Ma CY2003

277452
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division) FI
of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;hen S I{�J]O C, CERTICATION# J/74
0
WELL coNTaArron COMPANY NAnta hhs 4 �r Jf ��y rd 100,611 PHONE N )—n C Cic{(.- S,>2 4 — 3 a 6
STATE WELL CONSTRUCTION PERMIT#
' .J
ASSOCIATED W ERMIT#
(if a. licable) (if a..licable)
WELL USE (Check Applicable Box): Residential Yd'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: �I
Nearest Town: %iz a 1t L ri-7.L.y �% J Count' l
rt.,/ iZn., i A _ A , Co v t tz - - g 9 3/
(Street Name, Numbers. s, Cor n unit Subdivision, Lot No., Zip Code)
3. OWNER: . J C S L
Address S'7Ls RItej -p/ L'O r-e_ /a'r4
(Street or Cute No.)
4
5
6
7
rr/J„ i i1 4/ c.-
City or Town State Zip Code
6')- 36' -ins/
Area code- Phone number
DATE DRILLED ,L• -6-3
TOTAL DEPTH: ,325 .
DOES WELL REPLACE EXISTING WELL? YES 0 NO 3— '
Topographic/Land setting
rorillge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
To Formation Description
/ 75 (Vac.)
/7S' ?/7 ScZ Hsfay�
/ ' 3 ,?Ila_ Gra8-,-
From
c0
STATIC WATER LEVEL Below Top of Casino / 00 FT.
(Use "+" if Above lop of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requ lres a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): S METHOD OF TEST /O7/ illXet
10. WATER ZONES (depth): o./ (�
II. DISINFECTION: Type
12. CASING:
From
From To Ft.
From To Ft.
13. GROUT: Depth
From n To ,=3(7 Ft.
Hfi
LOCATION SKETCH 0
Amoc:a , TA- S Show direction and distance in miles from aaJeast
Wall Thickness two State Roads or County Roads. Include roael :T,
Depth Diamf�eter or WcalitFt. Mat riai numbers and common road names.
To ). FL % C R.:)1 �k
/� Material
6_
0471 DAP'
Method
(Y).LiO
From To Ft.
14. SCREEN: Depth Diameter Slot S'iza Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
IV
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONST .IC NG THE WELL DATE
Submit the original to the Division of Water Quality, Ground gdti C4n
Section, 1636 Mail Service (e1- Raleigh, NC
27699-1636 Phone No. [phone], Within 30 days. i : ,;G�'-1 REV. 07/2001
J
._C ZCCd
L.

277451
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cJim 5 I')-n lj fs� CERTIFICATION # /74P
%YELL CONTRACTOR COMPANY NAMK Y`j f7111/10ytr4 I Dell 41,6 II:IS 4 cZ� Q(j� ]�rke, PHONE # e6Sa. i_.-3 Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W1RERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential f<YMunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TR-,v�CLin/ 4 & CountyF/0 GrxJ
aloe/ R"/1/ ) n C`nr n rn,-, 2a— �c-7 3 I/
(Street Name. Number, Commitmity, Subdivision, Lot No., Zip Code)
3.OWNER: (4- C'c\Yo OOJ'F
Address t Si C, n�eYLs 12- e&_
(Street or Rout o.)
rila nU I at) NC_ nZ %
City or Town State Zip Code
1-1-9 — 2/6' 3 /
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 75'
graphic/Land setting
Idge ❑Slope DValley DElat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O - 3'
& R' /09
/09'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 3
7. STATIC WATER LEVEL Below Top of Casino: FZ.) 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 kIJ/11/2/_!,(--.
10. WATER ZONES (depth): Pi(' cid 0
11. DISINFECTION: Type 1f»
12. CASING:
Depth
From 0 To /C9 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To rT) Ft.
Diayneter or Wei ohL Ft. Mate al numbers and common road names. W
S12(j.7)' ��
Material
02'Ir a
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO`VSTRCTING'THE WELL DATE
Submit the original to the Division of Water Quality, Grodit eli ter Section, 1636 Mail Servldd da,'rlter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. IIIIII I-1 REV. 07/2001
L.
5-2 nr4- /771-r
r-- r'et n > 7tC
LOCATION SKETCH
Amount ,- [14 1:3 S Show direction and distance in miles from at least _.
Wall Thickness two State Roads or County Roads. Include tllsoad--
t

277450
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl-- Division of Water Quality - Groundwater Sectionn/ -
WELL CONTRACTOR (INDIVIDUAL) NAME (print):he, nlilS I'IY7 I)Ody\�� CERTIFICATION# d-/7 y'
%YELL CONTRACTOR COMPANY NAM& a)) C !.I01/2/1J Olett)'vi)Iru J-n C l PHONE in(_s2. ti-3 240
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WI ERMIT#
(if a. .linable) (if a. .linable)
I. WELL USE (Check Applicable Box): Residential &Municipal/Public 0 Industrial 0 Agricultural 0
Nionitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 4 t-k /J /Li County (fit-)
biographic/Land setting
�q L /-,YJ- Idge ❑Slope ❑Valley ❑Flat
//
I, 4/ r (e,ei/ fztSt e f2-/C,a — ?C}L t /i /' /2 (J. (check appropriate box)
(Street Name. Numbers, Community., Subdivision, Lot No., Zip Code) d wJ 3 Y Latitude/longitude of well location
3. OWNER: CSC' in Yl) s (r`-e e e• -e re (degrees/minutes/seconds)
Address S// SC : C e a-0 (I I) Q Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box)
Ai e (,0 Port 1& e h 4e1 lam. I , 3 V (o s a-- DEPTH DRILLING LOG
City or Town Stafe- zip Code From To Formation Description
(L27)- ge4 _ 7q 02. le p .72 5'
Area code- Phone number r r2 5 ' 4.3
'
4. DATE DRILLED A / — 0 3 LE_' ' .---)rS' /Lc c,a e: f-C-
5. TOTAL DEPTH: e2(4 S..'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 17:1-
7. STATIC WATER LEVEL Below Top of Casing. ,57) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): .2 f METHOD OF TEST
10. WATER ZONES (depth): 7X'
LOCATION SKETCH
11. DISINFECTION: Type R t» Amount .2 %A- /3 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diapeter or WcighVFt. Material numbers and cornmon road names.
From 0 To // "3 Ft_ in " S.(> p .i77) Pr 0--
From To Ft.
From To Ft. 0
0
13. GROUT: Depth Material,./ Methodl b.
From O To r±X Ft. conhJ, / fl JL'L) a
From To Ft. —
14. SCREEN: Depth Diameter Slot Site Material
From To Ft. in. itt.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Zl:.tcrial
From To Ft.
From To Ft.
:.c
5-,
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pir of bit 0 -e0 ?—,l - 03
SIGNATURE OF PEI2SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, GrounckW-at,er Section, 1636 Mail Service Cen$ft - Raleigh, NC
27699-1636 Phone No. [phone], within 30 clays. i
1101(At jl REV. 07/2001
tel
LFrL R S n `i:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qual
VAELL CONTRACTOR (INDIVIDUAL) Y.&?IE (print) Jaynes B. Brown
w ELL COST R:ACTOR CO.\IP.ANY ,NA\IE Hedden Brothers Well Drilling, Inc
277683
ity - Groundwater Section
CERTIFICATION (a 2045
PHONE d ( 828 369-9591
STATE \\ EI.L CONSTRUCTION PER\llT7 ASSOCIATED \VQ PER\IIT
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential` :Niunicipal'Pu'blic 0 industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use.
WELL LOCATION:
Nearest Town: Frank] in
Walnut Cove Rd
County Marion
(St.-ee: Nome, N'smbers, Community, Subdivision. Lot No., Zip Code)
3, 0AWNER: John Miller
Address 20 Cherry Street
(Street or Route No.)
Franklin, NC 28734
C uc or Town State
($2$)- 524-3508
Zip Code
.Area code- Phone number
4. DATE DRILLED 7-17-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO )3K
7. STATIC WATER LEVEL Below Top of Casing: 125' FT.
(Use' -r" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (epm): 25 METHOD OF TEST bl ow
10. WATER ZONES (depth): 1 20' -& 132'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight"Ft. Material
From 0 To 53' Ft. 6" pvr
From To Ft.
From To Ft.
I3. GROUT: Depth Material Nlethod
From 0 To 20 FtLsnnlite & wteaaL pitpal
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Tc Ft. in. in,
From To Ft. in. in.
15. SAND:GRAVEL PACK:
Depth Size :Alaterial
From To Ft.
From To Ft.
16. REMARKS:
Topographic Land setting.
❑Ridee ❑Slope ❑\'alley ❑Flat
(cheek apprepria:e box)
Latitude:'tonsitude of well location
(degreeslm-..;:es seconds:
Latitudelongitude source'.❑GPSOTopographic map
sillek box)
DEPTH DRILLING LOG
To Formation Description
53' clay & sand
From
0
53'
300' Granite
C..)
LOCATION SKETCH Show direction and distance in miles from dt least:-_ -_
two State Roads or County Roads. Include [file road ;-
numbers and common road names. _o
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION SARDS, AND THAT A _PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN R
SI NATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 ,Hail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-32221, within 30 days. GVW-I REV. 07/2021
c-
G

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qual
\\ ELL CONTRACTOR (INDI\'IDUAL)NANIE (print) James B. Brown
R'ELL CONTRACTOR CO\IPANv N AME Hedden Brothers Well Drilling, Inc
277682
ity - Groundwater Section
CERTIFICATION it 2045
PHONE [phone]
SLATE \\EI.L CONSTRUCTION PER.\IITif ASSOCIATED KQ PER\IIT=
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NIunicipal:Public ❑ Industrial 0 .Agricuitural ❑
Ntonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest Tov.nanklin
Fulcher Rd --Well #2
County Macon
(Street Name, Numbers, Community, Subdivision. Lot No.. Zip Code)
3 OWNER: Van Rogers
Addrass 3052 Georgia Rd
(Street or Route No.)
Franklin, NC 28734
Topographic Land setting
❑Ridge DSlope ❑\'alley ❑Flat
(cheek appropriate box)
Latitude. :longitude of well location
(degrees':::ir.u:es seconds)
Lar.tuda.1ongitude source:0GPSOTopographic map
(check box)
DEPTH DRILLING LOG
City or Town State Zip Code From
(828)- 524-6764 0
Area code- Peace number
4. DATE DRILLED 7-1 6-03
5. TOTAL DEPTH: 1200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOK1
7, STATIC WATER LE\'EL Below Top of Casing: 0 FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS 2 FT, Above Land Surfaces
`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 blow
10. WATER ZONES (depth):
79'
To Formation Descriction
79' clay & sand
1200'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Rail Thickness
Depth Diameter or \Ceieht.'Ft. Material
From 0 To 77 Ft. 6" pVc
From 81 Ft. 6" 188 steel
From
77' To
To
Depth
To
To
Depth
To
To
Ft.
13. GROUT: Nlarcria! Method
From 0 20 etbentnite & c.citrsiL lanced
From FL
14. SCREEN: Diameter Slot Size Nla!erial
From Ft, in. in.
From Ft. in. in.
15. S.AND:GRAVEL PACK
Depth
From To
From To Ft.
Size
Ft.
16. REMARKS:
Material
granite
W
0)
LOCATION SKETCH 1 - Show direction and distance in miles from'ztlleast
t\vo State Roads or County Roads. Include r, e road-=:
numbers and common road names. c.,
W
o
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL L
CONSTRLICTIO:DARDS, AND THAT A � PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 sail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\V-I REV. 07,2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
RR ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR CORI PANY NAME Redden Brothers Well Drilling, Inc
STATE \\EI.L CONSTRUCTION PERMIT= ASSOCIATED \\Q PERMMIre
(if auolicable) (if anplicab1e)
277681
- Groundwater Section
CERTIFICATION = 20d-5
PHONE = ( 828 369-9591
I. WELL USE (Check Applicable Box): Residential Mx Municipal Pilule ❑ Industr:a! 0 Agriau'1.tura'1. 0
Nlonitcring ❑ Recovery ❑ Heat Pump ?Water Injection ❑ Other 0 IF Other, List Use
WELL LOCATION:
;Nearest Town:Franklin County Macon
Rose Creek RD-rd just before Desota Place
(Street ,Norse, NamP.ers. Co. -amenity, Sabdi visbn, Lo: No., Zip Ccde)
3 OWNER Jenkins & Parrish
Address PO Box 1026
(S:ret or Rcute No.)
Franklin, NC 28744
City or Town Stare Zip Code
( 828- 421-1026
Area code• ?bone r.,:r,ber
4. DATE DRILLED 7-30-03
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO <
STATIC WATER LEVEL Belov. Top of Casing: 550 FT.
(Use "-" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated ator below land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD(gpm): 5 NIETHOD OF TEST h1ow
10. WATER ZONES (depth): 30S& 670'
Topographic Land setting
CRidge ❑Slope C'Nalley ❑'Fiat
'cheek apa..nate .cv)
Latitude longitude of we:1 location
Latitude
ource: GPS❑Tc, , __ c map
DEPTH DRILLING LOG
From To Formation Description
0 149' clay & sand
149' 700' granite
I L DISINFECTION: Type H T H
12, CASING:
Depth Diameter
From 0 To 147'Ft,
From 1 47' To 151 ' Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftterionite & ,_area iL RAT
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
From To FL in. i-..
15. SAND :GRAVEL PACK:
Depth Size Meter: al
6"
6"
Amount 16 oz
VA'aL Thickness
or Weight FL N1?:aria';
rue
.188 steel
From To
From To
Ft.
Ft.
0
W
1
LOCATION SKETCH o `-
Shove direction and distance In miles from at least cn
t•an::,
two State Roads or Count;- Reads. Ine!ude h:ca
0
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH i5A NCAC 2C, WELL
CONSTRUCTIONS RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOTE, WELL OWNER
-o`
SIGNATURE OF PERSON C
Submit the original to the Division of\\ater Quality, Gr
27699-1636 Phone No. (919) 733-322I, within 30 days.
j u CTING THE WELL 4
ifrt 1wnter Section, 1636 Mall Selk c�
LL' ,LJ
DATE
enter - Raleigh, NC
OW-1 REV. 07.2001
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
SWELL CONTRACTOR(INDIVIDL'AL)N AME (print) James B. Brown
WELL CONTRACTOR COMP.A.NS NAME Hedder1 Brothers Well Drilling, Inc
277680
- Groundwater Section
CERTIFICATION=2045
PHONE a ( 828 369-9591
SLATE WELL CONSTRUCTION PERMIT= ASSOCIATED \VQ PER7[IT=
(if aoalicable) (if avolicabl:)
WELL USE (Check Applicable Box): Residential ❑ Municipal Public» Industrial ❑ A,ricuit,:ral 0
Monitoring ❑ Recovery 0 Heat ?um? Water Injection ❑ .. -..- r . Te ns-•
2. WELL LOCATION:
Nearost Town. Franklin
Burningtown Baptist Churc
Wel1N::ne N''.unbe;s. Cocnr.unity, Su'odi isiot, Lot No., Zip Code)
7. OWNER Macon Program for ProareGa
Address PO Pnx 700
Count: Macon
(Street or Rout: No.)
Franklin, NC 28734
Cits or To.sn Sate
( 828- 524-4471
Zip Code
Area code- Pb aim nc-.ber
4. DATE DRILLED 7-28-03
5. TOTAL DEPTH: 150'
6. DOES WELL REPLACE EXISTING WELL? YESXQ NO 0
7. STATIC WATER LEVEL Below Top of Casing,: 25 ET.
(Use "+" if Above Tap of Casing)
5. TO? OF CASING IS 2 FT. Above Land Surface
-Top of casing terminated at:or below land surface requires a
variance in accordance w'lth 15A NCAC 2C .0113,
9. YIELD (spm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 40'. 90', & 105'
11
DISINFECTION: Type H T H Amount 16 oz
CASING: \ca:l T'hick-.,ess
Depth Diameter or V.eight'Ft. Material
From 0 To 28 Et. 611
From 28' To 37' Ft. "
pvc
-128 steel
am
From To Ft.
3. GROUT: Depth VMateriai Method
From 0 To 20 Fticanite & cntet:L Fx7t 7
From To FL
14. SCREEN: Depth Diameter Slot Size Nta er;al
From To Ft. i. in.
From To Ft. in. in.
15.SAND GRAVEL PACK:
Depth Size Material
From To Ft
From Tc Ft.
16. REMARKS:
vc,c
Topographic Land setting,
❑Ridee ❑Slope ❑A'alley :Flat
...e:'�aeprortiatr rex)
Latitude loneitude of voeil location
Latitude 1 �i'u;
DEPTH
From, To
0 30'
:-GPS:Tcpo_ rnao
'zh_--'roc)
- DRILLING LOG
Formation Des-rir-!a..
clay & sena
30' 150' granite
0
Cr.
LOCATION SKETCH .4 -,
Show direction and distance in miles from at tYst
t'..o State Roads or County Roads, Include t;ht,, ad ,
numbers a. and comon mnad names. O
0
I DO HEREBY CERTIFY THAT THIS WELL AVAS CONSTRUCTED IN ACCORDANCE WITH i 5A NCAC 2C, WELL
CONSTRUCTION ST„ARDS, AND THAT AACCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 /e PC-0->"7-"T")
7 -2--7 r)_3
SIC\ ATU.&E OF PERSON CONSTftzeEeING Tl:. AA °;,L T'
Submit the original to the Division of AA ater Quality, Groundblia.dtie-3-6316MaH-�rr.+ee nt F Raleigh, NC
27699-1636 Phone No. [phone], SS ithin 30 days. l i i 1.), Pr; .: V. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
\\ELL CONTRACTOR COMPANY NAME Redden Brothers Well Drillina• Inc
STATE \\ ELL CONSTRUCTION PERMIT= ASSOCIATED \\Q PERMtlT=
(ir aco :cab'.e)
(if aco:icable)
277679
Groundwater Section
CERTIFICATION = 2045
PHONE # ( 828 369-9591
WELL USE (Check Applicable Box): Residentiai ❑ Nlunicipal
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑
2- WELL LOCATION:
Nearest Town: Franklin
Bur-ni.
taireot Nr:ne, N:.:Hoer. Con:r..unity. su'odlvi;:or., La! No, Zip Cod:)
County Marnn
We2ll
3. O�;vNE, Macon era ram for PrnJress
Address PO Box Inn
($:Feet or Rook No.)
Franklin, NC 28734
City or Torso Sate
( 828 524-4471
Area code- Phone rr�nber
4. DATE DRILLED 7-28-03
5. TOTAL DEPTH: 100'
6. DOES WELL REPLACE EXISTING WELL? FES%X NO 0
7. STATIC WATER LE\'EL Below Top of Casing: 50 FT.
(Use' =" if Above Top of Casing)
E. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated at'or below land surface requires a
variance in accordance eith ISA NCAC 2C .0118.
S. YIELD (2prn): 30 METHOD OF TEST blow
10 WATER ZONES (depth): 45' & AO'
Zip Code
I I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or A1'eiaht'Fr. Material
From 0 To 26 Ft. 6" 188 steel
From To Et.
From To Et.
13. GROUT: Depth
From 0 To 20
u'blicIndustrial 0 A rict:'.hural 0
am
Ntateria1 Ntethoc
Fibs -mite & usii=ti Anti 1
From To Ft.
14. SCREEN: Dep:b Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAN'D'GRAVEL PACK:
Depth Size Material
From Tc Ft.
From To Ft.
Topographic Lard setting
❑Ridge 0Slope ❑Valley ❑Flat
I C.'. eok pro -ri'•Lois(
Latitude longitude of veil location
-
Latitude ilonittide sour.e, GGPS❑Toe _ =hit rage
'we)
DEPTH DRILLING LOG
From Tc. Formation Description
0 24' clay & sena
24' 100' a3anite
O
LOCATION SKETCH
Show direction and distance in miles from at t t —
t'vo State Rcads or County Roads. Include thxrdad tr,,,z
O
O7
numbers and common road names.
16. REMARKS: Well to be abandoned ASAP Reports filed with date
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE VWITH I5A NCAC 2C, WELL
CONSTRLCTIO\,S�{N. ,�ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEE WELL OP.IER
POI O
SIGNALL1<E OF PERSON CONSTRL' Ti.NGu3H4
iL
Submit the original to the DINision of Water Quality, Ground\kp tection 1636 N-13i1S—e'r-Trd,e te�rl�j Raleigh. NC
REV 0" 2001
27699-I636 Phone No. (919) 733-3:21, within 30days. 'I ,r
V

WELL CONSTRUCTION RECORD
North Caroling. - Deportment o` Environment and Natural Resources - Division of Rater Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
\\ELLCONTR.\cTORcomP.ANYNA.MEHedden Brothers Well Drillinc. Inc
277678
Groundwater Section
CERTIFICATION 2045
PHONE _ ( 828 369-9591
STATE WELL CONSTRUCTION PERMIT= ASSOCIATED \\Q PERMIT
(ifacniicable) (if aonlicablel
I. WELL LSE (Check Applicable Box): Residential V Municipal. Public ❑ Industrial ❑ Adricu:tura'i. ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 IPOther, List Use
2 WELL LOCATION:
Nearest Town: Franklin
150 Deercrossinci Rd
County Macon
(Street N.nne, Nuhn'beft, Community, Sub •vision, Lot No, Zip Code)
3. OWNER: Mrs. Chole Goodman
Addr,ss 150 Dccrcrossinq RD
(Street or Route No.)
Franklin, NC 28734
C :v or T.,.r Sate
( 8281- 369-3467
Zip Code
Arta code- P'houe.nu:-,her
4. DATE DRILLED 7-9-03
5. TOTAL DEPTH: 350'
6. DOES WELL REPLACE EXISTING WELL? YES 0 N0
7, STATIC WATER LEVEL Belov. Top of Casing: 100 FT.
;use "—" r Above Tap of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated at'or below Iand surface requires a
ariance in accordance with 15A NCAC 2C .011S.
9. YIELD (gpm): 80+ METHOD OF TEST bl nw
10 \VATER ZONES (depth): 332'
I I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Th:ckness
Death Diameter or Weight:Ft. A!aterial
From 0 To 97 Ft. 6" pvc
From 97' To 101 Ft. 6" -18R steel
From To Ft.
i3. GROUT: Depth Material Method
From 0 To 20 Ftteniite & etLad tL RTi-F3
From To Ft.
14. SCREEN: Depth Di.:t eter Slot Size Materiel
From To Ft. in. in.
Fror.. To Ft. in.
15. SAND 'GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic Land settir._
❑Ridge ❑Slope ❑\'alley ❑Fiat
ehae'eappropriate 'ace)
Latitude'loneitude of well location
L_:Itude lon_i:ode source:OGPSOTcpoeraphic map
-_:e:xbon?
DEPTH DRILLING LOG
From To Formaticr. Descrction
0 99' clay & sane
99' 350' granite
W
J
'D
LOCATION SKETCH tort
Show direction and distance in miles from atast
rod State Roads or County Reads. Include t'rRcadal
numbers and corm -non road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STA. RDS, AND THAT A CO>4 OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/
SIGNATURE OF PERSON CONStRU;CTING THE WELL FWAT -I
Submit the original to the Division of 1A'ater Quality, Groun:tl'vrater Section, 1636 Alail Service dtehter Raleigh NC
27699-1636 Phone No. [phone], within 30 days. '.GKW I REV. 07 200:

277677
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
\VELL CONTRACTOR (INDIVIDUAL),N AN1E (print) James B. Brown
\\ ELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc
STATE \\EI.L CONSTRUCTION PERMIT; .ASSOCIATED N'Q PERMIT=
(i`aonlicab'i.e) (if applicable)
- Groundwater Section
CERTIFICATION 6' 2045
PHONE _ ( 828 369-9591
1. WELL USE (Check Applicable Box): Residential V Municipal Public 0 Industrial ❑ .Agricultural 0
tAionitorine ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 I[Other, List Use
2. WELL LOCATION:
Nearest Tovvn: Franklin Count} Macon
Ledford Rd to Hoot Owl Rd
(S, teat 9::nee N:ambers, Con.irunir:, Subdivision. Lot No., Zip Codo)
3. OWNER. Elizabeth Henry
Adiodss 27 Parkridge Drive
(Street or Roae No.)
Franklin, NC 28734
Ctm or Town State Zip Code
(828)- 349-0730
Arta ode- Phone cumber
4. DATE DRILLED July 18, 2003
:. TOTAL DEPTH: 150'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casino: 76 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 I5A NCAC 2C.011s,
9. YIELD (gpm): 30 METHOD OF TEST hlow
10 WATER ZONES (depth): 80', 105', & 130'
I . DISINFECTION: Type H T H Amount 16 oz
12 CASING: Wall Thickness
Depth Diameter or V,'eI^_ht'F . Material
From 0 To 42 h 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth ,Nlaterial Method
From 0 To 20 Ft.isnUth & permit tzircxl
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in. in.
15.SAND.GRAVELPACK
:
Depth Size Material
From To Ft.
Topograp is Land set.ir:_
❑Ridge ❑Slope ❑Va'.lev ❑Flat
(check ap_ro -ant
Latitudelongitudo of vyell Location
Ltcudelanai:,de source:EGPSETcpocraphicr.)a
DEPTH
From To
0 40'
DRILLING LOG
Formation Desori_don
clay & sand
40' 150' granite
CO
n
LOCATION SKETCH ' =
Show direction and distance in miles from atl' st i=;
t.yo State Roads or County Roads. Include the load Co f;;,'_
numbers and common road names.
O
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON'STRUCTIO.' .A 'DARDS, AND THAT A JPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� s
SIGNATURE OF PERSON CONSTRL
Submit the original to the Division of Water Quality, Ground\\
27699-1636 Phone No. [phone], vrithin 30 days.
tflN'c"z' ��rEL 'Dig
iitr- ,Fedor, 1636 sail Service Ce4)t�r -1
is
aleigh, NC
EV. 07:'200:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section"�/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �t'�+ (/�' �� CERTIFICATIIOONN 1Von/`
e I/0V, //,. itlf C PHONE it
WELL CONTRACTOR COMPANY NAME ( / 24/1 e 4'2 6
STATE WELL CONSTRUCTION PERMITS/ __ASSOCIATED WQ PERMITS/
(if applicable) (if applicable) n
;
m ;
m
1. WELL USE (Check Applicable Box): Residential-er Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery Cl Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N Town: LOCATION,:
Town: County 47/91-64+
u/y e
(Street Nam , Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address //G'y...7r
(Street or Route No.)
City or Town State
(_ 3-
///le/' .cQ.h-//r
J573/
Zip Code
Ares code- Phone number,
4. DATE DRILLED // (/- t/3
5. TOTAL DEPTH: .205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: I/O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
`Top of casing terminated at/or below land surface requires a
variance in accordwe aith 1SA NCAC 2C .0118.
9. YIELD (gpm): t METHOD OF TEST R. ✓
10. WATER. ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
0
From To SI Ft. 10 Vtf
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To ,�-t Ft. Gear A 1 t�Uv„J, it y
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From______ To Ftin. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
rur
1.7) a
Topographic/Land setting 6,7
❑Ridge ❑Slope ❑Valley ❑Fla
(check appropriate box) �,ci
Latitude/longitude of well location T o
c1
m
(degmalmimttedeaonds)
Latitude/longitude source:❑GPS❑Topograpvc map t
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0
m
n
tr
L.
V,nl
CS?J
UVl
4- 56
64" eyr , fv
LOCATION SKETCFL
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/2_72,—/ .727/a-4-1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
))

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ,, Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME��yy (print) rut)' i:C97^IZ_ CERTIFICATION-#30.27
WELL CONTRACTOR COMPANY NAME I rA%t.% 40,), tn-'e �a 4' iI' 415 ✓, - PHONE # iZ .�y'7f.26
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residentiala Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: n/,('/ A-' County 41, c et)
('/Arts A%az
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 9��Dct}S
Address (I31 cAe-//,;1 �t
(Street 6r Route No.)
AG c 7.}Y
City or Town State Zip Code
C-)
Area code- Phone number
4. DATE DRILLED `7 -3 a-)
5. TOTAL DEPTH: Yd
6. DOES WELL REPLACE EXISTING WELL? YES O,NO 0
7. STATIC WATER LEVEL Below Top of Casing: jj 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 regdres a
variance hi accordance_th ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 4 . Y
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
th
From D To 9a Ft. b7r
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To 2C) Ft. /e.14o7,01 /11 G vi by
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From_ To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fla
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographi
(check box)
DEPTH s' IN
From To Formation Description
.1- y
3J
run
m
rt-11
n—+
Ti
Zia
cl
map
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material
�numbers and common road names.
i
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4dc, 42 /d - 0_3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
nna
w�

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i�nhl S ii-Of IA rk. CERTIFICATION .1/7 le
WELL CONTRACTOR COMPANY NAM j(}p(I(Z.ta bie..0v41I q �-P{(r v PHONE p 111,5-o214-3 ;26
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential O - Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Jy '/Jj/ C51-nr(q County Art (0-n
/- (fit) Caip re a_ a S'7 V/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -3-22-n aR-S (c
4. DATE DRILLED - t-I —D
5. TOTAL DEPTH: 7(s'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley P1F#a�
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address /a3 p r[t,L t Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No,) (check box)
I a - S /l/ C- c� g 7 (f DEPTH DRILLING LOG
or Town S e zip Code From To Formation Description
(E85- Sad- s3 2- r) ' I J
Area code- Phone number -; / ,. 7/7 s fi /(, (1i7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: 91') FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHQQD OF TEST,_-
10. WATER ZONES (depth): /it) ' .S7S/
11 DISINFECTION: Type
12. CASING:
Depth
From 0 To
To
//f"f-/ Amount ,-2
WallorWThickness
Dia eter eighFt. Mate
Ft. %" 5Zt R /V/ 1)Ft.
To Ft.
13. Depth Material
To ri(D Ft. Corn i �1
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
From
From
GROUT:
From n
279518
c
v t—rn
tv c<
lD Cc
ti
rrl
V
N
mz
5 Show direction and distance in miles fro (.at lea
two State Roads or County Roads. Includtethe road
y� numbers and common road names. Z
Method
4' A-/
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC.1 bD IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH{{S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

279517
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) t'h-e no 5/41')] )Qn rU CERTIFICATION #r /o
/�7 `
WELL CONTRACTOR COMPANY NAMQ' (r&)(L1J �l)P.11�lrtt l�'k ,�,n ( v PHONE n10%1Iso2 (/ 3 26
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMIT4
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential CVMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: 'Pie 0 V / 1o3 County An
I Q_ C!'7v
to�r-E• J eIIiV'recoRcA_ .iC73
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Cede)
Topographic/Land setting
DRidge m.Slape ❑Valley ❑Flat
(check appropriate box)
Latitudeilongitude of well location
3. OWNER: Fr o m k E, Pi ( �fl V e t an --( a h a,v C.li__„ (degrees/minutes/seconds)
Address o?,S65 i'?el/ PY;ea) Plc' /2c1 Latitude/longitude source:❑GPS❑Topographicmap
(Street/or Route No.) (check box)
/rd i L/ 4/Al/� DRILLING LOG
City or Town Stay, z C Formation Description
7,9' 9.7'
9 7 ' /n(' Vee.m4e, te/rf
13. GROUT_
From n
From
14. SCREEN:
From
From
4
5
6
7 o 3
p Code
DEPTH
From To
Area code- Phone number SQ: nc� �7h'r-ems
DATE DRILLED ./— 02 3 _e 3
TOTAL DEPTH: 02 `%.S z
DOES WELL REPLACE EXISTING WELL? YES ❑ NO / U Z G Y2nFY
i
7. STATIC WATER LEVEL Below Top of Casing: /3 (^ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD(gpm): ,!O METHOD OF TEST //awv/7titm
10. WATER ZONES (depth): //(9 .,2 S'
I I. DISINFECTION: Type ft�'N Amount
z
co O
co nrn
LOCATION SKETCH 0 om
r" T,-.j S Show direction and distance in miles from leasb�
12. CASING: Wall Thickness
Depth /
From 0 To /Q N Ft.
From To Ft.
From To Ft.
Depth Material To Ft. �,lp�,�
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
Dia eter or Weight/Ft. Material
5 R ,7 j' p
Method
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
srn
two State Roads or County Roads. Include t e roc
numbers and common road names. s rn
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 HQS BEEN PROVIDED TO THE WELL O JJEa__-.--.�.:�
IV
tn
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279516
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�\Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c/)?Di'll sltn/i(Li\ft CERTIFICATION #_el/Ile
WELL CON'TRACTORCOMPANY NAME( c Im, `ION,r4 H1)eilYeit I'k �(j )-PI e) PHONE # i�S(i._Sa2 L/--3 7,26 U
S'f ATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Yd---"Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 07/7) /1/
44 / S IIT ;OttIck
t
(Street Name, Numbers, Community,
(2- County All (c (eV .
f3 — S h ark I) 1-I-r I I rt L IL
Subdivision, Lot No.. ZiVCode) g g b 3
3.OWNER: -f. lXrlLIt'0)2
Address -;10 5 6%ti6; 1 1' 1101r! L 1L
(Street or Route No..)
hiC/Ikt_r'Al (
c73y
City or Town State Zip Code
'..`?/r%�/ -
Area code- Phone number c 1 C
4. DATE DRILLED 7— 1 1 — D 3
5. TOTAL DEPTH: <3._
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G1-
7. STATIC WATER LEVEL Below Top of Casing: c (l 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): 4/1(25 METHOD OF TEST A/01Zi/7t-C,f-�
10. WATER ZONES (depth): /70' - 7 !\' 6
LOCATION SKETCH T
II
12. CASING:
From 0
From
From
13. GROUT:
From (i
From
DISINFECTION: Type
Topo ra /Land setting
❑Ridge lope ❑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
l61
DEPTH
From To
%ra'
(A y •
VPCIn;rc lit -Cs
RiaLa j-r4r\:
C
O _
Amount '4 AS Show direction and distance in miles froi
Depth
To //1V Ft.
To Ft.
To Ft.
Depth
To (-)D
To
i4. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Wall Thickness two State Roads or County Roads. Includ
Dia peter or Weight/Ft. Mat5yial numbers and common road names.
�,. P1 Q_
Material — Method
FL w,),
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL i ,
CONSTRUCTION STANDARDS, AND THAT A n0�� F�H'S RECORD HAS BEEN PROVIDED TO TH� E� OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
279616
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) pt?-Gk &.44e/� // CERTIFICATION # �`>>--1
WELL CONTRACTOR COMPANY NAME CY/'ro+. !V-�QR- - �JIO.6/(//L /I �y's.h<r PHONE # ��7�/ 6-
STA 11 WELL CONSTRUCTION PERMIT# ASSOCIATED WQ1JPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATIOP
Nearest Town: County n-Lac.•ryr
(Street Name, Numbers, Community, SAdi vision, Lot No.. Zip Code)
3. OWNE
Address'�O
(Street or Route No.)
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 2 €0
5. TOTAL DEPTH: ,5-3.5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: ,e&0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*lop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 'It {i, 5—.METHOD OF TEST t
10. WATER ZONES (depth):
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. e
G
CR
CD.<
yC
^'Im
nz
0
c4
O
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
Front To Formation Description
d - /.?y //1��rQ
/02 t/- ,tl-71 J
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From v To /((95f Ft. v "GA -
From To Ft. /
From To Ft.
13. GROUT: Depth Material Method
From L) To c20 Ft. [� q�__ QJCL
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
From To Ft.
From To Ft
a
0
CO
16. REMARKS: -
i�,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTJ;UCTION STANDARDS, AND THAT A COPY OF THIS RFCORn I -Inc anFxt annv�sn TO THE WELL OWNER
zALA
SIGNATURE OF PERT O
Submit the original to the Division of Water Qualit
27699-1636 Phone No. [phone], within 30 days.
I NTRUCTI[ GTHE IE
ounertati�ID,)si36
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
DATE
c rvice Center - Raleigh, INC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Fed jl/L CERTIFICATION#3d-29/
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable)
(if applicable)
PHONE
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATIO
Nearest Town: t�/y i ytiitee' County `7c tr,ry>.
�EI�1�G. (iP•�fC
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. O\VNER �,
Address.-L-�/-hftpva e
4
5
6
7
)r
(Street or Route No.)
own State Zip Code
)-
Area code- Phone number
DATE DRILLED gat" 0-03
TOTAL DEPTH:
-7
DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
STATIC WATER LEVEL Below Top of Casing: /40 FT.
( Use `+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): it, METHOD OF TEST,
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
279615
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
4--(zgo
r
Depth y Diameer
From C To 1 p Ft. 6 79
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
From To Ft.
13. GROUT: Depth Material Method
From 0 "1'o 0 O Ft. eP7Ztsort- phut
Front To Ft.
14. SCREHN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size ' Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at toast -
two State Roads or County Roads. Include the road.
numbers and common road names.
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2—/o - -
SIGNATURE OF P
Submit the original to the Division of Water Q
27699-1636 Phone No. (919) 733-322I, within 30 d
osPa I eLU3' 16.1
DATE
Service Center - Raleigh, NC
GAA'-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE I3ED21.1h' nrrtr:

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural,�Resources
� Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 5Thadz L f %t4}4CERTIFICATION # JD.j
WELL CONTRACTOR COMPANY NAME I %�/e- Z%Di ��f ��ctryz /y 7/✓G— PHONE # (!/�01C1Z .7-77
STATE \\ ELI. CONSTRUCTION PERMIT# ASSOCIATED \\'Q I'ER\I IT#
(if applicable) (if applicable)
279614
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IfOther, List Use
2
WELL LOCATIO
Town: '1 //,�J.4e/s County Lin 21
C�C 14 /Y✓14,
(Street Name. Number, Community., Subdivision, Lot No., Zip Code)
3. OWNER:
Address
to
(Street or Route No.)
rS24irMid/. kc,
City r Totrn State
a � 775-
Zip Code
)-
Area code- Phone number
4. DATE DRILLED r Svj
5. TOTAL DEPTH: j d 5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1/O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*'fop of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): o METHOD OF TEST /i Y
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley DFlat
(check appropriate bos)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DEPTH DRILLING LOG
From To Formation Description
I1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter � or Weight/Ft.
From U' To . Ft. Y
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To02/
a Ft. (G,/4tA/7Z
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 r Material
From To Ft.
From To Ft.
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O n
C.)
to
m
—o r-
tV o<
CJ1 <_ r
yo
m
CO0 mA
CO
r--
unti
16. REMARKS: ' C3
tt
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL I' 1 '_ri
CONSTRU ' ION STANDARDS,
DS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. i
" S"S,l
SIGNATURE OF PERS
c
Submit the original to the Division of Water Qualit
27699-1636 Phone No. [phone], within 30 days.
N RUC;TINC TEIE WELL
city, S1cYon2U6361f1
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
je
9-/.6 -D.:
DATE
iee Center - Raleigh, NC
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section Cv,t/ip CERTIFICATION trr3b 73
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\VEI-I. COY! CO\IPANY NAME
STATE \VELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
PHONE
279613
1. WELL USE (Check Applicable Box): Residential Oir Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Near``sk� Town: County /T/A-te N
611AC- , Wyp/MVAJ,
(Street Name, Numbers, Community, Subdivision, Lot do., Zip Code)
3. OWNER: tgt
Address Lit 4,4Ph f`oAd
.4/,
(Street or Route No.)
frail/ f'l #A% WC
City or town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED g-a /-OR
5. TOTAL DEPTH: (pCS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: ,00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): " METHOD OF TEST 4:
10. WATER ZONES (depth):
Topographic/Land setting
[Midge ❑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
5-0
5--
11 DISINFECTION: Type
12. CASING:
Depth Diameter
From C.) To 5--b Ft. toe
From To Ft.
From To Ft.
13. GROUT: Depth
From D To ,� o Ft.
Material
Amount
Wall Thickness
or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
/9Jc-
Method
'et
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O o
CO
Cl
y 0"
rri
m
• c c�
fV o<
tJl -1-
• o D
� m
r1
m_
a
O
CO
(
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEI.
SIGNATURE OF PERSC
Submit the original to the Division of Water Quali
27699-1636 Phone No. [phone], within 30 days.
undwater Section, 1636
SEP 1 7 2003
GROUNDWATER SECTION
eurvu i C nrr2111UAI nrrirr
J
DATE
vice Center - Raleigh, NC
GW-1 REV. 07/2001 :',

279:244
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) <ITT) -en s/In /Ian\l�� CERTIFICATION it d./7 ee
V.ELL CONTRACTORCO:Y[PANY NAMES., i (kjla,r3 ll)e���l t(tIk-k t ).YLP l PHONE #ia 1324-3 Zb 6
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Yd�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: t' ) 4"(' - County Oi././Il'C )
1-a-4 I S te<,0 (INC Rg g 7h3
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:— r 2-e-Lt,jOe
Address I a FP I eQ S Q n'-(- CLm U-e- Pr1_
0 HZ) Sweet o Route No.) g 7b
4
5
6
7
9
10 ( P ) LOCATION SKETCH
City or Town State Zip Code
(£ k)- Cf y — S (^
Area code- Phone mmmberr
DATE DRILLED `/ —) S-D 3
TOTAL DEPTH:
IV(Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesiminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-.�/' 0/Cce
DOES WELL REPLACE EXISTING WELL? YES 0 NO p—
STATIC WATER LEVEL Below Top of Casing:.- 2 C. C 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.
YIELD (gpm): c t METHOD OF TEST �L9//1iD£-1�—,
WATER ZONES de Ih : .7.'Z" (�
11
12. CASING: Wall Thickness
Depth Diapeter or Weight/Ft. Mate ial numbers and common road names. S 2�
From 0 To .-2/ Ft. (n" smp,9: COY 1V 'z'%
rnz
From To FL CA c)
DISINFECTION: Type
HIP Amount QTA- P S
From To Ft.
13. GROUT: Depth Material Method
From O To ?2 Ft._eJn n a _n/0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
From To Ft.
From To Ft.
16. REMARKS:
Show direction and distance in miles from ^NEeastm
two State Roads or County Roads. Include tits roady7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
v
G
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH !S R COR HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Section -
\VELLCONTRACTOR (INDIVIDUAL) NAME (print):)/ii) Ylls I"r'i(L-A f+� CERTIFICATION# / r2/7 s{'
\VELL CONTRACTOR COMPANYNAMIK'.0n; S ( IJnMrl 1.01 h'ri ll-4 ).n e J PHONE gge6i,-SO2 y-3 a6
STATE\ VELL CONSTRUCTION PERMIT# ASSOCIATED WQPERMIT#
(if applicable)
(if applicable)
_wu
I. WELL USE (Check Applicable Box): Residential Cf--" nicipal/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: F,Cd2, k'/,,r) Countyla CC,L.)
4////5 Se/See A'.E..P€ Is739/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C-C/G STi 4 3YD JPl'i
Address / 35 Ru.i-h, Led rye 2r(
/ (Street or RouteNa.)
OM4//C i3
City or Town State
Zip Code
fs�Sh <Sa9/, e973
Area code- Phone numbers
4. DATE DRILLED ! .5
5. TOTAL DEPTH: OA
Topographic/Land setting
DRidge DSlope DValley 1�FIat—
(check appropriate box)
Latitude/longitude of well location
(degrees/mi nutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
4(00z
DEPTH
From
a
sa'
".S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO j
7. STATIC WATER LEVEL Below Top of Casing: 'f e-1 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 IUJU, itm
I . WATER ZONES (depth): I/o
I I. DISINFECTION: Type
12. CASING:
Depth Diamj�eter or Weight/Ft. Mate ial
From 0 To VSFt. /�" sz2(3,,i p/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To iifi Ft. (04yn ny.. Y aJ4 A_..A_...).
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size ' Material
From To Ft.
From To Ft.
16. REMARKS:
e- •s
(.)
cam'
o<
LOCATION SKETCH -n`_I\
Amount r-3 TA. S Show direction and distance in miles from a�east�c
Wall Thickness two State Roads or County Roads. Include t�i road,x_
numbers and common road names. •' r"""
N
4T1
0
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAEEN PROVIDED TO THE WELL OWNER
��i 0Q S B9-/s--` 63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResourcesl-- Divisionofof Water Quality - Groundwater Section / -
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) t I/ep I'l l 51 'to /1 �+1 lnJ CERTIFICATIONn/# P7 r{'
WELL CONTRACTOR COMPANY NAME IX.t)nt S (t"1<?jl�%..nr> Wei I lye ji'; 1t�j ].. ri C' J PHONE # %) —5-o2 y'3 :,24
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
279'43
1. WELL USE (Check Applicable Box): Residential fl- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
earest Town: rf!-I 2.LPL<71 County ae(rrt
4�C--1--E;JAy P.-t - T„e-e-Al; e2C2iy
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I2Q.LPLL Ed
Address Q,-,15,1_ A✓en'tix12-J.) fa
(Street or Route No.)
SCerasntL- fl•
City or Town State Zip Code
Rif/ >- 6%Q k (c o3 (
Area code- Phone number 0
4. DATE DRILLED / — f ! _L' 3
5. TOTAL DEPTH: 30'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 171.-------
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
/ (Use "+" if Above Top of Casing)
1
S. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a _
variance in accordance with 15A NCAC 2C .0118. V) G�
m e
9. YIELD (gpm): o2b METHOD OF TEST � WITX.-t '� ��
z�
10. WATER ZONES (depth): . 3dlb" /f�0'
LOCATION SKETCH fVN '�
`mt--
Sc,
I I. DISINFECTION: Type �{-/ Amount %�} 13 S Show direction and distance in miles from 3tyeasI '-
11.1 CASING:
o
Wall Thickness two State Roads or County Roads. Include roa3'm
Depth �-y �,) Din}meter or Weight/Ft. Mateerial numbers and common road names.
fV m
To `1 X Ft. ((, •� Sly �i r �
To graphic/Land setting
Chi iddge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/n:inutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e /a.J
S ca n 7�-5 "i-r -„ ss.
/3/GG rr-Ye?nT3--E_
DEPTH
From To
0 te.3'
(t) 47g'
c
From '� (j,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To Ft._4O4m D} /reil}
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Material
V
e,
1
r_
r—
r
T
rn
CD
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL C`_
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWN -
n_ y 7 _ e63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Gro n wa er Stction
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :Cann arnt P-S 2 . I tl t 1 So <l
WELL CONSTRUCTION RECORD
1 CERTIFICATION# a (
t-i0i
WELL CONTRACTOR COMPANY NAME `r.)`O C WP.0. dr,\\ n03 PHONE 0 fur) 831 -actcri
STATE WELL CONSTRUCTION PERMITS' ASSOCIATED WQ PERMIT'S
ifa licable (if applicable)
1. WELL USE (Check Applicable Box): Residential 12" Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT N:
Nearest Town: a//t2 _
Ccurttyf' \&Oorl
�ux\1us:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J. n,
Address 1%gi-4`1 hJ(al{(ar.
'R(kiapr2. oc_ 2.1T-Vb
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED f7- DI - O.
5. TOTAL DEPTH: 7OSt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i3—
7. STATIC WATER LEVEL Below Top of Casing: 6D' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1a METHOD OF TEST A.�
10. WATER ZONES (depth):
11. DISINFECTION: Type VIA -In clQ)iQi-� Amount 1S`
Wall Thickness
or Weight/Ft. Material
12. CASING:
Depth Diameter
From D To 60' Ft. /o,a5- Snc?l cvr
From To Ft.
From To Ft.
13. GROUT: Depth M;�t( rial \ Method
From D To , .A' Ft. Pt\C11nNe\QI . ICPKSCI-P
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(Street or Ro a No.)
Topographic/Land setting
DRidge IlJ�pe ON/alley ❑Flat
(check appropriate box)
T titnde/longitude of well location
1- 5Si 2 VI tAighz, '
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
-7rho ao(cr) C(k'k
o
a
DEPTH
From To
- S'
L,f7` - 3DS'
16. REMARKS:
LOCATION SKETCH
0
Show direction and distance in miles from a astr�
two State Roads or County Roads. Include roat
numbers
and common road names. _ z m
1 P�J'oA° J om ✓11
>O O
'-1
ao
mr
R eScu Q
a^5
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
A 2: ,Qii..-vim 7 - v i k
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
^
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. li.'.r-1 REV. dv[2001

WELL CONSTRUCTION RECORD 278998
North Carolina - Department of Environment and Natural Resources/ - Division"viof Water Quality - Groundwater Section //
WELL CONTRACtOR (INDIVIDUAL) NAME (print)/71 52C,r eiv. . CERTIFICATION 41/7/%
\VELI. CONTI(ACrOR COMPANY NAME Y r-"-w Gt�7z PHONE # 1�19�G
soot WELL CONSTRUCTION PERVIIT# ASSOCIATED AVQ PERI\IIT#
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialL Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
? WELL L owrx )��
Nears,�Towrlc_ County / t' LGshatD
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(3treet or
ute No.)
y .., Star Zip Code
77,2
Area code- Phone number
4. DATE DRILLED Lei '�3o -AD 3"
5. TOTAL DEPTH: i-605
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 'Mickel FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / 5— METHOD OF TEST Q U
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Depth
From d To rc, Ft
Front To Ft
From To Ft
13. GROUT: Depth
Front 6 To r9-3 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From 'I'o Ft. in.
From To Ft. in.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
fur_
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
Material Method
pOi
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size
Front To Ft.
Material
From To Ft.
16. REMARKS:
0
CO
t *1
"O
LOCATION SKETCH 'O ��
m
Show direction and distance in miles from mast :Jcrn
two State Roads or County Roads. Include tritiroatt
numbers and common road names. -1
CFI O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/20011
0

278997
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
q
WYELI. CONTRACTOR (INDIVIDUAL) NAME (print) Z C�-r f-f4%%� CERTIFICATION#.-N�//`p�
PHONE p 0� Sw2f-'�'=9%4
WELL. CONTRACTOR COMPANY NA\IE �.Ff1/L St -es,
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERt\II'I'k
Of applicable) (if applicable)
WELL USE (Check Applicable Box): Residential -if". Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: .( �lf-r p�e-� County `y2'Cl%rrins)
(Street Nance, Numbers, Community, Subdivisbt, Lot No., Zip Code)
r
3. OWNER: .G( 4;7/1
Address (7 �) '"/11 / /
(Street or Roum )
/J ' /ems 7t7/r
C tv or 1 own State Zip Code
-,gD('TO3 Lel
Area code- Phone number
4. DATE DRILLED to-5 -O3
5. TOTAL DEPTH: O5�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. �y ��
9. YIELD (gpm): c Gr-
METHOD OF TEST �n
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diarieter or Weight/Ft. Material
From 0 To "zo Ft. V 21�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Method
From 0 To Cz Ft. CQ7'Yl¢„-� Otivre -
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/in i mutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
� — 96 elaJy
— 9 O5i
c
0
LOCATION SKETCH
Show direction and distance in miles from i eastm 2
two State Roads or County Roads. Include lhi r
numbers and common road names. O _
A _-
0
O
Ca?
O
16. REMARKS:
I DO HEREBY CERTIFY THAT TEIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636Phone No. [phone], )within 30 days. GW-I REV. 07/2001
7 1_

WELL CONSTRUCTION RECORD 2 7'S 9O
North Carolina - Department of Environment and Natural Resourcesq- Division of Water Quality - Groundwater Section /� WELL CONTRACTOR (INDIVIDUAL) NAME (print) r/P 627/9e— CERTIFICATION d�01
VDELI. CONTRACTOR COMPANY NAME (',j'QnTe te/�en PHONE # wvt7j 7-yJ.��
STATE WELT, CONSTRUCTION PERMIT# ASSOCIATED WQ PER\IIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential.' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION
Nearest Town: ^, 41Gy4„) Countyfit ,¢9ya_a
/o40 f (h z.l 7.a.1
(Street Name. Numbers, Community, Subdi visiotfLot No.. Zip Code)
3. OWNER( d-X•
C,��iyL,7
•
(Sleet or Route Not
Address
7 T�
or loss State,. Zip Code
3
Area code- Phone number
4. DATE DRILLED /7 4/3
5. TOTAL DEPTH: F'-5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance s ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST Qti'U
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate bo.x)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth p Din er or Weight'Ft. Material
From D To L 0 Ft. //_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To, ei Ft. (7fJ ?, 126) te--7
From To Ft. d
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:
W
G
CA ��
ern
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names. tV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC ('--_ --
�..
27699-1636 Phone No. [phone], within 30 days. j{ GW-I REV. 07/20U1 J`--y----

WELL CONSTRUCTION RECORD 278995
North Carolina - Department of Environment and Natural Resources - Divisionrof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME rint) •cal CKA7Yist CERTIFICA ION #36/7.7/
\VEL1. CONTRACTOR COMPANY NAME ��/"{� .�_____ PHONE # .e
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERNIIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQ1y'
Nearest Town: -1.-,At�_4 County
r
(Street Name. Numbers, Community, Subdivij in, Lot No.. Zip Code)
3. OWNER:
Address
4
5. TOTAL DEPTH: b-ts-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: v FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): O METHOD OF TEST
10. WATER ZONES (depth):
oa)C /77J-
(Street r Route No )
/.9-,✓.4 V ,t/c OT7K/
TtitJtate_3 /
Zip Code
II
12
Area code- Phone number
DATE DRILLED (eri) -o3
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
l �s
I05 6�s
DISINFECTION: Type Amount
CASING: Wall Thickness
Depth Dr n)Fter or Weight/Ft. Material
From To�l%SFL U
From To Ft.
From To Ft.
13. GROUT: Depth y �Material 11 �/kv "M�et'hod
From D To 3-(7 Ft. (!C!I/n r V
From To Ft.
14 SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size r Material
From To Ft.
From To Ft.
16. REMARKS:
nj m
U cm
0a<
>n
Dr7
m
=o
-o
LOCATION SKETCH
Show direction and distance in miles from at -least 2
two State Roads or County Roads. Include tl9oad2
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Nz
fV rn;c
0
CO
0
c-�
1
-D
to
0
0
6-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC!
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2 v- ..
7.L

WELL CONSTRUCTION RECORD 278991
North Carolina - Department of Environment and Natur Resources - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAMi E rntt) Fred C/ia% le CERTIFICATION U31
\\ELL CONTRACTOR CO\II'AN\' N'A\IE o fco PHONE
STA'I E \\ELI. CONSTRUCTION PER.\II'1'# ASSOCIATED WQ PER\IIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): ResidentialZ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IIOther, List Use
2. \VELL LOCATIO
Nearest Town:
•
Countyrna- mt
(Street Nam0. wnbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4
ISirect or Route
.%'
r- c9--8"37
mat ty.eri Zip Code
LL�Y') l/
unber
(
4
5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: f 00 FT.
(Use "+" it' Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`"fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): eOS METHOD OF TEST Q,L ca
10. WATER ZONES (depth):
Area code- Phone n
DATE DRILLED '7 � [—'cU
TOTAL DEPTH: 431:2)
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
From b
Depth d Di me cr or Weight/Ft. Material
To n Ft. 00
From
From
To
To Ft.
13. GROUT: Depth Material
From 0 To ab Ft. PAW-42
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Topographic/Land setting
❑Ridge DSlope DValley ❑Flat
(check appropriate box)
of Nell location
(degrees/minutes/seconds)
Latitude/longitude sources❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
e— I8' did
3/g-- 5L_3 o
Method
Material
in.
in.
Material
From To Ft.
16.REMARKS:
O
C.J
r
0
rT
0
am
Do
Show direction and distance in miles fromsleasto
two State Roads or County Roads. Includent road i
rnz
numbers and common road names.
LOCATION SKETCH
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CJ1
0
0
0
W
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
n
G
c
c).
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NQ
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2901 `--
east

8
WELL CONSTRUCTION RECORD 2 8
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section s,(
WELL CONTRACTOR(INDIVIDUAL) NAME (print)�� .'tt&.) ( CERTIFICATION#SU2�
\\ELI. CONT I2ACTOR CO\1PANY NAME 3 1e5a .
PHONE # (Dt5�%.57{o
STATE WELL CONSTRUCTION PERMED( ASSOCIATED w'Q PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential.' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2.
WELL LOCATI
Nearest Town:
JJZ2 County.fN\O
'o-r .�
(Street Name. N6ntbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or Tr/cn - " State
( ) N/A -
Area code- Phone nyfnber
4. DATE DRILLED �P -&_ - 03
5. TOTAL DEPTH: 4/CX5"'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6b- 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:A NCAC 2C .0118.
9. YIELD (gpm): / D METHOD OF TEST 424)
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Dcptl)LTh, Diafncjer
From_ To �5'% Ft. b L.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To BZb Ft. (),Q-44.020.i. Y D°Nz_ ,o
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
,now.
Size Material
Ft.
16.REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
t — 9o.s
ei4
O
CO
0
O
rfl —CM
—c
rn
LOCATION SKETCHrn
Show direction and distance in miles from at Teas! c
two State Roads or County Roads. Includeall ro'
numbers and common road names.
-o
c.)
rn
cm as
tax
c')
a
r r'i
o-
r—
o
er
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST 2UCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE
7-2o3
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NE"L
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
r.�

WELL CONSTRUCTION RECORD '7 89 S 9
North Carolina - Department of Environment and Natural Resources -
Division/of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME( rint) Fred Cirtint CERTIFICATION 0-262/ \\ELL COVFR:ACTOR COMPANY NA?1E r--f7LtI'CL� .
PHONE # ifga. �/26'
SLATE \\'F.I.L CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: �/%
Near st Town: t✓6/14 �.
_ib-v,& C1
County / I L-OC- .,
( Street Name. Numbers, Conn unity, Subdivision, Lot No., Zip Code)
3. OWNER2
Address
((Street op Route No. 3 /)
ity or T%`,�� / ,QSfSttaatteee �'7 Zt Code �S /T/
% r � //
Area code- Ph6ne number
4. DATE DRILLED Li-o2U- o3
5. TOTAL DEPTH: /ooOC—
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: QUO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gm -is):) METHOD OF TEST /a,-^t.)
10. WATER ZONES (depth):
1I. DISINFECTION. Type
12. CASING:
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/lon6tude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c
O
c
rn
g2rfrn
—0 Cr-.
—Ca<
""" ern
Depth �r1
From 0 To tr" Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Matt trial L Method
From fi To aJ) Ft. Cl%YJti..-!
From To Pt.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. ill.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size y Material
From To Ft.
From To Ft.
16.REMARKS:
Amount
Wall Thickness
Di refer or Weight/Ft. Material
qF
LOCATION SKETCH
Show direction and distance in miles froinFleasi°�r
two State Roads or County Roads. IncludeQ}iccs
road
numbers and common road names. —�
cn
O Zi
Ct -_
r9
7 -
1
-v
c)
W n:>
0
CD
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ez41i�� 2- / 611,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 117/2001

279 090
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / _
WELL CONTRACTOR (INDIVIDUAL) NAME ^(print) c 'he nV)IS I-I-O'TIOM\Ai CERTIFICATIONN le
WELL CONTRACTOR COMPANY NAM&IXtipS (�1)(Lnrd II)Bi I))1ti vnC l PHONE N &i_.Se24-3 7,26 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ4ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CMunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ��//1
Nearest Twn::�.9/L�Li/2/ County Ada_or7( S At / a pnt _ Kea y Corte tfs73,/
(Street Name. Numbers, tommunity, Subdivision, Lot NO., Zip Code)
Q7?J/ S)iCrC
3. OWNER:
Address ( l(CEf'1- e 09 1-n r P ck
(Street or Route No.)
OEnkL;,)/ ,1/C ;7Ss73
City or Town State Zip Code
(lair)- 3(c9- 7&S3
Area code- Phone number
4. DATE DRILLED ! —// —a 3
5. TOTAL DEPTH: 0/7- 5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ''C FT.
(Use "4" 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): 9-0 METHOD OF TEST Ili//l r t
10. WATER ZONES (depth): ->7bP 1 0
11. DISINFECTION: Type
H-t-14 Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate ial
To -50 Ft. /
To Ft.
To Ft.
Depth
To r 7 Ft.
To Ft.
Depth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From 0
From
From
13. GROUT:
From n
From
14. SCREEN:
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
5ZRA1 p
Material 0.94-71
Method
pow
16. REMARKS:
Size 9 Material
Ft.
Ft.
T9pographic/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)
DRILLING LOG
Formation Description
/ntq
Rift T0.»t-l'_-
DEPTH
From To
o <37`
3 7 ' S0'
.57 e -
LOCATION SKETCH
4 %g-A---S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
{I2 wy�(/-/b0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . .` /� // �,, �i '// 1 f it /7 <, CERTIFICATION I
WELL CONTRACTOR COMPANY NAME (T/I//C 5'ttiS. tcb // �� P, /� a/7 lid() PHONE # j'�, f`x7 t"S4CA
STATE WELL CONSTRUCTION PERMIT# JS$OCLITED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentiaS Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Near^es�t Town: A4K1'.IJ County AIACt,/'3
ttNl j,Numb Co^,Ad
(Street Nana, Numbers, Can malty, Subdivision, Lot No., Zip Code)
3. OWNER: �N el b �andf � n
Address T f; G/ -7 15
(Street or Route No.)
tt,rl ,7\1 ; %7 `I
City or Town State Zip Code
�)-
Area code- Phone number
4. DATE DRILLED /- 3 -'
5. TOTAL DEPTH: 3
6. DOES WELL REPLACE EXISTING WELL? YES D NO 0
7. STATIC WATER LEVEL Below Top of Casing Ti_' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a 0 METHOD OF TEST f
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From f) To__Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From', To ) �, Ft.
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.
From To Ft.
Amount
Wall Thiclmess
Diamelter or Weight/Ft. Material
�•,-,' 11Ut-
Method
4t4_.Sic
16. REMARKS:
Material
r vtt��y7'
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
n- i✓/t9y
L2C - 5-3 v
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/9-30 -to 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME��r (print) /5 4/ (,.i>f4e CEItTIFICcAATTIpO'NN—a-�360///
WELL CONTRACTOR COMPANY NAME C »m 41)5 L1-1/ ',7) , I`i 4 y -LOG. PHONE 8 f 0r01 Ja v VP7k
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 01 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:�
Nearest I Towi , Town: A/t)7t Z AJ County YY\A C r)/t-)
Nam*oyNumbers,
(StRet Community. Subdivision, Lot No., Zip Code)
—
3. OWNER: 1M 1' Al Q/ fi
Address 35 (J.) 6 ¢515 .br.
(Street or Route No.) S/f i✓ U 7' tM
City of Town State Zip Cade
(_)
Area code- Phone number
4. DATE DRILLED /n2 -a DD-o
5. TOTAL DEPTH: —CSC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: JUv FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST "if; r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dagre W minuRdseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth or Weight/Ft Material
From_ To l- Ft._= w`.-
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 7 v FL (9,-N.6ir% f
From To Ft.
Method y
lJ//V 4
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:
LOCATION SKETCH
Show direction and distance in miles from as l...it
two State Roads or County Roads. Include toe road
numbers and common road names. n
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c=„
_ n
o -H
mz
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0
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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
a.;3/th7
SIGNATURE OF PERSON CONSTRUCTING THE WFT T DAE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEEpJ (print)Freci C:-Y/44-t. CERTIFICATION 4 307/
WELL CONTRACTOR COMPANY NAME grime ! ])rDS i / ' y_ l J' fly Luc. PHONE M "o -Xn
STATE WELL CONSTRUCTION PERMIT*/ AQSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public . Industrial Cl Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOO{.:
Nearest Town:�1v1I kJ, Al County Mete-0/0EIc ito ' l in RA yvi P.) . Reitf Pict,
(Street Name, Nudiben, Community. Subdivision, Lot No., Zip CodeY
3. OWNER: petit r Rn%Z
Address Io er to /A `/h /Pul4rl
(Street or Route No:j
j�rn/✓k )9 it/ in73Y
City or Town State Zip Code
Ara code- Phone number
4. DATE DRILLED 1a-/1c-03
5. TOTAL DEPTH: ?De,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l$
7. STATIC WATER LEVEL Below Top of Casing: 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 accordancep with 1SA NCAC 2C .0118.
9. YIELD (gpm): (DO METHOD OF TEST /41
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 81 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_ y To Y lo Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
r"
Material
Amount
Wall Thickness
or Wei t/Ft. Material
l FeeL
Method
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope OValley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes sewrds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek boa)
DEPTH DRILLING LOG
From To Formation Description
c O9
tbcc
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.
Zrfl
U-uJ
lnum
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/?/7-0.3-
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

280'746
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water QuaP,ty - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Bro47n CERTIFICATION 2045
\\ELL CO.N"TRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE s 1 828 369-9591
S'FATE \\'Et.L CONSTRUCTION PERMIT; ASSOCIATED \\Q PERMIT*
(if applicable) (if annlieable)
2
WELL USE (Check Applicable Box): Residential a Nlu ,icip.l:Pu'blic ❑ Industrial 0 4 'ic'uiturai 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IEOther, Lis: Use
WELL LOCATION:
Nearest Town. Franklin County Macon
170 Arvil Guyer RD
t S'.r: a: i`tnou. N.un`-eis. Com;r, unlr7, Sabre: J,t-n, Lot N'o., Zip Cede)
3. OWNER: Adam Burrell
.4ddrass 170 Arvil Guyer Rd
(Street or Roux No.)
Franklin, NC 28734
C'.t? cr Town State Zip Code
(828 )- 369-6145
Area code- Phone number
4, DATE DRILLED 10-8-03
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZix
7. STATIC RATER LEVEL Below Top of Casing: 100 FT.
(Use "-" if Ahove Tcp of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated aror below land surface requires a
variance in accordance with ISA NCAC 2C .0115.
9. YIELD (cpm): 6 METHOD OF TEST blow
I D. WATER ZONES (depth): 90', & 150'
11. DISINFECTION: Type H T H Amount 16 oz
:2, CASING: Wall Thickness
Depth Diameter or Weig:-,t'Ft. Material
From 0 To 85 Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
F rom 0 To 20 _ Ft.ha-mite & WtWWWL prized
Topographic Land setting
❑Rid•ze ❑Slope [-Walley ❑Flat
(check appro; ri as box)
L2itede'lcngitude of well location
:degrees ,:es. s:co•cs) Latitudehielongitude r ❑GPS ❑Topogrphis map
:see:( cost
DEPTH DRILLING LOG
From To Formation Description
0 83' clay & sand
83' 200'
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two Sate Roads or County Roads. Include the road
numbers and con -non road names.
0
W
0
0
N
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlater'al p'
From To Ft. in, in. 3
From To Ft, in. in.
155. SAND/GRAVEL PACK: 0
Depth Size - Nlaterial
From To Ft.
From To Ft.
16. RE`1ARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD ,d COPY 0.` THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/O—r- 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

280745
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL COVTRACTOR(I.NDIVIDUAL) NAME (print) James B. Brown
\\ ELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # ( 828 369-9591
SLATE \VEI.L CONSTRUCTION PERMIT? ASSOCIATED N'Q PERMITS
(ifannlicable) (if aenlicable)
1
CERTIFICATION = 2045
WELL USE (Check Applicable Box): Residential ❑ Nlunicipal.Pu'bhc ❑ Ind,.,.,ial 0 Aricuiturai ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town.Franklin County Macon
Corner of Patton Rd & Potts Branch
(Street Name, Numbers, Community, Sube hislen, Lot No., Zip Code)
3 OWNER: K & M Products
Address 4761 Old Murphy RD
(Street or Rcmle No.)
Franklin, NC 28734
Os or Toxr, Stale
( 828. 524-5905
Zi; Code
Area code- Pore number
4 DATE DRILLED 10-7-03
5, TOTAL DEPTH: 140'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use'=" if Above Top of Casing)
5. TOP OF CASING IS 2 FT, Above Land Surface*
'Top of casing terminated aCor below land surface requires a
variance in accordance with I5.A NCAC 2C .0118.
9. YIELD (_pm): 50 METHOD OF TEST blow
10 WATER ZONES (depth): 115'
I I. DISINFECTION: Tvoe H T H Amour.: 16 oz
:2. CASING: Wall Thickness
Depth Diameter or WeieE!Ft. Nlalena:
From 0 To 78 Ft. 6" .188 steel
From To Ft.
From To Et.
13. GROUT: Depth Material Method
From 0 To 20 _ Ft.L,a dte & care,` Rnr_ai
From To Ft.
14. SCREEN: Depth Diameter Slot Sze Material
From To Et. in. in.
From To Ft. in. in.
15 SAND.'GRAVEL PACK:
Depth Size , Material
From To Ft.
From To Ft.
16. REMARKS:
From
0
76'
Topographic:Land setting
❑Ridge CSlone :Valley ❑Flat
(check appropriate box)
Latitude longi ludo of well location
de fires tiw.r.s se:ends)
udc:'lonit,ide sour e•❑GPS❑Topogr^hic map
-_t Ktop)
DEPTH DRILLING40Gi_....
To Formation Desor tion
76' clay & sane
140' crranite
LOCATION SKETCH
Show direction and distance in miles from a: leas:
two State Roads or County Roads, Include :He road
numbers and commomroad names.
Sim
0
0)
I DO HEREBY CERTIFY THAT"WELL
tTTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, ELL
CONSTRUCTION S T.ANDA 3 AND THAT A COPY i THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNA T URE OF PERSON CONSTRUCTING THE WELL
/a-7 0
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07 2001

WELL CONSTRUCTION RECORD
North Cnroiina - Department of Environment and Natural Resources - Division. of Water Quality - Groundwater Section
w ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
\WEL.I. CONTRACTOR CO.NIPANY iNA;\IE Hedden Brothers Well Drilling, Inc
280743
CERTIFICATION''- 2045
PHONE P. ( 828 36i9=9-541
s'rATE WELL CONSTRUCTION PERMIT.' ASSOCIATED WQ PERMIT:
(if acplicable) (if acnlica'ble)
WELL USE (Check .Applicable Box): Residential 0 Nlunicipa'1Pubiic ❑ Industrial 0 Agricudural 0
ivlonitoring 0 Recovery ❑ Heat Pump \Vater Injection 0 Other 0 II -Other, List Use
2- WELL LOCATION:
Nearest Town - Scaly Mtn
Buck Knob Rd --Well #1
County Macon
(5:rcet Name, Nal::Coors, Cor.u,nunity, Su'b:avisun. Lot No., Zip Cod(f)
3. OWNER: Matt Smith
Addr.ss PO Box 44
(S)reet or Route No.)
Scaly Mtn, NC 28775
Or: or Town State Zip Code
(828). 526-9883
Area cods- Phone nur..her
DATE DRILLED 9-24-03
5. TOTAL DEPTH: 1200'
6. DOES \VEELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing,: FT.
(Use" ii Move Tcp o(Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of rasing terminated at. or below land surface requires a
variance in accordance with ISA NCAC 2C .011S.
9, YIELD (gpm): 0 METHOD OF TEST blow
10. WATER ZONES (depth):
Topographier'Land setting
❑Ridge ESlope ON/alley ❑Flat
(check appropnate box)
Latitude 'longitude of %veil locatlort
Latitude 'longitude source:❑GPS❑TopouraLFic map
(creck
DEPTH DRILLING LOG
From To Formation Description
0 19' clay & sena
19' 1200' granite
I i. DISINFECTION: Tvpe H T H Amount 16 oz
12. CASING: Wall Th.c:mess
Depth Diameter or \\'eight'Ft. Material
From 0 To 21 Ft. 6" 188 steel
From To FT
From To Ft.
I3. GROUT: Depth Ntateriai Method
From 0 To 20 Fttennte & cata!t P1t 3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlateriai
From To Ft. in. in.
From To Ft. in. in.
15. SAND'GRAVEL PACK:
Depth Size Material
From To
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
0
0
--t
N
O
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRLCTION STANDA,4,BpS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TEE WELL OWNER
SIGNATURE OF�PERSON CONING THE WELL DATE
Submit the original to the Division of \Vater Quality', Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. OW -I REV. 07/ 2001

280742
WELL CONSTRUCTIO` RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
K'ELL CO\TR,kCTOR(I;NDIVIDUAL) NAME (prin() James B. BrO4R1
WEL.I. CONTRACTOR COMPANY .\A\IE Redden Brothers Well Drilling, Inc
STATE
2
- Groundwater Section
CERTIFICATION'- 2045
PHONE ;; J 828 369 9- 9-1
\\ELL CONSTRUCTION PERMIT; .ASSOCIATED \\Q PERMIT=
(if aoplicab;el Cifapplicable)
WELL USE (Check Applicable Box): Residential C' Municipa'.!Pubiie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IrOther, List Use
WELL LOCATION:
Nearest Town, Franklin
425 Windy Gap Rd
County Macon
(Sire: Name, N.nnbers, Comm, unl:y, Su5d.'. G Is., Lot No., Zip Code)
3. OWNER: Gary Setser
.Address 425 Windy Gap Rd
IStreet or Route No.)
Franklin, NC 28734
C:tp cr Ta.sn State Zip Code
(82t- 524-3718
Area cede- Phone number
4. DATE DRILLED 7-31-03
5. TOTAL DEPTH: 125'
6. DOES WELL REPLACE EXISTING WELL? YES 22 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "=' if Above Tcp of Casing)
TO? OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated ac'or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gprn): 50+ METHOD OF TEST blow
10. WATER ZONES (depth): 97'
11 DISINFECTION: Tvoe H T H
12, CASING:
From 0
From To
From To
13. GROUT: Depth
From 0 Tc
From To Ft.
14. SCREEN: Depth Diameter Slot Size Materia'.
From To Ft. in. in.
From Tc Ft. in. in.
15. SAND'GR.AVEL PACK:
Depth Size Material
Depth 5
Tc 7
Amount 16 oz
V1'a11 Thickness
D,pj.188
ue;zr or \;.':.. S
6stool
Ft.
Ft.
Ft.
Materlai Method
20 Et.loastrate & cite:_ braced
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat'..
(che;A app roprl ate box)
Latitude'longitude of well location:
_otrcde'longi
DEPTH
From To
0 55'
55' 125'
(dere::: ::imines.setor.ds)
ide source:❑GPS ❑Tepogragi'nL ma-
_neck box) DRILLING LOG
Formation Des -sr -Lotion
clay & sand
_granite
LOCATION SKETCH
Show direction and distance in miles from at ,east
t'.vo State Roads or County Roads. Include the road
numbers and common road names.
O
co
O
n
1V
PO
dm
O
0)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SICNTUR_ OF PERSON CONSTRUCTING THE WELL
9- 3/-e)3
DATE
Submit the original to the Division of Water Quality', Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phonc No, [phone], within 30 days. GW-1 REV. 07:2001

