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
•i•ui._/kn;i:'dc source:❑GPS❑Topoo aphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION KETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
FrOOL Xenstersonu(lle-Lai&64-East
To Ft. •
IC{EQYi
To Ft.
Depth Material
To (Q9 Ft.S�7 onee to
To Ft.
Depth Diameter Slot Size Ntaterial
in.
in.
Take- a_ rruif-larxik.'R.oad .
Nlem a (prttin.ue -v Cross roads at Fraiflamd
r u" e) °KGt 0Id Cleararea-Toad c°-
Cl�proxir<a e ly Y4 rx.ife 40Wie
property OrL left.
0
7
W
Material
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WITH I5A NCAC 2C, WELL
S, AND THAT AA COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF OF PERSON CONST'RUC'1 NG THE WELL DA
hk Division of Water Quality, Groundwater Section, 1636 Nlail Service Ceen)tter' RRaateigEV. 0, NC0i
733-3221,.sithin 30 days.

2'70088
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Tames cAICamp.? Jr- CERTIFICATION# 71 iQ
WELL CONTRACTOR COMPANY NAME Camp' Well & Pnmp rrL Tnr PHONE #$7E1 4S"1-7322
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q' 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: Sa i�i 1,�It6i\} County 1 IU 04.q7
V E) 5 CV,
-,Fit " l - IN Y1 411 a L- C.O 1111
(Street Name,Numbers, Community, (Subdivision, Lot No., Zip Code)
%
3. OWNER: l &il i ll Via M . i,Ll llO'FI RCI E' r 5
Address PC) I30X I093
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED } ' & G S
5. TOTAL DEPTH: ti /� 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: I : O
(Use "V" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
' variance in accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ai r
10. WATER ZONES (depth): 5 `4 C
11. DISINFECTION: Type rh 1 or i na Amount 1 Lup
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From p To 4-3'_Ft. 6 1/4 GBR71 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 30 Ft, nr,zsc-at Ceanent Ha n3
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 DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box) -
DEPTH DRILLING LOG
From To Formation Description ,
0 11-0 63VtIUC 1 ;Ar(Ci rt it
4n 57 frmitAa`r 'r:ck
JOCATION SKETCH(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
JJ
/ O
Co
c')
O
I DO HEREBY CERTIFY THAT THIS
• CONSTRUCTION STANDARDS,
LL WAS CONSTRUCthD IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
ar yl 1E4 a,r 9 - I ` -63
SIGNATURE OF PERS(')N CONSTRUCTING THE WELL / '4' DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
C>

27038 /
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James ur
WELL CONTRACTOR COMPANY NAME ramp' q 1/.1a11
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
rarpp Jr CERTIFICATION# 21 18
,C Pump rn Tnr PHONE #69R) 451-7122
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential W Municipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tywn: _fed) U (� �>` County9 C. 1l(1 C Y'i nYL
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: L.)) R rC' Id Le E L'(�d��)vttr�
Address P D F e,Y 1Cel3
(Street ar Route No.)
J61- /.I (le,. JN (
Ciry or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED "AC-• 3
5. TOTAL DEPTH: .3 G
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4- FT.
(Use "4" 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 accordsyce with 15A NCAC 2C .0118.
9. YIELD (gpm): I C METHOD OF TEST A i r
10, WATER ZONES (depth): ` $c'
287'7 3
11. DISINFECTION: Type rh l nr i no Amount 1 ,4? (t$
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From Q To T)C Ft.6 1/4- SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Frorn_0 To 2 0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Neat Cement
IIa..,
16. REMARKS:
Topographic/Land setting
❑Ridge HSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box),
DEPTH DRILLING LOG
From To Formation Description
0 G rt({ CIA ✓ !Y\ i X
r; D ( S (1 r (,CXfie,( (c ck_
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
r
4.1:2' l.r�.tiJ
���r
0
GJ
'11
1 DO HEREBY CERTIFYTHAT'THII WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,:. ANb THAT A COPY O THIS RECORD HAS TREEN PROVIDED TO THE WELL OWNER
.:..� 6244 ,. ?,)4-63
SIG ATURE OF PERSON CONSTRUCTING THE WELL �7 DATE
I L
I Submit the original to the Divisions of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-- 27699-1636 Phone N0. [phone], within 30 days. GW-1 REV. 07/2001

t.
j `Submit theorigiva7 tp. , e Div sion of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
LL` 27699-1636 Phone No (919g 733- 221, within 30 days. GW-1 REV. 07/2001
270451
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James w C m mp, Jr CERTIFICATION # 71 "SR
WELL CONTRACTOR COMPANY NAME Camp c Wall R Pnmp !'ram Tnr' PHONE if 2R) A51-7122
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI
Nearest Tpwn
r>
(Street Name, Numbers,
3. OWNER: / E Y 1' V J-?/lc J E
Address f l o Y
II (Street o Acute No.) a
t c ep3h yt0 1/ l e N c- c2 71
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 2 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: I.€ FT.
(Use "+" if Above Top of Cuing)
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): IC METHOD OF TEST pit
10. WATER ZONES (depth):
11. DISINFECTION: Type Ch 1 nr i n p Amount I 'h Gt11)
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Q To i Ft. 6 1/
From______ To Ft.
From - To Ft.
13. GROUT: Material Method
From p Neat Cement Hand
eDR, 1 PVC
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 FArmatio Description
o I �i �l M� t�,L
MKS
Depth
To 2 p Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
�C�EV5n1tU1 »€ County F1 EYSnYt
re .- Dana
C9nmunity, Subdivision, Lot No., Zip Code)
-6 —G3
, It fl y ) 1r-/r,
).00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I
I! -DO IEREBYiCERTIF THA^'7HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFt T
rCONSTRUCTIOWSTANY5ARL5, AND THAT A COPY O THIS RECORD HAS i3EEN PROVIDED TO THE WELL OWNER
- 03
✓ SIGNATURE OF PER$ CONSTRUCTING THE WELL % DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
o •ktK el o I'V4 COI ?S CERTIFICATION# 243c.
WELL CONTRACI'OR(INDIVIDUAL) NAME(��p}}r��i�nt)Q 1 w��r,00
WELL CONTRACTOR COMPANY NAME t.PAJQR IQ t\4 - Vn L3 " ""-1. PHONE # 182b1 665-aOQZ
CCC11l ASSOCIATED WQUPERMIT#
(if applicable)
SATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential QI Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
270848
•
2. WELL LOCATION:
Nearest Town: Mettle rta 'Ate County llender5on
11:dden 1-1: it.1
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sc' &4ion
Address Qp t',t%:fi 35\
(Street or Route No.)
7Ju1leS 1Y
City or Town State Zip Code
(f)- (010 a,fl'j
oZS7Go
Topographic/Land setting
❑Ridge Ait1Slope ❑Valley ❑Flat
(Check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptior.
Area code- Phone number
4. DATE DRILLED .Zf 340 lc 3
5. TOTAL DEPTH: c205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lilt
7. STATIC WATER LEVEL Below Top of Casing: fe3 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 15A NCAC 2C .0118.
9. YIELD (gpm): a0 METHOD OF TEST te/9
10. WATER ZONES (depth): tl
I I. DISINFECTION: Type f:115 Amount Y
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 't') To 3-7 FL___i2S_ ata\ �1G5t:e=
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To 20 Ft. Cement coated
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:
3-7 over &zt4 tn
31 ao5 11 ran : t e
LOCATION SKETCH
Show direction and distance in miles frorrca_h least.'
two State Roads or County Roads. Includetbte road
numbers and common road names. -.
0
C:
rix) 1¢EREBTairtiryTH
I CONSTRUCTION STANAAR�
rS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/���t,�J�/ tk Gi...� a)a(o I e3
— ' I cnuST R OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the,',rDivis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
i7699-1 G36 Phone No.(9199 733-3.r I, within 30 days.
GW-1 REV.07/2001

270847
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tSITON.S. 1 v j a CERTIFICATION 24310
1p.,yp yks. t-n Woga3J'ex y_ 3tAt PHONE n ups) Vo5-o'oQ2
STATE WELL CONSTRUCTION PERMIT# U ASSOCIATED WQPERMIT#
(if applicable) _ (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
\YELL CONTRACTOR COMPANY NAME t�
City or Town State
(8ax) 221 c1HS
2. WELL LOCATION:
Nearest Town: 'jo.no, County 'Mtnaecsyn
?eso.,a::st Pear p u a
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1k - s 7-10.tvb
Address :310 1ne\oICeS.1itec Ham'
(Street or Route No.)
krkg;:tiQi. nc 287N8
Zip Code
Area code- Phone number
4. DATE DRILLED alas 103
5. TOTAL DEPTH: Ito
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1E1,
7. STATIC WATER LEVEL Below Top of Casing: \b FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2O METHOD OF TEST
10. WATER ZONES (depth):
Topogra9�hic/Land setting
❑Ridge rtSlope ❑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 Descriptior.
+\ la\ hvvc 9112I4cti
0
1 I. DISINFECTION: Type P; 11 5
12. CASING:
Amount Si
Wall Thickness
Depth Diameter or Weight/Ft.
From i-\ To la\ Ft. io-r4 t#av
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
ry
From 0 To 9-0 FL Cemer eoused
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
Material
Q I45}:C
From To Ft.
From To Ft.
16. REMARKS:
•
Show direction and distance in miles from aFSeast5 =.71
two State Roads or County Roads. Include K1t3 road::__
numbers and common road names.
LOCATION SKETCH
C
) D0(41'EREBYCERTIFIY7 +44
i
-0N'STRUCTION'STANDAA-C F,
7/
a>�
I_Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (9p 9) 7333221, within 30 days.
GW-1 REV. 07/2001
HIS WEAL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.2Iasio3
S IIGN URE OF PERSON CONSTRUCTING THE WELL DATE

270845
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
� Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ti4S1Fv7u.�+(O rWILeIj �ix Ina e, CERTIFICATION # 0-4,:(o
writ CONTRACTOR. COMPANY NAME U Ao.�+-]P•>Akr'o� w""^a�''`�^-r�UU, ,�^-� PHONE # (K29 (cb 5'oe.?`Z
STATE W'ELI. CONSTRUCTION PERMIT# UUUU U ASSOCIATED WQUPERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 'tt -y•t Q County "Hender:yon
5(c it CKo;�j (1Ccea a8l92
(Street Name. Numbers, ConMnun ity, Subdivision, Lot No., Zip Code)
3. OWNER: ,Ao,t-K •k ‘:N2br4 50.W16eC
Address 5(o 71:cxecu fierce Rwa
(Street or Route No.)
vr79 a
City or'I own State
(E2S- (n85 a4cc.
Area code- Phone number
4. DATE DRILLED 311 10Q‘
5. TOTAL DEPTH: ;7RS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 6e, 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): _ Q METHOD OF TEST._
10. WATER ZONES (depth):
Zip Code
Topographic/Land setting
DRidge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
so
(degrees/mi nutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-/- I Tr, IC 1
n.i P'C' \Zr etko
tot) 0 o£`S CTrG,r..tclre
L)
Li
II. DISINFECTION. Type Q`11,5
12. CASING:
Depth Diameter
From 4- / To 10 j Ft it u
From To Ft.
From To Ft.
LOCATION SKETCH
Amount -7 Show direction and distance in miles fromat least
Wall Thickness two State Roads or County Roads. IncludrOhe mail;
or Weight/Ft. Material numbers and common road names.
o s_
ytI -.
13. GROUT: Depth Material Method
From Q To :,CD Ft. Cxe,^'IarJk— _7<
From To FL
14_ SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. In. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
To
To
From
From
I6. RE
Ft
Ft
Ft
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND THAT.
%r(
ATURE OF P
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
317 /03
RSON CONSTRUCTING THE WELL DATE
Submit thit)figiiial to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

270840
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 151n.. l— tt (t�{�&saetnr%x CERTIFICATION # 0-4 3�
pp S c,n (ASIAPHONE # (R25) G65"a0?2
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
I. WELL USE (Check Applicable Box): Residential Pi Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towo: ti\ R.vx.,m,.1L'r County
la\ J040 T.31. a819 e1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: —4-°-tia ¶»a.
Address Va.\ Wagi31 l�.h
(Scror Route No.) �,19a
lls.�9>tnrtwtl.Cr v\C
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED al 1 3 103
5. TOTAL DEPTH: aS-`'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 3.). 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): \C) METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type c'
12. CASING:
Topographic/Land setting
DRidge ftSlope ❑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.
sl 1'63 ales 6ecdo('
G-rei, to
CO
Depth Diameter
From i\ To \%3 Ft. itt,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ao Ft. Cane t P't.ccci
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
Amount "-1
Wall Thickness
Material
\c/iSF:C-
or Weight/Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least=
two State Roads or County Roads. Include the road
numbers and common road names. o
N
rn
3td31EREBY CERTIFY
I -CONSTRUCTION STAND`
,el
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rC
I NA1MRE OF SON CONSTRUCTING THE WELL DATE
/la 103
'Sututiiit the original tP tfie Div ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone. No. (919j733- 221, within 30 days. GW-1 REV. 07/2001

