Ja 2 CY2003

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resoufpes - Division of Water Quality - Groundwater Section p
\\ ELL CONTRACTOR (INDIVIDUAL) NAME MIA
, ityr-4I el a�l1t CERTIFICATION #aC.S- 7Y�C�-
\VELI.CO..\TR,\CTOR COMPANY N AME MIA (-Ne en e
R OI! Y/� PHONE # Vic 5 Ov/ -v`�'� v
SLATE \\ ELL CONSTRUCTION PERMIT#
(if applicable)
277476
ASSOCIATED \VQ PERSIIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residentiali Municipal/Public ❑ Industrial 0 Agricultural 0
NIonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. \VEIL LOCATION: / ...LLL��� G Topooraphic'Land setting
Nearest Town: h �C/et-County:1 k(€5� ❑Ridge lope ❑Valley DFlat
(amenol�n Co J
/�v �' % (check appropriate box)
Lot No-, cod atiutde/longitude of well location
(Strew Name, Numbers, Community, Sethi -division, Zip
2
3. OWNERi/ /)l -�1�'�
Address �Q l5
(Street or ale No.) i 3 !/ 3
City or' / q �tate5 2 7 Zip Code
�G
rea co )- �L� ../ /
Arrc�al code- Phone number
4. DATE DRILLED W - S - 19-�
5. TOTAL DEPTH: 3�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4S METHQDOFT,EST A -I
10. WATER ZONES (depth): //
Q Q.5 (4/0
II. DISINFECTION: Type -)-"T/-� Am unt /3, 5
P. CASING: Wall Thickness
Depth Diameter or Weis ht'Ft.
-5Dr�`2/
From
From
From
13. GROUT:
From C
From
14. SCREEN:
From
From
To
Depth
To Ft.
To Et.
Depth Diameter
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
O To .27 Ft. % tit-(
To Ft.
Ft.
al
From
From
I6. REMARKS:
N tv-
Nlethod
Slot Size Material
in.
in.
latertal
(degreei'ntinuteiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
F: •
LOCATION SKETCH ___:
Show direction and distance in miles froulat least-
vo State Roads or County Roads. Include the ra£id.i
numbers and common road names.
/Oh e//le G
et
cI o1 7
IV
rs
co
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TF 0' P HAS BEEN PROVIDED TO THE WELL OWN
ER
SIGNATURE OF PER
ON CONSTR
CTING THE WELL
DATE
Submit the original to the Division of Water Quality, Ground c l
27699-1636 Phone No, [phone], within 30 days. I
J L
'Fh
edtxon 96331 1 SQtivicfr ealeieh, NC
kEV. 07/2001
I: I;

City or Town State (J Zip Code
($)- ccrat — 0009,,cy iz. O?tW3--
Area code- Phone number
4. DATE DRILLED to-3-03
5. TOTAL DEPTH: r-}
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: aci FT.
(Use..+" if Above Top of Casing)
S. 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 .011S.
9. YIELD (gpm): 2.0 METHOD OF TEST cat,
10. WATER ZONES (depth): 07/5 a (/2
c2"S0 ac) Lf20t c/Xi
11. DISINFECTION: Type h-r/7" Amount r�0,G�,
12. CASING: Wall Thickness
Depth [� Diam�e/ter or Weieht'R lar}nal
From 0 To oZ I Ft. 'YLf SDA'Li
From To Ft
From To Ft
13. GROUT: Depth Material Method
From 0 To Ft. es,% ..3-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
G
From To
From To
15. SAND/GRAVEL PACK
Depth Size.
From To Ft.
From To Ft.
Ft in.
Et. in. in.
16. RENIARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesy�- Division�of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) V I en n r t r I vi/ 14 £
\\ELL CONTl2: ACTOR COMPANY N,ANIE A�1'ii'. - -.€.- , 5-4-o7 Wed
L1_f7
277475
- Groundwater Section�l
CERTIFICATION # rXSJn
7
PHONE # (� JZ 'SSSo
sr. -\Tr: WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(ifapplicable)
plicable)
I. WELL USE (Check Applicable Box): Residential Ptir Municipal/Public 0 Industrial 0 Agricultural 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: II
Nearest Town: Sy4!//)-1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cod,
Topographic/Land setting
County _ ❑Ridge ir3SIope ❑Valley ❑Flat
_ - (check appropriate box)
rl77? Latitude/loneitudcof well location
3. OWNER + a-Q-di Cyr (PQ,tYYN---P (deerees.ntinutes/seconds)
Address 16 1 N (3 1..4a.PAti.1=o1 2 ta,E,_2 /.7)7Latitude/longitude source:❑GPSOTopographic map
reet or Route No.) /y, .1 (check box)
/(,e DEPTH DRILLING LOG
From To Formation Description
- e2Y
}{ �/
a/5- -c /7
02/7- 73a
a3o - 0232-
0232 4iZD
`z,20 - 4'29-,
S15-0
LOCATION SKETCH
Show direction and distance in miles from at IEalt
two State Roads or County Roads. Include thead
numbers and common road names. e7
El
= _.
aN rwrtt ,
ea*);
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
—
Submit the original to the Division of Water Quality, Ground\vat�r� Se's:JO* , Ii5.316 11h9i1 Sea We Center eigh, NC
t
27699-1636 Phone No. [phone], within 30 days. �k,' -- �� V. 07/2001
j

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\" ELL CONTIt:\CTOR (INDIVIDUAL) NAME (print) Ai_ kr-lin Math As CERTIFICATIONATy#CQc 77
\VELL CONTRACTOR CO\IPAN\'NA\!E/En-\T�'eCRef; ef; • I AMU (/rlii PHONE # (tar SL�6-
55-6-5
STATE WELL CONSTRUCTION PER\IIT#
277474
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Nlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IC Other, List Use
2. \VELL LOCATION: /
Nearest Town: S (013-- County e�-C1i:SU_
n
(Street Name, Numbers, ColMnun ay, Subdivision. Lot No.. Zip Code
3. OWNER:,.3rtClk `Sre-ZYtS /R4)
Address (6,, (i Gn er-S Lcd0 v✓
(Street or Route No.)
L o r'C as'7-z 9
�//�N{.(Cppin or own Zip Code
Area code- Phone number
4. DATE DRILLED 5-341' ` D
5. TOTAL DEPTH: ca6-J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: / d FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing tennis a tcd at/or below land surface requires a
variance in accordance with I5 A NCAC 2C .0118.
9. YIELD (gpm): Q 5— METHOD OF TEST Et/ 1"
10. \VATER ZONES (depth): / I S. S)
/✓zr(/,rt)
1 I. DISINFECTION: Type NY( F-i Amo mt
12. CASING: Wall Thickness
Depth Diameter or W'ei �l�I t/Ft. Material
From fJ To 3/ Ft. (, I/t/ , ) -57ee i
From To Ft.
From To Ft.
13. GROUT: Depth
From 6 To 0V O Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND.' GRAVEL PACK:
Depth Size Material
Iblaterial
Nlethod
From To Ft.
From To Ft.
16.REMARKS
Topographic/Land setting
❑Ridge PSlope DValley DFlat
ais- 727 (check appropriate box)
Latitude/longitude of well location
(deg rces'minutes'seco n ds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0- ;?(.0 Grp
eZ (G � r '^
Its � �/
q/s-//7 0/r�cl
//7—/4S' )4'1-,-c.....rZ•
t&-5 -/47
/ /G 7 — 2C
.J
LOCATION SKETCH c :
Show direction and distance in miles fromgi leas%
two State Roads or County Roads. Includae rolcd 51;
numbers and common road names.
C
-0
NJ N
5)‘‘-r-f-kz-r- T
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI CORD HAS BEEN PROVIDED TO THE WELL OWNER
airr/11--
b-30-v3--
SIGNATURE OF PERSON CONSTRIjJCING THE WELL DATE
Submit the original to the Division of Water Quality, Groundnryter Section, 1636 Mail Service Center; .[Raleigh, NC
27699-1636 Phone No. [phone], svithin 30 days. ) i __�.-_. _ i3,'{Ai }EV. 07/2001
1ll L;i

//\\��,�t /� //',�t j1 CERTIFICATION #2/ r
\VEI.I. CO\Tlt:\CTOR CO\IPA\\'\,\\IE /'tn 6'ee1te ars tc,.tj 1 _PHONE # fers - 55S0
ST.A T E WELL CONSTRUCTION PERMIT# ASSOCIATED wQ PER\IIT#
(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 LOCAT, —�7/ Topographic/Land setting
Nearest own �(�.� County/x374-t:-[Ls pp�� ❑Ridge lope ❑\'allzy ❑FLu
r n ' -PG' /C - -#� a len ✓2t /v C (check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code) 02as- 736, Latitude 'longitude of well location
3. 0\VNERTD40Ld nn���
Address PO ✓9 (O�
(street oc Route No)
1-esin titt %1tC b'73
WELL CONSTRUCTION RECORD 2 7 7 4 7 3
North Carolina - Department of Environment and Natural Resources rp - Division of Water Quality - Groundwater Section
\\'ELL COY! It:\CTOR (INDIVIDUAL) NAME (print) 11.atD /r1COLL
(degreeshni nute>,'seconds)
Latil tide/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(82X- 7VS3- V24 ' Suss✓
Area code- Phone number
4. DATE DRILLED .r/ /2 - 03
5. TOTAL DEPTH: 77—
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: -Zero FT.
(Use'* if Abme Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. y�
9. YIELD (gpm): fa- METHOD OF TEST /-('r ri'
10. WATER ZONES (depth):
6
11. DISINFECTION: Tvpe J77.4
12. CASING:
Depth
From C To 7Ft.
From To Ft.
From To Ft.
Diameter
W
CIS
LOCATION SKETCH:
Amount 3' KS how direc46M-an distance in miles from a( ast T
Wall Thickness J two State Roads or County Roads. Include troacilistiY
l~
or Weight 'Ft Ma terial numbers and common road names. ,
13. GROUT: Depth Material Method
From fo Et.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
From To Ft. in. in
15. SAND'GRAVE.I. PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RE.\IARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 9F THINORD HAS BEEN PROVIDED TO THE WELL OWNER
3O -Q31
SIGNATURd OF PERSON CONSTR Or CTHEIVEEL — -pAit
Submit the original to the Division of NVater Quality, Groundssldtensection, 1636 N aitSer fce Cedtdr7 Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. I j I' 01-gj }2EV. 07/3001
tt

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section
I2:\
WELL CONTCIOR(INDIVIDUAL) NANIEE (print)y
t ! to �{.(.µ�y(� CERTIFICATION#
SS ELL CON"112.-\C'FoR CO\IP4N\'Nk\tE /crta Y- iG"'eire—till0] �S (.Ck2.fa ,(J�,..lciniONE a(r�:)q 6-y&-5550
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED \\'Q PERMIT#
(if applicable)
(ifapplicable)
277472
WELL USE (Check Applicable Box): Residential" MunicipallPublic ❑ Industrial ❑ Agricultural ❑
tNlonitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Neat Town'
(Street Name. N
Topographic -Land setting
❑Ridge y(Slope ❑Valley ❑Flat
1�_ (check appropriate box)
.,hers. Contmhnity Subd,_.-lion. as- Latitude/longitude of well location
Lot No Zip Code)
-. OWNER: E C�t ea -f tSCntit a -we S
Address -77 0 % Lf ) r'
n 1S:rc-ROE[eNo
Ccir
inorTot Score' ' Zip Code
1770-
30rpl/
Arco code- Phone number
4. DATE DRILLED Jam- 3 0 ` G --S-
5. TOTAL DEPTH: ; C77) r,�
6. DOES WELL REPLACE EXISTING WELL? YES IDS"
NO
7. STATIC WATER LEVEL Below Top of Casino: 40 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 1 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): a 3 METHOD OF TEST / r
10. WATER ZONES (depth): 4-7 /
I1
12
13
(degreeshnlnutes'semnds)
Latitude/longitude source:❑GPS❑Topographic map
Check box)
DEPTH DRILLING LOG
From To Formation Description
o- 2-
4:7 - 4 7
`t 7— at
zV7J
DISINFECTION: Type t-f i / 1 Amount
CASING: Wall Thickness
Depths / Diameter or Veight'Ft. (Material
From 6 To N7 Ft. (t. Vy 1)2-21 to aL
From To Ft.
From To Ft.
GROUT: Depth Material d �--Met�hod�
From 0 To Ft. «e4 eILI— 4 -'
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 Size Material
From To Ft.
O
LOCATION SKETCH
Show direction and distance in miles from at Ieast-
two State Roads or County Roads. Include the r
numbers and common road names.
iket/0 7
C
L)
Cfi
J
wa
�¢—�--
/ °T I d<1.4_,)
From To Ft.
16. RENIARKS:
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 PROVID 1(TO,THE WELL OWNER
SIGNATURE OF PERSON CO. STIUCT, I HE/\r' L-----:/ DACE
i
I
Submit the original to the Division of Water Quality, Groun4ritter Section T636-1WailServtcefgntetf-Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. J GwaI REV. 0772001
Iahi

WELL CONSTRUCTION RECORD
277471
North Carolina - Department of Environment and Natural Re ource(s�j1 �Divisitn of Water Quality - Groundwater Section
j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f J A_.('.'(,,/77va.�L _ CERTIFICATION #_ !.
/44
WELL. CONT RACFOR COMPANY NAME Mil Le en e Iry . W ett PHONE # ( CrZ-=555 0
SLATE WELL CONSTRUCTION PER)IIT# ASSOCIATED WO PERMIT#
(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
2,
WELL LOCATION'
Nearest Town: (1-4-eetret, County
(Street Nan
3. OWNER:
Address
Numbers. Community, Subd
on, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat.
(check appropriate box)
U 7Ji_Latitude/longitude of well location
(Street or Rdu0.h' Q
(lit)City or Tovn —State Zip Coln
// o
rgei Area coda- Phone number.)- a
4. DATE DRILLED
5. TOTAL DEPTH: Jj 00
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO -&
7. STATIC WATER LEVEL Below Top of Casing: 1,O0 FT.
(Use "-" i f Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): 1/2_ METHOD OF TEST at-n-' 10. WATER ZONES (depth): /n0O
11. DISINFECTION: Type H1-
12. CASING:
Amount 446)4 -
VVall Thickness
DepthDiameter or WeightFt. Materjal
From 6 To____nn/--���. Ft._�-' 5/D2 Z/ 71,/t
From To Ft.
From To Ft.
13. GROUT:
From d
From
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To FL
From To Ft.
Depth Mate,r-ia�l, �� � Method
To ?-rt Ft. C^
To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. RENIARKS.
Si
`J.itct ial
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
a-- 67
(p0?- —//Go
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the - ad c;
numbers and common road names. v.:^
rrr. ^;
/07
L /ery.0
/ a-D yado
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF - 1 HAS BEEN PROVIDED TO THE WELL OWNER
go -6
0.$
SIGNAT
OF P
Submit the original to the Division of Water Quality
27699-1636 ('hone No. [phone], within 30 days.
$TR
TING,THE WELL - D}\TE
• r I
Grout E Atv't r Section, 1636 Dlail Sent A CFn(er - Raleigh, NC
1 i,, _ REV.07/2001
Ell
iCE

WELL CONSTRUCTION RECORD
h oti-n
North Carolina - Department of Environment and Natural Resources - Division of Water uality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) a4 � ' - � ""r, ,`'/ CERTIFICATION C# — `�-S� i /
WELL CONTR.ACTORCOMIPANYNAIIE f'1 1,-1- s-e>.e,Lc. L!/'e'? itl ea PHONE # �' .5 r}U '✓�iS
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural ❑ /
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use ' Al7 //) PrC Cite"
2. WELL LOCATIO r.
i
Near tTown: C�-� <-�ifije "County
'-`<PCc r
(Street Name, Numbers, Community Subdivision, Lot No., Zip Code)
3. OWNER: en le .(degreesiminutes!seconds)
Address 7Z70 / .P7 !fii-LT_ .l — - «,-,.7.T Latitude/longitude source:❑GPS❑Topographic map
M0 if eeiiv(/(kt or Ronte C
°7%/r
Topographic/Land setting
DRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Area code- Phone number
4. DATE DRILLED
DEPTH
City or To, spa, _ Zip Code From To
�23)- — 3 7 3�/ �/G t/ - ZS / i 5&u o
'- 3uo3
D — 5, 7
97_ S--
5. TOTAL DEPTH: 5 1) S.2 —5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO� _
95— i S;(
7. STATIC WATER LEVEL Below Top of Casing: / Li/ C) FT. 957E - :Z� )
(Use "+" if Above Top of Casing) ..?GG _ _26 /
S. TOP OF CASING IS � �y FT. Above Land Surface* -2 lv/ _ '7, J _
*Top of casing terminated at'or below land surface requires a n'ith 7 i—_ G ale/_L'�
variance in accordance I5A NCAC 2C .0118. 7
10. WATER ZONES (depth):
9. YIELD (gpm): 5 METHOD OF TEST 4t r .5,2 7 6, -- . cq SE<�
/ (.5- 02.6- 5 6 -5 XeCATION SKETCft ' t' / '1'-
11. DISINFECTION! Type �-t- 1 �---r Amount horn direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth --y Diameter or Weicht/Ft. Material , number and common road names.
From 6 To 3 Ft. /, �tl / 5}'S,-SFz-,/
From To Ft. �- �/ /
From To Ft. AtHI-C
ra-u.ci
CO
m c
(check box)
DRILLING LOG
Formation Description
13. GROUT: . Depth ,faterial Method
From 0To 0 FL (�"&?-nW r•F'
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.
Mut ti ial
From To Ft.
(Jl E
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 RE HA EEN PROVIDED TO THE WELL OWNER
,5 1 cL- ►�VG( L I 2 s
SIGNATURE OF PERSON ceN TTtS' 'fITS-t'EL . .UfT
1 �
Submit the original to the Division of Water Quality, Groutihva'tl'r Sction, 1616Mad3erva e C titer - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. i W-1 REV. 07/2001
J

�u /2/b1.4..
WELL CONSTRUCTION RECORD
277444
North Carolina - Department of Environment and N ral Resources - Division of
Water Quality - Groundwater Section
7
WELL CONTRACTOR (INDIVIDUAL) NAME (priin��'2k (print) A SCer /J c.. .-/CERTIFICATION,0 / /.- / -y
/
!T —. ^P_P/1-e .� ',2 / PHONE 0 ._/1 V--53--st
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PER\IIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other O If Other, List Use
Topographic/Land setting
County it .5(5)--4 DRidge Slope ❑Valley ❑Flat
a/y w�appropriate bos
yI C/Sr7lt r�J (check)
ZS wide =1- y�.3 Latitude/longitude well
From To
From To
2. WELL LOCATI r:
Nearest Town: S6/) _'/
fT,S r �G� et/ /7-/7 i n -z_ I/
(Street Name, Numbers, Community', Subdivision, iotNo., p ) e location
3. O\ 6ERJ) a-‘ (-)5
(Stree Ro to No.)
rTS( r) uP1 Air" ag7/3
,City r Town State / Zip Code
Area code- Phone number
4. DATE DRILLED lG — / 04 -9 )
5. TOTAL DEPTH: 55 U
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: / 5 Z FT.
(Use'+" if Above Top of Casing)
S. TOP OF CASING IS � /2 FT. Above Land Surface*
"Top or casing terminated atlor below land surface requires a
variance in accorda e with 15A NCAC 2C .0118.
9. YIELD (gpm): 7�` METHOD OF TEST �L'L
10. WATER ZONE (depth): t2 'joy 419')
Yz 336
11. DISINFECTION: Type 1 Amount ,?Scn
12. CASING: Wall Thickness
Depth Dia eter or Weight/Ft. I,tenal,
From> To 1-6 Ft.
�y!
Ft.
Ft.
13. .GROUT: Depth Material 1
From To ,7 O Ft. (x%�r4.,: r /
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND;GRAVELPACK::
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Material
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description,
DEPTH
From To
-- e2a>G,
C/%5 9V 7
-�-ii-
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.
Lk.4LYlZ Yh , , r��X�
'72/7 (21A
/emu —/ C S
A
-
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELI= Et
CONSTRUCTION STANDARDS, AND THAT A COPY OF T S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
IATURE OF taSON COj
INC THE WELL' D
Submit the original to the Division of Water Quality, Grouncl;ti at'er Section, 1636 Mail Ser ice.CRn i•i - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. I' ! j I1 REV. 07/2001

ii ri 4t 0 6 ?»
lay 76 02 — g /2
WELL CONSTRUCTION RECORD 277440
North Carolina - Department of Environment and Natural��Resources '-,tDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE/(("pfrriiinntt))) J)1/%/JAiit I tN IVI/4-11_{.5 CERTIFICATION # 2.5% Co
WELL CONTRACTOR CO\IPAN1'NA\IE 4 / i ai7�-,3' VV PHONE
a,41 S72)-5536
STATE w'ELL CONSTRUCTION PER.\IIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
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 LOCATION / Topographic Land setting
Near c7 F(�/�,��� ❑Ridge 177Slope ❑Valley ❑Flat
/ (check appropriate box)
(Street Name, Numbers,
`Community, Subdivision, Lot No.,
Zip Code) ' /�/1r\ j/t L54 -1E t7tde/longitude of well location
3. OWNER:S ) V I 1�! e 0 FINS 1/ J a_ ' v J (degrees/minutes/seconds)
Address C/r r� JJi--��j -J) 7e.j�' LBr F\' 12 C/Latitude longitude source:❑GPS❑Topographic map
11 Route Na) 'n ' % 1-'DEPTH
h t ) V 1 V l t a Y 7t5. DEPTH
(� Ci{y or T x'n State Zip Code From To
Fi'IAY y 7— tb
Arca code- Phone number _, j z/Ua
4. DATE DRILLED cl
5. TOTAL DEPTH: . W.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO :In
7. STATIC WATER LEVEL Below Top of Casing: 2�% FT.
/ (Use"+" if Above Top of Casing)
S. TOP OF CASING IS � �, FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. /�
9. YIELD (gpm): / METHOD OF TEST /—i- 7 ✓-
10. WATER ZONES (depth): /a 0
I1
12
Town:_� County
E 1/1 S fi'�'.q�' k1 L s -jrn .
DISINFECTION: Type ff %JC' Amount
CASING: Wall Thickness
Depth ( Diameter or Weiaht/Ft. Ma�t rnir
To Ft. - cc- V .C?.Q
From 0
From To Ft.
From To Ft.
V
D
13.. GROUT: Depth Material `^N ethocl
From i0 To gb Ft. 0 eci\ Qti
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:
(check box)
DRILLING LOG
Formation Description
LOCATION SKETCH
Show direction and distance in miles from at 'Est
two State Roads or County' Roads. IncluSthe Thad
numbers and common road names. a
AK, md-L--N
=�C
a �
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 i�� HAS BEEN PROVIDED
RVIDED TO THE WELL 4WV'N'E R +j9/
C a Nf(� �� �M \CA
SIGNATURE OF PERSON C
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
WELL DATE
artian, 1636-Maii Semniict 4enter - Raleigh, NC
I i iGW-1 REV. 07/2001
I,�

0
WELL CONSTRUCTION RECORD 2774 99
North Carolina - Department of Environment and Natural}Resources�- Division of Water Quality - Groundwater Section
\ .
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D Incc (1 CERTIFICATION #
(k�i� ibis)
WELL CONTRACTOR COMPANY NAME
R / z L7iecr l[1
/ PHONE R
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMII#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION
Nearest To au_
(Street Name, Number
3. OWNER: cS1
Address 1/4373
wl (7
City or Town
4'G- 7G 6
' �/r
l e/I!/I/w Eounty
?Zs/ rrm
tmunity, Subdivision, Lot No., Zip Code)
rLaL-
.672_
V met or KoucCNo.
State Zip Code
Area code- Phone number
4. DATE DRILLED /3 6)2--
5. TOTAL DEPTH: j7 U (7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,
7. STATIC WATER LEVEL. Below Top of Casing: 95 1 FT.
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2— FT. Above Land Surface*
"Top of casing terminated a t'or below land surface requires a
variance in accordance e'jth 1 "A NCAC 2C .0I18.
9. YIELD (gpm): — METHOD OF TEST AZ:L-/
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley- €lat
(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
n
o yJ_
-t
11. DISINFECTION: Type ftT7 Amount L
12. CASING: Wall Thickness
Depth --7 Diarr�er or Reieht/Ftt ter
From To r� 'L G-, Y - eri�
r
From To Ft.
From To Ft.
13. GROUT:, Depth Material
From c -1 To j (2Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
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. O
O
U7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY H[S CORD HAS BEEN PROVIDED TO THE WELL OWNER
J
�'Si7 3
��� Ct �� �.s-�r 7 J 5
SIGNAT RE OF SON O TRUCTIN'G'fHE WELL ----._7E
Submit the original to the Division of Water Quality, GE 14ndxdater Section; 163-6 Mail Ser�ice� denter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. i iGW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (prior) Ja.T,es B. Brown CERTIFICATION: 2045
3\El. I. CONTRACTOR CONIPANY NAME Eden Brothers Well Drilling, Inc PHONE # ( 828 369-9591
STATE. WELL CONSTRUCTION FER.NIITz .ASSOCIATED WQ PER?t1Ta
(if auelicable) (if aoolicable)
277684
L WELL USE (Check Applicable Box): Residential X, Municipal'Pu'blic ❑ Industrial ❑ AarictCtura1 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ 0:hu ❑ ItOther, List Use
2 WELL LOCATION:
Nearest Town Sylvia County Jackson
Dicks Creek
(•.nat Nome, Ne.'bees, Community, Su5d Y.sioi Lot No., Zip Code)
OWNER: Robert M. & Evelyn Riqdon
Address PC) Box 985 Lati
(Street or Rdute No )
Sylvia:= NC. 28779
City or -Irwin c, o- Zip Code
(828)- 586-4336
Area coda- Phone .number
4. DATE DRILLED 7-21-03
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO DC
TOTAL DEPTH: 25(1'
7. STATIC WATER LEVEL Belo: Top cf Casing: 150 FT.
(Use' *' if Abcce Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated a,or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): 1 5 METHOD OF TEST ]alms
10 WATER ZONES (depth): 75' & 85'
TopographicLand setting
❑Ridge 0Slope ❑V'a1te} ❑Flat
(cbee'e Pppreoriate heel
Latitude tonal ud e of well location
DEPTH
From, To
0 61'
(a:tamers 'tin...- econds
de :longitude source:CGPS❑Topographic nap
rock ton)
DRILLING LOG
Formation, Description.
clay & sand
61' 250' granite
0
c;
C
J ee
r.
II, DISINFECTION: Type H T H Amount 16 oz Snow direction and distance in miles from atrea_st RR,:;
V�I
12. CASING: AVal: Thic'.cne;s two State Roads or County Roads. Include th3aad n-,S2:
Depth Diameter or \ eight'Ft. Ntateca', numbers and common road names.
From 0 To 6R' Ft. 6" 18R sboel
From To Ft.
From To Ft.
13 GROUT: Depth Material Method
Fro^-, 0 To 20 Ftte"tnite & txtt:!L Rr�
From To Ft.
1». SCREEN: Depth Diameter Slot Size NL:ecal
From To Ft. in. in.
From To Ft, in. in.
15. SAND'GR4VELPACK:
Depth Size Material
From To Ft.
From To Ft.
IE. REMARKS:
LOCATION SKETCH
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
CONSTRUCTION TANDARDS, AND THAT ? CJPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON NSTRUCTING THE WELL DATE
-2'c,z/ `/i 3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Alail 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
James B. Brown
w'ELL CONTRACTOR (INDIVIDUAL) NAME (print)
N EL. t. CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc
277685
- Groundwater Section
CERTIFICATION = 2045
PHONE =(828 369-9591
STATE. WELL CONSTRUCTION PERSIIT= ASSOCIATED 1A'Q PERMIT
(if aooiicnbie) (if applicable)
I. WELL USE (Check Applicable Box): Residential, Municipals Publio 0 Industrial 0 Agricu turf ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 11Other, List Use
2 WELL LOCATION:
Nearest Town: Sylva County Jackson
(;rpen's (reek to Brooks Pranrh 1 /4mi_ on R
05:reet Name, Numhers, Community, Subdiai s'. o: , Lo: No_ Zip Code)
0 v\NER: Scott & Lora Webb
Address PO Box 174
(Street or Route No.)
Sytva, NC 28779
Cry or Town State Zip Coda
(828 )- 586-6647
Area code Phone no. -.'ter
DATE DRILLED 7-11-03
5. TOTAL DEPTH: 300'
6. DOES \YELL REPLACE EXISTING WELL? YES 0 NO Et
7. STATIC WATER LEVEL Below Top of Casing: 250 FT.
(Use'•-" if Above Top of Casing')
S. TOP OF CASING IS 2 FT. Above Land Surface
'Top of easing terminated at'or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gem): 5 :METHOD OF TEST hlow
I0. WATER ZONES (depth): 207
Topographic Land setting
❑Ridge ❑Slope ❑A'alley ❑Flat
(check r:rc:nate Sox)
Latitude longitude of well location
,degrees .,,:4:s.se:0,0,l
La;::udz'long itude sourcei0GPS❑Topo_raphic map
-..e.:c box)
DEPTH DRILLING LOG
From To Formation Description
0 88' clay & sang
88' 300' granite
W
c=
G) a
I _
:
LOCATION SKETCH
t IH T H Amount 1 6 oz Shows direction and distance in males from at -Fels; c,;
11. DISINFECTION: Type iyi-
ca . ri
12. CASING: Wall ThicImess two State Roads or County Roads, include t'henap r'
numbers and common road names. o --
From Diameter or R'eig:;:"F;. AL--terizlN cm
From 0 To 86 Ft. 6" pvr -
From 86' To 9n F:. 6" 188 stmT
From To Ft.
GROUT:
From 0
From
SCREEN:
From
From
Depth
To
To
Depth
To
To
Material ?Rfnod
20 fir. ut;te & catesiL PJtT
It.
Diameter Sot Size Material
Ft.
Ft. Ip. in.
SAND.'GRAVELPACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Ntateria.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S T. '`ARDS, AND THAT A -iY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATLKE SF PERSON CONSTRUCTING THE WELL
D.ATE
Submit the original to the Division of \\ ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
J7699-1636 Phone No. [phone], within 30 days. OW -I REV. 07 200:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
WELL CONTRACTOR (INDIVIDUAL) NAME print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/ 440 2
i : WELL USE (Check Applicable Box): Residential Municipal'Public 0 Industrial 0 Agricultural 0
S: Monitoring 0 Recovery ❑ Heat Pump Water n)ection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Neared Town:
277535
al Resources -Divisi.nofWater Quality -Groundwater Section
/
CERTIFICATION # .2 j6
1 rb PHONE # tg64/ k -.3/ 7/
ASSOCIATED WQ PERMIT#
(if applicable)
C unty
a 1a
(Strgtjt'yic, NumbFrs, Community, Subdivision, Lot No.. Zip Code)
3., OWNER:
Address
n
orRoute No.)
015-
Cit(/o(/Town State V Zip Code
Area code- Phone number n
4. DATE DRILLED 7- 2D 3
5. TOTAL DEPTH: /R S y ,,//
6...DOES WELL REPLACE EXISTING WELL? YES 0 NO t�
STATIC WATER LEVEL Below Top of Casing: /D FT.
(Use "+" if Above Top of Casing)
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): al) METHOD OF TEST 2 hxs
10.:WATER ZONES (depth): /lv S ' — 'o J p m
IL. DISINFECTION: Type /—f iH
12. CASING:
Depth Diameter
:-From To 37 Ft. 6
From To Ft.
From To Ft.
GROUT: Depth 4Material N odiod
Frvm c To .26 Ft. (1Jwrtz,6
From To Ft.
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.
To Ft.
Amount „..q
Wall Thickness
or Weight/Ft. Material
Pvl'
From
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Sfiat
(ebeck appropriate box)
Latitude/longitude of well location
(degrees minutes/ seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To . Formation Description
0 39
39' i8S' A zLAi ti
c
LOCATION SKETCH — '
Show direction and distance in miles from atWisst r
two State Roads or County Roads. Include th oad_
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—3/—c)3
SIGNATURE OF PERSO
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
1
DATE
ct� e Center - Raleigh, NC
I I I GW-I REV. 07/2001

272128
'WELL CONSTRUCTION 1UsUOiW
Nolllt Cololiva - Derailment of Environment and he
Nat i al Itesoces - Division of Water Quality - Oromldwnlcr Section
\\ ELL CON IIUCI OR (INDIVIDUAL) NAME (pilot) errfr ,�Ce6 a CER Il FICA: I70N r 2 o9
AM1 rIIONP, fYiCil SJ'� "Zf97
w ELL CON IIIACI VIr COMPANY NAME_ r/y'M� Nc? I UI(+1\C
ASSOCIA I P,II W Q Pr.RMI I N
s IAIF. H'FLI.CONS fIlUCr1ON RF,IIMII.r -- (it nPldisable
(it applicable
I. \WELT, USE (Check Applicable Ilox): Residential fEMuuicipni/Public U ludusltinl LI Agricultural ❑
tdonitoliug ❑ Rccovely U Ileat I'uulp Willer Injection U Other U If Other, List Use
2. WELL LOCATION: / -fa L�ileir
Neatest lolvu: ilJCI2!2. Omni)/
-- .� 1 ..1 tl.., 7la (WO
Neel!, Lunlbm% i.... _..
3. OWNEIL C✓ '! %�dn/ '7
Address
(Sheet of Route No.)
f1�h� ir1
7Ip Code
City or lone Slnle
Air tole. fhane nrnubcr
•1. DATk GRILLED Y -DI" 03
5. IQFAI.our HI: Y —-------
6. DOES WELL REPLACE EXISTINO \VI!LL7 YES U NO IT
7. STAT IC WA FED& LEVEL Below op4of Cns ig: /0 of h at I t
P. -TOP Ill' CASINO IS
1-f. Above Lnud Sul face'
•-top rl coring let winded slim hrlun Ilnd Dallis tr ioliti •
',hare h, •rronlliot nllh ISA NCAC IC .011e.
Q. tIEI.D(pplll): M
—J___ MEUDOR 1I!SF.y.Y-
Ill. WATER ZONES (depth):gio
'I opogrnph1c/1 t1 l sctliug
Ultidge USlopr ❑Wall cy UI' Int
(check eppn•prlale !floc)
l.nlituddiongilude of well location
(dearteJm InWc5) e.nnd)
Latitude:Hu i:Emir source:U(315E11 opogrnphic TWO
r:!:-rk Mt)
URiLLij:'1 LOO
Eo,inalion 17csciipli0u
UEll11
Prom To
0 60
6 - Yy)
+ 7lf numnnt.�tcP
II. DISINHIC HON:.):pc�f Wall
lhickncss
12. CASINO:
Depth Uimncler or Weight/El. Molehill
G Io �'7 II._E,{S S.4e zi .r'fiG
front flo1.n6 t It. s.:LS ,Iffy Ste.,/
Iraniw
"to fl. _ ___
�1n�19lint Menlo)!
U. GROUT Do !! .:/:: -L
f rom�—Ib %— I't.�Gr
14. SCREEN: Depth Diameter Slot Site Molehill
Iloul Tr. III. in. in.__
ROM _
To 1 1. in. in.
15. SAND/GRAVED, PACK: Site Molehill
Depth
frca❑ fit) II._
fnno _ to _ Ft_ —__--
fib. lkf N1�R` b: fE
IDODEREDYC1111l1 i1
COILS IRUCLI,QU,St41f,
're
LVC'A19.1J_SKILIC.11
Show direction and dislnncc in milts Corn nt Icnst
Iwo Stale Ronda or County Ronde. Include the rood
numbers nod colrlrllon rood names.
I
C7
r>
=J
,, C/ti.z to
u.,,,fhfi
co cm
Soc04
1.1111S WELL WAS GUNS I1tUCI EU IN ACCORDANCE W1111 ISA IICAC 2C, WELL
DS, AND'I ilAT A C0I'Y 01' 1111S RECORD HAS BEEN PROVIDED 10 THE WELL OWNER
SIUNAIURI! UI' I'EItSON CONS1IlUC1INO 111E WELL DM B
-CTIu'i:1
t) CE
Sub1n11 Ilie vrf'glnnl o to )Ivlslon of \Vntc1 Quality, Cromldkvnler Section, 1636 Moll Service Center
REV. Raleigh,
NC
pl
116no-1636I'hadle No. [phone], nllhln 311 days.

WELL CUNSTI(UC1!UN IUWI iii:1
IJo1111 Carolina - NcpaIUnud of Environment raid Nalnil Resources - Uivislon of Wnlet Quality - Urmn ilv, let Section
if /� ec e CLIt 11FICA rIO422S-lr1 �,���
N+- ELL CON I IlACIIIIIIINOIVIIMAL)NAVIE (phi) rCEIII / fAli sf"YO- 7
A/- Well Oc Iliro
5 E 1 CON IIU(I OIi CONIIUIio r nPI11 ASSOCIA7 IPA/ 15'rl 1' r,RDII 1M
SfAIE+v EI,I, CONSIItII C'1Il1N fElUll 111 if n rdicnblc
if n r'Roble
I. \VELI, USE (Check Applicable Box). Ilcsidrnlinl LV Municip8Vl'uhiic U Iu,Iusltinl I_I Agricultural U
Mouilol lug U Recovery U heat I'uuq, \Vnler Injection LI Ober IJ If Other, Lt5I Use
2. WF.LI,LOCA110N: �uC�SO�)
NemcSt.Io+cu: `' c"`=- Couuly_
Socc ___
(11 - _
(StrutNnmq tlumM1a 1. �+' �� "'hv. Sulnlivialno, lid lira:, ]Ip code)
1. 11WriE1:i0"/�f2i (�✓ee/it _ __
Add;css Jy be,l C r57 _c
tShri, o�lr mtle Nn.) in
�
71 Code
Cil)�or loon Slnle � I'
Ain crvlr I'h,n,r number
. •1. PAIIiDRILL EU Li-P."
5. l 01 AL Di:f F i i:_ 10_1
6. DUES WELL IUUI'I:ACI'. ENE; lINC \V!r! I'/ YES U NO 1
7. S IA I IC WA I IUt LEVEL, I1clow1Top of Unclo ir,r3o0• i„�j h I 8 l(Ill CASINO i"
f. Above I.l ,Sur Ewe, 1r . y I'mw
)_...I..,.!. ern mil
•
1 rr).ncr In .real dance n11l1 I5A NCAC 2C .01111.
O. ill; LD(ri") —!S" —METIIU1i'
OF 19•
IU.WAIER./MNI'.S(dellh):-/iy, -
J. T(� /UnouW -_ Cyr
II. DISINITTCIION:"I)'pc 1{ \Artrohirknrss
12. CASINO:l,rplh
I limncicr o1 AVcighUpl. �� cl inl
From y Ft �•2S 1
� fo Y � fr-T-
Fr h,Udainl 1trhod
IJ. (i110U12II)rl'll Il. 1 �i! /utim:
Fr PIII
1.1001_..— In_----ft.---- -_ - ' — — _
Diameter Sot Sire Material
IA. SCP-hI'tJ Dcpll+ l_ .
Ilom_—f,.--_ _ FL ——ire — in.
in.
floral ___ it,._ --II. ill.
15. SAt1U1311tAVEI, PACK: Sire Mntuinl
Orgill
Flom 10 El._
from foe FL
272127
fopoglnpllidl,nnJ ceiling
UIUhge OSlope I WVnlley Ul Int
(cheek .ppeurl.le hnr)
LnliluJdlungilude of well location
N15-c,28152 7 _W Ogle i/ 21. 2
tdrpr redndunlr Jc-'^nda
Lnliiudclhneilude sourceUCJI' SIJ 1 opogl opt ie Il 91
Idrrck M.)
IJ_L'1 111 f)IIILLIIJU 1,99
From to Formation Description
11I� I----FJifaiJt�R�FtFtFtFMi111
r GUNSi ItULI IUN SlAlllp
+ r'. L ILA
LUCATIUI _S!Kt I!
Show direction rand tlislnucc 61 miles hurt nl Ieosl
Iwo Slnle Roads or Corm!), Rands. Include the :and
numbers and co0111+01 rond names.
ri
0
IA F 1111S WELI, \VAS CUIIS I IttlCI I!D IN ACCOItUANCP WI111 ISA MAC 2C, WELI.
IU)S, AND" IIA I' A CUI'Y OF 11115 RECORD IIAS VEEN 1'IFUVIDEU 10111E WELL OWIIER
SIUIJAIUIII! Ult 1'RILSU1J CUFIS11tUCIINU'111E WELL UAW
F f' Sndnnll Ihr'ii+l Fbhlin Ih. DIclllnn of ll'nler Ijunllly, U1ountiwnler Section, 1636 Moll Service Center
1 REV. 2 )01
j1�,ao-16J6I'hvnvNu. (919)7JJ-J111,»Ilhln)1ldrays.

272126
WELL CONS 'IRUC•1RUN IUWURI)
Ninth Colulina - Ucpniuncut u[ E!!vllonulcut mil Nnlryynl Itenoulccs - Irlvlsluu of Wntct Quality - Urouodr,nter Section
[
CERIIFICA IIUN I✓``/ ��
ivF.LL CON I RACI Olt (INI,Ir•IIIIIA L) NAME II47 \ni I( Dr1U �ll) r110Nr,I1i'J-, "..
iv FAA, COt111tACI O11 cODIrANY NAMF. fC VV
ASSOCIAI rti R'r) FERMI U
Sf Arr raFl.6 C(INS IIIOCIIUN f'EIUIIU -- Irnlr!iconic ���a �.
if n IicnWc
1, WELL USE (Check Applicable flux): ItcskkIri,Ihil I4-"•ItitticIIInl/l'uhlic LI Indushinl LI Aglicullwnl L)
f`luniluli ig U Ilecuccly LI Ilrat )'leap 1Vnlct In)ccliou U Oilier U If Other, LIsl Use
2. ll'al, LOCA PION/ 'Popov,' netting
tdcn)csl I tncul�E' ✓'s"e C". --- Cuunly
GC/ .. d/1, Ullidgc USlopr 1 ]Vnlicy LII"lal
(ci rh nppvgnlnle hm)
11C S C J_ _ Lnliluddlongilutle of well lucnlion
(Soeel ?butte.NumFel e, Cr::::,• •,h.. $nlnlivielon, l nl iln'., 7.1p Code) 4/35e .Z�, Si. a, c c 3' a "3Y 0
,- 1�2. ( ilrplre4mIrmir✓v-n+od,1
1. A ldicss ���� C' c 045 L ((�//�� {'" l I- nitiudcrl,.neilude soutce:UUI'SU fopograpllic n: ql
Addicts —>? 51 G 1
($nal o: Route Ina.) ^ c1-1 r• I)kLUI box) Iwo 1,Uc)
\ Q o"n �� o Ir :ruin (check
Fonnnlion Ucsaipliun
Zip Code Ciry� nr Ia.ul Slnle i
Nr. mlr. number5-V - /pc o-/"-•ter/e_
..1. NAT1; UIl11.iIiii p.0 _3-
5. IOFAL Phil in.__/_ 00 __ --
6. DUES WEI,L REPLACE EXIS VINO WEE Ii ES U NO 1
3 0.- —P I'.
7. SIAIIC WAl-IiR LEVEL Ilclow g "5"I Cbovel _
(u.e ••.. Ir nl�ave I.,p nr a,l,�e)
8 101' VI' CASINO IS />2.-- i' I. Above I. and Silt [lice'
• Irp rl tailor Irlmlmdrd .l rr brio,/ Inn, tom !rice ninth it •
.,,loon to .rrnrd.Ilre., I111 Ise NCAC 1C. 01111. /
O. YIPI.N (Mint _.().. _._ MtUI IIUU Uf I IiSr_ = —_ --_..._
IU. WA 117l zuNES (depnp: LOCATION SEEP., 1
--7---- Show infection mid dislnnce In miles hole nl lead
1 I . C S CASINO:
IIIRd: Iry �iT� — Wnll I ldckurss Iwo Sink Monts or County Rnnda. Include the toed
rir
12. CASINU uunlbeis slid common toed nnnics. c
//�� 1.1
I!rpdr/ �' I�/limn/c�(lcr or lVcl�hUfl.snl�)
rrorlt�L--- Io 1:1. j— -.*
Boon 'InIt— ---- - j
From lo_..IL._.__--___—_.-- CY _
pypler�nl jeillud _
13. (it0ur Pit
I_i rh-res7��e-
flnnl �'Il' — -
fll,l,r _ II._ —I''— — — --
11. SICRO:IJ Depth Uinmcici Slut Sire Mnleiinl
. I
t l Ol l l_ Il,—_ _ I L _in.
t10III.
111__ __.
IQ_.--I1. in.
15. SANIAIRAVLI.I'ACK
Nrplh Sire pinialnl
From _ Tr., 1'I.__
flonl to_ — -
\;
L 1
I BU I11.. 1iF1-'-44 II I
CUI15IItUCIIOP I4
11IAI11115ll E! 1, WAS CONS I IIIICI PI) IN ACCORDANCE WII II 15A NCAC 2C, WELL.
D •US, AND 'I IIA I A COPY UP 1111S RECORD IIAS REtiN PROVIDED 10111E WELL OWlll;ft
SIUtlAI URI! UI' PERSON IONS IIUCI INN 111E WELL UA I L
C
SOlimI IlleLaihinnl tulthe I)I%lilnn of IVntrr Ilun111y, Clouudlrnter Section, 1636 h1111I Service Center- IlLVgli, N Unl
116�a-I(J6 -'hone No. 019)133-321l, „dlhhl 111(taps.