280710
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\TELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION = 2045
\\EL. E. CONTRACTOR COMPANY N AME Meriden Brothers Well Drilling, Inc PHONE p ( 828 369-9591
STATE \VEI.L CONSTRUCTION PERMITd ASSOCIATED \cQ PERMIT:
(if applicable) (if arnlicable)
I. WELL USE (Cheek Applicable Box): Residential ❑ Nlunicipal/Public 0 Industrial: ❑ Agricultural 0
N!onitoring 0 Recovery. 0 Heat Pump Water Injection ❑ Other 0 I[Other, Lis: Use
2. WELL LOCATION:
Nearest Town.. Scaly Mtn
Rocky Knob Lot #78
(Strec N;:ne, Numbers, Con.;nun ky, Subdisislcn, Lot No., Zip Code)
3. OWNER: Bryan Varoon, Esq
Address One Atlantic Center
(Street or Route No )
Atlanta, GA 30309-3424
County Macon
Ce, Cr Toter State Zip Code
(404 )- 881-7156
Area cods- Phone number
4. DATE DRILLED 9-17-03
5.TOTAL DEPTH: 1200'
6. DOES WELL REPLACE EXISTING WELL? YES C 900'NO
7. STATIC WATER LEVEL Below Top of Casino:
(Use "m' if Above Top of Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface
*Top of casing terminated at:or below land surface requires a
variance In accordance with ISA NCAC 2C .0119,
9. YIELD (gpm): 1 /2 METHOD OF TESTblow
10. WATER ZONES (depth):
11. DISINFECTION: Tvne H T H Amount 16 oz
;2. CASING: Wail Thickness
Depth Diameter or l!'eig_h:'Ft. Alatecz',
From 0 To 99 Ft. 6" pvr
From 99' To 1 ell' Ft. 6" _188 RI -eel
From To Ft.
Depth Material rNlethor.
To 20 F;tsrni.te & OSra?t lxnra3
To Ft.
DepthDlanre,,, Slot Sze Material
To Ft. in.
To Ft. in. in.
13. GROUT:
From 0
From
14. SCREEN:
From
From
15. SAND:GRAVEL PACK:
Depth Size N?aterial
From To Ft
From To Ft.
16. REN!ARKS:
L�9
FT.
Topo_raphiclLand setting
❑Ridge :Slope ❑Valley ❑Flat
(c'reok appropriate box)
Latitude longitude of well location
- es::;ir.ne; seconds)
Lat'cadelongit:lde-source:❑GPS❑To^e__ra^hie clap
:k coat
DEPTH. DRILLING -LOG -
From To Formation Descr'mtion
0 101 ' clay & sand
101' 1200' 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.
3
O
Cr)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c —/7—tO3
SIONRIC, griApIURE UREOFPERSONCONSTRUCTiNOTHE\\'ELL DATE
Submit the original to the Division of Water Quality', Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phonii No. (919) 733-322I, ithin 30 days. GVW-I REV. 07,200 NO:

5
6' 200
7. STATIC WATER LEVEL Below Top of Casing,:
(Lse "=' if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated ator below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gprn): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 115' & 278'
County Macon
WELL CONSTRUCTION RECORD
North CaroNna - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA31E (print) JaltleS B• Brown CERTIFICATION k 2045
\\ ELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE = ( 828 369-9591
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT=
(if applicable)
(ifaoplicab;e)
280741
WELL USE (Check Applicable Box): Residential apc Municipal:Public ❑ Industrial ❑ A;riculturai 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ «Other, Lis: Use
WELL LOCATION:
NearestTcwn: Franklin
Bradley Creek
(Street Nome, Numbers, Community., Su'bdisislon, Lot No., Zip Code)
3, OWNER:Jo Campbell
Address 240 Chateau Lane
(Street or Route No.)
Franklin, NC 28734
City or Tarn State Zip Coe
(828)_ 369-2989
Area code- Pitons nu -bar
DATE DRILLED 8-25-03
TOTAL DEPTH: 300'
DOES WELL REPLACE EXISTING WELL? YES)C NO 0
FT.
I I. DISINFECTION: Type H T H Amount 16 02
12, CASING: Wall Thickness
Depth Diameter or Wei_hiTi. Material
From 0 To 84 Ft. 6" .188 steel
From To Ft.
From To Et.
13. GROUT: Depth Material ARiR
From 0 To 20 Fttarnite & L ttst_
From To Ft.
I4. SCREEN: Dept'.- Dlame:er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND'GRAVELPACK
:
Depth Size Natuial
From To Ft.
From To Ft.
16. REMARKS:
Topo_raphioLar.d se:tir-e
❑Ridee Slope ❑Valley ❑Flat
Rhe:.k appropriate Sox)
Latitude longitude of dell location
Latitudelongi;tite source.CGPSCTepoyra_hie ma_
:ae<:c boy
DEPTH DRILLING bOG-
From To Formation Descriotion
0 82' clay & sand
82' 300' granite
LOCATION SKETCH
Show direction and distanre ir. es from at tea-
,
two State Roads or County Reads. Inotude the road
numbers and common road names.
a
O
Ct)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC :Cr AA'ELL
CONSTRUCTION STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S CNA RE 0? PERSON CONSTRUCTINOTHE \VELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 NIail 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
\VELL CONTRACTOR (INDIVIDUAL) NAME
(print) <l)(9- IS /In lif,-nrl� CERTIFICATION# o4/7 ee
\VELL CONTRACTOR COMPANY NAMQ r1n�S jib(12,� ���Plidiy fll`H ) -
ne PHONE #fia&i_.Sa4-3 a/o6
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED W ERMIT#
(if applicable) (if applicable)
n. flq�'i
I. WELL USE (Check Applicable Box): Residential Yl----Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: /�/�
Nearest Town: S("Q l-' Ifni- County 'J l6 (/ic_?
{nt• _ cf. l_ i?7tt1 r�. �"7'7.')
(Street Name. Numbers, Community, Sub/di vision, Lot No., Zip Code)
3. OWNER: in,c- 0I,1Y1itC' Ci,"
Address 7c - 2 (26- T n,t. '�.t Or ,rte
(Street or Rowe No.)
City or Town State Zip Code
070 )- ;-' . ._ - : r):
Area code- Phone number
4. DATE DRILLED - :Z I _ r 3
5. TOTAL DEPTH: (if S -�
Typographic/Land setting
edge ❑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 FormationDescript%on
' y7 t1 r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: G -(' e FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 5' METHOD OF TEST_h1U)U/
10. WATER ZONES (depth): -._j5C`' (/
pis 8/7/ rt r a, ; -I 1-
W
1.1
LOCATION SKETCH -
11. DISINFECTION: Type 1 t» Amount r� %4} A 5 Show direction and distance in miles from least?
12. CASING: Wall Thickness two State Roads or County Roads. Include the road='
Depthra
'0 To 7 Y Dia eter or Weight/Ft. Mate ''al numbers and common road names. `''
From Ft. rak $•j2 R ,v j p V 0_i
From To Ft.
From To Ft.
13. GROUT: Depth /1M,,aterial Method
From n To �ii7 Ft. 604,16-r,� pam.0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HQS BEEN PROVIDED TO THE WELL OWNER
fee
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) 5/TT)-nh15 1-�'Af In„\ A, CERTIFICATION # 217(p
WELL CONTRACTOR COMPANY NAMIr E!)niS (atoJla,,4 (%Jel l,�tfr I I —IC .)�t1 C1 PHONE#do- 5i_6a-/-3 Z6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED %V ERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box):- Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: qq
Nearest Town:' ' (1 jl 9 /// i ,i" County .4//7 ['/t) (
4 !-) L' 7S rrr, (i i 1 J i �,C'7;3 v
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip C e)
Topographic/Land setting
Idge ❑Slope ❑Valley °Flat:,
(check appropriate box)
Latitude/longitude of well location
3- OWNER: K' C' ( / /r/ (degrees/minutes/seconds)
Address 621,3`T ) f'r/C/n. C/; y c /'ci Latitude/longitude source:❑GPS❑Topoprephl-c—map:,. _.
_ (Street or Rothe No.) (check box) -"
7•7) it('! ; ,t_� /i(' 73) DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(._-: • E, / — C/e, /1 O �/ �' / /4
Area
.7/ � S S" L7 /61 E J/- I ay) r T Q-
A a code- Phone number
DATE DRILLED / - .3 C - t �
4
5
6
7
TOTAL DEPTH: n2 55 '
DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ J�
STATIC WATER LEVEL Below Top of Casing: —C— 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): 6 O METHOD OF TEST h/oz/Ji7�(f
10. WATER ZONES (depth): /5/C' ' (�
1I. DISINFECTION: Type fl"1"/-/ Amount ,---7TA-
12. CASING: Wall Thickness
Depth Dia eter or Weight/Ft. Mate
From 0 To l/� Ft. =5 2R,T Q
To Ft.
To Ft.
13. Depth Material Method
To R. 0_04-n 6j,7 �i(DAl
�
To Ft.
Depth
To
LOCATION SKETCH ' F-i
�j s Show direction and distance in miles from east -
two State Roads or County Roads. Include the roars=
fi� numbers and common road names.
From
From
GROUT:
From n
From
14. SCREEN: Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
280654
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
c

28069E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION n 2043
WELL CONTRA
CTOR FiBeCial EtOtherS;cell Erinm, Inc PHONE [phone]
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMIT# i
(if applicable)—-
i.
(if anpl icab le)
WELL USE (Check Applicable Box): Residential Lx' Municipal.'Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Mtn Macon
Nearest Town: scaly County
Rocky Knob
(Street Name, Numbers, Community, Su'bdi cis ion, Lot No., Zip Code)
3. OWNER: Bill Campbell
Address PO Box 123
(Street or Route Rio.)
Scaly Mtn, NC 28775
City or Town State Zip Code
( 825_ 526-8298
Area code- Phone number
4. DATE DRILLED 8-1 4-03
5. TOTAL DEPTH: 550'
6. DOES WELL REPLACE EXISTING WELL? YES ❑75O
7. STATIC WATER LEVEL Below Top of Casin_:
' FT.
(Use'=" if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated ateor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9, YIELD (gpm): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 50' & 550'
11. DISINFECTION: Type H T H Amount 1 6oz
12. CASING: Wall Thickness
Depth Diameter or AWeighCFt. Material
From 0 To 37 Ft 6" pvc
From 37 To 41' Ft. 6" .188 stool
From To Ft.
13. GROUT: Depth Material Method
From D To 20 Fteenthite & mutt pirced
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dep:It Size Material
To Ft.
To Ft.
From
From
16. RENIARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑FItt#`'u-
(check appropriate box)
-
Latitude longitude of well location
(decreer is seconds) I
Latitude'longitude source:❑GPS❑Topogr4phl0 map '„_
(cheek boa)
DEPTH DRILLING LOG
From To Formation Description
0 39' clay & sand
39' 550' 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.
O
O
c-)
N
lD
c!1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5 A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GAV-1 REV. 07;2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N A>IE (print) Mitchell D. Cook CERTIFICATION 2 2043
WELL CONTRACTOR COMPANY NAME Hall Ith3 Weil ail 11rrTr TIC PHONE : [phone]
STATE W ELL CONSTRICTION PER,\iIT8 ASSOCIATED \VQ PERMIT# —
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Nlunicipal'Publlc ❑ Industrial ❑ Agricultural 0
Nlonitorine 0 Recovery ❑ Heat Pump Water Infection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
NearestTown:Highlands County Macon
Walkingstick Rd Well 111
(Sired) Name. Numbers, Community. Subdivision, Lot No.. Zip Cede)
3. OAVNER:Nathan Melear
Address 1180 Wildcat Ridge RD
(Street or Route No.)
WatkinsvillP GA 10677
City or Tout, State Zip Code
(706 )- 769 8710
Area code- Phone number
4. DATE DRILLED 8-27-03
5.TOTAL DEPTH: 1100'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cf
7. STATIC WATER LEVEL Below Top of Casing: 1000 FT.
(Use `—" if Abose Top of Casing)
8, TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or belo ss land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST blow
10. WATER ZONES (depth): below 400'
11
12
DISINFECTION: Type H S H
CASING:
Depth Diameter
From 0 To 19 Ft. 6"
From 19' To 22' Ft. 6"
From
13. GROUT.
From 0
To
Depth
To 20
From To
Ft.
Amount 16oz
Wall Thickness
or \Veizht'Ft. Material
_PVC_
188 steel
Material
Ftla ante & u l ar
Ft.
14. SCREEN: Depth Diameter Slot Size Ntaterizl
From To Ft. in. in.
From To Ft. in. in.
15. SAND. GRAVEL PACK:
Depth Size Nlateriat
From To Ft.
From To Ft.
Nlethod
culbad
16. REMARKS:
Topographic'Land setting.
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreealni2r,t_5'sedonds)
Latitude longitude source:OGPS❑Tcpographic It» ap
(ei,eek box)
DEPTH DRILLING L06--- —
From To Formation Description
0 21' clay & sand
21' 1100 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.
0
W
O
n
N
sD
U1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, AAELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED To THE WELL OWNER
eard 2 2/0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R'ELL CONTRACTOR (I\DI\IDUAL)NA31E (print) Mitchell D. CC0k,,.,{= CERTIFICATION_ 2043
WELL CONTRACTOR COMPANY NAME -} 1 &d±ers ('L1 )�naw, PHONE + 828) 369-9591
STATE WELL CONSTRUCTION PERMIT= ASSOCIATED wQ PERMIT=
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 21 Municipal Public E Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. AA'EI.L LOCATION:
Nearest Town. Highlands County Macon
Walkingstick Rd Well #2
(S:ree Naive, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Nathan Melear
Address 1180 Wildcat Ridge RD La
(Sager or Route No.)
Watkinsville, GA 30677
City or Town State Zip Code
( 706)- 769-8710
Area code- Phone number
4. DATE DRILLED 9-2-03
5.TOTAL DEPTH: 1000'
6. DOES \\'ELL REPLACE EXISTING WELL? YES NO 0
7, STATIC WATER LEVEL Below Top of Casing: 800FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .01 I8.
9. YIELD (gpm): .5 METHOD OF TEST blow
10. WATER ZONES (depth): 1 75 '
11. DISINFECTION: Type H T H
12. CASING:
From 0
From 39'
From
13. GROUT:
From 0
From
14. SCREEN:
From
From
Depth
To 39 Ft.
To 43' Ft.
To Ft.
Depth
To 20
To
Depth
To
To
15. SAND GRAVEL PACK
Depth
From To
From To
Diameter
6"
6"
Amount 16oz
Wall Thickness
or \\'eight'Ft. Material
pvc
188 steel
Nlaterial Method
Ftbee rite & cetrifL gntzi
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
blateriai
From
0
41'
Topographic'Land setting
❑Ridge ❑Slope ❑A'alley ❑Flat
(check ap props late box)
Latitudelongitude of well location
(degrees S•.Inn.es seconds,
udc longitude source:❑GPS❑Topograph'i`c map
r:he:k tox)
DEPTH DRILLING bee ---
To Formation Description
41' clay & sand
1000' yLanite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
0
c-0
rV
a..
LO
01
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS \\'ELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ind
0
t2simx
nly
Pi
(P—
m73
0
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center - Raleigh, NC
27699-1636 Phony No. [phone], within 30 days. GAV-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) Mitchell D. Cook CERTIFICATION; 2043
w ELL CONTRACTOR COMPANY NAME Hall) ers V I1. Enh1j.n , Ire PHONE [phone]
STATE 1\ ELL CONSTRUCTION PERMIT= ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L29 :NlunicipalPublic 0 Industrial ❑ Agricultural ❑
N1onitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town:Highlands County Macon
Walkingstick Rd Well #3
(Street Name, Numbers, Community. Subdis ision, Lot No„ Zip Code)
3. OWN'ER:Nathan Mel
Addr ss 11130 Wildcat Ridge RD
(St:et or Route No.)
Watkinsville, GA 30677
Cite cr Toss State Zip Code
(71C0 )- 769-8710
Area code- Phone number
4. DATE DRILLED 9-4-03
5.TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "r' if. Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
^Tap of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (um): 0—DRY :METHOD OF TEST blow
10. WATER ZONES (depth):
Topographic 'Land setting
❑Ridge ❑Slope ❑valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees 'seconds)
Latitude longitude source:OGPS❑Topographic map
;ghee:. tat)
DEPTH DRILLING LOG
From To Formation Description
0 75' clay & sand
75' 900' granite
11 DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 73 Ft.
From 73' To 77 Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14, SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
16. REMARKS:
Diameter
6"
6"
Amount 16oz
Wall Thickness
or AWeight.'Ft. Material
_DVC
188 steel
LOCATION SKETCH
Show direction and distan_e in miles from ai feast!
two State Roads or County Roads. Include tE"e'road
numbers and common road names.
O
CO
O
Material Ntethod v7
Ftlzermite & caret -Rurca Iv
Ft.
Diameter Slot Size Nlaterial x.,
in. in. -lit
in. in. 4-0
U1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC v
27699-1636 Phone No. [phone], within 30 days. GAA'-1 REV. 07.2001

WELL CONtSTRUCTIONr RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
V1 ELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
P ELL CONTRACTOR COMPANY NAME 7 ErCtine5 Ll.iln1n, II'C
2807JI0
- Groundi,cater Section
CERTIFICATION = 2043
PHONE = 828) 369-9591
STATE \\ ELL CONSTRUCTION PER>I!TAI ASSOCIATED 11Q PER\11T.'
f applicable) (if applicable)
1, WELL USE (Check Applicable Box). Residential LR Municipal:Pnb'.ic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ 0:'her ❑ I; Other, List Use
2. WELL. LOCATION:
Nearest Tossrpighlands
Cold Springs RD
(5.:.-. Name, N',nnSers, Com.nunity, Su'xi,l sion, Lot No., Zip Code}
3. 0\VNER:Phillip Coppage
Adzfoss 19 Christmas Tree Lane -.
(8tree: or Route No_)
Highlands, NC 28741
City cr Town State Zip Code
( 828. 526-1988
Area node. Phone number 1-7-03
4. DATE DRILLED
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ILK
7. STATIC WATER LEVEL Below Top of Casing: 40' FT.
(Use if A'oose Top of Casing'
8. TOP OF CASING IS 2 FT. Above Land Surface
'Top of casing terminated at'or below land surface requires a
variance In accordance with ISA NCAC 2C .0118,
9. YIELD (_pm), 60 METHOD OF TEST blow
10. WATER ZONES (depth): 45', 85', 170'
Counth eon
I . DISINFECTION: Tvoe H T H
12. CASING:
Depth 36 Dieter
From 0 To
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. S.AND.'GRAVELPACK:
Depth
From To Ft.
From To Ft.
Ft
Ft.
Ft.
Nlaterial
Ft Cite & t_
Ft.
Diameter
Ft. in.
Ft. in.
Amount 1 6oz
Wall Thic:<ness
or AA'eicht'Ft. Material
.18-8 steel
16. REMARKS:
Method.
is -mid
Slot Sze Ataterisi
ic.
Size Ntateria'i
DEPTH
From
0
34'
Topographic:Land setting
❑Ridge ❑Slope ❑Valley ✓Flat
(then T-. =es:
Latitude longitudeof\sell location
, .......- seaccs'.
longRou uce srce:G'GPS❑ T cc__raphic eta_.
DRILLI`,r; LOG
To Formation Desc r;phon
34' clay & sad
200granite
LOCATION SKETCH
Show direction and distance in miles rrom at least
two State Roads or County Roads. lnc:ude the road✓
rumbers and conirnon road names. CJ O
0
C -)
rV
1D
Ut
1 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
"friAiale, t�. &&a% /0/7/l7 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qunlitc. Groundssnter Section, 1636 i\lail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GVV-1 REV. 07.2001
Co -n
-n
mJ
tn:
rinroJ
(0
0
z

Depth Diameter or Weight/Ft.
From To SC. / Ft. (c w) R ,v i Q
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To r) Ft. _ 4 D f(DA/U)
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:
28034.9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Sectionn
WELL CONTRACTOR(INDIVIDUAL) NAME (print) s?enllls11 /it)II rirArt, CERTIFICATION# d/7(e
WELL CONTRACTOR COMPANY NAM&ITtint i Jd 11/244r7 Wei 11)1(era I':k ,1.n e J PHONE # Say-3 d6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Q-1 i icipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 6 e/(2 n k' k trip County
(rQ.—E eY_'2cv d7?
(Street Name, Numbers, Community, Subdivision, Lot No:, Zip Code)
3. OWNER: /'✓1 (S81--(. R ti,l
Address 4f3 ("-pnc,�
(Street or Route No.)
.1) J PIi Q I j � A C', c K 7/ 3
i y or Town fate Zip Code
Area code- Phone number
4. DATE DRILLED / (1— :3-0 -3
5. TOTAL DEPTH: if c;
� „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
y'7' n I��j •
11.2 ' /' ,5"'C7 / 1 r 'C 9/A, Li—,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (F(> FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
9. YIELD(gpm): METHOD OFTEST_h/O2Ui'Y�(,E—,
10. WATER ZONES (depth): P` r 7.?-r (/
O c�
O
-1
o<
LOCATION SKETCH >'c
11. DISINFECTION: Type HIP Amount 0. TA-, S Show direction and distance in miles fro at IE35b
12. CASING: Wall Thickness two State Roads or County Roads. 1ncll die therroad
Matey numbers and common road names. n"
E
I
a
21
rum
IfIPJ
c
flit
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HP,xS BEEN PROVIDED TO THE WELL OWNER
/(4 e.3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / _
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) s -he nV)IS /-�[/ n11an%A. CERTIFICATION0//7 et
WELL CONTRACTOR COMPANY NAMK'1 jfl1S jkjIn gig J1)e1IThlid 1-,t .�..4e, PHONE#'7ed%_3a L/--32.b
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W�ERMITS/
(if applicable) (if applicable)
280330
1. WELL USE (Check Applicable Box): Residential LdVMunicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION�:s
C
Nearest Town: Y & it kLr nJ County
/✓ - f/wch, R-r-k - m e (eul (),-ver&
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) .2 &73 y
3. OWNER: / 4 /2/1t •�1 e t� APO
Address--"•5-c/r 1fr/i D }, V/Pd
(Street or Route No.) 7 5"n
City or Town State Zip Code
(Lucy aei g_ r5.3 i- 3
Area code- Phone number
4. DATE DRILLED /h-- % —L' 3
5. TOTAL DEPTH: Sac'
Topographic/Landing
❑Ridge OSlope (Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
0 3
,3c•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑—'
7. STATIC WATER LEVEL Below Top of Casing: c h FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .011A. 4)
9. YIELD (gpm): ., (t METHOD OF TESTI/def}L(�-,
10. WATER ZONES (depth): r)9%'f /7n/,' • /7n' (�
/ LOCATION SKETCH W r:z
1 I. DISINFECTION: Type WWI Amount ,---7 TA-B 5 Show direction and distance in miles from at lea
12. CASING: Wall Thickness two State Roads or County Roads. Incinde thgoad
Depth„ Dia eter or Weight/Ft. Matep'al numbers and common road names.
From 0To .1 7 Ft. _5..2R,f Pre -
From To Ft.
From To Ft.
13. GROUT: Depth
From 1 To rZ 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.
Formation Description
f(1
f31♦_t Ci ra +c
r
w
rs
—� cm
0<
Dc
Material
89471 Ztht
Method
pcv
16. REMARKS:
mrj
cQ
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/h-7-e3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesjj- Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) t1)-en Vll51 II -I-/) "(%�� CERTIFICATION # /7(P
\\'ELL CON'IR,\C'I'OR COMPANY NA!NQ nniS'r' 1I(%Mri W el I r) V`t -H 1n(' J PHONE Pig j$)�� Li-3 ;2 �J y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WidiPERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (2.--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. A'/ELL LOCATION:
Nearest Town: �n,<},O l_r nl County /) TS)Pographie/Land setting
( /'� /t. I (f (IOC t m.R'tdge ❑Slope ❑Valley ❑Flat
c( ` c ' 1 F C (-en /), , n, ) G IC 6.7. Ayvue 2 (check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) ,}.( 7"'J v_ Latitude/longitude of well location
3. OWNER: A-CI*)f1.]a C) 11/ Ic, /
C (degrees/minutes/seconds)
Address 67 s5 3- ; /j Pkir [ /5--- 0i -fir i. /<Zci Latitude/longitude source:❑GPSOTopographic map
(Street or Rowe No!) 1 i (check box)
l'l0stVi_T2,) /'(� e->C iX 7-3 J (/ DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(,Ca)- •36-9-- O7 7 e c y' (' Lr?t
Area code- Phone number
4. DATE DRILLED /�- rC—(1 3 9' c-S' .S.L/1'ar1 )'rst,_-;
Sd'' SOS' 73/1/ F -v0, i t-C__.
5. TOTAL DEPTH: • r
11. DISINFECTION: Type
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From 0 To .if/ FL (�" $12R,Ff �V
From To Ft.
From To Ft.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1-
7. STATIC WATER LEVEL Below Top of Casing: --0 - FT. O
(Use "✓' if Above Top of Casing) W
8. TOP OF CASING IS / FT. Above Land Surface* p�
-Top of casing terminated at/or below land surface requires a CD r,
variance in accordancith 15A NCAC 2C .0118. �f*t
9. YIELD (gpm): (\ METHOD OF TEST AINb'/xi � — 0<
(/ t
10. WATER ZONES (depth): ,�'L'; / 9 05 ,/ %e' * 70
LOCATION SKETCH �0
,-2 Tic /j S Show direction and distance in miles from i t beast m
two State Roads or County Roads. Include tji,roaE1
numbers and common road names. 0 0
c
ff ff{ Amount
13. GROUT. Depth Material Method r-- 1
From () To �(7 FL p(394/U t I Um
ra
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 111,:
From To Ft. in. in. CD
15. SAND/GRAVEL PACK:
tom,
Depth Size 2 Material ` ; „l o
From To FL " ' .a
fin'
280331
From To Ft.
16. REMARKS:
L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECED TO THE WELL OWNER
if � ORD HAS BEEN PROVIDED /()- k -r 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2001

(Street or Route No.)
I 1,6e JOLt t7,1 JL/ S-? �tc-
City or Town Strife., Zip Code
et-g)- k�• - �,r3 y rxr-
Area code- Phone number
4. DATE DRILLED I{' — /�S G_3
2808'73
WELL CONSTRUCTION RECORD
North Carolina - Department of' Environment and NaturalTTResources - Divisionlof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME y (print) cbe n il i S 1'}f) (l Qv+'x ril CERTIFICATION # el /7 [P
WELL CONTRACTOR COMPANY NAMKIK,f i ((tifi).nr4 'I� PIi Yen ^R�t ,) vie l PHONE # (�,j;24-3 �-b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W4\'ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential ids Municipal/Public 0 Industrial 0 Agricultural b
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: '-4 i 6/-{ L`) 4/7) s County �1 (7 r 0)tip
it if. I 6;TV%-7 .Sic ll. �. / /c /# L.h.4,7)i 7 y/
(Street Name. Numbds, Community, Subdivision, Lot No., Zip Code)
T pographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location.
3. OWNER:.- Ill^l v , a L.. (i (( S - (degrees/minutes/seconds)
Address E.S IG- 5 5-: ,C • Plf /in 5 ti Latitude/longitude source:❑GPS❑Topographic map
S (check box) .-
DEPTH DRILLING LOG
From To FormatioCDescription - -
27 / ' 5 1 / Lt 6 r'3 n i 12--t
5. TOTAL DEPTH: . 5J0_S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Illy
7. STATIC WATER LEVEL Below Top of Casing: ',77" 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): / ri METHOD OF TEST //�//f7J��
10. WATER ZONES (depth): k'
�( LOCATION SKETCH
n
11. DISINFECTION: Type III Amount r-.2 IAA 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
,!t Depth Diam�eter or Weight/ft. Matefial numbers and common road names.
From V To .2/ Ft. h` 5.Z2/R,1 pYQi
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From n To r9•D Ft._0p zajtL f)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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL IED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY
_OFTTH SS RECORD H S BEEN PROVIDED TO THE WELL OWNER
�V^
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

280870
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c /T)-en {i i s J-)-0' care) rtif CERTIFICATION #��7 yo
\YELL CONTRACTOR COMPANY NAM&fhnt� fbo(lnnnr4 IDJeOyedl:l<jt-.] tte PHONE #gI.,-.J/a214 a16(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIIPPERMIT#
(if a applicable) --- ___
PP ) (if applicable)
WELL USE (Check Applicable Box): Residential 0--"Municipal/Public ❑ Industrial 0 Agricultural ❑.
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: f� &iE L } A/ County ' CL-L6rL_.
.7nQ h etpel v.l‘u Th23y
(Street Name, Numb rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (11ft ✓+r+ (V 11 rj_
Address •3tin7 URc. -e l 1/, rcc' /. (Z'
�, (Street or Rode No.)
F(clt! » %f(_
City or Town State Zip Code
- 7/ k5
Area code- Phone number
4. DATE DRILLED /lt %
5. TOTAL DEPTH: 'fe'. �^
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W—
`73 c/
graphic/Land setting
dge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic-map... --
(check box)
DEPTH DRILILIING LOG
From To Formation Description--
0 3 -7 /' C rc
, 3 7 ' /re- " sc,,,cx5
lr ,P-' 9' 6 c /-O/1r c.- (tr/Mv- t-e-
7. STATIC WATER LEVEL Below Top of Casing: /.-;) r' FT.
(Use "1" 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): .�(+ METHOD OF TEST hlt Yz Lt_f
10. WATER ZONES (depth): r>74'5' (/
11. DISINFECTION: Type 11t»
12. CASING:
Depth
From 0 To it _ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To Ft.
From To
14. SCREEN: Depth
Front To
Front To
15. SAND/GRAVEL PACK:
Depth Size ,
LOCATION SKETCH
Amount ,-2 %k b 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Mate al numbers and common road names.
b" s�R.al pr%
/tMaterialMethod l
ea-ntBJ"/ �0-7A.0
Ft.
Diameter
Ft. in.
Ft. in.
From To
From To
Ft.
Ft.
Slot Size Material
in.
in.
Material
Os
CFI
TT,
0
--a
G
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THH}AT�D
A COPY OFTTHI#S_ RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0-9--r3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (9f9) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)<7)Q 1) ht 5 tin JQ„A CERTIFICATION,/./74o c2
WELL CONTRACTOR COMPANY NAM&Enni S thotlQ,yari c'J PHONE # esi-5aL/-3 g6c
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) / (if applicable) r---.-._..... _.... _..
1. WELL USE (Check Applicable Box): Residential f� Municipal/Public 0 Industrial ❑ Agricultural ❑ -
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: re' p' 4/. (llz County 4"(?(cr ti
441 S,- SSfrF-CO MI<Ylfl:j Q.Sr}L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) g .� L. 3v
3.OWNER: Ile s5€'0-ec (1 h, O'V
Address / i/ t(r Lh
(Street or Route No.)
o 4' c , 5" 7N 3
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / /' —/ n — C 3
5. TOTAL DEPTH: -r
Topographic/Land setting
❑Ridge OSio-Pe ❑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 Formation-Deseript)on
D (I/C,'r-
/1ry i err ,CAil ,d 1-70)1l
ril-u( r-!'.4.41Tc.
Too
T T,
Sec'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: f/' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /.;� METHOD OF TEST /07/%z7LC�
10. WATER ZONES (depth): L7-1/. 5 7
l 1. DISINFECTION: Type i--f/% Amount 71)- S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate al
From 0 To k7 Ft. /�" S1iR.gf ��
From To Ft.
From To Ft.
Depth
�^< Material Method ll
To FL �nyt Act,fl AiV
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size , Material
From To Ft.
From To Ft.
13. GROUT:
From %i
14. SCREEN:
From
280880
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
tV
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
/A COPY OFTTHf S RECORD H(AS BEEN PROVIDED TO THE WELL OWNER
e 6? c / +( ieFuizcit / C' — / (' — 0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

280S81.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?Ynt715Pi)I) rAA� CERTIFICATION I otl74
WELL CONTRACTOR COMPANY NAM&,I�t'.hnis +�11(44,4 IDeie . PHONE # l-S<_3a t -3 2-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT8
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Pell t/GL; 1/ County /fl 1'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /i I lr,l r I S
Address / ' `t .t AAF „ Al , 4 1 Q n„z_ 1,0 41 /
q Street or Route No.)
F�cl rrli l_t 2� /VC- t
City or Town State Zip Code
&LW- ,,71-fr7—cry.
Area code- Phone number
4. DATE DRILLED /LC - D 3
5. TOTAL DEPTH: 1fe'S'
Topographic/Land setting.
['Ridge ❑Slope ❑Valley 4%JF}at'
(check appropriate box) '
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
_SCLi7C't
/ /(5' 11/1if
DEPTH
From To
�) -5f/
6. DOES WELL REPLACE EXISTING WELL? YES ❑NO Gr �
7. STATIC WATER LEVEL Below Top of Casing: J 1 ) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): (7 METHOD OF TESTlm
10. WATER ZONES (depth):
11. DISINFECTION: Type i / -1 Amount c2
12. CASING: Wall Thickness
Depth . Diameter or WeighdFt.
From 0 To �r 3 FL to R
From Ft.
From Ft.
GROUT: Depth Material Method ,
From f FL /ID4"n a'� 00)AiV
From Ft.
To
To
13.
To
To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
LOCATION SKETCH
']-A- 5 Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
Slot Size Material
in.
in.
C
Size Material z o
0
IV
16. REMARKS: to Gc
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HQS BEEN PROVIDED TO THE WELL OWNER
to
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

281274
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
Water Quality - Groundwater Sectiononi,
WELL CONTRACTOR (INDIVIDUAL) NAME(print)W,U-'� c' �`�' l -m `S CERTIFICATION #7 `�8
WELL CONTRACTOR COMPANY NAME Y+ " t"-5vt ( LE' USal, I� U-1 K PHONE # 0)319'en-5
f
ASSOCIATED WQ PERMIT#
(if applicable) -
STATE WELL CONSTRUCTION PERMIT#
(if applicable) /
1. WELL USE (Check Applicable Box): Residential L� Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: TVItbk l-lA
cefailarlir
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -rStOE (2-.CAA
Address
(Street or Route No.)
County Me65-1,
City or Town State
Area code- Phone number
4 DATE DRILLED
Zip Code
5. TOTAL DEPTH: V1i. /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13-
7. STATIC WATER LEVEL Below Top of Casing: �cr-7 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 accordsgea pith ISA NCAC 2C .0118. al-h.
9. YIELD (gpm): l a METHOD OF TEST
10. WATER ZONES (depth): 5 1
Topographi setting
❑Ridge ❑Slope Valley OF al
(check appropriate box)
Latitude/longitude of well locatioIF
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map ` 'IJ
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
O 10
)u ' l0%3'
CO
;ow
E i Amount Show direction and distance in miles from aRast
Fri
LOCATION SKETCH
tlfe�oad�
11. DISINFECTION: Type two State Roads or County Roads. Include
12. CASING: Wall Thickness
Depth Di'm!�eter gr Weight/Ft. at rial numbers and common road names.
From D To ar) Ft. Cp�
o /4 .De-a-1. (1.
From To Ft.
From To Ft.
13. GROUT: Depth
From D To at Ft.
From To Ft.
Diameter
14. SCREEN: Depth
From To Ft. in.
Material
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Slot Size
in.
in.
Material
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

281158
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division
of Water Quality - Groundwater Section /'
WELL CONTRACTOR(INDIVIDUAL) NAME (print) S1)i 13V115 Jjf) IiQrA CERTIFICATION# OT./74O
WELL CONTRACTOR COMPANY NAM&'IX.hfTS (de(IQ�ari Wei IQ'�frlllc.� .j. %C J PHONE #il-V...3,4-3 gb a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential7d�Municipal/Public 0 Industrial 0 Agricultural I3---E`-f
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑. If Other, List Use
2. WELL LOCATION: M
Nearest Town: (nt.' ./f%l , County / ,f iQ
4 /5 Ctr,,ciee — m;s± Lr ?k763
(Street Name, Numbers, Community,
Subdivision, LO o., Zip Code)
3. OWNER: //Eh R-% h"E �c�ccle"
Address e / 0-</ PQF �il ¢.
' ,�(Stre#( or Ro a No.)
tot E P �171 idf11 7-
ny or Town State Zip Code
(5 ./)- T9.3 - b,.3Sf
11. DISINFECTION: Type
12. CASING:
Area code- Phone number
4. DATE DRILLED / / — / —P3
5. TOTAL DEPTH. .SOBS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [(Yr--
7. STATIC WATER LEVEL Below Top of Casing: '7) FT.
(Use''" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a -
variance In accordance with ISA NCAC 2C.0118. /
9. YIELD (gpm): / S METHOD OFTEST _/71W/Ji —
10. WATER ZONES (depth): /DC " / SAC/ <SCo' o
LOCATION SKETCH
't» Amount 2 %A-. S Show direction and distance in miles from at leas
Wall Thickness two State Roads or County Roads. Include the
p Dia eter or Weight/Ft. Mate al numbers and common road names.
Ft."
S-z2 R a i P V
_Topographic/Land setting-
Idge ❑Slope ❑Valley QF)i
(check appropriate box) �*
Latitude/longitude of well loc&qon
hic ma
NG LOG `�-
From 6
From
Fro
m Ft.
13. GROUT: p Material
From 13 Ft. apyyt dot
From Ft.
14. SCREEN: 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 `
QIAiC.J
Depth
To J
To Ft.
To
Depth
To ri(7
To
Depth
(degrees/minutes/seconds) -,�<;
Latitude/longitude source:❑GPS❑To.Oi
(check box)
DEPTH DRIL
From To Formation .- np ion
6 3 7 ' P, / a-e
3.7' 7S' SC n ��
75-' Soc" 310E C. -2:L'b
(
CJT
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH+S RECORD H S BEEN PROVIDED TO THE WELL OWNER
�% �i�a la
ll-1-0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
7.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print):helloll sfl
My) III4in nL- CERTIFICCATIIONN /740
WELL CONTRACTOR COMPANY NAM 6'IX-hniC �iJa ct I1)P,))�lYi)I ;1f ),n e J PHONE igt/al a(
STATE WELL CONSTRUCTION PERMITS{ ASSOCIATED W&ERMITS{
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q 1i nicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: f/? Om P 1, N 44Y' , County IY) A an:, 1 ❑Ridge ❑Slope ❑Valley LCI"t
CcS'GJ /.3ztene tf-/2.J - 5/Une CRt=rle_ C foss) n-ri, (check appropriate box)
(Street Name, Numbers, it Community, Subdivision, lot Na, Zip Code) 21 ii"/7 3 y Latitude/longitude of well location
3. OWNER:5/D7e ( Z2tit. 'r'7KSi YUJ. / )'Y e/4uri Pity gsgoe. . (degrees/minutes/seconds)
Address .300 R, vertwoocl. 0 T2-
(Street or Route No.) _
ErnIL/,,� i(iC- '73L/
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /6 - 2 —0 3
5. TOTAL DEPTH: <7l47/7' "
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lay
7. STATIC WATER LEVEL Below Top of Casing: �j[)FT.
(Use"+" if Above Top ofCas_ing)
8._ TOP OFLASINGIS / FT. Above Land Surfaces
'Top of cuing terminated atfor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ...5) METHOD OF TEST /08fat
10. WATER ZONES (depth): /() 3 ' -.2 (G' S ' (/
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e /, 2-c)
DEPTH
From
0
S'
To
r --
'5/
qr L/Llc" AUL< n %t
O
o `o
LOCATION SKETCH n S n
t I. DISINFECTION: Type fl IP Amount ,-172-it 5 Show direction and distance in miles frpp at It
12. CASING: Wall Thickness two State Roads or County Roads. Incite* thud
Depth
0 To 9(' Ft. Diaaetter or Weight/Ft. Material numbers and common road names.
From /n-` $.fR,,{ QYQJ
From To Ft.
From To Ft.
Depth;� Material Method l
To r-YIJ Ft. QOyyt Dj, %[))AiV
From To Ft.
l4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
13. GROUT:
From n
16. REMARKS:
Material
282080
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, w L
CONSTRUCTION STANDARDS, AND THAT COPY OF THJS RECORD S BEEN PROVIDED TO THE WELL OWNER C _i,
0
•
CJ1
F
/0-a 9 -v3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

2g"U( 9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;he n {7 i 51 /�-O'T{QrA Ili CERTIFICATION # �/7 if
�
WELL CONTRACTOR COMPANY NAM&N'.hfti 'tIQ,ylri lJ)PIIdl I( -di ilt Q_.7 e 1 PHONE #7%S2Y-�3 zb
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \c5 'ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential b - i icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION: 1 Topographic/Land setting
Nearest Town: • S (' t_ f ` hi f h County i) I Li On 7) ❑Ridge ❑Slope ❑Valley 0Ft5C
ti I'1iUn_ R �. p<t 4\cl , 1 0 , Al e p. a — �J C /{ I�� 1�71- (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot NoJZip Code) a, J,7 As.
Latitude/longitude of well location
3. OWNER: ,J 4,.L ' J e(/nt.. '_S
Address `' 7 t/ ,rfla r'l r S n�-e—
(Street or Route No.)
('(�<�{u>�
City or Town State
(7c6,)- — .-)/ L/ O
Area code- Phone number
4. DATE DRILLED /6 -/(
5. TOTAL DEPTH:
Zip Code
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From
L-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0--------
7. STATIC WATER LEVEL Below Top of Casing: -3/'7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a O
variance in accordance with I5A NCAC 2C .0118. l C...)9. YIELD (gpm): <2 METHOD OF TEST /1 hiliint-e en
10. WATER ZONES (depth): OCi ' 0 — fire
5 1` ' Rt. UL 2 J-/L"/
c
11 DISINFECTION: Type ht tli
12. CASING:
Depth
From 0 To S Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From () To r) Ft. 00471 bi
From To Ft.
Amount 5
Wall Thickness
Dia eter or Weight/Ft. Material
" s ?R r O��'—
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Size Material
16. REMARKS:
O
LOCATION SKETCH N.3
Show direction and distance in miles fromnleasl""
two State Roads or County Roads. Includeibe roTd'—
numbers and common road names.
,. .) rn
0 o
01 --'t
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT
�A' COPY
OF/T�H15 RECORD HAS BEEN PROVIDED TO THE WE
UG r 0,4 l lc LQC icI
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
�S a

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c f /j.tn h l S /4/) lid rU CERTIFICATION(' 01)7le
WELL CONTRACTOR COMPANY NAMI -EMI 4'Chi)[jn.Nri t))PIthY`t II . ) n e . PHONE #2-6_�. L/-3 a-6c
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERM1T#
(if applicable) (if applicable)
28 :078
1. WELL USE (Check Applicable Box): Residential Q i i nicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
N�earest Town: f A k L / 4/ County /ICI C( L/iN )
(Street Name, Numbers, Community, Subdivision of No., Zip Code) S 73
3. OWNER: e,, /--mod frt{c�
Address rj. 0nA r-3pS
(Street or Route No.)
�d'9 'kL)N JA/c—
City or Town S},te Zip Code
Area code- Phone number
4. DATE DRILLED / t " 6 —p 2
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ,< O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /G METHOD OF TEST IO /J teJ—
0. WATER ZONES
(depth): �2) " .,?'i2y
LOCATION SKETCH
Amount ,.Q %A' 5 Show direction and distance in miles fro ru t lead
two State Roads or County Roads. Includ5he ref f '--,
numbers and common road names. "
t
1 I. DISINFECTION: Type H'{"Ji
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From To .Sy FL fc'" 5-bR.,j
From To Ft.
From To Ft.
13. GROUT: Depth Material
From () To Ft. 00-171a7,J r
From
14. SCREEN' Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
To Ft.
Tspographic/Land setting
dge DSlope ❑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/0-e
Sot .eic- / ra
Fi'/ o e. 6- /'4,77 i
DEPTH
From
0
u'
5-9
To
5 ti'
c3
Material
.
F Z
Method _
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNERihr (,�f,C/� 0 ie -- /d - 0 6 -6 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

28194E3
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAN1E (print) James B. Brown CERTIFICATION 2045
1\ELL CONTRACTOR coNIPA:NY N.ANIEHedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PER91ITd
(if aonlicable)
PHONE P 828) 369-9591
ASSOCIATED WQ PERMIT:
(if apniicable)
I. WELL USE (Check Applicable Box): Residential el Municipal "Public ❑ Industrial 0 Agricultural 0
Nionitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION:
Nearest Town: Scal y Mtn
Buck Knob RD
County Macon
(Street Name, Numbers, Community, Subdisis ion, Lot No., Zip Code)
3. 0\\'NER: Danny Grindle
Address 3044 Hickory Hill
(Street or Route No.)
Gainsville, GA 30506
Ci tv or To'.m State Zip Code
(770 )- 536-2159
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 500 FT.
(Use "r" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at'or below land surface requires a
variance in accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 20 METHOD OF TEST blow
10 WATER ZONES (depth): 618' & 630'
11-7-03
700'
11. DISINFECTION: Type H T H Amount 1 6 oz
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Material
From 0 To 71 Ft. 6" pvc
From 71' To 75 Ft. 6" 188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. bernite & csra-tt. pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Ntaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND'GRAVEL PACK
Depth
From To
From To
16.RENIARKS:
Ft.
Ft.
Size Ntaterial
Topographie'Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees/minutes/seconds)
Latitudellongitude source: ❑GPS❑Topographic map
(eileok box)
DEPTH DRILLING LOG
From To Formation Description
0
clay y &
73' 700' granite
an
r
nary
LOCATION SKETCH
Show direction and distance in miles from a 12asi^. -
two State Roads or County Roads. Include t xro^
numbers and commont road names. co �.
0
lD
CO
N
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
p/.Y///% 2 —�
SIGNATU E F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G\W-I REV. 0712001
cC

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of boater Quality - Ground -wader Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION= 2045
ELL COVIRACTORCO:M PANYIN.A:IE Headen Brothers Well Drillinc, Inc PHONE ( 828 369-9591
STATE WELL CONSTRUCTION PERMIT - ASSOCIATED WQ PERMIT=
(if applicable) (if applicable)
281945
WELL USE (Check Appl c-'alc Box): Residential ❑ Men.
Nlonitering ❑ Recovery 0 Heat Pump Water Injection 0
al/Public 0 Industrial ❑ r.11tura''. G
Other ❑ I«Other, Lis: Use
2. WELL LOCATION:
-Nearost Town Frank]in Cour1v Macon
Burningtown to Welch RD-end of pvmt
(Sues[ Name, Na.nbers, Comm:nit?, Subdrvis'on. Lot No., Z:p Cie)
OWNER,• Kathy Parrish
Address PO Box 324
(street or Route No.)
Franklin, NC 28744
C:t, cc To'.n State Zip Code
826. 369-0440
Area code- P)or:e number
4. DATE DRILLED 10-17-03
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
i STATIC WATER LEVEL Below Top of Casing: 450 IT.
(Cse "-" ii Above Tor or Casini)
5. TO? CS CASINO IS 2 FT. Above Land Surface'
'Top or casln; terminated ator below land surface requires a
variance In 3 ccord ante with 15A NCAC 2C .0115.
9. YIELD (ecm): 4 METHOD OF TEST blow
10.WATER ZONES (depth): 130' & 465'
11. DISINFECTION: Type H T H
12, CASING:
Depth Dlame;e:
From 0 To 125 Ft. 6"
From Tc Ft.
From To It.
I3, GROL'T: Depth Material Method
From 0 To 20 Ft.belrite & cala.L wr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Niater.c
From To It. in, in.
From To Ft. in. in.
15. SANDGRAVEL PACK:
Depth Size Ntateri_I
Depth
From To Et.
From To Ft.
Amount 16 02
Wall Thickness
or V ei h:Ft. Material
188 steel
rrl
T000erap ic.Landsam:ez
❑Ride ❑Slope ❑Valley _Fiat
(heck appro r:1 a:e b.()
lor.2itud_ o: w'e11 location
.ude sourzeLGPSbox
CTce-gmapDEPT;alt/DRILLING LOG
From To Fo. —.Con D - 0 123' clay & s- Td
123' 500'
LOCATION SKETCH
Shay direction and distance in miles from a: ,__s.
b..c State Roads or County Roads Include :n_ soda
nurbers and common road tames. O
CO
0
vD
15. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST. ARDS, AND THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0!'.NER
D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the or ginal to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GV\ -1 REV. 072201
c
G
�0

\YELL CONSTRUCTION RECORD
281944
North Carolina - D r ..ant o f Environment and Natural Resources Division of Water Qual.t. - Groundwater Se:t.or.
WELL CONTRACTOR (NDI\/DUAL) NAME (print) James B. Erot. 1 CERTIFICATION =2045
W ELL COST R\CTOR CONIPANI'IN.AME Redden Brothers Well Drillinc, Inc PHONE _ ( 825 369-9591
STATE w EI.L CONSTRUCTION PERMIT= ASSOCIATED WQ PERMIT=
(if aorlioablel (if aonlicable)
1_ WELL USE (Check Applicable Box): Res'.dential Munici9a','FL:H.3 0 a! 0
tMtoni:orine ❑ Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
N_u.(._1Town Franklin
14 Muskrat Valley Rd
County Macon
(Strut Nnnrz, Nur..bors, Co ;;n' i i:,., SJJd sislor., Lot No., Zip Oade
3, OWNER John & Judy Leigh.
Add:o>s 14 Muskrat Valley Rd
(Street or Root: N.; )
Franklin, NC 28734
CH', or Toot.-, Snte Zip Code
( 828:- 226-3577
Area cod:- Phone r..rtber
4. DATE DRILLED 9-10-03
5. TOTAL DEPTH: 400'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casino: 300 FT.
(Use "(r• if Above To of Casing)
S. TOP OF CASINO IS 2 FT. .Above Land Surface'
-Top of casing terminated ar or below land surface requires a
variance in accordance with 15A NCAC 2C .0115.
9. YIELD (epm): 10 METHOD OF TEST b1OW
10 WATER ZONES (depth): 100' & 297'
Other ❑ ITOther, List Use
11. DISINFECTION: Type, H T H
12. C.AS:NG:
Deprit Diameter
From 0 To 92 Ft. 6"
Amotint 16 oz
Wall Thickness
or Wei:hit Ft. Material
.188 steel
From. to FL
From To Ft.
-
• 3. GROUT: Depth Material p.,,..eto,o..
From 0 To 0Ftie?mit? & c.,CIC1.. Rstr
From To Ft.
lot SCREEN: Depth Diameter Slot Size Materia:
From To It. in. in.
From. To Ft. in. in.
1=. SAND'GRAVELPACK:
Depth Sze Material
Fran. To
From To Ft.
16. REMARKS:
Topographic/ .ard settice
❑Ridge ❑Slope ❑Va(ev ❑Flat
l,-'-:ch addrocrlete -ox)
Latitudeloce mac- of we:1 location
Latitnce"ion_Ir:c
DEPTH
From To
0 90'
90' 400'
_G?SC'Tcpo_ra:hlc ❑a_
DRILLING LOG
Formation Des:- _ cn
clay & sand
LOCATION SKETCH
S-o;direction andd
two State Roads or Co-. t - •
taumcers and oomrnon road rates
0
0
0
G
tD
(77.3
I D0 HEREBY CEI THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRL'CTIO ST?. 'DARDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0A' NER
/O —D3
DATE
SGNA'('LIRE OF PERSON CONSTRUCTING THE WELL
Submit the df i;inal to the Division of Water Quality, Groundw nter Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. CA1'-I REV. 07,2001

281803
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na yak Resources - Division of Water Quality - Groundwater Section
�j
/7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (!1 !> N'� � e- � /�L L CERTIFICATION Stri
WELL CONTRACTOR COMPANY NAMF�CJ.se .o 2 f11.LP.PY- ldGt PHONE # Fignigi e0W2)
STATE WELL CONSTRUCTION PERMIT#mil,/,& ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare o County//7a-eoz i
4 .1 $73 y
(Sheet Name,, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:tJ,P, .3,C0-n..2.r,.asi (gee*
Address /.2t2 .&is4ypw� ( ee
A.S (Street or Route No.) e287/4
Zip Code
City or Town State �/
au
) f,..n.3 — 3.2.1-1
Area code- Phone n mbe
4. DATE DRILLED 3
5. TOTAL DEPTH: NZ O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RQ
7. STATIC WATER LEVEL Below Top of Casing:Jr FT.
(Use "+" if Above Top of Casing)
5
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): cp ME OD OF TEST -e.oso
10. WATER ZONES (depth): S' / G n'
11. DISINFECTION: Type Amount K•.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Fromf_To 3O Ft lv-ptea/ 9/1C
From To Ft.
From To Ft
13. GROUT: Depth Material Method .
From 0 To 20 Ft. rsizte.S( LOW »toy
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 settin
Midge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well loc
0
rri 0
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTop
(check box)
DEPTH a• L
From To Formatio
73
mn
htig
LOCATION SKETCH
Show direction and distance in •- . om at least
two State Roads or Coun ' . ads. Include the road
numbers and comet.: road names. D a
1
74 -7AnnA
-r
C r1
O
I DO HEREBY CERTIFY THAT THIS WFf.1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e /./03
SIGNATURE�ERS NO CONS UCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-he 1)P)15 ' J 'rind.i CERTIFICATION N rld74
WELL CONTRACTOR COMPANY NAMIc IjnI 1dtllo,�a 1.0e114wnlZ Q(j rt. J PHONE N -N1 _J o'2 14 —3 gb a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQfERMITN
(if applicable) (if applicable)
281796
1. WELL USE (Check Applicable Box): Residential ii-""Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use - - -
2. WELL LOCATION: nn
Nearest Town: 14- / ( N L 4 t 7)t County j 1 ' (f (4r
2$?S C7IC) 10cUIhalct 2A. 14/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Nu
3. OWNER: ( Ye T1 ilk. t•) )c� IZ S
Address `i : . e bx'
(Street or Route No.)
°Q-h i -erz-s Alp
k7/7
City or Town State Zip Code
(Pin- <9 C24 a -3,23 e/
Area code- Phone number
4. DATE DRILLED // - L 7 'G 3
5. TOTAL DEPTH: Lf r <'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /.S r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.rI
9. YIELD (gpm): 0 METHOD OF TEST JIV /1m
10. WATER ZONES (depth):--,Z%' (�
11. DISINFECTION: Type H"-h4 Amount r2. TJ S S
12. CASING: Wall Thickness
Diapeter or Weight/Ft. Material
Tpographic/Land settitig
dge ❑Slope ❑Valley CEIt
(check appropriate box) c)
Latitude/longitude of well 1. • owat
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑To
(check box)
DRIL
For1matio
/
t l a4
DEPTH
From To
'7 12
Q6. •
0
From fl
From
From
13. GROUT:
From
From
Depth .
To /:3 Ft.
To Ft.
To Ft.
Depth
To r7t/c��
To
Depth
To
Material
Method
ND
0
0
0
cal �
hic map
0
ING LO
r'C
V?it' In% L%f-F.
lib, (—Ma'2t t r 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.
FL „1
c -Z,
m
0
r
0
m
n
c
G
16. REMARKS:
Ft.
14. SCREEN: Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
0
w
0
N
r
cfl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL1tD IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H4S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
//—i7 —03
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
(�1

281795
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;hen V), S I� IIan%rl. CERTIFICATION0 ande
M
WELL CONTRACTOR COMPANY NAWh'M It S lDj�ytr4 WeillvrLU'at G� ]-n e 1 PHONE s dC a14 —3 al
STATE WELL CONSTRUCTION PERMITI/ ASSOCIATED W EMIT*
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentiali nricipal/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: //'Cem lG-' •� County / i
st
5tw/ 4G CUa--O7 Al 9r,»,)MLCrr.e./ Lri /1d
(Street Name, Numbers, Comfnunity, Subdivision, Lot No., Zip Code) r 1-.73
3. OWNER: J -✓r r' S f it /k
Address 90� l /rr'ti s,-/t 3 /77a k'
(Sheet or Route No.) r
l4'DUj/ph rX /705/
Cry or Town State Zip Code
(7/s )- sY f? to A-Z, 3
n Ancode- Phone number
4. DATE DRILLED / /— / �7 -d_3
5. TOTAL DEPTH: �:t'%'('
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .3 a h FT.
tow*" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below bud surface requires a
9. YIELD (gpm): '/ METHOD OF TEST
variance la accordance with ISA NCAC 2C .0118.
/Min~;''
10. WATER ZONES (depth): c 3t2 1 V
LOCATION SKETCH
,i.
11. DISINFECTION: Type ifa-» Amount .TA-5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di ter or Weight/Ft. Matey'al numbers and common road names.
From 0 To 0' FL 5-12 R , 1 Pre -
From To Ft.
Topographic/Land setting
tRidggee ❑Slope ❑Valley ❑Fiat
(check appropriate bot):.
Latitude/longitude of well Iodation'
From To
13. GROUT: Depth
From-D _To r`
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Material Method
FL eQar A2,1 p
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
C_.
(degrees/minutes/secottds) i a.Latitude/longitude source:❑GPS{t $ographic m
(check c )
DEPTH RILLIN
From To Fo
0 (..,3'
(;-3• t/ s• tutu o i
/i5' !ills' R roA, i+z.
0
CO
0
0
23.
r11
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF Tli)S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
24
//—/.—a3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
E,,c (print)< 1)� n 1V)I S !'�'i) lin.A fv�' CERTIFICATION # r2/74'
WELL CONTRACTOR COMPANY NAMS1)9.1 ifitp Mlle► I)Vrll:lt1 yrte1 PHONE fi, v5"a4-31(,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W6 'ERM1T#
(if applicable) (if applicable)
283121
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection CI Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: >Q /'A'k l; vV' County / 'I a_CGY�
(c4� f�c[G4re.cjL g , S93y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: e7i1 '1'V 41 e (`CL/l
Address C%ta) /1, C-L" au ark PA
(Street or Route No.) �IClnkl;Ti) A/o- &3
City or Town State Zip Code
- Sr to G-f
Area code- Phone number
4. DATE DRILLED / / —/ / b 3
5. TOTAL DEPTH: Cash)'
Topographic/Land setting
❑Ridgee ❑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
elo 1
rl E C_ {On ;
DEPTH
From To
Cc Sc
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: . r FT
(Use'+^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below tend surface requires a
valance in accordance with ISA NCAC 2C .0118. //
9. YIELD (gpm): / METHOD OF TEST A/ /0A/L'- n- CD
10. WATER ZONES (depth): /CV)' U T
11. DISINFECTION: Type
12. CASING:
Depth., &,
From it To
From To
From To
LOCATION SKETCH C
JJ# J' Amouni %A-ra 5 Show direction and distance in miles from aft
Wall Thickness two State Roads or County Roads. Incldde the.road
Dia eter or Weight/Ft. Matep al numbers and common road names.
Ft. n... S�R. 1 pY e
Ft.
Ft.
13. GROUT: DepthMaterial
s1;<
From fl To r-71' Ft. ep4, Lk),./
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method )
ri[i)A
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S BEEN PROVIDED TO THE WEL ^r—
// /)-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

283128
From 0 To i Y
From To
From To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELLCONTRACTOR(INDIVIDUAL)NAME (print) c1)-n)'l15 Rig 1- • CERTIFICATION# eT/7le
WELL CONTRACTOR COMPANY NAMK'b'4Itlr c jdeilnsetrA tile* l )YS 11 aL .�, n r PHONE aV51(_ Sit 1-1--3 LA C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential b Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Otn County /1n1 tt&r,
I++: S tea ;6C'I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: in r h (r' P. I -rh bYYt-' J Dw
Address "e1 LV ‘,/ in t✓ e _ in i 0)1 ,1-3
(Street or Route No.)
FYAtetk I;I-3 A/C- cQi; 13
City orTown State Zip Code
(- 3 (, `I - 3 rf 3 4'
Area code- Phone number
4. DATE DRILLED-e_ J/_3 0 3
5. TOTAL DEPTH: 3nri
92
pographio/Land setting
'dge ❑Slope ❑Valley ❑Flat
6 7 (.;j (check appropriate box)
Latitude/longitude of well location
6. DOES WELL REPLACE EXISTING WELL'/ YES 0 NO UJ-
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 ator below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD OF TEST
10. WATER ZONES (depth): e26-0
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
fr) 3 F' l 1(7.9
On' /lt r' /Ct--rat n %tc
o --
LOCATION SKETCH -
11. DISINFECTION: Type H- Amount r2 T S S Show direction and distance in miles fromiat least
12. CASING: Wall Thickness two State Roads or County Roads. Includ@the iiad
numbers and common road names.
Depth Dia eter or Weight/Ft.
Ft. n" S.fR,2i.
Ft.
Ft.
13. GROUT: Depth
From n To ri(7 Ft.
From To Ft.
MpeteJial
Material PUMA—)
00471 Bit pcJL )
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
tr _____
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, LL .._:_ -- —.-
CONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE
fhl 0 0 .ee
-.3 -' 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2831`_.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - i1M Division of Water Quality - Groundwater Section -r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e7jQh hl Sl /Ji)j1QU CERTIFICATIONr/1 o1fl4o
WELL CONTRACTOR COMPANY NAMM 4iniS +Vi!'lgnri IIJP.II JI-R me PHONE # .%ft a 1-1-3024<
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WOPPERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ft ❑ Industrial 0
Monitoring 0 R.ecovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ll
Nearest Town: gt,zytU%,TJt) County/ /�/j )oOLrKi
(,, 4 L fi rma 5 2<-‘_ R73
(Street Name, Numbers, Community, Subdivision, Lot No., Zi Code)
3. OWNER: I-t��-I ri t'(., cc,2,t, e. {Z
Address q)- 5)( 1 rJF/
(Street or Route No.)
i--vnMIvin,) (.`i17y-y-
City or Town State Zip Code
( .asly- .5 4/ - e3osy
Area code- Phone number
4. DATE DRILLED 1 ! -1 1 —0 3
5. TOTAL DEPTH: -
Agricultural ❑
Topographic/Land setting
❑Ridge CT8i6pe ❑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
3(� ' 7Ct S'�r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ql-
7. STATIC WATER LEVEL Below Top of Casing: 3,1O 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): .3 0 METHOD OF TEST
10. WATER ZONES (depth): f-Q t.2
5 '
11. DISINFECTION: Type H-1/4 Amouni
12. CASING: Wall Thickness
Depth Diameter or Weight/Tit Mate al
From 6 To Ft. ' SZ2 R ,� 1 pry
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From f) To r'`D Ft. 004?1 dnt cnu0
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:
LOCATION SKETCH
,..3 7"m_, S Show direction and distance in miles frori'6t !call E:;
two State Roads or County Roads. Includedhe r6dd,
numbers and common road names. c
W
0
N
Cr)
r: ti
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER .--_._...
rf' 0 ( l ,ea //—q -0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
From 0
28312E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ‘7)f n n i 5 /-ns 11 fir rrt.) • CERTIFICATION i oZ 1-74P
WELL CONTRACTOR COMPANY NAMK-IEX;()r) i 4 ftio II(Zy,r1 :u�Q(' . j, n. C J PHONE i�-%f'_S� y--3 a-b C
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W&�'PERMITi
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentialf--'-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9Ni
Nearest Town: Ayr- k/; A/ County Q (!114 2
(Street Name, Numbers, Community, Subdivis�, �Lotl No., Zip Code)
3. OWNER: Wu67r 6 r2-K) c)
Address /0/ C utii--1u7c l/• //
(Street or RAoute No.)
t4/0
CityorTown State Zip Code
(1,,2.)l 369- ?/0
Area code- Phone number
4. DATE DRILLED //-5 -U 2—
_Topographic/Land setting
❑lodge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
0/1 Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D /%3' Cl
73' & ssh-w
5. TOTAL DEPTH: %ton-
6. DOES WELL REPLACE EXISTING WELLY YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:.3'YD' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /UI/}rt
/hC(;r,2,0 /E
0
0
LOCATION SKETCH Cr c'`;
Amount TAB S Show direction and distance in miles from at leiTsE
Wall Thickness two State Roads or County Roads. Include the i-oatl
S numbers and common road names.
Depth Dia eter or Wei hUFt. Mnatejia�
To. _Lai Ft. n 5-b R .+i 1, Y
From To Ft.
From To Ft.
13. GROUT: Depth
From 15 To r-� Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
/t
Material
0247t M
Method
Slot Size Material
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THHAATT�t?u l A COPY OFn S RECORD BEEN PROVIDED TO THE WELL OWNER
O! Le 8_ 5- _0 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Pltone No. [phone], within 30 days. GW-I REV. 072001

283125
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) x?Ville/I 5 fin /IILyn rt. • CERTIFICATION Ncli7e,
WELL CONTRACTOR COMPANY NAMRbelai i �JIfgvi Wei J 1)16 Z1.4. ] P. e PHONE 1 X1 —37/a Y-3 a'6 C
STATE WELL CONSTRUCTION PERMITI ASSOCIATED WQYERMITI
(if applicable) (if applicable)
I- WELL USE (Check Applicable Box): Residential L 1 icipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Al qq
Nearest Town: J-RA/G'R L r County /i'I c1 ct7f
r!4! 4/ CLararrge f?,1 - ICivtsla_ n_
(Street Name, Numbers, CommutMy, Subdivision, Lot No., Zip Code) z g-r j 3 U
, 3. OWNER: JA } C k c I I /7} ; S{t-t.yo /
Address W9- A'i175/O,< L ac4-
q �� (Street or Route No.)
Wrl21,,U /i C_
City or Town State Zip Code
(S - 34-9- /1/179
Area code- Phone number
4. DATE DRILLED 1 J-/ h- D 3
5. TOTAL DEPTH: 4/-(?/J'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ql�
7. STATIC WATER LEVEL Below Top of Casing: (i) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface;
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ltwl1 LIJ-
10. WATER ZONES (depth): <3SS' (�
23Li
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesrseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
l" l a 1A ^i
RiU,o r-'ani9---
DEPTH
From To
(7 .�G
11. DISINFECTION: Type ✓ff%/ Amouni ,Q
12. CASING: Wall Thickness
Depth Diapieter or Weight/Ft.
From 6 To `7 Ft. � �` 5-? R.f (
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To ,,-"fp Ft. easy, 42
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
'
7S 3(d0'
W c.
LOCATION SKETCH
-n9-13 5 Show direction and distance in miles from at le
two State Roads or County Roads. lncluci be roams
MMatepal numbers and common road names.
Pr
Method
From To Ft.
From To Ft.
16. REMARKS:
Ca
0
rJ
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUE I LD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFTT`�S RECORD H BEEN PROVIDED TO THE WELL OWNER
0)10 le J1- 10-n3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282690
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and al Resources-- Di
Ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ./S 2 `-' i >;-) V LIM� d. /_ % CERTIFICATION g
WELL CONTRACTOR COMPANY NAJ4:(�"P't�'/1E iV�
��A/ //C-Pt1ONE # (S ? l 4/ si - a 7z)
�i05_
STATE WELT. CONSTRUCTION PERMIT# /�6 'Cn-._-\SSOCIATED \\Q PERMIAA _ --- - litapplicable.)tit applicable)
I. WELL USE (Check Applicable l3ox): Residential Municipal. Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAlIO :
Nearest Town: 4 r....k A
(succt Nal.n.i4Nitaitss. Cot�nuaiN_Sbditiim.I in Vo.lipL ode .
3. OWNER: (I e, inimt__ eun.l.)
Address / 3 f'l� _Lei (di l.autud�
c longitude ource:❑GPS❑Topographic map
17
cc-or FtiL—+ne No.Yt( ,iV 773 1 UI P11 (cheek h¢s)
1DRILLING LOG
City oron 'ihSlate hip Mode F rout). I / Pone: tit n Description
[-
( E _...7_�(j A C
of f
Area rode- Phone number �.__� -_
4. DATE, DRILLED /9 =/et 63
i. TOTAL DEP1IL 7, -.?.- /
6. DOES WELL REPLACE EXISTING WELL'. YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ) t /) 1.
IUsc't` it Ah.nc Top of Casing.)
8. TOP OF CASING IS / ET. Above Land Surface* - - - -- -- _ -
"Top of casing terminated at/or below land surface rennin's a
variance in accordant/ with ISA NCAC 2C .0118. - --- - - --
9. YIELD (gpn/,,,,,p: /S4 METHOD OF TEST a ,,,, - -
I o. urn LR ZONES (depth): .36�� / —'L/i q p» r
LOC:AT ION SKETCH
11. DISINFECTION: rope /-1-�7J :Amount 94:+_ ._b LLs_ Shots direction and distance in miles from at least
12. CASING: AAall'rhickness two Site Roads or County Roads. Include the road
Depth Diameter or AAeiuht Ft. ,Material numbers and common road nallICS.
From /0 To 2 Ft. (I' /1 _17Lfd_ p --
From 'l o Et. _ ("J 0
E r
From To l't. -': ( p
Q n
I3. (TROUT Depth /A Material Method i ) - .0 �n
From To c2O It. ( i/�P-o-� - 1 — �'<
0
From To �o
14. S(RE I:N: Depth Diameter Slot Siic Al,ucriul I - �" n�
3 ",
..--
From To Et. in. in. _.. _.__ t , f �-
Prom To Pt. in. l in- -.I O "'^
n
15. SAND:GRAVEL PACK: 1,� GJ7
Depth Svc Alutella' 1 - co o
Z
Topographic/Land settine
❑Ridge OSlope ❑Valley Xdat
check appropriate host
Latitudelongitude of well location
From To Ft.
From
16. REMARKS:
I DO 11E12E13Y C IRA IPY IIIATTIIIS WELl. WAS C ONS.' RIK l I l) IN ACCORD •ANCI. . wll II 15_A INCAC AA ELl.
CONSTRUCTION STAN AI DS, ANDIIIAIA COPY OF TIIIS RECORD I .' 131 F. 'I(OAIDI.D IO I IIII AAT.I.1 OWNER
/6' 63
Y�JJ A)x4 y/ini
SICINAIURI: 01PIiR.SUN CONS1121 C'TINt: Uri[ I. DA'rll
Submit the original to the Division of Water Quality', Groundwater Section. 163u Mail ]cn ice ('enter- Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. GbV-I REV. 07 2001

282689
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and/v��'num! Resources - Division of Water(,)uality - Grouna datcr Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -tern1/ rt----S) to WinrE�.n - CERTIFICATION #�✓ .2ga
1 b- fiu/M i`(-PIIONE. # I P G `/ 9 -. 3 / 7L,
\VE:1.I,CON"FRA(FOR CONIPAVI"NA\IF; Cj r(_�l'.L)r. ��- [Oat[OatPt NI(
STATE WELL CONSTRUCTION PERNIIT# _ /_y [J JZ.. _ASSOCIATED AAA) PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal. Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ I(other, List Use
2. WELL LOCATION:
Nearest Town: ri-CLI)
County fr2/2Q-con
Street Naas. Numhe(, Community. Suhdiu. on. Lot No-. hip code)
n«>//,1�/ £ .
Address 1:
F.?"'
Lily or Tovn
( 1
Area code -Phone number / -
_ 6 3
4.
5. rornL DEPTH: j/ S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC' WATER LEVEL Below Top olCasinn:
(disc" " Jr who ca'lop of C:<ingi
S. TOP OF CASING IS / ET. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCA( 2C .0118.
9. YIELD Igpnl): ja(i+ METHOD OF TEST r-S
10. WATER ZONES (depth):
5t
yr Roulc Nat �.R73/
State dip Cod:
DATE DRILLED
I I. DISINFECTION: Type /-1 7-//
12 CASING:
Depth Diameter
From 4 To ,2 C) Ft.6.,//
From To Ft.
From 'To Ft.
ihod
13 From.
11 : Depth �1m<rial N'I
From To �") E=t. F Awe-t-i�"�
From To Ft.
14. SCREEN: Depth Diameter Sot Sire Nlaterial
1-rom To Ft. in. in.
From To Ft. in. in. —
15. SAND (RAVEL. PACK:
Depth Si/e Nlatcrinl
From Io Ft.
:Amount is
VA all Thickness
ar AWeight I - .AnIalendl
From
To It.
16. REMARKS:
Topoinaphic/Lund setting
❑Ridge ❑Slope ❑Valley m
(cheek ePproprruc box)
I.witudelongitude of vicell locution
(dc,eraa irunums sccon.L.)
Latitude longitude source:❑GPS❑ Topographic nap
Iehcek hind
1)1 I) I DRILLING LOU
1-rom To Formation Description
___5312:443wLe
LOCATION SKETCII
Shots direction and distance in stiles from at least
nso State Roads or County Roads. Include the r tl
numbers and common road names. W o
L
O
O
Ui
cO
I DO IIER114Y (FRTIFY MAT TIIIS Nl`.LI. \VAS CONS IRUCI ED IN ACCORDANCE AAll l 115.A NCAC 2C. WELL
CONSTRUCTION STAND S, ANDIIIAh A COPY OF IIIIS I&P('ORD IIAS to :N 16ROVIDID To I ILL AAEI.t. OWNER
Lt) J•JY-P-L�I• ' �Z
/C). -3/ -- 0a
SIGNATURE 01t PERSON ('oNSTRL'CII Ntillll. WEI L DAIL
Submit the original to the Division of eater Quality, Groundwater Section. 163o Mail Sep ice Center - Raleigh. NC
27699-1636 Phone No. [phone]. within 30 days GAW-1 RI:V. 07 2601

282326
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesq- Division of Water Quality - Groundwater Section
ck ("/Y4t/e_ CERTIFICATION#35-73
PHONE # (rKU,-4:2/ "i7.5-24
WELL CON R C FOR (INDIV IDEAL) NAAlE� (print)
El I RMM/
\\ECON COMPANY NA E L /4/')//e'
STATE WELL CONSTRUCTION PER)IIT#
(if applicable) (if applicable)
I. WELL LSE (Check Applicable Box): Residenta Municipal/Public ❑ Industrial ❑ Agricultura
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 II Other, List Use
WELL LOCATION
Nearest Town: f-r,mi-/%1/ 1 CountyA)%//len
J'TC,A/) S /YroMir/v %fr-.! o a
(Street Nome. Numbers, Community, Subdivision, Lot No., Zip Code) L 3. OWNER: LI& Q,-/'img'
Address Z-AtJtn Vf1ntX Ad'
(Street or Route No.)
rcOile>li ai 31/
itv orl e Zip Code
Area code- Phone number
4. DATE DRILLED V-/2
5, TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. _
9. YIELD(gpm): C6f METHOD OF TEST /fiV
10. WATER ZONES (depth):
ASSOCIATED w'Q PER\IIT#
Topographic/Land sett y'
❑Ridge DSlope DValley MOM
(check appropriate box) cr z
Latitude/longitude of well Icwt`A' 1
c>
ads
(decrees/minmes/seconds) -"5) i
n 7
Latitude/longitude source:❑GPS❑TcPgr,—
(checkbox)
DEPTH DRILLINC LO
From To Formation De:cription
- er-b Chae
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (J To i6' It. ; ��e—
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From P To 2c Ft. C1'rnE/Z/ /0ec,-r,'7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To - Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
16. REMARKS:
Ft.
Ft.
0
o
CO
2
V
arC
1
r `� 1
LOCATION SKETCH
Show direction and distance in miles fronl€t lea9W-L!
two State Roads or County Roads. Includc4Ae road ,
0) oc
numbers and common road names. O
CO c
�)
C
s.0
tV
J
CIO
I DO HEREBY CERTIFY THAT THIS WELL WA* t . 1
CONSTI2 CTION STANDARDS, AND THAT A OI t " ` ' • • • HAS BEE
I }µ�•
SIGNATURE OF A 4 COIN`S`PRUtTIN THE W
Submit the original to the Division of Water •tality
27699-1636 Phone No. [phone], within 30 d ys. P.SHE
IILLE FEGIBONI OFFICE
H I5A NCAC 2C, WELL
IDED TO THE WELL OWNER
by
L DATE
gyjp)ON636 NI.'I Service Center- Raleigh, NC
GW-I REV. 07/2001
)CiDE A'I'CWiDJ