271601
North Carolina • Department d Environment and Natural Resources • Divlaion of Water Ou&Ity • Groundwater ctiop i r.
1636 Mal Service Center • Raleigh. N.C. 27699.1638Phone We) 733•9221 /'tat�� (�nn TrAl
-WELL•
CONSTRUCTION RECORD WELL CONTRACTOR- 27'7,4-4)/?1/ `X/f /7"-/wr21/0
WELL CONTRACTOR CERTIFICATION 11:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable own: Residential Municipal 0 Industrial 0 Agricultural ❑
- Recovery ❑ Heat Pump Water Injection ❑ Other ri If Other, List Use:
_ .:2:'' WELL LOCATION (Stow sketch of the location below) � , S�/c/
Nearest Town: 7/ t,>i h A /2 County //47 /
MIttSGA, a or Su and La ) DRILLING LOG
(Road Name and l ,��Conrtse�lH. `/T/— %O From To FmmaSon DssaiPtco
3 OWNER ���0 1 tie rTZ�
Address po,%;nx d /bU
/7/ rii/ orN /C 7l.
GtyorTam ZPCods
4.; DATE DRILLED
5. • TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 • NO__
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL. below Top of Casing: /, F FT.
(Use Y• a Above Top el CasNp)
9. TOP OF CASING 1S FT. Above Land Surface'
Top of caskg tam lnatsd.Yor below lend swims raqulns 1/2
vvJarNeoa In scoar-
danaweblSANCACBC 1s /�/DGI//i%
',10 YIELD (gpm):METHOD OF TEST ,�/.ti2 Cv o -7 'KO F�
11. WATER ZONES (depth).
Monitoring 0
DEPTH
/ G-S- K1 ; zsi,i 77-
12. CHLORINATION: Type Amount
13. CASINO: „7 C-
Waa Thickness
Depth <i Diameter orWsig.WR. Made
From O To /O k FL 4/ /� e : P vG
From To FL
From To FL
14. GROUT.
From U To FL
From To . Ft.
15 SCREEN '
pepth Diameter Slot Size
Fes` To Ft In. 1n.
From To FL In in.
From To FL In. In.
16. SANO/GRAVEL PACK.
. Depth . Size
From •To F(.....__.---
• From To FL
17. REMARKS:
Material
r-,
c-)
J
if additional apace is needed toe backol form i
LOCATION SKETCH c
(Show direction and custanee from at Mast two State
Roads. or other map reference poins)
e /- 0 »"r � c 5
,er'S L/Qe%
N'[' dv2rr,� ''/ 7
Material
I DO HEREBY CERTIF*
CONSTRUCTION STAG
FOR OFFICE USE Or
Quad Ha
MAY -
G ,tmvd7 0 /7/ ,- //' /.
/Z /52c' e. § u S
Material 0/77_7, /?i-o 6vA.,"
S/e //(`G
OF PERSON CONSTRUCTING THE WELL DACE
waW OwNy. Gowtdwalsr Simon within 30 days t v feel
Side No.
ASL EVILI
-tJ ,uWATER SECTION
REGIONAL OFFICE

21 2 3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
y� //
WELL CONTRACTOR (INDIVIDUAL) NAME(mint)CERTIFICATION # rra0 / 7
WELL CONTRACTOR COMPANY NAME ,[Jj +.' J-n4v /.f )1/1. olt;l • y Z&PHONE # (irnni 4 9,9 t ilO ci
NZ ASSOCIATED WQ PERMIT# 73423
STATE WELL CONSTRUCTION PERMIT#
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential Mumicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI , / Topographic/Land setting
N tTown: �puntyh' f� ❑Ridge (Slope ❑Valley OFIat
f 9 etzerr 4 Ai aryl °z ies PO/tcs1— (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) any L Latitude/longitude of well location
3. OWNER/ad/Lk W
Address /aD
nn (S f or Route, No.)
Cityor Lp C..
City or $rfa Zip Code
(talc b�6l— Y/99
Area code- Phone number 4. DATE DRILLED . 3/ 7/ LDS
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE ❑ NO ;EL
7. STATIC WATER LEVEL Below Top of Casing: /o / FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / 5 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): / 12 M) � OD OF � ST� 4(J
10. WATER ZONES (depth): /y 1
11. DISINFECTION: Type Amount e L
12. CASING: Wall Thickness
Depth ter or Weight/Ft Material
Frotn_0_ To . J /) Ft ytf.2/ Ft/ e
From To Ft.
-,78723.1
From To Ft.
13. GROUT: T/��® .,my
From_ Toopth Ft ! ��1.��
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fra o Ft. in. in.
From�To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From / To Ft.
16. REMARKS:
�HERE&Y dER±TFY
ONSTRUC1ION STANDS,
L
176994636 Phone No
(degrees/minutes/seconds)
Latitude/longitude sotace:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
H
Show direction and • " ce in miles fromegy least
two State Roads or unty Roads. Include ttie road
numbers and commo i road names. -3
J
° Pp
M
S WELL WAS CONSTRUCTED IN ACCORDANCE WTR-I 15A NCAC 2C, WELL
dD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PNS UCTIN� WELL
9/7/o3
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3 t21, 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
�/7(�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kenifrVh JVOL'rar CERTIFICATIOYpdi�/V�Cl/,
WELL CONTRACTOR COMPANY NAME , oir/re( Weil ano' Pu PHONE it 6g�—z�47
STATE WELL CONSTRUCTION PERMIT# /O / / ASSOCIATED WQ PER.\IIT#
(if applicable) (if applicable)
272263
1. WELL USE (Check Applicable Box): Residential El"--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N.
Nearest�'./�Town: CountyJe/?jPT ?
(/.1/. 01 )Q/7P
(Street Nam tubers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 2C f /iOrrneLYda.
Address /2 C F/✓1q/° hilly
(Street or qde .) ./
V i/Ua 8eark, VI cg34
ity or"n State
to/7J /Zip Code
Area code- Phone number
4. DATE DRILLED .3-6?3—d3
5. TOTAL DEPTH: t qC.J r
6. DOES WELL REPLACE EXISTING WELL? YES NO EY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" it -Above Top of Casing)
8. TOP OF CASING IS 1 V- FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordanwith 15A NCAC 2C .0118. ,/
9. YIELD (gpm): METHOD OF TESTlintel
/mel1
10.'v �4+.TER ZONES (depth):
BSI puke /H.slkl(er
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
�pep1ig Diamter or Weight/Ft. jlate..)
From TO Ft. aSpR.�/ V�J
From To Ft.
From To Ft.
Topogra ic/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopogiaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
13. GROUT: Depth Material A Method
From f) To Q _ Ft. ('i,t n"M- rOtered
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS:
0
W
—O
LOCATION SKETCH
Show direction and distance in miles from at Iea:it --
two State Roads or County Roads. Include theiIa d
numbers and common road names. p0
Frax egendersorr ae late
pc-
Q5t . Aug -Goad. 69 /x /-es fD
wo l ers Road. T/L ©h 141a/e's
2d• Co / f)d/e, /o end of
(,t/a,<ers ,?_d. Proger/-y is die'eef/y
across Old dva r &et toad —
U . D. Lane.
CtIN§YRUCT IONISTANI6
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
u, • IGNATURE OF PERSON CONSTRUCTI, G THE WELL DATE
[SuiuuLtheoriginal to [Ile Div sion of Water Quality, Groundwate Section, 1636 Nlail Service Center- Raleigh, NC
27699-I636I'htine No. (919) 733- 221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 7 2 2 6 0
North Carolina - Department of Environment and Natural Resources/m-
Divisionivof Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / ,c/l�I rl.( /0.ei a /� CERTIFICATION #GGI
WELL CONTRACTOR COMPANY NAME Barlfer We//and / // PHONE #
1-7243
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# ay/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Ao cuTrurr I ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other fir If Other, List Use ((l/T COI/rse
2. WELL LOCATI N:
Ne rest Town: }/P`ldersa7lvl /Ie County enders�n
r/ckyord A'vo d
(Street Name, Numbers, Community,
SSubdivision, Lot
Noo.,, Zip Code)
3. OWNER: (iJt9Wi v/yu�2�(� U/lf/y ease
Address L• I • 0 / 5
(Street Route No.)
He»deisa�vi!/eor , ,Y sgvezq
)ry Aei /2:2
5
4:g Zip Code
Area code- Phone number ? 0
4. DATE DRILLED ,_
3
5 TOTAL DEPTH: 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CV
7. STATIC WATER LEVEL Below Top of Casing: Q0 FT.
Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1• g3 FT. Above Land Surface*
'Top of casing terminated atfur below land surface requires a
variance in accordance with 15A NCAC 2C .0118. __i•
9. YIELD (gpm): / 00 METHOD OF TEST //rued
10. WATER ZONES
,,(ddeptthh): LOCATION SKETCH
bb1 FEC i/w � Show direction and distance in miles from at le OER
1. IS CASING: N: Type Amount
12. Wail Thickness two State Roads or County Roads. Include the rod
/�1 DepthQ Di)ai}�etcr or WeinhuTt.� Nlat�e�rial numbers and /cornrnon road names. 1
From To_e _Ft.IO !�{ • i$ _uL— From �e/ruerJ�i//7y/ut L ern
From To Ft. �.s �� West
Bodyard
From Depth
Ft. it
13. GROUT: DeMaterial �/ MethodoI/ z/e� 1 /s aunts
From�To r�C) Ft.2j/l()7lC& kij,eU 7oaGC . /V Z From To Ft. _--------- %2vatil(/71izft�rta/i%ce- �( �(.6l/��.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees,'minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check bux)
DEPTH DRILLING LOG
From To Formation Description
c�>
7.70
From To Ft.
From To Ft.
16. REMARKS:
DQ HE`R 'r oB B)LTIEy
OFYrTfgiUCh0[&iST AJE
I Submit the original to the D
„(- 276991636 PhbnLNut (919) 73
F
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C ELL
, AND TF• T A COPY % THIS RECORD HAS BEEN PROVIDED TO THE ELL 07 ER
U
SIDNA'f URE OF PERSON NSTRUCi lNG THE WELL
vision of Water Quality', Groundwater Section, 163E Mail Service Center - Raleigh, NC
-3221, ss ithin 30 days. GW-I REV. 07/2001

14. SCREEN: Depth Diameter Slot Size tit t I hLYYL
From To Ft. in in.
FrorSL To Ft. i22?L San-.1 �ce ]•mnumeadersonviU2 +cat
From To Ft.
end- of roe 4 Om
From To Ft. —_-
13.
GROUT: Depth /� Material d
FromS.L— To Ft. S 17 YID (1°# lF -turr� r(l ieO n_ B f q U.) t 11 o ul R
From To Ft. rY !_ � ��
M I Meth
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and. att/u��IIr.as�l,,Re//s��ou�r�cee1s - rDiivision of Water Quality - Groundwater Section
/��/'�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (chard / rl.�-C1(}�J(j`� ry CERTIFICATION
/N�rC9d�/2L0
WELL CONTRACTOR COMPANY NAME 'Banker We l I n v d Hint i r//� PHONE 0 Fa W11'/ Zs�J
STATE WELL CONSTRUCTION PERMIT# 1S 11 I ASSOCIATED WQ PEILMIT#
(if applicable) (if applicable)
272259
1. WELL USE (Check Applicable Box): Residential Gr' Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest Town: HfifiderSOnVi IIP CountyleldEKsort
5tnvUey 1,nrje.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,-tiara Stani�y
Address
11enlle s5r(Street or
N(IIe R
8i2 i 'ar(A3-IJ6Y-
139
Zip Code
Topographic/Land setting
DRidge DSlope ❑Valley eclat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
;,;itrde.,lc.t;;itude snt:rre: D- CJPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number
4. DATE DRILLED03
5. TOTAL DEPTH: ) yr
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: __ rig() FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. 33 FT. Above Land Surface'
'Top of casing terminated at/ur below land surface requires a
variance in accordanfe with ISA NCAC 2C .0118. —�+'"�
9. YIELD (gpm): f5 METHOD OF TEST�t_IYLI=C1 —
10. WATER ZONES (depth):
Zy p IYLS.tkIier LOCATION SKETCH —
II. DISINFECTION: Type Amount Show direction and distance in miles from atast :. _
12. CASING: Wall Thickness two State Roads or County Roads. Include tht oad c
- th Di eter or Weight/Ft. Material numbers and common road names. _. .
1-0 binOLI ay -Rd.-rig. or_ Molar
►20ad Cr() �
0
r-3
1I `RCad -
a er.a Lome
Turn 1� dn- StGLri
mate_ lea Fork Ort i y e_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A
DS, AND THAT A COPY DE THIS REC(f`RD HAS BEEN PROVIDED
SIGNATURE OF PERS
ONSTRUCTING TELL
CAC 2C, WELL
0 THE WELL OWNER
DATE
Submit the original to [Ise Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], n Rhin 30 days. GW-1 REV. 07/2001
i
J

272257
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ,Natural
,,,Resources - Division of Water Quality - Groundwater Section
y-��j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Vent/rift /u�.rary CERTIFICATION Warn?
T1 /
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERSIITW
(ifapplicable)
rKerWefl Qnri urn
Igil
PHONE NgiAI(:A /- `26
ASSOCIATED WQ PERMITI$
(if applicable)
1. WELL USE (Check Applicable Box): Residential Fr-Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA ON: `�I/
Nearest Town: enC�iSr5sOo)TVl I f P_ County �i02dPrsnn
)(laden bake iw'si(yo- Lot Ji5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topog�r�ayhic/Land setting
❑Ridge l3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER- /i1( .SY/Q11 .Orich IIC'lo)1. Ir,4.e.(EruimI-N2rsh�L() (degrees/minutes/seconds)
Address .. -o- •! / e__ nod Latitude/longitude source:OGPSOTopographic map
II ff (Street or Roue •.) (check box)
F endersonnee" N& A8139 DEPTH DRILLING LOG
City or own State Zip Code From To Formation Description
Area code- Phone number
4. DATE DRILLED I - I2-03
5. TOTAL DEPTH: 30'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
7. STATIC WATER LEVEL Below Top of Casing: ,QO' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS [.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): 3 METHOD OFTEST iIYYIPCI
10. WATER ZONES (depth):
y Oimp Iyi,s41-Lier
11 DISI VFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or N'eiehL'Ft. Materiel
From 0 To 145 FLJ_'/4+ t14t 5tite1 _ Pry )tend.ersonvitl,e +oke
From To Ft.— 'RCXL L -f-o COW Creek .Ta , az.
13. GROUT: Depth Material Method r( nh.t of Eidderi Lake Rock .
From 0 To a0 Ft. �©rlrreYe � r�� lake lea ut »idden Codes
From To FI. _—.__ I_
14. SCREEN: Depth Diameter Slot Size Material Lane , lot - 5 Ott other 6Ide.
From To Ft. inin. n r
From To Ft. in. ill. 0-
le •
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
-0
_
LOCATION SKETCH _
Show direction and distance in miles from at -feast
two State Roads or County Roads. Include the joad__:
Lumbers and common road names. —` -
16. REMARKS:
IlpO 1 E'RT CEIdTIF P THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
r fi, 'GONSt-RU±TION STArp S AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I i / LI Jo i
I SIGNATURE O
I SIGNATURE OF PERSON COMSTR 'CTING THE WELL DATE
Submit the original t'p thelivision of Water Quality, Graun Later Section, 1636 Mail Service Center - Raleigh, NC
276991636 Phone -No. (919) 3-322I, ....Thin 30 days. GW-1 REV. 07/2001