272125
NULL CONSTRUCTION RECORD
Noel i Carolina
I C 1' Dernllinen' of Environment mid Natural Resources - Divlslmt of Wnlcr Quality - Groundwater Secliull
CFRIIF ICKr ION
-
// //jj eeCe
R'F,LL CON 7 RA Cl OIr IINIIIn'117UA1.)NAaI F, (pried) {�-61r !
Il ZSS>
/le/ il<'tl \)V11,1i!cc
n'F.LI, CON MAC! OIt COnIPANY NAND: i!/`
ASSOCIA1 ED 111) 11E.101110
SrA1F WELL CONS cut IIC'eION fF.Ilail to ( applicable)
'cute if lc) -_
2. WELL LOCAL
Nero es' 1own: C4. Jer-ee County 34C fge'l
I. WELL LISE (Check Applicable Pon): liesideulinI ffMunicipal/1'mblie Li IiidusIrinl LI Agricultural I1
Monitoring LI Recovery [1 Ilea( Pump Water Injection ❑ Other L1 If Other, List Use
'fopoginpltic/Lnnd setting
L1llidgc l ]Slope ❑Vnllcy Opal
(check nppinpdalr hn.)
Latitude/longitude of well location
,q/3i',29 10 r'1— rd09J°/•1 "Yo t
(derreedndnu,e ✓sccnmli)
Lnliiudcrhmgitude gout cc:00PSC1Topographic mull
(check bo')
L)EL' CLi L1111).LINU i,UO
Flom To Formation Description
(Since Name, timbre.,C,,,, Itv, S4110.100, Uri tin ., Zip Code)
3. OWNER: ker /41/4e t/4,n3
Addles jcT 'E-/ Coast- Po (' i-ca—i
(Sorel or Route No.)
City or loon Stine zip Code
Art. mlr- thane timber
1. DATA DRILLED
5. 1 [Al. DEP i ii -_— 6. 170ES WELL REPLACE EXIS1INO WELL/ YES a No 1
J v 1-' f.
7. 5'iM IC WATER LEVEL DclorW1
uee!I ,, If AboveCasing: lop of Cndne)
A. "fOr' OF CASINO IS __it-. _ _ I-f. Above Laud Snlhce•
•lop rf mine Inudnsted •anr titian luul inflect ',quite; •
vnpnee L. suet dike r,lih I5A NCAC rC .011e.
0, YIELD fppin): MIifIIOD UI 1-IESE_ /T,/�_---
ID. WATER ZONES (depth): OS
.N T f Amount �Y
I1. DlSINF IrCrION:Type Wnlllhickncss
12. CASINO:
I7rl,ll, I/imucter or Wcigli ft. Mnterinl
I FI./ zs 5021 / /' 4'
Prollt�— o . /frY sige
6z rt. b"u' -
Flonl—__ ill
From To II'—.—
U. UROUI: Depth linen?'
I"tom 0 to .-2-t FI. 6y�`"/
Flom__ I o"--.—. Ft._ ----
Id sCl'!IF N: Depth Dinmelcr Slot Site
I rout
Tr. III. in. in.
_
flow__ lo_____ II II1. _ in.
I5. SAND/GRAVEL PACK:
i;, pi!: Sire
trout 10 1('--
I ineti ro 11.
'�tq l III I� iP
11/0IIrRPtlrtett!In
CONS IRUCIION STAN
1
jethod
esJa/e
Materinl
Mnlctlnl
D-,3°
O
s-o- 2ZO
CA
ndtcc
6-i/a . to
1,91;Al WILLS .EJ CJ I
Slow direction and distance in miles Dow nt Icnst
Iwo Slnle Roads or Comely Roads. Include -The Toad
numbers mid common road names.
I11115 NNE' 1, WAS GUNS I RUC' IID IN ACCORDANCE Will l ISA NCAC 2C, WELL.
)S, AND 111AT A COPY OF l I11S RECORD IIAS DEEN PROVIDED lO TI IE WELL OWNER
3 z/-o3
SIGNATURE OF PERSON CONSIIWCIIN0111E WELL
DALE
th
c. huifI
Ac +F\�hbinf2 IhF �MIgEfL11h e )Milan of Willer Qu11111 , Croundwriter Section, 1636 Mall Service CenterOW-1 REV, U7 NC
276v9 I636 MMufflehe No. [phone], vIlhln 311 doge.

2. WELL LOCATION):
Nerviest l own: OleCounty c�4CX-rf0/1-
•
_GUhsh,� 2—CC�QE
(CIae1 Name, Number', i.e.:::""^bv, 5nbdivieinn, Lot Idm., Zip Cale)
3. OWNER: WA Cr,ced4n6�/
Pl�'1'Y.V
Addicss
(�� �(�� PledorRoute No.) ^rG�1�.�
U C\\' to t\\ Zip Cole
City nr Tenn Ethic
C.—_)"
Ales tale I'hm'e number
A. DATIi DRILLED 3 -21'U3
5. TOTALDEM117_ £2—O - -----
6. DOES WEI.1.ILEI'LACLI EXISLINO WELL? YES LTI ENO I61-
7. S EAl IC WATER LEVEL Below Top of C'nsing'
y (Use"- If Above 'Ivy of (7.il„g)
R. TOE Of CASINO IS l? I-1. Above I .nod Sul fncc•
• Ivy or tsehq %mulnsied al/or LAo•r In'J 'urine trnnhrt •
"silence In 'nunlike nIII' ISA NCAC 7C .011A.
e. YIELD(ruin): Js_.—MET11oD.0FTEST_
1U. \Al Ent ZONES (depth): y �— —
d.l fJAmount
11. DISI NIECTION: Type unn
__-
12. CASINO: WnII "Iluckncsn
Depth Din idler or Weight/Ft. !Antolini
Pronl �) 'r-c 1! FI L lE2,�
Flom
Frolil ho
13. GROUT: Oepll!
110111 0 To, 19
hroni _ l0_-
14. SCPPhN: Depth n.
flolll fn . ill.
flow__
htl__ IT in.
111.
—_._-
15. SAND/011AVCLPACK:
north
to rt.
To rt.
from
rime
s r r- r �'1 e.
} d L
il..l�r"7r)11FRI"---- �YCFR11fY)11
f �i LUN51RUCIION SLANll
T J
Ft.
Sire
h ytetinl elhod
/ei1 .elJu..e
Dilunelcl Slot Sire Mnte:int
hLdednl
272124
WELL CONSTRUCTION IUECORI:
Notllr Cmolitla - Department of Euvlrollnelt and Natural Iteso Icecs`D�sion of Water Quality-C:oundwater Ir Section N
r.LLcon
I rum-con(INIII%'IU UAL)NANIE (piing /4/ j..
_,� 1( Di
I'IIUNP, • R)RTL2 9`7
ASSOCIAl EII wq rERMIIN
fif nuvlinable -_
WELL CUN 1 ItACl Olt COMPANY NAND', -
5fA1E tf ELL CONS 111 tirfIUN rEItM11N
lif np Aicnblc)
1. WELL USE (Check Applicable Ilea): Residential I Funicipal/Public U Indust ial El Agticullutal U
Monitoring U Reoovety U Ilea" fungi Writer Injection U Other Li If Other, List Use
Tnpoglnphic/Lmltl selling
[Midge CiSlope IiVnlIcy Mat
Idea npp'mptlale Ion)
Lnlituddloligilude of well location
4)35°22 446. -(42cP3`it 3i.�r
(Jegreet/minulrsh^c flint')
Lhtiludcr!niieitudc source:LICI 'S❑Topographic nl'p
(check box)
URILLINU LOU
Fot:nation Description
PEI'ill
Flom To
1,- cAllIUN KEJ_Gll
Show direction and distance in Miles Gun nl least
two Stale Bonds or County Ronde. include the road
nun:bets and colttlonn road names.
Soto 4.
Af 1111S WELl.1WAS CONS !RUC! ED IN ACCORDANCE WI HI ISA'ICAC 2C, WELL
S, AN IIIAf COPY Oru IS RECORD IIAS BEEN PILOVIDED10111E WELL OWNER
---- DAI S
Sid -WATCH PERSON CUNSIRMAINUlIIE WELL
C r SEC13!-�-
_ A -_-Sni'loill-Itk k 3+rt llte vision of Water Qunllly, Crnundwnler Section, 1636 Mall Service Cy`erl PotVtle, NC
216s9-1616 Phone Nu, [phone], Wlllilit 30 tiny,.

271910
WELL CONSTRUCTION RECORD .
NorYi Ca ;!irz • Department or Enyircrz:nt rid 'a?irzi Resalleas • DlYi i:„ •cf Water Qaalie/ • eau:d.-a.r Secftn
W1LL COAT(UCrcA UNDIY1D(11.L) NAlm" Np'i-n Mitchell D. Cook
WELL CONTRACTOR COMPANYNAMSE Hedden Brothcirs 4;..11 Dri ! 1 „gr Tarn
STATE WELL CONSTRUCTION PERDiIT! ASSOCIATED WQPERMIT;
(i!aeolieable) (iea;cllceele)•
CERTrF1CATIONe 2043
PyCni 7 .o (F2sy)'r„ 9..0:01
WELL USE (Check Appl cable Dcx): Residential22(M':..icipal?ubll: ❑ 1nd:at:IL t] Asr',:_I^ual ❑
NIceiten'ng 0 Recovery 0 HeatPump Water Injection G Other ❑ If Other, List Use
2. WELL LOCATION:
Neares:?oc Sylva Cc'. y Jackson
Fast Fnrk RT) to (green Taaf Tlrivp
(5711: Nsr.e, Ncm:m, Centmanin,,, Sdbdkel:q La: No., Zip Cade;
3, 0W ICER: Doug White -- Well #1
Address PO Box 7497
(S:e•.t cr Racie No.)
Maron, GA 31709
Ciy crTow: Sste Z:p CM:
(828)• 631-4700
Aims eet ?none n'airt,
4, DATE DRILLED Feb 28, 2003
55, TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES a NO x:
7. STATIC WATER LEVEL Below Top ofCasing: 0 FT
(tag "+" I!Abon Tcp c! Cut:4)
3. TO? OF CASING IS 2 Ft Above Laid Susace'
'Top or eurag i r,tti5 scar HOW I ani eudaee rquL•ua
nY.anoe le aeoare ante wIth 15A NCAC 2C ,0113,
5. YIELD (rrm): DRY METHOD OF TEST
10, WATER ZONES (depth):
blog
1I, DISr'FECTICN'Tvpe Hki A.mean: 1Eez
12. CAS:NC: Walt Thickness
C,crtn D: eter or W'ei St?:. M.ater'al
7ror. 0 me 20 R• _Sir__ pvc
From 20' Tc 24 ;it. 6" 188 steel
From To Ft.
13, CROU'i•. Depth Material N!e4.e:
From 0. Tc 2J Ft.hEsrrite R t ' prr1p-1
From To Ft,
14, SCREEN Dept ID'a.;,e:er
From To 71_in.
• From Tc Ft in
15. SAND/GRAVEL PACK:
' Dept` Size
From' To Ft.
From. Tc FL
6
REMA3:SS:
� r n
9 9. i.`" i d T —RCS FEE.
c a1v,tia irk.
x
'J•
3s:c
Submit ��
1v655.1A6IL'�T�� DOFIL"E with n 30 days,
51et$iu ;:atria;
• in.
Material.
Tcpograp'hic;La:,d set: g
C'R dge ❑S!ope 0Vzley CFIa:
(:leak '.:x)
.r..,,:de.,cng! :de. i we:',..calc.,
(5e,:.ea'ntI:u_s'I r,onL,)
Latins 51 n;lhide so...ce:D0?S 'Tcpcd,a;hi: trzz
leek :ex)
p;;T_ • pR!LLrN'GLOG
From ,^ To Fo_tien.Des:ro
0 22' ciao & s1
22' 1000' �; cs_te
LOCATIONSKETCH;
Show direction and d!s',ste in miles from . a: :as:
rx'o Eta:e Roads or Ccr.w Reads, in;l'__e the road
„_n:hers and corn_ io,n road names..
WELL
'TACOPY OFriISR_ECCRDHAS SEENPT?OV: FD TOFrA`LCWNEi
Or PERSON CONS TRUCT:NO Ticl WELL DA
of Water Quality, GroundwaterSectlon, 1636 Mail Servl;e Curter • Raleigh, NC
GW•i REV, 07,2001

' . n' R;.,, :;s • D:.,
�,.. ��a:.n>•a . �7i;a;cne,t of cavi;orro,r,, zr,: � N.,i ,
vitched D. Cock
LLCCh7rUCi0R(IYDlY1JVA.L)N'A.V2 (;:in;).
WELL C0 7PACCR COvt'A.ti'v ','.tvr E'i�de.^. Rrothy.75 wt i 1
STATI FELL CONSTRUCT:OT' P:R 11 Ta
0fa:alaa'cle
WELL CONSTRUCTION RECORD
V.:�. c.:.....
CSRT71CA710,Nh 2013
?' C 7
flri 11 irj,
271941
AS'3CIAT:O R'Q 77R�I7±
(it a::'latCit)
1W'.'ELL USE (Ce:R Applicable 5cx): Residential b: lc,a:?: 1 ! a2 0 >.2.0
Meei.crin; C Recovery ❑ F.eat: Wa:er L. :io G G;,.., If0't:;, List Us:
'r'p
2, WELL LOCATION; Jackson
ti:ares:TVA:a' Sylva Cee1ry
Skyland Dr. -Old Beta Community Bld
'e--1: N.r,:ien, L.; 2,7 Cat,
3.Cw•N_R Woodmen Of The World
Atc:ess 722 Bidden --Springs Rd
(S ; or Rocs No.)
Whittier. NC 28789
:, o,Tcw, Sate Z; CA.e
�28 )• 586-9155 (contact)
A.ta ca'e' Peens m:.-lcr
4. DATE DRILLED March 21 , 2003 •
TOTAL DEPTH: 175'
DOES WELL REPLACE EXISTING WELL? YES ❑ NO x
e
S. STATIC WATER LEYEL E:Ic'A•Tcp cf Casln3: 150 ;77,
(L.„ "I!A`.on:c;crCu'v,:)
8. TO? OF CASINO IS 2 itt,A:cve Land Sidi -fade
'To; ar eu!a9 uralna;td a:or: taw Zane a'.daae req:Iru a
v aCanoe'•. arr.dance w1:h'AA NCAC:C.0119. .
9, YIELD (arr.); 1 S METHOD OF TEST
10. WATER ZONES (depi'n) 108' & 158'
II, DiS' 7=1"1"1n>r' r\
12. CAS,AG:
Dg' L�0,Tt:e:
rr-.._�__7- 30 F•. b
,,. TC FL
T F.
GROUT: : D:, ti Matti -III NS<C-..cc'
Fr: m_11_T0_.7.-L__FL}�rrn La__ TIT''
Pram To Ft
14, SCREEN: D:,'i 12U:inemr SL.IStu Ma',a'.
Fr..., Tc _in. in.
Fruit Tc i.
15,SAND:GRAVEL.PACK;
Guth, S:u ' :a:ea:
Tc . .
1 ejcIclees
:-,
18b stan7.
Frain Tc
27
;7601
steel
:Ridge CSi: C':a_ey CF._•
(::r.'< e77::Pr1s_
.loft d'e
_.,..:de ,:ni' ._e so,....'210c? - arai'.. - .
(: «'::c.
r ticr. D:scriaticin
0:,. 58' -, 3
S8' 175' �'-==
LOC-.T!ON'SK TC
,.,..es fea'. leas,
St..a Ruts or Cc' Rcads. the
Ind c.r._.._,.;dad Damns.
as used as a liner for this well
RT ? a j WAS COSS7?,'.:CID, ACCC? ANCP.'' 3A:•:CACcc _LL
Sr- CTION S-&'r ,c s,'.n - 4T A CO? Y OFTA:S .RE CCc _AS:F. LiN ,o v';.,=D Tc`— `rc'' 0`z}7-F.
':
SI : A JRE0?PERSONCONSTRtCTrN3TP2WELL
, Mono Water Qualii;;,Grouodtivatar Statism, 155 Mall Semi:aCeae:•Ring; NC
p}iS1, !thin 30 days. G'r4•'1

271942
WELL CONSTRUCTION RECORD
W_LLCC:ITRACTC7(1iD:V1 'AL!tiA." Ur.,r,IMitchell D. Cook cERT;F:TATIcNo 2043
WT_LL CO>'TRACTORCCMFA,N: .widen Bro hcrs 4'=11 Dr11 T a rgr 7•.,,. ?;;C f (FCC:��.ia-0=-1
AS?OCIATZT 8'^?ZA":Te
STATi WILL C ; i7n"CT'0N ?'R?"Te
L WELL USE (Che:kn„_;-- Ic—vx)'Res;deCtial ,-,.Ic';aY?c'l ic AC
M.:nit:Fr.; Re:ever, C.ea:: ; Water In, .i.:�
C,.., lfC± r, Lis! Use
2 WELL LOCATION:
NeareatTo'ww,: Cullowhee Co--cr. Jackson
Caney Fork to Moses Creek
(Scr:; 1.4; N:., Zy CC
3. OWNER! Joe Fulmer
Adcess PC Rnx 1309
(6ree;:rRc t. Ns.)
Cullowhee, NC 28723
C:. :rTac 34tt Z;; C,2c
e23.,)• 293-5799
A
;, DATE DRILLED 3-25-03
S. TOTAL DE?TX • 300'
6, DOES WELL REFI.ACE EXISTI`NOWELL? YES C NO
7, STATIC WATER LEVEL Below Top of Casing' 2nD
(71e" 'I'Ae T:pe!Cub.;I
E. TO? OF CASING IS 2 FT, Above La,a S:ria:e'
'T:, of eur1;u:7.!F0!ss'a: ldaw Isc: Wr's:e rt1. rt s
vsrr.:0I:. a::caanae wlh 1:A NCAC 2C ,0:13.. �
5. YIELD (g rr 10 Af=T°CD OF TEST
10, WATER ZONES (ee;IP.): 1 R5' k 735r
II DIS;'?ECTION, Ty7.: ul= A:._., &z
12. CAS :NC, Wel: Jcc ess
vcl'_`
r,__ 0 161
From. To
:.. To
• 13, GROUT: D:pCi ,`4ateni
From To Ft.
14, SCRESN: Drr'i Dia:Titer S:c1.5:.: Dis'saa',
To Ft_• _in. • I1.
From To °t._
15, SAN'D:DP—AVEL?ACK:
Dc;C, S;u . Ma,er:a:
F Cr:;<: c:.i 8 steeI
F
F I.Fcn itezc .
p
To
.,.,,, To F;,
16. RSA*,AR:{S'
Sub
2169
Tc;: tphicr c serr:Tg
CSie;e CVa ey- ❑:;a,
,.•,..r;de , r:g'r... ,,.
;ic z'a bc.
FroM
y
0 159' dav 3.�i
159300' =rite
LOCATION 5?(TC_
r..2G_ dis:—,:c in :i fr:r 4'. i:as'.
rwc S;3k R caC.s C; CC :_ad
n_-':e:s a.d cam.. -...,.:,.ad
fr 1a Lw �_Al�
AS COSZTRUCT:J TN ACCOR_^.?..V C3'hT-"::7A NC AC 2C, `
CC?YOF -115FECC1C::LAS 3=E\';-RC'.,.,EDTO-C'rN=R
re 3
ERS2NCONSTRVC fl'0 Tin'Ai,: DATE
:It 01 b, tT®iqf Wata Quallw, Grc':adwater See !Ion, 16?6>IaIlSerrke Ce:;er-Ai eig`, NC
•1635AsHG�eAg�th r6 ghI
:.A' ^ 5, ?.ti:. 7.
I1
ION+RE
P6 �
FaV,

271943
WELL CONSTRUCTION RECORD
& : N of Y'a.:; CJa
�LL CONTRACTOR(INDUi:'AL) NAY': (rico. hitche ' D. Ccok Ciw f' A„CNe 2: 3
WELL CONTRACTOR COMPANY N tiiz 5rn7•h-re re-11 nr4114r-- Tr..- ,_..ter d KA7;1 <L==='
��,_ AS:CC:ATZJ W'QPERu:Ti
STATE WELL Ccslica'let PZR ..a Sir aoc!icaae)
fif atiolloablel
WELL USE (Ches'AA ':ae._ox): Re e drlia; :'� Iclpa.T-- 1r,ca:;a
Mc,.arinq 0 R• ��'a
C Heat. ^p Water Inje ticr.0 Ot', .: G 1f0'i1r, List Use
2, WELL LOCATION:
Nearest To /TDil1shorn Cc'.'.'+,Tarkcon
Barker's Creek —Smoke Rise —Lot #10
(§rr: N's—e, N':.:.tcn, C:c.TNi-,, 5:::2A.d:r. G; t{a, Z.; C 4C
2, Ow‘,. -ER Maurice Bosstick
Actress PO BOX 606
(St- :r Rx;e
lli1]shorn, NC 78775
ycT:a- S'a4 .Z77
4:,7R )• S86 0494
M�:a'e, Pcan:
4, DATE DRILLED 4-15—Dl
5, TOTAL DEFTE.:
6: DOES WELL REPLACE EXISTING WELL? `ES 717 NO aac
STATIC WATER LEVEL 3..• 'TcpcfCss'n3• 120 -i,
I(A.cv, 7:2:fCvLa;
L TOP OF CASING 15 2 FT. Abcve Land
Porcu:ni;rcIna;e5 e:'ortelo'Ia::d: race r, u
ne
I rt
,.ente!p e:c: rdann s+L'r�IU ��CAC :",011i.
YIELD (a, m` 4n METHOD OF TEST
10. WATER ZONES (depth): 110' & 215'
1; D-crN'rcCTION Tyre ELB A,-.,,., 1."
w'v': stic"c.ess
.'• ari,eter cr Wr.:SF:. S•Sa..tral
r F'.�_ "� c r I.:
...c._ San Tc 60 7:. 6"
To
I:: GROUT: D:r, , t..43teda:
0 To 7J Ft. t.:& t
Fran: To Ft,
14, SCREEN: Dc;'W P's-,e'er
:rt. Tc pt,_In,
Frcm Tc Pt itt
1:. SAND'GR.AVEL PACK:
p5'21 S;u . Ms:eria;
Fr..., • Tc °'
.188 s ccl
Me_.cd
ri
Skt Si a Ma_cal
Latin.±.:, c;:rada s:-...E0?SZ.r:p.a: .. C .
„Dasc or.
clay &
5R750' L._
;00A.T10v' CKPTC=;
S;asec:Cc=.cast;,..,.•da!ha
16. R°MAYJ<S'
iyt.t.A - rr'-` 1;_S � i WAS CONS ? C"D n .�CCCA= A.ti� x � :A < :CAC
Cr' Cri5h ' S tA1',,..4'i5 )1.'v{r,' ACOPY OF S vccwaAs 3ZEN FRO' ...,ED 70 T-_
• r'' !' I //l4Dll1/
LMAY — 7 ,—, vcNAls
St _`rrJt ,,*,e or!g r.ai to the D1vislackf R
77335.16 b I,vD1ma - 5FCT1�y1� wLhl
ASHEVftI E PJ-GONAL OFFICE
L
Se--;
�Rid5e c5;,. [:l/Z:.y _.
Fscm 58'
rr� is LF7o ff
EGP :LJNCJN'STR'',-- ''GT.D'r=__ JA 7:
•tar Qca!it), Groa:dwater Secti:a, 15:5?:ai! Se Hite Ce_trr • Ra:ei-ah_ NC
.130 Cay7, 0X.1 ?3V, 27,222!
•

Drilling
ASSOCIATED H'Q FERNIT1
(:r _accli.a„�..)
2, WELL, LOCATION:lvs Co,� .; Tackc^n
Nearest ToµT.t
kers Creek
(s^e: A'a.-.e, ti:,r,S m, cem u-L^p s':bdiv;sier, L= h'c., 2,2 c det
Logan Potts
1025 Fairview RD
NC �28779 t or Route No )
•
3. OWNER:_
Access
Svlva
c 6et irea 31u0633s,1
Aru, c 4e• Phone,ED March 28e 2003
4. DATE DR LEDs-
5. TOTA.L
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Belo`h Vise""IfA ):Tof Casins: FBI .
oeo'Cu.:;.
S. TOP OF CASINGS
FT. Above Land Surface'
'T
opaul tersatolatIS
a S: •ae r
SCAC •C,Cl3.
a
r
rulru
vaantte In aca:+anctwt,hlA
5. YIELD ( m): — — ._MET OD OFTEST
bias'
Irscer
13 GROUT: Dop
Frcrr 0 To 20
From To
14, SCREEN: De h
Fr To
Frc-, Tc
15. SANDGRAVEL PACK:
Depth
From Tc
Fran Tc---_
l6. REMARKS:
Z.2 Cc4e
O. WATER
ZONES (d•
DIS7NFECTION:Type I1
12, CASING:
^T°-.—�" F:. 6
From. 38' • To 42 Ft —6-r—
To Ft
Material
Fr,bemite & carat.
271944
WELL CO`STRUCTION RECORD
d at Reso�wo:> • Lr•il!cn ct ' Q,Ia'li,j
j`iC Ca.'O�ttL?•Leya w,�C. cf tnYluCMl:nt 3.9�h CERTiF1CAT10,Ve�0
James B. Brown
WELL
CO�TR.A CTOR(IYOI�1 u'_•Ai) tiA.;:E Grd%en Brothers 1nC. ?:i0tiE B281
369-9591
Redd)
Well
WELL CONTRACTOR COSSFAAY NA.NE.
STATE WELL CONSTRUCTION PERMIT*
(ir s:ell:able)
de 3 Muntclpat ubli: 0 Industrial G Aitli:alr_:. ❑
I.
E (Check Applicable Box): • G 0 it
WELL LS tic. Oahe•OLh , List Us:
�, -in 0 k::ove ❑ Heat "romp Water Ir.,:
h „nita• fi
Tcpog-ap':i'cita+d
❑kidse ❑Stove ❑Nall•; r'-;a'
(:heeds erp rate tag)
L.,..rad&1Cr.Z tale o: . .I lc:a'dtl
Latitude i.,r.^irad: so'.:r:et COPS 'X)
r.
r�rtrrNGLC'G
a'icc Descnpr.or.
0:-. 40' &sad
LOCATION;��`
Sh^� dr ctic n and dis�� :e ir, miles fror.. at leas;
Amour,: r:^ State Rows cr Cc':. y Roads. In..__e tint road
Wall Jc;c,ess
or We Matena. ,.umbers and common road_ names.
Ft.
D,a..ter SktSize
Ft ln.
in. _.
Size . Material
Ft.
Ft.
Steil
Su relit the original to the Dlvlslon
°Phv \;13s*3221,
�t`l �:�J�' �E.y,
A6.REGIONAL f
276
L WAS CONSTRUCED T`ACCOR�ANCS —ISANAC IC,
d4T;coPY OF T,.1- RECORD AS SEEN PROVIDED TOT==w cW_TL t.O:
VNER
DATE
TUR! OF PERSON CONS TRUCt INO T WELL
(Water Quality, Groundwater Section, 1636 `Tall Semite Center-Ralels'h, NC
'Rhin 30 days. GW•I FtaV, 07/2001
:o
rV
of

WELL CONSTRUCTION RECORD
and N'a?ITh R;sr.:a:e • DH'%IS
C=DiL'C: •'�•. 2.�uSL: :; tCYI;"v"�'1: G1 and 1 '
V•7.LL CCNTRACTCR(IND'XIDCl..)(print) Janes B. Brown
Drillirc,
2719.5
;CAT;CN.1 2045
Inc . ? nN2 r F791 ?6a-95
. en Brothers ;e11
WELL CCNTRACi O.R CCd?ANY N.A.�1Z •H •
STATZ FELL CCNSTRUCICA' PZA.'IIT*
(If accii:dae)
identia: rb }:"-1cigt•i.'ol:'CI" .. Indaiia1 0
.. WELL USE (Chock A,-,-II:2be BOX)'. R:s. .., .. .r.. t .! OL" ,' �.
Monitoring G Bettye , 0 Feat?u.;.? Wator In do ❑ 0:,..r . List iis
2. WELL LOCAT10Nt
tieara:Toy.-.: SYlva Ccr.,'
Jackson
Savannah -Ti mhPr TPaf itr-1-n 1-hn roA
(S: ra: NL-,e, Nur;en, Ccrr.-'_nIn,/, S':bCi'ri'.r.:...r N':., 212 Cod:)
Robinson Hey^.esr.le.•.. s'`x:a i1
i, Add :ss Larry r a:;_..de :,,de. s:'rc::r0?SC T c;cra:'.:!: r.
Access 22 EnslPy - ^'j'-•
-xk Fc x)
(5r<n e A:xe No.) .Z .22L++ • ;KILT i`'G LOG
4Yl NC 38T7.9 Fro.-. • Tc ^c.-r''ic ; Desori::!or.
cis,' or io41 sa,• Z.; C:1e 0 1 30' r' & ._Ci"
ffi9) SRF 51 �s 130' 200' =^```
IrS._I 0
Tcpog a bict a d so-ng
'de ct v.e
:x'e• ?here r,:r.:er April 3 20(1R
4. DATE DRILLED
.; 20(1'
5. TOTAL✓..• 1 rev-
6, DOES WELL ?LAC? EXISTING WELL? YES OXa
7. STATIC WATER LEVEL Bs!ow To; “Cas4,s: 150 FT.
(Used',"I' Ah. :Top :`Carte;
F. TO? Or CASINO 15 2 F7. Abcve Land Sara.. •
•Tcp or eu:nz te•^Irut: icor ht'ow 1v.i r:.Jece ee;':Ira a
eaCence In aec;r3mct,.l: 1$A N CAC SC,C1:31
9. YiELD(1m)':._7fl MET:iODOFTEST Fn.,/
10.'AATERZONES (depth): 148' & 156
11, DISIN'FECTION: 7;pe EL, A--c,t 'Ecz
12. CASING: Wi: T'J:''_e;s
Dr,;'•. D'tr-,eter crtir'c.3:.::. Mates_
0 Tc 128 Fr, 6 PVC
"`1 RR opal
'..�, 17$i'c 132 Ft.5n
T
F.:c TDO '`fates Me:'••:_'
15 GROUT: r?'i
0 ;L 1d*A'& ceTart
F;:r.. c
-.,,r DLT, . Sic: S:r~ Ma_=al
14. SCR E Depth ,In
Fr.c, To
6. Fron Tc
T^ Ft.
15. 5.4SD:GRAVEL PACK, . ,.
C tth
From Tc Ft.
Fro er] Tc
Si re
ASSCCIATZD ?ERSflTi
(If a:., :'
6, REMARKS
u7C is ,K."B YY, R'^I<v,reA Sv+.; 5iM5S,
CYS r !s&. ! {1 A,b..;i?r lirI
(4
-. SIGN. A 7
j,0CAT10N KET17Fr
n and dis'_ :e ir. ,,,.a for.. a'. Lt2S.
r,._ Stott Rcas cr C: stet:
r.tn'oess Lod ..0'..., on road n3-es.
3ubri7the origlna; to tht D;vlsloo o:
:i699.1'i" ihsra N0 4914 713.1221, with
F SELL!..!!!
AS 1'i Ui0' AL ( -
WAS CCNSTRCCTED rti' ACCC? ANCi W17:-: 13A NCAC 2C; V,tLL
TACO?Y OF in:S RSCOR.D HAS SEEN ?RC'd;DED TOT 0?) iR
E OF PERSON CONS TR:CTTN0 T.='rvELL
ater Qca!Ity, Grocadwa:er Sa2:;oa, 1316 ?fa:! Senloe Ce:ter • As:eig „. NC
n 30 days, GW•I REV. C7,2721
CO
PO
pl Tr

271946
WELL CONSTRUCTION RECORD
err a ^` $
t pt"^Yo'17.1 , alD � `W�r R ivwv.
WELL CONTRACTOR CCM?A,NY NAME Redden Brothers Wall D i1 irto 1. Psoe;E: 6) --.
SPATE WELL CONSTRUCTION PERStI T+
• (if a-on:able)
dential �:^ ioi;a1.7uaw ❑ Indus�ial: Assn:elr _.:
I. WELL USE (Check Applicable Eck): Res:. -"� , List Use
Mcnhorirg: Recovery ❑ Heat Pump WaterInjecti:r Other: If Oche .
T cp cg:aphie Land se ti g
:Ridge :Slope :Valley
(air.'[ ar ,repr:t'�'cs)
^d• _de c. well Ic._.._..
r., ?h.'...apeV a'h.:: "
La:(roc:lCagta;de sc'�:e._C• .— -.
(c5, xk b<c)
• pRILL 1Th O LCi
Formanon Des:r•:r•en
c'_-y&xtl
22•w
N''vr C':•JIIP3 • De; & :e'n : • ' ' Jd.T,eS B. ErOG.?' CEiT r: ICA7ICN p L14D
ILL CONTRACTOR(IND1v'IDCAL) NAME (piny r, • t CZRT p E281 3E4-9�°1
ASSOCIATED WQ PERMIT4
fir atoneable),
2. WELL LOCATION: Cc, ti 7ackson
Neare$tTown: Sylva
East Fork RD- Green Leaf Dr
(Steel Nave, N'ue.ito, Ccr.�-a.ry, S'aei'r do , 'a; N'a., Z'ip
3. OWNER Doug White--yle31 #2
Add.•ess PO Rox 7497
(Seel cr Reuce No.)
c n GA 31209
crTaw+: 5ia:e. r.;ce4a
Area ct• ?.can nar•'�r
4, DATE DRILLED March 13, 2003
5, TOTAL DEPTH: 1000
E. DOES WELL REPLACE EXISTING WELL? YES I8 NO ❑
7, STATIC WATER LEVEL Se:ow Tcp of Casing! n IT,
(7tt"�'I(Abo�t ropcfCu:+;; •
3, TO? OF CASING 1S 2 FT, Above Land S'.r;aee'
'Top oftulag tamInaud at'or Cf:ow Iand a:rrau: t“L•t; a
rar:anct In a:cnance trU'1 ISA NCAC SC •C113.
9, YIELD (gin)'• _DRY_ METHOD 0? TEST
10, WATER ZONES (depth):
11. DISINFECT1ON:Tvre Fyi A.:a'nt 1ECv
12, CASINO: Wii inir;cesj
.reap Co D,L.ete r•,;:,' cr W.:I.
F'_r., 0r To Ft.. 6"
From 38 To 42 Ft, __LLB
F;cn To Fe.
pe- Ma:triai • Method
3 GROUT: p,r�• 20 Ft, u1ite & L ,el:_ p-r.
From T: Ft,
14, SCREEN: Dept tii:,ete: SlotSize Maw ;al
c,,,,, To r 'I- L
n.
From Tc in, 'n
15, SAND,0RAYELPACK:
Dap':, Size . Material
Ma'er;ai
pvc
steel
16.
C
From Te
From Tc
REMAR{c
Ft,
Ft.
F:o:^. TC
0 40'
40' 1000'
LOCATION SKETCH
S^,cw d, eoticn and eis:a-nee in miles from at leest
ta't Sate Roads or CC':n" Roads, In:..'Se road
nentiers and c0r.-7,an road names.
> y�r. WAS CCNSTR 'CTZD N ACCOZ_^.t-C Y:.T=J11 NCACF CC, c.—
cy`iA ACOPY OFir:5RZCORDHAS BEEN PROVUDEDTOT- WELL.C'hti=r.
51CNXii ) O: PERSON CONSTRUCTING TF: W =:L DATE
S.bmlt tha original to the Division of Wstar Quality, Groundwater Sect:on, 1636 Nail Sen',ce Conte: • R3 e'g'' NC
'599.134Phsaa,'�'0.(9-1°)733.i311 1t?ln30dass, G' •:F V c ;2:01

27194'7
WELL CONSTRUCTION RE -CORD
.iNa r:' Re6o�,N $ . Deis J of AVS!!! • C „
Ncr�l soli^z•D;.,4,�ent 2045
James B. Brot41. CER i.ICAT10N a
1AnLL CON7 RA CrOR (SNDI�TOUAL)h'A,N i, (p�r�l% i Wall 1 i T v; np'g a $�1 .56a-95`?1
�eclde.-1 Brothers W_ll Dri1__rc _nc. , X_
WELL CChTRA CrOR CC}f?A,tiY hAS1C WQ 2i R`fl7a
STATE WELL CONSTRUCTION PdAASSOCIATED
+tICS (if Dl a`:Ie1•
(if axlisa:!el
I. WELL USE (Check Applicab :Box)'Resid:^rLa! 2 1x;un1c•^a, Fub'ie ❑ Ind:stia.❑ Agye:c!r i ❑
:Jnito^ng 0 • R:acvery D Heat Pu^pWar lc ��-❑ O:h•'0 If 0�.::, Liet Us:
2. WELL LOCATION', Top :ga; hbLLand se ±g
SYlva Ccu.ty Jackson ❑Ridge CS!oc: 0VaIle .-.,_.
Naas: Town. ..^.,., >, y
(cirk 1,r�.-...
Rkyl i na tZr;ve, tc D�Az'th F^r>4 Rd '^,.,,- ...:de c.: e:i lrat on
;S^+,Nv�.e, N'a.r,ben, CcC�r�.a^,i'/�SJ..�. d. r.cr�:.a;, a� �
• John E. Alford le,: <.:rr.le'J_o'eecooii
.. OWT ss 487 Rocky Face RD La:,.:delcr;i^,•e sc_;e:00?SST:pJ,-a;:hi: r
nap
A,. W e s s (Bench 'NA;
(So -re, or Roux Ni.) - Dc.TP • T+R%;,Llti'G LCC:,
SY1va. NC 28779 Formation Des:r'.dioc
Tc
e :; e: 86 su_ zip ear Oc- •
82' clay & s
(828). 586-6110 g2 300' -&
A ---a c. :• ?Nsn. o'�".`4r
4. DATE DRILLED 3-18-03
S. TOTAL DEPTX 30n'
6: DOES WELL REPLACE EXISTING WELL? YES 0 NO C
7. STATIC WATER LEVEL BetcwTee; efCasing. 200 FT,
(Un" "ltAba4o Tc; o,rCuL•, S;
S. TO? OF CASINO IS 2 FT, Above Land Surface'
'Tap or euIni tor:In:id tYer hdCw lani , rfaca re;clru a -
var:anee In a::rreanca whh. UA NCAC 2C ,011L
•
9. YIELD (STn).: 50+ METHOD OF TEST hla"'
10, WATER ZONES (depth); 280 LOCATION S ETC^:
Ili A^: S`. ' die en and d!sv,:e in miles ., a: least
11, CAS:NO: I01': T; re TrJ; t:,: 5:a!e�R:a?^s cr Cc r.' Road>..n.,.ds the ,:ea
CASING: 14'a.,18: c'r-,ess a
2� D' ..e:e trli(zL.:' Ma;e-:v a:i and CJ road n:T.ei,
0 To 84 F:. 6a 8 steel
Frc.., TJ Ft.
'rrcr • To It.
15 GROUT: Da falerial M. `,a'
From, 0 TC 20 rt,L: unite & tti'.17B priced
• %•c", Tc Ft.
14, SCREEN: D:ptt Dia..,eter S:Ct Siu ?fats :a
Fr.rnTo Ft. 'In.
Frc: To I.: —in,
-- '^
'6 SA.ND%GR.AYEL?ACK:
. �; Size . ,V,an=i
rrohi ' To Ft.
From Tc Ft.
• 16. iiEMAR:lc':
i
s:dr
Sybrrh the original to the D11'lsion
17�99.1�36 Phone No. (919) 73142211
SI__Gii0i!
' ULFICE
"?.' WAS CONSTRUCTED N ACCCR:DANCE'%41T-,, 15A NCAC 2C, V.tLL
TdATs,COPY 0? in5 R.ZCC.ti. RAS BEEN ?ROV:DED TC T - ELL OWNER
3—/y—o 3
ATJRE OF PERSON CONSTRUCTING TEE WELL
DATE
of Water Quality, Groundwater Section, 1626 hla:l Senlce Canter • Fule!g , NC
within 30 days. GW• FAY, G7v2C01
CO
rV
m

WELL CONSTRUCTION RECORD 273599
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VVEI.L CONTRACT"! OR (INDIVIDUAL) NAME (print) OLLJt L 4 rfrtf(t�
CERTIFICATION # '4I> 2
WELL CONTRACTOR COMPANY N ANIE Reller fvPll ANII/✓sj' PHONE # (p)11 `f'gp-R730
S'FA'FE WELL CONSTRUCTION PER:\IIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: jt h.14YiCl' County )AC'kse c.✓
t/ tvk<r. Clr (n ni c ; Jy En,j S444- A,i /.fr]S
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: eti,24k CJt2
Addre„ _36 Fred 5tlW40/1.kri
(Street or Route No.)
,20641
City or Town State Zip Code
%e )- C84 - %S-14
Area code- Phone number
4. DATE DRILLED I - 03 _ 0_3
5. TOTAL DEPTH: 11-3b -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
7. STATIC WATER LEVEL Below Top of Casing: .40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.1 NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST_IY frSGltt
10. WATER ZONES (depth):
I . DISINFECTION: Type P/cr,e, Amount /gAeA,,,s
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From I To Sy Ft._(/Ly 46rkwj j3lt'•
From To Ft.
Front To Ft.
13. GROUT: Depth Material pMetho�
From ( To aC Ft. Ce.Na AI a
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Topographic/La d setting
:Ridge 0Slope NJ Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshn inutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
n
—
O
0<
C r1
7,--0
--t
V rn�
Z �Yn
IV tea
LOCATION SKETCH _ 2
Show direction and distance in miles frontptleasE
two State Roads or County Roads. Include the ro
numbers and common road names.
-(4s, A$`L.Jttti RA
a-t3'?
AOALLIS
392-
From To Ft. /A S ao,+i
is,di-4A 6 i0/h;.
16. REMARKS:
_ rL¢11FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
C S n udflf IC�i14 S r4N DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
u j SIGNATURE OF PERSON CONSTRUCTING THE WELL
GrT
_L
Submit the original t$ the Ilivision
A` of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
j,7{,9H I(afi-lituua mn.4)19)7i3-3221,within30days. GW-I REV. 07/2001
DATE
ii: iJ
L 'ICE

L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division) of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s.1)-en IS tin I'(lyyx rl, CERTIFICATION #oZ/74'
WELL CONTRACTOR COMPANY NAMQI.t', flnii ��IJRrr� well)) I II;1/q �,n PHONE#i/ai,.e/7024-3 a(� G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fa-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: C 1eta V LI? A/C-- County (.ICS 6O
47rnrrtymm- (1-Ie1Tv;lle f&73k,
(Street .Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3- OWNER: Porbert- I c'c"c-1;eyrr
Address `RD, 6bX r7
I
(Street or Route No.)
f' h V'r I I -e A / C->
City or Town State Zip Code
DEPTH
From
Area code- Phone number
4. DATE DRILLED �_S--/y--j `70
5. TOTAL DEPTH: _5-6 c
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
''y It63'S' khofic NO;9l9) 733
v
ILl�
7 STATIC WATER LEVEL Below Top of Casing: (n0 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): L i METHOD OF TEST /u29, t C,f m
10. WATER ZONES (depth): /70 " 0270' (/
273389
Topographic/Land setting
12242i0Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
Sa-,,�s hn-t-0—
1 e M Yn %C w i -t -C--
�n
911
/0 7
SE5 2(1.Ia. 6W4n)te
LOCATION SKETCH
I I DISINFECTION: Type H 7'-14 Amount ,-2 TA- S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include 9 road43
Depth Diameter or Weight/Ft. Mate al numbers and common road names. .m
From 0 To /(t7 Ft. (c," '.aR,f1, Pile—
From To Ft. N
From To Ft. —
13. GROUT: Depth Material Method
From () To ri'D Ft.J0nm D.-it pa)/1/0
FromTo 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:
a
0
(NEf�EECBETIF>YTr
FR- YT N\RTAk1D
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fr044 ee
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
he original to 111e Diision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
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2. WELL LOCATION:
Nearest To'An: Dillsboro Ccunty Jackson
Tatham Creek
(Sc-e: Nsr,e, N'uc'cn, Ccrmva .eira S:.dldsi:4 'at Sc., Zip Co.)'
3. OWNER: Dawn Martin
Address PO Box 411
(Strout or Roue No.)
Dillshoro, NC 2872c
Clr,, or Ten S'4Slut:ZI, Code
C 2B)• 631-1441
Aria eodc• Phone nu:n cr
4. DATE DRILLED 5-1-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Tcp cf Casing: 275' c f.
Gin "!' I( Keay: To of CuLn;)
5. TOP OF CASING IS 2 FT. Above Land Surface'
•Tap of {mini terminaced tor below land surface reoulrea
variance In accordance with ISA NCAC 2C ,0115. •
9, YIELD (g-r,): 8 METHOD OF TEST h-g
10, WATER ZONES (depth.). 125' & 263'
11. DISINFECTION: TyTe HIH
12. CASINO:
De -Le
i
Fro•' 0 T_ To 26
,, Fro,26 To 30
F' To-
13. GROUT: Depth
Frain 0 Tc 20
:.cm Tp
14. SCREEN: Dcpte
From To
F o— Tc__
15, SAND/GRAVEL PACK:
Dec is
From Tc_
F ram To
I. REMARKS.
Diavietar
F• 6
Ft. 6"
ft
'Material
Ft bencnite
Ft.
DidC. 9r
Ft. 'In,
Arc'en t 1 Ea
Wall -51-.1eciess
cr Wr,t`rt. Mated!,
Fnvr
•188 steal
& core t
M et:ncd
S:ct Size Material
Material.
Ft.
Ft.
273385
WELL CONSTRUCTION RECORD
iro e d NataThi Re cu:C.S • DIv on OI Wa;:r Quzi.i!,I • Gro',2➢d'•4t,Z' SeC(ic"
Norm Ca,olina • D:pz;pT',er,f of "cnw,�ar.nt .,2n
%ILL CONTRACTOR (INDIVIDUAL) NAME (?''nt) James B. 13ro n CERTIFICATION = 2045
WELL CONTRACTOR COMPA..N? NAME Redden Brothers Well Drillinc, Inc. PHONE % F29 369-9591
WQ PER 1T4
STATE WELL CONSTRUCTION PEATfITY ASSOCIATED(if acolicabiel
(if aocii:abiel
I. WELL USE (Check Applicable Box): Residential, 0 M'c,,icipa1Tublic ❑ Indus: al 0 A.^:ul^i=i 0
—( N
Monitoring ❑ Re:overy 0 Heat Pump Waver Injection, 0 Other 0 If Other, Lis: Us:
TcperaphicrLatd setting
°Ridge ❑Siope °Valley ❑Fla;
(:hrk e7pro;::r• :-;;
I a:i^-de,lccgit' de c( wet:lc:a:ion
La:ireCe1cngitude se'sce:CG?SDTCpo;,aph.i: :tap
(enx'c bca)
DE? T P . DRILLING LOG
From • T o F-.a'ic- D s:
028' clay &
28' -inn, ,Emit{
LOCATION SKCTCH
S;no.« dfteztlor, and dls:r,_a in miles from a: leas'
r-e. State Reads cr Cnianr. Reads, In:lode ae read
,..robes and common read names.
Lay( {a
0.11
w=LL WAS CONSTRec-D R! ACCORDANCE WITH NSA NCAC 2C, w=LL
THAT ACO:"OF T3I131C_ZCORD _AS BEEN PROV;DED TO TF=`o?:.LOWNER
0
0
N
a
O
1 el . :
ubit the original to th
699.1636 Phone No44]Q
Sr
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
7.. �I
L.J
lvisio
3.322
'ATURE OF PERSON CONSTRUCTING T:1 WELL
DATE
of Water Quality, Groundwater Section, 1636 Mall Senice Center • Raleigh, NC
within 30 days, GW-1 REV, 07 2001
0
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sirs.
end
men
cno
m�
r:

WELL CONSTRUCTION RECORD
Q a rz 1 e . �YUOn of Wat?' h� • C^oU r.d a'Ar Sect) n
North �a;JI1tLe • De,'?^"-GS; of LnYI,OtwTlGrii 5:,� \ ;.,L':, RG3CwC I
> 2Od5
WELL CONTRACTOR (INDIVIDUAL) NAME (phr.) James B. BrOW11 CERTI:ICATICN:
WELL CONTRACTOR COMPANY NAME_ Redden Brothers Well Drillinc, Inc. ?HOSE#
ASSOCIATED WQ PERr1ITA
Qf avclicable)
STATE WELL CONSTRUCTION PERM1TM
(!f acolicable)
1. WELL USE (Cheek Applicable Box)' Residential Municipal/Public G 1ncssSa] ❑ A_^iv0P.L=.
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 0:he: 0 if Other, Lis: Us:
273384
2. WELL LOCATION:
Nearest Town. Sylva
CG'u•,N ,lark Ron
q Lane
Songbird
Ns-;e, N.:;.Scn, Co.:. i�:-nL/, Sub di vi ticr, '�•; A'e., Z17 Cie)
3, OWNER: Debra Lynn Nlagnsder
Access 301 Jade RD
(Stilt or Rou:a tio.)
Sylva N(` 75177.4 Z!^ Cx'a
Ci-,crTot, Sit
W28). Sr1R R7Q1
A.roa o tic• P`aoc n':nher
4. DATE DRILLED 5-7-03
5. TOTAL DEPTH: 350' 0
6. DOES WELL RE?LACE EXISTING WELL? S NO CS
7. STATIC WATER LEVEL BelowTcpofCasing: 200 F1.
(Un "+" If Abovc To; erCvthf;;
S. TOF OF CASING 15 2 FT, Above Land Surface -
•Top of culn1 teralr.aud at'or be:aw land ,urrau rruLu a
varance In accordance with 1!A NCAC 2C ,C113.
S. YIELD (gin)'. 30 METHOD OF TEST b.ar
10, WATER ZONES (depth)' 315' h 77C'
11, D1StNFECTION: T re EMI
12. CASING:
113 7
F•crr, 0 Tc F:
113' To 117 Ft. A"
To It
To Ft.
I3. GROUT:
Fror.. 0
Fron1�
14. SCREEN:
15. SAND;GRAVELPACK:
Dr C} Size . Material
From Tc Ft.
F r: r Tc Ft.
Ancunt 1Ede
W i Tric'cness
crWc.ght?t. Ma1er.a:
pvc
1R8 ctecl
16. REMARKS:
Met) c'_
PrI'
S,ct Size Ma_ al
in.
Tcpogapi_!c.tazd setti: g
❑Ridge 0Slope OVaile; OFIV.
(check
Lati^udelonglrode of we Ideation
p«vci r..lo.-s'exe n.ie)
La:,rudelongitude soorc_,OG?50Tcpo;—,apbic. •
(ai.xk bcx)
pE?T• DRILLrNG LCG
From To Formation Desorption
0 115' clay& sard
115' 350' grsnite
LOCATION SK.ETC^
Sp,.„ -,and d!st_,.e Ir. miles loom a: least
two State Roads cr Cc +Road,. Include tr.: read
;tombe:s End common road names.
A
77
0
Dlvi
,•rve, ..Is e33.3
ASHEVILLE REGIONAL OFFICE
::s w'ELL WAS CONSTRUCTED N ACCOZ:.A•>'CE ' iT= 13A NCAC 2C, W ELL
\CDTr-ATACOS"OF THIS RECORD HAS BEEN ?ROVIDEDTOTICE 'F:LCWYER
CNA r JRE OF PERSON CONSTRUCTING T:3 WELL DATr
Ion of Water Quality, Groundwater Section, 1636 hf aiI SerrIce Center • Rsleigh, NC^.
21, within 30 days, OW-1 FiV, 0 i,200:

WELL CONSTRUCTION RECORD
North Ca:olirta • Dep a;u"ient c tnyiranrent and Nar al Re3;wC:5' D1&ktor. of Wale.: QL'allW . GroundAt:: Se:;',^r,
WILL CONTRACTOR (1N'D1VIDL'AL)NAME (prl",;) James B. BT'04rn
CERTIFICATION d __LA 5
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drillinc, Inc. ?HONE A 1` a1
ASSOCIATED WQ PERMIT?
(if a:ell:abie) •
STATE WELL CONSTRUCTION PERMIT*
• (if epoli:abic)
f& Mu .,icipaiTu'biic 0 lndustrial 0 Agricultural 0
1. WELL USE (Cheek Applicable Box); Residential APP
Monitories ° Recovery 0 Heat Pump Water 1rje:tier. 0 Other ❑ If Otter, List Use
273383
2. WELL LOCATION: Jackson
NearestTt'tV, Country Sylva Cc ,
Haartl and Ri&JPYT•r h #2—nCcrnny�, N_, Z,; Cz<;
3, OWNER; Marrianne Harr
Address PC) Box 5
(Srnt cr Rama No.)
Sylva, NC 28779
Ciy cr Ton Stab Z!p Cc.de
628 )•586-0919
Ana dale. Pane ma,,:er 5-9-03
4. DATE DRILLED
a
5. TOTAL DEPTH: 650 ^
6. DOES WELL REPLACE EX1STNG WELL?YES NO VE
7. STATIC WATER LEVEL Below Top of Casing: 550 FT.
(tits "•"hASov: ToporCu:r.3;
S. TOP OF CASINO 1S 2 FT. Abcve Land Surface'
'Top of <ulnq tercelnab: at;or balow land atr.'ve re;4L-u
varance In acc:rdance with ISA NCAC 2C ,0113• •
.�v
9. YIELD (wpm): 3 METHOD OF TEST
10, WATER ZONES (depth)' 210' & 545'
11. DISINFECTION: Type
12. CASING:
Fiii
Fr
Ft.
- To Ft
GROUT: Dep, th 20Fron 0 To
From Tc_
14. SCREEN: Depth
From, To_
From Tc_
15. SAND/GRAVEL PACK:
Dcpth
From L To Ft
F rori T^ Ft.
Dr 16
F.-or. 22
F•o.^ 18.. To
A.nc'W t 1 Ece
Wail T'riecness
cr We gh:Pt.
6" .188
pvc
steel
Material b!eLlcd
F;.I 0.te & wI r,L Tamed
Ft.
D';a. leer Slot Siu Ma_r al
Ft. In.
in,
16. vMAR:<<'
in
Material
TopograD'htc.ZaZd s: :s
°Rdge ❑Slope °Valley. QFi_:
(:hr.'x a2�r:;.'.a- :cz)
L_..r.de,longimde of well lcca:ion
(hey .1q eb-lfS: ::J)
Laar:delcnsi:ude sc•WceCG?S'0Tcpo,—,a?hi:..
ap
(•'-sec's Ccc)
DRILLING LOG
Formation Descriction
clay &�:
20' 650' granite
PEFT-
Fro .. l�l
LOCATION S?CE TCH
and is miles fr-r., a: leas'
roc State Roads or Cc Roads, ic.ude read
,..-bers aed co m'ton road names.
C'S UC'G YD.7D9:`
J
tLL
ubrlt the original to tha v131
Rcc.1F1e Phone No. (919) 33.32
GROUNDWATER SECTION
ASPFVIU.E REGIONAL OFFICE
$ VC L WAS CONSTRUCTED N ACC CRJ,}NCE WITH 15A NCAC 2C, WEI:—
:DT•rATAC re RECORDOFT}USRASSEEN:ROVID`EDTOTEE ',E_LC`r ER
iS -t/R --S`"C)7
NA-rJR OOFPERSON CONSTRUCTNOTEE WELL DATE
n of Water Quality, Groundwater Section, 1636 Ma!I Service Center • Raleigh, NC
1, within 30 days, GW•1 tiV.09;200i
0
rV
0

2. WELL LOCATION:
Nearest Tow'C: SYlva Ceunry Jackson
Dillard Town RD across from Fast Sylva Baptist
(Soto: Nate, Cc t,n :olio/ S':bdir;sor, :.at No., Zip Code)
3. OW ER Doug Smith
Address 12 Chalet Hills
(Stec cr Roe No.)
Sv1va.NC 28779
Cit.' cr Tew'n Sate Zip Cede
(82• 586-6414
A. -ea code.
4. DATE DRILLED 5-12-03
5. TOTALDEPTH: 200'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Blow Top of Casing: 150 r t,
(WI "+" I(A' o9: To; of
8. TOP OF CASING IS 2 FT, Abcve Lard Surface'
*Top oreukj terminated at'or below land rurfact re;' lres a
variance tccvdance ydth 15.4 NCAC IC .CI18.
y YIELD (gr,n): 40 METHOD OF TEST hrsv
10, WATER ZONES (depth): 145' & 170'
11, DISINFECTION:Tyre
12. CASNG:
From ,. To_
Fr 13, To
GROUT: Oath ;r1ateia'. Method
Frcrr. 0 To23
From To Ft.
14. SCREEN: Depth Diameter SIctS:z: Ma'_ria1
F-oin To Ft 'In. ,.,.
From To FI.____in. in
Fri
132F:
Ft
Amoa,l lEcv
W'aB Try c't e ss
D' ter cr WeLsmwVFt. Mar_r,al
6" ,188 steel
15, SAND/GRAVEL PACK:
Dept
From To_
From
To
Ft.ha-atite & mmert prozet
Size . Matt:ia1
Ft.
Ft.
273382
WELL CONSTRUCTION RECORD
• Dvisr.. icof Waat:r Q.a iF'' CKoa2d'aa!ar Sty;ton
NO,��n ClJlln3 • Dep2,^le^„ CS E1YI(DRPI:ni 3+1dh3tW"?, HOta089 ��
ILL CON7RA0RUND I D''AL) NAM': (2-.,t) James B. Brown CERTFICATION# 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drillina, Inc. P:10NE ? �:so9-95a1
STATE WELL CONSTRUCTION PERMIT*ASSOCIATED WO PEFLMIT4Cif aoelicabie)
(!fecoli:ab!e)
I. W'_. L USE (Che:k Applicable Box)' Residen!ial h:unicipaLTubiic C 1ndasr y-
a! ❑ A�ri:ule! ❑
M ,torthg 0 Recovery O Heat Pump Water 1n e :ion ❑ Oche: u 1f 0'±er, Lis: Us:
Tcpog-api.c,:.acd setting
❑Ridge ❑Slope 01'ailey ❑Flat
(cx.'s arorcpr.e'_ e-x)
Latir.delongi^'de dwell lc:atlor
L„lr.de'lenginide so_ce:COPSOTcpac?apni: ,.
(aheex scx)
)2E?TP • DRILLING LOG
Fro-, Forna:icn Descrioticn
0 130' clay & x i
130' 200' granite
LOCATION SICETC^;
Show sr, an disl_ oe !r. c,i!es from a: ins:
two Slat. Roads or Cc `y Roads. Ir.:Iude rcad
numbers�a:,d co.;tm,on road na n s.
w'c LL WAS CONSTRUCTED N ACCOP.:•ANCt `%,1±= 1SA NCAC 2C, wT_LL
TrLAT A CO?Y OF TH:5''..0 RD HAS BEEN ?ROVi;ED TOTi— 'r Ei.L CW11=R
A i JR OF PERSON CONSTRUCTING TI-3 WELL
DATE
at Water Quality, Groundwater Sec:!oni 1636 NIa!I Senlce Center-Raleis:r, NC
within 30 days, GW-1 R`_Y, 0772001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources _-/Division of Water Quality - Groundwater Section
/�/��
WELL CONTRACTOR (INDIVIDUAL) NAMEE(print) Kenneth .hte_CrQ_ry CERTIFICATIONs'�grg�t/i
WELL CONTRACTOR COMPANY NAME 23rKer Weil and r' unt PHONE # �f7(1 {�'1rI� /Zna3
STATE WELL CONSTRUCTION PERMIT# 121 I ASSOCIATED WQ PERJIIT#
(if applicable) (if applicable)
2140G3
1. WELL USE (Check Applicable Box): Residential L9'MunicipahPublic 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest TowOn
n: yy NCI County lJ
MOLidice Ltbdivision -Lnf # 6-A
(Street Name, Numbers, C�ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: P�r}j1C.1 Aitacsk cL
Address �r5 lair
(Street or Route No.) 4:Q
9bzr7
60,
rein_ sail Zip Code
Area code- Phone number
4. DATE DRILLED �J—I�'Lk')
5. TOTAL DEPTH: Sao
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fir"
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1.33. FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance in accorda ce with I5A NCAC 2C .0118.
9. YIELD (gpm): Ili METHOD OF TEST_I fnecil
10. WATER ZONES (depth):
Y puny) II24SQ 71 eY
1 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dya eter or Weight/Ft. Nlterial
From 0 To .31 Ft. SD/Z2.I
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To c20 Ft. (',crtcnt
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Poured
16. REMARKS:
Topogra hic/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
co
•
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 yIva -toJ t klu .1D7.
-ra..Ke- a te-F-E on- W ui . 28I
wolf Lake 6ubc4visiof -toy
e-A. Vp ss Owen goad-
F L_ Lnc y &ad)
Lae_
L, l'y'pd`ME kEB\N CtytT
CONS.'RUC'IION SI
GRPOS,111WAGtEp18@%Git( to th GW-1 REV. 07,2001
ASi:Eci21769914--63 : t��iird SsiS 919 733-3221, within 30 days.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
wlCC /1u,
SIGNATURE OF PERSON CO ' TRUCTING THE WELL - DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC

ri\v
273945
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division�/'1of Water �Q}uality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ��• 1-e.h� , I la f"t I n 1('V ( frt S CERTIFICATION 2(, 7-/
Rti en B✓11syjp,n �Ft OS S Id eu PHONE # 1U"O1t7at0-59'S
STATE WELL CONSTRUCTION PERNIIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
\\ ELI. CON] 'R:\C'l OR CO\IPAN V N.UIE
1. WELL USE (Check Applicable Box): Residential Municipal Public 0 Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ 11'0ther, List Use
2. WELL LOCATION
Nearest Town: Lohlther County iCtC-KSOY)
Ear C.k- =rroJ ,u_tt-6-r1Z01
(Street Name. Numbers, To(Comnunit`yI.Y
. Subdivision. Lot No.. Zip Code)
3. OWNER: ��t`LILI+ ��-D t.Idau
o4,-f2'>'1 GI _r
Address -Y ci Fre d 5
Street or No.)
(i ht�Route ;�, N(, ag7 u 9
City or Town State Zip Coda
)- (n31 — 3�1
Area code- Phone number
4. DATE DRILLED 3-- 0 3
5. TOTAL DEPTH: (r,00
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing.: r-)O FT.
(Use "T' if Abuse Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated atior belose land surface requires a
variance in accordance with 15 A NCAC 2C .0118.
9. YIELD (epm): -3 b1ETHOD OF TEST 0-1
10. WATER ZONES (depth): 1%a- 7-051 ', a- 21G0'
d.-530/
I I. DISINFECTION: Type 147-F-I Amount RZ-1 0Z-
12. CASING: AWall Thickness
Depth �N Diameter or Weieht'Ft. Material
t From � To 1o` Ft.(ON QC C/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From ' C% To 2-0 Ft. Ce ri-eru(--
From
14. SCREEN:
Method
,o p
To Ft.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND:GRAVELPACK:
Depth Size Nlaterial
From To Ft.
From To Ft.
16. REM :ARKS:
I DO HEREBY CERTIFY THAT THIS \WEL
CONSTRUCTION STAN S, A,'D
it
Lr1Kt it
, Submit the original to tlr
27699-1636 Plume No. (9 1913.3-
��rCIIP. clECTION
r L OFFICE
WAS CON.
CO
Topographic/Land setting
❑Ridge .2Slope 0Valley ❑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
l 1 c -n t �2
Z05 - ZOi U t i
2_0-1-7130 c"..\ zee_
ZGC - Zlp Z._
2(a 530
530-S3a—
'�--IWAT ION Shfrl`CH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CQU r
�{ �I I -f u- 4-
IGN'ATGRE OF PERSON CONSTRUCTING THE WELL
6J
(jvl 130-r Klwj @
ciCa ce.�^
�}Z , Or\ \-1YC
0n
�a
—'tom
m.1
N
n:o
TRUCTED IN ACCORDANCE \VITH I5A NCAC 2C. WELL Cfl -4
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEIN
DATE
bn
-v
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

273944
Submit the original ti he
t7499-1-636 Phone-No_y9 9)
GP,OnE,A)P,FEP ` -2JDiN
... -t REEHEEEll i.r'iCE
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesy�/�- Division
oof Water
;r�5\,uality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(,((�pr�i/n�t) l% a to t I t(�t�M1'-'I L Ifs MOH /^/ /15 `a \//�' CERTIFIC(�A�[TION+(# ; cq
WELL CONTRACTOR COMPANY NAME 4 t"'t'r7 Cry P- �}t5 tUI I "/ r `' 6JJ7/V4 NE # (" 3) 7 ! �' e
STATE WELL CONSTRUCTION PER.\IIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 15Y Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DaDI O uC (LC
Address (6-I 'S45 Shoal (X- k(i(
(Street or Route No.)
LkIf-he'r, NG
City or Town State
( )- L{c1q-5100
Zip Code
9
Area code- Phone number n
4. DATE DRILLED
5. TOTAL DEPTH: .�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ig
7. STATIC WATER LEVEL Below Top of Casing: '70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordant with 15A N CAC 2C .0118.
9. YIELD (gpm): —METHOD OF TEST t_ l
M. WATER ZONES (depth): - I au' j 1 - 5U 1
LA— axes
II. DISINFECTION: Type 1-4TF1 Amount I`4•(o Z-
12. CASING: wall Thickness
Depth tory eter or Weight/Ft.Material
To l O (o FL� l l4 r I R �i S�2-Q-
From U
From To Ft.
From To Ft.
13. GROUT: Depth Material lethod
From v To -0 Ft. C — � --
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
DRidge Peope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
�1 Form��C�ycription
Fr_ i
(0,- I�O
Ian 1)3. rahl+
ISD
(t O — ISM c .) I
au thl
ii � 32A � Y-CA- '�
(s3,- 'LSO
LOCATION SKETCH
Show direction and distance in miles from at least
Iwo State Roads or County Roads. Include the road
numbers and common road names.
id—
z
I B4iLER.EELy. CERTIFY Tu T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
L Cr rS1.UciT1 ' S tY7 5 ND A Cam' rF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
44 ...9,
SIGNATURE OF PERSON 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources I- Division of Water Quality - Groundwater Section r//
WELL CONTRACTOR (INDIVIDUAL) NANII�E (print) J I� y'yn� �\Icit y-, r, I CERTIFICATION If r�C t K(.0
WELL CONTRACTOR COVIPANYNAME A CrrefAle 1�YDS "' .(� 1 OS \-`j`J� PHONE # j()20) c,clei— 5O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
273943
1. WELL USE (Check Applicable Box): Residential,E Municipal/Public ❑ Industrial 0 Agricultural O
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI Or
Nearest Town: OSh (e 6( � County kA0. Kam)
L,L2�nIfk 2S1r- WVe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i JE. Y 1 Jtt n w r
Address (o UV--t'CS
�II l (Street or Route No.)
(AL(Cs u s-t, r f )
ity or Town St Zip Code
(9v - Lf 7 f-742—,
Area code- Phone number /
4. DATE DRILLED '/
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (pI
7. STATIC WATER LEVEL Below Top of Casing: _60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordansci with 15A NCAC 2C .01I8.
9. YIELD (gpm): METHOD OF TEST a I r
10. WATER ZONES (depth):21/Z - 11 v / /')2" -Z7.5
riI 5zoy0
11. DISINFECTION: Type Vice Amount /?.5 D Z
12. CASING: Wall Thickness
Depth d 91ameter or Weight/Ft.
From 0 To 0, Ft. (0 /I`/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 Too0 Ft. (emen4-
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
P Vc
( lethod
L'
1F
From
From
RFMARKR•
To Ft.
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 esFription
co
26-IId wtaniM
a-- Cat
Ia— S KJra-nt- -
a-15-- 2-77 60_0 b
—300 `r-a-YIt _
LOCATIONS CH 5. is
Show direction and distance in miles frorsat 1 -I
two State Roads or County Roads. Inch' the gad
numbers and common road names. N
log
n r_
I.
bj t, 5 / c Q Cpe -
c<
J >c
yc
rn—
rr,
CO !itch' h)(Le.
viel( 3L
I.' 11„7
a tit
1 T'D VEr Y C&PTIF 1 1-;.`
1- STANDIA Rr�
L^„C3 �'
{
6451-6341
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
s 03
3C„
SIGNATURE OF PERSON CONSTR[JLTING THE WELL DATE
Okithe Di tision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
N'n.r��`9) 733 3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
-North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section p
6
We- r CERTIFICATION 0 id
WELL CONTRACTOR (INDIVIDUAL) NAME '' l r� ram/ `�
WELL CONTRACTORCOMPANY NAME "I'l l� �R - 7r5 WM1 I D' Li UtHONE ti (.2o) Style-55.�t0
STATE WELL CONSTRUCTION PERMITd ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
273942
1. WELL USE (Check Applicable Box): Residential t7i. Iv tunicipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO : `,
Nearest To\\ LQ-5A 1 �� S County I\/'. I�.i� ( 1 q
—Icon Ycur u9
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �11 C.Y‘Etcl �1Al�J Address Qt4C1 (ove 6lt-e-K,
(Street or Route No S
C�ncte(son,C arl(FZb
City or Town State Zip Code
(Z)-14-!3)-[01i(
Area code- Phone number
4. DATE DRILLED `I -1— o 3
5. TOTAL DEPTH: DSO r
6. DOES WELL REPLACE EXISTING \VELL? YES ❑ NO IA
7. STATIC WATER LEVEL Below Top of Casing: I 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated aCer below land surface requires a
variance in accordauye with I5A NCAC 2C .0118. •
9. YIELD (gpm)'O METHOD OF TEST a ( f
10. WATER ZONES (depth): (r O' ; I 0'
11. DISINFECTION: Type 1-1TH Amount i \.Z55OL.
12. CASING: Wall Thickness
Depth iameter or Weight/R. Material
From 0 To 3U Ft. (cI�t{I' • (I % 5P2,i
From To Ft.
From To Ft.
GROUT: Depth Material lethod
From 0To IQ Ft. pe.ilr\2fi- �OP
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
Ft. in. in.
SCREEN:
From
From To
SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
16. REMARKS
Topographic/Land setting
❑Ridge ❑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 fire CI
15- toe
6.)2- 12v
(too( tThi
C,r-ani 4-ei
r
O
CO
ti
LOCATION SKETCH b
Show direction and distance in miles fro root at leaSH
two State Roads or County Roads. Includ€jthe B
numbers and common road names.
N;lc,.
�II.0 `I f --l.l,t>�T
ro —t
(,ryv Cxc..Cvv Ina-C{CLi
R- L0)632 'lam
iIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3. r S'-23 03
SIGNATURE OF PERSON CONSTREKTING THE WELL DATE
dlu. j ljreggr}gTpat-f 011e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
PiT7- \9i(136-i.PGHdilAtin.XORIST733-tt21, within 30 days. GW-1 REV. 07/2001

6-3
273941
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NatuulrReso�u/r�ces - Division of Water Quality - Groundwater Section (�
WELL CONTRACTOR (INDIVIDUAL) NANIE((��(ttpp�r.yii�nt) s 0 1 i �'C`LI. rt(��' CERTIFICATION #2' O�
WELLCON'TRACTORCO\1PANYNANIE RN3t e efne, „(T� \.U&(1 "�1 ( �(1IUc'-PHONE # ( �I�O�-S�0
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 ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ,
Nearest Town:
1
Ivy
County -3. au<SO in
(Street Name, Numbers, Community, Subdivision, LotNo., Zip Code)
3. OWNER: V u cIK \] kt (-For
Address P 0 T30 )t X7
6j(Street nwolrlRout1 No.) C � D ! >
City or Town State
Zip Code
'14 3-3 a
Area code- Phone number
4. DATE DRILLED 1-1-- (-2
5. TOTAL DEPTH: 1--11 `) t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f
7. STATIC WATER LEVEL Below Top of Casing: 1 O 0 FT.
(Use "r' if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. •
9. YIELD (gpm): 30 METHOD OF TEST a k r
10. WATER ZONES (depth): ('-E0
l 1. DISINFECTION: Type -T N
12. CASING:
Depth, I "Diameter
From C.)To 1 1 Ft. (Ogg
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To DO Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
From
From
Amount n9.0.L18 Ov
Wall Thickness
or Weight/Ft. Material
Material tethod
(�(terlfi
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Depth Size Material
To Ft.
To Ft.
5'vl5'ft to tlie`
a` r 27G99 S:Fi3(, 1'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley RFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fru_ ' Form on De cription
o ,fanc?
�}a— 1L40 (rC nlle
Iv-14a, eio(h-1
Q
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.
AT TFIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL. OWNER
<T: /11
SIGNATURE OF PERSON CO i RUCTING THE WELL
]3 -03
DATE
Division of Water Quality, Groundwater Section, 1636 i\lail Service Center- Raleigh, NC
733-3221, within 30 days. GW-1 RE\'. 07/2001

WELL CONSTRUCTION RECORD
273940
North Carolina - Department of Environment and Natural/ �Reso�urrces - Division of Water Quality - Groundwater Sectio/n�
VWELL CONTRACTOR (INDIVIDUAL) N.AAIE((��(pr��yin\,ty))� J fl M�CUr CERTIFICATION# 316
\\ELI. CONTRACTOR CONI P.\N\T N.AME A/114 Orett'f.e rj%2)St 01 <' PHONE k fpi 5f518'50.3
S[Al E \\ ELL CONSTRUCTION I'ER\III# ASSOCIATED \\'Q PEIUIIT4
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential. NlunicipalPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 F-Icat Pump Water Injection ❑ Other 0 II -Other, List Use
'_. WELL LOCATI , ..
Nearest Town: rteklu (11-C County Joc-K-0
L,uttre I FCtJIS
(Street Name. Numbers, Community, SubJ1) ision, Lot No.. Zip Code)
3. OWNER: Ili; R1am cm.
3.
Addres> `k I I k - Gt "tt ct S f-
CdCL Or;et or a� No.) 3D,go3
r io.cn Sole Zip Code
(44 or
4-715
Area code- Phone number
-4. DATE DRILLED 1- I-1-0 3
5. TOTAL DEPTH: 900
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO 174/
7. STATIC WATER LEVEL Below Top ofCasing: .300 FT.
(Use"-.. ifAbo)c Top ofCasing,
8. TOP OF CASING IS FT. Above [and Surfaces
*Hitt of casing terminated aror belort land surface requires a
variance in accordance nit!) 15A NCAC 2C .0115.
9. YIELD (epm): 3(4 METHOD OF TEST at r-
10. WATER ZONES (depth): `t 50
Topographic/Land setting
❑Ridge ❑Slope ❑valley
(check ap propriatc box)
Latitude/longitude of well location
let
(decrees ntine;es Scoonds)
Lati«Ide longitude sourcc:OGPS❑Topographic map
t ghee% bo,l
DEPTH DRILLING LOG
From To Formation Description
— 35 50-vve{
35-4e0 6,j t+e
431) }SZ CCtvtf�
LiS)-- eicO
LOCATION SKETCH CO o
c
II. DISINFECTION. Type k1-f U Amount `EQ ,`� OZ, Show direction and distance in mile; from atSam �n1
12. CASING: Pall Thickness two State Roads or County Roads. Include tlal¢oade ni
Depth Dienmter or Weight Ft. Material numbers and common road names. v c:�
To Ft- 01 0 m---
S 7.-,
_
To Ft. n' Depth Nlatcrial
To zv Ft. C -e Ire- *
To Ft.
From 0 To `to Ft &01iU .Ia$ =fie
From
From
3. GROUT:
From - 0
From
Alctlwd
la. SCREEN: Depth Dianieter Slot Size Nlaterial
From To Pt. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ceattr CI- 4 ..IV N^
c,
C("% o)(), BY-1 eGW V F Z e f
\'LCLA-
�LJ (cL (A_, LCA ((5
16. REVIARKS:
pLsrJ)QPI1E:B4}IqII'FONC \R, TIO
LCOVIT�2I(
r
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the o_ riiiitt;IiiltUe Div
2g00s$1636 IILntc:INol l( 0 733--
••-�j. (If c— .23
IGNATL'RE OF PERSON CONSTCTING THE WELL DATE
;inn of VWater Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
221, within 30 days. GR'-I REV. 07,2001

t7
2'73939
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
n ^ e
WELL CONTRACTOR (INDIVIDUAL) NAMyE��/(t\p(riint)n 1 I✓QQI V \ - l.t-L{' r��"�y,/ j c CERTIFICATION #
\VELI. CONTI2:\CTORRCOMPANV NAME RYA Grecne rJ ✓I I\tte(Lf) 0c_59IUa-- PHONE a jt8/ig)5n-555D
ASSOCIATE \VQ PERMIT#
Of applicable)
STATE \VELI. CONSTRUCTION PERMIT#
(if applicable)
1. \CELL ESE (Cheek Applicable Box): Residential ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Ne. estTown: adA./a- County .�QCKSOfl
1-5rlu hwoor" ; Spbnvh k L( net,
mu
(Street Name. Numbers, Conmity, Subdivision. Lot No.. Zip Code)
3. OWNER: G-cne Coach
Address a to 17\1 vexc-A'e5a-
(Strect or Route No.)
SiI1/ 1J�
City or Town State
(Szb')- 581,-Ll0ci I
Area code- Phone number
4. DATE DRILLED HI-2.3-O2
5. TOTAL DEPTH- .Qeo'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E2
7. STATIC WATER LEVEL Below Top of Casing: v0 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 u
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gprp): 45 METHOD OF TEST Olt V'
10. 1VATER 7.ONES (depth):
II. DISINFECTION: Type
12. CASING:
Depth
From D To (05
From
Dr
as»q
Zip Code
Topographic/Land setting
DRidge Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPSCJTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0— (Do 0,IG/-1
(0- I�5
5 y-a n r
((c J- /6 7 CCwI h(
!(.6.7-2OO 9 hetnlfP,,
N7 H Amount C/ OZ-
Wall Thickness
Diagiieter or Weiehr'Ft. Material
F[
l 1 (wc/
To Ft.
From To Ft.
13. GROUT:_ Depth
From U To J50 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To in.
5. SANDGRA\'EL PACK:
Depth
From To
Nlaterial
Ft.
Size
Ft
From l o Ft.
Method
to
Slot Size Material
in.
in.
Nlaterial
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.
L),
I n pNSprufp 6PRInliONI IF'
\,r
T THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
JS, AND TI I.AT A COPY OF TFIIS RECORD HAS BEEN PROVIDED TO THE WELL, OWNER
S 4 NC
SIGNATURE OF ncucnfl I U'TIKG THE WELL DATE
Subnnt the WiginaL the vision of Water Quality, Groundwater Section, 1636 Mail Serviee Center -Raleigh, NC
y7699Ibt`G I iii ht-)Iai1r(9191 7 n 3221, n'ithnl 30 d'a)s_ GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
274423
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VV ELL CONTRACTOR (INDIVIDUAL) NAME
(print) ch{env1: 5 I A CERTIFICATION # P
/7(
\\"ELL CONTRACTOR CO\IPAN'V NAME,/�t".I)n'iS I,ItS1LIf.vlr4 11)PII 1I Yt JI'k1.1 J PHONE47%..3%2 -3 a4G
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED \VQi'ERMIT#
(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:
Nearysst Town: LLJh W-W-", ei2-
111/nrnaS t'4iie P
Couatty -SA citesm�'
(Street Name, Numbers, Community, bdivision, Lot No.. Zip C4rfrf - (f1
3. OWNER: L"e J r1L^o
Address P Or nX /7 3_,
• (Street or Route No.)
1-0111 his, -en, A/C --
or Town State
) L3 R9 - (� Ss 3
Area rode- Phone number
4. DATE DRILLED ..2) — /^ — [i 3
S. TOTAL DEPTH: .a 5.5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: cr7-.) 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): S METHOD OF TEST /U7�%/T%E-�
10. WATER ZONES (depth): c2 0 6
r7CA/k 9
Zip Code
Topographic and setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
P / ac
v AvAnr"' ab ' a e-e__
DEPTH
From To
1 I. DISINFECTION: Type
12. CASING:
Amount
Depth ��^�
From in To J> Jf Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Materia! ../
From i7 To AD?I Ft- /T(2,em 0. a
From To Pt.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
ra TA A S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Diapeter or Weieht/Ft- Mat fiat numbers and common road names
Wall Thickness
Method
pL1LI2L)
0
W
L
1
W
W
W
W
16. REMARKS:
l� ;L I L)Q Hbl1' EREcBRT!(FY
J ( CO:SISTPU.CTION
L r SalI ar+t-t-he-ar-�i
;76'? 1t6r116 IliihLi t1:ji(9E19) 73
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s_/ _ 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

274422
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / '_
WELL CONTRACTOR(INDIVIDUAL) NANl' EE (print) <I){�nIAI S J-c011Q„n �, CERTIFICATION it ol /7`{
WELL CONTRACTOR ACToa COMPANY NAM¢ np,S fd. jlfyr4 Wei 11)Y,1i-u Ter e PHONE#�raK_sa 4-3 gei
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ya--Munieipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
�
Nearest Toevn:k)t)i Hrt Pt2i /VL County ACKScIw
n C Q y /2 . IZ a- 7 CI- Et)
(Street Name, Sitmbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 00 Y 1 2RL-IA Q.rYt
Address 1 a3 iv Q(vI. P, p t .
(Street or RouteNo
Lab
'' II gt-9
Ci Typwn State ` Zip Code
)-y por y 9 7 - r3 2S/
Area code- Phone number
4 DATE DRILLED 5.3 a - 0-3
5. TOTAL DEPTH: 717)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): %.2 METHOD OF TEST 1/29G1/2/4
10. WATER ZONES (depth): f) a i/
11. DISINFECTION. Type 1 f»
12. CASING:
Depth
From 0 To '/ / Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
Fro III n To ,- D Ft.
Amount r 2 TA S
Wall Thickness
Dianteter or Weight/Ft.
" shp.Q
From To Ft.
Material
e124nDy7
Material
p1
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15_ SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
Topographic/ and setting
❑Ridge pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From
3D
yi
To
.�3U
76-)
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
C'?
0)
W
16. REMARKS:
r 1 6 DO,'HEIF-�.BV
I—CONS
Ll
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a-C11- � u� 5-26-63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
C l°4°{1R rm-iwyTidR the Di 'Isimt of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASMF76H4t763AQ1.1?ba1kri.NDF.I(dJ[9) 733-3221, within 30 days. GW-1 REV. 07/2001

274421
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
\\'ELL CONTRACTOR (INDIVIDUAL) NAME
(print) <lJI 1Tio15 /
WELL CONTRACTOR COMPANY NAM 'f
STATE WELL CONSTRLCrION PERMIT#
(if applicable)
Division)I of Water Quality - Groundwater Section
lM TiQC+� CERTIFICATION # etnce
ryn �, J1�2,.d �IIPIIdIrtll u ( 1,ne J PHONE #t2edC 5 2Li-3 ;l6 0
ASSOCIATED WQPERMIT#
(if applicable)
2.
WELL USE (Check Applicable Box): Residential Y�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
N rest Tovvm, � ✓0. A/ �- County ��GICS Chi
C�.nc 2� — is( re lH (�c'
(Street Notify Numbers, Community, Subdivision, Lot No., Z' Code)
3. OWNER: (4.41i
Address . n %'3 nx 13
(Street or Route No.) V� Al C7s' '779
ty or Town State Zip Code
gam- q— 049
Area rode- Phone number
4. DATE DRILLED 6--a3 --6 3
5. TOTAL DEPTH: taa
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: en FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '/0 METHOD OF TEST /07//;7.(1-Th
10. WATER ZONES (depth): (�
Topographic/Land setting
E-. ❑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
C'-1 ac'
SQ-n� < a .
0 ItU
Li0
v3'r 7s'
I I. DISINFECTION: Type
11.1-14 Amount
LOCATION SKETCH
r 2 TM- /3 S Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mateial
From 0 To (ro--3 Ft. (Ci " S.11.2 I P i c-
From To Ft.
From To Ft.
Depth Material Method
To �iL Et. C04y1 da �.16TTLi0
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
Ft. in. in.
13. GROUT:
From (5
From
14. SCREEN:
From
From To
15. SAND/GRAVEL PACK
Depth Size Material
From To
Ft.
From To
Ft.
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
L
ca
—D
w
W
CO
16. REMARKS:
-,
i1 h36 HEREBY CERTIFY ' 1--(.A-THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�--`N I CONSTRUCTION STAN�L JS, AND THAT A COPYOFTH{S RECORD HAS BEEN PROVIDED TTOO THE WI L OWNER
4rn a,(J I e e S 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
�-'—
G{ft4fCUAANN?E6tSACnlaO'Pb the D vision of Water Quality, Groundwater Section, 163E Mail Service Center - Raleigh, NC
AS!'.f i9q l$��r,'gtiu'xr Nk 61 1.1) aa3-322I, within 30 days. GW-I REV. 07/2001
•

WELL CONSTRUCTION RECORD 274244
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .3—E Er E��R ( )4YDE CERTIFICATIONOSU
WELL CONTRACTOR COMPANY NAME 4AAL .Csrn `^1.3)hVr+' irr)
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE % (3).$1429- $+t530
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:
NearestToQn� ao-ry U--+ County?-
Sqlr-c
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: I crru i�Qan�f2�V3Yr��
Address 7) - c act-t aaii8
(S reel or Route No.)
,Qn cC fy Yl G
C yor To Town J SState
( z8)- 11-97_ .a i2
a-87/3
Zip Code
Area code- Phone number
4. DATE DRILLED 5/5/aob3
6. DOES WELL REPLACE
EXISTING WELL? YES 0 NO ki!
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"
•Top of cuing terminated actor below land surface requires a
variance In accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): 1 ; METHOD OF TEST a'Li
10. WATER ZONES (depth): / 27
5. TOTAL DEPTH: 3. d'
II. DISINFECTION: Type
12. CASING:
ATN Amount 0, �L3
Depth
From 0 To S13 Ft.
From To Ft.
From To Ft.
13, GROUT: Depth MateriI
From e0 To ..2-0 FICA-rrw-INT
To
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:
Wall Thickness
Diameter or Weight/Ft. Material
6'/ci- CA27.1 PltC
Ft.
Slot Size Material
in.
in.
Method
Material
by- hjLtj `cunt. sa 3/0
-ta"--- (Q.i Lr S-flS
way .
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.
C_64,_e ot,y-4# gs,v Lti ,'
5C r -{ swr l l L�
Irt-7 y . 7 / 7.9l0 NJ L r'I fc. hp . '`�' r-z
p OI On Thittn twin,(I/Inkrts
sR (I/Ink !�P,. i !!!.,JJJ v...rrl
',!DO HER YCC
EIa] F
O NSTRU T1bN STAI
I /
U
L Submit the original W the
276994636. Pltopkti N0. (919)
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NA RE F PER ON CONSTRUCTING THE WELL DAT
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-322t, within 30 days. GW-1 REV. 07/2001

274136
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
B
WELL CONTRACTOR (INDIVIDUAL) NAM (print) �Lt CERTIFICATION #M 0 77
WELL CONTRACTOR COMPANY NAME LIlLIA / - lie HONE p S
STATE WELL CONSTRUCTION PERMrrt'# 7LS.2 -/.I. 376 CA soCTATED WQ PERMrr# (I 6 0 9a Ltd
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
N-.s st, own:_ County
.P61#-i T g 7 99
(Street Name, N
Subdivision, Lot No., Tip Code)
3. OWNE_-
Address
ct
m cam iy 9
c. Code
ma4-�ssG
Arca coda Phone number
4. DATE DRILLED y/'S
,r / 3
5. TOTAL DEPTH: ID
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 531
7. STATIC WATER LEVEL Below Top of Casing: 9D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /.'< FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordance hb 'SA NCAC 2C .0118.
9. YIELD (gpm): .SwtJ METHOD OF TEST "r
10. WATER ZONES (depth): /DD' J4.S
} �
Topographic/Land setting
❑Ridge PiSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type9l
12. CASING: numbers and common road names.
From t7 _To Depth ter or Weight/Ft ;7 FL .t4/ !/G
From To Ft.
From To Ft.
13. GROUT: Depth �r�Material a
From_ To m Ft. cjvifr.+/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
Fro To Ft. in. in.
15. SAND GRAVEL PACK
th Size Material
Fromo Ft. T
From / To Ft.
o 2
C r-"
r,
T ter'
is
LOCATION SKETCH ca m
Amount Oft 0Z- Show direction and distance in miles fro y tt lea
Wall Thickness two State Roads or County Roads. Includfhe rmd
16. REMARKS:
1,(3) ii3orrC r HAT 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
El)i " " y/�5/D3
L t`/ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I i
iEtpgtni{ 4ie-the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
'g7499461<(iPEpsehlkt ?)73313221,within 30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
B
CERTIFICATION #uL U 77
WELL CONTRACTOR (INDIVIDUAL) NAM (print) �/� -n ,p a �r/
iJ 141 Adt / doe PHONE (t (ft�a, «9 oy�I
WELL CONTRACTOR COMPANY NAME v T
STATE WELL CONSTRUCTION PERMITS/ P� f' 7L - $2:2113ASSOCIATED WQ PERMTI# t/ 3 9/Jr 3
(if applicable) (if applicable)
274135
I. WELL USE (Check Applicable Box): Residential IS Mtmicipal/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:
county,
elf277
(Street Name, NYrbbers, Community, Subdivision, Lot No., Tap Code)
3. OWNER: Qa1419
Address /.2
(Street or Bane
Alc. t,2$779
ar Taw State Zip Code
Topographic/Land setting
❑Ridge ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degas/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
}
Area coda Phone number / y/ D 3
4. DATE DRILLED I
5. TOTAL DEPTH: /4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI
7. STATIC WATER LEVEL Below Top of Casing: / / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface*
`Top or casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / ME OD OF TEST Tt►s n
10. WATER ZONES (depth): 40 - 7n0 •
11. DISINFECTION: Type— Amount to t o".
12. CASING: WallThickaess
ameter or Weight/Ft Material
From_Q—Torr,ln Ft. _14 t'ti/ (PVC -
From To Ft.
From To Ft.
13. GROUT: Depth ,,,, �tMMater�
From�_To ��ll 0_
Ft t F l
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
r
n
W
LOCATION SKETCH
Show direction and distance in miles fro
two State ' • ads or County Roads. Include
numbers an -•moron road names.
A
WELL
,5SA THAT A COPY OF THIS RWELL WAS ECORD HAS BEEN PROVIDIN ACCORDANCE WITH ED TO NCAC 2C,
WELL OWNER
i 4 �.�f; 0
IGNATUREOFPERSON CON��y
�/.3
THEWELL DATE
LSubmit_the_origlnal o_th.F Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Z7699-1636 PiloheNo. (9119) 733-? Z21, within 30 days.
GW-1 REV. 07/2001

275747
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES/ (print) 'nYLI �'t-tr-C- —SY/.L( Q I CERTIFICATION # , /30 zf 1
WELT. CONTRACTOR COMPANY NAME &reen#,/ RYO5 • L.(Jl // q l7u.eV Jilt-C PHONE # (po(6 c,ijRi -
$TATEWELL CONSTRUCTION PERMIT# /«c 2_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
,`WELL USE (Check Applicable Box): Residential P, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQAJ•
NepTown: LFXALI-t-vw% County (I 0.--CJCS
DSPINN tad- rRrF
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 1
3. OWNER: Sea ( 1 1 I x &c
Address 1 0 he)(((t r nit ` L C3YIr - ► Re •
(Street or Rout No.)
City or Town State Zip Code
Area code- Phone number , / y —1-)3
4: DATE DRILLED `t I 42 -
5.' TOTAL DEPTH: g 45 '
6.';DOES WELL REPLACE EXISTING WELL? YES ❑ NO t
7., STATIC WATER LEVEL Below Top of Casing: es, 0 FT.
(Use "+" if Above Top of Casing)
$. TOP OF CASING IS I FT. Above Land Surface*
*Top o(casrng terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '' METHOD OF TEST t.,2 A rs •
10. WATER ZONES (depth): S S / - %/'ern
: 11, DISINFECTION: Type al--/Y/-I Amount / J~ /
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Il To 6 Ft. %n /' c5:<e-e_l
From To Ft.
From To - Ft.
13. GROUT: = Depth Material Method
,From D To an Ft. C1AM.t.0 f
From To Ft.
14..`SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ^ To Ft.
From ' - To Ft.
Topographic/Land setting
❑Ridge NI.Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees.'minutes/seconds)
Latitude/lon_itude source:OGPSOTopographic map
(check box)
DRILLING LOG
DEPTH
From To Fo tion Description
6
st 3h/SI
Slot Size Material
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
9C:? Wd 1—l(lrCO
16.`REMARKS:
Omit the original to the
2 6..9 1636 Phone No (919)
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF TF113'AEC9RD HAS BEEN PROVIDED TO THE WELL OWNER
6-30-6-3
NATURE OF PERSON CO 11(UCTING TIIE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Ser. ice Center - Raleigh, NC
1, within 30 days. GW-I REV. 07/2001

ti
.WELL CONTRACTOR (INDIVIDUAL) NAME (print)
275733
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WEI4, CONTRACTOR COMPANY NAME n CERTIFICATION 4/3 c4 I
,/ pl Is yyt %. 2L PHONE p 4ia2glp V8-3/9d
STATE WELL CONSTRUCTION PERMITi4 /7 D! -. ASSOCIATED WQ PERiy1IT$l
(if applicable)
(if applicable)
1. 'WELL USE (Check Applicable Box): Residential Municipal/Public ID Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2.: WELL LOCATIO
Nearest Town: ._..�La County dal-.
Lo4- g oJsaw YYl v - re StirrLZ
(Street Name, Numpentommuni Suycli is'on, L t No Z Code)
OWNER; OLGk- 4Pa t j �vt4 e LI-C-
Address l3? Lut<I eIQP.hr't'(Aye
/� (SvicetorRouteNol
L7re_e-nut 11e 1/4-SC, .a' ICLI2
City or Town State I Zip Code
(T)-
. Area code- Phone number
'4. I DATE DRILLED to -- / r7 - 0 3
+', 5.`TOTAL DEPTH: & It S I
DOES WELL REPLACE EXISTING WELL? YES 0 NO 14
3: STATIC WATER LEVEL Below Top of Casing: SD FT.
' ) (Use "+" if Above Top of Casing)
8''TOP OF CASING IS ! FT. Above Land Surface*
*Top of caaing terminated at/or below land surface requires a
' variance In accordance with ISA NCAC 2C .0118.
9 'YIELD (gpm): e D METHOD OF TEST a h rs
JO. WATER ZONES (depth): /n 4S I - ,D qpm
11-• IaIS1NFECTION: Type / 17H Amount 1 D '-7
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From 1) To r%I Ft. /, 'e PVC
-Froth ` To Ft.
From To Ft.
3. GROUT: Depth Material + ethod
;From 0 To �0 Ft. (O,rna.0 .c
;From To Ft.
14. 'SCREEN: Depth Diameter Slot Size Material
>1 From To Ft. in. in.
;'From' To Ft. in. in.
151 `SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From - To Ft.
16.'REMARKS:
' ,i; 1'pOZiEREBY CERTtFPIII4T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Fomiatio Description
0 7 / I C�i.-�
7/ ' (Gs- hAwAh,tt.
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.
ty
0
CJI
' [' CONSTRUCTION -STAND S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-, C G -30 - 0 3
1 SIGNATURE OF PERSON CONSTRUCTING THE WELL - DATE
[ ,_$L4mU the ertginglfe the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ra27G49'a 636 irgn'c;lV'o.`%19) 7 3-3221, within 30 days. GW-I REV. 07/2001
rj
ch
0
G