WELL CONSTRUCTION RECORD
282325
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME(print)c1}- 74, e(446 CERTIFICATION #762/
WELT. CONTRACTOR CONII'ANY NAM /
E ( 044r 41,,,. Li-)e Jl 'Li- U aft,//e)C, P110NE # 1/57:2enC27- Y��{�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERAIIT#
2.
(if applicable)
(if applicable) r
WELL USE (Check Applicable Box): Residential. Municipal/Public ❑ Industrial 0 Agricultural 0 n
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATE,(1N:
Ncare+�t Town: fvf/P L/- n�
v'o c`4 50ullel
County /2)j4 ea14/
(Street Name. Number, Community, Subdivision, Lot No.. Zi
3. OWNER:
Address /51
(Street or Route No.)
riq nl/k/a/ ,t/ L „D 173y
Code)
City or Town State
e 5 r L1Yn/-e-
Zip Code
)-
Area code- Phone number
4. DATE DRILLED S-f-- 03
S. TOTAL DEPTH: to-5-5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: O FT.
(Use "✓' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): y METHOD OF TEST ZIi
10. WATER ZONES (depth):
I1
12
opographic/Land setting
❑Ridge ❑Slope ❑Valley Egc(e„
(check appropriate box) m
Latitude/longitude of well locatirm r„
ci
(degrees/minutes/seconds) ,
o
Latitude/longitude source:❑GPS❑Togo, :
c map
m _
a
(check box)
DEPTH DRILLING LOG
From To
s- 6s`c
T
fJL
Formation L/Loitiptiuu
-0
DISINFECTION, Type Amount
CASING: Wall Thickness
Depth Diamyter or Weight,Tt. Material
From_0 To (n 5 %')U`
From To Ft.
From To Pt.
13. GROUT: Depth Material
From D To is.? G Ft. C_:/IQFh)
From Ft.
14_ SCREEN:
From
From To
15. SAND/GRAVELPACK
Depth Size Material
to
Depth Diameter Slot Size Material
To Ft. in. in.
Ft, in, in.
Method
p6l%4 y
From To Ft.
From To Ft.
16. REMARKS:
0
Show direction and distance in miles from(° eas Y
two State Roads or County Roads. Includcal7e, ro£3
numbers and common road names.
LOCATION SKETCH
IV
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTI JCTION STANDARDS, AND THAT A COPY OF T ��� a.r_e�t�j�� THE WELL OWNER
to/d 0�
-'77
SIGNATURE OF PERSOI
Submit the original to the Division of Water Quality, (
27699-1636 Phone No. [phone], within 30 days.
ERUCTING THE WELL
u wat V- ctil,n, I39C tail
GROUNDWATER SECTION
ASHEVILLE BEGi01.NL OFFICE
DATE /c'
Center - Raleigh, NC
GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town: /1-tik/ 2/ County 414e4 4
/4/1rta) (1 ref( " l k/ yf Jc2 S
(Street Name. Numbers. Con n iunity, Sub licision, Lo(No., ip Codc
3. OWNER: .77.
WELL CONSTRUCTION RECORD 282324
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIA'IDUAL)NANIE (print) ( eou
'J ( 4 4/ . CERTIFICATION #.36--2,V.
ERTIFICATIOONN#.3U��
wELL CONTR:ACf012 COMPANY N.ANIE C/>¢[je- i,,pro a-v „-(1)h %/b, . ;in( PHONE #
STATE WELL CONSTRUCTION PERJIIT#
ASSOCIATED \\Q PERMIT#
Of applicable) (if applicable)
1. WELL USE (Cheek Applicable Box): ResidenlialB' Municipal/Public 0 Industrial 0 Agricultura r'�
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use v
cit
mg
o :?
n
T O
LING L
Topographic/Land set
❑Ridge ❑Slope ❑Valle
(check appropriate boll
Latitude/longitude of well I
aVI� (degrees/minutes/seconds
I a titude long dude source:❑GLS❑
f �= C�/'(treet or R6ur t/./r(checkDRI
Y.✓/ DEPTH DRI
n-or Tout State Zip Code From To Forma'
Area code- Phone number
4. DATE DRILLED C/-/S -o3
S. TOTAL DEPTH: kkt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: A, S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*"fop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /5— METFIOD OF TEST Ai r
10. WATER ZONES (depth):
VAd Tress -lY4 c
lat
n
J
aphis map
— 71 (V&
7 5-- V4) 5 fi✓/9/, ¢e'
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
•Depth _ Diameter or Weight/Ft. Material
From (7 To 75 Ft. &- V Z0c/e-
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From C To . .o Ft. ('C41/d / 1'7bitty �7
From To Ft. J
If. SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
in. in.
From To
15. SAND/GRAVEL PACK:
Depth Size Material
Front To Ft.
From To Ft
0
CO
O
n'
I o;_
�c
LOCATION SKETCH 0 ,4��,''--
Show direction and distance in miles from,arleasfci,`
two State Roads or County Roads. Includ
number and common road names.
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 •' ` - • = OVIDED TO THE WELL OWNER
5
t
' u t
SIGNATURE OF PERSON t TRUCTING THE WELL
nr
Submit the original to the Division of Water Quality. ndvvtilaiiSeatiDn,217,653 Nia
27699-1636 ('hone No. [phone], within 30 days.
DATE J/" C7
cc Center - Raleigh, NC
GW-I REV. 07/2001
c S,CTcw
ASt-tViLLE REGi OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and MCA/VP
Resources - Division of Water Quality
VAELI.CONTILVCTOR (INDIVIDUAL) NAME
(print) r CA/VP c'l'ALI�
\\ ELL CONTRACTOR COMPANY NAME( 7 y tw. tJ1725. 7-tie /A r://. i,7Mc.
star.: E VAELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
282323
cifapplicable)
- Groundwater Section
CERTIFICATION # So 7/
PHONE # yVlytll 542/20j,]6
1
2
WELL USE (Check Applicable Box): ResidentialliEr Municipal/Public ❑ Industrial ❑ Aericultcts
tral ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
1y::-
WELL LOCATI N:
Nearest Town: f j%J /19fiis County /�h1 e i'/ )
Sky lia/cy-
(Street Nat se. Numbers, Community. Subdivision, Lot No.. Zip Code)
3 OWNER:
Address /3% Pt Sal 13C>i Kl�r- (nr1/a
�
30(+a5- .2�
City or Town State Zip Code
( )-
Area code- Phone number ") 4. DATE DRILLED 'V- — 3
5. TOTAL DEPTH: / OOS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: .,� D'O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): f p;n� METIIOD OFTEST4;r
10. WATER ZONES (depth):
(Street or o to No.)
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth ,__ or Weight/Ft. Material
From O To &- 5 Et. Er -' /IJc..
Front To Et.
From To Ft.
13. GROUT: Depth Material Method
From C To .J o Ft. (re/1/l'z f h//li// j
From To Ft. 6 J
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Fr0111 To Ft. in. in.
15. SAND/GRAVEI. PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS'.
Topographic/Land
❑Ridge ❑Slope ❑Va
(check appropriate b
Latitude/longitude of wiL{J9: tion
cn
idles
iao•
6A(
FILLING
atiot Des
(degrees'mimaes see
Latitude/longitude source:❑GPS
(check
DEPTH
From To For
❑Flat
oeraphic ma
S G
✓ki71�1'i-C
t r,
1
(i
O
:> 0
— 1111 iT
nl '-;
O
LOCATION SKETC}I �� z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CO
CONSTRUCTION STANDARDS, AND THAT A COP
SIGNATURE OF PER
Rt coR4SHAisB EE
(
ONSTMWTI gTrIO ELL
5A NCAC 2C, WELL
D TO THE WELL OWNER
03
Submit the original to the Division of Water Quail y, Grpundwater Se c�n,S.36-Ahail S
27699-1636 ('hone No. [phone], within 30 days.
SFC ilON
() ICE
DATE/-3/-°3
vice Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 8 2 3 2 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Fc'id Crr/Me_ CERTIFICATION (5302V
WELI, COST RACTOR COMPANY NAME (IYAVie.: l-1-4l/)%.)P/l/'4,,7, JNe, PHONE #p91523`/�4
sL\TF: AA ELI, CONS l tLCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentia1,2' Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest
Town: f03rt4 / Al
C)!civ 1P Oiltl,j
Countyf jAGJti
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S#i.s
Address /» 5 ��&z '?,Y i (74 41--/
(Street or / No.) r7,eY
'3c jo„,, Sw 7 Zip Code
L -7 V
Area code- Phone number
4. DATE DRILLED L ' oaf' -
5. TOTAL DEPTH: ) 9b
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Yt' FT.
(Use '+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or helots land surface requires a
Variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): �i METHOD OF TEST 4..t
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From Z. To .77 Ft. - /?cic-
From To Et.
Front To Ft.
13. GROUT: Depth Material Method
From I' To o? c` Ft. /'2474rt, /9///k,47
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft, in. in.
U.SAND/GRAVEL PACK:
Depth
From To Ft.
Topographic/Land settin
❑Ridge ❑Slope ❑Valley
(check appropriate box) m
Latitude/longitude of well loci nR'
TU
(degrees/minutes,
n
seconds) m
Latitude/longitude source:❑GPS❑Top .graphic I
(check box)
DEPTH DRILL • ,
From To Formation Description
_37
97- yc'5—
eft
o
O cr:
mac:
•
tt
G
rt
From To Ft.
16. REMARKS:
Amount
Wall Thickness
Diameter or Weieht Ft. Material
Size
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU
CONSTRUCT ION STANDARDS, AND THAT A COPY OF THI
SIGNATURE OF PERSON CO
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone Na. [phone], within 30 days.
dwa yM400 riluflv'`QN Cen
ASNEVILLE REGIONAL Ot ICE`
hOC.ATIONSKETCH Cab
Show direction and distance in miles from atrh ast
two State Roads or County Roads. Include thaoad 11 2,
numbers and common road names.
w -
(V
J
2C, WELL
E WELL OWNER
ATE /t-17/-o)
r - Raleigh, NC
1 REV. 07/2001

282321
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
:ELL CONTR-vCfOR (INDIVIDUAL) NAME (print) r f 13/ QrAn e CERTIFICATION # [ /
WELL COS' It,AC'TORCOMPANY NANIr: t ri4/4r 6 LL)Q//' '//° t f nL, PHONE # ( 3.1 "y/�.7ll'
STATE w'ELL CONSTRUCTION PERMIT# ASSOCIATED AAQ PER.AIIT#
Of applicable) (if applicable)
al/Public D Industrial D Aericul
I. WELL USE (Check Applicable Box): Residentia�C�Municip.
Monitoring ❑ Recovery ❑ Heal Pump Water Injection ❑
2. WELL LOCATION:
`
Nearest Town: r Y /i✓Li72iv
&(v)CA
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
r'-Sy /fel/
(Street or Route No
F,t—�11/7/� 7_37
City or l own State Zip Code
( Area code- Phone number
4. DATE DRILLED � -/V ()-?
5. TOTAL DEPTH: % In0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Cc' FT.
(Use "-s" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a,
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 02 1 - METHOD OF TEST Air
10. WATER ZONES (depth):
Other ❑ 1 Othcr, List Use
511❑
cn
m A�
r- C
Topographic/Land st-tTig
:Midge ❑Slope ❑ValfNt.❑Flat
(check appropriate bo rE m
Latitude/longitude of wel4
n mn
r-
ion
(degrees/minutes/seem tS;o
Latitude/longitude sourcedLIGPSERTEc
(check
DFILLI
DEPTH
From To
- // o
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and common road names.
From
To //O Ft. h-f7. /Or/G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To a O H. e,41eA-/- l utii./i 1 y
From To Ft.
14. SCREEN: Depth Diameter SlotSize Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
graphic map U a a
NGI.b/i__ i
Format:ea Dcs,ript o
/9
0
0' C
-n
From To Ft.
Front To Pt.
16. REMARKS:
n
Nn_U
rn.-
cV
LOCATION SKETCH O
Show direction and distance in miles from aptt Icast5
two State Roads or County Roads. Include tA9 roa&'
I DO HEREBY
' CERTIFY TIIAT
CONSTRUCTI
ON
County /)'i.9Fd✓f
THIS WELL WAS C
STANDARDS, AND THAT A COP
L� ■I
SIGNATURE OF PF' golCON$tT�IIUCriaNG 2003 \ E
Submit the original to the Division of Ater Q ality,routt�nUUdllwaterSection, 16.6 Nlai
27699-1636 Phone No. [phone], within 30 d. es. GROUNDSVATER SECTION
ASHEVILLE REGIONAL OFFICE
FNS Rt❑457"O F�� H � 5 ., f E'ER
VITH 15A NCAC 2C, WELL
D TO THE WELL OWNER
6-/o - 03
DATE /d--
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
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [-1)-en V)I S 1 ikkA L CERTIFICATION# all le
WELL CONTRACTOR COMPANY NAMSb'T
hn t C fkliainrl Wei I A')Ys I -1441 n(' J PHONE U flf13o1 tJ .3 Z(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ4ERM1T#
(if applicable) (if applicable)
282298
1. WELL USE (Check Applicable Box): Residentialunicipa1/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: fie 47,71. t' Ana County Aria -cis
(c(I ef EriiiJ/)y i'nmm, -0 73y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ))(Liu'el9 SI(tit c,PId) CI et
Address 4',R'2 >'e)'rr,T d t„nn d Q P
(Street or Route No.)
%i't2'd ire / A ,) r1/e- 4173 /f
City or Town State Zip Code
(ka D- .5"a V-- S 73y
Area code- Phone number
4. DATE DRILLED /6 - tf _p 3
5. TOTAL DEPTH: /Sc
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
3/' Pl/2'
/5S' 2/7, P (21(44-,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t71I�
7. STATIC WATER LEVEL Below Top of Casing: .5 - FT.
(Use"+" if Above Top of Casing) ;,;
8. TOP OF CASING IS / FT. Above Land Surface' t '7 _
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): 5 METHOD OF TEST /kit/i �`1�' IOE WATER ZONES (depth): L/S� ' (�
c
W
11. DISINFECTION: Type J # e Amouni ,Q
12. CASING: Wall Thickness
Depth . Diameter or Weight/Ft.
From 0 To _3/ Ft. In-` 5-Z2R,.7i
From To Ft.
From To Ft.
Depth Material Method
To FLJOyn ai pc A
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
13. GROUT:
From
� a:T
is
• OO re,
n,
LOCATION SKETCH " c�
m 5 Show direction and distance in mile qom gleast
two State Roads or County Roads. Include A'ie road
Material numbers and common road names.
From To Ft.
From To Ft.
ASVE. Li
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF TH 5 RECORD ( S BEEN PROVIDED TO THE WELL OWNER
Or04- .� /--D�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Depth
0 To 7/ FL 51bR,�1 Q)Pe.
To Ft.
From To Ft.
13. GROUT: Depth Material Method
From fl To alp Ft. f p.tp_01� f?Qbc&)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness two State Roads or County Roads. IAekide -e road
Dia ter or Weight/Ft. Mate 'a1 numbers and common road names. 0
From co c
From o
n
w
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print);he n1,1151 tin Linn, Ad CERTIFICATION # /74
%YELL CONTRACTOR COMPANY NAMSEnniS 1410JInwtri IIJei1)Y[ii:N 11 PJ PHONE#T0-56e_Sa V-3 244
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
282296
1. WELL USE (Check Applicable Box): Residential fd�Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
topographic/Land setting
Nearest Town: /1%f&%)1.(/n4---3 County /Y)a Co--) tdge ❑Slope ❑Valley ❑Flat
Pftor14tS5 RE. Uci i&l7nL/ Lau-‘ ,2 r7jU (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., p Code) / Latitude/longitude of well location
3. OWNER: .Sf�f7�1y"1t) tea i e /Li
Address ADE . L'X 99'(2_,
.may 9 (Street or ARoute No.) ry. v
/
/ //A�Y1//lik) ✓r,�(- A? rj
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /2 - , 7 —6 3
5. TOTAL DEPTH: 5 Or •
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
tf 2 e l ay
DEPTH
From
D
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-----r--
7. STATIC WATER LEVEL Below Top of Casing:' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface* c,
*Top of casing terminated at/or below land surface requires a '"`
variance in accordance with 15A NCAC 2C .0118. // 1
9. YIELD (gpm): / 5 METHOD OF TEST hkJUr(/ c
10. WATER ZONES (depth): .;2 (l r 4F i -o m
LOCATION SKETCH
%%'-t"/r Amouni ,1 V4'% S _.
11. DISINFECTION: Type Show direction and distance in miles�om at Feast
12. CASING:
7i
Do
$a c-( tfm 3 -
/3lCre C- -2
c
0
W O
_ LI
L
GRO'JPI;_,'"'ATFR SECTION
ASHE`;iU_E REGICA'_ OFFICE
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD Hfj.S BEEN PROVIDED TO THE WELL OWNER
Oen 0 Fee
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
fn�

282289
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) <))-e nmiS1 ti-r) Jig- d. CERTIFICATION # .1/7 le
WELL CONTRACTOR COMPANY NAMEI�f.nn s Mo II'G,ytr4 IfleOyt 4. PJ PHONE F ,Se2 tJ 3ge
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED W
(if a..licable) (if a..licable)
I. WELL USE (Check Applicable Box): Residential 12 ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FQit'n//di itI,4/OC„ounty M (2 ((jvL-,
EH-
n r'at(r Ply nct_
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / / /,(C S(.f
Address aLi PM'on-eYL Q
(Street or Roue No.)
Fan kI ,, J n%c> g 7-
City or Town State Zip Code
(as'- 369- (0/73
Area code- Phone number
4. DATE DRILLED (? - a 3 - 03
5. TOTAL DEPTH: .._arno
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Wr
7. STATIC WATER LEVEL Below Top of Casing: Ern FT.
(Use "h" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires o
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 02 102_, METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type I- -t'f-!
ERMIT#
Tippographic/Land setting
ErRiage ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To .
Soo'
LOCATION
Arnouni ,_2 TA P 5 Show direction and distance in miles from at le
12. CASING: Wall Thickness two State Roads or County Roads. Include the ®d
,!1
Depthny ? Dia teter or Wci h/Ft. Material numbers and common road names. -�
From 9 To v ") FL b" S>p.yl pYC-- co
7
From To Ft.
From To Ft.
R SEC ION
ePAL_FIICE
13. GROUT: Depth Material
From (i To 7 Ft. eo-y i RI
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.
From To Ft.
Method
co
su
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ri' G'i -(../ 0 I le
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mai( Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
CO
rTh
c
a
0

282288
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) <1)%nil s kylllarAA CERTIFICATION #
WELL CONTRACTOR COMPANY NAM& "In;S fdotIaMJ I ei IVrr Lim .)-rtei PHONE#irhr(,_ja-4�3 �6O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED %V ERMIT#
(if applic_ble) (if a..licable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest MINN: K,2 O.n P),7ti County ( urn
2 Ski A. "&00 !t ,u h c -
� ubdivision, Lot No., Zip Code)
(Street Name. Numbers, Community, g-73'
3. OWNER: VILL.yt e. I PO Vh Qra
Address (06 l7_ (5-en 1* ni--t C!C l e rz_aci
Street or Route No.)
Prato k.l on73f
Cry or Town State 3 5 8 Zip Code
3b9—
Area code- Phone r:m'bcr
4. DATE DRILLED /— --03
5. TOTAL DEPTH: c
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO fDr
7. STATIC WATER LEVEL Below Top of Casing: /nf FT.
(Use "+" if Abose Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118. % /h)/,/x��
9. YIELD (gpm): r�_5 METHOD OF TEST h
10. WATER ZONES (depth): /S
Amount rQ T,4 iP S Show direction and distan
Wall Thickness two State Roads or County Roads. Include the road
opographic/Land setting
filakidge ❑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 Form tion Description
p r .� (ifs " / S9
F y' 0.z' /lei �(ro4,;-F -e_-
11. DISINFECTION: Type
12. CASING:
Dpth
From 0 To
From T o
From
13, GROUT:
From n
From To
14. SCREEN: tkr;i'
From Tu
From
15. SAND/GRAVEL PACK
Ddphi
From
From
16. REMARKS:
0ti
MAY i 8 2004
Ft.
Ft.
Ft.
Depth
o CD Ft.
LOCATION .KETCHBOGNOfNATER bE(1TION
' _LE R GIuNA'r OFFICE
Diameter or
numbers and common road names. O
Weight/Ft. Material C.)s-n r� .y ,? P ��
0
nn Material^
(y4T 01
Ft.
Diameter Slot Size Material
Ft. in.
Ft. in. in.
Method
Ft.
Ft.
Size Material
0
c:
c
O -
W
C cP
1 c
I DO HEREBY CE(CIIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL W _\
CONSTRUCTION STANDARDS, AND THAT A COPY OF TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER mT
ilr Q LIZ /I L. Pay (�� 7'iy 0? - �_
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE O —".
C'J c.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC "c
27699-1636 Phone Nu. t919) 733-3221, within 30 days.
GW-1 REV. 07/2001

28228'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (.75-9 )vll5I !'/)M A. CERTIFICATION
CERTIFICATION# 2/7 u
WELL CONTRACTOR COMPANY NAMt (4fi)!I 1J WeIIThV' II-14.4 .)-n('v PHONE #y'2-% _S3 / 3 g60
STATE WELL CONSTRUCTION PERMIT#
(if a..licablel
ASSOCIATED W
ERMIT#
(if a..licable)
I. WELL USE (Check Applicable Box): Residential ZlMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT,QN: . /
Nearest Town .R44-/l L. /V 111eCoumy ((Q..([M )
LfttI S tue s ay. • Oa e ize.S �/
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code), & 7 3 7
3. OWNER:
Address
(Street or Route No.) ' /
riitimleInt) /VC' cQSt73 7
City orT wn g State Zip Code
Area code- Phone number
4. DATE DRILLED 7— Do -0
5. TOTAL DEPTH: pips,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ,Ph FT.
(Use "+" if Aboce Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface"
*Top or casing terminated actor below land surface requires a
variance in accurdance is ill] ISA NCAC 2C .0I18.
9. YIELD (gpm): r METHOD OF TEST >�J/Llili/7L1,{
10. WATER ZONES (depth): ,?%S ` (1
Traphic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O .S C 12 c
%%` `74' vecoo CcuCrt-'e
/3 /tea i 124-4' > t�-
0/•
I1.
12.
LOCATION SKE CH
DISINFECTION: Type H t/V Amount ra TA -As Show direction and dista
CASING: Wall Thickness two State Roads or Coun
Depot . Diam�eter or Weight/Ft. Mate al numbers and common roa. names.
From 0 To �/ . Ft. /n " S-(� H� ., l P vQ---•
From To R.
From To Ft.
13. GROUT: Depth
From n To 7 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
04
e in m ^?+rWlSil• ""ESECTION
RoapisHITEoluste NC&4t0itItL OFFICE
Material,
(1 41
Method
From To Ft.
From To Ft.
16.REMARKS:
0
C
— AON CO g0 :C l!d
7>c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELt� PI
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL 0 ECU
' a
--
—0
1 �e
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 da\s. GW-1 REV. 07/2001

G tO LS U U iS
282156
WELL CONSTRUCTION RECORD
OCT 24 2003
GROUNDWATER SECTION
North Carolina - Department of Environment and Natural��'`Resources - Division of Water Quality - t roun9 Tare 1 eRttiRCIC)NAL OFFICE
\EI,I. CONTRALTI OR (INDIVIDUAL) NAN] E (print) Fn ("tIZL'e- CERTIFICATION#30
P/IONek Asa�/y�6A\ELT. CONTRACTOR COMPANY FUE eeyw SL Q(�t1%/ny NL
SF\i\\ ELI. CONSTRUCTION PERM IT# ASSOCIATED WO I'ERI\IIT#
(it -applicable) (ifapplicablc)
I. WELL USE (Check Applicable Box): Residenlial.2 Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other O IlOther, List Use
2. WELL LOCATION:
Nearest ToAvn: Foot- /. h' County j ' e dt')
(Street Name. Nuntb�rs. Community, Subdivision. Lot No.. Zip Code)
3. OWNER.y�u,J
Address
T;f
!'11d//1-ohl #eJ
or Route No.)
City orloon State Zip Code
Area code- Phone number
4. DATE DRILLED03
5. TOTAL DEPTH: oZ eb
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /5Z) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top ol'casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 a -♦- METHOD OF TEST 741-
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate host
Latitude'loneitude of well location
(degrees/minules/seconds)
Latitude longitude source:❑GPSO Topogra ph is map
(check box)
DEPTH DRILLING LOG
Front To Formation Description
1I. DISINFECTION.Typc Amount
12. CASING: Wall Thickness
Depth Diameter or AVcieht)Ft. Material
From (' To WZ) Ft. / 4 - /Uc.
From To Pt.
Front fo
13. GROUT: Depth Material Method
From n To O Ft. (.Es6if),/ 7y/Yat
om To
14. SCREEN: Depth Diameter Slot Size Material
From To It. in. in.
From To Ft. in. in.
15. SANIYCIRAVEL PACK:
Depth Size Material
From To It.
From To It
GPOTITE11114TrP SFCTION
LOCATION SICTAINFTf'ILLd R+ol - ICE
Show direction and distance in miles from at lea -Et
two State Roads or County Roads. Inch yhe idld
numbers and common road Humes. O
='
r7 -_
IV c
mo
N=
rna
n
16. REMARKS.
I DO HEREBY CERTIFY TIIAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH IUA
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED
Z V C' ter'
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sen
27699-1636 Phone No. [phone], within 30 days.
NCAC 2C, WELL
TO THE WELL OWNER
SOS
DATE
ice Center - Raleigh, NC
GW-I REV. 07/2001

282155
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalj��Resources�- Division of Water Quality - Groundwater Section
T WELL COSRACTOR(INDIAIDUAL) NAME (print, p'rni_ "Q e t_ t"4d.c y CERTIFICATION #s—�62I
WELL CONTR(ACrOR COMPANY NAME f e- /)( Lie /( ,r )r 'i/,'//c y-ni PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
( ifapplicable) (if applicable)
(T27 S '7 VYJ6
WELL_ USE (Check Applicable Box): Residential /Municipal/Public D Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2_ WELT_ LOCATE:
Nearest Town: %\tlk//. ',Lif 1 AA \i b L(j/A ° Ar vary e
County Af.ciA)
(Street Name. Numbers. Cnnmtuuily. Subdivision, Lot No.. Zip Code)
3. OWNER:,
Address CZ �.k�tiq / �(I\At -4
(Street or Route No.l
1-11-rw,.)tLnl 6IC b--)g-3y
City orTonn Slate Zip Code
At code- Phone number
4. DATE DRILLED -40
5. TOTAL DEPTH: qv'5
6. DOES W'ELI. REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 0-) 0 FT.
(Use "+" if About Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Tap of casing terminated at/or below land surface requires a
variance in accordanck with 15A NCAC 2C .0118.
9. YIELD (gpm): 7110 METHOD OF TEST f},Y
10. WATER ZONES (depth):
II. DISINFECTION: Tvpc Amount
12. CASING: Wall Thickness
Depth Diame)l'r or Weight'Ft. Material
From C; To .9 5 Ft. Lr l y ,,, f_.
From To Pt.
From To Ft.
13. GROUT: Depth Material / Method
From () To r� it Pt_ ( qaj- G//IY Y0014 b'i//
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To PI. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source: ❑GPS❑ t opo_raphic map
(check box]
DEPTH DRILLING LOG
From To Formation Description
- .Y5 a/ay
5 - O S �Nf/lti G
LOCATI
Show direction and di
two State Roads or C
numbers and common road names.
N S ETCH
ante itG0t0)10£44)1419g13g vtTION
0
co
O
c'3
N
0
tV
0
In
16. RENIARKS:
I DO HEREBY CERTIFY THAT TI ITS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322i, within 30 days. GW-1 REV'. 07/2001

282153 1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION ## J//�r
PHONE # <- .1 ,75'7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (/A Ylnte- C-TA )4C
Nv El.1, co NT R.<C OR COM PANy NAME (n/4.7,- y� �,
STATE VVELI. CONSTRUCTION ION PER.AIIT# ASSOCIATED AVQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): ResidentiaLW Municipal/Public ❑ Industrial ❑ Agricultural 0
Nloniloring ❑ Recovery ❑ Beat Pump Water Injection ❑ Other ❑ II -Other, List Use
2. WELL LOCATION: y� ^
Nearest Town: RA)k/ IJ County " U*t-is J
(Street Name. Numbers, Community, Subdivision. Lot No., Zip Code)
•
3. OWN ER: k0h ± Cf-Nr+''(7*
Address / cAl/h6 ('-1
(Street or Route No.)
0 F-.1/V atilt A__ 3ile- 4/7Citcor Tmsn State Zip Code
)-
Arca code- Phone numbs
4. DATE DRILLED /tYR _
5. TOTAL DEPTH: 26 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: COO FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Tip of casing terminated atlor helms land surface requires a
variance in accordance with 15.A NCAC 2C .0118.
9. YIELD (fpnt): « METHOD OF TEST 4ir
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope DValley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degreesm i nmesisseondsl
Latitude/longitude source:❑GPS❑Topo_raphic map
..check box)
DRILLING LOG
Formation Description
DEPTH
From To
-_3c)
3b- 9ss
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Front
From
From
13. GROUT:
From (2
Frill 10
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL. PACK:
Depth Size Material
Depth Diamete or WeiehFEL Material
"Co; � p FL 6, `%
To Ft.
To Et.
Depth Material Methocl
To02CI Ft. O
Et.
From To Ft.
From To Ft.
VI IL 1
71
04
, C0ND'':NATER SEC
Show direction and distal's...
•'IE rl L„qi TOFFION
ICE
LOCATION
KET
two State Roads or County Roads. Include the road
numbers and common road names.
60:3Ikid 6Z13000
c
O
CD
•n
c 0
a_
Urn
m
r J
_o
to
va
CD
c�
0
16. RENIARKS:
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONST),2UCTION STANDARDS, AND THAT A COPY OF THIS RECORD I IAS BEEN PROVIDED TO TFIE WELL OWNER
SIGNATURE OE PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

Yu-
282152
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
VVELL CO,TRACTOR (INDIVIDUAL) NAME
J (print) ( %tee d CrA4'�L '" CERTIFICATION #<545
AVELI. CONTRACTOR COMPANV NAME NA/de L ra5. e-oety f'7/� illy �j�G, PIIONE # (0 /%�4"
STATE \\ ELI. CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentiaLB'MunicipaIPublic ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery 0 Beat Pump Water Injection ❑ Other ❑ If Other, List Usc
2. WELL LOCATION''
Nearest Town: j"/'f//1/e/ G✓ County 479( x, N/
• Ohl
t$ncel Name Nlii thus, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: CA ; W9 V(Le racily
Address r'o h1;)C I-3
(Street or Route No.)
G4 3r, 3.3�
City or Torch / Stare Zip Code
;v ze—
)-
Area code- Phone number
4. DATE DRILLED 9-7—c�-3
5. TOTAL DEPTH: ?n
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: t/0 L> FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST AiY
I0. WATER ZONES (depth):
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diam �t r or Weight/Et. Material
From 0 To Ft. lz Ay /C,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From L To ;;,./C Ft. (' y •z, 1 /7I Ter, N'¢.
From To H.
7/7
•/
14. SCREEN: Depth Diameter Slot Size Material
Prom To Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Pt.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees.'ntinulesiseeonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From fo
TION
LOCATIO SK : ftWF 'LE REGIONAL OFFICE
Show direction and dist .m a east
two State Roads or County Roads. Include the Thal
numbers and common road names. O fl
W
O
n c ?
cIxD c r-`.
3 �m
N `
rn
W —,
co
16. REMARKS:
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4121/1�2E' 7'0Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Alail Service Center - Raleigh, NC
27699-1636 Thane No. [phone], within 30 days. GW-I REV. 07/2001

282151
,.•t 1;
i5 II \;ii y5
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section VA'EL f CONT IRAf TOR (INDIVIDt AL) NAME (print) : CCERTIFICATION #02 4
WELL CONTR2 CFO12 COAIP:ANV NAME rf'Af'/ ✓bSe L/Zy.//i/V j1d PHONE # Il%C VS/7,4
SLATE VA ELI. CONSTRUCTION PEI2)IIT#
(if applicable)
ASSOCIATED \\'Q PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential0 Municipal/Public ❑ Industrial ❑ Agricultural 0
tNIonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2- WELI. LOCATION:
Nearest Town: pJj/.7J
Cr" galA
(Street Name. N W➢bers. Community. Subdivision. Lot No.. Zip Code)
3. OWNER
Address
County 7111E e .ro
(Street or Route No.)
1;b, c_ aCC (3
City or -rote n State
Zip Code
Area code- Phone numberq
4. DATE DRILLED 7 -R —03
5. TOTAL DEPTH: 9 NC)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: ,St FT.
(Use "F' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a
variance in accordanc5 with ISA NCAC 2C .0118.
9. YIELD (gpm): lC METHOD OF TEST �i V
10. WATER ZONES (depth):
Topographic: Land setting
DRidge ❑Slope ❑Valley ❑Flat
( cheek appropriate box)
Latitude/lontitude of well location
(degrees )minutes: seconds)
Latitude/longitude so urce:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
L CAT(
I I. DISINFECTION: Type Amount Show direction and dis anee in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the ro9
Depth q Diamety or Weight/Ft. Material numbers and common road names. 0am` o
From r' To / - Ft. C 79i » tic- O c-,
From "Ca Ft. n
--t =.?
From To Ft. fV 5 :sT
13. GROUT: Depth Material ''//yyMethod
From 0 To 3.R Ft. (p!%O,. b tev.7✓`/ _ -H, p Eisc
From To Ft. y -- m
14. SCREEN: Depth Diameter
From To Pt. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size D1�
From "fu Ft.
From To Ft.
Slot Size
Material
in.
in.
GROUNDWATER S TION
LE REGIONAL OFFICE
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO: TRUCFION STANDARDS, AND TFIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7CrelLei
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/)-7 c�>J
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 ('hone No. [phone], within 30 days. GW-I REV. 07/2001

282150
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ��Natural Resources - Division of Water Quality Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L71}`_/j/7.Tt' f/ t CLIRTIFICATIION(0)69/
WELL CON] IL\CI OR COSIPANV NA OftYrik Og/l IUY./J. try rEe-1G PHONE N (72t 52V7/2'
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED \VQ PEI41IT8
(if applicable) (if applicable)
I. WELL USE (Check Applicable I3ox): Residential-0 Municipal/Public ❑ Industrial 0 Agricultural ❑
Nlonitorin e 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I,
Nearest Town: 1 p^f 4. /iY
iI p i'Kl-L4, ,C,J
County A)4LS1d
(Street Name. Numbers. Conuuuday. Subdivision. Lot No.. Zip Code)
3. OWNER:C..LIN-,( and Ica/
Address S 73 C ,f i'1gL�/C l(oei_
(Street or Roue No.)
I r i3 /'tom/ TUC -
it) or -Town State
Zip Code
Area code- Phone number
4. DATE DRILLED 16-15-0 3
5. TOTAL DEPTH: '730
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 1160 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 �w� )tli 15,A NCAC 2C .0118.
9. YIELD (gpm): S/� METHOD OF TEST �i ✓
10. WATER ZONES (depth).
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7d - "A3O
I . DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
y
From l3 m 7� Et. in�ci. (__
From To Pt.
From To Pt.
13- GROUT: Depth Material Method
From O Tries.).— Ft. �'P/j/c/v� 796Let, i17
From To H.
11. SCREEN: Depth Diameter Slot Size Material
From "fo Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATI
Show direction and dis
two State Roads or County Roads. Intl
numbers and common road names.
N SKEQIQ4INDINATER SECTION
I, REGI NL, OFFICE
O
0
fV
l'J
fV
CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A04-Lr (- 2 /o )-? —
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 ('hone No. [phone], within 30 days. GW-I REV. 07/2001

282148
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) iLIM(/ C/Aic i
\\ ELL COST RACIolt COMPANY NAME 61/%I/1C J �S 1+4-2✓J/'/%/j1s /Ott.-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED U'Q PER.)IIT#
(it applicable) (if applicable)
CERTIFICATION g3d7�
P IION E # i..5-7?
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ IFOther, List Use
2. WELL LOCATION:
Nearest Town: "Trod L/'T1 County /4,-12
�i ✓l„ /( Fi//S LArk—
(So'eet Name, Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: ) 1 24
Address \).J u(r.d .�rir.ale.
IS tenet or Route No.)
S k+9c,,w) [Y) S 3S2 f
City or Town State Zip Code
)-
Area code- Phone number
T. DATE DRILLED /D-7—L-3
5. TOTAL DEPTH: 3-05-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing:.2o o FT.
(Use `+" ifAbove Top ofCasing)
S. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3L METHOD OF TEST ,'9.
10. WATER ZONES (depth):
1 L DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From a To IDS Ft. - 4y
From To Ft.
From To Ft.
13. GROUT: Depth Material Me hod
From C> To:J O Ft. ec:221lr 17 /JU1ik9ro�1
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From .10 Ft. in. in.
Front To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
t
From To Ft.
From To Ft,
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4— /65
/d S — S—L C
LOCATION
Show direction and distancst
two State Roads or County Roads. Include the road
numbers and common road names.
�,t, t• ECTION
EVILLE REGIONAL OFFICE
16. RE'A'IARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 0_-3
SIGNATURE OF PERSON CONSTRUCTING THE WELL. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 284333
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION N a.4/DU
'
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) DC �S R. +UO r\SC N CERTIFICATION
WELL CONTRACTOR COMPANY NAME yY I I C t .J PA i c r 1� r r1 PHONE
ASSOCIATED WQ PERMIT('
STATE WELL CONSTRUCTION PERMIT# if applicable)
if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI N: County1VlGC�>i \
Nearest Town: 11 �,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cale)
3. OWNER._
Address
City or Town State Zip Code
Ares code- Phone number
4. DATEDRILLEDIa-t2S
5. TOTAL DEPTH: IBC`
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0--
Topographic/Land setting
[Midge IHS6pe ❑Valley ❑F18t
(check appropriate box)
La tituddlongitudc of well location;
(degrees/minutes/seconds)
Latitude/longitude source:UUPS❑Topographic map-.,
(check box)
i PT" PRILLtNG rag'
Frotn To F•n atiou Description
0 LI0` _ir
qrf - I F?S
7. STATIC WATER LEVEL Below Top of Casing: ,9-0 FT.
(Use "+" if Above Top of Casing)
r r Above Land Surface'
8. TOP OF CASING IS i
*Top of casing terminated at/or below land surface requu ea a
variance In accordance with IS NCAC 2CMETHOD OF TEST (Q it
9. YIELD (gpm): I �O
10. WATER ZONES (depth):
11. DISINFECTION: Type\rMn.
12. CASING:
Fron
From
Depth Diameter
o Tom Ft. (0,
To_
From To
13. GROUT: Depth
From 17 To_a.D.L.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft,
From To Ft.
Ft.
Ft.
Amount I S
Wall Thickness
or Weight/Ft. Material
Ma e��tat
Ft.lc�1c?
Ft.
Diameter
Ft. in.
Ft. in.
Method
Slot Size Material
in.
in.
Size Material
o
Z cr'
-- no
t OgATION SKkTCF t �c
Show direction and distance in miles fens atgiszt
two State Roads or County Roads. Inchtde rad
numbers and cortunon road names.
AQua-te
WC( c(k Rt.
juytgi AEC
R�
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, �Vgh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAM'. tnrintl _ JaV1e)P _G.L ))1, Lit 1 i I In
WELL CONTRACTOR COMPANY NAME V171; I19 f in)e-f clf:l!'✓I)
ASSOCIATED WO r zitiw ITO
(if applicable)
STATE WELL CONSTRUCTION PERMIT$
(if applicable)
284325
Groundwater Section
CERTIFICATION N..14lGti
PHONE N f8'22 ) 5C7-- %7
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCH ION:
Nearest Town: -wan I(1 n
0 eC eels,
County N1Cat Li n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. O W 14ER. V CIVkiQ-S
Address 2q Q4-4e,c vC\c\ ?ii\
City or Town State
( Area code- Phone number
4. DATE DRILLED Ia-3-c,3
5. TOTAL DEPTH: 1(c5`
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IU—
7. STATIC WATER LEVEL Below Top of Casing: 4t0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated st/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118. ,/�
9. YIELD (gpm): IC METHOD OF TEST ft,12
10. WATER ZONES (depth):
(Street or Route No.) 2n6
Zip Code
11. DISINFECTION: Type'h l t'L `X'1\e-i5 Amount ‘S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
,I From (.% To CSC?' Ft. to,:7.5- 40r-7/ pVCC.
From To Ft.
From_ To Ft.
13. GROUT: Depth Material Method
From_12___ . To D' Ft. �:1'f4.iVtc: peCCi.tGt-
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:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r,. �.5
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-3Z21, within 30 days.
GW-1 REV. 07/2001
Topographic/Land setting.
❑Ridge IyUSISpe ❑Valley ❑tIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ..
Latitude/longitude source:CIGPS❑Tbp ographie map -
(check box)
PEDTN DRILLING 1,OQ
From To I'.nrmation Ds ription
d - 35 ,
f7w
c
0 0
c—
a
rn
F ern
LOCATION SKETCH c req�
Show direction and distance in miles tram at gast
two State Roads or County Roads. Include thFroad
numbers and common road name I.
h )l
rtt
Nnn
Perleflowtt
0

284215
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ^(print) 51)211 111 S /-1-0 ad) rk, CERTIFICATION # J/% 11
WELL CONTRACTOR COMPANY NAMi hnfS ktiloytri IDe.11 rT:x 316 I Irj n.el PHNo ONE d)l.-J o24-3 a- e) G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
I WELL USE (Check Applicable Box): Residential Yd--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2
WELL LOCATIO
Nearest Town: r---n 4 2 /LL' A/ County ("( (,ni .=
.;S-tA( Ai, cl.,r=/\. &ores St,Lrl. Lr7`---ti-
(Street Name. Nurnbers, Community, Subdivision, Lot No., Zip Code) •,:) g>r% 3 (/
3. OWNER: 0 (1 {,j 1 I1 Lr' 44 h.x f,.• ,1T (degrees/minutes/seconds)
Address 5//V C1CLR,nit. 14A\\ihi. 0f1/ flf7 Latitude/longitude source:❑GPS❑Topographicmap
_
(Street or Route No.) (check box) I•
- --
�t 1- tQ tarl,,,�, R ( DEPTH DRILLING LOG •
City or Town 11 State Zip Code From To Formation Description
(4O'7)- 53a_1Ql_7 ci qte` 0-iCt4-1
yf, 7(,-' ire k2m•,c(Li ;t-c.
-V,- SEvr= I-31C'E 6-ILkI.'it-c.
4
5
6
7
Area code- Phone number
DATE DRILLED 1 ,i. - i t/ -
TOTAL DEPTH: .St. S'
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: z/C, 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): / • 6 METHOD OF TEST /u7///�1--.
10.WATER ZONES (depth):
3
Topographic/Land setting
ge ❑Slope ❑Valley ❑Flat.
(check appropriate box)
Latitude/longitude of well location
II
12. CASING:
DISINFECTION: Type
Amount TA -AS
Depth
From 0 To "7
From To
From To
13. GROUT-. Depth D�N
From (3 To r
From To
14
Ft
Ft.
Wall Thickness
Dia eter or Weight/Ft. Mate al
" sag,,- pf�
Ft.
Ft.
Material i
`-�
094-31
Ft.
Method
OD4/O
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. S.AND/GRAVELPACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3
0
up
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 TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fir 0, ea4-4c9--
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

284214
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7 en V)151 1I / !(2A A, CERTIFICATION,r# �%—r
/ y"
WELL CONTRACTOR COMPANYNAMKI ICIt)�n.viri ���P.iI�Y`r Ili /q� 1.7 YLP #Q PHONE o-��e24�-Gp
e"3
STATE \YELL CONSTRUCTION PERMIT(' ASSOCIATED WQPERMIT#
(if applicable) (if applicable) r-_ ---- /i
WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultura;lL7
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ci If Other, List Use
2. WELL LOCATION:
Nearest Town: 1-7•2 C )1 k IC 2 County Lc7ii
11It/..//LO1a(Y)ct0ph< p,d— :Its CRe-ok_
(Street Name, Numbers, Community(Subdivision, Lot No., Zip Code) a >7>� t/
PC,YT-e C b.e
f P_5 W. III /'1? file_ t=.. /; d
C j f t 1Yt 0 ,n I T I <) *-% (
City or Town State Zip Code
�3s.)); eQ y-� - <5o47
Area code- Phone number
4. DATE DRILLED ) — �) C 3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
3. OWNER:
Address
JTopographic/Land setting:
idge ❑Slope ❑Valley',
(check appropriate box) i
Latitude/longitude of well location
1
(degrees/minutes/seconds).; .1
Latitude/longitude source:❑GPS❑TgpographicRaa-__:`_
(check box)
DRILLING l,OCv —
Formation Description
S
pIL' ir/ ycito7t�-
DEPTH
From To
0 9t-3
(Street or Route o.)
7. STATIC WATER LEVEL Below Top of Casing: /CIO 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
9. YIELD (gpm):
MiETHOD OF TEST variance In accordance with 15A NCAC 2C .0118. /1/�,/,Z
2/ X-4
10. WATER ZONES (depth): Yct, ii7en
I I. DISINFECTION: Type
12. CASING:
Depth
From 0 To (4. i
From To
From To
13. GROUT: Depth
From n To r
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
LOCATION SKETCH
%7`" t» Amount 4-1 A— S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Mate 1 numbers and common road names.
Ft. h pY Ni
Ft.
Ft.
Material Method
Ft. CPmmil pcnAA)
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
0�
Ts 21
ICA
I o�
Uri
`ytc
a rs
3 aD
O rna
c
N --t
aD CD
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY F TH(S RECORDBEEN PROVIDED TO THE WELL OWNER
(}Q nn /;)-cVti3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
283756
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print):hen vl l S I /hm A, CERTIFICATION # �2./7(P
WELL CONTRACTOR COM PANY NAM�(X!hni s I�ll'G,�ri Wei 1c11 Y`r ii'k -n Cs J PHONE #iig �_ec9-3 �-d) 0
STATE ‘VELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT# _
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ca-*Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: '4 i2 /(L;n/ County ,A /�t
((
(i•4L•=. L; lt/t citr-r,+y Prr .2k739/
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: < J % `J cetlI t e
Address //,". / V ; itr; n'/-�/y' S icez//s hP.
(Street or owe No.) O
S m V r,i'A- 0�- 3 r e a-4
City or own State Zip Code
(17,0)- 3lC/-
Area code- Phone number
4. DATE DRILLED /) - / �C�3
5. TOTAL DEPTH: 7rs
6. DOES WELL REPLACE EXISTING WELL? YES.0 NO
7. STATIC WATER LEVEL Below Top of Casing: 7 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .01I8. /
/ .
9. YIELD (gpm): 3 METHOD OF TEST /h/g -/�
10. WATER ZONES (depth): / 3S
To ographic/Land setting
leRlage ❑Slope ❑Valley ❑FIa
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) 1 '---
Latitude/longitude source:OGPSOTopographiTnap
(check box)
DRILLING LOG
DEPTH
From To
G
74 ,
I I. DISINFECTION: Type
12. CASING:
From 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.
Rl"IP Amount r-2TA-P S
Depth
From 0 To /,rQep Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To �{7 17p)e�v
Wall Thickness
Diapseter or WeighUFt.
' SZR,21.
Matedal
Ft.
16.REMARKS.
Ft.
Slot Size Material
in.
in.
Material
Formation Description
13LItL= C14.L'i T C
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rc�ad
numbers and common road names. C -c
W
0 c r.,
Co o c
jo
rn
vs z
rriz
—t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�'Y' 0 e / <1- , —6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) h-e n t71SII ' l� (4_,, CERTIFICATION #`c1l7ee
WELL CONTRACTOR COMPANYNAMIS hn[S Im' [la�rri 111PIIa yeiil(;4i( 1 Ke l PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable) r- ---
283'755
1. WELL USE (Check Applicable Box): Residential t—Municipal/Public ❑ Industrial ❑ Agricultural f ,_ .
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: cm) A" (I- County // / etc ef /�
e-04 - /PSSc,)4f t. /�(, - m, Ctri le' et(�i-e'e'Lyee)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) . js - ,f
3. OWNER: (I)Plw,)(t2,7}�
Address S. a2 (Z,_ t ri
(Street or Route No.) �j
Qilk/r1C) I/c- ris
(Oil- 1).D-tY— > 3�r
Area code- Phone number
4. DATE DRILLED / :1 ./
5- TOTAL DEPTH: ?
City or Town State Zip Code
Topographic/Land and sett rig
ORidge Q&ISpe DValley LIF at
l (check appropriate box)
Latitude/longitude of well Idetuo
•
(degrees/minutes/seconds)
Latitude/longitude source:OGPSDTtpographie;
(check box)
DEPTH DRI LIN
From To Formation Description
(0 .� / " )e. !
(--
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O-
7. STATIC WATER LEVEL Below Top of Casing:4`3 C 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): -3 C METHOD OF TEST ,4/07///yt
10. WATER ZONES (depth): c-)/.^ "
LOCATION SKETCH
11. DISINFECTION: Type H-fp Amouni TA-5 Show direction and distance in miles from at least
12. CASING:
Wall Thickness two State Roads or County Roads. Include the road
Depth Diajeter or Weight/Ft. Mate ial numbers and common road names.
From n To / Ft. A?"` S.(2 �,92! p YQ
From To Ft. b
From To Ft. W o
13. GROUT: Depth /lMaterial Method co
From 1.) To r [- Ft. Q'17i D2 t pc21LA) I- c r
From To Ft.
Y G� cm
14. SCREEN: Depth Diameter Slot Size Material O o¢
From To Ft. in. in. y�
From To Ft. in. in. 3 �ma
15. SAND/GRAVEL PACK: — rn o
Depth Size Material CA) y�
From To Ft. — o
From To Ft. a
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T,HHAATTrORD H
A COPY OF TH S RECAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 283754
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) xi), nV)1 S rL CERTIFICATION # oZ/7 (to
WELL CONTRACTOR COMPANY NAME' I.Y,imic (JOI1(Zra UM01fi I.—u .1-14CJ PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable)
(if applicable)
2. WELL LOCATION:
Nearest Town: it &;1ILL; /),/ County /) la Lersi
Poi? ii,r)Arn U i1- 11 lac: / =,� g-%-3 y
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (CL%-k. L-i'f7krrcoo
Address / :,2 3 l e %ck -e (' t /) 1% 2
(Street or Route No.)
I I RnIei,k) ilia- C2 2 9/
City or Town State Zip Code
(0-c))- r(r)9--1/.71/ 7 &,
Area code- Phone number
4. DATE DRILLED 1 sod---1 O —C_3
5. TOTAL DEPTH:
esi,.6aY-3 a6c
1. WELL USE (Check Applicable Box): Residential Q iunicipal/Public 0 Industrial 0 Agricultura rEIL
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use -
ographic/Land set�mg
dge ❑Slope ❑Valley Iat
(check appropriate box) :'=',
Latitude/longitude of well Ioc[itlp
(degrees/minutes/seconds) m
Latitude/longitude source:❑GPS❑Topographic
(check box)
DEPTH
From To
fn 3 .;2
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): j_5 METHOD OF TEST ,/07//r U
10. WATER ZONES (depth): �,3L"
1 I. DISINFECTION: Type 71743-1/ Amount ,- TA- S
Wall Thickness
Depth Diapneter or Weight/Ft. Materiali
To 3.;Z. Ft. (�? SZ R, % p)C.,
To Ft.
To Ft.
13. Depth
To r4i7
To
14. Depth
From To
From To
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
Material .�
FC�JJ r�y3t"/7
Ft.
Diameter Slot Size
Ft. in.
Ft. in.
12. CASING:
From 0
From
From
GROUT:
From /')
From
SCREEN:
16. REMARKS:
Method
(-)cnt.L.)
Material
in.
in.
Material
DRILLING LOG
Formation Description
/lit
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 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ora° e
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

Depth
From To Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From O To r:f7 Ft.
LOCATION SKETCH
1 I. DISINFECTION: Type /%�'/-f Amount ,,2 TA -AS Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include thgoad
Dia eter or Weight/Ft. Material numbers and common road names. W CD
G '
' sJ R,� &l P K e-
Material
0.9471 411
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
2S3753
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section T
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s ?Yen Ills /Jy) I)(,fM rti CERTIFICATION # o1%74
WELL CONTRACTOR COMPANY NAME( hnt C ll2y,r4 Wei I rl T)v`i (J PHONE n 0%(.._ 6 a 9-3 a6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
� �� (if applicable)
WELL USE (Check Applicable Box): Residential Id�Municipal/Public ❑ Industrial ❑ Agricultural O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: /%?,A A k L) A/ County /Y Q.lryt--
Niiix2p_a_t_ a L'" llm )Ct\ k 73Cf
(Street Naine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I-1"Q/0 (C !-I et ej 1,
J%r' (-Tr,/Address l�'x (I;?eK h2
(Street or Route No.)
J<(1Cdcr(Ct_ 1 I, r3(I.a42o
City or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED 1 — I -S -C'
5. TOTAL DEPTH: Lftelfs
6. DOES WELL REPLACE EXISTING WELL? YES O NO I7Yr--
7. STATIC WATER LEVEL Below Top of Casing: /.17+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): / el METHOD OF TEST/)/UJ/,/r
10. WATERZONES(depth): 2.?L'' .,2/Ar� ' j�
Topographic/Land setting
❑Ridge I3Sfq- ❑Valley ❑Flat:-
(check appropriate box)
Latitude/longitude of well location
t )
L-)
1
"1
(degrees/minutes/seconds) -'—
Latitude/longitudesource:OGPSOTopographtc map I,
(check box)_..
DEPTH DRILLING LOG
From To Formation Description
et;
76- , e.„. rr' /2 nib- (Li? 4,2'7 7- L_
O
FTI
(—)
W
O
W
CD
orn
ern
c
rnCD
n r
en =
nA
ti
d
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT
�A' COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0 1. OW-k i -e
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quali
\V ELL CONTRACTOR (INDIVIDUAL) NAME (print)
\\ ELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT#
(if aopiicable)
283500
Groundwater Section
James B. Bryan CERTIFICATION = 2045
PHONE n 828 1369-9591
ASSOCIATED \VQ PERMIT:
(if applicable)
I. WELL USE (Check Applicable Box): Residential Nlunicipal'Public 0 Industrial 0 Agricultural ❑
Monitoring. 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Otto County Macon
Sam Cnrn Rd
(Street Name, Numbers, Coinntmt ry, Subdlvi s ion, Lot No., Zip Code)
3. O\WNER: Dave Robinson
Address PO Pox 20055
(Street or Route No.)
Franklin, NC 28744
City cr Toe'r. State Zip Code
(82R)- 574-9446
Area cede- Phone number
4. DATE DRILLED 12-15-03
5. TOTAL DEPTH: 440'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ
7. STATIC WATER LEVEL Below Top of Cosine: 350' FT.
(list "+" if Above Top of Casing)
5. TOP OF CASING IS 2 FT. -Above Land Surface*
'Top of casing terminated atter below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 NIETHOD OF TEST blow
10. WATER ZONES (depth): 135' & 260'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wail Thickness
Depth Diameter or \Weieht'Ft, Material
From 0 To 78 Ft. 6" pvc
From 78' To Al Ft. 6" 188 Steel
From To Ft.
13. GROUT: Depth Nlaterial Method
From 0 To 20 Ft. bsrnite & cn wt... pumped
From To Ft.
14. SCREEN: Depth Diameter
From To
Slot Size Material
Ft. in. in.
From To Ft. in. in.
15, SAND,'GR.4VEL PACK:
Depth Size \tateriai
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFl
CONSTRUCTION ST
Topographic 'Land setting.
ORidue ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of vyell location
(deerees.lninules •seconds}
Latitudo:lon gitude scurce:OGPS❑Topoeraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Desor tion
0 79' clay & sand
79' 440' granite
LOCATION SKETCH
c
Show direction and distance in miles froln at 851 c=
two State Roads or Count,. Roads. Include the-rnad
numbers and common road names.
AT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RDS, AND THAT OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r�
rn
0
NJ
IN)
0
Submit the ori,n al to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, INC
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 (INDIVIDU'AL) NAME (print) James B. Brown CERTIFICATION" 2045
WELL CONTRACTOR COMPANY NAN1EHedden Brothers Well Drilling, Inc PHONE = D28) 369-9591
STATE WELL CONSTRUCTION PER\IIT: ASSOCIATED \VQ PERMIT
(if applicable) (if applicable)
283499
WELL USE (Check Applicable Box): Residential-Municipa!'Public 0 Industrial 0 Agricultural 0
Nlonitoring ❑ Recovery 0 Heat Pump Pater Injection ❑ Other a If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Leatherman Raby RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER.Walter Coggin
Address 181 Pat Rogers RD
(S:roe: or Route No.)
Franklin, NC 28734
Cit> or Town State Zip Code
(82R- 524-4446
Area code- Phone number
4. DATE DRILLED 10-18-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 250 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST blow
10, WATER ZONES (depth): 163'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight Ft. Material
From 0 To 138 Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. ta'Ynite & ctrta'L pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SANDiGRAVELPACK:
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
(degreeo'rtinres 'seconds)
Latitudelongitude source:❑GPS❑Tcpographic map
(check box)
DEPTH DRILLING LOG
From
To Formation Description
0 136' cly& sand
136' 300' granite
0
0
n
171
LOCATION SKETCH
Show direction and distance in miles from feast=!`
two State Roads or County Roads. Include tkoiroaci-'-
numbers and common road names. —''
TN,
f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STnj?• ARDS, AND THAT A CORECORD HAS BEEN PROVIDED TO THE WELL OAANER
SIGNATU E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 dlail Service Center - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days, - GW-I REV. 07r2001

283498
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATIONte 2045
WELL CONTRACTOR CO;IIPANY NANMEHedden Brothers Well Drilling, Inc PHONE # [phone]
STATE \\'ELL CONSTRUCTION PERMIT: .ASSOCIATED W'Q PERMIT:
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential E11 Municipal:Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Franklin
3109 Fulton Rd
County Macon
(S(ree. Name, Numbers, Community, Subdivlsi on, Lot No.. Zip Code)
3. OWNER:Alice Wooten
Address 3109 Fulton Rd
(Street or Route No.)
Franklin, NC 28734
City or Ton State
28 )-524-4091
Zip Code
.Area code- Phone number
4. DATE DRILLED 11-21-03
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES fa NO 0
7, STATIC WATER LEVEL Below Top of Casing.: 150 FT.
(Use "." if Above Top of Casing)
S. TOP OF CASING IS 2 FT, Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST blow
10, WATER ZONES (depth): 110' & 170'
II. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or AWeight Ft. Material
From 0 To 43 Ft. 6" 188 Steel
From To Ft.
From To Ft.
13. GROUT: Depth Nlateria: Nlethod
From 0 To 20 Ft. innate & wiwL pumped
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 ❑\'alley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees/minutes seconds)
Latitude 'longitude source:OGPS❑Topographic map
(oheck box)
DEPTH DRILLING LOG
F0rem 41 ' Formation
& Daan.'rpIion sd
41700' granite
s
n f
LOCATION SKETCH ce
Show direction and distance in miles from eTMt, a,C= r,
two State Roads or Countv Roads. Include Fhb roa _U1
numbers and common road names, iv
'',
r„-
rr•.
t li
r— _.:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL L
CONSTRUCTION ST.I a • tS, AND THAT A COP ' F THIS RECORD HAS BEEN PROVIDED TO THE WELL OVj \ER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. . GW-I REV. 07r3001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qual
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY :r A.IEHedden Brothers Well Drilling, Inc
283497
ity - Groundwater Section
CERTIFICATION O 2045
PHONE # C28) 369-9591
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT;
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential NIunicipal(Public ❑ Industrial ❑ Agricultural ❑
Nionitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Franklin County Macon
Clarks Chapel to Frazier RD
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER'. Jeff & Jennifer Stanley
Address 24 Sapphire Lane
(Street or Route No.)
Franklin, NC 28734
City cr Town State Zip Code
(828 )- 369-2478
Area code- Phone number 78
4, DATE DRILLED 12-8-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ric
7. STATIC WATER LEVEL Below Top of Casing: 200' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT, Above Land Surface*
"Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 NIETHOD OF TEST blow
10. WATER ZONES (depth): 95' & 115'
11. DISINFECTION: Type H T H Amount 16 Oz
12, CASING: Wail Thickness
Depth Diameter or AVeiehrFt. Nlateriai
From 0 To 77 Ft. 6" pvc
From 77' To 80 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. taznite & c.att iL pumped
From To Ft.
14, SCREEN: Depth Diameter Slot Size N laterial
From ' To Ft in. in.
From To Ft. in. in.
15. SAND,'GRAVELPACK:
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
(decrees `.r.i notes'secenz's)
Latitude: longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0 78' clay & sand
300granite
c
rn
LOCATION SKETCH r' -"
Show direction and distance in miles from a4"Rast
two State Roads or County Roads. Include t .roac
numbers and common road name,.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION$-Y-CCyARDS, AND THATOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/2- 7-a3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. . GW-I REV. 07'0001

y �.
(Street or Route No.)'
F1'QmL, yJ /t1"C_
City or Town State
.ii - S — (1+ Qi Q1.1
Area code- Phone number
4. DATE DRILLED Irt �'- --Ct 3
5. TOTAL DEPTH: �-''Z5
6. DOES WELL REPLACE EXISTING WELL? YES O NO O-
7. STATIC WATER LEVEL Below Top of Casing: , FT.
283293
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) c r). nt715 '-!'O1)a.Art, CERTIFICATION# t1)74
WELL CONTRACTOR COMPANY NAM& 1 X.nj1i +r� 1)QM� !APO s I1 14 �" n r J PHONE # &1_Sa y--3 a-6 o
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential f�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nest Town: }; (,��! L , /(, County /
CLH u�°r;,1n)r�• 'RIn nr Rt?•,�S>'13y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
DRidge Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: vi C- 4 f C I of 12 (degrees/minutes/seconds)
Address L 5T CY(11I n i t2 (r ILL. a) IT,Q. Latitude/longitude source:OGPSOTopographic map
L/ (check box)
r C 7 3 T DEPTH DRILLING LOG
Zip Code From To Formation Description
/O //t/' (° /C74.
5/v' @6,' .S4;TA syrr,,_o .
66•' /00r' i�Lvtt= 6-12_0nt'r7 -C.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 02, S METHOD OF TEST lo?/Jr 4—.
10. WATER ZONES (depth): , 4OO' (1
11. DISINFECTION: Type
12. CASING:
Depth
From 6 To / Z)
From To
From To
13. GROUT: Depth
From n To r=9fi
From To
14. SCREEN: Depth
From To
From To
Amount TA -A S
Wall Thickness
Dia eter or Weight/Ft. Material
Ft. lr, R,Q1 PV
Ft.
Ft.
Material i Method
Ft. ea yt bj
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Size Material
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles front leis't
two State Roads or County Roads. Incline the 65/ufb
numbers and common road names. ct-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WEL
C+l
.c-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE c j
�o
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Ra
27699-1636 Phone No. [phone], within 30 days. GW-I RE . 07/2001

\YELL CONSTRUCTION RECORD
293861
N^rt'c Crnclit - D a. me t of Er vircnre1i, and Natural Reg_>.:.s Dlvlslen of Water Qualit C curd r Se::ion
WELL CONTRACTOR(I,VDI4IDUAL)NAME (print) Mitchell D. Cook CER'TIFIC.Ci0LN= ZQ13
fieELL CONTRACTOR CO>I PA.NY i,A iMIE CLi 'tc 11 a'11�i`Y'i, T!'L
STATE YELL CONSTRUCTION PERMIT?
PHONE - E23) 3E9-9 91
ASSOCIATED \YQ PER>IIT:
acolicab`.e) (':faaolicable) - — —
I. WELL USE (C'ne:k Applicable Box)[ Residential Lx Municipal.'Pub:ic ❑ Industria', 0 A.gricuiture: ❑
Monitoring ❑ Re:every 0 Heal Pump Wa:er injection ❑ Other ❑ L''Other, Lis: Use
WELL LOC.ATI N` _
arest Tow .Q QA
11 n xP
(Sic: Naine, Caoluniiy,S:..I /,ion, o! No., Zip CcdeI
3 c'i',r,,'a`����' _bi CP, .
Rout: �C )
` 4 Air in3'f
it. odowr. Zip Cissee
4. -DATE DRILLED d 5-03
5. TOTAL DEPTH: a S0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STA'i IC W'P.T°R L=o`Carin¢: /50 FT.
(Use e':ov: Top itr Casing:
S. TC? OF CASING IS 2 FT. Above Land Surface'
`Top or rasing terminated aCor below land surfa:e requires a
variance In accordan. with ISA NCAC 2C .0118,
9. YIELD (3pm): aMETHOD OF TEST b1c
10, WATER ZONES (depth.),
i
I I. DISINFECTION: Tace
12. CASING: •
De1 From 0 To IOa Ft. (C' _ __
Front iOai' To IO{a F. (or" 4128 :
From T^ .
13, GROUT; Depth Material Method ii
From 0 To 20 Ftteitnite & Lt.C:_ L:rcei
From To Ft.
1= SCREEN: De m , Die::: Material
Size ace„al
From i0 Ft. In. In.
From To Ft.' in. in.
15. SAND/GP_AVEL PACK:
Depth Sze Mat:ria:
From To Ft.
- From To Ft.
Topographic/Lard se =
❑Ridie OSlopeEVafley 0Fiat
:<a p iae a e)
L titudelen i:udt o. \\,e1 location
(iLersirsio..inuiti.istarsids)
e:4 ben)
D.RILL1NfLCD.
Formation Descr pi:n
clay &
D� granite
LOCATION SKETCH
F T H• Amount 1 Eo2 Show direction on'_ di<:a,,ce in miles :An at leis!
Wall Thickness two Stare Roads or County Roads. Include the road
Diameter o` Weigh/Ft.. Material num5ers and c ,mon road names
O
F
W
W
w
lD
IE. REMARKS:
1 DO HEREBY CERTIFY THAT TH:S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, R:LL
CONSTRUCTION STANDARDS N THAT COPY OF ISREC RD HAS ZHEN ?Ravi DED70TEE WcLL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
- Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636 Pltona,Na, [phone], evithin 30 days, GP;-1 REV. 07/2001

• 15. S.AND.'GR-.VEL PACK:
Dep:n
TO
To
From
From
WELL CONSTRUCTION RECORD
Nmill Carolina D o, rtment or E n>Itorm-,t and Natural Rc sourc:3 DL,..,la of V, Mer- Gro r_._: Section
ELL Cel'I RACTOR,I�1D11'IDIAL?i1A111E 1prinh James B' 21-C4r' CERTIFIC.ATION# 2045
WE'..L RA C70is COAIPA��NY,Vd,yt_
NAME en Brothers Well Drilling, Inc P4oNE 26 369-g591
COi�"f
STATE WELL CO,NSTRL'CTION PERMIT
(ifa;Hlicable)-
293856
ASSOCIATED WQ PERMIT= -
WELL USE (Chek Appiica'ol_ _Pox): Residential Municipal a tic ❑ Industrial 0 Aericul:urai 0
Monitorin; n- Recovery Gr Heat Pump Water Inic ,ion 0 Oilier _ lcOther, List Us_
2 WELL LOCATIO '. /{ ToD T a I ;'r a;. setring Ir_I.
Nearc •Tcwn': Ia si a County 11ri1).0 JR' ge OSIop 0Valley ❑Fiat
(e)leek aoscosdooe.c x
(S Nome., .L"c s, Ccm.p.u.il,Q SuSLivh'c L No., Zip code) Latitude/loniliv156 of welt !o a ICr
3. OWNER, k..--- *� _ 1.! 1 ( s: ,...
.=.aSs .• i .<.[ .G' /I La .ns't...,e s ce 0GPS:T .
:. Sc.*:'' ) T'!r: s -
crT/ a . <... Z'p Code To r For —a': Des -C,oc
Area e:qe• P'.,,o,en:,n::r/� /9 &00' cramt=
4, DATE DRILLED r9-LD-O.
5, TOTAL DEPTH: (_pnos
6. DOES WELL REPLACE EXISTING WELL? YEES, NO El
7. STATIC V,ATER_EVELEeio'.�'To: elCasi,nz �SQC) -.,
Rise "I: A:ur. : CarIng)
' 5. TO? OF CASING IS 2 Above Lan,:'VSurfa:e'
'Top of cash; terrrine:ed. ac'or below land reface requires a
variance In acco a with 154 NCAC 11 jC 0115.
9, YIELD (gpm) 3 V-:ETHQ. �r T blow
ID. WATER ZONES (dentn): l� LI
clay & sa.^.a7
LOCATION SKETCH
11. DISINFECTION• Type H T H Amount 16 oz Silo? di e:ticr, and distance in miles i:oir, at least
12 CASING: Wall Thickness r,vo Sale Roads or County Roads. Include the road
Dec.- Drama,'- o, )1 ch r v1.•, I n Cor,.IfM names.
,
From 0 T^ 69 ( Ft. 1s 1CnLly. r
F-rorr. To Ft. 0X- o
From To Ft Z o�;
iD."GROUT., r Depth Ma'er.ai Method v c^
From 0 To 20 Ft Li Lite & c.., pump •< c,
From To Ft. t o
Id SCREEN: :Depth Dane':Sot Size i -Trial 'a c.
From. To ,.. in 3
From. To It. in. ..,. W rnrn
a
W
tD G
Ft.
Ft.
Size Ma
16. REMARKS'
I D0 HEREEY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND_;AT A COPY OF THIS RECORD AS SEEN PROVIDEDTO ;HE WELL OVINE?".
IUREOFPERSON CONSTRUCTING THE WELL DATE
SIGN'
Submit the original to the Division of Water Quality, Groundwater Section, 1636;Mail Service Center • Raleigh, NC
27699-1631 Phone ,Na. [phone], within 30 days. • GW•I REV. 07:2501

293854
WELL CONSTRUCTION RECORD
Nor! CatoWho • Dopdrtmerr,t of En, d and Natural Resources • Di,ision of Water Q.a ,:y - Gre_^C^..ater Section
i1 ELL CO)TRvCTORLIIDIYIDL'aL)N,a,)1E (prier, Ja-tes F. Bro'+n CERTIFICATfO;V- 2045
WELLCONTRvCTORCOMPANY NAME Heaa_n Brothers Well Drilling, Inc PHON'E= ) 369-0591
5'rATE WELL CONSTRUCTION PERMIT= ASSOCIATED WQ PERMIT=
(ifao;licable) - (ifapPlicable)
WELL USE (Check Applicable Bcx). Residential MunicipaI/Pu`1ic 0 Industrial C`
Monitorin2 ❑ Recovery .0 Heat Pump Wa er In1ectic,, 0' OtHer 0 IF.Other, List Use
2. WELL LOCATIO
N`c c' Tc w n:
(Street Nee
3. OWNER'
County
AWL)rL
Con: nwlit, S loth,: r on Lot Nc, Zip Code)
eg70
440,z();;:,1VC
( Vag- PO(
1a Olaf
e9R731
Zit Coto
Artie cede. Phone nvm'ce-
4. DATE DRILLED '".,--) —(,)5
5 TOTAL DEPTH: to001
6 DOES WELL REPLACE EXISTING WELL? YES.,'^ N0
7. STATIC WATER LEVEL Belo'?, Top of CasHz. `i3O FT.
(L- "iiASr,:Tp crCa,ng)
S, TO? OF CASING IS 2 ET. Above Land S'arface*
'Tap of cas:n; tern,immed at'or below land surface requires a
variance In acccrdane with ISA NCAC 2C ,0115.
9 YIELD (gem): ___ ^ :METHOD OF TEST blow
10. WATER ZONES (depth): 41-5d
DISINFECTION• Type H T H
12 CASING:
De^''- D',amete
From 0 To 10 Ft. (n
From
Frcm To
13. GROUT: • Depth Material
From 0 Tc 20 Ft.) u to & - i-
From Ft.
14, SCREEN: Dep(h D'z.::titer
From.. To FL ' in
From To Ft. ln.
To Ft.
Amount 16 oz
Wall Thickness
Cr Welch L'Ft.
Nlethed
purr-
Siot Size D.Ia:erizl
in.
in.
15, SAND.'OR=.VEL PACK:
Dep;:. Size Ma!e;:a!
From To Ft.
From To Ft.
Too; ucr nr.; seThr.2
DRidg 0S0Vall ❑F1a
(ereirk a p r i0 e x)
Latitudelo o:''..!1 location
tdt"gret; M1briies ar.o •
L_ It,:d- I_fLit d;e sOtJ _.GGPS—'CF rO• t
DEPTH D"-:ILi rV LC, J
:rpm Top a Fc-r-.ati^r, Descro;ion
0 iO3 clay -& sand
(S$r &oaf c-ranite ._
LOCATION SKETCH
Sho'r direction and distance in -:Iles from. at Iea51
two State Roads or Co�.ir y Roads. Lno L...e the road
numbers and COC.iIo❑ road names.
W
W
CI)
16. REMARKS::
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND,rq?AT A COPY OF T ISR.,ETTW HAS SEEN PROVIDED TO SHE `,BELL0"NER
1p 'o(D • 02S
•SICKI .ORE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Scotion, 1636 Jlall Service Center - Raleigh, NC
57699-1636 Pnone No, [phone], within 30 days. • OW -I REV. 0 2001