272256
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
R�jeesoutrrces - Division of Water Quality - Groundwater Section
y,Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print)KennCt Aloe u CERTIFICATION W2M
WELL CONTRACTOR COMPANY NAME Eark'er Well and YLL IFT o
STATE WELL CONSTRUCTION PER.AIIT# IR 7 I ASSOCIATED AVQ PER.MIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El-- Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
rest Town: Countyei22d ersOl7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE(2.0104Art .SheL'tRnJ
Address CL Roo -----
4
5
6
7
(Street or onut Z 'o.)
Hfof RocKS 2731
)City ry�n Tow;-.q ) 15te Zip Code
Area code- Phone nbnuumber, ''�TT
DATE DRILLED 3t
'di I'Q3
TOTAL DEPTH: o' 20
WELL REEWYES ❑ NO fd'
STATICDOES WATER LEVELPLACE Below TopXISTING ofELL? Casing: �i5r t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
*Tap of casing terminated at/or below land surface requires a
variance in accords a with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST -rimed
10. WATER ZONES (depth):
'ly pump installer
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Topographic/Land setting
❑Ridge tat lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
PHONE if Lad42'11— /Z
C
LOCATION SKETCHShow direction and distance in miles from a`Ctleast
two State Roads or County Roads. Include -he road
From�To Ft %8 3aaZ( From fien er on-v I,� E.
From To Ft. T
From To Ft.t �l 1•n ft
13. GROUT: Depth - Material n NlethodB'Roust. �i
From 0 To cO FL20n0re{e f ntmod {{?�+ At
__
14. SCREEN: Depth Diameter Slot Size Material Oa U ear -wall ow l'At untaliL Rocco( •
From
Depth Dia toter or Weight/D. latcrial numbers and common road names.
+0 ALIIIS Gap ad• aK 'a;
(±t earw ow oc
OiaClear Creektoad. 4o a-r qht
To Ft.
From To Ft. in. in.
in. in.
Size Material
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Go l•3 Yfci(-es.-r`nerewill he. 3
111.60(I00'!vs Oft the_ n kit.(3/to of a.
{Idle past #ickory A res) tB ear
+ic ri9kf, tra9kt alwead- +D end
Ir4 ((1'DQ.HEltE'ICF.RT�d(
I LtO,'tj3TRUCTION3TiAIN
*l-IAT 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
i'CeY)vk.)EC. CIVIL_ ``2 I ``
SIGNATURE OF PERSON CONSTRUCTING FIE WELL DATE
L__submitthe.Driginal to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699--1636 Phgitk'; p [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
27 Zv4
_272.2541
North Carolina - Department of Environment and Natural JR�esources - Division of Water Quality - Groundwater Section//'�y-�-�
WELL CONTRACTOR (INDIVIDUAL) NANJJFF{{�� (print) )Kenneth Air -Cray/ CERTIFICCA�TIIO/N# �I�.(f/7�/2
WELL CONTRACTOR CONIPANY NANIEJ f2 ,t ?treat /kid P/ /iX� PHONE #[phone]
STATE WELL CONSTRUCTION PERMIT# /!U'! / ASSOCIATED WQ nitwit/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential iN Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATI N: •
NeajstTown. 0�r �Ii�UL1HO County`JV.QtldflIJ/7i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
ULLL . / /c L tLELLC ---
Address
ry o�o
Area code- Phone number
4. DATE DRILLED t3-14-03
5. TOTAL DEPTH: .S15
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L�
7. STATIC WATER LEVEL Below Top of Casine: GO FT.
22(Use "+" it Above Top of Casing)
8. TOP OF CASING IS /•G FT. Above Land Surface'
•Top of casing terntinated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): cs20 METHOD OF TEST //n0d
10 W TER ZONES (depth):
jet cwfl.s% /(._J
I I. DI SI FECTION: Type Amount
12. CASING: P Wall ThicknessDepth
or
From
0
To _ Ft.�ji�'xtcr�DRZ/t/Ft. Material
)e,_ 1059
(Stree
&e?
State Zip Code
prjtoute No.)
From To Ft.
From To Ft.
13. GROUT: Depth �/ Material
From 0 To 4' Ft.tdo/l& chi
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
DRidge DSlope ❑Valley Qdflat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSD-topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Meth())
Rr(U0
Slot Size Material
in.
in
From To Ft.
16. REMAR
li, I iP tl
tf-DG'HERE'B Li
FCONSTRUCTION STAND
$ulDtilt ilr�u4%,I SF:4t�1
O
-71
J —
LOCATION SKETCH -
Show direction and distance in miles from at —least -.
two State Roads or County Roads. Include.the road -1
numbers and common road names.
eat?occet. w et e. e
accit CGS "eoa d , v�
fyy ) 0,6 m •
lac fuccA
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'1) 1V03
IGNATURE OF PERSON CONSTRUC" G THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

2'72,25`i
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) RICHAR•D i%CCCRA►2y CERTIFICATION #Quin
WELL CONTRACTOR COMPANY NAME D/1QRrKER \AI ELL- AND LJJ%4 P
STATE WELL CONSTRUCTION PERMIT# I p 1' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IV-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: H ENDERSONVI LIS.. County HENDERSOtJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEAN E 5H 1 PNi1{IJ
Address r5- NILF5 'DRIVE
(Street or Route No.)
NE/4DER501/41VILLE , NO 28g42
City or Town State Zip Code
(BLS )- Ioq,- 484P,
Area code- Phone number
4. DATE DRILLED 3-6-03
5. TOTAL DEPTH: 1 ? '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9'
7. STATIC WATER LEVEL Below Top of Casing: 1'I0 z FT.
(Use "-r" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST TIMED
10. WATER ZONES (depth):
BY PLIAAP INsT411 Ei2
I . DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter
From 0 To Ft. �n i�$
From To Ft.
From To Ft.
13. GROUT: Depth (,,Material
From 0 To Ft. L1/ FTE
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IBflat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lalituue/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
LOCATION SKETCH
Show direction and distance in miles from at.lc5ast two State Roads or County Roads. Include the=road:.:
t,
or Weight/Ft. Material numbers and common road names. '�7
5DC21 r�Vr� FRo►� HI:NDERsoNV tL-L-E TAKr - H 4S/.
£' E. TO A LEFT oN Hou/A P
Method ROAD • TAKE A RI GHT OM ZEB
ThLLR.ED COieM ROAD AND A RsGFFT DPI
/J. LLEAR CREEK Ro47Tb A LEFT -
ON NARPEi2 L-Ar1 E . GO .3 M" L_E.S
AND TAKE A RIGHT oN HAYNES.
Go .I A&ILE AND TiuZN RtG-trr
ON NILES ROAD Tb L TSt2.
PRO PE2T7 13 ON TttE LEFT;
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
PHONE #) 1-1'L- /Z4
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S ARDS, AND THA A COPY OF THIS RECOIiDTIAS BEEN PROVIDED TO T WELL OWNER
SIIGNA RE OF PPF:RSON6NSTRU'CTING THE WELL DATE
to t le Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t46My 3 iNo. 91 733-3221, within 30 days. GW-I REV. 0712001
GROL^�1..•nib �EIihVOR ( ) >
ASHEVILLE F;Ec=14 ;L OFFICE
Submit the origil

WELL CONSTRUCTION RECORD
2i225f
North Carolina - Department of Environment and Natural Resources - //Diiv�ision of Water Quality - Groundwater Secti/o�n/��
WELL CONTRACTOR (INDIVIDUAL) NAME-p,(print) R I `.MART AtCeRA-R'Y CERTIFICATION(0_____!
WELL CONTRACTOR COMIPANYNANIET)ARKER. WELL AND PUMP PHONE ps{, (i M7443
STATE WELL CONSTRUCTION PERMIT# Lit I ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12---Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: HESIDERSOPJVILLE County RENAERSW
OFF OF llPU/ARDROAT
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: iQV I1J LIVELY
Address 6 o n/ARD GAEPSQAL
(Street or Route No.)
ft4T Roca , N& 2B131
City or Town State Zip Code
622))- CAg2- 6605
Area code- Phone number
4. DATE DRILLED .31-0-3
5. TOTAL DEPTH: 25
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I�
7. STATIC WATER LEVEL Below Top of Casing: LAO ' FT.
?? (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I •3 J FT. Above Land Surface`
•Top of casing terminated at/or below land surface requires a
variance in aceorday re with ISA NCAC 2C .0I18. —�'
9. YIELD (gpm): METHOD OF TEST I IMED
10. WATER ZONES (depth):
'B7 PLLMP ($STALL&
Amount
Wall Thickness
or N— VeigghhdFt. Material
,tee
I I. DISINFECTION: Type
12. CASING:
Depths Diameter
From 0 To 616 Ft. (O I I M
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To
Material
Ft.00r1cgeTE
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. �in
15. SAND/GRAVEL PACK:
Depth Size Naterial
Method
"Pou2£D
Slot Size Nlatenal
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 1:6(Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(:hi,:k box)
DEPTFI DRILLING LOG
From To Formation Description
W
LOCATION SKETCH "'-7 _
Show direction and distance in miles fronts least -
two State Roads or County Roads. Include the road
numbers and common road names. _— -
FROM HENDEl soNVILDE TAKE"
HWY. I176 S. TO u1°WAKD 'PJAi?
Coss OVER I-20 AND Go I•(S
JV-ILEs To BRICK Hou5E Just
PASS LIVED/ OI2cHARD <PACKWG
►inusE.
I �
L—Salx+3if thewi»Ftt t to t e Division of Water Quaitty, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARD , AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THF/WE OWNER
t
SIGNATURE OF P j;:IN CONSTRUCTING THE WELL / DATE
) 733-3221, within 30 days. OW-1 REV. 07/2001

r-� (,
V 1[ :. 1' !-e-ERTIFY'� HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�t, CONSTRUCTION STAND RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
{ SIGNATURE OF PERSON CONSTRUCTING T E WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001
WELL CONSTRUCTION RECORD 27 2 251
North Carolina - Department of Environment and Natural
l /Resources
�-- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ^(pr.�lnt/)On (L;ThJift(`rary CERTIFICATION # Zee
WELL CONTRACTORCOMPANYNMI SW -Ka- We(( and. lkLtnp PHONE # IpaB)647'%Z6?
871
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential (>3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: I�el2de/Sort
Nearest Town: Hefdersa'1YlIIe County
t�Lu��lxrl Fdrn )S - Lotgri
(Street Name,, Numbers, Community,1Subdivision, Lot No., Zip Code)
3. OWNER: 7i erb .�yoilfield
Address (10 Ili/ I -
6
(Street or Route Ns,)
City or Town State
(&&)- ggi-4400
Zip Code
Area code- Phone number
4. DATE DRILLED 5-03
5. TOTAL DEPTH: 30r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Fd---
7. STATIC WATER LEVEL Below Top of Casing: 30 ' FT.
22 (Use "+" if Above Top of Casing)
8, TOP OF CASING 1S 1- 3D FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordag)v with 15A NCAC 2C .0118.
9. YIELD (gpm): t-t METHOD OF TEST I I Tried
10. WATER ZONES (depth):
23y pump iFsb2U'er
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
Dept47 pp Dia leer or Weight/Ft. Material
From O To l o Ft. t0 % Y) SDQ -I PV CJ
From To Ft.
From To Ft.
13. GROUT: Depth //l1 Material
From 0 To , O Fts.oneree
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 Nlaterial
ASSOCIATED WQ PER -MIT#
Topogra hic/Land setting
DRidge lope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cncck box)
DEPTH DRILLING LOG
From To Formation Description
Method
f r)u.red
From To Ft.
From To Ft.
-u
LOCATION SKETCH —
Show direction and distance in miles from at least
two State Roads or County Roads. Include the: ad
numbers and common road names. lv '
From '4e d er5 ovLv(1(e -Lcdeaci,
ki iv-l-o fithDoWeL(
1-p7B ractiorct "Rood -fa
B ✓LLLt iorck N (l (-$c-Z% #
<actiDrct Carols
Lot -hc
the i-ig,i in4 to tl
6,90Lt6JB TTiouc a t 9

WELL CONSTRUCTION RECORD
272188
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME D RnwrnAn Wel 1 llri 11 I ng Tnr PRONE JIB 2A 257-7779
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential EX Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:HerviynrQonvi 1 aseCounty Henr➢erson
Jerrrd FQtntaa T.ni- #9 28792
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Jim Potter
Address 9 Chelsea Nix Lane
(Street or Route No.)
Hendersonville NC 28792
City or Town State Zip Code
( )-
Area code. Phone number
4 DATE DRILLED 2/ 1 1 / 03
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5.TOTAL DEPTH: 260`
6. DOES WELL REPLACE EXISTING WELL? YES O NO IX
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 6 METHOD OF TEST rotary air
10. WATER ZONES (depth): 200 s , 240
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter
or Weight./Ft. Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From 0 To 70 Ft.b1 /8 Srh 80 PVr
From To Ft.
From To Ft.
IJ. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
.743
1-21
0
16.. REMARKS:
MAY - 7 [.
Submit the original tp the
t—c ' -1 tpr1�I, kC-919) 7
per,: ; G,' GFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2111 /�'z
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
3-3221, within 30 days. OW -I REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtnt) Jeregly H. Bowman'
W ELL CONTRACTOR COMPANY NAME n Rnwman Wp11 nri 11 ingr Tnr
27218?
CERTIFICATION 12 8 0 9
PHONEY 87R 757-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WO PERMITS
(if applicable)
(if applicable)
i. WELL USE (Check Applicable Box): Residential Dit Municipal/Public 0 Industrial 0 Agricultural 0
:Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCAThO
Nearest Town: Flat Rock CountyHenderson
238 Divide Loop, Hendersonville; 28731
(][reel Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER James Hardy
Address 238 Divide Loop
(Street or Route No.)
Flat Rock NC 28731
City or Town Suite Zip Code
)-
Arcacode• Phone number 30 03
;. DATE DRILLED
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fla;
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH. DRILLING LOG
From To Formation Description
5 TOTAL DEPTH: 1 20
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Of
7 STATIC WATER LEVEL Below Top of Casing: 1 0 ' FT.
(Use "+" if Above Top or Cuing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface'
-Top of casing terminated &Uor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9 YIELD (gpm): 60 METHOD OF TEST rotary air
10 WATER ZONES (depth): 80 METIOD
II DISINFECTION: Type tablet Amount 6
12 CASING:
Wall Thickness
Depth Diameter or Weight/Ft, Material
From 0 To 80 FLh1 /8 Srh R0 pvr
From To Ft.
From To
13. GROUT: Depth
From 0 To 20
From To
4 SCREEN: Depth
From To
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.
Ft.
Material Method
N. concrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
I . SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From To
Ft,
16. REMARKS:
ASHEVILI.E 1
Vic' tt-"Alti)
L,'J
the
nr. i919)
,L OFFICE
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
SIGNATURE OP PERSON CONSTRUCTING THE WELL DATE
)IvIsion of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
D3-3221, within 30 days. GW-I REV. 07/2001
Of