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section,
r`(
WELL CONTI2:\CTOR(INDIVIDUAL)NAM�tE (print)) A cI)•' �`\�—SL1 r CERTIFICATION IL
WELL CONTRACTOR COMPANY' NANIEAAA GA C�.IJ G gem. `^tee.l\ fY UCa—PHONIE # ,mod S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIlT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: %1e \k.'2. Countyd C�.Sh
(Street Name, Numbers, Community, Subdivision, Lott No., Zip Code)
3. OWNER:Ce\03Cc\cn`ID-A-f\n 1<, -z
Address R 2a-(3 41 1) e'r v; lke_ L\)c I663
(Street or Route No) C-� A�
fr\e\Jovrr>�%occ_ PC`t
t'
City or Town State Zi Cod p J Jai 7 J 1
9,9S1i-72-3-iiot
Area code- Phone number
Topographic/Land setting /
DRidge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For ation Deription
4. DATE DRILLEarca- \a -CON any aczG % — 500i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ef' 5-b- — 6 on
7. STATIC WATER LEVEL Below Top of Casing ?D FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. x
9. YIELD (gpm): d- METHOD OF TEST Q .
10. WATER ZONES (depth): 0 ` `J-O(>
5. TOTAL DEPTH: (.9 00
.11 DISINFECTION: Type
12. CASING:
Depth Diameter
FromQ_To 9a Ft. to `4
From To Ft.
From To Ft.
13. GROUT: Depth f�� Material 1 Method
From 0 TONDL.Ft.0 fa(fer\j.t ,n p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount ra,i o7_S
Wall Thickness
51iehi Ft. Material�
From To Ft.
From To Ft.
16. REMARKS:
275325
LOCATION SKETCH
Show direction and distance in miles from araast c
two State Roads or County Roads. Include t�e road-o _
numbers and common road names. r= ▪ -
N -
—J r-
101�
N o t\D
1 ; a Ie s.4 iY %er
m
G
tats
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
, • V\ \YC �
SIGNATURE OF PERSON CONSTRUCTI¢4GT8E WELL DATE
ot,;ci,,.,ofYl', for Ounntv.Croundwnter SC'Fefion. 1636 Mail Service Center RNC
�1I

275323
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
-3�\ Yl • Q t ! \ 11 �y �z�
\\ELI. CONTRACTOR COMPANY NA\lEAPLAL} re eN) e- f f-cs \ �k rye. ski ! D a PHONE # P 5r\ 11' 3.J-5-O
STATE WELL CONSTRUCTION PI11 _` VI ASSOCIATED WQ PERMIT#
(if applicable) j"tt&t1 Cr_e_VA:0 r e0 • (if applicable)
I. WELL USE (Check Applicable Box): Residential 11 Municipal/Public 0 'Industrial ❑ Agricultural 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: II'CIZCJ/TLQ 2 Coupty�. C�SoN
� 1 i 0 r i-• C� tt rc.\-\ R c� // x/°1 d l a � gigs L. otl/=
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - ivision of Water Quality - Groundwater Section'
_ V� 4� CERTIFICATION # t.ql
t
Topographic/Land setting
❑Ridge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/m i n ices/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desctiption
,;2b i --295' cfna '-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: /rO FT.
(Use "+" if Above Top or Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C .0118.
9. YIELD (epic): y55 METHOD OF TEST G 1t ✓
10. WATER ZONES (depth):S�
3. OWNER: e.N t.pi/til/
Address r 0 � �'j -N c)
(Street or Route No.)
CL- roKee/NC
Zip Code
-4157 —L/3/O
City or Town State
Area code- Phone number ..11
4. DATE DRILLEDM IrCk 14 aa6a , 3
5, TOTAL DEPTH: ; i S'� Z•�-
II DISINFECTION: Type
12. CASING:
Depth
From _ To
14i1-t
Diameter
i[.
Amount r5-:1 02.
Wall Thickness
or Weight/Ft. Material
From To Ft.
From To Ft.
13. GROUT' Depth Material
From To A Ft. Cerr pta*
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
Slot Size Material
in.
in.
From To Ft
From To
Ft.
�1i Gc l�i--
0577 -- 3sz)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include th®ad
numbers and common road names.
c.)
.Chers
(mil/v�C C1l ttd
7113 ul
h=
Fri
0�
0
ebt
16. REtMARKS:✓I'Itkd (kepi( o1.55 ova +9-3l1c�.y'_I; -' -ktiQ GJP a(c 't Ar
1 )orr -att] 4 n,o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 0-'C- l +in—?
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE.�F PERSON CONStic ING T 1 E WELL 1 : TPA. E /
iii \
it
IIi
Submit the original to the Division of Water Quality, GroundJ. Section, 1636 Mail Service C`�n�c(� Raleigh, NC
11d : 1 \

Submit the original to the Division of Water Quality, Groundtra
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NANIE
STATE WELL CONSTRUCTION PER.\HT#
(if applicable)
2'75322
and 9rural �R/e�sJourrceess- Division
of Water Quality - Groundwater Section
t,r p CERTIFICATION# 2 597
we: PHONE # (1- f<P/F
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential.i' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQ
Nearest Town:
(Str�Siagit
ame Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 6) 4 /.50
n lefliq(Street or RouteRoteNo.)
City or Town State
U-4)- r293- 3744
i
CQx7aJ
Zip Code
Area code- Phone numbe
4. DATE DRILLED 1/S-; &5
5. TOTAL DEPTH: r c1/2/}1/4J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. n
9. YIELD (gprn): ,/ - METHOD OF TEST `-6.--L-1
10. WATER ZONES (depth): Mlle', (>•,(tr9 i 4, Ct 1
11. DISINFECTION: Type a TA— Amount rt a.eOZ
12. CASING:
7 Depth
From • To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth lMa'irerislLd* Method
From To 2-0 Ft. _�.Ls412--"
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Wall Thickness
Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
251s'-7it yin
LOCATION SKETCH
Show direction and distance in miles from atd2Ast
two State Roads or County Roads. Include t1ioadco __
numbers and common road names. C
/ 0 7 - 0-1.2-- +\\--
r._
ibSle_
&P Lac.f---4---Q—.� o (-tit-As
t^ f t 1 no a KC.L S
16. REMARKS: DhI I (M".fPY / D45 --- 0 ��06 i �_ 46- i-klr(1 P . Lia.Q: Cl ICC vkOO,$ curl. (
no
I DO HEREBY CERTIFY THAT THIS WELL �WVA ONSTRUC I RJ ACCORDANCE WITH 15A NCAC 2C, WaL LA)
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lAa . - 0 M
0 SIG ATURE OF PERSON CONSTRUQ'E1NG THE WELL
:-3cdion, 1636 Mail Service CenteE 14leigh, NC
Gli.,41 TiEV. 07/2001
i

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural \C Coal Resources(�Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D MC- ✓ng.- - CERTIFICATION # Q IS
D (/
O
WELL CONTRACTORCOMPANY NAME A -6rre Bros WtII 0rtci a-Sc\ Q -'PHONE # ($1y)SV,".-1' 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PE , IIT#
(if applicable) (if applicable)
275321
1. WELL USE (Check Applicable Box): Residential W Municipal/Public 0 Industrial O Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION: 1
Nearest Town: I�UItK County VaCIC_On
l)3V11-4e iwt (re f T1 zU l
(Street Name, Numbe"s, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (ore, 14CC( I
Address Z314 Q.n a.i -iVe--
(Street r oute No.)oakhiiI) 1
3—I5c)1
(0764o ...._ Stdte,7 Zip Code
Area code- Phone number,
4. DATE DRILLED s1 (S k03
5. TOTAL DEPTH: (Q asi
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ya
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 accord e s'ith ISA NCAC 2C .0118. •
9. YIELD (gpm):METHOD OF TEST at r
10. WATER ZONES (depth): (o20/
I1. DISINFECTION: Type Arn4 Amount 76 i HO2-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 3 I Ft. 1I4" Sig 21 pU C
From To -Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN. Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
Ft. Czfrko
Ft.
Size
Ft.
Ft.
lethod
Slot Size Material
in.
in.
Material
From
0 —
Topographic/Land setting
DRidge fiSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
5 O.An.-
ra tk c,
DEPTH
To
2(0
2a - 07.0
LOCATION SKETCH
Show direction and distance in miles from atxaast
two State Roads or County Roads. Include thiearoad:r _-
numbers and common road names.
Iv
J
id , 0
JD Autt (,W1A.t - ci
/goad h
2 3V /boa d
16. REMARKS:
I D0 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
G11,
N G NATURE Oill RSON CONSTR /TIN, THE WELL.. _ 'P to
Submit the original to the Division of Water Quality, Groundw atlerf Section, 1636 Mail Service Ceti(4 }tialeigh, NC
I L J

WELL CONSTRUCTION RECORD
N Re :3 a c,•
'`i' �1C3:Ji�f'3•L.
W= LL CO,NTRAC 0R(IND:�1DCAi.) NAME (ir'r'I% J'& s OA'
WELL CONTEU Ci0R C0�.. A.0• N'A.HE
5TATZ WELL CCNSTAGCTION?SMUT*
((azo;ioa:'.e)
liabl: Box): Reslderllal
�. WELL USE (G, .cAsp I. r-,
Ma,.,,,. ng ❑ Re;overy ❑ Heat Purr.; tit a:s; In:te .0. .
WELL LOCATILONt
Nearest Tc'.
D Lllar
(Sant
Z17 C e1
, 0`R, Ralph W. Davis Jr.
75 Malcxiv Lam
S 1va NC 7
c: Tom, Sa'�
A, -.a <a'a ?Er.a n':..•.e: 5-21-03
4, DATEDRILLEED�---
5 TOTAL DE?T'r.: 40_ Q — �C
6. DOES WELL RE?LACEEXISTINGµELL? ` S: NO N=,.
7. STATIC WATER LE �'c 9aow inn c(Css:ng: r
(tilt"e" If A`ov: Toq of Cm'i.i:
TO? OF CASINO IS z's�, Abcve Land Soda:.
'Tap of coin; lerrinsNd t,cr bait,'" land r:ruI:t;aru
',trivia Inacne:.aace rllh 13k N CAC 1C ,CI13. �;
9. YIELD (Krim): METHOD OF TEST
10, WATER ZONES (de;:h)', 115
275278
i'n �r5 0+,�1 Dri 111na TnC o�p�,'Z a Ea 1� 3G..
ASSOCIATED WQ PZR""1IT?
('(loaiv5',a
Ir,d's;iai ❑
0ih_: ❑If 0''' r is: Use
Jackson
on R
1! D:SrN?ECTIONITye FI Atc'::,, eoz
12, CASING: µ'a.:7-. ,ess
�_: ltsgWer crWeiatr" Va'•-,a.
79• pvc
0 �Tc 83'FI �— .188 stccl
F;�
1: GROUT: Dr: Ma:eria: Mcf.•.o'
Frcrr.. 0 Tc 20 Fi �ite & Lx,C.L ansi
14. SCREEN: Dep'± From in FtD.1.^, . Sc:1S.0 h'a-e'1
:noTo 'In,
Free T^ �_in.
15.SA..ND,'GRAYEL?ACK
Da::-, Sz: Nivcr.i
Fro& Tc
T=
16. RZ>MR-Kc•
E?&EaY C:RTIFY i =AT €:5 `"=C:•
CONS ..:C7.0 _TAN:DAR.^: N; i-:AT
'1-'r.•.
L,•or. 8T1c,
To;o a iC:,and. se z;
�'Rk_ Slept C aie: :.
(tact: atr; roe
ngl?Jde s:..._, CP?_L:Tona , :t:...-.
sx i
Fon:nat
ew&its :.
81 400' =tom
j.00ATI0N SKETCH
S'' , and is�,__ ,..,,.es a: le.,,
t: State Roads cr Cc ___ in.,.__
the road
r...,._:s and. C. r „ ,.3d Roads.
AS CONS:7/.2=_O T'' AC CC?.Zt ''CS ''1_. 15A
-Y BEES ?RO :DED TO THE ,'-. L C'- ER
cam`-!—U3
SiGNAiJREO?FE:SCNCCNSTRCC:INOT �'nELL
it ...,jl
Subrit the original to the DIvIeton of Water Qssliry, Grocndwa:er Secticn, 1'.36 Nfa'I Seni:e Ce::z;r,: Ra'.e:g=, NC
:76934636 Phone N'.. (919) 733.32:1, within 30 days, i
O
0
e_
w
0
-o
w
cn
cn

1. GROUT:
.cr 0
FrCril
14. SCREEN:
r.,..
2. WELL LOCATION:
Nearest Tr»T. lva CC V-„y Jackson
Ben Cwk Rd to Pecan Drive
X 1
S as1nsT,<,1'cn}:.y,C^�:.a Lr.'„Sv:.�. Le; Vic, Z.p <,
OWN_s; David & Carmaletta Gates
?.dW ess PC) Box 1934
(St_e;ar Rcote No.)
„ __ nir 9R•77"2
Dr; or Tour Sooto C.E.
U322, RR6 '3R91
A. -a c 4c- PS:ee n tbtr
4. DATE -DRILLED 5_ 1�—
S TOTAL DEPTH: 775'
6, DGES WELL REPLACEEXISTrNo WELL? YES NCxg'
7. STATIC WATER LEVEL Ee',owTop ofCas:ns: 200' FT.
(,, .f Above To; or Cuc,T.
TOP OF CASNO 15
2 : e. Above Land Surface'
>'Tc c(euln; fum:naud_ e:'or bdcw lied rort,ce req':Ru s
P C 011•
va?,an<e In :turd acct wish 16A ,l CA 1C, 3. �
YIELD _IQ__ METHOD 0? TEST ha';
9,10, WATER D ZONES
170 & 205'
11, DISNFECTCN:T;;e FTi Amour,: 1ECe
12. CASINO: Waa Tdak.ess
.188 steel
Cr''. E,?—.exr
87 Ft.
Fro :-.^,1_11Z_,T^-Ft, 6
1y Dori. To 20 c;,Li iL.e� L& cx:,itaa.
To
D:—y:11
T0_
From Ts—
:5. S.AND'GRAVEL PACK:
., To___
From To
16. REMARKS:
It.
Chat,:x:
Ft
Ft
SIza
Skl Size Material
. ,Y,aleca:
27 5 27'7
WELL CONSTRUCTION RECORD
nt ;,t , t :` ee 'Sa • D'1,' isi.s e4 'at Q_s',:, ' u_ . —
N:r
"�' � CEtui1CATICNtl 2`sd5
1A7-LL CONTRACTOR (1n::01DuAL) NAME (pint) James E. Erokr.
,; D F28 ey SS?1
Hedden Brothers F;ell Driilina, Inc. D f �--
WELL CC}7n.1 C1CR CC':?A,S; NAME AcSpCiA"ED WQ ?ER�fIT �
:TATt WELL CO,,SS Tn0'CT1On PERNI1Te
I. ,. •c.e Box):. Res:de tall 1'& Munic1pa' : n..,. z' Ar,_.,.__: ❑
WELL USE (C..e:A A:p,..
:=
::ni;aring R:::vey 0 .:a:: �^,pWater f ._r, .i`is: Us:
icco zdse..W_
ZR:dit CS,;;e Gvaae ❑Fia;
?c-- ,,ac`i: T
From To 9.ormatisor,25.ao,
0 ~901 cLa-.i8on
.a
90' 225'
ti =te
LOCATION c:`•TC`.
Sh difec.,.n ar a �,...r r.J,.es front a: Iea..
r= S;..e Road; cr Cc,�.
Road>, ....5e
the roar:
nanotetts :.d rr.� .x,
raad
na-:s,
CC:h Wd UEunr£0
1 CJ 14.=R29Y CE.'T Y ThAT' T:::5 WELL WAS CONSTRUCTED ,',1' ACCC • `;',17g. 15A `1CAC SC, WELL
C^'SinJrCVST RDS,AND Tr_4TACOPY Or,n,SRECO FL' :L1SBEEN ?R0Vi.: cD TC .= N,`,.
!<.er4:e C + tia,<8 NC
CHI.r3' C,300i _
` Sg\AiTL CGC :.'C'I`.GT: - WELL
Sv6rJt the orlElna: to the Dlr,sioa o1 Water Quality, Groundwater Sec:;cc, 1636 NI
:7699-1636 Phone No. (919) 7334221, Within 30 days.
51,

WELL CONSTRUCTION RECORD
and N1',..:. tR:3 a r:5•� li . :'I 4�ra rQ IM
i yr 11 rn � Iv1, I
W=LL CONTRACTOR(IND, rT JUAL)NA.r1' (rr ) JZTeS B. at-C.7 1
WELL CONTRACTOR COMPANY NAME golden Brothers Well Drilling, Inc.
ASSOC,A •Dwa ?t,,.
STATE HILL CONSTRUCTIONP3R1pTs
lita:ai:ab'1:1
1. WELL USE (Ch::k Applicable Box) Residenl;r:'3 Muni:
;:tr 3r ❑ Re:over, ❑ ..eat Ptu .p Water Injeotio . 0
"a
2.
WELL. LOCATION:
Nearest. Tcµ' SYl id
298 Timbuctu Rd
... V.., Zip C c
Cc:n? Jackson
3. OW'iR'Bob Gentes
Address 298 '1'lsnbuctuRd
(:+;; a Rv:te `:o,)
S lva NC 28779
C17' 6.4,2 r; C:ee
Ara :od •?::n:r, n'xr
4. DATE DRILLED 55-15-03
—
5. TOTAL DEPTH: 3660 -- q IFS ❑ NO xR
6. DOES W • L REPLACE EXIS �_ING WELL?7.
STATIC WATER LEVEL B?13WTop 'Casino'. 200 FT,
TAT v::" "I: AS:r: Cu:•T
S. TO? OF CASING IS 2 FT. Land S:r a::'
'Top c( cuing !err lr,aud afor:raw Lind rur:a:: n;:iru a
rerten::I.9 e:;:ran:e wIth 1:A CAC 2C ,Ca3, t�l rir
5. YIELD (rood): 100+ METHOD 0? TEST
10, `HATER ZONES (depth): 135' . 330' , & 360'
275276
CERT7:2A..2). 2245
In. stia A G
OC,.r ❑If
11. DIS NFFCTION. T;Te h'II1
1'2 CASING:
rrtm
13 GROUT:
Frc1
C•ia.?•eA: s:ctS'.:: Ma''. a:
v C .�I
T:1.
SAND/GRAVELSAND/GRAVEL
5. SAND/GRAVEL PACK:
DaLv Sag Ml:car
TM
0 ✓ 74 F: 6 pv_
74 78'?I 6 .188 steel
To Ft
oM.::::.:M.::::.:MMeth:::T
A.:.. .,,, Iea
W'a T: ic,ess
CrWd3Sc F;,
vc.
' To rt.
T rr'
TC^C.5'.'C: aitoti serW_
._.c,
❑R!d;e ❑Sire O'.'a:e; . •
:pr:pa-'.
of \•:e:!
L........ -S-J: d:'�... .,r . .-.
,r,ZLLT�'G :.C7
?oc- 76' cav &isics:-,-
76' 360'
;.00A,TION 5LTC'
S;•,_ a and is_,:: •., ..,.a r.•.. a: It at:
r-: R:ads or Co':. In..___ _•_ ..._
,..7a,
W
I6. REMAR:{S:
C _y_gy ! T v ,:5 WELL Y+AS CVSTR:.CTZ:7 ^' ACCCR..A`'CE':., 6A CAC 2C, 'ram•
u ONe-A�l F...5,AND T^_4TA r7Y0?ir::5RSCCRDHAS3:E PROVIDED TO -_L }_?.
CONS TR':
1'17! 0
/" 5i(.7'.ATE.'^v??cR:ONCC\STR:%CT:NC,TICS ricLL h{�
Subr.Jt the on :nal to the Dlrisioo of Water Quality, Groundwater Section, 1636?Ia!iSer : Ctn,e • :3 - -
27699•1636 Phone N'S. [phone], within _30 days. CI 'j�: r o-.2D:.
c
L.)
O
y
CJ
CO

275275
WELL CONSTRUCTION RECORD
., vli n,.,... i; ?..CL a:�,:i '. L".'w. ^2'P Q'.a
G. i 'roil /�,.,,.., 64
Pr=LL CCtiTnA"i0R i1.1'DIYIC6;A:,d YA.ti" ,�� i'L.tC.._- D. Cook Ci4?G:Cr";.:,�' M 2t,-3
ELL CC,ti7?AC70R CCM?A-'?NA.�:: �''-C+"�e11 �C'-"0'',:-hcrc 4i=11. T-i ili r-. •-^vr g!F'AO�aG=�<
57ATI FILL CC:Y3TRCC710?'?t NT1 WQ 7LR''::7>
(itaocll:able) ta:b'iub!:)
1 WELL USE (Che:k Appf^able :cx). Res .,.Hal b:'" J<IpeS ;�� ?.g✓,..,._ C
Mcr,,_, nq ❑ Re.cv: , C real. �T,p Wa:.r I.., ,..�C CIh Lii: L's:
2. li'ELL LCCATICN •
Nearen7c...Td Cashiers Cry.'+ Jackson
Tahala Shores •
Cx{
❑5!cpe PC.
(::1-:4
7, OHTCR , Bobby Johnson (aer.rs.T,,..::,� r.�
Ad±ess 1082 Pine Grove _,.r:ee•,:n,!r:Ce s:r:: _0-SCTcpera7:-.:.-
(Srr::: r Rrn. Na.) (e't.ec'¢ Lc.;.
Atlanta-, GA 30319 .__ ^ LLti'= LC7.
Cir.•.T.,:- suu Z.;cxr yes:= -.
(7701. 391-0500 F0..T 35' ray & c
A..-1:xe•F:vggr, .:er 35' 10001 c.._a_a
DATE DRJLLED 5-22-03
• 5. TOTAL ?TF' 1000'
E: DOES WILL REPLACE EX15T NO WELL? YES C NOX
7. 5TA.TIC WATER LEYEL 3e!cw Tcp cf Cask;. 950 r
(Vre"P.." if AS:va 7,a; of Cu:^. is
E, TC? 0F,CASiNO 15 2 FT, Abcve La-'. 5:^3ce'
'Too of tuG3' n_Inwd it. Or til oN lane hirfatr ri;Lrr,r
'n a::rda7:1 *L'h ISA tt'CAC fC,CI:3
YIELD (rm); .5 M:TLOD Cr, T:57 Er-"
12 H'ATER ZONES(dep,h); 420'
DISN CTilNh?";p7...
12, CAS;NQ,•
,�,,i}::.as
0 27 '0aP'<r
Frcm 27' it 17' c;. 188 steel
F. •
GROUT • D:,_h-Ma:er:a: • Me:'.cd
„m Tc F. !'ot7+i to R c't+"Pt1 ' a rrT
Tc
14, SC;.BEN; D:,'� 5'ci ci_ }ta:=e; •
Tc • In
• Frcm Tc _
I:. 5.AND'CPy,YEL PACK:
•Ds :, Siza Ua:er:a
• Fr:H Tc -
Ftcm
Tc F„
I5, REMAR:{5
1DO '223YC!. Irf it_ATT•-SIS WALL WAS CCNST?,:'CSC N ACCO,L^ANC-c15A NACOC.W='
CO:i517.I.CTIQNSTAN7?J.AS, A.'r✓i-i7 A CO?'f CF 5 E:Ct- sBEEN rt J;..0 To ?r r`'.,
5 �-z 1 )-�
S NA,.'rx.?CFPERS0NC0N5'iiL'CT;NL,.- -•
•
SIS M: 011 'plod to thi DbYslcc atWate Q.aIly, Gro.acwa e e9a:ac i'.55 I!; Seret a Cee•:• •'t g"•' vG
21:55.1555,Tr4ntNc,[phone],wfthIn31davi, Qn•:
.,, es `-rr. _l leas. •
S;a;e':ad.s cr Cc-L-,`,..P.c•-as.
?
_T...s a..d ._,....rr._.

wALL CONSTRUCTION RECORD
�^ C':...f' D; Ent r" .,.,t A�ati.n14nc, ;:i•Lul:.'a
3fLT,. :;.,'n;C� ,Li.i. ,...,
FILL CC,NTAAC CR fln;ly;-LAL ''AS 7 (pi- '; d.tche:'_ D. C.xk
Y.EL L CO' TFACiOCCU'??_Yv NAY' 're -"dell Erctthcrc 1c=11 n-i 1 , 1 n.. T-r•
STATZ FELL CONiTS CTC\ ?ZA};iTa ASiCC!ATZC Fy ?L21/41,17+
275274
•
2043
C77777'CA7-'7h e
L WELL USE (Check A^ ii-abl: Box): Aside,.liar b4 •a!' ! d;r�a: ❑ ' ..,._�, C
, N5o.i„, niC R: cre, 0 Heat. ;'Vait;Irj:.,. C' Ol,..r❑]f0� ,'!r;Usa
•
2. WELL LOCATION'; •
• Nara:Tcycs; Tuckasegee Cc.1..,.7 Jackson
155 Fred Smith•Rd
O:,'”;C ti::74.m, rj41 Y:., .'., p CYI,.
• 3. 01+'Y c R Marie Smith
Add.tw 155 Fred Smith Rd
Tuckasegee, NC 28783
Town SL Zi; C,a
($2$).293-9035
M-essa:a'a, P::ar rA:.ter
DATE DRICJ ED 5-19-03
5, TCTAL DEFTii• 150'
E. DOES WILL REPLACE EXISTING WELL? YES 0 NO Xk
7, STAT1CWATER LEVEL, Ee!owTo; ;or Czini 100' FT,
(Vat "r" I(Aervi Ter cfCuL:T
8 TO? OF,CAS:N(3 1S 2 7 a. Above Lard S ','ace•
'T:7 of eulni Or —Hilt: r:or:dow Isnl raY,nea rlq':In$a
Ylr;11af {n r:::rdan:i w: ISA NCAC •C, Ul,
Yi?LD (rrrn)' 40 METr.OD OF TEST b_z
IG, WATER ZONES (Cepih)» 70' & 130'
:' D:SL'7ECTi0N, Trie F
12. CAS;NC•:
Q 45 Jbsne;er
Fro- 45' T— S-2-5. 6"
Frcrn To Ft
. GROUT. Dc th Mue ;a:
To
14, SCREEN, D:,t Oia.^,e,r
?r. To _ in,
From', To ,
IS. SAN'D'OZAY_4FACK,
Dr,'h S`•7e
Prcra
Tc FL
15, R MA2:XSi
A.^:'W 1;-'Z
Wa.0 7 i 1lss
Cr
.188 steel
Methcfi
rrr4
SI::S!se Msria:
in,
. Malaria:
L.a:!r.d: ai( :'•so_.. _Or _ ._.a.. . --,
r :'I r ti'C LC
scar
SO' 150 car -it
j.00A-11.Th :ZTC-
S'..e Foals' or Cc.j .R:a $. 1
n.:Tbe.a i'.d 0.. r_•_ra-._.. .�. �...
C.c H.°799Y C?AT1?Y T:1.T i'r!ti Wilt WAS CCNSTA'.Cf Z) A_ _
_CNSP.'..'CT:ON STAN:t-7.0 . A.'y77.:AT A. CC'? YO? i:ii$ �,� 3z\� A __A� A ti
•
ITC 7-r:2
S 7, 9 /+eS �+
•
DA.I
:Cimitter Ciy!ral to twr DlNJ;cc oltirahr s11;y r 1
Q I Cr water era,.., 1555 NthSend a E FC a. ala�.J27
("5r,•113h ,r No. (919) 723. 2:I, wlthln 30 days,
I
GROUNDI,VA7 Lh. .ECTION
A SHEVIt i E REGIONAL. OFFICE
old OE HT CO

275273
WELL CONrSTRU1CTION RECORD
Nc,:, ca.'o:: r 72' 77:l C En,r„cr-7,a ,t a.,: Ni?.ti :.: ^:..8. D '15 , Wa"
w?;.LCONTRACTOR (I.N'DIti1 DC'CA.t1E (;•t,n Mitchell D. Cook
^:LL C0,1TP.ACTOR CCM'A,'&Bro hers 4i=11 ilrl 111—Tr 7-
-ASSOCIATE: 14Q 7:R".:7a
STATE WELL CCNSTRUCT:OT'? B flag
(if s ; lca;let
22R77I2A7(0}'S 2043
lRii l 1,,C•3 .C:.'
1 WELL USE (Ch::::< Appl ;a'b!e'Lex), Resine ,;ia: M'a is
Monitoring C Re:every C Meat. t; Water Iri: t,.,, ❑
2, WELL LOCATION';
NearestTovc: Cashiers Cci,-N Jackson
Cashiers—Zeb Alley Rd— on Right
..is9:; Sj':.i•'Ji:_ L :Nc. Zip Ce;
3. Otil? _R. Diana Nellans
Address 4384 Carvota Drive
Boynton Beach; EL 33436
one :.•Taw-, S1k ZI; CeG:
(828 421-1R1R--contact
ti^a c.za 7xne ca1.<r •
DATE DRILLED 5-8-03
TOTAL DEPTH: 1100'
6. DOES WELL REPLACE EXISTR C• WELL? YES 0 NO XR
7, STATIC WATER LEVEL EelcwTcpcfCuing: 1000n
(Lice" "I(Aov: To;
E, TO? OF CASINO 1S 2 77, Above Land Sdace'
'Tp of et:H; urmina!e'_ at':r Edow IaCd r'.'r'eu rquiru a
va,',anee 1$4, NCAC:C.OI:S.
9. YIELD (r-)' 4 METHOD OF TEST
10, v.'ATERZONE3 (de;;h): 45' & 985'
11 DISINFECTION: Tyre iwi Art :..": 16=
12. CAS'N'C•,
.0; Crnr.y:" R'
0 0 29 :. -'6 vcvc_
_, 29' Te 33 7: 6'� .188 stool
To F.
13. OROUT: De7C) Material Me?:e'_
^._Q___ Tc FtFxr, n; gde_n-F ' Pri -'
From To °L
14, SCREEN: Depir,
Prorr Tc__
Frotr, Tc
15, SA.':'D'ORAVEL PACK'
Dr'.:
• Diaaekr Vet St:4 Ma -a:
In. - sn
Front T^ at;,
16, RENIARK S This is well _#2 on same lot
0:h,:r G If 0'±'r, List List
h;.tom .ser
O'R!dge ❑SIc^e Ctia!ey
r.g!rades:_._C 0?__ ,cra;-..c
«'. x.
n-ir INO • w
esa
0 31 czar &
31' 1100'
_`.e
;OCA'rlo\ et TC
S:',. _ aitertirn aria ,,,.,es „:r, _. ,:as'.
State Rcas es
a^,._r..eE
1 CO HELfYC.RTi?YT_ATTrtls W3.... WAS CCl'ST?LJCicJ rN ACCCZAN'C!'d', ;! ;SA NCAC'C G?LL
CONS T?.;iCiON 5TA>-DAA2.25. AND ':4T A C0 V OF rcECCF0 _{S BEZN'no -- _
LL
e•
5
SiONATlar.RE of PERSON CO S COTTN'c ,KE WELL
SubrJ: the original to•the DlvisioSI of Water Quality, GroundwaterStelloc, 15:6Mali Srvhe Cm;ar •.
31699d636 Phone No, (913) 73341:1, within 30 days, Or,l
1. NC
e,C
o u
w
C_ n_
co
p;tiC_
tun
;f,
7..414
n�
W
W G
4,4
Er' brt, LJN
e '?F�'rJiNAL OFFICE

STATE BELL CC
,Ns T RCCT:C;Y?ER'U74
dalea=!e
WELLCONSTRUCTION RECORD
275272
Nor Ca.,Lr+ • De c. „ DH•1e ' W2,1.. Q.a,ir • C ^ .,.. c:kn
W2LLCCT'TRACTCR(ih'7iti1DCAL)NA.MZ (?"rt` Mitchell D. Cook CVR7 iCAT.1ONp 2043
WELL CC,tiTF.ACOSCOM?A,'i?;KAYi f73.a&t Brct./1,"rs +r=11 nr 4 11 nu+
AS:OCLATiD ti'Q?ERk:7•
(ifa:o!ica::e).
1, WELL USE (Ch.:k App!':ab Box); Resider:ia'
Mc.,,,cr.;C Re:cycry ❑ Hut Pa-;Wa::rla, ,,,:❑
2. WELL LOCATION:•
NearestTo'r,,; Cashiers Cc -r+ Jackson
Zeb Alley Rd on R—Tract A
(s:n' NLc. Y:,... . COST C� ,� s:`.!I'?�l: : h'o,.. Z.? Cx:;
O"nA3R. Diana Nellans
Address 4384 Caryota Drive
Pit.)
Boynton Beach, FL 33436
C:7, :rT;w 5:1:4 Z:•r. C:41
1328)•421-1313 contact
Arta:x <• ?a:a u.'�r.:u
4. DATE DRILLED 4-29-03
6. TOTAL DEFTk: 1000'
6: DOES WELL RE?LACE EXISTFNC WELL? YES LLD NO t
7. STAT:C WATER LEVEL Be:wr Tcp of Cas!cs'. 950
(the" " I!Aeow 7c; crCuLLi)
8. TOE OF CASINO IS 2 IT, Abcve Land S':da:e'
'Top of ca.;;; Ur❑Iea;e: aa'or tr:o'+Ian. ru'au
vl,^an: n u •.".ar.f w!:` 13A tr'CAC:C C::B.
YIELD (a;-,), 6 METHOD OF TEST h1C
. 1
0 WATER ZONES (depth) 80' & 710'
11 Dj:r''::''TifN'rype hiTi.
12. CASINO:
Fro:-0 26
Frcc. 26' Tc 30 "LT
To F,
19. GROUT: D:,.L Magri ?{e6c2
Frcrn 0 Tc 20 Fss,r;r_ t at rriP"
Tc Ft.
14 SCREEN: D rtL a.;,eur S, Ma eia!
.,. Tc ___in,•r,.
Frcr„ Tc • rt._,. _ In 5 SAND'CRAVEL PACK:
S:24 . M.a:er,L
7t.
F;cm Tc Ft,
Wan Tr:c,aess
pvc
,188 steel
OrnIr L'se
CS'-CVa.'!:7; _Fla.
del^^^ �• r.'. earl:car^
_...`!'_elcr.s!r�de s:r::•CO?SCTc;p:ra_`,i: r a
ec cn7s
ncyr:; 11.7.777c7:7 L0nr,
C^ Tc ::ic. :s: _r,
0' 28' c.—cti'l!enza
28' 1000'
;OCATf0NSK:TC=.
E....tcv
: ,. 5 ,.. .ads Cr Cc „a'_,
ccD.Ti.,, r:a
6. REMARKS:
74-0 Hry=!Y 'CERTIFY T-_AT TH:S R=LL WAS CONSTRVCD :'N ACCCRDA.N'C3'x- _: 1 eA NCAC 2C, v.
CCA'ST ,iCT;ONSTA'CA_ S,A.' +TATACC?':OFT:�ti::. iS?.ECCAsflE' S iOT; _- ...
r ti• :
S:GA'ATv'R:.O= PERSON COYSTR'_CTi,YO'-:WELL
Sub-!: the oriylnal to the D!H:lon of Water Quailry, Groundwatercn
Sec,. 16;e MJl5e;a C.
:7699.1636 Phone No, (919) 7S3.7:21, wlthln 30 days. , C_,•
•
NC
V,C 2:0
0
L.
CO
0
CA)
0

275271
WELL CONSTRUCTION RECORD
titLLCO TRAC O (I;m:Ukt)tiA.M: Gr,nr•b?itchell D. Cook
W £LL CO,tiT2eaCTOR COMPA.1'Y 4'ti`!£ Hecden Erothers
STATE_ V.£LL CV1•31R0'!CT'CY ? v'I-e A560CIAT£✓WQ?£R`,IT*
• (If arrcli a:1e1 6( a:clica:1e1
C2RTry1c T.CY:if 2043
o,ye r (R7a a use
I WELL USE (Ch::6 A.ppIica:!: Dcx); Rec Cle: 1a; 1nlC':?'Zia ❑
❑ Re;:,er, 0 Heat : : Wa':r I^ie:,,.,, ❑ Other a li OtIrler, Lis; Vs:
2. WELL LOCATION:
NearestTarr Cashiers Cc"„-; Jackson
Shiver Rd
N1.71, A',nban, __ c :.Idl'�: : N:.� Z.) Ct)
3. CWY=R: Joan Skelton
Address 230 West Paces Ferry Rd
(sY::r?.; i?:.)
Atlanta (;A 'InRn5
or To'. Sn:e
404 )• R1?-4431
A.', car. Pane ncska
4. DATE DRILLED 5-1-03
6. TOTAL DEPTH: 600' •
6; DOES WELL REPLACE EXISTING WELL? YES D NO $X
7. STATIC WATES LEVEL Below Top of Caslc3• 575 FT.
(fir "4" !(A*... Top c:ICA.sLIE
8. TO? OF CASING IS 2 FT, AbcVe Lac, Surface I.
'To; :f eu;ng l r._I ra'r:icor:rlow arda'rfi , rrq:ir❑e
w!;1 ISA'r'CAC :C ,C113!
YIELD(Err)' 80 METHOD 07T'cT h'W
10, WATER, ZONES (,ep'h): 485' & 560'
11 D'',",.."i 1-,N''‘_. .4I A_ ..:'W,1, 1622
12. CAS:NC, Well T',:aess
-- 0 — 28 p. L`:tTrg'er uF'r:,;::=" 2.lptsc
Trott 28' To 32r'; 6" e188 teel
• m • To F.., •
13GROUT: D ;:; ;Material
Frcrr 0 Tc F', Tire z
From Tc FL
14, SCREEN: Drrt: Di a. etc S:c: Sh
Fro- To Ft,_I
From Tc
1.5. SANDGRAVELPACK'
D:r:, Sias
..,. To
Ftcr, Tc
me'_';CL
P jt
F'.
Tc;:o ':':'L.a C. se71:.g
• (oar.'< :rrr:prtr.:
._.21r,:de Oil __e 6: 111
La:.r.de ,_r.; ide s:c..C3G?; - ; :ra; 1: r_;
• D;t!LLtiv LOC;
C, 30' .aa:yDur: ,
cis
30' 600' —rite
;OCA.7 ON S;{=ECM
�Sve;'_a:,d:Cc. ca,s.
..rrir:er5 and co.._, -.on road ❑_".:s,
15. REMARKS'
!GC H.EZ£2Y C_R T1?Y T'_{T TrsM _ WAS CONS -r-1 � R?J A..`[..'d' ,"`;-:;r
CONS LCT:CN STA.\;, _' 3 ?.ND THAT A CC:Y O -Tj6t C0?J 448142IN r z
Sf I'
I� r
a NAiJRs0?PERSON yJ?,,$I L..1tie1.;rtfi. 1.•
SvIrn.1: the c(ag!nal to the Dlvlslon of W'ate: Qca!l;y, G 'n.l ate Section, 1939 Mall St Y e
27699.1936 Phone No (919) 21.2111, Wdthln 30 drys
Utir`mAcERp[GIO A tlGl
1
,, .�w'��t [ F[GinrJHL J1-1-0
AC v-77.1L
0' '1=P.
-ATE
e:Ie Rre1y1-. NC
REb C 2 01
•

274594
'YELL CONS'1'1tUC'1.1ON lUsl Oii;:
North Cat olina - Department of Euvirimment nod Natural Renoureel - Division of Water Quality a Grououndwater n Section
\SELL CON I nAC1Olt (INDIVIDUAL) NAME (plug COY �e ECC
�jyjL/r ell Drilli(L(
r1IONE A ) �.�7-�5i'7
scut,CONI ItACIOR CORIPANY NAMF, ASSOCIMP.II IV() rP. RPM N
5 TA IF.St'ELL CONS tltUCt1ON P EIUtl11 if r I ,I icobF
if n I rlicnblc
lc
WELL USE (Check Applicable Boa): Residential hYhhuricipal/Public 17 Industrial LI Agricultural
Monitoring U Recovery ❑ Ileat Pump Wider Injection ❑ Other U IF Other, List Use
2. WELL LOCATION: �6CN°il
Nearest 'town: Sx/UCc _ _County
(Street Name, Nnmbern, C....... _ i'v. Subdivision, Lot No., hIp 0.1e)
3. OWNER: f7/e/i 44/JCL
b=/_ Cots - Fu
Address _� �n_
- (Street or Route No.) 2g \\�t
City PC 10011 Smle Zip Code
•1
5
6
7
R
d III ISA IICAC ct. YIELD(gprig•f—MEIl1UPOE IRS I. ;r
7ur. mlr. thane numbs- /Y-Of
DATE uftlLLUUU
TOTAL uLr1 IL_ 3 `fo--_-----
DOES WELL REPLACE EXISTING 1VELL7 YES_f0 NO
SL 1 IC, WATER LEVEL Dclors Tor of Cnsiog: S_ _ _I I.
wee ••a.•• Ir Above Ton of Cn'Ing)
f(lr U1' CASINO IS _1l_2- FP. Above mood Sol Piece•
•'I or pinging Inndn.ltd •Ilm btlon I.ud induct 'up!, is
C IC .0111
variance In .am .Alen r -
10. WA rEll ZONES (depili):
3-o
+
II. DISINFECTION: Type /74� —
12. CASINO:
Depot
Eton n G Io t— Et..
flour iy I 5'3 11.,
Fran To_ Pt.
13. GROU 1: Depth
how 0 To .2-6 F.
Erotn_---
IA. SCPJPEN:
imnl_
Foiii__ To --II
15. SAND/GRAVEL PACK:
Depth
horn fo Et.
Flom fo 1'I.
16. REMARKS:
� HI�
100IIERFEY It�'
CONSI RUCI IUN b I' All
GRIIrlki If hFrtil rIiihlotlse
ASHE(� 'hJt,'Tlia n'
--T
Amount Well 1 hickncss
Diameter or 1VcigliVPt. Mnlcrinl
E_-- SU/Q.7( Oaf
6.ZS- , /51? .5 ee
Mtlf4,H71f nd /ni MjfoJ
o_
Depth Diameter
l t. EI._iu.
hr.
She
Metednl
Materiel
'Ibpogrnphic/Lmld selling
IJltidge LJSIo1rc UVnllcy Clflal
(check nrrroptlele hnQ
Lnliludc/lougiludc of well location
N3S°2.3fro. U"Wo83 7'3o,L"
(degrresholnulee/sccnnd')
Lntilud:r!^I:eitudc source:U I SD Topographic nr'p
DRILLING L Q(i
Pounalion Description
J)WILE
Elorn To
n
to_c J IUI Kusti Iv
Show direction and distance in miles Rom niller b
Iwo Stale floods or County Bonds. Include Ile ,ri
numbers ntld common rood names. —'
c.fl
SY/" °
O
Co CH- Z-
Poe ✓
rr. o.ce.
11115 WE(.1, WAS CONS I IWCI E.D IN ACCORDANCE WITII I SA IICAC 2C, WELL.
5, AND TI IAT A COPY OF *1111S RECORD 11AS BEEN PROVIDED 1O 1IIE WELL OWNER
Got
SIGNAIUIU I.PERSON__ CONS I IWC1INO 111E WELL DALE
hltlon of 'Voter ()wilily, Groundwater Section, 1636 Mill Service Curler- RREValeigh,
4C
3-3221, wllldn 311 days.