293853
sTATE WELL CO,NSTRU'CTION PERAMIT=
(if acrlicabl•1 (ifavoliczb'le)•.
«'ELL CONSTRtiCTION RECORD
North Caiciina • Denrtment F Environment ar' Naturalkatural iesou.ces • Division c.` \. ater Quality Groundwver Section
'rYELL C0: RACT0R (1)1-X1'1DUAL) )A i5 IF „) - Ja:„es A. Erarn • CENT FICATtO.N ` 20""-.J
WELL COyTRAcTOR Co.m FAN y nAmE Heckler. Brothers 4)e11 ,Drill ing, Inc ?Hoy: = c 1 353_0;G1
ASSOCIATED tqQ PERMIT
i.i
•
WELL. USE (Chc k Applicable Box). Residentia, Municipa Ic iblic ❑ I dustr'a! 0 °_ --. a _I ❑
Monirorin_ 0 Re:o, • 0 Heat Pump \Vater Injection 0 Other 0 if Other, List Use
2. WELL LOCA IO_j
Neeoes:Town
Goer • Alacmu
(S e, N:: rs C-;.,a:ua v Su. -',if.: at No Zp Co‘?)
•
3 OWNER' Yl Li iyI,d ink ( ;
-P. ... 10 uA3q, yC .IT1ceA L. :cd_ ,i::ld„ s_.i et EOP ; i. -'tap
(click bon) --_
rcg73(/ DEPTH DRILLING LOG
Fr n. Toc. Fmat Descrt Lion
0 r clay & sra
7I ' i s 31 bran«_
Tcpoe c,:.artd .�pn,' -
0Rld2e ❑Sloe ❑Vah= >..,0FIa;
@freak opgrncr:ate box)
Latitu'e ': o` 'I loca:ion
(ota.. cr Rost, N^)
CR cr — n s::;-
8affl- .7 -97p
Area cede. Pl•cle nem:er(a
DATE DRILLED ti -OQ -63
5. TOTAL DEPTH: 120 t h
6, DOES WELL REPLACE EXISTING \ ELLP YES �0 NO /L
_
STATIC'W,'.ATER LEVEL Be;ow Top of Casinr. Rb FT.
(Use''t Abcva To: of Cask;)
€. TOP OF CASING IS 2 FT. Above Land Sc,. .
'Top at casing t rmiaated at'or below land surface rea Ere, a
variance In aecordan• with ISA NCAC 2C MIS. •
9, 'YIELD (ipm)• � METHOD OF TEST blow
• 10, WATER ZONES (decen): 15' I 3a'
LOCATION SIKETCri
I I. DISINFECTION:Type H T H Amount 16 oz Show direction and dis:arce in miles from at least 12, CASING: V,'a t Thickness • two State Roads or Ccur:y Read-. Include the road
De:,' I Diarne:e c k.;;,, Ft. Material cheern s and cool r-...-
From 0 • Tc lei Ft. Loel-.
o c
From LDQ. I To `l "i rL G„ , l$R _SlLLLD ..r- c
Frem - To Ft. M c)
13. GROUT: Depth Nlaterizt . Method '' '.^
From ' Tc 20 F;, 1-cL.,,'.r- & L�,Ptrmner; �-T
o,
lG
14, SCREEN: Dee::'. D'. a,ne:er clot Size ?ta:ericl -' ":j
From To Ft H. in = -rl
eni
FromTo Ca) m7,1
15, SA.ND,'GRAVEL FACK: w n
Depth Size P1a:erial - co c
From To z
From To F.
16 REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A. NCAC EC, WELL
CONSTRUCTION ST.AND.RDS, AND TH'TACOPY OF THIS
FECOR/�D-2A4AS BEEN
PROVIDEDTOTH[3/�JssELL V,'N'ER Al 6113
SIG, '.A t KE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qulity, Ground)vnter Section, 1636 Alai Service Center • Raleigh, NC
G1k'-I F V. fC722001
2'699.1536 Fnnna Na. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina • D:pairlent or Ei I, nmerta d Natural Resource • Division of Water QLal
'rYELLCO;yTRACI'OR(b)DIYID64L)YAINE (print)
Ja'1es E. Erann
WELL C0N'FRACTOR CON IFANI' NAME H' aan E=•o�-Hers We11 Drilling, Inc
293846
it: t Groundwater Section
CERTIFICATION .4 2045
PHONE [phone]
STATE WELL CONSTRUCTION PERY117= ASSOCIATED WQ PERYIIT4
aonllcah'e)
(ifaonlicable)-.
I, WELL USE (Check Applita'ble Box). Residential Municipal/Public 0 Industrial 0 A.cricult:21 0
Monitoring 0 Receve:y.0 Heat Ramp V. ater Injection ❑ Other 0 IIOth.er, List Use
2. WELL LOCATIO�j
Nearastn.Co'ttnt.
R.-We, g 3V
Zip Cc:it
Ara code. Prone numb
4. DATE DRILLED / I _0(
5. TOTAL DEPTH: /'{
6, DOES WELL REPLACE EXISTING WELL? YES G NO k
7, STATIC WATER LEVEL Below Top of Casing a FT.
(Use' IiAbcv: Top of Casing)
TOP OF CASING I5 2 FT. Above Land Surfa:ee
`Top of casin; terminated at.'or below land earrace requires a
variance In accordache with I5A NCAC 2C .01I9.
9. YIELD (gom): /004— MET ; D OF TEST blow
10, WATER ZONES (depth): bit
1 L-DiSINFEECTION: Type H T H Amount 16 oz
12. CASING: Wail Thickness
Deothc, // n
D m.eier e W " `I-t'ai
From 0To �1�LP r �0 - rip
From To Ft.
From To Ft.
13, GROUT. Depth Material Method
From 0 To 20 Ft.lauLite & purnr i
From To Ft.
14. SCREEN: •Depth Diame:e: S
From To Ftin.
et Size Material
in.
From. To F:, tn. In.
15. SANDGRAVEL PACK:
Dean Size tMateriai.
From To Ft.
From To Ft
Topog aph;C Land Sett na
GRid e ❑Slope Gb'al.e• ❑Flat
_ (check ap prap riate Con)
L atitude.Tongi1ude of well location
(de;rece mir'lies 3e.e.�a%
Latitiatailonoittide source, C_P:GPSEc.o..rap c -,i2:
(cted<' .a)
DEPTH DRILL lNG LiOG
Formation Des:1-1ottd9'
C_dV & Sa^.CI
From,. 3� r
/46I
crani.te
LOCATION SKETCH
Show direction and distance ir. mites from a; least
two State Roads or County Roads. Include the road
numbers and common rood names,
0
r
t
16. REMARKS:
I. DO HEREBY CERTIFY' , THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A
. NCAC C 2.0, WELL
CONSTRUCTION STAN •S AND THAT A CO Y OF T" RECORD HAS BEEN PROVIDED TO THE WELL O':NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Fir:,nc No, [phone], within 30 days. GVi•I R.E.V. 072001

267921
WELL CONSTRUCTION RECORD
North Czrlir? • DC artnent of EnYIr01neA' a'd Na"w'-i eS^w� • DIY;SIOn of Water Quality j • Grounder3'.Section
? LL CONTRACTOR (INDIVIDUAL) NA.YME (print) Mitchell D. Cook CZZRTrnCATION 0 2043
WELL CONTRACTORCON?A.NY NAME Redden Brothers Well Drill irg• Tnr, PMCNE 4 (R7R yveLQSo1
STATE W ELL COYSTRUCTiOY PER.1IIT. ASSOCIATED WQPERN1Ta
(if aoolicable)
(if ar!icable)
1, WELL USE (Check Applicable.Box): Residential Industrial C A ,.- su viral G
Mcnitonng ❑ Recovery 0 Heat Pump Water Injection 0 Other C If Other, List Use
2. WELL LOCATION:
Nearest Tow High]ands County Macon
Wildwood Subdivision Well #2
(S=.•: Ns.—.e, Nur,ben, Comr.'n;', S::Cl;is'.a: L:.; N4., Zp
3. OWNER: David Bock
Address 7i11 rhpat-wirk rnarrt
(Street o: Rome No,)
Atlanta, GA 30050
Ciy cr Town SU:e Op Cede
(678 )• 5R7-9797
A.aec e• Phone nr,,kr.
4. DATE DRILLED 1-29-03
5, TOTAL DEPTH: 1000'
6; DOES WELL REPLACE EXISTING WELL? YES 0 NO Rita
7. STATIC WATER LEVEL Below Top of Casing: 990' FT.
Ohl "n" If ASove Top of Cuth;)
S. TO? OF CASINO IS 2 e t. Above Land Su::ace•
• 'Top otculns ter :Ina;ed ''or below land surface r ;e1rts e
varsnce In a:cordan:, with ISA NCAC IC .0113.
9. YIELD (pm);: r p METHOD OF TEST ling
10, WATERZONES(depth): 45& 470'
11, DISr\?ECTION: Type HIM
12. CASING:
Depth Dietiti,etc:
Fro r.,.._Q To 37 F:.�_
From 37' To 36' Ft. 6"
From To F'
13. GROUT: Depth
From 0 To 20
Am nt 1 Elm
Wail rie'e,ess
cr Wrg::cl. Mate.;_'
,188 str
eel
Material Method
Ftlernite_Ega=nt • prcl-a-1
From To Ft.
14, SCREEN: Depth
-om To ^t • In.
From To • Ft in _ in.
15. SAND/GRAVEL PACK:
Depth Size . Malerai
Diameter Slot Size Mauna!
Fro... To Ft,
From To FL
Topographic/Land set`.Dg
CRidge ❑Slo- 0Valley ❑Fiat
• (:hr.'R
._....C:de, engio1de of wet! Iccat..on
(derustr.,:enus.'sxca)
Laaads ngitude soa.c :CG?SCTV , t.t ad
(c::ak box)
DE?TP • DRILLING LOG
From To Formation Description
0 34' clay & s�rl
34' 1 nun ' tgat to
LOCATION SK;TCF
Sho'x direction and dis'_ .e is miles from at :as
rxo State Roars o: C:un:v Roads. In:icdt the road
numbers end consnon road names,
16. REMARKS.
1 DO HEREBYCER tTa r W-• -(ti* CONSTRUCTED 7Y ACCORDANCE WITH ISANCAC 2C, WELL
CON'STEt4GTI0\.5 oAN'DAYD' S, A.$D TH.473AC(7?Y OF THIS RECORD F.AS BEEN PROV:DP,D TO Tin WELL
S1ONAT4A OF}sERSON CONSTRUCTING T:-E WELL DATE
,.d ,
Submltith'e Original to the Division of Star cuality, Groundwater Section, 1636 Mail Senlee Center - Raleigh, NC
27699.1636 Phone No, [phone], wl0,30 day,. GW•1 REV. 07,2001
0
(.0
—n
03
W
t,7
:1
7.7
cn=
O

26792'�
WELL CONSTRUCTION -RECORD
North CaiDlira • Dop3,is'ert of Environment zd�a,"al Reso"wis Division of \14,er Qal.lh!Crroursciwsttr Sectors
eERTMCAT toN a�5
WELL CONTRACTOR (INDri9 DUAL) N AM (print) James B. Browm
WELL CONTRACTOR COMPANY NA.N1E Redden Brothers Well Drillina Inc.?HONE a
ASSOCIATED W'Q PERNITd
STATE WELL CONSTRUCTION PERtitITi (if a-clicabsel
• 'a ; t;absel
•
1. WELL USE (Check Applicable Box). ResidentialMwkipal?ublic ❑ Industrial C AgicuL ral ❑
Monitoring 0 Recovery 0 Heat Pump Water Injecticn 0 Other G If Other, Lis: Us: -----
T opograp'hic Land se;ti: g
❑RIA °Slope GVa'!ey
ge .
(:ark epprpam box)
Lat'.n:de1ongir.:de of We.! Ic:aLcn
(?er :r.'m u:e0'OCCC e) :.
Latta de•longi:ude so'ce:CG?S_Topos,ap
map
(chxk bcx)
nips t
2. WELL LOCATION: Macon
Nearest TOWn: Franklin County
li'a Rd
(Steel Nvrnq Nu .Sm,Cer,"Ynl:/, S':bdi.fe'.r.., Sat No., Zip Cole)
5. OWNER: R: ° Batbares Waters
Address
(Spa cr Rocre No.) D:?TF:
Franklin NC 28734 :•a:icn Descr.cncn
Z:e• CcGe From. ' 51 , ay & s
Ci.y uTcwn Sap r
(r328). 0S57h 51' 400' g`"-- ----
te
Arta ex'e- Shona eu.T *.er
. 4. DATE DRILLED 1—
S. TOTAL DE?TH: any--
6. DOES WELL REPLACE EXISTrNG WELL? YES ❑ NO EBr
7. STATIC WATER LEVEL Below Tcp of Crs'.ng: as• F i,
(use if Ab:ve To^ or CuU;)
8• TO? OF CASINO IS 2 FT. Above Land S' ace'
'Top of cuing lerrsinaud Ester below lane surisce rq:Iru a
var•ance In accordance whh UA NCAC SC .011g•
9, YIELD (gprn) ...2 _____ METHOD OF TESTblad1
(depth): r 325 LOCATION C TG
0� WATERZONES S
EaAmcunt
itC¢ Sheri,' din;tion and dista.nee in miles from. a: leas:
1 i, DISINF_ TrON: Type— two State Roads or Cocnn� Roads. Inciuoe the ;cad -<
c
•Wall Trddkness
12. CASINO: t,: r.ambers and co mon pad names. o
pe;th Dia.�eter cr W'ei•' 81. stEe� w
T
From, 0 To Ft Ei --
Frog To Ft. coo ��n
F•cnt To •
Ft t
13. GROUT: . Depth Material Me:S^d J
Frcrr. 0 To 20 Ftksaute & cere t R
From To Ft. s 14. mr;
SCREc Va.—niter 5:et Size Ma_ -a! • <n
Frcn To F;. _In. __ in
N
Fro^ To It. in. in.
15. SAND/GRAVELe;th : Size . Material
Dea
From c. To Ft.
From Tc Ft.
16. REMARKS: j
Fix) HE?2!Y GEA T IFY e .XI its W-LL WAS CONSTRCCT_O N ACCOP. ANCE W17.-1 1,A NCAC 2C, WE.::-
CONSTRUCTIONST "1 , .'hamT-4TACOPYOF PII5RECORD HAS BEEN PROVIDED TOTrEWELL CWINER
/-� 7-o ?
:V<AArlin OF PERSON CONSTRUCTING T•= WELL DATE
Submit the brlglnal to the i�h1sla of Water Quality, Groundwater Section, 1636 Malt Stnice Center
1' RaleiKEY, NC
02Col
27699-1636 Phone No. (919) 733412 , within 30 days,

267923
WELL CONSTRUCTION RECORD
North Czo}ira • Department of Environment and Na?i 1 RascuNes • Division of Water Quality • Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NA -ME (print) Mitchell D. Cook czRTi1CATIOS s 2043
WELL CONTRACTOR COM?A.NY NAME Redden Brothers Well Dni 11irg Trin ?4OVr rr 0075:1-t a_0501
STATE W ELL CONSTRUCTION PERMITe ASSOCIATED WQ PERMITa
• (if aoelitabie) (if anolicable)
1. WELL USE (Check Applicable Box): Residential tg< Mwicipat?ub!ic ❑ •lndust:ial C Agri:ult -a! ❑
Monitoring 0 Re:overy 0 Heat Pump Water Injection C Other 0 If Other, List Use
2. WELL LOCATION:
Nearest ?worn: Franklin Co Linty Macon
1777 Hickory Knoll RD
(Sr..: Nate, Nemen, Cem:r, sky, Subdi'ris cr., Le: No., Zip Cz'e)
3. OWNER: - Bill & Ann Morse
Address 1772 Hickory Knoll Rd
(Street cr Route No.)
Franklin, NC 28734
City cr Tcwa Suu Zip Cod:
(RJR)• 154—sR51
Area c 4c ?bane na-br
4, DATE DRILLED 1-15-03
3, TOTAL DEPTH: i00'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 3
7. STATIC WATER LEVEL Below Top of Casing: 175' FT
(the "r" If Above Top orCasIrj)
S. TO? OF CASING IS 2 FT, Above Land Surface
'Top otulles :intimated eater btIow land 'errata requires e
vari,nce In accordance with 13A NCAC 2C .0113,
9. YIELD (gem), 10 METHOD OF TEST hicw
10, WATER ZONES (depth): 135' & 165'
11, DISINFECTION: Type Hki
12, CASING:
De; th ete•
From 0 To 105F1
Fro= To st.
From To F'.
Tcpcgraphic :.a:.d setti^.g
CRidge ❑Slope CVzlley ❑Fiat
(ar.R erpttpria_ bos)
iatirsdr;icngiade cf lc:a;(cr
(deFeca'miautes',xc❑ar)
Latit-deflongirude so•.,ce:CG?SCTopc ap;hic c p
(c::eck bwz)
• DRILLING LOG
Forrnaticn Description,
clay & 5�3
y aLite
DEPTH
From To
0 103'
103' 300'
LOCATION 5K TC^;
Ara^w' 1621z Show direr i n and dis'�h.e in miles ft-- at least
Wall 'I iolmess two State Roads or Ceunw Roads. Include the read
or Wei !t -t. Material numbers and common road na.r.es.
.1 tfii Steel
13. GROUT: _ Depth Material Me±hed
From_ To 2rl FtlonitP R c ,F pigw1
From To Ft.
14. SCREEN: Depth Diameter
FranTo F in,
• Fro- To Ft. in
15, SAND'GRAYEL PACK:
D,t.t1 Size . Ma:vial.
Froth To Ft.
From Tc Ft,
51c: Stu Mateia!
in.
In.
• 16. REMARKS:
I DO jpr nY'CART7^Y T 1 t,1:}:WI$,- S CONSTRUCTED IN ACCORDANCE WITH 13A NCAC 2C, WELL
CON i 1TR re1ON STANDARDS, Ae>.tt1 COSY OFT IS RECORD HAS BEEN' 2ROV:DED TO T Z WELL OWN -ER
4s l .I,e l h S/e75)
SIONAAy FPERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Wate Quality, Groundwater Section, 1636 Mail Sen to Ce:ter - Raleigh, NC
27699t1636Phortcfc (91Y)7t3.7331,ve thln3days, GW•1 KEY, 07/2001
0
(a
T
w
J
fV

267925
WELL CONSTRUCTION RECORD .
North Ca clir.? • Department of Environment and Natural Resc'ur:es • Div!son of Water Quality • Grouod';ra:er Section
WELL CONTRACTOR (INDIVIDUAL) NA.ME (prim:) Mitchell D. Cc ck CERT,T ICA T ION p 2043
WELL CONTRACTOR CO:r1?A:YYNA.v1E Hedden Brothers 40011 D'-i 11ingt Tnr PriON'E $ (P7R)V+Q—oSc1
STATE WELL CONSTRUCTION PERVITM ASSOCIATED WQ PERMIT*
(if accli:able) (if enoliczbie)
1. WELL USE (Check Applicable Box), Residential Mc M'u icipaVPublic ❑ 1nd'ustial ❑ Ag.-iculnua! 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other C If Other, List Us:
2. WELL LOCATION:
Nearest Town: Frank]. i n County Macon
(Sett Nsae, Nn^Son, C:r„mar.ly, Subdir, ricy Wt No., Z.p Ce)
3. OWNER: Donald Holland
Addess 30 Parri ¢h T.anr
(S(rnt or Route No.)
Franklin, NC 28734
Ciy or Town, Swe Zip Code
(82a)• SO6-159A roll
A. a code• Phone noro,b :
4. DATE DRILLED 1-14-03
5, TOTAL DEPTH: scat
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G
7, STATIC WATER LEVEL Below Top of Casing: snn FT,
(Ur. "*" If Abcve Top of Castr,j)
8, TO? OF CASING IS 2 FT, Above Land Surface!'
• 'Top of calla; teralna!ed a.or batow land surface regtPu •
variance In accordan;, with ISA NCAC 2C .0118.
9, YIELD (gpm): 7 METHOD OF TEST
10, WATER ZONES (depth): 1 n7& zinc,
1I, DISINFECTION: Type HIH Amount 1Ece
12, CASING: Wall Thickness
' Dc CI Dia.:,e:e: or W'eigEtTt. Material
Ft c,,_0_ To_AQ F' _EL__
From an' To 51 tt ("
• From To Ft.
13. GROUT: D:rtE Material Method
Fromm To 220 F'I nite & cxrm tt prize-1
F•o-n To Ft.
14, SCREEN: Depth Diameter Slat Size Material
Frem1 To 7t._in. in.
From To It in ir.
15. SAND/GRAVEL PACK:
Depth Size . Material.
Frorn ` To Ft.
From To Ft.
Pvr
,les ctec1
1
SIONATftt F PERSON CONSTRUCTING TFv WELL DATE
I
Subr .l: the original to the Division on'ate Quality, Groundwater Section, 1636 N1111 Sen ee Center • Raleigh, NC
27699p1636Phonrriar(919)733.3211,.within3 days, CW•1 REV 07,200i
Topoganhic/L and settin g
❑Ridge :Slope ❑Valley :Flat
(oheok top:op.?a'_ box)
._atft do.lcnginide cf we:: location
(der <imlcu:a'r xoa:.t)
Latitude .'or,gitudesource:COPSCTcpa aphom -
(c'::ak box)
DE?TW • DRILLING LOG
Prem. Formation :ion Descriction
For a2
0 49' clan & xd11
40' 550' grwate
LOCATION S KCFTCW,
Show direction and dist_nce in miles from at leas:
rr:o Sta:e Roads or County Reads. Include the read
numbers and con" --non road na-,:s,
16. REMARKS'
I DO NERLEBY.CERTWY THAT THIS ,'iv EirIPNI ,5 CONSTRUCTED TN ACCCRDANCE V:'I T:: 1 SA NCAC 2C, WELL
CONSTRUCT IONSTA.`v'9.A.DDSAN 2JtJCC? YOPTHIS RECORD HAS BEEN ?ROV:DEDTOTHE 'ri iLOWNER
///4z/G
63 :I I WV L- 833 88

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division) of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME:hie:hie (print) cn liis /iJ' a,y\rt CERTIFICATIONl# of /7 (,..0 \\'ELL CONTRACTOR COMPANY NAh1�1.('.flflii `C�flf ir( PHONE#���L/-3
� I��e��r1/S/r llTlt �, 11),-eJ�a arrj
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIRERMIT8
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Yd�Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: �/
Nearest/Town: C07( L� •4�' County 4/2 (��`�7y��/
rig; r»,1 /e (' 1" r e t ! _P'/YI it) , C I/4) ` �' 26.3
(weet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
dee
3. OWNER: I 0 /r) ll j1\1r S
Address 7AA1.3 ( 0ill i? FR19.
(Street or Route N
/11PS G. II£_ /Ll r /(}
Gyt r Town State Zip Code
Area code- Phone number
4. DATE DRILLED e�-/,. _7
5. TOTAL DEPTH: 3.5 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 2 [+ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /CC f METHOD OF TEST 1 /071)/y,((-,
10. WATER ZONES (depth): .�,- /\' - -?. (1
LOCATION SKETCH
If ft/ Amount 4 Tn b S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diamf�eter or Weight/Ft. Mate l numbers and common road names.
From a To Li/ FL hi' $--bR Q/
From To Ft.
From To Ft.
13. GROUT: Depth /1Material Method 1
From n To r�LD Ft. 0_047141 e ILQJ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
1 I. DISINFECTION: Type
26S 9
Topograp and setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(;-) /.5'-' C l :g!
1R ri b •-e-
/
3r' 9/• V?ip01.eILt e_
-3 -S5 8//cc. «Y4,o: t-P
O
W
rn
m
t,
v
16. REMARKS:
Fr_ II t4SO 1(fEREBY tER71IFtv,�TFrb7
€ NSTRUCTION STANDAW
_ r -
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fh'' 0 -el . -/,Q - O
25
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
LSubmit the original tothll Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
29699.1626 Phone. NoJ(919) 733-3221, within 30 days. GW-1 REV. 07/2001
A° 1 Inc
0

268595
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
TT 1 CERTIFICATION# et/7
E
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cl)�flM S '+n Li �� inn` •7 1 �-6 (�
WELL CONTRACTOR COMPANY NAM:hf 1 C (e Uanr4 (1)PI l li tfr l I ;-R . )- PiJ #
e PHONE
ASSOCIATED WOPPERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: A/) L
Nearest Town: y1c/a 2 JCL' 2l�t>unty _ /
rn
(04E, c CA'`n'rm
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L_Q!2R j SIenotC2
Adthess r>)S4/1) -J Et/;)n:`J CP`t
(Street or Route No.) 3
rhumit) IC if
Town City or n State Zip Code
_ to - s3 9-n
Area code- Phone number q
4: DATE DRILLED '-'('//_Q
5. TOTAL DEPTH: c22
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m/
7. STATIC WATER LEVEL Below Top of Casing: /0 ' FT.
(Use "+" if Above Top of Casing)
Topographic/Land setting
J DRidge ❑Slope ❑Valley IQFI'at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude souree:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description S
C `� "G?
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance 11 ith 15AMNCAC
ETHOD OF TEST
9. YIELD (gpm):
10. WATER ZONES (depth): / 5C > / SC) (42-55
Amount 4 %12)' S Show direction and distance in miles from at least
hide the roe
numbers and common road names.
4
I1. DISINFECTION: Type E-f14
12. CASING:
From
From.
From
13. GROUT:
From
From
14. SCREEN:
From
From To
15. SAND/GRAVEL PACK:
Depth
To
To
a
From
From
16. REMARKS:
HERE�YCLR
L
CONSTRUCTION S
Depth
To c2 / Ft.
To Ft.
To Ft.
Depth
To_ �� Ft.
To Ft.
LOCATION SKETCH
Wall Thickness
two State Roads or County Roads. Incd
Diapeter or Weight/Ft. MMatedal
lo" S D.R !
Material Method
01247I 017 pol"`�
Depth Diameter
To Ft. in.
Ft. in.
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
c
W 4>
-r1
rn C�
o=
CO =-r,
yc
ri7_
cia
c's
N o
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NE ARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
6,,' Sub{rtifthRlM$'Un•tl to t ie Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert REVgh, C
1 ASH'1 47H494636 PhantfilSe (91)) 733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cl)-e flMi5 /-�-0�'Qfy\[•s� CERTIFICATION# K/%4
WELL CONTRACTOR COMPANY NAMR 1 S IMOflf,,„ 4 I f ei Il y1 11 -u.t .1 "Yl P PHONE #i'a411/_Sa 1-/-3 a-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential fl C icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town:, ';LILT i Q//Y&ounty
f Pd_ —:?a�11 Cc,,;;� _(,•r/ /rJ
(Street Name. Numbers, Community, Sdbdivision, Lot No.. Zip Code)
3. OWNER: 120 C 2 C Co-ei
Address / %_`5 (? /2/C"7-
(Street or Route No.)
/728VA-/n4) il/'�— (C)3
City or Town Stat Zip Code
�r )- 3 9_ Ye ,
Area code- Phone number
4. DATE DRILLED <4.-I-L-b�
11
12
5. TOTAL DEPTH: .2,55-'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W�
7. STATIC WATER LEVEL Below Top of Casing: c 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. /
9. YIELD (gpm): SO METHOD OF TEST kW/lit
10. WATER ZONES (depth): ,Yl) J //�
LOCATION SKETCH
%f} /�j S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley inFfat—
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DRILLING LOG
Formation Description
• e/4,
DEPTH
From To
0 i3
(' 3 � 5S' llig l t-c-A
DISINFECTION: Type
CASING:
0
f%f14
Ft.
From Ft.
From Ft.
13. GROUT:
Amount
Wall Thickness
Dia eter or Weieht/Ft. Mat7ial
Depth/
To (^ 3
To
To
Depth
From
Material
Frorn o To ` (7 Ft. CO.lyi pya
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
fCJ4 O
Slot Size Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
268593
-o
(r)
115.1
5. iFNEDOgNSF
i 1 TR,UCTIb`k TAND
L. Submit the original to he Di
(; �7499 16J6y1hfcteNor 9) 73
gcut_1 Lir IL_
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ICY' 63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

268591i
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) <��il V)IS I(aMe CERTIFICATIION# tt /7/y'
WELL CONTRACTOR COMPANY NAMS'nnt s (WPI I j' to II m 7. is 0 PHONE 6;4-5;2 Y-3 a 6 a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentiall:]--Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:�
Nearest il`�
rest Town: /)Ait'l, lx./ A/t- County M1
ciclinn La 31-f-b- La -to , 2- 41(-l5
(Street Name, -Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /inn LV, /SO1---)
Address I _--3 Ci ";,�J 2 L .9r.-2-
(Street or Route No.
%rd-7l VA1a 4 C e-er73�L
City or Town State Zip Code From
as L3�9- .3�bc� 0
Area code- Phone number gri / / Cy
4. DATE DRILLED - 7 --D 3 /9 /
5. TOTAL DEPTH: 7.56'
Topogra c/Land setting
DRidge Mope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To, Formation Description
�rQ
/CPI) . 12 (1
7.50 A /Lc.< - (i-�c7m
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7. STATIC WATER LEVEL Below Top of Casing:_3,n O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118. �� //
9. YIELD (gpm): 3 METHOD OF TEST h ,{--,
10. WATER ZONES (depth): r35/7)' (one " 0
11. DISINFECTION: Type /t-tH Amount
12. CASING: Wall Thickness
Depth Dia eter or Weinh,/Ft.
From To y 9-D Ft.S jD R at
From To Ft.
From To Ft.
13. GROUT: Depth nM,,aterial Method
From n To r`�Ci Ft. Ca J7t t.2� .(7aIMA--)
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:
LOCATION SKETCH
S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
cap
rn
r,J
CO
—o
C9
[V
un
0
1 DO HERESY CIERTIFYLTHAT
EONSTRUCTiON-S XNDX Ds
J .
IS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF TH(S RECORD HQS BEEN PROVIDED TO THE WELL OWNER
OC,LY
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the originaFtolirje' Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
/+£1&9941&36 Phone No191p)E733-3:21, within 30 days. GW-I REV. 07/2001

G1) f 01(41, R11TI D11111D
Submit the original
�' !yfi99hb3� • . r
ASrElili f
268592
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C I/Tin l') IS/4t) I (,,A Al CERTIFICATIION# cZ/74a
IntijI m.c1 (De(I dU-Yai-r�Tt� . ],is #
eJ PHONE@ad).
/-5oZ 4-'3 ae,U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
w" ELL CONTRACTOR COMPANY NAM
1. 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: O h17) A�(' ' County 4-1 0 (.Jryv
wh c (ldk C?a_ -Sh„ e_ C2,fzz DNa (on,
(Street Naine, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: 'iSIO 1C20UnID
4
5
6
7
Address /(o .SQL(.tto .bi X i c H t4-- y
L` k (Street or Route No.)
LC) OI1-1v FI .33 (76D
City or Town State
(SM- S- %In)
Area code- Phone number
DATE DRILLED 2 - 3 - O 3
Zip Code
TOTAL DEPTH: aSS'
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
STATIC WATER LEVEL Below Top of Casing: kO 1. FT.
(Use "+" if Above Top of Casing)
8. TOP OE 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): k' METHOD OF TEST MILV/ei t
10. WATER ZONES (depth): . oZ' /,Yli' (�
I I. DISINFECTION: Type f{"- /i Amount IAA S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate''al
From 0 To S,2_ Ft. b" 5 D R-pre.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From O To ` 7 Ft. 09. -yt i7-1 �]�
From To Ft. Y
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:
u f'i .:
OfHCE
raglaphic/Land setting
tdge ❑Slope ❑Valley ❑Flat
M " (check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
0
/'
(o. S'2
Formation Description
Tor5n;
/K2,
Le )7 Pt-,//C'� l f f �-
tu,__ ('- 'a+ i f.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.
O
-n
rn
co
c-o
-o
w
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1(1444
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Section �" \\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) ,7)-e n � ( 5 Pr)I1T1(1- rU CERTIFICATION # oZ /7le
\\'ELL CONTRACTOR COMPANY NAM�IX� rants hp1)2>4J Wei Irt1\fr ii-Nd -rev J PHONE #�(ae —5�;24-3 a-6 6
STATE WELL CONSTRUCTION PERh11T# ASSOCIATED W ERMI7#
(if applicable) (if applicable)
26819rt
I. WELL USE (Check Applicable Box): Residential U-1 i1 icipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: "�
Nearest Town: l' %X i"/a kL;.47%/G County /2 e G-�
/Y? =}rLCelc C� pd — C�eu .c rain,.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: "‘Lc Z62nn ill 0,311%).--
Address 363 /21 Gc-f-/C( fr C/2, tog 0
(Street or Route No.)
(1((211t 4.7 C- 73
City or Town State Zip Code
� ) c51-u— a 7a5—
Area code- Phone number
4 DATE DRILLED / 9 —D 3
5. TOTAL DEPTH: 30, v '
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 02------
7. STATIC WATER LEVEL Below Top of Casing: 6/3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 02 S METHOD OF TEST
10. WATER ZONES (depth): e-23(9'
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To
From To
From To
13. GROUT: Depth
From (3 To 'D
From To
I4. SCREEN: Depth
From To
From To
I . SAND/GRAVEL PACK:
Depth
From To
From To
Diameter
Ft. n•_
Ft.
Ft.
LOCATION SKETCH
Amount o2 TA- S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or WeighUFt. Matep l numbers and common road names.
Material Method
�t
Ft. 17t d?t F7n,A/C
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
CD
CO
rn
W
ca
A
0
c
CJ
c2 _
72
Yo
r't cn CD
CD
0
z
16.REMARKS:
I DO HEREBY CERT!FYPTHelT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA tbAikDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No:-[phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionlof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [ I) -en kI15 jjf')' `(Ly\ r(, ' CERTIFICATION of /7 (,0
x �ELL CONTRACTOR COMPANY NAM&I.i(gnic hot 4,,4 Wei I�t/r II;u�y .),n PJ r�-FS)PHONE ,.,Sa 9-3 a.6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQr-\PERMITf
(if applicable)
(if applicable)
268198
I. WELL USE (Check Applicable Box): Residential ids Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: O C. County )
u— /Z _ �12c\
(Street Nawe, Numbers, Community, Subblivision, Lot No., Zip Code)
3 OWNER: G pY9.-C C-- V2-O
Address - 7 c)lOyuCe C-1€4, 124-1
(Street or Rowe No.)
11--TY1 ief S,S
City or Town State Zip Code
D �) 3-5-8- Os-7/
rea code- Phone number
4. DATE DRILLED / - 7 — O 3
5. TOTAL DEPTH: 77)_$-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/ (Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface•
'Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD(gpm): MET`ODOFTEST Ai/Wit
10. WATER ZONES (depth): d / (I) (�
r� LOCATION SKETCH
I I. DISINFECTION: Type %'�-%"%/ Amount r; 7-A-A;S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
^ Depth Dia ter or Weight/Ft. Mate- 1 numbers and common road names.
From 0 To SFL Pit
From To Ft.
From To Ft.
13. GROUT. Depth Material
From /5 To Ft. CQ7-yt yj,7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
pQU./0
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
tie :OIWV £-033£O
r 1 JNU Mu LKtr ctrcf
.fsr +-�� T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
I -�1 t C'CNSTRUCTIdN S AI\ Dl)..DS, AND THAT A COPY OF THIS RECORD HP,aS BEEN PROVIDED TO THE WELL OWNER
t -
07 0.3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original t the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9
I7699-I636Phone No: 19) 7
3-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
26'71n3
North Carolina • Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section`f'
// __
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c)Q h v115 ''�7)/)ln\(s) CERTIFICATION # 0Z17
WELL CONTRACTOR COMPANY NAMt/X.hntIitlln,irt WW)el I 1.)tftl In44 .j.nd J PHONE # <— Dy-'3 42- 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQi'ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check ApplicableBox): Residential unicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RIZ-7,kb /Y/l'C? - County 44 a f»vt
k't>°ha_7—) (11-L)MnTr L#4I SUul-ILJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: al. /c't CLLc:{nu
Address `/�O. VPhk 4 /
(Street or Route No.)
/.
/',4 q- v L r ,i/ /Vc-, fS 7y
City or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED �- /Lf —0_ 3
5. TOTAL DEPTH: SOS_
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4-) METHOD OF TEST /020f7t�l%�
10. WATER ZONES (depth): .Ch C • (�
I . DISINFECTION: Type1-14
12. CASING:
Depth Diayeter
From 0 To /) 7 Ft. (o
From To Ft.
From To Ft.
13. GROUT: . Depth Material Method
From I)To_9Ft. !p yyt ay p�T)A'0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
YES 0 NO
FT.
Wall Thickness
or Weight/FL Matey
16. REMARKS:
-gip
LOCATION SKETCH
Amount 4 %ig- pi S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
ram)
W
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
zo the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
iq (919)' 33-3221, within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section -
WELLCONTRACTOR (INDIVIDUAL) NAME (print) c'Neni�115 /TO/I(2rA fnk CERTIFI�CMATION# �/7 Y'
/
WELL CONTRACTOR COMPANY NAMEIX.hnjS JCA liaori Wel I 4.) In I Im1tq�j.).neJ PHONE #�'A- %1/_6e214-3 2b 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ'4ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:�
Nearest Town: Cjr4/z kLr 442.-County AI.( 2 (a)'v
Pl e((54.71-/¢; 11 �i')Plnr <t y/ Sine, f/ '
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
J 3. OWNER: r /71 Al a I /
Address —RC , h O)( j_I C
(Street or Route No.)
(x t v e.. I Oti-, A (( .
3 9 7 �3
Zip Code
O )
Area code- Phone number,
4. DATE DRILLED � -L 3 -C 3
5. TOTAL DEPTH: (7(7.5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ✓"
7. STATIC WATER LEVEL Below Top of Casing: /c1(0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118. �/
9. YIELD (gpm): 5 METHOD OFTEST _hiw/Jh1
10. WATER ZONES (depth): /& S (//
267108
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
II
12
City or Town 5. State
DISINFECTION: Type if "! - Amount
CASING: Wall Thickness
Depth Dia elver or Wei ht/Ft. Material numbers and common road names.
From To - Ft. P )4 C.i
From To Ft
From To
Ft.
13. GROUT: Depth
From n To r9f) Ft.
From To Ft.
Material Method
Prn�
14. SCREEN: Depth Diameter Slot Size hlateri^1
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:
irs,gu 4-troy Jct.
Submit the original 6o the
GRCN'W(!itil'IN. 919)
ASHFVILLE REGILN.... OFFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
)S, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
e /-/3 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 RSV. 07/2001
LOCATION SKETCH
4 TA. S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
L

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / WELL CONTRACTOR (INDIVIDUAL) NAME
(print) c71-ef) Y1IS flit1 'ant rL CERTIFICATION # 01/7 Y'
WELL CONTRACTOR COMPANY NAME .hni S jCIA jIa.„n,4 Wei I I( , _ , j , n ('J PHONE # , Sii_.Sa. 4--3 2.6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
267241
I. WELL USE (Check Applicable Box): Residential trMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
CennOrs Parr.PcCblrzheI Crn1n1•
(Street Name, Numbers, Community, Subdivision, Lot No., Z p Code)
3. OWNER: / c/C (`y,�- harPTIa
Address 02Ok' Pi c:�....�
(treet or Route No.)
City or Town State Zip Code
W)- 4� 9 - / b' 7 s
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number /
4. DATE DRILLED / — /—) 3
5. TOTAL DEPTH: 440 5— '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO U.2------c-
7. STATIC WATER LEVEL Below Top of Casing: 6, e, 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. h/W/J
,9. YIELD (gpm): 7 METHOD OF TEST_ r
10. WATER ZONES (depth): /4' -31n'
11. DISINFECTION: Type Ht» Amount r2 TA-13 S
12. CASING: Wall Thickness
From 0 To sD
Depth Diay�eter or Wet hUFt. Matep�pjI
Ft. p Ci
From To Ft.
From To Ft.
13. GROUT: ' Depth
From n To r(7
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Material Method,
Ft. CP r» [ T LUA�C.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
rr 1-1 Drp,H REB OEIRTI Y
I�� `-CDNSTKUcT10. v; A?:;
r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
C_
W
0
1
rn
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
, AND THAT A COPY F TH #S RECORD H S BEEN PROVIDED TO THE WELL OWNER
��I^1 mo^ — 7-0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
'tq the Di piision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
a ce12) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 267239
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section // --
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \e n h l 5I I I am CERTIFICATION`e
�# cl17
WELL CONTRACTOR COMPANY NAMKh'.Y T S'TIIA IQgnr4 IIP-I) Th ' I I T 4, 4 C i PHONE # @rtltl .-So214 24
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WeIPPERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: P j,!Li /✓MI, County �l Ld. cim_)
Krer,ermt• Fri(L,tug 2a r2Xit
(Street Name, Numbers, Community, Subdiv(sion, Lot No., Zip Code)
3. OWNER: /� ( e19 e/2
Address /0 S L1-r'_aj Ec+,
(Street or Rote No.
/11744ifrIr3 / vc>2 g7
City or Town State . Zip Code
c_5"02-4-_ 5 po s�
Area code- Phone number
4. DATE DRILLED / — b
Agricultural 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5. TOTAL DEPTH: Z 15'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: / �, V FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): L 0- METHOD OF TEST /O2I2i
10. WATER ZONES (depth): /t)/t / / 2 S' ,2 ()! U
LOCATION SKETCH
11 DISINFECTION: Type I--t"» Amount 4 TA- 13 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth .) Diameter or Wet htlFt. Mart numbers and common road names.
To J "J Ft. (n Y Ci
To Ft.
To Ft.
13. Depth Material
To r`}(7 Ft. 'O4p
To Ft.
l4. Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
From 0
From
From
GROUT:
From n
From
SCREEN:
Size
Ft.
Ft.
O
Method
roll
Slot Size Material
in.
in.
Material
CD
(.)
r
CO
as
O
16. REMARKS: rrl
W
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subtnitfhe original to the Dtvision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
'.7699-1636 Phone No. (919) t33-3221, within 30 days. GW-I REV. 07/2001
GROL1 A L 1, ` iON
ASHEV'ILLS pEe 1/4)*AL OFFICE
c
CD
CJ
c
c4
G
0

\D
lJ
WELL CONSTRUCTION RECORD
267238.•
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�)-eI3 vli SI /11')/ /(1n rh CERTIFICATION of/74o
WELL CONTRACTOR COMPANY NAME '1 X pn! S (J11(iiAri �Dei I .})V i I I',lf e PL P J PHONE # ice...3a 6/-3 g6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WOPPERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: • / /�
Near st Town: p,Qj/Lz/LI N We, County // I Q °n't-
center nit, IC& 1irun-) 2a. r,)?4'
(Street Name, Numbers, Community, Subdivftion, Lot No., Zip Code)
3. OWNER: AJ yt�2h
Address / S
(Street or Route NoSil
rig41 , NC/ t> g
City or Town State Zip Code
Er-5(5- 6a _ a`'Dor
Area code- Phone number I
4. DATE DRILLED / —12 -0-3
5. TOTAL DEPTH: r 1S/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
'(check box) .
DEPTH, DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / g f 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 .011 a.
9. YIELD (gpm): 2 a METHOD OFTEST _h/WJJr
10. WATER ZONES (depth): /.CO , / 2 S a DO U
11. DISINFECTION: Type ti -%f4
12. CASING:
Depth
From 0 To 7
From
From
13. GROUT:
From n
From
14. SCREEN:
From
From
15. SAND/GRA
To
To
Depth
To •` fp Ft.
LOCATION SKETCH
Amount � %��i S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diaye�t�er or Wei t/Ft. Matey l 'numbers and common road names.
Ft. ' 1/gK QY�
Ft.
Ft.
Material
To Ft.
Depth Diameter
To Ft. in.
To Ft. in.
VEL-PACK:
Depth
From To
From To
16. REMARKS:
,Co}4stkuc"k'1
Ft.
Ft.
Method
etTYJO
Slot Size Material
in.
in.
Size Material
c
r-
I,
Y THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original Io the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
L ____27699-Ib36 Pha{ e No. 919) 733-3221, within 30 days. GW-1 RSV. 07/2001

267501
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Section / -
R'ELL CONTRACTOR (INDIVIDUAL) NAME (print) c I )•e f V) 1 51 I 1T12A t'�� CERTIFICATIONr,,//#//4 /7 (a
\v ELL CO\TRACTOR COMPANY NAM6/�t',I)fiS (- 116,r7 I ilein-1 Yei II 'U ). ti eJ PHONE #ii%iSL 524--3 a 60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED kV t ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Fd--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: !'/CANk h1-'/L'C County M C'i Cern
L D U.' P Y - 4-'ri.a.
(Street Name. Numbers, CommMtity, Subdivision, Lot No., Zip Code)
3. OWNER: , cr-"CL et, I'Q+E S
Address 1.�i ?Ili�nm: j— %�%✓�/L- g,�
(Street or Route No.)
NJ2C.11 p./lam ) 1-2/ C3_�2'2125
City or Town Stade Zip Code
(-0 — 9-e' 7
Area code- Phone number
4. DATE DRILLED I - 6 ' D 3 - ..
5. TOTAL DEPTH: ��OS
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Slra f<, ajitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m/---
7. STATIC WATER LEVEL Below Top of Casing: ,-) fl FT.
/ (Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / 5 METHOD OF TEST k7i%i7Ll-}-�
10. WATER ZONES (depth): %",•r (%
11. DISINFECTION: Type -/"i-/ Amount
LOCATION SKETCH
As Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Diameter oWleiFt. Material
From 0 To 4/_7Ft. n lY
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To �� FL___0O.71 071 flmtiC
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.
S E
CRC
two State Roads or County Roads. Include the road
numbers and common road names.
(
CEIFFFWV F4h4R'
STRUCTION STANDARDS
FEB - A 2003
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
U HAT A COPY OF THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER
�i%lk �Q )v -o 3
IGN • URE OF PERSON CONSTRUCTING THE WELL
DATE
SubftMipt a toht ionafWaterQuality,GroundwaterSection,1636MailSerieeCenter-Raleigh,NC
z ro99 t6s6G-nnune(94733-332s, ithin 30 days. GW-I REV. 07/2001

269172
14. SCREEN:
From
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur I Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print),,��pp / et -if -Pe- e- CERTIFICATION #�Ji/75
WELL CONTRACTOR COM PANT NAME c�/\ii7ft- C7YLU-� /�//I/ / �✓�, r (-. PHONE It 0545-�'YI22Z
STATE WELL CONSTRLCIION PER?IITN
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: nl11, i✓ County J4r,An/
Me w A1til1 lob- We j
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: f-ryCVR-+VLc<
Address f4e,34uwphIA/
(Street or Route No
5/73 V
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED )-/t'Q3
5. TOTAL DEPTH: tp 5 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ( METHOD OF TEST /
10. WATER ZONES (depth):
.)
%sire i
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshni notes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type
12. CASING:
Depth G Diameter
From (i To / /% Ft. (c c'
From To Ft.
From To Ft.
13. GROUT: Depth
Prom (i
Material
To o? 0 FL /40%17,/,._,/
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
Amount
Wall Thickness
or Weight/Ft. Material
Pit -
Method
oyt-,:v
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
b
W
n
O
4S
aeon -act oT \'1n�i
FEB 2 0 2003
Submit the original to he D
GGG int'r Y 9) 73
ASHEVILLE REGIONAL OFFICE
THIS X ELL),, VAS CANS- (11(TF /lN AC
, AND Ha#ItC-C@P $FTta R_COt J
SIGNATURE OF PE'IFSON CONSTRUC ,
ANCE WITH ISA NCAC 2C, WELL
EEN PROVIDED TO THE WELL OWNER
02- - a_3
E WELL DATE
%ision of Water Quality, Groundwatek Sect on, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. .. GW-1 REV. 07/2001

269173
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) RCM 60-4 ✓C. CERTIFICATION #Jb2)
WELLCONTRACTOR COMPANY NAME en?Stay �Pl/6/ifi; y�WC— PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER\IIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentiaL2 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare. t Town:h'fri
-I r`r±//ea) //3 ik
(Street i{Fame. Numbers, Community, Sub('ivision. Lot No., Zip Code)
3. OWNER: ke SflYYc{
Address /02/5 y-✓•hsto
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1)— 3- 03
5. TOTAL DEPTH: S;TS-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /5 METHOD OF TEST %l"Y
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6- ? 9 c%
79= .rs-s
I�jJa ,'+r
I I. DISINFECTION: Type Amount
12. CASING:
Depth From O To 21
Ft. b-I-r/
From To Ft.
From To Ft.
13. GROUT: Depth Material �j Method
From To")° FL (p."94ji?.riJ(i✓i%Uf
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From, To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
"tic —
Size Material
16.REMARKS:
D
O
County M4C-r J
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
tV
—a
O
Ql
NSIRLICTEb IN AC
f i IO TA D THA A COPY OOF THIS REECGRE 5
FEBI 2 O 2003 J SIGNATURE OF PERSONCONSTRUCT1'R'G
Submit the original to t le Div isioli of N ater Quality, Groundwater Sec
(r b c ThAltn BE WOO 9) 7333221 ..within' 31) days..
ASHEVILLE REGIONAL OFFICE
/1
DANCE WITH I SA NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
120
'THIS
DAR06 AN
HE WELL DATE
ion, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

269398
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N turai Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print)
. A/.t//C , 3 a1.. L.t�l1 CERTIFICATION 7/�7
WELL CONTRACTOR COMPANY NAME s s.r�aGuZdiGW IALLli2 4t PHONE # (,111 4 fl ISVs-a
STATE WELL CONSTRUCTION PERMIT#
//Al
(if applicable)
ASSOCIATED WQ PE
(if applicable)
1. WELL USE (Check Applicable Box): Residential Et Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearesj,Town: County &ilk-c.
&Ley*
(Street Name, Nytpbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Add_-ess
City or Town
or Route No.)
IV•C.
State
(fat- 3H9-3 //
Area code- Phone number
4. DATE DRILLED .2 ,2 y/,o 3
5. TOTAL DEPTH: /9T'
6. DOES WELL REPLACE EXISTING WET f v YES 0 NO Dd
7. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / a"- FT. Above Land Surface*
'Top of wing terminated at/or below land surface requires ■
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST -Cent.
10. WATER ZONES (depth): /D $ '
nysy
Zip Code
11. DISINFECTION: Type �Q/
12. CASING: V
Depth
From_Q_ To yD
From To
From To
13. GROUT: Depth
From 0 To o2D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
th
From Z To
From
16. REMARKS.
(1 r-E6NSTREIGFIDN
LJ 1'
Ft.
Ft.
Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley rat
(check appropriate box)
Latitude/longitude of well location
(degrecs/miautes/saconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Amount Z. 02-- Show direction and distance in miles from at least
Wall Thiclness two State Roads or County Roads. Inclutthe Mad
Diameter or Weight/Ft Ma na1 numbers and common road n rr es. - c. -_
Material Method
Ft. Cgsryy tie id
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Material
To Ft.
THIS WFT.1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRU
02
G THE WELL DATE
z
L Saamit theoriginaltolthe D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
7699,-1 6 ate h(ti: 9) 73. 3221,within 30 days. GW-1 REV. 07/2001
a� � _ _ 63 �4q �� y •

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CIb-h l71 SII /3( A CERTIFICATION.I!ot-n/74'
WELL CONTRACTOR COMPANY NAMEZ 4r)nt C j-IO'fn., “4 et }) Yr I I . ).YIP v PHONE tliigl/'4.7/e2 14-3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nea st Town: 1�.RJ»CLj A/ 4/county Ai (} (:rn>J
Ca r/LL`n (-II4,� P� Cet e
(Street Name. Northers, rComnfu(ny, Subdivision, Lot No., Zip Code)
3. OWNER: c / a,/ p e 2 (< ,/6/
Address 8,. &R[ (A- L /O
4
5
6
7
(Street or Route No.)
0411( l i0
try or Town State
spy— 0-94/0
Area code Phone number
a 73 9/
Zip Code
DATE DRILLED 6 — / —D 3
TOTAL DEPTH: '/.5 i)
DOES WELL REPLACE EXISTING WELL? YES ❑ NO I—
STATIC WATER LEVEL Below Top of Casing: c1 n 0 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): r b METHOD OF TEST / ibiY1,2
10. WATER ZONES (depth): - Rh' 0
269347
Tpographic/Land setting
tdge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
S C7.72r S riazc?
p e, /t t.a,n; /
DEPTH
From To
`r9• - C/,sh•
11. DISINFECTION: Type
12. CASING:
,r1 Depth �,
From V To c.5J Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r%7 Ft.
From To Ft.
LOCATION SKETCH
71"/-/ Amount c-2 %J /3 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Material numbers and common road names.
b" s-� R / P ��-
Material
0
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method 1
Slot Size Material
in.
in.
16. REMARKS:
cf. al De HEIREBir qt_ft
TRUQTIOitcs
�
M R 2 0 2603
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
kRDS, AND THAT A COPY OF THE5 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to tt e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROUt#S-034?dllIMNo. [phone], within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGih!r,L OFACE

269879
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na 1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JV�V� c �f�'�n L,�, , CERTIFICATION #N�Jhp%� p-�
WELL CONTRACTOR COMPANY NAME ,(!/LEGI' /-11/13S! 1.0.919, Jas), Lt! PHONE # � it y/'D9p ci
STATE WELL CONSTRUCTION PERMIT# �`TT ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
4//,
1. WELL USE (Check Applicable Box): Residential 04 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest To County 7i%Q./ er-(
�'5 41 ./�7.3 y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: W "9t-Q.d4 if ��
Address 9b 76
(Street or Route No.) U
City or Town State Zip Code
w-3«9-na77'
Area code- Phone number/ L ^ Q /D 3
4. DATE DRILLED �
5. TOTAL DEPTH: Sns
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO S
7. STATIC WATER LEVEL Below Top of Casing: //o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / T FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
valiance In accordance with 1SA NCAC 2C .0118.
9. YIELD(gpm)• S METHOD OFTEST7 as
10. WATER ZONES (depth): //Q
11. DISINFECTION: Type/l/1/L
12. CASING: ((//
Depth Diameter
From Jf% To.15 Ft. G -15
Y
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To IUD Ft.
From To Ft.
Amount /7 n'
Wa11 Thickness
or Weight/Ft. Material
#.-/ f'C
Matra _ ea od t
14. SCREEN: Depth Diameter Slot Size Material
From /To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
�o Ft.
/ To Ft.
From
From
16. REMARKS'
1 I DO HEREBY CERTIF -1 IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
[CONSTRUCTION STAND4,LND THA1 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
SIGNtURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divison of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919)-733-3 21, within 30 days. GW-1 REV. 07/2001
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
JACATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.

WELL CONSTRUCTION RECORD
D artm t f Environment and Na Resources - Division of Water Quality - Groundwater Section
U9877
North Carolina - ep en o ��
WELL CONTRACTOR (1ND1VIDUAL) NA Ih(print) D AI � An_ ACERTIFICATION
WELL CONTRACTOR COMPANY NAME�f L N f
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
letY.ed ielel/1[Y/i PHONE
wtai b« D 7Da
7 A ASSOCIATED WQ PERMIT
(if applicable)
I. WELL USE (Check Applicable Box): Residential (8. Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI �2z2 ,tir�/�/-uc
NeazesLTo County 7fr1sAM.r
c cJd ep473 y
(Street Name, tubers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(ee' or Route No.)
City or Town State ��
( - 397-
Area code- Phone number
4. DATE DRILLED ///S 'z 3
5. TOTAL DEPTH: a P) S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO at
7. STATIC WATER LEVEL Below Top of Casing: /S 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 .0I18.
9. YIELD (gpm): /C METHOD OF TEST%j2o
10. WATER ZONES (depth): 70 r / gO
,f o Z
11. DISINFECTION: Type i Amount � 'r
Wall Thickness
or Weight/Ft. ter aarl
sr-2 / fd
12. CASING:
Depth
From To .'�� Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To> 90 Ft. [fo..-xo-.Si/—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft. in. in.
From To Ft. in. in.
15. SAN /GRAVEL PACK:
Depth Size Material
From To Ft.
From To11Ft. � {�
16. REMARKS: (.tyeet—lppa /,-t4 �Qi (.4. G Li CVO
Zip Code
ameter
Topographic/Land setting
❑Ridge ❑Slope ❑Valley psFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at 1
two State Roads or County Roads. Include
numbers and common road names.
M od s
8I.LF
Home-
s rye.
NOUS <
I ADO HEREBY CERTIF+ ] T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA S, T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
071//4-4-:, 6 a.(.0 /,s/d S
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
O
Submit the original to the 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (91917)3-3221, within 30 days. GW-1 REV. 07/2001
c�
0

3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na I Resources - Division of Water Quality - Groundwater Section
�j//�/
WELL CONTRACTOR (INDIVIDUAL) NAM (print)``�((/ /14,f / G g A/lLl LCERTIFICATION magi / .
WELL CONTRACTOR COMPANY NAME jn2e .4.41Q.td LLJ€L, L8{f-sL�Ci..-� ZA.L— PHONE 0 4U - o9(0
STATE WELL CONSTRUCTION PERMIT*/
(if applicable)
4//4=
ASSOCIATED WQ PERMIT*/
(if applicable)
269876
1. WELL USE (Check Applicable Box): Residential ia Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest To •
i Countya-itf-f
/& �e/ as7ay
(Street Name, Numbers, Community, Su--'sion, Lot No., Zip Code)
J'V�J
yo9T -c�iP � a*7
(Sweet or Router Na.) ..,21)
City or Town State Zip Code
eat- -317-007?
Area code- Phone number
4. DATE DRILLED ///y/D 3
5. TOTAL DEPTH: —7 n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 181
7. STATIC WATER LEVEL Below Top of Casing: a T FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l s FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. A
9. YIELD (gpm): /.2 METHOD OF TEST, Lketiu.
10. WATER ZONES (depth): //�i t
11. DISINFECTION: Type Amount 3 �Z-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From�To.�J" Ft. 6y #.Z/ Par
From To Ft.
From To Ft.
13. GROUT: Depth MA aterial From 40 To ,3S Ft. fJ,.na��ry
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 Ft.
From To Ft.
•
r-- ++DOHEREBY"CE
CONSTRUCTION STAND
Me od •
Topographic/Land setting
❑Ridge pplope [Walley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
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.
�SIATURE O PERSON CCONSTRUCTING THE WELL D TE/9/�
NG
Submit the original to the pivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No: [phone], within 30 days. GW-1 REV. 07/2001
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t
Rd
sew)

Su ml{the original to the Division
274999.1636 Phone No. [phone],1rw1thl
270332
WELL CONSTRUCTION RECORD
North Caroiira -Department of Environment and )1Naliii Reaolteee$ • Division, of Water Quality • Goundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) Mitchell D. Cook cERT ITICAT1oN P 2043
WELL CONTRACTOR coM?A,NY NAME Redden Brothers WP11 DH 1 1 i ng, Tnr F`iV.1E 0 f829I'eFi9-0501
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITA
noolicable) (if acol!cable)
1, WELL USE. (Check Applicable Box): Residenllal Y M'micipal7?ubl!c 0 Industrial C Agdeultural ❑
Mcnitorini 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Us:
2. WELL LOCATION:
Nearest Town: Franklin
TP44PntpP
County Macon
(Stint Nsree, Nur..ben, Com-:.iiy, SchdPrskr Le; No., Zip Cade)
3. OW N R: Gary Pollack C/O Paul Newby
Address 5737 Svlva Rd
(S:rt or Row. Na)
Franklin NC '78714
Ciy or Town Sate Zip Cole
(87R)• 574-9172
Ada o e. Phone nur.kr
4. DATE DRILLFD a-i 2-03
5, TOTAL DEPTH: 225'
6: DOES WELL RE?LACE EXISTING WELL? YES 0 NO'
7. STATIC WATER LEVEL Below Top of Casing: 50 FT,
(the "." If Abcve Top of Cuisii;)
S. TO? OF CASING IS 2 FT, Above Land Surface,
'Top of cuing trmina:id a;'or b.1ow land surftc. r.qulru a
variance In accordance with ISA NCAC 2C .0113,
9, YIELD (gpn)i 6 METHOD O5T;ST hltw
10. WATERZONES(depth): SO'
1 I, DISINFECTION: Type HIM
12. CASING:
De-,, h Di —eter
iron. 0 To 67 Ft. 6�f
From To ' Ft.
From• • To Ft.
13, GROUT: Depth Material
From_ To 20 Ft.}'�nrnitP R _rant
From To Ft.
14. SCREEN: Depth Di'ant iter
From To rt_in.
• From To •FI.in
15. SAND/GRAVEL PACK:
Depth Siu . Ma;eria:
From " To Ft.
Arrc'unt 1E02
Wall Thickness
Topoaia;tilcz.azd sett:mg
❑Ridge ❑Slope ❑Vaiitey ❑Flat
(check appropr.a'l b:x)
r.derlongin de of well lccat cn
(Ley noin:notosisr.co.P-i)
La:!rde1,ongirude so•u ceCOPSCTopob,aphic nap
(chock box)
r)RIT T.TNG LOir
Formation Description
rlgy & Sri
grail to
DEPTH
From
To
0651
65' 225'
LOCATION SKETCH
Show direction and distance in miles from a: leas;
two State Roads or Ccuny Roads. Include the read
erhl.g,.£i Wit. Mattnal numbers and com:ncn road names,
Method
P 9'1
Slot Size Meter a: •
in
From To Ft
16. REMARKS:
in.
I cfrkif . SY CERTIFY.M. T. TYIS WELL WAS CONSTRUCTEED TN ACCORDANCE WIT]: 15A NCAC 2C, WELL
CONSTRUCTt ION' STA.\'DARDS, AV'tt T A CO?Y 0? THIS RECORD HAS BEEN PROVIDED TO T O YY1LL CWNER
'rt,Y," O. rGo7.6 -2.,//o2. /0 k
OF PERSON CONSTRUCTING T=? WELL DATE
er Quality, Groundwater Section, 1636 Mail Service Ce¢ter • Raleigh, NC
30 days, GW'•1 REV, 07/200i
w
rat
N
0
0
cn
0

270330
WELL CONSTRUCTION RECORD
North Carolina • Departnent of Enyironm:nt and Nabbrai R:Sowoes • DiviSlon Cf Water Qtality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook cERTrpICA T lON Or 2043
WELL CONTRACTOR COMPANY NAME Hedden Broilers Well Drl11 ng Tnr PiONE d /A28.11(9-0501
STATE WELL CONSTRUCTION PERMIT4 ASSOCIATED WQ PERMTT+
(if aoolicabie) (if arelicabie)
WELL USE (Check Applicable Box): Residential Ec Mw cipat/Public 0 industrial : Ag.n._Il:um! 0
Monitoring C Recovery 0 Heat Pump Waver Injection, 0 Other 0 If Other, List Us:
2. WELL LOCATION:
Nearest Town: Scaly Mtn
Thomas Knob Lot #28
County Macon
(5r..t NL.-Ie, Numben, Ccmr.. e, Le: No., Zlp Cade)
3. O W N R: Rick Iler
Add.-ess 937 Tanrlmark ('irria
(Stan: or Route No.)
Tierra Verrip FT. 1R71
Ciy cr Tow.^, State Zip Code
(727)- 865-1094
APIA ca'c Pbcne nar..ber
4. DATE DRILL°D 2-11-03
5. TOTAL DEPTH: 500'
6; DOES WELL RE?LACE EXISTING WELL? YES 0 NO elx
7, STATIC WATER LEVEL Below TcpofCasing: 400FT,
(Vn"." If Above Top o.fCuL,;)
8. TO? OF CASING IS 2 FT, Above Land Su^ace'
• 'Top of cuing terminand e:or bdow land surfer' ',quires e
ver'ente In eccc rdance with ISA NCAC 2C ,0I18. label9. YIELD (gpm)! 12 METHOD 02 TtzST
10, WATER ZONES (depth): 95' & 3RS'
Tcpog;aphic,? azd setting
❑Rdge ❑SIo;e ❑Valley ❑Flat
•
er;rop-a_ b:x)
....tirsde,cngi de of wen lcoa:ton
(dsp,:a:aloo:; s'f xcndi)
Latircdelongitude soW:_:CG?SCTopca,aphi..,
(c!roc'c bee)
DF?T4 ORILLTNG LOG
From To Formation Des;rinaon
0 72' clay & send
72' 500' csta=te
1 I. DISrN•FECTION: Type HIH Amount 1E¢
12. CASING: Wall TrScimess
D'e th t r,eter cr W1,g! etrt. Material
From. 0 To 70 R.. b PVC
From 70' To 74' Ft.......6" 188 steel
From, • To Ft.
13. GROUT: Depth Material • Me the a'
From. 0 To ?I) Pt.l "it-e R rF'r pry -1
Fro- To Ft.
14. SCREEN: DeptS Dt'a,:,eter
From To=t._in,
Front To Ft. in
15, SAND/GRAVEL PACK:
' Dee.`, Size . Maaerie
From " To
From - To
Slot Size Material
_ in.
Ft.
Ft
LOCATION SK'TC;
Show direction and distant:, in mils frcrr at leas:
r e State Roads or CctL-.w Read;, Include the road
tubers ar.d cor'.n cr, road' names.
16. REMAR:{S'
1 I-IERBBY-£HrR"Flz-7�
5EC T (QN STAN•D.A$LS, 1tIJ
s:G
Submit the original to the Divisloo of W
27699-1636 Phone No. [phone] with
WAS CONSTRUCTED TN ACCORDANCE WITH 16A NCAC 2C WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE =LL OWNER
�K L //3
E OF PERSON CONSTRUCTING Th7 W _? DATE
ater Quality, Groundwater Section, 1636 Mall Se:wi:e Center -Raleigh, NC
n 30 days. GWi REV, 07/2001
E.R.7
rV
0
0
U1
0

270329
WELL CONSTRUCTION RECORD
North Carolina • Department of Enyi:onrn'nt and Natural Resources • DiYls!on of Water Quality • Crroundw:ter Section
WILL CONTRACTOR (INDIVIDUAL) NAME (Print) Mitchell D. Cook CERTr CATION p 2043
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Dri 11 irg, Trr-• ?NONE s fp2R)WI-0501
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(ifabolicabie) (if so:lice:It)
I, WELL USE (Che:k Applicable Box): Residential E< Mwicipat�ruo!!c 0 Industrial ❑ Ag- ub:1ra! 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION;
Nearest Town: Highlands
350 Continental Thrive
Cowry Maron
(5ra' Ns-e, N:m en, Cer—u,ly, Subd!r,s!crr, Le: Na., Z;p Cade)
3 OWNER: Tim Green
Address PO Box 827
(Ssr.: cr Route No.)
Cashiers, NC 28717
City cr Town State Zia Cod:
(828). 743-2968
A. a ca'e• Pt:cc ncr;er
4 DATE DRILLED 2-4-03
5, TOTAL DEPTH: 850'
6: DOES WELL REPLACE EXISTING WELL? YES 0 NO hoc
7. STATIC WATER LEVEL Below Top of Casing: 800 FT.
(We "r" itAbove Top or CaiL;)
8, TO? OF CASING 1S 2 FT, Above Land Surface'
• 'Top a cacIng nralnted aver bdow land surface ri;u!rea a
variance In tacc rdance with SSA NCAC 2C .0113.
9. YIELD (rpm); .50 METHOD OF TEST 1
10. WATER ZONES (depth): 110'
11 DISINFECTION: Type HIH
12, CASING:
Dr,C;
Fro t To 61 F'
From Tc Ft.
From. • To Ft.
13. GROUT: Depth
From 0 To x)
From To
14. SCREEN: D r'tu'
From To
From To
15 SAND/GRAVEL PACK
Drth
From To Ft.
From Tc Ft.
Ano,mnt 16ce
Wall Thick -less
Da}—;e;er cr6 188gl steel
Material - Method
Fr,j-=rrit= R r 4- p:rr-1
Ft.
Diameter
et._i1
Ft, in
16. REMARKS.
Sic: Siu Magda: •
• in.
!n.
Slue . Matelot
Toporaphic/Land setting
❑Ridge ❑Sic; e ❑Vzley ❑Flat
(Check a,:�r:p.ria'.: box)
Ltatiradericnsirade of we!! lc:aticn
(denea'n!auus's :end:)
Lat!rade.locgiNde sou ce:GG?SOTcporaphic ma;
(c: eck box)
DE?Tii • ORILr TNG LOC,
From To Fo.rmaticn Description
0 59' clay & sad
59' 850' c aLite
LOCATIONSKR.TCH
Show direction and dis't,^,:e in miles from at least
two State Roads or Cc.nty Roads, Include the read
numbers a-d common road games,
iX) ti.W.By..e!RTire—MKa aAI
bNSS1 jk1C D(QN ISTA.'N'DArC5 Al
LL WAS CONSTRUCTED rY ACCORDANCE WITH 1SA NCAC OC, WELL
:ATACORYOFTHIS RECORDHAS3 NPROV;DEDTOTra WELL OWNER
S:C?Q,'a,;y121OFPERSON CONSflUCT NO THWELL DATE
•
ubmlt the original to the Divislo':n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
7699.3636 Phone No, (91,9) 733r334 wit!' In 30 days. 0W•1 REV, 07I2C01

270328
WELL CONSTRUCTION RECORD
Nor Caiolina • Departrnar', of Environment and Ntrzal R6so',INes • Division of Water Qeality • CToU:d7ft6r S6ot,oA
wtLL CONTRACTOR (1NDW1 DEAL) NAME (pr.n0 James B. Brown
CERTIFICATION e 2045
WELL CONTRACTOR COM?ANY NAME Redden Brothers Well Drilling, Inc. PHONE, s 8, l 369-9591
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT?(I f a:cticabi:) -
• (if anti:able)
1. WELL USE (Check Applicable Box) Residential 3 Municipal/Public ❑ Industrial ❑ Agri: 0
Monitoring 0 Recovery Cl Rea: Pump Water Injection 0 Other ❑ If Other, Lis: Us:
2. WELL LOCATION:
Nee:es:Town! Scaly Mtn County Marnn
265 Cougar Ridge Lane
(Spa: Name:, NumSrt+, Corn^':r.lry, S:`di'Yiis r. Lot No., Zip Ctt'e)
3. OWNER:• June Duke
Address 265 Cougar Ridge Lane
(Sre:: cr Route No.)
Scaly Mtn, NC 28775
city er Town State Zip Coda
($28•)• 526—C441
A. -ea ogle• Phone number
4. DATEDR.ILLFD 2-6-03
5. TOTAL DEPTH: 600'
6, DOES WELL REPLACE EXISTING WELL? YES O NO Ex
7. STATIC WATER LEVEL Below Tcp of Casing: 550' FT,
• (W e "r" If Above Top of CaaL„';
8. TO? OF CASINO IS 2 FT. Above Land Surface'
'Top of wing terminated tao; below land surface require, a
variance Ire accordance with 15.4 NCAC 3C ,0113, I
9, YIELD (gpm):._3.— h
METHOD OF TEST ..cur
10, WATER ZONES (depth): 495' & 510'
11, DISINFECTION: Type Fm
12. CASING:
O Depth 21 pc D;as�ter
From
From ' •Tc Ft
Frog: To Ft.
13, GROUT: Depth Material • Method
From 0 To 20 Ftlx„ldte & c.ateL psix.
From To Ft.
14. SCREEN: Depth Di a.:,ete; Slct Siu Ma:ena'
From To Ft. 'In. .
From, To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size , Matecal
From' To Ft.
From Tc Ft.
A.mowt 1 Ece
Wall TnIcktess
cr W }t'Ft Natea;
i4 steel
16, REMARKS:
1PSW¢Y E. TIFY^rrter"ra'•
GQNSTRU 5 AND AR )
ToporaphieLand seeing
❑P:dge ❑Slope ❑Va'!ey ❑Flat
b:x)
L a:irude.,ng imde of well location
(etc :I.C.I]'Jt . see-cr.J;
La:,.ude.1ongirude so_..-:❑GPS,Topographi: „_.
(deck box)
PEP -FP • pR!L LING LOG
From. • To Formation Descr,otior,
0 19' clay & r3
19' 600' granite
LOCATION SKCETC:'
Shbr ,re:tio n and istra:e in miles &-m at least
r ^ State Roads cr Count/ Roads. include the ;cad
numbers and common road names.
1\3
73.
0
U1
0
rr
5 WELL WAS CONSTRUCTED N ACCOR-DANCE V.1TH I:A NCAC 2C, RtLL
D rr_AT_A C0?Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LArJREOFPERSON CONSTRUCTING T:_Vitt
-6-0 3
DATE
Submdt the original to the pm (Ie of Water Quality, Groundwater Section, 1636 Mill Sen',:e Cetter - Raleigh, NC
;7699.1636 Phone No, (919) /33.32.1, within 30 days, GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
270703
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section / _
WELL CONTRACTOR (INDIVIDUAL) NAME �n (print) c7)Yl15 Al drA t�U CERTIFICATION If of Y'
WELL CONTRACTOR COMPANY NAM&IX.j)ntS (J6I0,,n,4 ).n P.i PHONE liO-V,�.Sa L/-3 g66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Id 1 icipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heal Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /<Q 4 add L; A1A4' County Al At
�RLsk C12."CrDim. r1Sc�/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: 1rT'itnias t-/-)SSoe• -Clio,
Address C.39(' (7a t2a P h ope! 12a
(Street or Route No.) �y
S;IVey Pr, 7-Al 3 0 5a--
City or Town State Zip Code
,F-se - 4/-(1171-a--
Area code- Phone number p
4. DATE DRILLED / `' ` —CI 3
5. TOTAL DEPTH: , 3_ C S`
6. DOES WELL REPLACE EXISTING WELL? YES El NO Qll�
7. STATIC WATER LEVEL Below Top of Casing: 4' 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 15A NCAC 2C.0118.
9. YIELD (gpm): METHOD OF TEST ./2/02 /i74
10. WATER ZONES (depth):- - /_� U
Topographic/Land setting
❑Ridge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.D
J
r-^
N
.
LOCATION SKETCH
11. DISINFECTION: Type if-14-// Amount ra T1)- Ai S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
From 0 To
Depth Diap etter or Wet ht/Ft. Mate,4 1 numbers and common road names.
9a. Ft. /o'- Y (�
From To Ft.
From To Ft.
GROUT: . Depth
From ( To Ft.
From To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
13
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material
0.9471 am
Q
Method
Y
)07420
16. REMARKS:
Ft.
Ft.
Size
Material
0
CJ
C_
p
CO
O
U1
C.)
s (a L
�a DEPHEREBY.CfRT �Y AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION''/ N1jARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
, ' SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to tt e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636.Phon-ebo. [phone], within 30 days. GW-1 RSV. 07/2001
c
cn
rn

WELL CONSTRUCTION RECORD
271143
North Carolina - Department of Environment and Natural Resources/�- Division of Water Quality - Groundwater Section
%VEIT. CONTRACTOR (INDIVIDUAL) NAME (print) VA Aa C l/4qy✓L y CERTIFICATION#t�2/
WELT. CONTRACTOR COMPANY NAME OMeat ere 9. ote//J21 }.>\/„ z}yc - PHONE #
STATE \\ERI, CONSTRUCTION PERMIT# ,ASSOCIATED WQ PERi\IIT#
Of applicable) (if applicable)
Ii 2Siti 9.9,‘
WELL USE (Check Applicable Box): Residential-B Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FAt /kf/./ County Li /J
SkPerVAh pre grc v k/:J Vc.
(Street Nance. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: siniti t1A/tt'/✓S
Address
I (Street or Route No.)
C `i\c/ 4J/J �n
City or Town State
• �� was
Zip Code
)-
Area code- Phone number
4. DATE DRILLED 02-c7 03
5. TOTAL DEPTH: r/ 6j
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: y� FT.
(Use "+" it -Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of rasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 75— METHOD OF TEST /lth
I0. WATER ZONES (depth):
11 DISINFECTION: Type
12. CASING:
Depth
From O To 17(.0 Ft.
From To Ft.
From To
13. GROUT: Depth
From O To 17 0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sizc
From
From To Ft.
Diameyter
Amount
Wall Thickness
or Weight/Ft. Material
ALA —
Material
Ft. (i_dniaidi
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
4 - 9Ciigetz
W
m
Method
Slot Sizc Material
in.
I It.
Material
LOCATION SKETCH
Show direction and distance in miles from eashS_
two State Roads or County Roads. Include-1-e ro [& Y
numbers and common road names. "--
O
J E
90 .' 1!d 'iZ aid CO
16. REMARKS:
Tj.;. C
�I�LjZLr/
FEB 2 0 2003
ubmit the original to the Nisi(
19
a 61 ATER SECTION
ASHEVILLE REGIONAL OFFICE
T THIS WELIEWA$ N D THIvr A QR_P__
NATURE? QF PERSON 'CONSTRUCTING jt
n of Water Quality, Groundwater Se Lion,
, within 30 days.
E WITH ISA NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
ELL DATE
636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001
0
r

WELL CONSTRUCTION RECORD
271142
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),/,///rt eratvi' WELL CONTRACTOR COMPANY NAME C r/9/✓! efe✓LY> Adel/ V er, /I yd, j(t'rc.
S"TATF; WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION p�li //
PFIONE # (X2X 5.27 -p -;'
WELL USE (Check Applicable Box): ResidentiaL.2' Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATII:
Town:rt Nearest Tow*U L/ id County %Y1 7 ect)
(Street Nance, Numbers °Conunun ity. Subdivision, Lot No., Zi Code)
3. OWNER: Njmes AStNA./
Address 1 t C4k 10rs/
(Street or Route No.)
)k/, ,Jt_ DS13y
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3-/ - 63
5. TOTAL DEPTH: JDS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: % is 8'6 FT.
(Use "-" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): P5 METHOD OF TEST ,rf
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitudes longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
From To Formation Description
/is- 'o5 ynn- r�
CD
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth c Diameter or Weight/Ft. Material
From O To 115 EL b
Front To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D ToO r) Ft.J' '4y, cJ( L v ., .4/7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH ._
Show direction and distance in miles from atFast
two State Roads or County Roads. Include
numbers and common road names. —^
90 :1 lld hZ 03d CO LO
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WkPL44 C S7R JQ]fEI�IN C�
AND !HATCOPY-GrTHISRECORP
sti Fibji3 th2 t{}igia7to t
27699-1636 Phone No. (91'
GR3U?JDI.*,.ATER SECTION
ASHE/ILLE REGIONAL OFFICE
WRE OF PERSON`CONSTRUCTIt
ion o AVatk Quality, Ground
221, v@ithin &O days.
NCE WITH I5A NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER
WELL DATE
ater ectio 1, 1636 Mail Service Center- Raleigh, NC
GW-I REV.07/2001