272183
13 GROUT:
From 0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman ' CERTIFICATION # 2809
Rnwmnn Well Drilling, Tnr
WELL CONTRACTOR COMPANY NAME D
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
PHONE # 82A 2 5 2 — 7 7 7 9
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential (Y Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL. LOCATION:
NearestTown:Mountain Home County Henderson
412 Sugarloaf Mountain Road 28758
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.CWNER:Billy & Joyce McCraw
Address 412 Sugarloaf Mountain Road
trees or Route No.
Mountain Iisome C 28758
City or Town State Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
)-
Arca code Phone number
4. DATE DRILLED 1 /1 3/04
5.TOTAL DEPTH: inn '
6 DOES WELL REPLACE EXISTING WELL'? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use'+" i( Above Top of Cuing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.O1I$.
9. YIELD (gpm): 2 METHOD OF TEST rotary air
10. WATER ZONES (depth): 220'
n'
I I. DISINFECTION: Type
12. CASING:
tablet
Depth Diameter
From 0 To 27 Ft..81 /8
From To Ft.
From To Ft.
Depth Material Method
To 20 Ft. concrete gravity flow
Amount 6
Wall Thickness
or Weight/Ft. Material
SCh—B.O 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.
16. REMARKS:
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
D i REBY "EATIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
ICHNS\TkUtTIO TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Q SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ig- in- al to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
one Na. [phone], within 30 days. GW•I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiony�(/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) k�nne#h McCrary CERTIFICATION # O�LOO
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PEILMIT#
(if applicable)
1811
274066
PHONE I t0.#1e1191 — ! 210
3
ASSOCIATED WQ PER.MIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential O"—Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N: //
Ngarest Town: efldPflonval ✓° County'krta)P/'SW
6lielRnd pad
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: e-lJ f "i
Address oI0 a-'t- S chapel 1td.
(Street or Rau[ No.)
Fletcher) N� a473z
Ciry or Town St to Zip Code
(tjrO-f15IQ,
Area code- Phone number �3
4. DATE DRILLED ..'
5. TOTAL DEPTH: 30'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casine: 60' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS I.33 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordmict with 15A NCAC 2C .0118.
9. YIELD (gpm): `1' METHOD OF TEST -rim&
10. WATER ZONES (depth):
$y Pwip ivtstauer
Show direction and distance in miles from at least
12. CASING: Wall Thickness
1. DISINFECTION: Type Amount two State Roads or County Roads. Include the road
or Weight'Ft. Material numbers and common road names.
From 94el'tclersonvi Ile. -take SecuEancbut
Topoggrphic/Land setting
❑Ridge WStope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lanrtde/longitude sourze:❑GPS❑Topographic map
(check bon)
DEPTH DRILLING LOG
From To Formation Description
D
-o
Depth is ter
From 0 To ei Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From Q To 20 Ft. e.onCl-e-te.
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.
sokzl INC
uu� 2W * Fletcher.
Method n �on N()Ward Pa_ -tb
Poured a!juLe --r .u�a(- ontl and-
00 l/I o YYIi (e -h garland goad,
tit f Gy1andtoad. LtE Son
ith east 20d- dr�e-
9J O
LOCATION SKETCH
Material
r-I-Br CntcIIP�'
nt CONSTRUCTION STAN
'li
Ju ��
h, uOuPDilp-0hc orrlg)rtp1Flgf±he D
— - 27694-1636 Phone No. [phone], within 30 days.
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 0jjVNER
5-Z/o3
RAY `^— r 1
SIGNATURE OF PERSON CONSTRUCT THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an�d(% at�u(r,�al Resources--"Diivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) iC%24rdille&W r4 CERTIFICJ}ATTIIO/NN GOV/�2
WELL CONTRACTOR COMPANY NAME 3I rKeV Weil and F}jw 1 PHONE R Jpatrll F?'( !'IZ�/
STATE WELL CONSTRUCTION PER.HIT# r
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential IE Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
274065
2. WELL LOCATIQN:
Nearest Town:_
Rnl
ASSOCIATED WQ PER.MITtt
County' Yt(t v
D. -°at-# l2
(Street Na,,NNumbbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: an*,
Address y- �/
^� (Street or Rou No.) <y/ /J
City or own « otate l� Zip Code
dalg>- i78- 4/7s-
R9754
Area code- Phone number
4. DATE DRILLED O -0-3
5. TOTAL DEPTH: / 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: 440' FT.
(Use "-r" if Above Top of Casing)
8. TOP OF CASING IS l• 33 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. �1
9. YIELD (gpm): /0 METHOD OF TEST Juxzd
l0. WW TER ZONES (depth):
II. D SNFECTION: Type Amount
12. CASING: Wall Thickness
Depth.y� Di? eter or WeightTt. aterial
From 0 To_70__ Ft. & �� , I85"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 4n Ft././7/7PAxn-
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O1/4:14EREB VICERTIFY'I
CONSTRUCTION STAND
Topogra ic/Land setting
❑Ridge G]31ope ❑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
CD
r
r' T
CO r-i
I
CJCA Tr_
rx
— —4.
LOCATION SKETCH CO
Show direction and distance in miles from at least`
two State Roads or County Roads. Include the road
numbers and common road names.
�(/�J
Jae -it
xm Lanct ��u,-� e
t, Jag--
tv
ear eii P oad 2
Method Woad �7 4iat o
Qf
aC c t udc��- " r %
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE L S VNER
NATURE 0 PERSON C
HE WELL D TE
SOfriliettie ai sLailaTICAIIC Dis sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
_4�xr , IF, � t22 ), within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment andNatural Resources - Division of Water Quality - Groundwater Section
274062
o CERTIFICATION p t&DIO
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Phard Neerar
u
WELL CONTRACTOR COMPANY NAME �&rrKer ftic-lf and P ✓np
STATE WELL CONSTRUCTION PER.YIIT8 14311 I ASSOCIATED WQ PER)IIT#
(if applicable) (if applicable)
PHONE ft $?/I) 647- /7,o3
1. WELL USE (Check Applicable Box): Residential P3----MunicipaiPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: , Id��
N����r""est Town. flVi Ile. County N
nod gin n�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NelD LZ it, t
Address �j 5-`t
(Street or Route No.) 773
Sai aria , N (�
City ootSown State Zip Code
828)- 'r75- 30b8
Area code- Phone number
4. DATE DRILLED 5-12-03
5. TOTAL DEPTH: I gs r
6. DOES WELL REPLACE EXISTING WELL? YES �❑-r NO
c't
7. STATIC WATER LEVEL Below Top of Casing: O FT.
I. �� (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 accorda99rr��e,,.with 15A NCAC 2C .0118. r•
9. YIELD (gpm): j Q. _ METHOD OF TEST-
?I't7ed
10. WATER ZONES (depth):
By pwne fnstdltatign_
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Topoggra hic/Land setting
DRidge IldSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeilongitude source:❑GPS❑Topoo aphis map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From 0 To 49 Ft. fo 1/9 Svitz PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material A Method
From 0 To QO Ft. Lfooe_re+e. retired
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:
O -
LJ
r
a.�
'-0
3
W T'
0
LOCATION SKETCH a) a
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. I
From- /lenderIle_ e-4a_Ke_
LCS I%+owcLrd- 5oJacta-•
Turn left on /Race-DaiO` Rd.
s c{he_C©het' o Lt.{ ntiI /�RGeodan-fe-
(
rwaj 1 7'n t'
olQris Lan- apt
Lux')£2t cK cao
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL .VN 5
Submit the origi
27699-1636 Phone
GROU"jDwAiEP SF6iIJN
ASHEVILLE REGIGriAL ()SHOE
URE OF PE
CONSTRUCTING THE WELL
CIATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days.
GW-1 REV.07/2001

274060
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - llvision of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL/NAME (print)'JCh AI Qry CERTIFICATION q�10
WELL CONTRACTOR COMPANY NAME!1rKer Well and Pu
STATE WELL CONSTRUCTION PERMIT# d q J ASSOCIATED WQ PERMIT#
(if applicable)
0
(if applicable)
PHONE N f(jp(G) 641"/2++3
1. WELL USE (Check Applicable Box): Residential btunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI IN:: ,/
Nearest Tor end�rse/411e County gendersoft
AQno ferghis bat
(Street Name, Nubs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Vet Ones
Address 1 L{%7'fy!'jn Ct urt
'F 1 at Rock r Route a., 2873!
,,9�//JJQQCiry ocTn ,LNZ5 Zip Code
1110(n)"
Topographic/Land setting
❑Ridge ❑Slope ❑Valley aflat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeilongitude souree:❑GPS❑Tupographie map
(check box)
DEPTH DRILLING LOG
From To Forrnation Description
Area code- Phone number
4. DATE DRILLED Jr q
5. TOTAL DEPTH: �1.�5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ar---
7. STATIC WATER LEVEL Below Top of Casing: 21) FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS ' 03 FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. y--
9. YIELD (gpm): METHOD OF TEST — I I }lied
10. WATER ZONES (depth):
pump installer
1 L DISINFECTION: Type Amount
12. CASING: p Wall Thickness
Depth I I 0 Ft. 1 or or \, l 8 s t. Materiali t
From � To /
From To Ft.
From To Ft.
13. GROUT„,,: Depth
h��
From U To 20
Material
Ft. de»ne.reM
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
CO
7-
LOCATION SKETCH -C = r-�
Show direction and distance in miles fronta3 leat4j;1
two State Roads or County Roads. Include_tbe rd�a l
numbers and common road names. Gn o
Front AlendersonviUt fake -
Upward Road} -Tarn )eft
on Yana k oa-d. 4,ot g- 5 is
On Dana_ R Gad between
01 d Dana. Road and_ &I Wks
Road on -the rl(ht-
.1anct?e. hts-LotIS
v0
r'I .. i. I
L I DO HE
CONSTRUCTION ST
6R�ldktnitFt7['okFyi4i�ta the
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN ROVIDED TO THE \}FELL OWNER
SIGNATURE OF PERSON C NSTRUCTI ' , THE WELL
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
ATE

From_
13. GROUT:
From 0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �
R
WELL CONTRACTOR (INDIVIDUAL) NAME (print)1. CERTIFICAT�ICONN 2r(IA
WELL CONTACTORCOMPANY NAME Enrr�Ker VIP -II 017�1 P PHONE q dZQ /�rIZU^�
STATE WELL CONSTRUCTION PERMIT# 12' ! I ASSOCIATED WQ PERM ITN
(if applicable) (if applicable)
274053
1. WELL USE (Check Applicable Box): Residential ILK-Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N:
Nearest Town: endersemt Ile
( orvis Donne .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sohn W RnhPrtson
fr .13 al_
Address
(Street or Route No.)
��
TVA- R r w1, 0_,
firy or Town State )
Zip Code
Countyjkflo)erS0r)
)- '1— z4*I
Area code- Phone number
4. DATE DRILLED 5-2P - 03
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
7. STATIC WATER LEVEL Below Top of Casing: )0 ' FT. I
(Use "-v" if Above Top of Casing)
8. TOP OF CASING IS 1.33 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordagee with 15A NCAC 2C .0118.
9. YIELD (gpm): `f METHOD OF TEST Ti ll)6'01
10. WATER ZONES (depth):
Pump i nSEaJjQr-
1 t. DISINFECTION: Type
Topogra ic/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
12. CASING:
Depth ry/
From 0 To / 4.2 Ft.
From To Ft.
To Ft.
Diameter
1ol/k
e.0
r'1
r,
C7
Ca)
LOCATION SKETCH CO o
Amount Show direction and distance in miles from at leas
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and cornmon road names.
5bP7) pile.
Depth A Material Method
To'2Q. .Ft.. kattt& Pnlun2d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To
16. REMARKS:
L� fl30 ttEREBYCEltrf
CTGN-STRUC
Ft.
p pGR(4{�1y1�.t,[n��tiAtW tiEigiVQ1Y to the
J�� FYl YIWYY PIr, ,. *,rEFc
� �U
Fror)t ay, erscnv(Lit f(2 to )- Z
+v "Zz5 ConnEcfC(. rum_ 1QFt-
©r_ Ka ti t.e. a On 6,rer(zl
titI I Rbcd. 1rsk ri ht. 0R_
O_ONis Lame. , bend at Znd
lie . C3.O stra-t f LLh wL iv?
{&cnt OF yOU. - -# ii;1 ecrvis Lecne.,
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
,S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I2_-t/t/WAAL' 1' _ ```��'��,
SIGNATURE OF PERSON CONSTRUCTING TH 'ELL - DATE
1 ivision of Water Quality, Groundwater Section, 1636 .Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