274593
"WELL CON5'1'RUC'1'10N RECORD
ORD
North Carolina - Depal tlnciil of Environment and Natural Resources - Division of Water Quality C rouIndwat fr er SIFICANliouil
tvELL CON I RAC' OR N
(INUIVIUUAI) NAME Wing Aft /ee ce 903
PHONE�, llwll Dilllnnr __--
rvF,LL CUNtItACt Olt CUn1PANY NAME ir/i t -rr
ASSUCIA1 r.0 IV() PERMIIN
S tAtE WELLilica LICIIVN fElUll tN_-- ifa Idicable
'to
pl cnblc
WELL USE (Check Applicable Dux): Itesidcnl!nl Pr" Municipal/Public U Industrial CI Agricultural O
Monitoring LT Recovery U Ilcal Pump Water hljcctiml U Oilier ❑ If Other, List WC
Arco Cede- Plume nno'hei 03
d. DATE DRILLED
S. -1 OTAL DEP I.1I: IEL_ __________
6. DOES WELL REPLACE EXISTING WELL/ YES 11 NO 414--
1. STATIC WATER LEVEL Pclow Top of Casing: _ 2__I
l.
(Use "✓' If Above 'Top of Cooing)
B. TOP Or CASINO IS __/ -__ 1-f. Abnvc Load Marne'
•lei, of t.dnr Iennlnded otter briery land Anise Irwin" •
v nl.n re In •crnrd•er. nlih I5A NCAC 2C .0115.
MEITI0001'TESI_/�%
1U. \VATEIC ZONES (depth): /?Z
.fJ ? Amount _ 7J/ ^�
II. DISINPECrlou:'fppc �—Wall thickness
12. CASINO: n, D IJiarneter or WeigWeight/Ft.Nin icl inl
UcDepthSOi2.2l �✓L"
Prm
io C.,`i pt 6.25'
HMO To IT - —
Horn TO El. _ ---
!Medal Method
IJ. GROUT: Depth e v.
rfom, G Tv ,-F rt. orfhi2.( �i sp "e
nom_ Io__hl. — '
14 SCREEN: Depth Dimneidi Slot Sire Materiel
From
To El in. III.- in.
front__-Io--It. in.
15. SAND/GRAVEL PACK: Sire Mnlerinl
Depth
from ]b I'I. now To_ Et.
fo4.1ItIAL KDO IIEI1UPY cut lry 11
oils t;RUCIIGO & A DA
2. WELL LOCATION: i syk'k County ;7kGl�J�ie
Ncoresl'I own:
(Sheer flame. Nmnbets, Cc:."Mthy, Subdividon, Ind No., 7.Ip Cade)
(dep,eevminutes/sncnnde)
qr 04wA //orn6�Jlla —)— Lnii(ud:'l.^ Igiiutic soulce:UOI'SOTopogrnphic map
J. OWNER! Pf fY
Ad(Ire$s el o�Fllice)+----u-«ti--� (checkMn)
�— LL!jJO i,Qt)
l riote�.Tle SInle Flo) )�de )r1_.I 111 f-R'
\7.�----r - Folm;liml UcsTPiI
_ Cho- Zip Code I°Iolll I0 _ -
ity et Tann
_tZ
SO -!y_ 6l• ,t act
Topogrnplric/Llnul selling
Ult!dge LJSlopc UVnllcy Mint
(check nppt r.pdnle tiny)
Latitude/longitude of well location
/V35' R4' 31—Z"weir 06a0-3' 1
LS14 11 IO.ILSK.ETG)I I
Show direction and distance in miles hmINl Ict1
Iwo Slate Rends or County Roads. Incluttnc+the 1O -
mmltbcrsand common fond names. dJrY� L— (cCf
W,rAcrarlk •• icna Q45f n./!.
ci
SI 'NATURE OI PlIERSON cons UCI INO 111E WELL
GROUNDWATER SECTION
Aittin l REGIOUALoTteOW-1 Polelgh,NCREV. 01
u tin le m g nn o 1 le U c glair of Water Quality, Crnmldnnler Section, 1636 Mall Service Curler - IIsIeIRlh N
PCP-16J6 Thane No. [phone], within 30 dnys.
dye /LC
IS \VELI, WAS CONS I (WCI EU IN ACCORDANCE WW1 1 SA LICAC 2C, WELL
MINIM' fi COPY OE lulls RECORD IIAS PEEN PROVIDED 10 711E WELL OWNER
G'
DAIS
4 A,
rac/r 5

274447
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and atural Resour es -/9 ivi ion of Water Quality - Groundwater Section
WELL CO.NTR.ACTOIt (INDIVIDUAL) NAMIE rint)/`G /�K L%�'?e CERTIFICATION C2Z9
\VELL CONTRACTOR COMPANY NAME h (.e. kip /7 pi �✓fit,' PHONE # jam 7 g
STATE WELL CONSTRUCTION PER\IIT# ASSOCIATED WO PERMIT#
(if applicable)
(if applicable)
2.
WELL USE. (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑•
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Now 'si Tow r
I ow4aP
r'l
1
Countyci--SitC2 A'
(Street Name_ Numbers, Community. Subdivision, Lot No., Zip Code)
7
3. OWNER: "A- L r,'
Address 0 es
/) (Street or Route No.)
(1 ✓/ 0 Al lee Al:( r 7073
City or Town State Zip Code
( )-
Area code- Phone numbeL.
4. DATE DRILLED', - oZ`'-O 3
5. TOTAL DEPTH: a /
�je r*
6. DOES WELL REPLACE EXISTING WELL? YES NO F�
7. STATIC WATER LEVEL Below Top of Casing: ,W FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS aFT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance slits I5A NCAC 2C .0118.
9. YIELD (gpm): -75 METHOD OF TESTA ;&
10. WATER ZONES (depth):
11. DISINFECTION: Type f %Tf%
12. CASING:
y,�Topographic/Land setting
Lv7Ridge DSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From o Fr l itio Description
} Depth Di Rey'/
From � To� Ft.
Amount
Wall Thickness
or Weieht/Ft.
i g
From To Ft.
From To Ft.
13. GROUT: Depth
�vr 6vdykilledFrom 0 T o 2D F✓Pr'
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles fromaleasF
two State Roads or County Roads. IncludeCt4 ro
numbers and common road names.
� Tn
0-z
N
a C%
i157
16. REMARKS:
IL)OH RLI4Y CY IAj
r ( s 12A)Ct#O S1'r N
'2 Jae/
J
GNATURE OF PERSON CONSTRUCTING THE WELL
ubmit the original to the Divisi )n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
itbmxc N..,(919) 31-32.1, within 30 days. GW-I REV. 07/2001
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-I „M_
DATE

WELL CONSTRUCTION RECORD
274443
North Carolina - Department of Environment and N ural esoure s - Division of Water Quality - Groundwater Section
WELL CONTRACI OR (INDIVIDUAL) NAME (print) $ . ✓ CERTIFICATION N�V‘!
WELL CONTRACTOR COMPANY NAME if-. Le U'Lry �// p%/) f PHONE # P5Q) 6)27-WrS"
STATE; WELL CONSTRUCTION PER.\IIT# ASSOCIATED w'Q PERMIT#
(ifapplicable)
(ifapplicable)
I. WELL USE (Check Applicable Box): Residential B` Municipal/Public ❑ Industrials❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION
Ncitrest" oven:�ct.) )ktc4C'€
v
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
�/.
County(' AC ;isy
3. OWNER:rX (degrees/minutes/seconds)
Address l -7' Latitude/longitude source:❑GPSOTopoeraphic map
(check box)
DRILLING LOG
( )�T�o� Ffl�atiog Description
(t
Area code- Phone number._
4. DATE DRILLED .5 _7/9 - ,,
5. TOTAL DEPTH: fV'a'� Py '?Q
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I '
7. STATIC WATER LEVEL Below Top of Casing: ?6 FT.
(Use "+" i f Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): �' METHOD OF TEST A • T
10. WATER ZONES (depth):
Topographic/Land setting
2Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(1441/ie(StreAIL
or Route No.)
City or Town State
II. DISINFECTION: Type
11/1�
12. CASING: Wall Thickness
JJ Depth Diameter or We e t/Ft. Material
From )1',X To FL 6 /y ./5 .,'Ice:
From To Ft.
From To Ft.
13. GROUT: Depth Mat
„
From 0 To c�O Ft. C)=, N''
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.
Zip Code
Amount
Method
/� Mr
c
LOCATION SKETCH 0 3
CO
Show direction and distance in miles fromaleas0?-
two State Roads or County Roads. Includele
numbers and common mar) names.
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL
fv 0:7
DATE
ISubmit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
GROeJwWAt A. 46fITC NL (919) '33-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

272800
WELL CONSTRUCTION RECORD
Ca:?llra • Dr: t a Narw'=' Rso i :S • Div1s o of WI:Ter
N'2r�, . ;cT� ; D cnv;.a,r,,.m
W7.LLCONTRACTOR (INDD1DUA) NAME (print) Mitchell D. Cook
WELL CONTFACTCR CO:N?A.YY'A..t Hedden BsothPrs P%�31 Dri 11 t rig
STATE WELL CONSTRUCTION ?ERDNITe A590CIATED WQP:ANI7?
(If adclicable) (if a:olicabl:)
CERTIFICATION$ 2043
?SON'E (R7si)' 9—ccci
1. WELL USE (Check Appiiczole Eox): Res;denlial Municipa1/7ublic C Irides ia: C Ag-::ul?.La1 C
Mcr.i,cring ❑ Re:ovey 0 Heat Pump.Wa:er Injection ❑ OIh:; ❑ If OtIc:, List Use
2 WELL LOCATION;
N:arest Town. Tackasegee
Little Canada
Ccunr, Jackson
(Sr,-,: Ns.7e, N'•:-Sen, Ca74, M 1 Suhdly;dor, G: N. Zip Co)
3. OW�,:R • Ben Blackwell
AC:ess 139 Rives Palm Drive
(::fit sr ?e is No!)
Fort Pierce, FL 34946
: Tout, Sut< Zip Code
072_)• 466-2574
A.^e c 4c Phonem:.—,'.<:
4. DATP DRILT ED 4-22-03
.1. TOTAL DEPTH: 200'
6; DOES WELL REPLACE EXISTrN'O WELL? YES C NO 0
7. STATIC WATER LEVEL EelowTcp c; Casing. 1251F7
(Vse "t" 6'Aave To; or Ginn;)
8, TO? OF CASING IS 2 FT, Abovo Land Surface'
'To? c(culn4 bralraled 'e'er b,i w lend surfs:, regvlru a
n!,aece L, eaecrdm:a with ISA NCAC 2C .0113,
5, YIELD (gpm): 60+ METHOD OF TEST hing
10, WATER ZONES (depth): 100' , 140', & 172'
•
11, DISINFECTION: Tv;e HtH
12. CASING:
rotor C) To_ 79 F'.
Fr= 79' To R3 Ft.
13. GROUT:
From: 0
From
14. SCREEN:
Fro.,�
Aim:W.t 160E
Wa l hcic ass
T}:server a Weight?e. Mat ra
_1R8 steel
Depth •Material Method
To 2 Ft.}xmoite ' prpr*3
To • Ft.
D �u • Dianne:4s SlctSiu Maria!
Tc _in. • in.
• From To • Ft. in
15. SAND/GRAVEL, PACK
• Drpt"-. Siz M1fateia
Fr To FL
Fr..,. • To F'.
in
Tcpcg z2'cic/La d sc ti g
CRidge CSicpe CVaLey :Fla;
• (oSec err::prieu "re
Latir.:delcngin:de cf we.;IceaU:r.
(der.eear out. .exc:.:.t)
La".r:•elce3',rd:e so'a:es.oc.?s:Toperapci: r.—,
bcx)
DE? 1 `, DRILLING LOG
Frcr•. To Formation Desoic:ioa
p• 81'• c]av&�>;
81' 200' aaite
LOCATION SKETCH
S;h,.aw dire: n and disa.n:e in miles from a leas;
Csc Stale Reads c: In:,_.: the road
r.cmCers a-d:cm-mar. rrd names,
16. :REMARKS:
I DO HER=3:' CERTIFY Tr_AT TXIS ti=LL WAS CONSTRUCTED N ACCOR.^.ANCE W i ; SA NCAC 2C, WELL
CONSTRUCTION STA`eWA- S,A.4DT'^ATACOPYOFT-US RECORD AS32ENPROVIDED TOT= Rti=3
SICNATURE OF FERSCN CONSTRUCTING Tv WLLL DATE
Submit the original to the Division of Water Quailry, Groundwater Section, 1636,N1i1Servlce Center Raba h, *C '�' j
17695.163E Phone No, [phone], within 30 days, GW•1 O774001
—o
ca
c
0
c=
c
zm
ct
en 0
cpr
0r
c4
—i
0

27699.1636 Phone No. [phone], within 30 days,
WELL CONSTRUCTION RECORD
NDr i C .. e :e e , ate; Sec
i.•^';f2 • 17e":ft?ile-1 O�C1YifOf� ,e,i ^u,^,j �1`2"�1.':�: $ S • �h SIB � �°K'�: QL31f Cl . �i OCG�'� � I :fl
W2LL coNTR.1CrCR (INm11DUAL) NAME (24,r:0 Mitchell D. Cook cTR —4'CAr1ON ir 2043
WELL CONTRACTOR CONS?ANY NA -NI' Headen Brothers p.711 Dri 11 4 ng, Tnr. '-I. "NE Y (P2R1V9_O501
STATE WELL CO,NSTRUCTIONFER+:ITO ASSOCIATED WQPERNIT4
(if adellcable) (if aco!icabie)
1. R ELL USE (Che:k Appleicabie 5ox): Residential C Industrial d Agd:ulr:nl ❑
Mcr,L rng 0 -Recovery (0 Heat Pump K'a r 1rj :ion 0 Other ❑ IfOther, Lis: Us:
2. WELL LOCATION:
Nearest Towr: SYlva Cou y Jackson
Barker's (reek to Rockdale Rd
(SriNs-:, Nee.o n, Ca-,•:a^Ir,�, 5':SCh',!cr., W; 1&, Z'.; Ca'e)
3. ORNER' Michelle Barvchewsky
Address 1402 Rnnkrda1a RA
(St-nf or Root,' No)
Whittier N(' 28789
C y :rTcwn Sate Zip Cote
(828)- 586-3900
A.v ce. ?tor•t ni. b<
4. DATE DRILLED 4-23-03
5. TOTAL DEPTH: 100'
6: DOES WELL REPLACE EXISTING WELL? YES: NO Cc
7. STATIC WATER LEVEL Below Tcp cf Casing: 750 F7,
(use "+" ItAbove Top of Csibte) •
S. TOP OF CASINO IS 2 FT, Above Land Surface'
'Top o(cu'ng ttrmlnete s or beow Ind surface ra;ulna a
vsrtsa ti In a:coreon:a w::h 1SA NCAC 2C .011S•
9• YIELD (gpm)I 10 MFTHOD OF TEST h'rw
10• WATER ZONES (depth): 7F5'
11, DISDCFECTION: T ,e rizi A.-uw,' 10¢
12• CASING: Wallµh:Cle33
`
From 0 To 76 F. .t" •.�18�' • S eel
Frcfn To Ft.
• From • To Ft.
13• GROUT: Depth Material Niethe!
From 0. To 20 F'•1eami-e R r�rent • pr -i
From To Ft
14• SCREEN: Dr,th Dia.ate r Sict Slze Mataia
From To Pt._In. 1^
From Tc • Ft._ i❑
15, SAND/GRAVEL PACK:
DrC^ S:ze . ,v:a:eii
Fro,.. To FL
Fran To Ft
Tcperapi:ik' a d se...^.g
:Ridge ❑SIoce 0Ya ley pilot
• .•,..•rude, nglrade cf Yea local:..,
(depe:s.ni:uus'lxeoes)
La!irtdeiongirLes:tiree'CGPS Tcooa,ap^•i:^2p
(c::ec bee)
r1FFT� - OR LING LOG
From✓ T e Formaticn Dese ption
0 74' ciav &
74' 300' cLa:Lite
LOCATION S KETCM;
Shaw dfe:tic- and ±saanee niies E-rn al least
r. c Stale R:ads or Court; Reads. Include the read
numbers ar.d cor..mon r:ad rr as,
16. REMARKS:
I DO HEREnY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCODA,N'CE W1Tr4. :SA NCAC 2C, WELL
CONSTRUCTION 5TANDA W 5, AND T:AT A COPY OF T -1:5 MCOeRD HAS 3EEN PROY:DEED TO T—IF WELL, OV-1r'ris
SIGNATURE OF PERSON CONSTRUCTING TES WELL DATE
272799
O
CO
CO
-a
W
C
O
cn
cm
o<
Do
1,10rn
enz
rn
n
H
0
Submit the original totheDivision of Water Quality, Groundwater Section, 1636.Mil Senin Center • Raleigh C
OW1 REV. C7'230
HT I�
CROIJ^Jr',":'rTFR SECTION

WELL CONSTRUCTION RECORD
hcniCz:okrz•Detarn• t•, o��,,1otmen1R:3 :3•Di';a crWzt:rQ.a;,ry•ea,��.,: r
, rct_n
WILL CONTRACTOR (INDIYICUAL) NANNEE (prig) Mitchell P. Cook
WELL CONTRACTOR CCM?ANY HeCiden SSother= I•;.11 Dri 11 i rUr Tr,r,
STATE wlLL OONSnRUCT:ON PERtiuIT* ASSOCIATED WQ ?ER11i70
(if acoticablel (i( a:o;iced:10
CERTrrcATloN $ 2043
I. WELL USE (Check Appli:abie 5ox): Residential Municl,at!7ubi: ❑ Indt; ial ❑ Ay:ettiol a! 0
Monitoring O - Recovery 0 Heat Pat; Water Injection G Other 0 If Other, Lis; Use
2 WELL LOCATION:
Nearest Town: Glenville Ccu:,w Jackson
1095 N. Robinson Creek Rd
(S:-,: NL^,a, Nc.:.:an, Camrnu.: R,r, 5.beltadcr_ Lc: No, Z,p Ca'e)
OW-,1/4,.R; Robert C. Abel Sr.
Address 1095 N. Robinson Creek RP
(Scot: or Route No.)
Glenville. NC 28736
C:y a TOW",S':e Z!p C:G:
878)•743-2933
A.^s ox<• Pere n .t.eo
• 4. DATE DRILLED 4-11-03
5. TOTAL DEPTH: 200'
6: DOES WELL RE?LACE EXIST,T•G WELL? YES 0 NO it
7. STATIC WATER LEVEL Ee!ow Top of Casing: 100 r,
(Use "+,• I!Above Tap of Ca I:4)
8, T0? OF CASING IS 2 FT, Above Land Surface
'Top of cuing teralns!e5 st'or below land a•ur!ace riseVes s
nhsnce 1. s:core an a with ISA N CAC 2C .0112,
9, YIELD (sr —)i 30 METHOD OF TEST Elsa
I0, WATER ZONES (depth): 45' & 80'
11, DISTNFECTION•Tvpe iH A- .' 1E¢
12. CAS,'NG: Wail irjeC1ess
Dfp_, D:'26 -ist:: cr V ' M
Fr--0 To 37 F• . steel
Fr= To Ft.
From: T^
13. GROUT: De th Mater;a! Method
Front__ Tc 71.. FI1v*Tita R c t p*L"1
From To Ft.
14, SCREEN: Dcp1S Diare::r SICSi:< 3T/atr1a',
From Tc roh I
From To Ft,
16. SAND/GRAVEL PACK:
DI; Slu
From To Ft,
From, Tc
TcpcP pbi:/ a_.d se..Wg
❑Zdge ❑Slcoe GValley ❑:l=_;
(.:Seek e,7, apr;r:
.•atie,de.lcngle,ide ci
Lv1c,de br.;lride soW ..C'G?S:3Tcpc—apH:1. •
(oak's box)
r ti t,ING LOQ
Fcrrnaticn Descr.
day & c; .
c;_0i ite
From
To
035'
35' 200'
LOCATION S Y'-TC
Shaw d re:Iicr, and dis'zr._ miles fr:r, at least
:two State Roads or Count Reads. In_,_.: the raad
umbers z;•d tort ^,on road rears.
16, REMA.R:{S'
I DC. HZRZ3Y CERTIFY THAT THIS W=LL WAS CONSTRL CTIED N ACCORDANCE'
CONSTRUCTION STANDARDS, AND TrA4T A C0?" ri'S�Ti +O HAS
SIGNATURE OF PE.
Submit the original to -the Division o1 Water Qua'
37699.1636 Phone N. [phone], within 30 day •
oNSTRUCTrNG T; v WELL
roundwater Sealant 1636
S
'A NCAC SC, WELL
D 70 THE WELL CV R
DATE
•
win Ceater • Raleigh, NC
OW•I REV, 07/2001
272798
0
0
cn
cm
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sr
-10
mo
Gm
GO
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O
GRCUD<'LASFS: SILL!
'.
SECTION!
OSAL OF:10E

272797
WELL CONSTRUCTION RECORD
NcrtCanlr'•DDepa r T! ! 0 ofWa'rQa1 y C'cu:�a1::St; ci
:TCT o,En�:�.���'�.atan�ha;,L ,R r �c.>•D Is�n ,
WILL CONTRACTOR (INDIVIDUAL) NAME Cnint) Mitchell D. Cook CeRTrr!CATIOS 2043
WELL CONTRACTOR CO,M?A.YY NAY' Hedden Brothers ui=11 D'-111:ngr Trr ?:.ONE x P29) 9.—CSo7
STATE WELL CONSTRUCTION PERit1 Ta AS'OCIATED WQ PERMIT,*
ri
fadoilcablel (ifaoolicab1e)-
WELL USE (Che:R Applicable Box); Resideodal Indus ia! ❑ .Ag.-;r:ft al ❑
Monitoring 0 Recovery O Heat Pump Water lnjectioc 0 Other ❑ If Other, List Use
2. WELL LOCATION':
Nearest Town: SY1va Ca1-r Jackson
62 Bradford Lane
(Seim NLre, N•crn9en, Cemm_Jry, Sabdls s or. Gt N:., Z.p C 4.)
3, OWNER, • .Josh Istvan
Add.•ess 62 Bradford Lane
Sylva, I�Cyt28779Nc )
c TOW'. Save Zip Cade
(828). 497-1896
Ara cx'e•?t:n na. ' cr 4-24-03
4, DATE DRILLED
S. TOTAL DEPTH: • 4001
6: DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7, STATIC WA T ER LEYEL Below Top of Casins: R757i
Wit"r" I!Abon Top Culp')
S. TO? OF CASING 1S 2 FT Above Land Surface'
'Top cfeuln: n::Inattd ai'ar bt1or lend euriscu regclrn s
rsris,teL•,a:co rd mca with l SA TiCAC SC .011S. b
9, YIELD (gpn): 15 METHOD OF TEST
10. WATER ZONES (depth): 85' &'' 360'
11, DISPr'FECTION: Type MI Ain---0 1 Ecz
12, CASINO: Wel;t•Ic ess
iron 0 vith 65 F• 64e ;•.•. c: We bvF:. Mai0'wC
From 65 To 74' Ft. 6" .188 steel
• Fromm To Ft
13, GROUT: De;th 'Material • Methcd
Frm 0 To 2 Ft.t g rni t-a R c>?m-L • prpt-i
From To • Ft,
14. SCREEN: Drrth • Dfaneer S!e:Size Mate -'a! -
Fro;a To In, In.
• From Tc Ft in _ in.
15. SAND/ORAYEL PACK:
• Dept: size . Ma:via:
From: Tc Ft.
Fr.,, Tc F'
Tope phic/Latd se.:;rg
:Ridge OSIC;f. LiVa ley ❑?iat
(ohrk er,::par:?:x
...at:c.r1e.,ongt .de Cf We...c:anon
(der.es nlcaasl..:nSt) •
L"lr.de r.5irude soW.COOPSOToperaph!: rr
(c:•.a'x bcz)
• r)R!LLNNO LOG
From To Formation Description
0 • 72' clay & •
72' 400'- way±te
LOCATION SKETCH
She;;;,; direction and disanre miles from at ieas:
two State Roads er Ccw.w Roads. inole_e the :cad
numbers z.d car -non road names.
• 16, REMARKS'
1 DC HE2129Y C?.LT1FY T•=AT TfiIS li?LL WAS CONSTRLCiED TN ACCO?..DANCE ',;..71714. SA NCAC tC, WELL
CONSTR1.C10\\' STANDAP.DS, AND TEAT
A/NCO?Y O?i '-1 - �., ,"T-•: FILL CW'CR
ii.
s:oNA T JTRE 0'r P E RSO
Submit the ortglnal to the Division of Water Quality,
27699.1634 Phone No. [phone], within 30 days.
/E
T
1',i UC r`ti'G2WEL! i 1,i DA,ATc,
_
noiredwater Section, 1636 Ma11 .e.-yY;J Cer1e: •RaleT;., NC
CW•1 REY. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
272764
WELL CONTRACTOR (INDIVIDUAL) NANIE (print),�e„-6 JA—A) fE✓ CERTIFICATION
/Ndir/�
WELL CONTRACTORCONII'AN l' NAME if LPL vVe-// Pe'%� V:f-f PHONE # ) (r %SST1A
eP
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IVMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearesty Town: eU/ Dcu A ea County- ..'✓
rector P1.- ,« IMYC!
(Street Name_ Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fqDe /gr K�i
Address p L
(Street or Route No.
'4JNes L///i NC. ass
City or Town State Zip Code
( )-
Area code- Phone numbe
4. DATE DRILLED «_3c' -. 0?'
5. TOTAL DEPTH: ?'sf- -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fr atigta Description
0yo&Jo
N4.6-
7ff
Depth Diameter
From 92 To_0-2 Ft. &'/
From To Ft.
From To Ft.
13. GROUT: Depth
From 0' To �cU
Amount
Wall Thickness
or Weight/Ft. M ateri2
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
11/Z41 r
Material Method
Ft. L'ciMt (vroP
From To Ft.
14. SCREEN: Depth
From To
From To
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
I6.REMARKS
LL
Sublplt the original to the Div sion f Water Quality, Groundwater Section, 1636 Nlail Service Center- Raleigh, NC
27699i.1636PtfoileNo. (9,19;7)3- 221, s'ithin 30 (lays. GW-I REV. 07/2001
Topographic/Land setting
I9fdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
0 020
Dram
S
tV
p
Wiz:
"'
cc'
rn
0-c
5,r
340
En
—CD
cnz
ms
c a
0
7iL
j Ll,ii HEREBY CERTIFY THATTt ISZVELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
GONSTRUCTION STANDARDS, AND,'tHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
E OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
272759
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section [
CERTIFICATION 11c34
WELL CONII(.ACTOR (INDIVIDUAL) NAME (print),
(_e
WE1.1. CONTRACTOR COMPANY NA\IE
41 v/-79C?
We//C/i pvnro PHONE # (5Jt) C 77'SSS9
STATE \WEL.l. CONSTRUCTION PERMIT/1 ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0 •
Nlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If/Other, List Use
2. WELL LOCATION:
Nearest Town: 5 .144-
-]a4 et-
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: "0Oz✓NA ,2/9 ✓eevlb
Address a?45 %1v-vOi% ,Or
Street .
( or Route No.)
X4rAleee Xt. 70s� g
City or Town State Zip Code
/1/Count 4-
( )-
Area code- Phone number
4. DATE DRILLED , /' O
5. TOTAL DEPTH: ,.245--
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: 73 FT.
(Use "+" if Above Top of Casing)
8. TOP OE CASING IS FT. Above Land Surface*
*Tap of casing terminated at/or helow land surface requires a
variance in accordance with 15A NCAC 2C .0103.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth):
DISINFECTION: Type /117274 Amount
II
CASING:
Depth
From � To /9
Prom To Ft.
From To
� „Topographic/Land setting
fiLaidge ❑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 Fo atio Description
0 /V '9-
/0 ae
A?/6,T
es -
Wall Thickness
Diameter or Weight/Ft. Lena
Ft. 2L
Ft.
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.
Ly/w Jo
13. GROUT: Depth Mp terial ��� tethod
From G� To 07% F[Bztig,,v,»1 "4.. ,.or VM
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Prom To Pt. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 WV 6- AVW CO
0
aOHER LEICiYhtWH+A-T-T4_
'CONSTRUCTION STANDARD
S ,A
Suibmit the original to the I) 'isiot
'-3221
27699-1636 Prune Na.
/ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATCTUKE OF
PERSON CONSTRUCTING THE WELL
9L/6- 03
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �1
WELL CONTRACTOR (INDIVIDUAL) NAME' (print) CERTIFICATION # 3r' "r
WELL CONTRACTOR COMPANY NAME Great 4- N..w f)� PHONE # frEjLL, SAX "-3Z 7d
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
273078
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential TT- Municipal./Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: "'"�'
Ne estTown: N./M County vr2CkS0r'1
A 131i wv. J rl P< C V e-- - � C wLej
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Col
3. OWNER:
Address
Topog aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r GYt e2• 1'Y eSWVC Idcgrecs.mintnesneconds)
% 9 Di) ,S k l e et . Latitude/longitude source:❑GPS❑Topographic map
(Street or Rowe No. ^O p /� (check box)
Q �l C rY % Z7 7
City bl Town State Zip Codc
( )-
Area code- Phone number
4. DATE DRILLED ¥'.2 % -D3
5. TOTAL DEPTH: 1/5. *
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tµ
7. STATIC WATER LEVEL Below Top of Casing: l OD FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING 1S I FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance In accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST a , rS
10. WATER ZONES (depth): 3 2 S- `i prom
11. DISINFECTION: Type
12. CASING:
IA T El Amount a 5
Depth
From © To 1a Q Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r7Q Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
pvc-
Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
Method
I4-,p
Slot Size Material
in.
in.
Size Material
From To Ft.
DEPTH
From To
6 a I
/,,2 ' 2 4'S
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.
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
j 7Yh
k.t ASLONSTIx'1'JC'MD lneCORDANCE WITH I5A NCAC 2C, WELL
QITHAT A COPY Or TI IIS RE S BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONST
I THE WELL DATE
Submit the original to the Division A#-Vyte rQrtAkty trpundlvater Section, 1636 Mail Senice Center - Raleigh, NC
27699-1636 Phone No. (919) 7333221 fhitr,31)¢uys. GW-I REV. 07/2001
c
fl
fa tit,
f-
m
o<
3,-o
viz
rbta
-r
G

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) IJ Y'{' -5(')-L Y--0—
WELL CONTRACTOR COMPANY NAME G te t e.N-,L/— r5 rtr.. WWI "I— P14.a..pI
STATE WELL CONSTRUCTION PERMIT# /41 D .Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
273077
- Groundwater Section
f, 'CERTIFICATION# 3it'
41I
` 'THON E # ($Z`p :� q' — 3 ! i 0
_ 1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION- p Topographic/Land setting
. Nearest Town: .-tt� airw a County (1 eyi<SaN `Ridge ❑Slope ❑Valley ❑Flat
C/
Lb -I- I 47 . -- t -Y _e_ic l 1*rN- . - 811••` (check appropriate box)
(Street Name, Numbers, Community, Subdivision,/�COS
No., Zip Codc) lns�..,i— Latitude/longitude of well location
3. OWNER: o2-is-rat T7r,�. COS E_ C$ o 6 . T, .)::'"-` "-
Address t ROD .534 f a.nci '77 e-
iii4 or N/et ,a.l 02 01 7
(degrees. minutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
to a ti
h_
5. TOTAL DEPTH: `745 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. -STATIC WATER LEVEL Below Top of Casing: a S b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST c ‘lc-5 • 9
10. WATER ZONES (depth): ate t - l r,.prn 3+5- 1P ry O
S - r, P r.--�
I-{-T'H Amount - Shoe. direction and distance in miles from at at
or Weight/Ft. Material numbers and common road names.
4 t v
11. DISINFECTION: Type
12. CASING:
Depth Diameter �-• yo
From n To bFt. I it P V c', r T. rr'o
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To Ft. C1t-vv.:.`., - I b -
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
LOCATION SKETCH W ct
Wall Thickness two State Roads or County Roads. Include the•iSad -r^
c
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY TH
CONSTRUCTION STA
D
JiP-Id
WELL WAS CONSTRUCT= I
rD THAT A COPY OF THIS P C
I
SIGNATURE OF PERSON CON 3TR
Submit the original to the )ivisifm;r ttteF ttalflfy', niuLndwa
27699-1636 Phone No. (919) tea -JELL, within 30 days
ACCORDANCE WITH I5A NCAC 2C, WELL
D_ HAS
BEEN PROVIDED TO THE WELL OWNER
T ✓LC/ -3 3
G THE WELL DATE
er Section, 163o \fail Service Center - Raleigh, NC
GW-I REV.07/2U01
City odTown '�tate Zip Codc
Area codc- Phone number
4. • DATE DRILLED '-I" 1 U - 0 3

\YELL CONSTRUCTION J JOiU
Nuith Caloliva - Depnlhncnt of Environment nod Natural Resources - Division of Water Quality Uiouti .10 Whig ICatNON Ner Section
,�eit "tet e 2 Y12 0?
11F.LL CON IMCI(111 RNIII YIUUAI-I NAME s�/�illn� _p11ONP. N (�
1YLLL CON 111ACt Olt CONrANY NAAf F. �� ASSOCIAI N-1/ W(1 Rr•MttIN
(if Applicable)
Sf ArE n'rl.I, CONSIIIIICIION I'EILAl1IN
(il nitplicnblc)
1, WELL USE (Check Applicable Iloa): Residential EVMuuleipal/Public ❑ 111d,isliint LI Agricultural LJ
Monitoring L1 Itccovcry LI Ilcd rump 1Vnlcr Injection LI Oilier Li if Other, List Use
fapuglnphid1mld selling
❑ItiIge L1SIopc ❑Vnllcy LI Ini
(check nppl r.pt late hn .)
Lnliluddiyngiludc)of well Iocalilon „
Nis°0Z9 4.2 wof3:Is 21.2
(de greet oloolo/r -nosh)
Lntitude!I^!lei1Ude source:O0�k5 topographic rnr•p
(ch
PivaII EAULLINJ LQ(J
From To Foimalion Ucsuipfiuu
276094
2. WELL LUCATIUN7'. L(
NenieslIo1Vn. C�e�O/CCe
(shut 'Jame, Nhnhv. S.IJivieion, Ud Nn., 71p Cc.le)
umbue,"
3. OWNER. ed/;e
Address J r, I__e__an
(Street to Route Nn.)
A tDlCit) \ or r�L`SXt om;SI- C
Ai • mlt. Phone nnmht! /�
• 4. DATE DRILLED G _
' 5. TOTAL TIL_ quo _ _------
6. DOES WELL REPLACE EXIS 11110 W F11,7 YES ❑ NO LY
7. STATIC 1VA 1EIt LEVEL Below Top of Cnsiug: _f
(lite "t" If Above lop of Cn,lip)
A. 7tlp 01- CASINO IS Y _ __ 1-f. Above Land Smince
•lrp rf t.dnr tandnnitd On! Arlon !awl suitor' trgnh to •
',whore In •rtord•i,tnlllt IAA NCAC IC 011A.
V.YIPI.U(HPltl):_qt ____ MEIIIODOETES
I_
Ill.1VATEll ZONES (depth):
4-41I. DISINFFCI ION: Typc�Alliflllllt _nll'IhickncsA
12. CASINO:Dinme r or AVclgliVE1 Mnlcrinl
Depth. , Sfee I C.2 . _lj
D _fo L1.
rl.
County 74C45OL
Llnll
from 1°
Fmnl l o—
13. 01100 t: Depth t
From 1: To v`-b
Prom _ To_ _ FL —
bimnelcr
14. SCREEN: Urplh
Flom .I.o_ __ 1-1 _in.
7o IT in,
from___
15. SAND/GRAVEI- PACK: sae
Deptl'
now 1, 1'1
Dom To
2`6iIc1
zip code
IQ. _ REMARKS"
i� n lN. i 11IIS 1fEIl. WAS C0LIS I ROWED IN ACCORDANCE WffN 15A?ICAC 2C, WELI.
I 1 � I _ cONS1LRUCI ION Nn 0IAT A COE OF'NUS RL'CORC IIAS rVpEN rgoviuno.10111E WELL OWNER
I;,.,-1��i CONSi11UCIlONSIN'i��ci •�• - (� _,20'o;_____
— SIUNAI ll tl! OF PERSON CONS.' IW(Jl INO 711E WELL
L-- _ 1
" li�� 0W-I IUEV,07/2001
F. h��'�jl!�f�'��„L1�Y�!C�'�fC�he U Vlrinn of 1Vnlrr Qunlllyt Groundwater Section, 1636 Mall Service Cotter - IInIeIRh, f,C
ill¢ o. -1221, Iv Ellin 311 tiny!.
Ft
1'l __
�ntcil%9I
t. T etaL
Slot Size
in.
iu.
Mnlclinl
ethod
effeir e.
Mnlet al
0 —yo
Show direction Arid distance in miles Roma least
Iwo Slnle Monts or County Ronde. Include -Hie loll
uwnhcls nod common rand uanies.
LV4LlTIQI�Y..EJGII
rct
0
0

W ELL CONSTRUCTION RECORD
276088
North Carolina - Department of Envir nment and Natural Resources - Division of Water Quality - Groundwater Sectior
%ww se.vt CERTIFICATION # a436
WELL CONTRACTOR COMPANY NAME .e SQtarJGf < 4 i • u� 1 � PHONE # 629 a 5f- /Solt
STATE WELL CONSTRUCTION PERMIT t ASSOCIATED WQ PERMIT#
miammom(if applicable) (if app`cable��—�—
6
1. WELL USE (Check Applicable Bc:;): Residential 6d Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ He,Pump Water Injection ❑ Other ❑ If Other, List,Use
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t e tNC1c14
2. WELL LOCATION:
Nearest Town: Me. ie Va%tel County TacKSc,-
1-kc:cnle, Lae ;Ate Cre,Ak ity Lt.i- a1q
(Street Name. Numbers, Community. Subd )ision, Lb1 No.. Zip Code)
3. OWNER: ietehce O 11¢:I
Address 110E s)J 142 nd 1(lv2
(Street or Route No.)
bav:e Ft 3:;:a5
City or Town State Zip Code
(954)- g143 OI0
Area code- Phone number
4. DATE DRILLED 5-3o-03
5. "TOTAL DEPTH: 31i S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ
7. STATIC WATER LEVEL Below 'Top ofCasing: 7® FT.
(U xe "+" if Above Top of Casing)
8. TOP OF CASING IS i T. Above Land Surface*
*Top of casing terminated at/or below Is r d surface requires a
variance in accordance with 1 SA NCAC : C .0118.
9. YIELD (gpm): Co METH, AD OF TEST k t�
10. WATER ZONES (depth):
^Alp %AC.
Tcfpographic/Land setting
❑Ridge *Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
■ MI
(degrees/minutes/seconds)
Latitud:/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Descript en
- .Z4 eiNec V5eca6T
'21! %a 4'IC
it (ea:t e
11. DISINFECTION: Type illS Amount $
12. CASING: Wall Thickness
or Weight/Ft. Material
.0 2i P\si:e
Depth Dia.rater
From 'VI To 024 Ft._to:=L
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a Ft.
From To Ft.
D l tterial
C tment
Method
�tuc a�i
14. SCREEN: Depth Diame to Slot Size Material
From To R. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Si: c Material
From To Ft.
From To Ft.
16.REMARKS:
LOCATION SKETCH
Show c irection and distance in miles from at lea it
two StEte Roads or County Roads. Include the ri a
numbers and common road names.
1 DO HEREBY;CI;R;I IhY 1 h4.{ 1 HIS WI.LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS'TRl'; TION STAKI:b0St AND T iAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
itSIIGNA7lIREO
RS 011 CONSTRUCTING THE WELL
5.30-03
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
57695'4636;Rho%gljpi[(199) 733'3221, within 30 days.
GW-1 REV. 07/2001

North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
WELL CONSTRUCTION RECORD 276617
tural Resources - Division of Water Quality - Groundwater Section
E (print) to/// ee Ct" CERTIFICATION # ✓?V05
07y/ee We!/ U/://Aty PHONE 1( (6241) f-f2-Afri)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential BI" 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:
County .);(C-Aid yt
(Sbect Na _, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ,Di,v:J feridso/i.
Address Po 6'eit /32-
( ite/chee
City or Town State Zip Code
(ga)- '197- 5271
Area code- Phone number 4. DATE DRILLED 7 0 y 03
5. TOTAL DEPTH: 3,710
6. DOES WELL REPLACE EXISTING WELL? YES L'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /r2- METHOD OF TEST
10. WATER ZONES (depth):
(Street or Route No.)
ti•C,
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From,_,(2____ To 6 `/ Ft. 6,25
From 6 `1 To 15- Ft. C ;5—
From To Ft.
13. GROUT: Depth aterial •
From_(1 To 3 Ft. 0'1/4464
From 3 To 20 Ft. Oilsle-
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N35`a7'424'-1.00f5'1 '36.3
(degrees/minutes/seconds)
La(i`udeinneitude source:❑GPS❑Topographic map
(check bow)
DEPTH jjKiU NO LOG
From To Formation Description
0-60 Clay
60 - -7'{d re.
Amount �f t
Wall Thickness
or Weight/Ft. Material
SORo I ,VC
/0" Stze1
�il/7`
Size Material
From To Ft.
16. REMARKS:
viethod
es se: e
esJ6'/e.
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. t=
c
C)
0
CO
CO
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AbCOF.DANCE WITH 15A NCAC*WELL
WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD A BEEN-PROVIDEDTOTHE WELL OWNER
. - - (fie
illA
SIGNA
1•
Division of Water Quality, Groundwater Section, 1636 Mai13er enter - Raleigh, NC
Submit the original ...__ the -GW 1 REV. 07/2001
27699-1636 Phone No. (919) 733-,iiii, ni(LIn 30 :lays.
TURE OF PERSON CONSTRUCTING ;THE WELL

WELL CONSTRUCTION RECORD
276611
North Carolina - Department of Environment and Napral Resources�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) le Kure- CERTIFICATION # a4o-3
WELL CONTRACTOR COMPANY NAME %/k/ wet 1 OnI I t J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
PHONE # (S-Z5')
2. WELL LOCATION; /
Nearest Town: c/e. °e /_
C; 9 (Ali ft
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /le,it= C4';/4os2, e-
y'' Po j 4n
Address Co 'Tn,��°%-'�`• Vcu r
County 'DT-Cbet/
(Street or Route No.) (fi
C x\olotOL i X L ^��
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 7-a 03
5. TOTAL DEPTH: .3 2,o
6. DOES WELL REPLACE EXISTING WELL? YES NO Er
7. STATIC WATER LEVEL Below Top of Casing: 4) FT.
(Use "+" if Above Top of Casing)
8. TOP or C.^.S!NO is / FT. Above Land Surface*
*Top or casing m-: cd _t?r h.nw lana surface feyoilea a
variance in accordance with ISA NCAC 2C .0118. `/1 ./,
9. YIELD (gpm): I.J METHOD OF TEST
10. WATER ZONES (depth): 3 i f
11. DISINFECTION: Type %f rh' Amount 4 61/2-4
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From f2 To %Y Ft.;25� Stilt( ,IX -
From ) 9 To /'O Ft. € •.ZS" /9)' S7
From To Ft.
13. GROUT: Depth
From_0 To .0 Ft.
Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
-1,6.-REMARKS•
Ft.
Ft.
Method
Slot Size Material
in.
in.
Size Material
numbers and common road names.
x id
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
6,3t ✓413• 36,C�.
(degrees/minutes/secords)
Latitude/longitude source:❑GPS13Topographic map
(check box)
DEPTH FRILLING LOG
From To Formation Description
20- 324 6,r,s, . f 2
LOCATION Way"
Show direction and distance in miles from at least
two State Roads or County Roads. Inclluude the road
co c-
z>
c
Seep
1'-DOHEREBY.CERRTIW'Y-THAtlT WELL WAS CONSTRUUIbD IN ACCORDANCE WITH 15A NCAC 2C, WELL
;CONSTRUCTION STANDARD, fA1j4D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�zn'7 �1Ga I 2/ c'3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
cuh Sit the Original/to '.fhe ;vision or 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)
rcy ke Le_ CERTIFICATION I r2Y0�
WELL CONTRACTOR COMPANY NAME 227, //er r^le-� Or '. l i l i `�) PHONE M (k';Ih t'Y/
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable) -�
1. WELL USE (Check Applicable Box): Residential fMunicipal/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: C4€ieae-e.
UiRcr1 /a� N 112'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) y
3. OWNER: tut,,I 6e sS
Address « Tr,f"'" e°o't,
(Street or Route No.)
C1'CSflC tJ
City or Town State
( Area code- Phone number �; G S
4. DATE DRILLED 7 - 1
5. TOTAL DEPTH: L. / o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13-
County -T;ic %u
en IX L (('kt'k
rJi, �4j
::`1\t
Zip
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS /" L FT. Above Land Surface"
*Top of wing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST 4' /
10. WATER ZONES (depth): Scc
11. DISINFECTION: Type
12. CASING:
Depth
From G To //L.
/-/77
From To
From To
13. GROUT: Depth
From 0 To 2 v
To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Amount Yy r r2
Wall Thickness
or Weight/Ft. Material
From
14. SCREEN:
From
Depth
To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
batisBY-6EltAty!
CONSTRUCTION STANI
Diameter
Ft. (,2)"
Ft.
Ft.
,Material /Method
Ft. i:,ff,/d /4ies5,2
Ft.
Ft.
Size Material
276610
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
N3S'.L7'to, 11" auoy.ted0'27.s:.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
At-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inde the road
numbers and common road names. r'
TTHIS WELL WAS CONSTRUCILD IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 /y_os,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L 'L' 1CIL
q 5ugntt2 theletigl1 MOtbEthe Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' Raleigh, NCREV. 1
/76QQ_1616 Phone No. [phone], within 30 days.

276583
11'LLL CONS•1'1tUC'1'1ON HLLOR
Nodil Car olinn - Derailment of Environment turd Natural llesoul ccs - Division of W atet Quality - Or ouiidwater KrN N .Iiu l
ANIr tn. Intl ferry f ecCC- `
,rF.LI, CON IMCI on llnulvinU,;L)N_. v �)-a SY)
%771k7 J�tl aY1(—i(1Q
MOM: / �'�1�
writ Con 1 RAC! OR COMPANY NAME ASSOCIAT7p tYt)rE::."-=lrM- —.
5 rA It )YELL CONS IItuctioNfCIUIIIr ifnrrlicoblc �..��.e
if n r ,licnblc
WELL USE (Check Applicable Ilox): Residential W--MunicipaVrublic U Iudushial CI Agricultural ❑
Monitoring ❑ Recovery U Ilcal Pump Water Injection U Other U If Other, List Use
lopognnphic/I.nlld setting
2. R'InLLL0CA110N: iSC!_OR( ❑Midge IJSlope ❑Vnliry LiElal
�'4.z"':2ke c_ County------
Nealesl I O,l'IC(cheek nrgrrrnthirr hno
se to _------------ --- I.ntituddlongitude of well location
__---- r
(Street flame, Numbed, Cam••• - hv, Subdivielon, U,1 No., Zlp C..le) U J , Ic Ysi, oi�) •( ),• YY
(degrte n r r
3 OWNER. Sdiar tr Gdzlc%.
Co.�� Pn r�4-1 Lalilt.ld!^ngiludc sowcc:CJ(iPSCllbpoglaphic nrgl
C 7r; (7o� (check b'r'i
Adchcss ___1¢---- ),Ili1.LlN(i i,()
Si(eel or Rnule Na) ���`� ))1 -
r��Ylo - Prom 'fo Formation Description
Stole Zip code
Cil)'r lone —_-
rr _�— 0_ 5$ iT/7,u,-1
I--)
Au" code Phone ED ' y-_'�,J GAY ry,"f 'L
.I. DATE
DRILLED -It j J .
5. 1 ova. DEP FIE_ (00 _.______
6. DOES WELL REPLACE EXISTINGWELUI YES U NO EI
7. 5 FA11C WATER LEVEL Belowf. Top ." If Above lop of a(irra)
R. TOP OE CASINO IS __/ L _ — 1f. Above I.nod Surince• __---.--_-__—_
•top el c .ling le.ruln.nd •tior orlon Ism' or, lace. viols is •
r orloree In •ccord•irce nhh ISA NCAC SC.0 ill.
o, Y1111.O (Fro„). 30METIIpU OP'I-EST /r%— --�— --
--- .
10. WATER ZONES (depth): �U j<l_.C<Lll IUtJ_SKJ.J_411
ic7. Show direction MId distance in miles f unnl nl (cast
11. DISINFECTION: I'ype_�� nunlnl_�Y\Will Illickucss two Stale Roads or County Roods. Include the road
r
11. CASINO: Perth J v Diameter or W elizirpr . erinl numbers and cmnnbdn rood names.
et 1 rtO
0 Tom I L Il" •�y O
non P
Horn To Et . il"+r
Et. _ m
Fm0 1 eo [vlethod D -x
CJ
Perth Mnlc inn ,/ "�
13. OR111 I o, t�Gnd /0 v-Z- ea I
Ilm❑ U foil 11 _ ��
RPM__ TO 1'l.__ _ -
14. SCP.taiN: Dcpllh Uimncncr _Slot Site Mnlctinl p°"v
III. in. ?..
n om__,__ To
II. in. in. CO
LIDIS. SANl7/liIIAVI)L ill Site Mntetlnl
From To II.
r. Et._--
From
16. REMARKS: WIiLL
• 1120UrRrcr:l
nl",it1�1 i(i 7 1115\\rFII"\VAS CONS IlWCIl,D111ACCUIWANCE"Willi lsAflCACx,
tion—s M$, ) AND THAT A COPY or TIUS RECORD I IAS DEED PROVIDED 101 I IL WEL'- OWNER
rcurtsfittie
DAIS
SIONAUM! 01'PERSON CONSIRUCIIN0111BWELL
-- unlll Groundwater Section, 1636 Mall Service C,n r''Weigl' Nn01
Spppol (lip hoot n� (fl9) DI Itlnn of 1Vnler Q Yr
"17 aN6=PhoneNC019)7Jj-7111,w'ithinJIIda s.