271375
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [.1)i nVll S'J I II0,-A Ai CERTIFICATION
WELL CONTRACTOR COMPANY NAM�IX,hn'ii (1)Ila„,,r4 ei IhYS�-)$) �II �'n ( PHONE# aa 14-3 cZ bG
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): ResidentialYnunicipal/Public ❑ Industrial ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: ,/ /��t
Nearest Town: nib /V C _ Ali County 'I 1.L L(5k.-3
CriU) e.er L a-fs' !? A (-t 4 I S
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
. / / 2h') ".�
3 OWNER: :r Y'/�VZfiIe(°E' �(' t
Address C),
(Street or Route N
// f 0In/151% / I I -
City or Town State Zip Code
q35,a2- r23 V-cabt2
Area code- Phone number
4. DATE DRILLED cil) _;,) 7- 03
5. TOTAL DEPTH: -:r) 1
D
Topographic/Land g2 4 2003
❑Ridge ❑Slope aLPr�r �Il�e DFlat
(check approprNG WRr t • OF i3(VIRONMENT
Latitude/longitude cAN@NAT:UR&RESOURCES
MOORESVILLEREEE ONA, OFFICE
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From T9 Formation Description
c.l a
r 1
4'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
VJ—
S n <�-za.c•—E.
Q._ (e-� L r _
7. STATIC WATER LEVEL Below Top of Casing: /e) - 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): JL S METHOD OF TEST ill/4 / C�
10. WATER ZONES (depth): ,/) / y
/1
LOCATION SKETCH
I 1 . DISINFECTION: Type H'i/-/ Amount r2 TA- S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 7n Ft. (7 n- _ fed/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To rkI FL ea-yt 6r
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
Material
O
CO
LJ
—O
IV
0)
0
16.REMARKS:
!f 1
rt
STRU TIQ S. F, 1 •O S,fAND HAT COPY OF TH S RE RECORD HAS BEEN PROVIDED TO THE WEHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL OWNER
3-7 - 0 3
APR 2 8 2003
Submit theorigi,aal teithe
1.17699-1636 Phone NV,(919) 73
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELLCONTRACTOR(INDIVIDUAL) NAME (print) c7)�nv115 'ITOI1(b-A �� CERTIFICATION #o2/7 Y'
w' ELL CONTRACTORCOMPANY NAM&IX.I))ji s fnoilay,r3 (I)PII>`-, ll'ltt/�j� ]-.ri P_z PHONE NA�1'It'—.6a y-3 L.26
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMITW
(if applicable) (if applicable)
271378
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: 12»41C"L; 4/A/C'_ County 44a(e L]
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: W; 11, OmVa
in Qm OY -ef2
Address 12 Sic / C'. lc S t
(Street 6r Route No.) f,7S y
City or Town State Zip Code
e216- 34,-9- n®iY
Area code- Phone number
4. DATE DRILLED 3 - C2 5 -6 3
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0/r-I
7. STATIC WATER LEVEL Below Top of Casing: .D O O FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118./�/'
9. YIELD (gpm): � METHOD OF TEST !/r7t-C-f--+
10. WATER ZONES (depth): 23C> (�D U ' (�
11. DISINFECTION: Type
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Novi 1
From 0 To yy Ft. /�? •` $-72g,� I f%Y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To .� Ft. cO,vyt 62r� ro-wv
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
AP
%f 1 -4 Amount
From To Ft.
From To Ft.
16 REMARKS:
Lopographic/Land setting
aiRge ❑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
a x4 s b,1_2_,_•
//iy4' (705 Rlitc. (r-'or„t-Q_
LOCATION SKETCH
f,9, S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
CO
=;
W
iV
0)
c
L_-" binit the ong(nai to
F. ', 27699=1636 Phone Ng. (yl
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
tRDS, AND THAT A COPY OF THIS RECORDEEN PROVIDED TO THE WELL OWNER
{I� 3- 5-0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # oZ J7 (P
2/699-1636:Phone No, (91-9)'ad
\VELL CONTRACTOR (INDIVIDUAL) NAME (print)< 1)-e flas/h) s�I II inn
cU n/ r
WELL CONTRACTOR COMPANY NAMIi gn'i s 'I118,pnJ IDJet 1��r l�:-u'( .).yl('.) PHONE �Li-3 gb'
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED NV ERMIT#
(if applicable) (if applicable)
270979
WELL USE (Check Applicable Box): Residential Yd�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION: qq
Nearest Town: (O//()/ / C:" • County /1"l Q Lit)
(2%,/idc k};» n�/�— 7)),,4 el re_ �r0.CCIM
(Street Name,>mbers, Cddtlnunity, Subdivision, Lot No., Zip Code)
3. OWNER: 7-hEreSC 1/CciCObzb
Address - V/ [/i, 01(1 r-/ ,Q; clop 2.d
(Street or Route Nd)
� !%) /2 c>7. g- 763
CI y or Town State Zip Code
« C' 9- iS( &
Area code- Phone number
4. DATE DRILLED ,_, —/ 7 -U 7
5. TOTAL DEPTH: "In 5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO �-
7. STATIC WATER LEVEL Below Top of Casing: < C 0 FT.
/ (Use "+" if Above Top of Casing)
/
8. TOP OF CASING IS FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordanz with 15A NCAC 2C .0118.
9. YIELD (gpm): 77) METHOD OF TEST iU1Urx-el—•
10- WATER ZONES (depth): /o20J /LfDj .770/ 370 it
Topographic/Land
setting
❑Ridge ❑Slope LtValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi nutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(!lay
lvirvy,rf'et_ ! r.1-
/0 5— S fed f•C7;
DEPTH
From To
0 / LU
/0 /�
/9
11. DISINFECTION: Type H f"/a
12. CASING:
From 0
From
From
13. GROUT:
From
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Amount
LOCATION SKETCH
4 T/} 5 Show direction and distance in miles from at least
Wall Thickness
Depth Diameter or Weight/Ft.
To /CS�Ft. (n" 5.Z2 1
To
To
Depth
To__ 1 Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Material
0Onyt its
two State Roads or County Roads. Include the road
Mpate/ical. numbers and common road names.
Method
po-wv
Size Material
Ft.
Ft.
tv
O
16. REMARKS: cJ
11100 HRE6'Y CERTIFY MATT
CONSTRUCTION STANDARDS
'0
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORDiJ( IHAS B�EEN PROVIDED TO THE WELL OWNER
l G L
az% — / 7 - c 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to thepivisin of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-I REV. 07/2001

2716:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ^(print) N�-e hhI SI Itj)QNS?.j CERTIFICATION # o2 /7(P
WELL CONTRACTOR COMPANY NAME/.t".I)n.iC ( I(n,✓rrI ()leia)yer 11 :ll cs„. j.V1 v PHONE #i(AS) __SoZ 4-3 a24 G
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ-PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential fl unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C lin AV'C County 71 1(i(ent_
LL)aitai et) mFvl,LU ) notew. Ru 2d
(Street Name. Numbers, Community, Subdivision, Lot No.,p Code)
3. OWNER: /'( [Y}i / .( 0 /z
Address ,Q `% 77)7/)l5J! i %t i)1-o
(Street or Route No.)
I I %o Cra. 6oty /
City or Town State Zip Code
MILD- 04S- L/7tts—
Area code- Phone number
4. DATE DRILLED 3 -3 % _o 3
5. TOTAL DEPTH: 7,00
Topographic/Land setting
Gge ❑Slope ❑Valley ❑Flat
0 HD (check appropriate box)
(/C- as 7E3 Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
S 4 "i rt 5 n -Q
v e Q rn / C. c t i '1 L-
1- c._
DEPTH
From To
/C5.
/b(n S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: -"/ O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / CP 7- METHOD OF TEST kZ/J;7e,C�-.
10. WATER ZONES (depth): (ES' (1
II. DISINFECTION: Type {f i"/% Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate al
From 0 To 023 Ft. b" S7)13_,2/ PV
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To rii) Ft. 004-p bat OAi_--)
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 5
TA-/3 S Show direction and distance in miles from tat Teas( _
two State Roads or County Roads. Include kie road'
numbers and common road names.
0
ut
J
16. REMARKS:
I DQQ (£lrRBY ¢!RTIFI�''H(4T I ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GON3Tm&CTION-STANDARDS; A HAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-3/ -3
SIOr4TURE OF PERSON CONSTRUCTING THE WELL DATE
I Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division11 of Water Quality - Groundwater Section // __
\YELL CONTRACTOR (INDIVIDUAL) NAME ^(print) c .e nos S I4-p'T'(�M d_, CERTIFICATION #/ot/7`to
\\'ELL CON'1'li.\CTOR COMPANY N'A!NK /X.hniC `C�lln./tri IIiP,tirll ij ITN �((t yi C' J PHONE #tf$) iJ o24-3 z�'J U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: To o ra hie Land setting
(� County �CU7Z DRidge i ❑Valle ❑
Near st Town: 1P g p
�� � � � �P Y Flat
e /v Ho .n-k k riro - (check appropriate box)
tree; ,1 h % k. - Latitude/longitude of well location
(Street Nerve, Numbers, Community, Subdivision, LoWu., Zip Code)
3. OWNER: vibr c. L Y' roy
Address /F.5'9n C / al Ie S () heir [ Ps
(Street
roueo o Route N .)
�,'i.Q41i it ?hi ti C..—
I I. DISINFECTION: Type
12. CASING:
Depth
From U To Pk)
From To
From To
13. GROUT: Depth
From fl To ri't7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
City or Town State Zip Code From To
r d 73 (1 DEPTH
)- r3h9 - /c/S)
Area code- Phone number ._,
4. DATE DRILLED s7 — i 2/ 3 ���,• (,,
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /CO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01(8.
9. YIELD(gpm): / 5 METHOD OF TEST k7//t7l,�
10. WATER ZONES (depth): U-R fa C' S /1 (�
} it i-/ Amount r� 7-4 SS
Wall Thickness
Dia eter or Weight/Ft. Mate al
Ft. ('" SaR,i,/ p�
Ft.
Ft.
Material
Ft.JOq-ti
Method
CD.(
Slot Size Material
in.
in.
Material
From To Ft.
271619
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Iet
f k ry -
Cz,Vi .1 S'Fry t O_
ICI lie h
Cc)
LOCATION SKETCH
Show direction and distance in miles from it least --_
two State Roads or County Roads. Include-4)e road
numbers and common road names.
0
Ct1
til
16. REMARKS:
r, I-D I{(ERE,3Y ciS RTIFY THAT Ti-�$ ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CQ4'StRUCTION STANDARDS,.» N THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3A-- c13
Or 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division o' Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], wiithin 30 days. GW-I REV. 07/2001

271618
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NA(print) S7).e ni� l S I I J(L \ (1_, CERTIFICATION V CERTIFICATION et /7 '
wELL CONTRACTOR COMPANY NAMK.I.C�nnl S'Cei)Q,vn4 Wei I t vri II yn e l PHONE t/i7 _Sa Li -3 a-6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 12----Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: graphic/Land setting
Nearest Town: %P4/1/4 L County 41
,4(gN_. ip'[� dge ❑Slope ❑Valley ❑Flat
/ilORv ( hh/#i/ frti G/4 (1 i citi lank IMP d (q (check appropriate box)
(Street Nan-tr./Numbers, Community, Subdivision, Lot Nisi, Zip Code) (7 �y -5 / Latitude/longitude of well location
d ! 1
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
3. OWNER: .77 C J (v 11 S E---
Address .Q Q.-9 y /4 ./ C-N 1- 4 42)C Kd_
(Street or Route No.)
73 V
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 21 - R
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W— "
7. STATIC WATER LEVEL Below Top of Casing: /(') (i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): -5-0 METHOD OF TEST /hEt1r _
variance in accordance with 15A NCAC 2C .0118.
10. WATER ZONES (depth): /'S 5) c-.) ,2DJ r C/Ti'
//11 LOCATION SKETCH
11. DISINFECTION: Type {f- 14 Amount 0.Th-{� S Show direction and distance in miles from ak Ieast=1:
DEPTH
From To
U /9-'
12. CASING:
Depth K/ Diameter or Weight/Ft. Mate al numbers and common road names.
From To ( f� FL (�" 512R rxi J Pet
DRILLING LOG
Formation Description
ScindS/ein�
13l Ct c , r22ir.'i 1-2
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
- n
From (3 To D Ft. l_0tm d7� pow
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.
L
()
Wall Thickness two State Roads or County Roads. Include [-file road
O
CJl
a 5
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 TH{S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Juk i�Q 3-03
r - S16NATF1 E 121 CONSTRUCTING THE WELL DATE
Submiti the original to, the Djvisionof Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], with1Pf30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECQRD
North Gandina - Department of Environment and
WELL (4N MOW FOR (1NDIVIDLA L) NAME (print)
WELL (pri t/sameCOMPANI NAME SGrrn
SFATE*ELL. CONSTRICTION PERMIT/I
(Ifapwlicahlc)
Natural Resources - Division of Water Quality
arcnn .port«.
f1 i :k, (J4 U , lar: l l
AFSUCIA'fED WQ PERM! IN
(if applicable)
272339
- Groundwater Section
CERTIFICAIION N_3 t
PRONE a {'7r1r) -1F2 - 3' PL
1. E USE. (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Rifni$L ituringCI Recovery ❑ Heat Pump Water Injection Other 0 If Other, List Use_ _..
ijrL LOCATION:
Inept Town:__._ _ F_1. U
lbenett
e.
Nano, Numbma, Community,
3. OV,aIIN F:11:_rl .'.--c< ..... R� %4J C L1 li i
AgreS5
0 ti_o ._A_-... (. • ,i K7 6 3
flay of rove
zip L ode.
ti._ neck Phone number - 4. DAA'E DRILLED ,t - 3 C' 3..._--
5. TO 'AL DEPTH p-EXIST
/ , c __- /
6. DOES WELL REPLACE -EXISTING WELL? YES ❑ NO of
7. ST$TIC WATER LEVEL Below Top of Casing: _ 0. FT.
(Use "I-" if Above' fop or Casing)
S. TOP OF CASING IS . l /1 FT. Above Land Surface'
+ er maim tennlaatcd attar below. land surface requires a
fr me la act rrdaAA((e 1w�iIb 15A NCAC 2C All&
9. YD (gpm):._Ui.1- -_ MIif!IQD pi, FEST,,�fr-�' -
0. WATER ZONES (depth):. I. _---
•
County aCO✓�
..___ /t'ILo± Hp
Subdivision, I cu No., Zip Code)
(Stmet or Route No.)
11. Di$1NFIiC11ON:Type-_-f T fr-f
12. CASING:
Depth Itiw�eter
From D To ? I Pt. ip
FriHn ._ 'To... I't.
Amountr/y Cup
Wall Thickness
or eight/Ft. Material
5IC-(P'7 NC
From To _-_Ft. _ 13. GROUT: Depth p Material Method
FrOm__Q...... Io..2-0 1t`
14, SC$CEEN; Depib I)iantcter Slol Size Material
Prom To
Ft
15, SAND/CiRAVELPACK:
Depth
Frpm .- __11t.
Ftbm _ . . To
Size Material
Topographic/Land setting
❑Ridge Slope ❑Valley Mat
(check appropriate box)
i.atitude.'lungitude of well location
- (degrccs/minules/seeondti)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH
From To
PR11.I,LNQ LOG
Formation Description
Ore -ye. t'R1 y
u ti+a..e of Ta /
•
LOCATION SK it
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
/✓c o
gfti
16, REMARKS:
1 DQH•cri;E�..�RLBY CERTLEY THAT ITIIS WELL WAS CONS (RUC TED IN ACCORDANCE WI I11 15A NCAC 2C, Wnl.l
CONS't;RII('HON STAly))ARDS, AND THAT A COPY OF THIS RECORD HAS BEGIN?RVVIDEO'I'O'TILE Wba_I.OWNER
'-` - NA'IUREOPPERSON CONSTRUCiINCiTHE WELL DATE
PStT�.a _
LeliON
��,L f cIICE t t
�hl IIII
of flt1ter cpuallly, 6/ro4k d 6fe Section, 1636 Mail Service Center - Raleigh, NC:
bithin 30 days. GW-I REV. 07:2001
L. _ - -- _
z SLkJetT I ONI+1t`(3f 11 M SIAMQ WUS W7 £t:oT 20-V0-21dt'

(depth):
(t )_---
A.r. rrlr. n,rnr ninnbct _�
.1 NAlli URILLI'U )
5.'INIAl,NIIIiII_-�y5-—�„tlVlal�l YES LI iJG L1
6. Ul)I1S \VIil.1, 10:11 ALE, E:i1311U•.• _I I.
1. S [Al IC \VATEI: LEVp.L I1eIo (Vie"riii °It(Abovleh: rnt ntConing)
8. l ltr Us CASINO INtt IS _ t.-b rion i
pY. Above I.nnd Sullhce'
•
• try ri nJnp ter n'Inded stir' I�rlon 1•'. tI rm 1•rr wining
.nl•nte In arty. Alai I5A NCAC IC 01111
Q. 1'IEI N (Hint )' --`7---61B1DOD UF'll•SI'it /
Ill. \Vol fill ZUNPS
__----
—�-- Show intention nod 1I191nItCC III IIIIIeS flow ni ca�
1 l
4AUI`;INFIICI-Il uwnbcls
12.
—I I'1.
from_
ill__
II.--- Method
I'rmn- bird iinl
13. UItUUf: Depth
11out_� tofL—
11 —
Ilom .—
-to- Slot Sire Mnklinl
Uimnelet
14, 5CP11:1J• Ncplh ill. lll.
I IOW l,._-
- I I il, __ In.
Iloin_ frt- tI.
15. SAtIlaillAVlil.l'ACK: hlnlctlnl
Depth Size
Lo___ 11.-
Ilnln ft.
dour 10
27233.7
11'1�LL (;UNS'I'ItUC'I'IUN
IU COi:1)
_ 1 ` CY1 , '\��,�— CER MICA uull p a0_44
tioilliCniulina - Ucpn Wield of Envlioioiictd niul Nnlutal Renuulccs - Division of Willer Qunlily - Urourldwider Section
rr ELL CON 1 RACIUlt NNIii c omr'IOUALIME h' \
n-EI,t. CON I IIACI tllt COPIrANY NAME
Asstrelnleuw•grennuLlf —_---
SfAIF,, reEli CONS IIWCiION fEIIfdIU_
fn1dWIv
if dinddc
Indushinl 1-.I nglicuhulnl U
icabic
1 ,� Ihcf c If Other, Llsl Use --�—
\PPLL LIS1: (Cheek Applicable Don): Ilcslti L'IIIIaI 1�/ hllltlll'llrnl/I'ulrlic
Montleiiug U Ilccoveiy LI herd I'uwp \Vnlct In)culion ❑ U
'Follown1 iiie,/ .onf1 netting
UIUdgc HSlopc I ]Vnllcy Ullnl
(clrrr4 nppngnl•le tin')
Lnllludc/lungilude of well lucnliun
(drpirrn/ndnnlr JcnnnriI')
Lniiliiilid,ngiludc SMIICV tllirl'Sl1I npogl nphic m.'ll
ck bent.;
I-JRILLIr!(1 1,0U
I'on notion Ucsuip1iun
2. WNen1 I login" Count
1� 9--0004%— —
rub! tlumV` —�.hv. 5n6Jivinlo. I.I llo., 7.II'C
(Cbrrl I1 nine, NuwM1n.• C� ^'"'"
J. n\.7111:n! Y1Q-- elfl\\C�th ASP
Add' CSS
(Surd of Poole tln.)
TLAY
R FL
Cqy nl J o..„ Smle
71r colt
Roil To
J,UCAI IUI1 51(10CII
it nd
mount _ rn9 Iwo SIn le Ilonds of County Rond9. Inc ut c }r, a�9
NV nli and common rand unntcs. o
CASINO: Uimudar of 1VcighVlL Mnlcnnl
Droll
/� 1n�_- fl. /
Imnt�t _
0
c1
—' in-:
n 7 I�6' Illllrhi �- NISLI.
Iti 1VIILII
'' I I- I PY MAT 11115 Writ WAS CONS I IIIICI Ir.0 RI ACCORDANCE WIl II I5A IICAC 2C,
( i DO CLALS INC' t IDAEDS,AIM111A1-ACU1'YUP1111511ECUI1UIIASBEENPRUVIUED1UTIIEWELLO
J CUIISIRUCIIU ail '__—S ---
i SIUNAIURI! Olt I'EIISUlI CONS 1RUC11NU'I IIE WELL
DM A
GhCr' iA, it
ASHwILLt rl�Gi, _. ( I, c uw-1 Ilev. ul)zonl
t is Wile IIIrI51nn nl 1\'nlrr I�unllly, CI Section, 1636 Mill Service Coder-IlnlelRla NC
1769n-1636 I'Iwne No. (919)1JJJ111, nllllin 3II tlny�•

272233
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\E1.1. CO.NTR.AC I OR (INDIVIDUAL) NAME (print) t, 4/P t' CERTIFICAJION LTC/7/
\YEI.L COST R.\CIOR CONIFAN\' NAME PHONE
STA'I E VVEI.I. CONSTRUCTION I'ERNIIT#
lif applicable)
ASSOCIATED \\'Q PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential,! Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IF Other, List Use
VVEI.I. LOCAT N:
NearestTown: fq4 kith/5- County .49_,),✓
�/1 // 1�A1i%lu s,rr ,4 4 d l yue
(Street Nat ie. Numbers, Community) Subdiv isio6, Lot No.. Zip Code)
3. OWNER
a1P
AddressCsrtr,ty S'Yu 'f+J;nti
(Street or`ltoute No.)
36 (0,26
City or )I me n Stale
Zip Code
Area code- Phone number
4. DATE DRILLED ala-03
5. TOTAL DEPTH: 05-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: e FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top aeasing terminated at/or below land surface requires a
variance ill accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): (1.7 METHOD OF TEST r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate boN)
Latitude/longitude of well location
(degreeslntinutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(check hox)
DEPTH DRILLING LOG
From To Formation Description
0 - ? j (_t ilf
3 5- -
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diamalcr or AVcight/Ft. Material
From { _ To 3 5 FL (-) c- /3 ✓ 4.—
From To Et.
From Tn Ft.
13. (_TROUT: Depth .Material Niethod
From Z� To `). c. Ft. (1 iYl<', I I„ ✓t---�
From To Ft. i
14. SCREEN: Depth Diameter Slot Size Material
From To Fl. in. in.
Front To Ft. in. in.
15. SAND/GRAVEI. PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rohc!
numbers and common road names. 9
16. RENLARKS:
HAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origin II to t ie Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GRO(jG:417ft$`I',)WC41C 164)1?No. (91 ) 733-3221, within 31) days. GW-I REV. 07/2001
ASH/LE rEG OrHOE

I
L. L.
272232
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
vv ELL CON 1RAC FOR (LVmYIDEAL) NA)u/E P/"Ll/l✓ (print) „•, �CERTIFICATION�[��//7�pu"��jd/9
w El1. CO_N IR-ACTOR COM PANT NAME ` irkrie 3 Lee V��,:NI J4G. PHONE # 6/i(pl /� �
STATE WELL CONSTRUCTION PERMUTE ASSOCIATED \YQ I'ER\IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 I FOther, List Use
2. WELL. LOCATIWTopographic/Land setting
Nearest Town: t7+it1flidell5 ❑Ridge OSlope DValley ❑Flat
�Lick' e-vfeetk (check appropriatehox)
Latitude/longitude of well location
3. OWNER. .\+r ill PG4(Ddt- (degreesMinutes:seconds)
Address C' C fj tW / r� / Latitude/longitude source:❑GPS❑Topographic map
/(Street or Route No.) (check box)
1- . S 12//A"N-LY 7r% L_ <�) 47y1 DEPTH DRILLING LOG
of or 'Ion II Smr Zip Code From To Formation Description
( )-
Arai rode- ('hone nunther L2 - h / (7/,4 .
4. DATE DRILLED a" Qai "a3 6'‘" , R 30 �y,ghtr
,
5. TOTAL DEPTH:?--7t /
6. DOES WELL REPLACE EXISTING WELL? YES 0 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*
*'I'op of easing terniina fed at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 72 u METHOD OF TEST LYC4✓G"
10. WATER ZONES (depth):
County MAW JQ)
(Street Name. Number, Conmtunilt Subdisision, Lot No.. Zip Code)
LOCATION SKETCH pp
11. DISINFECTION: Type Amount Show direction and distance in miles from aCleast
12. CASING: Wall Thickness two State Roads or County Roads. Include trroad
Depth Diameter or Weight/Ft. Material numbers and common road names. �7
Front L) To G7V Ft. 4.' /n;,C. —
From To Ft. Y "-
From To Ft.
13. GROUT: Depth Material Method
From O To 90 Ft_ L/49,a7( �1r:I1V'/eei
From To Ft. Jl
14. SCREEN: Depth Diameter Slot Size Material
From To It. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O.HEII)EBV' CEIt I FY ThfATf t\S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
NS'TILJ`Z-I1f3N `3T 4ND�2�D, tIt� D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rs)l I
i; 1et-i- ["i`Z i
dI"
Sulnnit the original to the D visit)!
27699+1306. R ltintie tN'16i(11441433-1221
AFJEF II 1 c:-'rlor
3
'ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
within 30 days. G W-1 REV. 07/2001

2'72197
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural%�Resources - DivisionlIof Water Quality - Groundwater Section
\TELL CONTRACTOR (INDIVIDUAL) NAME}��(print) CIJ'e hi7151I /In ji ann rlv CERTIFICATrI/ON1 d/7(P
\\' ELL CONTRACTOR COMPANYNAMKIX.hn'i C 'CO!InNtd II)ei Irllfr, lla/d _�,YL P J PHONE gi/i%-X1 ,-SC2Q L24 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITW
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential El--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: / (q
Nearest Town: r /z�'/�k �-t /U L' - County M a LIYC%
L-9/i/4 r2 e pit rl �� /!-• 02 k 73 (
(Street Name. Numbers, Community, Subdivision, Lot o., Zip Code)
3 OWNER: f-1
Address a7l5'7 (firntr)cx.y rcJC
(Street or Route No.)
b rla,fla,-) R I 3aD9 _(0?-0/
City or Town State Zip Code
F - 3 69- 9tol3
Area code- Phone number
4. DATE DRILLED - -7 -D3
5. TOTAL DEPTH: SO.S-I
6. DOES WELL REPLACE EXISTING WELL? YES
0 NO
7. STATIC WATER LEVEL Below Top of Casing: /SO FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /�)/
9. YIELD (gpm): .;� METHOD OF TEST h `/!//7t
10. WATER ZONES (depth): c- C1.S / <A7[i
11. DISINFECTION: Type
12. CASING.
Depth
From 0 To ._.5-0 Ft.
From To Ft.
From To Ft.
Topographic/Land setting
DRidge EISrpe ❑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
C'IculJ.t
.S'Z?nnKC %hi.P�
VPo1,,,r.r/; t-e
3fto (7-• 'et t z
DEPTH
From To
!I'
It
' .0 co
LOCATION SKETCH
Amount ,-3 T,4 A S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Material numbers and common road names.
" saR /
13. GROUT: Depth Material Method
From t i To r Ft. Co4yyr dr CriVv
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.
!b.REMARKS:
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND T�TACOPY FTH'S�CORDHgSBEEN PROVIDED TO�EWELL OWNER
IA AY - / 2003
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-I REV. 07/2001
/ L OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL COS'fIL\CfOli (INDIVIDUAL) ,\:\\I E�� (print) Lip (/ �/'fi /lid'. CERTIFICATION��'
# �/"/
WELL COY! RACTOR COMPANY S:AMEL,//Orkie ditc /L// / N'— PHONE
STATE VA ELI, CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMITCONSTRUCTION
(if applicable) (if applicable)
272231
I. WELL, LSE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump AVater Injection ❑ Other ❑ II Other, List Use
2. WELL LOCATi - t:
Nearest Town: r/,�/,4 / County P})/-)e:�
.k COPe—— 6utru ./yq(-7)CU/v
(Street Name. Numbers. Community, Slfadiusiolt, Lot No.. Zip Code)
3. OAVNEI{J-2 // 11 c//
Address �, i�A R/ , pn/�C• (`�
(Street or Route No.)
CD n(I35
City or Tosco State Zip Code
Area code- Phone number
d. DATE DRILLED /'„'1 -
5. TOTAL DEPTH: yn
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: c 'L) FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): /0 METHOD OF TEST 4/r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑ fopoeraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(-)✓-t
I I. DISINFECTION: Type Amount
12. CASING: Wall "Thickness
Depth D/ia�nyter or Weight/Ft. Material
From 7% l o /0 Ft. !O r/
From To Ft.
From To Et.
13. GROUT: DepthMaterial Nlethod
From O To . 2 (Li FL 0ely/.-,(1 l/P' 1,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK'.
Depth Size Material
1-t'oni To Fl.
From To Et.
16. RFAIARKS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common roar! names.
O
0)
I DO 4REBY CLR'j LJ'N tjI'PA. r TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
L f ttl� TJ/k10{-46?1-ST4]'IOA; S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
" 1I SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
C II^it trritp� he+tp-the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NC
AS:
G FjhE9tiL)A}-461y16Atc 'p 109) 73'� 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 Sectionio
(h*aa' ( 1-tbe CERTIFICATION #. )j✓ /3
WELL CON -I R .NCI OR (INDIVIDUAL) NAME (print)
\AEI.L CONT IL\CI Olt COMI'ANV NAME 1.
272230
t'k/de
✓ rc Lc)r/1 s�rriA/'u.'a, flt PHONE # .z 1 -5%52c
STATE WELL CONS"' RUCTION PERMIT# ASSOCIATED WQ PERMIT#
Of applicable) (if applicable)
1.
2
WELL USE (Check Applicable Box): Residential. Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: FAk/, nJ County %f%,QC-dty
�11.3Ay �C%�✓
(Street Name. Numbers. Community.
Subdivision, Lot No.. Zip Code)
3. OWNER:(;-U:r) tkipt. uAi
Address '7L t 0e I1.1/ r'.d
(Street or Route No.)
bra,)ri;y N( .3S J.3y
City or 'tau n State Zip Code
( )-
Arca code- Phone number
4. DATE DRILLED /-w-ui
5. TOTAL DEPTH: ?L
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /ft) FT.
(Use `+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface*
'Tun of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 i METHOD OF TEST At r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude so urcc:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
!i't' /`y
/47
/vy- at 5'
11. DISINFECTION: Typo
12. CASING:
Depth
From (_) To J'u t' Ft.
From To Ft,
Front To Ft.
13. GROUT:: Depth
Front - To ;lc; Ft.
Diameter
v
Amount
Wall Thickness
or AA'eiehLFt. Material
Material
nintif
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
lL L;CJ n-'y
Slot Sizc Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
Co
v
r�.
0
4)
1<[}O HEREBY, t CIF
4N ST-At
cphis,Itthe o.. ..
ASHLVH_#l'[''�1"o(f'I,t�'fI
) the
l )19)7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS 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 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
272228
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\VELLCONTI(ACfOR(I (INDIVIDUAL) NAME (print) /i /i/Z' ('fall/ CER'f1EICATION#3Z>%/
VAELL CONTI(\ CT OR COMPANY N:A)IE(?Ypjle er-tS Lc)e'L/ �r//'n IA1t_ PRONE #(Zf✓Ci'].c.649%V4
Sl I E \ IAA. CONSTRUCTION I'E It\I I'f# ASSOCIATED WQ PER\I IT#
( ifepplicable)
(if applicable)
I. WELL LSE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial ❑ Agricultural 0
tNlonitoring ❑ Recovery ❑ Heat Punip Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIcibila
Nearest Townes rAnid n/ County ✓)14e.iN
61N (CN�j '9d %f/' ✓ ,[fir.
(Street Name. Numher, Community, Subbditision, Lot No., Zip Code)
3. OWNER: Rt.> /hq/wn) 1
Address SHIN 1r u5 i e 'QnC
(Sieer or Route No.)
F��LOki tit A) 4_ 3(0AV
City or Town State
( 1-
Zip Code
Area wde- Plwne num'mcr
4. DATE DRILLED �'I2-0-3
5. TOTAL DEPTH: 1/5-5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /Z 0 FT.
(Use `+" i f Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`lop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):;i1b 4-ii 2SMETHOD OF TESTA -,AI,
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deerees'minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o �Y
�y- yS3-
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From l7 To nFt. 11)-y
From To Ft.
Front To Et.
13. GROUT: Depth MaterialA Method
From 0to : ei Et. PP/Vf.-nT .)L' 6Z�,:v-i
From To _ FL ✓
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. in.
From To Ft. in. in.
15. SAND/GRAVEL. PACK:
Depth Size Material
From To Ft.
From To Et.
LOCATION SKETCH
Amount Show direction and distance in miles from
Wall Thickness two State Roads or County Roads. Include
or Weight/Et. Material numbers and common road names.
1lC
easl_9
road: _.
.7-70
rl
-22
16. REMARKS:
d071143E11' 4;l(TIt
iUtqS11Or ION S'rt8
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI 115A NCAC 2C, WELL
AND TIIAT A COPY OF THIS RECORD flAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
c Submit the original toll the 1 'vision of Water Quality, Groundwater Section, 1636 Nlail Sell ice Center - Raleigh, NC
27699_I616 I htiRSlVdMq(919) 7 3 3"21, within 30 days, GW-I REV. 07/2001

27222'7
WELL COST RA CI OIt COM PANS N.A IE6/7/214 er05 L /j „2»c
STA'I t: AAELL CONSTRUCTION PERVIIT8 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat iral Resources - Division of Water Quality - Groundwater Section
VA ELL CONTRACTOR (INDIVIDUAL) NAME (print r 2c/�%�
�� �//i/7 Fi CERTIPICpAT7I�O�VW // ////
PHONE f ,tid{.il,% 7, 7��6
I. 'A'ELL, USE (Check Applicable Box): Residential ) MunicipaVPublic D Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery ❑ Heat Pump AVater Injection ❑ Other ❑ 11' Other, List Use
2. AVELL LOCATION:
Nearest Town: F(/11)k/ 4 )
Cl1kvkr C-Alivel.p.J,
(Stag( ,Name, Numhers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER& iel. 'i7,l1stetc
Address y c/.wk5 (%1 v/
(Street or Route No.)
Frei•t1/i1) C-73/
City or Teem State
County /!!/Q!'ai4
Zip Code
)-
Arca code- Phone number
4. DATE DRILLED 03
5, TOTAL DEPTH: %D,�'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use'-+" if Above Top of Casing)
8, TOP OF CASING IS / FT. Above Land Surface*
-cog of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2-U 3 u METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreestntinu tesfseconds)
Latitude/longitude source:❑GPS ❑Topograph is map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- yoh
(1/47),
�/,19iCc.
11. DISINFECTION: "type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Materi
From f) To Ft. v p U!,
From To Ft.
Frunt To Ft.
13. GROUT : Depth Material
From 12 To ,z c Ft. 084921.
From To
14. SCREEN: Depth
From To
From To
Ft
Diameter Slot Size Material
Ftinin.
in. in.
Method
15- SAND/GRAVEL PACK:
Depth Size Material
From To Fr,
From To Ft.
LOCATION SKETCH oo
Show direction and distance in tniles from ;last
two State Roads or County Roads. Include t roadt
numbers and common road names.
16. RENIARKS:
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
/0`_ 17 - 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L__Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
"'276994636 F IOOON° [phone], Within 30 days. GW-I REV. 07/2001
'nL UFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalNaResources - Division of Water Quality - Groundwater Section
VVEI.I. CONTRACTOR (INDIVIDUAL) NAME (print) /1. (jta4i (iA ✓ CERTIFICATION#:30%-9
# Ld' S �e,
WELL C(l N'IR:\C"1012 CO?II'AN'1' NAME Cp/�t/1r/t' �1'�'.���� ��� ��/4 PHOPHONE��,t1Y y�.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED AVQ PERMIT#
1 if applicable)
(if applicable)
272226
1. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: tithAtNcj
(`eve k.
County T/4(c A)
(Street Name. Numbers. Community, Subdicislon, Lot No., Zip Code)
3. OWNER:VAthni nkuVricW
Address \ O. TeX a / 95
(Street or Route No.)
,sirs Nc it? VI
CIState Zip Code
)-
Area code- Phone number
4. DATE DRILLED ,3-3-0 3
5. TOTAL DEPTH: vs -s-
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: lib FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm). / 5 METHOD OF TEST,4/r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D - at,
11. DISINFECTION. Type Amount
12. CASING: Wall Thickness
Depth
From (] To 3 0 Ft.
From To Ft.
From T o
Diameter or AA'eight/Ft. Material
G-Y
13. GROUT: Depth Material i Method
From (.) fo `) V Et. ZTeo/<. -i vi R-�
From To Ft. �'a
14_ SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.
From To Et. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material
From "To Pt.
From lb Ft.
LOCATION SKETCH
Show direction and distance in miles fromRIeasL
two State Roads or County Roads. Include:iliac toad-,-
numbers and common road names. ' `
O
d7
16. REMARKS:
�hNCTRLCTFON Sit.
J
'^. � SIGNATURE OF PERSON CONSTRUCTING THE WELL
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIME WELL OWNER
A/
DATE
—Su.hmillflC_ori_inal to tht Division of Water Quality, Groundwater Section, 1636 Mail Seimice Center- Raleigh, NC
c.,i_ 27�i9,,9'16�Yr�f16idON°. [phone], within 30 (la)'s. GW-1 REV. 07/2001
= 'AL CEFICE

WELL CONSTRUCTION RECORD 272225
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section VVEL1.CONTRACTOR (INDIVIDUAL) N AAlE� -((print) '/et/ ej,tie_ CERTIFICATIONOj#�6.07//
\\ ELL CONTIL CIOR COMPANY NAME entlic dr-wh f'r•t ./I `l )ri/LN9, rite PHONE # fr%p(p .Sc?Y'0776,
STATE \VLLI. CONSTIiL C'rl O.\ I'E Ri\IIT# ASSOCIATED WQ PER\Irr#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nloniloring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2- WELL. LOCATION' �11
rpni ktri Count,in.
Nearest Town:
4g/ 5-
(Street Name.
Nti
3. OWNER: R•
nbers. Community, Subdivision, Lot No., Zip Code)
chvd f-lyytt
Address 5? J,serkti, 3 3/
(Street or Route No.)
O b Id L t-O 767 j
Cite or Town Stale
Area cock- Phone number
4. DATE DRILLED 0
5. TOTAL DEPTH: r`4:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: //0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /.) METHOD OF TEST ,4 /
ID. WATER ZONES (depth):
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.
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c - e1Ay
- `/05-pleiN,tc-
II
12
13
14
15
DISINFECTION: Type Amount
CASING: Wall Thickness
Depth _ Di. meter or Weight/Ft. Material
From G% To 5 Co FL W? pi:ce,
From To Ft.
From To Ft.
GROUT: Depth
From (..) To
From To
SCREEN: Depth Diameter Slot Size
From To Ft. in. in
FRII[t To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material Method
FL
Material
0
O]
ID. REMARKS.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
C
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Subunit the or ioiinal jo the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163)5 1 hwiu)b. (919) t33-3221, within 30 days. GW 1 RLV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
\VELLCONTRACTOR (INDIVIDUAL)NAME (print) <7)-e111)v11 S Ry)
WELL CONTRACTOR COMPANY NAM
STATE \VELL CONSTRUCTION PERMIT# ASSOCIATED NV
(if applicable)
272094
Division of Water Quality - Groundwater Section
Hum um Ad CERTIFICATION # 4 /7 ee
�hehnl e !I(1 r� �1�21 � �'i 11734 4 j d) P J PHONE # .. SSo2 t/-3 2 , lJ
ERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential L3- 1- icipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION: '/G �1
Nearest Town: ©h)U County 4 Q (0o2,a
.SIe/r%rl'h2.ci—%vPzS;dl_ f��- S
Street Names Nui hers, Community,S�ubdivision, Lot No., Zip Code)
/
3. OWNER: Ch 1`r ' C�00
Address LQ ( Pa /YI F / 2 Ve
(Street or Route No.)
City or Town State
,/�-J-�-t-snr� 7 (f / - n2 In 9 J
Area code- Phone number
4. DATE DRILLED �i / S -Z
5 TOTAL DEPTH: %bs
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ft) FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. //
9. YIELD (gpm): /0 METHOD OF TEST / 1U7/J17UC,�-.
10 WATER ZONES (depth): �/'n 7.2 — (�
<33 '7 %,j—
TopSgraphic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
O U
20 1t3
/r3 ,f'7
Zip Code
I I . DISINFECTION: Type /f f%/ Amount .--2 TA- A S
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Mated al
From 0 To_17 Ft. /n " $,j)R ,,7i Pete --
From To Ft.
From To Ft.
13. GROUT: Depth Material
n
From Too�(? Ft. CP�?t0-r ‘32+
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.
!6. REMARKS:
(./
j/-f e m i (") c
LOCATION SKETCH
SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
23
:NJ
I'J
riv HOE Y C,61R*YF
j) ILL Cc'STRV SIENO
,t
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT
yA COPY OF TTH+S, RECORD H S BEEN PROVIDED TO THE WELL OWNER
HA
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-2`76994636 Rho6c No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division) of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) VI/LnosS 1-�-o/ln„'\r�� CERTIFICATION# it/740
Ili1c S lC�1la,ylri I1)Pl l �l rt l l u q_ .} n e PHONE 4niduca t —3 alb
0
ERMITq
WELL CONTRACTOR COMPANY NAM
S'fATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED NV
(if applicable) (if applicable)
272093
1. WELL USE (Check Applicable Box): Residential f---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Pic /l'4kb Al C- County .M a COIL,'
kr`eykirm// �» (' lRckt C he.pe.i CLh,ar,. 4 (-t S
��3n�Street Name. Numb s. Community, Subdivision, Lot o., Zip Code) S7 g 7 ( l
fRy�,RD)
OWNER:__.K%'Fi-cl 4;
Address :3 y 7‘t',q, ,
(Stre t or Rowe No.)
F—�hOtikl,kJ Ale -
City or Town State
3L" .('gvo
Area code- Phone number
4. DATE DRILLED 4_ / L/ —L1'75
5. TOTAL DEPTH: QTi C'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /nor FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing Terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. //
9. YIELD (gpm): /C METHOD OFTEST�/klbr- -
10. WATER ZONES (depth): 9 7-5' a— 4.7 o -
I I. DISINFECTION: Type
.. T3 V
Zip Code
Amount r2 %A / S
12. CASING: Wall Thickness
Depth
From 0 To i4 / Ft.
From To Ft.
Fro RI To Ft.
13. GROUT: Depth
From O To ri(7
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
Dia eter or Weight/Ft. Mate ial
/7" s� R / P �C,
Material Method
Ft. COAX 4 1 potiJ
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley Irk
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
5 /2"
G/(2/
Sum 7/nn e'--
I/p0Q'),(/, 1,1-7c
P3/UP ft-R'a.-nr-I-.7-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
16. REMARKS:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF /
THIS, RECORD HAS BEEN PROVIDED TO THE WELL OWNER
It.
n J`� `T/—Lr
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the:Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
17,640-1636-Phvrrc_No VI9r`/33-32 1, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2720a ;
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ND-ef) V)1 S JTn /)O-A rt. CERTIFICATION #cal/74a
w' ELL CONTRACTOR COMPANYNAMK 1)ninDilyr �.f)2��al�lr t(:1t .f �1'F C J PHONE Nin)/.S.Z24 —3 oZb U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q i iT icipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: "� �1
Nearest Town: Fie /fi2'l< l-1 /U County A' t a LQIYI__>
0rbee(aC ekLri—.4n 'a it* s 2A !sk-LoJ
(Street Name. Nuum�bers./Community, Subdivision,, Lot No., Zip Code) p 1 3
3. OWNER: /.. 0F) e v� £ 2) VI d DD /J" (degrees/minutes/seconds)
Address 9/8" (n 7)-)1t i.('f T /D/2_ Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
Z- C k f /R-Kid p I 3 3 gi 0 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
et-)- Co w—g'35Cf l) r>20" < /�zr
Area code- Phone number
4. DATE DRILLED 4/—/7-6_3
5. TOTAL DEPTH: —'-CJ S
Topographic/ and setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
9
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: et)* FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): -3 METHOD OF TEST
10. WATER ZONES (depth): 50/ 1(
11. DISINFECTION: Type 11
12. CASING:
From
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r= Ft.
Amount
Wall Thickness
Depth Diameter or Weight/Ft.
To Ft. tn.'
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size
Ft.
Ft.
Material
C0A71 07T
Ft.
Slot Size Material
in.
in.
LOCATION SKETCH
,J S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
Method 1
Material
16.REMARKS:
HERE C�Rt t7Y THAT a S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ST JCTION, STAND4JRDSWND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0&(./ -ee 7 —0 3
SIB NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divisitn of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

•D''s:.,..'�'r'd�2.'�!2 t` •C.;�,r;;',_�t'5'...'_',
� ,Cft 's97 NECa:. �:3vr., S I
WELL CONTRAC70R (iOXF, D P791`
WELL CC.NT:21CTCR CC1:PA.ti: N'A.`1z
.t:�C:2^^. E'cOu^.2•-S ;Cell Drill Inc. ?4.^. ti'"a a
369-9591
STATZ V-ELL CONSTRUCT:CS PzA+.:TY
(',Ia;cli:a7.el
C^ )' e$Lderlla: ;^ ,C l�al
WELL USE e: v rla3biC BOXY. R �;,0 ,,. ...
Watt: fa 0;.... _ is 0 , Lis: Ur
Monitoring R:covery O Heat ,•_.
`2 To O. tph o....aazc S:..:g
ge .. .
alsy
Latin:de , nii ...de ,.. s•. e.. .....
2. WELL LOCATION:
Nearest To' ErS1-in
Eli'ay to Henry Rd
($redNs-,<.�.'l.r:::n. Ca,r,:.tltlry,StlbG 4i:: r_L. ;v_,•Z.; Cxe.
3. r" F Jack & Kathleen Kramer
Macon
AS$CCIATZC `,7Q?ER4;
;:i a:cliv.'o a
Address 1809 Mac -Alice Drive
($t,i or<Z:CI<74r
Knoxville TN 37918
^•.r• rr T✓+,, s.,, ZI; Ccd<
( 85• 687-3448
Ane Cade, P.:n<r.
4. DATE DRILLED
S TOTAL DEPTH:
6. DOES WELL REPLACE EXISTr•G FELL? :ES G NO
ax
7. STATIC WATER LEVE.. Below Top i Casin3 200' FT.
TA: ;Vs," "I!A*:,<-r;oicuL",1
3. TO? OF CASING IS
2 FT. Abcve Land Sara::'
'Tr; or euir.q l<mdnaud a:'cr b<Ic* lani e:r'+c<;<;:Ir<i
rar:anee In ac:ar.ance *�:`, 1$A riCAC tC .0113.
5. YIELD (S r): 15 ;M;ZTHOD 0? TEST
4-1-03
250
10, W'ATER ZONES (d epib): 195
[ i A c' .: 14c2
:2. CASINO:
F._— 0 :0_34
Fro 77
GROUT: Drr_•,� Ma:ena:
,,, 0 To Lt-°- Size. & cz,r=a. Rt--
rrora ..
Telz'sess
or Fcfi8$t.
safcc
14. SCREEN: �e t
From To
Frcrn To
IS, S.AND'ORAVEL PACK:
De:",
From
16. RZMA.RKS
To
L'{Y:,eb: Sct5.a `da'u-.a1
ro
70
Size
Maria.
DE?TV
F0 -. 32'
r,, _-y &N,,.'
32' 250' wit
LOCATION 5:CTC�-
Sh.. dire.., n an ;s ..... -rites :bon-. a:teas
r c S:a.e�Roads cr Cor.-' °.--_,..c..___ _._ road,
p —A[Fr c A:i7fl" •�=`A ,-.�.. w7LL `4. AS CCNST?.:; D tA' ACC c�r.77CZ : 5A hCAC V._LL
i%1 i sT.A.N ` le'�41 i_A.7ACOPY C=ir:;SF�CCZ,=AS BEEN ?n_,:r.;7 __L..-YE?.
,7 : A
�I �°.�'�Ai�R20?FEASCA'CCASTR'_�:I`�'GT=3V,nLL DATE
NC
I Si.brJt the cr<E'nal to the Dlr,slo of Water Q.allry, Gro_adware? Seo::en, 16.6 }tyi Seniee Ceo'er • Ada e a 2C,,:
1E5�•;S36Prorte So,,(91?, 73342211Y, lt4 n:0 days, Cvs•: R-.
271937
WELL CONSTRUCTION RECORD
ri .tre Ja"7.2s B. Brown. cz T IcAT:CNc 2_.0
FN.)
0' 1-7

271956
\YELL CONSTRUCTION RECORD
,p v Nat.11 W3.ID,'d5 Wa:cQ 2 ..:ZI;-
G^,�,. Mitchell D. CcDock,...A. C o- 2043
F>LL CCh;?l.CTCR (INDiY;CLti),'<A.`r: ,
i1.L COST RA CT; R CCM?A-4Y NAY. E Hamdell ErOT21"-e 4;> 1 r1-11'1r^.
STA Z WELL CC,S3TR UCTICNPER';ITe AssCC1ATE NQ ?ERY,:'t
(if acakay!e(,(e:c�1:E:'Ie1
!. WELL USE (Che:x A;rl :a: Box); Residec;ial .=.y'....,__.
b!crd�rn; ❑ Re.:ver C Heat . - Water InjertIon�G 0:',.4r : lfC:S•:, List Us:
2, WELL LOCATION.;
Nearest'ic Franklin Cc••-,-, Macon
Cowee Mtn rd across from scenic pull off
(S:v:'. Ni.-,t, A:..�.,.., ' °:`.:?•i lla. ...t?.'•., Z.; CC
3. OWNER; Richard Stwaason
Adcess 4517 Water Oak Lane
(stn.: et Aacn Na)
Jacksonville, FL 32210
TQc%r, .5 Z.;C4
(9n4)• snq—R76R
4. DATE DRILLED 4-2-03
S. TOTAL DE?TX: R50'
6: DOES WELL RE?L.4CE EXISTNO WELL? YES NO Itx
7. STATIC WATER LEVEL 3e!ow7cp cf Ca.ti,Hg: 800' FT,
(VW." I`A`.:v, o; c!Cm1r4;
8. TO? CI CASINO IS 2 • r i, Move Land Sc== •'
of euUj!u :k:altd etbr lel1,0 la,:. l'JCeee rrgd ru a
virtV:e is e:c'daa:a 15A:iCAC SC .C1IS. 9, YIELD (rr.)! 2n MBTHOD OF TEST h, ' w
IC. w'?.TER ZONES (de?la); 795 & 840
lI DISINFECTION; 7
t
I2. CASNC•:
L '�SA •:.
Fro— 0 To 99 F.
Frczt 99' 106?:, 6"
To�
13, GROUT: 7):,i1
Fr,,.. 0- Tc ?'
To
14, SCREEN; Dc t. L'a-•it::
Tc
From Tc °t _
IS. SAND'0RAVZLPACK:
• Dr:: Slu
From To
Front it
'i•
F;
-..,,acz
TJ".Asa
cr
pv
.I88 steeCi1
Material
Ft,!-em^+'-o
It,
Sk; Mater:::
in.
Me'_:c'_
r i-y r
se -3
=Rldie CSb CVaI •;
.,de s:_..•^O?S :ra: -
;, R:'_ L r C L OO
0 104' _.&-=--6
104' 850' :te.
;OCAT'0YS:{=TC-
S:•.dIrectIon anal d5L :e in,,.•,:5 :tr.::: at leas:
Rcad5 cr :. ,t's -.,. L9< r;__
•'_'T»e:i a:•d :,.�"�_�. roa_.._C...
16. REMA. XS'
CT_J A CR^A.\ A — A N.: AC-
((( 3.� rY r;s WAS cc s �.
3.`C:�e,�A.`.^A,�S,d�,.�:Tj: "ACC?YO �evC.. .AS3i: \ 1., O
2 � P 1Y
r
Scbr'r the o',y!ral to the Dhv's'at et 'ate; Q;a!Ity, Grouedw ate: Ss:tan, 151$ ME! 5er.':e Ce::e R eig^ NC
T699 %q!Fhon i4a,-(113 ,34-:I, ydt 130 da; S. CW: KEY, CT2:01
10EPERSONCONSTUC i1C•TF:REL. DATE

A.d�as 6850 NW 50th Street
(S:-r, Cr Re: e No)
Oral a, FT, 34487
e: u4-. sue
(357)• 679-07AR
,A cage• 1,::ac •''-,,e:
DATE DRILLED 3-27-63
TOTAL
271955
WEIJL CONSTRUCTION RECORD
• CC TF CTCA (1,1:PriDUAL‘,‘IA.Y2 trim, Mitchell D. Cook C:.,,,.,_r; :4z 2043
O M? .Y2 H'..ades 5rotncry p7=11 ^p-i
E'-L C,, ,1 T:.A C'7�R CC. �. A.YY h'ti
w :!OC1 n?s v,I7i
STATE HILL a y 'R
Nfarollcable' (if ec.....,.
L WELL L USE (Chuk A;;Box). Residential =
Mcr.,s.2;0 Re:overy 0 ..eatF ; 'ales' ❑ C:...r❑ If:istUs:
2. WELL LOCATION;
Nearest Tot: Franklin
Dalton Creek
,..:',o.. 2.; C4c)
3, OµYER' Byron Packer
4,
E: DOES WELL REPLACE EXISTING WELL? YES 0 NO X$
7, STATIC WATER LEVEL Ee'.cwTc; c`Cas'ir 250FT.
(Ulf "r" I!A, cve Top e! Cu'a;)
S. TO? OF CASINO 15 2 FT. Above Lard 5':da:e'
'To; cr cuing Nrr.lnale: se'cr:dow lu„ r.rfne rvgclru a
variance in a:::re,aace wl:h ISA "'CAC :C .0118.
c,. YIELD ($,n); t 5. MF.TBOD 0? TEST h.o,.
C WA T oR ZONES (depth). 740' 1f 775'
Cc...-.;:' Macon
T c;co -azci se...eg
ca.
�Rd;e ❑S'_�� C1'a'ler
.....
d. so —
ai Sc;,
- •
F�o 82' &
82' 300'
LOCATION CK. C-
11, DISINFECTION: 7y7a HT.1 A-..,. 15C2 5:.:- and die_,._ ,.. ,es fr:a'. le__.
12, CASINO, WahT'.CC'es ,s .. _State:arscrCa�.�Rcad.., s.Ir.: _ether:_-
Drh �U.1.:ter c?k'dylT;. .? a r J.,.-be.$=.d:.-r.,_,,r:adrzr,.--.
Fr:.—.�� c 79 F pv
c.-^ 70' T c R4'F;. _ 188 steel
_o
i3. GROUT: Dq:h Maea: • Me::c'
. rar„ 0 Tc 71
Frn Tc Ft,
14, SC?.EEN: D:,'i a. -:ter Sc:t $1 a b}aria',
Fro-, ,Tc rt,_k a,
Frcr, Tc
I5. SAND/GRAVEL r"ACK.
• D;r:; S:u • MaleL
Frcr " To
. :cm Tc
F;.}-�a,-.•.is k c, ^i rrr
IS.REMARKS:
REMARKS:
K
ttT.31 T Fr5 \A WAS C0<57a. a..J T.`e ACCC?A.\ ."iTh • .A :,'CA=' V. :.
Ira 5 A�..•1:�:5 A.1'D�,i 'ACC'YOF S CC:..HAS 3'_\r EDTOT LC' NE:t
Li `• S .
3 /a. ? /a.?
= C"E?SON CONS TR' "T:NC IF:
p*e original to the A4Yislata at W tar gully, Groundwater Sect:oc, IE3$ Nta: Sen;;e Ceeta Tiara°_ NC
21633•16j6 Pn.»i* Ni (31S) 1JS Je$1 wlthlt: 3O days, G'',1:2' 67; 2:-01

271954
WtELL CONSTRUCTION RECORD
ijr r ' an! Na'%."1 R ,r. : r..). Th , . W;:i Q' a1', • C _
CG.\irUC"GR NAY, u U , Mitchell D. Cock c_ A.: a 20-J
1;=LL (i1D.�1r A..,
WILL CO.NTPACTOR COMPANY N'A.s1Z Hedden 5rot..r'ors rr;c11 ill 1
AS?OCIATZc
STAiZ HILL CCNiTRC'C'OY?'RJs" a
(if se:IIcable
r 1 - :da i ;;�, i. .3': CJ�1:: ❑ I; �':P`�2 ❑
. 1 � WELL USE (G:9<:k A:p^, ea'D,e LCn): Re3� .912 T�` .Ir •'+'-'••. •_�•
D!:eL�r ❑ R:ooYe , T. Feat. p Wa:et Ir, ,..rnC O;F.:: ❑ li 0'ae:, Li‘: Use
ri
2, WELL LOCATION:
N:a::st ToRT,: Highlands Cc_,r; Macon
2460 Cashiers Rd
..: C;.mr.. ., 54`-4H,:r, ;h:, Z.7 C' t:
3. OW1:R Highlands -fawn R Carden Well 1J2
Ads-33 74F0 ilaRhinrR Rri
(S:-ttt :r N'e.)
ui r3hl ands ,D1C 28741
:eTcwr,, State Zi; Cxe
(_f123. 52A-7195
:xe. pe:ne
4 DAT^ DRfi, FD 3-12-f1"l
5, TOTAL DS? TH: 4n11'
6, DOES WELL :REPLACE EXISTFXO WELL? YES C' NO Xx
7, STATIC WATER LEVEL Se!owTcpefCasln3•
(Un°."I(.A Top ofC&o
TO? OF CASING IS 2 FT, AScve Land S.othcee
Top of ev:HS lcr:Ina,rd a:'r. !flow land re;alne a
varan:e In a::: r: ann wlt, :A'•'CAC 2C ,0111, .
9. YIELD (v.n)» 50 METHOD 0? TEST
IC, WATER ZONES (depth): 3R0'
11 DISINFECTION: Tye b Ane:zit 16-z
12. CAS;1'O: Wail Tr:c'sss
• DA 7 L.,i-2 :r cr W'c.7::7L
Fro: 0 "c R1 7' . F"
Frcc. 32' To 50 F, 6" .188
Tc F'
Maar;i
Svc
tec!
13, GROUT: D:r:n Mat., -:al
Frcm_f_Tc 27 F1.l Tito & c -t-rL ' pr-f-a4
F To Ft,
14, SCREEN: De t.S.
Frppr, Tc tt. •
Frcr, To • °'^
15. SAND,'GRAVEL PACK:
Dr 5!u
F rcr. Tc Ft.
.,.,,, Tc F'.
1E. REMARKS Set 5" steel tacker (a 80'
V' 04.7.gaw
TC;Ora; .._._.c ser.:.$
:Sr.'s
__.. r�'_e', r.5ir _: so_.. CGFc CTc.cj,ap;•...
;FFT_..
0`^ 4R'
4R400'
L0C4.TICN
5 ,'.6 di:e: n an_ '1 ,:3 a: leas:
R:a:s
e:3 Cr as eat:5
L WAS CONST?':777.0 TN ACOCYC A.NCE 0.^,— :A NCAc:
ATACO?YOFimI5FCLOO D=:A$55Eti?3C ,.,C.,TGT-= ._-C'r`,=:,
//ems/0.9
SICNATUASCFPERSON CONS'n c—'cT-SWELL 0A
L
SL16mIt the or g1nal to•tba DIvsilac of Sf'ater (C2,.alley, Grocodwater Saetlen, 1636 Mai( Sari:a Cecia Ra r;`_ NC
76i5 :534 Phcn,;.1o. (3_1S)1'......Yt1, wL'h:ln 3Q days. ow.: F.E G7.2.0,

271953
16. RSMAt{S'
.r, rrrp 34
Iri1 icS CCNSTRLC: TN ACCC4: T: ANC='xT^:::5A 'C At :C
Free' A°4S sTA _CC?Y 0; 3IE>.;TRC„-.0.. T:' ' 07-- =R
77 e ij-19 Coe
S :'N•A; C =.:..d: ? E.S0N CONS T A. CrNC TREE WE '.
SVC^ t the g1y!nal to the DINilec of Watar Qca!Iw, Gro,oach4 ater Se:t!oa, 1635 flail Ser ,te Canter • Rso.!;F_ "C
;7553.1636 Pp`pne Nc,(9�z .e3.3321,_W1•hin SO dr,o. C'R'•: tiV, OL:';O!
WILL CONSTRUCTION RECORD
C to ;Na"...': :i... ' J 'I, Y''a::; Q', Cr .:3e:
) Mitchell D. Cook c77,7 ! A,IO ? 2043
WILL CONTRA CTCR (.N7i�1:vA..,) N'A. �+ •• G WELL CON'TF C i 0R COM?Art N.A.Y.E. Hamden Erohcrs v 11 h-a, i l i rr- p: c.: v (87f 1?c4.Cc:'
STATE V:ILL CCN3TROCT:ON ?°R7"7in A5:CCIATZ WI; ?IR`t:T?
' (ifacoll:a;le, 6faz:115:1:10,
I, WELL USE (Che:kA;p11:a:!e'O x): Reside,:ial Nl'�.icpa'.T. C In''a:ie
Nicr ,cr C Re:c er ❑ Heat •P -.; Yi�a'er Irj: do ,C 0;h:r If Other, Lis; L'Se
2. WELLLOCATICN:
Karat To•,:: Franklin Ccc
360 North Tnnpa Crpink RR
1 ; e va,, ..r.,..r,... _ �'4 S:: dl �d!: L:' :�':, 2.; ccs-
3. 0W?iR Joe Bell
Acid•ass 360 North Jones Creek Rd
Macon
F"rankl in NC '78734
,Te s:,:e r, C:Ee
(878)• 349-4f7!1
A. --a axe• ??.:-a
4 DAt" DRILL ED 3-76-03
5, TCTAL D^°Trd: 1SO'
6: DOES WELLREPLACE EXISTItiO WELL? YES C NO 'tx
7, STATIC WATER LEVEL Ee!owTop c`Casin3. 135'
(Lie I(A`.cve T; c CuL•:
E. TO? OF CASINO 1S 2 FT. Land S:din:e'
- 'Tope,'eu:,i41am!nahe sc>:ttIo‘• I an: rJr;eungclrv;a
vatlanee'- u::r dams w;t1 1SA N CAC SC.e:1S,
S. :'e=_^ (_rr), 60 `;=TROD 0? EST hl-n
10, WATER ZONES (depth); 90' & 127'
L DISN•FECTION: Tare 'ral„i
12. CAS:NG:
Fror.,.._Q_ To 73 ::
Tc Ft
To
13, OROUT: CFCs
Frcrt 0. Tc ?')
Frcm Tc
14, SCREEN: C:rth
From, Tc
From, Tc
15. SA'r'D,OR4VELFACK:
Dr CI
From' To
From, Tc
A.:...., 1E
Wail oictess
cr 1R8tT steel
F;,Fcrrnii� k c-- ^ ' j+mr=4
Ft.
aT,eter S::t 51L: 1kles,sria:
In. ' n.
F 17
S'.aa Ma�e'a:
Ft.
Tc:.: ;fal:,Za:.c set::.;
CRidy: CSI:pe '•e - :a!
_GES CT;pcb.ap .. 712
nrLt !NG LGQ
From.021' ,s: &em..,
71150'
;OCATION'c{:TC-.
5:. .h_ d!s z^:. ,..,...,n `_.,. al leaV.
ti.c 5,...•'.ads cr Cc Rc d_s..,,.,__. ,. ,.__
,._-.:::sztd c,,,a. road n_ o..es,
I CC`fr
C CN5-7177'
3�-2.6/03
CAT:

2'7 1 9 5 e'
WELL CONSTRUCTION RECORD
h Q
^i C ofr,1 • D:;:r' �` ror_s:a z~.. N '� '"..
cc,v7RAc-cB (<n-,.
Mitchell D. Cook CERT ..A:IOY$ 2043
WELL CC7TRACTOR CCM?A.YYN'AN! Hoiden Erthars G;=11 lri11i-r 7-- 'HCv'i }'(RiAI'2n'q—.Cc�+
STATE ti!LL CCA'STR°CT'ON P'RYI`, ASSC:ATZC WC? PER.'I:74
fadcli:able; (ifa;Jicsb!e'r
Reside •,ia;E< v ;.,_a:7c': In dust;_ 0
-.y•' ❑
I. WELL USE (C;.e:k Applkabi: Eox) - ..�,__.
Mcr.lic r. ❑ .7,e:oyeri ❑ Hat P; ; Waver Iniecti:7, 2 0:her 0 Ii Qt :, L•.: US:
2. WELL LOCATION:
N'sara:To 1a:Franklin Macon
Millbrook Cove We11#2
..r. �.. •., �.•-. Z'.- CXa;
i. C\'v=R: Lefty Marsh
Adc:e33 79 Maclor Forest Heights RD
(S:r:::r R:uh No)
Franklin NC 28734
; Tc"-7, Z'., Cxe
($2S)• 524-5153
A. --a c e.?L::,e -
•
4, DA"^ D�'.Lr ED 3-17-03
5, TOTAL DEPTH 400'
6, DOES WELL REPLACE. !XI ST1NG WELL? y s a NO Cs
7. STATIC WATER LEYEL E.IOW Tcp cf Czsini: Y75' 7?.
;us; "*" I!Ahcn T:, crCu::ii
8. TO? OF CASINO IS 2 FT, Abeve Land Surface'
'T:; ofculea to —!raft: uo: helMan?i rf ,rl.qclna
va-ie:e In a::::?an:e +r;C, ISA NCAC SC ,CI13,
.. YIELD (rr.)I 30 mETHOD OF TEST
0, `A'ATERZONES (deptr.): 365'
Dt5 '_= Ti^N' re EtH
12, CASINO.
• Dc; 4 D'. at ie r
Pr:r 0 ,-- 66 �•
Frc:. 66' Tc72'F;. 6"
•
•3. GROUT'. Dr,:^, Ma;,r;a!
Frcrr, Tc ?' FI�Fnrr to & Cu- ar
From Tc Ft,
14, SCREEN: Dri.th • L`'a.:.e'e:
=.a:.1, Tc - _in.
Frcr Tc
1 a, SA4'D101VEL PACK:
Vr$:a: .
A o'' 1Ea
Wa:, Ira,esa
ct M>\.-,',
�Dvc
.188 steel
S,c; S! MaeSa'.
I f..
in.
Fre t.
.,.,., Tc
F;.
7c cd a c
_R.5ie CSIc;te _.;a•
F'!.I .cca'.o .
__...Jd! 'Joni — de s:...t ='GP Tcpc ap ,
Tc a1;c
0 68' 71a & �L
68' 400'
'y00&T!ON S KETC
S:. dLec:r, ir, ,.,.•es fro. , at Ins;
. 5lale R:ads ct Ccu Rua:113. 49e,.__
15. R°N:ARXS:
Ito yL, c•.Z , 1'ATTI s.v,—. WAS CCNST?_CD TN.' A ORDA.1 i., .eA NCAC] `n ^
CONETis C 4.C. (E' A :”1:4, ?.. ). T} r. CO?Y OF _ S R:CCZ.. F-As BEES , a.. •;_'l=
.. 70 O r,.,
//?/0a
s:CNA J?S iF PERSON CONSTR' DT NC ,:3'3e__ DATE
Sub^.a ti . crlerlal te•the Diw1311c of WWW-ater Quality, Groo:dratar Sac:ion, 1EE35 V111 Sent:e Ce:;er • Ra;e,q`, NC
^.
Srssy•1636'P1.oneNc,(315)l37.73:1,wlthln0da;o, Gi','•1:'V,G7,2:G1

2'719 51
WELL CONSTRUCTION RECORD
N ^thCa.^ilr? • J' '714 C L7,'hv i2:N-al ° 'DY;i7 Wa.:7
B=LL CC ITRA C-OR (ihDlY:7GA:.)iVA>*. (r'' ,) Mitchell D. Cook C',7:ATI^Ve •2043
WELL CO.VTF.4CTOR COS;?A-NY,1'Ay,L f de,'t Brot.hars G;e11 D.r;11 irg, Tr' o-p";' d (57fj)11"0-0^=''
57ATT- B-ZLL CCA'iTRUCT:ON 7IR.�SITM
• (if e.olicab'',e
AS?OC!ATLC
ifi. t:.:!c& it)
I. WELL USE (Chs:k Appiicable Sox)] Reside..Ja1 ti:c icipalT... C ,r dau;x: 0 Ay. -a:]:
C Re:ovcry ❑ Heat: t.; ?rimer In, G Ot,,., rb: ifctes, Lis; Use
2. WELL LOCATION:
Nearest 6t..cy: Scaly Mtn Macon
Brown Mtn
..: Ns7.1,
3. OWNER: • Kevin J. Shearon
Aduss 101 Foxview Court
Chestertown. MD 21620
:r T:w>. Sax Zip C,4:
(410)• 77R-5962
Asa cxe. 7%tne
4, DAT; DRILT ED 3-13-03
5, TOTAL DE?Tc: 700'
6. DOES WELL REPLACE EXISTING IN'G WELL? nS C NO 3t
7. STATIC WATER LEVEL. 3e„w Top cf Casiny: son
(us* "✓' I(Ay_+ve Tc; ofCvL.".a
8. TOF OF CASINO IS 2 FT. Abcve Land Surface'
'Top of euHHi a;e! u'ar Eelew 11n7 r.r'.ace ri;' (r l a
va?,an:e In a:ur:an:s wliE 154 NCAC:C .ons.
i, YIELD (g;m): 2 M3T1i0D 0? T3ST
10, W'A T ER ZONES (depth): 565'
DISNF ECTION: T ,e
12, CASING:
th
Fro..—�_7- 20
For. 20' Tc 24'
Tc
13, GROUT: De Ui
From 0 'c >'1
To •
14. SCREEN: Dr,'� •
. Tc
From To
i.e. SAND'GRAVELPACK]
Drt-. • Stu
Prom' Tc = t
To FI,
A.:,:':nt 1E2
i}J& es
er
L yet:r
F
18$ steel
Matea:
F'.prr
:e:
11,
Ft
S:d Size Meten •
Tcrco�: Zcse...tg
0RJdye CSb C'', sy CFI
(::r.'e
d, d.,rw.e
(d: y:.ea.T,:uVax:e�i
Laar_del:r.yir�de s:' 22G?S22T' , :ra;:',1: 7.22
(:S.ec 'cs)
DE D:,!L- [','G :CC
. To alien Desccc:(cr.
0 ^ 22' cis,/ & �L
22' 700'
jCCATtO'' 5K: TC
S;. e Reads c; Cc ` Rcadt. t;^,.
read names
6. R°MARKS'
I-
CONS
.1
SvItmt the orlg1na1 to the Divisioa of Water Quality, Grc':udwa:er Seeti:n, 353E Mall Senl:e Cc:ter-Aieiyh, NC
376»-163EPtcou+1 (3} } 3?•}} },3yj;hln10 CatsG'n•1 F3Y C`i:01
,T 3 5 CCNSTA�_C' `D ^. ACCCZA.1 i ;:A ` A
N SvY.ti:.-A'. 3, 4.`DL4: A CO?Y OF TN $ R° C?" -_A5 BEEN ;DE; TO , O:.L
C«T3'
�/ 3 /0 3 .,
:CNA; w' . iRS CONS PUO NOT:-2 wz:- DATE
CD
C.)
fJ
cJ

WELL CONSTRUCTION RECORD
�_ N'a? . sDkisL:r.
CONTRACTOR (iJ=_ es B. Brrwr. CiR::::CK:LC}. G2L45
W iLL �'D!tiiDUAi.)i�'A. O?,�• WELL CcYTrtAccR . Brothers L7e11 DriUinC- E.23 AT G5C1 ASSOCIATZD'�Q?ER4:7?
STATE WILL CONSTRUCTIONP3R`:17e (if anolicab1e)
(if a ;h;ab!el
1 Re3identla: Mu.n1:,;a�, u1:11: r 1":�':5:.�� ❑
WELL USE (C;^Re: vAecy able B at V- .2 Y; a'e: 1c Oa:: C if 0±c:', r is: Us.
M rit3,^.nj ❑ Ke: '
2. WELL LOCATION'' Mamn
Meares: Tewr..; Franklin Cc'..�.
Holly 4nr z >, (,rri F¢tataa —
3, OWNER: Keith B. Sprictgel SR
Addess
Z.; C:4e
CI��I Of T='1� ate'
(fi7R, zno aa3 —
4. DATE DRLLED 4 14-03
5 TOTAL DEPTr': �0__ -92-----
6. DOES WELL RE?LACE EXISTING ING WELL? :TES C NO 33c
STATIC WATER
EVE ae:owTcp cf Csslnj .121E_—
7. ('Ae"-:: If Abar: T:; :!Coati
TO? OF CAS:NC, 1S 2 FT, Above Land Surface'
8. 'Tcparwlettrrlo,p!,;or be'aw ; an; rsr'e:r r:;':Iru1
w'•p '! NCAC 2C.C!a.
uren<e In a:c:r!a�iae �. � A
S. YIELD (rrn)': _4_0___— METHOD OF TEST 'a.ae''
10. WATER ZONES (de;::,):
11, DISINFECTION: T}pe
12. CASINO:
Dern
Fro —5.8- F
ekric':.^.; 1 ficz
Wa:1 T :r..eSS
c r R'r, s`•;: -:.
F•ca 58' I c�2 i I. 6 _.j-aa
�.�... To Ft,
13 GROUT: Dept
F.,, 0 Tc 20
From
Tc
1e, $CREEN''. De ±
c;c To
rcr• Tc
15, SAND;GRAVELPACK:
Dept1
From To__
From Tc-
6, REMA..KS.
:c r.-v=-v •-
f;
!
y r
LShbr°h 'it'karigln1altotheDivision
2769:9-1636 Phone No. (919) 13 2:1,
LCiID1!
Mate -,a:
pvc
steel
Ft. & cetert
Ft.
Dt a. -re:” S:ct s .e Ma'_ ;ai
In. .:
In.
$:Ze Ma:era
CRc.e CSIaas C\'a:ey _.
(cSr.A
of
s: z:: 7-2
Hex ;r'�KAJ-
ICn D- r.
e:.:Il_
OFr60' cav & xL
60' 200'
LOCATION S`TCH
dire:Hon and ir. r:V,es r:r. a'. leas:
r::c State Scads cr Co _._,. ; _:_ raea
r. erm a•,d .n-.cr, roan names
'EL'. WAS CAN-TRUCTED;s' ACCCP-C A>'C_w-;-; 1SA •CAC:C:
i 4TA_=Y0?in.SR:CCRD-.AS BEEN? F.: LBEDTOT rE••carC }
7.71 OF PERSONCON•STR'_ 1N'O
f Water Quality, Groundwater Section, 1636 A!afl Sea';: Canter. Paler. N NC
Ithin 30 days. GW ?IV: 07,2?01