274058
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM` (print) 1 - 1I ' 1 ,I C i CERTIFICATION � #finr r/2��7t/rnly^)o(/J
WELL CONTRACTOR COMPANYNAME II � L �� PHONE #)1�`17-rl2o3
STATE WELL CONSTRUCTION PERMIT# 1 J i ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tir NlunicipaLPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATil N:
Ne rest Town: Henderconville County derviemn
ry s Lane
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IJo% l JII0 f Y
Address S l) QI"V
Street or Route No.)
Pnt- Roos Nei 2g731
City or Town S ate._ Zip Code
,2')- Cg2->HI�
Area code. Phone number
4. DATE DRILLED ,5-2 1-03
5. TOTAL DEPTH: 02 0 I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B'
7. STATIC WATER LEVEL Below Top of Casing: II- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. -�
9 YIELD (gpm): C METHOD OF TEST ! IYj M
10. WATER ZONES (depth):
'By pump installer
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To I 0 Ft. 6 I/8 5DKZ) Pdr:
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft._63i'Ie Mir__
Frorn 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
Topoggr hic/Land setting
❑Ridge [FtSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
I atintde/!ongituA.e ssottrce:DGPS❑Tnpogranhic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Method
rims and
Material
From To
From To
16. REMARKS
LSubmit Ihoor+ in �J to Di
2T09'-L63G �`hwie iNP',Net) 733
Ft.
Ft.
CO
Z
1
CJ
Show direction and distance in miles from at Igsto
two State Roads or County Roads. Irwin=themad
numbers and common road names.
From 9Ienderscnvi Ile date I Z—
to 225" (;onnEeEOr. Turn IeR on
&ciact.. Cn fl'JKt qo cthou.+-
IOC -}-o Ge�nryeva,7 N f�(' Read
6-o 30'-'F00' -Ea ecrUis Lane.
TLka a l er& 04 pond .
'O 1 -
LOCATION SKETCH
IITI
't 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
C.f/W1•% -Itit- H't - C / 3 0 / 03
SIGNATURE OF PERSON CONSTRUING THE WELL - DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, nithin 30 days. GW-1 REV. 0'7/2001

274138
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) 1 -' ,/J �� p CERTIFICATION it O 77
WELL CONTRACTOR COMPANY NAME Lt 1LI� IIHLLf�w dee PHONE,/`E /i �!9- ofi8L
STATE WELL CONSTRUCTION PERMIT# 4L ,t'I. ASSOCIATED WQ P lP.RMIIW * /V S /
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential PI Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO CZ! 4 Nearest Town. Jr�Es� df�t-
County
f_�9Lc 1.h (eT,�S?18793
(Street Name, Numbers, Cowmmity, Subdivision, Lot No., Tip Code)
/ran ,E3OyD
3. OWNER: TOSc 70e44CC
Address rft EM yL c s a �s
sattact or Route C. No.)
City or Town State Zip Code
( j'
Area code- Phone number
4. DATE DRILLED /J//
5. TOTAL DEPTH: .29 s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jig
7. STATIC WATER LEVEL Below Top of Casing: ,a b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. S FT. Above Land Surface*
`Top of casing terminated at/or below land unlace requires ■
variance In accordance with 1SA NCAC 2C .0118. •
9. YIELD (gpm): .2 D METHOD OF TESTtec cD
10. WATER ZONES (depth): /4DY'
11. DISINFECTION: Type Amount /D
12. CASING: Wall Thickness
Depth
ter or Weight/Ft
From %% T_31 Ft. OS/1/
To FL
To Ft.
Depth Material
To_,,„1/2_ Ft. t2*n1a4
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
Fro To FL in. in.
15. SAND/GRAVEL PACK
Depth Sine Material
From Ft.
From To Ft.
From
From
13. GROUT:
From D
16. REMARKS:
IDOIHEREBY-10EIt".
( CUNSTRUCIION ST
,e B$l to th GW-1 REV. 07/2001
L ;Hi `276994436PhorieNti4919) 733-3221, within 30 days,.
ir
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimosa/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(eheok box)
aEla DRILLING LOG
From To Formation Description
c
0
w
C a :''
La
LOCATION SKETCH ca `
Show direction and distance in miles frottrat least
two State Roads or County Roads. Include the or ad
numbers and common road names.
.T THIs WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFi i
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
; «/21/03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC

274137
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
B
WELL CONTRACTOR (INDIVIDUAL) NAM (print) I D Al ../1� ' 'o p CERTIFICATION #d D 77
WELL CONTRACTOR COMPANY NAME r1 (1)JLP t✓�%l doff PHONE P�(/ a. oy�
STATE WELL CONSTRUCTION PERMIT# �fT ASSOCIATED WQ PERMIT., . 217
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential UL MunicipailPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI T! 0 `�
Nearest own: County�9.-ed c
d Jf 23
(Seed Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3.OWNER:&-G *tit/jf Zvi
Address# ?SG .s.� eta
.�a�srat or Route �/rr, No.) e28773
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED $7/ D 3-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IV
7. STATIC WATER. LEVEL Below Top of Casing: .ir FT.
(Uae "r" if Above Top of Casing)
8. TOP OF CASING IS 1.�' 1� FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance in accordant with 1SA NCAC 2C .01111.
- OD OF 10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0S1ope ❑Valley NBIF1at
(check appropriate box)
Latitude/longitude of well location
(degreahuimdexkxonds)
Latitude/longitude source:❑GPS❑Topographic map
(ebeck box)
DRILLING LOG
Formation Description
DEPTH
From To
9. YIELD (gpm): METH ESTI: u.t/
eh : 178t a6d
11. DISINFECTION: Type rs '-
12. CASING: ((//
From /7 ToD7i Ft
From To Ft
From To Ft.
13. GROUT: Depth Material 1d� (fhb
From1L To�lL_ Ft. evflare �f M_�.t./
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro o Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From / To Ft.
From To Ft.
Amount 42 O�
Wall Thickness
or Weight/Ft yfptelial
�L
16. REMARKS: -�
1:0:83 t CN S"IANDi
c
C
LOCATION SKETCI-L CJ n
Show direction and distance in miles from leant'
two State Roads or County Roads. Includathe rozd
numbers and common road names.
al)
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
dD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SS; 6tag y1/4 t3
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
S kkbmit the original to thufiivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
276919;1636 Phonne NO+ (9(9) 733-3221, within 30 day GW-1 REV. 07/2001
�. YV

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N unal Resources - Division of Water Quality - Groundwater Section n
WELL CONTRACTOR (INDIVIDUAL) NAMEo(print) ppO/f On/ G ,23 AL n 4.' -�QQ CERTIFICATION #D2 (7(
WELL CONTRACTOR COMPANY NAME £.eala ed-.2 d t L(�/� si/btl1 L &4t PHONE # Wald o9'fl
STATE WELL CONSTRUCTION PERMIT# N A' ASSOCIATED WQ PPERMIT# a` 73 4 J
(if applicable) (if applicable)
2'74134
1. WELL USE (Check Applicable Box): Residential t8 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: •
Nearest Town: J/en Gus n i County
r»geo £srflS tt/3 e2si'79s—
(Street Name, Numbers, Community, Subdivision, Lot No., Tap Code)
3. OWNER.:
Address # tz
(Street or Route No.)
aaLce s, BG iV. e. .1879 7._
fl nr� y-4/Xi!Zip Code
Area cede- Phone amber /
4. DATE DRILLED Y. ✓�
5. TOTAL DEPTH: a .5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®
7. STATIC WATER LEVEL Below Top of Casing: 4Q FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface'
*Top of casing terminated allor below rand surface requires a
variance in aordaa with I5A NCAC 2C .0118.•
9. YIELD (gpm):ee_Q_ MEOD OF TE TL.r. a
10. WATER ZONES (depth): S r 1,2 66
Topographic/Land setting
❑Ridge ❑Slope tdValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslmiwtesfnxonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPT$ DRILLING LOG
From To Formation Description
11. DISINFECTION: Type,ebri
12. CASING:
From a
From
From
13. GROUT:
From 0
From
14. SCREEN: Depth Diameter Slot Size Material
From ......„To Ft in. in.
From / To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
From / To Ft.
Depth,_ ameter
To b Ft.
To Ft.
To Ft.
To Depth."
Ft. each 1<i
Amount
Wall Thickness
or Weight/Ft. serial numbers and common road names.
CO _
To Ft.
16. REMARKS:
FOREPY ct&YAND,
L 4'
Submit the originakte the Divis�on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles . •mat least
two State Roads or County Roads. Inc de the road
rhqc o f3TNTe5
S WELL WAS CONSTRU(.1tD IN ACCORDANCE WITH 15A NCAC 2C, WFJ I
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFT I OWNER
mac 1 D3 aG/C we, 3
ATURE OF PERSON CONSTRUCTING THE WELL DATE

North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COh1 PANY NAME
S'LV I E \C ELL. CONSTRUCTION PERMIT,/
(if applic: blel
WELL CONSTRUC'I'ION RECORD
ce{s - Division o Warr Qua
� 1l 1`1 PHONE a ft* ty Y.i74r,.i
t1�1 �L
PERM(
275764
Groundwater Secliop.03
CERTIFICATION
ur
i
ASSOCIATED WQ
o A
(if applicable)
1. WELL USE (Check Applicable Box): Residential 1L+' Municipal/Public O Industrial 0 Agricultural 0
Monitoring I Recovery 0 Heat Pwnp Water Injection 0 Other O I (Other, List Use_
2. WELL LOCATION1:/1�,
Nearest Tow �Z/bratKt el. County )-(etAc—`
�e�s.5o
f2.-CI C K ,YK d• LiYCoCie
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: l9 417u- int&
Address el t..0 L Llw.. 0y �0...L
(Street orRoute No.) 1 e_m i.. L/
C' Y D`F r
City or Town ' State Zip Code
1
Arco code- Phone number CD a4. DATE DRILLED 5`S `V� L3 -�
5. TOTAL DEPTH: 2 I-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q Q. 1— C1,
7. STATIC WATER LEVEL Below Top of Casing: 00 FT. I
(Use"+" if Above Top of Caving) J 8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top o! casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0119 t( //��
•
9. YIELD (gpm): zo METHOD OF TEST L1 a a4b ?.Sh
Topoggr3Phic/Land setting
❑Ridge @Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/secands)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
10. WATER ZONES (depth): 2- 30
II. DISINFECTION: Type1I b 1tT Amount Z
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Depth
From Q . Too Ft.
From To Ft.
From To Ft.
13. GROUf• Depth /1� Material --tt__ Method
From----- To Ft.0 l.1® rtr4 t Q 1 t__
From _ To Et.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft in. in.
From To Ft in, in.
15 SAND/GRAVEL PACK.
Depth Size Material
From To Ft.
From _lo FL
LOCATION SKETCH --t
Show direction and distance in miles from at least `
two State Roads or County Roads. Include the road
numbers and common road names.
�Fwt� z5
o l d z 5
Cc� bi u._. C-d-
16. REMARKS -- ---
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
$TAT DA\ n D S
ti
r..-, SRfNATLRE OF PERSON CONSTRUCTING THE WELL DATE
Iolj
I;rM4nfThe orlgTiiaTFo iFe lTi+istdb ofWaterQualify, Groundwater Section, 1636 Mail Service Center Raleigh,
2001
C
v It;4}6 Phone No. (919) 733-32 i, a'j+I�lhin 30 days.
II I

275755
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res s - Division o(Watgr Quit - Groundwater Seclio603
YID. K Z
(INDIVIDUAL) NAME (print)
11
` I
/ CERTIFICATION MQ�
\1EL1, C(1N'TRACI'OR( i'
WELL CONTRACToit COMPANY NAME '� • • ( PHONE k ift'ke.= 4+a4V
ST Ai WELL CONSTRUCTION PERMITS ASSOCIATED WQ FERMI
(if applicable) — (if applicable)
I. WELL USE (Check Applicable Box): Residential t!i'/ Municipal!Pubhe 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I; Other, List Use
2. WEI.L LOCATI
Nearest Town' '(40V., CountAARtti
Street Name. Num ers, Com m wm y ubdivision, Lot No.,Ziip Code)
3 OWNER:
Address
c k a--
lOZ
(Street or Routs -No.) Q r
'��SV dy.t Ir-1 d • �J J
City or Town State Zip Code
Area code- Phone number O
4. DATE DRILLED - ZLt
5. TOTAL DEPTH:. r —
6. DOES WELL REPLACE EXISTING WELL? YES,�
t❑^ O PC]'
7. STATIC WATER LEVEL Below Top of Casing: T
T.
(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.011S. /� 1
•
9. YIELD (gpm): 15 METHOD OF TEST .11 C9114ti
nah
10. WATER ZONES (depth):
11. DISINFECTION: Type b)t$ Amount Z
12. CASING: Wall Thickness
or Weight/Ft. Material
n t\ salt
Topoggr3phic/Land setting
❑Ridge MSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude or well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograp hic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Depth Diameter
CV
From ._. To � Ft.
From To Ft.
From To Ft.
i3. GROUT: Depth
From _ To
From To H.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. _ in.
From_ ---To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sire Material
From To Ft.
From __To Ft.
O
c_
c
ter-
Show direction and distance in miles from a(N(Jast t^
two State Roads or County Roads. Include troa �V
numbers and common road names. rn o
LOCATION SKETCH
tqwt,c 't 4-- ►i-
i1w1►(` -d .
Material��((�� Method
FL�Qj►�id�L(. _�0MIX
16. REMARKS: ___
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTvL�FtCI�p$rTA1S1?4�DS, ANDX THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL v
a SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
hitt)the ori nai to the I/ivision P#ater Quality, Groundwater Section, 1636 Mail Service CeClnnnr, Raleigh,
6'Bhiuic o.4.911' 1733z32S3h (Sv it�tin 30 days.
I
tJ r
HCN
i ICE