26813'11
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section /�j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ElyA isci `�V/le CERTIFICATION G'/
WELL CONTRACTOR COMPANY NAME // /(E we "Q Pu The PHONE M g52ig6W7S-/g'
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT4
l if applicable)
(if applicable)
I. WELL USE (Check Applicable 13ox): Residential C'Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Beat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ✓__
Lth< d rfri Crre
County -146gip '✓
(Street Name, Numbers, C(1nununity, Subdivision, Lot No.. Zip Code)
3. OWNER: //Dw'APL2) 1,0 y/-�
Address �j3o YO✓Jc� mu
(Street or Route No.)
(o r+ nr^n)r p4.
wn
City or ToState Zip Code
( Area code- Phone number
4. DATE DRILLED /-/5- ` O 3
5. TOTAL DEPTH: 9...E
6. DOES WELL REPLACE EXISTING WELL? YEW NO ICK
7. STATIC WATER LEVEL Below Top of Casing: 73 FT.
-"t (Use "+" if Above Top ofCasing)
8. TOP OF CASING IS " C FT. Above Land Surface*
*Top of casing terminated at/or below land surface tertnires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): /,t METHOD OF TEST f/
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
Topographic/Land setting
('Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/l ong it
DEPTH
From To
(degrees/minutes/seconds)
ide source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatio Description
ell- 7
N.t.tA - s &'e
(fv-^RN/me_
c
Depth
Prom To '7 Ft
From To Ft.
From To Ft.
13. GROUT: Depth Ma eri l
From 0 To oct I:tee.tery-
From To Ft.
14
7 Amount
Wall Thickness
Dipi to t er or Weight/Ft. teri j
f %� .SOr-a/ I/93A
SCREEN: Depth Diameter
From To Ft. in.
From To Pt, in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Metthhod
Slot Size Material
in.
in.
Material
16. REMARKS:
LOCATION SKETCH coo
Show direction and distance in miles front Icast-
two State Roads or County Roads. Includ=the rotrc-h.
numbers and common road names. 1 --
0
-0 _io
�{/y6a
c>'
I DO I'1EREI3Y-CE tl'1F* 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
SIGN. URE OF PE!:SON CONSTRUCTING THE \VELL DATE
-Submit the original It
37699-1636 Plume No. (
the Division of \Vater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-I REV. 07/2001

26'792'
WELL CONSTRUCTION RECORD
a Quality. Gfouz±:,� er Sae;',on
?'ml Resou e:5 DIv'isiea of Watt: North (,'a(Ji;Ra • DeyZ^P�e n: of 'Environment aP\+_ Ja1aIne£i B. BYOwT? CERTIFICATION y ZAGS
W%LL CONTRACTOR (INDIVIDUAL) NAME (pr.::t) E�^ e ) 4j-9591
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc. Px.,.':...
STATE
OY PERMIT* ASSOCIATED WQ PERti11TA
WELLCO>1STRUCTi . (if a:^'ica`le)•
f s t!icabiel
Municipal/Public ❑ ladustrial ° Age:u1^�a °
I. WELL USE (Check Applicable Box): Residential tS0;her G li Other, Lis' Use
Heat Pump Water Injection CIMonitoring 0 Recover; 0 p
2. WELL LOCATION:
Nearest Town: Glenville Co=ry Tarkson
Cullowhee Forest Tot #FS
(Srer Ns..:e, Nur bm, Cem-':.-.iy, Sub:irrle:, Lo; Nc., Zlp Code)
5. OATEREarl V. Magri .Tr
Address PO Box 71194
(5re:t cr Route No.)
Metairie LA 700"33
ciy c Tcwn Sat Z.; C.1e
(5nm• RR 7S
Area code. Pbcae cunber
4, DATE DRILLED 1-30-03
5. TOTAL DE?THE 300'
6; DOES WELL REPLACE EXISTING WELL? YES 0 NO $3c
7. STATIC WATER LEVEL Below T cp of Casing: Sri
• (chi "✓' If Above Top or Cal.i2
3. TO? OF CASING IS 2 FT: Above Land Surfboat'
,Top of ou1oz ter:otnaud a:or blow ILnd surface requlru a
v.risnce In accatdmce with ISA NCAC 2C ,0115. i
9. YIELD (pm): �4— METHOD OF TRST
cw
10. WATER ZONES (depth): 73c' , 7st' r R 7Qn'
11. DISINFECTION: Tvpe
12, CASING:
Fcm 0DTo st.th 89
From Aq' To QS
Fro n_ To
13 GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth
FronTo,___
From Tc__
15: SAND/GRAVEL PACK:
Dep:4
Front To
From Tc Ft.
Ili Ancunt 16x
16, REMARKS
Wall h:loess •
D,, c. W�c',33. t rt, Maser aJ
ayp :. pvC
Fe. t
Ft 1RR stppl
Ft.
Material M,_ od
Ft.lezrite & cite trs;L pmx3
D:arneter
Ft
Ft. in,
Slot Size Material
in,
Size . Material
Ft
Tcpoyaphic/Land seti.g
❑Ridge ❑Slope °Valley ❑Flat
(<he;R lam: rr.L•_ b: _%)
L a".r.de;longir:de cfwe'l:lcca;ion
(:ey_:L .I::aLeCC:L:Jt
p
Le^i a.:rod^nglr„deSJ�..e;°G?`°'IJpJgf2r�,is
.._o
(ch:ci bcz)
p TP DRILLING LOQ
Flom To Formation Descrict!cn
0 91' clay &s cl
91 ' 300' granite
LOCATION SKETCH
Show direction and distance in miles ft-m, at leas:
ttvo State Roads cr Count/ Roads Include the ;cad
numbers and COrat7An road hates.
RR��H4Xs.9YOi nfY`t?AT1tr:-1_`r WAS COYSTRUCT7DINACCORD ANCEWITI'.1SANCAC1C,hELL
0TRL'CTIOW5- NDARDSAYD HAT ACC" OF T5i :5 RECORD ;AS BEEN FROVIDED70T^CWELL CW12R
' plaue, 9 /-40 - 6 3
11 1 �,(
, I ,. SI LMRE I. FERSON CONSTRUCTING THE WELL DATE
Subr4t the original to the Division of Water Quality, Groundwater Section, 1636 N1a1I Service Ceeter • R.s eigh, NC
27699•}1636-fett? (919 151:3TS1, within 30 days, GW'-: ?_V. 07/200i
O
CO
m
CD
I
fV

WELL CONSTRUCTION RECORD
Department 01 Enytrorjn t a t r e vi ion of !er Quality • Ground otter Sec:lmn
r
North Ca:olirz • De; ene zip ha Wzr R sc'wo S • DI Is z,
Ni'ILL CONTRACTOR (INDIY1D UAL) NAME (pint) Mitchell D. Cook
WELL CONTRACTORCo11?ANY NAME Heiden Brot her.S WP11 DrLlltrg Tnr^ PMONe S (R2Alloc —Oca1
STATE HELL CONSTRUCTION PERStIT* ASSOCIATED WQ PZZRMI74
(if aoolicable) (if aoo!icab!e) •
267912
L WELL USE (Check Applicable Sox): Residential & Munici;atPub!ic C Industrial C Agrioulrc3! C
Monitoring C Recovery 0 Heat ?urn; Waver Injection C Other C If Other, List Use
2. WELL LOCATION!
Nearest Tow^,.: SYlva County Jackson
Ochre Hill —Wildcat Mtn Trail
(Seeat Nsne, N'c^bare, Cem.....i , S:bdiral:, Lc; No., Zip Code;
3. OWNER: Charlene Luciani Trustee
Address 2429 Upper Bellbrook Rd
(Ste-t or Route No.)
Xenia, OH 45385
Ciy c,Tcw^, Sax Zip Code
( R7R- 611 —4700
M� cx'e• Ptcne nurksr
4, DATE DRILLED 1-21-03
5. TOTAL DEPTH: 200'
6: DOEs WELL REPLACE EXISTING WELL? YES C NO ec
7. STATIC WATER LEVEL Below Top of Czsias; 150FT,
(Use "r" If Above Top of Caelni)
8. TO? OF CASINO IS 2 FT. Above Land Surface'
'Top of cuing teranand at'or blow land surface requires a
variance In arcer.ance with ISA NCAC iC .011S,
9. YIELD (gpm)1 20 METHOD OF TEST
10. WATER ZONES (depth): 105' & 135'
blow
11. DISINFECTION: Type HIH
12, CASING:
Fro— 0
From To Ft.
From. To F'.
13, GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN; Depth Diameter
From To 7t._in.
From To Ft in.
15. SAND/GRAVEL PACK:
• Depth Size
DI-r_:
To 45
From To
From To
Ft.
Ft.
!}a.veter
F' - 6
Ant nt 10c¢
} LI T'JCccess
or µ .188 steel
Material Methorl
Ft.}rnit•e= R cart • PrT'S
S,'a Siz.e Malaria!
in.
in
Mateeia:
ToporaphicfLard se-Wg
❑Rldse :Slope ❑Valley :Flat
(:beck a,propr;a'U I;:x;
L.atirsdelcreiiiirtide 0f we:1 L.:a:1cr
(der. s'C.:'JxSaeU.nde)
La:irrdelongi ude so'u e: C'?S0Topcgrap;.i: ma
«'a bex)
PERTH • Oitr r.NG Lon
Frem To Formation Des:rip :io n
0 43' ciaY &3
41' 200' grar_te
LOCATION c KETCH
Shoal diceoticn and diszre in miles f:c.r, at leas:
rr:o State Roads or Ccu.:v Roads. 1nc!ude the read
„umbers and corr.-non road r.arn:s.
16. REMARKS
I<€'e-
WeC-eRnIwrra a err
jcO-��TRUctio" STAlq.'DARL E;A.
1
III
I'''II
urbrTh the original to the Divisi
7699 1636 Phone No (919)..733 31
L WAS CONSTRUCTED IN ACTOR:ANC?: WITH ISA NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED To T:O WELL OWNER
i/.1/3
n 0? PERSON CONSTRUCTING T:v WELL DATE
ater Quality, Groundwater Section, 1636 Mall Sent;e Ceattr -Raleigh, NC
In 30 days, GW•1 REV. 0172001
CZRTI—ICATIONe 2043
O
co
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N
xo

26792.1_
WELL CONSTRUCTIONRECORD
North Carolina • Deya^nent O1 Environment and Na.,W, -at R ovv4'0e'c es Division of Wat!: QQ!a!i y • Grcand'nttter FAciion
, .
James B. Brown CERTIFICATIONy 2045
W?LL CON'TRACTOR(SND111DL'Ai) NAME (y r(s t,t
WELL CONTRACTCRCO'1PA:NY NAME Redden Brothers Well Drilling Inc. ?HONES 1 36�"5591
STATE WELL CONSTRUCTION PERMIT*
• Cf a:on:ablel
1, WELL USE (Check Applicable Box): Residential h:cticpaV?ublic ❑ Industrial ❑ A_i:ulr z! ❑
Monitoring 0 • R:covey 0 Heat Pump Water Injection 0 Othe: ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town' (.1111owhee
n..ne F rk
(St -et Ns.-
4u,-Son, Community, Subdlnsl:r, L. t No., Zip Coda)
3, OBalsam Grove Boo*'mot rh„r h
sPC a�Y cl0
(St -re cr Route No)
Ci ; cr Town smote Zip C:4e
Ccunry Jackson
(a). SRF, 0294 rnntart
A-.e core. ?aerie awn:er
4. DATE DRILLED 1-20-03
5, TOTAL DEPTH: I 6. DOES WELL REPLACE EXISTING WELL? YES 0 NO u"3
7. STATIC WATER LEVEL Below Top of Casing: sn FT•
(7a u
it Above To; orC.1j)
2
8, TOP OF CASING IS Ft Above Land Sauce
e
'Top of oaf's= terilnead at'or below land surface re;utres a
va?,ance In accordance with ISA NCAC SC .0118.
9, YIELD (gpm): METHOD OF TR ES T� e h.o
10. WATER ZONES (depth)'.
11. DISINFECTION: Type Fai Arno ' t 1
Ecz
12. CASING: Wail Tr cic,ess
• Der.-1 Disye,er „rWr,-u$cl, Material
Fro-, 9 To Z Ft. steel
From 'To Ft.
13 GROUT: D;r_^ F, Matea: Method
20 Ft. .te & ant
From 0 To
turned
From To Ft.
14, SCREEN: Depth Dia:niter Slot Size Material
Frsn• To Ft.__1"
From To Ft_in. in.
15. SAND/GRAVEL PACK:
Depth Size . Ma!e,ial
From To Ft.
From Tc Ft.
ASSOCIATED WQ PERMITS
(if a:elite:lel •
16. REMMARXS:
Tcpo zphic :.a: d s:tri:.g
❑Ridge ❑Slope °Valley ❑Flat
(ebrk approprem box)
L at!t,derlongir.ide of welt location
(dayrre r'.I:utz sCC:.::J)
La:imde;loagirade source:03?50Tc7.0b,ap..ic r—,
(check bcz)
DEPT'r • DR L LNG LOG
Front • To Formation Description
0 /5r1ay & x,il
35' 175' granite
LOCATION „SNITCH
Show direction and distar_e ir. miles front at least
r c State Rows or County Roads. Include the rcad
,.umbers and common road names,
VZM$Y CtnT(rytnA r, ELL WAS CONSTRUCTED T`f ACCO?ANCE Vrliii ISA NCAC 2C, 1:EL
S, , ATACOPY OFi'r:
i15RECORD'AS3==NPROVIDEDTOT—W=:L0\V•ER
i���{I aloN5-
°5:i.. '0"rPERSON CONSTRUC iNGT:vWnLL DATE
1
Subnplt_the origlnal_to thsDl on o! 'ater Quality, Groundwater Sectlon, 1636 Mall Senile Center •Rae:gh, NC
127699.1636 Phone No. (919) 733.31E 1, wi hln 30 days, CW REV 07i200:
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3 1.
1-0

267911
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mi trhell D Cook CERTIFICATION p2043
WELL CONTRACTOR COMPANY NA.MEHedden Brothers Well Drilling, Inc PHONE p( AY 369-9591
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMIT4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential) Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: cyl.ra County ,Tarksnn
.7na1- hpfnrc flrhrp Hi 11 Rapti qt Church
(S Ceet Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ron Martin
Address 56 Cedar Wnrx1 Drive
(Street or Route No.)
Waynesville, NC 28785
City or Town State Zip Code
(828)- 926-8401
Area code- Phone number
4. DATE DRILLED 1-16-03
5. TOTAL DEPTH: 275 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Etc
7. STATIC WATER LEVEL Below Top of Casing: 225' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST blow
10. WATER ZONES (depth): 75 & 205'
11. DISINFECTION: Type HTH
12. CASING:
Depth 28
From To
From 28To 32
From To
13. GROUT: Depth
From__ To 32
From To Ft.
Amount 16oz
Wall Thickness
Diameter or Weight'Ft.
Ft. 6"
Ft. 6" .188
Ft.
Material
Ft.CrrrFnt & trrrni e
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SANH/ORztvEL PACK; =C
`) Depth it fl t, 1 Size Material
fit pram —To 1l
--. From To !'' t11I
l {I
,1 46. REMARKS: Well m s requirements of NCDENR variance request
Material
pvc
steel
Method
pnpml
Slot Size Material
in.
in.
Topographic/Land setting
[Midge ❑Slope ❑Vailey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'minutes/secands)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 30' , clay & sand
30' 275' granite
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.
I Iho-HERESY CERTIFY THAW THI WELL WAS CONSTRUCTED rN ACCORDANCE WITH 1SA NCAC 2C, WELL
C011iS (RUGTIRN STANbA-.ZS, AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T[dE WELL OWNER
o 0
CO c=T1
—
CO='a
t
J _=
tV
cD
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ci
r;
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

267920
WELL CONSTRUCTION RECORD
NerVI Carolina • Depa w LSt o; Environment end Naranal Re50Ufv9S • Division Of WaterQllall.1ty Grout isAer SA �ttr ZQCS
WILL CONTRACTOR (INDIVIDUAL) NAME (Firm; James B. BrOwTm
WELL CONTRACTOR COMPANY NAME HedQef Brothers Well Drilling Inc. PHONE 7FORm1
ASSOCIATED WQ?ERNIT=
STATE WELL f a;; CONSTRUCTION PER�pTM (if a:clicabiel
ffacclicabi:)
c'..tu''0
1, WELL USE (Check Applicable Pox)'Residential NIu icip=�?ub,ie 0Industrial C Agri
„p Water Injection C Other 0 If Other, List Use
Monitoring 0 Recovery C Heat Pump ,.�
2. WELL LOCATION:
Nearest Town: Cullowhee
Cousaty Jackson
5^s: h's-:, N;r..Sen, Cem�r::r.i:/� Subdivtteia, Lo: No,, ZIP Cole)
(
3. OWNER -�lt n._P za RrJ
Addresse"
(Stilt er Route No.)
Cullowhee NC 28723
CI-,, or Town StlY
82$ 293-0337
A.a c dc- Phan ru^eber -03
4. DATE 1 -1 5
DRILLED__ :.03
S. TOTAL DEPTH: 125�--- 6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ca
i,
7. STATIC WATER LEVEL Pe!owTop o,AbaysT,19.0—) :
• (Wc"''Il Above Top olCu.iE)
8. TO? OF CASINO IS 2 FT. Above Land Surface'
'Top of wing tirrolnatid itior blow land rurrrc req' lru a
variance In accardance with ISA NCAC 2C .0119. .
•
S, YIELD (5prn)'•2(1__— METHOD OFTEST
blow
10, WATER ZONES (depth): 70
Z:p Coat
11, DISINFECTION:Type Pal
12, CASINO:
De; th From 0 To--�Q-F:•
From To Ft.
Fro^t_ To Ft.
15 GROUT; Dept:. p
From 0 To
From To Ft.
14. SCREEN: Depth Diarheter
From____ To Ft. 'In.
From Tc It in,
15,SAND'GRAVELPACK:
Depth Size
From To Ft
From Tc Ft.
Diihlieter
A.:,can t 16ce
Wall Thickness
cr W1tv,8pL Mateo
steel
Ma:eria. Met.`.o'
Ft.1eto & LE 1Ys,L p reel
Slot Size Material
n, i
. Mataral
1 Ci,7Cg'L;
ticiLand Setting
❑Ridge ❑Slope 0Valley ❑FFlat
(chak iP7 rpde'- bas)
Lat'tnide,, ngtr'de of Welt location
La',. ide:longitude soc._.CG?SDT0poraphi:
map
(fee box)
PEPTP DRILL TNG LOG
To Formation Descr ad
From , 68' � & d
granite
FR' 175'
LOCATION SKCETCM
Sher direction and disar_e in miles from at least
two State Roads or Canty Roads, In:iude the read
numbers and COrnmOr road names.
�16
Ili)11 DO!tFrerm'aX 1 -LEA S
t' CONSTRUCTION ST AnD
u
S WELL WAS CON5Tat'CT•_'D N ACCORDANCE W Tri 11A NCAC 2C, W LLL
F1.<D7*.-:AT ACO?"OFTHiSR CORDHASBEEN PROb':DED707E2WELL CW\ER
tc
S`GNATURE OF PERSON CONSTRUCTING T:'2 WELL DATE
1
&unit the edging to* Divis
A. erg-1636'PhaneNo. 149E733.3:
an of Water Quality, Groundwater Section, 1636 Mall Sen{ce Ctater-Raleigh, NC
•
11, within 30 days, GW•! KEY, 07/2?0:

WELL CONSTRUCTION RECORD
Nahral Resou:: es Division of Wai,,er Qcatiy
Norm Carolina • Doparnent e; Envirorunent andJYI4�
WELL coN7tUCTOR (INDtti1DUAL) NAME (print) JameS B. Brown
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drillina, Inc.
STATE
ON PERMIT* ASSOCIATED Wig PER11ITi _.
WELL CONSTRUCTS �.
(if acolicable)•
' (if 8r011cdbie)
1. WELL USE (Check Applicable Box): Residential CS M'unicipaVPublic C Industrial C Ag,-icuLoun1 ❑
h ni;orn ❑ Recovery C Heat Pump Water Injection 0 Other ❑ If Other, List Us:
fc g
267919
• Groead9,11,Zr Sesl�arl
CERTIFICATION p 2045
PHONE st 8291 369-9591
2. WELL LOCATION: County Jackson
n
Nearest Town,i'lelicter
Just Past Stiliwe11 Farms
(S-rot None, N:r..Ssn, Ccrnr.,:riry, ScbdiYil:G Lo: Na., Zip Cods)
5. OW-NeR 'Doug Farris
Address Pf1 Wsr R"i1
(sre•.t cr Route No.)
GY1x,a n1r 28379
Ciy c: Tcs SP.o:e Zip Code
0282 SR1S 01 RS -
A'ea coda Pone r :o `b<r
4. DATE DRILLED 1 14 03
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO j c
7. STATIC WATER LEVEL Below Top of Casing: 100' FT.
(Gin "✓' if Abova To; of Cu.L;)
8. TO? OF CASING 1S 2 FT, Above Land Surface'
'Top of cuinz Urinated atior blow land surface revoiru a
variance la accordance wl'h l$A NCAC 2C 4113.
•
9, YIELD (rim): • 75+ METHOD OF TEST bkid
10. WATER ZONES (depth): 135' & 175'
Topogaphic/Lazd sexing
❑Ridge ❑Slope °Valley °Flat
(: rk appropria.. b:x)
Latirsde,longir.de of well location
(der.eshtteoteersaeneit
La:'irade.longinide srace:0O?S❑T:poi,aphi: ^ •
(c ec bcx)
• DRILLING LOG
Formation Desari:tion
rl ray & x it
DEPTH
Riot To
0 761
2.6' 200'
11. DISINF=7'TIO'1'T'pe
12. CASING:
• De[n P'amelee
F-o•� 0 To 28 Ft 6
From :To F.
From To Ft
13, GROUT: Depth
From 0 . Tc_
From To_
Imi
14, SCREEN: Depth
Fror To
From To
15. SAND/GRAVEL PACK:
D pth
From To Ft.
From
Material
A nicr„ 160Z
Wail Trk'ness
crWeN'trt. Mat. ,•'
•1$"$ steel
Ft.hercnite & L E
Ft.
Dia.-niter
Ft 'In
Ft. in
Tc
Ft.
Method}
iTed
Slot Size Material •
Size • Material
grranite
LOCATION SKETCH
Show direction and distazne in mires from at least
tictio. State Roads or County Reads. Include the read
„inbers and common road vanes.
st H_LBYCE?T}?•Y rtf
l -C S t nUCTION STA. RDSV,
1CN
..L WAS CONSTRICT=t t`r ACCORDANCE V.1 iH 11A NCAC 2C,
ir_AT A COCO?"OF THIS RECORD RAS BEEN PROVIDED TO TWELL OWNER
.TIC:
•
rURE OF PERSON coNSTRUCC1NG THE WELL DATE
SuThe orljlnal to tits Pirisfon o Water Quality, Groundwater Section, 1636 Mall service Center - Raleigh, NC
176 6}S 3ia!bOsteNti,,1919 633`s'
thin 30 days. • GW'•i REV C72001
en
0

267917
WELL CONSTRUCTION RECORD
c of W le: Quality • C o :d':,ata; Ssc,tan
NorthCZJI1Ra • I.i C; atL^,1Grt of EnYliOntnGnt andi1:t'wLl RCSOt1fC":$ • Division a CERTIr1CATl0h'+5
Va LL CONTRACTOR (INDIVIDUAL) NAME (prr.t) James B. Brown
WELL CONTRACTOR COMPANY NAME
Brothers Weil Drillina Inc. PHONE $ 828.E 9591
ASSOCIATED WQ PER.MIT9
(if a:olcab':1
STATE WELL CONSTRUCTION PERMIT*
•(;f ao:iicabie)
1. WELL USE (Check Applicable Box): Residential $ M rici;3V?Ub l: 0 Industrial ❑ A,
Monitoring ❑ • Reoovey ❑ Heat Pump Water Injecttor ❑ Other ❑ If Other, List Us:
2. WELL LOCATION: Couny
Nearast Town:_ sylya
(Stern Nam:, Nun ter, Corne:ciy, S:Sdivt,L: , Lot N., Zip Co.)
3. OWNER: Josebh Trent na
Address
(Ste.' cr Route No.)
B son Cit NC 28713
Cityor Town Sax Z'.p Code
($28) 488 5fi10
Aron coda none FYTl —13-03
ber
4. DATE DRILLED
5, TOTAL DE?TH: 3.0 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13c
7, STATIC WATER LEVEL B:10w Top of Casing: 2nnFT.
• (Use Ne" If Above Top orCu.L;)
3, TO? OF CASINO 1S 2 FT, Above Land Surface•
'Top of win/ terminated sJor be:ow Iani surface rqulrt a
variance In lc:valance w4h 1e.A NCAC GC ,0113.
YIELD 12 METHOD OF TEST blow10, WATER ZONES (depth): 160' & 205'
Jackson
11, DISINFECTION: Tyre
12. CASING:
0 Ltepth Di cater
F•orn 37 Ft. 6
For 37' To 40 Ft 6" .188 see
Fromm To Ft.
13 GROUT: Depth Material Method
From, 0 Te 23 Ft.Le La ate & c,rjtes,t 1>
red
From- To Ft.
14, SCREEN: Depth Diameter Slot Size Material
Fromm To It. In.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Dstth Size . Material
From To Ft
From Tc Ft,
EDE
Amount 1 Ec¢
Wall Tr'ccess
orWei,ghtrt. Mateda.'
vc
15, REMARKS':
T cporaphiciLazd set itg
❑RiauS• ❑Slope ❑Valley ❑Flo.
(;`heck apropt t :x)
Lat'.r:derlongirade of well Iccatltr,
Latftudelongirsde so'.:...ICG?:CTcpo,,ap`._ ma;
(<'•.xk 'xx)
DE?TF • DRILLING LCQ
Fro-, • 3To 8' clay &Faso pticc
0
grzrtte
38' 300'
LOCATION SKETCP
Show direction and dist;.nce it miles from at least
tuo State Roads or Couny Roads. include the rcad
numbers and common road names.
a 1R0 H=MBY C ATIFY T AT tat 5!,T=LL WAS CONSTRUCTED 1` ACCORDANCE WIT - 15A NCAC SC, W =LL
CQNSTRUCTIO} STAI•I'D.ZE.,,A.N'pFretACOPY OFmHAS WEE:LOWER
.l—/3-43
III LIREOFPERSONCONSTRUCTNOTI-2WELL DATE
Submlt the original to the Dlvltlon a Water Quality, Groundwater Section, 1636 hall senice Center - Raleig ; NC
1769et•IE35PhonaNo, (9157733>3121i !thin 30days, GW•1RIV.07/230

267918
WELL CONSTRUCTION.RECORD
c5
♦ ,1 ^ Water<'it ' Groundwater Sac(',.r
North Carolina • D6'F2il;,1G"'.t 0f Environment and h:C�l.'Zi RG>OU.'CSS • Division of �'' / ION WILL CONTRACTOR (INDIVIDUAL) NAME r,n) Js nes B • Brown CZATir]CRATAT ON 9 9591
hcclaen Brothers well D_illinc Inc.. ioNz A �s
WELLCCNTRActoRcoNPAVYUAVIr
ASSOCIATED WQ PERMIT#
(if sr:lice:1e)-
STATE WELL CONSTRUCTION PERti1ITA
(if ariicable)
aUPublic C.: Industrial 0 Agrisultu.al
WELL USE (Check Applicable Box): Resi
deci
tia!' M r p
Monitoring 0 Recovery 0 Heat Pamp Water Inj:ctien 0 Other ❑ If Other, e:, Lis: Us:� --
2. WELL
LOCATION: Topographic/Land nd setting
Nearest Town:Sy1va CO L•5Jackson ❑Rdge °Slope ❑Valley ❑Fat
Can =-rke7•"o'a•-b:s)
(5::eNv�e,N:r.Sn, Gc-^':ni^Sbdive!<r, G: �<, Zip Ce e ongi"'de of well location
3. 0WT_R'.
Add::Sa
cr R-:::e No.)
Cdntori - S,� ,p Cede
Ci r. T<wn
eo tcrsn
A•ta c• Phone naTber
.4. DATE DRILLED1-10- 3
5. TOTAL----
6: DOES WELL REPLACE EXISTING WELL? YES ❑ NO %3C
::OW'TC Of Casing:—�--
rl,
7. STATIC WATER LEVELS (Use O" If Above Top Of Caa'.v)
8. TO? OF CASuthi , t IS b, oW
F i, Above Land Surisee'
'Top olealn4 U::�tnated a."or Eelaw land surface regclroe
valance In 'cca rdmce w1;h ISA NCAC fC •0111.
9. YIELD (g?m)I 10 METHOD OF TEST _hicw_--
10. WATER ZONES (depth):
11, DISINFECTION: Tyre
12. CASING,
x a•
Dia-�.ete:
Fro l7 Tc 47F:. F
Fro c, 47e Tee-�•t._—�—
F:c To
13, GROUT: Dept
From 0 To 20
From To
14, SCREEN: Dept`s
From____.— To
Fron To----
15, SAND%GRAYEL PACK:
Dep
Tc
To
From
From
Ft
A^_Fcv
•ctln'
(ley^.:}^d]'4_Y30.'4.:es; t:. •
La:i`ade;9o:.airade so':r;e;OG?SOTopo •aphl: r •
(c:•.eck bcx)
D:7TF nzir r T'`'G LCG
From T o Formation Des:np:icr.
S5 e c•1 av & �:i
55' 605r�rite
1 nr•a Tic\• S{_TC.^.
Shc direction and and dis:a :e in miles rorn a: leas;
Wail Trdecoess r;'o S;al: Roads or County Roads. include the read
cr WeirgSt7t, Mate.. :.umbers and Common road names.
pvr
._r1f38 stReI
Material M•tcd
0:s ite & t j
Ft.
Dian.eter Slot Size
'In, •
F:
Ft
Ft
Ft
tn.
Material
in
Size . Material
16._Rv.MA..P.XS
; In �. I WELL
I µELL WAS CONSTRUCTED N AC ANCE µ' 1IA 'NC AC tc,
: ON tRUCYC ST.AWA �jj,,,,T�s CORD::AS BEEN PROVIDED 707 PSE WELL OV,*:ER
' -"CONSTRUCTION S I r1D17A'wP,IA'hh� -4T A C0?Y OF THIS RS..
1 I
/ -to -03
j C,. G: TURE OF PERSON CONSTRUCTING 7_ ViTcLL
DATE
Sulbri[tlfe originaltal�a„ vision of Water Quality, Groundwater Section,1636 Melt Senice Cees r •
•�LVgh, NC0:
27, t 3b Yhona Na, (919ji3131:1 within 30 days,
0
CO
T1
rn
:C
iD

267913
WELL CONSTRUCTION RECORD
i
�;2iib/' Ground'ntw�
Nor C2TJIlIta •• D:; S'C71C^.t of ClYifC1L?l.nl'611d i�BC�L12 "C� .30�w'OB9' Division 01Watt; CEn7�rICATIOY p 20�5
WELL CONTRACTOR(1NDIlTD UAL) NAME (print) James B. Brck21
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drillincr, Inc. ?HONE,. 828 369-9591
ASSOCIATED WQ PERMIT?
STATE WELL CONSTRUCTION PERMITS (ifaoelicable)'
' (if a.Oheablel dble)
1, WELL USE (Check Applicable Box): Residential C3 xunic!paV?ublio ❑ Indurrial ❑ AFieultra! 0
Monitoring 0 Recover! ❑ Heat Pump Water Injerticc ❑ Other ❑ If Other, L!s; Us:
2. WELL LOCATION:
Nearest Town Dillsboro Ccunw Jackson
578 Diamond Ridge Rd
(Star N:me, Na11Sens Cenn':.tirq La N:., Zip Code)
3, OWN=R' • Rodney Coagins
Address Pt:) Rnx 736
(5croa: or Route No.)
Webster. nC 28788 •
Ciyc:TcuW Sate Z'.?C:2,
(828)• 586-5499
A. a cede• Pena rcnber
4. DATE DRILLED 1-8-03
5, TOTAL DEPTH: 475'
6, DOES WELL REPLACE EXISTING WELL? YES C NO Ex
7, STATIC WATER LEVEL Below Top of Casing: 425' IT.
(Un "✓' if Above To orCuLng)
8. TOP OF CASINO 1S 2 FT, Above Land Surface'
'Top of win/ terrnlneNd a•:or btIow Tend rurfra re;vIres a
mience In accordance wH'h ISA NCAC 2C .0113.
9, YIELD (pm): 10 METHOD OF TEST h na
10. WATER ZONES (depth): 445
1!. DISINFECTION: Type
12. CASING:
• Depth
From0 To 33
From 33' •To 38
From_:_ To
im
F•
Ft.
Ft
Arncunt 16DD
Wail TrIelciass
cr Wtiyctrt. Ma:eial
pvc
_ 1 88 steel
TcpCraptbic/ and Se:tizg
0Rldg© ❑Slope ❑Valle; Fat
(ehrk 2.77 ne.:at z
La:'.r.de:loagir de cf we:; locaticn
(eey-eir.:eu-ieee.:.b)
La.,.ude,1ongin:de sc r;e:COPSDTCpog,ap`:_ map
If heck bex)
Prior;; ➢R71 LrNG LCQ
From . To Formation Description
0 36' clay & xlci
36' 475' mite
LOCATION SKETCH
Show directi:n and distance in r.,iles fr-r. a: leas:
r-c State Roads cr Ccr. y Roads. include the ;cad
„umbers ar.d common road names.
13 GROUT: Depth Material M
Frorn 0 ToaagxFt.Site & Ceuzi
•Frcrn_(_ To 3R' Ft.h-.rnitP R cni-rrlt nrrrs7
14, SCREEN: Dejth Dia.tete; SlctSize Mate is
From To Ft,__in,
From To ____in. _ in,
15. SAND/ORAVELPACK:
D5714 Size • Matrial
From To Ft.
From Tc Ft.
• 16. REMARKS' casing was but ed entire length as required by variance
"ri Q}7 HEREB Y CG iTii:Yi1tT.T}?p5 :a.... WAS CONSTRUCTED 11 ACCOSDP.NCc V.11ISA NCAC 2C, Vrc..L
C By ION RD-,•k1' -AT A COPY OF i:{;5 RECORD HAS BEEN PROVIDED TO T 1z E:,L OWNER
:ONSCT"
L'
Subnit the original to the Dl4loa oWater Quality, Grouadwatar Section, 1636 Mall Seniee Center • Raleish, NC
27699.1636 Phone No. (919”31•3221, 14(thin 30 days, GW •! :KEY, 07r2001
rf
DATE
E OF PERSON CONSTRUCT(NO T:r2 WELL
0
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rn
q
t
IV
a.p
0

267908
WELL CONSTRUCTION RECORD
North Ca:0lin • Department and N t a Re ;es Division of Water Qualit/ • Crcund'-.ter Secden
.�2rC71Cnt Of GnY{a uI''n� t 3 w i SJ'1.v
WILL CONTRACTOR (INDIVIDUAL) NAME (pea:0 Mitchell D. Cook CERT r?ICAT ION a 2043
WELL CONTRACTOR COM?A,NY NAME Hedden Brother Well Dri 11 f rg, Tnr PHONE d (R78VIPX-0401
STATE WELL CONSTRUCTION PERM1Ts ASSOCIATED WQ PERNITa
firaoolicabie) (if a:clic/els)
I. WELL. USE (Che:k Applicable Bex): Residential Mun.icl;a'/?ubiic C Industrial ❑ Ag :ul oral ❑
Monitoring 0 Reeevery 10 Heat Pump Water Injection ❑ Other ❑ If Other, List Us:
2. WELL LOCATION:
NearestTown: Cashiers County Jackson
Whiteside Cove --Holly Berry —Lot #9
(Sete: None, N:rn'oen, Com v13t' SubdiNs'l:c, Lc: No., Z:p Ce)
3. OWNER: J. Haynes Waters III Builders
Ad ess PO Box 7257
(Srcet or Roca Na)
Beach Island. SC 29841
Ciy or Town Save Zlp Cod:
(804. 279-1993
Ar.4 cte- PO:ne n 'tter
4 DATE DRILLED 1-8-03
5, TOTAL DEPTH: Rv4'
6; DOES WELL RE?LACE EXISTING WELL? YES G NO
7. STATIC WATER LEVEL Below Top cf Casing: 125' FT,
(0,1 "r" I`ASove Top of Cm'v.g)
E. TO? OF CASING IS 2 F?, Above Land Surface*
"Top orcuing brminetnd aa'or bstow lend sortie. requires s
varlet ce In Accordance with ISA NCAC SC .01I8,
9. YIELD (gpm): 60 METHOD OF TEST h'rzi'
10. WATER ZONES (depth): 85' & 305'
11, DISINFECTION: Type HIH
12. CASING:
Dc L Dia��p::r
From 0 To 20 F:.
Frocs 7n' To Ri Ft. 6"
From• • To Ft.
And unt 16o2
Wall Tnicicess
cr W::ght'Ft Niater.oi,
pvc
188 steel
13. GROUT: Depth Material Me:hcd
From a To X) F:i'n rite & (Furth ' pre rri
From • To Ft.
14. SCREEN: Depth Dit-m:4r Slot Size Mat :ia:
Free To rt. _in. _ in.
From To • Ft. in _ i^
15. SAND'GRAVEL PACK:
Depth
From To Ft.
From Tc Ft,
6--R€1:A�uc•
Size . Mate.;al
Tope aphic/Land setti: g
CRidge ❑Slope ❑Valley ❑Fia;
(oheck err-.pr,a'_ E:x;
..a.. ,:de,Icngl`t:de of well tcoat'icn
(dey osr.;CVts'irconaQ
Latittde:^,ongitude se•u-ceCG?SOTopcb,aph c map
(o;:a's box)
D"e?TH DRtL?.TNG LOG
From To Formation Descrio:lc:1
0 79' rinv & S3T1
79' 325' cgaiite
L.00ATION5KFTCP,
Show dire:^::; and dis:nee in miles `rem a; least
Can State Roads er Ceunw Reads. Include the read
numbers and con.ton read names,
:fl9Y C2 T1 " TiAeijta WELL WAS CONSTRUC Dr ACCCRDA,'CE WITH 15A NCAC 2C, WELL
NSTRU'CION'STA.N ARDS,IA. aTEATACO?YOFT;ISRECORD HASBEEN PROV:DED TO7-3W LLCWNER
NA/2/U 3
S:ET'v'RE OF PERSON CONS T:tUCTFNG THE WALL DATE
S\hi1Nit the oHgtnal to the Dirisloz of Water Quality, Groundwater Section,1636 Mall Service Ceeter .Raleigh, NC
27,05H,636;1Thei a No, (919)73a4221 within 30 days, GW'l REV, 07/2C01
0
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tJa
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C
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0
0

2. WELL LOCATION: - --�� �� ,
Nearest Town- Wt.... 4/( County��C1C_iL2'
E, Cope- 072 e e' 7
(Street Name. >U tubers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: vk"53-e 15J-7//C1/iO
Address 4'(s-' -77 ,— he./ cci 2-"L)
(Street or Route No.) d
S'-- /vq, tic- c. - 71,
Ity or Town State Zip Code
yj) ) 4, 3/� .Q1,s---
Area code- Phone number
4: DATE DRILLED / -1cc. —0 3
OTAL DEPTH �e' 5-0'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACi012 (INDIVIDUAL)NAME
(print)5�'enhls ''�O �I a^A AA
CERTIFICATION # 17 40
WELL CONTRACT CO\IPANY NAMccIX. hntc't��InMri I�)el�.ti tfi ll-u �j j,n P J PHONE #`b'�i- 7a4-3 a-6
STATE WELL CONSTRUCTION PE RNIIT# ASSOCIATED W ERMIT#
(if a livable)
(if at �licable)
1. WELL USE (Check Applicable Box)' Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
267110
(degrees/minutes/seconds)
Latitude/longitude source:OGPSCITopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
5. T
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO QI�
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 casiig terminated at/or below land surface requires
variance in acurdance with 15A NCAC 2C .0118.
9. YIELD (gpm)• 7 METHOD OF TEST
10. WATER ZONES (depth): /o'>< 9 T
LOCATION SKETCH
�114-P Amount 77 - A S Show direction and distance in miles from at least
1
2. CASING: Wall Thickness
1. DISINFECTION: Type two State Roads or County Roads. Include the road
Dia serer or Wet /Ft. Matejit numbers and common road names.
Depth js , r5�� YY
From �� To 2 Pt. (n t l ?jX P o
t.4
From .I o Ft. L
From _ To Ft. Y
13. GROUT: Depth Material Method \
N
From�
_— To 7L FL ��'yt 611Col/VC-2--
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 ._Co Ft.
16. REMARKS.
0
W
0.)
n
GROUP:ON✓/,.td
. 5q n �Ao
ASHEVILLE F' kARr,) k
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
NDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(yi^-1—a3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
e ter-REVgh, 001
[phone], within 30 days.

r 5 Ix
r (4 I (nr('�,�,, E Y
CONS'.--AUCTl trN S' AN
269078
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section —r / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 3.enV) I S /In II an,rk� CERTIFICATION #/Di/�%
\\ELL CON'rRACTORCOM[PANYNAMKIX/Dr))�'�/I1cgnri Wei I�,r, I l.Df A -)ten C' PHONE#m�- %)/..3oZ 1-3 2 U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Yd--Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ,- 1 -e V1 U; I I P //C County 3 /r IC SLht,
CI-)aIyU,Lt- C' BA
(Street Name. Numbers, Comn pity, Subdivision, Lot No., Zip Code)
3. OWNER:�Iv2� ,rn fa_
t f
Address i"./r), iDYx 39�
(Street or Route No.) I<�AV FLI f. 33ct93
City or Town Sitate Zip Code
S{ )- iy-3 -.3l 33
Area code- Phone number
4. DATE DRILLED — / U/ --0
5. TOTAL DEPTH:
�vS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST kl/1e7,�1�
10.
WATER ZONES (depth): oi;O ,2(,e) '
11. DISINFECTION: Type H11-1
12. CASING:
Depth(T//
From 0 To " Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From (7 To Ft.
From To
14. SCREEN: Depth
From To
From To
Amount r2 7-4 h S
Wall Thickness
Diameter or Weight/Ft. Material
(r'" „ 5`f2Pi
Material
n
CO4r4J
Ft.
Diameter
Ft. in.
Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
Topographic/Land settin
❑Slope ❑Valley /aflat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
C/ 4-ci
(.rdv--f
DEPTH
From
S- /747(i )ZDC-((
8/Ur .' ( ai,,1
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
n
16. REMARKS:
L--Submit the original t the
A ter 27699-1636 Phone \q:(919)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THHJS RECORD)B. EEN PROVIDED TO THE WELL OWNER
l I {I c
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionvi(of Water Quality - Groundwater Section
‘A ELL CONTRACTOR (INDIVIDUAL) NAME (print)C Phi[M I '-)• + t G-F-`11 s CERTIFICATION # 5 9 7
C
1C ELL CONTRACTOR NAM E/\/}lj l�--r`r'r�M1�e �I�p S.LJ :\1 �C1;© �Li)uPFIONE # ( l 5% -.'�5 'U
STATE WELL CONSTRUCTION I'ER\IITk ASSOCIATED \\'Q PER\IIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ll [vl unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump AVater Injection ❑ Other 0 If Other, List Use
2. WE.IL_ LOCATIO((N��:
Nearest Town: 1.62,_.�S (ACE-) County Se.c-V-I£ON.'
(Street Name. Numbers, Community, Shibdivision. Lot No_. Zip Code)
3. OWNER: -1 0,i-r\ E.Lt fil) {l Ct to le_Li.%
\dd'ess `� e=z .�, l,et r K a. ,rVSYT. (fel cS'
(Street or Route No.)
r
City or Torn State Zip Code
(' c
Area code- Phone number
Topographic/Land setting
❑Ridge DSlope DValley It3Flat
(check appropriate box)
Latitude'longitudc of well location
(degrees'ntinutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From _To E rmation Descriptii n
O L(„ C.-IafvcY
4. DATE DRILLED 4;ntu• J'- :3�LC 5 - - 1g 5
d. TOTAL DEPTH: 1'75 (_, c -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Se-- ( . _ y 5
7. STATIC WATER LEVEL Below Top of Casing: 1 (U FT. 97 _ S 7
(Use"-" if Above Top of Casing) '-r! - ( j
S. .FOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or belotc land surface requires a
variance in accordance with 15:\ NCAC 2C.0118.
9. YIELD (gpm): J. 5 METHOD OF TEST (x
7J5 ) a
269079
C4 cc.. -) «j-
CLAD
C r ot-FLt,-
CUV ({- _J
(9 rl( P-
0c:
6-
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. !!
V
(\) , 1 i 3 /i 1.,:) , ,
la. SCREEN: Depth Slot Size Material (� y
From To in. / '�i,A !-JCi_r OrnaJ
C'r-:.-,�Y
From E To Pt. ill. ll \ i A -. /� P_! 1 ��
I �_ SAND GRAVEL PACK: p etc t- 9. , Or: A9,t. �a Ai CI
Depth Size Material (I
(1_ L cN
To Ft. 1
To Ft_
10. WATER ZONES (depth): ,') - (. C. % - q 5-
15J- 7crr7a"
I I. DISINFECTION: Type HTIi Amount h S `2>7-
12. CASING: Wall Thickness
Depth Dianrter or AVeighdR. Material
From CO To G., ( Et. Le l $75 Stk*'-ei1/4
From To Et.
From To Ft.
13. GROUT: Depth Nlaterial _ Nlethod
From 0 TooR Cv Ft. C'.eme ' ¥ \ ix U
From To Et.
From
From
Diameter
Ft. in.
in.
I6. RLNIARKS:
Submit the original tGii he
1-_-:-.76-9,9-r636 Phone Ntt (9 9) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
DS. AST T COPY •' fHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 clays. GW-I RE\'. 07/2001

269081
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA)IE (print)Crie ,UN itCERTIFICATION#ri6
ELL coN'rancl Oli CO?II':\Nr N.-\\teA/3/l G. tx;u ° its 4S 7)
(Le@I ec C v �t it F HONE n K1�) 5<<L S.-
5
STATE WELL CONS"I'li l'C''1ION I'ER\ll'I'p ASSOCIATED WQ PERMIT#
(if. .licable) (if a..licable)
I. WELL USE (Chock Applicable Box): Residential 2 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:(1.c.,.\\CLCNVQ Cam. Count � eACS':
(j\cL,. C\ \\c>i_\�he_e c4,v �CL\\oL;k\ec
(Street Name. Number, Community. S„bdisision, Lot No.. Zip Code)
3. OW'NER:
Topogr. Ic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
City or Town State Zip Code From To .
(`s. )-(1193- 5gLir/ O -3f
Arca code- Phonc number
4- DATE DRILLEIIT2 Lhsc N. I T aCC3 3 LI - 7 [ >
S. TOTAL DEPTH: -3L:(a t ,.'%G - 7�-.)
6. DOES WELL REPLACE EXISTING \YELL? YES 0 NO © 2-:1 — 1 3 Z.,
7. STATIC WATER LEVEL Below Top of Casing: to b FT. 23t —'LQ 3: -
(degrees:minutes/seconds)
Address a17 1,z l.-r pe t` ti� Rrti:?� Ltf'i VL Latitude/longitude source:OGPS❑Topographic map
(Street or Rout: Nb.) (check box) .
P c-`r
(Use'--" if Above Top of Casing) '7
S. TOP OF CASING IS / FT. Above Land Surface* ?
'lop of casing terminated at/ur below land surface requires a
variance in accordanyt with I5A NCAC 2C .0118. _1- / - a c c, /
DRILLING LOG
Fornaatjon Description
9. YIELD (gpm): C7& U METHOD OF TEST CV( t
10. WATER ZONES (depth): I -/1„t / /D'"d30
/c _ a 2 6 LOCATION SKETCH
I I. DISINFECTION: Type I-tT H Amount 13 , - CAc3. Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. include the road
Diameter or W'ei^_ht./Ft. Material
(: 4 L b"E' SFrt'.k
Depth
From-- To. �iS Ft
From To Ft
)
From To Ft.
13. GROUT: Depth Material Method
From 0 To c7&17 Ft-l�ei1X n't+ I np
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
From To Et.
From To Et.
numbers and common road names.
1L)r� Ji,/ / p
/ W
m u I ,herr
0
W
16. REMARKS:
CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PRO ILDED TO HE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to t tc Di ision of Nhter Quality, Groundwater Section, I636 Mail Service Center -Raleigh, NC
L3s-34.1-6 Plume .No. (9) 733 3221, within 30 days. GW-1 REV. 07/2001
CE