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTTResources - Divisionlof Water Quality - Groundwater Section (to \\'ELLCONTRACTOR(INDIVIDUAL) NAME
(print) Cl/'e rmis I-n /TJQ r1J CERTIFI�CAAT^IOON#/cl /7
\\'ELL CONTRACTOR COMPANYNAM�IXIl)')'i S I?�l'I}.✓�r� LJ,i }.IlYr ll-: I( -14 C' i PHONE #@rf iil �J o24-�3 aG`
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable) (if applicable)
271927
1. WELL USE (Check Applicable Box): Residential Td❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: 8./) PL, 4 A'l",County Al //Iry
Oath Sfrrl. e �rt„M. SPA[ (2a a S73/
(Sireet Naine, umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -,SCLC2C- r/,
Address c%LC7 Pc Ck c t? < L d—
(Street or Rowe No.)
J-it/3wl/ L ; nl iv'C
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED q —� 3 '4-3
5. TOTAL DEPTH:
Typographic/Land setting
VIRi'dge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
P / 41
�=
vr' 1Zrh• ('�I.d--C-'
DEPTH
From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VJ/
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): 3 METHOD OF TEST /07V,7C-C,f--.
10. WATER ZONES (depth): c' 5 (1
11. DISINFECTION: Type
12. CASING:
R-1—» Amount
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 6 To .rZ/ Ft. ( s. p z j PV e—
From To Ft.
From To
13. GROUT: Depth
From O To r
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS
Ft.
Material `� Method `
Ft. aO4• l a,� fOCDA
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
LOCATION SKETCH
r� TA . S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
rV
N
(n
I S CON IKUL tII F
MAY 7 2 03
T'-
)A
.T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF TH S RECED TO THE WELL OWNER
if ��k 'J ORD HAS BEEN PROVIDED y —.;z 3 —E3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
F4�(v,Ylyrdtilytdegg94e Iito the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
p(., - 27699-.t636i"RJ1dne No1(r919) 733-3221, within 30 days. GW-I REV. 07/2001

2'719 G
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section --
\'ELL CONTRACTOR (INDIVIDUAL) NAME (print) tlTT/-ehhiS I IIQM A, CERTIFICATION #/o//Z/7 sf'
WELL CON'(' RACTOR COMPANY NAM PHONE atifig ) —.7 oZ Li -a ;76 G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 12�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
/�_ /` Nearest Town: 6i�%%U / /%7C- County 7 (ens
(-Z)Q eti 2c( - 6)1G-, V/ LiL/1 S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: P 6Yl J Lt c.-o P
Address 0.t5 //Y/lm5Afp ()(
J(Street or oute No.)
1 1'aM'l. UZi - c�0/L/ /
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 4 —! 7
5. TOTAL DEPTH: �-11 i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m�
Topographic/Land setting
❑Ridge UbSICie [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
SC( cA 5
e/£-n
l.3 )tct �Ya24„-/-
DEPTH
From To
//'
G^E, 5'
///
7. STATIC WATER LEVEL Below Top of Casing: 'fel FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): _S METHOD OF TEST /021)T71li--+
10. WATER ZONES (depth): Ice
(1
11. DISINFECTION: Type 1 f-i{
12. CASING:
Depth Diameter
From 0 To 4 1 Ft. /C5"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From O To c*ID Ft. 0O4)10-
LOCATION SKETCH
Amount 4 %A- s s Show direction and distance in miles from altast
Wall Thickness two State Roads or County Roads. Include tfrt)road
-
or Weight/Ft. Material numbers and common road names.
Stec _
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
CD
Method
rV
Slot Size Material cr n
in.
in.
From To Ft.
From To Ft.
16. REMARKS
C I Pg HaY
CONSTRUCTION if
L ! MAY — 7 210R
i rHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JARDS, AND THH}A�T/A COPY OF/T�HIS- RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GROUNSWilitiili t$ rQJ' g' nal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Ay['v/11-1-0441 , lt4pgilCkn [phone], within 30 days. GW-I REV. 07/2001

... .
(Strati M ROatC No
State
StZip['ode
WELL CONSTRUCTION RECORD
Nods Canal ins - Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section
t1�Lt• C'ONfl'RAC OH (INJIVtMW4L) NAME (print)/rt(r. /J I cr�li.H l't:N'1'IF'I(1A'f10N N, 1�
' �I 14 Cv7NTRACfORCOMPANV NAME, Cr.-�.-, �EcrJL/L. Jt2 CC'.e\ PHONE to ('1t61r•7 `?[ -!'
arm* IA. tONSTRt!CTION PERMrra-4 ASSOCIATED ()PERMIT"
(i IcoIkab1C) titapplieablc)
14 Eld, USE (Check Applicable Box): Residential 0 Municipal/Public 0' Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other O If Other, List Use __
2J *ELL LOCATION:
' f Shirai Tbwn: _ e_f'1,' ' CCounty fZ/s .
tt my. Numbers. Community. o
( 1 a /r SUMtivision. 1 ul No.. Zipj�Code) ����
3.y nR:' !ru! `UMS/1L4h1. <t�„l"..)LP1/ Lcxi.i`)_t v,h
Odra,* _._.
City ar T
L. )-_
Arne cots Pijone minibus
4. atiTEDRILLED_ ='1 4::
5. TOTAL. DEPTH: ..._1..
6.'DOES WELL REPLACE EXISI1NG WELL? YES to NO 4
i. StATIC WATER LEVEL Below Top of Casing: 50 FT.
(1 Lse "t" if Above rap or Casing)_
((E CASING IS _ FT. Above Land Surface'
��ae��r�R elr,♦hMS War batow Ord nrfaa regrirb
ie nteerdaeeawkbI5ANf:AC2C,61it.
9.:YIFLU(gpm): T"/J�- v11I1i000FTF,ST�/�c,rpyp�r�
W. WArh:RZONLS(depth): .'�!0',-r,rp_'-..., / I
11. DgSINFECTtON: Type 14
12;CASING:
Depth
From To t
!t?rpm To Ft,
C Frem • To I
13,;GI}OUT: Depth
Prgat f/ To y 5—
Frain
. fo
I4t'jsgREE±N:: Depth
From To t
From To F
T
Ft
Topographic/Land setting
DRidge DDSlope CIValley OFlat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/in inuke/setondn)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
!EiPT�1 f). 1i2 LLINGi,QG
From I o Formation Description
.C' /r/4 .. _-.
Pg(/4Fj Amount * //<(0,,.7
Wall Thickness
Diameter or Wei hVFt. Material
•.1, /V tin .SxStC.-..
t.
Material
-� Method F. <-.Cti s.i :. .._C-..--
Diameter Slot SizC Material
1. in. -. __ in. _ _
r in. in
15.'SA474DLGRAVh:L PACK:
Ikpth ¢c
tFr4m 'To I I.
!Non .:..___To 11.
Material
Groat,KL.vk.
n r / y/0
—Ovo L e v-11k—
17 s
10
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.
RT IFY THAT 1'I1IS VV'i:Li. WAS CONSFRUC 1'ED IN ACCORDANCE WITH I5A NCAC 2C, WILL
STANDARDS.ANI)THATACOPY OFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'AGNATE )F PERSON CONSTRUCTING THE WELL, /f)4FT
foal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
No. [phone], within 30 days. OW -I REV. 07/2001
TTZSZ8L9OLT !NI11I21C 113M SIAtIC WHS Wd tt' ZT se-0T—Nflf

WELL CONSTRUCTION RECORD
273392
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)l//L nl'li 5 -k f(LA rJ
CERTIFICATION it ot/%:P
h
w'ELL CONTRACTOR COMPANY NAME h't I C t—Fl l/1.,,_I l) IPI 1 ))-
,fr, l k n P z PHONE P lt1 /„,.Sa L/—W a 6 G
ASSOCIATED W ERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential & unicipal/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: FR,¢/142 //44) County Matt
eaa. BR U,c c!r RA
c;r3 L
(Street Name. Numbers, Community,/Su ivision, Lot No., Zip Code)
3 OWNER: / hum as i.�+tnurn2„
Address 41-53n 3: m-/'dnj, MR,
STATE WELL CONSTRUCTION PERMIT#
Of applicable)
D✓lava ) r r.
(Street or Route No.)
City or Town State Zip Code
— e5-r`
S
Area code- Phone number
4. DATE DRILLED - 43 —(L3
5 TOTAL DEPTH: -2/(15
graphic/Land setting
DIR-idge DSlope ❑Valley OFlat
(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
O 7CO,
On' 0S 3e
z-Q.53
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO &Y.--
7 STATIC WATER LEVEL Below Top of Casing:) FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): �i D METHOD OF TEST
10 WATER ZONES (depth): ti(), e ,,c1)
!. DISINFECTION: Type
12. CASING:
Depth
From U To53 Ft.
From To Ft.
From To Ft.
!3. GROUT. Depth
From n To 19(7
f1-1 Amount TA AS.
Wall Thickness
Dia�eter or Weight/Ft. Material RR'
Material
FL COnyt 0.7
From To Ft.
14 SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
5 SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles fry at Ica
st
two State Roads or County Roads. Inch, they:
numbers and common road names. —< em
N3 o.<
�m
>o
pm(ri o
"e"en
-- - ▪ cn
0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A 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 DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
t dh69-9 Ib7bYhr� r. (919) 33-3221, within 30 days.
GW-I REV. 07/2001
.r_I-- L (FFiCE

273391
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division) of Water Quality - Groundwater Section ��""
\vELL CONTRACTOR (INDIVIDUAL) NAME (print) [�� h ✓l1 5 Pi) I iQM A, CERTIFICATION�/O d.l7 e�
WELL CONTRACTOR COMPANY NAM& .hhi S (ColIQgnr lice I))Yer l�Sll d(� .j.nC PHONE p %-$I ,.��oZ U-3 07 �' C
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ'YERMIT#
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential Yd�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Pik 4 N)/ )•--i /i/ County Q.Crrni
(-0 (4- (() • (u a-L/ct) PL-4 r-c-2 - 7 3 U
(Street Name, Numbers, Corninaanry, Subdivision,mLot No., Zip Code)'
3 OWNER: Reyi S inicLI-e{2,
Address 33 3Ot-00 a l., ,E,&._
(Street or % Ramie —Ho.) g73 Ly u�7�Irz, li
City or Toyn State Zip Code
Area code' Phone number
4 DATE DRILLED 0 /a `63
5 TOTAL DEPTH: err—) 5-,
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO �t
7 STATIC WATER LEVEL Below Top of Casing: /d FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): r�.S METHOD OF TEST /07/)l -f—�
10. WATER ZONES (depth): S ' (�
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
/0 ' S ar.-
Jo' deRInni rre
I I lxz— Cy -At aril; -t -Z—
graphic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
6'
11. DISINFECTION: Type
Amount
12- CASING: Wall Thickness
Depth Diaff eter or Weight/Ft. Mate al
From 0 To i.>2/ Ft. (^4 5-22 Rr,! Pet e—
From To Ft.
From To Ft.
13. GROUT. Depth Material Method
From n To ri-(7 Ft. CQO')t8-, (fold
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.
/'
.7)0 S"
LOCATION SKETCH
4 TA- S Show direction and distance in miles from at least
two State Roads or County Roads. Include dine road
numbers and common road names. o
N
O
16. REMARKS:
[fv �� 0 'p1, Ry Y i FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
' NSTRUn1_10i ANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
/I � �. 5 - / 0 — 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
----Submit the origina to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2709-i636 hone N. (919) 733-322I, within 30 days. GW-I REV. 07/2001
trFILE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 5i)-envlIS Jj-O/'QtA CERTIFICATI�ON# o1J%4
\\'E LL CONTRACTOR COMPANY NAMIC{S J 1JQ„v,r1 Wei II-l[ .��yt (' J PHONE #1�rj$( —5o2 L/-3 a.ej 6
STATE wELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ldfr-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: I
Nearest Town: Pik i}22'KL.t 'ci County AI t2 e.t )t
(p(fi) hC11 sN1/-eh.2<?-Orerrneadrrz,_t
(Scree: Name. Number, Community, Subdivision, Lot No., Zip Code) j— (y.-' E
3 OWNER: / C c{ iek
Address f t- a Q._ 131,x r QO SS
k-e_eT2r ) r. 3a�r
Ciry or Town 'State Lfr Zip Code
Area code- Phone number
DATE DRILLED 5 —47 —0-3
4
5. TOTAL DEPTH: /,Q(1'
6
7
(Street or Route No.)
13. GROUT: Depth
From n To r-iD Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
273390
Topographic/Land se'ng
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C / c(,c,
Jcc,-_ rl S
C V a'Yi 1
DEPTH
From To
0 1/v
Li()' S C)
Y7,.
DOES WELL REPLACE EXISTING WELL? YES ❑ NO m—
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 or casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): 6'FJ METHOD OF TEST I /OZUi71-11--,
10. WATER ZONES (depth): /1)0 i /2L? j /.S/J' 0
I I . DISINFECTION: Type {f fH Amount %A} 13 S
12. CASING: Wall Thickness
LOCATION SKETCH
Show direction and distance in miles from at leastgg:''
two State Roads or County Roads. Include rggp
Depth Diameter or Weight/Ft. Mate ial numbers and common road names. 2_
From To-->/D Ft. bit S-Z2p), f PIS v a,'*,
From To Ft. --m
From To Ft. N E5,-,
-r
Do
—1
2
m
cnz
Pi
Maternal
//11
Methcd
Slot Size Material
in.
in.
16.REMARKS'
a
O
CD
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
re.r0 `STf(rE;CTION , AND THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
;1 I III SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to RI
22_699-1636 Phone No. O9) 73
JP:
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-i REV. 07/2001

273388
WELL CONSTRUCTION RECORD
at • DIVI3:or. Of �r aie Q'll?lli'�! • CerO nd'ttr S6�(IOn
North Cazolina • D:gzrcnecl Of Enviroru�ent andN :i7; Res.°w3 s
WILL CONTRACTOR (INDIN1DtA.) 'AM' (p''::) James B. BrOWn CERTIFICATION y 2045
WELL CONTRACTOR COMPA-NY NAME Hedden Brothers Well Drillina, Inc.Inc. PP,ONE a 828369-9591
STATE WELL CONSTRUCTION PZR4(IT4 ASSOCIATED WQ PERMIT0(ifaoclicabte)
' (if 09CIICable)
I, WELL USE (Check Applicable Box): Residential 3 h:unicipal'Publio ❑ Industrial ❑ A_ri:ulr n
Monitoring 0 Recovery 0 Heat Purap Water Inje tier. 0 Other ❑ If Other, Lis: Use
2. WELL LOCATION;
Nearest Town. Almond co Macon
Macon
Needmore -new rr1 arrncc frnm f i rcs el ore -
(Senn: Name, N'vn'nn, Ccr.:....r,, S:hdldei-r, L : Nc., Zip Code)
3, OWNER: PO Larorg
Ad .ssBox 2233
(St -el: ar Rr::e No)
CiyceTcWnTe�SL- Zi; Cote
Q32B-34RR-16RB
Au code• Phone n'unber
4. DATE DRILLED 4-17-03
5. TOTAL DEPTH: 900'
6. DOES WELL RE?LACE EXISTING WELL? YES ❑ NO $k
7. STATIC WATER LEVEL Below Top of Casing: 875' P.T.
(Use "+" If Abort To of Cas:.g)
S. TO? OF CASING IS 2 FT. Above Land Surface*
'Top or em:ng terrntnend tt'or b,:ow lend sarfu re;':free e
verance In accardntce w::515A NCAC 2C ,OIt3. hi�Ct9
9, YIELD (Korn). 1 /2 METHOD OF TEST
10. WATER ZONES (depth). 850'
1I. DISINFECTION:Tspe FMi
12, CASING:
Ce
From 0 Top 59 Ft. 61'
From 59' To 63' Ft R"
From To °t
13. GROUT: D:pth
From 0 - To
From To Ft.
Nia!eria
p;,}rrite & L ,
A.rcy..„ 16oz
s...cess
cr cig t. rI.
1RR
14. SCREEN: Depth LY,a.;.e:er
FromTo Ft. 'In.
From To Ftin
15. SAND/GRAYEL PACK:
Dept Size
From ` To Ft.
From Tc Ft.
16 REMARKS'
Material
pvr
gfool
S;otSlr~ Material
in.
Mate:a
0
Tcpo phi: :,a::d stain;
❑Ridge ❑Slope ❑Valet' ❑Fiat
1-2.::":'ie.105;giride C1 well 1c:atii n
(Sean _hnnft.62Ytx.cnne)
Latlrad:.longitude Sasce:DG?SCLIT;F0;,at r •
(:Fleck tcx)
• pRrLLrNG r 04
Fre-; To Formation Des;rttticn
0 61clay & sand
granite
DE?TR
61' 900'
LOCATION SKETC
Sho w dL . and distance in miles from a: leas:
two Statt Reads er County Roads. Include the roof?)
numbers and common road names. �[
tV
Su�ralt the original to tha DIIon
2 7691sJt611!6,!;OPX1 .'.Y,ocK, 9)(;''v33.32311
PSHE.I.L E RECILiAt. HH•E
'ELL WAS CONSTR::CTED N ACCCRDAN'CS `i+iT• 15A NCAC IC, WELL
T•-ATr;Or' OFT:SRECORD HAS BEEN PROVIDED TOT^ 'BELLCWNEER
OF PERSON CONSTRUCTING ma WELL
sf Water Quality, Groundwater Section, 1636 Man Service Center • Raleigh, NC
within 30 days. GWI REV. 07/200i
a
0

273387
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 CERTIFICATION # 2047
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE it f 828 38 91
STATE WELL CONSTRUCTION PER.M1T# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential &k MunicipaUPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Frank] i n County Macon
125 Morgan Rd
(S reet Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Tony Morgan
Address 125 Morgan' .Rd
(Street or Route No.)
Franklin, NC 28734
City or Town State Zip Code
( 828)- 369-0182
Area code- Phone number
4. DATE DRILLED 5-3-03
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface•
'Top of cuing terminated a for below land surface requires a
variance In accordance with 1SA NCAC 2C.0118. blow
9. YIELD (gpm): 15 METHOD OF TEST
10. WATER ZONES (depth): 180'
11. DISINFECTION: Type H'Pf-T
12. CASING:
Depth
From 0 To 55' Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__ To 20 Ft. l-i rn'Fn &'-nin f- prpz 3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Matera!
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
DiazSi)fter
Amount 1 Firw
Wall Thickness
or Weight/Ft. Material
.188 steel
From To Ft.
From To Ft.
16 REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeslnioutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
0 53' clay & sand
53' 225' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roi d�
numbers and common road names. ea
—c
--C
fV
CD
LL
¢T7tiyr Pant STkN _ t, ANDilS w+ WELL
T COPY 0�' THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
• ATURE OF PERSON�2QNISTRUCTING THE WELL
DA
ubmlt the original to the
vis 4n of Water Qualty; Groundwater Sectlon,1636 Mail Service Center -Raleigh, NC
276 1d3rd'.R.6oh8 Nd.C(9I19) 733-3211, within 30 days.
ASI•'IF71.L1 REGIONAL OFFICE
GW-1 REV. 07/2001

273386
WELL CONSTRUCTION RECORD
• Nai'�lr:) Reso'waes • Dfvlil:n o1 Wair Quality • Cerou24'nt'.Zr, SectI0r,
l i:r �i Ca:Ji;IL eya, ��,t'.�C�.".lYifoflL'1.D12.1d �
WILL CONTRAC70R(IND1v1DL'AL) NAME (pant) '1'e'-ees B. Brown CERTirICATlONe 2045
WELL CONTRACTOR C0M?A.SY N'A.ti1E Hedoen Brothers Well Drilling, Inc. P?^v° # (28) 369-9591
STATE WELL CONSTRUCTION PZANIIT# ASSOCIATED WQ PERNIT#
f a:oliciatel acclicabie)
1. WELL USE (Cheek Applicable Box)'. Residential 8 M'a,icipa4?ublic ❑ lnd'ss i t3 A_-ica:^ynae. ❑
t'.cn 0 0the: ❑ If Other, h:onito^ng ❑ Recovery � Heat Pa:.p WaterIn;e-, Lis: Use
2. WELL LOCATION;
Nearest Town: Almond County Macon
Almond—acroeD rd from pnc* nffi na
($rt:N.r.e,NtI-:nn, Cern-.'::. tJ, Sd iA,io,'L. Na., Zip Code)
3. OWNER. Michael Ho]tnn
Add.•ess 4651 „Meadow cluh nr;vc
(S:rf or Roaa No.)
Snawanee• CA l0024
cif; of Taw't S to z:p cade
(828 )- 488—RCRR ornrk
Ana cede• Pone n':.r. cr
4. DATE DRILLED 4-23-03
5, TOTAL DEPTH: 600'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO Z
7. STATIC WATER LEVEL Below Tcp of Casing: 500 FT.
(On ! '• If Above To; of CuLrg)
S. T O? OF CASING IS 2 r a. Above Land Scsr ac:'
'Tap of cu!,./ lerrntraNd a:'or blow land rar!ace re;clre, a
•
varance In accordance whh 13A NCAC 2C 4113.
9. YIELD (gpm), 1 -5 METHOD OF TEST blcw
10. WATER ZONES(de^t:h): 470'
11. DISINFECTION: Tyre HIFi
12. CASING:
proms 0 Te 104 F;. 6
Fro7..14 Te 108 Ft. 6"
From. To Ft.
13. GROUT: D:pth
From 0 To 20
F•c-'1 To Ft.
l4. SCREEN: Dept`
From, To
Po— Tc_
15, SAND;GR.AVELPACK
Deovi
°rpm Te
F rcn Tc Ft.
�ti ait T-^c cess
cr Weigbt`Pl. Mate?:Ai
pvc
1RR Gtaa1
Material Me:: _d
Ft.k mite & cat pined
Dia:ne:er s:ct Size Mateaal
Ft
,,in.
16. REMARKS•
siz: . Mater:al
Topographic. ar.d se`i:g
❑ idge ❑Since ❑Valley ❑Flat
(che:k ar;:s7ri,a^ )u',
Lati%de , ❑g1 'de cf uric.; 1cca:ion
(ter.es-.i_uzi exon:.,)
L at:rdelcngi^ade so.ros;0G?S'0Tcpo;,aphic r.
(bz'a kcz)
pE?TF • PR!LLTNO LOG
From To Fo -,aticnDescr;cticn
0 106' clay & sand
106' 600' ` n=te
LOCATION SKTCF
Shc d re;tioe in miles r„a, a: leas:
t-xc. State Rc a-s o: Celt..`/ Reads. Include. ..,_ eca=
n.mbess a.'d common road names
0
Iglr
IV
brtlt the original to the Division
i99.163 Sihone No. (912) 73 -3221,
CRO'<bNCdh'ATER SE'.:1I0:J
AF•'r -LE r ` :I:iCE
L WAS CCNSTRUCTZD 1N ACCCR',# :CE W Th 13A NCAC 2C, W=LL
TEATACOreOF TH.:3RECORD HAS BEEN?ROViDED TOTHE WELL Oµ?,ER
.2-3 -6 y
AIJR!OFPERSONCOSSTRUC—trNGT: WELL DATE
of Water Quality, Groundwater Section, 1636 Nail Senate Center • Raleigh, NC
within 30 days, GW-i REV, 07/200i

274034
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) x IT)-en 1 5/--O /I () , A., CERTIFICATION it nit'
r
w ELL CONTRACTOR COMPANY NAMIi hnt i 1�' li(Z,I,tr4 Iiei J � tf, 11 ; u - n e l PHONE #i)S,-J o2 /-3 b2-6
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED NV ERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential 12---Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town_ �i /�� C County in Q EtSyiJ
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3- OWNER:C Q1/-1L afro
Address 17.-A7i- j (f 3
(Street or Routec')
1 > f / 7�
City or Town State/AZip Code
3Q,G_ 5rs.
Area code- Phone number
4. DATE DRILLED -
5. TOTAL DEPTH: Se C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
7. STATIC WATER LEVEL Below Top of Casing: 76' FT.
(52&763
Topogra and setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Co` (enr
3cr
(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. /
9. YIELD (gpm): VO METHOD OF TEST ZiO/Un2l
10- WATER ZONES (depth): 0275- ' (
I I. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From n
From
14. SCREEN.
From
From
%f f14 Amount ,2 Th- A S
Depth
To '6".72 Ft.
To Ft.
To Ft.
Depth
Tof7
To
Depth
To
To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Ft.
Wall Thickness
Dianteter or Weight/Ft. Mate 'al
Material
CQ47t 67
Ft.
Method
f)rn4�
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
0
CO
LOCATION SKETCH
Show direction and distance in miles from Zleast EC
two State Roads or County Roads. Include ttla roan
numbers and common road names.
v
w
DI A RI £TN A IOND q
R
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
LSubmit the original to tine Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
17.459945J,6-13hgnM:(3119) 733-_221, within 30 days. GW-I REV. 07/2001
;Idat. OFFICE
0

274033
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c/)I-e. ISI I-J-/) 1I(Ly\ CERTIFICATION q /7
\YELL CONTRACTOR COMPANY NAh1&I>111") I011Q41J l 1iellr1>Nt ll ;l[�r rt(%l PHONE Ny1r�1$).--5 Li-3 a e
STA'nE \YELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Y�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: M
NearestG
Town: / ' 4/Lr L,4' County Ci CCN
•
,1,4ce�;1.,e�KP-F242,e/z IZ,L-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER:
Address
1-EL.}
/S 0,9/Fro e i 72c1
(Street or Route No.)
F�.4ti'kL; 41 /1/(S73
City or Town State Zip Code
fl 7Z L/ 9 /9
rcA a code- Phone number
4. DATE DRILLED (o —0. 3
5. TOTAL DEPTH:-2(Dr9'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9- YIELD (gpm): ,S8 METHOD OF TEST /2/0.il%;74,4
10.WATER ZONES (depth): ,'/"J /%b/ 3/N/ (/
II. DISINFECTION: Type if�"F
12. CASING:
Depth
From 0 To 2/ Ft. .�R.Q1
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
>
From ()_ To ,9� Ft. e.Jn'yi @1 iQLvI/
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount ,-,Z TA- A S
Wall Thickness
Material
Pi
15. SAND/GRAVEL PACK:
Depth
From To
From To
Diappieter or Weight/R.
(n" S
Size Material
Ft.
Ft.
Topographi and setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(-/atiL
SLI 17/L:}Lys
Ye/2do,CL_,(rt-�
A7/ect_ �4ar' F
DEPTH
From To
U 4.3
r5'i
LOCATION SKETCH
Show direction and distance in miles from a fast
two State Roads or County Roads. Include tljoadE2
numbers and common road names.
C "r
16. REMARKS:
FE 17:p ORE;:, NER`)IFN[,�H4
i IgONSTRUCTION ST1NDA'�
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t.
IGNATUI2E OF PERSON CONSTRUCTING THE WELL
DATE
�} Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
033-3221, within 30 days. GW-1 REV. 07/2001

3. OWNER:C11)-e-1O res i SC_{1 et?
Addressf'
�(Sw1eet or Route No.)
T i a. iv I. r k) /c/c-
Ci�v or Town State
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Section / -
WELLCONTRACTOR(INDIVIDU.AL) NAME
(print)[/Ie nVli S I II �� CERTIFICATION # /7le
\\'ELL CONTRACTOR COMPANY NAMES. fln, � /do Ifrittri Wei I11Yt I I m n e l PHONE # mr��) —3;2 4 —3 Li ei
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
271037
1. WELL USE (Check Applicable Box): Residential Yd�Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 1f Other, List Use
WELL LOCATION: Topographic/Land setting
Nearest Town: 1 R,q,vk -t 4,/encounty /4& taw ❑Ridge ❑Valley ❑Flat
I (r'Z41C s C har%�es --eta sy 1-Y valop eny_ (check appropriate box)
(Street Name, Nwnbers, Comtnunity, Subdivision, Lof o.iG Zip Code) Latitude/longitude of well location
(degrees/minutes/seconds)
Li COQ (fh C. - �/) 41 I n o L'[ j.¢j.atitude/longitude source:❑GPS❑Topographic
(check box)
DRILLING LOG
Formation Description
Cr1'o.c.1,y
ar(k_9"zr e
vs wit 0it/
; t -C
Lce_ i�-vntE--
Zip Code
Area code- Phone number
4. DATE DRILLED 0'•; I— O3
5. TOTAL DEPTH: - "55O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ar.) FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`"fop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,7cs METHOD OF TEST A/(J2//1;7•.1.-
10. WATER ZONES (depth): /Q_i- (�
DEPTH
From To
CJ �3
5:9' IC '
fon' I:L�
11. DISINFECTION: Typc
-/-N Amount
12. CASING: Wall Thickness
Depth Diampseter or Weight/Ft. Mate ial
To Ft. (/,'` S.b(j.Q( pe �.
To Ft.
To Ft.
Depth Material Method N
To ri L' Ft. A(1J7 i Ppg (---)01LA—)
To Ft.
Depth Diameter Slot Size Material
From 0
From
From
13. GROUT:
From n
From
14. SCREEN:
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
in. in.
in. in.
Size Material
Ft.
Ft.
16. REMARKS:
t`F_h u,, +IR¢2mf8 W€iQTfCLilto the
S!'U7699W-O'61ihll"tti • 0
map
W
L
LOCATION SKETCH
G
,-1.-r/t 3 S Show direction and distance in miles from at Nast f
two State Roads or County Roads. Include the road 5 c
numbers and common road names
-o
w
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lox. fie(' s' ;29-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

274420
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL
TRACTOR (INDIVIDUAL) NAME
11(1,4
WELL CONTRACTOR COMPANY NAMK on; ct):���/�cmflOn1 IiJe ' ,611-u _ .4e v PHONE pia� CERTIFICATION Li— 3 aZ6
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WOPPERMIT0
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential l--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION),
Nearest Town: O�TU 4w County /4'[n
ai G(7-I2_--)
S ik c pe2/z Qc 441 S
(Sveei Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (9 6�rr Ca""O d f Yeci
Address /ln q (_i' r i a ,To e I)P-
(Street or Route No.)
Ihie Gam- 3no 97
ity or Town Stat Zip Code
n-�n- Sas'0
Area code- Phone number
4. DATE DRILLED S "0 7 - C 3
5. TOTAL DEPTH: 'W)S'
6. DOES WELL REPLACE EXISTING WELL? YES/❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (cc 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
(gg accordance with 15A,/CAC 2C OI8. `/u)� �
9. YIELD pm): � METHOD OF TEST h i
10. WATER ZONES (depth): qL5 z
11. DISINFECTION: Type H f-P
12. CASING:
Depth
From 0 To /y/ Ft.
From To / Ft.
From To Ft.
13. GROUT: Depth
From n To Ft.
From To Ft.
14. SCREEN: Depth
From To
Topographic/Land setting
DRidge ❑Slopey ❑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
fin' c' ia,I
;5-4
3 PPhu- 6- -vC1/»; t"�-
LOCATION SKETCH
Amount ,-2 T'4I j S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Mate al numbers and common road names.
lc," sa R j P (--
From To
15 SAND/GRAVEL PACK
Depth
From To Ft.
Material
e0 7t 07
Method
)(5MA—)
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From To Ft.
16.REMARKS:
Apo HEAthY[ E.
CONSTRUCT! NI
D>�
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND TH�AT A COPY OFTH S RECORD H(�S BEEN PROVIDED TO THE WELL OWNER
,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
t1-1i(rSteBritH-ehe rr,groal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
,71'14,2ASr E ` U r2cF'r'( �xii"d' o. (9 9) 733-3221, within 30 days. GW-I REV. 07/2001

274143
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) N ��[s (pri�nt))� 4702.4411C lea
�p Q CERTIFICATION 0.2 0 77
WELL CONTRACTOR COMPANY NAMEEy/ 44tLi l.e 1[GI.L11,,, as PHONE p gaga «9 o9fl
STATE WELL CONSTRUCTION PERMIT# 4 / fi ASSOCIATED WQ PERMIT# 2/1
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
NearesLTow • County %i%Q/fd r2
.23123y
(Street Name, Number, Cammumty. Subdivision, Lot No., Tap Code)
3. OWNER: /
Address 1 y — u� �p
.Zf-73y
ctinowit.. State Zip Code
Ara code- Pa number
4. DATE DRILLED ylnio3
5. TOTAL DEPTH: %/) S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g.
7. STATIC WATER. LEVEL Below Top of Casing:
(Use "4" if Above Top of Casing)
8. TOP OF CASING IS / 5 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In atcer ante with ISA NCAC 2C .0118.
9. YIELD (gpm). METHOD OF TEST 7741 c
10. WATER ZO depth): tD t
16. REMARKS
HSRF.tY d
CON8lEttet(IN. At 1
11. DISINFECTION: Type
12. CASING:
Diameter
From 0 TDo�y� Ft 6
From_ To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To_,,,Q_ Ft &flaa4
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topographic/Land setting
❑Ridge ASlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degeeshmimttes/sewods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1 c<
tT rIc
"O m�
ter. -
LOCATION SKETCH Wr",
Amount Show direction and distance in miles fronWt least
Wall Thickness two State Roads or County Roads. Inclode e rad
or Weight/Ft al numbers and common road names.
n
From To Ft.
Material
From To Ft.
A D
LI-A
AIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Li�15IGNa OFF .ti . 6'e WELL ATED13 to 3
Isuhmit the.tviginal ta.thk Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
;7659-163¢ Phohefri?I 733-3221, within 30 days. GW-1 REV. 07/2001
n,r .11 0 i'ICc

WELL CONSTRUCTION RECORD
275552
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Sectiony-t
WELL
le
WELL CONTRACTOR COACTOR MPANY NA N) AME. I�(prit't )` <Jim 11 �Ir� I��� I��(,)✓y\ � CERTIFICATION it tsr-//
hrl!' LYt a i{ 1.-n ('J PHONE #il-�1 —A502 y--3 o2.b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if a..licable)
(if a..licable)
1. WELL USE (Check Applicable Box): Residential ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Watch Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI0_1:
Nearest Town: 1-1(itl k 1, k Count)il (,(/y(
(k wee (aim m, L e& -h<'1° L 1-, h a_
(Street Name. Numbers, Community, Subdivision, Lot N r Zfp Code) a k
3. OWNER: \ (J)1a M. L-((4., �_..
Address /45-05- E/2
(Street or Route 0.)
lop /t C_ �2,5
riyQirn✓ 73V
City or own State c Zip Code ") e b 9— State_
Area code- Phone nwnber
4. DATE DRILLED Cr, --I -) 3
5. TOTAL DEPTH: .SAS
Topogra and setting
:Ridge 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
0 o) ? e Cc
a 2
tie/ Y
6. DOES WELL REPLACE EXISTING WELL': YES ❑ NO W-
7. STATIC WATER LEVEL Below Top ofCasine: v2.5-(i FT.
(Use "+" if Abe.c Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface rry wires a
variance in accordance with ISA NCAC 2C .0118. t
9. YIELD (gpm): 3 i7 METHOD OF TEST id/
10. WATER ZONES (depth): 0),5 1/ z
11. DISINFECTION: Type It t» T4I S
12. CASING: Wall Thickness
Depth ! Diaj�toter er A'."eight1> Mate ial
From O To 91 Ft. (� " SZ (? .°9 +
From To Ft.
From To Et.
13. GROUT: Depth: Material Method
l
From O To Ft. CO.tyt D2 fCC)'VV
From To Ft. /
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. Ill. in
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
QM1
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
01
16. REMARKS:
1136 EBX,CERTIFV THAT THI
tO,N$ RUCTION StA JDARDS A
L WAS Ct INSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AT A COI' ' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�I C'' tcSLA
/ r C Cut
RE OF PERSON CONSTRUCTING THE WELL
DATE
ubmi� the original to the Divisi n of Vter Qu:.lity, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
7699-163r�f1(yW[d`Ci�1ftIQT:7,j21, wit tin 30 dn� s. GW-1 REV. 07/2001
1 ' )r,L C FFI/1E
L

WELL CONSTRUCTION RECORD
275551
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)c-he 1111E 51 J-�-n IT)(jzy\�� CERTIFICATION #r�/740
WELL CONTRACTOR CO.\IPANY NAMEI.C'nn'S 7',j�'I(�)7ri Wei In Vr11711 .�. yt L' PHONE #�r7-�,r."r) 1-/-3026 /)
STATE WELL CONSTRUCTION PERMIT/1
ASSOCIATED W ERMIT#
(if anlicable) (if a..licable)
I, WELL USE (Check Applicable Box): Residential YJ�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIQN:
Nearest Town: IrQ4\ k 1 r ✓L 4'h County AI a (e).—)
44-I Sa R t To Aez-% I �S-73 (7/
(Street Name, Numbers, Community, Subdivision, Lot No., Zipp od
3. OWNER: r'•Ik2 S-e; f-ey
Address 553 Ma "/ Lee Prl
(Street or Route Nbrj
�'V7..n7ied/1_)
City or Town State
(a say— J/rQ7
Zip Cod/
Area code- Phone numbeff
4. DATE DRILLED (0 —1 1 — D 3
5. TOTAL DEPTH: c (7_.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ('c - FT.
(Use "+" if Abow 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 (gout): /(7 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑ ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well iocation
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Ve2.mr7 -e—
AI L<Ri C va.n t -e -
DEPTH
From To
(.3 (2_ 3
_ 7C
Ll 7
LOCATION SKETCH
I I. DISINFECTION: Type Al f"f-4 Anwun: r2 T1 ,i S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ,, Diampmeter or Weight:Ft. Material numbers and common road names.
From O To %6/ Ft. (2" 53.bw.2l PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material _ Method
From n To Ft. 09,471p}1 (MA—)
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:
CO
CO
CO
Cat
0
mt
C7
o_=
yc
rn
n
Cn
r
G
CQ)s$TRUGTION STANDARDS,
Submit the original to the Div ston
2769 16sd Ipne.ft ;I - 221,
,. iH°L
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PELSON CONSTRUCTING THE WELL DATE
f Water Qu.elity, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ithin 30 de) s. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
275550
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'7)I-(9 ni,215 I Jj \ CERTIFICATION # o�/7le
%VELL 11
CONTRACTOR COMPANY NAM& .nnlS'Y 14 I1leilaT)V`r n e I PHONE # _So2 Y-3 a-6 6
STATE WELL CONSTRUCTION PERMIT#
(if anlicable)
ASSOCIATED NV ERMIT#
(if a..licable)
1. WELL USE (Check Applicable Box): Residential tYMunieipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump \\ :der Injection ❑ Other ❑ If Other, List Use
2
WELL LOCATION:
Nearest Town: FP din fr County /1 Q-CCAtJ
(nyCt) (L)21)at %v Ttnh-e✓&a.L{u Rd_
(Street Nyn , Numbers, Community, Subdivision, Lot No.. Zip Code) Ql (77Jx
3. OWNER: PL%- , /It/ J,,c_LPea: d
Address / / j �—'// /Y)n % n S T •
(Street or Route No.) //c. rJc'!3
City or Town State Zip Code
BaZi- .3L,9— a9-90
Area code- Phone number,
4. DATE DRILLED (c - /1 o 3
5. TOTAL DEPTH: 1/'15
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): cc:,. METHOD OF TEST
10. WATER ZONES (depth):.
Topographic/Land setting
❑Ridge ❑a3Yop ❑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
ei 15 Glace
I S' 3.2' .SCz�-rgS fzn-e
3..' in' ve(Lpnt t�l-, t <
llrt }'Qg3 i2
LOCATION SKETCH
11. DISINFECTION. Type it 77-1. An.ount ..:2 %A- , S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dta eter or \';eigi:;.Pt. ntep� numbers and common road names.
From 0 To rye Ft. (n' S-(j i -1 ,'7 / I-' V
From To Ft.
From To Ft.
13. GROUT: Depth Material _ Method
From ( To rt9D Ft. e0'f 6r7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in. itt.
15. SAND/GRAVEL PACK:
Depth Size Matcriai
From To Ft.
From To Ft.
l6. REMARKS
Da.
O
r
Ql
..-1,1170 H LR):B Y CERTtFy Ti
VON STRUCTtON'STAN DARDri
<I
Sul}mit the original to tl
27649-i;60j IftwAtw-4`fb (aa9)EN
WELL WAS CrNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COL:" OF /TlH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER a/Ci- 'l I e-F 6-//-o3
ATURE OF PL!:SON CONSTRUCTING THE WELL DATE
ision of Water Qu:dity, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
(3221, within 30 da's. GW-I REV. 07/2001

WELL COiSTRUCTION RECORD 275270
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION e 2045
\\ELI. CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE#{ 828 369-9591
STATE \\'ELL CONSTRUCTION PERM lilt( ASSOCIATED P'Q PERMITS
(if applicable) (it -applicable)
1. WELL USE (Check Applicable Box): Residential O N lunicipaFPublic 0 Industrial ❑ Agricultural ❑
tAlonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Ocher ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. ETown: Frarklin County Macon
#55 Upper Peak's rrepk REi
{Sire:: Nnne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Gary Gunter
Address 2625 Toruga&_Iane
(Street or Route No.)
Ft. Lauderdale, FL 33312
Citv or Town State Zip Code
(954 )- 581-1 190
Area code- Phone number
4. DATE DRILLED 6-4-03
5, TOTAL DEPTH: 400'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO fc
7. STATIC WATER LEVEL Below Top ofCasine: 300 FT.
(Use "." if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011s.
9. YIELD (epm): 10 NIETHOD OF TEST blow
I , WATER ZONES (depth): 330'
I L DISINFECTION: Tvpe H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or AWeieht'Ft. Nlaterial
From 0 To 54 Ft. 6" pvc
From To Ft.
From To Ft.
13. GROUT: Depth tAlateriai Method
From 0 To 20 Ftberc ite & wiaaL p.xrFa1
From To Ft.
14. SCREEN:
From
From
Depth Diameter Slot Size Nlaterial
To FL in. in.
To Ft. in. in.
15.SAND,GRAVELPACK:
Depth
From To
From To
Ft.
Ft.
Size Nlaterial
Topographic Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check apprcpria:e box)
Latitude 'longitude of well location
(degrees'.r.ino:es seconds)
Latitud:longitude source:OGPSOTopographic map
(inn::k box)
DEPTH DRILLING LOG
From To Formation Description
0 52' clay & sand
52' 400' 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.
CC l Wd ofHnr£0
16. REMARKS:
Submit the original to t
1 ,, ou J.61L.Pl.,m:r" 4vT
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE PERSON CONSTRUCTING THE WELL DATE
e DiCs!on of \\ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733- 21, withi 1 GW-I REV. 07/2001
ir:.
0
c
ct.
rn
01)
O

275269
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 42045
WELL CONTRACTOR (INDIVIDUAL) NA9IE (print) James B. Brown
w ELL COSrRACTOR CO,IPANY \.UIE Hedden Brothers Well Drilling, Inc PHONE [phone]
STATE \\'ELL CO),S112CCTION PERNI1T5 ASSOCIATED WQ PERMIT=
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Otto County Macon
Coweeta Church Rd
(Street Nate, Numbers. Community, Subdivision, Lot No,. Zip Code)
3. 0\\'NER: Nate Pellem
Addrss 13136 Meergate Circle
(Street or Route No.)
Orlando, FL 32837
City or Toxn State Zip Code
407 )- 856-8145
Area coda Phone number
4. DATE DRILLED 6-2-03
5, TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing.: 175'FT.
(Use "—" if Above Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at'or below land surface requires a
variance in accordance with 15A NCAC2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 170'
I I. DISINFECTION: Type H T H Amount 16 02
12. CASING: R'all Thickness
Depth Diameter orANei^-ht.'Ft. Alateral
From 0 To 211 Ft. 6" 1 AR G7-PP1
From To Ft.
From To Ft.
13. GROUT: Depth :Material Method
Frorr, 0 To 20 Ftba-cnv-te & cema t Rnis7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridee ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude.'Iong.itude of well location
(degrees/minutes seconds)
Latitude'longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
1 0 9' clay & sand
19' 200' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cormnon road names.
CC :1 wd OC ?IN CO
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA ' ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pj
SIGNATURE OF PER,_ Q -�COPSTRCCTF?.4TIIC \VL I DATE
\I t I I:
Submit the original to the Division of 1A ater Qvallky, Groundwater Section 19 ail Service Center - Raleigh, NC
27699-1636 Phony No. [phone], within 30 tiers'-':
1
GW-I REV. 07/2001
c
c)
mcrs
m
G
ASHFVILLE REGI

WELL CONSTRUCTION RECORD
Na:.zlR....,.11 R',. cike'a _ C . ! }a
James B. Brown CERI!F:CA.IONt 204,5
R=LL CCVTRA CTC3 ('ND:�1D�'A!`'+'A. .
IH den Brothers Well Drillina, Inc.-;^•qC a 5291 309-9.591
PER 'M ASSOCIATE; PERv11TA
STATE YELL CONSTRUCTION' 1t:"
(if 2:911ea:'I C)
I WELL, i
USE (Check A;;Ii e Box): Residential 3 ti"' t.::i:aRL:Clio Ina:a'a)) ❑ A
' :2DI
Monitoring ❑ Re:overy 0 ..eat Pup Water In]t:: cr C1 0:,..r u i 0' , :.is: Liss
S. WELL LOCATION:
NearestTowT.: Franklin Cc'W,y Macon
Horseshoe Ridge Rd
Sv"..'irlr„'...^I Vn., 2,7.xr;
OWNER: Bill Sites
Address 10719 NW 234th Si-raat
E;Co4e
ar
Alachua, FL 32619
Ci-• <: Teo Suit
O• 467-2577
A.ro+ ea'e•
4, DATE DRILLED 5-20-03
5, TOTAL DEPTH.: 7n0'
6. DOES WELL REPLACE EXISTR <0 WELL? :ES G N0
7. STATIC WATER LEVEL B:tow Tc; cfCa5irg:100' ^r.
(Cn' 'If Above To; erCuis„
.. TO? OF CASING IS 2 : . Above Land S _.e'
'Top or coin{ to �!n aced a:o; 6'aW land $ , 4 re;arei a
variance la attor!aa:e rltt 1!A NCAC 1C.0113,
9, YIELD (g;'n): 50 M°TFOD OF TEST i
10. WATER ZONES (depth): 70' R 167'
11, D:SNcBCT10N: T; r:
CASFNC:
?o
Tc_
13 GROUT:
Fr..,.. 0 Tc 20
:m To
14, SCREEN: Depth
From To
275267
»ELL CC,NTRACTC.R CCY:?A.' Y NAME
rc 63 F:, 6
r't
•_: ❑
TcCC6:a .ic.tan'd sew::;
GRia,.ge ❑Sic: ❑.'a.' ❑Fis,
-e
LiaUruilelc
rg:-
Dr,TH
To-,aiicn ts:-, -.,
From.0 61 ' , & Ena
, '-tilt
i1; I7 r nc :LCE
61200'
w ^_'e
OCAT1CN 5KET,C_
A.:,.,. 16cz Sh.•A ...,...,.a ar,d dis r,._ ,.',les .,..r a: le-.,
R'a!I Tr.etess r 3:2:1 Rcas cr Cc.ir...__s.....,-.----
C irta::'.a, r.7:.e73 r,a s.
Steel •
Material Me::•.od
Ft.L .rite & Ca.a ar>d
Tflmete s:ct S:Le Ma- a
n.
From To
15. EASD:GR.AVEL ?ACX:
Depth Sit: Mat<di
Tc Ft.
To Ft.
16 REM.ARXS:
1 DC H Z?.5 Y CEP. ?Y A r TH:s w':1L WAS CCNSTRUCT' '1 A CC,ZANCE '1 A NCAC 2C v'.9:.1-
CONSin'UCTJO\ r ARDS, A.' D T.-:.AT A COPY OF Tr: R.L. C RD P:A3 N--Ra-Q'd,iS..,TQ WELL ELL C YER
l }�
SICNArJ.'CPPES-SCNCO> LCi: :CS WE L III DA
r .
.`A1
Submit the original tc the Dlvislon of Water Quallry, cacA sdwater StFlVga, 15;k6 Nail : Center • R'_elg. NC
:7599.1636 Phony Nat [phone], within 30 days, '( w
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VLLNLDEV ECIp4\F1. OLFif;E
pc�rGR`c'iLLE

275265
WELL CONSTRUCTION RECORD
N:,!ing.D;arU^r,•tC:.n,,'OM'dlte..9::Na`L'dlRe:..:..$•pl'v13
WILL CONTRACTOR (1CID11iDUAL)it AN! (rint) Jras B. Brown
-•ELL CONTRACTOR CO;:?Ae,": Lei A.erlE H de^. Brothers Well Dr'_ :iilc, 7:::. ? C`'D a 828) 369-9391
STATE I4ELL CONSTRUCTION PERI:(Ta A6$OCIATZ: WQ PERSMITi(if a::�i:ati:i
(if a;cli:a;,el
1 e' Q:?' 1 t7 . Cif":
C7RTi-'CATION o L0:45
WELL USE (Chesk ^Ilca•cle Ccx)' Re31deciial I$ N:':L'ici:a'cTLClic 1nd7St.al CS
v!C ."��" ❑ '�:..^�'! ❑ Heat ?l.ID; Water Inj: .. o. G;tCf 0
2. WELL LOCATION:
Nearest TC')C. Franklin- Cc_.
Corbin Rd Lot #14
�: �'., Z ; C.<•
(a'_'�.ettY�i'r. c, tip.:,:c.�i :.'� ��:�..�..�<,iYY�'f l'i .'
3 OWN R Bill & Cindy Nemeth
Ad;.:ess 612 Brooks _ane
(So-ec; :r Reu:e So,)
Birmingham, AL 35244
or Tour. 5'42 2.;CCGe
Q5 )•985-4566
Ara : 4c• Ph:ne na-hi:
4, DATE DRILLED 5-19-03
5 TOTAL DE?Tn: 200'
6 DOES WELL REPLACE EXISTTN•G WELL? ES -' NO Da
It. STATIC WATER LEVEL S:1:w Tc; of Casin;: 130 F ,
(cis ' l(Abose It; orCu:-.I,
7OF OF CASINO IS 2 FT; A'Ccve Lang
S.
•Te; orcu:niters a'ad a::r J,:.w land rarfau re; Irela
var.ance In aco:r:m:e wilb :SA "'CAC eC ,CIIL, tii •
9. YIELD (fin): 40 METHOD OF 'TEST
IC. WATER' ZONES (drt^): 126' & 136'
Macon
II, EC I3 ESE A.Tc'::,t lEa
CiSCN'F_ T,.,N': Ty;z
T'
12 CASING:F'i. ctess
D<;_, 18 'D Tr t: c: We,„t: M a ,. ated,,
0 i:. vc
Fr Tc 22' .188 steel
;.-m To Ft,
I3 OROUT: v, ). a'.:ria.' McL4od
F:cr. 0 Tc 20 F„mull: & tz,e.,. ^.I,[.e..
f I
14, SCREEN: D'e;th C a.- ScU e S.Material
7;c To Ft �In, i.
...
Fr0C1 Tc in;
IS. SA.NDTGRAYELPACK:
.Tie-.:; 5;z: . Ma:e-a.:
7rn ' Tc Ff.
FL
i—a1 ES
T cpc p C.:.atd
O'o'd-aa ❑J.: ':I
Wit' . I_:a: en
e ait`."
F,__ ?;r-alien Des:r',:;;:n
0� 20' cis &
20' 200'T--atte.
LOCATION .s'C.TCH
.�. .. ar.d tr. r'.:;,41.5 `ter` al I-^_,.
f;.c S. late Reads or CC'..yRca:i L.:.___.:...___
c_
w
I5. REMARKc.
' DC HEREBY C.RnFY THAT =.:5 w_..L WAS CCN!TR.,CrED ;1• A_CC? A..CE R_--:^f A AC 2C:_
CCNJI. JC.ON' ??
..OLDS, { .A Aco OF In,JPC:CCFD. HAS BEEN i.C_i1..EJ:JTin .Siz-eZ
S:GN.ATtaz ,_/o ?ERS:N
ScbrrJt the original to tha D;vlsloc of Water Qcality, G
17699.1635 Phone No. (919) 733.32:1, within 30 days,
ater Section, 1636 Mii Serf,
J
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..:zr •Raieg:„NC
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GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CO\STRUCTIO1 RECORD
C?ict.3 • Dtpr r', of ?'i �!ci.,T:^,i2_ >'irit1 tia.•;n•D ai.1 .rWarQ'.a }r n
CC;47RACCR(L4cIYi;,UAl),'`'A.'it Q'•n, Mitchell D. Cook CT7 i •'AT'^vA 2043
ELL CC!ITRACTOR Cp',1??..4Y,NAY.: Hen C'_"ot-hers_ V ''1 Dr4ll(r,7 _c(;g tl (?7=1:,:.wc.._
STATE WELL CCNSTRLC7:c.4'? RNIT! ASSCC!ATID F'Q PERNI74
(if ac:I :able" (if a,.<s:l:)-
•
WE' USE (Check Ap;licab;e.=:x): Reideclla; N.'':.nki-at !��'.us z 0
L:cr ng 0 - Re:cve 0 Eat ^ ^.Wa,.:1cj: ,..r. ❑ 0:hen 1
❑ r`O"' List Use
�
WELL :OCATION: •
Neara:Toa,a: Franklin CcuwMacon
next rd on R past Cherokee Ruby Mine
;Sc-e! h's-r N:,c;a,; � - S: elti' alc: t'ti: Z,p Cxa;
OWNBR, Carl Bates
A'_ as 16956 Hollow Tree Lane
(St. :. Rr Li he
Loxahatchee, FL 33470
(561 �. or 9Wr�� )98-6641
z;Cxe
Ara P.Itnt n:.:,k:
4, DATE DRU.' ED 5-12-03
5. TOTALDEFTh: 700'
E::0E5 WELL REPLACE EX15TrNO WELL? YES ❑ NO DE
7, STATIC WATER LEVEL. .s!,cw'cc; Ca2in3. 650 7,
✓ ie
S. TC? OF CASINO IS 2 FT. Abcve Lay- 5.rfa 7e'
T.1p a(eula; t rY7:(ra:f: a Vo::4:ow lam i r-ra:t ritanu
4e'1):ef IP lr:rdan:l wU", ISA 4'CAC SC AI I I.
YIELD (i'n); 3 rwOD OF
IC. ',r,:ATER ZONES (death): 365'
:2. CASINO;
To
F:. TC
Ts F,
Fail mk:cns
GROUT: Dr,.i Matsr;al a� d
e_�t
rr:-. 0, Tc 71 Ft, W�r trc s_'i rr''
F•: Tc F.,
:4, SCREEN: Dart i'Lc,eter 5:1: $�• •v, —
Fr., •, Tc _In, ri a1,;
..
n.
Fr nn Tc 14: ,,, In.
.15. SA..ND/GRAVEL PACK:
Ir.:.-.' ''' Tc Ti
Ff..., is F'
16• ti p A.R.;<S
CRdg: ❑SIk%e r'
“tric17,w:•>s7 :c.;
__.;.-de r.g; !de $c.... C(D'.... cj,a:
taYtC],
Derr. ;R'._INC LC"
F0 ' 54. c. .:5rth
icn
54' 700' cran ;,�
;0CATI0SIC=7C:
_..-'cireaic,^and:is:r-:ei:,,-,1!:;
S'z e R:ate .: Ccc
r..Tbe:s 2'..'�. :..,..: �..:ad n_T..•. .... �...
CO H?:iE3Y C3RTi?Y T =.AT h7 WZ ▪ WAS CO?'STA V'C-J .:N
ST?..ti __ A CCL+,.\'C z SAS A �.a_�SS, ?.ti7 is _4', ACO?Y 0 Sti,^,CR",,?c 3::A
r..
,N
S:eNA1- 3CF.EzCNw,
SvSn,'t tn. original to .the DRI:!cc of Watar QtiaUry, Q
159>•1535FhInaNa(3'15)132•32 1' -
�� thlr.39 days, .
tV
34
DATE
fCe • a eig`„ C
Owl : REV. C7I2:01
275264
0
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CO
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GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Dep.:runent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRA( I OIt (INDIVIDUAL) NAME (print) c.7).P n♦7t S I"�y} ) ' ACERTIFICATION # 0/-/740
WELL CONTRACTORCOMPANYNAN1& s (?m/I(arri �l)eiI�•fr II,c .).n el PHONE#�'2-V,.,Jo7. LI--3 a-6r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITq
(ifarolicable) (if a..licable)
275254
1. WELL USE Check Applicable Box): Residential Yd�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Rater Injection 0 Other 0 If Other, List Use
2. WELL LOCA.TI4 N
Nearest Tow:.: /} r GJ/'1 )& s County ,/ (Q .[per_
�iTahl2 �S (J /b(0 Siy<A� L#/
(Street amt. N hers. Community, Subdivision, Lot No., Zip Code)
3.OWNER:fa W r 1SBn—
Address _) q RprtrMe._ OZ- (.L ct
(Saco or Rbdfc No.)
h1Q41As NC agy`7y-1
City o 's. n State Zip Code
Crag ;34c9- O7cfb
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEI' f ii: 3 Q S
6- DOES WELL. REPLACE EXISTING WELL? YES ❑ NO W-
7. STATIC WATER LEVEL Below Top of Casing: 9O FT.
(Use "+" if Abo.e Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing mania-ated at/or below land surface requires a
variance in aaeudmwn with ISA NCAC 2C .01(8.
9. YIELD (gpm): 3 b METHOD OF TEST
10. WATER ZONES ((icpth):
I1. DISINFECTiDN: "I )'pc
12. CASING:
From 6 To ,.` / Ft.> � (
From i o Ft.
From To Ft.
13. GROUT: :Jape,
From (3 _ To Ft.
From lb Ft.
14. SCREEN: Wm`. Diameter
From l'o Ft. in.
From To Ft. in.
15. SAND/GRA\.EL PACK:
iJ_Dn.
From To
/7 Material
CJr1'N 47
From
Ft.
Ft.
TDpegraphic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
P4 A ./
11, t.'-��Ya m
r2 / r 20S'
t,
LOCATION SKETCH co
/% fN Amount TAWS S Show direction and distance in miles frornat least:-
two State Roads or County Roads. Incluthe rnad
numbers and common road names. w
0
Wall Thickness
Diameter or WeighlFt. M/�aterial
/n S %.� . /i Y �i
Method
GTUiO CO
tV
Slot Sizc Material
in.
in.
Size Material
r
cn .
r;
0
16.REMARKS:
Submit thhe Di
- . ,'n' - �
A Gn9LNCIE IONA GLI OOYI) t) 733
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

275253
WELL CONSTRUCTION RECORD
North Carolina l:)cnt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON -MACH UR (.' I)IVIDUAL) NAME (print) ;he 19 F11 S /—n On;,A C1 CERTIFICATION # oin
WELL CONTR.-ACIl1R C'')AIPANY N'APIK 110 vent -14 � )-nP ) PHONE a g-c6iS24-3 Li& 0
STATE \\'ELL CO Ne I lit C'I ION 1'ERI\I IT#
(Mar: Y.,it 2)
ASSOCIATED WQ'PERMIT#
(ifa..licable)
I. WELL USE rool. Applicable Box): Residcntiel ❑ Industrial 0 Agricultural 0
Monitoring ❑ 1<c. r;cry ❑ Ideal Pump VSlater Injection ❑ Other ❑ If Other, List Use
2. WELL LOC.-o
'
Nearest�Toy., . -�,(� Qnle rL)/(� County ,{ 1 a ((h.,.-
4( 7/ 5 T7 (T1C v(Y rSD)'- Ch(dLA.�L 7r� 0 Q �i /
(Saco Nan. P _s. ' bum :nwrny, Subdivision, Lo) No., Zip Code)
3. OWNER:__,,1✓_CIt)2_1,
Address L7���1���1����
Rcc c No )
—E P i p 11/ ("' i ss'7 3 j�
Ciry Or T Sate Zip Coda
(a ‘3 te%- aO c/
Asea rvee-Pho .. t
4. DATE DRILL. .9 Lo —.,Z 3— D J
Topographic setting
DRidge ape ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ninuteslseconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
S. TOTAL DE'
6 DOES WELL LEP.-:ACE EXISTING WELL" YES 0 NO GOY--
7- STATIC WA.1SI<:.EViiLBelow Top ofCasing: H-26 FT.
(Use "+" if Abo.o Top of Casing)
8. TOP OF CA`I AG :) / FT. Above Land Surface*
'Top of casing t.: ,tlor below land surface requires a
variance in uc.a.d.wc. .Kith I5A NCAC 2C .0118. i
9 YIELD (gpn, . 30 METHOD OFTEST %)/0)U171-!
10. WATER ZO":> (t: r;th;:n' c2a-/(J"- U
I I. DISINFECT'.._';:: -oe {%--}'» Amount %A -A 9
12. CASING: Wall Thickness
D donicler or Weight/Ft. Mate ial
From '0 -. eQ - F; /n" S-R f7'I PVC
Froth
From
13. GROUT' _pr. Material —
From r) y , ';5 FI- �Oct)2, br4i._
From
14. SCREEN,
From
From
15 SAND/GRAS ! .-.
Provo
Prom
16. REMARKS
Ft
CI"
Method
Diameter Slo', Sizc Material
m ut
Size Al Aerial
co FP
LOCATION SKETCH c -:
Show direction and distance in miles from atleastill)E2
two State Roads or County Roads. Include road.
numbers and common road names.
r
W
N
t5
Submit the urioi:a' tt rc
GE .. u1loN
APP'r`IRLI FIESNLIAL OFFICE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S„AND THAT A COPY OF TEES RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t— T e G— 2 3 -0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of AVoter Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 d:n s. GW-1 REV. 07/2001

2'75252
WELL CONSTRUCTION RECORD
North Carolina - Dcpa: unent of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTR:a CT OR (INDIVIDUAL) NAME (print) cii 11 i7151 f-�-nll(a,Au CERTIFICATION# �%%�
\YELLCON'fli:\CT ORC O;\IPAN'Y NANI LCIX. nni� IJfla.,nri 'N .)-11e ) PHONE#il-&i_Sa 14 —3 ab 6
STATE WELL CONS I'RCC'I ION PERMIT#
(ifaolicable)
ASSOCIATED WQ'pERMIT#
(if a..licable)
I. WELL USE (Check Applicable Box): Residential El----Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI ,N '/
Nearest Town: —/24 bki-; /t Count �YI CLC4OC_'
6,qf 7-7)2.-7l;J /Z.d._ SFr '
(Street Name. Numbers. Coo:m uty, Subdivision, Lot No., Zip Code)
3. OWNER:�7)-S f-7 rt "
Address /5k6 .5•nc eerS' l [ern Rd
(S.r ei ur �Ro/we No.)
ita-neJ; YU /V C-
City or Torn State Zip Code C)
Area code- Phone ;n::, da
4. DATE DRILLED to -ab-03
5. TOTAL DEPTH: x3O5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
To graphic/Land setting
idge ❑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 Tov Formation Description
re)
eLi
if P.v yn7 e It
I (ti
(oC /&
/0.Ci jaj.
—6e�2,I'E2C"
7. STATIC WATER LEVEL Below Top of Casing: of C9 FT.
(Use "+" if Abot c Top of Casing)
8. TOP OF CASING I / FT. Above Land Surface*
•Top of casing tet minved at/or below land surface requires a
variance in accordance trill! ISA NCAC 2C .0118.
9. YIELD (gpm): SP METHOD OFTEST /O79,
0. WATER"LONES(drmh): r�`"� �.SO' �751
11. DISINFECTION: !vpe Hf1 Amount ,-2TA
12. CASING:
From 0
From To Ft.
From
13. GROUT: Dcp:i.
From i) fo
From To
14. SCREEN: D;p:h
From To
From To
15. SAND/GRAVE!- PACK:
Depth
From To
From to
Ft.
Material
�D.ly 6y
Wall Thickness
Deice Diameter or Weight/O.
To/a/ Ft. h"
Ft.
Diameter
Ft. in.
Ft. in.
Mal to the Divi
IV 10.-hh4eStEiCT(ION) 733-3
Ft.
Ft.
Slot Size
dS
MateEial
Method
i
in.
Size Material
Material
O
LOCATION SKETCH co
Show direction and distance in miles from at lec?;t
two State Roads or County Roads. Include the -tad
numbers and common road names. -�
W
rV
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 dacs. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
P l,atb t at olilin - I lcl':ulnicnl nrlinvimnmenl and Natural Resources - Division of Wahl Quality - Groundwater Section C
'/._ F__. 3-0(vTNSCrnurIGT1oNp �7
nl I.rnA'IIt,\lInit (INDIVIDUAL) NAM r•. IPrinr) 6r3ii/J.►9jj.��� 1 rP yy Qt
\tIII t (ti''I It At Inn C(t\IPANP NAAII',__. n�G _I'1I11Nr. P ISr{r)S�(^(J
Y.I .\ I I. \\ 1-111. ( (INS I IlIt I ION 1'KINIIi# ASSOC IRI rP trt) rrltMl la
l ilopylicl)lc1 (il algdicable)
I \\ I I.I, I I';I' I (lheck Applicable Box): Residential L7 �% Municipal/Public 0 Indust; MI ❑ Agricultural ❑
N�niilol iu It i.l Rcnncry ❑ Ilcat Pump Water Injection I Olhct I7 If (llbcr- List 1. Ise
\cl I I.I t)(';\ I II )I'Jn
:tics( Imin /2 Jb e_lALS County Mr`i-COri
ju&t_u.SKA 12.4
Y tin ri N:m:a. Nam bom. 1,nnnnniny. Subdivision, I.ni No. Zip Ctvlc)
} (IAANI-Ft-Ltry-
\ilii,„„ .396 C ewe -iVea flR
itn° A14 . f L
l:, in I ) :ac Zip Cade
tea, _ 5a I 7`7 Yo_D
27523'7
Topogr:q\Ilic/Land selling
Ridge l_1SIolrc [Valley Dial
rhec( nppogniale box)
I itiludc.'longiludc of well location
( do rrecshn ini d es/seconds)
Lnliludc'longilude sourer:0(1l'SOTopngrapliic neap
(check hnl
I)lll'III DiItILLING_LOQ
nom ( 1n formation Description
G7 ' - )US (RA (� I remit
CO
g l I II' Of CASING I': / IT. Above Land SurIacc• C— n_.
c ' I,q, nl nvinp rtnninntrd slim brim,' laud 'Mime Winkel • `' -,
,I;unr In nrrord:mrr nllh ISA NUM' IL .nI IP 9
...
�n \ n l D In'pm) !Q. nm.rl lc 1 or 1 Is r_141✓Z ___ __ � ,_
In \c;\1I[R II)WI Slit-ptli) 1� f ._-- _?_-
1 OCAI ION SREICII -a
y v
Ch1_QRTNQ Amount -/QQ fP Show d;iccliiin and distance in miles [tonl,al Icttgr'
I I P;INI f( I II Tvp"
I I ,\`,IN, Wall lUickncss Iwo Sndc Road: or County Roads. Indudclhc I(P'
Weight/Ft Dumb(Im and counnnn road 11anics. r
IHitt',Uiaml� yylcr orll c6i ht/ft. hLdrlial
I „,m. (,)___ h).6) 1 P1.__62_YB°. S_b_Ez. ' Pvc
h 1111111t71111111lit, //��
,1 I IA I I'. DRILLED LQ — a'{_•O
5 I n' AI. I)EI 111: . ,.2(D_S'
DOTS \\'fl I. RI!I'1 ACT, EXISTING WELI 7 YES v N(',) Elf
7 SIAI IC WATER. l.l[\'I',LBelow Top orC'a.sing:
it Ise "1" if Above 'top oltacibpl
I inin _. I a
I Will _... 10 fl
I t liltOt.)I - I)cpll: /hlalciial
I 1:,ol__ G_. i n p�0_ _ :i._Lette!T
I ii,ui _ _ Itt _ _. 1-L__..__..------
I I 7.1 I iI:rJ- Ilpl1, Nimncler Slut time hlainhi'
I u,u1 I u 1 I._____ in. III _ ...I... _
11,un - l o.
I)4•plh Si7c kinkily!
111,m_
I inn 1u It.
l0 1P FIAP.f.S.
I' 1 1(0ir)llll�)II`i'IIiEF,ll
-.J.I --t tmttYETS—T1f1TSTA II
,'- -
);;;
A lethud
O
AI 1111SVVIiI, WAS CONS Iflt ICI TI) IN ACCDIIDANCI WI III ISA NCA(- 2C, WELL
IDS, ANI))1A1A COPY 4)p'I I IIS RECORD) IIAS BEEN I'I(()VIDPI) 101l IL WELL OWNER
G-2v-o 3
I(iNAl'tli OF NASD MILT ING'I I III \\'liI.I,
to Iln•II)i%islon of \Valet Quality, Grmmdn
2-ha't 1616 phony Nilol'I)btI1221,nilldu111(la)t.
DAC li
ler Section, 1(; 6 Alall Scn Ice Critter-l(nl(•Igh, N('
(iW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division l of Water Quality - Groundwater Section
‘YELL CONTRACTOR (INDIVIDUAL) NAME (print) c 1T), HM1 5 I�'1OM l+� CERTIFICATION #o`I7`/
to
"ELL CONTRACTOR COMPANY NANIK 41120 i ( j.0ggr4 (iE' (I l rx ]� YL C J PHONE #?esi_."//) 02 L/-3 6
STATE WELL CONSTRUCTION FERMIT# ASSOCIATED W(j'PERMIT#
(if applicably) (if applicable)
274825
WELL USE (Check Applicable Box): Residential EYMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: �/ nn
Nearest Town: d l/O ��� County ty) t/
/Lt / % 1.p 0 - e4s- e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) (0/y/M •
3- OWNER: r C-(� Ck-�-& �7,1./j1/ l ✓V
Address 5 Si L4fc /,D7-e(Z2_
(Street or Route No.)
�a e /Qnd $.-3n
ON or Town State Zip Code
F�2 3lc 9. 3 o Pr'D
Area code- Phone number
4. DATE DRILLED ) - I - 63
5. TOTAL DEPTH: /7S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ©—'
7. STATIC WATER LEVEL Below Top of Casing: //7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): _,Sb METHOD OF TEST
10. WATER ZONES (depth): 9f ' 8)S'
Topographic/Land setting
BFGdge ❑Slope ❑Valley ('
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DRILLING LOG
To Formation Description
DEPTH
From
n 9L
LOCATION SKETCH o -
I I. DISINFECTION: Type /t f-6 Amount T,4, S Show direction and distance in miles from leasr?.w
12. CASING: Wall Thickness two State Roads or County Roads. Includee road'`
Depth Diameter or Weight/Ft. Material numbers and common road names. _ otc
From 0 To ,3 Ft. /� ` S1� R .� j �� o
From To Ft. aMI
From To Ft.G
_ fin;
13. GROUT: Depth Material Method rM
cm 7.7
From n To r Ft. apUyt 6) rey,A,0 - -n-t
From To Ft. CO o
Material
14. SCREEN: Depth
Frorn To
From To
15. SAND/GRAVEL PACK:
Depth S
From To Ft.
From To Ft.
Diameter Slot Size
Ft. in.
Ft. in.
I R
u
I DO HEREBY CERTIF."'
CONSTRUCTION STAIIF
J
AFHESglabb1R Ihuorigmail !tttthe division of Water Qualitt, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
in.
ze Material
)T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT l �A COPY OF THIS RECORD HAS/\��BEEN PROVIDED TO THE WELL OWNER G tN(.(r� oZ( /-S- '- _ 6-3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

274824
WELL C(.INSTRUCTION RECORD
North Carolina Department of Environment and idatut' I Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print). (- ji FI s / Nary\ A, CERTIFICATION # d-/7le
1x ELL CONTRACTOR COMPANY :NAMKITA'=A ,s P Lt,2yya'� Ii)ei}1)'ir 11 ata .]-.riPJ PHONE#iiaSO? 4-3��i
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if a plicable)
I. WELL USE (Check Applicable Box): Residen_ial YY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump \V,..,r injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Ny arest Town: ii:/Q qqqqqq jPL. l /j/ Count , Q (qy( )
Lie9-I.LI rc� in-PymaLc
(Street Name, Numbers, Community,, Subdivision, Lot No. Zip Code)
`/ 3. OWNER: /7 (1_ U / CVI' C it
Address)
7I q 613 '// 077-
l IeaEaia_i mzrorRoji_' Iute o
%337,k3
City or Town State Zip Code
(12. E7 '7aS- (523ni
Area code- Phone number /
4. DATE DRILLED _h --0
5.TOTAL DEPTH: 3E)
6. DOES WELL REPLACE EXISTING WELL? iLlS ❑ NO
7. STATIC WATER LEVEL Below Top of Casii C-
aton ha" ifAbo:.. fop oferesingl
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated utlor below land surface c , .trey a
variance in accordance with ISA NCAC 2C .0119. i
9. YIELD Capin): 4' 6.-.) METHOD OF TES ` -' l'1lidirt
10. WATER ZONES (depth): / ,D �2r 0 ` ,��21)t '
LOCATION SKETCH
Arm. ant ,_ )j,- R 5 Show direction and distance in miles from at least
12. CASING: Wall . two State Roads or County Roads. Include( ro:uf
Depth Diameter or V. ;iglibei. Material numbers and common road names.From 0 To / Ft . A/� Sfre1
From.;1 /' SAR21 P✓ L
From
Topographic/ L_an d t i n g
❑Ridge ❑Slope }Galley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C / (2.r/q
(
DEPTH
From To
'77' fag`
)l>'
QI
FT.
11. DISINFECTION: Type H f»
13.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
GROUT:
FIGM O
To /n,s' Ft.
To Ft.
Depth To . Z^vl Ft.
From To FC
From
rI
ASr476V 99IC3''Wl'., �F
\ ..K
r 1 FBY' c
CONSTRUCTION S f ANT'
ate Mrial
Diameter
Ft.
Ft.
Ft.
Ft.
Size
Slott
Method )
Material
THIS WELL WAS C t Tfio IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COP' I I r 3 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v 1 1 'L, C' ((ate„
SIGNATURE OF I'r,!:.add CONSTRUCTING THE WELL DATE
Fli-bpiii1t Ella(-ukio fi(yldu the D vision of Water Quai.t), Groundwater Section, 1636 Mail Service Center- Raleigh, NC
P71 within 30 cIa) i GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
274107
North Carolina - Department of Environment and Ttura(l�Resources - Division of Water Quality - Groundwater Section
WELL CO.N'fl(turoR (INDIVIDUAL) NAME (print) ( Pr41-r e CERTIFICATIONpeIO�23 (7
VA' ELI. COAT RACroR COMPANY N AME /A6�1_ V )S I�PU ��rhk l/t./1y, In(_ PHONE # (O.(0).S;27-7.c�6
STATE \\'ELI, CONSTRUCTION PER\IIT# ASSOCIATED VVQ PER\IIT#
(irapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential-8 Municipal/Public ❑ Industrial 0 Agricultural 0
Nlonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. N ELL LOCATION:
Nearest Town: Fein k/;N
Ott//a�tv C�Of
(Suer Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: :Thrya JjOL�P_1/
Address 130 h'oX /
(Street or Route No.)
f - ant, 4-,✓ NL
County )')'itic 2),u
City or Town State Zip Code
( )-
(Vm code- Phone number
4. DATE DRILLED 4/-01/- 0 -4)
5. TOTAL DEPTH: 5.3D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing VC) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD (gpm): S METHOD OF TEST 9�Y
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 70 FL l 791/2L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .2 D Ft. Cz ,--
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 .fo 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.
v
G
16. REMARKS:
Submit the ie o Huh
k9f NisK,PYion$4'Gt6
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY O _ ! _ -' � t ' '� ED TO THE WELL OWNER
SIGNATURE OF PE
e Div sion of Water Qua
733- 221, within 30 day
ONSTRUCTING THE WEL
rou¢Idvitter SectioP:I636\t all
GROW .�)1:'r:i.`r.. SEC�iON
ASHEVILLE f/FGI::J;{AL rQ-RCE
DATE
crvice Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturala�-ur�Resources - Division of Water Quality - Groundwater Section
WELT. CONTRACTOR (INDIVIDUAL) NAME (print) /*Ted (/AW CERTIFICATION t6 ?Z)77
WELL COWER:\CI OIRCON11'ANY NAME crib e s-/c/25 �2/1/4r0&i/ll_,fi! d_- PHONE # j'VyT sse
STATE WELL CONSTRUCTION I'ERVIIT# ASSOCIATED N'Q PER)IIT#
Of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentialk7 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATInO, 1
Nearest Tow. / 7Y't7 AA-7/ County �/�/1/eYCci
UIDAJ,Sr46,av P64-4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Coda)
3. OWNER:
Address 357 //,Lyj ,a
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ,�—-0
5. TOTAL DEPTH: (p C6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: y6 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 (pm): / 0 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5`Z) — lG' 6`0
II. DISINFECTION. Type Amount
12. CASING: Wall Thickness
Depth Diame»cr or Weight/Ft. Material
Front O To VO Ft. (i 77 lio
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 02 O Ft.�'- 7e1 -/ 0 v,/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from t leas
two State Roads or County Roads. Include rode
numbers and common road names. ='m
to
0
N
16. REMARKS:
THIS WELL WAS CONSTRI
AND THAT A COPY OF
274706
CTEDJN ACCORDANCE WITH I5A NCAC 2C, WELL
TOPP, Hpg B�E�RQ/I[>'=6\ LO THE WELL VVN�R�
l�lr�r Th
DATE
TRUCTING THE WELL
JUN 13 2003
Submit it the original to t� a Dii ision of Water Quality, Groin (lbater Section, 1636 Ma
'74?) ((�16.1'f�o �, it,.ctri1 )) 733 3221, n ithin 30 days.
GRJ��nJ..�.: AiE I '
c _r OFFICE
SIGNATURE OF PERSON
0
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
-"Sect]
ce Center - Raleigh, NC
GW-I REV. 07/2001