274619
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) VVt tr4wy2r-( CERTIFICATION # & I3to
d PHONE # (SfZ9 a55-Z(o&*S
WELL CONTRACTOR COMPANY NAME Ckett8 S41.41rA t C I I VOt•7Ae-
STATE WELL CONSTRUCTION PERMIT` ASSOCIATED WQ PERMIT#
(if applicable) I ' (if apFlicable
1. WELL USE (Check Applicable Be::): Residential 6d Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ He-r. Pump Water Injection ❑ Other ❑ If Other, ListUse
2. WELL LOCATION -
Ne
arest Town: '/ead r5 I'll vf)l a County T/eAderncn
a Nic Mead, tJ Lo+ i. 5
(Street Name. Numbers, Community. Subd, ision, Lot No.. Zip Code)
3. OWNER: Ale o/P hi1 it<el-
Address Po Rex aatl
(Street or Route No.)
2/enderaenv,llc NC ,22713
City or Town State Zip Code
( 2k)- tdlN- 3%0S
Area code- Phone number
4. DATE DRILLED 6- ao
5. -TOTAL DEPTH: 18b
6. DOES WELL REPLACEEXISTING WELL? YES ❑ NO FI
7. STATIC WATER LEVEL Below op of Casing: )ao FT.
(U "+" it -Above Top of Casing)
8. TOP OF CASING IS i ET. Above Land Surface*
*Top of casing terminated at/or below Ierd surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST R;
10. WATER ZONES (depth): G
11. DISINFECTION: Type
12. CASING:
Depth
From -VI To gG
From To Ft.
From To Ft.
3
Tdpographic/Land setting
❑Ridge OlSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seceads)
Latitude/longitude source:❑GPS❑Topographic rrap
(check box)
DEPTH DRILLING LOC:
From To Formation Descript on
CO Ole(' ij ecen
s3o
iBs Sr ca."11.e
C_
CD
CD
y fir-.
LOCATION SKETCH
` :13 5 Amount .g Show direction and distance in miles from tNea.;t ic.:'
Wall Thickness two State Roads or County Roads. Include73+e rc�^
Dia:reter or Weight/Ft. Material numbers and common road names.
Ft___._ `l— tt 2( sr;3 ••
13. GROUT: Depth NI aerial Method,
From 0 To ad Ft. e'_mtn+ a�CLrQd
From To Ft
14_ SCREEN: Depth Diamrt,r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Si: e Material
From To Ft.
From To Ft.
16. REMARKS:
c
us
CJl
51- P"'~\ e a
p9 HECLE9Y C'ERT1-Y A
—/ �CONSTRUCTbON STAtj AL
Lbnlir �u€Pt�ttla� �d the 1
00Q 1163 PhGne(N.I(119)7
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND MAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5-ao-o3
SIGNATURE OF PERSON CONSTRUCTING THE 'BELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

274604
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) to c rzCk td. ia.w lecg CERTIFICATION # a'13t
WELL CONTRACTOR COMPANY NAME e►. & Saw>rces Q-�- n WCl 1'y0o+t.1� Tito. PHONE # fStN�j a55-�jj xg'
STATE WELL CONSTRUCTION PERMIT# 0 ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential 6d Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Hea. Pump Water Injection ❑ Other ❑ If Other, ListUse
2. WELL LOCATION:
Nearest Town: F I ttevoi C County
1-tany9Q Forest 1-t'r J!'7
(Street Name, N'umbers, Community. Subdi. ision, Lot No-, Zip Code)
7ie.^aRCto n
3. OWNER: lion t3;relyf••'ela
Address 3.5 ('^e>nFtela. Lane
(Street or Route No.)
f Ie.'rehe,t• AC
City or Town State
c2a!)_ (.aa• qla$
Area code- Phone number
4. DATE DRILLED y' 8
3
o28-f:33
Zip Code
5. TOTAL DEPTH: 506
6. DOES WELL REPLACEEXIST[NG WELL? YES ❑ NO 81
7. STATIC WATER LEVEL Below Top of Casing: 6t FT.
(Us "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 I'T. Above Land Surface'
'Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): aZ METHCD OF TEST
10. WATER ZONES (depth):
To'pogr is/Land setting
❑Ridge Mlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ininutes/seconds)
Latitude/longitude source:❑GPS❑Topographic rrap
(check box)
DEPTH DRILLING LOG
From To Formation Description
4- i -7& oaf 3 etat.N
11. DISINFECTION: Type 1:115
12. CASING:
Depth Diameter
From *VI To —7a... FL_ (D'4I
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a Ft,
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
a1 rias}:C
M Aerial Method
C"men# cAss-
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sizc.
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
G-ra.al+e
O
c_
r
c)
LOCATION SKETCH
0
Show direction and distance in miles front's) least_ r`--.
two State Roads or County Roads. lncludee read
numbers and common road names.
Cl1
W
16.REMARKS:
[t 1 c1Fi HEI}(E{iY
L� CC 1StRuer!C1PJ sr -AN
I r�,
it J)
Submit the original roc the
rI").699-16361Pliorie'/K6(919) 7
ACHE HE F _ --'i_E
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND TEA J A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OFPER90N CONSTRUCTING THE WELL
t_i.B-03
DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 17e tr: CK 7.1. Kc.w tr.?. CERTIFICATION # ay31.0
WELL CONTRACTOR COMPANY WANE eye Sawrcrst 'S G.n HCILz^1tte' PHONE It(Iasia55-Lf-SS
STATE \VELL CONSTRUCTION PERMITt dd ASSOCIATED WQ PERMIT#
(if applicable) - _ (ifapplcable)
1. WELL USE (Check Applicable Bo::): Residential 1W1 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Hea: Pump Water Injection ❑ Other ❑ 1f Other, List,Use
2- WELL LOCATION:( 4
Nearest Town: F)etC`he-� County ge.�1erSriar
Yc rae
(Street Name, Numbers. Community. Subdir ision, Lot Na. Zip Code)
3. OWNER:
Address
• o.cw Q' '(\cat
b4% SUM: t,t R%a°vc Or
(Street or Roe No.) C
iie.na¢rZanvt1%e nc wog 3.
City or Town State Zip Code
( Sat)- VI - gala
Area code- Phone number
4. DATE DRILLED IA- a`k' O
5. TOTAL DEPTH: 3-05
6. DOES WELL REPLACEEXI,STING WELL? YES ❑ NO iJ
7. STATIC WATER LEVEL Below Top of Casing: +}O FT.
(Us "+" if Above Top of Casing)
8. TOP OF CASING IS 1 I T. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpn): too METHCD OF TEST RI
10. WATER ZONES (depth):
274600
2Topographie/Land setting
[ereidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudc of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic crap
(check box)
DEPTH DRILLING LOG
From To Formation -Description
4-% ptef t eea et
Q_ 05 G-reav e_
11. DISINFECTION: Type 1:14S
12. CASING:
Depth Diarretcr
From i% To 3o Ft. (.01:_
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ao
Amount iO
Wall Thickness
or Weight/Ft. Material
. ;I i i c.s+:
M Aerial Method
Ft. C.:.nni nt CwC
From To Ft.
14. SCREEN: Depth Diametir
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
r AD
b c
LOCATION SKETCH C_ ":
Show direction and distance in miles from leas r
two State Roads or County Roads. Include the ro t i2
numbers and common road names. N
--V
a
r�c1c t
ccc
(3-=t7'4S tt Ce.r f
ui
CO
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-ay-ca
GNATURE
PERSON CONSTRUCTING THE WELL
DATE
Submit the original tote Div sion of `Hater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
kl+om-A' ) 733- 221, within 30 days. GW-1 REV. 07/2001
11 tut �'ilOh�
ASuEVILLr 1-1:'

W ELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NADIE (print) tit c c:Clc l'1. 14wy2tot CERTIFICATION# ay3(v
d PHONE # {SfZ9 a55-zo,5*i;
Ooris1R(LCT
WELL CONTRACTOR COMPANY IIAMTE ettle SOi3x+V[<��San ascl "fl 'rote-
sits -
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) E' (ifa dicable
I. WELL USE (Check Applicable Bc;;): Residential 6if Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heir_ Pump Water Injection 0 Other 0 If Other, ListUse
274598
2. WELL LOCATION:
Nearest Town: 1t 1ev -1"42-5- County Z}1214efJ tics
N. M11Rlver +Lae.
(Street Name. Numbers, Community. Subd)ision, Lot No.. Zip Code)
3. OWNER: �t 00'ttkIo.t Mc.M: 1.n
Address aQct ( 45eC ccJ' ^'rl•VQ
(Street or Route No.)
Fieac 1,ec mt. g2132_
City or Town State Zip Code
(%- & fo%-i- OfcCIS
Area code- Phone number
4. DATE DRILLED 5' lto - O3
5. -TOTAL DEPTH: a65
6. DOES WELL REPLACE.EXISTING WELL? YES 0 NO LI
7. STATIC WATER LEVEL Below op of Casing: 'zip FT.
(U ;n "+" if Above Top of Casing) •
8. TOP OF CASING IS i ET. Above Land Surface'
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): `% METHOD OF TEST a
Rt '
10. WATER ZONES (depth):
11. DISINFECTION: Type In S
12. CASING:
Depth Diareter
From '41 To CAC Ft. (till
From To Ft.
From Ft.
13. GROUT:
From 0
To
Depth NI Aerial
To ail Ft. C.t_mena
Amount
Wall Thickness
or Weight/Ft Material
}i Flesttc
From To Ft.
14. SCREEN: Depth Diamct:r
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Si;:e Material
From To Ft.
From To Ft.
Method
�ut.c
Slot Size Material
in.
in.
16. REMARKS:
Tdpog phic/Land setting
DRidge Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic crap
(check box)
DEPTH DRILLING LOG
From To Formation Descript on
_ ioi pie( 3 ecelcv)
alo5 Crre-n1'e
O
za
c
(V
LOCATION SKETCH
Show direction and distance in miles fromM lea d: cs
two State Roads or County Roads. lnclude5e rc
numbers and common road names.
ca.) a
7t
t1S
wt.
f"!wy I ql
I DO HFRFRY CERTIFY THAT THIS WI ILL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
PN`SjfAFF3D�&s AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,,
SIG 1 Al URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
7699 1-636Phnne No. (9119) 733 3221, within 30 days. GW-I REV. 07/2001

13. GROUT:
From 0
From
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
From To
From To
WELL CONSTRUCTION RECORD
274597
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) is-¢ t cu. 7-t % y -rj CERTIFICATION # a43e
d PHONE # (4L9 a 5$ ]Bost
sVELL CONTRACTOR COMPANY NAME et* SzentalS 'S-n Nr 1110E Alp tee'•
STATE WVELI. CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) (ifapplcable)
I. WELL USE (Check Applicable Bo':): Residential bd Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ilea: Pump Water Injection ❑ Other ❑ If Other, List,Use
2. WELL LOCATION:
Nearest Town: '}?egdcrsonw the County 7kk*ders:.,
2,05 ii..fq N P4fs a8,cu
(Street Name, Numbers. Community. Subdi' ision, Lot No., Zip Code)
3. OWNER: Jo''i1N Thancn4
Address (9.C5 'Ntivf 'd F'h^r
(Street or Route No.)
?i¢ndyr$bnvilhe (JC- 02879 9
City or Town State Zip Code
(31 )- Co58 11aio
Area code- Phone number
4. DATE DRILLED ('-30. 03
5. -TOTAL DEPTH: c2E6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 74I
7. STATIC WATER LEVEL Below Top of Casing: I OS FT.
(Us: "+" if Above Top of Casing)
8. TOP OF CASING IS i IT. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC iC .0118.
9. YIELD (gpm): 30 METHCD OF TEST e
10. WATER ZONES (depth): 4
II. DISINFECTION: Type ?:ti5
12. CASING:
Amount 8
Wall Thickness
Depth Diameter or Weight/Ft. Material
From •11 To `it Ft. (kl it Pi rtes%+ C
From To Ft.
From To FL
Depth M Aerial Method
To ad Ft. e-'_mtn* a:.ca.A__
To FL
Depth Diameter
To Ft. in.
To Ft. in.
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
Tdpographic/Land setting
DRidge 1 Slope ❑Valley DFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic rrap
(check box)
DEPTH DRILLING LOG
From To Formation Description
_hi_ 40 oaf Z eeacn
1-Ito a8s
(rin.."21e.
r
o {—
t_ n�
LOCATION SKETCH
Show direction and distance in miles fronciat Iea.ror
two State Roads or County Roads. IncludWhe r
numbers and common road names.
340
C!1
CO
16.REMARKS:
0
fI
ONSTRUCtIOtHEREBY. C4ST) NDRR
Submit the original to the Ihivisic
276p94636 Phone No. (919)'733-322
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
JD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i•3o-o3
ATU' OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I, within 30 days. GW-1 REV. 07/2001