269341
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J \ {-1 { k� �'�\'4- f kj CERTIFICATION #, l �4'
pp� Doe) t
�
WELL CONTRACTOR COMPANY N ANIE AAA 6-rrYF`� `F�rc,�: �Ja p�S�l\x.� PHONE a txgo-75 -5 93
STATE WELL CONSTRUCTION I'ER\IIT# ASSOCIATED \VQ PERMIT
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Cr x e Kit) ( CountvTa-eisc,, Sad
r i c�h+ h1*-s .
(Street Name. Numbers, COtflmunity. Subdivision, Lot No., Zip Code)
Address 511 1 4-2,1 0 r, cs..?
(Street or Route No.)
:�7?�lAJ� ���.1G TJa O.- UsJ r
City ur Town State I Zip Code
cttt3)- 15 9 -- %S-/'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L+fflat
(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 D cription
Area code- Phone number
r11L1.1`
4. DATE DRILLED rr. Y 5. < C)-' j'"% — > [O
5. TOTAL DEPTH: 7 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la' CO - o ._
7. STATIC WATER LEVEL Below Top of Casing: 4D FT.
(Use "-v" 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 accord. nc»ith I5.-\ NCAC 2C .01 IS.
9. MELD (gpm): A- METHOD OF TEST (� I�
10. WATER ZONES (depth): T7,00
11
12
DISINFECTION: Type I`i" 1- "
CASING:
Depth
//�� Diatn'ter
From \J To LA a Ft. CD C%
From To Ft.
From To Ft.
Amount a`1, 6 C Z,
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Nlatcrial Nlethod
�) To1D From ,oi U Ft. —<:_fl'AF;.7r
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 Aaterial
From To Ft.
From To Ft.
R I
100 HEREBY -CERTIFY THAT.T
CONSTRUCTION STANDARDS, AN/
sJ
a c`'1/4_' ,' +
G i i ch. t '(- i
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rona
numbers and common road names. c
0
N o *-o LT)
C�A", ('
TACT
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
co
0
C o C \\ 3—<�- c3
SIONAT 'RE OF PERSON CONSTRIXTING THE WELL DATE
Submit the original to the Division of A'ater Quality, Groundwater Section, 1636 Mail Scrvice Center - Raleigh, NC
27699-1636 Phone No. [phone],ivilhin 30 days. GAV-I REV. 07/2001
0
.-__
al

269348
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionlof Water Quality - Groundwater Section 40
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t�I1� fl VV) I SI My) an A,CERTIFICATION W/%
WELL CONTRACTOR COMPANY NAMKIX.nni< (J o!i'`ynrJ L/iei1TYr ll`14 �tl le a PHONE N��/-`%)O_J o24'3 Z , G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERM1T#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential P�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO : J ,RCtcSz'n-2
Nearest Town: '- 1 V GL 4/L— County .4
(Street Name. Numbers, Community, Subdivision, Lot No., Zip C e)
Topographic/Land setting
❑Ridge ❑Slope ❑Flat
(check appropriate box)
Latitude/longitude of well location
3- OWNER: l I I _ i �� -e_ L _ (../V) V) ! µ_tad /) O n (degrees/minutes/seconds)
Address [3< Rnx— I/- V Latitude/longitude source:❑GPSOTopographic map
/� (Street or Route No.) (check box)
��, �(SF�i�'U ,'VC— �7s ,5 J 'DEPTH DRILLING LOG
City or Town St to Zip Code From To Formation Description
�)
Area code- Phone number,
4. DATE DRILLED 3 — 7l — Ly 3
S. TOTAL DEPTH: •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casings 3'O C'D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): SO METHOD OF TEST IO?t'i?24
10. WATER ZONES (depth): Wei 2< D (1
LOCATION SKETCH
11. DISINFECTION: Type Al / P Amount 4 TI4 S Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth /, Diaff�eter or Weight/Ft. Matef ial numbers and common road names.
From 0 To / 6/7 Ft (r+" SZ2R,j pv C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,
From l To r=i (7 Ft. Coary1 0r Lilet/l/
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 Ft.
16. REMARKS:
kT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DAR DS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L.__Submit the original lb the )ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
..: 27699-1636 Phone No.,[phone], within 30 days. GW-1 REV. 07/2001
N

1 N R CTdt. i•'
MAR 2020
Submit the or
GROIR69Vdt;65ff gnu:WON 1919)
ASHEVILLE RLG(L 6L 0'r et
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl-- Division) of Water Quality - Groundwater Section / "
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :hen 51 Wei
�I I ann d. CERTIFICATION # C2/7(
WELL CONTRACTOR COMPANY NAM& hnl R Ir !iaytri 'LPI01, IIn s/�j . ,YIPJ PHONE M��% _Sa4-3 abG
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W4 ERMITq
(if applicable) (if applicable)
269346
1. WELL USE (Check Applicable Box): Residential l�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 Townti ; 1(5loom County 1 F}-Gfc SAS
(9c ,?e ll;/l Carom, '7Sz-
r
(Street Name, Numbers, Community,
'�Subdivision, Lot No., Zip Code)
/
3. OWNER:. ' k c.- `� lt. h V1 i VL d . j1 (Tau,
Address '4r 0. 86x e�l
(Street or Route No.)
/l.S%nr) A/C-- c
City or Town State Zip Code
W - tea/
Area code- Phone number �1 �
4. DATE DRILLED —63
5. TOTAL DEPTH: (00 b
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: c 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.0I18. '
Topographic/Land setting
3I e ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
5—
/s >)c�
n.+
9. YIELD (gpm): / METHOD OFTEST �//O)ij1) f
10. WATER ZONES (depth): 'CAD' (� /-
LOCATION SKETCH
Show direction and distance in miles from at least
1 I. DISINFECTION: Type
12. CASING:
H ff+ Amount o; inS
Depth
From 0To ‘,/ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To c9D Ft.__Q___ d2�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frorn To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
� l ez
R1Luc
,
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Mate ial numbers and common road names. o
SZ2 R , I . P rc
23
rJ
Method
From
From
16. REMARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF TH 5 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, 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
L- 1
\\'ELL CONTRACTOR(INDIVIDUAL)NAA1E (print) Ll t t, '(i1' `CILI fU( CERTIFICATION)IQ trio
\CELI. CONTRA CfOR COMPANY NAM E 4A'—t%1't'c",1r- 1.De11 1s —, js%-
STATE WELT CONSTRUCTION I'ERMIIT# ASSOCIATED WQ PERM,IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ig Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAV,ON:
Nearest To wn:en1((\:\9�
County
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: IL . 11 TT —
Address % . O- 9 r Z\ x J
(Street or Route No.)
(s\-- 1Th e ti ] ( ?
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED SepterAbet. 10)-Dee a
5. TOTAL DEPTH: 900
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑"--
7. STATIC WATER LEVEL Below Top of Casing: is '7 j FT.
(Use'+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Q METHOD OF TEST CL l r
10. WATER ZONES (depth): 0
11. DISINFECTION: Type i-1 T IA
12. CASING:
Depth agieter
From C) To .,Zg- Ft.
From To Ft.
From To Et.
Topographic/Land setting
DRidge DSlope ❑Valley leplat
(check appropriate box)
Latitude.'Iongitude of well location
(degrees/Ill in a tei/sem nds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation De'cription
O — a SCat.°
a3 - 9DC cy-a t r
LOCATION SKETCH
Amount 39, 3a p<,. Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Veight.'Ft. Material numbers and common road names.
13. GROUT: Depth Nlaterial
From h To ,3.b Ft. C-emetc,4--
Front To Ft.
Nlethod
1 —
14_ SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SANDrGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RE,NIARKS:
1.. c, L. F(o
ToLcs
a
O
O
cis tLib,
FT
0
z
DOLHEIjEBMCERTIFIT TIII f
r C&YSTRUCTlE3t4 STA'x`D1k[
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
t
IGNATURE OF PERSON CO81"ST- CTING THE WELL DATE
Submit the original to Sh'e Div ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919).733-1221, within 30 days. GW-I REV. 07/2001

269851
3. OWNER: W
Address
f' CCa.
City or Town
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA\IE (print) ]' �d (Y I \ 1 1 \ '�:-tS CERTIFICATION' r cCr�
WELT. cONTRACroR CO\II'AN\' NANIEA/%'t l� C—i^Ceiat. /Y`� '\\ [hr-?`:v lLci-PFIONe k p,'.�, o'C-�,. '.ij X,�j ��,
sI ATt: WELL CONSTRUCTION PER\IIT#
(ifapplicable)
ASSOCIATED WQ PER\IITd
Of applicable)
1. WELL USE (Check Applicable Box): Residential Ird Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: 4 U 112) Cr--- Co1j ySCk_C .S&/t.➢y
(stree( Name. Numbers, Community. Subdivision. Lot No.. Zip Code)
ex, rim RFAO.( i
Cj r7 S lA t / ly-N> S Y'r'f'
15 4 t or Route No.)
/'/C;! ,i\Ci. 3;j//5'1,
Sta e / Zip Code
3 r,s
Area code- Phone number
Topogra e/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitudeilongitude of well location
(de_rees: mi nwesiseconds)
Latitudc'lone itude source:❑GPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
4. DATE DRILLEDSc t.w1c,.r'tf;0. -1 "aut.3 / ;
5. TOTAL DEPTH: 17 p(; / )S C: _ i 5— n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EB �') _
7. STATIC WATER LEVEL Below Top of Casing: I Atli FT. `� f ft _
(Use "r' if Above Top of Casing)
S. TOP OF CASING IS 1 ET. Above Land Surface*
*Top of Casing terminated at/or below land surface requires a
variance in : ccordanc- aith I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST C it. Y—
ID. WATER ZONES (depth): I — I b'U I — / [ s
I I. DISINFECTION: Type Amount '* Z
12
13
I4
15.
CASING:
Depth
From p Ti To �._5 Ft.
From To Ft.
From To Ft.
Wall Thickness
Diaeter orAA'eiaht'Ft. Material
(4, y P rc`�
GROUT: Depth r-� Naterial
From _iTo2_ Ft./� -cn 8n
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To FL in.
SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
Nlethod
Slot Size Nlaterial
in.
in.
Ft cm
From
v -P`)
CA('l(A.3 IT- (—
/1C, 1:,"�—�
l I — 1 l U t r t r`+ C_
LOCATION SKETCH
Shoes' direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C3/ ii/�
) /3`f;1
.r135'3
rvrc t
Lt
16. REMARKS:
ric 1 VG,FTEREB) CER11hYTt,
I CQNSTRUCrIONST»
HIS WELL WAS CONSTR CTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
P IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to thte Division of VA'ater Quality
27699-1636 Phone N6, (919) 733-J221, within 30 days.
Groundwater Section, 1636 Alail Service Center -Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division \of Water Quality - Groundwater Section
%AELL CONTRACTOR (INDIVIDUAL) NA lE (print)G7-1p r['N '", kt\e 'V\'t CERTIFICATION #x.`7ci
WELL CONTi\C'r02 CO\I'\\1\UE �i �'r�LTit/.�L�\F-(- (JG--PHONE it (5',2.Sj'5-g"(r '.$S rJ✓
SPATE WELL CONSTRUCTION PER\IIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 0 Municipal/Public IS/Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare't Town: -u \\'C \a ))\s‘Cs7L-1- County z'-CSC-5C'f'�
(Street Name, Numbers. Coinmunigt Subdicisl on, Lot No., Zip Code)
3OWNER: r
. CC l�' xl>E',�`.�' c i(-h I�Lu7(=A"E"i �= 1 (dzP J mcs. mimuesaaronds)
Address `i vi C �f. UU t�I (\ S CV V e , Lx.ri-r i?c.S Latitude/longitude source:❑GPS❑Topographic map
(Street or note No.) (check box)
S
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (ep(m): .. C-: NIETHOD OF TEST �. v r
10. WATER ZONES (depth): C _ 1 75 5— 'a
10
I I. DISINFECTION: Type i-i Y}± Amount IS, t1 cz,
13. CASING: Wall Thickness
Depth 7-, Disaster or WeiohtFt. Ntaterial
From 0To.5 / Ft.Jo 1-1 P VI[
From To Ft.
From To Ft.
13. GROUT: Depth Ntaterial Nlethord
Froin_) To akFt. aerr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
q \ — 6, rive
City or Town State
Zip Code `x 14
y=o 1c.L. 1 -- 16-0
From To
15.SAND'GRAVELPACK
Depth
From To Ft.
Size Ntaterial
From To Ft.
Topoggraa lie/Land setting
❑Ridge LdSlope ❑Valley DFlat
(check appropriate box)
Latitude 'longitude of well location
DEPTH
From To
1 l J
4.
lc7 S 1( 7
5.
6. DOES \4 ELL REPLACE EXISTING WELL? YES ❑ NO LtiT ._) y S ,;) :I •17
7. STATIC WATER LEVEL Below Top of Casing: LK) FT. =U% —
(Use "+"ifAbove Top of Casing) F'C -_ (�4i�
TOP OF CASING IS 1 FT. Above Land Surface*
4E .a— �IC.
2698A
DRILLING LOG
Formation Description
C,-•
tMr9
<,
Area code- Phone numberrft
DATE DRILLEDLk .3J atiC_-3
'- I.
TOTAL DEPTH: y 1 u i S _) 4 5 c
n L L�
C-c v t4
��1 rot, 1�e-
r`n \'d"-p
.—‘.IN( k)fTC-
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.
'7
1'
0
O
0
16. RE\I:ARKS:
rat
DO 14ERE BNI.CERTI FS,THI re-LIS1
STRUGTfOyr STAND I41
'`:/
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AN l%l% 4F-THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�i/Ar 7.4- Gz_j
- '91GNATLRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-3 21, within 30 days. GW-I REV. 07/2001

WELL USE (Check Applicable Box): Residential 11"blunicipallPublie ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION: Nearest Town: Li c�.f-k e— CC my c_e•
O a%)
t
(Streat Name, Number. ni�
i 1u ¢y, Subdicislon, Lot No., Zip Code)
ns So''S<e
3. OWNER: (k f, rk1V^:--,�'� Do -tEl—
Address ., ((J"�'C1)C d3 % .._75
(Street or Route No.)
\A-QIN3(De N
-1It (Ni Q- l5''I i-'3
cl�t
City or Town State 'Zip Codc
Area rode- Phone number
4. DATE DRILLEDI�'`.�ic .r ;?Oi
TOTAL DEPTH: `j CC-2
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\ ELL CONTRACTOR(INDIVIDUAL) NAME� (printk ri' i. ,u at. 1 I `cc -\-\({` C CERTIFICATIONNio5z%7
WELL CONTRACTOR CO\IPAN1' NAME •7/44T r f C Nv /.i/ 1-`. �U it el. CERTIFICATION
# ? \�J h,±5 I:
SATE: WELL CONSTRUCTION PER\IIT# ASSOCIATED \\'Q PERMIT#
(ifapplicable) (if applicable)
2.
S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0' I`s2 -- I'i9.
Topogra :c/Land setting_
❑Ridge @lope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(degreeshni notes/seconds)
Latitude/longitude source:❑GPSOTopoeraphic map
(check box)
DEPTH DRILLING LOG
From To _ Formation Description
II5
Amount z9r.,
Wall Thickness
Depth Diariz_ter o 4'ei;t'I't. Nlaterial
C) To Ida) Ft. lc- y V�r —
To Ft.
To Ft.
13.
To
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.
DISINFECTION: Type
Depth Nlaterial
GROUT: Nlethod
Front (9 r ; D
From
7. STATIC WATER LEVEL Below Top of Casing: ) be- FT.
(Use"+" if Above Top of Casing) IJ. — -{ I` C; C t"c' rei 1 i'
S. TOP OF CASING IS I FT. Above Land Surface* ,� I (- - -' .� e i
'Top of casing terminated at/or below land surface requires a _..�
variance in accordance with 15,\ NCAC 2C .0118. /�
9. YIELD(gpin): "7 METHOD OF TEST \ L,-y r --g(,:; <a-- 5-OCi cf'n tK, r +L
10. WATER ZONES (depth): a - -I YC) 5 — Su-. 0
115--/ -c)
raINe •'1-<
11
12, CASING:
From
From
Front
14 H
Size
Slot Size Nlaterial
in.
in.
Nlaterial
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.
LAMA))) J y
` \. c / r y Cw
c) f T u3
l E. (, I 1
ra
O
O
r;
n
x
x
16. RENIARKS:
'
_� IOp, HF,REK'C/ERTIFY
.CLL SII.R.L 7- 4:54-STAII
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT. COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
- a b - ? 3
DATE
x Submit the origin'p110 he Di ision of VALter Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
27699-163b Phone No (f11'9) 73. 3221, within 30 dacs. MN" -I REV. 07(2001

270371
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print)\-h-2n 1I S /1 iia,, CERTIFICATION # 0L/7 (to
WELL CONTRACTOR COMPANY NAM& "InkC fr1010.44C4 Wei II1ift I!,-14 Q(j .),n C J PHONE #i'ag'.. a -3 j' d
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential El-<nicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: 5yy / 6'c2.- /(C- County J AL( KS �ry�
Cope C'pve,e t !-S¢et./es /; cop, pct.,
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (ltE'y 14 tT
Address cs2 7 / tr—de. -Q'
hod .),5771
Sc/V&
(Street or R to No.)
ty or Town State
-frQc--)- 6d:2 - 3s-
Area code- Phone number.
4. DATE DRILLED 3 -/� - D 3
Zip Code
5. TOTAL DEPTH: Sc.5" •
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: -s'C 4- FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): -,2 METHOD OF TEST /6171J-) 4--.
10. WATER ZONES (depth): -ADO' (�
LOCATION SKETCH
r% t» Amount %/} S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
numbers and common road names. C -;
Topographic/Land setting
lahricTige ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Vd)7tO/e'A'( 1a1-€-
.S7;ir(—I0 /r.r'
(#.4 k c_
DEPTH
From To
r`' / f
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To /CV Ft.
From To Ft.
From To Ft.
Diatneter or Weight/Ft. Mate 'al
13. GROUT: Depth Material Method
From (5 To � Ft. 0,047' n.,,TX n/T)4
From To Ft. f
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVELPACK:
Depth
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Size Material
ram
16. REMARKS:
DO HEREBY CERTI
CONSTRUCTION STAID
Submit the original to th
AT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
5-6-0.3
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919733-3221, within 30 days. GW-1 REV. 07/2001

270370
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\v ELL CONTRACTOR (INDIVIDUAL) NAME (print) <'he n n 15 Iit)11 a,., CERTIFICATION # c3-17 (�
VYELL CONTRACTORCOMPANY NAM& hf'i S ffliIif,✓uiIn II';7S.q �n (' i PHONE ttig S113a 4-3 a2b6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Yd---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: F53) vf3 4 / C-- County --1.4 ( ' S
LL^r �4c»Lit) St, rid, a k 779
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3- OWNER: vJ ? / I/
Address (C 5-.1 /Vfir ve/Z'SeN e D2•
:3 3 ( a.
(, (Street or Route No.)
InetI1Cc
City or Town State
Material
CO-fT na:.,
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
Zip Code
�Y�L) (..3 5- s3; c) o
Topographic/ and setting
❑Ridge 13St6pe LDValley ❑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
Area code- Phone number„ j
4. DATE DRILLED J — I -L',3 . G+
5. TOTAL DEPTH: '%C%5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
0
7. STATIC WATER LEVEL Below Top of Casing: /50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): . 5 METHOD OF TEST bZf%17C,�m
10. WATER ZONES (depth): - (%C. r 4/ ,f2)
' (1
11. DISINFECTION: Type {f"f"f% Amount
12. CASING: Wall Thickness
0
Depths/ Diapeter or Weight/Ft.
From To _7lrr Ft. (S1hR,.,1
From To Ft.
From To Ft.
13. GROUT: Depth Method
From n To 4.1 Ft. r /Tie,(/
Formation Description
e t2 017C w_t t I-
‘: lIrt s
/3) ELI Gram t 1 -41-
LOCATION SKETCH
/3 S Show direction and distance in miles from at least
p `de -
From
From
To Ft.
To Ft.
two State Roads or County Roads. Include the road._
numbers and common road names
16. REMARKS:
IDO. MAHEREBY CERTIFY A
NSTRUCTION STANDARi
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
gNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the -division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919),1k33-32: 1, within 30 days. GW-I REV. 07/2001

270335
WELL CONSTRUCTION RECORD
Ncr'ci CarDlira • Deyaftenl of Ervlror:ru nt send Natu.ai Rasau::es • Division of Water Quality • Crcu d'ht: Seotlon
WELL CONTRACTOR (IN'DIY'IDUAL) NAME (print] Mitchell D. Cook CERT r1CATION it 2043
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well D*'i 111 rg, Tnr ?NONE a fP2A121Q—°501
STATE WELL CONSTRUCTION PERMITn A550CIATED WQ PERMIT*
• (i`gooli:able) (if a:olicab!:)
1. WELL USE (Check Applicable Sox)! Residential Municipariublic ❑ Industrial C Agr::ultural ❑
Monitoring 0 Recovery 0 Heat Pump Waver Injection O Other ❑ I; 0'±e;, List Us:
2. WELL LOCATION.
Nearest Town: Cashiers Couny Jackson
Wild Ridge to the top
(Snit Ne.'te, Neu,::n, Cetr.:u::w, Sub'.ir, e!cr. Lc; No., Z:p Code;
3, OW-,,_R, Billy & Joyce Webb
Address 6 Brookcreen Place
(Sect or Route No.)
Statesville, NC 28677-3548
Ciy or Tewn Sate Zip Cod:
(704)• 872-6489
A.a code. Phone.^.t:.,.ter
4, DATE DRILLED 3-7-03
5, TOTAL DEPTH: 900'
6. DOES WELL KEN -ACE EXISTING WELL? YES 0 NO X8
7. STATIC WATER LEVEL Below Tcp 0 Casing; 850' FT,
(unlit" If Above Top orCatin;)
S. TO? OF CASING IS 2 FT, Above Land Surface'
'Top ot cuhig terminated saor below land aurraco requires a
variance In accordance with ISA N CAC 2C .0118.
9, YIELD (gpm)i 40 METHOD OF TEST hlnv
10, WATER ZONES (depth): 815'
1!. DISINFECTION: Type FIH
12, CASING:
0 Dept 20 Dias-ets;
Fror To F' 6'
From 20' To 24 ` Ft. 5'
• Flom• To
13, GROUT: Depth
From L To 20
From To
14, SCREEN: Dcptb
From To
• From To
15, SAND/GRAVEL PACK:
Depth Size
From To Ft.
From Tc Ft,
Am^^1' 1Ecz
Wall Tnicess
er Weg.S,t7t. Material
Vc'
.188 S ee
Ft.
Material
Ft.Irrrtrita R aetzr t
Ft.
Diameter
=t._in.
Ft. in
Methcd
Slot Size Material
in.
in.
Material
TODodaphic'Land setting
❑Ridge ❑Slope ❑vzley ❑Flat
Latinidelcn;itude cf well Iccaticn
icenes'nloates'ircerio
Latir.deion;L^ude source.72G?S0Topod,aphic map
(ckeek box)
DE'TF • DRILLING LOG
Fp m •229 Forrnaticn Descri; :ion
22' 900'
ga"cte
LOCATION S K7TC-,
S;,,c.v directlon and distance in miles from a leas:
two State Roads or Ceunty Reads, Include the read
numbers and contmor, read nam:s.
• 16. REMA .KS:
FrPO sigA..EBYCBMT1FYt`r-.ATTHrSvga L WAS CONSTRUCTW rN ACCORDANCE WITH ISA NCAC 2C, WELL
COr+BT,t'CTIONSTANDARDS 4110 , TACO?YOF THIS RECORD HASBEEN ?ROY:D.DTOTr=WELL OWNER
r%1l. �e.� ' ( AI r`o 3 /7/03
s:oNe.iii- -R.E. OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of • ater Quality, Grouodwater Section, 1636 `fall Service Ceeter • Raleigh, NC
;76994635 Phone No. [phone], wit In 30 days, GW1 REV. 07/2001

7r©i 59' To 63
From To
13. GROUT: Depth
From 0 'Pc 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Dept;-,
From To
From To
16. REMARXS
270334
WELL CONSTRUCTION RECORD
North Ca;olirz •D•D3rC7e^i of En/IiDGneitu'd Nat ' Re50UCeS • Division Of Watr QL.IIC� . GCCcd• .e-Sec
tion
WELL CONTRACTOR pND1Y DUAL) NAME (prim Mitchell D. Cook cERT,r 1CA T ION el 2043
WELL CONTRACTOR COMPANY NAME Hedden Brothers We11 Dri 11 i rg Tr.r ?''Oy'r ,e (R7f01F+Q-0501
STATE WELL CONSTRUCTION PERMIT4 ASSOCIATED WQ PZZ.RM1Td
(if aoolicable) (if aoolicaele)
I. WELL VSE (Check Applicable Box): Residential & M'unicipaVFubiic C Industrial O Agri uft..ra! ❑
Monitoring 0 Recovery CI Heat Pump Wa:er Injection. ❑ Other ❑ 1f Other, List Us:
2, WELL LOCATION:
Nearest Town: Cashiers COu:,tr Jackson
Taylor Rd Lot 4C-2
(Smt S•L , N'r..ens Come:_•;re, SabdRtstor., W; No., Et; Ce)
3. OwT:R: Pat & Myrna Horn
Address PO Box 21424
(Street or Route No)
Hilton Head Island, Re 79975
Ciy or Town. Sau Zip Cede
(843). 681-4676
Asa ce• none nu.—•yer
4, DATE DRILLFD 2-21-03
3 TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Yoc
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Ne "t" I!ASove Top of Caa;ng)
S. TO? OF CASING IS 2 FT, Above Land Surface*
'Top or cuing terralnated aVor helow land turtle' squires a
variance In accordance with 15A NCAC IC AI13.
9. YIELD (gprn): 0 DRY METHOD OF TEST don
10• WATER ZONE'S (depth):
11, DISINFECTION. T'p• HIH
12, CASING:
Fror 0 ToC 59 R. Dta
Ft. 6" 188
Ft.
Mateda! Method_
Ft, t'ecc;rP R r rcrl- pTirri
Ft
Diane:et Slot Size. Mate-s!
Ft. in. _ in.
Ft,_i� i^
Amcunt 16¢
Wall Thickness
or F'eig.h 7.
MaterH
pvc
steel
Size . Matena1
Ft.
Ft.
Topoap'nic'T and seng
❑Ridge ❑S1cc avi:`.ley ❑Flat
(ohrk erg:apra'_ h:x))
Latittdellonzithide of well 1c:at'•o❑
Nezreein;ca Uo'aaenes)
Lat!t.de1^ngitude so•n:me:COPS0T •c^ ca.apr..: map
(teak dex) -
OR T T rN•G LOG
DE?T:'
Crv^ 10 Formation Dcs ri7 on
061' riey &
Al ' 1000'
CI ailte
LOCATION SK;TCM
Show dire. n a and distance , miles from al least
rat State Roads o: Count,/ Roads, Inch_de the read
numbers and coma -nor road names,
1 DOHE re OgR ISY Tr_4T THIS�a
COYskT,RL,C noN STA.NO...3pS, A,N? T
•2C
SKNA
WAS CONSTRUCT cD N ACCCRDANC'c WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO T P WELL OWNER
OF PERSON CONSTRUCTING THE WELL
Submit the original to the Dh lslon of R a
27609.1636 Phone No. (919) 733•3121i within
DATE
er Quality, Groundwater Section, 1636 Mall Serrlce Center - Raleigh, NC
30 days, GW•1 REV, 07/2201

270333
WELL CONSTRUCTION RECORD
Ncrth Carolir.? • De;arCnent of EnYIroILment and Nataral, Resot4Ces - DIV1sicn of Water Q1:a11:ty • C7rcu:d'rialer SectlAn
r James B BrowTt cgRTrtcATION: 20d5
µzLL CONTRACTOR (INDIVIDUAL) NAME (;,,•:)
WELL coNTRACtoR cOMPANY NAME Redden Brothers Well Drilling, Inc. ?HONE a )'-b9-5591
STATE ASSOCIATED WQ PERN ITe WELL CONSTRUCTION PERtitITM (if a:el:cabie)
(if a::ii:abie)
•
l WELL USE (Check Applicable Box): Residential 21htu ici;3 ?ublic ❑ Indus:Mal ❑ Agri:ult al ❑
Monitoring ❑ • Re:cYery ❑ Heat Pump Water Injection. ❑ Other 0 If Other, Lis: Us:
2. WELL LOCATION:
Nearest Town: Sylva County Jackson
Frady Cove —Tint #14
(se -to: Ns.:, Nur..S:n, Co.:.r::niW, S:bdi'Atirr, La: Na., Zip Ccd:)
3 01VTER:• Howard Monroe Parris
Adiress P() Pox 576
(5re•.t cr Route No.)
Dill tiro, Nr 771725
Ciy, of Tewn State Zip Code
(qu$)• 9R6-1155e
Are code- none nanber
4. DATE DRILLED 2-4-03
5. TOTAL DEPTH: 250'
6. DOES WELL REPLACE EXISTrNO WELL? YES ❑ N0 Rc
7. STATIC WATER LEVEL BS:ow Top of Casing': ?no F,
(Vn" " I(ASove Top or CaaLi;�
S. TO? OF CASINO 1S 2 FT, Above Land Sur ac:'
'Top of cute; tenolnated , or brim land iurtace regalrei •
variance In accordance with ISA NCAC 2C ,0:13.
9, YIELD (gpm):._-5_— METHOD OFTEST hcw
10, WATER ZONES (depth)'. 85 & 7 04
'
11. DISINFECTION: Type
12. CASING:
Dgth
From 0 To 61
From To_
14, SCREEN: Depth
t'rorn To_
From To
15. SAND/GRAVEL PACK:
Dcth
From To Ft.
;tor- Tc Ft,
F:
From 61' To 651Ft 5_
From To Ft.
13 GROUT: Dept: Material
From 0 To 20 F: L= 1ite &
Ft.
D rmeter
Amcunt 16cE
Wail Tr'cle,ess
srWei/at/Ft. Material
pvc
-18B steel
1};azit: ;
Fit.In,
Ft. in.
Size
Me.hod
Furred
$let Site
1
. Material
T000rzphic :.aad setti:g
❑Ridge ❑Slope ❑valley ❑Flat
(clink ar,roptiaat to ex)
]a'i'�de,icnZ ode cf
(derttirie-i:w;r.'_f)
Lati`id:"rngirude so:r:e.0G?S❑Tcpo..apht: rcLap
(oheck bcx)
pEPTP • DRILLING LOQ
From. To `FormationDescription
0 63' ay
63' 250'
granite
LOCATION SKRTC!i
Show direction and dis:an:s in miles frcrr.a: least
r,c State Roads cr Counry Roads. Inciude Me road
r and conm.on road names,
• 16. REMARKC'
Lv WAS CONSTRUCTED N ACCORDANCE w;T 13A NCAC 2C, V,=L:
rs-a TACOPY 0? THIS RECORD HAS BEES PROVIDED TOTHE WELLOWbER
Itp x 'nitc_:e^1F-t-r-t_ATrt-::s-
QONSTRLIC"eT TANDARID S, .NTJ
j
4ubr It the original to the DlvislotW
ah639.163'5 Phone No. [phone] with
E OF PERSON CONSTRUCTING T'= WELL
2-V- 2
DATE
ter Quality, Groundwater Section, 1636 Mali Seritt Center -Raleigh, NC
30 days, GW•1 REV, 0712001
O
CO
7:Pe.
rV
O
u1
0

DRILL DEEPER
REFERENCE "The Barn Restaurant"
270331
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Bruce L. Morgan
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc. PHONE a [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNXTA
(if applicable)
(if applicable)
CERTIFICATION 2047
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: Cashiers County Jrlckson
107 "The Barr Eestaurant"
(Stint Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JB & Ruth Hooper
Address PO Box 1399
(Street or Route No.)
Cashiers, NC 28717
City or Town State Zip Code
(87R )- 743-0185
Area code- Phone number
4. DATE DRILLED March 10, 2003.
5, TOTAL DEPTH: r1TrIFM TTFTTP 1 50'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO btl
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 2 METHOD OF TEST blow
10. WATER ZONES (depth):
11. DISINFECTION: Type T-ITH Amount Rnz
12. CASING: Walt Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
16. REMARKS: Well i s now 300ft deeps Tag
Ceen Brot proms
IDO;HEREBY CERTIFY I
CONSTRUCTION STAI
Topographic/Land setting
0Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(cheek box)
DEPTH PRILLTNG LOG
From To Formation Description
150300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rood
numbers and common road names,
0
on well identifies as being drilled by
Sylva. Copy to
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
OF P
ERSON CONSTRUCTING THE WELL
3y-A3
D TE
Submit the original to ale Div sion at Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV, 07/2001
NCDNR

WELL CONSTRUCTION IUECORII
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - 0,cutidwnter (ION.lion
/.I,.ec
\\'F.LLC(INIMC7 OIt (INDIVIDUAL) NAME (pang /E'/vY
,2903
rnoNE a (r Y l�
WELL CON IIUCI OR COMPANY NAPIE /�Li U J
AS80C1A1E.11 R't) r ERI' 11a
fif npplicabic)
StAIE \\'FILL CONStI1t1Ct ION fEIUl I IN
if applicable)
I. WELL USE Recovery
tcco er ApplicableL1I[cat)Residential LI
PumpWnler In Injection Municipal/Public
l
Other If Other, List Use llwaf
Topogtnpllic/Lmtd setting
Midge USlope UVnllcy (]Flit
rowel( npprnpdnle hn.)
e-e
LnliluJdluugilunic of :lI localwll�
N3s`as'�3-o''_wc.s'3`if ;1V.7
(ilegrrer/nnnute,/rz^nlrl
"�___ Lnliiaadl^rrpiluJc soutcc:UO(chI''SCIropoglaphic n:=p
k box)
I. RILU14(i WQ
ronnaltml Ucscriplion
270281
2. N'I1L1, LOCATION: CounlyfUCl�o2
L/�
Nearest 'I Town! — ,
GIJ/v il1_ terek -----------
'Street thine, Nulllbe'' Co::::':"'ro, Sah(1ivisio 1, U,1 No:, 7.Ip Cole)
3. OWNER: &;// 7/c• Sort �f
Addlcss
(Sarel or Roule No) ^�� `�--
/���'+�-��---ZIp Cole
City al hot•„ Stole
Arta rorlr• rinme 1111mb 0 Si- 03
A. DATE DRII LED
5. TOTAL DEPilL__Z-ZO----------
6. DOES WELL REPLACE EXISTING \VE.LI;1 YES U NO I
7. STATIC WA tER LEVEL Below Top of Casing: S° . P I.
1 ((Ire "1' If Above lop of Coring)g. -1 Or or CASING IS ET. Above Lind Sul like'
•terr of e.rine Irt mL,.lyd ann. btlon inn,l ',One trip!. es •
,.hone In.trorl.ntt * Ilh IS p1G METAC IC NODsl('� ---
o, YIELD (pion')' �� _—
10. WA VEIL ZONES (depth): _ --
4-4r,,,.. HT�— Anould. �c_ —
Willi thickness
Dinlncler or Weight/IT Material
12. CASING:
Depth
rront___C_.Io bj
np11 Io
until Ib
I rd
13. GROU I: Dept, 42
I'lmn O I_r - _ It A 1n1 J
To fl`—
Prop,_ IJ. SCEErtl' Depth Diameter
1 tom__'Ib IT _ in.
in
from —_- To-- 11
15. SAND/GRAVE', PACK! sire
Dept,
From I I't.—
l tolil To 1'1.__--
`�1 r, REMARKS: __— --
1DCILIE7tf[LisCdRlIrYTII4Fi
CONS]RUCIIONSIANDA11 rl
Submit the original to the Irk Is
17699 1636 Phone No. (919) 733-3
Slot Site
111.
Material
Method
-csrri%L
Material
tint
Flout To
D S-a
SO — lza
Show direction and distance in miles Gom nl Icn51
Iwo Slate Roads or County Roods. Include the toad
numbeis turd common road names.
S WELL WAS CONS 1IWCI ED IN ACCORDANCE Wi l I I I5A IICAC 2C, WELL
ID THAT A C 1'Y or lilts ILECORD IIAS BEEN PROVIDED 10 THE WELL OWNER
;NATO lL' OF PERSON CONS IIW(1 INC 111E WELL DATE
nn of \Vnlrr Quality, Groundwater Section, 1636 Malt Service CeJWr- IRLVgh 2C0i
11, wllhh131) days.

1ilia,' , MI'
rImIL
�� nS� rt. i•1I
1i rt.
Flom_
Firm_ 'fn___ Ft __ M(clinl
Deptha
13. OIIOUI'.
from D To %L fl/i•�t<./Y�
. floor- In-..
IA. �CPJiI ll Depth
Uinn nlel
I'L_ in.
Ilolll -- �— 11 in.
How_ Io_—
15. SAtl11l311lAVl'.L I'ACK' Sire
Perth
I'Inin_
To I'I. _
Flom ha
• -TR. MO
IDOHERE IR•lh
COIIS11lUC11UN,
11.
2. Wild, LUC,EA c j /ems County t DL2
tEdl_
NcMrsl l onn_= JtiCy
--------------
In5L11-" ��--dl.. Snbtlirirlml. LAI In., Zip Cwle)
(Caret iin,ne, N... hn.. Lca:r^� ,
__- ��('''�y'�-- ng/ C'c,.�ST_Yi1_.
nddlc5s 'Shed PI Rnule 11n)
Clly nl ton„ Simr
71p Code
cc -Jr- Mine rumba
a. Un11:nRnIED 3—L
5_ E
1IOVAL IMF iit._020--ir•-• nt\y!:!17 tE5 oilU LJ�
6. UUPS \VELL I/F.I'LACE. ;U3I •W/ I E.
1. SfAIIC \VnlER LEVEL Uclot`Ulel1 of -It(Above iv1-nlc?dng)
f F. Above Land Sullilce
P. I Ir O R•oInE CASINO IS 11'
• I rp rl r•rhq 1n v,h,dnl •Ire, -Edon b„J riming rnpJ, rr .•'�
cvl.ncr I,. .rrrrA.irte nllb 15,nN(AtIC ED il I 1UU (1 I^11'sS 1_��r
o YIFI.I)IPpnl)t__5_.__
IU AV AlrRZUNES(dcptb): --
Ja
11. NISINITC11011: 1)Ire� Willi "I ldckncn,
12. CASINO! I )inmeier or \VeiglIVi'I. hlnirlinl
Method
fief —nice
Slot Sire f,lntuinl
bl.
In
finirtinl
WELL CONSTRUCTION 1UsCORL:
1'
Nolo. Carolina - Ucparhucnl of linvbuunlcnl mid 1lnlwal Ilenolnccs - Ulvlslml of W nlcl Quality - Ulowldwnlcr . cr lull
P ELL CON IIIA C'I1111'INDIVIDUAL) HANIF. IP•Inq T.' 4e1L CF,IIIIF ICA I IONSu
901
1{r.1,L CON I11AC11)11 COnIrANY NAME.
;Wee- moNe s iy, yam' �yy
ASSOCIAI ell IV() rrRMI l r
5 tAIE{{ ELL CONS IIIIICI ION r Erni I U__ ---- I(nrlinable
\('FI.I, USE (Check Applicable Box): RCSlllcllllnl t ITIIIIIelirnl/Public U IuJusllinl LI Aglicullwnl U
u LT Wier U If Other, List
WC
'Avidly' Mg LI Ilccova)' U Ilcal 1 atop 1Vnlct Infection
fopnglnpll!dl,n id 5clling
Ult!dgc I.ISlnpr UVnllry UIlnt
(cheek nepopdele bn4
1,nliluddluugiluJc of well
location
+s �6, i
(de p ertimin,tlrJ1 •^ 1.)
LnliluddlriliEiluJc EOM ec:Li 11'SC11 opogl aphic nryt
Icbo-k Ina)
Plan
Uflii,l,!I11I Li)(l
hoot 'I10
[mutation i'rrcrilrlion
270279
— 3c
WC/0PN SK..IiJ_Gll
Show llileclloll nod Mainline In Mile Gum nl lensi
Iwo Slide Rands of County Ron's. Include the toad
ttumbeis nod common tond names.
()coo id
7
dead Q I
0
CO
S
tv
0
0
u1
111A I-111IS WELL WAS CONS I IIUCI RU IN ACCORDANCE WI111 I SA MAC 2C, WELI.
UAltl}S, ANU'I IIAI A CUI'Y UI''IIIIS RECORD IIAS HEED
PROVIDED LLVN
(fiz�--
SU_NAI URI!_Ur Lt5UN CUI1S IlWJI114O'I IE WELL unlE
iwg1', nl
_$ubudl the nllpinnl 1 Ibe 111{Illnn of \1'nlrr ()utility, CrnuudlrnhF Section, I636 Mill Service Oilier - IIgIeIRh, NC
11(sQ1616 I•hcnt Nn. 9191 733-3111, sllhht 311 tiny,. 0wrI
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al ResotlICCs - Division of Water Quality Groundwater er s rcatiolt j
WELL CON TRACTOR ONUI VIl1UAL)NMIE (Pilot) PIIONE
WELL CONTRACTOR COMPANY NAMEQ FERMI TN
STATE WELL CONSTRUCT -ION PEMII fl i(pr ASSOCIATED I\YWablc
if a, licublc
I. WELL USE (Check Applicable Box): Residential CYfvltlnicipal/Public O Industrial ❑ Agricultural 0
Monitoring ❑ Recovery O Ilea( Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
(Ridge OSlope ❑Volley Mat
(check epptnprlate box)
Latitude/longitude of well location
(degreee/minulo/sccende)
Latitude/longitude source:OGPSOTopogtaphic map
(check boa)
Mall pR1LLI O LOG
noun To Formation Description
2. WELL LOCATIO�N:/- T �L,f o�2
Nearest town! e`Ct`e County 7aC
f
(Stint Nero , Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i/)C, L-c-J5ek
Address
(Slice( or Route No.) e
( (�� s..-r � V 1 —
City or Town
Stole Zip Code
(-)
Area code- rhene wonkier
4. DATE DRILLED !L
5. TOTAL DEPTH 20
6. DOES WELL REPLACE EXISTING W ELL7 YESO Fir.
(Use STATIC WATER LEVEL Uclo,(U ce U lAbove of
Casing:
v1Top of Coming)
8. TOP OF CASING IS / Er. Above Land Surface•
•'nor of wing let ndnAled Nor heron land surface requires •
verbose In Accordance will' ISA NCAC 1C .0118.
9. YIELD (gpm): _ . METHOD/OF TEST
10. WATER ZONES (depth): es
I I. DISINFECTION: Type//Tfi nlnmo,lc_
_—\ynll'Ihickncss
44
12. CASING: Diameter orwcight/Ft. Material
Depth - -AW S1/Et/
front G' Tait
Ia t-.:'S -
From To IT -
From _To fl.
Myelin Method
13. GROUT: To ::" �ers�
frmin�_ To �'
From_ To F1. --
Diameter Slot Size Materiel
Id. SCREEN: Depth in.
-I-.. Ft. in. from --- in.
Frmn
To Ft. in.
15. SAND/GRAVEL PACK: Depth Size Material
To
To
From
From
)6.'R P.ts1
I DO HEREBY CERTIFY-1
CONSTRUCTION STAID
A
rt
Ft.
270276
ION KETSI(
Show direction and distance in miles from at least
Iwo State Roads or County Roads. Include the road
numbets and common toad names.
o
0
rx.)
CD
0
u1
1IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND T AT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
SIG ATUIIL' OF I'ERSON CONSTRUCTINO TILE WELL DA'CB
,NC
Submit Ibe PrlginnlluWaterilhe DI blow of aler ()milk,()milk, Crnwldwaler Section, 1636 Mall Service Center - Raleigh,17699-1636 rime No. [phone], within 30 days. OWrI REV.h

• 270275
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al al Resour cs - Division of Water Quality - Groundwater Section
ez �G �' CERTIFICATION 1 'kC
-51
PHONE a r�'%Y>'1 93i-%( 55'7
WELL CON TRACTOR (INDIVIDUAL) NAME (piing
WELL CONT MCI OR coalrANY NAME
STATE WELL CONSTRUCTION rEMllta
f aURlicable
2. WELL LOCATION: - LL
�ls�(GL
Nearesl'fown:
(Street Ner e, Number, Community, Subdivision, Lai No., Zip Code)
3. OWNER: f%3e sicSs,al
Address Cis
(Saeot�Route No.)
C h0'f(`aIDQ Lt-
City or Toum Stale
Arts code- Phone number • L)�
4. DATE DRILLED___—__------
5. TOTAL DEPfII: ---
6. DOES WELL REI'LACE EXISTING WELL? YES 0 NO
IA-
7. STATIC WATER LEVEL Below eTop oI Casing:
ET.
rc ing)
B. TOPOF CASING IS / Pf. Above Lard Surface'
•Top or n,InE Iennlnded •tar Wow land not race requires •
v.rlance In •ccord•iee with ISA NCAC IC .011 A.
9. YIELD (Um): 5 G METIIOD OF'FEST
ID. WATER ZONES (depth): l/O
.ta Aurouul---«----
II. DISINPECTION:'i}'pc 1—�--Wall Thickness
12. CASING:
Depth � Diameter or 1���U14. Material
Fro!: ii TO JLL_- Ft
Ero111 To Et.
From To IT
13. GROUT: Depth a nic r cthod
Depth�
From 'I'v � P1. /lC ai�
i
From To_ Ft.
14. SCREEN: Depth Dinnmler
item Tt,-_-FL_---in.
Flom _ To EL iu.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
To
ASSOCIATED WQ IF-IN11TW
(if onul icablc)
W ELL USE (Check Applicable Dux): Residential ©Municipal/public 0 Industrial 0 Agricultural fJ
Monitoring ❑ Recovery 0 Neat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
URidge 0Slope ❑Valley DPhil
(check Appropriate box)
Latitude/longitude of well location
(degrees/minutes/s^condi)
Latitude/longitude source:OGPS07opographic map
(check boa)
pR)LLIKL.LOG
Formation Description
County f,c4J.Cn
From
1 DO IIEREDY COME,
CONSTRUCTION ST
1Y2. : ti
ind
RIL1.Lite nrlgIr
276,m-1636 Phone No.(919)
Et
1 1c%
hip Code
/
Slot Size Material
in.
in.
Size Material
P E11L1
From To
LfIJ-/10
Jack ION KE �I(
Show direction and distance in miles from al least
two Slate Roads or County Roads. Include the rood
numbers and common road names.
0
Ctl
T TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
AND TIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
2-3- 03
SIGNATURE OP PERSON CONS1RUCfINO TIIE WELL DA1B
-
Ithlon of Water Quality, Groundwater Section, 1636 Mall Service Eviler-1 Il Vgh, NC
UJ-3221, wllhht 30 tiny!.