272T96
WELL CONSTRUCTION RECORD
� .2e:Ot17::S • 17 .'S 9 0I WaIt Q'ual'r! Crcucd' 11:r Se;l Jn
NorCl C2:Jltr2.17LC?ftTilent OrEn' fOfu��e"�t ^u�^� h:� 1.2i
WELL CONTRACTOR (INDIIIDUAL) NAY" (pr,r Mitchell D. Cook CERTIFICATION It 2043
WELL CONTRACTORC0M?ANY NAY:: Heiden Brothers Wall D'd1, 'ng, Trr'
STATE WELL CONSTRUCTION PERNIT4 ASSOCIATZ: WQ PEAN1Ta
(if abolkable) (if zcellctaa
? o:v'r x 191211 +9-c5o,
I. WELL USE (Che:k Applioabk 3ox): Residen:ial?u MunJcipat?ub!ic ❑ -• Industrial CI Agri::v:1%n.! ❑
3,1cnitcring 0 - Recover, L1 Heat Purr.; Water Inio:rich ❑ Olher ❑ .If Other, Lis; Us:
2, WELL LOCATION
Nearest Town: Franklin Cca.-r,, Macon
Depot Street •
(Sent NLT:, N':,zden, Cemmc^iey, 5:'t d;;1alcr. [a. N:., Z.p Cate)
3. OWNER. Nantahala Hardwood Company
Adr"•ess PO Pox 1149
(5t-et or Reno No,)
Franklin; NC 28734
cr Town State. Zip C:d:
(828)• 369-126R-Jarry mean contact
Arta co. P::M ncim:.er
4. DATE DRILLED 3-19-03
5. TOTAL DEPTH.. - 600'
6; DOES WELL REPLACE, EXISTING WELL? YES a NO
• 7, STATIC WATER LEVEL Below Top of Casing: 95 FT
To; of Ciith;) •
8. TO? OF CASINO IS 2 FT. Above Land Surface*
• 'Top creufng trm!ralod e.or bo!ow land rur,'ace roq•dr,, a
vartence In s:ar.an:e with ISA NCAC 2C .011S, hr�
9, YIELD (vm)i 50 METHOD OF TEST
10, WATER ZONES (depth): 165'
11, DISINFECTION: Tyre
12, CASING:
Drr'',
Fr-- 0 Tc • 50
From To
F- m To
H1-H Anc Wit 16cz
Wail T}:::cress
DigTe c
Fr or W.1 '$'t.
F t.
• 13. GROUT.. Dgth
Frm 0. Te 20
From To
14, SCREEN; Depth
From To
From To •
IA SA.ND/GRAVEL PACK:
' Dept;,
Frcri To Ft.
steel
Material Me:hce
Ft barite R crBlt prrel
Ft
Dia.ze:er Sic; Size Matta'.
Ft _I1 In.
Ft.i, -
S!u . Material
From To F'
Toper:cap'aic/land setizg
r•0Ridge ❑Sicpe GVailey' ❑Fla;
(:he« err:peiete E•x)
..».,.',;de, le ngir�d.• cf Well Icoat'A,^.
(dey:.:ar. ouUaeronOs)
La'ird'_elcni-rode soldce 00?SCTcpoa,a7lti: rrap
(o;.<e'x boo)
DEFT_ DRILLING LOG
Fr0.^ To For.-2 tier. Des,Hption
.,
0 48' cav & �>3
48' 600' 4 acte
y0CAT10N S <YTC
Shaw direction and dire:e in mtl:s from at leas:
hap State Roads or Ccu.' Reads. Include the rcad
„Umbers a-.d cocr.,on road names,
16. REMARXS;
I CO H=RZS'.Y CERTIFY i r_AT T•r:IS WELL WAS CONSTRI-CTED N ACCCPDANC? ?(IT:: 1 SA NCAC :C, WELL
CONSTRUCT ION STANDARD S, ANDTHATiT A CO?Y OF T•rii ���"_ •
... ..N OVIDED TO TF2 WELL CWNCR
•
SIGNATURE OF PERSON CO
Submit the original to The Division of Water Quality, Gr
37699.1636 Phone No, (319)7314321, within 30 days,
GTiNG T Wzir--�:
dLater Ssotloa, 1636MIN Send'
/os
ATE
•
-ter • Raleigh, NC
W.1 REV,07/2001
—o
Cs
W

272795
WELL CONSTRUCTION RECORD
Ncr, C3 91,f2.117'"zrQn'e"t or Enyftcmueilt L'12 Na:ui:! RZ > 1:5.17 is!;ri of Water Q.a ri C udd'da: r 5e;t cn
Vats:.COYTRACrOR(INDIVIDUAL) NAME (prtrtt Mitchell. D. Cook CERTIFICATION' It 2043
WELL CONTRACTOR Co:N?ANY NAME Hedden Brothers 47=11 Dr; 114 rg, Tnr ?-CASE a rR2s4126q—eSc,
STATE WELL CONSTRUCT:OS?ER r4 AS'OC'ATZD WQ PZRMITe
(if abviieabie) (if a. licebi:)
1. WELL 'USE (Check Applicable Box), ResideNia' Mui cipa: =ubfi; C Ind2stial G Ay-:st:In: at ❑
Monitoring 0 Re;:very ❑ Heat Pump Water Injection ❑ Oth:r ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town: Highlands
Court+ Macon
Skyline Drive
C:nn:_.:y, Za: dlYs!en, L.-: Ne., Z.p Coe)
3, 0'V ER: Klaus Mehlhorn
Add.Jess 5224 Neff Lake Rd
(St -se: et Rc.0 No,)
Brooksville, FL 34601
CIy :: Town Sac Zip Cod:
352• 796-0568
axe, ?hang aunSer
4, DATE DRILLED 4-17-03
3. TOTAL DEPTH: 500' 6: DOES WELL REPLACE EXISTING WELL? YES 0 NO $!c
7. STATIC WATER LEVEL Below Tcp of Casing: 400 FT
(List I(A6cv: Top cf CuL';)
S. T0? OF CASING IS 2 F T, Above Land S:dacc'
'Top cfeulne tr.r!na:eel *Van beow lard surface e' l=aa
variance In accordance wt h UA NCAC 2C .CI13, 9, YIELD(gpm): 5 M°TI-'0DOFTEST h1 7.
10, WATERZOi'=S (^epth): 80& 380'
11, DISINFECTION: Tyre EtH
12, CASING:
Dc _^
Fr^— 0 To 36 F'
Frr. 36' To 40it
A.:,ort 16:
Wail Ttcicuss
Tr Te'e: orWs3:2:7. Ma:trta1
6' .188 steel
From. To F'
13, GROUT: Dept: Material • • `!e_' .eel
Frrn_Q_ Tc 71 Ft elite & ns.ant 2trm9
From To Ft.
14, SCREEN': Depth Dfa.;,eter
From To In
From Tc Ft, in
15, SANDIGRAYEL PACK:
DrL`. Slu . Matena:.
From To Ft.
Fr:m Tc F.
Sic: Size Mauna!
In
Taco platc La:d seta.;
0Ridge ❑Slope ❑Valley ❑Fist
Latir:de.;cngir,:de clue;l location
(decute ri.J_:ex.nde)
La:.r:de.'longinsde sourc.'7_70PSJTope ap is ,
(o;,a'< Scz)
)]EF • DRILLING LOG
From To Formation Deso
0 38' clay &
38' 500'
J,0CAT10N S K.ETC?
S;. direction an'_ disk:e in miles `r .,, at ,east
hxio State Roasts cr Count; Roads. Include the road
„_-hers and co, on road names,
• 16. REMARKS:
1 DC MEREEY CERTIFY e KAT THIS W?LL WAS CONS TR:'C'i ZD l`,' ACCOR^ANC= `•I -: I!A NCAC 2C, WELL
CONSTRUCT ON STAND A.n5, A.'W T.-AT A COPY OF T'1iS f CC RD F'_AS BEEN P30ViDED TOT-c: WE',)— OWNER
SIcNATUR?. o? PE. ,O'S' 4ii'N'GLlr-. WE» DA
II ; •c
Submit the original to -the Division of Water Qua Ikv, Qrouodwate; Section, 1636 hIfg15 nit. Cecter -Raleigh, NC
176994636 Phone No, (919) 7334221, within 30 day ,u t Lt: • L/ GWd1 R.F.Y. 07i2C01
0
Ca)
1
CO
.D
3
W
U
ca
cs,
oc_
Do
—4,
rno
,urn
cnz
m73
0
z
4TER SECTION
'ITEI:C ;P r-I-iDE

272713
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section
v5'ELL CONTRACTOR (INDIVIDUAL) NA(print) (print) 51)-efI vl) 5 I-(-/) / )Q , CERTIFICATION 1/ 4 /7 �
55'ELL CONTRACTOR COMPANY NAMKI.f✓nnt S `1�jl1 CTnr7 I1)e0{Ill-u ,) -ne PHONE si'a%11.5;24-3;246
STATE WELL CONSTRUCTION PERMIT)/ ASSOCIATED WIRERMIT8
(if applicable) (if applicable)
I
WELL USE (Check Applicable Box): Residential & %i icipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:N
Nearest Town: PA !�-idec; g,7'L County /14aC Lr4?? %
Liz." 4Li-LS Lart o7—mrjS/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3- OWNER: en VD lIks_ /t.�q.n
Address S/ ' Ll a`,La S. f-1
(Street or Route No.)
OYla eau 1= i v 5? 6 97
City or Town State Zip Code
(967- -5- — 3,2 3 5
Area code- Phone number i,''//
4. DATE DRILLED 7-- 2—/>
5. TOTAL DEPTH: 305`
TopovaBbierLand setting
❑Ridge L'dslope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a 44r C/a -Li)
,f7' e31-,.5' !'s/G/� 6-rd-..)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
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 wit I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): /57' .�
1 I. DISINFECTION: Type
12. CASING:
Depth r1
From 0 To O / Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r-(7 Ft.
From To Ft.
Amount
Wall Thickness
LOCATION SKETCH
7',4,3 S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Diameter or Weight/Ft. MMatep� m numbers and common road names
Material
ep4, bat
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method `
Slot Size Material
in.
in.
From To Ft.
a
3
Carl
CO
16. REMARKS:
C R frY'�'HF
16JSI`�N DrZR
SuHmit- the -aciginaLto th_ejDivis
27699-1636 Phone No. (910) 733-3:
IS 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
en
NATURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2I, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcels-- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t�.2 n n 1 511 /ill I TkL-A rU CERTIFICATION # `oc-17 (e
xx' ELL CONTRACTOR COMPANY NAMISIX.II)jiS'C'o112.ytri ftiei1.tl�t l�:lf Q�( ,�. YL e I PHONE # ��)�,Jd /-3 a6 U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable) (if applicable)
272712
2
WELL USE (Check Applicable Box): Residential & 1 ii icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
WELL LOCATIOI`I:
Nearest Town: iCA)i}J//2_1. /1./'I/(7County
CotV/C)hv Lpy,,hae/ — f`7ci4' .4s P
(Street Name. Numbers, Community, Su division, Lot No., Zip Code
/05
3. OWNER: M�Y� /..,J roo �" s
Address 5" ' j /y2 S ecq
// (Street or Route No. J �?
4%r1 ��n3 1/C d 7-3 y
City or Town State Zip Code
cie 5;2V—'/(.5a./
Area code- Phone number
4. DATE DRILLED 4 —
5. TOTAL DEPTH: 4-S5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: o2T FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): c METHOD OF TEST �0)/Ji7Ll_f
10 WATER ZONES (depth): /fvC'` (1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ef'lat
Co M rt` v (check appropriate box)
n: mS Lai] Latitude/longitude of well location
L2,L e--
11. DISINFECTION: Type "HIP
12. CASING:
Depth
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth /�M,.,aterial Method
From () To Ft. 02A71,.%7• ((7T V� r
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.
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
s5as%,,12--
ei 7 ) ' ye'? vr. d,a,..P i f -0--
i{3 l L.L. q. Yn
LOCATION SKETCH
Amount c.T4 S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
16.REMARKS:
Dia eter or Weight/Ft. Material numbers and common road names.
" SCR �/ P/0-
O
O
�=
0m
CC
cm
z_
z rn
>8c
rn
m- a
cnz
C0J-4
G
INJ N 6 L: V
1-= I 6?) HEREBY dER
CONSTRUCTION STAR
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ali tQ_
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
L
Submit t1teoefdin31110 the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699 1636 Phone No. (4i91�3-322l, within 30 days. GW-1 REV. 07/2001

Li
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t7)-9 n Vll S /-)-n /l arA fs.
CERTIFICATION # oZ l% iP
WELL CONTRACTOR COMPANY NAM& �/ `
PHONE # }r iSl .- c2 4-3 o2.-6 Ci
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential f-"Municipal/Public ❑ Industrial ❑ Agricultural 0
:Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATEgN l/
Nearest Town:.r/�.A1 kL,,47(-County /M/ ((,L.007v
g& tnv E g73U
(Sven Name. Numbers, Community, Subdivision, Lot No., Zip Code) /
3 OWNER: !i✓. I"1Hil6YtA
Address /60 i%.e'a C.oftr_P (-'?) Y-e-
(Street or Route No.)
FQOI l (? Inv A/C-- % 3 Z/
City or Town State,_Zip Code
(3 3it- 9— c7,37
Area code- Phone number
4. DATE DRILLED 5 -I —05
5.. TOTAL DEPTH: _? 06'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ?C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated aUor below land surface requires a
variance in accordance with I5A NCAC 2C.0118. / //
9. YIELD (gpm): .� i) METHOD OF TEST MY/
10. WATER ZONES (depth): c2Lf S r
11. DISINFECTION: Type
12_ CASING:
DEPTH
From To
f7 --57)
,p 1)S
r7c lad
cil�l 31DS
272697
Topographic/Land setting
:Ridge ❑Slope ❑Valley eFlai
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C' I Q'c.-%
ez-nck 3
((rJ 1e n. n-n i z/�t
,t)1ft.� lY"(Q; ', / C
LOCATION SKETCH
r Amount %A-,t; S Show direction and distance in miles from at least
Depth Diameter
From 0 To 1 a Ft. (n"
From To Ft.
From To Ft.
I . GROUT: Depth Material
From n To ,---P-(7 Ft. n'.r12 Der z
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
• L.C5( - SfreW
It
From
From
Depth
To Ft.
To Ft.
i 'ER€6Y£ERT -T
CONSTRUCTION STAND
e bi-Idit a{ku
il
(thDiv
37b957mtc-
6 Phrici-ty{_ 7-3-3
Method
Slot Size Material
in.
in.
Size Material
tri
07
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
arlkk e .51/—n3
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

273049
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
wELL CONTRACTOR (INDIVIDUAL) NAME (print) x l /-e. f / S l-17, 1I an'N CERTIFICATION # oZ/7 40
w'ELL CONTRACTOR COMPANY NAMK ha, (D ei l416 I I .I . n f .1 PHONE # ni.-5-z2 4--3 .;;Z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I WELL USE (Check Applicable Box): ResidentialCE--Municipal/Public 0 Industrial ❑ Agricultural ❑
2
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: .SC QIc-9M�' County 1. ZOl'L-
H1G-la/-Ak-b C---1- S'h<l, e &EH jerl-•
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Codey
3 OWNER: f(t.c.4LT {—i 5)1 (7
Address // S (1 Q r4 (a I e. D
(Street or Rout o.)
P fer8cue. r
City or Town State Zip Code
rjt?tl )- 911 - jr 11/7
A rea code- Phone number
4. DATE DRILLED 5 -.Q --D
5. TOTAL DEPTH: LAC
To graphic/Land setting
edge ❑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
C-A ,
S Q.-h o4 C/74-4
R/zc-d_ G-,-rz,n t
DEPTH
From To
0 '/0'
I/O' .52 -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �~
7 STATIC WATER LEVEL Below Top of Casing: 6n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top et casing terminated aJor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm): 7 METHOD OF TEST /0/Ui7�1,(--.
10. WATER ZONES (depth): 60' (/
II. DISINFECTION: Type
12. CASING:
Depth
From 0 To 5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To rtO Ft.
From To Ft.
Amount ,1 TA- AS
Wall Thickness
Dia eter or Weight/Ft. Mate al
5 R,v( Pr
/7Material Method
ty,,4?1anr�
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Slot Size
in.
in.
Material
15 SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
W
Tie
N
a
3
O
O
' Y DI HEAEE3v'I CEflT
CONSTRUCTION S 1
y�lt,hsQ,rjgjplal to th
r'."4/#h66't6. 919
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
RDS, AND THAT A COPY OF TH 5 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�Ttve �'vl -dam
P/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)I S
wE Lt. CONTRACTOR COMPANY NAM 4lXhh;C Irtx/In tlntl CERTIFICATION# /7,
STATE WELL CONSTRUCTION PERMIT
PHONE #@,3) —ASP 4_34 G
(if applicable)
City or Town State Zip Code
(-_gaZ From To Formation Description
Area code. Phone number
4 DATE DRILLED 5 /nn
5. TOTAL DEPTH:r.Si. �� i r—ta/y
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-----`
7 STATIC WATER LEVEL Below Top of Casing: __0_FT
£' TOP OF CASING IS _UseF . bovTop of Casing)
Fd s r AboveceLand Surface' ------__
'Top of using terminated aUor below land surface requires a
Variance in accordance with 15A NCAC 2C .0118. //
9. YIELD (gpm): i 0 METHOD/�OF TEST/7/OF
10. WATER ZONES (depth): ,'
I I. DISINFECTION: Type /f% Amount
! 2 CASING: Wall Thickness
Depth0 Diameter or Weight/Ft. Mate ial
Frorn To .�� Ft, n
Frorn To Ft.s '/�
�
From To Ft.
13. GROUT: Depth Material
Method
From J
n To FI. /r/i _6__� �i(�
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Material
Ft. in. in.
From To Ft. in.
15 SAND/GRAVEL PACK: in.
Depth Size Material
From To Ft.
From To Ft.
ASSOCIATED W ERMIT#
_ / (if appl icable)
I WELL USE (Check Applicable Box): Residential rd'[�
.Monitoring 0 Recovery0 nmcipal/Phelic ❑ Industrial 0 Agricultural ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: ffp,7.CL/ /44/e
-----,�_ County
c*fjyj Parinal LV1 i' 11614)Qc
iStreei N e `Numbers, Community, Subdivision, Lot No., Zip Code)
rV g73u
3 OWNER:�e"lr P(�
Address / rs t� �Y-e• Pn� ) r�� (degrees/minutes/seconds)
(Street or Rouse No.) /C Latitude/longitude source:❑GPS❑Topographic map
iiQ'31k.7�j�/� 7� DEPTH (check box)
DRILLING LOG
273048
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
16. RE.MARKS.
Du EREBY CERTIFY "� P� �t
CONSTRUCTION STANDkRDS,
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.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Gbbhiit theta-AO?ny
al to Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Ar'2.69 1'At6FPfIPA p-o'p919� 73 221, within 30 days.
�
GW-I REV, 07/2001

276098
11'131,1, CUN5'I IIUCTIUN IMCvx:::
\llC0 cenilrICA'nuriI..7'l0
Ninth n
Cnlulion - Deli:0 cld of IiiivIionolen' nod Ilnlmal Resources - Division of Miler Quality - Ulom,dwnlcr ecttit;ui
w ELL CON !RAC' 1111 (INIIN'IOUAL) NAME Ir,lul)A11en
writ. QINIIIAL'I on COPIrANI'NAME ASSlIC1Al r,ll vv't)rrItMI7N __-_-_-.--
SiAIr.%sil.l. COrJsimi(1 ItiN ftitnii U ----- ilnrdicnblc
II n i diarblc
ter- r 1 1;;d;;;;;in{ ; 1 tight -Aloud LJ
(heck Appiic ndi- :•:'')' !rrehibilllini i- Flii;ili:q�•.l u,;lie
I. WvIit ii I1g U
M1louilol iug LI Itrcovc,y LI I lad Pony )Nair) Infection Li Ulhcr Li If (Mier, List Use
'fopofnnlmio'!.anti rrtii;:g
Llithige LI.".lope ClVnliry i,'I`I I
(d,rrk •r i''P Lrr lint)
(rLntiluddluugilude of well location
A/i1 -5 14/4W,3_3(;z6
(Jrgrrrdndn,rlri t,•n li)
Lnlit;;;;;; gihnle sourcc:L111I' SL11 (togropllic Toil
(check l n.)
)1I(11.lU!U LU(J
l�hl_I11
I'Iolil lb PQnnalio❑ Ucsuiption
C) 7O /4 c
j Iry ___ �_
S/ � ram----
2. WI:1.1,LUCAIIUN:
Ncnlesi 1 ower-L�
(/ y nv SnbJivirinn, In111n., 711 Cr•Ir1
3. UWNI!R: �J 6-r;
nddlcss
�Q2 _ Cc- G\�''
(slier) o, Mmlr Nn.)
Iy ni I" 5laic 711, Carle
cily nt Inrn
nrA l li . )'lane twining• �3 0 .2 _
.1. Nn71: UI(II Lf D_
5. -I l)lnl, I)EI l II_—_L_ i .---- -
6. N1 Al \VI.LL PJt LRVlk ItcI W-1 111Vf.l l;l 1'RS U NO is
7. S fn11C \VATGR LGV h.L hclow it of Cnsing: __
(llu"," If Ahnvr lop al CnJny)
CASINO IS l�/Z. _ I' f. ALnvr Land Sol Ince° R. -I lIf Uf rlen l•,rd,nt Lrt ngnlnr • - O
•Irprlr•d,rl I•Ird•Ilo,l r�
+nlernrI,•rt): •5 nllhlsnftI l 11C.0111R.__---
nleuluuul Ir•sJ Y'l ---_ G
1 \'1liltZO)E 5-- . C_ p°LOCA110145 .IJ--- -
I11. WA I lilt ZONES (depth): _ �- nd,
- ----�� Sl,ow direcllun anti dislnncc m u,ilce lion, nt.lc.
Amount _`.2 Iwo Slnle Rondo m Comity 'tondo. Include I r< loncf
II. UISINII!CIIUN:I)1'c�it-5--\Vnlllhickcssco._-
12. CASINO: I)iniorlrr or \Vri P11VI'I. I.I Irdnl (tumbril n0 d t�ii,c tynd onlncs.
IImIL
from- ——it ---�
Ft. _ __- Method
I'I mn__- Io- Molehill I). mot] Tvp26_ )). pa rt-led-^!4. �rtit, lL,.n
hole �— l„_ p/it�� A"
PL_`._ Mnluinl
Ilrnn-_._- lo -- Dinnmlei SlotS1Tc
f lowl „ _ 11 ---iu. __
fL_ in. _- iu.
floill- - --_ to-- --- RrfK'v
IS. SAND1 11tAVPertPACK: Mnlnlnl g(N*0-21/5
Irpll, Sire
Flom_ lo
to I'1.-- ---
frou,--
16. IIP.61ARKS:
P� Doi 111 01'}'
i./ r-( ttS-)ltcicfil:."e"!*!tf� l
Ln$nTudl 112 6ilaw-,
`. 11477-I G 16 1`hn+lc No "
a
, AND 1IIAf A COPY U1''11115 RECORD IIAS BLEIl I'I(UVIUI!U •10111L WELL OWNER
WI'.I I, WAS CUIIS I IuICI PI) 111 ACCUIIUANCIl WI III 15A IICAC 2C, WPM.
unI
ItR ---- 27ieIRIO 1IW WELL
,,.UNAIUIU! UI' 1'CIlSUN Cl1iiSIL.,..-
IInIeIRi:,ill.
nnl
china of Willey ()wilily, Cround,rnler Section, 1636 Mull Service CU'111,1 IILI\'. U it •. r
3111, ollldn JII tiny,.

WELL CONSTRUCTION RECORD 276180
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\V/ -
WELLTT
NAME (print) <')-envl:5 fin f�i CERTIFICATION# oZ17(to
WELL CONTRACTOR COMPANY NAME .j)n'fs (cicillarA 10e11))`ft11-v, rige J PHONE #2-f(—ale2 —3 ge 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: CL/ unty ✓Y Ia,
13y2c1 1=fIraPn 2A— ar-Frgigo.rJhet, 1 (brnrn'
is:ruet Name, Numbers, Community, Subdivision, Lot Up.. Zip CcY& J
3. OWNER:' S rs/ 'PY� /atterl/
Address 2 Lt $y12d FA—FA-R in act
(Street or Route No.)
rya/yli rd /t/(- 02/735/
ity or Town State Zip Code
Area code- Phone number
•
4. DATE DRILLED
5. TOTAL DEPTH: (2 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ?(I)FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): SO METHOD OF TEST -C
10. WATER ZONES (depth): a et)
11. DISINFECTION: Type H fH
12. CASING:
Depth
From 0 To c` V Et.
From To Ft.
From To Ft.
Amount .,Z TA AS
Wall Thickness
Dia peter or AA'eight/Ft. Mateial
13. GROUT: Depth Material -_/ Method
From O To rA) Ft. (�07t ar./ 90--m_A—A
From To Ft.
14. SCREEN: Depth Diameter Slo: Slze 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 ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
73I t c_ 6-4,n -e
DEPTH
From To ,
0 a,i
r571-' 3n '
LOCATION SKETCH
Show direction and distance in miles from at leeast
two State Roads or County Roads. Include the tr9n, d
numbers and common road names.
de re
I c
up
I DO HEREBY CERTIFYITII4 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL r"--
CONSTRUCTION STAND' qS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL O\ieit£R V
1
6t� SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the D vision of VA'ater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
CE'.27,§,99+,1.6S4Rli j101. 11(919) 73
rSHF.YH f ,:DNAl_ O=LICE
-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Dep::rtment of Environment and TNatural Resources - Division of Water Quality - Groundwater Section le
WELLCONTRACOit(INDIVIDUAL) NAME (print) cT/){f nl'll S fir
fif3�Y1 �i CERTIFICATION# c1J7
WELL CONTRACT"! OR COMPANY N'AMK .h)TiS (4 iIn3 1.0e Ill V`r tim .j.n (• j PHONE # _3;24-3 c
STATE WELL CO.sSTItUCTION PERMIT?' ASSOCIATED W EAMIT#
(if a..licable)
(if a'olicable)
276179
I. WELL USE (Check Applicable Box): Residential Y�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
_ Nearest Town:
i.r.c e.L P Jl Po nt-h Y
(Street Name. Nu:ubers, Community, Subdivision,
3. OWNER: p nx„-etl) }-i G'Z
my m Cd- unv
Mi-ri- I1i.gh
Lot No., Zip Code) en
_1
Address 1_5-3_6, 1 Jeer i k /;(Street or Route No.)
,�j'il ,,�' /
Cityir Town State Zip Code
r51,2 — y/.32
Area code- Phone number (/p
4. DATE DRILLED 1/ — 6 �UJ�
5. TOTAL DEPTH:
ographic/Land setting
idge ❑Slope ❑Valley ❑Flat
levoi S (check appropriate box)
tee / Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: /i FT.
(Use "+" if Abase Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of casing lenni coned atlur below land surface requires a
variance In accondance with ISA NCAC 2C .0118. //
9. YIELD (gpm): , 5- METHOD OF TEST n/010r7Llt
10 WATER ZONES (depth): r) WE'
11 DISINFECTION: hype R - Amount ,22
12. CASING: Wall Thickness
Dap::
From 0 To,,, -2._ Ft.
From To Ft.
From To Ft.
13. GROUT: Wpm Material
From n lb D Ft. 02471 al
Dia eter or Weight/Ft.
(',.
From To Ft.
14. SCREEN: Dcp',
From
From To
15. SAND/GRAVEL PACK:
Depa.. Sizc
16-1rani; fE
LOCATION SKETCH
/3 S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
Method
Diameter Slot Sizc Material
Ft. in. n.
Ft. in. in.
From To
From To
16. REMARKS
Ft.
Ft.
:Material
C)
0
I DO H'Fi'REI3Y 4f1 FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS I RUL, I I( - I A(\ DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- II GP— 0 I -eQ,uc9-^ --63
I SIGNATURE OF PEI:SON CONSTRUCTING THE WELL DATE
,111. Gt 10fdngulaI
PSHEVILLE kM6Y9A163fr lime
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
(9 9) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - :)efznment or Environment and Natural Resources - Division of Water Quality - Groundwater Section
ex 'ELL CONTEACIJR.INDIVIDUAL) NANI E (print) anv115 J—Oj]aiAA, CERTIFICATION�`�# bi��Le
f?y� I/Jetne,,ll-u4.j,ne) PHONE #i(g551.-
/.J`o24-3; 6
ASSOCIATED W ERNITq
V1'ELL CONTE AC'1011 cO:AIPAAY NANI
STATE AA'ELL CO ]STRCCTION PERMEdd
(if a..licable)
(if ar-i:ce.':'x)
I. WELL USE It_hc_1 Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring L. R_:overy ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. \VELL LOC:'. "IC'<. Topograp and setting
Nearest Tow:.. _kid%U / %iA;» : County 4/)42 CiM—J ❑Ridge ape ❑Valley ❑Flat
(�Vr/ / f L1C/ ar -/,, it c4 14 i c h la7 (check appropriate box)
(Street Name N :. Comm( its, Subdivision,
uubd vl ion, Lot No . Zip Code) of s -7 if / Latitude/longitude of well location
G/2-Cl
3 OWNE
Address /6 eLy Vne 1' d->s v n
.:cc[ or Robe No_)
jIOp- (6 (9fr7''/
City T. :1 State Zip Coda
)- C3L-2_4" — f3to00
Area code- Pt.ore tat
4. DATE DRIL1MD
5. TOTAL DEE Ili:
6 DOES WELL SSE
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
3 Cl ) I t 1(� ,(ci ,,, s 't- CI
LACE EXISTING WELL? YES ❑ NO
7. STATIC WA1 ER LEVEL Below Top of Casing: (7 FT.
(Use "T' if Above Top of Casing)
8. TOP OF CAS.NC .S / FT. Above Land Surface'
Top of casing :or n,.:.,:ed at/ot below land surface ru lures a
variance in ace., d a:.eith 15A NCAC 2C .0118.
9_ YIELD (gum. z METHOD OF TEST hk..)79/71-41--.
10. WATER ZOE'.-5 I _ pth): �?n
1I_ DISINFECT! . N
12. CASING:
From
From
From
i3. GROUT.
Front O
From
14. SCREEN.
Front
From
15. SAND/GILA%.
From
From
16. REMARKS.
A/ f» An) unt
(
Wall Thickness
Diannetcr or V;eight'P;. Mate ial
Material Method
00-iyo
)Ia eLer S!ol Size Material
FI. III. Ia.
FL in.
Ft.
Ft
Size Material
276178
LOCATION SKETCH
S Show direction and distance in miles from at least
two State Roads or County Roads. Includeaj e
numbers and common road names.
ca
R1
n
CD
•,-)\
J�
DO tHf REBYfC:E!r3:I F1
CON31RLLtIU.z z. rSv
I;
1
HO 1244IYEss)tremo to the
ASI EVI`dt69 .iE6.a6. %o(6FFIOE('i t9)
733-3221, within 30 days.
eT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COP`( OF.11-I S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�r 0 -,,, r�7 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
27 617'7
North Carolina - )cp.:rtment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VYELL CONTIta(l OR 16DIVIDUAL) NAME (print) ;he of 15 1--n f12n A> CERTIFICATION if 4/7(P
WELT CONTRA('. OR I.O\1PANY NANILC I)ni_S 1.I0ii0,nrJ Wei 1`),(r I(T1c�.j,. �r�-Ijl Y1 P u PHONE #�.702 Li-'3;1e U
STATE VYELL CO N STRL CrION PEIOMIT# ASSOCIATED W ERMIT#
lila: icab'.e) (if a..licable)
2.
WELL USE ;hec Applicable Box): Residential rel inicipal/Public 0 Industrial O Agricultural 0
Monitorine P. Rurovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOC.'.. IO;).
Nearest Toa:2-4.1.-755 County__Ay\.(2 iety(
(Street Name. N tbeit. Commuoir., Subdivision, Lot Na., Zip Code)
3 OWNER. j/. r4/
Address �a:Jp 17�2.t
:rc YYor�,Roue No.) _7r ai Mkt) lA� -7 c� /3
ClbsOril n Star: Zip Code
Area code- Hue ..
4- DATE DRII - .'D 7—/--‘13
5. TOTAL DEP: H: qos
DOES WELL !CEIS_:ACEEXISTING WELL': YES ❑ NO
ER '.EVEL Below Top of Casing: %SC FT.
(Use "+" if Abos e Top of Casing)
NG IS FT. Above Land Surface*
mir,ied at/or below land surface requires a
r ERR. stint 15A NCAC 2C .0118.
_S NIETHHOD OF TEST /)/8/7/%/x
i:'',tlh): //.ce
6
7- STATIC WA-
8. TOP OF CA1)
'Top of casinsi
variance in ae,
9- YIELD (epr)
10. WATER ZO'.
II- DISINFECT
12. CASING:
From 0
From
From
13. GROUT:
From n
From
14. SCREEN.
From
From
15. SANDIGRA.
From
From
16. REMARKS:
N:.,)pu Hf/V
pep:
o J Ft
! e Pt.
To i't
T graphic/Land setting
idge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To / Formation Description
Q,
n 3/
.3 /' 1Xs'
�J
LOCATION SKETCH _
Amcunt r2 T,4,t3 S Show direction and distance in miles front+) (east
\Vall Thickness two State Roads or County Roads. Includ6-(le ro41
Diameter or vseighert. material numbers and common road names. C
S�(-,' y) P��
xi,-_ Material Method
`o —)f7 Pt epGyt @k: [70Ifit/
to Ft.
(ep
[Diameter Slot Size Material
Ft. in. in.
Yu Ftin. in.
I' VCK:
re
ro
ETO eCEERt±UYiC)i,,i.
LUNb l Kul, I Jul
GROU,VGSI'Mt'cii_rfl[7N'l_l to
ASHEV1I LE2f9,89790163.6MdF07E • (1,
Ft.
Size N9aterial
O
r
TI1AT 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
4.�Q '%- / 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Divisiun of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
9) 733-3221, within 30 do's. GW-I REV. 07/2001

276176
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division1of Water Quality - Groundwater Section
WELL CONTRACl0R(INDIVIDUAL)NAME (print)< �-Phy)15 I j1%tit\rt. CERTIFICATION# r2/%le
WELL CON'rRr\C"i'OR COMPANY NAMLS;IX'.hniC ( IIar,rJ IVeIlal ter II ;x .),n P J PHONE a`ja&i_Sa4
STATE WELL CONSTRUCTION PERMIT#
(if a;:ol}cable)
ASSOCIATED W ERMIT4
(if icable)
1. WELL USE Check Applicable Box): Residential f2�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: tY i
CountyinQ,ena-
(Street Name, N.mbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER:42' r P li (.0 ,
Address .3(0 9 h rt (CD a —CI
(Sued or Rome No.
/� I. A h k2,t��-s , 2S 2 V/
citgsr Tc.'. n State Zip Code
�( )- -6-6 A —_33-9-y
Area code- Phone number
4. DATE DRILLED L.. —D. 3
5. TOTAL DEPTH: //CIS
Tppographic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
c,' i/".5-, fl//i F'(:1e.4.2a'i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO mJ,
7. STATIC WATER LEVEL Below Top of Casing: /.SO FT.
(Use "+" if Abose Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance wins ISA NCAC 2C .0118./G)JU
9. YIELD (gpme 5-METHOD OF TEST r
10. WATER ZONES (depth). %.57) V /000 (l
II. DISINFECTION: Type
12. CASING:
LOCATION SKETCH
Amount r12 %A-. S Show direction and distance in miles from at least
Dept}:
From To
From To
From To
13. GROUT: Ucpta
From () To .
From To
14. SCREEN: Deplt
From To
From To
15 SAND/GRAVEL PACK
Depth.
From To
From
Ft.
Ft.
Ft.
Diameter or Weight/Ft.
be` SZR.V 1
Wall Thickness two State Roads or County Roa€include the road
material numbers and common road name.
Material Method
FL 094-71. o, .rJ6I4i0
Ft.
Diameter Slot Size Material
t, in. in.
Ft. in.
Size :Material
Ft.
l o Ft.
O
c
ril
icc
c�
0
16. REMARKS:
'.I 409,417
ONST
Submi the o
GROUNG!NATER LELY699-1636 PI
ASHEVILLE REL!O1.LY. T -ECE
CEP.; 1E1' THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
ON S-AN 7.ARDS, AND THAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
in II-12- I I -eQ — cQ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
rigiu:il to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
one N't,. [phone], within 30 days. GW-1 REV. 07/2001

270105
11'ELL C;l)NS•I'ItUI;'1•IUN IUitiih::;
tJollh Cnluliva - Ucpallulcnl u(Ilnvhunulcut ma Hata al Recalled UI`IWrite' Quality CIS° Illt ICA Ilut+ w�UD
IVEI.I. CON I RACI Olt IINIJIVIIPIJAI.) NAMIE.'Holly /1 -- 37-19�7
ZE (Ic \i' riruotlE a 1r�+1 5
WELLC(IN11tACI 011 conlrANr NAME ASSVCIn'1 P,Ir tYI) 1'P,IIDII IM
$fAIF. ❑YLI. CONS t11UCIIlIN rF.IUIIU_ __--- it nr rlicnblc
it n ilirnblc
WrIt US1I. (Cllrck Applicable Pox): Ilectdcnlinl bkiliniluipnliPublic U 1101' ilfnl LI Agticullulal U
f,lonilol iug U Itecovcly LI I lcat Pinup IVntet IIlJcclion LI Ulhcr U If Oilier, List Uec_
'fopnfnn Idl.tnnl netting
2. Nentc, LUCAII. N: Ullidge I .J°Pe LIVnIlry UI'Inl
Ncnlccllolrn: �/�/./ 'r
(arch nlgmq„I t ',nil)
%Inuii . t _ _ - -" .__. - _ - 1 IiluddlmllUde of welt location
-- h.. SubJividvn, Ind I70, Zlp ------ 14a. tde v7Si�
Icurri Iln�na N nlrt l., C......... S S II! —.--_— -
Idr0.vrrJndmtl.Jr-�u,l.l
3. l7iVIJ FI .DPC1\ tipaC-_-_ --. _— (,nliluda'!^r'giluO a rt/ml:UUI'SCI falrogrnpllic nrgl
Addlcss ierl ‘I M "_ - Idled I ')
(cued of Route NM Ltl�� 1 d1 RILLII7U I,UC)
"00-0fl---- - III onnnliou U ipt'un
- $Inge Zlp Code --- i
CAI/m Im.n %
(rt )-
Alt. <NV fluor nninM1n
. 1. PA IDUIIILLI!U _S--
5 -i'li VAL 11G1'Ill:_ ------- -.
.Irl W1:117 YIIS U NO dr"
G. UllBS Wig), ttl:pl A1'p. il;�iSi v..�. - 1
1. S [N t IC WA I EIt LEVEL Ilelu'v e �'r°u )icing!lifivr r ( 5_til ;,-- t I =_
IL 01' (11" CASINO IS ----._----- I'1. Above Loud Sot litee'
Iry r I<.J" t Inndn.Iul *Uri helot. bull rnnIIl^<t ...nthtr.
..Jnrtt In .r<ordance nIlli I5A NUAI' IC. nn
U. IIPI.D(ri""): _g5.._-R1L1110DU1' 1IiSIli_il
III. WA 1 fill TONES (deplb): _ —
+ yh — Amount \; Iwo Slnle Rauh of County Raclin. hie lml�ha rop
11. C S CASINO:
-WIJ: 1 c Wnlllhielarss
R. CASINO Ru ulh cis and euuuumt rood moon.
Perth 17inwctrr oI Wright/IL . c, I I. n1Lr
,_ ,1Ly� ilJ �'-
r nlL--
Ilom_ •
•Io— it.—
)°- ft.--- -_ ----
rip._ MInIFlli nl i Method �
I1. Ull(1D f: 'Ftl'll' ^/ f1,,--��(�/', I/�1 I) Cc C
H. SCPI:fN Ucpllt Dinnletcl Slot5itc nlnteiinl --�� •�
-f., 1'1._iu.-___-_- a.
boor— _— _ _ fu.
TO______IL Ica.
Ilom_--__-.
15. SAND/IJIIAVIII.I'ACY.: Sire ptnlrllnl
I1rlllll C yt�
floor lv= fl.-- ",
TO II. - c
Itemr
a-
IJIL I
III 10
— 6
51
LUCATIUN_5V.I:1 C11
Slaw IIIlection nllll dinlnllrc In Illiles Ii°I1+n1l I )sl",l
Le"/(
16. Ill h1At(:S:___ ---
I DO I II Rf 11Y CLIt I lrV Iit(- I IIIS WELL WAS CONS I [Weill") III ACCOIIUAIICtl• WI 111 I5A tICAC, 2C, W111,1.
,U12SlI�ll4IIONSIANO}n}llS,ANN'IIIAfACOPYUI'IIIISRECUR()IEASBEENI'IIUVIl2LID1U11I OWNER
_- -- 111-
1ItUAltl
/ SIUNAI UIUI UI' I'CIISUtJ GUNS UCi 111U L WE'LL
I' rr c
+Slrt*m}I4+rr+Nlp-foal Iri the 1 Ivltlnn of IVnln tjunllly, Ctnunthvn(er Section, 1636 Mill Service Center - ll•ltich,
" N a 1 1J221, within 311 tinys.
UWr1 REV. IA;nu'dfilf l'hnJYt Nil�,l�l)
sYere

276862
WELL CONSTRUCTION RICCORU
Iv1nrh I :nnlilla 11(pznn of of Iinvinnnncul and Natural Rrson((rs - I.tI)ivisiou o1 L',alrl Oval
,tilllll\nl\('n)p(INnI\'Innnl,)Nnnrv;Ip11„pn142✓�������_J�y^)C'.S
Nggq
I I I l rINl MN( Ilntrinu'.\N) Nnn11'.__.Ch�L+y�kee. .e,t/.
't'I'.13 ((1\S 1111'1. -I n )N' 19710111 W ASSIWI 11, 11 W 11 IT. lt'1I I M
ill .1 ,Iisabll-I (if:1111 Ii :dd0
itv - (innmd vntcr Sections
_.- ('k.Il11FICn'll (1NNp 3?9(K5
_ I'IIONE M f $)
1 I 1 lHI (I h, (1. ,Applllablc Hex) 12csidcnlial Municipal/Public 1I Him!!
'.1 111ian n1l I 11ct L 1 !Ica( l'uny) Wader Injcclinn I ()din I I(1 46 •1. I by I 1,.1
A 1.1 1 1 1 n :\ 1 11 111
c iS i • Sl l—VcP_mv-'e
('oust} J 24C_CY')
t11n.. Nun1611 1 i,n.nitItI I Snallrvi ii,n, 11,1 Nu.. Zip ('oriel
1 I IA1.'N1.11
,\llhr•: PC) %30.4_.__La 5
{� 1'(10. 11n It111nr N111
I;141A; C/7 / fib .33s‘,y
IIc�1 In,ai s11111 Zip c'nar
3,
I„V.1r 1'h1.1m mn111.,.1
nun 7I'.0 7—//,-03
-1
1i I1111 ': \\III R 1 19,\('I! GXIS I ING \%, 11.9 YES LI NI )
( ; I A I IC \V 111'I2 1 1 AFL I.l:low Top nT('asing:._/Q . 1 1
(t l,r " ." if Above 'I ep of ('nalnrl
H 11 q' 1 /1 ('ASIN(i IS / FT. Above Land Sml:1ny'
A 11g1 •,1 (-Rini, In rninoll"I •Icor 11(In,, Inod •111Ince ee10719 1
fp11,1•In nrnn dnnlr „In115,\ NUM' 2( .n11fl. n
111'I I) (cinn) Po -_ NitillIOU GIr TEST 4i /h_
11' .A I I'R INI (drplll 1, ��� ci30
•
II
I'
111'1111 11 Ifni I' I,c L�{;�R l^2� Nnuunf _./C,p. 4\
.1',1t4II ‘Volt Thicknr^.c /,�
High Ili:nrl(.r ut A cighl/ll. r•In1••liul
C_ 3C)
11
111
U-r pill .l:tt'i:d
It( .3G-1 11 CPubE' )
Iv I
1,,. 111
I n11n I I,
I non Io
11 1VrIII/1il'AA'I'I
I )rl•ih
1 1 1111 1 n
1 1 1.11 111
11, 1'I'.1.\I'1
1`I .._
1l
I)i,unrlrl SIIti Si tt
II.
11 i11 _.__
Si c 1'I:tlti l
II
II_
I„ 11It ltl111 t 1 inn ll if AlyIA 1 I IIIS \V1'
r(lr";Tr'tfi 11r7N-FYi(1!I) � U;:, ANI)
Ell i
LLi1• 1i.11
Apticullural 1,1
I1ry,1,to;I is/I ;nnl sclliug
I Il+ubs N`nh,pc UA'nllcy ❑flat
1 lire.: 11 1 i:ae hot)
I Ilil,llh 'Irlultihule oh %cell lucllino
1.1. I•,t ct,, ti,VI1r<II • rlttt I<1
Lalihld '111n,1iunir nnnccll( il'SLl l'opngtaphic map
1)11'111 D121LLINGI.OS)
11mn I„ formation Ucscriplinn
- ..30 ✓ems
. �� .'!�5 1TT
V
N `
I )1AlION SKE ICI I cn
A
Slimy Ili1! I lion :mil (lis4ulcr in %sites ROW casIn
I%c, Sh11r I'na1l•: 11I Comity Roads. Include J1ac to;ji _.
uun hrlC ;It'd common %troll names
Fri c;
CC N r-,
\VAS ('UNSIRIIl II'U IN A(C(1RN,\'11-I t\1111 I5A 11('A(.• 2( \\'EII.
A COPY OI I III`• Pi ( ) IIAS 111:I N I'RO\'ll)NI) IOl I1IT WELL OWNER
u/(i7t��J J //—b3
Ill'II NIII111' \\'11 I ()Al I?
-C._..
+u 1, n,(-I 16( f1,�liri,rlj u Nu•;I)irisinn of \1'tiler (Juallly( I;Iuun(Im;der &•rlinn, Ir, v, mail titlce Crider - Raleigh, NC
b'.1(' I illyfI,1,_rNil I II r �'1.11221, mllhin JIIdays. U1V- 1I21!V. 111/211111

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t7)-envl l s/'{-t) //)Q cli CERTIFICATION/ # /7
\\' ELL CONTRACTOR COMPANY NAMIS 9 ntS 170IJ4 r4 Wei I 1) V`t Il:)C ; 11 (� z PHONE k�1;16',,,Ja--3 ge, (J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0--Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Nearest own: �Qy/l�%/1V �1T' County Ma r^{fyv
( u/ Hi//5f3e — L.,Hie rovrf23y
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:lj)(0(2tid_`-Pa. / jyv
Address /7..3c/j 7-/9nma s rote / ox l 3
(Scree or Route No.)
City or Town Stdte.1 Zip Code
0S0)- , ,:35— 3,3-07
Area code- Phone number
4. DATE DRILLED 7- .� �/ - 6 3
5. TOTAL DEPTH: c'3r),5-'
276827
graphic/Land setting
Idge DSlope 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
L/S' /oe' Sam fire
City ' .-34)s' 43tit_ lc- r Yc2,n z /->e_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V�
7. STATIC WATER LEVEL Below Top of Casing: 9G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): / 3 METHOD OF TEST /7/U203-/I ./- ,
10. WATER ZONES (depth): 02 35 x (�
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To 6 e7 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r Ft. 0_04-r 2,1 CV/3.---)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Mate 'al
" sa R / O ��
16. REMARKS:
LOCATION SKETCH
T,9 %3 S Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. F'
'7.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CO'NSTRUCT10€¢$TFh ARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Hi I ( SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'I t)7
Submit the origin:jl to t
17699-1636 Phone !v o. (91
L CM'.5t-ut3ICtitottt
ASrtr\ _LE i [r,l a 13CE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001

276826
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section _
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) e,/TT1I-e (7VI15 I II arA C(ei CERTIFICATION# a./7`/ f'
WELL CONTRACTOR CONII'ANY NAM& IX.hnt C `rioLia,„ ri II)P.I l �tfi l l-ul(�( ), n P J PHONE ai'2-/K-Se2 V-'3 �-b 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W6 PERMIT#
(if applicable) (ifa..licable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION: n
Nearest Town: vRfrNK L%/ A/C —County J! Q-COnJ
(-i'LII S nrINAlr 12r1 f`S73y
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t .hCLtiIe3
Address '7 j e.tthn7El pm.
(Su cet or Route No.) r ,
N f L Trig ��
City or Town State Zip Code
Toy,_ .5*� 87)g,3
Area code- Phone number
4. DATE DRILLED `J—/7—v3
5. TOTAL DEPTH: T'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Moto Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing termi a at ed aNur below land surface requires a
variance in accordance w Itt ISA NCAC 2C.0118.
9. YIELD (gpm): METHOD/OF TEST Alw it.
10. WATER ZONES (d •pth): /Pl,C'
Topographic/Land setting
❑Ridge ❑Slope DValley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C ctt
sa r
le[:as rc ..LTA
(9) t (lad -C.-
DEPTH
From To
O '1 '1
(7r7 min
a �! 3,Sl1--
1 I. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT: ( Material Method
From O ty4-n 471 ,17MM )
From To
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcp:h Size :Material
From To Ft.
�� LOCATION SKETCH
Amouni ,--,� %h` I; S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diamj�eter or P: eight/Ft. Mate al numbers and common road names.
To LI�Ft. (n" S.t�(-�.�7 PY
To Ft.
To Ft.
Depth
To . D Ft.
Ft
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRI If TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit theI to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 hone o. [phone], within 30 days. GW-I REV. 07/2001
t LI FCtION
ACHEVULF CLECi JAL OFFICE

Plni
^ n S ` /_ t, £'j 7? (degreeshninutes/seconds)
Address tl.f`I V+ L t ry- Ce %ive Latitu e/longitude source:❑GPS❑Topographic map
(Street or Route No.) I
DEPTH
From To
C) fee
( ' iLat
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD.
1 I, DISINFECTION: Type
12. CASING'.
3.OWNER: _-Q/:Ia40 112;(t)',nS
WELL CONSTRUCTION RECORD 2 7 6 8 2 5
North Carolina - Department of Environment and Natural Resources - Division' of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA(print) :hen it l s I Hay, ^� CERTIFICATION #`J/7 (p
ELL CONTRACTOR COMPANY NAM61.�,1ln'i i /[()!I(�,t,� Ill et q v,li'.lf .J,n ('� PHONE #i/ar,--5o?L?-3 a-e)6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W143PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Yd---Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: fr P 4 4 >J- - q//'' County')
I-tt.IC r'e V'6- j7A (GSy-r'I in 26_ — C t &ti(G5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) C hgure- /
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(check box)
A M i 4 (' C S �s �I. .�4i ) DRILLING LOG
City or Town Stater�r.oZip Code
c )- 9 rF0 7 ,5
Area code- Phone number rI
4. DATE DRILLED / — I S)-1)3
5. TOTAL DEPTH: Fr c •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 8) 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): .. 5 METHOD OF TEST h/02/J/ �
10. WATER ZONES (depth): - 6-1 (7
LOCATION SKETCH
Amount rQ T,9 , S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diajneter or Weight/Ft. Material numbers and common road names.
” '- R, / PvQ-
Depth .
From 0 To I .i p FL
From To Ft.
From To Ft.
13. GROUT. Depth;N
Fromr� To_- t. Ft.
Formation Description
C' t l-?
5,1 ,
(e y rriiCculln}z
RI if rtt,>ai
Material
%104)1 P:, J
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
Slot Size
in.
in.
Material
Material
16. REMARKS:
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
_A&FN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC4!N4THE WELL
Submit the original to the Division of Water Quality, Groundwa
27699-1636 Phone No. [phone], within 30 days.
-. -DATEr I if
�i
tzeLtion, 1636 Mail Service CentdrL, eigh, NC
Gy81 .07/2001
gip{
ChriCE

276614
W'1:LL CONS FRUC•I IUN IUWUAW
Noltlt Cmoliva - Ucpal Uncut of Envlounlcut mnl Ilnlocal Itenou+cce - Divlslon of Writer ()wilily - Urouudwnlcr Section
trim) _ -�5 ?. �`�SQCI ccn ilr;CKuuri a uUy
\\ Ku, CONING"7llll (lN tll l'11111A1.) NAME lr I � — 1 f, 1` �� ruor+e x CO R'��- �j�
..c.l\ r
WFI,L CUr+I tIA CI o❑C(/nIrAN1'NAPIF, (Y��+-++---
ASSOCIAI VIP WI) I'E1th111a —
SIA1E\vEl.l.C(INSIIIIII:IItINfEltr•Illlr_ _---- ( ll )
it n r rlicnblc
i `slit nblc -.
I. \VFFL1, USE (Check Applicable Ili\): Ilcnidcnlinl i lti cipal/Public U Indnelrinl CI Agricultural U
Mo+lilin iug U Ilccovcty II I Icat Pinup \Vnlct Injection LI Other U If Ullicr, Llsl Use
I vVI!tI.L)CA1I)11
Pknrccllo.\Ir' - .. ---
(ounly /i%C/C0
TSA fir-h col Ji virinn 1 - ---- 1p C••Ir)
l-
oner tlnnir, Nnml rl•,.... ....
Addlccs
($Urcl in Houle lln.)
Slnle 7Ir chile
cuyr, loon
•foposyniddc/I.mnl ceding
Ullidgc A.1RGIpn I1Vnllry UI'Inl
(clink ft/twi 1ele bn•)
LnIlludc/luugilude of well location
4/35f /I NL93: 3E
(drg,rr•/mhunrvla-•"nd'
LnIHw!-rlrnlgilude Smncc:Ll(II'S[7 fipnglnphic n�'p
(check 1,n•)
IIIIII...!r ( 1.1)_(J
1'onnalipn Ucsuipli0Il
I)LJ'1II
Prom In
LA7 •
( h.
Anne <r.lr I In•ne ninnbei
. d. PATIUItil.LI'.Uf0_-_.27-ij-S __
5 JornLlPPln_Lacit_Cp—
-- ----
6 IMPS W ELI, RPE ACU. pxIS 11141 WEI1,7 YES U NU
7. S I Al IC WA I Elt LEVEL liclow'hill of Cricing: _ 0-._I-I •
(line ' ' a Above l„I, rl reflex)
A. t ra p hf(iAS II$.__.I.__
PI Above I. nod .^,ullilce'
•trrrlr.drr It ?minded .iw brin Lod nn L<• irI Il
ul.nre In Inn/dome nIlh 15A NCA(' lc.nlla.
i \'mlltrl.11,) _I lam_
MEIIIUDOF 1ES1.Q_
IIt. WAI IUt 7.UNI S (depth). _ ----
auyl lb Rack Auunnd . _
1I. C S NIT 11331:IJ type C Wall lld<knrne
12. CASINU:
hrpUl Diameter m VVcip,h UFI. 6lnlcunl
< ,� L't---
I.rnok_Q_ 1n �_ t� 11./ 2S- S� RI
\'lam Ii_I1._— -
from_ to --_ft. _-
MnRrinl Method
11. Item, Perth pLe I(e
f nl, O 1fog_ Il. pad
let SCRI:I:tl, Depth Iin i lcl Slol Sire Mnluinl
Tr, Il — -in. --- it.
trout_ — --- ill.
I t, II in. --
Ilnnl__. _._._
15. SANU/UItAV'I, PACK.: DepthSire Mntninl
Elton to —El_
flan Io---ll'----
CJCi`
LUCAy.il)N-SK_EJ C,i1
chow dincction null dish -nice in Miles lion n1 lenct
Iwo Stale 'toad: • F'ounly pond+. InclutIShe load
uuatbcis nud common toad laic" CO
C
ligyde ,ev
16. ItfMARKS:
I Do IIfRf IIY CEItlifv IlinI iiii9 WE.I I, WAS CONSI ItlIClllU IN ACCUIt0A11C11 WIIII ISA)Ii;hr 2C,WELL
CONSI!MCI ION 51ANDAP.US, AIID IIIAf A COPY UF'lI1IS RECORD IIAS DEU111'IIUVIDLI'1 t4 111�K'E-LL- ' LIEft-----1
, �-1
— , II
SllitlAlUlU!Ufl'PIlSMIJCUNSJitUC11NU111BWI1LL I UAII.
i
Subndl the nilglenl In Ile Illvl\lun of \\'n(nQunllly, Cruuntlwnler Section, 16)6 Mall Sl1vIce Crider
IUl
lellit 7tQ1'
11690-1636 I'lonc No. (9191711 12I1, Within 311 dnys.
•
...

County 7)24.Con
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
tt.
From To
16. REMARKS:
I DO HEREBY CERTIFY T
CONSTRUCTION STAND/
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , sir uYl D S 1(. , l.L�) 1 St`) {\ CERTIFICATION # a 40 q
WELL CONTRACTOR COMPANY NAME I�v\r\l Pf \An \\ 8c,`l,,nq PHONE # Keac37-2rxr7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDAWQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C�Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIpN:�
Nearest To/wn:AP/in✓1 '
de7QL1AH x'i✓.
(Street Name,
✓Numbers, Community, Subdivision,dLot No., Zip Code)
3. OWNER:1 %i c4- 4/,✓i%fh
Address / 9S %U%t.. t c2a 4L it. etc
(Street or Route No.)
7 ,(/ �. zBl//
ty or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED -7 -„2l-i - 03
5. TOTAL DEPTH: I DS '
6. DOES WELL REPLACE EXISTING WELL? YES fiCNO la
7. STATIC WATER LEVEL Below Top of Casing: C ` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): (o METHOD OF TEST IQ i e
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To ch Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From b To .2,o Ft.
Diameter
Material tt
ptYtiG ✓i
From To Ft.
Slot Size
276613
Topographic/Land setting
[Midge ❑Slope CjW 1ley DFlat
(check appropriate box)
Latitude/lopgitude of well location
N: 3s/1'5B// ul fi1`.57;55
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To or j t on Description
0 - ,99' l5ou riers<4RcQuo
av - 'So '
' IOS sszn:FP
11�� pa11017 Amount 1S'
Wall Thickness
or Weight/Ft. Material
5ne2( �1v�
Method
prNcar ro
LOCATION SKETCH
S*O:: direction and distance. i.^. miles from at least
two State Roads or County Roads. Include the road
nuiribers and common road names.
in.
in.
Material
0
CAD
CZ
,kr,c‘h
0
0
CO
:T TNIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—SIGNATURE-OF PERSON-CONsTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

276484
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionlof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) sh-e nhl S l /��rr\A CERTIFICATION o2-17(p
WELL CONTRACTOR CONIPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
.hntfkQir4Il)pll)1irtim74 PHONE ai'a16/_.5;24-3a60
ASSOCIATED W ERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential CI---icipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI q _
Nearest Town: /r /l ,2kL r A/ County 44
62 (wry(
.)��� cbai.'e in nit /� )ft,fv 2� `��j3 v
(Street Name. Nwnbers, Community, Subdivision, Lot No.. Zip Code)
3 OWNER: ,7D1)/0 ("ni// 12)4,ci11{1/4”-1-677
Address ,,3,5 , n.,-94) h; 1 / Co It ; C 1 Y -
i (Street orRoute No.)
/'-i Q,,3 Ai 0_ r c73 y
City or Town State Zip Code
l bd- 3L- S'SS•
.�
Area code- Phone number
4. DATE DRILLED 9 - 3
5. TOTAL DEPTH: /c/7h'
jopographic/Land setting
rflRiidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude ofweli location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(9 /' " t a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12Y--
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 actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): . 5 METHOD OF TEST /0)U/72-41.--`
10 WATER ZONES (depth): 30Ga ' �l
I1
12
DISINFECTION: Type
CASING:
Depth
From 0 To (-) (
From To
From To
13. GROUT: Depth
From n To r-:"(^%
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
LOCATION SKETCH w
Amount r; TAP S Show direction and distance in miles from aaleas
Wall Thickness two State Roads or County Roads. Include k road:L.-:
Diaft eter or Weight/Ft. Material numbers and common road names.
Ft. h" Sj2RQ/ pV
Ft.
FL
Material Method
Ft'.__O_P4714i� t7?,v0
Ft.
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft.
Slot Size Material
in.
in
Material
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS \YELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Off
di 7— . 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL -DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Serviele Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. j GW-I REV. 07/2001

276483
WELL CONSTRUCTION RECORD
North Carolina - Depar.ment of Environment and Natural Resources - Division of Water Quality - Groundwater Section w'ELL CONTRACTOR (INDIVIDUAL) NANIE (print) x.1) -no' S 1-11 ad, (41 CERTIFICATION fi tan
c Pr) 140llo,JJII)P,II�FrII�� j_n(jPHONE tt2d_>2Li-3�6�
WELL CONTRACTOR CO?I I'ANY NAb1
STATE WELL CONSTRUCTION PERMITk ASSOCIATED W('ERMITti
(ifa licablc).-_ (if a..licable)
I. WELL USE (Cheek Applicable Box): Residential n�Mun icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION. y
Nearest Town. �iQ.47/ iritJ Coo.nty
(Street Nome. Numbers, Cc. ewnity, Subdivision. Lot No., Zip Code)
3- OWNER. j eJ1YI; S l_C 1,7 he42
Address 7 11/c'57 is //S L'
(St: uat „r Route No.)
42u/ti t/i
City or Toun (Rare
Lf/q— 093C'
5930 Zip Cod,
Area rode- Phone nuniner
4. DATE DRILLED /—c;2- S -O 3
5. TOTAL DEPTH: 9,SC'
6. DOES \VELL REPLACE EXISTING WELLY YES ❑ NO ©�
7. STATIC WATER LEVEL Below Top of Casing: LYZ.SIFT.
(Use "*' if Abo e Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing lermin.ucd atior below land surface rayulres a
variance in accordance oh!: ISA NCAC 2C .0118. j
9. YIELD (gpm): METHOD OF TEST /2/8)2%rX-tf--.
10. WATER ZONES (Jcp.ny. y 6'
To ographie/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
11
12
13
14.
15
DISINFECTION:IVvoo Hfp Amuunt r TAAS
CASING: Wall Thickness
Dcp:i. Diameter or A`Yeight'Ft- Mate ial
From 0 To /fC C It. LC S-tb (> ,y l eo___,
From To Pt.
From To Ft.
GROUT: Derr.:: Material Method From 0 To :=."'" Ft. 0,+-n /?.),f 2074�l/1
From To Ft. 7
SCREEN: Del -.a Diameter
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PAC:;:
Deo'.:H
From To
From I o
16 REMARKS:
FL
Ft.
Size Mate; ia]
Slo: Size Material
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(7I
9, a.\-)r\SVfim, o
ll.e CLyam, +
DEPTH
From To
(cc !0�'
7r' 14-
LOCATION SKETCH
Show direction and distance in miles from least`
two State Roads or County Roads. Include road
numbers and common road names. -..-
I DO HEREBY CERTI0::
CONSTRUCTION STALDA
I:': F THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
LDS, AND THAT A COPY OF THIS S RECORD HAS BEEN PROVIDED TO IHE WFI.L 0YS'NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qu,,lity, Groundwater Section, 1636 Mail ServiceC nQ,t-Raleigh, NC
27699-1636 Phone No, (919) _33-3221, within 30 day s. GW-iI REV. 07/2001

276482
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\v ELL CONTRACTOR (INDIVIDUAL) NAME (print) c fT)e n MIS I-1-yji lacy\ A, CERTIFICATION #.2/7�
WELL CONTRACTOR COMPANY NAM PHONE #i(V-i$)/4Jr.a L/-3 a-6 U
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if an:Si:able) (if a.. licable)
1. WELL USE (Check Applicable Box): Residential Y.�Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Tour F.e 4-2f3•L; Ej/ County 41 ( ((In e
(PLi LC Jp cn 3S h-) fi-t)1CAS 2ed o 00 w1�[
(Street Name. Nemben, Counnur:i y, Subdivision, Lot No., Zip code) `� g 1 3 1
3 OWNER: ; (,a.yta R t )�
Address IT.[N, PL x .?9 (1- : Y'n \T&C ) )-I, .3d
(Street or Route No.)
City or Trnrn State Zip Cods
0?5e)- ':Se -8 1/
Area code- Phone numberc7
4. DATE DRILLED / - a / - ('-3
5. TOTAL DEPTH: //C j
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ��
7. STATIC WATER LEVEL Below Top of Casing: r" tmil FT.
(Use "+" if Abdo Top of Casing)
o. TOP OF CASING IS FT. Above Land Surface*
raphic/Land setting
Idge ❑Slope ❑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 Description
c .-P/'
//CiS-
•Top of casing terminated at/or below land surface requires a
variance in accordance ssitlt ISA NCAC 2C.0118.
9. YIELD (gpmr / METHOD OF TEST •9/0/9/71 C
10. WATER ZONES (depth): ihitf)(1 • i
Clot
LOCATION SKETCH
11. DISINFECTION: Type Li fA/ Amami( , T4, S Show direction and distance in miles from at least
12. CASING: Wail Thickness two State Roads or County Roads. Include the road
Depth / Dimjpeter or Weight/Ft Mate ial numbers and common road names. 0
From '0 To / Ft (�" .... /�,y/ �
From To Ft. ':
CD
From To Ft. 1
13. GROUT: Depth. Material Method
From (i T o /{7 Ft. Pnyt D)r � - ,O TM,0
From To Ft. =
14. SCREEN: Depth GA
From To r_ N
From To _ ic. 0
15. SAND/GRAVEL PACK:
Depth Size Material
Diameter Slot Size Material
Ft. in.
Ft. in.
From To Ft
From T o Ft.
16. REMARKS:
I DO HEREBY CEICT!FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND:;RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE; WELL OWNER
9e(er' �Q� -.yid/i 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL NATE
Submit the origin.tl to the Division of Water Quality, Groundwater Section, 1636 Nail Service Ceniti- -:j sleigh, NC
27699-1636 Phone No. [phone], ys ithin 30 das s. GIN -I REV. 07/2001

WELL CONSTRUCTION RECORD
276480
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
%HELL CONTRACTOR (INDIWIDUAL):NANIE (print) James B. Brown
CERTIFICATION n. 2045
neLl. coNTR.ACToR COd1PAw NAadE Redden Brothers Well Drilling, Inc PHONE n (828 369-9591
SLATE \SEI,L CONSTRUCTION PERMIT ASSOCIATED \SQ PERMIT:
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal. Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovers' ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Almond
cardinal RD
Count' Macon
Street Name, Numbers. Comer. un i ty. Subdi cis ion, Lot No., Zip Code)
3. OWNER: Jim LaBarr
Address 6224 47th Avenue East
(Street or Route No.)
Bradenton, FL 32403
Gn' or Town State
( 941). 755-3104
Area code- Phone number
4. DATE DRILLED 6-27-03
Zip Code
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "-" if Aboe Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at'or below land surface requires a
varience in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm). 20 METHOD OF TEST blow
10. RATER ZONES (depth): 319' & 451 '
I L DISINFECTION: Type H T H Amount 16 oz
12, CASING:
Depth
From 0 To 34 Ft
From 34' To 55 Ft.
From To Ft.
Wa11 Thickness
Diameter or R'eicht'Ft. Material
6" pvc
6" .188 steel
13. GROUT: Depth ;Material Method
From 0 To 20 Ft.bat-mite & &UInIL pitted
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.
La
From
0
53'
Topographic,'Land setting
❑Ridge ❑Slope [Walley ❑Flat
(drop:< appropriate box)
Latitude/longitude of well location
(degreesemi nr.tes seconds)
tide'longitude source.DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation Description
53' clay & sand
500' 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.
03
16, RENI.ARKS.
I D0 HEREBY. CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAB• RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of \\ ater Quality, Groundwater Section, 1636 Mail Service C,G6ter- Raleigh, INC27699-1636 Phone No.[phone], within 30 days. (gCyA'-I4-REV. 07'2001
t

WELL CONSTRUCTION RECORD
276479
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAJIE (print) James B. Brown
CERTIFIC Trox 82045
\\EL.[.CO.NTRACToft COMP.ANVNAME Hedden Brothers Well Drilling, Inc PHONE �J828 369-9591
SPATE, WELL CONSTRUCTION PERMIT'-
(ifaoplicable)
ASSOCIATED WQ PERMIT=
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Pu'blic ❑ Industrial 0 Agricultural 0
Nlonitoring 0 Recovery 0 Heat Purnp Water Injection ❑ Other 0 IrOther, List Use
2. WELL LOCATION:
Nearest Town. Franklin County Macon
Houston Farm RD
(Street Name, Numbers. Community. Subdivision, Lot No., Zip Code
3. 0WNER:SCOtt Blanck
Addres 1952 Farmwocd Drive
(Street or Route No.)
Lawerenceville, GA 30043
City or To'.vr. State Zip Code
(770)- 338-2695
Area code- Phone number
4. DATE DRILLED 7-3-03
5.TOTAL DEPTH: 500'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casino: 400' FT.
(L'se "-" if Abo; e Top of Casing)
8, TOP OF CASING IS 2 FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
variance in accordance \cith ISA NCAC 2C .0118.
9, YIELD (gpm): 6 METHOD OF TEST blow
10- WATER ZONES (depth): 280' & 410'
II. DISINFECTION: Tvpe H T H Amount 16 oz
12. CASING: WaIl Thickness
Depth Diameter or AA'eightFt. Nlaterial
From 0 To 64 Ft. 6" pvc
From 64' To 85Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftl'arnite & Wtra1L psrPe3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaterial •
From To Ft. in. in.
From To Ft. in. in.
15. SAND -GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic, Land setting
DRidge OSlope DValley DFlat
(check appropriate box)
Latitude'longitude of well location
(degrees:minutes seconds)
Latitude. longitude Source:❑GPS❑Topographic r. .a
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0 83' clay & sand
83' 500'
granite
LOCATION SKETCH
Show direction and distance in miles from at leas:
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH 15A NCAC 2C, WELL
__CONSTRUCTION ST N1374RDS, AND THAT A5 PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL D:ATEr�.' --
Submit the original to-ttt4 Divtston of Water Quality', Groundwater Section, 1636 ?tail Service Center sleigh, NC
27699-I636 Phone No. [phone], vrithin 30 days. GV I REV'. 07, 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NA?IE (print) James B. Brown
\\ELLCONTRACTORCo)IPANYNAMEHedden Brothers Well Drilling, Inc
276478
- Groundwater Section
CERTIFICATION f 2045
PHONE a ( 828 369-9591
STATE: \WELL CONS] RUCTION PERMIT: ASSOCIATED WQ PERMIT=
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 'Municipal:Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ 1 f Other, List Use
2. WELL LOCATION:
Nearest Town: Almond Cotmh COf
1 mile past Nantahala Village on right;
(S:rcet Name, Nu',nbeis, Community. Subdi vi>ion. Lot No.. Zip Cod
3. 0\VNER: Bennit Roberson
Address 11 Reynolds Bridge RD
(Street or Route No.)
Kingston, GA 30145
City or Tm:n State Zip Code
(770)- 336-5227
Area code- Phone number
4. DATE DRILLED 6-30-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L
7. STATIC WATER LEVEL Below Top of Casino: 200' FT.
(Use' =" if Above Top of Casing)
R. TOP OF CASING IS 2 ET. 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): 14 NIETHOD OF TESTblow
10. WATER ZONES (depth): 1 10' , 114', & 253'
II
13. CASING:
DISINFECTION: Type
H T H
Depth Diameter
From 0 To 48 Ft. 6"
From To Ft.
From To Ft.
13. GROUT: Depth Nlaterial Method,
From 0 To 20 Ft ute & l.ti1 IL p.qe
From To Ft.
14. SCREEN: Depth Diameter Slot Size Nlaterial
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Nlaterial
Amount 16 oz
Wail Thickness
or Weight'Ft. Nlatecal
pvc
From To Ft.
From To Ft.
16. RENIARKS:
Topographic; Land setting
❑Ridge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude longitude of well location
Latitude'Iong
DEPTH
From To
0 46'
46' 300'
(de _greeslninutes seconds)
tide source:OGPS❑Topographic map
ocycck box)
DRILLING LOG
Formation Description
clay & sand
�cranite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
Lk)
r_
IEC
0
0,
_. IDO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \\'ITH 15A NCAC 2C, WELL
;;_'•\ CONSTRUCTIO TAN ARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the originalto he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone J o. (9 9) 733-3221. within 30 days. OW-1 REV. O7'2001