From: Scott Gantt To: Date. 5/8/2003 Tirne: 9:40.14 PM
Page 5 of 5
272791
WELL CONSTRLCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT #
(if applicable)
l WELL USE (Check Applicable Box) : Residential ❑
Recovery ❑ Heat Pump Water Injection ❑
2. WELL. LOCATION:
Recareot town'. BAT CAVE
LOT -9 GRANT MTN ESTATES
ASSOCIATED WQ PERMIT#
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑
Other ❑ If Other, List Use:
County HENDERSON
Sweet Name, Numbers. Community, Subdivision, Lot No,. Zip Code)
3 OWNER HICKORY NUr DEVELOPMENT CORD
ADDRESS POB 276
(Street or Rout< No.)
LAKE LURE
Ciy or Town
828-625-0866
NC
Stale
Area Code - Phone N mnber
4 l)AEl': DRILLED 4/2/03
y. TD I At DE!P 1'l l 220
Zip Code
6. DOES WELL REPLACE EXISTNG WELL? YES ❑ NO 0
T. STATIC \VATER LEVEL Below Top of Casing- 50 FT.
(Usc'+" If Above Top of Casing
8. TOP OF CASINO IS 2 Fr. Above Land Surface*
'Tap otRasLig terminated at'or below Imd surface requires a variance ,n
ow:ord re aid119A NCAC 2C.0118
9 11EinIq1110: METHOD OF TEST ARDM
10. PLATER ZONES (depth): 85
IRSINEECTION: TYPE HYPOCHLORITE Amount 5
C. 1SING:: Wall Thickness
Depth Diwrieler or Weight/Ft. Material
I'rorr. 0 l'0 66 Ft 61/4" SDR 21 PVC
O
Depth Material Method
From 0 To 12 Ft. GRAVEL MIX GRAVITY
11. SC RE
Depth Diameter
Fra;. NA To Ft.
I' SA\D'GRAVEL PACK:
Depth
I5. RP:ALARKS.
Slot Size
in. in
Size
Material
hlaterial
Monitorin,_ ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.27.210 / 82.19.445
(degrees/minutes/seconds)
Latitude/longitude source: ❑X GPS ❑ Topographic map
From
0
DEPTH
To
l2
DRILLING LOG
Formation Description
Clay
12 220 Consolidated Rock
C_
O
"c
a
a
LOCATION SKETCH
Show direction and distance in miles from at least
tevo State Roads or County Roads. Include the road
numbers and common road names.
IlUNTERS TRL
GRANT MTN ESTATES
GRANT MTN RD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IiAS BEEN PROVIDED TO THE WELL OWNER.
4/3/03
SIGNATURE OF PERSON C'ONS'I'R LC TING'1110 WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-163fP1i 4eTNu-(9T9)-73?3229,-within30 days,
GW- 1 RE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ands Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)b,.2SY1
\VEL1. CONTRACTOR COMPANY NAMEAMs%UO
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ces - Division o�/WaterQua�ty
�K.l K�
"s 1
272774
V CERTIFICATION ft ftail
PHONE ft arts�Za
Zl{L
ASSOCIATED \VQ PERMIT>♦J st .
(if applicable)
• S.
- Groundwater Sect�o 03
I. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
?. WELL LOCATION:
Nearest Town:
it IC. Co
(Street Name. Numbers, Community,
3.
��l lttouun��JL`Se IA$•C'i q
Sdbdi t Ni,b.Zip Cod) Z$ l 0
�l C
OWNER: tk5 V+VY+:�C L4'4
Address
.(Street or Routr�'a.)
zA-c Co vu a
J
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ' ZL" on
5. TOTAL DEPTH: t '5
6. DOES WELL REPLACE EXISTING WELL? YES ON O FCY
7. STATIC WATER LEVEL Below Top of Casing.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S ` FT. Above Land Surface*
*Top of casing terminated at/or below land surface OF TES l v4 requires a��
9. YIELD(gpm). 7_ METHOD^Ja tsi rah
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L�Iflat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance In accordance with 15A NCAC 2C .0118.
t
10. WATER ZONES (depth): 7tST_
4( 3 C
11. DISINFECTION: Type tb1�-Amount Z
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Depth
From 0 To /50 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
16. REMARKS:
J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
_
0
cm
Cm
Cc v.-c1/41-sat
en
• m�
N 0
G
Sub the original to the Div
2769 -GI.-Y,,h!115A`$V
ASHEVIL'LF I?F(<
`CTIOR
(JR-ICE
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_z.3-v3
r<URE OF PERSON CONSTRUCTING THE WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REV. Raleigh,
NC
ithin 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and'/Natural tNResources - Division of Water Quality - Groundwater Section
ry�Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (Meth oCrarYy CERTIFICATION k c2a
WELL CONTRACTOR COMPANY NANIE y 30�rker Well amd Purhp
STATE WELL CONSTRUCTION PERMIT/I 1 d ! % ASSOCIATED WQ PERMIT#
(if applicable) (i f applicable)
PHONE tti 2% 64 I -7Zrp3
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: Nearest Town: endlorwnvl IIt✓ County PFderf0l2
y2 Cir /th, !' (Kr /r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:<VArl Tr
LIQ ant
(987/60- 77123
City r own State Zip Code
�t /)- ��h— 9755
Area code- Phone number
4. DATE DRILLED 4/ 2ij 03
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO F(�
7. STATIC WATER LEVEL Below Top of Casing: /0 ( FT.
(Use "*" i f Above Top of Casing)
8. TOP OF CASING IS 1•� FT. Above Land Surface'
*Top or casing terminated at/or below land surface requires a
variance in accorda e uh ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST ! l#'idecL
10. WATER ZONES (depth):
X� pump installer_
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
�Depth�n ia�1 ter or Weight/Ft. phJp(erial
From To ``7T� F[. ��21 //�lG
From To Ft.
From To Ft.
13. Method
Address
egiithn
(Street • Qoute No.)
5. TOTAL DEPTH: / 0
GROU Depth n Material
From 0 To Q_ Ft.42i2t l'l0tt Paired
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
lfj: REMARKS:
272653
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lairude!lopgitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
o
W
cn
O
Y
.,al
En .�.
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
Front r1�zdersorrvfl(e ZaXe /4' E
- Nocoa_rd Cato Zooid .Take a -
left on_ `Brookside d2rxy Ed.
1st scree& On_ left /s darolina--
. Trooerfy is On-the-
r5h•t. 1-4-2_ 1s On the 6-0K
I DO HEREBY CERThII,
CONSTRUCTION STAI
.T TFIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5.A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
)2.—Q/1/1/3/4.A.L‘— 77/71 ? C
i)-0?
SIGNATURE OF PERSON CONSTRUCTING THE WICL DATE
�� .Snhdik the dri lii Lit Eo the Division of Water Quality, Groundwater Section, t636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], itithin 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)PichardMe Cray CERTIFICATION /N}r--�C( �/-�/�
(( PHONE N gonb-r r-72 3
WELL CONTRACTOR COMPANY NAME Barker Well and P /p
STATE WELL CONSTRUCTION PER:MITN 1 O' l 1 ASSOCIATED WQ PERM ITN
(if applicable) (if applicable)
2'72603
I. WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: �I
Barest Town:ffroIersonvilit County `llefderson
bean
ounfaun - kot # 18
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 5(Y7l BC1 Wfe
Address 10h 51 j4 W 22nd Street 1.
(Street or Route No.)
Pembroke nioes FL 33026
City or Town State Zip Code
(954)- 950- 096E
Area code- Phone number
4. DATE DRILLED If ZCI -03
5. TOTAL DEPTH: 6057
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ete
7. STATIC WATER LEVEL Below Top of Casing: I q0 ET.
2 (Use "+" if Above Top of Casing)
S. TOP OF CASING IS I '3l FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): 10 METHOD OF TESTTIrned
10. WATER ZONES (depth):
$y pump instewer
it. DISINFECTION: Type
12. CASING:
Depthat Diameter
From 0 To 021 r Ft.I(i__ SDQ2I __PAC_
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To .20'_ Ft.t-,qqo()[1J'C '2-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Amount
Wall Thickness
or Weight'Ft. Material
n- leethod
Toured_
Slot Size Material
in.
in.
Size Material
DEPTH
From To
/Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
scare r::DCPSDTopographic map
(check box)
DRILLING LOG
Formation Description
-
C
1 (.13
G11 �r
�.r)
L-
LOCATION SKETCH -tom-Io
Show direction and distance in miles fromleas=
two State Roads or County Roads. Includeet'tl rolg=
numbers and conunon road names.
Prom fleadersonv i 1/�e {a.ke'''
'Coact -fa Walnut Nye_ toad. �Rre
a Y I ht -to Bear �ock•A un.�-ain.
-prate_ Q Iek On itatin cehe/kt)unlzzir--
oad . Lot ft f8
T.D0--FIEREHY CEItTW X
I LUNS(RUC I TUNS IANL.I
LL',
trait ile oFlC4m 1T J�p the Di
27699-16361'!iotleiNiiF(t9) 733
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONS;
TING THE WELL.
'DATE
G�
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalResources//- Division of Water Quality - Groundwater Section
�y�
WELL CONTRACTOR (INDIVIDUAL) NAME 2 (print) Kennet{2 /Nit Crary CERTIFICATION /glr�l/Ai1
WELL CONTRACTOR COMPANY NAME BorCIeer WPJI and Ain? f PHONE k .5)b7/-%�
STATE WELL CONSTRUCTION PERMIT# I Q / ! ASSOCIATED WQ PEILVITrt
(if applicable) (if applicable)
2'60JI-
I. WELL USE (Check Applicable Box): Residential Municipai Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATI N: 11��
Nrest Town: de.rsonvIIIE County) epn'Przzn
e°ses I/iQO—
(Street Name, Numbers, Coinmuniry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
Wend-entry/Ile, NG
City or Town State
(2a)- &qa-ba l i
Area code- Phone number
4. DATE DRILLED l-2 1 -03
5. TOTAL DEPTH: i05r
6. DOES WELL REPLACE EXISTING WELL? YES O NO l
7. STATIC WATER LEVEL Below Top of Casing: HOC r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ) • 33 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accorda ce with 15A NCAC 2C .0118. -�•
9. YIELD (gpm): METHOD OF TEST ! 1{Y1edi
10. WATER ZONES (depth):
3y p(u7tpiastsder
1I. DISINFECTION: Type
12. CASING:
2fgl
Zip Code
Topogra IC/Land setting
❑Ridge lope ❑Valley DElat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Depth Dia eter
From a To_5Q_ Ft. ti'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To ZD Ft. ((orie..rett
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. In.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
Front Alendersonvitle e biftW.
-C
0
c
r-
CJI
or \Veight/Ft. Material
5D)22 I love,
Take Q IefL Gi.t Dan
rOh-t at is J unL iR-
Turn
Turn ri ht at TBr`yhtwa
Turn lefk a-t 15tarvieW }a Is+
lot On the r5ht.
Method
Poured
I� v u
Je-{{ER£B-Y CC
If/INSTRUCTION STANDAf? I .�
ROl i'ft"!N'ER C 10 frisio
35Ttote a.
LOCATION SKETCH
Show direction and distance in miles frorfat least
two State Roads or County Roads. Inclu the read
numbers and common road names.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
SIG A' URE OF PERSON CONSTRUCTING TH WELL DATE —
of Water Quality, Groundwater Section, 1636 Mail Service CGWrI Raleigh,REV. hNC
01
, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and $rural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAMEf(print)—
WELL CONTRACTOR COMPANY NAMESoifer
STATE WELL CONSTRUCTION PERMIT# /87/
(if applicable)
272601
Division of Water Quality - Groundwater Sectio�n/�)
fart/ CERTIFIQCA�T�IjON/#/)K/JL�t//�
PHONE #gag- 77( /
ASSOCIATED WQ PEILMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ET-1—VI un ic ip a UPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT ON: �enderSCYl
Npares�t/Town'/ 1.. ersomi /I& County
` (t2iX nn 'Odd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Tehorah7Aeo doss/s
Address 't5 ree yr%tie_
(Scree r Rout No)
,4rden 28 J0Y-
Zip Code
Area code- Phone number
4. DATE DRILLED — ".
5. TOTAL DEPTH: 5
6. DOES WELL REPLACE EXISTING WELL? YES NO gr
7. STATIC WATER LEVEL Below Top of Casing: L FT.
(Use se "t" if Above Top of Casing)
8. TOP OF CASING IS 1,33 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accord�. ce�nh ISA NCAC 2C .0118. �'Me
9. YIELD (gpm): �
--F-� METHOD OF TEST l /d7I
10. WATER ZONES (depth):
Bunxo ins/oilier
I. DISINFECTION: Type
12. CASING:
FromDepth Dia,7�{ ter
___ To Ft. �0
From To Ft.
Topogrwhic/Land setting
DRidge Hope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
LatituuSiongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O
C.
a
1
(J1
(1,
cti r .
0
LOCATION SKETCH CJI
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. latenal numbers and common road names
(ez �v
s�
From To Ft.
13. GRO T: Depth Material �N/Methhod
From To_p(2.__ Ft eore vfe-
(Y
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
To Ft.
From
From
To Ft.
�I n
r"OONSTRUCTION STANDAR
L'ci
Material
rant nyi fie_ -lake ill
-rant /66 onoNoulard acp Rd.
-rate a_ riot on Zeh dem.
L'll°ar L'reet &t. and- a
rw1th-ran GA_
(Alan Pood. Will b - -/,t-
lo c drive (Ott the r ht.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D TH[ATA COPY OF THIS
P.ECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIINATURE OF PERSON CONSTRUCTINiI THE WELL. DATE
visir n of Water Quality, Groundwater Section, 1636 hail Service Center- Raleigh, NC
I, xi Rhin 30 days. GW-1 REV. 07/2(101

opographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:LA/PSD l opographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
O
W n
C11
LOCATION SKETCH 4- n-t
Show direction and distance in miles fffi at East
two State Roads or County Roads. Include tha oad
numbers and common road names.
Prom Nendersonv i I ►P -ake Kan a-
1 .oad-t-o Crab ereek•toole a- rr9kid
Method 0±3ui(Inj Creek..Take a te.c+-a4--
foured YIrs± I&.ersPrkion arour aL kouse —
wateh -or rt hL -1-urn On Underwood.
Volt ow grav�I road 5t.rcti
d kb
aheaand--Mien 1eOE 4rxturrtoin
Jordan Mountain Esta-La tact he
T THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A 2CT CSF TH!S RECORD HAS BEEN PROVIDED T.'-SE WEJL OWNER
•
D3
SIGN: TURE OF PE L SON C Sr!&UCTING THE WELL
From 0
From
From
13. GROUT:
From 0
From To Ft.
14. SCREEN:
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
To
To
272A)00
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�jj(print) 1\ 1 chard Ale era ry CERTIFICATION ft 2DIC
WELL CONTRACTOR COMPANY NAMET.J orKer WeI I and R.(mp
STATE WELL CONSTRUCTION PERAMIT/I 1 O I I ASSOCIATED WQ PEILNIT0
(if applicable) (if applicable)
PHONE W gA C41- I Z
1. WELL USE (Check Applicable Box): Residential IK-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIIN:
Nearest Town
6 County F1endelson
h c
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. 0WNER u1 _lender t __
Address j� ( reccen-t if FOad
(Street or Route No.)
Co n Stakinn , VA I'772R
N n)-City o Tawp — Z�ta3 Zip Code
(O
Area code- Phone number 1'
4. DATE DRILLED 4_4 --03
5. TOTAL DEPTH: Cons' z
6. DOES WELL REPLACE EXISTING WELL? YES 0 N0. Q'
7. STATIC WATER LEVEL Below Top of Casing: 320' FT.
gg (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I ' a3 FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires a
variance In accord. c�e with ISA NCAC 2C .0118. 9. YIELD (gpm): 0�11 METHOD OF TEST-Fr/led
10. WATER ZONES (depth):
By pump i nst'zI ter
1l. DISINFECTION: Type Amount
12. CASING: \Va!I Thickness
Dept or Weight/Ft. Material
To 5D/2.2-( PVG_
To
To
.Dianieler
Ft. X
Ft.
Ft.
Depth Material
To 7.0 Ft.e.nncrete,
Depth Diameter
in.
in.
Slot Size Material
in.
In.
Size Material
From Ft.
From Ft.
I- -4ae 11EREDY eER?tFI
CONSTRUCTION STAN
L Sqb ii gaig theoe&Foit the n ivision of Water Quality, Cr s ound: ter Seciion, 1636 Dlail Service Center - Raleigh, NC
�� 1,_..
tone o. (919) 733-3?2 i, Ir ithin 30 dad-s. GR'-1 REV. 07'200!
ATE