270271
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Suction •
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /-Zr t,3//rccCC/'� { CERTIFICATION
WELL CONTRACTOR COMPANY NAME ,4 1
/�c/- lI D(ill It ,.t,t `1F. PHONE # JS:% »1-2%57
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a"--Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CAer,:a'e"'
6',/itv //NI d22.
County-32CAso:z
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
/ p)i"tiCle�
3. OWNER: %�%,i- � r
Address en rig"d/ Ccn3f-
(Street or Route No.)
GO
rn00118, CC_ 2211cl
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED •2 -Ci -C
5. TOTAL DEPTH: 2Z itC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E-
7. STATIC WATER LEVEL Below Top of Casing: 7C FT.
e
f Above Top of Casing)
8. TOP OF CASING IS /z. (Us FT. Above Land Surface•
•Top of cuing terminated at/or below land surface requires a
variance In accordenre with I5A NCAC 2C .01I8.
9. YIELD (gpm): / S'� METHOD OF TEST /T v
10. WATER ZONES (depth): 25 C
I1. DISINFECTION: Type /71ry
12. CASING:
Depth Diameter
From G To 96 Ft.C-i-f
From To Ft.
From To Ft.
13. GROUT: Depth
From C% To.% Ft.
�gtena
Amount “4/6✓7%
Wall Thickness
or Weight/Ft. Material
From To FI.
14. SCREEN: Depth Diameter
Front To Ft. in.
From To Ft. ....
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
)Aethod
/t',S.i U'f°
Slot Size Material
in.
in.
Size Material
E i Kr/C./ARKS:
I DO HEREBY CERTIFY
cRN,STRUCT1ON STANI
;t 11
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
4/ 35 °-26..516 w cs-.>"tzt-r72
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH, DRILLING LOG
From To Formation Description
- C % t
4r5` 251C
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.
Cr-Leg R,
0
THIS WELL WAS CONSTRU(,1ED IN ACCORDANCE WITH 15ANCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2—ct3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ASi+arflt=the.xriginal Ye-the-Elvision of Water Qunlity, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1616 Phone No. [phone], within 30 days. GW-I REV. 07/2001

270270
From
From
13. GROUT: Depth
From 0 To C
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Najural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r-'rr7 At f-C t; CERTIFICATION" ;;NOS
WELL CONTRACTOR COMPANY NAME 97/ //E r Well Ori 1I I r9 Inc PHONE " .Zhu) FT)" a 94
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: / 1
Nearest Town: C_h8/-4,Ae&
'103.I ripn QA
(Street Name, Numbers, Community, Subdivision
3. OWNER: id/tin —4.42 CAE" it
Address CO tQu e"y-! i
County 54)(X.f
, Lot No., hip Code)
e —Tait &'/
(Street or Route No.)
C lC: Ch9 . Z�s 11q
City or Town Stale hip Code
( )-
Area code- Phone number
4. DATE DRILLED 2 - D 9- 03
5. TOTAL DEPTH: /00
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑'
7. STATIC WATER LEVEL Below Top of Casing: /C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / z FT. Above Land Surface*
•Top of cuing terminated at/or below land surface requires a
varlance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST /Fi r
10. WATER ZONES (depth):
1I. DISINFECTION: Type
12. CASING:
Depth
From To /
To Ft.
To Ft.
zhdateppal
Ft. rerfladeb=
TH
Diameter
Ft. L- -2
Amount /KYc,P
Wall Thickness
or Weight/Ft. Material
Si3C,2 /
Method
7retfQ t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N 35.0,26., 22 V - wt fic/C./JG `
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
C - Jo c/4y
LOCATION SKETCI{
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
A-1 DOHEREBY-CERTI
CONSTRUCTION STAND
11 2 1
T THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to Jhe D
9 "27E4-1836 Phone No:019) 7'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
I-3221, within 30 days. GW-I REV. 07/2001
•

27059,
WELL CONSTRUCTION RECORD
North Carolina - DepartrGtt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
'ELL CONTRACTOR (INDI\ ou,.%L)NAAIE (print {� C'
)�1 ""mil A �'/'[CERTIFICATION k:21��
WELL CONT ItAC'TOIt CO:
STATE VAELI. CONSTRUCTION
(if applicable)
ASSOCIATED w'Q PERMIT''
(if applicable)
1. WELL USE (Check Applicable Box): Residential M' b1unicipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: - County �-C SO lD
CCIYI I) t-Gw
(Sheet Nome. Ter_ OWNER:uer CCt-f 1J fi-Pre_
Address V• 0 . 6 77 v /(o D
(Sheet or Route No.)
C`-i 1Cl/341-k6riG`L\--c2
City or Town State Zip Code
tk)- Yo- 38t`/
Area code- Phone number
Topographic/Land setting
❑Ridge ❑Slope ❑Valley !Flat
(check appropriate box)
Latitudellonoitude of well location
4i,sroesdntonmzCa*cnnds\ ....
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ForplaUon Description
0— % (,
4. DATE DRILLEDf-r.l)ruGrtia�,2f'ca3 /lq — is 0
5. TOTAL DEPTH: 3,- 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er----rQlt 0 - 47,29.,
7. STATIC WATER LEVEL Below Top of Casino: ' CS FT.
TOP
(Use "+" if Above Top of Casing)
S. OF CASING IS / FT. Above Land Surface*
'lsp of easing terminated at/or below land surface requires a
variance in accordance with lip NCAC 2C .01 IS.
9. YIELD (gpm): 3 METHOD OF TEST I A r, r
10. WATER ZONES (depth): (y 0
1 I. DISINFECTION: Tvpc f{7—H Amount PI( 6.3 bz
12. CASING: Wall Thickness
Depth Diaptieter or Weight/Et. Material
From 0 To et/ Ft. (p 7-{ Pi/0
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 l o 020 Ft. Cpf_f
From To Ft.
Nlethod
op
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
Front To Ft.
From To Ft.
16. REMARKS:
2b2 — 3
CL'f
e-camu,.+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.
7Li sy I
cO� c
LI (L /
Scan', view I \
N
CIN
I DO HEREBY CERTIF. "rat Trot ITS"i�Et.
CONSTRUCTION STA DA �,A`(bTIMT COZY
t
j V\ .
-t Lit
SIGN.ATUROI_PERSO:
Submit the original t) the Division of Water Quality' Gro
27699-1636 Phone No. 919) 734S2n wixhitr34 thla5.�
ED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ECORD HAS BEEN PROVIDED TO THE WELL OWNER
rr
TRVCTING THE WELL DATE
3 - G- i3
ndwater Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/200I

WELL CONSTRUCTION RECORD
27106'7
North Carolina -Department of Environment and Natural Resources - Division
11 of Water Quality - Groundwater Section // --
WELL CON'TRACTOR(INDIVIDUAL) NAME (print)<1TT/-e not S1-in 11 £ CERTIFICATIONOI4 c1/7`f'
vv' ELL CONTRACTOR COMPANYNAMK nn1 S jJia�r4 Weil)) `(r(I''1td p.n.e PHONE # �S1—.7a4-3 4 G
STATE t1'ELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(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 IC Other, List Use
2. WELL LOCATION:
Topographic/Land _s_elting
NearrQst Town: C lee ( .o v I I-e. -- County�J 4(/C S lino ❑Ridge ❑Slope alley ❑Flat
\ 0 r't"Ltl' % F1 m Y✓1 • Oa.k S ) &cl)r-4- �2/7 (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: E 4'2S/ / ' l_ t
Address 4 L C ny 2 4 t- iT D iQ •
(Street or Route No.)
IJiC)4-L-4/-Di Alm e) 761/ DEPTH
itv or Town State Zip Code From To
,
Area code- Phone number
4. DATE DRILLED Oa — / 7 —0 3
5. TOTAL DEPTH: 705.'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lii—t-----
7. STATIC WATER LEVEL Below Top of Casing: /00 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): / a METHOD OF TEST_ / 7/1)2-C�`
10. WATER ZONES (depth): /(0. 570J CO75 (1
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
s a�
‘21,c QC._/Y—
R/& Crr'r6 nr-t
(2 -7 q
% 7D5—
—n
<�J
•
c-c
CO
LOCATION SKETCH — —
1 I . DISINFECTION: Type /f 1- 1-4 Amount ra T4 A S Show direction and distance in miles from at least=
12. CASING: Wall Thickness two State Roads or County Roads. Include the ld
Depth �7 Diameter or WeigheEt. M tep l numbers and common road names.rn
From 0 To ! r7 / Ft. cc S1�2R,. 1 YY rn
From To Ft. N
From To Ft.
13. GROUT: Depth Material Method --0
From (1 To Ft. �0�1M O. pc)—a/`i =
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material O
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
16. REMARKS:
Ft.
Ft.
APR 1 0 2003 ; f-)
Submit the origin I to t
27699-1636 Phoq\— o. (9
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH I5A NCAC 2C, WELL
RDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2—/7-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001
DATE
c

WELL CONSTRUCTION RECORD
271146
North Carolina - Dcparunent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)N:UIE (print -Ie .iti ci\t ii\L„ s, CERTIFICATION 7
AA G—rccr.,sv Uk-`\ L`a
R F.1.1. CONTRACTOR COMP:\.\1'.\:1\IF.: 1'T�� S11 jti47H0.\E #)t',�')rj ?-(p,.J 5-6
STATE \\ ELI. CONSTItlC11ON PER,llT# ASSOCIATED \\'Q PERMIT#
(if, ,livable) (if a..l icable)
I. WELL USE (Check Applicable Box): Residential tN Nlunicipal/Public D Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Purnp Water Injection 0 Other ❑ 11 Other, List Use
2. WEI.I. LOCATION:
klearest To v�j' �' '0C>✓ County. -7:3 CUe_tO `L2Ct
(Street i unr_ Numbe s. Community. Subdkision, Lot No., Zip Code)
3. OWNER'\''-i Ceti c- t N(7.'FQ i
/ Address o w-') 1)c��-1 ; ,-.) k..`4- i�J 'Q—
, (Street or Roue No.)
�,
Citvor To n State Zip Code
4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Icc"
7. STATIC WATER LEVEL Below Top ofCasing: LC FT.
(Use "+" if Abose Top ofCasing)
S. TOP OF CASING IS FT. Above Land Surface*
'Tap or casing terminated at/ur below land surface requires a
variance in accordance with I5.1 NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST a-. c
10. WATER ZONES (depth): »-/Ce Q
11. DISINFECTION: Type En-- H Amount I I
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Naterial
From 0 "1'o L{ Ft. tr 1 51- r
Area coda- Phone number
DATE DRILLED J,tULks\ /`\.QCU:S
TOTAL. DEPTH: r-5b
From To Ft.
From To Ft.
13. GROUF: Depth Material Method pp rrl
From To c;: CI) FLfef�Ne-rc)k —Fri-1 C l / `70 Cl l piii< JU-'.d. c1
From To Ft. v 1 1 �_ -. ) (
14. SCREEN: Depth Diameter Slat Size Nlatarlal - ic--
C1
From To Ft. in. in. _C LJ
From To Ft. in. in. (.-.
15. SAND. GRAVEL PACK: ' c
Depth Size Material CI
CA) F22
From To Ft. cr c
w �-
From To Ft.
Topogr. Ic/Land setting
DRidge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes 'seconds )
Latitudc/Iongitude source:❑GPS❑Topographic map
(check bow)
DEPTH DRILLING LOG
From To Formation Desc riptiot
H� ��C.-(j�cG. tvlr ��
4 1 / 0
)D I-1L\ cCc.
L4c - 1 40-
140—,7/c:
(Yr, I :'At-
41
-.i, 5 0 G, f'<,.l) r't-C
LOCATION SKE e'H
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
16. RENIARKS:
--+B0II1.12E.I3V C'
`zC )S LLC'1fic\14
C i , I I -I % 3„ c, I , CCCton
•
Submit the original to( he D
- 27699-1636 Phonc•No. (9'I 9) 73
THIS WELL WAS CONSTR,JJCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELj OWNER:
CO ET
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD 271141
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .„40/lit'/e (✓ftnl'L CERTIFICATION #309/
p L
WELL CONTRACTOR COMPANY NAME (I/4C✓e dry S. dee// l)r // ✓ ti 1>✓[- PHONE # f ')S�ak/-' V7�
STATE WELL CONSTIRLC'I'ION PER:\IIT# ASSOCIATED\\'Q PERMIT#
(i('applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nloniloring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: s'y/J4 County.. Vlf Fs '
+11L, (',)
(Street Name, Numbers, Community., Subdivivo Lot No., Zip Code)
3. OWNER: /
Address 1 . S Hm%14I Ui;
e
Cfty or Town State Zip Code
( )-
Area code- Phone numher 4. DATE DRILLED /'/S- 0.3
5. TOTAL DEPTH: sri
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /X"t7 FT.
(Use `+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): al° METHOD OF TEST Q.th,
10. WATER ZONES (depth):
1 I. DISINFECTION: Type
12. CASING:
7k- Y.3L)
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/S - 77 6/4y
Depth Diameter
From U To 7 $ Ft. VC,
From To Ft.
From To Ft.
13. GROUT: Depth Material -1 t.
✓.
From �%To a cis hi. (`,-ryi 1,�C -7M-4
From To Ft. 1
Amount
Wall Thickness
or Weight/Ft. Material
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
Diameter
Ft, in.
Method
Slot Size
in.
in.
Material
LOCATION SKETCH a r-t -
Show direction and distance in miles from &NeasC'
two State Roads or County Roads. Include the roai3 ==
numbers and common road names. t�
v o
7.1
Size Material
en
rn re;
16. REMARKS:
Ft.
From To
Ft.
10
JON iIJ/ fIC1N9i'//14��EA
FEB�Z 00 2003
2'D>
-IIS \ &, VP3 C(/r�,1tiS U�T -IN (At
ND THAI 6_-°0ORD
SIGNATURE OF P,4R 2/\ QNSTRCi1CTING.4k-
Division (if VV'at, r Quality, Groundwaterhectic
131R091ND.WATEAISE&TI((9fE9) 733-2221, Nithin 30 days.
ASHEVILLE REGIONAL OFFICE
Submit the original to th
ANCE WITFI ISA NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
E WELL DATE
n, 1636 Mail Service Center- Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
271376
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / _
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) sDe fl 1l sI /1 /)NQvy\ CERTIFICATII�ON # 01/74'
WELL CONTRACTOR COMPANY NAMEC J111 i s 1t'li)i)aJ Wet I r(lY1 I I ;124 .1.lM1 e J PHONE #�; '. 3&2 4-3 L G
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED NV ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 13�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
11-
Nearest Town.( a s�.2c ✓ , r'/7S �County 4 $ /lhv
go r (947/7
(Street Name, Nu tnbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER:--U' A I) /Y 1 'E' le -
Address 713// '%um,/ ✓ / -e/ae.
_ (Street or Route N6.) C� ^
Cc / h julvJ /3e'.k P/ 3✓(
Ciry or Town State Zip Code
)- '7,e57- 75-:i/
Area code- Phone number
4. DATE DRILLED 3 -/ ,£ -03
5. TOTAL DEPTH: 9().S"
Typographic/Land setting
IOU ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
/I7.r_
verm' etc._ tr
f /Lc2_ (.✓ic&M , { `Z-
DEPTH
From To
/ 5/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: %7n FT.
(Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith 15A NCAC 2C .0118.
9, YIELD (gpm): METHOD OF TEST AkiU/}yt
10. WATER ZONES (depth): /7/" 31 '5
1 I. DISINFECTION: Type Hfk Amount
12. CASING:
From 0
From
13. GROUT:
From 15
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
Depth
To ,•Z( Ft.
To Ft.
From To Ft.
Depth
To aD
LOCATION SKETCH
4%A p S Show direction and distance in miles from at least
Wall Thickness
Diameter or Weight/Ft.
two State Roads or County Roads. Include the road
Material numbers and common road names.
5Z2R,f1 QKQ_
Material
Ft. e0971Oj
FL
Method
pw0
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
To Ft.
Material
16. REMARKS:
Yi-CE
TWYFFAT
CP +TEICT N 3T _ D l ,D
APR 2 8 2003
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
) THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 — / g — 6 3
ATURE OF PERSON CONSTRUCTING THE WELL DATE
St4bmit the original to the Blivisio 1 of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636. Phone No.. (919),733-3221, within 30 clays. GW-1 REV. 07/2001
�.__ar

270980
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section // __
WELL CONTRACTOR (INDIVIDUAL) NAMES (print):1)te 15 I-0110.,, A, CERTIFICATION# 01/7`f'
WELL CONTRACTOR COMPANY NAMIS (Mi t C 'no ()Uri IIJe I Th Y1 11 . )-n e J PHONE #tg%(—vc CI-3 i 4 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Y i icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIN:
Nearest Town: t-iF Et e', Ili` 27C County A-C K S d4-L-
I01 ! ee /Lc_ -71 45.;7;�.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:l.0 I r II t 0rlo\ L— L' C. IL
Address '4> 0, f'i 6 x (0.(9
(Street or Route No.)
(2-Iet1Ille 4.7C--, rc7.3l1
City or Town State Zip Code
WlC)(r)- _C - aom
Area code- Phone number
4. DATE DRILLED D—i7—t'
5. TOTAL DEPTH: ,.3SS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FL'Y
7. STATIC WATER LEVEL Below Top of Casing: S 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
"'fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0119.
9. YIELD (gpm): L/ 0 METHOD OF TEST AbitirrrT,�t�
10. WATER ZONES (depth): 626 �). "
11. DISINFECTION: Type H9-14
Amount ,"-27-4I;5
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Mattee'al
From a To,�/ Ft. /!?" SZ(Z i Pv
From To Ft.
From To Ft.
13. GROUT: Depth
From £ To r7L
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.
Material
Ft. CO4"1 6s
Method 5
DEPTH
From To
2n" 3 S'5
tdggraphic/Land setting
e ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e iO4
I/P?✓1nr f41rr-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.
CD
GJ
Slot Size Material •:-7
in. r>
in.
Material
W
SD
C;
16. REMARKS:
W HEREBY»CERTIFY THA
CONSTRUCTION STANDARP
TfI3 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the bivisic n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
?7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and /N�atural Resourcee/s- Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (p/riint)( /c' s-�
At Jl) J 1 f (�`J � CERTIFICATION QT
E \VLI, COY] RACTOR CO)IPANV NA>MFA A/ Grre Ule f>rts. Wt'.l( �(�4-OSs �P/IONE;: 113.491 5-550
STATE \VELI. CONSTRUCTION PERMMIT#
(if applicable)
271704
ASSOCIATED \VQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential La' Municipal/Public 0 Industrial ❑ Agricultural ❑
\Ionitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Srr, V30.NVwV\ Countcc-cAxASSCIN3
e cC i340cSk:-2- l--e.+yl)
(Street Name. Number, Connnnln', Subdivision, Lot No.. Zip Code)
3. OWNER: S k ha Aid
Adclress C1,-171
(Street or\ Route No.)
City or Town Sute f Zip Code
31 -3C;vti
Arca code- Phone number
4. DATE DRILLED eiNct_cc,,,\N \ ) cC3
S. TOTAL DEPTH: 3 w
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: li 0 ET.
(Use "+' if Ahoue Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated atfor below land surface requires a
variance in accordance with ISS A NCAC 2C .0118.
9. YIELD (gprn): j 5 METHOD OF TEST ,( ,'r 3L_, D - IpbZ
10. WATER ZONES (depth): r — / 00 & - / 5 - /,,,0 .9. 4p'. — ?art ,q re/ N,'IL P
.�-: L U LOCATION SKE H
1 I. DISINFECTION: Typc }-i Tit Amount 15, 7.5.0.1 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dianicter or Weld-MEL Material - numbers and common road names.
Topogra -eland setting
❑Ridge Lo3lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees lminutes .'seconds)
Latitude.'lonedude source:0GPS❑Topographic map
(check Lost
DEPTH DRILLING LOG
From To Formation Description
fs8 L I CH
-/Gr, rA.rci :tfe
io'7 l35 r nn„4�
L3s�_3 '7
/OD - fDa
/3'7 - /c'b
From 0 To G 3 Et. (; y is-: S><r=r l '/ y >�1,,�
From
From To
To Et.
Ft. �7 y, %/ S. / �Lf� / r%C»
t7t f y
crnn 1-'
Lis -i-Li
Ur�
13. GROUT: Depth Material
From0 To_Rcei Ft. C-e'rne...)T
From To Ft.
14. SCREEN: Depth Diameter Slot Size platcrial
From To Ft. in. in.
From To Ft. in. in.
IS. SAND"GRAVEL PACK:
Depth Size :Material
From To Ft.
From To Ft,
Method
L p
16. REMARKS:
5 R. ists' ,C3ecc_ LaOoej
doH tEIBy CiR±i,LtYT}I
i?ONSTRUC 1 tON S t;-t'1IJEif
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D -I I IAJ,AVCOPY Od4 I IIS RECORD I I AS BEEN PROVIDED TO l:I lE WELL OWNER
,NATURE OF PERS
N CONSTRUCTING THE WELL DATE
Sul3ititthe original to theOivisi n of Water Quality, Groundwater Section, 1636 flail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-32 I, within 30 days. GVW-1 REV. 07;2001

WELL CONSTRUCTION RECORD
271703
North Carolina - Department of Environment and Natural Resourcesurry��- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CrJrAJA(J 0 . /flea/1 tS//l��• CERTIFICATION #.'5fl�q
WELL CO.\ ItACTOR COMPANY NA\IEM4A- C-rrpNP. 8r!)J. G')F_li js'T�Si/LJIA_- PHONE # '✓�r� �J r "555b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERIIT#
(if applicable) (ifapplicable)
ammosaim
I. WELL USE (Check Applicable Box): Residential 5Municipal/Public ❑ Industrial ❑ Agricultural 0
tNfonitoring 0 Recover), 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
7
WELL. LOCATION
Nearest Town: CountvTe..Ci st_�ry
r
�y 6
(Street Pane. Numbers, Community, Subdivision, Lot No.. Zip Code)
Address I St% LT0.1 u o-N.p
(Street or Route No) k
A O.,rn p o ti Cr
City or To Stater Zip Code
7�c 9'7'1- 79'73
Area code- Phone number
4. DATE DRILLEDCno.ec I�r9CO3
=. TOTAL DEPTH: �j C C�
6. DOES V.'ELL REPLACE EXISTING WELL? YES ❑ NO CV"- 7. STATIC WATER LEVEL Below Top ofCasin_: c9-O FT. S _ 1 ?
(Use `+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accurdance with ISA NCAC 2C .0118.
9. YIELD (gpm): r% METHOD ;IF TEST a
10. WATER ZONES (depth):, — /D 5 ° (%
I I. DISINFECTION: Type 11 T Pr Amount 5 o'z,,
12. CASING: Wall Thickness
Depth Diaaeter or AWeieht'Ft. Material
From 0 To '7'7 Ft. (D IS-s- Sf eei
From To Ft.
From To Ft.
13. GROUT: Depti
From D To 0 Ft.
From To Ft.
Material
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
15. SAND 'GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
--t,ILTI ('
(OASTR(CTION ST.AN
Topogra Ic/Land setting
❑Ridge La}Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(degrees 'utinuteslseconds)
Latitude longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fprmation Descriptio 1
:icLi / &QNc0
DEPTH
From To
0 - 7a
•7 .! _.. z J J (`c:
Ca
I5'l-3--a G(Ll +f
c?l. "ri,a Cno. 1- m
LOCATION SK _ 'H
Show direction and distance in miles frotft least
two State Roads or County Roads. Includelthe roacL
numbers and common road names.
ifyl SL/ / v&- /C% raf�ee
S R"q t C(A-mPVC -eet<
SR./1/08
Nlethocl
Slot Size Naterial
in.
in.
Material
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
AND HAT A C P19F THIS Z'ORD HAS BEEN PROVIDED TO THE VWELI. OWNER
GNATURE OF
ERSON CONSTRUCTING THE WELL
DATE
Stlbnlit the original to the Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Pt/09-1636 Phone No. (y19) 733-3221, within 30 days. GW-I REV. 07/2001

271701
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of - Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME^r(prinD6-/e 1I' ) Brea. . /7) 4 hAss,.
a(��tCERTIFICATION k:7r5717
\YELL CONTRACTOR COAIPAN V N A\IE/-A 46-reeij Brea. IVefi D ss,. '�j r`-
$j'lUr—PHO\EK(ZiSC},3S'�✓'�1:sc 0
STATE WELL CONSTRUCTION i'ERMIT# ASSOCIATED \VQ PERMIT#
(ifapplicable) / (if applicable)
1. WELL USE (Cheek Applicable Box): Residential E7 Mtmicipal/Publie ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
3. WELL LOCATION:
Nearest Town: t Lei-S0--Cle Countyci C CiS(1,
\-\ Tip M*NCJaM4S fit -11v,N)4s 1(1)
(Street Name. N nbers. Conn unity, Subdivision. Lot No.. Zip Code)
Topogra to/Land setting
❑Ridge CA7Slope ❑Valley ❑Flat
(check appropriate boo)
Latitude/longitude of well location
3. OWNER-c(T1eSfl'VLn'\rl(\ibiys4ZSL.,e fYlecIRci-e_ (de_reeslninutes seconds)
Address ar;A-3 1-, FCCK 9 Latitude/longitude source:❑GPS❑Topographic map
(check box)
Street or Route No )
City or To..n State Zip Code
(k 'i- 4 al - Si 'a 5
Area code- Phone number
4. DATE DRILL.EDJann.sr1
DEPTH
From To
n /t .5
5. TOTAL DEPTH: 3OQa `7 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ✓ - i L '7
7. STATIC WATER LEVEL Below Top of Casino: Ir:). 6 FT.
(Use "+"it' Abo.e 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 Rh 15A NCAC 2C AR 13.
9. YIELD (gpm): 1 o METHOD OF TEST a-v C
10. WATER ZONES (depth): 3 -- I to 5 ey - a 7 0
Sou 9co3
IL DISINFECTION: Type r{ TN Amount I . 5D 02.
12. CASING: Wall Thickness
Depth Diameter or WeiehtTt. Material
From C3 To (o1 FL '\ I Sys Si-eeA
From To Ft.
From To Ft.
13. GROUT( Depth
Front U To rip Ft. Qerrxe t
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Nlateria
From To
From To
Ft
Ft.
16. RE\I.ARKS:
DRILLING LOG
Fompion Description
av
r ct n1, •f �-
i(// a -7() � ( it A; f �-
7- 30C% gra-A2 e
LOCATION SITE-TH 73
Show direction and distance in miles from 3Reast --
two State Roads or County Roads. Includeth road___
numbers and common road names.
—
Material Dlethod
Its 0o/C(gE� Kew
r'�
(NJ-•
sdreeK
S 139 &f'Ket
I'Do\AAle art dreg Lk�ve
i�-i� p
\ !' ' I DO 14E}tEF YC(=RTiF
Cf 7NSTRUCTIdJt S�
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THATCOPYOF,THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/r:
SIGNATURE OF PERO\ CONSTRL'CTI\G THE WELL DATE
Submit the original t!)the tivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
C12699-1636 Phone Nu. '(919) 7_ 3-3221, within 30 days. GAV'-I REV. 0712001
PSrf

pc.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL,
ELL CONTRACTOR (INDIVIDUAL) NAME (print)G I eN iU 1Y\, mp �`ps CERTIFICATIONATi s'/
/4
WELL CONTRACTOR COMPANY NAME AAP, G,- enve. errs, Ur�e U tfc- IT , PHONE p 051!) St) --' gip
STATE WELL CONSTRUCTION PERNIIT4 ASSOCIATED \VQ FERMI -Ed
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public VIndustrial ❑ Asricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCAT ON;
Nearc-t Town: r�rQ at'r -- ConntyZ-ct.tt pf�
V i��S\m"Nr0Cv OSSt
Noma. A'umbers, Community, Subdix isioq Lot
(Street Zip Code)
3. OWNER: \-)t\C(� l- rCstS \rN1
Address 7O e5 LC) e r'
(Street or Route No 1
City or 1'twn State
o, Zip Code
qu2-1 l - 58(c- (�?7it
Arca code- Phone number
4. DATE DRILLEfF(gt�r_ at ace 3 °-.7 0 — .3
5. TOTAI. DEPTH: 45U
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 13 0 FT
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated atlur below Land surface requires a
variance in accordance with 15,k NCAC 2C .0118.
9. YIELD (gpm): 3 C METHOD OF TEST Q,j r
10. WATER ZONES (depth): a 3 0 3 —3 2 D
ac J 4jT
1I. DISINFECTION: Type ff j If Amount020• 05na,
12. CASING: Wall Thickness
Depth Chatter or Weicht/FI. Material
From 0 To 5 Et. (.o LIc P 1(_Ce
From To Ft.
From To Ft.
13. GROUT: Depth Material _/.letltod
From To I: Ft(1P.,7]eA)fi Jag_
From To Ft.
14. SCREEN` Depth Ditmeter Slot Size :Nlatcrial
From To Ft. in. in.
From To Ft. in. in.
15. SAND./GRAVEL PACK:
Depth Size Material
From To Ft.
From To H.
16.REMARKS:
271700
Topogra hic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ad notes/seconds)
Latitudeloneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fol1in�ation Description
h_ t70 Cq!Q\�
— 7� gre,ni)`�e.
�')b— 3?i._V s'�
3'1 — lit ctfc,f)444�
41 n - 4t� ec�v rt
L1/4. - trio �t}�
LOCATION SKETr
Show direction and distance in miles from - two State Roads or County Roads. Include1the roams
numbers and common road names. --I
3 ) QLtst'Nes 3 It tj C`--
c +i\e_A.1 , k+
c3e r o tY\; I-Q,
I (11O HEj2Ef3Y GkRT-IFY TFAT THIS WELL 1 AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT NCOPY OE THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original tp the C
27699-1636 Phone No.1(919) 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL
— / — 6JJ
DATE
i Wision of Water Quality, Groundwater Section, 1636 Dlail Service Center - Raleigh, NC
3-3221, within 30 dams. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2.71699
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VAELL CONTRACTOR (INDIVIDUAL) NAME (print) cN), 911fr' L /. CERTIFICATION at L
PHONE # (?4 -) 58t -5550
WELL. CONT R. CTORCONIPANY NAN1EA-At(Cep Pi.\P evr,s k,lp\\ C) it(IJ�
STATE WELL CONSTRUCTION I'ERNIITi ASSOCIATED \\'Q PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential L2f Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: T
Nearest Town: —TIN. cKCL' ncecceCounty
\?J cN\tom..\- CN n
(Street Name. Number. Community, Subdivision, Lot No.. Zip Code)
3. OWNER:SiCr- POt",.DC2-1\
Address Os CA \tr. rev"E-
(Street or Route No.)
Sc. cKsm1
N>_\\o.s.:)\-Nee N as a& 7a3
City or Ton n State . Zip Code
(-f. )-a9' — 93/0
Area code- Phone number
4. DATE DRILLED/-3
5. TOTAL DEPTH: a tic/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C3 3-00 . , Cs
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use "." if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15:\ NCAC 2C .0118.
9. YIELD (gpm): atN METHOD OF TEST Oki C-
IO. WATER ZONES (depth): p e>
Topographic/Land setting �
❑Ridge ❑Slope ❑Valley IH'Flut
(check appropriate box)
Latitude/longitude of well location
(decrees.:minutes:seconds)
Latitude; Ion gitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr _ `To Foortation Description
1 I. DISINFECTION: Type
12. CASING:
Depth
From_ Tol. C(
From To
From To
13. GROUT: Depth
From (') To,c(C)
From To
Id. SCREEN: Depth
From To Ft.
From To Ft.
5. SAND.GRAVEL PACK:
Depth
From To
From To
Diameter
Ft. Le LI
Ft.
Ft.
Amount Ioi, 3?ez,
Wall Thickness
or Weeuht'Ft. Material
Material Method
Ft. 0 •eN\a 1,, A- T p .
Ft.
Diameter Slot Size Material
in. in.
in. in.
Size Material
Ft.
Ft.
16. RENIARKS:
r—
it PO'FIE[:EBY CERTIFY T A
CONS —Milt I ON STAND.
r 0 rC ,x % L
0CLC A-y
ac, ass cyck.t e
•
LOCATION SKETCH "'' _
Show direction and distance in miles frotirat lefst �
th o State Roads or County Roads. Includd`?he road
numbers and common road names. _I t .. . .
/D cu_ ot 1)e j AEkc.see5Q
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
371) - 1 it (frr! cj- l• 3
IGN'ATLRE OF PERSON CONSTRL'CNG THE WELL, DATE
YrGmit-the original -t0 ithe Division of )Water Qu alit), Grou n d,vater Section, 1636 plait Sc rsice Center -Raleigh, NC
p$7699-I636 Plione No. (.2111517 4=
221, within 30 days. GW-1 REV. 07/2001

L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\TELL CONTRACTOR (INDIVIDUAL) NAME (print) r /%l I 5�%
/��t ' M 1 CERTIFICATION'
w EL.I. CONTRACTOR CO?IPA.\1',\:UIF,g/T/TC f_f Al+' /'ns zit c)a—PHONE e 02,f) 'SPIV 9 5Z%
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13----Municipal/Public 0 Industrial 0 Agricultural ❑
tNlonitorin2 ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
47169E
2. WELL LOCATIO t:
Nearest Town: Ci OcaNl n)c.i\-1 County AS ol.i
Be eAN.onc o C J c.ck �e:t2, iw4-leap
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER:
Address • [l -
kro. Co -• JCL-asd k }Z
0 )c
(Street or Route No.)
Sr7:al-3
City or Town State Zip Code
(a)- Gr3 l —3(c 4V
Area code- Phone number
4. DATE DRILLED(\0s3'N )4 cr,"3
5. TOTAL DEPTH: QD-o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top ofCasin2: P/G
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST a f'r
10. WATER ZONES (depth): /Z/L
FT.
II DISINFECTION: Type /4 %H Amount _3(, 0%Za
12. CASING: Wall Thickness
Depth_ Diameter or WeiehtiFt. Material
From 6 To '7 D Ft. b -9Pf(%
From To Ft.
From To Ft.
Depth ��}l MLaterial Method
To 2 C: Ft.P AileApf / ,-, p
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 iAlaterial
From To FL
From To H.
13. GROUT:
From /)
From
16. REMARKS:
HfR.'aarat ik T CONSTRUCTION STAB .1.1
G.' Submit the origin:9f to the
P=.2'2699-.1636 I'.hunc NO. ..(9.1
Topogra is/Land setting
❑Ridge L' Sope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
FromTo ForrHation Description
j — ` CM" :'
CjrgnJif—
jY (1 cL,o14-+t
n
LOCATION SKETCH .t,
Show direction and distance in miles froth at bans))
two State Roads or County Roads. lncltfcc the road
numbers and common road names.
it Li Sri/urt- // ( biA)
L e , 0.lU L r rdh
QeerkL oca brit1'
\T THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
{1F2 .AND TA{AT A PY OFTRECORD HAS BEEN PROVIDED TO THE WELL OWNER
7
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
)ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GAW-1 REV. 07/2001

al/Public (�
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0
WELL CONSTRUCTION RECORD
North Carolina - Department f E
oEnvironment and Natur 1 Resources - ivision of Water Qualit
%A'ELI, CONTRACTOR(INDIVIDUAL)tN:u'lE (print) O 1 �. m ��u Cr
\\BI,LCONTRACTOR CO\IP.AN\NAME,/ CrrreAte %3r6S. (I)P.11
STATE WELL CONSTRUCTION PERNII7# ASSOCIATED \VQ PERNIIT1
t if applicable) (if applicable)
271697
y - Groundwater Section
CERTIFIC�AyYJt TION /t(,
PHONE
�+
WELL USE (Check Applicable Box): Residential 0 Municip
2. WELL LOCATIO, j
Nearest Town: o._/rC /j' t r&ounty �t-kjn/�
% -Tn. Jh //\ r Jf e StG u rrr ti - hit 1 / o 7
(Street Name. N umber,Conununity, Subdivision, Lot No.. Zip Code)
3. OWNER:Tt,mP)�f C1CcSt'ni.Lro3'I'�
Address % `J S(7C('/-i) Y-%i-e L/ ID r�
(Street or Route No.) ( Yt
e t-ch r �/—s, !V C M�9, r7
City or Town State Zip Code
9L 124
Area code- Phone number
4. DATE DRILLERJ&Alaary ct/`C(.)3 Se-4
5. TOTAL DEPTH: 1/,X0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Lt
7. STATIC WATER LEVEL Below Top of Casing: /D FT.
Industrial 0 Agricultural 0
If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ®flat
(check appropriate box)
Latitude/longitude of well location
(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 I5A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST a ter
10, WATER ZONES (depth): 49 lc 0
11. DISINFECTION: Type*
12. CASING:
From D FL
From To Ft.
From To Ft.
Depth
To
Amount ‘9 U. tX 5oz
Wall Thickness
Diar�ieter or Weight:Ft. Material
3. Gons j ToptO ` wMaserial Method
From To OD_ Ft. L F m tc ir,J 1
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAN'DIGRAVEL PACK:
Depth Size tNlaterial
From To Ft.
From To Ft,
Slot Size Material
in.
in.
16. REMARKS --------------
I L9Y0 HRREE.Y CLI2ikY
rCTIcTSTRL'CT1ON-STA- I
(degrees/minutes/seconds)
Latitud✓longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From�To Formation Desc,{ iption
0 — L7 / A K.)CY,
eta-LI5Lm
LOCATION SKETCH o
Show direction and distance in miles fromit? least.
two State Roads or County Roads. Includee road 7,,
numbers and common road names. 7-5
/a7/ (<' L/ Cc-s6'rCr;S
O ak n+U
J
UfrS343pniT,tltt on rTiu l l51tlle I7
ASHPAfj,$04-1636,fhonciNo.,,13119) 73
-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
J. Lj nm it. C r / ` 4-13
SIGNATURE OF PERSON CONST&CTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

271688
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourceseso- Division of Water Quality - Groundwater Section/
\\ELI.CONTRACTOR (I\DI\'IDUAL) NAME ��f(\p,rr{ii\nt) Urrir lJ11 1's',��t ��)�(r / CERTIFICATION #rt/�// 6//
\AELI. CONTRACTOR COMPANY NAME Af',f'\ e �I W `^"e l'D C1{-SL)IU�tIO.\E # fOLp) SD V�S777%
ASSOCIATED WQ P� Rxi IT#
(if applicable)
STATE: WELL CONSFRCCI'ION PERMIT#
(if applicable)
1. AWELL. USE (Check Applicable Box): Residential 0 Municipal/Public CY Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
? WELL LOCATI : •
Nearest Town:�en() I lit) Count ' y-�
1
iJbr*on dZGi__�4) Go 0 wr
(Sweet Name. Numbers, Community. Subdivision, Lurt No, Zip Code)
3. OWNER: 11 hI('urO
Address Po 1_XD )C ZAP ti
(Street or Route No
CcS1T(ei5 N� ag )
itv or To.cn _Say toil Zip Code
( (a - 'Sl ti 3
Area code- Phone number a I 03
4. DATE DRILLED 401
S, TOTAL DEPTH: I 1-100
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO g
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use `+" if Above Top of Casing)
S. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15.\ \CAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST al r
10. WATER ZONES (depth): cR— 4/ 4o3 - -1-10_f
1 I. DISINFECTION. Type i-Vr t-r
12. CASING:
Depth t (t Diameter
From Q Tos53_8_ Ft. S'"
From To Ft.
From To Ft.
13. GROUT: Depth , , Material
From 0
Amount I IS Oz
Topographic/Land setting
DRidge ❑Slope ❑Valley fit
(check appropriate box)
Latitude'longitude of ',yell location
I degreesimi nutesseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr T Formation D,ription
um
0- 48 8"
«r e - i'
'+Ef4- `NO
Arab/+�
770 -17 co u r ti
1 /2-) 400 %ramp-C
LOCATION SKE H
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Includge rail
or Weieht'Ft. Material numbers and common road names
1Z_2 51 t
To538 Ft. y enTif
Method
JfV� n
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 NI erial
From To Ft.
From To Ft.
16.RENLARKS:
a
y ink`
-I--- a
--,I-F Co tact,
sTl�ECti710141§l
4.1
Submit the origiiii u tl e Division of ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GFfu'
?7699 16361'hancliii. (91') 733 3221, vwithin 30 da) s. GW-1 REV. 072001
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r
SIGNATURE OF PERSO:L' CONSTRUCTING THE \WELL.
DATE

WELL CONSTRUCTION RECORD 271.E 3
North Carolina - Department of Environment and Natural Resourcc�ess�- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J t , MCC
v ELL CONTR-ACFORCOMPANY NA>IEJ}%1/4 G eiie nroS, (Lt11 .,QUPJI
CERTIFICATION # 9/ RL
PHONE # 07-8F SSG -5556
STATE WELL CONSTRUCTION PERNIIT# ASSOCIATED WQ PERy11T#
(if applicable)
(ifapplicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
tNlonitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION' _
Nearest Town: Cc.I -en(U (1/'� County.J
{..ecLe
(Street Na ti . Nuti C-rtCComi pity, t i sio . Lot No., rLip Code)
3. O\VNERCZ'E v".. �n C prJrJGr
Address [- . G • B r> '- / 3' 3
(Street or Route No.)
h;e-e A) 0-
City or Town $tat6 Zip Code
)- 43-cir(cz1
Area code- Phone number
T. DATE DRILLED.[^[ \ft r IS a[G3
6. TOTAL DEPTH: - 5 0 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LR�
7. STATIC WATER LEVEL Below Top of Casing: / (s 0 FT.
(use 'tit" i f Abose Top of Casing)
S. 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 NC,\C 2C .0118.
9. YIELD(gpm): Li 5 METHOD OF TEST Ct 'r
10. WATER ZONES (depth): 5 1 5
II. DISINFECTION: Type 13i T hi Arnount�C�.
12. CASING: Wall Thickness
Depth r Diaeter o Weie fFt. Material
From t t
To C/; f t FL q ��
From To Ft.
From
To Ft.
13. GROUT' Depth Naterial Method
From 0 To__an Ft. 1 �1 ' emt> w*
From To Ft.
14- SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To Ft.
Ft.
Inp
Front To
16. REMARKS
Topogra is/Land setting
DRidge lope ❑Valley DFlat
(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 Desc,(iption
I S-ri tJ r)
Yct #s,7-r
C. G 0I. ti
1/4Jt C( Fe--
.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.
D 7 C /eNoi 1IE
kcLuvrc_ H all S o
act I< N o bcf)
cn 5
al <r,
L, fl :� A,j
dbyHEFH
R Y CERTIF`}THATT HI
CU*STRUCT ION STANDARDS,
YELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, \VELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
SIGN
TURE OF PERSON C'ON'STRUCTIN'G THE \VELL DATE
Submit the original to the Division pf ater Quality, Groundwater Section, 1636 i\lail Service Center- Raleigh, NC
L_27699-1636 Phone No. (919) 733-322.0vithin 30 days. GW-1 REV. 07/2001

stab
r
egt,} a s� 7 79' WELL CONSTRUCTION RECORD
2721.6 3
North Carolina- Department of Enviromnent and Natural
Natural Resources-Diivviision of Water Quality - Groundwater Section
n
\ct:LL CONTRACTOR (INDIVIDUAL) NAME (print)l 1E3, N `T\r 7 t IQ \\r`� CERTIFICATION r//
2 f p
\\TILL cost izxceDiz CONIFANV N,UIt lA G— t•YNe :/ .2rt .: 1.0t Il t a- ili__ PHONE # l"1/� /?CZj .*iG e)
STATE \\ IAA, CONSTRUCTION PERMITS.'
ASSOCIATED WQ PER\IlTO
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential D Ntunicipal!Public g Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other II -Other, List Use S Lt i) 1") ("0 tvg ; 0tJ
WELL LOCATION:
Nearest Town: S �� Cci County3RGkS Sc 3
.5k44rkiaao ,A.SC rr £ c' cm Qrser�cf-
grk(StICCI Name Numbers, Community, &ubd iciswn, Lot No., Zip Code)
lVQ N Cr &\Sr•..m “\-\-fv Vey-5e.-v�
73�OW NER: C3--t-'\4-5 Q t tc; \, cat c�l
[Address CAN. S v-e-et
(Street or Route No)
Cite or Tow Sate Zip Coda
(vL3)- q5to— 033
Area code- Phone number
4. DATE DRILLELi ctM ctlrc, I C7 v2CCNS
5. TOTAL DEPTH: 5`i -) / f 15 - I I "7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q I I i - -..3cC
Z STATIC WATER LEVEL Below Top of Casing: 4b FT. -icc, -_ 5 C-. t
(Use"+" if Abocc Top of Casing) _3_- _ `J St,
S. TOP OF CASING IS I FT. Above Land Surface*
"'I op of easing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpnt): I N1ETHOD OF TEST G t r
10. WATER ZONES (depth): . — ) t 5 a - 3 tc
1
Topogra hic/Land setting
❑Ridge LYSlope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(dccree<n utes'seconds)
Latiaide/longitude sou
DEPTH
From To
()— 3s,
I I
1?
DISINFECTION: Type 1-\1--j-I Amount gig( %SB'z•
CASING: Wall Thickness
Depth,. I� Diat toter
From b To Lk Ft. (tr. 4
From To Ft.
From To Ft.
13. GROUT: Depth Nlaterial Nlethod
From (2 To b Ft_ 1, PIOic- ___I—() i,
From To Ft.
Id. SCREEN: Depth Diameter Slot Size Ntaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND'GRAVEL PACK:
Depth Size :Nlaterial
or Wei _ht'Ft. Material
i S +c-C - (
From To Ft.
From To Ft.
16. REMARKS:
13 `' —
rcc:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
C{ f c
etc i
n v 4 k) lift
I• c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
number and common road names.
LUccA tv
3/1 �'I 1
C LI-(C� ( 1
A_ Pc
(r ) _.
HEREI' CI�RTttY Tb1AT
JC NSDfUC I ION S[AND !Q
a/
S WELL WAS CONSTRUCTED IN
'D THA A CS'Y THIS
i
IL NATURE 0
SrildtYUT7ftc or tgin:rLto th4'!. Divisio
27699-1636 Phone No..{91 ) 53-322
o<
�c
CORDANCE WITH UA NCAC 2C, WELL --D mc,
HAS BEEN PROVIDED TO THE WELL OWNED corn
�''�
PERSON CONSTRUCTI\G1HE WELL DATE to
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
, within 30 [lays. GW-I REV. 07/2001
i