276477
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
\\ ELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE' ( 828 369-9591
STATE \\ ELL CONSTRUCTION PERMIT? ASSOCIATED NV() PERMI(T0
(if eoplicable) Of applicable)
WELL USE (Check Applicable Box): Residential &d Municipal'Public 0 Industrial 0 Agricultural 0
Nlonitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: Highlands
19 Christmas Tree Lane
County Macon
(St get ,Name. Nainbers, Canr.nunity, Subdi Nisi on. Lot No., Zip Code)
3. OWNER:
Address 19 Christmas Trcc Lane
(Street or Route No.)
Highlands, NC 28741
Phillip Coppage
City or To.cn State Zip Code
(828 )- 526-1988
Arca code- Phone amber
4. DATE DRILLED 6-23-03
S. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 250' FT.
(Use • z" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated atior beloss' land surface requires a
variance in accordance nit]) ISA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST blow
10. WATER ZONES (depth): 230;
11 DISINFECTION: Type H T H
12, CASING:
Depth Diameter
From 0 To 24 Ft. 6"
From To Ft.
From To Ft.
Topographic:Land setting
❑Ridge ❑Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude.'lon_ituda of well location
(degrees. minutes: seconds)
Latitudellongitude source.❑GPS❑Topographic map
(check tor,
DEPTH DRILLING LOG
From To Formation Description
0 22' clay & sand
22' 300'
granite
LOCATION SKETCH
Amount 16 oz Show direction and distance in miles from at least
Wail Thickness two State Roads or County Roads. Include the road
or WeightFt. Material numbers and common road names.
pVr
13. GROUT: Depth Nlaterial Nlethod
From 0 To 20 _ Et.barcnite & LetlttrL piped
Rout To Ft.
14, SCREEN: Depth
From To
Diameter Slot Size Material
Ft. in. in.
From To Ft, in. in.
15.SAND'GRAVELPACK
:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
0
C- )
:
LUC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
--ceNSTRUGH-ON ST \RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original td the Division of Water Quality, Groundrvnter Section, 1636 Alail Service Center - Raleigh, NC
27699-1636 Phone Nu, [phone], within 30 days. GW-I REV. 072001

276476
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDU.AL)?A.\IE (print) James B. Brown
\\ELL CONTRACTOR COMPANY NA)1EHedden Brothers Well Drilling, Inc PHONE of 828 369-9591
STATE WELL CONSTRUCTION PER)IIT* ASSOCIATED \\'Q PERMIT
(ifaoplicable) (if applicable)
CERTIFICATION k' 2045
WELL USE (Check Applicable Box): Residential X Nlunicipal Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Rater Injection 0 Other 0 !f Other, List Use
2. WELL LOCATION:
Nearest Town:Highlands
963 Shortoff Rd
Count\ Macon
(Strazt Name, Nu:rbe:s, Cornmunita, Su'adicisio:t, Lot No_ Zip Code)
3. OWNER: Lambert Chandler
Address 963 Shortoff Rd
(Street or Route No )
Highlands, NC 28741
0ty or Town Staid
(828 )- 526-1055
Area code- Phone number
4. DATE DRILLED 6-11-03
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO )M
7, STATIC WATER LEVEL Below Top of Casino.: 450 FT.
(Use "+" if Aboae Top of Casing)
Si. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (epm): 4 NIETHOD OF TEST hl nw
10. WATER ZONES (depth): 283 & 460'
Zip Code
I I. DISINFECTION: Tvpe H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or \ceight'Ft. Materiel
From 0 To 40 Ft. 6" Svc
From 40' To 55' Ft. 6" 188 —steel—
Ft.
From To
13. GROUT: Depth
From 0 To
From To
14. SCREEN: Depth.
From To
From To
15.SAND:GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RENIARKS:
Material Method
20 Ft Yscnits & Matt p-ITe
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Topographic. Land setting
❑Ridge ❑Slope , DValley ❑Flat
(check appropriate boa)
Latitude'loneitudc of well location
(degrees l..iinutee seconds)
Latitudo'longitude source:OGPS❑Topographic map
(:beak tor)
DEPTH DRILLING LOG
From To Formation Description
0 53 t clay & sand
53' 500 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.
0
W
L
w
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONs ... NDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OR'NER
C —r -s U.3
SIGNATL RE OF PERSON CONSTRUCTING THE WELL DATA
�Submit the original to the DI\is?on of FVater Quality, Groundwater Section, 1636 Mail Service CeralerRaleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 (lays. OW -!I' REV. 07 "2001

276474
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION 2045
\\ELL. CON"( RACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE efJ 82B 369-9591
STATE WELL CONSTRUCTION PERNIIT= ASSOCIATED \\'Q PER\IIT7
(if anplicable) (if apnlicable)
t. WELL USE (Check Applicable Box): Residential Zf Nlunicipal Public ❑ Industrial 0 Aerieultural 0
Monitoring 0 Recovery' ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
Count Macon
3052 Georgia RD
(Street Name, N'uabet's. Community, Subdivision, Lot No., Zip Code)
3. O1WNER: Van Rogers
Address 3052 Georgia Rd
(Street Or Route No.)
Franklin, NC 28734
Cl() or To .sn Save Zip Code
( 828) 524-6764
Area code- Phone number
4. DATE DRILLED 6-13-03
5. TOTAL DEPTH: 800'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO )
7, STATIC WATER LEVEL Below Top of Cosine: FT.
(L'se "+' if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (eom): 0—DRY METHOD OF TEST
10. WATER ZONES (depth):
Topographic'Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longitude of well location
(degrees rninu:es.secondst
Latitude 'longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
To Formation Description
65' clay & sand
From
0
65'
800' _granite
1 1. DISINFECTION: Tope H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight Tt. Material
From 0 To 67 Ft. 6" pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 _ Ft Lgrnite & caratt parked
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.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From To Ft.
16. REMARKS: Well is to be hydrofracted--
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTI• TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIt.'A'RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centif;galeigh, NC
27699-1636 Phone No. [phone], within 30 days. G11.-1I'V, 07 2001
1
L

WELL CONSTRUCTION RECORD
276410
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section —r
‘YELL CONTRACTOR (INDIVIDUAL) NAME (print) clT)-e h MiS '-('O 1](1-i- 1'U CERTIFICATION it ot//y
WELL CONTRACTOR COMPANYNAMK S �C��(��.ytr� {i)et1)){, ((`1{ ) nC' PHONE #�,.7 eZ 4'3 g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITCONSTRUCTION
(if applicable) (if applicable)
__
WELL USE (Check Applicable Box): Residential Y�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Racovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: �/t 4-44CLi47,447 County 4.-C(.0 1
(0 CI( l� '( LLrt-ooleCkctai CAmm• ffk2r1/247•✓ irYl
(Street Name. Nuntbeu, CoRununity, Su- division, Lot No„ Zip Code) E 5T•
8n3`f
3. OWNER: c ;hi (iickyne-l0
Address /7 a 5 2-I V i nqe, tm t? _ s
(Sweet or Route No.9
Sa ra Sot& P) 3cE-2-3
City or to n State Zip Code — g f
Area code- Phone number
4. DATE DRILLED 7—// —03
5. TOTAL DEPTH: 4ZO S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Abo' c Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ///)/,/
9. YIELD (gpm): S METHOD OF TEST h U/ 4—.
I0. WATER ZONES (depth): /9-61/
Tyr pographic/Land setting
Pi$ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
11. DISINFECTION: Type Hill
12. CASING:
Dcp:h
From 0 To (17- Ft.
From To Ft.
DEPTH
From
0
ems'
b; y
LOCATION SKETCH
Amount ,-Q TA-. S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia aeter of Weight/Pt. Material numbers and common road names
From To Ft.
13. GROUT: Depth
From %5 To Ft.
Material
eonh
From To Ft.
14. SCREEN: Dep:h Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Dcp:n Size Material
To Ft.
From
From
Method
pc),,,(
Material
0
W
C—
C
t—
N
0
.e—
ta
16. REMARKS:
1; r-,,11 DO HEREBY C,ERTI =Y THE
CONSTRUCTION S ANDAR
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OFTFI S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I; : .SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
lithe on. final to t At Divis
Z 6 ?-1636 P'homclti;cs PLO) 733-3"
"' . , F1CF
on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
ran IC
ca
0

u V
276439
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Sectiony//�
WELL CO:NTRACTOI& (INDIVIDUAL) NAME (print) she. f) hf 5 Pin 1I (2A rU CERTIFICATION d-/7 le
WELL CONTRACTOR COMPANY NAM&IX,flnt S'cIR)jln,vtri II)P•��al 1�r��'; lta Ile J PHONE #i'2-erfi_S2 Li —3 g6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQPERMIT#
(if a. livable)
(ifa livable)
I. WELL USE (Check Applicable Box): Residential 12--Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 R_covery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2,
WELL LOCATI N:
Nearest Town: y Dm (�lifc/w County/AO
(04c r m�14_S R& kr73Z�
(Street Name. Nunt'ners, Community, Subdivision, Lot No.. Zip Code))
3. OWNER: L4 i
Address
cam 1e IS^eF`l or Route bla)
Cit or Taw: State l`
a'f 30sy
Area code- Phone wan her
4. DATE DRILLED /
S. TOTAL DEPTH: c37_S v
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7. STATIC WATER LEVEL Below Top of Casing: fo FT.
JOO 5j
Zip Code
(Use "+" if Abocc Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing to rn:!na ted at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): oZ S METHOD OF TEST hLW/ W. WATER ZONES tdepth): 2'/Z>� . ?,?f (�
I I. DISINFECTION: Type
12. CASING:
HEN
Amount
Wall Thickness
Depth Diam�eter or Weight/Ft.
From 0 To 7/0 Ft. (p•` S.�(is).5f
From To Ft.
From To Ft.
13. GROUT: Dinh
From /3 To 7 Ft.
0-1947)
Material
From To Ft.
14. SCREEN: DE- :h Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Devil Size .Material
From '1') Ft.
ppographic/Land setting
ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Sy
sr
9�`
9a • 3 75
LOCATION SKETCH
T,}. S Show direction and distance in miles from at least
pp,
Method
Q2Vt/
two State Roads or County Roads. Include the road
numbers and common road names. o _
W
C_
C
N
0
w
From J Ft.
16. REMARKS:
1 p0 HFRFRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST ' .112.1T +ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
gt,LIL Leantc9-- 3
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to th Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
�-ifi99-F634Phoue_Na. ri191. 733-3221, within 30 days. GW-1 REV. 07/2001
(" -IBv!
ASFf t LCO 01110E

276438
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR(INDIVIDUAL)NAME(print)e.b-e, 115 ni)nnQ,>\r{, CERTIFICATION t�./74'
WELL CONTRACTOIRCOMPANYNAM� I1niS IC�(i)tlI C.vtr1 �1)P.It�v`r ll Th. .j-n C• J PHONE # r e6i_.�i ;24-3 a6
STATE WELL CONS! RUCTION PERMIT# ASSOCIATED Wilal4ERMITO
(ifa••licable)
(if ap• l iccb le)
I. WELL USE (Check Applicable Box): Residential0---Cv cipal/Public ❑ Industrial O Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION: A
Nearest Town. 0 /J O Aire County O_ Ont
mac / 7 L a-a.n.e/ Lh v.e - (tlftl rQ Yci ' 3
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
(Lick; YU
Address'-©.t36x 7Q(Ft
\Iele0
Street or Route No.)
)�Ir 3 9lo
City or To n State Zip Code
Area code- Phone c.:mber _
4. DATE DRILLED --/U -03
5. TOTAL DEPTH: c 05''
6. DOES WELL ICEI'LACE EXISTING WELL? YES ❑ NO &Yr
7. STATIC WATER LEVEL Below Top of Casing: (o%) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpmj: t S METHOD OF TEST /D7/%r7Llf—.
10. WATER ZONES (depth): 1 / 5 r o2hb ' (�1
11. DISINFECTION: Type Al- P Amount 4 %A A S
12. CASING:
From
From
From
13. GROUT:
From n
From
14. SCREEN:
From To
From To
15. SAND/GRAVELPACK.:
Dcp:h
To
To
0
De;'u
To
To
To
Dopth
To .=
To
Ltar;h
Ft.
Topograa c/Land setting
❑Ridge Q75lope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 �3r c
�In 3
y'
rns' lI LI_ t)--r ci,n rife_
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
Ft.
Ft.
Material Method
Ft- cp. ytryp4 -CTItio
Ft.
Diameter Slot Size . Material
Ft. in.
From
From
Ft. in.
Size
Ft.
Ft.
16 REMARKS:
r�
1 I DO HEREBY CER71F' -Ig4
�`� CONSTRUCTION SfjfA4I
'I
- `J
L i
.F Subrnit the angiml) t,� the rvision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
46491:Itilb:(..0 (91217 3 3221, within 30 days. GW-1 REV. 07/2001
Material
CO
N
r
0
w
0
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE N [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
276433
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public El Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ANDREWS County MACON
SWAN DRIVE
(Street Name, Numbers, Community, Suhdivisicm, tat No. Zip Code)
3. OWNER: ERIC 8 SHANNON WEST
Address 568 JUNALUSKA RD
(Sheet or Route No.)
AQUONENC 28781
City or Town State Zip Code
( 828 )_ 321-0884
Area code- Phone number
4. DATE DRILLED 6-23-03
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ed
7. STATIC WATER LEVEL Below Top of Casing: 110 FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
"Top of rating terminated al/or below land surface requires a
variance In accordance with 15A NCAC 2C .a118.
9. YIELD (gpm): 5 METHOD OF TEST AIR
10. WATER ZONES (depth): 120'
1 1. DISINFECTION: Type CHLORINE
I2. CASING:
Depth ' Diameter
From 0 To 76 Ft. 6118'
From To Ft.
From _ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
Front To Et.
14. SCREEN: Depth Diameter Slot Size material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PA('.K:
Depth Size Material
From To _ Ft.
From To Ft.
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
16. REMARKS:
T'opographic/Land setting
❑Ridge �Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tdegrees/minutescsrconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 76' RED CLAY
76' TO 305' GRANITE
L.QCATION SKETCH
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
f=- -- XTITF.REH\ L.rcitt I,ktkr THIS WELL WAS CONSTRUC'IIiD IN ACCORDANCE WITH 15A NCAC 2C, WELL
I j I ( CONS rug ST P NIbn-Ri)C, AND TI 3COPY OF THIS Itj ORD HA EN PROVIDEI)'10 THE WELL OWNER
I Submit the original to the
-2769t- F63 6 Plane No. -(919) 7
ERSON C
70y 6 -23--er 3
G T}tE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mall Senice Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATIONS 3295
WT.LI. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING
276432
PHONE " f 828) 837-8008
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential RI MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ANDREWS
SWAN DRIVE
County MACON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES PATTI
Address 568 JUNALUSKA RD
(Street or Route No.)
AOUONE, NC 28781
City or Town State
( 828 )_ 321-0884 ,
Area code- Phone number
4. DATE DRILLED 6-20-03
5. TOTAL DEPTH: 345
Zip Code
Topohic/Land setting
❑Ridge IHSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sdurce:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 80' RED CLAY 8 SAND
8ff TO 142' GRAVEL
142' TO 345' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ild
7. STATIC WATER LEVEL Below Top of Casing: 86 FT.
(Use"+" if Above Top of Casing) '
8. TOP OF CASING 1S 1 FT. Above Land Surface*
"Top of casing terminated .Uor below land surface requires a
variance In seeordana with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 210' '..
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'4 .l-I-t 12.
I I. DISINFECTION: Type CHLORINE Amount 100 PPM_-
12. C'ASING:
Depth
From 0 To 142 Ft.
From To Et.
From,_ _ To Et.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
Wall Thickness
Diameter or Weight/Ft. Material
61/4" .188 STEEL
From To Ft.
14. SCREEN: Depth Diameter
From To Ft, in.
Front— To Ft. in.
15.SAND/GRAVEL PACK:
Depth Sim Material
Method
GRAVITY
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
cJ o
11)0TIERERYt?t?RTihY WA THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
(1ONSTRUC1ION:STANIil4, AND TI COPY OF TIIISREECORI�I,IS KEEN PROVIDED TO THE WELL OWNER
I 1
SI ATURE O�RSON 4N5 NG'IkIF. WELL DATE
Submit the original told e D vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
i-- 27b99-16j4}Ipmrivv:-(`ji9)739-322I,within 30days. GW-1 REV. 07/2001

11 l l"'
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WELL CONSTI4II(' I'ION ILI':(.'Oltl)
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276430
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WELL CONSTRUC I ION RAJA) It I)
276429
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;
SIGNA
1 I ly'n 111)Ik- S f; l lC11
Sllnvv ditl•,•liun and (likI:ul[r in miles frnnf.�1 Irlsl
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nllmhl-r; :Ind 1-ninnl„n rond u:nnc,s.
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ets1..
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'Ila'f tt 11•,111rd± N,a,r7"I"! -) 11271, 11111 iu 111 tIa15. (i\\' 1 PI . II'/21101

278345
i
Nolina -Dep ent.
I�1.S9N'q, itnCtraY 1kultvin AL) NAM
sANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
Environment and Natural Resources - Division of Water Quality - Groundwater Section
./�" �CERTIFICATION #nZ O 77
G2tL 11/zcu rp sy :LK PHONE # igg / «9 o9Sl
_ASSOCIATED WQ PERMIT#
(if applicable)
(print)_
4//7
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Neare�Jt'`7Toyytl• County I/
LL7ursr�s �, eras e2f73y
(Street Name, Numbers, Community, Subdivision,
Lot No., Zip Code)
3. OWNER. . Lra10&-at t.
Address /TY� »t &e %A..t op�
Street or Routtec No.)
arty
City or Town State Zip Code
qs7) 3.2J-//Zee
Area code- Phone number
4. DATE DRILLED S//i-/ O3
5. TOTAL DEPTH: a. DS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO go
7. STATIC WATER LEVEL Below Top of Casing: yn 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 .0I18. _ •
9. YIELD (gpm): 7 THOD OF TEST l--4-e0
10. WATER ZONES (depth): / 9..5 r
11. DISINFECTION: Type Amount _,231-Ita
12. CASING: Wall Thickness
Depth Diameter or Weight/Ftiv terjal
From To 90 Ft. (0 // tt.Z/
From To Ft.
From To Ft.
From 0 To13. GROUT: Depth Material s1 M, d.
�Q_ Ft. Coma/ 1`f sad.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Ft in. in.
From To Ft. in. in.
15. SAND/
From
From
16. REMARKS:
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge (Slope ❑Valley ❑Flat
(cbeck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH pRILLING LOG
From To Formation Description
rn
-O ?-
O r
LOCATION SKETCH -o m
Show direction and distance in miles front legs
two State Roads or County Roads. hiclu O he rpt5
numbers and common road names. '
ON o
To
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.
sr/iajo
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTTResources - Division of Water Quality - Groundwater Sectionn
WELL CONTRACTOR (INDIVIDUAL) NAME
(print)<he h n1 s f/ /1t). �� CERTIFICATION #ot-/7
WELL CONI'RACTORCOMPANY'NAMKtinli';YijIJQytr� I(/eilr1)r(tl(-Y,q j.n( a PHONE #igs)/r3;214-36
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 0/717J WC- County / /� t1 Q !{17�a
f C'x pi-via/co ('; .cl e� 49i S .2k763
,Sired Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �—r-
A L (C J7) A -try--)
Address /Urrv3%ii /'neva/ ,, 0 ira! C
/ , 1 (Street or Route No.)
Wl�FrlSft,clL- p-/ g';I)-7it, 6-
City or Town State Zip Code
�)-Or6 - 4.-3 k -(50/3
Area code- Phone number
4. DATE DRILLED — 1 3 - 03
S. TOTAL DEPTH: (,S/)'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1B-
7. STATIC WATER LEVEL Below Top of Casing: r. 5-O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 3 METHOD OF TEST 6/0G/7/-2
10. WATER ZONES (depth): 6/. C fr i
1 1.
12.
DISINFECTION: Type {-/ f/l
T9pagraphic/Land setting
iddge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Sn' ht (rah; 1-
LOCATION SKETCH
Amount 2 T,4 /3 S Show direction and distance in miles from at least
CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia}}peter or Weight/Ft. Material numbers and common road names.
From 0 To g� Ft. (� " S R2/ Q (0—,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
F From Cyan a: fOIL/0
n To r-rC7 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:
O
(a)
C
G7
ry
cn
0
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Plume No. [phone], within 30 days. GW-I REV. 07/2001,-

278005
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c/).enni5 I Wag, rA./ CERTIFICATION # ol //74t'
WELL CONTRACTOR COMPANY NAMBb'.I)nl S (clat3NlJ Wei l )Y'r I I ;14 q , j - n ('./ PHONE #/'a15)/_Sa L,._3 a-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Yd�Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATIO :
Nearest Town: 4,01-) 4/ County Ala a c,,,
1-1-4-1S ren•1-;9s F32 2A
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) /
3. OWNER:
Address 4),n.8DX iFc/
(Street or Route No.)
r Gi,k I;-,U A/e, ss74"/
City or Town State Zip Code
(s t�)- $69- (7'7 3
Area code- Phone number,
4. DATE DRILLED -/3
5. TOTAL DEPTH: CS'
opographic/Land setting
IDRidge ❑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
1-07,
DEPTH
From To
5'3'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ea 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 410 METHOD OF TEST /Oyt/72 {
10. WATER ZONES (depth): S-`/' (ef�f' o2 n ' (/
11. DISINFECTION: Type hi" f'f/
12. CASING:
Depth
From 0 To -✓- . Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To 11-9Z)
Material
Ft. Cam. by
From To Ft.
LOCATION SKETCH
Amount ..-� %A- S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or WeighUFt. Material numbers and common road names.
�" 5-bRn71 Pre-
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.
Metho, d
CSLI�
0
r
t�
N
Slot Size Material in. o
in. _
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL I
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
i
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001;:;
1'

278004
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :hen V)ISk)/iQl'\rli CERTIFICATION oZ/%le
WELL CONTRACTOR COMPANY NAME t)nt s (o0114,113 �j)Pl 1TTdltfr l l j-n eu PHONE # t,5-;2 L/-3 a-60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
Cif applicable)
I. WELL USE (Check Applicable Box): Residential LYMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: / % .(Im-k County 410 (,f)r -,
Coif-t (mlta ;he, 0d —reyA hofw( L n
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) It g 7'/ /
3.OWNER: L-J !1'MQfoh O
Address IODtj-3 ( vr}.F f h// p i DI2
L (Street or Route No.)
fr.-4
rs L� cvL l . r7
City or Town (J State Zip Code
(36a)- Sig • ci9/ 9
Area code- Phone number
4. DATE DRILLED Sf 1 .$ - 63
5. TOTAL DEPTH: .JQSI
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO O-
3ppographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
DEPTH
From
O �7' a,
u2'
49' ..50s ell,, e. (-rJen ;-1- e_
7. STATIC WATER LEVEL Below Top of Casing:. C() FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): ! METHOD OF TEST /07/ir77,1
10.WATER ZONES (depth): ;The
/7ne (/
1 I. DISINFECTION: Type Iff"/%
12. CASING:
Depth
From 6 To c 9 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From n To Ft.
From 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:
Amount r TA -AS
Wall Thickness
Dia eter or Weight/Ft. Mate al
%" sZ R j P
Material
0.0471 pl,
Ft.
Slot Size
Method
Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. c.o
N
Ul
0
N
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T/HH)ATyA COPY OFTTHIS RECORD H(�S BEEN PROVIDED TO THE WELL OWNER.`
4/ 0(/(k l +�i�F c�`~ i s- 6 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mai( Service Center -Raleigh, NC'
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 0:/100
rn

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. BTOWn CERTIFICATION=2045
\\ ELL CONTRACTOR C0 IPANS NAME Hidden Brothers Well Drilling, Inc PHONE = (828 369-9591
STATE. WELL CONSTRUCTION PERMIT? ASSOCIATED N\'Q PERMIT=
t if aoplicab'.e) (if applicable)
2'78:533
I. WELL USE (Check Applicable Box): Residentialnc Municipal: Public 0 Industrial O Agricultural ❑
Monitoring 0 Recovery. ❑ Heat Pump Water Injection 0 Other 0 It Other, List Use
2 WELL LOCATION:
Nearest Town: Franklin County Macon
Bethel Church Rd to Moses RD
(S:r:at Name. Numbers, Con:munity, Subdi:ision. Lot No., Zip Cade)
3. OWNER: Lynn Myers
Address 743 Hidden Trail
(Street or Route No)
Franklin, NC' 2R734
City or Town State
(828)- 369-2366
Arta code- P'.:one number
4. DATE DRILLED 8-20-93
5. TOTAL DEPTH: 240
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Mac(
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Lse" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at'or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 8 N1ETHOD OF TEST bil ow
10. WATER ZONES (depth): 53' & 210'
1 I. DISINFECTION: Type H T H Amount 16 02
1r. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Material
From 0 To 20 Ft. 6" Avc
From 20' To 24 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method.
From 0 To 20 Fttaaite& atylt »r!
From To Ft.
l4. SCREEN: Depth Diameter Slot Size Nlater'a_I
From Tc Ft. in. In.
From in. in.
Tc Ft.
15. S.AND:GRAVEL PACK:
Death Size Material
Zip Code
From To Ft.
From To Ft.
Topographic Land setting.
❑Ridge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude longitude of yveil location
(degrees nan.nes. seconds)
Latitude longitude source:OGPSOTopographic map
:.meek box)
DEPTH DRILLING LOG
From. To Formation D an�tion
0 22' clay
22' 240' granite
0
0 0
U
n—�', a
1
rn 0
cc"
rn
CO *rn
at)
LOCATION SKETCH -p m�
Show direction and distance in miles from feast =0m
two State Roads or County Roads. Include tfeproa�+i�
numbers and common road names. a
CO o
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC iC, WELL
CONSTRUCTIONS\NDARDS. .AND THA COPY of THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section. 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], nithin 30 days.
GW-I REV, 07 2001

2i3:132
From 25'
From
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\ELL CONTRACTOR (INDIVIDUAL) SAME (print) Mitchell D. Ccok CERTIFICATION = 2043
\\'ELL CONTRACTOR COMPANY NA'IE FeB31 BITZ1 t S 11 Drilling, Inc PHONE # [phone]
SPATE \\ ELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 23 Nlunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery. 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HicjhlandS Count,: Macon
Horse Cove-85 Hill Crest Dr
(Street Name. Numbers. Community. Subdivision. Lot No., Zip Code)
3 OWNER: Arline Roman
Address 85 Hill Crest Drive
(Sweet or Route No.)
Highlands, NC 28741
City or Town State
I828)- 576-49.5
Area code- Phone number
4. DATE DRILLED 8-19-03
5.TOTAL DEPTH: 1000'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [7.5
7_ STATIC WATER LEVEL Below Top of Casing: 900' FT.
(Use "-" if Abaue Top of Casing)
3. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 NIETHOD OF TEST blow
10. WATER ZONES (depth): 805'
II. DISINFECTION: Type
12. CASING:
Depth
From 0 To 25
To 29' Ft. 6" .188 steel
H T H Amount 16oz
Wall Thickness
Diameter or Weight.' Ft. Material
Ft. 6" pvc
To Ft.
Material Nlethod
Fttarnite & cerait aural
Ft.
Diameter Slot Size Naterial
Ft. in. in.
Ft. in. in.
15. SAND 'GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. RENIARKS:
Topographic. Land setting
❑Ridge ❑Slope EValley ❑Flat
(check appropriate box)
Latitude/lonvitude of well location
(degrees minuss. seconds)
Latitude "longitude source:❑GPS❑Topograp hic map
t check box)
DEPTH DRILLING LOG
From To Formation Description
0 27' clay & sand
271000' granite
O
W �
(n
0
as
Cm
cr'
a<
0
fri
LOCATION SKETCH — rt.,
CA)`na
Show direction and distance in miles from at leas
two State Roads or County Roads. Include ro 0
numbers and common road names. Z
L
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- Zeta
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07 2001

'- i S531
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources.- Division of Water Quality - Groundwater Section
\SELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION: 2043
WELL CONTRACTOR COMPANY NAME Hain aOthe s 1-1 Dnll2rrt. 1-Fr PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Nlunicipal,Public 0 Industrial 0 Agricultural ❑
Nionitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2WELL LOCATION:
Nearest Town: Highlands County Macon
Highalnds Queen's Mountain
(Street Name. Numbers. Cominunity. Subdivision, Lot No.. Zip Cod_)
3. OWNER: Terry Wilson
Address PO Box 512
(Street or Route No.)
Highlands, W 28741
Ctt. or Town State Zip Code
(828)- 526-2852
Area code- Phone nwnber
4. DATE DRILLED 8-20-03
5.TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO)
7. STATIC WATER LEVEL Below Top of Casing.: 125' ET.
(Use "—" if Above Top of Casing)
3. TOP OF CASING IS 2 ET. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with liA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 80' & 270'
11 DISINFECTION: Type H T H
l2. CASING:
Depth Diameter
From 0 To 23 Ft. 6"
From 23To 27 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ftbarnite &
Amount 16oz
\Va11 Thickness
or Weight/Ft. Material
pvc
1R8 stapl
Method
arced
From To Ft.
1-1. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND.'GRAVELPACK:
Depth Size ;Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic. Land setting.
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudelongitude of well location
(degrees mi ntiessecondst
Latitude. longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 25' clay & sand
25' 300' granite
O {
W
v
arra
a(n
cm
o *rn
Yc
LOCATION SKETCH 3 =o
Show direction and distance in miles from ''W astcz
two State Roads or County Roads. Include t11` roa a
numbers and common road names. GJ -i
+— z
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J. P/2a/0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07 2001

78530
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (I.NDIVIDUAL)NAME (print) Mitchell D. Ccok CERTIFICATION 2043
WELL CONTRACTOR COMPANY NAME Hsi al &Other^ W 11 [�]],]-71'y�, Tj'2 PHONE # [phone]
S'f ATE WELL CONSTRUCTION PERMIT# ASSOCIATED wQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential 3 Municipal/Public 0 Industrial 0 Agricultural ❑
Nlonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 II Other, List Use
WELL LOCATION:
Nearest To\v„Highlands
County Macon
165 Jack Wilcox RD
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Jean Snyder
Address 165 Jack Wilcox Rd
( Street or Route No-)
Highlands, NC 28741
C i ty or Town State
L82&- 526-2911
Zip Code
Area code- Phone number
4. DATE DRILLED 8-22-03
5. TOTAL DEPTH: 460'
6. DOES WELL REPLACE EXISTING WELL? YES ICI NO ❑
7. STATIC WATER LE\'EL Below Top of Casing: 350 FT.
(Use' if Above Top of Casing)
S, TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated ator below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (epm): 60+ NIETHOD OF TEST blow
10. WATER ZONES (depth): 450'
I1. DISINFECTION: Tvpc H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or Weight.'Ft. Material
From 0 To 112Ft. 6" .188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To 20 Ftban ite & oetstt Rn[ 1
From To Ft.
14_ SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Naterial
From To Ft.
From To Ft.
16. RENIARKS:
Topographici Land setting
❑Ridge DSlope Valley 0Flat
(check appropriate box)
Latitudeloneitude of well location
(degrees minutes seconds)
Latitude longitude souroe:❑GPS❑Topographic map
icheck box) -
DEPTH DRILLING LOG
1
From T10' Formation Dssanation
0 y & e(
110' 460' granite
-C
s
p
cn as
-0 orn
t—
2_
CO fm
'.a
LOCATION SKETCH "fl m�
Show direction and distance in miles from aeast—i
two State Roads or County Roads. Include &Qroa
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tt €
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality', Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07,22001

WELL CONSTRUCTION RECORD
278529
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D.r�Cook
,,,, CERTIFICATION/42043
WELL CONTRACTOR COSIPANV NAME HanErcttrrs W!1 t)nlla y, 21-c PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Highlands County Macon
Walkingstick to Rock House RD # 127
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Nancy Carter
Address 475 Forest Rd
(Street or Route No.)
Athens , GA 30605
City or Town State
(706 )- 549-6559
Area code- Phone number
4. DATE DRILLED 8-28-03
Zip Code
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EF
7. STATIC WATER LEVEL Below Top of Casing: 80FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST blow
10. WATER ZONES (depth): 85' & 115'
11 DISINFECTION: Type H T H
12. CASING:
From 0
From 25'
From
13. GROUT:
From 0
Depth
To 25 Ft.
To 29 Ft.
To Ft.
Depth Material
To 20 Ftbarnite & catch.
To
Diameter
6"
6"
Amount 16oz
Wall Thickness
or Weight/Ft. Material
pvc
1RR
From 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.
Rbnel
Method
paired
Slot Size Nlaterial
in.
in.
Material
16. RE\(ARKS:
Topographic/Land setting
❑Ridge DSlope 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
0 27' clay & sand
27' 200' granite
W
cn
Pr,
LOCATION SKETCH
c rn
cm
Zc
ilk
>o
Show direction and distance in miles from eastr 1
two State Roads or County Roads. Include te wag, -
numbers and common road names. W rna
n
CO 5
$— o
CO
c)
r
1-17
u1
(nJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 \fail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2.78556
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R ELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION; 2045
It ELI. coNTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE #f 828 369-9591
STATE. W ELL CONSITRLCTION PERMIT= ASSOCIATED WQ PERMIT=
(if aophcabiel (if applicable)
1. WELL USE (Check Applicable Box): Residential xr Municipal Public ❑ Industrial ❑ Agriculture! 0
N1oni(ormg ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 GOther, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
0dd 64'to Shady Ridge Rd to Hnnuninghird Trail
(Bice' Nome, Numbers, Community, Subdivision, Lot No., Zip Cod_(
3. OWNER: M L Rickersnn
Adaress 11 Hnmminghird Trail
(Street or Route No.)
Franklin, NC 28734
City or To r. State
828)- 369 7197
Area cod:- Phone number
4. DATE DRILLED Drill Deeper 8-1-03
5. TOTAL DEPTH: drilled 175' well now 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'=" if Above Top of Casing)
€. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at:or below land surface requires a
variance in accordance with I5A \CAC 2C .011s.
9. YIELD (gpr): 1 NIETHOD OF TEST blow
10. WATER ZONES (depth):
LOCATION SKETCH S r,
Show direction and distance in miles from at least tni
two State Roads or County Roads. Include theroad o�
number and common road names. eJ F-t
o
Topographic Land setting
GRicge ❑Slope ❑\'alley DFlat
(check appropriate box)
_atitudelongitude of well location
(degrees ':minutes. seconds)
Latitude i5neitude source:0GPS ❑Torographic map
(;heck box)
DEPTH DRILLING LOG
From To Formation Description
0 clay & sand
granite
W
N
—O
Zip Code
I I. DISINFECTION: Tvpe H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or W'eicht.'R. Material
From 0 To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.barnite & wtesiL pir{a3
From To Ft.
14, SCREEN: Depth Diameter Slot Size dateriai
From To Ft. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Nlzterial
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN .ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST�1?v'QARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center -Raleigh, NC
GW-1 REV. 07 2001
27699-1636 Phone No. [phone]. nithin 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
\y ELL COMR ACTOR(1NDI\'IDL AL) N ASIE (print) James B. Brown
RELI. CON] RACTOR COMPANI ..\A\IE fedden Brothers Well Drilling. Inc
CERTIFICATION 2045
PHONE # ( 828 369-9591
STATE \\EI.L CONSTRUCTION PER\llT= ASSOCIATED \yQ PERMIT#
(if aup'icable) (if applicable)
I. WELL USE (Check Applicable Box): Residential MunicipalPu'blic 0 Industrial 0 Agricultural 0
,Monitoring 0 Recovery 0 Heat Pump \Vater Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:Franklin Count Macon
Wide Horizon Drive
S::eat N.u:m, N.us.oea. Cona:tunics. Subd i'. is'an. Lot Na., Zip Co',de
3. OWNER Martha Solesbee
.Address PO Box 693
(Street or Route Na)
Franklin, NC 28744
Cits or Tian State Zip Code
(828 )-524-4785
Arca code" Pbona somber
4. DATE DRILLED 7-24-03
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use' if Above Top of Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated a['or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gym): 20 METHOD OF TEST blew
10. WATER ZONES (depth): 173' & 250'
I L DISINFECTION: Tyne H T H Amount 16 oz
:2. CASING:
Depth
From 0 To 11 EFt.
From 116'To 120 Ft.
Diameter
6"
Wall Thickness
or \\'eight.Ft.
Material
pvc
188 steel
From To Ft,
13. GROUT: Depth Material Method
From 0 To 20 Ft.tetinite & t..catent. RTT 1
From To Ft.
14. SCREEN: Depth Dianteter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND.GRAVEL PACK:
Depth Size 'Material
From To Ft.
From To Ft.
Topographic Land setting
❑Ridge ❑Slone ❑\'alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latcudelong
DEPTH
From To
0 118'
(degrees cun:us. seconds)
uda source:❑GPS❑Topographic map
'.cheek text
DRILLING LOG
Formation Description
clay & sandy
118' 300' granite
C
O
Caere'
LOCATION SKETCH f crn
Show direction and distance in miles from at Fast o`
two State Roads or County Roads. Include tii'Aoadm
numbers and common road names. ._ —4v
am
W m�
w
0
z
16. REMARKS: -- "-__--
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
C0NSTRUCTI0ANDARDS. AND THALA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the DINis`on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-221. nithin 30 days. GVW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2 7`s 5'0 0
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION d 2045
WELL COVIRACTOR CO)IPANY NAME Eedden Brothers Well Drilling, Inc PHONE#I 828 369-9591
STATE wEI.L CONSTRICTION PERMIT;
(if applicable)
ASSOCIATED WQ PERMIT;
(if applicable)
1. WELL USE (Check Applicable Box): ResidentiaPEC N lunicipal: Pu'blia ❑ Industrial ❑ A_ricultural 0
Ntonitoring 0 Recovery ❑ Heat Pump Rater Injection 0 Other ❑ li'Other, List Use
2. WELL LOCATION:
Nearest Town: Aquone
Jarrett Creek
County Macon
(Street Name, Numbers. Community, Subdix i sign, Lot No.. Zip Cod_)
3. OWNER Elona Henry
Addr:ss 1283 Ranchette RD
(Street or Route No_)
West Palm Beach, FL 33415
Ciy or Taw State
(-5k])-_ 689-9555
Area cod. Pb,one number
4. DATE DRILLED 8-14-03
5. TOTAL DEPTH: 140'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOH3
7. STATIC WATER LEVEL Below Top of Casino: 50 FT.
(Use "-" if Above Top of Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface`
•Top of casing terminated at'or below land surface requires a
variance in accordance with LEANCAC 2C .011S.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 90' & 120'
1 I. DISINFECTION: Tvoe H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or \'.eieht't. Nlaterial
From 0 To 70 Ft. 6't .188 steel
From _ To Ft.
From To Ft,
13. GROUT: Depth Nlacerial Method
From 0 To 20 Ftter-Mite & czitt=aaL Rr�al
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15 SAND:GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic. Land setting
❑Ridge ❑Slope ❑valley ❑Flat
(;heck appropriate box)
Latitudeloneitude of well location
(Je42es ^.In'aes. seconds)
Latitude longitude source.❑GPS❑Topographic map
ioheck box)
DEPTH DRILLING LOG
From To Formation Description
0 68' clay & sand
68' 140' granite
t0
rrri a rn
-13 `-m
t �—
m 2>m
no
LOCATION SKETCH -o m�
Show direction and distance in miles from east
two State Roads or County Roads. Include 9 roart
number and common road names. Ca) -"i
r
16. REMARKS: ---"-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT ,w1 STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of N\ater Quality, Groundwater Section. 1636 Mail Service Center -Raleigh, NC
27699-1636 Phonc No. [phone]. within 30 days. GAW-I REV. 07(2001
0
O

WELL CONSTRUCTION RECORD 273559
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R ELL CONTRACTOR (INDIVIDUAL) NAME (print) _ James B. Brown CERTIFICATION # 2045
1WEL.I. CONTRACTOR COMPANY NA.IE Redden Brothers Well Drilling, Inc
PHONE # ( 828 369-9591
STATE wEI.L CONSTRUCTION PERMIT. ASSOCIATED R'Q PERMIT=
(if aunlicab:e) (if applicable)
I. WELL USE (Check Applicable Box): Residential at Municipal.'Public ❑ Industrial 0 Auricuitura! ❑
Ntonirrring 0 Recovery ❑ Heat Pump Water Infection 0 Other 0 IrOther, List Ese
2. WELL LOCATION:
Nearest Town: Franklin County Marnn
Clark's Chapel
(Sire: .Name, N.un'oers. Community. 3ubdi vi iion, Lot No, Zip Coda
3. OWNER Joe Johnston
Addr.ss PO Box 63
(Street or Route No.)
Brooksville, Fr 34605
City er Toi.vr, State Zip Code
(352 i- 796-5669
Area code- Phone number
4. DATE DRILLED 8-12-03
5. TOTAL DEPTH: 340'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC \WATER LEVEL Below Top of Casing: 250 FT.
(Use if Above Top o(Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated at:or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. Y[ELD(gpm): 20 YIETHODOFTEST hlnw
10 WATER ZONES (depth): 315'
11. DISINFECTION: Tvoe H T H Amount 16 oz
12. CASING: ACall Thickness
Depth Diameter or P'eight'Ft. Material
From 0 To 99 Ft. 6" pvc
From 99' To 103 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Nlelhod
From 0 To 20 Fiber -mite & catait pitted
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Fr. in. in.
From To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude'lomtitude of well location
(degrees minutes:seconder
La wile longitude souroe:❑GPS ❑Topographic map
toiteck box)
DEPTH DRILLING LOG
From To Formation Description
0 101 ' clay & sand
101' 340' _granite
0
o a
tq
m
"a
'urn
o°
�m
LOCATION SKETCH
CO frrn
>0
m%
Show direction and distance in miles from ,'Fast a„..,
two State Roads or County Roads. Include ett4roag'�
numbers and common road names. C4 ti
F o
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAflRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA.TL'REOF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servioe Center - Raleigh, NC
27699-1636 Phan:: No. (919) 733-32_21, 'A Rhin 30 days. GW-I REV. 07.2001

WELL CONTRACTOR OR COMPANY NAM&
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-`?ERMIT#
(if applicable)
(if applicable)
773',20
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\': ELL CONTRACTOR (INDIVIDUAL) NAME (print)\/){ n}lIS I-f-n /Jim rt. CERTIFICATION # /7(p
�°qn' S ft1 iJa,,,rIn I I -It y n (i PHONE # finl...6 2 Li-3 J 6 d
I. WELL USE (Check Applicable Box): Residential Yd--Municipal/Public 0 Industrial 0 Agricultural 0
Nloniloring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: r/2/-,4J / i 4/County A/QCOYL )
=719/A g rk-(te.- I,x_ Pet_ gn y
(Street Name. Numbers, Community, Subdivision,nLot No., Zip Code)
3. OWNER: L S a.a. e, C t 10 S [in-_,
Address Mt, 61-er? /--o.fir-
(Street o R6ute No.)
IP O2(f93}
City or Town State Zip Code
(iec2fr r369- 93 y
Area code- Phone number Cy
4. DATE DRILLED 6 — I g-63
5. TOTAL DEPTH: I.".5'
Topographic/Land setting
❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
LAC -
be) •
DEPTH
From
0
L/.-'
(7 (')'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /i S ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD (gpm): d S METHOD OF TEST
10. WATER ZONES (depth): &LY / S/D '
II. DISINFECTION: Type
12. CASING:
Depth j�
From 0 To �p/ Ft. ( -bR Q / P e
From To Ft.
From To Ft.
13. GROUT: Depth Material Material Method
From n ToD EL 007M Grin 2/TH..0
From To Ft. 7-
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:
5'
LOCATION SKETCH
H. 9- i Amount rt.-2 in xj S Show direction and distance in miles from at leas=
Wall Thickness two State Roads or County Roads. IncludQj}je ro§d
Dia eter or Weight/Ft. M l numbers and common road names. i'
n" 5 c
CO
'-o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
if Obt-k . LQ W—Ifs --L) -,.7)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone Nu. [phone], within 30 days. GW-1 REV. 07/2001
Thr

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CO.\TRACTOR (INDIVIDUAL) NAME (print) 2)-en)1iS /-E-n / ivy\CERTIFICATION# r1/7tip
WELL co\TaACToR COMPANY NAME pni S' Id&1)2i,rd TelI�i �fiJ -x ,> )n (•J PHONE si',g�_,�;24-3 a6
STATE \SELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WERMIT#
(if applicable)
278329
WELL USE (Check Applicable Box): Residential YIMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
7
(Street Mine. Number, Commut
, • /
County / I Q Cj)t '
y, Subdivision, Lot No., Zip Code)
3. OWNER: 7/PV'L 1 "S
gel
Address 68 Phitrry
(Street or Route No.)
City or Town State Zip Code
(S. - 6a- c� so /
Area code- Phone number (t
4. DATE DRILLED K —// —03
5. TOTAL DEPTH: a) 15"
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degreeshninu tes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
6e- .J7,S"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �-
7. STATIC WATER LEVEL Below Top of Casing: e70 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): 4461 M THOD OF TEST
10. WATER ZONES (depth): & 054 2'r
11. DISINFECTION: Type
12. CASING:
Depth r J
From To <k0i Ft. ,-- j p
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From nTo r- FL eO7ryr al 7g),I./0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 0
-e .
!1 LOCATION SKETCH
%f 11/ Amount ,_. %, S Show direction and distance in miles Frain at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or WeighUFt. Mate ial numbers and common road names.
72001
6
EFT

WELL CONSTRUCTION RECORD
278328
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 87)-el') i71 S P-n"(,]ly\ A, CERTIFICATION # oZ/7 le
w'ELL CONTRACTOR CONIPANY NAM hp i S 140 j)(Zy J II)eI I )1yrr IL yYL P J PHONE #la—3a Li-3 g 6
STATE WELL CONSTRUCTION PERMIIT# 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 ❑ If Other, List Use
2. WELL LOCATIO,%
Nearest Town:: /" g(Z/y/ /G/,)(J County MO OM
(,,41 ( c</JQ (44) ({1»vrr' ij/?Y1O/rl fi/%-
(Street Name, Numbers, Collimunity, Subdivision, Lot No., Zip Code) e9 [S 7
l-112
3 C�
3. OWNER: ea 7 1%2r T7--
Address all Mez , Pau /-l• -II 2a
(Street or Route No.)
F11/4 V (, Id 4/c, S73 y
City or Town State Zip Code
( 7- <369 -06�f7
Area code- Phone number
4. DATE DRILLED �—%--�3
5. TOTAL DEPTH: 4 e7
T graphic/Land setting
edge ❑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
01
i a>
S Qm
/L/ >°- (k ram % f
DEPTH
From To (3 S1;.
(cY' 'K7 C.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO WJ,
7. STATIC WATER LEVEL Below Top of Casing: 62() 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): 9 METHOD OF TEST /!U)/Jrt epm
10. WATER ZONES (depth): q/) ` (�
11. DISINFECTION: Type
12. CASING: Wall Thickness two State Roads or County Roads. Include road
Depth / �y Diameter or Weight/Ft. Mate ''al numbers and common road names. c.
From O To (c7 Ft. (�„ $.(jpo,j_ pV� c� ��.
From To Ft.
From To Ft.
Hf�
LOCATION SKETCH
Amount ,-3 F4. S Show direction and distance in miles frommb least-'
13. GROUT: Depth Material Method From n To Ai) Ft. 00nn O -4jr./ ,(7(Q,(/
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:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL 0
�� Q�Q 7 0 3
11
0
'v
N rt
ERA
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

w33ti 7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionn-
WELL CONTRACTOR (INDIVIDUAL) NAMj�(print)<7)ef)1`)IS /Jn11OrAA, CERTIFICATION# °In7`/i
WELL CONTRACTOR COMPANY NAM a'1.1'.rtnis (cID)Ingnr� 1/Jelly., It :ynr PHONE #ia-5H/_,j;24-3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential tnunicipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town; 7:59,q-,bkt; ile'�ounty. /17Q (ram
Couree Cbmm. 1Yh•ce
(Street Name, Numbers Community, `-
ty, Subdivision, Lot No., Zip Code) cc:`'O p73,5t
3. OWNER: / '
Address
1 a V e p,^he(,os��
06 X (Pi
6 (Street or Equte o.) ^s,, 7 b 3
(
City or33-Town State Zip Code
✓—fl/2
Area code- Phone number�7.
4. DATE DRILLED S —��v3
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESp NO �t�
7. STATIC WATER LEVEL Below Top of Casing: /o 0
Agricultural 0
Typegtaphic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
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—inMETHODOF TEST >h//7/jl}e
10. WATER ZONES (depth): .r, 75 / r
I I. DISINFECTION: Type R 9-14 Amount r2 T,4. S
12. CASING:
Depth
From 0 To /a5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From - () To rD Ft. CQ?yi Du if ,(Da),(�(�
From To Ft. 7 -
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. Mate 'al
b" S-b R i O ��'—
From To Ft.
From To Ft.
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
6 '73 "
9'7r
97' l as'
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.
a6
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNEk.
�' O( 0 �� - P—?—�3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC,,,
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2)QF
L ji

278624
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural)Resources
WELL CO,N'TIACI'Olt (INDIVIDUAL) NANI E (print) L[TG1 te_
biC)t-1 Loco—
T:1.1. CON'I lt:%CIOlt COMPANY NAME
- ivisi n of Water Quality - Groundwater Section
&ticic e CERTIFICATION# ay�S
CUMPA /, Wc- PHONE a (33L) 196 g —1.1010
S I ATI' WELT. CONS" RUCTION PERMIT# ASSOCIATE D \\'Q PER\Irra
(ifappl icable) (if applicable)
WELL USE (Check Applicable I3ox): Residential Municipal/Public D Industrial ❑ Agricultural ❑
Nloniloring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest "[town: /OP /vtv/n County /114 CO FJ
3 t,o aimuey Fib&&ie J)R-
(Slree None, Numbers, Comm inity, Subdivision, Lot No.. Zip Code)
3. OWNER: cs-Aa) ' binJA FeN.tieL(.-,
Address NaF 377-A s-T
n eI or Route No.)
130CA KhTetJ Ft 33431
City or Town Stale Zip Code
(5J)- 3(;):.2.-13SS`(
Area code- Phone number ,J
4. DATE DRILLED O -o28'O 3
5. TOTAL DEPTH: LI Li 0
6. DOES WELL REPLACE EXISTING WELL? YES O NO C)
7. STATIC WATER LEVEL Below Top of Casing: 6)0 PF.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of rasing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): '/a, M OD O f TEST �
Mc.TROD '^�
ID. WATER ZONES (depth): I (D — / Of
11. DISINFECTION: Type 41 H- Amount
(2. CASINO: Wall Thickness
Depth Diameter or Weight/Ft. Material
From �'I To.� (A) Ft. tits $0E-21 Pve_
Front To Ft.
From To Ft.
13. GROUT Depth Material Method
Froth l) To_dO Ft. Fort • r,F'K
From To Ft. %'U v.!"C
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. _in. in.
From To 11. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From TO Ft.
16. REMARKS:
I DO HEREBY CFI(
CONSTRUCIIO
Topogrt is/Land setting
❑Ridge L11Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tdegrees/min ales/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEI'TII DRILLING LOG
From To Fornii lion Description
0 — 113 _So,
113— l93
173-141-/ Soft Sop
C (fl
144- IEea
Ilol- VVb Fete
I'1 I - '-(N o Mott 6107
3 U rzJ y --03 c, O Z 9
LOCATION SKETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names. O
w
rn
m
CO
TTIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I I5A NCAC 2C, WELL
DARDS, AND TT TAT q• COPY 0' THIS RECORD HAS BEEN PROVIDED TO TI IE WELL OWNER1./A SIGNATURE OF PERSON CONS"IIING TI33WELD I!J it NIrE
Submit the original to the Division of Water Quality, Groun
27699-1636 I'hne No. [phone], within 30 days.
Section, 1636 Mail Scrvic
r - Raleigh, NC
1 REV. 07/2001
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GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

278617
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c en Vlls/461IOnrL CERTIFICATION It 0I/7
WELL CONTRACTOR COMPANY NAME( i 'v l �2rr4 Wei I ye,II P'4 .ptP PHONE 47% ..-3. Y.—s o`7-61 V
STATE %YELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a-' i icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:..' n
Nearest Town: O/,l[U /76 County , ^/ 'Ct
441// ,5* GMI. Toni m .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C�/L-CL Id- i'C
Address Lf-I l -V iJ D Item eu 12 c6,
(StreAor Route Noh
City or Town State Zip Code
(-i! s.Qy-ef7c�R°
Area code- Phone number -7
4. DATE DRILLED _/ -3 —U 3
5. TOTAL DEPTH: .SJCO
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
eta
A)/i? e -,�'ti 2„ t r
DEPTH
From To
C et'.
c9' .ril/)'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ql�'
7. STATIC WATER LEVEL Below Top of Casing: tO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / ? METHOD OF TEST
10. WATER ZONES (depth): ce%'
LOCATION SKETCH
11. DISINFECTION: Type H -LP Amount c1 TA -A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the roe2
Depth t Dia�'eter or Weight/Ft. Mnate ia1 numbers and common road names. m
From 0 To OL' Ft. Ln" S1'2R..” Yr� rn
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From I) To (*ID Ft co, 4..., 021iV
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HQS BEEN PROVIDED TO THE WELL OWN
i.
a�L� fee
SIGNATURE OF PERSON CONSTRUCTING THE WELL
9-- 63
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, N
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2
tD
7C
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us

279615
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c/J-ef Il i 5 Pr /'(Zyl CU CERTIFICAT�ION 11 ol/7 (
WELL CONTRACTOR COMPANYNAMK ICt IION14 IDPII� Yet I I ,�- n P l PHONE N0Tt),f,'J L/-3 a4j
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W ERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential ra-- nicipal/Public ❑ Industrial 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(if applicable)
WELL LOCATION:
Nearest Town: r 4A/ki, County
(een a�?�
11ters
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) /
3. OWNER: HOW r .e___ L er) k-i n S
Address ,-h3 L; HI e- Rrn,1 ,[r L,
(Street or Route No.)
T2r °m lc 1, p we. a w 7 y
City or Town State Zip Code
(Z2 - r '51v — Qfl- "
Area code- Phone number pp
4 DATE DRILLED ;T. 3
5. TOTAL DEPTH: .2 0,5-.
Agricultural 0
To graphic/Land setting
edge ❑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
ram 7/
DEPTH
From To
0 3 ki'
3 cf pc-‘
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0.-------
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 aUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a` METHOD OF TEST / i/VPi7Ll.{
10. WATER ZONES (depth): .>f() '' (�
LOCATION SKETCH
I I. DISINFECTION: Type HEN Amount ,-2 %gA S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the roams
Depth / / Diameter or Weight/Ft. Material numbers and common road names, O
From 0 To-3V Ft. hi' 5,Z2R,/ pVe—
From To Ft.
From To Ft.
13. GROUT: Depth Material�Method ,
From n To �{7 Ft. CPA -XI 07t .(7al/Vr./
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:
N
rn
co
3
0
Ui
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH{S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO i�'=\ �h • .-^ — — PATE
Submit the original to the Division of Water Quality, Gr
27699-1636 Phone No. [phone], within 30 days.
Q�l
ter Section, 1636 Mail Ser
OCT 2 7
nter- Raleigh, NC
W-I REV. 07/2001

277676
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Rater Quality - Groundwater Section
\ELL CON1'RACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION: 2045
\\ELI. CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE [phone]
STATE \AELL CONSTRUCTION PERMIT' ASSOCIATED \Q PERMIT=
(if explicable) (if aonlicablel
WELL USE (Check Applicable Box): Residential ti, NlunicioalTu'olic 0 Industrial 0 Agriculture ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ 110ther, List Use
2. WELL. LOCATION:
Nearest Toy, ry Franklin
Corbin Rd
County Macon
(Street Name, N.unbes. Con inuniry, Subdivision. Lo: No., Zip Cede)
3. 0WNER:David Stiles
Addr:ss 2384 Rabbit- Cresk Rp
(Street or Route No.)
Franklin, NC 28734
:y o: Tc., .n Sate Zip Code
c� ,
( 828) 524-6884
Area code- P)ona Eu-rber
4. DATE DRILLED 7-21-03
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "-" if Above Top o(Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface -
•Top of casing terminated attar below land surface requires a
va riunce in accordance with 15. NCAC 2C .0118.
9. YIELD (gpm): 6 NIETHOD OF TEST blow
10 WATER ZONES (depth): 185', 205' , & 307'
11. DISINFECTION: Type H T H Amount 16 oz
CASING: Wall Thickness
Depth Diameter or \':e::-.:..Ft. NtateTizl
From 0 To 149 Ft. 6" pvc
From 149' To 153' Ft. 6" _188 _ci- L_.
From To Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft.i=arrnite & t.3ir31L P-ram
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From To Ft. in. ic.
From To Ft. in.
15. SAND'GR-4VEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic Land setting
GRicrte ❑Slope ❑Valle\ ❑Flit
(:he:'k a;pre-a:: box)
Latit.delongitude of well location
--o.nc,
lom_ituce source:EGPSGToco_ra^hie
DEPTH
From To
0 151'
DRILLING LOG
Formation Description
clay & sena
151 ' 400' crranite
O
W
LOCATION SKETCH
Show direction and distance in miles fro:
tv.o State Roads_ o: County Roads. Includ
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 155A NCAC 2C, \VELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0AA
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CO4uI
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CM
SiCN'ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 072001

278831
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section --
WELL CONTRACTOR (INDIVIDUAL)NAME
(print) x7)enMt 5 /4tjlarA CERTIFICAT�I/ON#t1/7//Y
WELL CONTRACTORCONIPANY NAM&'1X,i111i f ilatrr4 (I)P,I l4)lit l-Hi( PIP l PHONE # 3f1-..Sav/-3 g6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ'PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential LYMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: PictO1-n Ll%i✓47'.County ,' / „� ,
(lc// /J� XYPn4/8712•7 v- ectc.n
(street Name. Numbers, Community, Subdivision, Lot No., Zip Code) 0, S' 7 3 y
3. OWNER: L-Q22j .5h,011,%e/r-l-
Address /%Ct -1..>%)r•-( ; v/J Ira -Ann r rri
(Street or Route No.)
f"1z72)k/, J A7C.- g'13 y
City or Town State Zip Code
( f 362 9- -7&,43
Area code- Phone number
en
4. DATE DRILLED 1'-;:.2 i' -C'3
5. TOTAL DEPTH: -S sc '
Typegraphic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
143'
171-?
ry r - Sn'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7 STATIC WATER LEVEL Below Top of Casing: ) o r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): y METHOD OF TEST hEUr71.-.
10. WATER ZONES (depth): -S.V L`' (%
I I. DISINFECTION: Type 1 f'f'
12. CASING:
From
From
From To
13. GROUT: Depth
From ( To r(7
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Depth
0 To .D
16. REMARKS:
Ft.
To Ft.
Ft.
Material
Ft. eP47i 4).
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
LOCATION SKETCH
Amount ,..� t4 Q S Show direction and distance in miles from at least C
Wall Thickness two State Roads or County Roads. Include the road cn
Dia eter or Weight/Ft. Mate 'al numbers and common road names. '1
bt'
" sbR,Qj Ore-- 7
Method
Qjl
Ft.
Ft.
Size
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T,/HAA,T^A COPY OF TTHlSS RECORD H/�p'/�S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
7V
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278336
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
w /
ELL CONIIt \C I On (INDIVIDUAL) NAME aria S f`/W� /C CERTIFICATION (I2y/S
O r:1.I. COShht.\Cron COMPANY NAME �7 V k �'� /l/ e // l [/ C— PHONE a 17r6 ),ilk'' 17V()
sty! r: Na ELI. CONSTRUCTION PERNIrra ASSOCIATED AVQ I•ERiA1E11
lit. applicable) (if applicable)
I. WELL USE (Check Applicable Laos): Residential Iunicipal/Public 0 Industrial 0 Agricultural 0
Nlonitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 II -Other, List Use
2. WELL LOCATION:
Nearest Totyn: Ll'i0^) County /)ir.-CO^-
to).chi, rr s-7NL125 ftu
(Street Nome Numbers. Community, Subdivision. Lot No., Zip Code)
3. OWNER: /2lic/ I' Q►.) It �1/.-on) p.//
Address C27 µ) jri11ubI��C .S /HIQS IdT
(Street or Route No.)
City or l own State Zip Code
I—,S5c37
:Area code- Phone nmnher >
4. DATE DRILLED r) A. 7- c)
5. TOTAL DEPTH: 2 U
6. DOES WELL. REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: iq 0 FT.
(Use"s" if Above lop of Casing)
R. TOP OF CASING IS ( FT. Above Land Surface*
'hill of rasing terminated at/or bolus. land surface requires a
cari:utce in accordance tsith I5A NCAC 2C .0118.
9. YIELD (gpin): 5U METHOD QF TEST •� /VW
10. WATER ZONES (depth): / 9 7-/ y
II. DISINFECTION: Type
12. CASING:
Prom
�� rr Amount
Wall Thickness
Depth /Uianhcicr �orINW�eight/R )yaterial
1,21
From To FI.
From "I-o Ft.
13. GROUT: Depth Material
From To&ZU Pt. Pt ,4 • /Vj„C
I'rnm To Ft.
14. SCREEN: Depth
From To
From 17t
15. SAND/GRAVEL. PACK
Depth
Prom Tn H.
Nlelhud
(,/?N
/Gs.trcd
Diameter Siot Size Material
Ft. in. n.
in.
From To 1:1.
Sizc Material
lu
Topographic/Land setting
Midge °Slope :Walley OHM
(check appropriate box)
I. atihulc:longitucIe of well location
(degreesntin ulc s'sccnndsl
Latinidc'bnigitude sourcc:OGPSOTopouraphic map
triteck host
DEl' Ill DRILLIN(i LOCI
From To Formation Description
50
/ 9 7 -f ;
CrE-
o
CO It
rn 0.
n
—n �rl
1 c`rn
N --Ern
30)?."1 - fjJ G•a 1/5 a, �'10
LOCATION SKETCH 23m
(nz
Show CUD:CIion and distance in miles fromQlea9pz
• row
0
z
two State Roads or County Roads. Includ
numbers and common road names.
&JI'nc%ny S4-n;i�
16. RliNIARKS.
tot
I DO 11E12E13 )CER 11FY 11IAT TIIIS WEI..I. WAS CONSTRUCTED IN ACCORDANCE WI III ISA NCAC 2C, WELL
CONSy9 ON STANDARDS. AND THAT A -OPY OF TIIIS RECORD I IAS BEEN PROVIDED "To P1 Ili WELL OWNER
SI(;NATUItE OF PERSON CONS I RUCTING (LIE \\ Fl 1.
Submit the original Iu the Division of Water Quality, Groundwater Section, 1636 Mail Sen ice
27699-1636 Phone No. [phone], avithin 30 days.
L9
- Raleigh, NC
REV, 07/200I
1
GROU14Ot?.ATFR SECTION
eourvn r nrcii,.ttpt 11P 1r..F

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
w'EI.1. CONttt:\C IOlt (INDIVIDUAL) NAINIE (print/)- SITU n -- v_3c. I lc�1/ ee r CERTIFICATION #r_)
w El.I. CON.: It OR CONIPANV NAME Vile jk,J kJef/ 63. _")c- PHONE # IS5C) 4U':i-4I1y0
tit AT t: NC ELL CONS" RUCIION 1'EI \llT# ASSOCIATED 1VQ I'ERPIII'#
Or applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Vlonitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use f/.^Z Deify-
2 \VEI.L. LOCATI
Nearest Town:
l
N:,
i)Cir`?c4S County/Gd7)
LO4V,ir N (? D
Sie, Naive. Numbers. vnmmnity. Subdivision. Lot No.. Zip Coda
Topograi hic/Land"settin
❑Ridge ❑Slope ❑Valley I1t7Flat
(check appropriate hoi)
Latitude/longitude of well location
el
my NP.R'../�JQ /1 I �(.', I('_ �� � . r �N,cfC!/Q— (degrees:minutes/seconds)
Address 003b V3CvG.ti i� Latiltidr.longitude sotuce:❑GPS❑Topographic map
-� IShcct or Route NV) (check hox)
J�chan- oc ag %J! Diii,11I DRILLING LOG
nyor taco State Zip Code Frottt To Fomlati�l1 Description
(14)- 7 ti ' 9-7Y�
Area code- Phone number
T. DATE DRILLED "d �+ - O
5. TOTAL. DEPTH: 70 L
6. I)OLS WELL REPLACE EXISTING WELL? YES 0 NO
7. STAIT(' WATER LEVEL Below Top of Casing:
(Use "a" if Above Top of Casing)
S. TOP OF CASING IS
I FT. Above Land Surface
El
• 1 ip of casing; terminated attor below land surface requires a
rariuncc in acciirdiince with I5,A NCAC 2C .011II. �
9. YIELD (ppm)': MET(IOD OF TEST 4/7 kin/
11) WA1 ER ZONES (depth): l38II, LYo - Z"y�
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From To /�i Ft,&./?S _SDC„11 CO:
Prom To Pl.
Front To Et.
I)
14
15
(I120UI: Depth Material Method
From Ct Tu )( Et. rLr/.(7/.( 1_/t1
Fain To FL ['Oka
SCREEN: Depth Diameter Slot Size Almeria!
I -tom "to Elin. in.
From to Ftin. in. —_
SAND/GRAVEE, PACK:
Depth Size Material
From To Ft.
From To Et.
16. REMARKS.
y_ff 1 K- di i S, z o
20/al/ -/,3(-) (p.On o
LOCATION SKETCH cn 2:-.
Show direction and distance in miles frontgeasec
two Stale Roads or County Roads. Include Ntc roiarc
numbers and common road names. fV ya
— rn
3 -orrt
O (A�
rna
Gil
I DO HEREBY Y CI,t TIDY TI TAT T I IIS WELL \YAS CC))NSTRUCTEU IN ACCORDANCE W ITI I I5A NCAC 2C, WELL
CONSTRUCT LOJV STANDARDS, AND ItIA")/� C( C)tr lli� IS 12 f"CORD IIAS BEE
CORD TO lliE WELL OWNER
3
SIGNATURE OF PERSON CONSTRUCTING 111E WI[LI.
Submit the original to the Division of Water Quality, Groundwater Section, I636 Nlail Service 'e Rear - Raleigh, NC
276)9-I6)6 Phone No. (919) 73}_}221, within 30 days. f-i tl+a REV. 07/2001
278835
GROWM'AI/3I N EECHION
ACL ) i r rr (,tart

278834
\\JELL CONSTRUCTION Itl!CO1(I)
North Carolina - Departmeol of Environment and Natural Resources - Division of \valor Quality - Groundwater Section
n �� "FLL ,NI CUHA( Ult 11N IInIn11A l,) NApl h: �h (a lA (print ht,/le 5
CI:1U 1FICA ION' M-S y1
atr:I. I.( I/ c,/-rs «)1'// co. __---l'IIO : a 1116) 1/4, A/StO
sl.\l I. \\ I . I. CONS'1 nl'1I ION 11E101Il k
111 applicahlc)
ASSOCIAI 1' 11 \\ 1) PF:It. I II //
(if apple clblrl
VA FJ_I. EIS! (Check Applicable Box). Resit cnlial /Miuricip it/I ohlir ❑ Indllsirial ❑ Amicullural ❑
\Inniloring ❑ Rccoccly ❑ Ilea( Pump lValcr hajcclion I: ()Wei LI ( IIHlltl. I. isl Use
2 VA'Ell. I ()CATION:
Nearest Iotan: /<LPC( ONt I`"'_ County /174G.O ^�
f3)1-4-C h-( kb
(Street N'nnm. N:Ilnpas. Cnnm unily.. SSuubditisinn. lot No_ zip Carte)'
U1WNLR • RL71:0 .1'S1 IeAit33
\ddlcxs 37(f 1?HSPAiHJ f—IQic-1>`z4
($heel nl Rome NCI )
Area code- pLlmc lmm hrpr
I DATE DRILLN) O 5 O 3
5 lY)'fAl ULPII1 ���
6 DOIiS VAI:L1. RIII I.ACI: EXISTING WELL'? I t 1 I SrfiI NO
7. STAT IC \ A.I Lli\ LI. Below Top of( (sing: (�b_-_LT.
(Use "t"if AIu c lop oI)asioer
8. 1 01' OE CASING IS / 1111 Above Laud Surface`
'lap HIrasing IerminalMJ aUor brims (and 'urfacr rnplires a
sariaurr In accordance nitli 15,\ NCAC H' .11118.
9_ YIELD (gum): (pNAHAIOI)OF ETES An,/
11) ACATER /ONES ((lend , , 7(1 -/ j'l gccj 164A
(2) Lot" Iis-L4c4
3
51a1r zip Gnlc
DESINFEC I ION:( vpc /'/ % /7 Amount
CASING: Wall ILickncss
Depth Diameter nr \\'dicta/III. nlalcli;l
Lrom -' 1 Tu /Of/ FL O./ZJ",. ,S/)l2"2/ Jt'C
From To 1111_
From To 11.
13. (iRUU I` Ucpth Material Melll}lJ
I bats( _ I a C .27 II I. �tcj i /71/X ljf ivj
I lnm Tn III. /Le i,f rec)
1I St ItLEN`. Pooh Di:unctcr Slot Sizc IAI:nclial
Isom in II. in. in.
lienI o PIin. in.
15. SAND/GI2\'FI. I':\( K.
__ ____
A
I )opal Sizc (`least i;d
Elan) Te 11.
Pn ml Ta 111
44/ - sot,
l-oprigraphlc/Land selling
I lRidgc ❑Slnpc ❑A'alley flat
1ncec 1 appropriate Nix/
1
iolilwltdIungiIlllc OHAnC location
.513e .. 1-/915.3.36./_2Q /J
Idsnccsnvssccnd.
1 :troll-r lrnlriludc soncc'❑(II'SO ropoglaphie map
(shot EA)
1)111' 111 URII.I_ NG Lou
Ilwin nn Ib ronnlYon Description
99 l7`i /1/e l ar
(jl- 25S M
(75 1ro 5 h
!,I.4 J. 2C OL.0
301274 - O3 {'„ (>12...
1.O(A (ION SKI: 1 (11
Shaw Minton and distance in miles linen al Icasl
Iwo SI:nc hoods or County Roads_ Include the rand
O
rl IllllhdI5 and Cnllllllnll 11111(1 Il11l IlCS.
/I'l/rF
W z
In RIiMAl21:S: 1 )i/ ••'1de✓ d� ((i,S/:yy e,1G/ de...(/ -CEO /d /4'<C .
DO IILRI-.ISV' ( -I:RI II N HEAT -EATS VAI].I, WAS CONS I12UC1I'D IN ACCUItI) ANIT WI III 15A N('.A( 2C. AVII 1
( DNS 1It11(l IIiN SI AND :1ROS./AND IIIA 1 A (,'OI'Y OF.I I IIS RILL/RD IIAS 111 I N I'I(IA'II)I D 10 I1111 VVII I, 0AVNPI2
si(NA I BItr DI PERSON ('UNS 1 IN It I ING 11II 1111 I �P
Subnlil the or to the Uic idol' of \Valor Qu:dily, Grouudn ale! Sccliun, 11,16 plait Scr\ice
27699-1616 1'Iulllr ',Nu. (919) 7 3-1221, n illlio 311 flay s.
,j 7t(1), —I11 ,S 21Z-0
I
' rnll�•t'. Raleigh, NC
1 11111-II RI!\' 117/211111
II L.
J

WELL CONSTRUCTION RECORD
-North Carolina- .Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section''
M
WELL CONTRACTOR (INDIVIDUAL) NA(print) /�� CERTIFICATION #.2/21
WALL CONTRACTOR COMPANY NAME✓'f//
r�PAIQ /�J#n2J. �./J1,u. �- riyµ��yL PHONE # (t�2�tlR- 3/'ID
,
TAW WELL CONSTRUCTION PERMIT# 1 '//).2 ASSOCIATED WQ PERMIT#
• (if applicable) (if applicable)
277523
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
'. Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. : WELL LOCATI
r Topographic/Land setting
Nearest Town: rticirri Ct4 Countym01C-trn ❑Ridge ❑Slope ❑Valley la
FA �t
en( 1 Cv� S (check appropriate box) - (Street
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
f q L I ppp
3. OWNER: 1,015 YV GA (degrees;minwesisecondsl
' Address 134 NF A C��..,i, i.xm Latitudeiloneitnde source:EGPSOTopographic map
(- S[reetorRoute o.) (/' (check box)
—re -k to D MCA City or Town State a�fJ�'i' DEPTH DRILLING LOG
From To Formation Description
r3 /O3' (.,2i�
'Area code- Phone number
4 . DATE DRILLED /p - Ls - O 3 /c) 3 ' o s 5 ' h
5-TOTAL DEPTH:
6d-DOES WELL REPLACE EXISTING WELL? YES 0 NO
7.: STATIC WATER LEVEL Below Top of Casing: $U T.
(Use"+" if Above Top of Casing)
8. (TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
• 9. YIELD (gpm): 30 METHOD OF TEST 3 k r5 -
10. WATER ZONES (depth):• S2?,5-' - ,5O cy p rrl
LOCATION SKETCH
Show direction and distance in miles from at lust
two State Roads or County Roads. Include the road -_
numbers and common road names.
n
CO
al•
11. DISINFECTION: Type I r 1-1 Amount /63
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 6 To /L93 Ft. 6, " PV C.
From To Ft
,.From To - Ft.
13. GROUT: Depth Material Method
From n To 30 Ft C 0 nw...LAA
.:.From To Ft.
14.'SCREEN:- Depth Diameter Slot Size Material
-From - To Ft. in. in.
From'To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From To Ft.
16. REMARKS•
'.I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDAR S, AND THAT A COPY OF THIS RED HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TI IE WELL DATE
Submit the original to the Division of Water Quality, GFonii
( +I terfSectitin 163M 1i aliSe riv�enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. ,) ' yp , �I I GW-I REV. 07/2001
L --/

Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
WELL CONSTRUCTION RECORD
277453
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Sectiony//�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �Jj- nh,51 /4tjhtiS A, CERTIFICATION #rrot l7e
WELL CONTRACTOR COMPANY NAM6't.T.hnic (R()IIQMr� I�1eIi�,�[ll :lf J n(J PHONE #ci'D—Jo24--32-(J' a
STATE \VELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 12---Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
NearestToymnJ2JF4IC. `r /Y County//?Q
/1/ �ysa� 0 lz 9,3 ��3 cf
(Street Name. Numbers, Community, Subd'�ion, Lott��No., Zip Code)
3. OWNER: CCic% t° � SL[JQ."Y El
Address
& 9 7/Lf P vs-az- &: Y y Pa
City or Town State Zip Code
(M)- 679
Area code- Phone number C'
4. DATE DRILLED 71— { —0
5. TOTAL DEPTH: 3 SS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /d(J 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. /�/j/
9. YIELD (gpm): .? O METHOD OF TEST j) llirrr�_J--,
10. WATER ZONES (depth): c 4-0 ' 3 a cc'' 0
Topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(L S ` - U
go'- 3FS'
LOCATION SKETCH
11. DISINFECTION: Type ARP Amount ,� TA- A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Mate al numbers and common road names.
D Ft. n 5 2 R ,� 1 Pig'- CO
From To Ft.
Depth
From 0 To
From To Ft.
13. GROUT: Depth
From n To r Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
/Material Method
(J9 47i dJ COLA-)
Slot Size Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Orfee v 63
SIGNATURE OF PERSON CONS DATE
f-Setttfl37't636 Matt Set vh.e gel) r - Raleigh, NC
IGI REV. 07/2001
i