L
272599
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resources - Division of Water Quality - Groundwater Section
/��/�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) chord
7AJUP ary CERTIFICATION
pppC lrr/it/
WELL CONTRACTOR COMPANY NAME Orker We II Qnd f.imp PHONE #y1e(e)WO'/263
STATE WELL CONSTRUCTION PERMIT# tZI'`I ASSOCIATED WQ PER.VIT#
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT ON:
earestzown: or1dersonu'I
ear Kock *KM(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 'f'.
n n (Stree) or_Route No )
County 7tl ersok
of0 ,`lit
�� pCiry 0 ot
Tgwn 1[ te& Zip Code
gat 5 f„I.
Area code- Phone number ��nn22
4. DATE DRILLED I W
5. TOTAL DEPTH: 55 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12'
7. STATIC WATER LEVEL Below Top of Casing: 020 r FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS I.33 FT. Above Land Surface*
*Top of casing terminated at/ur below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): r90 METHOD OF TEST —Timed
10. WATER ZONES (depth):
33y puny) Instatter
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth �Diameter or Weight/Ft. Material
From 0 To rx I Ft. 1)/3 SDI2,21
From To Ft.
From To Ft.
13. GROU Depth
From To ,0,0
From To
14. SCREEN: De
From To
From To
Ft.Q((JJ Material
(l er e
Ft.
Topogr3phic/Land setting
❑Ridge IdStope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude scurce:❑GPS❑Topographic trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
1IM/1eGt/{,��jy�`d
pth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size
F t.
Ft.
Material
w
CJ1
'ci m�
rn
CI 7 f' rl�
r =i
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Front MenciersonviUa lnee IC a
V-oad. 1aYe a 1€ft on (china Co` c
Foust. Takes a_ right On_ dear (�fx;k
-to o`Ie$L Oft `Rent/mgeree1.
Inin et j ats y +-Wn trn on dirt
root. Neer lef4- cd "Y' Cal road -
Lot is on -the beet.
Bear RocL ✓if{_ou,tfs n Cs-tth's
Lot E4z
L�CIiHEK:�BI�iC�,R'TIQ'rP
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A CO f Y OF THIS RECORD FL S BEEN PROyflSED TO TFIFy WELL C9IVNER
LSuUl7Tl{ th4Ft f igf
h �d76BB-'?63b I (ePtfllu,
SIGN
URE OF PERSON CONSTRUCT1NC -IE WELL / DATE
it Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733 3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envir mment and Natural Resources - Division of Water Quality - Groundwater Sectior
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Vtsc-] Ctc i4- Sa.Wy4+'% CERTIFICATION# a43to
WELL CONTRACTOR COMPANY NAME C. Wt.,'" 4 A .>rc• PHONE # (z9 Sfa SS - ifnis
STATE WELL CONSTRUCTION PERMIT = ASSOCIATlIEL' WQ PERMIT#
(if applicable) ' ' (ifaqdicable
I. WELL USE (Check Applicable Bc ii): Residential 14 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 He r: Pump Water Injection 0 Other 0 I f Other, List,Use
2. WELL LOCATION:
Nearest Town: gnat.. County lie>Iciecscn
penny\uc.'•,m Ave. Lot it r-1
(Street Name. Nu4bbers, Community. Subd 'ision, Lot No.. Zip Code)
3. OWNER: Cc-c {Auk" cdvv..And}.:h
Address d5 f)i-
(Street or Route No.)
flt•dzr .vc aR14:74
City or Town State Zip Code
(t•aaV%
Area code- Phone number
4. DATE DRILLED L'tr-c:3
5.--TOTAL DEPTH: at5
6. DOES WELL REPLACF, FXI,STII IG WELL? YES 0 NO IA
7. STATIC WATER LEVEL Below' -op of Casing: 3 0 FT.
(U >: "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below lord surface requires a
variance in accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): ti METH' )D OF TEST R'e
10. WATER ZONES (depth):
276091
Tcfpographic/Land setting
[Midge ®Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
■-
(degrees/minutes/se:cads)
Latitud.:/longitude source:❑GPS❑Topographic rrap
(check box)
DEPTH DRILLING LOU
From To Formation Descripllen
yR G�€ec t5 eta en
L\g w8:7 (r Ce.es]te
1I. DISINFECTION: Type • :iI'S Amount %
12. CASING: Wall Thickness
Depth Dia. refer or Weight/Ft. Material
From i % To 4$ Ft.__tQ _i # .21 le:NiF C.
T
From To Ft.
From To Ft.
13. GROUT: Depth Dlaerial Method
From 0 To ao Ft. C._fnent cuC41-4:1
From To Ft.
14. SCREEN: Depth Diamt t tr Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Si: c. Material
From To Ft.
From To Ft.
16.REMARKS:
1'DO).,-IEREB•! CERTIFY 11.
j-
LOCATION SKETCH
Show c irection and distance in miles from at lea ;t
two Ste to Roads or County Roads. Include the/read
numbers and common road narres. o
w
C
CD
rn
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND T -IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
--
SIGNATURE OF PE
ON CbNSTRUCTING THE WELL DATE
Submit the ofiginnl to -the Dilision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 PNonq`Na;t919) 73313221, w thin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirohr tent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAMI (print) D¢fPtQK liQaA'ti �QKt__¢rg CERTIFICATION# a4'1f0
WELL CONTRACTOR COMPANY NAME CA.S1,4 54w,t.Cta Son klelvax' ?tin* 71nC PHONE # ( $ (o S 2_1_
STATE WELL CONSTRUCTION PERMIT# _" ' ASSOCIATED WQ PERMIT#
(if applicable) (if applictblc)
1. WELL USE (Check Applicable Box) Residential l8 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat I ump Water Injection 0 Other ❑ If ether, List Use
2- WELL LOCATION:
Nearest Town: C\C a Zn
County 74 eider Son
eennSyiv amid. live_ acne Li
(Street Name, Numbers. Community. Subdivis m, Lot No., Zip Code)
3. OWNER: eat crks. l ECLAnciS�•i
Address r,5 X.eitt, .Me,-.,e: g, 1, (".VQ
(Street or Route No.)
ta�den uc
City or Town State
(?,2 S)- 89 1 aria
Area code- Phone number
4. DATE DRILLED fo`to- O 3
5. TOTAL DEPTH: c28S
6. DOES WELL REPLACE EXISTING
7. STATIC WATER LEVEL -Below To)
(Use'
8. TOP OF CASING IS t FT
*Top of casing terminated at/or below land
variance in accordance with I5A NCAC 2C
9. YIELD (pm): 1 ME : HOL
10. WATER ZONES (depth):
Zip Code
WELL? YES 0 NO
of Casing: 50 FT.
e" if Above Top of Casing)
. Above Land Surface*
surface requires a
.2Q118.
OF TEST R e
276082
Topographic/Land setting
❑Ridge Slope ❑VaIL=y ❑Flat
(check appropriate bor.)
Latitude/longitude of welt location
(degrees/minutes/secon Is)
Latitude/longitude source: ❑GPS❑ T opographic mr f
(check bo c)
DEPTH DRILLING LOG
From To Fomtution Description
i-A 'Ica 4.4
Oyes We -don
:o ag (scot':tC
I1, DISINFECTION: Type e m
12. CASING:
Depth Diame'::r
From 't'i To 41 cd Ft. foil:
From To Ft.
From To Ft
13. GROUT: Depth
From O To 2O Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. n.
From To Ft. -a.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount to
Wall Thickness
or Wcieht/Ft. Material
t3zt ?It+r4
Mat tial
CQ-nnn+
16. REMARKS:
Do-HER',EBjY 6 RTI Y T
CON5TI<UCTi6.NST7CNl).
J1
C,'>,,ee!x; K+ftwl@ifim h
L i 2709943 63611"110ith. N'A1-49T9) 73
eD
Method
Po,,.caa
Slot Size Material
in.
in.
Material
LOCATION SKETC4
Show direction and distance in miles from a.Least
two State Roads or County Roads. Include the roae -_
numbers end common road names
L ---
0
01
THIS WELI WAS CONSTRUCTED IN ACCORDANCI WITH 15A NCAC 2C, WELL
, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN T I .E OF PERSON 60NSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3221, with -n 30 days. GW-I REV. 07/2001
:n St

WELL CONSTRUCTION RECORD 276081
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grouhdwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) OQeO iC IC 's-ktaiarrlis 50.A�Qt`j
WELL CONTRACTOR COMPANY NAME CAltliR Sat -Wet a bon Np
el\t-um� p TnC PHONE # ($ to6'S'o102Z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # a43fo
I. WELL USE (Check Applicable Box): Residential IN Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town: (1e&t-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: e css
County-1-1¢ndtr3;,•,
r%-F Ay 1 fi1
Address (cfl t- -p 1 cu.*K
(Street or Route No.)
ficaen nc
0187CL1
City or Town Slate Zip Code
( )-
Area code- Phone number
4. DATE DRILLED (o-9c3
5. TOTAL DEPTH: a85
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: rLa FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C . 118.
9. YIELD (gpm): 20 METHOD OF TEST
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at lUeast
two State Roads or County Roads. Include tl%&road'
numbers and common road names.
Topographic/Land setting
DRidge °Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m in Wes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomiation Description
}\
a 10
Ove. %.doek
Q(.0 ;o a_85 Cca.n:re.
R. 51.
11. DISINFECTION: Type Q:NS
12. CASING:
Depth
From t'i To 2(o Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Q0 Ft. CC.90.41+ Po.�caa
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diameter
� 4
Amount c
Wall Thickness
or Weight/Ft. Material
rk2k 1>1451—
Cr>
-r
O
01
16. REMARKS:
11 I DO HEREBY CERTIFY (t
n COwc-rttu LION STANQ*
(
--Submit-the ornal top the 1
L
27099 1636 Phone Nti:J(9I9) 7
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
111.0.4i 2ct..- JR)S t l a 1 9 1 a3
SIGNATURE OF PE'&SON`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

IJ
276069
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /`/Zt_La°k S J// In CERTIFICATION wrr,,`'/ 7I
WELL CONTRACTOR COMPANY NAME CTrO,* rl RINDP \NQ Il S PLAI \P (n PHONE M f027) c, er -1200
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT Cs' S & a
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ct 'MunicipaVPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FiLlit (,L-F:x n u 1 t �e-
0f T 25s
County-h61X-
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: I�W Ct d TiI(
Address Two f3 O K 3 I
,QCFL (Street orRowa�e )78
r\ G
City or Town State .Zip Code
('a28)- L'9 c . cl35
Arca code- Phone number
4. DATE DRILLED /-/`i'O.3
5. TOTAL DEPTH: / G }
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a--
7. STATIC WATER LEVEL Below Top of Casing: 3 0 ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
*Top of cuing terminated odor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '--/ METHOD OF TEST 4,
10. WATER ZONES (depth): /00
11. DISINFECTION: Type /-/ 1 N Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To �i /? Ft. i dj, 2ZC Pic -
From ,30 To 3 J Ft. 1 y 21,4 PVC_
From To Ft.
13. GROUT: Depth Material Method
From 0 To 2 0 Ft. b "/kffo-n'Y /%i; F lG1100/2,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Frog, To Ftin. in.
15- SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge B31ope ❑Valley ❑Flat
(check appropriate box)
Lat_ityde.lonjitu e of well location
�5'l/ A3#O$l°
(degrccs/minutcs/ nds)
Latitude longitude source:C$GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D 0
- tc awal
471 - / C 3— /3 n-w; h=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include thejoad
numbers and common road names.
0
16. REM/ARKS:
-IDO IR-REBY-MO
CONSTRUCTION 8 -
L.
Submit the original to
L__ -_ 2.7_699-1636-Phone.No. (9
THAT THIS WELL WAS CONSTRUL 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS. ANA'IFHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i -/s--c73
SIGNATURE OF PERSON CONSTRUL I ING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001
8 E`

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUALYNAME (print) Je reply H. Bowman' - CERTIFICATION S 2809
WELL CONTRACTOR COMPANY NAME D Bowman We11 nri 11 inr7 Tnr PHONE ti 87A 257-7779
STATE \VELL CONSTRUCTION PERMITS ASSOCIATED WI? PERMIT/
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Gerton County Hender,_on
Stoneridge Estates Lot #43
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code)
3. OWNER:
Address
Calvin M. Cornf rth
2537 CJRub Drive
Strect or oute No,
Aiken 0 SC
City or Town State
Submit the original
27699-1636 Phone No
Zip Code
( Area code Phone number
4. DATE DRILLED '/10/09
5. TOTAL DEPTH' S60'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
7. STATIC WATER LEVEL Below Top of Casing: 100 FL
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C ,OIlL
9. YIELD(gpm): 4 METHOD OFTEST`.Dotary air
10. WATER ZONES (depth): 260' 340'
480'
I . DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 51 Ft.F1 J8 Sch_E0 DVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter
From To Ft, in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
29803
276012
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) H
DEPTH DRILLING LOG
From To Formation Description
Material Method
Slot Sizc Material
in,
in.
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.
Po
o
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rnatcrn Irn ir,i ��-. a.......5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I f0/63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
(919)i733-3221, within 30 days. GW-I REV. 07/2001
Gn0UP1S''.,:N.S_ER SECTION
ASr:FVfi.F REGiD!".AL OFFICE